Articles: postoperative.
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Observational Study
Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset.
Large observational studies of accurate data can provide similar results to more arduous and expensive randomised controlled trials. In 2012, the National Hip Fracture Database extended its dataset to include 'type of anaesthesia' data fields. We analysed 65 535 patient record sets to determine differences in outcome. ⋯ Mortality within 24 hours after surgery was significantly higher among patients receiving cemented compared with uncemented hemiarthroplasty (1.6% vs 1.2%, p = 0.030), suggesting excess early mortality related to bone cement implantation syndrome. If these data are accurate, then either there is no difference in 30-day mortality between general and spinal anaesthesia after hip fracture surgery per se, and therefore future research should focus on how to make both types of anaesthesia safer, or there is a difference, but mortality is not the correct outcome to measure after anaesthesia, and therefore future research should focus on differences between general and spinal anaesthesia. These could include more anaesthesia-sensitive outcomes, such as hypotension, pain, postoperative confusion, respiratory infection and mobilisation.
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Infectious Disease Case Reports Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: An 85 year old male with CAD, severe aortic stenosis, sick sinus syndrome status post pacemaker and CHF, underwent a coronary artery bypass graft and an aortic valve replacement surgery with pericardial valve. He received a preoperative dose of IV vancomycin and cefazolin and 3 postoperative doses of cefazolin as part of the prophylactic protocol. On Hospital Day (HD) #4 he became septic and had several episodes of diarrhea with right lower quadrant abdominal pain. ⋯ We believe that the institution of IVIG was surgery averting for this patient with significant comorbidities even though it has only been described in case reports.Reference #1: J Salcedo, S Keates. Intraveous immunoglobilin therapy for severe Clostridium Difficile colitis. Gut 1997; 41: 366-370DISCLOSURE: The following authors have nothing to disclose: Nicolas Crescimone, Giri Srikanthanoff label use.
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Transient left bundle branch block (LBBB) associated with physical exertion has been described in patients with and without coronary artery disease. A 64-year-old woman with no history of coronary artery disease underwent Nissen fundoplication under general anesthesia. Preoperatively, an exercise-tolerance test revealed LBBB, without ischemic symptoms. ⋯ Cardiac enzymes were negative. Subsequent electrocardiograms revealed persistence of LBBB. Anesthesiologists should be aware of the possibility of perioperative transient LBBB in the absence of cardiac ischemia.
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We describe a case of postoperative uvular edema in a pediatric patient who underwent general anesthesia via a laryngeal mask airway at our institution. Although numerous cases of uvular trauma have been reported in the literature, its association with laryngeal mask airway use remains rare.