Articles: operative.
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To explore the collaboration between human factors (HFs) experts and clinicians in order to improve perioperative patient safety. ⋯ Human factors engineering is underutilized worldwide. Patient safety would benefit from collaboration with HF experts to design resilient systems. Healthcare organizations must consider HF to develop and implement user-centered solutions to improve safety for patients and professionals.
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Bleeding during cardiac surgery may be refractory to standard interventions. Off-label use of factor eight inhibitor bypass activity (FEIBA) has been described to treat such bleeding. However, reports of safety, particularly thromboembolic outcomes, show mixed results, and reported cohorts have been small. ⋯ Low-dose FEIBA administration during cardiac surgery does not increase risk of thromboembolic events, intensive care unit length of stay, or mortality in a propensity-matched cohort. Higher doses were associated with increased acute renal failure and postoperative transfusion. Further studies are required to establish the efficacy of activated factor concentrates to treat refractory bleeding during cardiac surgery.
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Randomized Controlled Trial Comparative Study
Comparison of Intercostal Nerve Block and Serratus Anterior Plane Block for Perioperative Pain Management and Impact on Chronic Pain in Thoracoscopic Surgery: A Randomized Controlled Trial.
The intent of this study was to compare the analgesic efficacy of intercostal nerve block (ICNB) under direct thoracoscopic visualization and serratus anterior plane block (SAPB) with ultrasound guidance during thoracoscopic surgery's perioperative period. Furthermore, it examined their impact on chronic pain and identifies potential risk factors associated with its development. ⋯ ICNB and SAPB demonstrated comparable analgesic effects, with similar rates of chronic pain occurrence. Chronic pain independent risk factors included resting VAS score at 12 hours, chest tube duration, and surgical duration.
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In recent years, the integration of advanced diabetes technology into the care of individuals with diabetes has grown exponentially. Given their increasing prevalence, insulin-requiring people with diabetes may present to preoperative clinics or the operating rooms wearing such devices. ⋯ Therefore, perioperative clinicians need to become familiar with diabetes technological advances, and device features and have an understanding of how they can be used in the perioperative period. This consensus statement aims to serve as an educational material as well as to serve as a guide to perioperative clinicians caring for patients wearing diabetes devices (insulin pumps and continuous glucose monitors).
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Critical care medicine · Dec 2024
Observational StudyHigh-Density Lipoprotein Anti-Inflammatory Capacity and Acute Kidney Injury After Cardiac and Vascular Surgery: A Prospective Observational Study.
Acute kidney injury (AKI) predicts death after cardiac and vascular surgery. Higher preoperative high-density lipoprotein (HDL) concentrations are associated with less postoperative AKI. In animals, HDL's anti-inflammatory capacity to suppress endothelial cell adhesion molecule expression reduces kidney damage due to ischemia and hemorrhagic shock. The objective of this study is to evaluate the statistical relationship between HDL anti-inflammatory capacity and AKI after major cardiac and vascular surgery. ⋯ Patients with chronic kidney disease undergoing cardiac and vascular surgery who have dysfunctional, pro-inflammatory HDL have a higher risk of postoperative AKI compared with patients with anti-inflammatory HDL. Conversely, a higher HDL anti-inflammatory capacity is associated with a lower risk of postoperative AKI, independent of HDL concentration. Higher long-term statin dose is associated with higher HDL anti-inflammatory capacity.