Articles: operative.
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Eur J Trauma Emerg Surg · Jun 2020
Comparative StudyEarly results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications.
Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with non-operative treatment, with special focus on the impact of surgical complications. ⋯ Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2020
[Anaesthesia-related Infection Prevention during Operations].
The processes of anaesthesia during operations enable surgical disciplines to perform a wide range of procedures. However, anaesthesia procedure may also represent a potential risk of infection for the surgical patient. Important hygiene measures concern the following topics: hand hygiene, surface disinfection, administration of parenteral drugs, dealing with catheters, intubation, perioperative antibiotic prophylaxis, temperature management, change intervals, OR workflow organization. The selection of hygiene measures for anaesthesia staff in the operating theatre listed in this article is presented in the sequence of the work flow, whereby certain topics such as hand hygiene naturally play an important role in all work phases.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2020
[Cancer Patients: Relevant Aspects for Anesthesiology].
Surgical oncology makes up an essential part of all surgical procedures performed. Anesthetists can contribute significantly to the treatment success by a thorough pre-operative assessment of patients. ⋯ Hence, it is the responsibility of anesthetists to gather knowledge about the changes in organ systems due to the rapidly increasing list of anti-cancer agents. This article serves as a review from anesthetists to anesthetists conveying the important aspects for taking a comprehensive patient history as well as summarizing the adverse events of major drug classes currently in use in oncology.
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An amendment to this paper has been published and can be accessed via the original article.
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Am J Health Syst Pharm · May 2020
ReviewProcalcitonin in special patient populations: Guidance for antimicrobial therapy.
Procalcitonin (PCT) is an endogenous hormone that increases reliably in response to bacterial infection, and measurement of serum PCT levels is recommended to help guide antimicrobial therapy. The utility of PCT assessment in special patient populations (eg, patients with renal dysfunction, cardiac compromise, or immunocompromised states and those undergoing acute care surgery) is less clear. The evidence for PCT-guided antimicrobial therapy in special populations is reviewed. ⋯ Procalcitonin may be a reliable marker of infection even in special populations with baseline elevations in serum PCT. However, due to unclear threshold values and the limited inclusion of special populations in relevant clinical trials, PCT levels should be considered along with clinical criteria, and antibiotics should never be initiated or withheld based on PCT values alone. Procalcitonin measurement may have a role in guiding de-escalation of antibiotic therapy in special populations; however, the clinician should be aware of disease states and concomitant therapies that may affect interpretation of results.