Articles: cations.
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Thrombosis is a common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. ⋯ VTE associated with hospitalization was the leading cause of disability-adjusted-life-years (DALYs) lost in low- and middle-income countries, and second in high-income countries, responsible for more DALYs lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. VTE causes a major burden of disease across low-, middle-, and high-income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate if improved utilization of preventive measures will reduce the burden.
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Surg Laparosc Endosc Percutan Tech · Oct 2014
Randomized Controlled TrialSugammadex reduces postoperative pain after laparoscopic bariatric surgery: a randomized trial.
Morbid obese (MO) population is increasing every year worldwide, and laparoscopic bariatric surgery (LBS) has a central role in their treatment. The postoperative period of MO is not free from complications. The introduction of sugammadex has brought huge developments in patient's safety and nowadays LBS is performed with better care and quality. However, the effect of this agent in postoperative pain is still unknown. ⋯ Sugammadex is associated with less pain felt in the PACU. This "opioid-sparing" effect, combined with less PONV and a faster discharge from the PACU, makes sugammadex an indispensable drug in this type of patients and allows fast-track surgery in the MO.
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Plast. Reconstr. Surg. · Oct 2014
Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes.
Enhanced recovery after surgery (ERAS) pathways represent a multimodal approach to improve the quality of postoperative care by diminishing the stress response to the trauma of an operation, thereby minimizing hospital length of stay and potentially complications. At a time when healthcare costs are being intensely scrutinized, efforts to reduce patient morbidity and hospital stay are imperative and timely. ⋯ Although hastened patient recovery is clearly multifactorial, our pathway, incorporating alvimopan, early feeding strategies, and multimodal pain therapy with an emphasis on the reduction of opiate usage as well as precise intraoperative nerve block with novel longer-acting local anesthetic Exparel, appears to provide significant improvement in postoperative pain, bowel function recovery, and shorter hospital stay. Although a prospective evaluation of the entire ERAS pathway as well as contribution of its various components is currently ongoing at our Hernia Center, we believe ours or similar ERAS pathways will soon become standard for the vast majority of patients undergoing abdominal wall surgery.
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Opioids remain the most common analgesic tool for the surgeon, owing to their cost-effectiveness in both the inpatient and outpatient setting. Aside from these attributes, opioids have significant side effects that are associated with morbidity and mortality. Specifically, obese patients, patients with sleep apnea, and the elderly may be at an increased risk of experiencing sedation and respiratory depression in response to opioids. ⋯ These clinical scenarios are associated with extreme challenges in postoperative analgesic management. With all opioid prescribing, other sedative medications should be limited or avoided as the risk for additive sedation is significant. This review aims to describe systematic methods to reduce opioid side effects and identify specific risk-reduction strategies within each risk group.