High Morbidity Seen in Emergency Surgery

2010 ◽  
Vol 3 (9) ◽  
pp. 10
Author(s):  
DIANA MAHONEY
Keyword(s):  
Emergency Surgery ◽  
High Morbidity

scholarly journals Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

2019 ◽  
Author(s):  
Denise Battaglini ◽  
Chiara Robba ◽  
Patricia Rieken Macêdo Rocco ◽  
Marcelo Gama De Abreu ◽  
Paolo Pelosi ◽  
...  
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Emergency Surgery ◽  
Unit Length ◽  
Peep Level ◽  
Anaesthetic Management ◽  
Plateau Pressure ◽  
High Morbidity ◽  
Postoperative Pulmonary Complication ◽  
The Impact

Abstract ABSTRACT Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

scholarly journals Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

2019 ◽  
Author(s):  
Denise Battaglini ◽  
Chiara Robba ◽  
Patricia Rieken Macêdo Rocco ◽  
Marcelo Gama De Abreu ◽  
Paolo Pelosi ◽  
...  
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Emergency Surgery ◽  
Unit Length ◽  
Peep Level ◽  
Anaesthetic Management ◽  
Plateau Pressure ◽  
High Morbidity ◽  
Postoperative Pulmonary Complication ◽  
The Impact

Abstract Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

scholarly journals Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

2019 ◽  
Author(s):  
Denise Battaglini ◽  
Chiara Robba ◽  
Patricia Rieken Macêdo Rocco ◽  
Marcelo Gama De Abreu ◽  
Paolo Pelosi ◽  
...  
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Emergency Surgery ◽  
Unit Length ◽  
Peep Level ◽  
Anaesthetic Management ◽  
Plateau Pressure ◽  
High Morbidity ◽  
Postoperative Pulmonary Complication ◽  
The Impact

Abstract ABSTRACT Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

scholarly journals Evaluation of outcomes in elderly patients diagnosed with colorectal cancer

2018 ◽  
Vol 5 (4) ◽  
pp. 1201
Author(s):  
Neil Lawrence ◽  
Joshua Griffiths ◽  
Keith Chapple
Keyword(s):  
Colorectal Cancer ◽  
Operative Treatment ◽  
Emergency Surgery ◽  
Performance Status ◽  
Significant Risk ◽  
Distant Metastases ◽  
The Elderly ◽  
High Morbidity ◽  
Tertiary Referral Centre ◽  
Emergency Presentation

Background: Colorectal cancer in the elderly carries a high morbidity and mortality. The National Bowel Cancer Audit Programme is a high-quality audit incorporating all UK colorectal cancer patients. Author analysed this database to investigate the local outcomes for this high-risk group.Methods: Data (mode of presentation, presence of metastatic disease, treatment surgery, colonic stent or conservative and WHO performance status) was collected on all patients aged 85 years or over diagnosed with colorectal cancer at a large tertiary referral centre over a 5-year period. Ninety day and 2 year-mortality was obtained for all patients.Results: Ninety patients (45 male, 45 female, median age 88.9 range 85.0-97.9 years) were included (47 emergency presentation, 43 elective presentation). A 18 of 47 patients underwent emergency surgery. A 90-day and 2-year mortality in this group was 17% and 69% respectively. 29 of 47 patients presenting as an emergency had non-operative treatment (2-year mortality 87%). Two years mortality for patients undergoing emergency surgery was 100% if aged above 90 years or if distant metastases were present. Eleven of 43 patients presenting electively underwent surgery. 90-day and 2-year mortality for this group was 18% and 0% respectively. Two years mortality for those presenting electively and undergoing non-operative treatment was 62%.Conclusions: Decision making must be very carefully considered in patients aged over 85 years as the presence of metastases, poor WHO performance status or age over 90 carries with it a significant risk of mortality at both 90 days and 2 years following diagnosis.

scholarly journals Endoscopic stenting for malignant tumors in the area of the bauginium fl ap

2020 ◽  
Vol 174 (5) ◽  
pp. 78-81
Author(s):  
A. S. Vodoleev ◽  
M. S. Burdyukov ◽  
S. S. Pirogov ◽  
E. S. Karpova ◽  
D. G. Sukhin ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Malignant Tumors ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Stent Migration ◽  
Endoscopic Stenting ◽  
High Morbidity ◽  
Right Colon ◽  
Long Distance ◽  
Ileocecal Region

Introduction. Stenting in the ileocecal region is not a routine procedure. Proximal colonic obstruction is generally managed with primary surgery, although there are no RCTs to support this assumption. Recent reports have shown that emergency right colon resection can be associated with high morbidity and mortality rates. We report about 8 cases of obstructive ileocecal cancer for palliative treatment. Case report. Four men and 4 women (mean age, 69 years; range, 62–82 years) were stenting for obstructive ileocecal cancer between September 2014 and December 2019. Emergency SEMS placement was attempted in the remaining 5 cases. An uncovered colonic stent (S&G Biotech; Boston Scientifi c) 22, 24, 25 mm in diameter, 6, 8or 9cm in length, was used. Clinical success is achieved in all cases. One patient was diagnosed with stent migration 4 weeks after stenting, and repeated stenting was performed. Five patients received chemotherapy after stenting, two patients refused further treatment. Discussion. Placing SEMS for ileocecal obstruction is technically challenging for the following reasons. The long distance from the anus, tortuosity of the bowel and angled anatomy of stricture make an ileocecal lesion difficult to reach endoscopically. SEMS can be an alternative to emergency surgery for obstruction due to right colon cancer. In our study, we had migration in 1 case, no perforations or stent ingrown were detected. Conclusion. Stenting for malignant tumors of the ileocecal region, complicated by intestinal obstruction is an eff ective and safe minimally invasive intervention, and can be used as an alternative to emergency surgery.

scholarly journals Indications and Complications of Stoma Formations in Emergency Surgery

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Mürsit Dincer ◽  
Gamze Çıtlak
Keyword(s):  
Emergency Surgery ◽  
Early Stage ◽  
Emergency Operation ◽  
Demographic Characteristics ◽  
High Morbidity ◽  
Cancer Death ◽  
Surgical Indications ◽  
Life Saving ◽  
The Right ◽  
Indications And Complications

Introduction: Colorectal cancers are the second leading cause of cancer death in Europe. Colonic emergencies are associated with high morbidity and mortality. The aim of this study was to discuss the ostomy indications, stoma preferences and the early stage results of these operations. Methods: The cases who underwent emergency operation were investigated retrospectively. Demographic characteristics, surgical indications, preferred type of stoma, postoperative early stage complications were analyzed. Results and Conclusion: As a result, the stoma still maintains its importance in colorectal surgery. Frequencies are preferred to minimize morbidity in emergency surgery procedures. The operations at the right time with the right indications are life-saving.

scholarly journals Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

2019 ◽  
Author(s):  
Denise Battaglini ◽  
Chiara Robba ◽  
Patricia Rieken Macêdo Rocco ◽  
Marcelo Gama De Abreu ◽  
Paolo Pelosi ◽  
...  
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Emergency Surgery ◽  
Unit Length ◽  
Peep Level ◽  
Anaesthetic Management ◽  
Plateau Pressure ◽  
High Morbidity ◽  
Postoperative Pulmonary Complication ◽  
The Impact

Abstract Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

Inhibitor treatment by rituximabin congenital haemophilia A

2009 ◽  
Vol 29 (02) ◽  
pp. 151-154 ◽  
Author(s):  
Escuriola Ettingshausen ◽  
R. Linde ◽  
G. Kropshofer ◽  
L.-B. Zimmerhackl ◽  
W. Kreuz ◽  
...  
Keyword(s):  
B Cell ◽  
Immune Tolerance ◽  
High Titre ◽  
Clotting Factor ◽  
Severe Bleeding ◽  
High Morbidity ◽  
Haemophilia A ◽  
Concomitant Treatment ◽  
Bleeding Tendency ◽  
Severe Haemophilia

SummaryThe development of neutralizing alloanti-bodies (inhibitors) to factor VIII (FVIII) is one of the most serious complications in the treatment of haemophiliacs. Inhibitors occur in approximately 20 to 30% of previously untreated patients (PUPs), predominantly children, with severe haemophilia A within the first 50 exposure days (ED). Immune tolerance induction (ITI) leads to complete elimination of the inhibitor in up to 80% of the patients and offers the possibility to restore regular FVIII prophylaxis. However, patients with high titre inhibitors, in whom standard ITI fails, usually impose with high morbidity and mortality and therefore prompting physicians to alternate therapy regimens. Rituximab, an anti-CD 20 monoclonal antibody has been successfully used in children and adults for the management of B-cell mediated disorders. We report on the use of a new protocol including rituximab in two adolescents with severe haemophilia A and high titre inhibitors, severe bleeding tendency and high clotting factor consumption after failing standard ITI. Both patients received a concomitant treatment with FVIII according to the Bonn protocol, cyclosporine A and immunoglobulin. Treatment with rituximab resulted in a temporary B-cell depletion leading to the disappearance of the inhibitor. FVIII recovery and half-life turned towards normal ranges. In patient 1 the inhibitor reappeared 14 months after the last rituximab administration. In patient 2 complete immune tolerance could be achieved for 60 months. Bleeding frequency diminished significantly and clinical joint status improved in both patients. In patient 1 the treatment course was complicated by aspergillosis and hepatitis B infection. Conclusion: Rituximab may be favourable for patients with congenital haemophilia, high-titre inhibitors and a severe clinical course in whom standard ITI has failed. Prospective studies are required to determine safety, efficacy and predictors of success.

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer

2020 ◽  
Vol 99 (5) ◽  
pp. 200-206
Keyword(s):  
Oesophageal Cancer ◽  
Surgical Procedure ◽  
Anastomotic Dehiscence ◽  
Gastric Conduit ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Therapeutic Algorithm

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 117-119
Author(s):  
Munir Ahmad Wani ◽  
Mubarak Ahmad Shan ◽  
Syed Muzamil Andrabi ◽  
Ajaz Ahmad Malik
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ct Scan ◽  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

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