Fact file 13: Surgery

2017 ◽  
Author(s):  
Daisy Fancourt
Keyword(s):  
Operating Room ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Blood Tests ◽  
Operative Care ◽  
Life Threatening ◽  
Exploratory Surgery

From the Greek ‘χ‎ ε‎ ί‎ ρ‎’ meaning hand and ‘ἔ‎ ρ‎ γ‎ ο‎ ν‎’ meaning work, surgery investigates and/or treats diseases and injuries either for functional or cosmetic purposes. Elective surgery is carried out for non-life-threatening conditions at the patient’s request, whereas emergency surgery has to be carried out quickly; exploratory surgery is used to aid or confirm diagnoses, while therapeutic surgery is used to treat a diagnosed condition. Although ‘surgery’ is typically used to refer to the period in the operating room, there are important pre-operative stages, including phlebotomy (blood tests) and anaesthesia, and sometimes complex post-operative care....

scholarly journals Rivaroxaban and Hemostasis in Emergency Care

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Jürgen Koscielny ◽  
Edita Rutkauskaite
Keyword(s):  
Emergency Care ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Management Strategies ◽  
Plasma Concentrations ◽  
Factor Xa ◽  
Bleeding Risk ◽  
Severe Bleeding ◽  
Minor Bleeding ◽  
Life Threatening

Rivaroxaban is an oral, direct Factor Xa inhibitor, approved for the prevention and treatment of several thromboembolic disorders. Rivaroxaban does not require routine coagulation monitoring and has a short half-life. However, confirmation of rivaroxaban levels may be required in circumstances such as life-threatening bleeding or perioperative management. Here, we explore the management strategies in patients receiving rivaroxaban who have a bleeding emergency or require emergency surgery. Rivaroxaban plasma concentrations can be assessed quantitatively using anti-Factor Xa chromogenic assays, or qualitatively using prothrombin time assays (using rivaroxaban-sensitive reagents). In patients receiving long-term rivaroxaban therapy who require elective surgery, discontinuation of rivaroxaban 20–30 hours beforehand is normally sufficient to minimize bleeding risk. For emergency surgery, we advise against prophylactic use of hemostatic blood products, even with high rivaroxaban concentrations. Temporary rivaroxaban discontinuation is recommended if minor bleeding occurs; for severe bleeding, rivaroxaban withdrawal may be necessary, along with compression or appropriate surgical treatment. Supportive measures such as blood product administration might be beneficial. Life-threatening bleeding demands comprehensive hemostasis management, including potential use of agents such as prothrombin complex concentrate. Patients taking rivaroxaban who require emergency care for bleeding or surgery can be managed using established protocols and individualized assessment.

scholarly journals Optimization and Minimization of Disturbance to the Operating Room

2014 ◽  
Vol 8 (2) ◽  
pp. 1334-1340
Author(s):  
F. TAIF ◽  
A. NAMIR ◽  
M. AZOUAZI ◽  
S. EZZBADY
Keyword(s):  
Operating Room ◽  
Constraint Programming ◽  
Emergency Surgery ◽  
Programming Model ◽  
Elective Surgery ◽  
Significant Proportion ◽  
Reactive Scheduling ◽  
Legal Structure ◽  
Medical Language ◽  
The Cost

Requests for surgical surgery can occur unexpectedly. We can not, in any circumstances when the demand for care arises.Some requests can be queued and scheduled for future dates. These applications are generally surgeries that are not of an urgent nature, they can be delayed without danger to the patient. In medical language, this type of application is generally designated b y the elective surgery, or scheduled.However, a significant proportion of applications within the field of emergency and requires immediate care. This type of application is inherently difficult to predict, and therefore not schedulable and is generally d esignated by the emergency surgery. Depending on the legal structure of the hospital, it may be obliged to accept all emergency patients In this paper, we study the problem of reactive scheduling surgeries in operating rooms with consideration arriving urgent cases.In this context, we propose a reactive programming model procedure whose purpose is to minimize the cost of inserting these urgent cases and also take in consideration the availability of o perating theaters and Surgeons. To solve this problem, we propose a heuristic based on constraint programming

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

Reservation Planning for Elective Surgery Under Uncertain Demand for Emergency Surgery

1996 ◽  
Vol 42 (3) ◽  
pp. 321-334 ◽  
Author(s):  
Yigal Gerchak ◽  
Diwakar Gupta ◽  
Mordechai Henig
Keyword(s):  
Emergency Surgery ◽  
Elective Surgery ◽  
Uncertain Demand

scholarly journals Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

2009 ◽  
Vol 91 (3) ◽  
pp. 205-209 ◽  
Author(s):  
JO Larkin ◽  
TB Thekiso ◽  
R Waldron ◽  
K Barry ◽  
PW Eustace
Keyword(s):  
Emergency Surgery ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Sigmoid Volvulus ◽  
High Rate ◽  
Colonoscopic Decompression ◽  
Non Operative Management ◽  
Overall Mortality

INTRODUCTION Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

scholarly journals P034 STRANGULATED DIAPHRAGMATIC HERNIA: TEN CASES REPORTS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Mehmet Gunay ◽  
gorkem uzunyolcu ◽  
yalın iscan ◽  
kaan gok ◽  
hakan yanar ◽  
...  
Keyword(s):  
Total Gastrectomy ◽  
Diaphragmatic Hernia ◽  
Emergency Surgery ◽  
Penetrating Trauma ◽  
Abdominal Symptoms ◽  
Threatening Condition ◽  
Segmental Bowel Resection ◽  
Life Threatening ◽  
Surgery Department ◽  
Laparoscopic Techniques

Abstract Aim A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity as a result of a defect within diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. DH can be life-threatening, resulting in incarceration and strangulation. Material and Methods From June 2009 to April 2021, ten cases of strangulated diaphragmatic hernia were admitted to our Emergency Surgery Department of General Surgery with respiratory and abdominal symptoms. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. Results There were 5 (50%) men and 5 (50%) women with a mean age of 66 years (range, 20–85 years). . Emergency surgery was performed by laparoscopic in 4(40%) patients and open in 6(60%) patients. Two patients had a history of penetrating trauma to the left thoracoabdominal region. Segmental bowel resection was performed in 3 patients and total gastrectomy in 1 patient. Reconstruction was not performed in the patient who underwent total gastrectomy due to ischemia and perforation. In the postoperative period, wound infection was observed in 2 patients. Anastomotic leakage was observed in 1 patient and treated with end enterostomy. Empyema was observed in one patient after discharge, the empyema was evacuated and thoracoscopic decortication was performed .The patient who underwent total gastrectomy died due to septic shock and comorbid diseases. Conclusions Strangulated diaphragmatic hernia is a life-threatening condition and requires emergency surgery. Laparoscopic techniques can also be used in treatment.

Pediatric Anesthesia Outside of the Operating Room

2011 ◽  
pp. 236-243
Author(s):  
Keira P. Mason
Keyword(s):  
Operating Room ◽  
Patient Management ◽  
Pediatric Anesthesia ◽  
Anesthesia Care ◽  
Life Threatening

The anesthesiologist is increasingly being called on to provide pediatric anesthesia care for children in settings outside the operating room (OR). Providing anesthesia in these off-site venues challenges us to gain a familiarity with the procedures, tailor an anesthesia plan to the procedure and location, as well as to plan for the management of life-threatening situations. This chapter will review the different off-site locations and discuss the unique aspects of patient management associated with each area. Typical locations are outlined in Table 24.3.

Anaphylaxis in the OR—Causes, Recognition, and Treatment

2018 ◽  
pp. 199-206
Author(s):  
Surangama Sharma ◽  
Lovkesh Arora
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Cholecystectomy ◽  
Operating Room ◽  
Clinical Manifestations ◽  
Preventative Measures ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Elective Laparoscopic Cholecystectomy

Anaphylaxis in the operating room is a life-threatening condition that can evolve rapidly. As an anesthesiologist, it is important to understand the pathophysiology, diagnose the condition, recognize the inciting agent/agents, and manage it appropriately. It is equally important to confirm the diagnosis for preventing a catastrophic event from happening in future. This chapter defines anaphylaxis, discusses the clinical manifestations and most common causes, and describes ways it can be diagnosed. It also considers treatment and preventative measures. The chapter uses a case study of a 55-year-old female, weighing 85 kg and a body mass index of 36 with no other known comorbidities, who is scheduled to undergo elective laparoscopic cholecystectomy.

scholarly journals Preoperative Risk Assessment: A Poor Predictor of Outcome in Critically ill Elderly with Sepsis After Abdominal Surgery

2020 ◽  
Vol 44 (12) ◽  
pp. 4060-4069
Author(s):  
Anne C. M. Cuijpers ◽  
Marielle M. E. Coolsen ◽  
Ronny M. Schnabel ◽  
Susanne van Santen ◽  
Steven W. M. Olde Damink ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Abdominal Surgery ◽  
Hospital Mortality ◽  
Emergency Surgery ◽  
Outcome Prediction ◽  
Elective Surgery ◽  
Perioperative Risk ◽  
Physical Status ◽  
Icu Admission ◽  
Apache Iv

Abstract Background Postoperative outcome prediction in elderly is based on preoperative physical status but its predictive value is uncertain. The goal was to evaluate the value of risk assessment performed perioperatively in predicting outcome in case of admission to an intensive care unit (ICU). Methods A total of 108 postsurgical patients were retrospectively selected from a prospectively recorded database of 144 elderly septic patients (>70 years) admitted to the ICU department after elective or emergency abdominal surgery between 2012 and 2017. Perioperative risk assessment scores including Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality (P-POSSUM) and American Society of Anaesthesiologists Physical Status classification (ASA) were determined. Acute Physiology and Chronic Health Evaluation IV (APACHE IV) was obtained at ICU admission. Results In-hospital mortality was 48.9% in elderly requiring ICU admission after elective surgery (n = 45), compared to 49.2% after emergency surgery (n = 63). APACHE IV significantly predicted in-hospital mortality after complicated elective surgery [area under the curve 0.935 (p < 0.001)] where outpatient ASA physical status and P-POSSUM did not. In contrast, P-POSSUM and APACHE IV significantly predicted in-hospital mortality when based on current physical state in elderly requiring emergency surgery (AUC 0.769 (p = 0.002) and 0.736 (p = 0.006), respectively). Conclusions Perioperative risk assessment reflecting premorbid physical status of elderly loses its value when complications occur requiring unplanned ICU admission. Risks in elderly should be re-assessed based on current clinical condition prior to ICU admission, because outcome prediction is more reliable then.

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