scholarly journals Oxygen delivery optimization using lithium indicator dilution and pulse power analysis during major surgery in high-risk patients

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P305
Author(s):  
S Lobo ◽  
N Oliveira ◽  
F Lobo ◽  
E Rezende ◽  
B Borges ◽  
...  
Keyword(s):  
High Risk ◽  
Oxygen Delivery ◽  
Power Analysis ◽  
Indicator Dilution ◽  
Pulse Power ◽  
Major Surgery ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals A novel use of cement as a salvage procedure in patients with complex spinal injuries with proximal junctional failure

2018 ◽  
Vol 100 (6) ◽  
pp. e154-e157 ◽  
Author(s):  
K Divani ◽  
S Selvadurai ◽  
S Molloy
Keyword(s):  
High Risk ◽  
Major Surgery ◽  
Salvage Procedure ◽  
Proximal Junctional Kyphosis ◽  
High Risk Patients ◽  
Pain Scores ◽  
Risk Patients ◽  
Life Threatening ◽  
Proximal Junctional Failure ◽  
Junctional Kyphosis

Long-construct fixations can be complicated by proximal junctional kyphosis. In elderly, high-risk patients with numerous comorbidities, lengthy surgical times and increased blood loss associated with revision osteotomies and extension of fusions are not often tolerated and pose serious life-threatening risks. We present a salvage technique used in a patient with proximal junctional failure and demonstrate its role in improving symptoms and functionality in those not deemed fit for major surgery. Pre- and postoperative pain scores in accordance with the visual analogue scale, walking distances and radiographs were reviewed in a patient who underwent the salvage technique to ascertain the subjective and objective difference in pain and functionality. The patient showed marked improvement in pain scores and walking distances postoperatively. Additionally, the degree of proximal junctional kyphosis was lower on postoperative radiographs. While holding risks of its own, our described technique can be performed in select cases and is a good salvage procedure in high-risk patients. It prevents their exposure to the risks that accompany large revision operations and fusion models with further potential to fail. We recommend that our technique is performed only at specialist centres.

The Benefits of Pre-Assessment with Cardio-Pulmonary Exercise Testing

2010 ◽  
Vol 20 (5) ◽  
pp. 173-176 ◽  
Author(s):  
Shirley Collier
Keyword(s):  
High Risk ◽  
Case Studies ◽  
Exercise Testing ◽  
Major Surgery ◽  
Patient Case ◽  
Local Practice ◽  
High Risk Patients ◽  
Co Morbidity ◽  
Risk Patients

This article reviews the benefits of pre-assessment with cardio-pulmonary exercise testing (CPX) and the effectiveness of preoperative interventions in high-risk patients undergoing major surgery. Three patient case studies will be presented from local practice, to give examples of how patients' co-morbidity has been improved prior to surgery or how decisions for surgery can be modified as a result of the CPX test.

Epidural Anesthesia and Analgesia in High-Risk Patients Undergoing Major Surgery

2018 ◽  
pp. 230-234
Keyword(s):  
High Risk ◽  
Randomized Trial ◽  
Epidural Anesthesia ◽  
Postoperative Analgesia ◽  
Pain Control ◽  
Adverse Outcomes ◽  
Major Surgery ◽  
High Risk Patients ◽  
Postoperative Respiratory Complications ◽  
Risk Patients

This case focuses on the effectiveness of using an epidural in high-risk patients undergoing surgery by asking the question: Do intraoperative epidural anesthesia and postoperative analgesia in high-risk patients presenting for major surgery decrease adverse outcomes compared with alternative analgesic regimens? This multicenter, randomized trial demonstrated improved pain control and a reduction in postoperative respiratory complications with the use of an epidural for intraoperative anesthesia and postoperative analgesia in high-risk patients undergoing major surgery. A significant effect on overall complications or mortality was not demonstrated.

scholarly journals Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery

JAMA ◽  
2017 ◽  
Vol 318 (14) ◽  
pp. 1346 ◽  
Author(s):  
Emmanuel Futier ◽  
Jean-Yves Lefrant ◽  
Pierre-Gregoire Guinot ◽  
Thomas Godet ◽  
Emmanuel Lorne ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Organ Dysfunction ◽  
Management Strategies ◽  
Major Surgery ◽  
Pressure Management ◽  
High Risk Patients ◽  
Blood Pressure Management ◽  
Risk Patients

scholarly journals Understanding decision making about major surgery: protocol for a qualitative study of shared decision making by high-risk patients and their clinical teams

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033703
Author(s):  
Sara Shaw ◽  
Gemma Hughes ◽  
Tim Stephens ◽  
Rupert Pearse ◽  
John Prowle ◽  
...  
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Shared Decision Making ◽  
Service Providers ◽  
Phase 1 ◽  
Video Recording ◽  
Major Surgery ◽  
Shared Decision ◽  
High Risk Patients ◽  
Risk Patients

IntroductionSurgical treatments are being offered to more patients than ever before, and increasingly to high-risk patients (typically multimorbid and over 75). Shared decision making is seen as essential practice. However, little is currently known about what ‘good’ shared decision making involves nor how it applies in the context of surgery for high-risk patients. This new study aims to identify how high-risk patients, their families and clinical teams negotiate decision making for major surgery.Methods and analysisFocusing on major joint replacement, colorectal and cardiac surgery, we use qualitative methods to explore how patients, their families and clinicians negotiate decision making (including interactional, communicative and informational aspects and the extent to which these are perceived as shared) and reflect back on the decisions they made. Phase 1 involves video recording 15 decision making encounters about major surgery between patients, their carers/families and clinicians; followed by up to 90 interviews (with the same patient, carer and clinician participants) immediately after a decision has been made and again 3–6 months later. Phase 2 involves focus groups with a wider group of (up to 90) patients and (up to 30) clinicians to test out emerging findings and inform development of shared decision making scenarios (3–5 summary descriptions of how decisions are made).Ethics and disseminationThe study forms the first part in a 6-year programme of research, Optimising Shared decision-makIng for high-RIsk major Surgery (OSIRIS). Ethical challenges around involving patients at a challenging time in their lives will be overseen by the programme steering committee, which includes strong patient representation and a lay chair. In addition to academic outputs, we will produce a typology of decision making scenarios for major surgery to feed back to patients, professionals and service providers and inform subsequent work in the OSIRIS programme.

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