scholarly journals Efficacy of Histidine–Tryptophan–Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study

2021 ◽  
Vol 24 (1) ◽  
pp. E170-E176
Author(s):  
Ihab Ali ◽  
Ahmed Hassan ◽  
Hoda Shokri ◽  
Ramy Khorshed
Keyword(s):  
Hospital Stay ◽  
Myocardial Protection ◽  
Inotropic Support ◽  
Time Duration ◽  
Blood Cardioplegia ◽  
Ventilation Time ◽  
Cross Clamp Time ◽  
Segmental Wall ◽  
Number Of Patients ◽  
Significant Difference

Background: In cardiac surgery, myocardial protection is required during cross-clamping followed by reperfusion. The use of cardioplegic solutions helps preserve myocardial energy stores, hindering electrolyte disturbances and acidosis during periods of myocardial ischaemia. This study aimed to compare the efficacy and safety between the histidine–tryptophan–ketoglutarate (HTK) solution and blood cardioplegia in various cardiac surgeries. Methods: Three-hundred-twenty patients aged 30-70 years old undergoing various cardiac surgeries were randomized into the HTK group and the blood cardioplegia group. The ventilation time, total bypass time, cross-clamp time, length of intensive care unit (ICU) or hospital stay, and postoperative complications were analyzed. Results: The total bypass time and cross-clamp time were significantly shorter in the HTK group than in the blood cardioplegia group (P < 0.001). Segmental wall motion abnormalities (SWMA) at postoperative echocardiography were significantly higher in in the blood cardioplegia group (P = 0.008). The number of patients requiring DC Shock was significantly higher in the HTK group (P < 0.001). The number of patients requiring inotropic support was significantly higher in the blood cardioplegia group (P < 0.001). The length of ICU, hospital stay, and ventilation time were significantly longer in the blood cardioplegia group than in the HTK group (P = 0.004, P < 0.001, P < 0.001, respectively). The number of patients requiring prolonged ventilation was significantly higher in the blood cardioplegia group compared with the HTK group (P = 0.022). There was no significant difference between the study groups regarding electrocardiographic changes, 30-day mortality, and 30-day readmission. Conclusion: The use of HTK cardioplegia was associated with significantly shorter cross-clamp time, bypass time, duration of mechanical ventilation, length of ICU stay, and length of hospital stay. It is associated with less incidence of postoperative segmental wall abnormalities and less need for inotropic support than blood cardioplegia. Custodiol cardioplegia is a safe and feasible option that can be used as an effective substitute for blood cardioplegia to enhance myocardial protection.

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

Intermittent Tepid Blood Cardioplegia Improves Clinical Outcome

2003 ◽  
Vol 11 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Teing Ee Tan ◽  
Sulman Ahmed ◽  
Hugh S Paterson
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Protection ◽  
Contractile Function ◽  
Perioperative Myocardial Infarction ◽  
Blood Cardioplegia ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Cold Blood ◽  
Clinical Benefits ◽  
Cold Blood Cardioplegia

Intermittent antegrade cold blood cardioplegia is the predominant method of myocardial protection, but recent studies suggest that warm or tepid blood cardioplegia may improve the return of myocardial metabolic and contractile function. Data were collected prospectively on 1,533 patients undergoing cardiopulmonary bypass in a single surgeon's practice. The use of intermittent antegrade cold (4°C) blood cardioplegia in 951 consecutive patients from September 1994 to November 1997 was compared with intermittent antegrade tepid (28°C) blood cardioplegia in 582 consecutive patients from July 1998 to July 2000. The two groups were similar, but the symptom class was more severe and there were more redo and combined procedures and more operations within 7 days of myocardial infarction in the tepid group. Significant clinical benefits identified in the tepid group included reduced usage of intraaortic balloon pumping postoperatively (4.4% versus 2.2%) and reduced incidence of postoperative atrial fibrillation (25.7% versus 20.6%). There was no significant difference in mortality, perioperative myocardial infarction, cerebrovascular events, or use of inotropics between the groups. Intermittent tepid blood cardioplegia is clinically appropriate and safe to use in patients undergoing cardiac surgery.

scholarly journals Nondrainage after Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis Does Not Increase the Postoperative Morbidity

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jianguo Qiu ◽  
Ming Li
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Postoperative Recovery ◽  
End Points ◽  
Acute Calculous Cholecystitis ◽  
Vas Score ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Significant Difference ◽  
Calculous Cholecystitis

Background. It is now established that prophylactic drainage is not needed after laparoscopic cholecystectomy (LC) for chronic calculous cholecystitis. However, the benefit of drains versus their potential harm for acute calculous cholecystitis (ACC) following laparoscopic LC has been questioned. Therefore, we conducted a comparative study to assess the need for drainage.Methods. Between January 2014 and October 2016, 212 patients with ACC undergoing LC undergo either drainage (n= 106) or no drainage (n= 106). The primary end points were the number of patients with postoperative drain-related complications, early and late Visual Analogue Scale (VAS) score, and hospital stay. Secondary end points included estimated blood loss, postoperative recovery, analgesia requirement, and cosmetic satisfaction result.Results. There was no bile duct injury and mortality in both groups. The overall complication rate was 12.5% with no significant difference between those with or without drainage (P=0.16). Normal activity resumption was significantly faster and the postoperative hospital stay was slightly shorter in the nondrainage group (P=0.03 andP= 0.04, respectively). The early VAS score in the drainage group was significantly higher (p<0.05). There were no significant differences between the two groups in postoperative hematology test, late VAS score, and patient satisfaction of cosmetic outcome.Conclusion. Routine drainage for patients with ACC after LC may not be justified with similar drain-related complications compared with nondrainage group.

scholarly journals The spinal adjuvent - intrathecal nalbuphine as effective as intrathecal fentanyl

2020 ◽  
Vol 11 (3) ◽  
pp. 4492-4498
Author(s):  
Pratibha Deshmukh ◽  
Medha Sangawar ◽  
Nikita Dhumne ◽  
Vivek Chakole
Keyword(s):  
Dural Puncture ◽  
Local Anaesthetics ◽  
Hyperbaric Bupivacaine ◽  
Time Duration ◽  
Post Dural Puncture Headache ◽  
Intraoperative Hypotension ◽  
Number Of Patients ◽  
Significant Difference ◽  
To Receive

Opioids are favoured as adjuvants to local anaesthetics for spinal anaesthesia. The present study was aimed to compare the clinical efficiency of intrathecal nalbuphine with fentanyl as an adjuvant to 0.5% hyperbaric bupivacaine. 100 adult patients of either sex, ASA grade I and II, aged 18–60 years were randomized into two groups of 50 each to receive either fentanyl 25 μg (Group BF) or nalbuphine 500µg (Group BN) with 3 ml 0.5% hyperbaric bupivacaine, making drug volume to 3.5 ml in each group. Sensory and motor block characteristics, duration of analgesia, VAS score, haemodynamic and side effects were recorded. The sensorimotor characteristics were comparable and found no significant difference between the two groups, (P>0.05). The time duration for adequate analgesia in group BN was 366.40 ± 37.32min, and in the group, BF was 361.39 ± 43.96min, (P= 0.567). In both, the groups, quality of analgesia during the procedure was excellent in a maximum number of patients (96% each group). Sedation score, hemodynamic and respiratory rate changes were comparable between the two groups. In group BF, 4 (8%) patients complained nausea/ vomiting, pruritus was observed in 2 (4%), intraoperative hypotension in 3 (6%) and bradycardia in 2 (4%) and post-dural puncture headache in 2 patient (4%). In group BN, only bradycardia was observed in 3 (6%) patients. Nalbuphine and fentanyl were found to be equally efficient, but nalbuphine had a lower side effect profile, readily available as it does not come under the Narcotic act. However, we suggest Nalbuphine-bupivacaine combination as a better alternative than fentanyl-bupivacaine combination.

scholarly journals Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis

2015 ◽  
Vol 14 (2) ◽  
pp. 88-92 ◽  
Author(s):  
Jean Carlo Frigotto Queruz ◽  
Allan Kato ◽  
Carlos Abreu de Aguiar ◽  
Luiz Muller Avila ◽  
Luis Eduardo Munhoz da Rocha
Keyword(s):  
Idiopathic Scoliosis ◽  
Hospital Stay ◽  
Posterior Approach ◽  
Thoracolumbar Spine ◽  
Average Hospital ◽  
Icu Stay ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group Ii

<sec><title>OBJECTIVE:</title><p> To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.</p></sec><sec><title>METHODS:</title><p> The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.</p></sec><sec><title>RESULTS:</title><p> The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels), and Group II presented an average of 6.36 vertebrae (5-11 levels). Complications did not show statistically significant difference.</p></sec><sec><title>CONCLUSION:</title><p> Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.</p></sec>

scholarly journals Early enteral nutrition in acute pancreatitis - how beneficial is it?

2021 ◽  
Author(s):  
Shruthikamal Venkat ◽  
Rajesh Subramaniam ◽  
Vijai Raveendran
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Pain Score ◽  
Tamil Nadu ◽  
Early Enteral Nutrition ◽  
Medical College ◽  
Severe Pancreatitis ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

Background: Acute pancreatitis is an inflammatory disease of pancreas and is one of the leading cause of acute abdomen requiring hospital admission. Nutritional support plays a crucial role in this hypercatabolic state in not only providing calories but also in preventing complications and decreasing recovery time.Methods: This prospective study was done among 120 patients with acute moderate and severe pancreatitis who got admitted in department of general surgery at Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India between 2018 and 2019.Results: 67 (55.8%) patients were in early enteral and 53 (44.2%) were in parenteral/delayed enteral group. Maximum number of patients were in 30-40 years age group. The mean of patient age was 40.33. Mean duration of hospital stay in enteral group was 7.06 and in parenteral/delayed enteral group it was 14.09 (p<0.001). Mean pain score in enteral group was 2.69 and in parenteral group it was 6.51 (p<0.001).Conclusions: There was significant (p<0.001) decrease in hospital stay duration and pain score in early enteral group compared to parenteral/delayed enteral group. Infections related to feeding route was found high in parenteral group. No significant difference found in complications of acute pancreatitis. Hence early enteral feeding is more beneficial in terms of shortened hospital stay, decreased pain score leading to reduction in usage of analgesics and reducing the recovery time and less nutrition related complications in management of acute moderate and severe pancreatitis.

scholarly journals Inguinal hernia repair – TEP or TAPP?? A comparative analysis between both the laparoscopic procedures in a tertiary care center

2020 ◽  
Vol 11 (6) ◽  
pp. 84-88
Author(s):  
Atia Zaka Ur Rab ◽  
Sheikh Saif Alim ◽  
Wasif Mohammad Ali ◽  
Syed Amjad Ali Rizvi
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Prospective Study ◽  
Hospital Stay ◽  
Inguinal Hernia Repair ◽  
Tertiary Care ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Normal Work

Background: Inguinal hernia surgery is one of the most common elective procedures performed by the surgeons and has evolved from open to the laparoscopic technique. Aims and Objectives: This prospective study was conducted to find out intra-operative and post-operative outcomes in patients undergoing TEP and TAPP for inguinal hernia repair. Materials and Methods: A prospective study was conducted on 50 adult patients who underwent laparoscopic inguinal hernia repair between November 2017 to November 2018. It was a randomized study and equal number of patients were allocated to TAPP and TEP group based on the surgeon’s preference. Results: Operative time [p<0.0001], intensity of pain (VAS) was significantly higher in TAPP compared to TEP in the immediate post-operative period (6 hours) and during hospital stay [p=0.0299]. No significant difference observed in VAS between TEP and TAPP during follow up [after 1 week (p=0.2298), 2 weeks (p=0.2337), and 4 weeks (p=0.3944)]. Both TEP and TAPP were comparable in terms of Intra-operative and Post-operative complications {seroma [during hospital stay (p=0.1573), after 1 week (p=0.6375), after 2 weeks (p=0.5513)]; haematoma [during hospital stay (p=0.1492), after 1 week (p=0.3125)]} and Conversion (p=0.3125), and Length of hospital stay (p=0.3960). Time to resume normal work [p<0.0001] was significantly more in TAPP than TEP. Conclusion: TEP has a definite edge over TAPP taking into consideration the lesser intensity of post-operative pain during hospital stay, shorter duration of surgery and relatively early return to normal work associated with the former procedure. TEP should therefore be regarded as the procedure of choice for inguinal hernia repair.

scholarly journals Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil

2003 ◽  
Vol 61 (2A) ◽  
pp. 188-193 ◽  
Author(s):  
Norberto L. Cabral ◽  
Carla Moro ◽  
Giana R. Silva ◽  
Rosana Herminia Scola ◽  
Lineu César Werneck
Keyword(s):  
Hospital Stay ◽  
Stroke Unit ◽  
Survival Curve ◽  
Clinical Status ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
General Ward ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.

Effects of Anticholinergics on Postoperative Vomiting, Recovery, and Hospital Stay in Children Undergoing Tonsillectomy with or without Adenoidectomy 

1999 ◽  
Vol 90 (3) ◽  
pp. 697-700 ◽  
Author(s):  
Ashwani K. Chhibber ◽  
Stewart J. Lustik ◽  
Rajbala Thakur ◽  
David R. Francisco ◽  
Kenneth B. Fickling
Keyword(s):  
Nitrous Oxide ◽  
Hospital Stay ◽  
Neuromuscular Blockade ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Postoperative Vomiting ◽  
Inhalation Induction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Nitrous Oxide Oxygen

Background Nausea and vomiting are the most frequent problems after minor ambulatory surgical procedures. The agents used to induce and maintain anesthesia may modify the incidence of emesis. When neuromuscular blockade is antagonized with anticholinesterases, atropine or glycopyrrolate is used commonly to prevent bradycardia and excessive oral secretions. This study was designed to evaluate the effect of atropine and glycopyrrolate on postoperative vomiting in children. Methods Ninety-three patients undergoing tonsillectomy with or without adenoidectomy were studied. After inhalation induction of anesthesia with nitrous oxide, oxygen, and halothane, anesthesia was maintained with a nitrous oxide-oxygen mixture, halothane, morphine, and atracurium. Patients were randomized to receive, in a double-blinded manner, either 15 microg/kg atropine or 10 microg/kg glycopyrrolate with 60 microg/kg neostigmine to reverse neuromuscular blockade. Patient recovery, the incidence of postoperative emesis, antiemetic therapy, and the duration of postoperative hospital stay were assessed. Results There were no significant differences in age, gender, weight, or discharge time from the postanesthesia care unit or the hospital between the groups. Twenty-four hours after operation, the incidence of vomiting in the atropine group (56%) was significantly less than in the glycopyrrolate group (81%; P&lt;0.05). There was no significant difference between the atropine and glycopyrrolate groups in the number of patients who required antiemetics or additional analgesics. Conclusions In children undergoing tonsillectomy with or without adenoidectomy, reversal of neuromuscular blockade with atropine and neostigmine is associated with a lesser incidence of postoperative emesis compared with glycopyrrolate and neostigmine.

scholarly journals Laparoscopic Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Total Abdominal Hysterectomy

2014 ◽  
Vol 8 (2) ◽  
pp. 59-62
Author(s):  
Fahmida Zesmin ◽  
Begum Hosne Ara ◽  
Fatema Begum ◽  
Nusrat Fatima
Keyword(s):  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Length Of Hospital Stay ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Case Control ◽  
Eligibility Criteria ◽  
Laparoscopic Assisted Vaginal Hysterectomy ◽  
Number Of Patients ◽  
Significant Difference

This case control study was conducted in the department of Gynae & Obstetrics, Sir Salimullah Medical College & Mitford Hospital (SSMC & MH), Dhaka, during the period of January 2008 to December 2008 to compare the length of operation, blood loss, length of hospital stay, drug requirements for pain and post-operative pain and activity levels between Laparoscopically Assisted Vaginal Hysterectomy (LAVH) & Total Abdominal Hysterectomy (TAH). A total of 50 patients who met some eligibility criteria were consecutively included in the study and matched in a case control manner for age, weight, diagnosis & uterine size. The procedures were performed by the same surgeon. On average, LAVH operations took significantly longer than TAH operations (P<0.001). Equal number of patients of both groups (40%) needed blood transfusion. No significant difference about haemoglobin level compared to TAH group on 3rd POD (P=0.246). However total amount of analgesics needed was much higher in the TAH group than that of the LAVH group (243.7 ± 40.3VS 182.1 ± 69.6 mg; P= 0.005) and the total cost of operation was significantly less in the TAH group (4500 ± 500 takas) than in the LAVH group (6500 ± 500 taka) (P<0.001). It was observed that LAVH group produced earlier relief from pain in terms of pain VAS on 3rd POD, (P<0.001). LAVH is less painful, has a shorter length of hospital stay and quicker return to work than TAH. Moreover LAVH does not increase intra or postoperative complications. DOI: http://dx.doi.org/10.3329/fmcj.v8i2.20370 Faridpur Med. Coll. J. 2013;8(2): 59-62

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