scholarly journals TYMPANIC AND TEMPORAL THERMOMETRY IN HYPOTHERMIA ASSESSMENT FOR ADULT IN INTRAOPERATIVE ABDOMINAL SURGERY

2016 ◽  
Vol 25 (4) ◽  
Author(s):  
Rutes de Fatima Terres Danczuk ◽  
Eliane Regina Pereira do Nascimento ◽  
Patrícia Madalena Vieira Hermida ◽  
Luciana Bihain Hagemann ◽  
Katia Cilene Godinho Bertoncello ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Mild Hypothermia ◽  
Patient Characteristics ◽  
Study Data ◽  
Tympanic Temperature ◽  
Moderate Hypothermia ◽  
Total N ◽  
American Society ◽  
Temporal Measurement ◽  
American Society Of Anesthesiologists

ABSTRACT Objective: to analyze the association between sociodemographic, clinical, operative and environmental characteristics with hypothermia events, measured intraoperatively by tympanic and temporal thermometers in adult patients undergoing elective abdominal surgery with visceral exposure. Method: prospective quantitative, correlational, observational study. Data were collected by means of structured instrument containing the variables: age, Body Mass Index; American Society of Anesthesiologists class; type of anesthesia; time of surgery; tympanic and temporal temperature; temperature and relative humidity of the surgical room. Temperatures were assessed by methods of tympanic and temporal measurement in 63 patients. The data analysis sought an association between hypothermia and patient characteristics, type of anesthesia, surgical environment, according to the method of measurement and surgical time. Results: Among the 63 patients, 15 (23.8%) had hypothermia. Of the total (n=15; 100%) number of hypothermic patients, 13 (80%) had mild hypothermia. Moderate hypothermia was identified only by temporal thermometry in three (20%) patients. Severe hypothermia was not identified, and in two (13.3%) patients the hypothermia was identified only by temporal thermometry. Hypothermia had a statistically significant association only with age (p=0.0027) and sex (p=0.015), when measuring tympanic temperature. Conclusion: Only sex and age showed correlation with hypothermia during surgery measured by tympanic thermometry; no variable influenced hypothermia measured by temporal thermometry.

scholarly journals Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Tumor Resection ◽  
Intestinal Resection ◽  
Postoperative Outcome ◽  
Initial Study ◽  
Hospital Death ◽  
Grade 3 ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundAnticipating postoperative evolution in surgical patients is an important issue in our daily practice.We have demonstrated in a previous study that predictors of postoperative outcome are multiple including American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A detailed description of postoperative outcome was undertaken in children aged between 6 and 10 years included in the initial study.ObjectiveTo describe postoperative outcome in children aged between 6 and 10 years included in the initial cohort in abdominal surgery, neurosurgery and orthopedics.MethodsSecondary analysis of postoperative outcome in children aged between 6 and 10 years included retrospectively in the initial study of 594 patients. The study was approved by the Ethics Committee.ResultsThere were 88 patients with a mean age of 98.7±13.8 months.The most common surgical interventions were scoliosis in 23 patients (26.1%), femoral osteotomy 7 patients (7.9%), limb tumor resection 7 patients (7.9%), intracerebral tumor resection 6 patients (6.8%), intestinal resection 5 patients (5.6%), Chiari’s malformation 4 patients (4.5%), pelvic osteotomy 4 patients (4.5%) and renal transplantation 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3) and 13 (14.8%) were ASA grade 4. 22(25%) patients had intra-operative and or postoperative complications (organ dysfunction or sepsis). 2 patients (2.3%) had intra-operative hemorrhagic, 1 patient (1.1%) had an intra-operative difficult intubation and 1 patient experienced intra-operative anaphylaxis. 9 patients (10.2%) had postoperative neurologic failure and 2 (2.3%) postoperative cardio-circulatory failure. 3 patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). Median total length of hospital stay was 9 days [5-16].Conclusion25% of the patients had intra-operative and or postoperative complications and most of them were ASA grade ³3. Integrating goal directed therapies to optimize intra-operative management in these patients is a necessary implementation to improve postoperative outcome in surgical pediatric patients.

scholarly journals Preoperative warming combined with intraoperative skin-surface warming does not avoid hypothermia caused by spinal anesthesia in patients with midazolam premedication

2007 ◽  
Vol 125 (3) ◽  
pp. 144-149 ◽  
Author(s):  
Simone Maria D'Angelo Vanni ◽  
Yara Marcondes Machado Castiglia ◽  
Eliana Marisa Ganem ◽  
Geraldo Rolim Rodrigues Júnior ◽  
Rosa Beatriz Amorim ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Spinal Anesthesia ◽  
Intramuscular Injection ◽  
Randomized Study ◽  
Skin Surface ◽  
Physical Status ◽  
Surface Warming ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Midazolam Premedication

CONTEXT AND OBJECTIVE: Inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. The aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with midazolam premedication. DESIGN AND SETTING: Prospective and randomized study at Hospital das Clínicas, Universidade Estadual Paulista, Botucatu. METHODS: Thirty patients presenting American Society of Anesthesiologists (ASA) physical status I and II who were scheduled for elective lower abdominal surgery were utilized. The patients received midazolam premedication (7.5 mg by intramuscular injection) and standard spinal anesthesia. Ten patients (Gcontrol) received preoperative and intraoperative passive thermal insulation. Ten patients (Gpre+intra) underwent preoperative and intraoperative active warming. Ten patients (Gintra) were only warmed intraoperatively. RESULTS: After 45 min of preoperative warming, the patients in Gpre+intra had significantly higher core temperatures than did the patients in the unwarmed groups (Gcontrol and Gintra) before the anesthesia (p < 0.05) but not at the beginning of surgery (p > 0.05). The patients who were warmed intraoperatively had significantly higher core temperatures than did the patients in Gcontrol at the end of surgery (p < 0.05). All the patients were hypothermic at admission to the recovery room (T CORE < 36° C). CONCLUSIONS: Forty-five minutes of preoperative warming combined with intraoperative skin-surface warming does not avoid but minimizes hypothermia caused by spinal anesthesia in patients with midazolam premedication.

Preemptive Intravenous Morphine-6-glucuronide Is Ineffective for Postoperative Pain Relief

2000 ◽  
Vol 92 (2) ◽  
pp. 355-355 ◽  
Author(s):  
Cyrus Motamed ◽  
Xavier Mazoit ◽  
Khaldoun Ghanouchi ◽  
Frédéric Guirimand ◽  
Kou Abhay ◽  
...  
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Postoperative Pain ◽  
Patient Characteristics ◽  
Skin Closure ◽  
Acute Postoperative Pain ◽  
Morphine Group ◽  
Intravenous Morphine ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Morphine-6-glucuronide (M-6-G), a major metabolite of morphine, is reported to be more potent than morphine when administered intrathecally; however, its efficiency remains under debate when administered intravenously. This study was designed to assess the analgesic efficiency of intravenous M-6-G for the treatment of acute postoperative pain. Methods After informed consent was obtained, 37 adults (American Society of Anesthesiologists physical status I-II) who were scheduled for elective open knee surgery were enrolled in the study. General anesthesia was induced with thiopental, alfentanil, and vecuronium and was maintained with a mixture of nitrous oxide/isoflurane and bolus doses of alfentanil. At skin closure, patients were randomized into three groups: (1) morphine group (n = 13), which received morphine 0.15 mg/kg; (2) M-6-G group (n = 12), which received M-6-G 0.1 mg/kg; and (3) placebo group (n = 12), which received saline. At the time of extubation, plasma concentration of morphine and M-6-G was measured. Postoperative analgesic efficiency was assessed by the cumulative dose of morphine delivered by patient-controlled analgesia. Opioid-related side effects were also evaluated. Results No difference was noted in patient characteristics and opioid-related side effects. Morphine requirements (mean +/- SD) during the first 24 h in the M-6-G group (41+/-9 mg) and the placebo group (49+/-8 mg) were significantly greater (P&lt;0.05) compared with the morphine group (29+/-8 mg). Conclusion A single intravenous bolus dose of M-6-G was found to be ineffective in the treatment of acute postoperative pain. This might be related to the low permeability of the blood-brain barrier for M-6-G.

scholarly journals Analysis of perioperative cardiac arrest in a rural hospital in Korea

2020 ◽  
Vol 15 (3) ◽  
pp. 325-333
Author(s):  
Young-Mu Kim ◽  
Jae-Ho Lee ◽  
Hyun-Soo Kim ◽  
Jin Sun Kim ◽  
Hong-Seuk Yang
Keyword(s):  
Cardiac Arrest ◽  
Patient Characteristics ◽  
Physical Status ◽  
Related Factors ◽  
Surgical Department ◽  
Incidence And Mortality ◽  
Regional Gap ◽  
Hospital Patients ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: Perioperative cardiac arrest has been studied in many countries but few related studies have been conducted in Korea. Previous studies were not applicable to rural hospitals due to differences in the demographics between the regions. In the present study, the incidence, mortality, and related factors of perioperative cardiac arrest in a hospital in Youngdong province were analyzed and compared with previous research.Methods: A retrospective study was conducted from the January 1, 2012, to December 31, 2018, on patients who underwent both anesthesia and surgery in our hospital. Patients who received local anesthesia were not included in the study. The collected data included the patient characteristics, anesthesia methods, the American Society of Anesthesiologists physical status, surgical department, emergency status, traumatic status, pre- and post-cardiac arrest medical records, and patient outcomes.Results: A total of 57,746 patients received anesthesia and underwent surgery during the study period, and 28 patients (4.85 per 10,000 anesthesia cases) received cardiopulmonary cerebral resuscitation (CPCR) during or within 24 hours of surgery. Eight patients survived and twenty patients died (3.46 per 10,000 anesthesia cases). There were three anesthesia-related arrests and all of these patients survived. When limiting the analysis to patients with intraoperative CPCR, the incidence and mortality were 1.56, and 1.39 per 10,000 anesthesia cases, respectively.Conclusions: The incidence and mortality of perioperative cardiac arrest in our hospital were higher than those in a recent study in Seoul, demonstrating a regional gap in Korea.

scholarly journals Continuously sutured versus linear-stapled anastomosis in 76 robotic-assisted Ivor Lewis esophagectomies

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
K J Neuschütz ◽  
L Fourie ◽  
R Schneider ◽  
M Bolli ◽  
M von Flüe ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Anastomotic Insufficiency ◽  
Duration Of Hospitalization ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Anastomotic Techniques

Abstract Objective We introduced robotic-assisted Ivor Lewis esophagectomies (rob-E) using the da Vinci Xi in Oct. 2015. Two anastomotic techniques have been performed – continuously sutured (COSU) and linear-stapled (LIST). Aim of this study is to evaluate the two anastomotic techniques regarding perioperative outcomes in our experience. Methods Retrospective analysis of prospectively collected data between Oct. 2015 and Dec. 2020 including 76 patients. 45 underwent COSU and 31 LIST. Techniques are demonstrated with video material. Minor (Clavien-Dindo &lt; = 3a) and major (Clavien-Dindo &gt; = 3b) morbidity, rate of anastomotic insufficiency, mortality, and duration of hospitalization were compared. Results Patient characteristics were as follows: median age of 69 (35-83) years in COSU and 70 (36-83) years in LIST (p = 0.575), male gender in 84.4% of COSU and 83.9% of LIST (p = 1.000), and physical status with American Society of Anesthesiologists score 3 in 62.2% of COSU and 67.7% of LIST (p = 0.771). Concerning tumor characteristics there were 91.1% adenocarcinomas in COSU and 96.8% in LIST (p = 0.642), whereas the others were squamous cell carcinomas and one neuroendocrine tumor in COSU. The tumors were stage II in 22.2% respectively 32.3% and stage III in 57.8% respectively 48.4% of COSU and LIST (p = 0.555). Comparison of minor morbidity occurring in 60.0% of COSU and 54.8% of LIST (p = 0.813), major morbidity in 8.9% respectively 16.1% (p = 0.473), incidence of anastomotic insufficiency in 8.9% of COSU and 6.5% of LIST (p = 1.000), rate of surgical reintervention necessary in 2.2% respectively 9.7% (p = 0.298) as well as mortality of 2.2% in COSU and 3.2% in LIST (p = 1.000) showed no difference. Median duration of hospitalization of 20 (13-49) days in COSU and 20 (14-62) in LIST (p = 0.423) did not differ. Conclusion In rob-E COSU and LIST show comparable results and a preferable technique cannot be determined yet. Our results do not support the results of previous reports (Cerfolio et al.) that demonstrated a superiority of LIST. While stapling the backside of the anastomosis in LIST impresses as an elegant way to overcome the surgical demanding part of the anastomosis, other disadvantages such as compromising perfusion of the gastric conduit may prevail and limit the benefits. Further studies with a larger cohort are planned in order to draw more decisive conclusions.

scholarly journals Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

2021 ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Abdominal Surgery ◽  
Tumor Resection ◽  
Postoperative Outcome ◽  
Initial Study ◽  
Postoperative Outcomes ◽  
Hospital Death ◽  
Grade 3 ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BackgroundAnticipating postoperative evolution in surgical patients is an important issue in our daily practice.We demonstrated in a previous study that there were multiple predictors of postoperative outcome, including American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A detailed description of postoperative outcome was undertaken in children aged between 6 and 10 years old included in the initial study.ObjectiveTo describe postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics.MethodsThe secondary analysis of postoperative outcomes in children aged between 6 and 10 years old was retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee.ResultsThere were 88 patients with a mean age of 98.7±13.8 months.The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%).Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4.Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphylaxis. Nine patients (10.2%) had postoperative neurologic failure, and 2 (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42(47.7%) patients had intra-operative transfusion.There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5-16].ConclusionTwenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade ³3. Integrating goal-directed therapies to optimize intraoperative management in these patients is necessary to improve postoperative outcomes in surgical pediatric patients.

Cerebral, tympanic and colonic thermometry in the piglet

1996 ◽  
Vol 8 (1) ◽  
pp. 125 ◽  
Author(s):  
K Haaland ◽  
PA Steen ◽  
M Thoresen
Keyword(s):  
Confidence Interval ◽  
Temperature Difference ◽  
Clinical Medicine ◽  
Mild Hypothermia ◽  
Animal Experiments ◽  
Tympanic Temperature ◽  
Moderate Hypothermia ◽  
Non Invasive ◽  
Ischaemic Brain ◽  
Colonic Temperature

The temperature of the brain is crucial for the outcome of hypoxic/ischaemic brain damage. In clinical medicine and in animal experiments involving survival after hypoxia/ischaemia, non-invasive measurement of cerebral temperature is needed. We have therefore compared tympanic and colonic temperature with cerebral temperature in the newborn piglet during hypothermia. Ten piglets aged 12-60 h were cooled to 35 degrees C (mild hypothermia) for 150 min and rewarmed. Thereafter, four of the piglets were again cooled to approximately 29 degrees C for less than one hour (moderate hypothermia). During stable mild hypothermia and normothermia the cerebro-tympanic temperature difference in individual piglets was less than +/- 0.4 degrees C (95% confidence intervals < or = 0.18 degrees C) and the cerebro-colonic temperature difference was -0.7 to 0.4 (95% confidence interval < or = 0.28 degrees C). The differences were larger during moderate than during mild hypothermia and largest during rapid changes in body temperature. Then the tympanic temperature correlated with the cerebral temperature significantly better than did the colonic temperature (95% confidence interval -0.3 to 0.3 versus -0.6 to 1.4 for the ten minutes with the least good correlation).

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

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