scholarly journals Optimization of perioperative management of patients with small intestinal urinary diversion after radical cystectomy

2017 ◽  
Vol 98 (6) ◽  
pp. 900-906
Author(s):  
T N Musayev ◽  
Z Sh Vezirova
Keyword(s):  
Radical Cystectomy ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Urologic Oncology ◽  
Patient Preparation ◽  
Combined Anesthesia ◽  
Small Intestinal ◽  
The Republic ◽  
Criteria For Evaluation

Aim. To evaluate the incidence of complications of the developed scheme of management of patients in the perioperative period after radical cystectomy with small intestinal urinary derivation. Methods. The study included 105 (100%) patients treated at the department of urologic oncology of the National center of oncology of the Ministry of Health of the Republic of Azerbaijan during the period from 2008 to 2015. Modified Hautman Ileocystoplasty was performed in 87 (82.9%) patients, urine derivation by Bricker’s method - in 18 (17.1%) patients. Tactics for patient management corresponded to the proposed scheme of patient preparation and algorithm for the management. The main criteria for evaluation of the efficacy of the proposed scheme were the incidence and nature of the most common complications in the early postoperative period (30 days) according to the Clavien-Dindo classification. Results. 131 complications occurred in 71 (67.6%) patients within 30 days after the operation, out of them one complication in 32 (30.5%) patients, two in 23 (22%), three complications in 11 (10.5%), four and more - in 5 (4.8%) patients. The most common complication in the early postoperative period was gastrointestinal atony - 33.4% (n=35). Conclusion. Combined anesthesia and extraperitoneal bladder removal provide significant reduction of the incidence of postoperative gastrointestinal atony; for conclusive evaluation of the effectiveness of the proposed complex controlled studies are necessary.

scholarly journals Perioperative evaluation of kidney function for patients with complicated forms of coronary artery disease

2020 ◽  
pp. 52-58
Author(s):  
O. Gogayeva ◽  
V. Lazoryshynets ◽  
A. Rudenko ◽  
L. Dzakhoieva ◽  
O. Yuvchyk
Keyword(s):  
Coronary Artery Disease ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Kidney Function ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Chronic Obstructive ◽  
Artery Disease

The study aimed to analyze kidney function for patients with complicated forms of coronary artery disease (CAD) in the perioperative period. Methods. It was a retrospective analysis of 110 high-risk patients with complicated forms of CAD, who were operated on and discharged from the National M. Amosov Institute for the period from 2009 till 2019 years. Kidney function was evaluated by glomerular filtration rate (GFR), calculated online with СKD-EPI formula. Results. Among the included patients there were 86 (78.1%) patients with metabolic syndrome, 81 (73.59%) patients with disorders of glucose metabolism, 82 (74.5%) subjects with chronic obstructive pulmonary disease and 38 (34.5%) patients had chronic kidney disease (CKD) 3-5 stage. Preoperative risk stratification with EuroScore II scale was 9.4%. All operations performed in cardiopulmonary bypass; Custodial cardioplegia was used in 53 (48.1%) patients. The average perfusion time was 111 minutes, average cross-clamping time was 73.9 minutes. Acute kidney injury in the early postoperative period had 9 (8.1%) patients. Conclusions. At the admittance 38 (34.5%) patients with complicated forms of CAD had CKD 3-5 st. Analysis of the GFR dynamic in the early postoperative period shown a decrease in GFR in 71.05% of patients. Transient acute kidney injury with 50% sCr growth had 9 (8.1%) patients but didn’t require hemodialysis.

scholarly journals Photodynamic therapy in the treatment of stomach cancer

2018 ◽  
Keyword(s):  
Photodynamic Therapy ◽  
Postoperative Period ◽  
Intestinal Anastomosis ◽  
Effective Means ◽  
Combined Treatment ◽  
Early Postoperative Period ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Biopsy Channel ◽  
Small Intestinal

The analysis of the results of treatment of 10 patients with gastric cancer with high surgical risk, who in the treatment complex used photodynamic therapy with photosensitizer Photolon and further irradiation with a semiconductor laser with a wavelength of λ = 0.67 μm cross-irradiation fields introduced through the biopsy channel of the endoscope. Endoscopic PDT can be used at the stage of combined treatment in combination with drug therapy and surgical interventions and is an effective means of preventing the development of esopha- geal-small intestinal anastomosis failures in the early postoperative period. Endoscopic PDT can also be used in the postoperative period as a prophylaxis of early postoperative complications in cases of detection of tumor cells in the margins of resection.

scholarly journals The level of Brain natriuretic Peptide as a Predictor of the Postoperative Period at Operations with Artificial Blood circulation

2019 ◽  
Vol 3 (6) ◽  
pp. 114-120
Author(s):  
Yu. A. Bakhareva ◽  
Z. Z. Nadiradze ◽  
A. V. Muravskaya
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Natriuretic Peptide ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Results Of Treatment ◽  
Rate Of Increase ◽  
High Level

The level of natriuretic peptide is regarded as a prognostic predictor of postoperative heart failure in modern cardiac surgery, and moreover, this hormone is included in the standards of its early diagnosis around the world. This study was conducted at the Irkutsk Cardiac Surgery Center. The results of treatment of 78 patients were analyzed in order to determine the relationship between the dynamics of brain natriuretic peptides and the course of the early postoperative period in operations with artificial cardiopulmonary bypass. Patients were divided into three groups according to the level of natriuretic peptide elevation in the postoperative period. The study proved the dependence of the postoperative period on the multiplicity of the increase in the level of natriuretic peptide B-type.It was found that the higher the rate of increase in the hormone, the lower the numbers of the cardiac index in the postoperative period, longer duration of inotropic support (p > 0.05) and higher doses of adrenomimetics (p > 0.05). The duration of mechanical ventilation was also longer in the groups where a high level of natriuretic peptide was recorded (p > 0.05). Thus, the multiplicity of natriuretic peptide elevation can be a prognostic criterion for the postoperative period in cardiac patients. It is important to note that a single determination of the level of natriuretic peptide should not be used as a marker of postoperative heart failure and this study confirmed the necessity to monitor the dynamics of brain natriuretic peptide’s level in the perioperative period in patients operated with extracorporeal cardiopulmonary bypass.

scholarly journals WAYS OF PREVENTION SYNDROME OF INTRA-ABDOMINAL HYPERTENSION IN BARIATRIC SURGERY

2019 ◽  
Vol 178 (5) ◽  
pp. 16-21
Author(s):  
M. I. Neimark ◽  
A. Yu. Elizariev ◽  
R. V. Kiselev
Keyword(s):  
Bariatric Surgery ◽  
Continuous Infusion ◽  
Postoperative Period ◽  
Fast Track ◽  
Perioperative Period ◽  
Abdominal Pressure ◽  
Fast Track Surgery ◽  
Beach Chair Position ◽  
Abdominal Hypertension ◽  
Combined Anesthesia

Patients with obesity who have undergone intra-abdominal endoscopic intervention belong to the category of patients with an increased risk of developing the syndrome of intra-abdominal hypertension (SIAH), which dictates the need to develop interventions aimed at its prevention.The OBJECTIVE was to evaluate the effectiveness of complex integrated methods of SIAH prevention in patients with morbid obesity with endoscopic bariatric surgery.MATERIAL AND METHODS. A randomized trial of 69 patients with a body mass index >35 kg/m INTENSIVE 2 was conducted; patients were divided into two groups depending on the type of anesthesia. In the 1st group (n=34), the operation was performed under combined anesthesia based on low-flow inhalation with desflurane in combination with prolonged epidural analgesia (PEA) with ropivacaine. Maintaining a deep level of myorelaxation under the control of acceleromyography in the post-tetanic counts (PTC) mode was achieved by continuous infusion of rocuronium. In the perioperative period, the infusion patients were in the «beach chair» position, and their research was carried out according to the principles of fast track surgery. In the 2nd group (n=35), the operation was performed under combined anesthesia based on lowflow inhalation with desflurane, neuromuscular blockade was performed by bolus injection of rocuronium under the control of acceleromyography in train of four (TOF) mode. Analgesia was provided by systemic administration of opioids. In both groups, markers of kidney injury were investigated, intra-abdominal pressure was monitored, the effectiveness of recovery after surgery and the quality of postoperative analgesia were assessed.RESULTS. A significantly lower level диурез of intra-abdominal pressure (IAP), связь higher compliance evaluation of the anterior crit abdominal внутрибрюшной wall, and a significantly стаканов lower level управляемой of markers of renal study injury in the отмечено postoperative period bariatric were revealed raga in the first дозе group compared to the second group during темпу the perioperative study period. keulenaerСONCLUSION. The effectiveness of using the position of deep muscle relaxation in the continuous infusion mode, adequate analgesia in the perioperative period using neuraxial techniques, using the «beach chair» position on the operating table and in the postoperative period, managing patients using fast track surgery for preventing the development of SIAG was identified.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

The Catecholamine, Cortisol, and Hemodynamic Responses to Mild Perioperative Hypothermia 

1995 ◽  
Vol 82 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Steven M. Frank ◽  
Michael S. Higgins ◽  
Michael J. Breslow ◽  
Lee A. Fleisher ◽  
Randolph B. Gorman ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Perioperative Period ◽  
Skin Surface ◽  
Routine Care ◽  
Early Postoperative Period ◽  
Care Group ◽  
Arterial Blood ◽  
Forced Air Warming ◽  
Blood Pressures ◽  
Forced Air

Background Unintended hypothermia occurs frequently during surgery and may have adverse effects on the cardiovascular system. Although the mechanisms responsible for the cardiovascular manifestations of hypothermia are unclear, it is possible that they are sympathetically mediated. In this prospective study, relationships between body temperature, the neuroendocrine response, and hemodynamic changes in the perioperative period were examined. Methods Seventy-four elderly patients, undergoing abdominal, thoracic, or lower extremity vascular surgical procedures, were randomly assigned to either "routine care" (n = 37) or "forced-air warming" (n = 37) groups. Throughout the intraoperative and early postoperative periods, the routine care group received standard thermal care, and the forced-air warming group received forced-air skin-surface warming. Core temperature, forearm minus fingertip skin-surface temperature gradient, and plasma concentrations of epinephrine, norepinephrine, and cortisol were measured throughout the perioperative period, and the two groups were compared. In addition, heart rate and arterial blood pressure were compared between groups. Results The routine care and forced-air warming groups did not differ with regard to age, sex, type of surgical procedures, anesthetic techniques, or postoperative analgesia. Mean core temperature was lower in the routine care group on admission to the postanesthetic care unit (routine care, 35.3 +/- 0.1 degree C; forced-air warming, 36.7 +/- 0.1 degree C; P = 0.0001) and remained lower during the early postoperative period. Forearm minus fingertip skin-surface temperature gradient (an index of peripheral vasoconstriction) was greater in the routine care group in the early postoperative period. The mean norepinephrine concentration (pcg/ml) was greater in the routine care group immediately after surgery (480 +/- 70 vs. 330 +/- 30, P = 0.02) and at 60 min (530 +/- 50 vs. 340 +/- 30, P = 0.002) and 180 min (500 +/- 80 vs. 320 +/- 30, P = 0.004) postoperatively. Mean epinephrine concentrations were not significantly different between groups. Mean cortisol concentrations were increased in both groups during the early postoperative period (P < 0.01), but the differences between groups were not significant. Systolic, mean, and diastolic arterial blood pressures were significantly higher in the routine care group. Conclusions Compared with patients in the forced-air warming group, patients receiving routine thermal care had lower core temperatures, a greater degree of peripheral vasoconstriction, higher norepinephrine concentrations, and higher arterial blood pressures in the early postoperative period. These findings suggest a possible mechanism for hypothermia-related cardiovascular morbidity in the perioperative period.

scholarly journals Possibilities of therapy with beta‑blockers in the perioperative period in patients during cardiac and extra‑cardiac surgery

The Clinician ◽  
2020 ◽  
Vol 14 (1-2) ◽  
pp. 73-81
Author(s):  
D. P. Kotova ◽  
V. S. Shemenkova ◽  
V. A. Demina
Keyword(s):  
Postoperative Period ◽  
Beta Blockers ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Successful Outcome ◽  
Myocardial Oxygen Demand ◽  
Cardiac Events ◽  
Perioperative Therapy ◽  
Surgical Interventions ◽  
Wide Range

Сardiac complications are the most frequent non-surgical complications after surgical interventions, increasing the length of the patient’s stay in the hospital, the economic costs and the percentage of deaths. The frequency of patients with cardiovascular diseases who require surgery is also high. Optimization of drug therapy in the perioperative period is one of the factors of successful outcome of the surgical intervention.The pathophysiological basis for the development of many cardiac events in the postoperative period is an increase in the activity of the sympathetic nervous system, which leads to an increase in heart rate (HR) and myocardial oxygen demand. These changes may increase the risk of myocardial ischemia, arrhythmias, and other cardiovascular events in the early postoperative period. For example, the development of myocardial infarction (MI) in the perioperative period leads to an increase in hospital mortality by 15–25 %, and increase in the risk of developing cardiac death in the next few months.The main group of drugs for relieving these effects is beta-blockers (BB). This drug class has a wide range of applications: treatment of angina, arrhythmias, hypertension, MI, heart failure. Currently, there is a large evidence for the possibility and feasibility of using BB in patients undergoing surgery.In this article, the authors highlights the issues of prescribing BB in patients with comorbid pathology in the perioperative period. The analysis and comparison of studies on various aspects of BB use in the perioperative period performed. Currently, there is a mixed opinion about the benefits and risks of perioperative therapy of BB, which causes the high relevance of this issue for discussion.

scholarly journals Simultaneous LC-MS/MS-Based Quantification of Free 3-Nitro-l-tyrosine, 3-Chloro-l-tyrosine, and 3-Bromo-l-tyrosine in Plasma of Colorectal Cancer Patients during Early Postoperative Period

Molecules ◽  
2020 ◽  
Vol 25 (21) ◽  
pp. 5158
Author(s):  
Mariusz G. Fleszar ◽  
Paulina Fortuna ◽  
Marek Zawadzki ◽  
Bogna Kosyk ◽  
Małgorzata Krzystek-Korpacka
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Postoperative Period ◽  
Solid Phase ◽  
Surgical Site Infections ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Specificity And Sensitivity ◽  
Liquid Chromatography Tandem Mass ◽  
Colorectal Cancer Patients

Quantification with satisfactory specificity and sensitivity of free 3-Nitro-l-tyrosine (3-NT), 3-Chloro-l-tyrosine (3-CT), and 3-Bromo-l-tyrosine (3-BT) in biological samples as potential inflammation, oxidative stress, and cancer biomarkers is analytically challenging. We aimed at developing a liquid chromatography–tandem mass spectrometry (LC-MS/MS)-based method for their simultaneous analysis without an extract purification step by solid-phase extraction. Validation of the developed method yielded the following limits of detection (LOD) and quantification (LOQ) for 3-NT, 3-BT, and 3-CT: 0.030, 0.026, 0.030 ng/mL (LODs) and 0.100, 0.096, 0.098 ng/mL (LOQs). Coefficients of variation for all metabolites and tested concentrations were <10% and accuracy was within 95–105%. Method applicability was tested on colorectal cancer patients during the perioperative period. All metabolites were significantly higher in cancer patients than healthy controls. The 3-NT was significantly lower in advanced cancer and 3-BT showed a similar tendency. Dynamics of 3-BT in the early postoperative period were affected by type of surgery and presence of surgical site infections. In conclusion, a sensitive and specific LC-MS/MS method for simultaneous quantification of free 3-NT, 3-BT, and 3-CT in human plasma has been developed.

scholarly journals Results of combined anesthesia application with the usage of non-narcotic analgesics in the surgical oncology practice

2012 ◽  
Vol 93 (3) ◽  
pp. 431-434 ◽  
Author(s):  
S Z Tanatarov
Keyword(s):  
Postoperative Period ◽  
Rating Scales ◽  
Surgical Oncology ◽  
Early Postoperative Period ◽  
Cardiac Monitoring ◽  
Control Group ◽  
Narcotic Analgesics ◽  
Surgical Interventions ◽  
Combined Anesthesia ◽  
Oncology Practice

Aim. To evaluate the effectiveness of pre-, intra- and postoperative intravenous administration of paracetamol in combined anesthesia in patients undergoing surgical interventions in the surgical oncology practice. Methods. Examined were 35 patients aged from 43 to 75 years, operated on under combined anesthesia. During the operation and after its completion an infusion of liquid paracetamol at a dose of 3.3 mg/h was performed. Cardiac monitoring was conducted, the content of cortisol in the blood and the Bispectral Index were determined. The pain indices measured by visual analogue and digital rating scales were determined in the postoperative period. The control group included 35 patients in whom anesthesia was performed without the use of paracetamol. Results. During the infusion of paracetamol an adequate level of analgesia was achieved without development of adverse reactions on the part of the vital systems. The use of paracetamol in the early postoperative period contributed to the reduction of pain on digital rating and visual analogue scales compared to the group with basic anesthesia. Conclusion. The use of liquid paracetamol is a promising and safe method of additional analgesia.

scholarly journals Signs of congestion in patients with perioperative atrial fibrillation in major noncardiac surgery

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
O Dzhioeva ◽  
VA Shvartz ◽  
OM Drapkina
Keyword(s):  
Atrial Fibrillation ◽  
Abdominal Surgery ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Cardiac Monitoring ◽  
Funding Sources ◽  
Number Of Patients ◽  
Acute Decompensation ◽  
Focused Echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Purpose to evaluate the frequency of perioperative atrial fibrillation in patients with postoperative signs of systemic congestion. Methods we examined 102 patients who underwent cardiac monitoring in the perioperative period to detect episodes of atrial fibrillation and focused echocardiography to detect signs of systemic congestion. All patients underwent abdominal surgery lasting more than 180 minutes.Clinical, laboratory, and echocardiographic criteria were used to verify systemic stagnation in the postoperative period in patients after non-cardiac surgery. Results we determined the number of patients with perioperative AF who had acute decompensation of HF in the early postoperative period, determined by signs of systemic stagnation. When assessing the number of patients with preoperative anamnestic AF, which was initially 16 people, in 100% of cases in the postoperative period, decompensation of HF was noted. When evaluating the number of patients with intraoperative AF, which was detected in 24 patients, decompensation of HF in the first 24 hours after abdominal surgery was observed in 23 patients (95.8%) (OR: 25.4; 95% CI: 3.27-198.14; p &lt;0.001). When assessing the number of patients with postoperative AF, which was detected in 36 patients, decompensation of HF in the first 24 hours after abdominal surgery was observed in 35 patients (97.2%) (OR:57.4;95% CI:7.39-435.45; p &lt;0.001). Conclusion in major non-cardiac operations, most patients with perioperative atrial fibrillation show signs of systemic stagnation in the postoperative period with FOCUS.

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