scholarly journals DOES ANEMIA AFFECT PERIOPERATIVE PAIN INTENSITY IN AGED PATIENTS WITH DIABETIC FOOT SYNDROME?

2017 ◽  
Vol 11 (3) ◽  
pp. 195-201
Author(s):  
Mariy A. Sheina ◽  
S. V Sokologorskiy ◽  
A. A Zvyagin ◽  
S. A Orudzheva
Keyword(s):  
Postoperative Period ◽  
Oxygen Delivery ◽  
Medical Documentation ◽  
Aged Patients ◽  
Time Points ◽  
Post Surgery ◽  
Oxygen Delivery Index ◽  
Mean Pressure ◽  
Vas Scores ◽  
Diabetes Patients

Background: As diabetes takes on pandemic proportions more than 500000 aged (over 50 years) patients undergo pedis amputation yearly. Anemia is very often accompanied diabetes mostly in aged patients. Anemia may influence somehow the pain severity in postoperative period. Objective: To investigate the possible anemia influence on severity of post surgery pain in aged diabetes patients with anemia. Design: A retrospective medical documentation analysis. Setting: Federal scientific centre. Patients: 58 diabetes patients aged from 50 to 75 with and without anemia after elective pedis surgery. Intervention. Patients were allocated to one of four groups: - 16 patients with anemia who received naropin combined with lidocaine for peripheral nerve blockades (I group), 14 patients with anemia who received only naropin (II group), 11 patients without anemia who received naropin combined with lidocaine (III group) and 17 11 patients without anemia who received only naropin. Main outcome measures: Levels of mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on four time points: 24 hours before surgery, in operating room, 12 and 24 hours after surgery respectively. Results. VAS scores and levels of mean pressure was higher in anemia groups postoperativly - 3,3±1,50 vs 0,6±0,82 and 101,7±7,81 mm Hg vs 87,9±12,08 mm Hg respectively. Glycaemia levels had no statistically significant differences neither in time points nor in groups. Oxygen delivery index levels also had no differences in time points but levels were significantly different between groups. Conclusion: Taking in account the results of the analysis it is obvious that anemia contributes to the severity of pain in postoperative period in aged diabetes patients somehow. More clinical investigations must be done to evaluate exact portion of anemia contribution.

scholarly journals THE CENTRAL HEMODYNAMIC STATE IN DIABETES PATIENTS DURING LOW LIMB SURGERY

2018 ◽  
Vol 12 (1) ◽  
pp. 47-54
Author(s):  
S. V Sokologorskiy ◽  
M. A Sheina ◽  
A. A Zvyagin ◽  
S. A. Orudzheva
Keyword(s):  
Mean Arterial Pressure ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Oxygen Delivery ◽  
Single Injection ◽  
Time Points ◽  
Hemodynamic State ◽  
Central Hemodynamic ◽  
Anesthesia Technique ◽  
Diabetes Patients

Background: As diabetes takes on pandemic proportions, more than 1000000 patients undergo some kind of low limb surgery yearly. While peripheral hemodynamic state during such kind of surgery in these patients has been studied quite well in various anesthesia technique, the central hemodynamic state and systemic oxygen delivery remain unclear. Objective: To evaluate a single-injection nerve block vs spinal anesthesia influence on central and peripheral hemodynamics and systemic oxygen delivery during low limb surgery in diabetes patients. Design: A prospective cohort study. Setting: Federal scientific centre. Patients: 31 diabetes patients during elective low limb surgery under single-injection nerve block and spinal anesthesia. Intervention: Patients were randomly allocated to one of the two groups according the anesthesia technique - either a single-injection nerve block or spinal anesthesia. Main outcome measures: Levels of cardiac index mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on five time points: 24 hours before surgery, during surgery, before discharging from operating room, 6 and 24 hours after surgery respectively. Results. Levels of cardiac, systemic vascular resistance and oxygen delivery indexes together with mean arterial pressure had no statistically significant differences in time points in group received single-injection nerve block technique. These patients had full pain relief even in 6 hours after surgery and 24 hours after surgery their VAS pain scores were not more than 3. A single-injection nerve block technique shown its prolonged pain-relief effect with minimal systemic side effect. In patients with spinal anesthesia technique statistically significant decreases of mean arterial pressure and systemic vascular resistance with parallel cardiac index increase in time points were observed. In 6 hours after surgery, their VAS pain scores were not more 2 and 24 hours after surgery not more than 4. Spinal anesthesia once more shown to be reliable and effective but not long-acting intraoperative anesthesia technique. Additional postoperative pain relief necessity is a specific spinal technique problem. Conclusion: The results of the study showed that a single-injection nerve block technique due to its low influence on systemic circulation is more preferable in patients with compromised circulation system, while spinal technique may be used in patients with no heart and vascular disturbances. More clinical investigations must be done to evaluate central hemodynamic changes during these types of anesthesia in diabetes patients more precisely.

RETROSPECTIVE ANALYSIS OF THE MEDICAL DOCUMENTATION OF PATIENTS WHO APPLIED TO THE AMBULATORY OF GENERAL PRACTICE - FAMILY MEDICINE

2019 ◽  
Vol 72 (5) ◽  
pp. 938-941
Author(s):  
Оlexander Ye. Kononov ◽  
Liliana V. Klymenko ◽  
Ganna V. Batsiura ◽  
Larysa F. Matiukha ◽  
Olha V. Protsiuk ◽  
...  
Keyword(s):  
Family Medicine ◽  
Middle Ages ◽  
Risk Groups ◽  
Medical Documentation ◽  
Aged Patients ◽  
Family Doctors ◽  
Functional Changes ◽  
Medicine Clinic ◽  
Leading Role ◽  
The Family

Introduction: In today’s realities of health care reform in Ukraine family doctors play a leading role. The aim of our work was to analyze the medical cards of patients who applied for medical care to the family medicine clinic. Materials and methods: It was analyzed outpatient medical cards of 87 patients who applied to the family medicine clinic in the Khotov village, Kyiv region. The study included people aged 18 to 60 years, which corresponded to the groups of young and middle ages according to the WHO classification. Review: Our findings indicate the prevalence of functional changes among young people: somatoform dysfunction of the autonomic nervous system - 9 (37,5%) and the development of organic manifestations at middle-aged patients: arterial hypertension - 32 (62,7%) and coronary artery disease - 17 (33,3%). Conclusions: This study is important for determining the risk groups, early diagnosis and prevention of diseases.

scholarly journals Recovery of early postoperative muscle strength after deep neuromuscular block by means of ultrasonography with comparison of neostigmine versus sugammadex as reversal drugs: study protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043935
Author(s):  
Xuan Wang ◽  
Yingyuan Li ◽  
Chanyan Huang ◽  
Wei Xiong ◽  
Qin Zhou ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Muscle Strength ◽  
Neuromuscular Blockade ◽  
Postoperative Period ◽  
Controlled Trial ◽  
Complete Recovery ◽  
Early Postoperative Period ◽  
Time Points ◽  
Muscle Groups ◽  
Randomised Controlled

IntroductionDespite the use of quantitative neuromuscular monitoring together with the administration of reversal drugs (neostigmine or sugammadex), the incidence of residual neuromuscular blockade defined as a train-of-four ratio (TOFr) <0.9 remains high. Even TOFr >0.9 cannot ensure adequate recovery of neuromuscular function when T1 height is not recovered completely. Thus, a mathematical correction of TOFr needs to be applied because the return of a normal TOFr can precede the return of a normal T1 twitch height. On the other hand, different muscles have different sensitivities to neuromuscular blockade agents; thus, complete recovery of one specific muscle group does not represent complete recovery of all other muscles. Therefore, our study aims to assess the muscle strength recovery of respiratory-related muscle groups by ultrasound and evaluate global strength using handgrip dynamometry in the early postoperative period when TOFr=0.9 and corrected TOFr (cTOFr)=0.9 with comparison of neostigmine versus sugammadex as reversal drugs.Methods and analysisThis study will be a prospective, single-blinded, randomised controlled trial involving 60 patients with American Society of Anesthesiologists physical status I–II and aged between 18 and 65 years, who will undergo microlaryngeal surgery. We will assess geniohyoid muscle, parasternal intercostal muscle, diaphragm, abdominal wall muscle and handgrip strength at four time points: before anaesthesia, TOFr=0.9, cTOFr=0.9 and 30 min after admission to the post anaesthesia care unit. Our primary objective will be to compare the effects of neostigmine and sugammadex on the recovery of muscle strength of different muscle groups in the early postoperative period when TOFr=0.9 and cTOFr=0.9. The secondary objective will be to observe the difference of muscle strength between the time points of TOFr=0.9 and cTOFr=0.9 to find out the clinical significance of cTOFr >0.9.Ethics and disseminationThe protocol was reviewed and approved by the Ethics Committee of The First Affiliated Hospital, Sun Yat-sen University. The findings will be disseminated to the public through peer-reviewed scientific journals.Trial registration numberChiCTR2000033832.

scholarly journals Long-term postoperative opioid prescription after cholecystectomy or gastric by-pass surgery: a retrospective observational study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Viktoria Larsson ◽  
Cecilia Nordenson ◽  
Pontus Karling
Keyword(s):  
Observational Study ◽  
Postoperative Period ◽  
Medical Records ◽  
Early Postoperative Period ◽  
Retrospective Observational Study ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Post Surgery ◽  
Gastric By Pass

Abstract Objectives Opioids are commonly prescribed post-surgery. We investigated the proportion of patients who were prescribed any opioids 6–12 months after two common surgeries – laparoscopic cholecystectomy and gastric by-pass (GBP) surgery. A secondary aim was to examine risk factors prior to surgery associated with the prescription of any opioids after surgery. Methods We performed a retrospective observational study on data from medical records from patients who underwent cholecystectomy (n=297) or GBP (n=93) in 2018 in the Region of Västerbotten, Sweden. Data on prescriptions for opioids and other drugs were collected from the patients` medical records. Results There were 109 patients (28%) who were prescribed opioids after discharge from surgery but only 20 patients (5%) who still received opioid prescriptions 6–12 months after surgery. All 20 of these patients had also been prescribed opioids within three months before surgery, most commonly for back and joint pain. Only 1 out of 56 patients who were prescribed opioids preoperatively due to gallbladder pain still received prescriptions for opioids 6–12 months after surgery. Although opioid use in the early postoperative period was more common among patients who underwent cholecystectomy, the patients who underwent GBP were more prone to be “long-term” users of opioids. In the patients who were prescribed opioids within three months prior to surgery, 8 out of 13 patients who underwent GBP and 12 of the 96 patients who underwent cholecystectomy were still prescribed opioids 6–12 months after surgery (OR 11.2; 95% CI 3.1–39.9, p=0,0002). Affective disorders were common among “long-term” users of opioids and prior benzodiazepine and amitriptyline use were significantly associated with “long-term” opioid use. Conclusions The proportion of patients that used opioids 6–12 months after cholecystectomy or GBP was low. Patients with preoperative opioid-use experienced a significantly higher risk of “long-term” opioid use when undergoing GBP compared to cholecystectomy. The indication for being prescribed opioids in the “long-term” were mostly unrelated to surgery. No patient who was naïve to opioids prior surgery was prescribed opioids 6–12 months after surgery. Although opioids are commonly prescribed in the preoperative and in the early postoperative period to patients with gallbladder disease, there is a low risk that these prescriptions will lead to long-term opioid use. The reasons for being prescribed opioids in the long-term are often due to causes not related to surgery.

scholarly journals Short Plate with Screw Angle over 20 Degrees Improves the Radiologic Outcome in ACDF: Clinical Study

2021 ◽  
Vol 10 (9) ◽  
pp. 2034
Author(s):  
Kathryn-Anne Jimenez ◽  
Jihyeon Kim ◽  
Jaenam Lee ◽  
Hwan-Mo Lee ◽  
Seong-Hwan Moon ◽  
...  
Keyword(s):  
P Value ◽  
X Rays ◽  
Common Procedure ◽  
Fusion Surgery ◽  
Post Surgery ◽  
Plate Group ◽  
Vas Scores ◽  
Short Plate ◽  
Degenerative Cervical Spine ◽  
Screw Group

Background: Anterior cervical discectomy and fusion surgery is a common procedure for degenerative cervical spine. This describes allospacer and implant-related outcomes, comparing medium plate–low screw angle and short plate–high screw angle techniques. Methods: From January 2016 to June 2019, 79 patients who underwent ACDF were prospectively enrolled. Patients were divided, depending on the plate–screw system used: medium plate–low screw angle (12.3 ± 2.5 to 13.2 ± 3.2 degrees), and short plate–high screw angle (22.8 ± 5.3 to 23.3 ± 4.7 degrees). Subsidence, ALOD, and sagittal cervical balance were analyzed using lateral cervical X-rays. NDI and VAS scores were also evaluated. Results: Age for medium plate–low-angled screw group is 58.0 ± 11.3 years, and 55.3 ± 12.0 in the short plate–high-angled screw group (p-value = 0.313). Groups were comparable in mean NDI (p-value = 0.347), VAS (p-value = 0.156), C2–C7 SVA, (p-value = 0.981), and lordosis angle (p-value = 0.836) at 1-year post-surgery. Subsidence was higher in the medium plate–low-angled screw than in the short plate–high-angled screw (25% and 8.5%, respectively, p-value = 0.045). ALOD is also more common in the medium plate group (p-value = 0.045). Conclusion: Use of a short plate and insertion of high-angled screws (more than 20 degrees) has less chance of subsidence and occurrence of ALOD than the traditional technique of using medium plate and low angle.

Systematic review and meta-analysis of opioid use at 3, 6 and 12 months post-operatively by opioid naïve orthopaedic surgery patients

2021 ◽  
Vol 17 (6) ◽  
pp. 517-529
Author(s):  
Karen-leigh Edward, PhD, BN, GDipPsychology ◽  
Beata Stanley, BPharm ◽  
Lisa Collins, PhD ◽  
Amanda Norman, BA ◽  
Yvonne Bonomo, MBBS, FRACP, PhD, FAChAM ◽  
...  
Keyword(s):  
Systematic Review ◽  
Strong Evidence ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Opioid Use ◽  
Time Points ◽  
Post Surgery ◽  
Potential Factors ◽  
Meta Analyses ◽  
Orthopedic Patients

Background and objective: There is evidence that opioid initiation post-surgery is contributing to the problem of chronic misuse and/or abuse of over the counter medications in the community, and that orthopedic patients may be particularly at risk. The aim of the systematic review with meta-analysis was to identify research that examined opioid use at 3, 6, and 12 months post-operatively by previously opioid naïve orthopedic surgery patients.Design, databases, and data treatment: A searched review with meta-analysis was undertaken. Eight databases were search. Meta-analyses conducted at all three time points (3 months, 6 months, and 12 months).Results: The search yielded 779 records, and after screening, 13 papers were included in meta-analysis. Results provide strong evidence that post-operative opioid use amongst the opioid naïve is a real effect (7 percent at 3 months, 4 percent at 6 months, and 2 percent at 12 months). A Z-test for overall effect revealed strong evidence that this proportion was nonzero for opioid use at 3, 6, and 12 months (p 0.001 for all time points). A small but significant proportion of opioid naïve patients who are prescribed opioids remain on these medications up to 12 months post-operatively.Conclusions: The nature of the studies included in the meta-analysis were varied, hence subanalyses regarding surgery type, characteristics of the patient group or other potential factors that might influence the progression to longer term opioid use after these surgeries could not be explored. Given this, further research in this area should explore such specific orthopedic subgroups.

scholarly journals The phenotype of NK-cells in the dynamics of the post-operative period in patients with peritonitis in depending on the outcome of the disease

2019 ◽  
Vol 9 (3-4) ◽  
pp. 539-548
Author(s):  
A. A. Savchenko ◽  
A. G. Borisov ◽  
I. V. Kudryavcev ◽  
V. D. Belenjuk
Keyword(s):  
Nk Cells ◽  
Postoperative Period ◽  
Peripheral Blood ◽  
Nk Cell ◽  
Favorable Outcome ◽  
Control Group ◽  
Preoperative Period ◽  
Surface Receptors ◽  
Post Surgery ◽  
Purulent Peritonitis

Our study was aimed at investigating dynamic phenotype pattern of peripheral blood NK cells in patients with widespread purulent peritonitis (WPP) during postoperative period depending on disease outcome. A total of 48 patients aged 30–63 with acute surgical diseases and abdominal injuries complicated by WPP were examined. Blood sampling was performed before surgery (preoperative period) as well as on day 7, 14 and 21 during postoperative period. 40 apparently healthy age-matched subjects were included in control group. Peripheral blood NK cell phenotyping was performed by using flow cytometry with directly immunofluorescently tagged antibodies. Mean fluorescence intensity was measured to estimate expression levels of NK cell surface receptors was measured. It was found that in patients with a favorable WPP outcome during preoperative period the percentage of mature NK cells was decreased that was restored by the end of the postoperative period (21 days post-surgery) due to elevated mature, cytotoxic and cytokine-producing NK cell subsets. In addition, percentage of CD11b-positive NK cell subsets was increased upon favorable outcome by the end of postoperative period as well as frequency of CD57-positive NK cells relative to the preoperative period. However, frequency of mature NK cells with unfavorable WPP outcome vs. control vs. favorable outcome was decreased during preoperative and entire postoperative period. Moreover, amount of cytotoxic NK cells was elevated during examination period upon unfavorable WPP outcome. Further, percentage of mature CD11b-positive NK cells in this patient cohort was decreased during preoperative period and post-surgery. Percentage of CD57-positive NK cells was decreased during entire postoperative period in patients with unfavorable vs. favorable outcome vs. control group. At the same time, patients with unfavorable outcome of this infectious-inflammatory disease were shown to display upregulated expression of CD28 and CD57 markers on NK cells. such features identified in phenotype of peripheral blood NK cells in patients with unfavorable WPP outcome reflect abnormal mechanisms in NK cell maturation and migration, which, in turn, determines disturbance in events regulating acute inflammatory reaction in WPP. 

scholarly journals Nadir oxygen delivery to the brain as a risk factor for postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting: A myth or fact

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M N Abdaljawad ◽  
S Taha
Keyword(s):  
Risk Factor ◽  
Postoperative Period ◽  
Oxygen Delivery ◽  
Artery Bypass ◽  
Neurocognitive Impairment ◽  
Early Postoperative Period ◽  
Neurocognitive Impairments ◽  
Structural Brain Damage ◽  
Neurocognitive Test ◽  
Mild Impairment

Abstract Background There are many factors that determine the best neurocognitive outcome following cardiac surgery. Optimum oxygen delivery to the tissues has always been the goal to optimum perfusion. Some patients may exhibit neurocognitive impairments in the early postoperative period; that could be easily missed clinically as they are not associated with radiographic evidence of structural brain damage. At this study we aimed to correlate the lowest oxygen delivery levels with incidence of neurocognitive impairment in the early postoperative period by Folstein test. Methods A non-randomized, prospective pilot study was designed to correlate the nadir oxygen delivery (DO2) during CPB with post-operative cognitive impairment. The study included 271 patients of both sexes, an age group of 50e60 years with university level of education, scheduled for elective, isolated CABG for three vessel disease. All patients underwent pre-and post-operative neurocognitive test by a specialized neuropsychiatric doctor. Results with a mean nadir DO2 of 291 mL/min/m2, the majority of the patients exhibited “normal” results, with a mean nadir DO2 of 266 mL/min/m2 92 patients showed mild impairment in their cognitive behavior, while the worst results “moderate” and “severe” were associated with means of 244,200 mL/min/m2 successively. Conclusions The nadir oxygen delivery is a risk factor for development of post-operative neurocognitive impairment. A level below 260 mL/min/m2 is generally associated with higher risk while a level below 220 mL/min/m2 carries the worst prognosis.

scholarly journals Inadequate oxygen delivery index dose is associated with cardiac arrest risk in neonates following cardiopulmonary bypass surgery

Resuscitation ◽  
2019 ◽  
Vol 142 ◽  
pp. 74-80 ◽  
Author(s):  
Craig Futterman ◽  
Joshua W. Salvin ◽  
Michael McManus ◽  
Adam W. Lowry ◽  
Dimitar Baronov ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Bypass ◽  
Oxygen Delivery ◽  
Bypass Surgery ◽  
Cardiopulmonary Bypass Surgery ◽  
Oxygen Delivery Index

Minimizing Variability in Interpretation Modality Among Spanish-Speaking Patients With Limited English Proficiency

2019 ◽  
Vol 18 (1) ◽  
pp. 32-39
Author(s):  
Seiichi Villalona ◽  
Christian Jeannot ◽  
Mery Yanez Yuncosa ◽  
W. Alex Webb ◽  
Carol Boxtha ◽  
...  
Keyword(s):  
Limited English Proficiency ◽  
English Proficiency ◽  
Cross Sectional ◽  
Time Points ◽  
Spanish Speaking ◽  
History Of ◽  
Vas Scores ◽  
Communication Modalities ◽  
The Impact

Introduction: Provider–patient language discrepancies can lead to misunderstandings about follow-up care instructions and decreased adherence to treatment that may contribute to disparities in health outcomes among patients with limited English proficiency (LEP). This observational study aimed to understand how emergency department (ED) staff went about treating patients with LEP and examine the impact of consistent interpretation modality on overall patient satisfaction and comprehension. Method: A cross-sectional study was conducted among Spanish-speaking patients with LEP presenting to the ED. A survey was administered at two different time points: after patients provided their history of present illness and after the patient received information regarding follow-up treatment. Results: Analysis of average visual analog scale (VAS) scores by consistency of interpretation suggested higher overall scores among participants that received care via the same communication modalities during both the history of present illness and at disposition, when compared with patients that did not. At both time points, video-based interpretation was associated with higher VAS scores in comparison to other modalities, whereas phone-based interpretation was associated with lower VAS scores. Conclusion: Providing consistent modes of interpretation to patient’s with LEP throughout their ED visits improved their overall satisfaction of care provided and understandings of discharge instructions.

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