scholarly journals Perioperative management of patients with hypertension. Guidelines

2020 ◽  
pp. 7-33
Author(s):  
I. B Zabolotskikh ◽  
A. E Bautin ◽  
E. V Grigoryev ◽  
A. I Gritsan ◽  
K. M Lebedinskii ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Perioperative Management ◽  
Perioperative Complications ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Laboratory Diagnosis ◽  
Early Postoperative Period ◽  
Critical Conditions ◽  
Surgical Interventions ◽  
Based Medicine

This article described the main theses of clinical guidelines of the Russian Federation of Anesthesiologists and Reanimatologists on the perioperative management of patients with arterial hypertension. The classification of hypertension, the principles of stratification of the risk of perioperative complications associated with the patients hypertension in the perioperative period are presented. The principles of clinical, instrumental and laboratory diagnosis of the condition of such patients are described. The principles and approaches to the treatment of emergency and critical conditions associated with hypertension are given. An algorithm for the preoperative assessment of the patient and recommendations for planning surgical interventions in patients with arterial hypertension are given. The principles and algorithms of preoperative preparation are described in detail, including antihypertensive therapy, premedication, especially the choice and management of anesthesia, and management of the early postoperative period. All information presented in the article is based on evidence-based medicine data obtained by domestic and foreign researchers.

scholarly journals EFFECTS OF HYPERBARIC OXYGEN THERAPY ON THE POST-OPERATIVE PERIOD IN PATIENTS WITH A DIFFERENT FUNCTIONAL STATUS

2019 ◽  
Vol 26 (2) ◽  
pp. 93-105
Author(s):  
Andrey V. Stakanov ◽  
Vladislav V. Golubtsov ◽  
Alexey E. Muronov
Keyword(s):  
General Population ◽  
Functional Status ◽  
Postoperative Period ◽  
Perioperative Complications ◽  
Colonic Obstruction ◽  
Combined Treatment ◽  
Risk Groups ◽  
Early Postoperative Period ◽  
Surgical Interventions ◽  
Complications And Mortality

Aim. To evaluate the effi cacy of hyperbaric oxygenation (HBO) in patients with a different functional status (FS) after the elimination of acute colonic obstruction (ACO).Materials and methods. A retrospective analysis of 210 medical records of patients who had undergone emergency surgical interventions aimed at ACO elimination was carried out. Based on the value of the direct current potential (DCP), the patients were divided into three groups: 1st (n = 96) with the DCP value from –30 mV and below — FS subcompensation; 2nd (n = 60) with average negative DCP values from –15 to –29.9 mV — FS compensation; 3rd (n = 54) with low negative and positive DCP values from –14.9 mV and higher — FS decompensation. The correlation between patients’ FS and the incidence of postoperative complications was studied, and independent predictors of fatal outcomes were identifi ed. Subsequently, a quantitative analysis of complications and mortality was carried out in each group depending on the use of HBO sessions in the postoperative period, followed by an assessment of their effi cacy.Results. According to the number of perioperative complications and mortality, risk groups in terms of the unfavourable course of the postoperative period were identifi ed: patients with high negative DCP values, for whom the arterial hypotension and acute kidney injury (AKI) could serve as the independent predictors of death; and patients with low negative and positive DCP values, for whom the statistically signifi cant predictors of mortality were shown to be the DCP level, hypotension, AKI and pneumonia. HBO sessions in the postoperative period allow the number of complications in the general population to be reduced: pneumonia by 7%, delirium by 8.8%, AKI by 6.3%, intestinal dysfunction for more than 3 days by 7.3%. In addition, HBO contributed to a 2.9% decrease in suppurative diseases. The analysis of the data on the HBO application in the general population and FS information showed HBO to have a positive effect on the general somatic status of ACO patients. In addition, HBO treatment is shown to decrease the incidence of complications in the early postoperative period. The effi cacy of HBO is found to be higher in the cohort of the most severe patients with decompensated FS, where such complications as delirium, pneumonia and gastrointestinal paresis were decreased by 22.2%, 13% and 18.5%, respectively. As a result, in this group of patients, a signifi cant decrease of 11.1% in 30-day mortality was achieved.Conclusion. The postoperative period depends on the actual FS. The conducted analysis of HBO therapy has convincingly confi rmed its effi cacy in the combined treatment of patients after the elimination of ACO. 

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 Perioperative Management of the Adult Patient on Venovenous Extracorporeal Membrane Oxygenation Requiring Noncardiac Surgery

2018 ◽  
Vol 128 (1) ◽  
pp. 181-201 ◽  
Author(s):  
Michael A. Fierro ◽  
Mani A. Daneshmand ◽  
Raquel R. Bartz
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Perioperative Management ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Postoperative Management ◽  
Noncardiac Surgery ◽  
Drug Dosing ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Circuit Function

Abstract The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.

Parkinson-kórban szenvedő betegek perioperatív ellátása. Irodalmi összefoglaló

2015 ◽  
Vol 156 (34) ◽  
pp. 1355-1359
Author(s):  
Béla Fülesdi ◽  
Calin Mitre ◽  
Csilla Molnár
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Life Expectancy ◽  
Statistical Data ◽  
Perioperative Complications ◽  
Management Strategies ◽  
Perioperative Period ◽  
Interdisciplinary Cooperation ◽  
Surgical Interventions ◽  
Proper Strategy

Similarly to an increase in life expectancy, the incidence of Parkinson’s disease increases as well. In parallel with this, more patients with Parkinson’s disease undergo elective or urgent surgical interventions. According to recent statistical data, more than half of the patients with Parkinson’s disease are not properly managed when they are hospitalized for surgical interventions. It is also clear that properly managed Parkinson’s disease patients have an approximately 50% lower rate for perioperative complications. The authors aimed to summarize the most important complications, the updated peri- and intraoperative treatment and management strategies of patients with Parkinson’s disease. They intended to underline that interdisciplinary cooperation and knowledge of the proper strategy may result in more successful treatment of Parkinson’s disease patients during the perioperative period. Orv. Hetil., 2015, 156(34), 1355–1359.

Fixed combination in patients with arterial hypertension: focus on antihypertensive and nephroprotective properties of fixed combination of lisinopril and amlodipine (clinical example)

2020 ◽  
pp. 19-28
Author(s):  
E. Yu. Ebzeeva ◽  
O. D. Ostroumova ◽  
N. M. Doldo ◽  
E. E. Pavleeva
Keyword(s):  
Kidney Disease ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Adult Population ◽  
Secondary Damage ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Based Medicine ◽  
Modern Population

Arterial hypertension (AH) remains one of the most significant medical and social problems in the world, its prevalence among the adult population is 30–45%. Along with this, the modern population is characterized by a high incidence of chronic kidney disease (CKD), including due to their secondary damage in the framework of hypertension. In turn, CKD is an important independent risk factor for the development and progression of cardiovascular diseases, including fatal ones. The use of existing approaches to nephroprotection in the treatment of patients with hypertension will significantly improve the prognosis both in patients with risk factors for developing renal dysfunction and in patients with pre-existing kidney disease. According to current recommendations for hypertension in such clinical situations, therapy should begin with fixed combinations of antihypertensive drugs. The combination of an angiotensin converting enzyme inhibitor (ACE) and a dihydropyridine calcium channel blocker (CCВ) demonstrated the greatest effectiveness according to evidence-based medicine in patients with high-risk hypertension, including from the standpoint of nephroprotection. In the presented clinical case, the successful use of a fixed combination of ACE and CCВ in a patient with hypertension and microalbuminuria is described.

scholarly journals P3 A closed loop audit on pre-operative anaemia in major elective orthopaedic surger

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Chan Hee Koh ◽  
Nicolai Gruner-Hegge ◽  
Dancho Ignatov ◽  
Aneesul Shakir ◽  
Chan Hee Koh
Keyword(s):  
Closed Loop ◽  
Perioperative Management ◽  
Consensus Statement ◽  
Preoperative Assessment ◽  
Action Plans ◽  
International Consensus ◽  
Change In Practice ◽  
International Consensus Statement ◽  
Preoperative Anaemia

Abstract Introduction The international consensus statement on perioperative management of anaemia advises that patients with haemoglobin (Hb) <130 be treated before undergoing elective operations. The advantages include reduced risk of acute kidney injuries, infections and transfusions, and quicker recovery. Methods Data was collected prospectively from 127 consecutive patients undergoing elective arthroplasties at Hinchingbrooke hospital. Baseline compliance with the consensus statement was first assessed in May 2018, and the results presented at a clinical governance meeting. Departmental action plans included early identification of anaemia and treatment to Hb 130, delaying operations where necessary. We then reassessed compliance in May 2019. Results There was a statistically significant change in practice (p = 0.036). The proportion of patients undergoing arthroplasties despite Hb < 130 reduced from 38% to 21%. Those operated with Hb < 120 decreased from 14% to 0%. The proportion of preoperative anaemias that were appropriately investigated during preoperative assessment increased from 11% to 80% (p < 0.001). The increase in attempted treatment of preoperative anaemia prior to surgery however was not significant (7% vs 20%; p = 0.279). Discussion Implementation of departmental action plans resulted in substantial improvements to clinical practice. For those that underwent arthroplasties despite mild preoperative anaemia, it may have been felt that delays in improvement to quality of life for treatment may be unacceptable, or the causes (e.g. chronic disease) difficult to treat. Further action plans should involve even earlier identification of anaemia, involving primary care at the point of referral.

scholarly journals STMO-07 Adverse events related to the glioblastoma surgery and their perioperative management in our hospital

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii10-ii10
Author(s):  
Hideki Kashiwagi ◽  
Shinji Kawabata ◽  
Seigo Kimura ◽  
Ryokichi Yagi ◽  
Naokado Ikeda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Venous Thrombosis ◽  
Perioperative Management ◽  
Perioperative Complications ◽  
Epileptic Seizures ◽  
Residual Tumor ◽  
Complete Removal ◽  
Tumor Localization ◽  
Vein Thrombosis ◽  
Before And After

Abstract Background: The standard treatment for glioblastoma is surgical resection following chemoradiation therapy. The rate of removal or the amount of residual tumor has some impact on the prognosis of patients with glioblastoma, but the highly invasive nature of this tumor makes complete removal limited to the contrast-enhanced lesions difficult due to its localization. Furthermore, when postoperative seizures and venous thrombosis are included in surgery-related complications, these perioperative adverse events can cause delays in the initiation of chemoradiotherapy and delay the return to work and home, such as prolonged hospitalization and rehabilitation time. Methods: We retrospectively reviewed the perioperative status of the recent 50 consecutive cases with histologically confirmed as glioblastoma at our hospital, the patient background, tumor localization, and perioperative treatment, and so on. Results: The major perioperative complications were ischemic or hemorrhagic complications, epileptic seizures, venous thrombosis, and pneumonia; CTCAE grade 2 or higher, grade 3 or higher, and grade 4 occurred in about 40%, 20%, and 10%, respectively, with some patients having multiple complications. Discussion: Although there was a tendency for ischemic changes around the cavity of the resection as the resection rate increased, most cases were asymptomatic and it seemed to be acceptable if residual brain function could be preserved. Residual tumors tended to show hemorrhagic changes and epileptic seizures because this is thought to be that the tumor was deliberately left in place to preserve function, based on the localization of the tumor. Postoperative FDP levels were useful in predicting the development of deep vein thrombosis and pulmonary artery thromboembolism. Conclusion: Because glioblastoma has short survival time and patient PS before and after surgery varies greatly depending on tumor localization, it is important to consider risk-benefit strategies for each case and to establish a scheme for a seamless transition from perioperative management to the introduction of postoperative therapy and maintenance therapy.

scholarly journals Perioperative management with biologics on severe aortic valve regurgitation caused by Behçet syndrome: the experience from a single center

2021 ◽  
Vol 12 ◽  
pp. 204062232110267
Author(s):  
Luxi Sun ◽  
Jinjing Liu ◽  
Xiufeng Jin ◽  
Zhimian Wang ◽  
Lu Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Perioperative Management ◽  
Perioperative Period ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Behçet Syndrome ◽  
Reactive Protein ◽  
Behcet Syndrome ◽  
Sparing Effect ◽  
Median Interval

Background: To investigate the efficacy and safety of biologics in the perioperative management of severe aortic valve regurgitation (AR) caused by Behçet syndrome (BS). Methods: We retrospectively analyzed 20 patients with severe AR caused by BS who were all treated with biologics during the perioperative period of cardiac surgeries in our center between February 2016 and October 2020. Results: A total of 20 patients with severe AR were enrolled, including 19 males and 1 female, with a mean age of 39.1 ± 8.8 years and a median course of 8 [interquartile range (IQR) 5.25–10.00] years. Before biologic administration, 92.9% of the patients who underwent aortic valve replacement had failed conventional therapy and developed postoperative paravalvular leakage (PVL) at a median interval of 4 months. Biologics were administered with background glucocorticoids (GCs) and immunosuppressants during the perioperative period for 22 aortic valve surgeries, including preoperatively with a median interval of 3.5 (IQR 2.75–4.25) months in 13 cases and within 3 months postoperatively in 9 cases. After a median follow up of 21 (IQR 15–32) months, 2 out of 13 cases (15.4%) preoperatively, and 1 out of 9 cases (11.1%) postoperatively treated with biologics developed PVL, and the rest were event free. The Behçet’s Disease Current Activity Form score improved significantly (7 versus 0, median, p < 0.0001). Decrease of erythrocyte sedimentation rate [25.0 (IQR 11.00–36.25) mm/h versus 6.5 (IQR 4.0–8.8) mm/h, p < 0.001], and C-reactive protein [20.77 (IQR 7.19–29.58) mg/l versus 1.53 (IQR 0.94–2.92) mg/l, p = 0.001] were achieved rapidly and effectively. The GC dosage tapered from 40 (IQR 30–60) mg/d to 10 (IQR 5–11.25) mg/d, p < 0.0001. Immunosuppressants were tapered in number and dosage in 6 (30%) and 20 patients (100%), respectively. No serious adverse event was observed. Conclusion: Our study suggests that biologics were effective and well tolerated for the perioperative management of severe and refractory AR caused by BS, which significantly reduced the occurrence of postoperative PVL and had favorable GC- and immunosuppressant-sparing effect.

Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

2021 ◽  
Vol 23 (3) ◽  
pp. 157-164
Author(s):  
Valery V. Semenov ◽  
Sofya А. Prudyeva ◽  
Alexander A. Kurygin
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Treatment Strategies ◽  
Repeated Administration ◽  
Early Postoperative Period ◽  
Diagnosis And Treatment ◽  
Wound Therapy ◽  
Active Growth ◽  
Surgical Interventions ◽  
Ventral Hernias

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

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