Practical Review of Mechanical Ventilation in Adults and Children in The Operating Room and Emergency Department

2021 ◽  
Vol 16 ◽  
Author(s):  
Christian Zanza ◽  
Yaroslava Longhitano ◽  
Mirco Leo ◽  
Tatsiana Romenskaya ◽  
Francesco Franceschi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Operating Room ◽  
Protective Ventilation ◽  
Alveolar Recruitment ◽  
Cochrane Library ◽  
Surgical Patient ◽  
Emergency Setting ◽  
Recruitment Maneuvers ◽  
Operative Complications ◽  
Post Operative Complications

Background: During general anesthesia, mechanical ventilation can cause pulmonary damage through mechanism of ventilator-induced lung injury which is a major cause of postoperative pulmonary complications, which varies between 5 and 33% and increases significantly the 30-day mortality of the surgical patient. Objective: The aim of this review is to analyze different variables which played key role in safe application of mechanical ventilation in the operating room and emergency setting. Method: Also, we wanted to analyze different types of population that underwent intraoperative mechanical ventilation like obese patients, pediatric and adult population and different strategies such as one lung ventilation and ventilation in trendelemburg position. The peer-reviewed articles analyzed were selected according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) from Pubmed/Medline, Ovid/Wiley and Cochrane Library, combining key terms such as: “pulmonary post-operative complications”, “protective ventilation”, “alveolar recruitment maneuvers”, “respiratory compliance”, “intraoperative paediatric ventilation”, “best peep”, “types of ventilation”. Among the 230 papers identified, 150 articles were selected, after title - abstract examination and removing the duplicates, resulting in 94 articles related to mechanical ventilation in operating room and emergency setting that were analyzed. Results: Careful preoperative patient’s evaluation and protective ventilation (i.e. use of low tidal volumes, adequate PEEP and alveolar recruitment maneuvers) has been shown to be effective not only in limiting alveolar de-recruitment, alveolar overdistension and lung damage, but also in reducing the onset of pulmonary post-operative complications (PPCs). Conclusion: Mechanical ventilation is like “Janus Bi-front” because it is essential for surgical procedures, for the care of critical care patients and in life-threatening conditions but it can be harmful to the patient if continued for a long time and where an excessive dose of oxygen is administered into the lungs. Low tidal volume is associated with minor rate of PPCs and other complications and every complication can increase length of Stay, adding cost to NHS between 1580 € and 1650 € per day in Europe and currently the prevention of PPCS is only weapon that we possess.

Post-Operative Complications in the Elderly Surgical Patient

Gerontology ◽  
1983 ◽  
Vol 29 (4) ◽  
pp. 262-270 ◽  
Author(s):  
David Gwyn Seymour ◽  
Robert Pringle
Keyword(s):  
The Elderly ◽  
Surgical Patient ◽  
Operative Complications ◽  
Post Operative Complications

scholarly journals Evaluation of alveolar recruitment maneuver on respiratory resistance during general anesthesia: a prospective observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junko Nakahira ◽  
Shoko Nakano ◽  
Toshiaki Minami
Keyword(s):  
Mechanical Ventilation ◽  
General Anesthesia ◽  
Recruitment Maneuver ◽  
Peak Inspiratory Pressure ◽  
Alveolar Recruitment ◽  
Trial Registration ◽  
Inspiratory Pressure ◽  
Forced Oscillation Technique ◽  
Respiratory Resistance ◽  
Recruitment Maneuvers

Abstract Background Alveolar recruitment maneuvers enable easily reopening nonaerated lung regions via a transient elevation in transpulmonary pressure. To evaluate the effect of these maneuvers on respiratory resistance, we used an oscillatory technique during mechanical ventilation. This study was conducted to assess the effect of the alveolar recruitment maneuvers on respiratory resistance under routine anesthesia. We hypothesized that respiratory resistance at 5 Hz (R5) after the maneuver would be decreased after the lung aeration. Methods After receiving the ethics committee’s approval, we enrolled 33 patients who were classified with an American Society of Anesthesiologists physical status of 1, 2 or 3 and were undergoing general anesthesia for transurethral resection of a bladder tumor within a 12-month period from 2017 to 2018. The recruitment maneuver was performed 30 min after endotracheal intubation. The maneuver consisted of sustained manual inflation of the anesthesia reservoir bag to a peak inspiratory pressure of 40 cmH2O for 15 s, including 5 s of gradually increasing the peak inspiratory pressure. Respiratory resistance was measured using the forced oscillation technique before and after the maneuver, and the mean R5 was calculated during the expiratory phase. The respiratory resistance and ventilator parameter results were analyzed using paired Student’s t-tests, and p < 0.05 was considered statistically significant. Results We analyzed 31 patients (25 men and 6 women). R5 was 7.3 ± 1.6 cmH2O/L/sec before the recruitment maneuver during mechanical ventilation and was significantly decreased to 6.4 ± 1.7 cmH2O/L/sec after the maneuver. Peak inspiratory pressure and plateau pressure were significantly decreased, and pulmonary compliance was increased, although the values were not clinically relevant. Conclusion The recruitment maneuver decreased respiratory resistance and increased lung compliance during mechanical ventilation. Trial registration Name of registry: Japan Medical Association Center for Clinical Trials. Trial registration number: reference JMA-IIA00136. Date of registration: 2 September 2013. URL of trial registry record: https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRE02_04/JMACTRE02_04.aspx?kbn=3&seqno=3582

scholarly journals Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas—A Systematic Review and Meta-Analysis

2020 ◽  
Vol 10 (1) ◽  
pp. 120
Author(s):  
Rianne J.A. Helgers ◽  
Bjorn Winkens ◽  
Brigitte F.M. Slangen ◽  
Henrica M.J. Werner
Keyword(s):  
Systematic Review ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lower Extremity ◽  
Odds Ratio ◽  
Cochrane Library ◽  
Total N ◽  
Operative Complications ◽  
Post Operative Complications

Background: Lymph node dissection (LND) is recommended as staging procedure in presumed low stage endometrial cancer. LND is associated with risk of lower-extremity lymphedema and post-operative complications. The sentinel lymph node (SLN) procedure has been shown to have high diagnostic accuracy, but its effects on complication risk has been little studied. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma. Methods: A systematic search was conducted in PubMed and Cochrane Library. Results: Seven retrospective and prospective studies (total n = 3046 patients) were included. Only three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01–0.37; p = 0.067), 0.07 (95% CI 0.00–1.21; p = 0.007) and 0.54 (95% CI 0.37–0.80; p = 0.002) in these studies. The pooled odds ratio of any post-operative complications after SLN versus LND was 0.52 (95% CI 0.36-0.73; I2 = 48%; p < 0.001). For severe post-operative complications the pooled odds ratio was 0.52 (95% CI 0.28–0.96; I2 = 0%; p = 0.04). Conclusions: There are strong indications that SLN results in a lower incidence of lower-extremity lymphedema and less often severe post-operative complications compared to LND. In spite of the paucity and heterogeneity of studies, direction of results was similar in all studies, supporting the aforementioned conclusion. These results support the increasing uptake of SLN procedures in endometrial cancer.

scholarly journals Meta-analysis of Glutamine on Immune Function and Post-Operative Complications of Patients With Colorectal Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Tao Yang ◽  
Xuhong Yan ◽  
Yibo Cao ◽  
Tiantian Bao ◽  
Guangsong Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Immune Function ◽  
Anastomotic Leakage ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Small Sample ◽  
Cochrane Library ◽  
Control Group ◽  
Operative Complications ◽  
Post Operative Complications

The aim of this meta-analysis was to evaluate the clinical significance of glutamine in the management of patients with colorectal cancer (CRC) after radical operation. Electronic databases, including PubMed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), VIP medicine information system (VIP), and Wanfang electronic databases were comprehensively searched from inception to 30, July 2021. Prospective randomized trials with glutamine vs. routine nutrition or blank therapy were selected. The immune function related indicators (including IgA, IgG, IgM, CD4+, CD8+, and the ratio of CD4+/CD8+), post-operative complications [including surgical site infection (SSI), anastomotic leakage, and length of hospital stay (LOS)], and corresponding 95% confidence intervals (CIs) were assessed in the pooled analysis. Subsequently, the heterogeneity between studies, sensitivity, publication bias, and meta-regression analysis were performed. Consequently, 31 studies which contained 2,201 patients (1,108 in the glutamine group and 1,093 in the control group) were included. Results of pooled analysis indicated that glutamine significantly improved the humoral immune function indicators [including IgA (SMD = 1.15, 95% CI: 0.72–1.58), IgM (SMD = 0.68, 95% CI: 0.48–0.89), and IgG (SMD = 1.10, 95% CI: 0.70–1.50)], and the T cell immune function indicators [including CD4+ (SMD = 0.76, 95% CI: 0.53–0.99) and the ratio of CD4+/CD8+ (SMD = 0.92, 95% CI: 0.57–1.28)]. Meanwhile, the content of CD8+ was decreased significantly (SMD = −0.50, 95% CI: −0.91 to −0.10) followed by glutamine intervention. Pooled analysis of SSI (RR = 0.48, 95% CI: 0.30–0.75), anastomotic leakage (RR = 0.23, 95% CI: 0.09–0.61), and LOS (SMD = −1.13, 95% CI: −1.68 to −0.58) were decreased significantly in glutamine group compared with control group. Metaregression analysis revealed that the covariate of small-sample effects influenced the robustness and reliability of IgG outcome potentially. Findings of the present work demonstrated that glutamine ought to be applied as an effective immunenutrition therapy in the treatment of patients with CRC after radical surgery. The present meta-analysis has been registered in PROSPERO (no. CRD42021243327).Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO, Identifier: CRD42021243327.

scholarly journals 389 Impact of Surgical Drain Output Monitoring on Patient Outcomes in Gastrointestinal Surgery: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Kowal ◽  
W Bolton ◽  
B Van Duren ◽  
J Burke ◽  
D Jayne
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Gastrointestinal Surgery ◽  
Cochrane Library ◽  
Emergency General Surgery ◽  
Operative Care ◽  
Operative Complications ◽  
Output Monitoring ◽  
Surgical Drain ◽  
Post Operative Complications

Abstract Aim Surgical drains are widely utilised in Gastrointestinal Surgery to prevent intra-abdominal collections and identify post-operative complications. Surgical drain monitoring ranges from simple output measurements through to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect post-operative complications and impact on patient outcomes. Method A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing gastrointestinal surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. Results The search returned 396 articles. Following abstract review, 383 were excluded and 13 articles were included for full review. The studies were classified according to speciality: Oesophagogastric (1), Pancreatic (6), Hepatobiliary (2), Colorectal (3) and Emergency General Surgery (1). Post-operative monitoring of amylase and bilirubin decreased the incidence of post-operative complications (pancreatic fistulas, intra-abdominal infections, surgical site infections), length of stay and mortality rate in Pancreatic and Hepatobiliary Surgery. Testing of drain contents following Colorectal Surgery can aid anastomotic leak and the detection of peritonitis, however this did not confer any improvement in patient outcome. Surgical drain monitoring did not improve patient outcomes in Oesophagogastric Surgery. Conclusions Surgical drain monitoring has established advantages in the post-operative care for patients undergoing Gastrointestinal Surgery. Enhanced surgical drain monitoring involving the testing of drain amylase, bilirubin, lactate, and cytokines may improve detection of complications in the immediate post-operative period.

Lung-Protective Ventilation

2017 ◽  
Vol 35 (1) ◽  
pp. 37-53 ◽  
Author(s):  
Rex A. Marley ◽  
Kaycee Simon
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Operating Room ◽  
Ventilatory Support ◽  
Pulmonary Complications ◽  
Additional Treatment ◽  
Protective Ventilation ◽  
Treatment Modalities ◽  
Lung Protective Ventilation ◽  
Risk Patients

Historically, mechanical ventilation of the lungs utilizing relatively large tidal volumes was common practice in the operating room and intensive care unit (ICU). The rationale behind this treatment strategy was to yield better patient outcomes, that is, fewer pulmonary complications, and a reduction in morbidity and mortality. As evidence-based practice has evolved, potential harmful effects of traditional, nonphysiological mechanical ventilation (ventilation with larger tidal volumes and the tolerance of high airway pressures) even in shortterm treatment have been shown to correlate with systemic inflammation and the development of ventilator-associated lung injury. Lung-protective ventilation principles using more physiological tidal volumes, avoiding high inspiratory plateau pressures, along with appropriate levels of positive end-expiratory pressure have been shown to decrease pulmonary complications and improve outcomes in patients with acute respiratory distress syndrome requiring ongoing ventilatory support in the ICU. In addition, current research is beginning to validate the benefit of providing more physiologic ventilator support in the operating room, particularly for high-risk patients undergoing major abdominal surgery, in minimizing acute lung injury. A review of lung-protective ventilation measures including benefits and potential side effects is presented. Additional treatment modalities and therapeutic considerations are offered for inclusion in optimal patient management.

Comparison of the Effects of Dexamethasone Administration on Postoperative Sequelae Before and After “Third Molar" Extraction Surgeries

2020 ◽  
Vol 20 (3) ◽  
pp. 356-364 ◽  
Author(s):  
Ehsan Shoohanizad ◽  
Milad Parvin
Keyword(s):  
Oral Surgery ◽  
Controlled Trial ◽  
Maxillofacial Surgery ◽  
Third Molar ◽  
Cochrane Library ◽  
Third Molar Surgery ◽  
Third Molars ◽  
Operative Complications ◽  
The Impact ◽  
Post Operative Complications

Introduction: Impacted third molars (ITMs) surgery, is one of the most common methods in the field of oral and maxillofacial surgical operations. Administration of corticosteroid such as dexamethasone diminishes the postoperative sequelae. The study aimed to compare the impact of dexamethasone administration on pre-operative and post-operative complications in third molar surgery. Methods: We collected all randomized controlled trial data on the influences of pre-operative and postoperative dexamethasone administration between 2006-2019 on third molar surgery sequelae by searching the keywords: dexamethasone, third molar surgery, wisdom teeth, corticosteroids, oral surgery, maxillofacial surgery, preoperative, postoperative, pain, swelling, and trismus in international databases such as: Web of Science (ISI), PubMed, Scopus, Embase and Cochrane Library. Results: Twenty-three articles were included in this narrative review. Among them, 22 studies used dexamethasone in particular and 1 study used dexamethasone with amoxicillin. Twenty studies evaluated the prescription of dexamethasone in pre-operative and post-operative routes on pain, trismus and edema following third molars operation. Five studies administered dexamethasone postoperatively and 15 studies administered the drug preoperatively. Two studies evaluated the preoperative and postoperative administration method. Fourteen studies used a 4 mg dexamethasone dose and drug administration was variable. The treatment period in postoperative studies varied between 1 to 7 days. Conclusion: Dexamethasone appears to be a promising agent in in reduction of post-operative complications following third molar surgery. As a potent anti-inflammatory agent, it has an effective role in pain, trismus and edema reduction distinguished from the routes of administration, dosage and timing, pre or postoperative prescription.

scholarly journals Anxiety in the Operating Room Before Elective Surgery

2020 ◽  
Author(s):  
Amir Ahmadzadeh Amiri ◽  
Kasra Karvandian ◽  
Ali Ahmadzadeh Amiri ◽  
Aida Zeinali
Keyword(s):  
Operating Room ◽  
Trait Anxiety ◽  
Elective Surgery ◽  
Anxiety Level ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Operative Complications ◽  
History Of ◽  
History Of Anesthesia ◽  
Post Operative Complications

The experience of pre-operative anxiety in patients is a common and accepted issue; however, anxiety can potentially increase the patients' need for care, the level of post-operative pain, and ultimately patients' morbidity and mortality. The goal of this study was to determine the patients' pre-operative anxiety level right before they undergo surgery in the operating room. This study was conducted as a prospective crosssectional study. Accordingly, completed State-Trait Anxiety Inventory questionnaires as well as demographic and contextual variables of 230 patients undergoing surgery were evaluated. Data analysis was taken out using SPSS v24. P of less than 0.05 was considered significant. 230 patients with an average age of 48.95 (14.68) years were enrolled. The frequency of mild, moderate, and severe anxiety among the patients was 50.8%, 37%, and 12.2%, respectively. The analysis revealed that the patients' age, gender, occupation, awareness about the type of anesthesia, and place of residence, as well as the type of anesthesia, had no significant correlation with the patients' pre-operative anxiety. However, a significant difference was found regarding patients’ preoperative anxiety level and their educational, marital, awareness of post-operative complications, and trait anxiety status as well as their history of anesthesia. Therefore, to reduce post-operative complications, it is recommended that the patients with these characteristics be given priority for interventions aimed at reducing pre-operative anxiety.

Post-Operative Complications in the Elderly Surgical Patient

1984 ◽  
Vol 28 (3) ◽  
pp. 223
Author(s):  
D. G. SEYMOUR ◽  
R. PRINGLE ◽  
Dola S. Thompson
Keyword(s):  
The Elderly ◽  
Surgical Patient ◽  
Operative Complications ◽  
Post Operative Complications
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