Perioperative Anemia: A Modifiable And Not So Benign Risk Factor (Preprint)

2020 ◽  
Author(s):  
Kelsey Pan ◽  
Shiyi Pang ◽  
Michael Robinson ◽  
Dianne Goede ◽  
Senthil Raj Meenrajan
Keyword(s):  
Risk Factor ◽  
Functional Status ◽  
Management Strategies ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Postoperative Management ◽  
Modifiable Risk Factor ◽  
Early Management ◽  
Review Management ◽  
Perioperative Anemia

UNSTRUCTURED Anemia is a commonly encountered finding either during the preoperative assessment or during postoperative management of the patient. Anemia often gets overlooked while more emphasis is paid to cardiovascular and pulmonary evaluation. Evidence however suggests that presence of anemia in the perioperative period can predispose patients to other complications. Awareness of the consequences of anemia in the perioperative period can lead to better recognition and early management of this potentially modifiable risk factor. In this review we focus on the effects of anemia on the cardiac, pulmonary, neurologic, cognitive and functional status outcomes of patients. We also review management strategies that could be employed, depending on the available time and resources.

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.

Managing the Postoperative Neurosurgical Patient

2018 ◽  
pp. 224-232
Author(s):  
Daniel Ripepi ◽  
Colleen Moran
Keyword(s):  
Management Strategies ◽  
Postoperative Nausea And Vomiting ◽  
Preoperative Assessment ◽  
Postoperative Management ◽  
Sodium Balance ◽  
Anesthetic Techniques ◽  
Postoperative Fever ◽  
Specific Complication ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients

Managing the postoperative neurosurgical patient involves timely recognition and management of specific issues that arise in the immediate postoperative period. The likelihood that a specific complication will arise for a given patient is influenced by the nature of the procedure, the anesthetic techniques used, and the patient’s preoperative comorbidities. The risk of some complications can be reduced with appropriate preoperative assessment and medical optimization. The management and treatment of postoperative complications is equally important, and often management techniques used are unique among neurosurgical patients. Included among the common postoperative management issues in neurosurgical patients are postoperative nausea and vomiting, pain control, sodium balance, postoperative fever, airway management, blood pressure management, and fluid therapy. Management strategies along with rationale for these postoperative concerns are discussed in this chapter.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Acoustofluidic separation enables early diagnosis of traumatic brain injury based on circulating exosomes

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Zeyu Wang ◽  
Haichen Wang ◽  
Ryan Becker ◽  
Joseph Rufo ◽  
Shujie Yang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Flow Cytometry ◽  
Brain Injury ◽  
Early Diagnosis ◽  
Tissue Injury ◽  
Management Strategies ◽  
Acoustic Properties ◽  
Early Management ◽  
Biomarker Analysis ◽  
Downstream Analysis

AbstractTraumatic brain injury (TBI) is a global cause of morbidity and mortality. Initial management and risk stratification of patients with TBI is made difficult by the relative insensitivity of screening radiographic studies as well as by the absence of a widely available, noninvasive diagnostic biomarker. In particular, a blood-based biomarker assay could provide a quick and minimally invasive process to stratify risk and guide early management strategies in patients with mild TBI (mTBI). Analysis of circulating exosomes allows the potential for rapid and specific identification of tissue injury. By applying acoustofluidic exosome separation—which uses a combination of microfluidics and acoustics to separate bioparticles based on differences in size and acoustic properties—we successfully isolated exosomes from plasma samples obtained from mice after TBI. Acoustofluidic isolation eliminated interference from other blood components, making it possible to detect exosomal biomarkers for TBI via flow cytometry. Flow cytometry analysis indicated that exosomal biomarkers for TBI increase in the first 24 h following head trauma, indicating the potential of using circulating exosomes for the rapid diagnosis of TBI. Elevated levels of TBI biomarkers were only detected in the samples separated via acoustofluidics; no changes were observed in the analysis of the raw plasma sample. This finding demonstrated the necessity of sample purification prior to exosomal biomarker analysis. Since acoustofluidic exosome separation can easily be integrated with downstream analysis methods, it shows great potential for improving early diagnosis and treatment decisions associated with TBI.

scholarly journals Failure to Medically Optimize Before Total Hip Arthroplasty: Which Modifiable Risk Factor Is the Most Dangerous?

2021 ◽  
Vol 10 ◽  
pp. 18-23
Author(s):  
Joseph M. Statz ◽  
Susan M. Odum ◽  
Nicholas R. Johnson ◽  
Jesse E. Otero
Keyword(s):  
Risk Factor ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Modifiable Risk Factor ◽  
Total Hip

Risk factors for glaucoma: what do they really mean?

2011 ◽  
Vol 17 (3) ◽  
pp. 233 ◽  
Author(s):  
Anthea Worley ◽  
Karen Grimmer-Somers
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Health Care Providers ◽  
Management Strategies ◽  
Care Providers ◽  
Reference Guide ◽  
Future Assessment ◽  
Primary Health Care Providers ◽  
Patient’S History

Glaucoma is an insidious eye disease, potentially putting 4% of older Australians at risk of blindness, unless detected sufficiently early for initiation of effective treatment. This paper reports on the strengths of evidence and glaucoma risk factors that can be identified by primary health care providers from a patient’s history. A comprehensive search of peer-reviewed databases identified relevant secondary evidence published between 2002 and 2007. Risk factors that could be determined from a patient’s history were identified. A novel glaucoma risk factor reference guide was constructed according to evidence strength and level of concern regarding risk of developing glaucoma. The evidence is strong and consistent regarding the risk of developing glaucoma, and elevated intraocular pressure, advancing age, non-Caucasian ethnicity and family history of glaucoma. There is moderate evidence of association with glaucoma, and migraine, eye injury, myopia and long-term use of corticosteroids. There is conflicting evidence for living in a rural location, high blood pressure, diabetes and smoking. Early detection of people at risk of developing glaucoma can be initiated using our risk factor guide coupled with a comprehensive patient history. Timely future assessment and subsequent management strategies for at-risk individuals can then be effectively and efficiently actioned.

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