scholarly journals Pheochromocytoma: Multidisciplinary Approach Perioperative Considerations

2021 ◽  
Vol 21 (3) ◽  
pp. 674-680
Author(s):  
Miryam Elizabeth Céspedes Morón ◽  
Roxana Camargo-Román ◽  
Nicanor Rodriguez-Gutarra ◽  
Alicia Mispireta-Castañeda
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adrenal Gland ◽  
Multidisciplinary Approach ◽  
Perioperative Management ◽  
Perioperative Complications ◽  
Laparoscopic Technique ◽  
Left Adrenal Gland ◽  
Surgical Preparation ◽  
Rule Out

Patient scheduled for an adrenalectomy with laparoscopic technique, due to a tumor of the left adrenal gland. The diagnosis of chronic arterial hypertension was difficult to control, so a test was requested to rule out pheochromocytoma, resulting in a tumor of the left adrenal gland. The teamwork of the specialties involved in the care of the patient, effective communication, pre-surgical preparation and perioperative management, resulted in minimal perioperative complications in the patient, remaining in the intensive care unit for one day and reducing the hospital stay.

scholarly journals Is the Jury Out or In?

2019 ◽  
pp. 743-760
Author(s):  
Anna M. May ◽  
Thomas R. Gildea ◽  
Reena Mehra
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Obstructive Sleep Apnea ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Perioperative Complications ◽  
Health Care Expenditures ◽  
Level Of Care ◽  
Obstructive Sleep ◽  
Respiratory Management

This case illustrates potential perioperative complications associated with obstructive sleep apnea (OSA): respiratory decompensation sometimes leading to morbidity, mortality, increase in the level of care, and increased health care expenditures. OSA is common and affects more than 40% of the surgical population. However, an estimated 85% of those with OSA are undiagnosed preoperatively. This chapter describes an individual with severe OSA complicated by perioperative respiratory failure who required intensive care unit admission and emergent reintubation. This case is used to highlight perioperative considerations for OSA screening, testing, and treatment with a focus on respiratory management based on guideline recommendations. This case underscores the most common types and timing of such postoperative complications and ways to prevent and treat them.

scholarly journals Non-haemorrhagic causes of obstetrical intensive care unit admissions in tertiary care setting

2020 ◽  
Vol 9 (4) ◽  
pp. 1392
Author(s):  
Preet Kamal ◽  
Surinder Kaur ◽  
Harleen Kaur ◽  
Madhu Nagpal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidisciplinary Approach ◽  
Care Setting ◽  
Tertiary Care ◽  
Medical Illness ◽  
Tropical Diseases ◽  
Medical Disorders ◽  
Tropical Conditions ◽  
Tertiary Care Setting

Background: Management of critically ill obstetric patients involve intensive monitoring in intensive care unit. In present scenario there are significant number of obstetric patients with sepsis, tropical diseases and medical illness that require ICU care. The aim of this study was to evaluate in more detail the non-haemorrhagic causes of obstetric ICU admissions and to identify and adopt high risk strategies as prime learning objective.Methods: It is a prospective ongoing study conducted in 50 patients in SGRDUHS, Amritsar from December 2016 to October 2019, who were admitted in obstetric ICU, out of them 30 cases were attributed to non-haemorrhagic obstetric causes. All demographic parameters along with gestational age, diagnosis on admission, intervention done prior to shift to ICU and details of treatment given in ICU were evaluated. Patient outcome, review of mortality and area of improvement were also noted.Results: Majority of the patient (70.1%) were admitted in 3rd trimester. Obstetric sepsis (13.33%), infective diseases (16.66%), tropical conditions (16.66%), medical disorders (26.66%) and hypertensive disorders (26.66%) were the major causes of admission to obstetric ICU. There were 33.3% mortalities observed in present study and 40% were due to respiratory failure. In ICU mechanical ventilation was done in 63.3% cases and blood products were given in 33.3% of patients.Conclusions: A multidisciplinary approach is ideal to handle non-haemorrhagic situations especially related to medical disorders and tropical diseases. Review of the ICU admissions and periodic audit can improve management of morbidities as well as reduce maternal mortalities.

scholarly journals Management of Gestation with Abnormal Invasive Placenta Complicated by an Extra-preterm Premature Rupture of Membranes in a Tertiary Perinatal Centre

2020 ◽  
Vol 27 (3) ◽  
pp. 113-124
Author(s):  
N. V. Mingaleva ◽  
T. B. Makukhina ◽  
E. S. Lebedenko ◽  
T. A. Anikina ◽  
M. D. Kotleva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Loss ◽  
Multidisciplinary Approach ◽  
Second Phase ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Increased Risk ◽  
Invasive Placenta

Aim. Assessment of methods for prolonging gestation after an extra-preterm premature rupture of membranes (PROM) in a patient with abnormal invasive placenta and the efficacy of a multidisciplinary approach for treatment of a combined obstetric pathology in a tertiary perinatal centre.Results. A clinical case is reported of PROM at 22+6 weeks’ gestation in a patient with two caesarean scars on the uterus and abnormal invasive placenta. In a tertiary perinatal centre, pregnancy was prolonged to 36+3 weeks’ term. The period between PROM and delivery was 96 days. A planned caesarean section and metroplasty were performed in the setting of temporary balloon occlusion of common iliac arteries. Blood loss was 75 mL/kg. Placenta increta without chorioamnionitis was confirmed histologically. The patient stayed in the intensive care unit for two days and was discharged home on the 8th day. The newborn was assigned the Apgar score of 6/6. For two days, ventilatory support was rendered in a neonatal intensive care unit. The newborn was diagnosed with congenital pneumonia, the first-degree hypoxic-ischemic damage of the central nervous system and transferred to the second phase of nursing.Conclusions. A multidisciplinary approach and high technology facilities in the setting of a tertiary perinatal centre allow to reduce perinatal losses and provide high-quality care to patients with an increased risk of massive blood loss with the capacity to manage organ-preserving operative delivery with full rehabilitation in the postoperative period.

scholarly journals Perioperative Management of Pancreaticoduodenectomy: Avoiding Admission to the Intensive Care Unit

2019 ◽  
Vol 6 (3-4) ◽  
pp. 108-115
Author(s):  
Walid Faraj ◽  
Deborah Mukherji ◽  
Ahmad M. Zaghal ◽  
Hussein Nassar ◽  
Farah H. Mokadem ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Perioperative Management

Defining Outcomes after Colon Resection in Blunt Trauma: Is Diversion or Primary Anastomosis More Favorable?

2018 ◽  
Vol 84 (8) ◽  
pp. 1288-1293 ◽  
Author(s):  
Alaina M. Lasinski ◽  
Lindsay Gil ◽  
Anai N. Kothari ◽  
Michael J. Anstadt ◽  
Richard P. Gonzalez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Primary Repair ◽  
Perioperative Complications ◽  
Primary Anastomosis ◽  
Data Bank ◽  
Colon Resection ◽  
Colon Injury

Previous literature demonstrates the safety of primary repair in penetrating colon injury requiring resection, without the creation of a diverting ostomy. It is unknown whether a similar approach can be applied to patients with blunt colon injury. The aim of this study was to measure outcomes in patients who underwent colon resection with and without ostomy creation after blunt trauma injury to help direct future management. Using the National Trauma Data Bank for years 2008 to 2012, we identified patients with blunt trauma mechanisms who underwent colectomy. Patients were stratified into two groups: primary anastomosis and diversion with ostomy. Primary outcome was inpatient mortality. Secondary outcomes included length of stay and perioperative complications. All risk-adjusted analyses were performed using logistic regression with consideration of interactions. Five hundred eighty-one observations met our inclusion criteria. Baseline characteristics between the two groups were similar with the exception of age (37.3 vs 42.2 years, P < 0.001) and admission Glasgow coma score (13.2 vs 12.1, P = 0.002). Risk-adjusted mortality for the two groups was not statistically significant (2.3% vs 3.0%, P = 0.63); however, patients with primary anastomosis had a shorter length of stay (18.2 vs 28.1, P < 0.001), fewer days in the intensive care unit (10.9 vs 16.2, P < 0.001), and fewer ventilator days (10.5 vs 14.6, P = 0.01). In patients requiring colon resection after blunt trauma, mortality is not different for those who receive a primary anastomosis versus ostomy. Patients without diversion had shorter hospital stays, intensive care unit days, and ventilator days. These data support that primary anastomosis is safe in this patient population.

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