scholarly journals Risk factors for postoperative spinal infection: A retrospective analysis of 5065 cases

2019 ◽  
Vol 10 ◽  
pp. 121
Author(s):  
Matt El-Kadi ◽  
Erin Donovan ◽  
Laurel Kerr ◽  
Coby Cunningham ◽  
Victor Osio ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Infection Rate ◽  
Immunosuppressive Drugs ◽  
Smoking History ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Record Review ◽  
Subsequent Introduction ◽  
Retrospective Medical Record Review

Background: Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism. Methods: Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk. Results: The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time. Conclusions: Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.

Absence of Bronchodilation during Desflurane Anesthesia

2000 ◽  
Vol 93 (2) ◽  
pp. 404-408 ◽  
Author(s):  
Mitchell J. Goff ◽  
Shahbaz R. Arain ◽  
David J. Ficke ◽  
Toni D. Uhrich ◽  
Thomas J. Ebert
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Volatile Anesthetics ◽  
Smoking History ◽  
Respiratory Resistance ◽  
Volatile Anesthesia ◽  
History Of ◽  
Respiratory System Resistance ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Bronchospasm is a potential complication in anyone undergoing general anesthesia. Because volatile anesthetics relax bronchial smooth muscle, the effects of two newer volatile anesthetics, desflurane and sevoflurane, on respiratory resistance were evaluated. The authors hypothesized that desflurane would have greater bronchodilating effects because of its ability to increase sympathetic nervous system activity. Methods Informed consent was obtained from patients undergoing elective surgery with general anesthesia. We recorded airway flow and pressure after thiopental induction and tracheal intubation (baseline) and for 10 min after beginning volatile anesthesia ( approximately 1 minimum alveolar concentration inspired). Respiratory system resistance was determined using the isovolume technique. Results Fifty subjects were randomized to receive sevoflurane (n = 20), desflurane (n = 20), or thiopental infusion (n = 10, 0.25 mg. kg-1. h-1). There were no differences between groups for age, height, weight, smoking history, and American Society of Anesthesiologists physical class. On average, sevoflurane reduced respiratory resistance 15% below baseline, whereas both desflurane (+5%) and thiopental (+10%) did not decrease respiratory resistance. The respiratory resistance changes did not differ in patients with and without a history of smoking during sevoflurane or thiopental. In contrast, administration of desflurane to smokers resulted in the greatest increase in respiratory resistance. Conclusions Sevoflurane causes moderate bronchodilation that is not observed with desflurane or sodium thiopental. The bronchoconstriction produced by desflurane was primarily noted in patients who currently smoked. (Key words: Bronchospasm; respiratory resistance; volatile anesthetics.)

Malaria in Children in Chicago

PEDIATRICS ◽  
1993 ◽  
Vol 92 (1) ◽  
pp. 83-85
Author(s):  
Benjamin Emanuel ◽  
Neil Aronson ◽  
Stanford Shulman
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
Malaria Endemic Area ◽  
Overseas Travel ◽  
History Of ◽  
Record Review ◽  
Recent Immigration ◽  
Childhood Malaria ◽  
Retrospective Medical Record Review

Objective. To review the experience of a large children's hospital and two community hospitals in Chicago in which malaria was diagnosed in children during a recent 6-year period. Methods. Retrospective medical record review covering the years 1985 to 1990. Results. Twenty cases of childhood malaria were diagnosed, generally in patients hospitalized for fever unresponsive to oral antibiotics also associated with splenomegaly, with presumptive diagnoses of malignancy, typhoid fever, acute appendicitis, or urinary tract infection. History of recent immigration to the United States or travel to a malaria-endemic area was frequently not elicited until several days into hospitalization, thus delaying diagnosis and therapy. Conclusions. Because malaria in the United States pediatric population has increased as a result of foreign immigration and overseas travel, pediatricians must be alert to the possibility of malaria in febrile children, and the importance of antimalarial prophylaxis should be communicated to parents of children traveling to endemic areas.

scholarly journals Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

scholarly journals Intraoperative anaphylaxis

2018 ◽  
Vol 5 (2) ◽  
pp. 62-65
Author(s):  
Sujita Manandhar
Keyword(s):  
Standard Protocol ◽  
Recurrent Tonsillitis ◽  
Upper Eyelid ◽  
Anesthetic Agents ◽  
Anesthetic Drugs ◽  
Eyelid Swelling ◽  
History Of ◽  
Facial Area ◽  
American Society ◽  
American Society Of Anesthesiologists

A 24 years lady was scheduled for tonsillectomy for recurrent tonsillitis had anaphylaxis and asystole before extubation, she was revived successfully.She had no known history of allergy and exposure to anesthetic agents and was classified as an American Society of Anesthesiologists, ASA I. In the operating theatre, her baseline vitals were unremarkable and remained hemodynamically stable on receiving antibiotic and anesthetic drugs. The anesthetic course remained uneventful throughout the surgery. Upon removal of surgical drapes, upper eyelid swelling was noted, that rapidly progressed to facial area within minutes, and she developed cardiac arrest which was managed with standard protocol and resuscitated successfully.  

scholarly journals Associations of hypertension Diabetes Smoking History and SNPs with Responses to Aflibercept Treatment for tAMD and PCV

2019 ◽  
pp. 170-177
Author(s):  
Tanaka K ◽  
Furuya K ◽  
Mori R ◽  
Kawamura A ◽  
Yuzawa M ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Initial Treatment ◽  
Smoking History ◽  
Diabetic Patients ◽  
Therapeutic Effects ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
History Of ◽  
One Year ◽  
The One

Purpose: To determine the correlation between therapeutic effects of IVA treatment on typical AMD (tAMD), and polypoidal choroidal vasculopathy (PCV) and the history of hypertension, diabetes mellitus, smoking history and single nucleotide polymorphisms (SNPs).Methods: Prospective, interventional study. Subjects were assigned to 125 untreated patients with exudative AMD (tAMD: 58 patients, PCV: 67 patients, male: 91:34, mean age 73.4 years). Among the tAMD patients, there were 28 bimonthly injections 30 who received pro re nata (PRN) injections after three monthly injections. Among the PCV patients, 33 were treated with bimonthly injections and 34 received PRN injections after three monthly injections. Therapeutic effects were evaluated by best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (CCT), and exudative change after 3 months and 1 year from initial treatment, and also the history of hypertension, diabetes mellitus, smoking and five SNPs (rs10490924, rs800292, rs699947, rs1061170, rs13278062).Results: Improvements of BCVA, CRT were observed in all groups at 1 year after initial treatment. The one-yearchange in CRT showed significant improvement in nonsmokers than smokers in tAMD. The one-year change in CRT indicated a significant improvement in non-diabetic patients in PCV. There was more exudation at both 3 months and 1 year who had smoking history in tAMD. With respect to the rs1061170 mutation of tAMD, in the case with TT type, significant residual exudation was noted at both 3 and 12 months.Conclusions: The history of smoking and diabetes could be influence to IVA treatment for AMD.

Cervical Corpectomy: Complications and Outcomes

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS295-ONS302 ◽  
Author(s):  
Maxwell Boakye ◽  
Chirag G. Patil ◽  
Chris Ho ◽  
Shivanand P. Lad
Keyword(s):  
Type 1 Diabetes ◽  
Multivariate Analysis ◽  
Mortality Rates ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Corpectomy ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Objective: Previously, information on cervical corpectomy complication rates has been obtained from retrospective analysis of single-institution data. The aim of this study was to report 30-day mortality and complication rates after cervical corpectomy using multicenter prospective data from the Veterans Affairs National Surgical Quality Improvement Program database. Methods: The National Surgical Quality Improvement Program database was used to identify 1560 patients who underwent cervical corpectomy in United States Veterans Affairs hospitals from 1997 to 2006. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on morbidity and mortality rates. Results: A total of 1560 patients underwent corpectomy, with an overall in-hospital mortality rate of 1.6%, a complication rate of 18.4%, and a mean length of stay of 6 days. Multivariate analysis identified age older than 80 years (odds ratio [OR], 21.24), history of Type 1 diabetes (OR, 2.36), American Society of Anesthesiologists class greater than 3 (OR, 6.93), and dependent functional status (OR, 3.17) as the most significant preoperative predictors of complications. Three or more corpectomy levels (OR, 2.46) and operative duration longer than 6 hours (OR, 3.45) were also found to be significant predictors of postoperative complications. Patients who underwent 3 or more levels of corpectomy had a return-to-operating room rate of 17.9% and a graft/instrumentation failure rate of 5.4% compared with those who underwent single-level corpectomy, who had rates of 6.2 and 1.87%, respectively. Patients who were returned to the operating room had significantly higher mortality rates (7.0 versus 1.2%) and accounted for 39.9% of the total number of complications. Multivariate analysis identified age, American Society of Anesthesiologists class, history of disseminated cancer, and diabetes as the most significant predictors of mortality. Patients with Type 1 diabetes had 4-fold higher mortality rates compared with patients with no history of diabetes or diet-controlled diabetes. Conclusion: We have analyzed the morbidity and mortality data on the largest series of corpectomy reported to date. We have demonstrated the impact of age, American Society of Anesthesiologists class, and number of operated levels on complication rates. Type 1 diabetes was established as a strong risk factor for 30-day mortality after cervical corpectomy.

Vancomycin-Resistant Enterococcus (VRE) Bacteremia During Acute Myeloid Leukemia (AML) Induction Therapy Is an Independent Predictor of Poor Outcome

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1487-1487 ◽  
Author(s):  
Moshe Ornstein ◽  
Sudipto Mukherjee ◽  
Michael K. Keng ◽  
Paul Elson ◽  
Ramon V. Tiu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Complete Remission ◽  
Infection Rate ◽  
Research Funding ◽  
Patent Application ◽  
Cleveland Clinic ◽  
Smoking History ◽  
Cell Transplant ◽  
History Of ◽  
The Impact

Abstract Abstract 1487 The presence of VRE bacteremia in hematopoietic stem cell transplant recipients portends a worsening clinical course and poor overall survival (Avery et al; BMT, 2005). The impact of VRE bacteremia on outcome in AML patients (pts) receiving induction chemotherapy (IC) has not been established. We conducted an IRB-approved retrospective study of AML pts who received cytarabine-based IC at Cleveland Clinic between 2000–2008 to determine VRE rates and effect on complete remission (CR) and overall survival (OS). Data on age at AML diagnosis (dx), gender, diabetes, smoking history, history of antecedent hematological disorder, pathologic classification, hematologic parameters at dx and at VRE occurrence, metaphase cytogenetics (per CALGB/Alliance 8461), precedingnon-VRE bacteremias, invasive fungal infection (IFI), time from dx and induction to VRE and number of VRE infections, complete remission (CR) and overall survival (OS) were collected from our AML database. The association of these factors with VRE bacteremia was assessed using Fisher's exact test, the Cochran-Armitage trend test and Wilcoxon rank sum test. The impact of VRE bacteremia on OS was assessed using a 2:1 matched-pairs analysis based on gender and year of dx (+ 3 years), and factors known to influence outcome: age at dx (+ 5 years), etiology, and cytogenetic risk. The timing of VRE was also accounted for in the matching. Frailty models, which included a term for WBC at dx, were use to assess the impact of VRE bacteremia while taking into account both the impact of WBC and the paired nature of the data. Of 350 pts evaluable for analysis, the median age at dx was 57 years (range 19–88); 192 (55%) were male; 114 (33%) had secondary AML; median baseline WBC was 10.4K/mL (range, 0.48–550); cytogenetic risk distribution was favorable (14%), intermediate (54%), and unfavorable (32%); 45% were current or former smokers; 17% had a history of diabetes; and 7% had IFI. With the exception of IFI (16% in pts with VRE versus 6% in non-VRE pts, p=.04) there were no significant differences in these factors between the two groups (all p>.08). Of 37 pts (9.8%) who had documented VRE bacteremias during IC, the median interval from the start of IC to VRE infection was 17 days (range, 9–58). The majority (89%) of VRE bacteremias occurred in pts receiving IC between 2005 and 2008 (infection rate of 22%, 33/152) while only 4 infections occurred in 198 pts treated between 2000 and 2004 (infection rate of 2%). One plausible explanation for this epidemiologic shift could be the frequent use of fluoroquinolone prohylaxis to prevent neutropenic fever, which became routine in 2004. The overall CR rate for the cohort was 73%; 70% in VRE pts and 73% in non-VRE pts (p=0.7). Median follow-up was 72.2 months (range 1.1–145.4). Unadjusted median OS for the entire cohort was 12.8 months (95% C.I. 10.6–15.9); 7.1 months (95% C.I. 3.9–16.5) for VRE pts and 13.1 months (95% C.I. 11.2–16.3) for non-VRE pts (p=0.13, Figure 1A). Using the 2:1 matching to adjust for the impact of age, etiology, and cytogenetics, VRE pts had a significantly inferior OS compared to non-VRE pts even after adjusting for WBC at dx (p=0.04 and.80, respectively, Figure 1B). Mutivariableanalyses confirmed this association. In conclusion, VRE bacteremia in pts undergoing IC for AML is an independent risk factor for worse OS. The routine use of fluoroquinoloneprophylaxis is likely contributing to the increased prevalence of VRE bacteremia. Consideration should therefore be given to escalating VRE appropriate antibiotic care in these patients sooner and in the post-remission setting. Figure 1. Survival from Diagnosis A. All patients B. VRE cases and matched controls Figure 1. Survival from Diagnosis . / A. All patients . / B. VRE cases and matched controls Disclosures: Saunthararajah: Cleveland Clinic Innovation: patent application for oral THU-decitabine., patent application for oral THU-decitabine. Patents & Royalties. Advani:Genzyme: Honoraria, Research Funding; Immunomedics: Research Funding. Maciejewski:NIH: Research Funding; Aplastic Anemia&MDS International Foundation: Research Funding.

Assessment of the cutaneous trunci muscle reflex in neurologically abnormal cats

2020 ◽  
Vol 22 (12) ◽  
pp. 1200-1205
Author(s):  
Aaron M Paushter ◽  
Devon W Hague ◽  
Kari D Foss ◽  
William E Sander
Keyword(s):  
Metabolic Disease ◽  
Body Condition Score ◽  
Traumatic Injury ◽  
Spinal Pain ◽  
Diagnostic Classification ◽  
Neurologic Disease ◽  
Condition Score ◽  
History Of ◽  
Record Review ◽  
Retrospective Medical Record Review

Objectives The aim of this study was to evaluate the presence of the cutaneous trunci reflex (CTR) in a population of neurologically abnormal cats in regard to age, body condition score (BCS), sex, breed, evidence of traumatic injury, pain, known metabolic disease, mentation, neurolocalization and diagnostic classification. Methods A retrospective medical record review was performed to identify cats with a history of neurologic disease undergoing a complete neurologic assessment between 24 September 2012 and 20 March 2019. CTR outcome (present, absent), signalment, evidence of traumatic injury, pain, known metabolic disease, mentation, neurolocalization and diagnostic classification were recorded. Results A total of 182 cats were identified. The CTR was present in 118 cats (64.8%) and absent in 64 cats (35.2%). Statistical analysis revealed no association between CTR outcome and age, BCS, sex, breed, evidence of traumatic injury, non-spinal pain, known metabolic disease, mentation, neurolocalization or diagnostic classification. A significant association was found between spinal pain and CTR outcome ( P = 0.037). Conclusions and relevance These findings suggest that elicitation of the CTR in the cat can be unreliable. Further prospective controlled studies are warranted to determine whether continued inclusion of the CTR in feline neurologic examinations is justified. Consideration of the reliability of the CTR is indicated, particularly in the context of fractious or anxious patients for which only a limited window for examination may be present.

scholarly journals The use of direct oral challenge to confirm allergies to penicillin class antibiotics in Danish children

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Thomas Krusenstjerna-Hafstrøm ◽  
Sune Rubak
Keyword(s):  
Clinical History ◽  
Specific Ige ◽  
Prick Test ◽  
Number Of Children ◽  
History Of ◽  
Review Study ◽  
Drug Challenge ◽  
In The Beginning ◽  
Record Review ◽  
Retrospective Medical Record Review

Abstract Background A high number of children are referred to pediatric departments with a suspected allergic reaction to antibiotics. The prevalence of true allergy is considered to be significantly lower than shown from clinical history and symptoms alone. This study investigated the historical use of direct oral challenges at three specialist pediatric departments in Denmark. Methods In this retrospective medical record review study, 141 children (69 boys and 72 girls) with a clinical history of suspected penicillin class allergy were investigated. A standardized questionnaire for drug allergy was completed in the beginning of the investigation, which also included a skin prick test (SPT), measurement of IgE to different types of penicillin, and a drug challenge (DC). Results Only four (2.8%) of the patients referred for further investigation in our study had a positive DC. We found no correlation between a positive DC, positive SPT or elevated specific IgE. None of the patients with a positive DC reacted with a rash alone prior to investigation. Conclusions Allergy to penicillin in children is rare and probably overestimated. In children reacting to penicillin with a rash alone, our study indicated that the rash was probably not related to allergy and treatment should thus be continued.

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