scholarly journals Results of Surgical Treatment of Infective Endocarditis Complicated with Lung Impairment

2019 ◽  
pp. 49-66
Author(s):  
H. B. Koltunova ◽  
A. R. Babochkina ◽  
S. P. Spysarenko ◽  
L. M. Avramenko ◽  
O. A. Krykunov
Keyword(s):  
Mechanical Ventilation ◽  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Postoperative Period ◽  
Negative Impact ◽  
Early Postoperative Period ◽  
Lung Protection ◽  
Cardio Pulmonary Bypass ◽  
Pulmonary Bypass ◽  
Lung Impairment

The initial lung impairment in patients with infective endocarditis (IE) has a negative impact on the results of surgical treatment and rate of postoperative respiratory failure (RF). Mechanisms of development of RF are quite complicated, but the leading role is played by the initial septic lesion of pulmonary tissue in IE and surgical treatment with the use of cardio-pulmonary bypass. The aim of the study was to analyze results of surgical treatment of patients with IE, operated with the use of cardio-pulmonary bypass, implementing the method of intraoperative lung protection. Materials and methods. The basis of the study was clinical data of 663 patients with IE who were examined and treated at the SE “Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine” from 01.01.2016 to 01.01.2018. Diagnosis of IE was established according to the Duke University criteria Anesthetic support was carried out in accordance with standard techniques. For intraoperative lung protection, together with perfusion of the pulmonary artery with arterial blood, the mechanical ventilation was maintained for the period of bypass circulation. For determination of pathomorphological changes of lungs in patients with IE, histological analysis of intraoperative lung biopsy was performed. Results. In the surgical treatment of patients with IE with the use of standard method of anesthesia support, the rate of RF in the early postoperative period was 52 (7.8%) cases. The use of the modified method of intraoperative management led to the decrease of the signs of adults respiratory distress syndrome during the postperfusion period: decrease in the edema liquid in the alveolar lumen (p = 0.027), decrease in protein precipitate in the alveolar lumen (p = 0.031), decrease in the incidence of signs of alveoli collapse (p = 0.002). The use of the lung protection method offset the negative impact of intraoperative volume of blood transfusion on the lung function after surgery and the duration of mechanical ventilation (r = 0.121, p = 0.522). The introduction of lung protective in patients with IE, operated with the use of cardio-pulmonary bypass, contributed to decrease in the rate of RF in the early postoperative period from 7.9% to 2.8% of cases in the study groups. Conclusions. Implementation of the new protocol allowed to conduct long-term surgical interventions with the use of cardio-pulmonary bypass without increasing duration of mechanical ventilation and reducing the oxygenation index in the postoperative period, and contributed to the decrease in the frequency of postoperative RF.

The regional anesthesia for surgical correction of the malformation of upper extremities in pediatric

2017 ◽  
Vol 8 (5) ◽  
pp. 83-90
Author(s):  
Julia A. Manokhina
Keyword(s):  
Young Children ◽  
Upper Extremity ◽  
Regional Anesthesia ◽  
Surgical Procedures ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Negative Impact ◽  
Early Postoperative Period ◽  
Surgical Correction ◽  
Nerve Blocks

The article presents an analysis of the publications devoted to the problems of anesthesia to surgical procedures at the malformations of the upper extremity in children. The article reviews the questions of epidemiology, classification of upper extremity malformation, safety of anesthesia and the role of regional blockades in the structure of intraoperative and postoperative analgesia to surgical procedures at the malformations of the upper extremity in children. Children are more likely than adults to experience stress in the operating room and early postoperative period. Children are almost impossible to prepare psychologically for the upcoming anesthesia, surgical intervention, a sense of pain after it. Surgical correction of malformations of the upper limbs in children is characterized by multistage and high traumatism, which requires the search for adequate methods of anesthesia, capable of ensuring not only the absence of pain, but also the negative impact on the nervous system of little patients. The key to the application of regional anesthesia in young children is the need for sedation or general anesthesia. The use of ultrasound navigation and electrostimulation of peripheral nerves significantly increases the level of safety and success of their realization. At present, the questions about the duration of postoperative analgesia with the use of peripheral nerve blocks and the need for additional anesthesia in the early postoperative period have been little studied. The influence of the applied anesthesia technique on the state of young children in the postoperative period are requires further investigation.

Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact

2010 ◽  
Vol 112 (2) ◽  
pp. 455-460 ◽  
Author(s):  
Alejandro A. Rabinstein ◽  
Seung Young Chung ◽  
Leslie A. Rudzinski ◽  
Giuseppe Lanzino
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Functional Impairment ◽  
Postoperative Period ◽  
Strong Association ◽  
Early Postoperative Period ◽  
Acute Subdural Hematoma ◽  
Early Functional Outcome ◽  
Gcs Score

Object The purpose of this study was to evaluate the incidence of seizures or epileptiform abnormalities on electroencephalography (EEG) studies in patients undergoing surgical treatment for acute subdural hematoma (SDH). Methods This was a retrospective study of 134 consecutive patients with acute or acute-on-chronic SDH who underwent surgical treatment at the authors' institution between January 2004 and July 2008. Detailed information was collected regarding baseline clinical data (including preexistent functional impairment); Glasgow Coma Scale (GCS) sum scores before and 24 hours after surgery; presence of clinical seizures; EEG findings; and functional outcome on discharge and up to the 6-month follow-up. All brain CT scans were reviewed to calculate SDH volume and midline shift. The Glasgow Outcome Scale (GOS) score was used for functional assessment, and GOS scores of 1–3 were considered indicative of poor outcome. Univariate and multivariate logistic regression analyses were performed to identify statistical associations. Results Clinical seizures or epileptiform changes on EEG were observed during the acute postoperative period in 33 patients (25%). Preexistent functional impairment and seizures/epileptiform EEG findings after surgery were independently associated with poor functional outcome upon hospital discharge (p < 0.001 for both). Preexistent functional impairment (p < 0.001), lower GCS score before surgery (p = 0.04), and lower GCS score 24 hours after surgery (p = 0.007), but not seizures/epileptiform EEG findings, were independently associated with poor functional recovery at 1- to 6-month follow-up evaluations. Seizures/epileptiform EEG findings had a strong association with lower GCS scores after surgery (p = 0.01), and they were more common in patients who underwent evacuation by craniotomy (p = 0.02). Conclusions Epileptic complications are common after acute SDH evacuation, and should be suspected in patients with an unanticipated depressed level of consciousness after surgery. Seizures worsen early functional outcome, but delayed favorable recovery is possible. Therefore, one should be cautious when discussing prognosis in the early postoperative period of patients with epileptic complications.

scholarly journals SURGICAL TREATMENT OF CAROTID STENOSIS IN PATIENTS WITH CORONARY HEAR+T DISEASE IN ORDER TO PREVENT ISCHEMIC STROKE

2020 ◽  
pp. 124-126
Author(s):  
I. S. Pulyaeva ◽  
V. A. Prasol
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Carotid Stenosis ◽  
Postoperative Period ◽  
Stable State ◽  
Length Of Hospital Stay ◽  
Early Postoperative Period ◽  
Main Stage ◽  
Simultaneous Operations ◽  
Ischemic Attack

Summary. Goal. To analyze the results of surgical treatment of carotid stenosis in patients with coronary heart disease in order to prevent ischemic stroke. Materials and methods. The analysis included 18 patients treated in the SI «V. T. Zaitseva IGUS of NAMNU» from 2017 to 2019 in combined atherosclerotic lesions of the coronary and carotid arteries which evaluated the reserve brain. Results and discussion. All patients with two-stage treatment of the first and second groups were discharged in a stable state, one had a clinic of transient ischemic attack in the postoperative period. Conclusions. Simultaneous operations are advisable in patients with a reduced reserve of both coronary and cerebral circulation. The risk of developing cerebral and cardiac postoperative complications is comparable with the results of phased operations, reducing the length of hospital stay of the patient. The results of the hypoxic test serve as an additional criterion for the decision to impose an internal intra-arterial shunt. This allows you to reduce the time of the main stage of carotid endarterectomy and to avoid additional possible complications in the early postoperative period.

scholarly journals Secondary neurological outcomes in patients with brachiocephalic and coronary artery disease in the early postoperative period after simultaneous and hybrid surgical treatment

2021 ◽  
Vol 10 (4) ◽  
pp. 58-67
Author(s):  
O. V. Maleva ◽  
O. A. Trubnikova ◽  
I. V. Таrasova ◽  
S. V. Ivanov ◽  
O. L. Barbarash
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Postoperative Cognitive Dysfunction ◽  
Early Postoperative Period ◽  
Brachiocephalic Artery ◽  
Neurological Outcomes ◽  
Simultaneous Surgery ◽  
Artery Disease ◽  
Hybrid Group

Aim. To compare secondary neurological outcomes in patients with brachiocephalic and coronary artery disease in the early postoperative period after different surgical treatment strategies (simultaneous and hybrid).Methods. Secondary neurological outcomes were evaluated in 43 patients with coronary and brachiocephalic artery disease in the early postoperative period after (1) carotid endarterectomy and on-pump coronary artery bypass surgery; (2) percutaneous coronary intervention and carotid endarterectomy. Demographic, clinical, instrumental data were collected. Neuropsychological assessment was performed using the Mini-Mental State Examination and Frontal Assessment Battery. Memory, attention and neurodynamics were measured using the “Status-PF” software at days 2–3 before the surgery and at days 5–7 after it. The presence of postoperative cognitive dysfunction was estimated on the basis of criteria defined as a 20% decline on 20% of the tests. Statistical analysis was performed using the software package “Statistica 10.0”.Results. Patients who underwent hybrid intervention demonstrated improved attention and memory in the early postoperative period. Complex visual-motor reaction significantly increased in patients after simultaneous surgery. Attention differed significantly in both groups. Thus, patients from the hybrid group processed more characters per 1 and 4 minutes while completing the Bourdon proof reading test. The total number of processed characters prevailed in the hybrid group. Cognitive processing speed was higher in the hybrid group according to the brain performance test. The incidence of early postoperative cognitive dysfunction was 60% in patients after simultaneous surgery and 11% in patients after hybrid surgery (p = 0.006, OR±SE 12.5±3.2).Conclusion. Hybrid intervention has shown its superiority over simultaneous intervention in terms of low rate of early cognitive impairment, thereby confirming the necessity to take into account the obtained results while selecting the optimal surgical treatment in patients with coronary and brachiocephalic artery disease present with cognitive deficits at baseline.

scholarly journals IgM, IgA, IgG, and complement components as pre-operative markers for the development of multiple organ dysfunction syndrome in patients with infective endocarditis in early postoperative period

2021 ◽  
Vol 6 (3) ◽  
pp. 35-45
Author(s):  
A. V. Ponasenko ◽  
M. V. Khutornaya ◽  
A. V. Tsepokina ◽  
Yu. A. Kudryavtseva
Keyword(s):  
Infective Endocarditis ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Postoperative Period ◽  
Postoperative Outcome ◽  
Multiple Organ ◽  
Early Postoperative Period ◽  
Multiple Organ Dysfunction ◽  
Complement Components ◽  
Native Valve

Aim. Here, we studied whether the immunoreactivity in pre-operative period defines early postoperative complications in patients with infective endocarditis (IE).Materials and Methods. We consecutively enrolled 110 patients with subacute IE (80 with native-valve IE and 30 with prosthetic valve IE) who underwent a heart valve replacement, then measuring the levels of IgM, IgA, IgG, and complement components in their serum and evaluating their correlation with an adverse early postoperative outcome.Results. Compared with patients< 50 years of age, those ≥ 50 years of age had 2-foldand 3-foldhigher prevalence of systemic inflammatory response syndrome and multiple organ dysfunction syndrome in the early postoperative period. Notably, these numbers correlated with increased С3d and С5а along with reduced Ig М and IgG. IgМ below 9.5 mg/mL and IgG below 2.0mg/mL indicated a 3-foldhigher risk of multiple organ dysfunction syndrome (OR = 3.07, 95% CI = 1.96-4.04, р=0,001).Conclusion. Serum IgM, IgG, and complements factors C3d and C5a may be used as prognostic markers of multiple organ dysfunction syndrome in the early postoperative period.

scholarly journals Iatrogenic Supraclavicular Nerve Injuries in Surgical Treatment of Clavicle Fractures

2015 ◽  
Vol 22 (2) ◽  
pp. 50-54
Author(s):  
A. S Zolotov ◽  
M. S Feshchenko ◽  
O. I Pak
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Early Postoperative Period ◽  
Surgical Approaches ◽  
Nerve Injuries ◽  
Clavicle Fractures ◽  
Traumatic Damage

Incidence and pattern of disturbed sensitivity in the zone of surgical intervention was studied in 24 patients with clavicle fractures. Traumatic damage of supraclavicular nerve (not related to surgery) was observed only in 1 case. Disturbance of sensitivity in the zone of surgical intervention was noted in 21 (87.5%) patients. Mean area of anesthesia made up 44.5±29.3 cm2 (from 8.0 to 125.5 cm2). That complication developed at both horizontal and vertical surgical approaches. Intraoperatively supraclavicular nerves were visualized and preserved in 6 patients however disturbed sensitivity in early postoperative period was observed in 4 cases. Preventive isolation of supraclavicular nerves does not always ensure the preservation of sensitivity in early postoperative period.

New Potentialities in Surgical Treatment of Proximal Humerus

2011 ◽  
Vol 18 (1) ◽  
pp. 21-27
Author(s):  
Eduard Ivanovich Solod ◽  
A F Lazarev ◽  
Ya G Gudushauri ◽  
M G Kakabadze ◽  
A S Roskidaylo ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Surgical Treatment ◽  
General Condition ◽  
Postoperative Period ◽  
Proximal Humerus ◽  
Original Method ◽  
Early Postoperative Period ◽  
Early Rehabilitation ◽  
Control Group ◽  
Stable Fixation

Original method of stressed osteosynthesis for the treatment of proximal humerus is proposed. Primary tension of Y-shaped pin fixative and secondary tension that is created at its intramedullar insertion and blocking enable to achieve stable fixation of fragments without inflicting additional intraoperative injury in patients of any age and independently of their general condition. Preservation of blood supple in fragments, low traumatic osteosynthesis, and possibility of patients' early rehabilitation define the prospective of this technique for the treatment of patients with fractures on the background of osteoporosis. The importance of drug therapy for osteoporosis in the early postoperative period is shown. Experience in treatment of 62 patients aged from 23 to 78 years is presented. Control group included 30 patients with similar fractures who were treated using osteosynthesis. In the main group good results were achieved in 82.3% of patients, satisfactory - in 17.7%, no poor results were observed. In control group good results made up 40%, satisfactory - 56.7%, poor 0 3.3%.

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