scholarly journals PENANGANAN PERIOPERATIF ANESTESI PADA RESEKSI FEOKROMOSITOMA

2013 ◽  
Vol 3 (1) ◽  
Author(s):  
Mordekhai Leopold Laihad
Keyword(s):  
Blood Pressure ◽  
Blood Glucose ◽  
Postoperative Period ◽  
Perioperative Management ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Intravascular Volume ◽  
Anesthesia Management ◽  
Definitive Therapy ◽  
Intraoperative Management

Abstract: Definitive therapy of pheochromocytoma is a surgical resection. Anesthetic perioperative management toward pheochromocytoma resection plays a very important role in decreasing morbidity and mortality. This management includes preoperative preparations, intraoperative management and postoperative management. The preoperative preparations involving multidiscipline approaches have several objectives: controlling blood pressure, creating an adequate intravascular volume, assessing effects of the disease to end-organs, recognizing conditions pertaining to pheochromocytoma, and controlling blood glucose and electrolyte levels. The intraoperative management is a continuation of the preoperative preparations. Its main objective is to preclude the event of hypertension crisis. The postoperative management is aimed to anticipate important complications which possibly occur in the early postoperative period, such as: hypertension, hypotension, and hypoglycemia. Keywords: pheochromocytoma, anesthesia, management, preoperative, intraoperative, postoperative.   Abstrak: Terapi definitif terhadap feokromositoma adalah reseksi. Penanganan perioperatif anestesi pada reseksi feokromositoma sangat berperan dalam menekan morbiditas dan mortalitas. Penanganan ini meliputi persiapan preoperatif, penangananan intraoperatif dan penanganan pasca bedah. Persiapan preoperatif dilakukan secara multidisiplin dan bertujuan untuk mengendalikan tekanan darah, mencukupi volum intravaskuler, menilai pengaruh penyakit terhadap end-organ, mengenali dampak dari kondisi-kondisi yang terkait dengan feokromositoma, serta normalisasi kadar glukosa dan elektrolit. Penanganan intraoperatif merupakan kesinambungan dari persiapan preoperatif dan bertujuan utama menghindari terjadinya krisis hipertensi. Penanganan pasca bedah bertujuan untuk mengantisipasi kemungkinan terjadinya komplikasi penting pada periode pasca bedah dini yakni hipertensi, hipotensi dan hipoglikemi. Kata kunci: feokromositoma, anestesi, penanganan, preoperatif, intraoperatif, pasca bedah.

scholarly journals Impact of the Pre-operative Chemoradiation Therapy on Complications in Patients with Locally Advanced Esophageal Cancer

2019 ◽  
Vol 8 (4) ◽  
pp. 30-36
Author(s):  
M. S. Shogenov ◽  
M. M. Davydov ◽  
A. K. Allakhverdiyev ◽  
A. A. Filatov ◽  
A. K. Chekini ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Postoperative Period ◽  
Locally Advanced ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Main Group ◽  
Chemoradiation Therapy ◽  
Thoracic Esophagus ◽  
Complex Treatment ◽  
Locally Advanced Tumors

The aim of this study was to evaluate the effect of the chemoradiation therapy on the incidence of postoperative complications and mortality rate in patients with locally advanced tumors of the thoracic esophagus.The study included men and women over 18 with histologically verified squamous cell carcinoma of the thoracic esophagus with TNM stage cT3-4aN0-3M0. Patients were divided into two groups: patients in a main group (n=26) received a complex treatment, patients in a second group (n=30) undergoing only surgical treatment.The first stage of treatment was performed for all 26 patients and included 2 courses of preoperative chemotherapy, followed by a chemoradiation therapy with a 44–46 Gy with weekly injections of chemotherapy. Surgical procedure (R0) was performed for 24 patients (92.3 %) in the main group and for 26 (86.6 %) in a second group.Therapeutic complications were developed in 17 (65 %) patients in a first group, while in a second group this rate was in 18 (60 %) patients from 30. The incidence of surgical complications was slightly higher in a group of patients received a complex treatment –7 (26.92 %) patients. In the surgical group such complications was  noted in 6 (20 %) patients. The only death in an early postoperative period was in 1 (3.84 %) patient from the main group. The cause was sepsis and the development of multiple organic failure. There were no lethal outcomes in a surgical group.Estimating the incidence of complications, it should be noted that the use of chemoradiation therapy in the neoadjuvant regimen does not significantly affect the course of the postoperative period. The mortality rate was slightly higher in in the group of patients received complex treatment. At the same time, improvement of the ostoperative period and a reduction of mortality rate in group ofpatients undergoing complex treatment is possible due to  optimization of preoperative preparation, postoperative management and competent selection of patients.

scholarly journals Assessment of the effectiveness of antihypertensive therapy in early postoperative period in patients with kidney tumors after nephrectomy

2012 ◽  
Vol 18 (5) ◽  
pp. 412-420
Author(s):  
S. S. Davydova ◽  
I. A. Komissarenko
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Calcium Channel ◽  
Antihypertensive Therapy ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Laparoscopic Nephrectomy ◽  
Kidney Tumors ◽  
Hypertensive Patients ◽  
Group Ii

Objective. To analyze the dynamics of blood pressure in the early postoperative period in hypertensive patients with kidney tumor after nephrectomy. Design and methods. We examined 96 patients with cardiovascular diseases and kidney tumors, at the age from 41 up to 75 years (mean age — 57 ± 6,3 years), who were planned for nephrectomy (I group). Group II included 53 patients aged 37-65 years (mean age — 49 ± of 7,2 years) who underwent laparoscopic nephrectomy. Daily monitoring of blood pressure MECG-DS-HC-01 («LCA Advanced technologies», Russia) was performed in all subjects. Results. Young hypertensive patients (from 40 to 48 years, mean age — 43,7 ± 4,6 years) demonstrated blood pressure elevation in the early postoperative period after nephrectomy even when antihypertensive medication was taken. At the same time elderly patients (from 56 to 85 years of age, mean age — 65,3 ± 7,5 years) develop hypotension episodes. Calcium channel blockers appeared to be highly effective in young patients who also demonstrated higher blood pressure levels in the postoperative period after laparoscopic nephrectomy, as compared with patients after open surgery. On the second day after the open nephrectomy 22,9 % (22 of 96) patients required antihypertensive treatment correction, and on the tenth only 1 % (1 patient out of 96) required treatment enhancement, whereas in group II on the second day after the intervention 100 % patients required therapy enhancement, and on the tenth day 60,4 % (32 out of 53) patients needed some correction of the treatment. Conclusions. Hypertensive patients with kidney tumors require precise control of blood pressure before the operation and correction of antihypertensive therapy, as almost one third of the patients develop increase of blood pressure in postoperative period. Calcium channel antagonists should be considered as a drug of choice in the young patietnts (mean age — 44 years) as they allow to achieve target blood pressure, that is necessary to improve renal blood flow and protects the kidney. At the same time 20 % of elderly patients (age 66) develop hypotension episodes requiring lower doses of antihypertensive drugs.

scholarly journals Endoscopic Nd:YAG Laser Treatment in the Perioperative Management of Tracheobronchoplasty

1996 ◽  
Vol 3 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Takehiko Fujisawa ◽  
Yukio Saitoh ◽  
Masayuki Baba ◽  
Mitsutoshi Shiba ◽  
Yasuo Sekine ◽  
...  
Keyword(s):  
Laser Treatment ◽  
Postoperative Period ◽  
Nd:Yag Laser ◽  
Perioperative Management ◽  
Lung Ventilation ◽  
Postoperative Management ◽  
Distal Margin ◽  
Mainstem Bronchus ◽  
Preoperative Period ◽  
Sleeve Lobectomy

The objective of this study was to determine the role of endoscopic Nd:YAG laser treatment in the preoperative or postoperative management of tracheobronchoplasty. Eighteen patients with severe stenotic lesions of the trachea or bronchus underwent Nd:YAG laser treatment. Nd:YAG laser treatment was performed in the preoperative period in 14 patients and in the postoperative period in 4 patients. The indications for Nd:YAG laser treatment included emergency airway dilatation, confirmation of the distal margin of tumor, and safe tracheal intubation in patients with severe tracheal stenosis. The indications for Nd:YAG laser treatment in patients with severe stenosis of the mainstem bronchus were confirmation of the distal margin of tumor and recovery of lung ventilation during the preoperative period and reopening of the bronchial lumen to prevent obstructive pneumonia in the postoperative period. Among patients treated with Nd:YAG laser preoperatively, the indications were completely achieved in all 14 patients, except for 1 patient with adenoid cystic carcinoma who underwent treatment of the right mainstem bronchus. Among patients treated with Nd:YAG laser postoperatively the indications also were achieved in all 4 patients with severe granulomatous stenosis of the bronchial end-to-end anastomosis following sleeve lobectomy. In conclusion, endoscopic Nd:YAG laser treatment played an important role in the perioperative management of patients undergoing tracheobronchoplasty.

scholarly journals Impact of Daikenchuto (TU-100) on The Early Postoperative Period in Duodenal-Jejunal Bypass

2021 ◽  
Author(s):  
Shohei Okikawa ◽  
Hideya Kashihara ◽  
Yuji Morine ◽  
Mitsuo Shimada ◽  
Kozo Yoshikawa ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Postoperative Period ◽  
Gut Microbiome ◽  
Intestinal Inflammation ◽  
Diabetic Rats ◽  
Cytokine Expression ◽  
Early Postoperative Period ◽  
Microbiome Composition ◽  
Lower Blood ◽  
Jejunal Bypass

Abstract Introduction: We investigated the effect of Daikenchuto (TU-100) on the early postoperative period in duodenal-jejunal bypass (DJB).Methods: Study 1: The effect of TU-100 on diabetic rats was investigated. Rats were sacrificed after receiving TU-100 for one week. Study 2: The effect of TU-100 on DJB was investigated. Rats in the DJB and TU-100 treated DJB groups were sacrificed 24 hours postoperation to evaluate blood glucose, cytokine expression, and gut microbiome.Results: Study 1: TU-100 did not affect glucose or body weight. TU-100 suppressed intestinal inflammation and modified the gut microbiome. Specifically, Bifidobacterium and Blautia were increased, and Turicibacter were decreased in this group. Study 2: Both DJB and TU-100 treated DJB rats showed lower blood glucose at 24 hours postoperation than at preoperation. Cytokine expression in the liver and small intestine of the TU-100 treated DJB group was significantly lower than that of the DJB group. The gut microbiome composition in TU-100 treated DJB rats was altered. In particular, Bifidobacterium and Blautia were increased in this group.Conclusion: DJB suppressed blood glucose during the early postoperative period. TU-100 may enhance the anti-diabetic effect of metabolic surgery by changing the gut microbiome and suppressing inflammation in the early postoperative period.

scholarly journals Experience with the dexmedetomidine for sedation in pediatric neurosurgery in the early postoperative period

2020 ◽  
Vol 33 (3) ◽  
pp. 56-65
Author(s):  
L.V. Havrylova
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Respiratory Depression ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Neurosurgical Department ◽  
Arterial Blood ◽  
Vital Functions ◽  
Adequate Sedation ◽  
Intensive Observation

Objective ‒ to maintain the adequate sedation and analgesia without respiratory depression in children up to 4 years old with spinal cord pathology in early postoperative period (first 3 days) in inpatient department; to decrease digestive system motor function depression; to exclude aspiration possibility; to start early children’s natural feeding in postoperative period.Materials and methods. From October 2019 to January 2020 dexmedetomidine sedation was performed by the prolonged infusion administration to 10 children (6 children aged 6 month to 1 year and 4 children up to 4 years) with spinal cord and vertebral pathology (spina bifida, meningomyelocele, myelocele, teratoma, lipoma of lumbar spine) in early postoperative period at intensive observation ward of neurosurgical department. During the first three days after the surgery and dexmedetomidine prescription the vital functions monitoring was being performed for 24 hours. Arterial blood pressure, heart rate, blood saturation have been scheduled by one of the parents. The immediate access to oxygen and parent’s permission for using this sedation method were the obligatory requirements.Results. The appropriate sedation target was achieved after the dexmedetomidine prescription for the children with the spinal cord and vertebral pathology in early postoperative period at intensive observation ward of neurosurgical department; the dosage of opioid analgesics was successfully decreased by 50 %. The respiratory depression was not observed. The blood pressure and bradycardia were not haemodynamically significant. Swallowing reflex was saved, which led to early physiological nutrition and excluded aspiration risk. The following transfer of patients after the surgery to the neurosurgical department bypassing ICU reduced the financial expenditure of the hospital.Conclusions. Dexmedetomidine provides with the adequate sedation in early postoperative period and can be recommended for the usage in children with the spinal cord and vertebral pathology as the safest medication due to minimal cardio-respiratory complications during moderately prolonged prescribed period.

scholarly journals Application of sorbitol-based infusion preparation for normalization of biochemical indicators in the blood in surgery patients with direct rectal cancer

2020 ◽  
pp. 17-17
Author(s):  
Ye.S. Varivoda ◽  
I.Ya. Orishchin ◽  
V.M. Lutsiv ◽  
V.Ye. Varivoda ◽  
B.R. Dzis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Blood Glucose ◽  
Anterior Resection ◽  
Postoperative Period ◽  
Total Protein ◽  
Biochemical Parameters ◽  
Early Postoperative Period ◽  
Intravenous Infusions ◽  
Complex Drug

Objective. To study the effect of intravenous infusions of the complex drug Rheosorbilaсt polyfunctional action on the biochemical parameters in the blood in operated patients with rectal cancer after anterior resection of the rectum in the early postoperative period. Materials and methods. The study of biochemical parameters in the blood of 30 patients with colorectal cancer was performed in the first days after surgery, and on the 2nd, 3rd, 5th day after administration of the drug Rheosorbilact. The drug was administered intravenously at a rate of 40 drops per minute. The daily dose of Rheosorbilact was 800.0 ml. Results. As a result of biochemical studies in patients with colorectal cancer, in the first days after anterior resection of the rectum revealed a decrease in total protein, increased concentrations of urea, creatinine and blood glucose. To correct the biochemical parameters in the blood of such patients immediately after surgery was administered intravenous infusion of Rheosorbilact. After repeated intravenous infusions of Rheosorbilact for 5 days, a significant increase in total protein content, a significant decrease in the concentration of urea, creatinine and blood glucose in the operated patients was found. Therefore, multiple intravenous infusions of the complex drug Rheosorbilact multifunctional action lead to the normalization of biochemical parameters in the blood. Conclusions. In patients with rectal cancer after anterior resection of the rectum in the first days after surgery revealed a decrease in total protein, increased concentrations of urea, creatinine and blood glucose. Repeated intravenous infusions of the complex drug Rheosorbilact multifunctional action normalize the biochemical parameters in the blood in operated patients with rectal cancer after anterior resection of the rectum in the early postoperative period. Rheosorbilact infusion is recommended for widespread medical use in such patients, especially in the early postoperative period.

scholarly journals Negative-pressure wound therapy is effective for peritoneal dialysis catheter exit-site management in the early postoperative period

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Haruna Fukuzaki ◽  
Junichiro Nakata ◽  
Shuko Nojiri ◽  
Yuki Shimizu ◽  
Toshiki Kano ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Postoperative Period ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Site Formation ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Wound Therapy

AbstractPeritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential because it has an open wound that is always adjacent to a PD catheter tube. This study aimed to examine the effectiveness of negative-pressure wound therapy (NPWT) for postoperative PD catheter exit sites. Thirty patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day was lower in the NPWT group than in the non-NPWT group (p = 0.0049). Analysis of variance F statistic for the effect of NPWT over 180 days was highly significant (11.482595, p = 0.007). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period.

scholarly journals Postoperative management of patients with endometriosis

2020 ◽  
Vol 14 (2) ◽  
pp. 182-191 ◽  
Author(s):  
Ju. E. Dobrokhotova ◽  
D. M. Kalimatova ◽  
I. Yu. Ilyina
Keyword(s):  
Surgical Treatment ◽  
Combination Treatment ◽  
Postoperative Period ◽  
Comparison Group ◽  
Clinical Manifestations ◽  
Hormonal Treatment ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Main Group ◽  
Uterine Ligaments

Aim: to assess the effectiveness of using dienogest in combination with postoperative interventions in patients with endometriosis.Materials and methods. There were enrolled 102 patients with signs of external endometriosis underwent examination and surgical treatment, subdivided into 2 groups: 67 – main group (after surgical treatment, received dienogest 2 mg/day for 6 months), 35 – comparison group received no hormone therapy in the postoperative period. Surgical treatment included removal of endometrioid ovarian cysts, endometriosis foci on the pelvic peritoneum and sacral uterine ligaments. Course of the early postoperative period (up to 1 month after the intervention) as well as the long-term dynamics of the disease manifestations (3, 6, 12 and 15 months later) were assessed.Results. Dienogest was administered after surgical treatment due to endometriosis that reduced the severity of dyspareunia and intensity of chronic pelvic pain by 3.5- and 2-fold, respectively. The probability of achieving control over uterine bleeding 6 month after the onset of treatment due to endometriosis manifested with metrorrhagia showed that combination treatment (consisting of dienogest) was 3.19-fold higher compared to surgical treatment alone (OR = 3.19; 95 % CI = 1.70–11,0; p < 0,05). Recovery of normal menstrual cycle in 63 (94.0%) women of the main group was established 1.5–2 months after completing of hormonal treatment, while in the comparison group pain and dysmenorrhea relapsed in some patients at the 6-month follow-up. Decreased libido as a side effect in patients who treated with dienogest was observed in 2 (3.0 %) women.Conclusion. Dienogest was highly effective in the combination treatment of patients with verified endometriosis that resulted in reduced severity of pain and metrorrhagia. The drug was featured by low level of side effects. Thus, a combination treatment of endometriosis containing dienogest at a dose of 2 mg/day applied during postoperative period allows to reduce the severity of the disease clinical manifestations and improve treatment outcome.

scholarly journals AB0292 A RETROSPECTIVE STUDY OF PERIOPERATIVE MANAGEMENT OF PATIENTS WITH SLE IN TOTAL HIP ARTHROPLASTY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1172.2-1173
Author(s):  
I. Kushnareva ◽  
M. Makarov ◽  
T. Popkova ◽  
A. Khramov ◽  
S. Maglevaniy
Keyword(s):  
Total Hip Arthroplasty ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Perioperative Management ◽  
Early Postoperative Period ◽  
Aseptic Necrosis ◽  
Total Hip

Background:Aseptic necrosis (AN) of bones is one of the most serious complications of systemic lupus erythematosus (SLE), which is characterized by multicomponent joint damage mainly in young people. Long-term observations show that two thirds of patients have multiple aseptic necrosis of bones, with the femoral head being most often affected. Obviously, caused by much strain on the hip joint. In this regard, total hip arthroplasty (THA) is an integral part of the treatment of SLE patients. Despite the fact that THA in these patients allows to achieve good functional outcomes, the amount of complications remains high.Objectives:To retrospectively analyze the outcomes and structure of complications to determine the tactics of perioperative management of patients with SLE.Methods:The retrospective group included patients over 18 years of age with a reliable diagnosis of SLE, established according to the classification criteria (SLICC, 2012, ACR, 1997). 123 THA were performed in 77 patients. Outcomes and the structure of complications were analyzed for the period from 1998 to 2016 inclusive.Results:The period of hospital stay of patients was analyzed. Cementless fixation of the components of the endoprosthesis was used and the friction pair was metal-polyethyleneIn all cases. In 23 patients, additional fixation of the acetabular component with screws was performed, which indirectly indicates a poor quality of bone tissue. A more detailed analysis of these patients revealed a long period of glucocorticoid therapy (from 1.5 to 35 years). In 3 patients, during preparation for implantation of the femoral component, a femoral fracture occurred, which required using the cerclages. One patient also had a fracture of the acetabulum, which required the implantation of a Müller anti-protrusio ring. The above-described technical features led to increasing of the total time of surgery, which significantly increased the volume of blood loss. Thus, this required transfusions of blood components: fresh frozen plasma (FFP), erythrocyte suspension, as well as replenishment the circulating blood volume with colloidal solutions.Prevention of thromboembolism. All patients in the postoperative period underwent common measures of prevention of venous thromboembolism. The drugs of choice were calcium nadroparin (Fraxiparin) 0.3 or 0.6 ml subcutaneously - depending on body weight, respectively, or Dabigatran etexilate (Pradaxa) 220 mg per day, or rivaroxaban (Xarelto) 10 mg per day.Prevention of infectious complications. The first injection of antibiotic is carried out immediately before surgery achieve it’s maximum concentration in blood plasma just in the time of first incision. In the postoperative period, antibiotic therapy was carried out for at least 5 days. In 1 patient, the course of antibiotic therapy was prolonged and another broad-spectrum antibiotic was added due to a history of tuberculosis infection. Postoperative rehabilitation in patients with SLE met standard protocols: activation in bed and verticalization was carried out on day 1, standing with crutches and walking on day 2.Conclusion:During the period of hospital stay in the early postoperative period, not a single one thromboembolic event developed, as well as no cases of infectious complication occurred. There was one case of dislocation of the femoral component of the endoprosthesis, which was immediately repaired in the early postoperative period.Disclosure of Interests:None declared

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