scholarly journals ESTIMATION OF THE EFFECTIVENESS OF ASSOCIATED ANESTHESIA BASED ON EPIDURAL BLOCKADE IN CESARIAN SECTION IN PATIENTS WITH «EVIDENT» MITRAL STENOSIS

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
A Muminov ◽  
M Matlubov ◽  
S Tarayan ◽  
F Nishanova ◽  
A Ilxamov
Keyword(s):  
Postoperative Period ◽  
Muscular Activity ◽  
Early Postoperative Period ◽  
Epidural Block ◽  
The Body ◽  
Epidural Blockade ◽  
Clinical Observations ◽  
Group I ◽  
Balanced Anesthesia ◽  
Cesarian Section

aim. To assess the efficacy and safety of general associated balanced anesthesia based on epidural block during cesarean section in patients with “severe” mitral stenosis.Material and methods. The results of clinical observations, and a complex of clinical, functional and biochemical studies during cesarian section of 26 women aged 18-30 years, with a gestation period of 32-34 weeks had been studied. All patients had «severe» MS (according to A.N. Okorokov, s classifications). Depending on the method of anesthesia all patients were divided into two equal groups Patients of group I (n=13) were operated under conditions of associated balanced anesthesia (CBA) on the basis of epidural blockade (EB) patients of group II (n=13) were operated under conditions of one of the most common variants of multicomponent anesthesia (MCA). The operations were performed in a planned method, their durations made 35-60 minutes. The duration of anesthesia were 50-110 minutesResults. Significant advantages of CBA on the basis of EB became apparent: minimal expense of narcotic preparations and muscular relaxants: rapid rehabilitation of reflex muscular activity, making it possible to carry out extubations of trachea in earlier term: opportunity of using epidural catheter in postoperative period in order to receive prolonged postoperative analgesia. Conclusion. CBA on the basis of EB provides reliable antinociceptive protections of the body from surgical aggression, ensures a smooth course of anesthesia and early postoperative period and therefore has an obvious advantage over the traditional version of GMCA with AVL.K

scholarly journals Management of patients in the post-operative period after the hip joint replacement accessed by low-invasive access

2019 ◽  
Vol 1 (4) ◽  
pp. 32-38
Author(s):  
N S Nikolaev ◽  
A V Efimov ◽  
R V Petrova ◽  
D V Kovalev ◽  
M I Ivanov
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Modified Rankin Scale ◽  
Surgical Access ◽  
Group I ◽  
Group Ii

Up to 1.5 million total hip arthroplasty is performed annually in the world. In Russia, at least 300 thousand patients a year need hip replacement surgery. High tissue invasiveness during surgical approaches presents special requirements for the rehabilitation process in the early postoperative period. Accelerating and making it more efficient is possible with the use of the least traumatic operating access. The purpose of the study is a comparative analysis of two models of the organization of rehabilitation in the postoperative period after hip arthroplasty: using standard Harding surgical access and the minimally invasive Rottinger access. Material of the study - patients operated on with standard Harding access (group I, n = 227) and front-external Rottinger access (group II, n = 266). Criteria for inclusion of patients in both groups are primary coxarthrosis without previous surgical interventions, exclusion criteria are connective tissue diseases, severe comorbidity. Group I patients underwent postoperative rehabilitation according to the standard protocol, group II - according to the rehabilitation concept "ERAS, fast-track". To assess the effectiveness of the rehabilitation at all stages in both groups, the rehabilitation potential was assessed on the rehabilitation routing scale (SRM), the dynamics of the pain syndrome on the visual analogue pain scale (VAS), the verticalization period was taken into account, the main assessment scales of the patient's motor functions and psychological status were used in hip arthroplasty: Harris scale, quality of life questionnaire (EQ - 5D), modified Rankin scale. Results and discussion. The proportion of hip arthroplasty using MIS access in the total number of operations increased from 0.7% in 2015 to 10.1% in 2018. The studied groups are comparable in terms of the ratio of men and women, average age, number of observations, BMI and the volume of blood loss. The surgeon duration and the duration of the stationary phase in group I exceeded the similar parameters of the II group. The modified Rankin scale at admission and discharge in all patients showed moderate disability, starting indicators and results after 3 months were more prosperous in group II. Both groups had an equivalent score on the Harris scale before surgery and after 3 months after it, more pronounced positive dynamics of the quality of life on the EQ-5D scale ("thermometer") was noted in group II. A decrease in pain after surgery compared with baseline, with regression to 0.8-1.0 points by 3 months after surgery, was noted in all patients. The assessment on the rehabilitation routing scale did not differ in both groups. At the stationary stage, group I patients walked with additional support on crutches (100%), group II - on a cane (92.5%). On long days 4-6, 82.8% of patients of group I and 91.7% of patients of group II passed long distances. At the end of stage I rehabilitation, 83.7% of group I patients and 92.5% of group II were sent to the outpatient rehabilitation stage, the rest were transferred to stage II of rehabilitation in a 24 - hour hospital. The third stage of rehabilitation, all patients went on an outpatient basis at the place of residence. At the follow-up stage, the data of a telephone survey of group II were analyzed (n = 68, 25.6% of the respondents). By 3 months, the Harris score exceeds 90 points, satisfaction with the operation is 97%. As a result of the use of surgical MIS access for hip arthroplasty, all patients had good rehabilitation indicators. Conclusions. The general approach to managing patients after hip arthroplasty is similar for all types of surgical access, however, MIS-access creates the most favorable conditions for the rehabilitation of patients in the early postoperative period: a positive attitude of the patient, reduced blood loss, reduced surgical incision, the possibility of early activation and transition to the general regime for 6-7 days. The results of the study showed the advantages of a model for the organization of rehabilitation in the postoperative period after hip arthroplasty using mini-invasive access over standard surgical access. Group II patients (MIS access) had a higher level of physical activity and a low level of pain in the early postoperative period.

scholarly journals FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

2021 ◽  
Vol 4 (18) ◽  
pp. 38-44
Author(s):  
S.Y. Kostiv ◽  
I.K. Venger ◽  
B.Y. Maslii ◽  
B.P. Selskyi ◽  
N.I. Tsiupryk ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Lower Extremities ◽  
Early Postoperative Period ◽  
Arterial Blood Flow ◽  
Arterial Segment ◽  
Arterial Blood ◽  
Tibial Arteries ◽  
Group I ◽  
Hybrid Revascularization ◽  
Stenotic Lesions

                The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment.                 Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction.                 Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries.                 Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

The Adrenal Medullary Transplant Operation for Park in son's Disease : Clinical Observations in Five Patients

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 999-1004 ◽  
Author(s):  
Richard D. Penn ◽  
Christopher G. Goetz ◽  
Caroline M. Tanner ◽  
Harold L. klawans ◽  
Kathleen M. Shannon ◽  
...  
Keyword(s):  
Side Effects ◽  
Caudate Nucleus ◽  
Postoperative Period ◽  
Motor Performance ◽  
Early Postoperative Period ◽  
Transient Effects ◽  
Abdominal Incision ◽  
Gradual Improvement ◽  
Clinical Observations

Abstract The recent report by Madrazo and coworkers on the successful treatment of Parkinson's disease using adrenal meduilary tissue transplanted to the caudate nucleus has aroused international interest in the procedure. The present article reports our initial experiences with the operation in five patients and discusses the postoperative effects of the procedure, the protocol used to monitor motor performance, and the need for cooperation with the two registries that have been created to follow morbidity, mortality, and efficacy. We intend to alert the neurosurgeon to important side effects, but not to assess the long term efficacy of the procedure. Postoperatively, a number of transient effects were seen in our patients, the most striking being somnolence, delusions, and lack of significant pain in spite of a large abdominal incision. The only complications have been respiratory. After the early postoperative period, gradual improvement of on-off times and Schwab-England disability scores was seen over 20 weeks. Long term cooperative studies are needed to demonstrate the efficacy of this procedure. Neurosurgeons doing transplant operations are urged to join the registries so that uniform information can be collected.

scholarly journals Effectiveness of the concept of fast-trak surgery for simultaneous laparoscopic hernioplastics and cholecistectomy

2021 ◽  
Keyword(s):  
Postoperative Period ◽  
Inpatient Treatment ◽  
Fast Track ◽  
Early Postoperative Period ◽  
Wound Complications ◽  
Fast Track Surgery ◽  
Surgical Interventions ◽  
Group I ◽  
Laparoscopic Hernioplasty ◽  
Group Ii

The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.

scholarly journals Stationary replacement technologies in the surgical treatment of simultaneous pathology in gynecological patients

2018 ◽  
pp. 64-71
Author(s):  
A. N. Shikhmetov ◽  
L. A. Osin ◽  
A. M. Zadikyan ◽  
A. A. Pazichev
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Subsequent Treatment ◽  
The Body ◽  
Operating Table ◽  
Operating Team ◽  
Simultaneous Operations ◽  
Repeated Surgery

The authors analyzed the results of simultaneous operations in 238 patients with regard to the combined surgical and gynecological pathology performed in the hospital-replacing environment of the ВСDС of PAO «Gazprom». Previously, all patients were assigned to the sequence of stages, the location of trocars, taking into account the additional stages of the operation, the position of the monitor, the location of the operating team, the position of the patient on the operating table during each stage. Performing simultaneous laparoscopic operations does not lead to an increase in the number of intra- and postoperative complications in comparison with isolated interventions and is not accompanied by great technical difficulties, but causes a somewhat longer duration (on average, 20.6 ± 1.5 min), which, in our opinion , is not critical for anesthesia. There were no significant differences in the course of the early postoperative period and the intensity of the functional systems of the body. Advantages of simultaneous operations are undeniable: two or three surgical diseases are cured simultaneously, progression or serious complication of the disease is prevented, operative treatment of which would be postponed for a later period, the risk of repeated surgery and anesthesia is eliminated, the time of total stay of the patient in the hospital and subsequent treatment is reduced, economic efficiency of treatment is increased.

Evaluation of Myocardial Contractility Determination with Tissue Tracking Echocardiography after Levosimendan Infusion in Patients with Poor Left Ventricular Function and Hemodynamics

2015 ◽  
Vol 17 (6) ◽  
pp. 313 ◽  
Author(s):  
Veysel Sahin ◽  
Ihsan Sami Uyar ◽  
Ilker Gul ◽  
Mehmet Besir Akpinar ◽  
Ahmet Feyzi Abacilar ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Group I ◽  
Tissue Tracking ◽  
Low Ejection Fraction

<p><b>Background:</b> The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery.</p><p><b>Methods:</b> We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, ?% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 ?g/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 ?g/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 � 4.72 years). Dopamine at 10 ?g/kg/min and/or dobutamine at 10 ?g/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 � 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student <i>t</i> test and ?<sup>2</sup> test were used for statistical analyses.</p><p><b>Results:</b> There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II.</p><p><b>Conclusion:</b> Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.</p>

scholarly journals Influence of the choice of the method of perioperative analgesia on the possibility of early initiation of enteral nutrition as part of early rehabilitation in pediatric laparoscopic oncosurgery

2021 ◽  
Vol 7 (4) ◽  
pp. 43-47
Author(s):  
O. A. Petina ◽  
N. V. Matinyan
Keyword(s):  
Gastrointestinal Tract ◽  
Enteral Nutrition ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Epidural Block ◽  
Surgical Interventions ◽  
Perioperative Analgesia ◽  
Early Activation ◽  
Caudal Epidural Block ◽  
Caudal Epidural

Introduction. The need to perform nutritional support for children with cancer is widely recognized. The body of a child suffering from a malignant tumor needs additional amounts of energy and plastic substrates. Patients with signs of protein-energy insufficiency are at risk of developing complications in the early postoperative period. A significant role in compliance with early rehabilitation after surgery (ERAS) protocol is played by the method of perioperative analgesia. Caudal epidural block is the most widely used regional method of analgesia in children, allowing to start earlier enteral nutrition and prevent the development of postoperative paresis of the gastrointestinal tract (GIT), thereby speeding up the recovery of patients after surgery. In this study, we evaluated the effectiveness and safety of early enteral nutrition tactics in oncology children, in the postoperative period during laparoscopic surgical interventions, in order to prevent gastrointestinal paresis in combination with early activation of patients. In the present study, we evaluated the effectiveness of the tactics of choosing perioperative analgesia from the perspective of the possibility of early initiation of enteral nutrition in children with oncopathology, in the postoperative period after laparoscopic surgical interventions, in order to prevent paresis of the gastrointestinal tract in combination with early activation of patients.Materials and methods. The study included 40 patients of the research Institute of Children's Oncology and Hematology of the Russian Ministry of health, ASA II—III, operated in 2017—2019for malignant abdominal tumors by laparoscopic method. Patients were divided into 2 groups randomly. The CB group included 23 children who were treated with caudal epidural block as a regional component of combined anesthesia (CB group, n = 23). The control group-GA included 17 children who underwent General anesthesia (group GA, n = 17).The analysis of the early postoperative period (day 1) was performed. Postoperative nutritional support was performed to prevent gastrointestinal paresis in combination with early activation of patients and consisted of early (from day 1 after surgery) enteral nutrition. We used a therapeutic mixture of Alfare® based on whey protein hydrolysate (for children under 1 year) and Peptamen® Junior based on hydrolyzed whey protein, a complete balanced dry mix (for children from 1 year to 10 years). The volume of enteral nutrition was calculated based on the number of calories per kg of body weight. We started therapeutic nutrition with volumes of 1/2-2/3 of the calculated volume and increased the volume to the required patient tolerance.Results. Enteral nutrition in children in the CB group was connected from 4.7 ± 0.5 hours. In the GA group, enteral nutrition was switched on in 10 (59 %) patients 20 hours after the end of surgery. 5 children developed gastrostasis, which required medication to stimulate the gastrointestinal tract.Conclusions. This study demonstrates that in the conditions of effective neuroaxial blockade in the perioperative period, it is possible to start enteral nutrition as early as possible, reducing to a minimum the frequency of postoperative intestinal paresis during laparoscopic surgical interventions, contributing to early and rapid recovery of patients.

Does the Technique of Skin Closure Affect the Cosmesis of Cervical Thyroidectomy and Parathyroidectomy Scars? A Review of Literature

2018 ◽  
Vol 34 (05) ◽  
pp. 524-528 ◽  
Author(s):  
Sridhayan Mahalingam ◽  
Anton Alatsatianos ◽  
Lisa Pitkin ◽  
Alwyn D'Souza
Keyword(s):  
Postoperative Period ◽  
Early Postoperative Period ◽  
The Body ◽  
Tissue Adhesive ◽  
Skin Closure ◽  
Parathyroid Surgery ◽  
Review Of Literature ◽  
Published Evidence ◽  
Cosmetic Outcomes ◽  
Visible Area

AbstractThe cosmetic outcomes following thyroid and parathyroid surgery is a priority for patients as the surgical scar is in a visible area of the body. Although some have advocated the use of minimally invasive and robotic surgery, these are not without risks and it has been suggested that the scars are not necessarily more favorable. The three most common means of skin closure include the use of subcuticular sutures, clips, and tissue adhesive (with or without deeper subcutaneous sutures) and there are no previous reviews of the published evidence. In this study, the authors compare the cosmetic outcomes through a systematic review of literature. Three studies (n = 200) comparing subcuticular sutures and clips suggest superior cosmetic outcomes with sutures (with statistically significant differences in the immediate postoperative period). Three studies (n = 213) comparing sutures and tissue adhesive show superior outcomes with sutures in the early postoperative period with no differences thereafter. Two studies (n = 202) comparing tissue adhesive and clips do not show that one is superior to the other and show no significant differences. Overall the data are limited; however, the evidence suggests that subcuticular sutures may offer superior cosmetic outcomes than clips and tissue adhesive in conventional thyroid and parathyroid surgery.

scholarly journals Comparing the outcome of patients discharged in early postoperative period, with patients discharged at late postoperative period in a tertiary care hospital

2017 ◽  
Vol 6 (7) ◽  
pp. 3054
Author(s):  
Kavitha Marimuthu ◽  
Malarvizhi Loganathan
Keyword(s):  
Caesarean Section ◽  
Wound Infection ◽  
Postoperative Period ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Early Postoperative Period ◽  
Phone Call ◽  
Care Hospital ◽  
Group I ◽  
Wound Discharge

Background: It has become common practice to discharge women from hospital early after caesarean section, to satisfy their wishes or to reduce workload the objectives of this study were to determine women’s satisfaction, and rates of wound infection, maternal readmission, and early postnatal depression. Postnatal hospital stay has two main objectives; the first, to identify any complication for both mother and newborn and the second, to provide the necessary support to the new mother for her return home. The two main reasons for this change in the service provided are to improve women’s satisfaction during this period and to reduce the cost to the health system.Methods: Retrospective study from January 2016 to January 2017 in a tertiary care hospital. Patient underwent Lower Section Caesarean Section (LSCS) were grouped into 2 groups. Group I- patients discharged on 5th post-operative day (POD). Group II-patient discharged at 8th POD. 500 patients were included in each group. Patient discharged on 5th POD was instructed about the warning symptoms of puerperium about fever, breast engorgement, wound discharge, foul smelling vaginal discharge, and advised for suture removal in nearby health facility.Results: Those who discharged at 5th POD (500) were followed through phone at 10th POD and only 498 could be traced and complications and satisfaction was made in discharge proforma. Of 500 patients discharge at 5th POD only 498 responded to phone call. Wound infection was found in 2 patients of those 2, both were asked to attend the post- natal clinic and found to have mild wound induration with minimal wound discharge which responded well to oral anti biotic and daily dressing in nearby health facility.Conclusions: In developing countries like India 70% of the patients undergo delivery in government hospitals. Most of them were belong to low socio-economic status and they have to go to daily work for their daily needs. If a patient is admitted for a prolonged period in a hospital the helping members who come to hospital, have to stay along with the patients and they will lose their daily income which will create debt to the family which in turn causes economic burden and psychological stress. This will reflect on the post-natal nutrition to the mother and baby.

Changes in the body composition of the surgical infant in the early postoperative period

1987 ◽  
Vol 22 (6) ◽  
pp. 546-549 ◽  
Author(s):  
Andrea L. Winthrop ◽  
Peter J.H. Jones ◽  
Dale A. Schoeller ◽  
Robert M. Filler ◽  
Tibor Heim
Keyword(s):  
Body Composition ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
The Body
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