363 results match your criteria Perioperative Management of the Female Patient

Pharmacologically Induced Ventilatory Depression in the Postoperative Patient: A Sleep-Wake State-Dependent Perspective.

Anesth Analg 2021 05;132(5):1274-1286

Department of Anesthesiology and Perioperative Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota.

Pharmacologically induced ventilatory depression (PIVD) is a common postoperative complication with a spectrum of severity ranging from mild hypoventilation to severe ventilatory depression, potentially leading to anoxic brain injury and death. Recent studies, using continuous monitoring technologies, have revealed alarming rates of previously undetected severe episodes of postoperative ventilatory depression, rendering the recognition of such episodes by the standard intermittent assessment practice, quite problematic. This imprecise description of the epidemiologic landscape of PIVD has thus stymied efforts to understand better its pathophysiology and quantify relevant risk factors for this postoperative complication. Read More

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Frequency and Temporal Distribution of Postoperative Respiratory Depressive Events.

Anesth Analg 2021 05;132(5):1206-1214

From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.

Background: The frequency and temporal distribution of postoperative respiratory depression (RD) events are not completely understood. This study determined the temporal distribution and frequency of RD episodes in postsurgical patients continuously monitored by bedside capnography and pulse oximetry.

Methods: This was a post hoc study of a subset of postsurgical patients enrolled in The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial from 2 sites in the United States. Read More

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Subcostal Anterior Quadratus Lumborum Block Versus Epidural Block for Analgesia in Open Nephrectomy: A Randomized Clinical Trial.

Anesth Analg 2021 04;132(4):1138-1145

Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.

Background: Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies. Read More

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Perioperative Ulnar Neuropathy: A Contemporary Estimate of Incidence and Risk Factors.

Anesth Analg 2021 05;132(5):1429-1437

From the Department of Anesthesiology and Perioperative Medicine.

Background: Retrospective and prospective studies 2 decades ago from the authors' institution reported the incidence of perioperative ulnar neuropathy persisting for at least several months in a noncardiac adult surgical population to be between 30 and 40 per 100,000 cases. The aim of this project was to assess the incidence and explore risk factors for perioperative ulnar neuropathy in a recent cohort of patients from the same institution using a similar definition for ulnar neuropathy.

Methods: We performed a retrospective incidence and case-control study of all adults (≥18 years) undergoing noncardiac procedures with anesthesia services between 2011 and 2015. Read More

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National outcomes and characteristics of patients admitted to Swedish intensive care units for COVID-19: A registry-based cohort study.

Eur J Anaesthesiol 2021 04;38(4):335-343

From the Departments of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences (MSC, PJB, RÅ, HA), Department of Anaesthesia and Intensive Care, Vrinnevi Hospital, Norrköping, Department of Thoracic and Vascular Surgery, Medical and Health Sciences, Linköping University (LE), Department of Anaesthesia, Intensive Care and Perioperative Services, Umeå University Hospital, Umeå (RKB), Department of Public Health Reporting, Public Health Agency of Sweden (AT), Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience, Linköping University, Sweden (SM).

Background: Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission.

Objective: To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19. Read More

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Retrospective Analysis of Peri-Intubation Hypoxemia During the Coronavirus Disease 2019 Epidemic Using a Protocol for Modified Airway Management.

A A Pract 2020 Dec 17;14(14):e01360. Epub 2020 Dec 17.

From the Departments of Anesthesiology, Perioperative, and Pain Medicine.

This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. Adherence to the airway management protocol was high. Read More

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December 2020

Maintaining Access to Orthopaedic Surgery During Periods of Operating Room Resource Constraint: Expanded Use of Wide-Awake Surgery During the COVID-19 Pandemic.

J Am Acad Orthop Surg Glob Res Rev 2020 12 15;4(12):e20.00100. Epub 2020 Dec 15.

From the Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD.

Introduction: Wide-awake local anesthesia no tourniquet (WALANT) presents a nonstandard anesthetic approach initially described for use in hand surgery that has gained interest and utilization across a variety of orthopaedic procedures. In response to operating room resource constraints imposed by the COVID-19 pandemic, our orthopaedic service rapidly adopted and expanded its use of WALANT.

Methods: A retrospective review of 16 consecutive cases performed by 7 surgeons was conducted. Read More

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December 2020

Discharge Destination After Shoulder Arthroplasty: An Analysis of Discharge Outcomes, Placement Risk Factors, and Recent Trends.

J Am Acad Orthop Surg 2020 Dec 14. Epub 2020 Dec 14.

From the Midwest Orthopaedics at Rush, Rush University, Chicago, IL.

Introduction: Rates of shoulder arthroplasty continue to increase. Factors influencing disposition and the effect discharge destination may have on perioperative outcomes are currently unknown. This study (1) investigates patients undergoing total shoulder arthroplasty subsequently discharged to home, skilled nursing facilities, and or independent rehabilitation facilities; (2) identifies differences in perioperative outcomes; and (3) investigates the risk of adverse events and readmission after nonhome disposition. Read More

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December 2020

Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean.

Anesth Analg 2021 05;132(5):1362-1377

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California.

The purpose of this article is to provide a summary of the Enhanced Recovery After Cesarean delivery (ERAC) protocol written by a Society for Obstetric Anesthesia and Perinatology (SOAP) committee and approved by the SOAP Board of Directors in May 2019. The goal of the consensus statement is to provide both practical and where available, evidence-based recommendations regarding ERAC. These recommendations focus on optimizing maternal recovery, maternal-infant bonding, and perioperative outcomes after cesarean delivery. Read More

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Logistical Considerations and Clinical Outcomes Associated With Converting Operating Rooms Into an Intensive Care Unit During the Coronavirus Disease 2019 Pandemic in a New York City Hospital.

Anesth Analg 2021 05;132(5):1182-1190

From the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York.

Background: Coronavirus disease 2019 (COVID-19) emerged as a public health crisis that disrupted normal patterns of health care in the New York City metropolitan area. In preparation for a large influx of critically ill patients, operating rooms (ORs) at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP-Columbia) were converted into a novel intensive care unit (ICU) area, the operating room intensive care unit (ORICU).

Methods: Twenty-three ORs were converted into an 82-bed ORICU. Read More

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The predictors of Enhanced Recovery After Surgery utilization and practice variations in elective colorectal surgery: a provincial survey.

Can J Surg 2020 Sep-Oct;63(5):E460-E467

From the Department of Surgery, McMaster University, Hamilton, Ont.

Background: Enhanced Recovery After Surgery (ERAS) protocols use evidence-based perioperative practices that reduce morbidity and length of stay and improve patient satisfaction. ERAS is considered standard of care; however, utilization remains low and substantial practice variation exists. The aim of this study was to pragmatically characterize variation in colorectal surgery practice and identify predictors of ERAS utilization. Read More

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November 2020

Comprehensive Risk Assessment of Morbidity in Pediatric Patients Undergoing Noncardiac Surgery: An Institutional Experience.

Anesth Analg 2020 11;131(5):1607-1615

From the Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Background: Utilizing the intrinsic surgical risk (ISR) and the patient's chronic and acute conditions, this study aims to develop and validate a comprehensive predictive model of perioperative morbidity in children undergoing noncardiac surgery.

Methods: Following institutional review board (IRB) approval at a tertiary care children's hospital, data for all noncardiac surgical encounters for a derivation dataset from July 2017 to December 2018 including 16,724 cases and for a validation dataset from January 2019 to December 2019 including 9043 cases were collected retrospectively. The primary outcome was a composite morbidity score defined by unplanned transfer to an intensive care unit (ICU), acute respiratory failure requiring intubation, postoperative need for noninvasive or invasive positive pressure ventilation, or cardiac arrest. Read More

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November 2020

Safety of the LMA®Gastro™ for Endoscopic Retrograde Cholangiopancreatography.

Anesth Analg 2020 11;131(5):1566-1572

From the Departments of Anesthesiology and Perioperative Medicine.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) patients typically receive either tubeless anesthesia or general endotracheal anesthesia (GETA). Patients receiving propofol-based total intravenous anesthesia (TIVA) are at higher risk of sedation-related adverse events (SRAEs) than patients receiving GETA, primarily due to the need for additional airway maneuvers. The increasing use of non-operating room (OR) anesthesia and the perception of a higher incidence of adverse outcomes in non-OR areas has led to the development of devices to improve safety while maintaining efficiency. Read More

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November 2020

Risk Factors for Bowel Injury in Hysterectomy for Benign Indications.

Obstet Gynecol 2020 10;136(4):803-810

Department of Obstetrics and Gynecology, University of Ottawa, the Ottawa Hospital, the Ottawa Hospital Research Institute, and the Departments of Surgery and Biochemistry, Microbiology, and Immunology, University of Ottawa, the Ottawa Hospital, Ottawa, and the Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.

Objective: To estimate the incidence and risk factors for bowel injury in women undergoing hysterectomy for benign indications.

Methods: A retrospective cohort study was conducted among women undergoing hysterectomy for benign indications from 2012 to 2016 at institutes participating in the American College of Surgeons National Surgical Quality Improvement Program, including both inpatient and outpatient settings. Bowel injury was identified using Current Procedural Terminology codes as patients who underwent bowel repair at the time of hysterectomy or postoperatively within 30 days. Read More

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October 2020

Incidence of and Factors Associated With Prolonged and Persistent Postoperative Opioid Use in Children 0-18 Years of Age.

Anesth Analg 2020 10;131(4):1237-1248

Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.

Background: Long-term opioid use has negative health care consequences. Opioid-naïve adults are at risk for prolonged and persistent opioid use after surgery. While these outcomes have been examined in some adolescent and teenage populations, little is known about the risk of prolonged and persistent postoperative opioid use after common surgeries compared to children who do not undergo surgery and factors associated with these issues among pediatric surgical patients of all ages. Read More

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October 2020

ADAPT-2: A Randomized Clinical Trial to Reduce Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery.

Anesth Analg 2020 10;131(4):1228-1236

From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, California.

Background: Recent limited evidence suggests that the use of a processed electroencephalographic (EEG) monitor to guide anesthetic management may influence postoperative cognitive outcomes; however, the mechanism is unclear.

Methods: This exploratory, single-center, randomized clinical trial included patients who were ≥65 years of age undergoing elective noncardiac surgery. The study aimed to determine whether monitoring the brain using a processed EEG monitor reduced EEG suppression and subsequent postoperative delirium. Read More

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October 2020

Hospitalization Patterns for Inpatient Pediatric Surgery and Procedures in California: 2000-2016.

Anesth Analg 2020 10;131(4):1070-1079

Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California.

Background: We report hospitalization patterns from 2000 to 2016 for young children (ages 0-5 years old) in California who underwent 1 of the 20 most common inpatient procedures that required general anesthesia and evaluate the estimated probability of treatment at a tertiary care children's hospital (CH) by year.

Methods: We hypothesized that children ≤5 years old increasingly undergo care at tertiary care CHs for common inpatient surgeries or other procedures that require general anesthesia. Data from the California Office of Statewide Health Planning and Development dataset were used to determine procedure, patient age, year of procedure, and hospital name. Read More

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October 2020

Case Studies Using the Electroencephalogram to Monitor Anesthesia-Induced Brain States in Children.

Anesth Analg 2020 10;131(4):1043-1056

From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.

For this child, at this particular moment, how much anesthesia should I give? Determining the drug requirements of a specific patient is a fundamental problem in medicine. Our current approach uses population-based pharmacological models to establish dosing. However, individual patients, and children in particular, may respond to drugs differently. Read More

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October 2020

Development, Implementation, and Evaluation of a Telemedicine Preoperative Evaluation Initiative at a Major Academic Medical Center.

Anesth Analg 2020 12;131(6):1647-1656

From the Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California.

Background: With health care practice consolidation, the increasing geographic scope of health care systems, and the advancement of mobile telecommunications, there is increasing interest in telemedicine-based health care consultations. Anesthesiology has had experience with telemedicine consultation for preoperative evaluation since 2004, but the majority of studies have been conducted in rural settings. There is a paucity of literature of use in metropolitan areas. Read More

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December 2020

Oxygen Reserve Index: Utility as an Early Warning for Desaturation in High-Risk Surgical Patients.

Anesth Analg 2021 03;132(3):770-776

From the Department of Anesthesiology and Pain Medicine, University of California Davis, Davis, California.

Background: Perioperative pulse oximetry hemoglobin saturation (Spo2) measurement is associated with fewer desaturation and hypoxia episodes. However, the sigmoidal nature of oxygen-hemoglobin dissociation limits the accuracy of estimation of the partial pressure of oxygen (Pao2) >80 mm Hg and correspondingly limits the ability to identify when Pao2 >80 mm Hg but falling. We hypothesized that a proxy measurement for oxygen saturation (Oxygen Reserve Index [ORI]) derived from multiwavelength pulse oximetry may allow additional warning time before critical desaturation or hypoxia. Read More

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Echocardiogram Utilization Patterns and Association With Mortality Following Severe Traumatic Brain Injury.

Anesth Analg 2021 04;132(4):1060-1066

Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Department of Anesthesiology.

Background: Severe traumatic brain injury (TBI) can result in left ventricular dysfunction, which can lead to hypotension and secondary brain injuries. Although echocardiography is often used to examine cardiovascular function in multiple clinical settings, its use and association with outcomes following severe TBI are not known. To address this gap, we used the National Trauma Data Bank (NTDB) to describe utilization patterns of echocardiography and examine its association with mortality following severe TBI. Read More

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The Geriatric Nutritional Risk Index is a powerful predictor of adverse outcome in the elderly emergency surgery patient.

J Trauma Acute Care Surg 2020 08;89(2):397-404

From the Division of Trauma, Emergency Surgery and Surgical Critical Care (Z.J., M.E.M., A.N., J.M.L., K.M., N.K., K.H., M.W.E.H., A.M., D.K., P.F., N.S., M.R., G.V., H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts; and Department of General Surgery(Z.J.), Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.

Background: The degree to which malnutrition impacts perioperative outcomes in the elderly emergency surgery (ES) patient remains unknown. We aimed to study the relationship between malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), and postoperative outcomes in elderly patients undergoing ES.

Methods: Using the 2007 to 2016 American College of Surgeons National Surgical Quality Improvement Program database, all patients 65 years or older undergoing ES were included in our study. Read More

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Acute Kidney Injury and Outcomes in Children Undergoing Noncardiac Surgery: A Propensity-Matched Analysis.

Anesth Analg 2021 02;132(2):332-340

From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California.

Background: Acute kidney injury (AKI) has been well documented in adults after noncardiac surgery and demonstrated to be associated with adverse outcomes. We report the prevalence of AKI after pediatric noncardiac surgery, the perioperative factors associated with postoperative AKI, and the association of AKI with postoperative outcomes in children undergoing noncardiac surgery.

Methods: Patients ≤18 years of age who underwent noncardiac surgery with serum creatinine during the 12 months preceding surgery and no history of end-stage renal disease were included in this retrospective observational study at a single tertiary academic hospital. Read More

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February 2021

Association between mothers' postoperative opioid prescriptions and opioid-related events in their children: A population-based cohort study.

Health Rep 2020 07;31(6):12-19

Sunnybrook Research Institute, ICES, the Department of Anesthesia at the University of Toronto, the Department of Critical Care Medicine at the Sunnybrook Health Sciences Centre, and the Interdepartmental Division of Critical Care Medicine at the University of Toronto, Toronto, Ontario.

Background: Postoperative opioid prescriptions may be associated with risks of unintentional poisoning and drug diversion in other household members. The objective of this study was to explore the association between mothers' postoperative opioid prescriptions and incidence of opioid-related events in their children (aged 1 to 24 years).

Data And Methods: This retrospective cohort study used individually linked administrative health data from Ontario, Canada. Read More

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Opioid-Free Epidural-Free Anesthesia for Open Hepatectomy: A Case Report.

A A Pract 2020 Jun;14(8):e01238

Departments of Anesthesiology.

Opioid-free perioperative approaches hold promise to reduce opioid use after surgery and their associated side effects. Here, we report the perioperative analgesic plan of a patient who requested opioid-free care for an open partial hepatectomy. Opioid-free anesthesia care for abdominal surgery is usually dependent on epidural analgesia. Read More

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Risk Factors for Intraoperative Hypoglycemia in Children: A Multicenter Retrospective Cohort Study.

Anesth Analg 2021 04;132(4):1075-1083

From the Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan.

Background: Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors in a multicenter cohort. Read More

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Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery.

Anesth Analg 2021 03;132(3):752-760

Department of Anesthesiology and Perioperative Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida.

Background: The impact of the Florida State law House Bill 21 (HB 21) restricting the duration of opioid prescriptions for acute pain in patients after cesarean delivery is unknown. Our objective was to assess the association of the passage of Florida State law HB 21 with trends in discharge opioid prescription practices following cesarean delivery, necessity for additional opioid prescriptions, and emergency department visits at a large tertiary care center.

Methods: This was a retrospective cohort study conducted at a large, public hospital. Read More

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Machine Learning Applied to Registry Data: Development of a Patient-Specific Prediction Model for Blood Transfusion Requirements During Craniofacial Surgery Using the Pediatric Craniofacial Perioperative Registry Dataset.

Anesth Analg 2021 01;132(1):160-171

Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida.

Background: Craniosynostosis is the premature fusion of ≥1 cranial sutures and often requires surgical intervention. Surgery may involve extensive osteotomies, which can lead to substantial blood loss. Currently, there are no consensus recommendations for guiding blood conservation or transfusion in this patient population. Read More

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January 2021

Persistent Blood Flow inside the Woven EndoBridge Device More Than 6 Months after Intracranial Aneurysm Treatment: Frequency, Mechanisms, and Management-A Retrospective Single-Center Study.

AJNR Am J Neuroradiol 2020 07 11;41(7):1225-1231. Epub 2020 Jun 11.

Department of Neuroradiology (H.A.N., S.S., P.-F.M., L.P.), Hôpital Maison-Blanche, Reims, France.

Background And Purpose: Due to its high safety and great efficacy, flow disruption with the Woven EndoBridge (WEB) device is increasingly used to treat intracranial aneurysms. We recently identified patients with intracranial aneurysm treated with the WEB who presented with residual blood flow inside the device ("contrast-in-WEB" phenomenon) more than 6 months posttreatment. This series reports the frequency and underlying mechanisms and discusses management of this phenomenon. Read More

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