Anesthetic implications of obesity in the surgical patient.
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ABSTRACT:
SUBMITTER: Dority J
PROVIDER: S-EPMC3311489 | biostudies-other | 2011 Dec
REPOSITORIES: biostudies-other
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Project description:BACKGROUND: If one party has more or better information than the other, an information asymmetry can be assumed. The aim of the study was to identify the origin of incomplete patient-related preoperative information, which led to disruptions and losses of time during pre-anaesthetic patient briefing. We hypothesized that lower employees' educational level increases the amount of disruptive factors. METHODS: A prospective observational study design was used. Patient selection was depending on the current patient flow in the area of the clinic for pre-anesthetic patient briefing. Data were collected over a period of 8 weeks. A stopwatch was used to record the time of disruptive factors. Various causes of time losses were grouped to facilitate statistical evaluation, which was performed by using the U-test of Mann and Whitney, Chi-square test or the Welch-t-test, as required. RESULTS: Out of 221 patients, 130 patient briefings (58.8%) had been disrupted. Residents were affected more often than consultants (66% vs. 47%, p?=?0.008). Duration of disruptions was independent of the level of training and lasted about 2,5 minutes and 10% of the total time of patient briefing. Most time-consuming disruptive factors were missing study results, incomplete case histories, and limited patient compliance. CONCLUSIONS: Disruptions during pre-anesthetic patient briefings that were caused by patient-related information asymmetry are common and account for a significant loss of time. The resultant costs justify investments in appropriate personnel allocation.
| S-EPMC3851798 | biostudies-other
Project description:As of 2018 cancer is responsible for almost 9.6 million deaths annually and, with an aging population, the incidence of cancer is expected to continue to rise. Surgery is an important treatment modality for patients with solid organ cancers. It has been postulated that, due to potentially overlapping processes underlying the development of malignancy and the therapeutic pathways of various anesthetic agents, the choice of anesthetic type and method of administration may affect post-operative outcomes in patients with cancer. This is a literature review of the most recent evidence extracted from various databases including PubMed, EMBASE, and the Cochrane, as well as journals and book reference lists. The review highlights the pathophysiological processes underpinning cancer development and the molecular actions of anesthetic agents, pre-clinical and retrospective studies investigating cancer and anesthetics, as well as ongoing clinical trials. Overall, there are conflicting results regarding the impact of regional vs. general anesthesia on cancer recurrence, whilst the majority of data suggest a benefit of the use of intravenous propofol over inhalational volatile anesthetics. The biological changes associated with the surgical inflammatory response offer a unique opportunity to intervene to counteract any potentially cancer-promoting effects.
| S-EPMC8175878 | biostudies-literature
Project description:Coronary artery bypass surgery (CABG) in dextrocardia with situs inversus patients is reported less in literature. Due to abnormal looping and associated other congenital anomalies, anesthetic implications and surgical difficulties become challenging in these patients. Transesophageal echocardiography examination (TEE) needs multiplane angle adjustments compared to normal heart to obtain the images. Here, we describe a 53-year-old female patient having dextrocardia with situs inversus who underwent CABG and discuss the perioperative management and multiplane adjustments during TEE examination.
| S-EPMC5686927 | biostudies-literature
Project description:IntroductionPericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent approximately 6% of all mediastinal masses. Patients can present with symptoms similar to acute chest pain or right-sided heart failure or can be asymptomatic.PresentationA 46-year-old female who is known to have hypertension and hypothyroidism presented to the breast clinic with left breast mass that was proved by core needle biopsy as proliferative breast lesion. During the preoperative assessment, the patient reported progressive shortness of breath and cough over the last two years and bilateral lower limb edema. Her preoperative chest X-ray showed a well-defined oval like opacification at the right cardiophrenic angle that was proved by chest computed tomography imaging as a cystic mass od most likely a pericardial origin. A huge pericardial cyst originating from the right diaphragmatic surface was excised through a mini-sternotomy incision with smooth postoperative recovery. The patient-reported significant improvement in her symptoms and her lifestyle during her follow up.DiscussionPericardial cysts represent 6%-7% of all mediastinal masses with an estimated incidence of 1:100,000. About 70% of pericardial cysts originate at the right cardiophrenic angle and less frequently at the left cardiophrenic angle, they are usually suspected when the chest x-ray shows an enlarged contour of the right heart border. Mediastinal cysts have many differential diagnoses and the preoperative decision might be challenging in many cases. Pericardial cysts appear as oval, thin-walled homogeneous masses on cardiac computed tomography. The choice between surgical intervention and conservative follow up is related mainly to the size and symptoms that are induced by the cyst.ConclusionAs pericardial cysts are rarely diagnosed pathology, a high index of suspicion is essential for diagnosis. Surgical resection is indicated when they are huge, enlarging in size or symptomatic. Morbidity and mortality risks following pericardial cyst excision are very low.
| S-EPMC7286924 | biostudies-literature
Project description:To report the changes in patient-reported quality of life for women undergoing gynecologic oncology surgeries.In a prospective cohort study from 10/2013-10/2014, women were enrolled pre-operatively and completed comprehensive interviews at baseline, 1, 3, and 6months post-operatively. Measures included the disease-specific Functional Assessment of Cancer Therapy-General (FACT-GP), general Patient Reported Outcome Measure Information System (PROMIS) global health and validated measures of anxiety and depression. Bivariate statistics were used to analyze demographic groups and changes in mean scores over time.Of 231 patients completing baseline interviews, 185 (80%) completed 1-month, 170 (74%) 3-month, and 174 (75%) 6-month interviews. Minimally invasive (n=115, 63%) and laparotomy (n=60, 32%) procedures were performed. Functional wellbeing (20 ? 17.6, p<0.0001) decreased at 1-month, and recovered by 3 and 6months. Emotional wellbeing increased (16.3 ? 20.1, p<0.0001) and anxiety decreased (54.2 ? 49.0, p<0.0001) at 1-month, and were stable at 3 and 6months. Physical wellbeing scales were not sensitive to surgery. These patterns were consistent across procedure type, cancer diagnosis, and adjuvant therapy administration. In an exploratory analysis of the interaction of QOL and quality, patients with increased postoperative healthcare resource use were noted to have higher baseline levels of anxiety.For women undergoing gynecologic oncology procedures, temporary declines in functional wellbeing are balanced by improvements in emotional wellbeing and decreased anxiety symptoms after surgery. Not all commonly used QOL surveys are sensitive to changes during the perioperative period and may not be suitable for use in surgical quality metrics.
| S-EPMC4978531 | biostudies-literature
Project description:Anesthesia blocks consciousness and memory while sparing non-conscious brain activities. While the exact mechanisms of anesthetic action are unknown, the Meyer-Overton correlation provides a link between anesthetic potency and solubility in a lipid-like, non-polar medium. Anesthetic action is also related to an anesthetic's hydrophobicity, permanent dipole, and polarizability, and is accepted to occur in lipid-like, non-polar regions within brain proteins. Generally the protein target for anesthetics is assumed to be neuronal membrane receptors and ion channels, however new evidence points to critical effects on intra-neuronal microtubules, a target of interest due to their potential role in post-operative cognitive dysfunction (POCD). Here we use binding site predictions on tubulin, the protein subunit of microtubules, with molecular docking simulations, quantum chemistry calculations, and theoretical modeling of collective dipole interactions in tubulin to investigate the effect of a group of gases including anesthetics, non-anesthetics, and anesthetic/convulsants on tubulin dynamics. We found that these gases alter collective terahertz dipole oscillations in a manner that is correlated with their anesthetic potency. Understanding anesthetic action may help reveal brain mechanisms underlying consciousness, and minimize POCD in the choice and development of anesthetics used during surgeries for patients suffering from neurodegenerative conditions with compromised cytoskeletal microtubules.
| S-EPMC5575257 | biostudies-other
Project description:Background: Patient waiting time is considered as a crucial parameter in the assessment of healthcare quality and patients' satisfaction towards healthcare services. Data concerning this has remained limited in Vietnam. Thus, this study aims to assess patient waiting time in the outpatient clinic in Viet Duc Hospital (Hanoi, Vietnam) in order to enable stakeholders to inform evidence-based interventions to improve the quality of healthcare services. Methods: A cross-sectional study was conducted from June 2014 to June 2015 in the outpatient clinic at Viet Duc Hospital. Waiting time stratified by years (2014 and 2015), months of the year, weekdays, and hours of the day were extracted from Hospital Management software and carefully calculated. Stata 12.0 was employed to analyze data, including the average time (M± SD), frequencies and percentage (%). Results: There was a total of 137,881 patients involved in the study. The average waiting time from registration to preliminary diagnosis in 2014 was 50.41 minutes, and in 2015 was 42.05 minutes. A longer waiting time was recorded in the morning and in those having health insurance. Conclusions: Our results provided evidence that despite the decrease of waiting time from 2014 to 2015, waiting time was much higher among patients having health insurance compared to their counterparts. The findings suggest that human resources promotion and distribution should be emphasized in outpatient clinics and health insurance-related administrative procedures should be simplified.
| S-EPMC5482327 | biostudies-literature
Project description:Reducing readmissions has become a focus in efforts by Medicare to improve health care quality and reduce costs. This study aimed to determine whether causes for readmission differed between obese and nonobese patients, possibly allowing for targeted interventions.A matched case control study of Medicare patients admitted between 2002 and 2006 who were readmitted after hip or knee surgery, colectomy, or thoracotomy was performed. Patients were matched exactly for procedure, while also balancing on hospital, age, and sex. Conditional logistic regression was used to study the odds of readmission for very obese cases (body mass index >35 kg/m2) versus normal weight patients (body mass index of 20-30 kg/m2) after also controlling for race, transfer-in and emergency status, and comorbidities.Among 15,914 patient admissions, we identified 1,380 readmitted patients and 2,760 controls. The risk of readmission was increased for obese compared to nonobese patients both before and after controlling for comorbidities (before: odds ratio, 1.35; P = .003; after: odds ratio, 1.25; P = .04). Reasons for readmission varied by procedure but were not different by body mass index category.Obese patients have an increased risk of readmission, yet the reasons for readmission in obese patients appear to be similar to those for nonobese patients, suggesting that improved postdischarge management for the obese cannot focus on a few specific causes of readmission but must instead provide a broad range of interventions.
| S-EPMC3637915 | biostudies-literature
Project description:Dengue infections are increasing globally and account for significant morbidity and mortality. Severe dengue results in microvascular changes and coagulopathy that may make surgical intervention risky and the overall surgical management challenging. We outline the potential surgical manifestations and complications following dengue infections and describe the clinical, pathogenetic, diagnostic, and treatment aspects of dengue and surgical patients. The main surgical presentations were acute cholecystitis, acute pancreatitis, acute appendicitis, splenic rupture, bowel perforation, gastrointestinal bleeding, and hematomas. Dengue may also mimic an acute abdomen without any true surgical complications. A majority were treated nonoperatively. Misdiagnosis and unnecessary surgical intervention resulted in poor outcomes. Better knowledge of the potential surgical complications would help in early diagnosis, treatment, and referral to specialized centers and thus improve outcomes. A high degree of suspicion of dengue fever is necessary when patients in a dengue-epidemic area present with acute abdomen or bleeding manifestations. In endemic areas, early dengue antigen testing and abdominal imaging before surgical intervention may help in the diagnoses. Multidisciplinary team involvement with case-by-case decision-making is needed for optimal care.
| S-EPMC7790109 | biostudies-literature
Project description:BackgroundSurgical site infection is a major perioperative issue. The morbidity of surgical site infection is high in major digestive surgery, such as pancreaticoduodenectomy. The comprehensive risk factors, including anesthetic factors, for surgical site infection in pancreaticoduodenectomy are unknown. The aim of this study was to investigate the perioperative and anesthetic risk factors of surgical site infection in pancreaticoduodenectomy.MethodsThis was a retrospective cohort study conducted in a single tertiary care center. A total of 326 consecutive patients who underwent pancreaticoduodenectomy between January 2009 and March 2018 were evaluated. Patients who underwent resection of other organs were excluded. The primary outcome was the incidence of surgical site infection, based on a Clavien-Dindo classification of grade 2 or higher. Multivariable logistic regression analysis was performed to investigate the association between surgical site infection and perioperative and anesthetic factors.ResultsOf the 326 patients, 116 (35.6%) were women. The median age was 70 years (interquartile range; 64-75). The median duration of surgery was 10.9 hours (interquartile range; 9.5-12.4). Surgical site infection occurred in 60 patients (18.4%). The multivariable analysis revealed that the use of desflurane as a maintenance anesthetic was associated with a significantly lower risk of surgical site infection than sevoflurane (odds ratio, 0.503; 95% confidence interval [CI], 0.260-0.973). In contrast, the duration of surgery (odds ratio, 1.162; 95% CI, 1.017-1.328), cerebrovascular disease (odds ratio, 3.544; 95% CI, 1.326-9.469), and ischemic heart disease (odds ratio, 10.839; 95% CI, 1.887-62.249) were identified as significant risk factors of surgical site infection.ConclusionsDesflurane may be better than sevoflurane in preventing surgical site infection in pancreaticoduodenectomy. Cerebrovascular disease and ischemic heart disease are potential newly-identified risk factors of surgical site infection in pancreaticoduodenectomy.
| S-EPMC7556444 | biostudies-literature