Comparison of biomaterials in the early postoperative period

Background: Laparoscopic hernia repair necessitates the use of biocompatible materials. A prospective, double-blind study was conducted to compare two different polypropylene meshes. Methods: The study included 40 men with primary inguinal hernia undergoing transabdominal preperitoneal polypropylene mesh repair. In 20 of these men, a monofile, heavy-weight, rigid mesh was implanted (group A), and in the remaining 20 men, a smooth, heavy-weight variant of polypropylene mesh was implanted (group B). Complications, pain development, inability to work, physical conditions, testicular volume, and blood circulation were documented. Results: Reconvalescence in group A was slower than in group B. In group A, the postoperative values of the visual scales for pain development were higher; inability to work was 7.3 days longer; urologic disorders were worse; activities of everyday life were more reduced; and SF-36 data showed a significant reduction of physical problems (p < 0.05). Conclusions: The polypropylene mesh variant seems to be more compatible with the human organism than conventional mesh. Not only the material, but also the structure seems to influence the comfort of the mesh.     

Validation of pulse oximetry for monitoring of hypoxaemic episodes in the late postoperative period

We monitored 12 patients undergoing major abdominal surgery using a pulse oximeter (Nellcor N-200) and a transcutaneous oxygen tension monitor (TINA, Radiometer A/S) on the second or third night after operation. Of the shortest hypoxaemic episodes measured with the pulse oximeter (< or = 30 s duration), 78% also occurred in the transcutaneous oxygen tension measurement. Episodes of longer duration (> or = 1 min duration on the pulse oximeter) were, in 95% of cases, reflected in the transcutaneous oxygen tension measurement also. Thus postoperative episodic desaturations lasting > or = 1 min are at least 95% likely to be a real phenomenon.      

呼吸气囊三种清洗用具的应用效果比较

目的探讨应用清洗篮筐、清洗网袋及别针式器械架三种清洗工具对呼吸气囊清洗质量、干燥度及遗失率的不同,探讨较好的呼吸气囊清洗消毒工具。方法连续3个月每个月随机取60个呼吸气囊共300个配件,按月分为清洗篮筐组、清洗网袋组和别针式器械架组,比较三组清洗效果、干燥情况和配件遗失情况。结果三组清洗效果比较,差异无统计学意义(P0.05);三组配件干燥率和遗失率比较,差异有统计学意义(均P0.01),器械架组的配件干燥率最高、遗失率最低。结论使用别针式器械架可确保呼吸气囊清洗效果,能有效地干燥气囊配件,降低配件的遗失率。     

Laparoscopic sleeve gastrectomy follow-up: use of connected devices in the postoperative period

BackgroundDuring the last decade, laparoscopic sleeve gastrectomy (LSG) has become the most performed bariatric procedure worldwide.ObjectivesTo evaluate the feasibility of the use of connected devices in monitoring patients operated on by LSG and discharged 24 hours after surgery under the enhanced recovery after surgery protocol.SettingPrivate hospital, France.MethodsThis is a prospective pilot study designed to assess the risk and benefit of using connected devices in the postoperative follow-up of patients operated on by LSG. Patients operated on with LSG were discharged 24 hours after surgery, and vital signs such as blood pressure, heart rate, peripheral capillary oxygen saturation, and temperature were monitored via connected devices with data sent to an internet platform to make them immediately viewable by the surgeon.ResultsThe study population consisted of 82 women and 18 men. The mean body mass index was 43.4 kg/m², and the mean age was 39.6 years. Two patients were reoperated on for bleeding and, consequently, were excluded from the study. At postoperative day 8, 1 patient presented with tachycardia, fever, and mild abdominal discomfort. After the alert was received from the internet platform, the patient was immediately contacted, admitted to the ward, and promptly reoperated on. At 1 year after the surgery, the mean percentage of excess weight loss and total weight loss were 68.1 ± 18.1% and 36 ± 9.8 kg, respectively. For the patients not available for follow-up at the 1-year control, weight loss data were extrapolated from the internet platform. Globally, 92% of patients felt safe when they returned home, and 92% of patients would recommend this way of managing the postoperative period.ConclusionsIn conclusion, this study shows that the early postoperative follow-up to an intervention such as LSG can be done at the patient's home under the monitoring of connected devices without a risk of increase in the rate of complications and rehospitalization. The role of the connected devices in the long-term postoperative follow-up seems promising.     

Fluid administration during abdominal surgery influences on coagulation in the postoperative period

OBJECTIVE: Postoperative coagulopathy is an important concern for patients after major surgery. Our objective was to define the factors that correlate with postoperative deterioration in coagulation. DESIGN: Retrospective clinical case study. SETTING: University hospital. PARTICIPANTS: Adult patients (n = 150), who underwent major abdominal surgery, were randomly chosen to participate in the study. For each patient, demographic and medical data, anesthetic information, type and duration of surgery, hemodynamic variables, fluid administration, as well as preoperative and postoperative prothrombin time and partial thromboplastin time were collected. Statistical analysis was used to determine which factors correlated with deterioration of coagulation tests. RESULTS: We found statistically significant correlation between deteriorating coagulation functions and administration of more than 3 l of crystalloids during abdominal surgery. There was also correlation between administration of more than 500 ml of colloid administration and elongation of protrombin time. The remainder of the above studied factors did not correlate with deteriorating coagulation. CONCLUSIONS: Administration of more than 3-l crystalloids or 500-ml colloids during abdominal surgery correlates with postoperative coagulopathy.     

Pulse oximetry reduces the unnecessary administration of oxygen in the postanesthesia recovery period

OBJECTIVES: To investigate whether patients admitted to the postanesthesia recovery unit (PRU) need routine oxygen supplementation in the immediate postoperative period, by measuring changes in arterial oxygen saturation (SpO2) with a pulse oximeter. MATERIAL AND METHODS: Two hundred ninety-nine patients were admitted to the PRU after surgery. All breathed room air after their operations. During transfer to and time in the PRU, SpO2 was recorded. We administered oxygen through a face mask to patients whose SpO2 fell below 94% and to patients whose SpO2 levels fell below baseline, when baseline values were less than 94%. We recorded patient data, physical status (ASA), type of anesthesia, duration of surgery, Aldrete score upon admission to the PRU and SpO2 before and after surgery while the patient breathed room air. RESULTS: General anesthesia was used in 82.3% of the patients and local-regional anesthesia with sedation in 17.7%. PRU stay was 75.6 +/- 92.4 min. Twenty-five percent of the patients were treated with oxygen after surgery and 75% did not require supplemental oxygen. Time until the appearance of desaturation was 3.3 +/- 2.8 min. The coefficient of multiple correlation between postoperative SpO2 while breathing room air (dependent variable) and preoperative SpO2, age and duration of surgery was R = 0.522 (p < 0.001). CONCLUSIONS: Our results are sufficient to demonstrate the validity of pulse oximetry for avoiding indiscriminate oxygen supplementation in patients admitted to the PRU.     

Estimation of pulmonary oxygen consumption in the early postoperative period after thoracic surgery

Lung injury, including pneumonia, can occur in the early postoperative period following thoracic surgery. Pulmonary oxygen consumption is thought to increase in patients with pulmonary infection. This study measured oxygen consumption in relationship to lung injury in the early postoperative period after thoracic surgery. Thirty-five patients who underwent thoraco-abdominal oesophagectomy for oesophageal cancer were studied. Measured oxygen-consumption was obtained by indirect calorimetry and calculated oxygen-consumption was simultaneously determined by the reverse Fick method. The difference in oxygen consumption was attributed to pulmonary oxygen consumption. The difference in oxygen consumption increased to 23.1 ml.min(-1).m(-2) on postoperative day 2. In patients with pneumonia the difference in oxygen consumption increased significantly to 39.0 ml.min(-1).m(-2) the day before clinical onset of pneumonia, and it increased further to 65.7 ml.min(-1).m(-2) on the day that pneumonia became clinically apparent. These findings suggest that the difference in oxygen consumption may be useful for estimating the extent of lung injury and for predicting pulmonary complications in the postoperative period.     

Myelography in the late postoperative period in patients subjected to anterior cervical decompression and fusion

Summary During a 13 year period, 286 patients with cervical disc herniation and/or spondylotic spurs, were subjected to anterior decompression and vertebral interbody fusion with autologous bone.Twenty patients were re-admitted in the late postoperative period due to recurrent radicular symptoms and/or signs of myelopathy. In these patients myelography was performed again. In 14 patients spinal cord compression and/or nerve root involvement at a new level was visualized. At the operated level, however, the myelograms demonstrated a smooth anterior wall in the spinal canal.The series confirms the safety, effectiveness and reliability of the Cloward procedure in achieving long term spinal cord and nerve root decompression, and a solid vertebral interbody fusion.     

Ventilatory pattern and associated episodic hypoxaemia in the late postoperative period in the general surgical ward

Episodic oxygen desaturation is frequent in the late postoperative period and seems most pronounced on the second and third postoperative nights. However, the ventilatory pattern has not been described systematically during this period. We studied the ventilatory pattern and associated arterial oxygenation using the Edentrace II equipment (impedance pneumography and pulse oximetry) on the second and third postoperative nights in 28 patients undergoing major abdominal surgery. Ventilatory disturbances were common and included periods of hypopnoea, and obstructive, central and mixed apnoeas. Overall, the median (range) respiratory disturbance index (apnoeas + hypopnoeas per h) was 12 (0-121), with the patients spending 6% (0-65%) of the night in some kind of ventilatory disturbance. It was not possible from pre-operative snoring habits to predict patients who developed postoperative ventilatory disturbances. Overall, 23% (0-100) of the hypopnoeas and 7% (0-100) of the apnoeas were associated with episodic hypoxaemia. In conclusion, ventilatory disturbances were common in the late postoperative period in the general surgical ward and often associated with episodes of oxygen desaturation.     

Comparison of pre- and postoperative administration of ketoprofen for analgesia after tonsillectomy in children

BACKGROUND: Tonsillectomy is commonly performed in children, but unfortunately it is associated with intense postoperative pain. The use and optimal timing of nonsteroidal anti-inflammatory drugs (e.g. ketoprofen) during tonsillectomy is controversial. METHODS: We evaluated the safety and efficacy of ketoprofen in 109 children, aged 3-16 years, during and after tonsillectomy in 1998-2000. Standardized anaesthesia was used. Forty-seven children received ketoprofen 0.5 mg.kg-1 at induction (preketoprofen group) and 42 children after surgery (postketoprofen group), followed by continuous ketoprofen infusion of 3 mg.kg-1 over 24 h in both groups; 20 children received normal saline (placebo group). Oxycodone was used for rescue analgesia. RESULTS: Pre- and postketoprofen groups did not differ in experienced pain or in opioid consumption in the first 24 h after surgery; demonstrating that ketoprofen did not have a pre-emptive effect. Patients in the placebo group received 30 more oxycodone doses than did patients in the ketoprofen groups, but the difference was not significant (P=0.074). Two patients (5) in the postketoprofen group had postoperative bleeding at 4 h and 26 h, respectively. Both patients required electrocautery to stop bleeding. Neither the incidence nor the severity of adverse events differed between study groups. CONCLUSIONS: This study demonstrates that ketoprofen did not have a preemptive effect and, at the dose used, did not perform statistically significantly better than placebo.     

Comparison of two methods of intravenous administration of morphine for postoperative pain relief

Morphine sulphate was used for the control of pain following major abdominal surgery for a period of three days either as patient-controlled or continuous infusion. The two groups of patients were comparable with regard to patient and operation details, duration of infusion, pain scores and complications. The only significant difference was a reduced dose requirement of morphine in the patient-controlled analgesia group (P less than 0.005). Some possible explanations for this finding are given. It is suggested that a properly supervised continuous infusion of morphine is as good as patient-controlled administration. There was a negative correlation between the age of the patient and the dose of morphine used.