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Hironobu Tanigami Naoki Yahagi Keiji Kumon Yasuhiko Watanabe Masaki Haruna Junki Matsui Hideaki Hayashi 《Artificial organs》1997,21(1):21-23
Abstract: After cardiac surgery, patients often require prolonged mechanical ventilation. We studied the effectiveness and potential toxicity of isoflurane sedation in 40 patients undergoing mechanical ventilation after cardiovascular surgery. All patients who received isoflurane (0.5-1.0 minimum alveolar concentration [MAC]) were well sedated by it without significant adverse effects, such as renal, hepatic, or cardiovascular dysfunction. The highest serum inorganic fluoride concentration recorded was 45 |x molL after 98 MAC h. Patients on isoflurane recovered more rapidly and were weaned from mechanical ventilation sooner than those sedated with intravenous drugs including fentanyl/midazolam. Patients who received intravenous sedatives, but not those on isoflurane, often showed tachyphylaxis in the early stages, and some exhibited an abstinence syndrome involving nonpurposeful movements. Patients sedated with isoflurane did not show these two side effects. In conclusion, isoflurane can provide effective long-term sedation for patients after cardiovascular surgery without significant adverse effects. 相似文献
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Cendán JC Abu-aouf D Gabrielli A Caruso LJ Rout WR Hocking MP Layon AJ 《Obesity surgery》2005,15(9):1247-1251
Background: Obese patients occasionally require either elective or emergency critical care services following bariatric surgery.
We describe this subgroup of patients. Methods: From July 1, 1991 to July 31, 2004, we performed 1,279 bariatric operations;
241 (19%) required admission to the surgical critical care service. We retrospectively reviewed medical records for gender,
body mass index (BMI), age, whether the operation was initial or revisional, and whether critical care admission was elective
or emergent. 3 complication clusters (thromboembolic, pulmonary, and anastomotic) were identified using discharge ICD-9 codes.
The costs and length of stay of these subpopulations was calculated. Results: Patients were on average 46 ± 10 years old,
with BMI 59 ± 13. Critical care admission was emergent in 52.7% (n=127) of cases. Revisional cases did not differ from the
initial cases in BMI (56.4 vs 59.2, P=0.42) and they were no more likely to require emergent critical care admission than initial cases (P=0.16). Revisional cases were hospitalized longer (27.2 ± 25.6 vs 12.5 ± 18.7 days, P =0.003); had higher total hospital costs (US$ 60,631 ± 78,337 vs 27,697 ± 52,351, P=0.025); and were more likely to die from their complications (revisional surgery mortality 6.5% vs 1.9% for initial surgery
[P=0.002]). Conclusions: An increasing number of surgical revisions will likely accompany the recent increase in popularity
of bariatric surgery. In our experience, these patients require significant critical care services, and have longer, complicated,
and more costly hospitalizations. 相似文献
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Anne Klausing Markus Martini Matthias Dominik Wimmer Sascha Gravius Dieter Christian Wirtz Thomas Martin Randau 《The Journal of arthroplasty》2019,34(4):717-722
Background
Postoperative complications are the main consumers of technical, medical, and human resources. Especially in the field of elective joint replacement surgery, a specialized, easy-to-obtain, and cost-efficient preoperative stratification and risk-estimation model is missing.Methods
With preoperatively surveyed patient parameters, we identified the most relevant parameters to predict postoperative medical complications. We devised a prospective risk model, measuring the individual probability for intermediate care unit (IMC) or intensive care unit (ICU) admission. The study includes all patients (n = 649) treated with primary or revision total knee arthroplasty in our clinic from 2008 to 2012.Results
The association between general comorbidity scores and mortality risk is well known. Among different comorbidity scores, the Charlson Comorbidity Index is not only relevant for overall postoperative complications (odds ratios [OR] = 2.20) but also predictive of specific complications such as the postoperative need for blood transfusion (OR = 1.94) and unexpected adverse events (OR = 1.74). Considering adverse events, c-reactive protein and leukocyte levels are also highly relevant. Upon predicting a necessary postoperative transfer to an IMC or ICU, the preoperative hemoglobin level, the Charlson Comorbidity Index, and the Index of Coexistent Disease stood out. The latter indicates an increased rate for an IMC/ICU stay by 341% per point. Condensing the most influential predictors, the probability for postoperative IMC/ICU transfer can be calculated for each individual patient. Using the routinely assessed patient's variables, no steadier prediction is possible.Conclusion
The introduced risk-estimation model offers a specialized preoperative resource-stratification method in knee joint replacement surgery. It condenses the most influential, individual risk factors to avoid clinical test redundancy and improve resource efficiency and presurgical care planning. A prospective follow-up study could help validating the risk model in clinical routine. 相似文献14.
Dongsheng Wang Ying Kong Bei Zhong Xiaobin Zhou Yanbing Zhou 《Journal of gastrointestinal surgery》2010,14(4):620-627
Background
Fast-track surgery is a new, promising comprehensive program for surgical patients and is beneficial to recovery. Prospective randomized, controlled clinical trials involving fast-track surgery for gastric cancer are lacking.Patient and methods
Ninety-two patients with gastric cancer were randomly divided into a fast-track surgery group (n?=?45) and conventional surgery group (n?=?47). We compared outcomes (duration of postoperative stay in hospital, fever, and flatus, complications, and medical costs); postoperative serum levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein; and resting energy expenditure between two groups.Results
Compared with the conventional surgery group, the fast-track surgery group had no more complications (P?>?0.05) with a significantly shorter duration of fever, flatus, and hospital stay, and less medical costs as well as a higher quality of life score on hospital discharge (all P?<?0.05). With a significantly lower resting energy expenditure (days?1 and 3) postoperatively (P?<?0.05), the fast-track surgery group showed a lower serum level of tumor necrosis factor-α (days?1 and 3), interleukin-6 (days?1 and 3), and C-reactive protein (days?1, 3, and 7) than the conventional surgery group (all P?<?0.05).Conclusions
Fast-track surgery can lessen postoperative stress reactions and accelerate rehabilitation for patients with gastric cancer. 相似文献15.
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Most bariatric surgery patients are triaged directly to the medical surgical floor postoperatively. However, patients at high
risk due to comorbid factors, who have failed postoperative extubation or have suffered intraoperative complication, may require
intensive care unit (ICU) or intermediate-level care (IMC). The special needs of the morbidly obese IMC/ICU patient include:
triage, mobility, visiting, fluid resuscitation, management of sleep apnea, airway management, transporting for out of ICU
procedures, and preventing pressure ulcers. Traditional approaches to nursing care require new thought when dealing with the
massively obese. Our experiences with the special needs of these critically ill morbidly obese bariatric surgery patients
are described. 相似文献
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Kermarrec N Marmuse JP Faivre J Lasocki S Mognol P Chosidow D Muller C Desmonts JM Montravers P 《Obesity surgery》2008,18(2):171-178
Background To report the prognosis and management of patients reoperated for severe intraabdominal sepsis (IAS) after bariatric surgery
(S0) and admitted to the surgical intensive care unit (ICU) for organ failure.
Methods A French observational study in a 12-bed adult surgical intensive care unit in a 1,200-bed teaching hospital with expertise
in bariatric surgery. From January 2001 to August 2006, 27 morbidly obese patients (18 transferred from other institutions)
developed severe postoperative IAS (within 45 days). Clinical signs, biochemical and radiologic findings, and treatment during
the postoperative course after S0 were reviewed. Time to reoperation, characteristics of IAS, demographic data, and disease
severity scores at ICU admission were recorded and their influence on prognosis was analyzed.
Results The presence of respiratory signs after S0 led to an incorrect diagnosis in more than 50% of the patients. Preoperative weight
(body mass index [BMI] > 50 kg/m2) and multiple reoperations were associated with a poorer prognosis in the ICU. The ICU mortality rate was 33% and increased
with the number of organ failures at reoperation.
Conclusion During the initial postoperative course after bariatric surgery, physical examination of the abdomen is unreliable to identify
surgical complications. The presence of respiratory signs should prompt abdominal investigations before the onset of organ
failure. An urgent laparoscopy, as soon as abnormal clinical events are detected, is a valuable tool for early diagnosis and
could shorten the delay in treatment. 相似文献
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