Overnight hospital stay and/or extended recovery period may allow long-duration oral and maxillofacial surgeries in the operating room of a dental hospital in an outpatient setting: a single-center experience

Objectives@#The requirement for overnight hospital stay should be considered preoperatively according to patient-related factors, type of surgery, and anesthetic management plan. In this study, we aimed to define the major factors that influence consideration of overnight hospital stay in patients undergoing oral and maxillofacial (OMF) surgery in an operating room (OR) of a dental hospital in an outpatient setting. @*Materials and Methods@#The records of patients who underwent oral procedures under general anesthesia between 2014-2017 were reviewed. @*Results@#A total of 821 patients underwent oral procedures under general anesthesia; 631 of them underwent OMF surgery in the OR of a dental hospital, and 174 of these patients were hospitalized for overnight stay. There was no significant difference in the number of patients with comorbidities between the outpatient and hospitalized patient groups (P=0.389). The duration of surgery was longer in the hospitalized patient group (105.25±57.48 vs 189.62±82.03 minutes; P<0.001). Double-jaw (n=15; 310.00±54.21 minutes) and iliac crest grafting surgeries (n=59; 211.86±61.02 minutes) had the longest durations. Patients who underwent iliac crest grafting had the highest rates of hospitalization (79%). The overall recovery period was longer in outpatients (119.40±41.60 vs 149.83±52.04; P<0.001). @*Conclusion@#Duration of surgery was the main determinant in considering whether a patient required overnight hospital stay. However, patients with an American Society of Anesthesiology physical status score <3 may be scheduled for OMF surgery in the OR of a dental hospital in an outpatient setting regardless of duration of surgery if overnight hospital stay is planned or an extended recovery period is provided until patients meet the discharge criteria.

Heat shock protein 60 antibody. a new marker for subsequent atrial fibrillation development

To examined the pre-and post-operative anti-HSP60 antibodies of serum from patients in preoperative sinus rhythm. We prospectively studied 45 consecutive patients admitted for elective CABG from 2004 to 2005. We randomly selected 10 patients developing AF [study sample [Group A]] and 10 postoperative patients without AF [control [Group B]. The study took place at the Department of Cardiovascular Surgery, Hacettepe University, Ankara, Turkey. Anti-HSP60 IgG value was 27.76 +/- 12.69 absorbance units [AU] in Group A preoperatively and decreased to 13.73 +/- 5.51 AU postoperatively. Controversially, preoperative value of anti-HSP60 IgG was 9.94 +/- 2.92 AU and decreased to 6.72 +/- 1.89 AU, postoperatively in Group B. Statistical analysis showed significant difference regarding preoperative anti-HSP60 IgG levels in Group A compared to Group B, which might be interpreted as an association between postoperative AF and preoperative levels of anti-HSP60 IgG. We provide the first evidence demonstrating the association of pre-and post-operative circulating anti-HSP60 antibodies with postoperative AF. These results suggest that serum HSP60 antibody levels may be a marker for subsequent development of AF

effect of halothane, isoflurane, sevoflurane and propofol infusion on renal function after coronary artery bypass surgery

Renal insufficiency after cardiac surgery is associated with increased mortality, morbidity, and length of stay in the intensive care unit. We investigated the effect of isoflurane, halothane, sevoflurane and propofol anesthesia on perioperative renal function following elective coronary artery surgery. The medical records of 224 patients, in the Hacettepe University Medical Faculty Hospital who had undergone cardiac surgery in one year, were retrospectively reviewed. 65 [29%] patients received isoflurane, 68 [30%] patients received halothane, 64 [29%] patients received sevoflurane, and 27 [12%] patients received propofol infusion as part of maintenance anesthesia for coronary artery bypass surgery. Patient characteristics [age, sex, preoperative ejection fraction], operative data [duration of CPB, duration of operation, number of distal anastomoses, usage of diuretic, intraoperative crystalloid and blood transfusion], intraoperative urinary output, preoperative and postoperative [6th hours and 24th hours] BUN and plasma creatinine levels, were not statistically significant between and within groups. Intraoperative inotropic agent [dopamine] was used in 8 [12.3%] patients in the isoflurane group, in 10 [14.7%] patients in the halothane group, in 11 [17.2%] patients in sevoflurane group and in 9 [33.3%] patients in the propofol group. Postoperatively fluid and blood transfusion, postoperative drainage, urinary output, diuretic usage were smiliar between the four groups [p>0,05]. Inotropic agent was used in 8 [12.3%] patients in the isoflurane group, in 9 [13.2%] patients in the halothane group, in 16 [25%] patients in the sevoflurane group and in 7 [25.9%] patients in the propofol group. It is concluded that, halothane, isoflurane, sevoflurane and propofol infusion anesthesia as part of anesthesia maintenance for elective coronary artery bypass surgery does not affect early postoperative renal functions