ABSTRACT
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are 5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
ABSTRACT
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are 5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
ABSTRACT
Purpose@#We compared the outcomes between the total endovascular approach using a unibody bifurcated aortoiliac endograft and the gold standard aortobifemoral bypass (ABF) surgery for the management of extensive aortoiliac occlusive disease (AIOD). @*Materials and Methods@#This retrospective observational study compared the outcomes of endovascular technique with unibody bifurcated endograft (UBE) using the Endologix AFX unibody stent-graft and a standard surgical approach (ABF) in the management of AIOD based on patient records in Western Vascular Institute, Galway University Hospital, National University of Ireland. Procedural details and outcomes were documented to compare both groups. @*Results@#From January 2002 to December 2018, 67 patients underwent AIOD (20 UBE and 47 ABF). Both the ABF and UBE groups showed 100% immediate clinical and technical successes without 30-day mortality. There were no statistical differences in the overall survival and sustained clinical improvement between the bypass and the UBE groups; however, statistically significant differences were observed in 3-year freedom from re-intervention and amputation-free survival. Furthermore, the mean length of the intensive care unit (ICU) stay was significantly lower in the UBE group than that in the ABF group (0.75 days vs. 3.1 days, P=0.001). @*Conclusion@#Total endovascular reconstruction of AIOD is an alternative to invasive bypass procedures, with a shorter ICU stay.
ABSTRACT
Purpose@#We compared the outcomes between the total endovascular approach using a unibody bifurcated aortoiliac endograft and the gold standard aortobifemoral bypass (ABF) surgery for the management of extensive aortoiliac occlusive disease (AIOD). @*Materials and Methods@#This retrospective observational study compared the outcomes of endovascular technique with unibody bifurcated endograft (UBE) using the Endologix AFX unibody stent-graft and a standard surgical approach (ABF) in the management of AIOD based on patient records in Western Vascular Institute, Galway University Hospital, National University of Ireland. Procedural details and outcomes were documented to compare both groups. @*Results@#From January 2002 to December 2018, 67 patients underwent AIOD (20 UBE and 47 ABF). Both the ABF and UBE groups showed 100% immediate clinical and technical successes without 30-day mortality. There were no statistical differences in the overall survival and sustained clinical improvement between the bypass and the UBE groups; however, statistically significant differences were observed in 3-year freedom from re-intervention and amputation-free survival. Furthermore, the mean length of the intensive care unit (ICU) stay was significantly lower in the UBE group than that in the ABF group (0.75 days vs. 3.1 days, P=0.001). @*Conclusion@#Total endovascular reconstruction of AIOD is an alternative to invasive bypass procedures, with a shorter ICU stay.
ABSTRACT
Background: delirium is an extremely common syndrome in the intensive care unit [ICU]. It is characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists [MMA] have the potential to decrease the incidence and severity of delirium
Aim of the study: to review and assess the role of melatonin in several clinical applications in perioperative management, critical care and pain medicine
Conclusion: melatonin reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behavior; anesthetic requirements; steal induction; and safety. Evidence-based, multi modal, surgical and anesthetic approaches have reduced morbidity and mortality following surgical procedures
Subject(s)
Humans , Melatonin/pharmacology , Anesthesia/adverse effects , Critical Care , Delirium , Perioperative CareABSTRACT
Background: shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period. It is a frequent, unpleasant, and undesirable complication occurring after sub-arachnoid block [SAB], secondary to vasodilatation as a result of sympathetic blockade. The incidence of shivering has been reported to be about 36-85% after spinal anesthesia. The present study was designed to compare the efficacy of diclofenac sodium and pethidine on reducing postoperative shivering following sub-arachnoid block
Objectives: the aim of this study was to investigate the ability of intravenous infusion of diclofenac sodium [1mg/kg maximally 75mg] to treat established post-spinal shivering
Patients and Methods: after approval from departmental ethics committee in Ain shams university and written informed consent from the patient, a randomized study was conducted on ninety adult patients with American society of anesthesiologists [ASA] physical status I, II and III aged from 18 to 65 years. The study was conducted from September 2017 to February 2018. The study was a randomized, prospective, double-blind, placebo-controlled study. All patients were informed about the study design and objectives as well as tools and techniques. Informed consent was signed by every patient prior to inclusion in the study
Results: after approval of the department of anesthesiology, intensive care and pain management at Ain Shams University ethical committee, this randomized study was conducted on ninety patients who were scheduled to have surgery with spinal anesthesia. The design of the study included three groups, each constitutes of 30 patients [n= 30]
Conclusion: the data showed that pethidine infusion was more effective than diclofenac sodium infusion in management of shivering after spinal anesthesia. However diclofenac sodium was better than placebo in non-significant way