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As part of U-40 activities, chapters have traditionally held sessions of lectures and hands-on as the Basic Lecture Course (BLC) to improve the basic skills and knowledge of young cardiovascular surgeons. Because of the COVID-19 epidemic, we have shifted our activities from onsite to online. This column focuses on “management of postoperative delirium and pain” in the lecture of “Postoperative Management in Cardiovascular Surgery” given by the Chubu Chapter in 2020. We summarize the lecture and report the results of a questionnaire survey of the U-40 members.
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Radical hysterectomy combined with pelvic lymphadenectomy is the mainstream management for early-stage cervical cancer. However, the high radicality of such procedures is accompanied by high risk for complications. How to reduce the complications while ensuring the extent of surgical resection represents a dilemma faced by gynecological oncologists. Besides surgical techniques, multiple aspects during patient management should be involved in the measures for preventing surgery-associated complications in cervical cancer patients. By strictly grasping the surgical indications, being familiar with the use of instruments, paying attention to the application of surgical operation details and skills, strengthening postoperative management, and paying attention to the learning curve of surgeons, the incidence of surgical injury can be controlled at a low level.
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Noninvasive neuromodulation technique is a non-invasive, safe and convenient research and treatment method, which is mainly regulated by electrical stimulation and magnetic stimulation. In recent years, it has been more and more used in the research and treatment of brain function. It has been confirmed in the regulation of cognitive impairment, depression, anxiety, delirium and insomnia in patients with stroke. Clinical departments such as neurology, rehabilitation department, pain department and other disciplines have widely used this technique of non-invasive neural regulation, but its application in the perioperative period is less, especially for postoperative sleep disorders in patients with general anesthesia. Postoperative sleep disorder is a common and easily neglected complication, which is often manifested as postoperative sleep structure disorder, sleep quality decline, sleep is obviously shortened, and the sleep function of patients with general anesthesia is more likely to be affected. Postoperative sleep disorder includes many influencing factors before, during and after operation, affecting the whole perioperative period and even a few years after discharge.
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A 61 year old woman who had been receiving treatment for ulcerative colitis for 14 years complained of respiratory discomfort on exertion and was diagnosed with severe mitral regurgitation due to mitral valve prolapse. Minimally invasive mitral valvuloplasty with right mini-thoracotomy was performed in our facility. Laboratory findings showed elevated levels of serum creatine kinase (CK) and CK-MB immediately after surgery. In addition to elevated levels of myocardial enzymes, ST depression was seen in an electrocardiogram on postoperative day 2 ; therefore, we suspected myocardial ischemia during the surgery. Despite the persistently elevated levels of myocardial enzymes, coronary angiography showed no significant abnormalities. Because of the possibility of false CK elevation, we performed CK electrophoresis, which revealed the presence of macro-CK type 1. CK-MB activity is often falsely elevated when determined by immune-inhibition in macro-CK patients, and that leads to the suspicion of myocardial ischemia. We considered that it may be highly difficult to identify macro-CK in a patient after cardiovascular surgery owing to elevated levels of myocardial enzymes in most such patients.
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Objective Performing special studies in patients with adenocarcinomas of the esophagogastric junction (AEG) can provide an effective clinical basis for diagnosis and successful treatment.Methods We retrospectively analyzed and summarized the diagnosis,operative procedure,and postoperative complications in 52 cases of AEG in patients who underwent surgical treatment at the First Hospital of China Medical University between June 2011 and May 2016.Results In addition to carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19-9) is a useful tumor marker with a positively higher rate of preoperative detection of AEG.With respect to choice of surgical approach,type Ⅰ tumors were treated using transthoracic en bloc esophagectomy with resection of the proximal stomach,while type Ⅱ and Ⅲ tumors were primarily treated with an extended total gastrectomy with transhiatal resection of the distal esophagus.We observed in our study that stage Ⅲ tumors were the most common type,and intra-pulmonary infection was the commonest postoperative complication.Conclusion AEG continues to remain one of the most difficult clinical problems.Middle-aged and elderly patients presenting with persistent epigastric and postprandial discomfort require special attention.Adopting a rational surgical strategy is the basis of achieving radical cure.We propose that patients with type Ⅱ tumors should be treated with a radical total gastrectomy,and a distal esophagectomy through the esophageal hiatus,if necessary,should be combined with a thoracic approach to ensure radical surgery.
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Objective To investigate the safety and effect of none routine nasogastric decompression tube after radical gastrectomy. Methods The clinical data of 100 patients who underwent radical gastrectomy in our department from January 2013 to January 2015 were retrospectively analyzed. Among them, 50 patients did not receive postoperative nasogastric tube decompression (group A) and 50 patients received nasogastric tube decompression after operation (group B). The time to flatus, semi-liquid diet, length of hospital stay and associated postoperative complications were compared between the two groups. Results The time to have semi-liquid diet ([5.82±1.10] d vs[7.80±1.92] d) and length of hospital stay ([6.82±1.27] d vs[9.10±3.42] d) in group A were significantly shorter than those in group B (P0.05). Conclusion None routine nasogastric decompression tube is safe for patients who have received radical gastrectomy, and it may accelerate postoperative recovery and shorten the hospital stay.
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<p><b>OBJECTIVE</b>The study aims to investigate the correlation between total input for a period of 24 h and the daily physiological requirements to develop practical guidelines for postoperative infusion management of cleft patients.</p><p><b>METHODS</b>Sixty-three cleft lip and palate patients under three years old who underwent surgery were included in the study. The amount of liquid taken orally as well as intravenous input were recorded for a period of 24 h and compared with the daily physiological requirements. Based on the comparison results, the amount of intravenous infusion was adjusted to match the physiological requirements. Eighty-one patients under one year old were also included to evaluate the effectiveness of the adjustment. The amount of liquid taken orally and intravenous inputs were also recorded and the correlation between total input and urine output analyzed.</p><p><b>RESULTS</b>The total input of the first group of patients significantly exceeded the physiological requirements. After adjustment, the liquid intake remained at the same level, but the total intake moved closer to the physiological requirements. Statistically significant correlations were observed between liquid taken orally and intravenous intakes, and between total intake and urine formation.</p><p><b>CONCLUSIONS</b>More precise management of postoperative infusion is necessary for cleft patients. For patients less than six months old, the amount of intravenous infusion should be around 60% of the physiological requirements, whereas that for patients between six months and one year should be around 75%.</p>
Subject(s)
Humans , Cleft Lip , Infusions, Intravenous , Postoperative PeriodABSTRACT
The postoperative management of papillary thyroid microcarcinoma (PTMC) is one of the most important parts of management for PTMC,and it includes the initial management and long-term management of PTMC.The initial management of thyroid cancer is based on initial recurrence risk stratification system.The initial risk stratification system can be used to guide initial TSH suppression therapy,RAI assistant therapy and management of follow up.Initial risk assessment of recurrence,as a static representation of the patient in the first few weeks post-operatively,could not be continually updated during follow up.In order to account for the changes of the recurrence risk and disease specific mortality,re-stratification of risk should be performed during follow up,using all the clinical,biochemical,imaging (structural and functional),and cytopathologic findings obtained during follow up.Re-stratification of risk can inform clinicians on degree of ongoing TSH suppression,frequency and intensity of follow-up,and need for additional therapies were recommended in guideline.Adjustment of TSH suppression therapy should incorporate the impact of side effects and set TSH targets to ensure the benefits of TSH suppression outweigh against the potential risks.
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Lung transplantation has become the standard of care for select patients with advanced lung diseases of various etiologies. A relatively scarce donor pool limits wider application of lung transplantation. Donor selection criteria, donor management protocols, and improvement in postoperative management have lead to improved overall survival with a median survival rate of 5.7 years. Bilateral lung transplantation has become the procedure of choice for most indications due to significantly better long term survival, especially in patients younger than 60 years. Proper management of donor organs may increase the utilization rate of scarce organs and through the increasing number of lung transplantation and improvement in postoperative management, many patients on the waiting list may achieve a new life after lung transplantation with excellent quality of life and long term survival.
Subject(s)
Humans , Donor Selection , Lung Diseases , Lung Transplantation , Lung , Patient Selection , Quality of Life , Standard of Care , Survival Rate , Tissue Donors , Waiting ListsABSTRACT
<p>Central diabetes insipidus (CDI) is a disease that caused by insufficient or no anti-diuretic hormone (ADH) secretion from the posterior pituitary, which results in an increase in urine volume. CDI is controlled with ADH supplementation thereby reducing urine output and correcting electrolyte imbalance. However, reports on perioperative management for CDI patient are scarce, especially for patients who underwent cardiac surgery. We herein report our experience of the management of a CDI patient who underwent surgery for valvular heart disease.</p><p>The case is a 72-year-old woman who developed secondary CDI after pituitary tumor removal. She had been controlled with orally administered desmopressin acetate hydrochloride. She underwent aortic valve replacement and mitral valve repair for severe aortic, and moderate mitral regurgitation. Immediately after surgery, we started vasopressin div, which yielded good urine volume control. However, once we started to switch vasopressin to oral desmopressin administration, the control became worse. We thus made a sliding scale for subcutaneous injection of vasopressin every 8 h according to the amount of urine output, which resulted in good control. Overlapping administration of vasopressin and oral desmopressin between postoperative day 12 and 17 resulted in successful transition. The patient was discharged with oral desmopressin administration. Management with sliding scale for vasopressin subcutaneous injection after surgery was useful in controlling a CDI patient who underwent major cardiac surgery.</p>
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Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.