Research progress in influence of perioperative hypotension on postoperative outcome of patients / 中南大学学报(医学版)

With the advancement of disease treatments, the number of patients undergoing surgery worldwide is increasing. However, many patients still experience severe perioperative complications. Perioperative hypotension is one of the common side effects during surgery. Physiologically, perioperative hypotension can lead to insufficient perfusion of important organs and result in acute and chronic irreversible organ injury, which cause serious consequences for the patient's postoperative hospitalization and even the long-term outcome. Therefore, in order to optimize perioperative circulation management and improve the quality of life for patients after surgery, it is of great importance to investigate the relationship between perioperative hypotension and postoperative myocardial injury, ischemic stroke, postoperative delirium, acute kidney injury, and postoperative mortality. Individualized circulation management and reasonable application of vasoactive drugs may be the key point to early prevention and correct treatment of perioperative hypotension, which is of great significance for reducing perioperative related morbidity and mortality and improving the prognosis for the surgical patients.

Postoperative outcome in thoracolumbar spinal tuberculosis: a retrospective study

Background: Spinal tuberculosis is the most common location of extra pulmonary tuberculosis. ATT alone may not be suitable in all situations, especially when treating patients with risk of instability, progression of neurologic deficit, and failure of medical treatment. Surgical intervention is a major treatment modality for symptom relief in spinal tuberculosis.Methods: The aim of this study was to assess the immediate post-operative outcome in surgically treated patients with dorsolumbar spine tuberculosis at Department of Neurosurgery Government Medical College, Thrissur. All operated patients of dorsolumbar spinal tuberculosis during 2014 September to 2019 august were included under study.Results: A total of 57 patients were included in the study. The mean age of the patient was 42.77 years. There were 40 males (70.2%) and 17 females (29.8%). 55 (96.5%) out of 57 patients were having sensory symptoms. 41 (71.9%) out of 57 patients were having motor symptoms. Bladder involvement 23 (40.4%) and bowel involvement 15 (26.3%) were also noted in the study. Sensory symptoms improvement in post-operative period was noted in 46 (80.7%). Motor symptoms improvement was observed in 23 (56.1%) out of 41. Bladder symptoms improved in 6 (26.1%) out of 23. There is improvement in clinical symptoms, neurological function immediately after surgery. Surgical patients have faster improvement and can be mobilized earlier. Improvement in sensory symptoms (96.5%), motor symptoms (56.1%) and bladder symptoms (26.1%) were noted in our study in the immediate post-operative period.Conclusions: There was significant immediate relief in symptoms and morbidity of patients undergoing surgical treatment for dorsolumbar spine tuberculosis.

Perioperative glycemic control and its outcome in patients following open heart surgery

Background: Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population. Materials and Methods: Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016. Results: Of the 129 patients included in the study, male dominated 101 (78.3%). Most frequent surgery was coronary artery bypass grafting (CABG) 123 (95.3%), CABG plus aortic valve replacement 4 (3.1%), and CABG plus mitral valve replacement 2 (1.6%). Considering diabetes, only 3 (2.3%) were on diet control, 112 (86.8%) on oral hypoglycemic agents (OHA), whereas 9 (7%) had control on both insulin and OHA. Only 5 (3.9%) had type I diabetes. The mean fasting blood sugar (FBS) was 154.58 g/dl, and the mean duration of diabetic mellitus was observed 12.32 years. Microvascular and macrovascular complications were 26/129 (20.16%) and 17/129 (13.17%), respectively. Total 75 (58.1%) patients did not require insulin and 54 (41.9%) were treated with insulin intraoperatively to keep the blood glucose level less than 200 g/dl. Cardiac arrhythmias were frequent in the insulin group (P < 0.05), which was also associated with increased stay in the cardiac intensive care unit. Conclusion: Inadequate glycemic control during open cardiac surgery can possibly lead to increased perioperative morbidity and mortality and with decreased long-term survival and recurrent ischemic events. Therefore, aiming for blood glucose levels around 140 mg/dl appears reasonable. Further studies are required to define specific glucose ranges for a clearer definition of recommended blood glucose goals in postoperative cardiac patients for the best outcomes in patients with diabetes mellitus.

Intervention of family-integrated care model for children with enterostomy and their caregivers / 中国实用护理杂志

Objective@#To investigate the effects of family-integrated care (FIC) on postoperative outcomes in children with enterostomy and their caregivers.@*Methods@#From August 2017 to August 2018, 50 children with enterostomy and 50 family members of the Children′s Hospital of Hunan Province were selected as subjects. According to the random number table, the children and their families were divided into control group and the observation group, each group was 25 cases. The control group was given a routine nursing mode to intervene, and the observation group was given an FIC mode for intervention. Postoperative outcomes were evaluated using the incidence of ostomy complications and readmission rates. The pre-intervention and outpatient follow-up were used to assess the psychological status of the family members using the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), and to assess the postoperative care of the family's intestines using the postoperative evaluation of the postoperative intestines. The level of knowledge mastery. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to assess the psychological state of the family members, and the postoperative care knowledge evaluation form for the postpartum was used to evaluate the postoperative care of the family.@*Results@#The incidence of ostomy complications in the observation group was 8.70% (2/23), which was lower than that in the control group (34.78% (8/23) (P<0.05). The readmission rate of the observation group was 0(0/23), which was lower than the control group 17.39% (4/23) (P<0.05). After intervention, the SAS scores and SDS scores of the families of the two groups were lower than those before the intervention, and the SAS scores and SDS scores of the observation group were lower than the control group(P<0.05). Before discharge and 3months of follow-up, the scores of postoperative care knowledge evaluation scores of the observation group were higher than those of the control group(P<0.05).@*Conclusions@#FIC mode can effectively reduce the incidence of complications and readmission rate in children with enterostomy. It has positive significance for improving the negative emotions of children′s family members and improving the mastery of postoperative care.

Intervention of family-integrated care model for children with enterostomy and their caregivers / 中国实用护理杂志

Objective To investigate the effects of family-integrated care (FIC) on postoperative outcomes in children with enterostomy and their caregivers. Methods From August 2017 to August 2018, 50 children with enterostomy and 50 family members of the Children′s Hospital of Hunan Province were selected as subjects. According to the random number table, the children and their families were divided into control group and the observation group, each group was 25 cases. The control group was given a routine nursing mode to intervene, and the observation group was given an FIC mode for intervention. Postoperative outcomes were evaluated using the incidence of ostomy complications and readmission rates. The pre-intervention and outpatient follow-up were used to assess the psychological status of the family members using the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), and to assess the postoperative care of the family's intestines using the postoperative evaluation of the postoperative intestines. The level of knowledge mastery. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to assess the psychological state of the family members, and the postoperative care knowledge evaluation form for the postpartum was used to evaluate the postoperative care of the family. Results The incidence of ostomy complications in the observation group was 8.70% (2/23), which was lower than that in the control group (34.78% (8/23) (P<0.05). The readmission rate of the observation group was 0(0/23), which was lower than the control group 17.39% (4/23) (P<0.05). After intervention, the SAS scores and SDS scores of the families of the two groups were lower than those before the intervention, and the SAS scores and SDS scores of the observation group were lower than the control group(P<0.05). Before discharge and 3months of follow- up, the scores of postoperative care knowledge evaluation scores of the observation group were higher than those of the control group(P<0.05). Conclusions FIC mode can effectively reduce the incidence of complications and readmission rate in children with enterostomy. It has positive significance for improving the negative emotions of children′s family members and improving the mastery of postoperative care.

Adverse respiratory events after general anesthesia in patients at high risk of obstructive sleep apnea syndrome / Eventos respiratórios adversos após anestesia geral em pacientes com alto risco de síndrome da apneia obstrutiva do sono

ABSTRACTINTRODUCTION: Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia.METHODS: This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011. Primary outcome was the development of adverse respiratory events. Demographics data, perioperative variables, and postoperative length of stay in the Post-Anesthesia Care Unit and in hospital were recorded. The Mann-Whitney test, the chi-square test and the Fisher exact test were used for comparisons.RESULTS: Subjects in both pairs of study subjects had a median age of 56 years, including 25% males, and 59% were submitted to intra-abdominal surgery. High risk of obstructive sleep apnea patients had a higher median body mass index (31 versus 24 kg/m2, p < 0.001) and had more frequently co-morbidities, including hypertension (58% versus 24%, p < 0.001), dyslipidemia (46% versus 17%, p < 0.001) and insulin-treated diabetes mellitus (17% versus 2%, p = 0.004). These patients were submitted more frequently to bariatric surgery (20% versus 2%, p = 0.002). Patients with high risk of obstructive sleep apnea had more frequently adverse respiratory events (39% versus 10%, p < 0.001), mild to moderate desaturation (15% versus 0%, p = 0.001) and inability to breathe deeply (34% versus 9%, p = 0.001).CONCLUSION: After general anesthesia high risk of obstructive sleep apnea patients had an increased incidence of postoperative respiratory complications.

RESUMOJUSTIFICATIVA E OBJETIVO: Os pacientes com escore STOP-BANG > 3 possuem alto risco de desenvolver apneia obstrutiva do sono. O objetivo deste estudo foi avaliar as complicações respiratórias no pós-operatório imediato em adultos com escore STOP-BANG > 3 após anestesia geral.MÉTODOS: Estudo prospectivo de dupla-coorte, comparando 59 pares de pacientes adultos com escore STOP-BANG > 3 (alto risco de apneia obstrutiva do sono) e pacientes com escore STOP-BANG < 3 (baixo risco de apneia obstrutiva do sono), similares no que diz respeito ao gênero, idade e tipo de cirurgia, admitidos após a cirurgia eletiva em sala de recuperação pós-anestésica (SRPA) em maio de 2011. O desfecho primário foi o desenvolvimento de eventos respiratórios adversos. Dados demográficos, variáveis no perioperatório e tempos de permanência na SRPA e no hospital após a cirurgia foram registrados. Os testes de Mann-Whitney, qui-quadrado e exato de Fisher foram usados para comparação.RESULTADOS: Os indivíduos de ambos os grupos de pacientes do estudo tinham uma média de idade de 56 anos, 25% eram do sexo masculino e 59% foram submetidos à cirurgia intra-abdominal. Os pacientes com alto risco de apneia obstrutiva do sono apresentavam uma mediana maior do índice de massa corporal (31 versus 24 kg/m2, p < 0,001) e comorbidades mais frequentes, como hipertensão (58% vs. 24%, p < 0,001), dislipidemia (46% vs. 17%, p < 0,001) e diabetes melito dependente de insulina (17% vs. 2%, p = 0,004). Esses pacientes foram submetidos com mais frequência à cirurgia bariátrica (20% vs. 2%, p = 0,002). Os pacientes com alto risco de apneia obstrutiva do sono apresentaram mais eventos respiratórios adversos (39% vs. 10%, p < 0,001), dessaturação de leve a moderada (15% vs. 0%, p = 0,001) e incapacidade de respirar profundamente (34% vs. 9%, p = 0,001).CONCLUSÕES: Após a anestesia geral, os pacientes com alto risco de apneia obstrutiva do sono apresentaram um aumento da incidência de complicações respiratórias no período pós-operatório.

Presence of Hernia Sac in Prediction of Postoperative Outcome in Congenital Diaphragmatic Hernia.

We conducted this study to assess the value of presence of hernia sac in prediction of postoperative outcome in congenital diaphragmatic hernia (CDH). Data were obtained form medical records of 70 children operated for CDH between 2002-12. Postoperative neonatal death occurred in 1/10 (10%) of infants with a hernia sac and 26/60 (43.3%) in cases without a hernia sac, respectively (P =0.04). Perinatal morbidity in surviving infants was lower in the group with a hernia sac although not significantly. We conclude that the presence of a hernia sac is associated with better postoperative outcome and overall prognosis of CDH.

Initial Experience Using Gasless Transaxillary Robotic Thyroidectomy by a Single Surgeon / 대한내분비외과학회지

PURPOSE: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. METHODS: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. RESULTS: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61~310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31~270). The mean number of LN resected was 3.9 (range 0~28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2~7). CONCLUSION: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy.

Effects of different levels of hemodilution during extracorporeal circulation on lactic acid and postoperative outcomes in children with congenital heart disease / 中国输血杂志

Objective To study the effects of different levels of hemodilution during extracorporeal circulation(ECC) on the concentration of lactic acid and postoperative outcome in children with congenital heart disease.Methods Sixty children with congenital heart diseases undergoing open heart surgery with ECC were randomly divided into three groups: groupⅠ(n=20) underwent mild hemodilution [Hb(80—90)g/L],groupⅡ(n=20) with medium hemodilution [Hb(70—79)g/L],and groupⅢ(n=20) with deep hemodilution [Hb(60—69)g/L].The concentration of lactic acid and PaO_2 in groupⅡ and group Ⅲ were compared with groupⅠ before ECC,during ECC,after ECC and 24h after the operation.The rate of homologous transfusion during ECC and the postoperative dosage of furosemide were also compared among the three groups.Results The concentrations of lactic acid and PaO2 in the three groups were all within normal range before ECC,during ECC,after ECC and 24h after operation.The homologous transfusion rate during ECC were lower in groupⅡ(30%)and groupⅢ(15%) compared to that of groupⅠ(50%)(P

Pharmacokinetics of Digoxin in Stomach Cancer Patients Undergoing a Gastrectomy under Enflurane Anesthesia / 대한마취과학회지

BACKGROUND: Sometimes digoxin may be needed to be administered during anesthesia for the control of the ventricular rate and mitigation of lung congestion. For the lack of studies in surgical patients we wanted to determine digoxin pharmacokinetics (PK) in subjects undergoing a gastrectomy under enflurane anesthesia. METHODS: Over 72 hours, 16 serum samples from each of 14 subjects (ASA status 1 or 2) diagnosed with gastric cancer were collected after a single intravenous dose of digoxin 10ng/kg actual body weight for serum concentration measurements by fluorescence polarization immunoassay. Digoxin was injected 30 minutes after beginning surgery. Two, three and non-compartmental (TwC, ThC and NC, respectively) PK parameters were determined using WinNonln. The important parameters (AUC, Cl, Vss, t beta 1/2 [elimination half-life], Vc, MRT) of 3 PK's were statistically evaluated about which compartment PK was appropriate to the data here. The parameters of TwC PK of the surgical subjects were compared to those of nonsurgical ones which had already been published by other investigators. The postoperative outcomes (ambulation date, diet date, discharge date, complications, APACHE II and MOF [multiple organ failure]) in 19 patients (nondigoxin group) not treated with digoxin were compared with 19 patients (digoxin group) treated with digoxin 5ng/kg two times at 2 hour intervals during surgery. RESULTS: No significant differences were found in parameters between TwC and NC. Significant differences were observed in parameters of PK between ThC versus Twc and NC (P < 0.01). Cl and Vss of surgical subjects were larger than those of nonsurgical ones, and t beta 1/2 was similar. No significant effect of digoxin on postoperative outcomes was demonstrated. CONCLUSIONS: The dosage of digoxin for surgical patients should be titrated to the bleeding amount and the severity of surgical trauma because of larger Cl and Vss. The effect of digoxin on postoperative outcomes remains to be studied.

Clinical Outcome of Pterional Approach to the Anterior Communicating Artery Aneurysm Surgery According to Identification of H-Complex

OBJECTIVE: In case of the anterior communicating artery(A-com A) aneurysm surgery with pterional approach, complete identification of A-com A complex(H-complex) has been thought to be important and influence the clinical results. The authors present a retrospetive analysis to determine the significance of identification of H-complex in A-com A surgery. METHODS: We analysed 90 cases among 116 cases that were operated the A-com A aneurysm with pterional approach from June 1993 to May 1998. The cases were classified according to aneurysmal direction, size, and placement of A1-A2 junction by preoperative angiogram and intraoperative findings. RESULTS: Incomplete visualization of H-complex was influenced by the approach side to the anteriorly placed A1-A2 junction, larger than 11mm in aneurysmal size and superior or posterior direction of aneurysm. Postoperative outcome was influenced by Hunt-Hess grade, and seemed to be better when the approach was performed to side of the posteriorly placed A1-A2 junction with or without dominant A1, but aneurysmal direction was not concerned with postoperative outcome. CONCLUSION: The results suggest that in A-com A aneurysm surgery with pterional approach, careful evaluation of preoperative angiogram and approach to the side of the posteriorly placed A1-A2 junction lead to better outcome.

Clinical Characteristics of Chronic Sinusitis with Asthma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis has been closely related to bronchial asthma. We investigated clinical characteristics of chronic sinusitis including the extent of disease, radiographic findings, subjective sinusitis symptoms, and postoperative outcome in sinusitis patients with asthma, and compared them with those without asthma. MATERIALS AND METHODS: 24 sinusitis patients with asthma and 103 patients without asthma who underwent endoscopic sinus surgery were evaluated. We compared the following 7 parameters between asthma and non-asthma group : presence of allergy, previous sinus surgery, degree of preoperative polyposis, preoperative disease extent scored with OMU CT findings, severity of sinusitis symptoms, patients' sinusitis symptom changes, and postoperative outcome. Postoperative outcome was evaluated by examining the endoscopic findings in 99 patients (asthma group '. 21, non-asthma group 78) who were followed up for more than 6 months. Patients sinusitis symptom changes were also compared before and after surgery in each group. RESULTS: Patients of both groups showed improvement of sinusitis symptoms after surgery. There were no statistical differences between the two groups on the presence of allergy, previous sinus surgery, preoperative polyposis, preoperative OMU CT scores, and severity of sinusitis symptoms. However, asthma group showed poorer postoperative outcome, which was statistically significant, compared with those without asthma. CONCLUSION: Chronic sinusitis with asthma is characterized by poorer postoperative outcome, but there were no differences in the extent of preoperative diseases, allergy, or previous sinus surgery between the two groups. Adequate preoperative management, close attention during surgery and careful endoscopic postsurgical follow-ups would be necessary for patients with chronic sinusitis with asthma.

Clinical Analysis of Spinal Cord Tumors:Review of 105 Cases(981-1991)

The authors analyzed 105 cases of spinal cord tumor in regarding to the age, sex, location and distribution, clinical presentation and postoperative outcome. They were confirmed by pathologic study at the Kyung Hee Medical Cented from 1981 to 1991. The incidence of spinal cord tumors was slightly predominant in males. The most commom tumor was neurogenic tumor. The neurogenic tumor composed 43.8%(46 cases), and the rests were meningioma 15.2%(16 case), metstasis 10.5%(11 cases) and others. The tumor were located most frequently in the thoracic area(31.4%) and in the intradural extramedullary space(56.1%). Most common initial symptom of spinal cord tumors were pain and it's mean duration was 8.3 month. The patients were assigned to one of four groups according to their neurologic deficit. About 66.6%(70 cases) of the patients were included in Groups I and II(mild neurologic deficit), and others were classified in Groups III and IV(significant to severe neurologic deficit). Complete tumor removal was achieved in 70.4%(4 cases) of the patients, and subtotal removal was performed in 26.7%(28 cases), and biopsy was performed in 2.9%(3 cases). Among the 105 patients, the postoperative outcomes on dischage were recovery in 36 cases(34.3%), improved in 45 cases(42.9%), stationary state in 12 cases(11.4%), and progression in 12 cases(11.4%).