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Objective@#To analyze the characteristics of perioperative mortality (POM) in oral maxillofacial head and neck cancer patients.@*Methods@#A retrospective study was adapted for head and neck cancer patients who were treated and had POM in the department of oral maxillofacial & head and neck oncology in Shanghai Ninth People′s Hospital from Jan 1999 to Dec 2019. Demographic information, disease characteristic and clinical records were collected. The factors of POM were classified into surgical complication, medical complication, mixed complication (surgical and medical) and personal complication. SPSS 17.0 software was used to analyze the cause composition for POM under different condition.@*Results @# 55 patients were included: 39 were male, and 16 were female. A total of 12 patients had a smoking history. Furthermore, 28 patients had general comorbidities. 20 underwent preoperative radiotherapy and 9 received preoperative chemotherapy. Squamous cell carcinoma was the most frequent pathological diagnosis in 37 patients. A total of 9 patients had tumors in the maxilla and skull base. In addtition, 4 patients had POM preoperatively, 1 patient had POM within the operation, and 50 patients had POM postoperatively. The leading causes of death were as follows: rupture of the carotid artery was the most frequent (8), and the surgical complication of pulmonary infection was the main medical complication (6). Pulmonary infection and hemorrhage were regarded as the main mixed complication (4). Two patients had POM due to personal complications. The higher the American Society of Anesthesiologists (ASA) score, the higher the proportion of medical factors in POM (P=0.039).@*Conclusion@#The composition of POM in oral maxillofacial- head and neck cancer (OMHNC) patients was complicated. Carotid artery rupture was the most common and fatal surgical complication, especially for those who underwent preoperative radiotherapy. Pulmonary infection was the most frequent medical complication, and those who had a higher ASA grade tended to have more complication.
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Background: Shivering is commonly encountered both after regional and general anaesthesia (GA) with a little higher incidence in patients receiving GA. The aim of study was to compare the effectiveness of dexmedetomidine and tramadol in decreasing postoperative shivering in patients undergoing laparoscopic surgery.Methods: Total 120 patients were included in this study. In order to get a 5% level of significance and 80% power number of patients required in each group was 40, with a total of 120 patients. Randomization of groups was done based on closed envelope method. Patients were allocated into three groups group I, II and III of 40 patients each. Patients in group I and group II were administered 0.75 μg/kg of dexmedetomidine and 1.5 mg /kg of tramadol in 100 ml NS respectively half a before extubation, while patients in group III did not receive any pharmacological intervention.Results: All three groups were comparable regarding distribution of age, gender, ASA grade and temperature at beginning and end of surgery and were non-significant.Conclusions: Dexmedetomidine seems to possess anti-shivering properties and was found to reduce the occurrence of shivering in patients undergoing general anaesthesia with minimal side effects although its anti-shivering effect was not superior to tramadol.
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PURPOSE: Simultaneous bilateral total hip replacement (THR) has some advantages, but the efficacy of simultaneous bilateral THR is still controversial in patients with high risk ASA grade. Presently, we compared simultaneous bilateral to staged THR in high-risk patients according to the ASA grade. MATERIALS AND METHODS: We retrospectively compared 60 high risk patients (ASA grade 3 and 4) with simultaneous cementless total hip replacements with a matched group of 60 patients with staged cementless total hip replacements between January, 1991 and June, 2009. Significance was determined to be p-value < 0.05. RESULTS: Postoperative cardio-vascular complication was found in one case of simultaneous THR, and pulmonary thromboembolism was found in two cases of staged THR and in three cases of simultaneous THR. Wound infection was found in three cases of staged THR and in two cases of simultaneous THR. Delirium was found in four cases of staged THR and in five cases of simultaneous THR. Dislocation developed in two cases of staged THR and in three cases of simultaneous THR. Blood loss was higher in the staged group, but the transfusion amount was higher in the simultaneous group. Postoperative ambulation was initiated earlier in staged THR, but at the final follow-up no statistical significance was observed. Admission time and cost were reduced in simultaneous THR. CONCLUSION: It is considered safe to perform simultaneous cementless bilateral THA in patients with high anesthetic risk, if meticulous preoperative evaluation is done.