Adverse Events and Risk Factors of Blood Transfusion in Cardiovascular Surgery: A Prospective Cohort Study

Abstract Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients' groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.

Prevention and management of ophthalmic anaesthesia-related complications / 中华实验眼科杂志

Advances in ophthalmic surgery,together with achieving greater patient safety,have changed the requirements,methods and choice of regional anaesthesia of the eyes.So far,there still lacks of an absolutely safe ophthalmic regional block method,and the intraoperative anesthesia method depends on the needs of the surgeon and the expectations and the cooperation of the patients.The majority of ophthalmic procedures can be performed under regional anesthesia,but the proximity of important structures,such as the blood vessels,optic nerve and the brainstem,leads to increased risks associated with these blocks.The most serious one of these complications is brainstem anesthesia.An clear and full understanding of these complications,which may sometimes be life-threatening,is thus vital to the anesthesia practitioner.Procedural improvements include a close evaluation of the precise anatomy of the region,with particular attention to injection sites,depth of injection,position of the eyeball,and techniques to avoid nerve damage and accidental injection into surrounding structures,including blood vessels,eyeball and cerebrospinal fluid.To emphasize the importance of the prevention,recognition and management of these complications,which includes the extremely serious complication of brainstem anesthesia.

The effect of preoperative carbohydrate administration on postoperative insulin resistance and immune function in patients after gastroenteric tumor resection / 中国医师杂志

Objective To investigate the effect of preoperative carbohydrate fluid intake on postoperative insulin resistance and immune function.Methods Sixty elective gastroenteric tumor resection patients were randomly divided into test (n =30) and control (n =30) groups.Control group were fasted before surgery,while test group were given oral carbohydrate before surgery.The blood samples were collected to measure the levels of fasting blood glucose (FBG),fasting insulin (FINS),and cellular immunity (CD3 +,CD4 +,CD8 +,and CD4 +/CD8 +) before operation and 1,3,7 day postoperation,respectively.Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance.Results Compared to preoperation,the levels of CD4 +,CD4 + / CD8 +,and HOMA-IR at 1 day postoperation in both control and test groups were significantly higher (P ＜ 0.05).Compared to test group,the levels of CD4 +,CD4 +/CD8 +,and HOMA-IR at 1,3 day postoperation in control group were significantly higher (P ＜ 0.05).At the seventh day after surgery,HOMA-IR levels in the test group were returned to the preoperative level (P ＞ 0.05),while the control group was still higher than before surgery (P ＜ 0.05).There were no differences in CD4 + and CD4+/CD8 + at seventh days after surgery between two groups (P ＞ 0.05).Conclusions Preoperative carbohydrate administration may shorten the insulin resistance duration after gastrointestinal cancer surgery,reduce the intensity of insulin resistance,and improve immune function.Thus contributes to the rehabilitation of patients.

Tratamento fisioterapêutico no pós-operatório de laparotomia / Physioterapeutic treatment in postoperative of laparotomy

Objetivo - As complicações respiratórias são comuns em pacientes submetidos à cirurgia de laparotomia e essas complicações podem ser diminuídas ou evitadas aplicando-se protocolos de tratamento de fisioterapia respiratória no pós-operatório. O objetivo da presente pesquisa foi verificar a resposta do tratamento da fisioterapia respiratória em pacientes no primeiro dia pós-operatório de laparotomia. Verificando possíveis alterações no volume minuto (VM), volume corrente (VC), pressão inspiratória máxima (Pimáx) e pressão expiratória máxima (Pemáx),e na dor pós-tratamento fisioterapêutico. Métodos - Dezenove pacientes, no primeiro dia de pós-operatório, realizaram uma única sessão de fisioterapia, na qual foram submetidos a um protocolo de tratamento composto de incentivador respiratório, exercícios de reexpansão pulmonar, além de propriocepção diafragmática. A dor, VM, VC, Pimáx e Pemáx foram avaliados pré e pós-tratamento. Resultados - A amostra foi constituída em suas maiores porcentagens do sexo feminino (57,90%) e média de idade de 42 anos. As laparotomias mais frequentes na população estudada foi a colecistectomia seguida de laparotomia exploradora. Houve aumento da dor no pós-tratamento, provavelmenteem decorrência das próprias técnicas fisioterapêuticas e obteve-se aumento do volume minuto, volume corrente, pressão inspiratória máxima e pressão expiratória máxima apresentaram-se significativamente maior no pós-tratamento. Conclusões - A resposta do tratamento da fisioterapia respiratória em pacientes no primeiro pós-operatório de laparotomia, contribuiu para a melhora do quadro respiratório, no que diz respeito ao volume corrente e minuto, e nas pressões inspiratórias e expiratórias máximas, porém foi evidenciado aumento do quadro de dor após o procedimento fisioterapêutico.

Objective - Respiratory complications are common in patients who underwent laparotomy and these complications can be minimized or avoided by applying treatment protocols for respiratory therapy postoperatively. The objective of this research was to assess the treatment response of respiratory therapy in patients in the first postoperative day, laparotomy. Also, check for possible changes in minute volume (MV), tidal volume (VT), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), and pain after physical therapy. Methods - Nineteen patients in the first days after surgery, underwent a single session of physiotherapy, which underwent a treatment protocol consisting of incentive spirometry, lung re-expansion exercises, and diaphragmatic proprioception. Pain, MV, VC, MIP and MEP were assessed beforeand after treatment. Results - The sample included in their higher percentages of females (57.90%) and average age of 42. The most frequent laparotomies in the study population was followed by laparotomy cholecystectomy. There was increased pain after treatment, probably as a result of his physical therapy techniques and obtained an increase in minute volume, tidal volume, inspiratory pressure and maximal expiratory pressure were significantly higher in post-treatment. Conclusions - The response of the treatment of respiratory therapy in patients in the first postoperative laparotomy, contributed to the improvement of respiratory symptoms in relation to tidal volume and minute, and maximum inspiratory and expiratory pressures, but the increase was evidenced picture of pain after the procedure physiotherapy.

Outcomes of Hepatic Resection Using Intermittent Hepatic Vascular Inflow Occlusion with Low Central Venous Pressure / 한국간담췌외과학회지

PURPOSE: Blood loss and transfusions during a liver resection are associated with higher morbidity and mortality rates. With applying hepatic vascular inflow occlusion (Pringle maneuver), persistent bleeding during a hepatic transection is caused by back flow from the hepatic veins. Therefore, low central venous pressure facilitates to reduce-bleeding from the hepatic veins by lowering the back flow pressure gradient. An intermittent hepatic vascular inflow occlusion was applied, with a lowering of the central venous pressure, during a hepatic resection in our series of patient. The effect of these maneuvers in reducing bleeding and the postoperative complication rates were analyzed. METHODS: Between December 2000 and September 2003, in 153 hepatic resection patients, where this technique was used, the intermittent vascular inflow occlusion and maintenance of the central venous pressure as low as possible were accrued in this study. The overall outcomes of patients that had a hepatic resection, focusing on the amount of bleeding, blood product transfusion and complication rates, were analyzed. RESULTS: The median blood loss was 652.5 ml, and 111 patients (72.5%) required no perioperative blood transfusion. The median units of blood required in the patients who needed a transfusion were 2.3 U. There was no evidence of renal derangement related with low blood flow into the kidney by keeping central venous pressure as low as possible. There were minor complications in 34 patients (22.4%) and two in-hospital mortalities (1.3%) associated with hepatic failure in cirrhotics. CONCLUSION: A hepatic resection, with an intermittent Pringle maneuver and a low central venous pressure, is a very simple and effective modality to reduce bleeding during a hepatic transection, with low morbidity and mortality rates and without hepatic and renal dysfunctions.