Approximately 40% of pheochromocytoma and paraganglioma(PPGL) cases are familial, typically presenting earlier with more complex symptoms. This paper synthesizes literature and guidelines to inform on clinical charact...Approximately 40% of pheochromocytoma and paraganglioma(PPGL) cases are familial, typically presenting earlier with more complex symptoms. This paper synthesizes literature and guidelines to inform on clinical characteristics and perioperative care for PPGL. Pheochromocytoma in von Hippel-Lindau(VHL) disease exhibits heightened secretion activity without significant perioperative hemodynamic changes. Tumors in multiple endocrine neoplasia type 2(MEN2) have a stronger endocrine function, which may induce hemodynamic fluctuations during surgery. Therefore, pheochromocytoma screening is essential at all stages of MEN2. Neurofibromatosis type 1(NF1) often presents multisystem lesions and can result in difficult airway. Pheochromocytoma should be evaluated when NF1 patients present hypertension. Pheochromocytoma and paraganglioma type 5 may present multiple lesions of pheochromocytoma or paraganglioma. In summary, hereditary PPGLs may present with severe lesions in other systems, beyond tumor function. A multi-disciplinary team(MDT) approach is often invaluable in perioperative management.展开更多
1 Background Over the last 20 years, the number of older adults requiring surgical interventions has substantially increased and will continue to escalate as the population ages. Perioperative management of older pati...1 Background Over the last 20 years, the number of older adults requiring surgical interventions has substantially increased and will continue to escalate as the population ages. Perioperative management of older patients poses challenges not encountered in younger individuals. People over 70 years of age are more likely to have multiple comorbidities, physical and cognitive impairments, and reduced cardiac, pulmonary, and renal reserve. These factors predispose older patients to increased risk for perioperative complications and prolonged length of hospital stay, which in turn increase risk for iatrogenesis, nosocomial infections, and perioperative mortality.展开更多
Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 20...Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 2023)were screened and divided into two groups randomly.Each group consisted of 30 cases.The perioperative routine was used in the control group.The observation group underwent the perioperative routine along with better respiratory care.Oxygenation indicators,surgical complications,and family satisfaction levels of the groups were compared.Results:There was no significant difference in the oxygenation index between the two groups of children at admission(P>0.05).At discharge,the oxygenation indicators in the observation group were better than those of the control group,and the incidence of surgical complications was lower than that of the control group.The total satisfaction of family members in the observation group was higher than that of the control group(P<0.05).Conclusion:During the perioperative period for children with congenital heart disease,the implementation of respiratory care,which mainly involves symptomatic care,catheter care,sputum suction care,etc.,can actively improve the oxygenation indicators,reduce surgical complications,and promote faster and better recovery,of children with congenital heart disease.展开更多
Background:This study aimed to evaluate the effectiveness of using animation as education material for family empowerment program on perioperative care for caregivers whose children were to undergo neurosurgery.Method...Background:This study aimed to evaluate the effectiveness of using animation as education material for family empowerment program on perioperative care for caregivers whose children were to undergo neurosurgery.Methods:A total of 204 caregivers were randomly assigned to either the face‐to‐face oral nursing educated group(Oral Group)or the animation‐assisted nursing educated group(Animated Group).The nursing education primarily focused on instructing caregivers about the manual vibration method.The primary outcome of interest in this study was participants'knowledge level,collected by a 10‐item questionnaire.Secondary outcomes included child patients'clinical data,including hospitalization days,treatments,and signs of pneumonia.Results:Participants in the Animated Group exhibited significantly higher accuracy in perioperative care knowledge assessment,and patients in this group had a lower chance of requiring atomization therapy compared to the Oral Group.Conclusions:The animation‐assisted nursing education program effectively enhances pediatric caregivers'knowledge,reduces respiratory complications after surgery,and offers valuable insights for future studies on the use of such programs to instruct caregivers.展开更多
Hip replacement(HA)is mainly indicated for the elderly,who generally suffer from various underlying diseases such as hypertension.This article provides a review of the key points of perioperative nursing care for pati...Hip replacement(HA)is mainly indicated for the elderly,who generally suffer from various underlying diseases such as hypertension.This article provides a review of the key points of perioperative nursing care for patients with hyper-tension undergoing HA.It analyzes the key points of care during the periop-erative period(preoperative,intraoperative,and postoperative)and proposes directions for the development of perioperative nursing care for HA.The pro-gnosis for patients can be improved through the modification of traditional medical approaches and the application of new technologies and concepts.展开更多
Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. ...Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.展开更多
BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate ...BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.展开更多
In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative...In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative counseling,dietary optimization,minimally invasive procedures,and early postoperative mobilization,these protocols have ushered in a new era of surgical care.Despite encountering hurdles like resistance to change and resource allocation challenges,the efficacy of ERAS protocols in improving clinical outcomes is undeniable.Noteworthy benefits include shortened hospital stays and bolstered improved patient-safety measures.Looking ahead,the horizon for ERAS in orthopedics appears bright,with an emphasis on tailoring care to individual needs,integrating cutting-edge technologies,and perpetuating research endeavors.This shift towards a more personalized,streamlined,and cost-efficient model of care underscores the transformative potential of ERAS in reshaping not only orthopedic surgery but also the journey to patient recovery.This editorial details the scope and future of ERAS in the orthopedic specialty.展开更多
AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation pro...AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.展开更多
Artificial intelligence(AI)demonstrated by machines is based on reinforcement learning and revolves around the usage of algorithms.The purpose of this review was to summarize concepts,the scope,applications,and limita...Artificial intelligence(AI)demonstrated by machines is based on reinforcement learning and revolves around the usage of algorithms.The purpose of this review was to summarize concepts,the scope,applications,and limitations in major gastrointestinal surgery.This is a narrative review of the available literature on the key capabilities of AI to help anesthesiologists,surgeons,and other physicians to understand and critically evaluate ongoing and new AI applications in perioperative management.AI uses available databases called“big data”to formulate an algorithm.Analysis of other data based on these algorithms can help in early diagnosis,accurate risk assessment,intraoperative management,automated drug delivery,predicting anesthesia and surgical complications and postoperative outcomes and can thus lead to effective perioperative management as well as to reduce the cost of treatment.Perioperative physicians,anesthesiologists,and surgeons are well-positioned to help integrate AI into modern surgical practice.We all need to partner and collaborate with data scientists to collect and analyze data across all phases of perioperative care to provide clinical scenarios and context.Careful implementation and use of AI along with real-time human interpretation will revolutionize perioperative care,and is the way forward in future perioperative management of major surgery.展开更多
Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biom...Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients.展开更多
Individualized nursing care addresses the needs,experiences,behaviors,feelings,and perceptions of patients and families,but its implementation in clinical practice contexts remains challenging.This review aims to map ...Individualized nursing care addresses the needs,experiences,behaviors,feelings,and perceptions of patients and families,but its implementation in clinical practice contexts remains challenging.This review aims to map the factors that interfere with the individualization of nursing care,in acute medical and perioperative settings.Scoping review was conducted according to the Joanna Briggs Institute guidelines.The MEDLINE,CINAHL,Cochrane,SciELO,Scientific Repository of Open Access,and LILACS databases were searched for publications from January 2017 up to March 2023.Of the 124 articles selected,17 met the inclusion criteria.The individualization of nursing care is complex and shaped by multiple variables in the care environment,nursing,and patient characteristics.The institutional organization,the nurses’expertise,and the patient’s attributes were identified as variables that interfere with the individualization of nursing care.Individualized nursing care is responsible for better quality of care and health outcomes.The identification of the variables that affect individualized care contributes to planning programs to improve individualization,during hospitalization and the discharge.展开更多
BACKGROUND Pancreatoduodenectomy represents a complex procedure involving extensive organ resection and multiple alimentary reconstructions.It is still associated with high morbidity,even in high-volume centres.Predic...BACKGROUND Pancreatoduodenectomy represents a complex procedure involving extensive organ resection and multiple alimentary reconstructions.It is still associated with high morbidity,even in high-volume centres.Prediction tools including preoperative patient-related factors to preoperatively identify patients at high risk for postoperative complications could enable tailored perioperative management and improve patient outcomes.AIM To evaluate the clinical significance of preoperative albumin-bilirubin score and other risk factors in relation to short-term postoperative outcomes in patients after open pancreatoduodenectomy.METHODS This retrospective study included all patients who underwent open pancreatic head resection(pylorus-preserving pancreatoduodenectomy or Whipple resection)for various pathologies during a five-year period(2017-2021)in a tertiary care setting at University Medical Centre Ljubljana,Slovenia and Cattinara Hospital,Trieste,Italy.Short-term postoperative outcomes,namely,postoperative complications,postoperative pancreatic fistula,reoperation,and mortality,were evaluated in association with albumin-bilirubin score and other risk factors.Multiple logistic regression models were built to identify risk factors associated with these short-term postoperative outcomes.RESULTS Data from 347 patients were collected.Postoperative complications,major postoperative complications,postoperative pancreatic fistula,reoperation,and mortality were observed in 52.7%,22.2%,23.9%,21.3%,and 5.2%of patients,respectively.There was no statistically significant association between the albumin-bilirubin score and any of these short-term postoperative complications based on univariate analysis.When controlling for other predictor variables in a logistic regression model,soft pancreatic texture was statistically significantly associated with postoperative complications[odds ratio(OR):2.09;95%confidence interval(95%CI):1.19-3.67];male gender(OR:2.12;95%CI:1.15-3.93),soft pancreatic texture(OR:3.06;95%CI:1.56-5.97),and blood loss(OR:1.07;95%CI:1.00-1.14)were statistically significantly associated with major postoperative complications;soft pancreatic texture was statistically significantly associated with the development of postoperative pancreatic fistula(OR:5.11;95%CI:2.38-10.95);male gender(OR:1.97;95%CI:1.01-3.83),soft pancreatic texture(OR:2.95;95%CI:1.42-6.11),blood loss(OR:1.08;95%CI:1.01-1.16),and resection due to duodenal carcinoma(OR:6.58;95%CI:1.20-36.15)were statistically significantly associated with reoperation.CONCLUSION The albumin-bilirubin score failed to predict short-term postoperative outcomes in patients undergoing pancreatoduodenectomy.However,other risk factors seem to influence postoperative outcomes,including male sex,soft pancreatic texture,blood loss,and resection due to duodenal carcinoma.展开更多
Background:Most outcome studies in congenital cardiac surgery for“low weight”neonates include patients undergoing surgery without cardiopulmonary bypass(CPB).The primary objective of our study was to identify risk f...Background:Most outcome studies in congenital cardiac surgery for“low weight”neonates include patients undergoing surgery without cardiopulmonary bypass(CPB).The primary objective of our study was to identify risk factors for in-hospital mortality in neonates weighing less than 3 Kg and undergoing surgery with CPB.In addition,we compared the effect of early surgery with CPB(before 37W-gestational age(GA))for congenital heart disease to delayed surgery until a corrected GA of 37 weeks in an attempt to promote weight gain.Methods:Retrospective single-center study including all patients operated between 1997 and 2017.Uni-and multivariable analysis were used to analyze outcome.Results:143 patients were included.The median weight was 2.7 Kg and 49(34.3%)weighted<2.5 Kg.80%of the patients were Risk stratification STAT categories≥3.114 patients(80%)were operated without delay(usual timing,median age 9 days),whereas 29 patients(20%)entered a delayed strategy(median age 30 days).In-hospital mortality was 21.7%.By multivariate analysis,dysmaturity,preoperative positive ventilation,post-operative ECMO requirement or resuscitation,and any residual lesion were predictors of in-hospital death.In-hospital mortality in the usual timing group and the delayed group were 21.1%and 24.1%,respectively(p=0.71).In-hospital mortality for neonates operated prior to 37W-GA(n=10)was 27.3%.Conclusions:Predictors of in-hospital mortality in neonates less 3 Kg requiring CPB surgery did not differ from those unveiled in other contemporary studies.Our data demonstrates that a strategy of delaying surgery in selected patients resulted in similar clinical outcome.展开更多
Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patie...Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent epicardial LAAL from 2014-2019 (median CHA<sub>2</sub>DS<sub>2</sub>-VASc score = 4.0). There were 251 and 228 patients discharged with and without AC, respectively, who were followed for 30 days. Patients were matched via 1:1 Propensity Score Matching (PSM;n = 115 per group). Post-discharge outcomes included stroke, bleeding, readmission for cardiac re-intervention, mortality, and a composite endpoint comprised of the aforementioned outcomes. Results: There was no difference in post-discharge stroke incidence regardless of AC (adjusted cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC;p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003 - 0.057] with AC vs 0.009 CI [0.001 - 0.046] without AC;p = 0.738), readmission for cardiac re-intervention (ACI 0.009 CI [0.009 - 0.009] with AC vs 0 CI [NA] without AC;p = 0.340, post-discharge mortality (ACI 0 CI NA with AC vs 0.009 CI [0.001 - 0.046] without AC;p = 0.123, or in the composite outcome (ACI 0.026 CI [0.007 - 0.069] with AC vs 0.027 CI [0.007 - 0.071] without AC;p = 0.824. Conclusion: Cessation of AC in patients with elevated stroke risk following epicardial LAAL during cardiac surgery does not affect stroke rate, mortality, or bleeding incidence up to 30 days post-discharge in this preliminary analysis.展开更多
To investigate the additional clinical impact of hepatic ischaemia reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI) following liver transplantation. METHODSThis was a single-centre retrospect...To investigate the additional clinical impact of hepatic ischaemia reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI) following liver transplantation. METHODSThis was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation (OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT (> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration (CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase (AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor (< 1000 IU/L), moderate (1000-5000 IU/L) or severe (> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications (AKI and HIRI) alone and then as a combined outcome. RESULTSOut of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustained moderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively (P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation (P < 0.001) and intensive care length of stay (P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication (P = 0.049). CONCLUSIONHIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.展开更多
Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experienc...Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experience significant postoperative morbidity and full recovery after surgery takes longer than we think. In recent years, enhanced recovery pathways incorporating a large number of evidence-based perioperative interventions have proved to be beneficial i n t e r m s o f i m p rove d p o s t o p e ra t i ve o u t c o m e s, and accelerated patient recovery in the context of gastrointestinal, genitourinary and orthopedic surgery. The role of these pathways for pancreatic surgery is still unclear as high-quality randomized controlled trials are lacking. To date, non-randomized studies have shown that care pathways for pancreaticoduodenectomy and distal pancreatectomy are safe with no difference in postoperative morbidity, leading to early discharge and no increase in hospital readmissions. Hospital costs are reduced due to better organization of care and resource utilization. However, further research is needed to clarify the effect of enhanced recovery pathways on patient recovery and post-discharge outcomes following pancreatic resection. Future studies should be prospective and follow recent recommendations for the design and reporting of enhanced recovery pathways.展开更多
Patients are often nervous prior to surgery and females might suffer the most. Increased nervousness needs attention as it can negatively affect postoperative recovery. Support from nurses, i.e. being present, attenti...Patients are often nervous prior to surgery and females might suffer the most. Increased nervousness needs attention as it can negatively affect postoperative recovery. Support from nurses, i.e. being present, attentive, empowering and helpful to the patient, and talking about what is on the patient’s mind, might help to reduce nervousness. However, there is a lack of evidence as to the ideal level of attention and resources to reduce preoperative nervousness. The objective of the current study was to compare a range of care combinations with standard care to female patients prior to sedation and cancer surgery primarily on difference in change in nervousness from admission until sedation before cancer surgery, measured on a Visual Analouge Scale. Using simple randomization and numbers in sealed envelopes, adult gynaecological patients scheduled for open cancer surgery were allocated to care provided by a nurse anaesthetist and: A) a surgical nurse, B) no additional care, C) a known nurse , and D) a relative. Only the statistician was blinded. The trial stopped when the calculated numbers were included. In the full analysis set, compared to standard care A) (n = 61), we observed the following mean changes and [95% confidence intervals]: B) (n = 65) 1.05 [CI: 0.298 to 1.794] with p = 0.006, C) (n = 61): -0.38 [-1.140 to 0.385] with p = 0.330, D) (n = 71): 0.23 [-0.498 to 0.967] with p = 0.528. Female cancer patients will benefit from supportive care by a surgical nurse from the time of arrival on the operating ward plus supportive care from a nurse anesthetist from 5 - 10 minutes after entering the operating ward. It is not recommended at any time to rely fully on the support of relatives. The effect on adults of preoperative painful procedures and patients’ time alone on the operating ward should be further investigated.展开更多
Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that ...Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells(such as monocytes, neutrophils, and specific tissue macrophages) with release of pro-or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.展开更多
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)for peritoneal surface malignancy can effectively control the disease,however it is also associated with adverse effects which m...BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)for peritoneal surface malignancy can effectively control the disease,however it is also associated with adverse effects which may affect quality of life(QoL).AIM To investigate early perioperative QoL after CRS/HIPEC,which has not been discussed in Taiwan.METHODS This single institution,observational cohort study enrolled patients who received CRS/HIPEC.We assessed QoL using the Taiwan residents version of the MD Anderson Symptom Inventory(MDASI-T)and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire(EORTC QLQ-C30).Participants completed the questionnaires before CRS/HIPEC(S1),at the first outpatient follow-up(S2),and 3 mo after CRS/HIPEC(S3).RESULTS Fifty-eight patients were analyzed.There was no significant perioperative difference in global health status.Significant changes in physical and role functioning scores decreased at S2,and fatigue and pain scores increased at S2 but returned to baseline at S3.Multiple regression analysis showed that age and performance status were significantly correlated with QoL.In the MDASI-T questionnaire,distress/feeling upset and lack of appetite had the highest scores at S1,compared to fatigue and distress/feeling upset at S2,and fatigue and lack of appetite at S3.The leading interference items were working at S1 and S2 and activity at S3.MDASI-T scores were significantly negatively correlated with the EORTC QLQ-C30 results.CONCLUSION QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC.Our findings can help with preoperative consultation and perioperative care.展开更多
文摘Approximately 40% of pheochromocytoma and paraganglioma(PPGL) cases are familial, typically presenting earlier with more complex symptoms. This paper synthesizes literature and guidelines to inform on clinical characteristics and perioperative care for PPGL. Pheochromocytoma in von Hippel-Lindau(VHL) disease exhibits heightened secretion activity without significant perioperative hemodynamic changes. Tumors in multiple endocrine neoplasia type 2(MEN2) have a stronger endocrine function, which may induce hemodynamic fluctuations during surgery. Therefore, pheochromocytoma screening is essential at all stages of MEN2. Neurofibromatosis type 1(NF1) often presents multisystem lesions and can result in difficult airway. Pheochromocytoma should be evaluated when NF1 patients present hypertension. Pheochromocytoma and paraganglioma type 5 may present multiple lesions of pheochromocytoma or paraganglioma. In summary, hereditary PPGLs may present with severe lesions in other systems, beyond tumor function. A multi-disciplinary team(MDT) approach is often invaluable in perioperative management.
文摘1 Background Over the last 20 years, the number of older adults requiring surgical interventions has substantially increased and will continue to escalate as the population ages. Perioperative management of older patients poses challenges not encountered in younger individuals. People over 70 years of age are more likely to have multiple comorbidities, physical and cognitive impairments, and reduced cardiac, pulmonary, and renal reserve. These factors predispose older patients to increased risk for perioperative complications and prolonged length of hospital stay, which in turn increase risk for iatrogenesis, nosocomial infections, and perioperative mortality.
文摘Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 2023)were screened and divided into two groups randomly.Each group consisted of 30 cases.The perioperative routine was used in the control group.The observation group underwent the perioperative routine along with better respiratory care.Oxygenation indicators,surgical complications,and family satisfaction levels of the groups were compared.Results:There was no significant difference in the oxygenation index between the two groups of children at admission(P>0.05).At discharge,the oxygenation indicators in the observation group were better than those of the control group,and the incidence of surgical complications was lower than that of the control group.The total satisfaction of family members in the observation group was higher than that of the control group(P<0.05).Conclusion:During the perioperative period for children with congenital heart disease,the implementation of respiratory care,which mainly involves symptomatic care,catheter care,sputum suction care,etc.,can actively improve the oxygenation indicators,reduce surgical complications,and promote faster and better recovery,of children with congenital heart disease.
基金Technology Foundation Project of Shanghai Jiaotong University School of Medicine,Grant/Award Number:Jyhz2015。
文摘Background:This study aimed to evaluate the effectiveness of using animation as education material for family empowerment program on perioperative care for caregivers whose children were to undergo neurosurgery.Methods:A total of 204 caregivers were randomly assigned to either the face‐to‐face oral nursing educated group(Oral Group)or the animation‐assisted nursing educated group(Animated Group).The nursing education primarily focused on instructing caregivers about the manual vibration method.The primary outcome of interest in this study was participants'knowledge level,collected by a 10‐item questionnaire.Secondary outcomes included child patients'clinical data,including hospitalization days,treatments,and signs of pneumonia.Results:Participants in the Animated Group exhibited significantly higher accuracy in perioperative care knowledge assessment,and patients in this group had a lower chance of requiring atomization therapy compared to the Oral Group.Conclusions:The animation‐assisted nursing education program effectively enhances pediatric caregivers'knowledge,reduces respiratory complications after surgery,and offers valuable insights for future studies on the use of such programs to instruct caregivers.
文摘Hip replacement(HA)is mainly indicated for the elderly,who generally suffer from various underlying diseases such as hypertension.This article provides a review of the key points of perioperative nursing care for patients with hyper-tension undergoing HA.It analyzes the key points of care during the periop-erative period(preoperative,intraoperative,and postoperative)and proposes directions for the development of perioperative nursing care for HA.The pro-gnosis for patients can be improved through the modification of traditional medical approaches and the application of new technologies and concepts.
基金supported by the University of California Davis Health System Department of Anesthesiology and Pain Medicine,and NIH grant UL1 TR000002
文摘Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.
基金Supported by the Scientific Research Foundation of Peking University Shenzhen Hospital,No.KYQD2021096the National Natural Science Foundation of China,No.81972829Precision Medicine Research Program of Tsinghua University,No.2022ZLA006.
文摘BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.
文摘In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative counseling,dietary optimization,minimally invasive procedures,and early postoperative mobilization,these protocols have ushered in a new era of surgical care.Despite encountering hurdles like resistance to change and resource allocation challenges,the efficacy of ERAS protocols in improving clinical outcomes is undeniable.Noteworthy benefits include shortened hospital stays and bolstered improved patient-safety measures.Looking ahead,the horizon for ERAS in orthopedics appears bright,with an emphasis on tailoring care to individual needs,integrating cutting-edge technologies,and perpetuating research endeavors.This shift towards a more personalized,streamlined,and cost-efficient model of care underscores the transformative potential of ERAS in reshaping not only orthopedic surgery but also the journey to patient recovery.This editorial details the scope and future of ERAS in the orthopedic specialty.
基金Supported by Social Development Fund of Jiangsu Province,No. BS2007054
文摘AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.
文摘Artificial intelligence(AI)demonstrated by machines is based on reinforcement learning and revolves around the usage of algorithms.The purpose of this review was to summarize concepts,the scope,applications,and limitations in major gastrointestinal surgery.This is a narrative review of the available literature on the key capabilities of AI to help anesthesiologists,surgeons,and other physicians to understand and critically evaluate ongoing and new AI applications in perioperative management.AI uses available databases called“big data”to formulate an algorithm.Analysis of other data based on these algorithms can help in early diagnosis,accurate risk assessment,intraoperative management,automated drug delivery,predicting anesthesia and surgical complications and postoperative outcomes and can thus lead to effective perioperative management as well as to reduce the cost of treatment.Perioperative physicians,anesthesiologists,and surgeons are well-positioned to help integrate AI into modern surgical practice.We all need to partner and collaborate with data scientists to collect and analyze data across all phases of perioperative care to provide clinical scenarios and context.Careful implementation and use of AI along with real-time human interpretation will revolutionize perioperative care,and is the way forward in future perioperative management of major surgery.
基金supported by Emerging industry leading talent project of Shanxi Province(No.[2020]587)。
文摘Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients.
文摘Individualized nursing care addresses the needs,experiences,behaviors,feelings,and perceptions of patients and families,but its implementation in clinical practice contexts remains challenging.This review aims to map the factors that interfere with the individualization of nursing care,in acute medical and perioperative settings.Scoping review was conducted according to the Joanna Briggs Institute guidelines.The MEDLINE,CINAHL,Cochrane,SciELO,Scientific Repository of Open Access,and LILACS databases were searched for publications from January 2017 up to March 2023.Of the 124 articles selected,17 met the inclusion criteria.The individualization of nursing care is complex and shaped by multiple variables in the care environment,nursing,and patient characteristics.The institutional organization,the nurses’expertise,and the patient’s attributes were identified as variables that interfere with the individualization of nursing care.Individualized nursing care is responsible for better quality of care and health outcomes.The identification of the variables that affect individualized care contributes to planning programs to improve individualization,during hospitalization and the discharge.
文摘BACKGROUND Pancreatoduodenectomy represents a complex procedure involving extensive organ resection and multiple alimentary reconstructions.It is still associated with high morbidity,even in high-volume centres.Prediction tools including preoperative patient-related factors to preoperatively identify patients at high risk for postoperative complications could enable tailored perioperative management and improve patient outcomes.AIM To evaluate the clinical significance of preoperative albumin-bilirubin score and other risk factors in relation to short-term postoperative outcomes in patients after open pancreatoduodenectomy.METHODS This retrospective study included all patients who underwent open pancreatic head resection(pylorus-preserving pancreatoduodenectomy or Whipple resection)for various pathologies during a five-year period(2017-2021)in a tertiary care setting at University Medical Centre Ljubljana,Slovenia and Cattinara Hospital,Trieste,Italy.Short-term postoperative outcomes,namely,postoperative complications,postoperative pancreatic fistula,reoperation,and mortality,were evaluated in association with albumin-bilirubin score and other risk factors.Multiple logistic regression models were built to identify risk factors associated with these short-term postoperative outcomes.RESULTS Data from 347 patients were collected.Postoperative complications,major postoperative complications,postoperative pancreatic fistula,reoperation,and mortality were observed in 52.7%,22.2%,23.9%,21.3%,and 5.2%of patients,respectively.There was no statistically significant association between the albumin-bilirubin score and any of these short-term postoperative complications based on univariate analysis.When controlling for other predictor variables in a logistic regression model,soft pancreatic texture was statistically significantly associated with postoperative complications[odds ratio(OR):2.09;95%confidence interval(95%CI):1.19-3.67];male gender(OR:2.12;95%CI:1.15-3.93),soft pancreatic texture(OR:3.06;95%CI:1.56-5.97),and blood loss(OR:1.07;95%CI:1.00-1.14)were statistically significantly associated with major postoperative complications;soft pancreatic texture was statistically significantly associated with the development of postoperative pancreatic fistula(OR:5.11;95%CI:2.38-10.95);male gender(OR:1.97;95%CI:1.01-3.83),soft pancreatic texture(OR:2.95;95%CI:1.42-6.11),blood loss(OR:1.08;95%CI:1.01-1.16),and resection due to duodenal carcinoma(OR:6.58;95%CI:1.20-36.15)were statistically significantly associated with reoperation.CONCLUSION The albumin-bilirubin score failed to predict short-term postoperative outcomes in patients undergoing pancreatoduodenectomy.However,other risk factors seem to influence postoperative outcomes,including male sex,soft pancreatic texture,blood loss,and resection due to duodenal carcinoma.
文摘Background:Most outcome studies in congenital cardiac surgery for“low weight”neonates include patients undergoing surgery without cardiopulmonary bypass(CPB).The primary objective of our study was to identify risk factors for in-hospital mortality in neonates weighing less than 3 Kg and undergoing surgery with CPB.In addition,we compared the effect of early surgery with CPB(before 37W-gestational age(GA))for congenital heart disease to delayed surgery until a corrected GA of 37 weeks in an attempt to promote weight gain.Methods:Retrospective single-center study including all patients operated between 1997 and 2017.Uni-and multivariable analysis were used to analyze outcome.Results:143 patients were included.The median weight was 2.7 Kg and 49(34.3%)weighted<2.5 Kg.80%of the patients were Risk stratification STAT categories≥3.114 patients(80%)were operated without delay(usual timing,median age 9 days),whereas 29 patients(20%)entered a delayed strategy(median age 30 days).In-hospital mortality was 21.7%.By multivariate analysis,dysmaturity,preoperative positive ventilation,post-operative ECMO requirement or resuscitation,and any residual lesion were predictors of in-hospital death.In-hospital mortality in the usual timing group and the delayed group were 21.1%and 24.1%,respectively(p=0.71).In-hospital mortality for neonates operated prior to 37W-GA(n=10)was 27.3%.Conclusions:Predictors of in-hospital mortality in neonates less 3 Kg requiring CPB surgery did not differ from those unveiled in other contemporary studies.Our data demonstrates that a strategy of delaying surgery in selected patients resulted in similar clinical outcome.
文摘Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent epicardial LAAL from 2014-2019 (median CHA<sub>2</sub>DS<sub>2</sub>-VASc score = 4.0). There were 251 and 228 patients discharged with and without AC, respectively, who were followed for 30 days. Patients were matched via 1:1 Propensity Score Matching (PSM;n = 115 per group). Post-discharge outcomes included stroke, bleeding, readmission for cardiac re-intervention, mortality, and a composite endpoint comprised of the aforementioned outcomes. Results: There was no difference in post-discharge stroke incidence regardless of AC (adjusted cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC;p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003 - 0.057] with AC vs 0.009 CI [0.001 - 0.046] without AC;p = 0.738), readmission for cardiac re-intervention (ACI 0.009 CI [0.009 - 0.009] with AC vs 0 CI [NA] without AC;p = 0.340, post-discharge mortality (ACI 0 CI NA with AC vs 0.009 CI [0.001 - 0.046] without AC;p = 0.123, or in the composite outcome (ACI 0.026 CI [0.007 - 0.069] with AC vs 0.027 CI [0.007 - 0.071] without AC;p = 0.824. Conclusion: Cessation of AC in patients with elevated stroke risk following epicardial LAAL during cardiac surgery does not affect stroke rate, mortality, or bleeding incidence up to 30 days post-discharge in this preliminary analysis.
文摘To investigate the additional clinical impact of hepatic ischaemia reperfusion injury (HIRI) on patients sustaining acute kidney injury (AKI) following liver transplantation. METHODSThis was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation (OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT (> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration (CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase (AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor (< 1000 IU/L), moderate (1000-5000 IU/L) or severe (> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications (AKI and HIRI) alone and then as a combined outcome. RESULTSOut of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustained moderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively (P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation (P < 0.001) and intensive care length of stay (P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication (P = 0.049). CONCLUSIONHIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI.
文摘Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experience significant postoperative morbidity and full recovery after surgery takes longer than we think. In recent years, enhanced recovery pathways incorporating a large number of evidence-based perioperative interventions have proved to be beneficial i n t e r m s o f i m p rove d p o s t o p e ra t i ve o u t c o m e s, and accelerated patient recovery in the context of gastrointestinal, genitourinary and orthopedic surgery. The role of these pathways for pancreatic surgery is still unclear as high-quality randomized controlled trials are lacking. To date, non-randomized studies have shown that care pathways for pancreaticoduodenectomy and distal pancreatectomy are safe with no difference in postoperative morbidity, leading to early discharge and no increase in hospital readmissions. Hospital costs are reduced due to better organization of care and resource utilization. However, further research is needed to clarify the effect of enhanced recovery pathways on patient recovery and post-discharge outcomes following pancreatic resection. Future studies should be prospective and follow recent recommendations for the design and reporting of enhanced recovery pathways.
文摘Patients are often nervous prior to surgery and females might suffer the most. Increased nervousness needs attention as it can negatively affect postoperative recovery. Support from nurses, i.e. being present, attentive, empowering and helpful to the patient, and talking about what is on the patient’s mind, might help to reduce nervousness. However, there is a lack of evidence as to the ideal level of attention and resources to reduce preoperative nervousness. The objective of the current study was to compare a range of care combinations with standard care to female patients prior to sedation and cancer surgery primarily on difference in change in nervousness from admission until sedation before cancer surgery, measured on a Visual Analouge Scale. Using simple randomization and numbers in sealed envelopes, adult gynaecological patients scheduled for open cancer surgery were allocated to care provided by a nurse anaesthetist and: A) a surgical nurse, B) no additional care, C) a known nurse , and D) a relative. Only the statistician was blinded. The trial stopped when the calculated numbers were included. In the full analysis set, compared to standard care A) (n = 61), we observed the following mean changes and [95% confidence intervals]: B) (n = 65) 1.05 [CI: 0.298 to 1.794] with p = 0.006, C) (n = 61): -0.38 [-1.140 to 0.385] with p = 0.330, D) (n = 71): 0.23 [-0.498 to 0.967] with p = 0.528. Female cancer patients will benefit from supportive care by a surgical nurse from the time of arrival on the operating ward plus supportive care from a nurse anesthetist from 5 - 10 minutes after entering the operating ward. It is not recommended at any time to rely fully on the support of relatives. The effect on adults of preoperative painful procedures and patients’ time alone on the operating ward should be further investigated.
基金Supported by Brazilian Council for Scientific and Technological Development(CNPq)Carlos Chagas Filho Rio de Janeiro State Foundation(FAPERJ)+2 种基金Department of Science and Technology(DECIT)Brazilian Ministry of HealthCoordination for the Improvement of Higher Level Personnel(CAPES).
文摘Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells(such as monocytes, neutrophils, and specific tissue macrophages) with release of pro-or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.
基金Supported by Chang Gung Medical Foundation through grants,No.CMRPG6H0341-43.
文摘BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)for peritoneal surface malignancy can effectively control the disease,however it is also associated with adverse effects which may affect quality of life(QoL).AIM To investigate early perioperative QoL after CRS/HIPEC,which has not been discussed in Taiwan.METHODS This single institution,observational cohort study enrolled patients who received CRS/HIPEC.We assessed QoL using the Taiwan residents version of the MD Anderson Symptom Inventory(MDASI-T)and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire(EORTC QLQ-C30).Participants completed the questionnaires before CRS/HIPEC(S1),at the first outpatient follow-up(S2),and 3 mo after CRS/HIPEC(S3).RESULTS Fifty-eight patients were analyzed.There was no significant perioperative difference in global health status.Significant changes in physical and role functioning scores decreased at S2,and fatigue and pain scores increased at S2 but returned to baseline at S3.Multiple regression analysis showed that age and performance status were significantly correlated with QoL.In the MDASI-T questionnaire,distress/feeling upset and lack of appetite had the highest scores at S1,compared to fatigue and distress/feeling upset at S2,and fatigue and lack of appetite at S3.The leading interference items were working at S1 and S2 and activity at S3.MDASI-T scores were significantly negatively correlated with the EORTC QLQ-C30 results.CONCLUSION QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC.Our findings can help with preoperative consultation and perioperative care.
