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Chlebny T, Zelga P, Pryt M, Zelga M, Dziki A. Safe and uncomplicated inguinal hernia surgery in the elderly – message from anesthesiologists to general surgeons. POLISH JOURNAL OF SURGERY 2017; 89:5-10. [DOI: 10.5604/01.3001.0009.9149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Elderly patients are often discouraged from surgery due to the risk of complications that increases with age. Aim We wanted to assess mortality, morbidity, and complications in patients older than 75 years who underwent elective or emergency inguinal hernia repair in a single center. Methods All patients older than 75 years who were operated on because of inguinal hernia in the Department of General and Colorectal Surgery, Medical University of Lodz between 2003 and 2015 were analyzed. Detailed information was collected with regard to patient demographics, mode of admission, comorbidities, type of intervention, applied anesthesia, and 30-day outcomes. Postoperative outcomes included medical and surgical complications, readmissions, and survival status. Results One hundred thirty-two patients older than 75 years were operated on for inguinal hernia, 16 (12.1%) in an emergency setting and 116 (87.9%) in an elective setting. Eighteen patients (13.6%) developed complications, 8 (50%) in the emergency group, and 10 (8.6%) in the elective group. In the emergency group, severe medical complications (Clavien-Dindo 4) were frequent, whereas in the elective group, severity of surgical and medical complications was not significantly different (Clavien-Dindo median score 2, p=0.6084), and these complications were classified as mild (Clavien-Dindo 1-2). One death occurred in the emergency group. Conclusion Inguinal hernia surgery in the elderly may be safe and effective in an elective setting and if regional anesthesia is used. Careful examination of patients before surgery and identification of potential risk factors associated with co-existing diseases are vital for reducing the risk of complications. Key point: Hernia surgery in patients older than 65 years is a low-risk intervention, if carried out in an elective setting.
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Affiliation(s)
- Tomasz Chlebny
- Oddział Anestezjologii i Intensywnej Terapii, Uniwersytecki Szpital Kliniczny im. WAM – Centralny Szpital Weteranów,Łódź
| | - Piotr Zelga
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
| | - Mateusz Pryt
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
| | - Marta Zelga
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej, Uniwersytet Medyczny w Łodzi
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Kopić J. Volatile anaesthetics and cardiac protection in abdominal surgery. Wien Klin Wochenschr 2015; 127:543-8. [PMID: 26160319 DOI: 10.1007/s00508-015-0819-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/25/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical studies have shown that sevoflurane is cardio-protective in cardiac surgery patients, but this effect is doubtful in general surgery patients. This study has researched the influence of sevoflurane on the perioperative cardiac function and the incidence of cardiac ischaemic events in abdominal surgical patients. METHODS Out of 80 patients scheduled for elective colorectal surgery, 42 received balanced sevoflurane-fentanyl anaesthesia, while 38 received intravenous midazolam-fentanyl anaesthesia. The cardiac index (CI) and cardiac function index (CFI) were measured by the PiCCO device, and Troponin I levels were measured at the beginning of surgery, as well as 4, 12 and 24 h afterwards. BNP was measured at the beginning of surgery, and 24 h afterwards. The data analysis was conducted using the Mann-Whitney nonparametric test, with statistical significance set at p < 0.05. RESULTS There was no statistical difference in perioperative Troponin I, BNP, CI and CFI values between the SEVO and TIVA groups throughout the perioperative period. CONCLUSIONS Sevoflurane had no effect on the cardiac biomarkers Troponin I and BNP, and on the PiCCO parameters of cardiac function in abdominal surgical patients. Further research on the preconditioning effect of volatile anaesthetics in general surgical population should be concentrated on the population of patients with a high perioperative cardiac risk.
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Affiliation(s)
- Jasminka Kopić
- Anesthesiology and Intensive Care Ward, Dr. Josip Benčević General Hospital, Štamparova 42, 35000, Slavonski Brod, Croatia,
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Booker KJ, Holm K, Drew BJ, Lanuza DM, Hicks FD, Carrigan T, Wright M, Moran J. Frequency and Outcomes of Transient Myocardial Ischemia in Critically Ill Adults Admitted for Noncardiac Conditions. Am J Crit Care 2003. [DOI: 10.4037/ajcc2003.12.6.508] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia.• Objectives To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events.• Methods Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II.• Results A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P < .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P < .001) and cardiac events (P < .001) than did patients without.• Conclusions Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.
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Affiliation(s)
- Kathy J. Booker
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - Karyn Holm
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - Barbara J. Drew
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - Dorothy M. Lanuza
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - Frank D. Hicks
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - Tim Carrigan
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - Michelle Wright
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
| | - John Moran
- Millikin University, Decatur, Ill (KJB), DePaul University, Chicago, Ill (KH), University of California, San Francisco (BJD), University of Wisconsin, Madison (DML), Rush University, Chicago, Ill (FDH), Loyola University, Chicago, Ill (JM), University of Illinois, Chicago, Ill (TC), and St. Mary’s Hospital, Decatur, Ill (MW)
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