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Álvaro-Sánchez E. Nursing care in the postoperative period after Glenn surgery. A case report. Enferm Intensiva (Engl Ed) 2024; 35:146-158. [PMID: 37648600 DOI: 10.1016/j.enfie.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 09/01/2023]
Abstract
Glenn surgery is used as a palliative procedure in children with Hypoplastic Left Heart Syndrome (HLHS) and its objective is to partially redirect the systemic venous return. An individualized care plan is presented for a 7-month-old infant, admitted to the Pediatric Intensive Care Unit (PICU), after undergoing Glenn procedure. And is shown her evolution during admission. Marjorie Gordon's 11 functional health patterns are used for the nursing assessment, highlighting among the altered patterns, the nutritional-metabolic and the activity-exercise, due to their implication in hemodynamic changes derived from the surgery. Due to their association with the most common postoperative complications in this type of surgery, 8 diagnoses were prioritised according to NANDA-I taxonomy: risk for infection, excess fluid volume, risk for shock, risk for bleeding, risk for decreased cardiac output, impaired gas exchange, ineffective airway clearance and risk for ineffective cerebral tissue perfusion. In each of them, expected patient outcomes and nursing interventions, were selected using the NOC and NIC taxonomies, respectively. Outcome criteria scores showed a favourable evolution after 7 days from admission, only 3 of the diagnoses selected at the beginning remain active. The development and reassessment of the nursing care plan has made it possible to make an effective monitoring of patient's postoperative evolution and to standardize nursing care, ensuring safe and quality health care. The lack of similar case reports in available bibliography has prevented us from comparing actions, therefore it has been necessary to disclose these scientific articles to guarantee best evidence-based practice.
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Affiliation(s)
- Ester Álvaro-Sánchez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Reina Sofía, Córdoba, Spain.
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López Segura M, Busto-Aguirreurreta N. Postoperative agitation or delirium in paediatric patients. What we know and how to avoid it. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:467-472. [PMID: 37678453 DOI: 10.1016/j.redare.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/10/2022] [Indexed: 09/09/2023]
Abstract
Emergence delirium or postoperative agitation is the name given to the state of altered consciousness that occurs after surgery and especially affects pediatric patients. Its incidence is not negligible, reaching 80% of cases in certain studies. It is frequently confused with other clinical entities, for which reason a scale has been validated to facilitate its diagnosis. Risk factors include age under 5 years, the presence of pain after surgery and especially intense preoperative anxiety. Pediatric emergence delirium presents as an adverse event after surgery and influences patient safety by significantly increasing patient comorbidity. It is essential to recognize the entity, as well as its risk factors, in order to apply effective preventive measures to reduce its incidence and intensity when it occurs.
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Affiliation(s)
- M López Segura
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - N Busto-Aguirreurreta
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario de Navarra, Pamplona, Spain
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Çakıcı MÇ, Kazan Ö, Çiçek M, İplikçi A, Yıldırım A, Atış G. Predictive risk factors of urinary tract infection following flexible ureteroscopic lithotripsy. ARCH ESP UROL 2021; 74:503-510. [PMID: 34080570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. METHODS A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. RESULTS Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001) and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05). Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73-6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13-4.68, p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%. CONCLUSIONS Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.
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Affiliation(s)
- Mehmet Çağlar Çakıcı
- Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey
| | - Özgür Kazan
- Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey
| | - Muhammet Çiçek
- Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey
| | - Ayberk İplikçi
- Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey
| | - Asıf Yıldırım
- Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey
| | - Gökhan Atış
- Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey
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Alvarez L, Imbaquingo G, Rivadeneira MF, Reascos L. Validation of the translation and cross-cultural adaptation into Spanish of the Postoperative Nausea and Vomiting Intensity Scale. ACTA ACUST UNITED AC 2020; 67:538-544. [PMID: 32819752 DOI: 10.1016/j.redar.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing surgical procedures, generating patient dissatisfaction and increasing hospital costs. The Postoperative Nausea and Vomiting Intensity Scale identifies clinically significant cases; however, it has not been validated in Spanish. OBJECTIVE To carry out a cross-cultural adaptation of the PONV Intensity Scale into Spanish and validate it for use in the postoperative period of patients undergoing elective non-cardiac and non-intracranial surgery. MATERIALS AND METHODS Cross-sectional validation study of a diagnostic test. The NVPO Intensity Scale was culturally adapted to Spanish and administered to 393 adult hospitalized patients at 6 postoperative hours. The data were compared with the Apfel Scale and nausea measured on a visual analogue scale (VAS). Internal consistency and inter-observer concordance were calculated. RESULTS 59.8% of patients presented NVPO, of which 14.5% were clinically significant. An acceptable internal consistency was obtained for the NVPO Intensity Scale (Cronbach's alpha 0.7) and a high inter-observer correlation (Kappa 0.9, 95% CI 0.86-0.92), statistically significant, for the overall scale. The correlation with VAS was high (Rho Spearman 0.9). The mean VAS and Apfel scale score was significantly higher in patients with clinically significant PONV. CONCLUSIONS The PONV Intensity Scale adapted to Spanish is a valid and reliable instrument for monitoring and evaluating postoperative nausea and vomiting.
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Affiliation(s)
- L Alvarez
- Anestesiología, Reanimación y Terapia del Dolor, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - G Imbaquingo
- Anestesiología, Reanimación y Terapia del Dolor, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - M F Rivadeneira
- Epidemiología, Facultad de Medicina, Instituto de Salud Pública, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
| | - L Reascos
- Servicio de Anestesiología, Hospital de Especialidades FF. AA. N° 1, Quito, Ecuador
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Atalay YO, Mursel E, Ciftci B, Iptec G. Clavipectoral Fascia Plane Block for Analgesia after Clavicle Surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2019; 66:562-563. [PMID: 31727320 DOI: 10.1016/j.redar.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Y O Atalay
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - E Mursel
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - B Ciftci
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - G Iptec
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
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Alcázar Sánchez-Elvira L, Bacian Martínez S, Del Toro Gil L, Gómez Tello V. Postoperative management in the Intensive Care Unit of head and neck surgery patients. Med Intensiva 2019; 44:46-53. [PMID: 31174894 DOI: 10.1016/j.medin.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 01/26/2023]
Abstract
Patient care after major head and neck surgery has changed in recent years. Tumors are the most common reasons for this type of surgery, though it is also used to treat benign conditions. Recent advances in equipment and surgical techniques have improved the postoperative course in this field, allowing early recovery, less pain and infection, a shorter hospital stay, and even better aesthetic results. This is due to the use of minimally invasive techniques, which are gaining relevance. Such techniques allow complex procedures in the head and neck region, through natural orifices or small incisions, with minimal damage and sequelae for the patients. Despite these advances, however, the complexity of the treatment intervention requires multidisciplinary patient management, mostly in the Intensive Care Unit, in order to monitor the possible occurrence of complications. Potential risk factors include previous comorbidity, the type of surgery involved (e.g., bilateral cervical lymphadenectomy), multiple transfusions, and the appearance of early complications requiring repeat surgery. Despite the existence of several studies, there are no standardized protocols for the postoperative period in surgeries of this kind. This causes many specialists to resort to accelerated recovery protocols (ERAS: "Enhanced Recovery After Surgery") that have already been established in other surgical specialties.
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Affiliation(s)
| | - S Bacian Martínez
- Departamento de Cirugía Máxilofacial,Hospital HLA Universitario Moncloa, Madrid, España
| | - L Del Toro Gil
- Departamento de Otorrinolaringología,Hospital HLA Universitario Moncloa, Madrid, España
| | - V Gómez Tello
- Departamento de Medicina Intensiva, Hospital HLA Universitario Moncloa, Madrid, España; Servicio de Urgencias, Hospital HLA Universitario Moncloa, Madrid, España; Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España
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Abstract
Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1-4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. Recently, there have been significant advances related to organizational aspects, new anesthetic and surgical techniques, prognostic scales, perioperative management and greater participation and involvement of the patient. This new series of Medicina Intensiva will address fundamental aspects of how Departments of Intensive Care Medicine can add value to the surgical process, in a coordinated manner with other services. Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.
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Ogawa T, Inoue S, Inada M, Kawaguchi M. Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity. Med Intensiva 2019; 44:216-225. [PMID: 30799043 DOI: 10.1016/j.medin.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. DESIGN A retrospective cohort study was carried out. SETTING University hospital. PATIENTS Surgical patients with severe comorbidities. INTERVENTION The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i.e., no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls. VARIABLES OF INTEREST Poor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90. RESULTS No significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs. 28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p=0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs. 2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs. 3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p=0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10kg (0.70-0.97), p=0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p=0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001]. CONCLUSIONS Postoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries.
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Affiliation(s)
- T Ogawa
- Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan
| | - S Inoue
- Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan.
| | - M Inada
- Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan
| | - M Kawaguchi
- Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan
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Cañueto J, Jaka A, Toll A. The Value of Adjuvant Radiotherapy in Cutaneous Squamous Cell Carcinoma: A Review. Actas Dermosifiliogr (Engl Ed) 2018; 109:476-484. [PMID: 29759308 DOI: 10.1016/j.ad.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/05/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common cancer in humans and its incidence is rising. Although surgery is the treatment of choice for cSCC, postoperative adjuvant radiotherapy has an important role in local and locorregional disease control. In this review, we analyze the value of postoperative radiotherapy in the management of high-risk cSCC (in particular, cases with perineural invasion), cSCC with positive surgical margins, and locally advanced cSCC (with parotid gland and/or lymph node metastasis).
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Affiliation(s)
- J Cañueto
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, IBSAL Instituto de Investigación Biomédica de Salamanca, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - A Jaka
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - A Toll
- Servicio de Dermatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
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Martínez Carapeto I, López Castilla JD, Fresneda Gutiérrez R. [A comparison of post-surgical plasma glucose levels in patients on fluids with different glucose concentrations]. An Pediatr (Barc) 2017; 89:98-103. [PMID: 29132842 DOI: 10.1016/j.anpedi.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/18/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To compare plasma glucose levels and incidence of hyperglycaemia in the post-operative period after general surgery using fluids with different glucose. METHODOLOGY A randomised, open-label, non-blind, clinical trial was conducted on patients admitted to Paediatric Intensive Care Unit after elective surgery. The inclusion criteria were from 6 months to 14 years of age, with a weight greater than 6kg, onset glucose level >60mg/dL, and a signed informed consent, with no oral intake and maintenance intravenous fluid therapy using fluids with 3.3% or 5% glucose. Plasma glucose levels were measured before surgery, on admission, and 8, 24, and 48h, with the mean glucose levels and incidence of hyperglycaemia (glucose level >150mg/dL) in both groups being compared. RESULTS A total of 60 patients received glucose/saline 1/3 (51mEq/L sodium and 33g/L glucose), and 70 glucose/saline 5/0.9% (154mEq/L sodium and 50g/L glucose). Mean glucose levels were higher in the group receiving glucose 5%, with no statistical difference. There was no significant difference in the incidence of hyperglycaemia; 8h: 26% in the 3.3% group vs. 21.3% in the 5% group (P=.63); 24h: 20% vs. 22.7% (P=.8); and 48h: 19% vs. 23.1% (P=.78). CONCLUSIONS The use of fluids with 3.3% glucose in the post-operative period of general surgery maintains mean glucose levels in a similar range to that of patients receiving fluids with 5% glucose, with no difference in the incidence of hyperglycaemia.
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Affiliation(s)
- Isabel Martínez Carapeto
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - José Domingo López Castilla
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Reyes Fresneda Gutiérrez
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, España
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Tornero Tornero C, Fernández Rodríguez LE, Orduña Valls J. Multimodal analgesia and regional anaesthesia. Rev Esp Anestesiol Reanim 2017; 64:401-405. [PMID: 28347551 DOI: 10.1016/j.redar.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/28/2017] [Indexed: 12/20/2022]
Abstract
Multimodal analgesia provides quality analgesia, with fewer side effects due to the use of combined analgesics or analgesic techniques. Regional anaesthesia plays a fundamental role in achieving this goal. The different techniques of regional anaesthesia that include both peripheral and central blocks in either a single dose or in continuous infusion help to modulate the nociceptive stimuli that access the central level. The emergence of the ultrasound as an effective system to perform regional anaesthesia techniques has allowed the development of new regional anaesthesia techniques that formerly could not be carried out since only neurostimulation or skin references were used. It is essential to take into account that even with effective blocking it is advisable to associate other drugs by other routes, in this way we will be able to reduce the required doses individually and attempt to achieve a synergistic, not purely additive, effect.
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Affiliation(s)
- C Tornero Tornero
- Unidad del Dolor, Servicio de Anestesiología, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Anatomía Humana, Universitat de Valencia, Valencia, España.
| | - L E Fernández Rodríguez
- Servicio de Anestesiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - J Orduña Valls
- Unidad del Dolor, Servicio de Anestesiología, Hospital Clínico Universitario de Valencia, Valencia, España
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Luger MHA, Ewering T, Arba-Mosquera S. Analysis of seasonal changes in residual refraction 1-year after corneal laser refractive surgery: a retrospective study. J Optom 2014; 7:138-146. [PMID: 25000869 PMCID: PMC4087176 DOI: 10.1016/j.optom.2013.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To analyze the effect of seasonal changes in residual refraction 1-year after corneal refractive surgery using the SCHWIND AMARIS laser system. METHODS 5740 consecutive treatments have been retrospectively reviewed. For all eyes, aspheric treatments were planned with the Custom Ablation Manager software and the ablations were performed with the SCHWIND AMARIS system (SCHWIND eye-tech-solutions). Seasonal outcomes were evaluated in terms of residual refraction stratified per treatment month, as well as stratified per year season. Student's T test comparing stratified values with global ones was used for the statistical analysis. RESULTS Treatments performed in April, June, August, September, and October showed relative undercorrections of the spherical equivalent (SE) (-0.09D), whereas treatments performed in January, February, and March showed relative overcorrections of the SE (+0.13D). Similarly, treatments performed in spring and summer showed relative undercorrections of the SE (-0.04D), whereas treatments performed in winter showed relative overcorrections of the SE (+0.10D). CONCLUSIONS Seasonal differences in refractive outcomes were observed among a large scale population. The effect of these environmental variables on refractive outcomes warrants further evaluation.
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13
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Ayuso MA, Sánchez-Etayo G, Polanco M, Risco R. [Obstructive laryngeal disease and obstructive sleep apnoea syndrome, a combination with serious peri-operative risk]. ACTA ACUST UNITED AC 2014; 61:505-8. [PMID: 24342169 DOI: 10.1016/j.redar.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
Abstract
We present the case of a patient who was diagnosed with chronic bronchitis, obstructive sleep apnoea syndrome, and large Reinke laryngeal oedemas that were removed by transoral laser microsurgery. In the immediate post-operative period acute respiratory insufficiency occurred due to pharyngeal collapse that required emergency re-intubation, after which the patient was transferred to the ICU where mechanical ventilation was given for 18h. Subsequent progress was normal. We describe the combination of various risk-factors related to anaesthetic management and the importance of considering each one of them, especially the preoperative detection of the severity of obstructive sleep apnoea syndrome.
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Robles MJ, Formiga F, Vidán MT. [Delirium prevention and treatment in elderly hip fracture]. Med Clin (Barc) 2014; 142:365-9. [PMID: 23790577 DOI: 10.1016/j.medcli.2013.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/14/2013] [Accepted: 04/18/2013] [Indexed: 12/28/2022]
Abstract
The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.
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