Publications by authors named "Joshua D Stearns"
Background: Pain control after minimally invasive repair of pectus excavatum (MIRPE) can be challenging, especially in adult patients undergoing surgical repair. This study reviewed different analgesic modalities used over ≥10 years after pectus repair.
Methods: A retrospective analysis was performed of adult patients (≥18 years) who underwent uncomplicated primary MIRPE at a single institution from October 2010 to December 2021.
Article Synopsis
- Pectus excavatum is a common chest wall deformity that affects cardiopulmonary function, and this study investigates its impact on adult patients before and after a minimally invasive surgical repair.
- The research, conducted on 392 adult patients at Mayo Clinic Arizona, shows that 68% had abnormal oxygen consumption prior to surgery, but significant improvements in cardiopulmonary metrics were observed post-repair, indicating enhanced oxygen consumption and ventilation.
- The findings confirm the negative cardiopulmonary effects of pectus excavatum and demonstrate the substantial benefits of surgical intervention in affected adults.
Article Synopsis
- The Nuss procedure involves placing bars to repair pectus excavatum, which may hinder chest movement and compliance during CPR.
- Research indicates that these bars significantly reduce the depth of chest compressions and increase the force needed to achieve proper compression depth.
- There's potential for using active abdominal compressions and decompressions (AACD) as an alternative CPR method for patients with Nuss bars, warranting further study.
Background: Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined.
View Article and Find Full Text PDFPectus excavatum (PE) can recur after both open and minimally invasive repair of pectus excavatum (MIRPE) techniques. The cause of recurrence may differ based on the initial repair procedure performed. Recurrence risks for the open repair are due to factors which include incomplete previous repair, repair at too young of age, excessive dissection, early removal or lack of support structures, and incomplete healing of the chest wall.
View Article and Find Full Text PDFDiabetes mellitus (DM) and hyperglycemia are associated with increased surgical morbidity and mortality. Hyperglycemia is a determinant of risk of surgical complications and should be addressed across the continuum of surgical care. While data support the need to address hyperglycemia in patients with DM in the ambulatory setting prior to surgery and in the inpatient setting, data are less certain about hyperglycemia occurring during the perioperative period-that part of the process occurring on the day of surgery itself.
View Article and Find Full Text PDFObjective: Assess the impact of guidelines on the care of patients with diabetes undergoing elective surgery.
Methods: A multidisciplinary team developed perioperative guidelines. Overall changes in key measures were evaluated after guidelines were introduced and compared with a historical cohort.
Objective: The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures.
Methods: Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation.
Background: An institutional policy was previously established for patients with diabetes on insulin pump therapy undergoing elective surgical procedures.
Method: Electronic medical records were reviewed to assess documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of care.
Results: Twenty patients with insulin pumps underwent 23 procedures from March 1 to December 31, 2011.
Case reports indicate that diabetes patients receiving outpatient insulin pump therapy have been allowed to continue treatment during surgical procedures. Although allowed during surgery, there is actually little information in the medical literature on how to manage patients receiving insulin pump therapy during a planned surgical procedure. A multidisciplinary work group reviewed current information regarding the use of insulin pumps in the perioperative period.
View Article and Find Full Text PDFObjective: To assess perioperative management of patients with diabetes mellitus who were being treated with insulin pump therapy.
Methods: We reviewed records for documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of surgery.
Results: Thirty-five patients (21 men) with insulin pumps underwent surgical procedures between January 1, 2006, and December 31, 2010.
Background: Adverse cardiac events that follow cardiac surgery are an important source of perioperative morbidity and mortality for women. Troponin I provides a sensitive measure of cardiac injury, but the levels after cardiac surgery may vary between sexes. Our purpose in this study was to evaluate the prognostic value of troponin I levels for predicting cardiovascular complications in postmenopausal women undergoing cardiac surgery.
View Article and Find Full Text PDFPurpose: To assess whether obesity is associated with mortality or other adverse intensive care unit (ICU) and post-ICU outcomes.
Methods: A meta-analysis of studies from PubMed and EMBASE databases.
Results: Twenty-two studies (n = 88,051 patients) were included.