Perioperative Outcomes of Robotic-Assisted Hysterectomy Compared With Open Hysterectomy.

Background: Increasing numbers of robotic hysterectomies (RH) are being performed. To provide ventilation (with pneumoperitoneum and steep Trendelenburg position) for these procedures, utilization of lung protective strategies with limiting airway pressures and tidal volumes is difficult. Little is known about the effects of intraoperative mechanical ventilation and high peak airway pressures on perioperative complications.

Medical humanitarianism in the United States: alternative healthcare, spirituality and political advocacy in the case of Our Lady Guadalupe Free Clinic.

Exclusionary practices in dominant market-based systems are recognized as contributing to global health inequities. Undocumented immigrants are particularly vulnerable to unequal access to healthcare. Humanitarian NGOs strive to respond meaningfully to these health inequities among migrants and undocumented immigrants.

Living donor liver transplantation: selection, perioperative care, and outcome.

A perception that living donor liver transplantation can be accomplished with an acceptable donor complication rate and recipient survival rate has led to the acceptance of living donor liver transplantation as a viable alternative to decreased deceased donor transplantation. Careful candidate evaluation and selection has been crucial to the success of this procedure. Advancements in the understanding of the lobar nature of the liver and of liver regeneration have advanced the surgical technique.

Serum vasopressin concentrations during orthotopic liver transplantation.

Background: We report measurements of the temporal response of serum vasopressin concentrations in the period after reperfusion of the liver graft during orthotopic liver transplantation (OLT).

Methods: Vasopressin concentrations were determined in 11 adult patients undergoing OLT by radioimmunoassay of samples collected after induction, at 5 minutes prior to reperfusion, and at 10, 20, 30, 40, 50, 60, 90, and 120 minutes after reperfusion.

Results: Pre-incision vasopressin concentrations ranged from <0.

APACHE III outcome prediction in patients admitted to the intensive care unit after liver transplantation: a retrospective cohort study.

Background: The Acute Physiology and Chronic Health Evaluation (APACHE) III prognostic system has not been previously validated in patients admitted to the intensive care unit (ICU) after orthotopic liver transplantation (OLT). We hypothesized that APACHE III would perform satisfactorily in patients after OLT METHODS: A retrospective cohort study was performed. Patients admitted to the ICU after OLT between July 1996 and May 2008 were identified.

Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment.

Background: Patients with obstructive sleep apnea are at risk for perioperative morbidity. The authors used a screening prediction model for obstructive sleep apnea to generate a sleep apnea clinical score (SACS) that identified patients at high or low risk for obstructive sleep apnea. This was combined with postanesthesia care unit (PACU) monitoring with the aim of identifying patients at high risk of postoperative oxygen desaturation and respiratory complications.

The emergence of "personhood" in organ procurement.

This article begins and ends with an account of the actions of one person. I propose that such heroics are rooted in an instinctual recognition of "personhood" as it emerges from a particular human "other." I propose that heroism grounded in the recognition of "personhood" is descriptive of those acts of organ donation that are founded on free will.

Controversies in anesthetic management of liver transplantation.

Controversies in the anesthetic management of liver transplantation (OLT) include the exclusion of patients with pulmonary hypertension, intracranial pressure monitoring in patients with fulminant hepatic failure, preoperative screening for coronary artery disease, perioperative use of anticoagulant medications, and early extubation after surgery. This manuscript discusses these controversies from the perspective of two institutions that possess a long tradition of providing liver transplantations for patients with end-stage liver disease.

Management plan to reduce risks in perioperative care of patients with presumed obstructive sleep apnea syndrome.

Study Objectives: Obstructive sleep apnea (OSA) has been associated with increased perioperative morbidity and mortality. We initiated a protocol designed to screen patients preoperatively and monitor them postoperatively. The goal was to identify patients who were at risk for oxygen desaturation after discharge from the postanesthesia recovery room (PACU).

Right hepatectomy for living liver donation vs right hepatectomy for disease: intraoperative and immediate postoperative comparison.

Hypothesis: Perioperative events of patients undergoing living donor (LD) right hepatectomy are similar to those of patients undergoing right hepatectomy for disease (DZ).

Design: Institutional review board-approved retrospective case-control study.

Setting: Eight hundred-bed tertiary care referral center.

Risk factors for mortality after surgery in patients with cirrhosis.

Background & Aims: Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal. The utility of the Model for End-stage Liver Disease (MELD) in predicting mortality after surgery other than liver transplantation is unknown. The aim of this study was to determine the risk factors for postoperative mortality in patients with cirrhosis.

Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery.

Several studies have demonstrated increased morbidity and mortality in patients with cirrhosis undergoing anesthesia and surgery. Cirrhosis is a chronic liver disease, which may affect all body systems. The severity of the disease, assessed by the Child-Pugh classification, has a substantial effect on patient outcome.

Vasotrac arterial blood pressure and direct arterial blood pressure monitoring during liver transplantation.

During liver transplantation two arterial catheters are often placed. The Vasotrac is a noninvasive monitor that provides radial arterial blood pressures by a tonometric method. We investigated whether the Vasotrac would be an accurate substitute for an arterial catheter by comparing Vasotrac blood pressures with simultaneous direct radial blood pressures recorded from the contralateral arm in 14 patients undergoing liver transplantation.

The effect of in vitro recombinant factor VIIA on coagulation parameters for blood taken during liver transplantation.

Recombinant factor VIIa (rFVIIa) has been utilized in pilot studies in orthotopic liver transplantation (OLT) when administered to patients at doses of 68.37 microg/kg and 80 microg/kg. Although some effectiveness in normalizing measurements of coagulation has been demonstrated, the optimal dose for patients undergoing OLT has not been established.

Preoperative assessment of the patient with liver disease.

Patients with liver disease are at appreciable risk when undergoing anesthesia and surgery. Attempts to quantify this risk have been thwarted by the diversity of disease states and illness severity that such patients bring to the operating theater and the myriad of procedures they may undergo. This review discusses the indications and contraindications for surgery in patients with liver disease and attempts to give specific recommendations for optimizing the clinical status of a patient with hepatic dysfunction prior to operative intervention.

Preoperative dobutamine stress echocardiography, intraoperative events, and intraoperative myocardial injury in liver transplantation.

Introduction: The appropriate method of screening for coronary artery disease in patients who present for liver transplantation is currently uncertain.

Methods: We assessed the utility of a screening protocol using dobutamine stress echocardiography (DSE) in 119 patients who underwent liver transplantation. Patients with cardiac risk factors had DSE performed, and those with positive results were referred for coronary angiography.

The transplant recipient for nontransplant surgery.

The transplant recipient has traded a life-threatening illness for a chronically immunosuppressed state. Subsequent anesthetic management for non-transplant surgical procedures may be challenging. The anesthesia provider must be aware of the degree of post-transplant organ dysfunction and alter anesthesia techniques accordingly.

Facilitating research projects in schools and clinical respiratory care departments.

As the profession of respiratory care evolves, greater demands are being placed on educators, managers, and practitioners as they encounter a mass of new literature and the latest technology. Respiratory care schools and clinical departments are under increasing pressure to prepare students and staff with the skills needed to efficiently and effectively consider the numerous primary research investigations, systematic reviews, consensus practice guidelines, and institutional continuous-quality-improvement data. A classroom and work environment that encourages openness and discussion and rewards inquiry is of fundamental importance.

The diagnosis of obstructive sleep apnea as a risk factor for unanticipated admissions in outpatient surgery.

Unlabelled: The goal of this study was to determine whether the preoperative diagnosis of obstructive sleep apnea (OSA) is an independent risk factor for perioperative complications in patients undergoing nonotorhinolaryngologic outpatient surgical procedures. We used existing databases to identify 234 patients with polysomnography-confirmed OSA who had outpatient surgical procedures in the years 1997 through 2000. Control patients were matched for type of anesthesia, age, sex, body mass index, surgical procedure, and surgical date.

Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay.

Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive patients (>17 years) undergoing liver transplantation to receive either our traditional anesthetic (thiopental, pancuronium, 50 microg/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 microg/kg fentanyl).

Religious involvement, spirituality, and medicine: implications for clinical practice.

Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes.