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| http://dx.doi.org/10.1213/ANE.0000000000004919 | DOI Listing |
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Eisenmenger syndrome during pregnancy: A true anesthetic challenge.
Med J Armed Forces India
December 2024
Professor & Senior Advisor, (Anaesthesia & Critical Care), Command Hospital (Eastern Command), Kolkata, West Bengal, India.
Eisenmenger syndrome (ES) is a rare congenital heart disease (CHD) that occurs in persons with large intracardiac anatomical defects which may go undetected for many years, consequently results in reduced life expectancies and high mortality in the third and fourth decade of life. Pregnancy in patients with CHD and pulmonary arterial hypertension (PAH) is presaged with challenges, and perioperative management of such cases remains a topic of debate. Our case had both, atypical presentation, not diagnosed until her third trimester of third pregnancy and a quick progression to a severe stage with PAH and CorPulmonale.
View Article and Find Full Text PDFThe effect of supplementary parenteral nutrition with different energy intakes on clinical outcomes of patients after gastric cancer surgery.
BMC Surg
December 2024
General Surgery Section, Zherong County Hospital, No. 8 Shangqiao Road, Ningde, Fujian, 355300, China.
Background: To investigate the effect of postoperative supplementary parenteral nutrition (SPN) containing varying energy intake levels during the early postoperative period on the clinical outcomes of patients diagnosed with gastric cancer.
Methods: Data from 237 patients, who were diagnosed with gastric cancer between January 2016 and June 2022, were retrospectively analyzed. Patients were divided into 2 groups based on mean daily SPN energy intake: low (L-SPN; < 20 kcal/kg/day); and high (H-SPN; ≥ 20 kcal/kg/day).
Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called "Damage Control Resuscitation".
View Article and Find Full Text PDF"It's Traumatic for All of Us": A Qualitative Analysis of Providers Caring for Seriously Ill Veterans With Surgical Conditions.
Ann Surg Open
December 2024
Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Objective: We aimed to characterize sources of moral distress among providers in the context of surgery.
Background: Moral distress is defined as psychological unease generated when professionals identify an ethically correct action to take but are constrained in their ability to take that action. While moral distress has been reported among healthcare providers, the perspectives of providers working in surgery specifically are not often explored and reported.
The Use of the Procedure Room for Wide-Awake Local Anesthesia, No Tourniquet Hand Surgery in "High-Risk" Patients.
J Hand Surg Am
December 2024
Department of Orthopaedic Surgery, The University of Chicago Medical Center, Chicago, IL.
Purpose: To study if patients who would be deemed high-risk individuals by traditional classifications of American Society of Anesthesiologists (ASA) or the updated guidelines of ASA Practice Advisory (ASAPA) can safely undergo surgery under wide-awake local anesthesia, no tourniquet in a procedure room setting without any increased risks of complications.
Methods: We analyzed 436 surgeries performed in our procedure room over a 4-year period. No medical comorbidities precluded a patient from surgery within the procedure room, and no preoperative clearance was required.
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