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Major Abdominal Surgery (major + abdominal_surgery)

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Medical Sciences	100%

Selected Abstracts

Adalimumab for Crohn's disease with intolerance or lost response to infliximab: a 3-year single-centre experience

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009
A. OUSSALAH
Summary Background, Adalimumab is effective in inducing clinical remission in patients with Crohn's disease who lost response or became intolerant to infliximab. Aim, To evaluate long-term efficacy and safety of adalimumab as a second line therapy in luminal and fistulizing Crohn's disease. Methods, We report our single-centre experience in 53 patients. We evaluated maintenance of clinical response defined as the absence of adverse events leading to drug withdrawal, no major abdominal surgery and no loss of clinical response in initial responders. Major abdominal surgery, steroid sparing, complete fistula closure and safety were also assessed. Results, The probability of maintaining clinical response was 77.2%, 67.8% and 50.8% at 26, 52 and 130 weeks respectively. The probability of remaining major abdominal surgery-free was 82.3% at 26, 52 and 130 weeks. Complete fistula closure occurred in six of 10 patients, and eight of 10 patients were able to taper steroid therapy. Adverse events occurred in 31 patients (58.5%) leading to adalimumab withdrawal in nine patients (17%). Conclusion, Adalimumab therapy may be effective in the long term in both luminal and fistulizing Crohn's disease in infliximab-failure patients, half of patients maintaining clinical response and potentially avoiding major abdominal surgery in 80% of cases. [source]

Indigenous and austere technique of self-retaining abdominal retraction for facilitating surgical exposure

JOURNAL OF SURGICAL ONCOLOGY, Issue 5 2006
Sajid S. Qureshi MS
Abstract Adequate exposure is of paramount importance in major abdominal surgeries. This is achieved by appropriately placed incision, proper position of the patients, and judicious use of retractors. A third assistant is usually required for retaining the retractors. Self-retaining retractors have also been utilized for assisting in adequate exposure of the operative field. However, these retractors are complex and unwieldy, causing hindrance in the movement of the surgeon. We describe a technique of self-retaining abdominal retraction that is simple and also obviates the need for an additional assistant. J. Surg. Oncol. 2006;93:420,421. © 2006 Wiley-Liss, Inc. [source]

Functional intravascular volume deficit in patients before surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
M. BUNDGAARD-NIELSEN
Background: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. Methods: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a ,10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit. Results: Forty-two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200,600 ml), with no significant difference between the three groups of patients. The required volume was ,400 ml in nine patients (15%). Conclusion: The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal-directed fluid therapy. [source]

Blood volume is normal after pre-operative overnight fasting

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2008
M. JACOB
Background: Pre-operative fasting is assumed to cause a deficit in intravascular blood volume (BV), as a result of ongoing urine production and insensible perspiration. Standard regimes consist of volume loading prior or simultaneous to any anaesthetic procedure to minimise the risk of hypotension. However, fluid overload in the context of major abdominal surgery has been shown to deteriorate patient outcome. Our study aimed to quantify total intravascular BV after fasting by direct measurements and to compare it with calculated normal values in comparable non-fasted patients. Methods: After 10 h of fasting, total plasma volume (PV) and red cell volume (RCV) were measured via the double-label technique (indocyanine green dilution and erythrocytes labelled with fluorescein, respectively) following induction of general anaesthesia in 53 gynaecological patients suffering from malignoma of the cervix. The corresponding normal values were calculated individually from age, body height and body weight. Results: Measured BV, RCV and PV after fasting were 4123±589, 1244±196 and 2879±496 ml, respectively. The differences to the corresponding calculated normal values were not significant (3882±366, 1474±134 and 2413±232 ml, respectively). The measured haematocrit reflected a slight anaemic state (0.35±0.03). Conclusion: Our data suggest that even after prolonged pre-operative fasting, cardio-pulmonary healthy patients remain intravascularly normovolaemic. Therefore, hypotension associated with induction of general or neuraxial anaesthesia should perhaps be treated with moderate doses of vasopressors rather than with undifferentiated volume loading. [source]

Arterial oxygen tension increase 2,3 h after hyperbaric oxygen therapy: a prospective observational study

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2007
B. Ratzenhofer-Komenda
Background:, Inhalation of hyperbaric oxygen (HBO) has been reported to decrease arterial oxygen tension (PaO2) in the early period after exposure. The current investigation aimed at evaluating whether and to what extent arterial blood gases were affected in mechanically ventilated intensive care patients within 6 h after HBO treatment. Methods:, Arterial blood gases were measured in 11 ventilated subjects [nine males, two females, synchronized intermittent mandatory ventilation (SIMV) mode] undergoing HBO therapy for necrotizing soft tissue infection (seven patients), burn injury (two patients), crush injury (one patient) and major abdominal surgery (one patient). Blood gases were obtained with the patients in the supine position under continuous analgesia and sedation before the hyperbaric session (baseline), during isopression, after decompression, after each transport, and 1, 2, 3 and 6 h after exposure. Heart rates and blood pressures were recorded. Intensive care unit (ICU) ventilator settings remained unchanged. Transport and chamber ventilator settings were adjusted to baseline with maintenance of tidal volumes and positive end-expiratory pressure (PEEP) levels. The hyperbaric protocol consisted of 222.9 kPa (2.2 absolute atmospheres) and a 50-min isopression phase. The paired Wilcoxon's test was used. Results:, Major findings (median values, 25%/75% quantiles) as per cent change of baseline: PaO2 values decreased by 19.7% (7.0/31.7, P < 0.01) after 1 h and were elevated over baseline by 9.3% (1.5/13.7, P < 0.05) after 3 h. SaO2, alveolar-arterial oxygen tension difference and PaO2/FiO2 ratio behaved concomitantly. Acid-base status and carbon dioxide tension were unaffected. Conclusion:, Arterial oxygen tension declines transiently after HBO and subsequently improves over baseline in intensive care patients on volume-controlled mechanical ventilation. The effectiveness of other ventilation modes or a standardized recruitment manoeuvre has yet to be evaluated. [source]

Clinical trial: the impact of cyclooxygenase inhibitors on gastrointestinal recovery after major surgery , a randomized double blind controlled trial of celecoxib or diclofenac vs. placebo

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
D. A. WATTCHOW
Summary Background, Ileus occurs after abdominal surgery and may be severe. Inhibition of prostaglandin release reduces post-operative ileus in a rat model. Aim, To determine whether prostaglandin inhibition by cyclooxygenase inhibitors, celecoxib or diclofenac, could enhance gastrointestinal recovery and reduce post-operative ileus in humans. Methods, Two hundred and ten patients undergoing elective major abdominal surgery were randomized to receive twice daily placebo (n = 67), celecoxib (100 mg, n = 74) or diclofenac (50 mg, n = 69), preoperatively and continuing for up to 7 days. Primary outcomes were hallmarks of gut recovery. Secondary outcomes were paralytic ileus, pain and complications. Results, There was no clinically significant difference between the groups for restoration of bowel function. There was a significant reduction in paralytic ileus in the celecoxib-treated group (n = 1, 1%) compared with diclofenac (n = 7, 10%) and placebo (n = 9, 13%); P = 0.025, RR 0.20, CI 0.01,0.77. Pain scores, analgesia, transfusion requirements and adverse event rates were similar between study groups. Conclusions, Perioperative low dose celecoxib, but not diclofenac, markedly reduced the development of paralytic ileus following major abdominal surgery, but did not accelerate early recovery of bowel function. This was independent of narcotic use and had no increase in post-operative complications. [source]

Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2006
M. SAKON
Summary.,Background:,Venous thromboembolism (VTE) has been considered to be a rare surgical complication in Japan. Aim:,To investigate the incidence and risk factors of VTE in Japanese patients undergoing major abdominal surgery. Methods:,A prospective, multi-center epidemiological study was conducted from December, 2001 to August 2002 in 39 medical institutes throughout Japan. A total of 173 patients with general (n = 128), gynecologic (n = 23), and urologic (n = 22) surgery were analyzed. For the diagnosis of deep vein thrombosis (DVT), bilateral venography was performed in all patients. Lung ventilation/perfusion scintigraphy was carried out in patients suspected of pulmonary thromboembolism (PTE). Results:,There were 36 patients with distal DVT (20.8%) and five patients with proximal DVT (2.9%). One patient was diagnosed as PTE. Overall, VTE was diagnosed in 42 patients (24.3%). By univariate analysis, only age (60 years or older) was identified as a significant risk factor in the whole study population. When analyzed by the stepwise multiple logistic regression model, female gender, operation site, age, and operation time were four risk factors found to be significant. The incidence of VTE was closely related to the number of risk factors that patients had. As many as 44% of patients with three or four risk factors developed VTE while those with one or two risk factors showed about a 17% incidence of VTE. Four patients lacking any risk factors did not develop VTE. Conclusions:,Venous thromboembolism is common in Japanese patients undergoing major abdominal surgery. Pharmacologic thromboprophylaxis is considered essential, particularly in those patients with multiple, potential risk factors. [source]

Adalimumab for Crohn's disease with intolerance or lost response to infliximab: a 3-year single-centre experience

Stress-inducing factors in ICUs: What liver transplant recipients experience and what caregivers perceive

LIVER TRANSPLANTATION, Issue 8 2005
Gianni Biancofiore
The aim of this study was to compare a number of potentially stress-generating factors related to an intensive care unit (ICU) stay from the points of view of patients undergoing liver transplantation or elective major abdominal surgery and their caregivers in order to identify differences and similarities that may help to optimize patient care. The ICU Environmental Stressor Scale questionnaire was administered to 104 liver transplant recipients, 103 major abdominal surgery patients, 35 nurses and 21 physicians. The ICU staff were asked to complete the questionnaire on the basis of their perception of patient stressors. Both patient groups identified Being unable to sleep, Being in pain, Having tubes in nose/mouth, Missing husband/wife, and Seeing family and friends only a few minutes a day as the major stressors; the healthcare providers correctly identified the most stressing factors for the patients, but gave them higher scores. The mean scores were 71.9 ± 18.7 for the transplant recipients, 66.3 ± 20.9 for the patients undergoing elective major abdominal surgery, 99.7 ± 19.2 for the nurses, and 92.7 ± 16.1 for the physicians (P < 0.001). The qualitative evaluations of potentially stress-inducing ICU situations were substantially the same in the 2 patient groups, but the transplant recipients seemed to feel them more acutely. Although the caregivers identified the most discomforting situations, they overestimated the degree of stress they cause. The staff of each ICU should therefore seek to understand and reduce (even by means of simple interventions) the particular causes of psychophysical stress felt by their patients. (Liver Transpl 2005;11:967,972.) [source]

Meta-analysis on the effect of dopexamine on in-hospital mortality

ANAESTHESIA, Issue 6 2009
S. Gopal
Summary The objective of the study was to determine whether dopexamine alters in-hospital mortality. The following databases were searched, Embase (1974,July 2007), Medline (1950,July 2007), CINAHL, PubMed and Cochrane Clinical Register of Controlled Trials (CENTRAL). Two reviewers independently checked the quality of the studies and extracted data. Six randomised controlled trials totalling 935 patients were included. Mortality was not significantly different with dopexamine treatment (relative risk 0.75, 95% confidence interval 0.48,1.18, p = 0.22). In conclusion, dopexamine does not improve in-hospital mortality in patients undergoing major abdominal surgery and in the critically ill. [source]

Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery

ANAESTHESIA, Issue 1 2009
I. Königsrainer
Summary In a quality improvement audit on epidural analgesia in 300 patients after major abdominal surgery, we identified postoperative lower leg weakness and premature catheter dislodgement as the most frequent causes of premature discontinuation of postoperative epidural infusion. Lower limb motor weakness occurred in more than half of the patients with lumbar epidural analgesia. In a second period monitoring 177 patients, lumbar catheter insertion was abandoned in favour of exclusive thoracic placement for epidural catheters. Additionally, to prevent outward movement, the catheters were inserted deeper into the epidural space (mean (SD) 5.2 (1.5) cm in Period Two vs 4.6 (1.3) cm in Period One). Lower leg motor weakness declined from 14.7% to 5.1% (odds ratio 0.35; 95% confidence interval 0.16,0.74) between the two periods. Similarly, the frequency of premature catheter dislodgement was reduced from 14.5% to 5.7% (odds ratio 0.35; 95% confidence interval 0.17,0.72). With a stepwise logistic regression model we demonstrated that the odds of premature catheter dislodgement was reduced by 43% for each centimetre of additional catheter advancement in Period Two. We conclude that careful audit of specific complications can usefully guide changes in practice that improve success of epidural analgesia regimens. [source]

Systematic review of the literature for the use of oesophageal Doppler monitor for fluid replacement in major abdominal surgery

ANAESTHESIA, Issue 1 2008
S. M. Abbas
Summary The use of intra-operative Doppler oesophageal probes provides continuous monitoring of cardiac output. This enables optimisation of intravascular volume and tissue perfusion in major abdominal surgery, which is thought to reduce postoperative complications and shorten hospital stay. Medline and EMBASE were searched using the standard methodology of the Cochrane collaboration for trials that compared oesophageal Doppler monitoring with conventional clinical parameters for fluid replacement in patients undergoing major elective abdominal surgery. Data from randomised controlled trials were entered and analysed in Meta-view in Rev -Man 4.2 (Nordic, Denmark). We included five studies that recruited 420 patients undergoing major abdominal surgery who were randomly allocated to receive either intravenous fluid treatment guided by monitoring ventricular filling using oesophageal Doppler monitor or fluid administration according to conventional parameters. Pooled analysis showed a reduced hospital stay in the intervention group. Overall, there were fewer complications and ICU admissions, and less requirement for inotropes in the intervention group. Return of normal gastro-intestinal function was also significantly faster in the intervention group. Oesophageal Doppler use for monitoring and optimisation of flow-related haemodynamic variables improves short-term outcome in patients undergoing major abdominal surgery. [source]

The use of patient-controlled epidural fentanyl in elderly patients,

ANAESTHESIA, Issue 12 2007
T. Ishiyama
Summary We studied whether delivering postoperative analgesia, using a patient-controlled epidural analgesia (PCEA) device was effective and safe in elderly patients. We enrolled 40 patients aged >,65 years (elderly group) and 40 patients aged 20,64 years (young group) scheduled for elective major abdominal surgery. PCEA infusion was started following completion of surgery. Mean (SD) fentanyl consumption (10.7 (3.7) compared with 10.5 (2.7) ,g.kg,1, p = 0.76) and number of times patients pressed the bolus switch (32 (36) compared with 44 (38), p = 0.16) during the first 24 h postoperatively were similar in the two groups. Pain scores, which were similar in both groups at rest, were significantly lower in the elderly on coughing (at 24 h, p < 0.05). In addition, average pain scores were similar at the time of PCEA bolus demands in the two groups. Elderly and young adult patients therefore required similar amounts of patient-controlled epidural fentanyl to produce satisfactory pain relief. [source]