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Endocrine and Neuroendocrine Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Natasha Shrikrishnapalasuriyar, P.N. Plowman, Márta Korbonits, Ashley B. Grossman
The mainstay of treatment for pheochromocytomas requires surgical resection, following a minimum of 7–10 days’ blockade with either oral phenoxybenzamine, where available, or doxazosin in effective doses to normalize blood pressure. Any β-adrenoceptor blockade should be reserved for complementing α-adrenoceptor blockade after this has been shown to be effective: A target blood pressure at rest is 130/80 mmHg, with some advising the necessity for a postural drop, although in our experience this is not always necessary. Improved preoperative medical preparation and modern anesthesia and surgical techniques have resulted in a low perioperative mortality of less than 1% in major centers.67
Outcomes Following Endovascular vs Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Perioperative mortality was significantly higher for open repair at 30 days and during hospitalization. There was no significant difference in all-cause mortality at 2 years. Mortality after perioperative period was similar in the two groups. No differences were observed between the two groups in procedure failures, secondary therapeutic procedures, aneurysm-related hospitalizations, or 1-year major morbidity. See Tables 8.1 and 8.2.
Surgical management of coronary artery disease
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Melissa M. Anastacio, Alejandro Suarez Pierre, Jennifer S. Lawton
In a retrospective analysis of data from the National Inpatient Sample, the adjusted rate for all CABG-related mortality steadily decreased from 2.7% in 2008 to 2.2% in 2012 (48). The median age of CABG patients was 65 and over 54% had more than two comorbidities (hypertension, diabetes mellitus, history of MI), reflecting an increase in severity of comorbidities over time (48). Although the rates of in-hospital cardiac, respiratory, and infectious complications decreased (p < 0.001), the rate of postoperative hemorrhage increased (p < 0.001) over the study period resulting in an increase in the overall complication rate from 34.4% in 2008 to 46.2% in 2012 (48). Independent predictors of perioperative mortality were age, female gender, and higher number of comorbid conditions (48).
Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Preoperative evaluation of surgical patients should focus on risk management aimed at preventing perioperative mortality and side effects, physical morbidity, and acute relapse of chronic illnesses, which can lead to last-minute surgical cancellations and perioperative complications. Careful consideration of the impact of the patients’ chronic medications on anesthetic and analgesic management is critically important. The preoperative risk assessment and management of chronic medications are influenced by the extent of the surgical procedure, the patient’s physical state, and co-morbidities, as well as the type of anesthesia and analgesia to be administered during the operation [109]. The primary care physician and the anesthesiologist have the challenge of determining the risk of precipitating withdrawal or relapse of the patients’ underlying medical conditions by discontinuing chronic medication and whether it is preferable to continue the drug during the perioperative period and deal with potential adverse drug-drug interactions. Specific perioperative concerns and recommendations regarding the management of chronic medications will be discussed in Part II of this drug review.
Impact of chronic medications in the perioperative period –anesthetic implications (Part II)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Preoperative evaluation of chronic medications used by patients undergoing surgery should focus on risk management aimed at preventing perioperative mortality, physical morbidity, and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. The preoperative risk assessment should consider the extent of the surgical procedure, the patient’s physical state and co-morbidities, as well as the impact of chronic medications on anesthetic and analgesic drugs. Primary care physicians and anesthesiologists have the challenge of determining the risk of precipitating a relapse of the patients’ underlying medical condition(s) if they discontinue chronic medications. It is important to consider whether the risk of relapse of a chronic medical condition is preferable to continuing the drug during the perioperative period and facing potentially adverse drug interactions with anesthetic and analgesic drugs.
Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register
Published in Acta Orthopaedica, 2020
Håvard Dale, Sjur Børsheim, Torbjørn Berge Kristensen, Anne Marie Fenstad, Jan-Erik Gjertsen, Geir Hallan, Stein Atle Lie, Ove Furnes
When stratified into risk groups, perioperative mortality after THA was 4/105 in low-risk patients, 34/105 in intermediate-risk patients, and 190/105 in high-risk patients. High-risk patients had nearly 9 times the risk of adjusted perioperative death after primary THA compared with low-risk patients (Table 4). We found no statistically significant difference in risk of perioperative death between the 4 modes of fixation, in either of the 3 risk groups or 2 subgroups (Table 3, see Supplementary data). That was also the finding when assessing perioperative death in the 4 fixation groups by Fisher’s exact test with Bonferroni multiple comparison correction. In Fisher’s exact test without correction, and not adjusted for patient characteristics, uncemented THA had lower perioperative mortality, compared with cemented (p = 0.03). The 24 patients who died were older and more comorbid (Table 5, see Supplementary data).