China
Africa
Explore chapters and articles related to this topic
Exposure for spinal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The majority of postoperative complications are related to the respiratory system. A review of 505 children who had an anterior spinal exposure reported a 9.8% overall complication rate with half of the complications being respiratory in nature, including effusions, pneumothoraces, atelectasis, and respiratory failure. Gastrointestinal complications included superior mesenteric artery syndrome, which resolved with conservative management (parenteral nutrition or use of a nasojejunal feeding tube), and gastrointestinal bleeding. The other complications reported in this review were vessel injuries at the time of the exposure and urinary tract infections. A more recent review of over 19 000 children with scoliosis surgery revealed fewer but similar complications, with a 1% incidence of neurologic and pulmonary complications, and a 2.3% risk of a wound infection.
Anaesthetic Management of Early-Onset Scoliosis
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
Damarla Haritha, Souvik Maitra
The postoperative course is as important as preoperative optimisation in a patient with scoliosis because it takes time for the lung volumes and capacities to improve after surgery. There is a significant variation in the literature regarding this aspect. Various studies reported that the pulmonary function test (PFT) parameters improve after surgery [56, 57, 58, 59, 60], though few concluded that lung volumes decrease after surgery [61, 62], and a few reported that there is no change in the lung volumes after the correction [63, 64]. However, the surgical approach and the duration of evaluation after surgery will change the PFT parameters. Open anterior approach, requiring disruption of rib cage, injury to the respiratory muscles and pleural adhesions in the postoperative period, may prevent optimal change in lung volumes [65]. In the immediate postoperative period after posterior instrumentation, it studies have shown that the lung volumes actually decrease on Day 1, reach a plateau at Day 3, and reach baseline values 2 to 3 months after surgery [31]. This, along with the major fluid shifts, blood loss, and pain, makes the patient more at risk of postoperative pulmonary complications. The other anticipated complications are postoperative ileus due to prolonged infusion of opioids for analgesia, worsening of the neurological status, postoperative visual loss, nerve compression injuries due to intraoperative malpositioning and worsening of bulbar symptoms in a patient with previous history. Other rare complications such as pneumothorax, air embolism in prone position, and superior mesenteric artery syndrome due to compression of superior mesenteric artery between the third part of the duodenum and aorta during correction of severe deformities, and syndrome of inappropriate antidiuretic hormone release (SIADH) due to handling of the nerve tissue [23]. The postoperative care centres on chest physiotherapy, adequate analgesia, careful neurological monitoring, and early ambulation.
Nutritional management of a polytrauma patient in an intensive care unit
Published in South African Journal of Clinical Nutrition, 2021
An ongoing, unexplained and inconsistent pattern of vomiting provided another major challenge, developing on day 17 and persisting until day 38 post-injury. There was no evidence of abdominal sepsis and the surgeons saw no need for further surgery. When investigations such as a gastroscopy and a gastrograffin challenge yielded normal results, and prokinetics did not provide consistent relief, the surgeons considered superior mesenteric artery syndrome (SMAS) as the possible cause of the clinical picture. Computed tomography (CT) angiography was unremarkable. Feeding varied from exclusive PN, to PN and trophic nasogastric feeds, to PN and oral nutritional supplements (ONS) over the course of four weeks. Chewing gum was given to stimulate peristalsis. While recommendations for the management of SMA syndrome and enteral intolerance include post-pyloric feeding as well as PN, the facility experienced a temporary shortage of naso-jejunal tubes and PN remained the primary feeding route.2,5 To alleviate the patient’s notable muscle wasting, he was given testosterone injections of 200 mg on days 25, 32 and 40.