Abdominal Surgery Patients Research Articles

Intrathecal dexmedetomidine: Useful or not?

Spinal anesthesia is used commonly intra operatively. However, local anesthetics are associated with relatively short duration of action. A number of adjuvants have been used to prolong the postoperative analgesia. Objectives: To evaluate role of dexmedetomidine added to heavy bupivacaine 0.5% intrathecally for lower abdominal surgeries. Subjects and methods: Sixty two patients were randomly divided into one of two group, Group (D) received 3.5 mL volume of 0.5% hyperbaric bupivacaine and 5 μg dexmedetomidine in 0.5 mL of preservative free normal saline intrathecally. Group (P) received 0.5 ml normal saline added to the same dose of heavy 0.5% bupivacaine and served as placebo. Results: There was significantly less time needed to reach T8 sensory level, 2-segment regression, and time to reach Bromage 3in group (D) compared to group (P). There was significantly more time needed for first requirement of analgesia in group (D) compared to group (P). There was a significantly less analgesic dose requirement in group (D) compared to group (P). Conclusion: Receiving Dexmedetomidine at a dose of 5 μg provides earlier sensory and motor blockade, less postoperative analgesic requirements, less shivering among patients of lower abdominal surgery under intrathecal anaesthesia with no sedation effect or neurologic complications.

Age-related requisite concentration of sevoflurane for adequate sedation with combined epidural-general anesthesia

BackgroundThe requisite anesthetic concentration of sevoflurane required to obtain adequate sedation when sufficient analgesics are supplied has not been determined. The purpose of this study was to determine the requisite age-associated concentration of sevoflurane to obtain an adequate level of anesthesia during combined epidural-general anesthesia by bispectral index (BIS) monitoring.MethodsTwenty-seven elective abdominal surgery patients (American Society of Anesthesiologists physical status I-II) were enrolled. The patients were divided into two groups of more or less than 60 years of age. We investigated the concentration of sevoflurane required to obtain an adequate sedation level during combined epidural-general anesthesia, maintaining the BIS value between 40 and 60.ResultsThe requisite sevoflurane concentration required to keep the BIS value at 40-60 was not stable during surgery. In the younger group, the maximum concentration of sevoflurane needed during surgery was 1.95 ± 0.14 (95% confidence interval: 1.87-2.10) vol%, while it was 1.54 ± 0.44 (95% confidence interval: 1.27-1.80) vol% in the older group (P < 0.01).ConclusionsThe requisite concentration of sevoflurane required with combined epidural-general anesthesia was 2.5 vol% for the younger group and 2.0 vol% for the older group as determined by BIS monitoring. We believe that these percentages are sufficient to avoid awareness during surgery with adequate analgesia.

Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient

Although transversus abdominis plane (TAP) block is an effective way of providing analgesia in post-operative abdominal surgery patients; however, it can be considered as an anesthetic technique in high-risk cases for surgery. We report a case of a geriatric female with chronic obstructive pulmonary disease in the respiratory failure, hypotension, posted in an emergency with old perforation leading to peritonitis. The surgery was successfully conducted under bilateral TAP block, which was used as a sole anesthetic technique. TAP block can be considered as an anesthetic technique for abdominal surgery in moribund patients.

Development and reliability & validity of knowledge-attitude-practice questionnaire for abdominal surgery patients

Objective To develop a knowlodge-attitude-practice questionnaire (KAPQ) for abdominal surgery patients,in order to provide an available tool to evaluate the KAP status of patients' postoperative pain.Methods The KAPQ was established on the basis of clinical experience,literature review and expert consultation.Ninety patients with abdominal surgery in a three level hospital in Jiangsu province were chosen by convenient sampling and SPSS was used for the scale reliability and validity.Results The internal consistency reliabilities of the KAPQ and its three subscales were respectively 0.899,0.933,0.903 and 0.888.The copy of reliability of three subscales were respectively 0.886,0.763 and 0.821.The content coefficients of three subscales were respectively 0.946,0.921 and 0.949.Factor analysis showed that the questionnaire had good construct validity with a common explaining variance more than 0.4.Conclusions The KAPQ has good reliability and validity,thus it can be used as an effective tool to evaluate the health-related knowledge-attitudepractice of the abdominal surgery patients' postoperative pain. Key words: Abdomen ; Postoperative pain ; Health-related knowledge-attitude-practice ; Development of questionnaire ; Reliability; Validity

741

Introduction: Post-operative abdominal sepsis is associated with high morbidity and mortality. Early diagnosis and prompt intervention is crucial to reduce mortality. Computed Tomography (CT) is the imaging modality of choice to determine the presence of an intra-abdominal infection with 94% sensitivity and 91% specificity. Hypothesis: False negative CT scan findings delay targeted intervention for abdominal sepsis. The context in which false negative CT scans occur needs to be better elucidated in order to optimize patient outcomes. Methods: Records from adult post-operative abdominal surgery patients between January 2009 and June 2010 were reviewed to identify those who developed abdominal sepsis. Data reviewed included clinical presentation, operative findings, laboratory data, CT scan results, and interventional radiology data. Abdominal sepsis was defined as patients with abdominal abscess, anastomotic leak, bowel perforation, colistridium difficile colitis, mesenteric ischemia, positive peritoneal cultures, or biliary tract infections. Results: One hundred fifty nine patients who developed post-operative abdominal sepsis had a CT scan of the abdomen and pelvis prior to source control. Thirty (19%) patients were found to have a CT scan that was non-diagnostic or missed radiographic manifestation of the source of abdominal sepsis. Of these patients, an underlying source diagnosis was identified for 23 (72%) patients by reoperation or by repeat CT in conjunction with drainage in 7 (28%) patients. Etiologies included anastomotic leak (40%), intra-abdominal abscess (33%), hollow viscus perforation (10%), clostridium difficile colitis (7%), and other (10%). False negative CT scans resulted in a delayed reoperation (3.7 days compared to 1.4 days, p<0.01) or IR drainage (5.7 days vs. 1.5 days, p<0.01). Delayed intervention as a result of an initially non-diagnostic CT resulted in a mortality rate of 27% vs 12%, p=0.08. Conclusions: False negative abdominal and pelvic CT scan leads to a delay in source control in patients with post operative abdominal sepsis. Most of the missed sources of abdominal sepsis were patients with anastomotic leak followed by abdominal abscesses. Negative CT scan findings should be interpreted with caution in the clinical setting of abdominal sepsis.

Probiotic/Synbiotic Therapy for Treating Critically Ill Patients from a Gut Microbiota Perspective

The gut is an important target organ for stress caused by severe insults such as sepsis, trauma, burn, shock, bleeding and infection. Severe insult to the gut is considered to have an important role in promoting infectious complications and multiple organ dysfunction syndrome. These are sequelae of interactions between deteriorated intestinal epithelium, the immune system and commensal bacteria. The gut is the “motor” of multiple organ failure, and now it is recognized that gut dysfunction is a causative factor in disease progression. The gut flora and environment are significantly altered in critically ill patients, and the number of obligate anaerobes is associated with prognosis. Synbiotic therapy is a combination of probiotics and prebiotics. Probiotic, prebiotic and synbiotic treatment has been shown to be a promising therapy to maintain and repair the gut microbiota and gut environment. In the critically ill, such as major abdominal surgery, trauma and ICU patients, synbiotic therapy has been shown to significantly reduce septic complications. Further basic and clinical research would clarify the underlying mechanisms of the therapeutic effect of probiotic/synbiotic treatment and define the appropriate conditions for use.

Methods of Patient Warming during Abdominal Surgery

BackgroundKeeping abdominal surgery patients warm is common and warming methods are needed in power outages during natural disasters. We aimed to evaluate the efficacy of low-cost, low-power warming methods for maintaining normothermia in abdominal surgery patients.MethodsPatients (n = 160) scheduled for elective abdominal surgery were included in this prospective clinical study. Five warming methods were applied: heated blood transfusion/fluid infusion vs. unheated; wrapping patients vs. not wrapping; applying moist dressings, heated or not; surgical field rinse heated or not; and applying heating blankets or not. Patients’ nasopharyngeal and rectal temperatures were recorded to evaluate warming efficacy. Significant differences were found in mean temperatures of warmed patients compared to those not warmed.ResultsWhen we compared temperatures of abdominal surgery patient groups receiving three specific warming methods with temperatures of control groups not receiving these methods, significant differences were revealed in temperatures maintained during the surgeries between the warmed groups and controls.DiscussionThe value of maintaining normothermia in patients undergoing abdominal surgery under general anesthesia is accepted. Three effective economical and practically applicable warming methods are combined body wrapping and heating blanket; combined body wrapping, heated moist dressings, and heating blanket; combined body wrapping, heated moist dressings, and warmed surgical rinse fluid, with or without heating blanket. These methods are practically applicable when low-cost method is indeed needed.

Laparoscopic versus open colorectal resection in the elderly population

Elderly patients are often regarded as high-risk patients for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The aim of this systematic review and pooled analysis was to review the current data published regarding the differences in operative outcomes of laparoscopic and open surgery in the elderly population. A systematic literature search of Medline, Embase, Web of Science, and Cochrane databases was performed. Studies that compared outcome following laparoscopic and open colorectal resections in the elderly (≥70) population were included. Primary outcomes were operative death, anastomotic leak, pneumonia, length of hospital stay, and return to bowel function. Secondary outcomes were operative time, intraoperative blood loss, postoperative cardiac morbidity, ileus, and postoperative wound infection. The results of this systematic review and pooled analysis demonstrate the safety and potential benefits of laparoscopic colorectal resection in the elderly population. The latter include reduction in length of hospital stay, intraoperative blood loss, incidence of postoperative pneumonia, time to return of normal bowel function, incidence of postoperative cardiac complications, and wound infections. The results of this pooled analysis demonstrate the potential short-term advantages of laparoscopic colorectal resection in the elderly population. Further studies are required to examine the long-term survival following laparoscopic and open colorectal resections in the elderly population.

The effect of traditional Chinese medicine on distension after abdominal operation

Objective To observe the effect of traditional Chinese medicine on distension after abdominal operation.Methods A total of 80 cases of abdominal surgery patients with distension were divided into observation and control groups according to operation time order.The control group was given conventional therapy,the observation group was given hot salt compress and traditional Chinese medicine.Results The healing and postoperative recovery,anus bowel movements exhaust time were statistically significant between the two groups ( P ＜ 0.01 ).Conclusions Salt and traditional Chinese medicine hot compress on distention after opereation has obvious effect,and it is simple,convenient and feasible,is worthy to be popularized. Key words: Chinese medicine; Hot compress; Abdominal surgery; Distension

P02.81. Symptom management with massage in postoperative colorectal patients: a randomized controlled trial

Methods A randomized-controlled trial was designed for colorectal abdominal surgery patients. Patients were randomized to either receive a 20 minute massage on POD 1 and 2, 20 minutes of ambulation, or a visit by the massage therapist (no massage). Baseline physiologic data (HR, SBP/DBP, RR) were collected 30 minutes prior to and after either intervention. A standardized assessment of patient perception of pain, tension, anxiety, satisfaction with overall care, and relaxation level utilizing a visual analog scale (10 point Likert scale) was obtained before and after the intervention. The IRB approved study was powered to detect a difference at the 80% level. Repeated measures models were used to compare the symptom scores at different time points. T-tests were used to compare same day pre-post intervention changes.

Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study

BackgroundWe investigated the impact of incisional hernia (IH) on quality of life and body image. MethodsOpen abdominal surgery patients were included in a prospective cohort study performed between 2007 and 2009 in an academic hospital. Main outcomes were incidence of IH after approximately 12 months and Short-Form 36 and body image questionnaire results. ResultsThere were 374 patients who were examined after a median follow-up period of 16 months (range, 10–24 mo). Seventy-five patients had developed IH (20%); 63 (84%) were symptomatic. Adjusted for age, sex, and Charlson Comorbidity Index score, patients with IH reported significantly lower mean scores for components physical functioning (P = .033), role physical (P = .002), and physical component summary (P = .010). A trend toward significance was found for general health (P = .061). Patients with IH reported significantly lower mean cosmetic scores (P = .002), and body image and total body image scores (both P < .001). ConclusionsPatients with IH reported lower mean scores on physical components of health-related quality of life and body image.

Clinical anlysis of Laparoscopic surgery in treatment gynecological malignancies

Objective To investigate the clinical effect of laparoscopic surgery on gynecologic malignancies,providing information for the clinical therapy.Methods 35 patients with gynecologic malignancies treated with laparoscopic surgery were selected as the observation group.While 35 cases of abdominal surgery patients were selected as control group at the same period.The incidence of postoperative complications,survival rate and other conditions of the two groups were observed and compared.Results The operation time of laparoscopic surgery group was longer than open surgery group,no significant difference between the two groups(P ＞ 0.05 ).Blood loss,hospital slay and recovery time of body temperature of the laparoscopic surgery group was significantly lower than open surgery group ( P ＜0,05).2 cases had urinary retention,1 urinary tract infection and 1 deep vein thrombosis occured in observation group; while 3 urinary retention cases,1 intestinal obstruction case,1 deep vein thrombosis case,1 abdominal wound infection case occured in control group,and the difference was significant ( P ＜ 0.05 ).2 patients lost in each group.3-year survival rate of laparoscopic surgery group was similar with open surgery,the difference between the two groups was not statistically significant( P ＜ 0.01 ).Conclusion Excision and pelvic lymph node dissection under laparoscopy is an effective method in treatment of gynecologic cancer,and with less trauma and faster recovery. Key words: Laparoscopy; Uterine neoplasms ; Gynecologic surgery

Effects on Postoperative Salivary Cortisol of Relaxation/Music and Patient Teaching About Pain Management

The physiological and psychological stress of surgery and postoperative pain can leave patients more susceptible to infection and complications. The present study was designed to determine whether two interventions, patient teaching (PT) for pain management and relaxation/music (RM), reduced cortisol levels, an indicator of stress, following abdominal surgery. Patients (18-75 years) were randomly assigned to receive PT, RM, a combination of the two, or usual care; the 205 patients with both pre- and posttest cortisol values were analyzed. A 2 × 2 factorial design was used to compare groups for PT effects and RM effects. Stress was measured by salivary cortisol before and after 20-min tests of the interventions in the morning and afternoon of postoperative Day 2. Saliva was stimulated with lemon juice and analyzed with high-sensitivity salivary cortisol enzyme immunoassay. Comparisons using analysis of covariance (ANCOVA), controlling for baseline levels, showed no PT effect or RM effect on cortisol in the morning or afternoon. Post hoc ANCOVA showed no significant effects when intervention groups were compared to the control group. Although in previous studies, RM reduced pain and music reduced cortisol on Day 1, in the present study the cortisol response to surgery was not attenuated by PT or RM on Day 2. The RM intervention can be used for pain but needs to be further tested for effects on plasma cortisol in abdominal surgery patients on their first postoperative day.

Effects of the induction with Dezocine on incidence of the postoperative agitations of the patients during recovery period after remifentanil anesthesia

Objective To investigate the effects of induction with Dezocine to prevent the agitation of the patient after remifentanil anesthesia.Methods 60 patients of upper abdominal surgery,ASA Ⅰ ～ Ⅱ class,were randomly divided into 3 groups,20 patients in each group,anesthesia was induced with the midazolam 0.05 mg/kg,propofol 1 ～2mg/kg,vecuronium 0.12mg/kg.Analgesic drugs were administer as follow:control group,remifentanil ( group Rmf )1 μg/kg; fentanyl group ( group F) 4 μg/kg; Dezocine group ( group D) 0.2mg/kg.Remifentanil、propofol are used to maintain anesthesia.The time of recovery and extubation,the VAS pain score,the Ramsay score and adverse reactions such as vomiting,respiratory depression after extubation were recorded.Results Compared with group Rmf,the hemodynamic parameters was more stable in group F and group D.Compared with group F ( 1 μg/kg),the VAS pain score,the Ramsay score and adverse reactions significantly decreased in group D ( P ＜ 0.05 ),and the time of extubation in group F was longer than group D(P ＜ 0.05).Conclusion 0.2mg/kg of Dezocine could be used for the induction of anesthesia to reduce the incidence of agitation and adverse reactions during recovery period. Key words: Anesthesia recovery period; Dezocine ; Fentanyl; Remifentanil

Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence.

BackgroundPostoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal.MethodsThe objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n = 5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR) < 0.5-were collated into the algorithm.ResultsThe five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential.ConclusionAn expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.

Early Ambulation : An Ugly Phrase for a Beautiful Idea

The present study was undertaken to assess the effect of scheduled ambulation of selected post-operative outcomes between control and experimental groups in two hospitals of Bangalore; scores of post-operative outcomes of the two groups were also associated with demographic variables. The sample of 60 major abdominal surgery patients admitted in two hospitals was subjected to a rating scale of 14 demographic items and 35 items on parameters of post-operative outcomes like pain, fatigue, urine retention etc. The results showed that scheduled ambulation was effective in reducing the severity of selected post-operative outcomes.

The Safety and Feasibility of Low-Molecular-Weight He-parin Prophylaxis in Major Abdominal Surgery Combined with Neuraxial Anesthesia

Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia is unproven. We sought to evaluate the safety and feasibility of chemical VTE prophylaxis in a prospective group of patients undergoing major foregut procedures under a combination of epidural and general anesthesia. Methods: A prospective database of all patients undergoing major foregut surgery from 2004-2009 was maintained and analyzed. Epidural catheters were placed pre-operatively and used for post-operative analgesia for three days in all patients. Factors evaluated included age, ethnicity, sex, length of stay, duration of epidural placement, complications of epidural placement and post-operative management, and VTE events. A uniform protocol was followed regarding the timing of low-molecular-weight heparin (LMWH) administration with epidural catheter insertion/removal. Results: A total of 237 patients formed the study group. The mean age was 57 years (range, 19 - 88) among 121 (51.1%) women and 65 years (range, 20 - 95) among 116 (48.9%) men. One hundred and sixty-six patients were Caucasian (70%), 37 Black (15.6%), 15 Hispanic (6.3%), 12 Asian/Pacific (5.1%), and 7 other (3%). All epidural catheters were removed on the third post-operative day. There were a total of five VTE (2.1%) events postoperatively. No peri-operative or post-operative epidural catheter associated complications occurred. Conclusions: Concomitant epidural catheterization and LMWH anticoagulation is safe and feasible in major abdominal surgery patients, including those undergoing major hepatic resection. Guidelines for VTE prophylaxis and LMWH administration in the setting of neuraxial anesthesia are well established and applicable to this unique patient population.

Microbiology of Surgical Site Infections in Abdominal Tract Surgery Patients

IntroductionKnowledge of the microbiology of surgical infections after abdominal surgery can be of use when prescribing effective empirical antibiotic treatments. MethodAnalysis of surgical infections after abdominal surgery in patients enrolled in the Prevalence of Infections in Spanish Hospitals (EPINE) corresponding to the years 1999–2006. ResultsDuring the period of the study, 2280 patients who were subjected to upper or lower abdominal tract surgery were diagnosed with an infection at the surgical site (SSI). Eight hundred and eighty-three patients (37%) had an operation of the upper abdominal tract (gastric, hepatobiliary, and pancreatic surgery) and 1447 patients (63%) had lower abdominal tract surgery (appendectomy and colon surgery). A total of 2617 bacterial species were isolated in the 2280 patients included in the analysis. The most frequent microorganisms isolated were, Escherichia coli (28%), Enterococcus spp. (15%), Streptococcus spp. (8%), Pseudomonas aeruginosa (7%), and Staphylococcus aureus (5%, resistant to methicillin 2%). In the surgical infections after upper abdominal tract procedures, there were a higher proportion of isolations of staphylococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp. and Candida albicans and less E. coli, Bacteroides fragilis and Clostridium spp. ConclusionThe microbiology of SSI produced after upper abdominal tract surgery did not show any significant differences compared to those of the lower tract. However, more cases of SSI were detected due to staphylococci, K. pneumoniae, Enterobacter spp., Acinetobacter spp. and C. albicans and less caused by E. coli, B. fragilis and Clostridium spp.

An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach™)

Background: Because algorithms for difficult airway management,includingtheuseofnewopticaltrachealintubation devices, require prospective evaluation in routine practice, we prospectively assessed an algorithm for difficult airway management that included two new airway devices. Methods: After 6 months of instruction, training, and clinical testing, 15 senior anesthesiologists were asked to use an established algorithm for difficult airway management in anesthetized and paralyzed patients. Abdominal, gynecologic, and thyroid surgery patients were enrolled. Emergency, obstetric, and patients considered at risk of aspiration were excluded. If tracheal intubation using a Macintosh laryngoscope was impossible, the Airtraq laryngoscope (VYGON, Ecouen, France) was recommended as a first step and the LMA CTrach™ (SEBAC, Pantin, France) as a sec

PCV46 Clinical and Economic Burden of Major Bleeding in Abdominal Surgery Patients

PCV46 Clinical and Economic Burden of Major Bleeding in Abdominal Surgery Patients