Aftermath Of Surgery Research Articles

Cardiac autonomic and cortisol stress responses to real operations in surgeons: relationship with individual psychobiological characteristics and experience

BackgroundSurgeons are exposed to high levels of intraoperative stress, which could compromise their psychological well-being in the long term. This study aimed at exploring the effects of real operations on the activity of stress response systems (i.e., cardiac autonomic function and hypothalamic–pituitary–adrenal axis) during and in the aftermath of surgery, and the moderating role of individual psychobiological characteristics and different levels of experience (senior vs expert surgeons).MethodsHeart rate, heart rate variability, and salivary cortisol measures (as indexes of cardiac autonomic and hypothalamic–pituitary–adrenal axis activity, respectively) were assessed during real operations and in the perioperative period in a sample of surgeons (n = 16). Surgeons’ psychometric characteristics were collected using questionnaires. Results. Real operations triggered both cardiac autonomic and cortisol stress responses which were independent from surgeons’ level of experience. Intraoperative stress responses did not affect cardiac autonomic activity during the following night but were associated with a blunted cortisol awakening response. Moreover, senior surgeons reported higher levels of negative affectivity and depressive symptoms than expert surgeons prior to the surgery. Lastly, the magnitude of heart rate responses to surgery positively correlated with scores on negative affectivity, depression, perceived stress, and trait anxiety scales.ConclusionThis exploratory study allows to put forward the hypotheses that in surgeons cardiac autonomic and cortisol stress responses to real operations (i) may be associated with specific individual psychological characteristics regardless of the level of experience, (ii) and may have a longer lasting impact on hypothalamic–pituitary–adrenal axis function with potential implications for surgeons’ physical and psychological well-being.

Traumatic Spigelian hernia in a child

Spigelian hernia is an uncommon surgical condition in children and accounts for only 1% of all abdominal hernias. Its traumatic origin has been described sporadically in the literature. We report a case of a 9-year-old boy, brought to the emergency department 2 hours after abdominal trauma caused by a bicycle's handlebar grip at the lower abdomen, complaining of abdominal pain. Apart from edema, bruising and tenderness of the right of lower abdomen, physical examination showed a 1.5 * 2 cm reducible swelling lateral to the rectus muscle and a 1-cm facial defect of the anterior abdominal wall at the same site. Ultrasonography concluded to diastasis between the rectus abdominis muscle and the broad abdominal muscles with evidence of a hernia sac. The diagnosis of traumatic Spigelian hernia was retained and the patient was operated on. He had primary repair of the defect in layers using interrupted sutures. He was discharged in the same day and the aftermath of surgery was uneventful. In conclusion, traumatic Spigelian hernias are rare entities in children which diagnosis should be considered following blunt abdominal trauma. We recommend careful abdominal examination after trauma to highlight swelling and/or aponeurotic defect.

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

Bilateral Divergent Shoulder's Fracture Dislocation Case in an Ischemic Stroke Patient.

Introduction:The literature review revealed that nowadays only about 15 cases of bilateral shoulder dislocation associated with the fracture of the upper end of the humerus have been published. The triad of lesional mechanism designated by the triple syndrome E composed of epilepsy, electrocution, and external trauma was the circumstances noted in which these fractures dislocations occur with migration of the two humeral heads either forward or backward.Case Report:An architect of 36-year-old, right-handed, was admitted in emergency department for loss of knowledge of progressive installation. At admission the blood pressure, pulse, and temperature were normal. There was a right hemiparesis predominantly in brachiofacial side and an aphasia. After intensive resuscitation measures, the cerebral computed tomography scan revealed a left temporoparietal hypodensity area affecting the middle cerebral artery superficial territory with a mass effect compatible with acute ischemic stroke. During the hospitalization, episodes of generalized tonic-clonic convulsions appeared with a fever at 39°C and a leukocytosis at 35 thousand on the 5th day. These convulsions caused on the right shoulder an anterior dislocation under coracoid, associated with a fracture of the greater tubercle and on the left shoulder, posterior dislocation with much displaced comminuted articular proximal humeral fracture. We did reduction by external maneuvers for the right shoulder and open reduction with internal fixation by anatomical plate of left shoulder lesions. In the immediate aftermath of surgery, he presented episodes of agitation which led to the dismantling of the left shoulder fixation. He was evacuated to the North Country where an ablation of the left shoulder material and stabilization by locked plate were carried out. The sequelae were marked by the occurrence of an osteomyelitis with osteolysis of the entire upper right humerus extremity. It will require an inverted prosthesis.Conclusion:The surgical treatment must be done by a solid assembly and consultation with neurologists and anesthetists is essential. This multidisciplinary management could prevent any convulsive postoperative seizures that would risk sacrificing all therapeutic efforts.

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

The family experience of "sudden health": the case of intractable epilepsy.

This article reports the experience of "sudden health" among six families who participated in an exploratory qualitative study of families with a member who elects to have corrective surgery for intractable epilepsy. Families were interviewed pre- and post-surgery (6-8 months) and the interviews were analyzed using a constant comparative methodology. Findings indicated that (1) families were organized in two primary ways (nesting and crisis) to deal with epilepsy and the aftermath of surgery and (2) "sudden health" had differing effects on these families depending on their organizational style, emotional communication process, and developmental dynamics.

The promotion of tumor metastasis by surgery and stress: Immunological basis and implications for psychoneuroimmunology

This mini-review emphasizes a psychoneuroimmunology (PNI) perspective of the hypothesis that stress and surgical excision of the primary tumor can promote tumor metastasis. It first establishes the empirical and theoretical basis for control of metastasis by cell-mediated immunity (CMI), as well as the interactive role of non-immunological risk factors. It then describes the various aspects of surgery that suppress CMI, and the neuroendocrine mechanisms mediating suppression by stress and surgery. Last, it briefly reviews the empirical evidence, from animal and human studies, for the promotion of metastasis by stress and surgery, with specific reference to the mediating role of CMI. It is concluded that: (a) Immunological mechanisms most likely play a role in limiting metastasis in patients with solid tumors. (b) Immunosuppression can be deleterious, especially when surgery is conducted early, before the tumor develops insurmountable mechanisms to escape immune destruction. (c) The most sensitive period for the establishment of metastases is the immediate aftermath of surgery. Interventions aiming at reducing stress and immunosuppression should thus strive to start beforehand. (d) ‘Psychological and physiological insults activate similar neuroendocrine mechanisms of immunosuppression. Therefore, a multimodal therapeutic approach should be used to prevent tumor metastasis during the perioperative period. (e) Studies employing interventions aimed at reducing the surgical stress response should preferably assess immunological indices with an established clinical relevance, and follow up long-term recurrence provided sample size assure statistical power. (f) The progress toward earlier detection of cancer, and our growing understanding of immunosuppression, continuously improves the chances for successful PNI interventions.

The fivefold root of an ethics of surgery.

Surgical ethics have generally been framed as general medical ethics applied to surgical contexts. This model is helpful, but may miss some of the special features of the surgical process and relationship. It is suggested in this paper that there are five categories of experience and relationship which are especially important in surgery--rescue, proximity, ordeal, aftermath, and presence. The sense of rescue, the feeling of relational proximity, the ordeal and aftermath of surgery are things which the patient experiences. Understanding these experiences allow surgeons to understand what may be asked of them in an ethical sense. Recognition of the reality and validity of each category in the surgical process highlights the importance of presence, the acts by which the surgeon demonstrates that he is present to the patient throughout the surgical process and its aftermath. While the teaching of communication skills may never compensate for insensitivity, the ideal of presence as virtue and duty can be taught by precept and example.

Coming out of intensive care crazy: dreams of affliction.

The impetus for this article was the author's experience of illness, necessitating 5 months of hospitalization, 7 weeks of which were spent in a coma in an intensive care unit (ICU). The origins and general characteristics of ICUs are noted. A pastiche of illness narrative is constructed to allow for the author's own comment on his experience. The intensive care syndrome (ICS), a permeable category, continuing the aftermath of surgery and the social, psychological, mechanical, and pharmaceutical effects of the unit itself, is discussed. Dreams of affliction, a component of the ICS, are explored; the prior sociological history of the neglect of dreams, an essential universal, is also pointed out. The author's dream forms and their shamanistic parallels are explored. In Foucauldian language, they are considered a product of the fragmentation of the cosmological spirit, whereas the author was a medical object and mechanical appendage. Nursing is in a strategic position to make patients' dream narratives their own as an aid for understanding illness.

Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis

A prospective investigation is described which sought to test the role of illness cognitions in determining patient responses to a surgical intervention for osteoarthritis. Illness cognitions were assessed amongst a consecutive sample of patients with osteoarthritis of the knee or hip prior to undergoing joint replacement surgery. Functional activity and depression were assessed pre-operatively, and at 3 and 9months post surgery. At pre-operative assessment, functional activity and depression were univariately associated with the perceived consequences of osteoarthritis. Path analyses using longitudinal data demonstrated that illness cognitions had predictive value in explaining outcomes. Depression at 3months was associated with higher pre-operative perceived control beliefs suggesting that patients who have high control pre-operatively may be at risk for temporary depressed mood in the immediate aftermath of surgery. This effect was not maintained at 9months. Depression at 9months was lower amongst patients who were more active at 3months, who did not attribute their condition to wear and tear and who had higher expectations of surgery. Functional activity at 9months was higher amongst those who did not attribute their condition to growing older and who perceived more control over symptoms. Socio-demographic variables were not associated with change in functional activity or depression over the course of surgery. The results provide support for an illness cognition approach in explaining functional activity and depression outcomes following surgery.