Major Abdominal Surgery In Patients Research Articles

Survey of intravenous fluid maintenance therapy for surgical patients in the UK

Surgical patients receive various intravenous maintenance fluids after major surgical procedures. Usually these fluids are prescribed by most junior surgical trainees with different levels of experience. We surveyed intravenous maintenance fluid therapy for post major abdominal surgery patients among surgical trainees in London, UK.

Emergency Major Abdominal Surgery in Patients over 85 Years of Age

The aim of this retrospective study was to evaluate the outcome and prognostic parameters of patients over 85 years of age undergoing major abdominal emergency surgery. The medical records of 45 consecutive patients aged over 85 years who underwent major abdominal emergency surgery between May 1999 and November 2001 were reviewed. The mean patient age was 88 years. Eight patients were American Society of Anesthesiologists (ASA) IV or V, 21 were ASA III, and 16 were ASA I or II. We performed 38 median and 7 right subcostal laparotomies. Perioperative mortality was 26.6% (3 times higher than that of the overall population at the same age). Perioperative complications occured in 29.5% of patients. Ten patients returned home after surgery, of whom 70% remained alive at the end of the study. Twenty-three left the hospital for a long-term care institution or post-acute care unit: of these 20% remained alive at the end of the study. Among ASA I or II patients, 43.7% remained alive at the end of the study, although 18.7% died within 1 month of the surgery. Among ASA III, IV, or V patients, only 17.2% remained alive at the end of the study, and 34.5% died within 1 month of the surgery. None of patients classified as ASA IV or V survived for more than 6 month after surgery. With an overall mortality rate of about 30%, and with the clear correlation between increased mortality and higher ASA scores, the place of palliative treatment must remain a major consideration for patients in this age group classified ASA III or higher. When surgery is performed, early return home, should be encouraged.

Combination of diaphragmatic plication with major abdominal surgery in patients with phrenic nerve palsy

The role of simultaneous prophylactic diaphragmatic plication during major abdominal operations is evaluated. In five patients with a history of phrenic nerve injury, postoperative ventilation requirements and hospital stay were significantly reduced when synchronous diaphragmatic plication was performed, compared with corresponding values obtained during previous abdominal operation without diaphragmatic plication. In addition, diaphragmatic plication was associated with postoperative improvement of respiratory mechanics and blood gas exchange.

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

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.

Shunt revision after major abdominal surgery in patients with Spina Bifida

Shunt revision after major abdominal surgery in patients with Spina Bifida

Adenovirus-mediated insulin gene transfer improves nutritional and post-hepatectomized conditions in diabetic rats

Background: Impaired nutritional conditions in patients with diabetes are significant risk factors after major abdominal surgery. We constructed recombinant adenovirus vector carrying the human insulin gene (AxCAIns) for in vivo insulin gene transfer to improve metabolic impairments after a major operation in patients with diabetes. We tested the effects of AxCAIns on nutritional and post-hepatectomized conditions in rats with diabetes treated with streptozotocin (STZ). Methods: AxCAIns was injected into the spleen in diabetic rats treated with STZ. Blood levels of glucose, total protein, albumin, and C-peptide of human proinsulin were measured and the expression of transferred human insulin gene was analyzed in various organs. Diabetic rats underwent 70% partial hepatectomy with or without AxCAIns injection, and post-hepatectomized conditions were analyzed. Results: STZ-induced hyperglycemia was reduced by AxCAIns injection. Decreased serum levels of total protein and albumin in diabetic rats were significantly restored to normal levels by AxCAIns injection, and human C-peptide was detected in the sera of AxCAIns-treated rats. Human preproinsulin messenger RNA, which represented the expression of transferred insulin gene, was detected in the liver and the spleen, but not in other organs. Serum albumin levels, remnant liver weight, and ratios of postoperative body weight to preoperative body weight were significantly increased by AxCAIns in hepatectomized diabetic rats. Conclusions: AxCAIns injection to the spleen efficiently transferred the human insulin gene mainly into the hepatocytes and produced enough human proinsulin to improve nutritional impairments and post-hepatectomized conditions in diabetic rats. Insulin gene transfer with intrasplenic injection of AxCAIns may be available to improve metabolic impairment after major abdominal surgery in patients with diabetes. (Surgery 2000;127:670-8.)

CD4 cell counts as a prognostic factor of major abdominal surgery in patients infected with the human immunodeficiency virus.

To measure the prognostic utility of helper T-cell (CD4) counts in human immunodeficiency virus (HIV)-infected patients undergoing major abdominal surgery. Retrospective case series. Three university-affiliated hospitals. Forty-three HIV-infected patients undergoing major abdominal surgery. Morbidity and mortality rates with respect to CD4 cell counts. Nineteen of 32 patients who had CD4 cell counts less than 0.20 X 10(9)/L (200 cells/microL) suffered major complications compared with 2 of 11 patients who had CD4 cell counts greater than 0.20 x 10(9)/L (200 cells/microL) (P=.03). Perioperative mortality was 38% for patients with CD4 cell counts less than 0.20 x 10(9)/L, and was 9% for those with CD4 cell counts greater than 0.20 x 10(9)/L (P=.13). Six months postoperatively, mortality rates were 47% and 9%, respectively (P=.03). Of patients with septic processes perioperatively (n=12), mortality was 75%, and was 19% (P=.009) for those with nonseptic processes (n=31). Nine patients had HIV-related intra-abdominal pathologic conditions at laparotomy. Mortality was 56% perioperatively (P=.13) and 88% after 6 months (P=.001). Sixty-eight percent of patients who received blood product transfusions developed complications, whereas only 7% of those who did not receive transfusions developed complications (P<.001). Overall mortality and morbidity rates were 37% and 49%, respectively. Patients with morbidity had lower CD4 cell counts (median, 0.034 x 10(9)/L) than those without complications (median, 0.102 x 10(9)/L) (P=.02). Similarly, patients who died had lower CD4 cell counts (median, 0.031 x 10(9)/L vs 0.088 x 10(9)/L) (P=.05). Patients with acquired immunodeficiency syndrome-defining CD4 cell counts undergoing major abdominal surgery developed more complications and had poorer outcomes at 6-month follow-up compared with HIV-infected patients whose CD4 cell counts were greater than 0.20 x 10(9)/L (200 cells/microL). A perioperative septic process and HIV-related pathologic conditions seen at laparotomy are also associated with worse outcomes.

Postoperative Complications After Thoracic and Major Abdominal Surgery in Patients With and Without Obstructive Lung Disease

To determine the risk of thoracic and major abdominal surgery in patients with chronic obstructive pulmonary disease (COPD). Retrospective cohort study with controls. A 692-bed teaching hospital. A cohort of 26 patients with severe COPD (FEV1 < 50 percent predicted) undergoing thoracic and major abdominal surgery was matched by age and type of operation to 52 patients with mild-moderate COPD and 52 patients with no COPD. The 26 patients with severe COPD had rates of cardiac, vascular, and minor pulmonary complications similar to patients with mild-moderate COPD and without COPD, but experienced higher rates of serious pulmonary complications (23 percent vs 10 percent vs 4 percent, p = 0.03) and death (19 percent vs 4 percent vs 2 percent, p = 0.02). All deaths and instances of ventilatory failure in the patients with severe COPD occurred in the subset undergoing coronary artery bypass surgery. Logistic regression revealed that increased age, higher American Society of Anesthesiologists class, an abnormal chest radiograph, and perioperative bronchodilator administration were associated with higher cardiac or serious pulmonary complication rates. Spirometry was not an independent predictor of postoperative complications. Clinical variables appear better than preoperative spirometry in predicting postoperative cardiopulmonary complications. The utility of preoperative spirometry as well as the benefits of perioperative bronchodilators in patients in stable condition remain to be determined.

Granulocyte microbicidal function in patients undergoing major abdominal surgery under balanced anaesthesia.

Granulocyte microbicidal functions were studied in 11 major abdominal surgery patients with the luminol-enhanced chemiluminescence method. The responses of granulocytes in phagocytosis of zymosan, S. aureus and E. coli and responses to N-formylmethionyl-leucylphenylalanine (FMLP) were unaffected by surgery. The percentage of high-peroxidase-activity cells among neutrophils was increased on postoperative days 1 (P less than 0.01) and 3-4 (P less than 0.05). We propose that microbicidal-related oxidative phagocytic functions of granulocytes are well maintained after major abdominal surgery under balanced anaesthesia.