Postoperative Management Of Patients Research Articles

Extended Neuroendoscopic Endonasal Approach for Resection of Craniopharyngioma in Children.

ObjectiveTo explore the surgical approach and technique of neuroendoscopic endonasal resection of pediatric craniopharyngiomas and to further evaluate its safety and effect in children.MethodsThe clinical data of 8 children with craniopharyngiomas who were surgically treated by neuroendoscopy through an extended endonasal approach in our center from 2018 to 2021 were retrospectively analyzed. The related surgical approach and technique were evaluated to improve the surgical results and further reduce the surgical complications when removing craniopharyngioma in children.ResultsAll 8 patients achieved a gross-total resection of the tumor under neuroendoscopy. Postoperatively, 2 cases of transient hyperthermia and 4 cases of transient hyper- and/or hyponatremia occurred within the first 2 weeks, all of which were quickly controlled. Seven patients had symptoms of diabetes insipidus to varying degrees after the operation, and 4 of them improved within 1–3 months after surgery, but 3 cases still needed oral pituitrin. There were no cases of coma or death, leakage of cerebrospinal fluid, or severe electrolyte imbalance after surgery. During the postoperative follow-up of 3 months to 2 years, no tumor recurrence was found. Among the 7 patients who suffered postoperative neuroendocrine deficiencies, 3 patients were found to be temporary during the follow-up, but 4 patients still required hormone replacement therapy. Particularly, postoperative visual deterioration and olfactory defect that occurred in patients were all improved during follow-up periods. In addition, 4 cases of obesity were noted at the last follow-up.ConclusionsExtended neuroendoscopic endonasal resection of craniopharyngiomas may be used as a safe and effective approach for children. Due to the poor pneumatization of the sphenoid sinus and worse compliance of treatment in children, surgical techniques of exposing the sellar region, removing the tumor, and reconstructing the skull base, as well as postoperative management of patients was proposed. However, due to the limited surgical cases in the study, the surgical safety and effects of the extended neuroendoscopic endonasal approach for children with craniopharyngiomas need to be further studied in the future.

Narrative Review of the Post-Operative Management of Prostate Cancer Patients: Is It Really the End of Adjuvant Radiotherapy?

Simple SummaryAmong patients with prostate cancer who have been operated on, a subset harboring high-risk features will present with a biochemical recurrence (BCR). Adjuvant radiotherapy (aRT) was proven to significantly reduce the risk of BCR when compared to salvage radiotherapy (SRT) but suffered from several limitations: a lack of patient selection criteria, a higher treatment-related morbidity and an uncertain benefit for long-term clinical endpoints. In the same clinical setting, early SRT (eSRT) appears as non-inferior to aRT with a lower morbidity, replacing aRT as the preferred option. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient.Despite three randomized trials indicating a significant reduction in biochemical recurrence (BCR) in high-risk patients, adjuvant radiotherapy (aRT) was rarely performed, even in patients harboring high-risk features. aRT is associated with a higher risk of urinary incontinence and is often criticized for the lack of patient selection criteria. With a BCR rate reaching 30–70% in high-risk patients, a consensus between urologists and radiation oncologists was needed, leading to three different randomized trials challenging aRT with early salvage radiotherapy (eSRT). In these three different randomized trials with event-free survival as the primary outcome and a planned meta-analysis, eSRT appeared as non-inferior to aRT, answering, for some, this never-ending question. For many, however, the debate persists; these results raised several questions among urologists and radiation oncologists. BCR is thought to be a surrogate for clinically meaningful endpoints such as overall survival and cancer-specific survival but may be poorly efficient in comparison with metastasis-free survival. Imaging of rising prostate-specific antigen (PSA), post-operative persistent PSA and BCR was revolutionized by the broader use of MRI and nuclear imaging such as PET-PSMA; these imaging modalities were not analyzed in the previous randomized trials. A sub-group of very high-risk patients could possibly benefit from an adjuvant radiotherapy; but their usual risk factors such as high Gleason score or invaded surgical margins mean they are unable to be selected. More precise biomarkers of early BCR or even metastatic-relapse were developed in this setting and could be useful for the patients’ stratification. In this review, we insist on the need for multidisciplinary discussions to fully comprehend the individual characteristics of each patient and propose the best treatment strategy for every patient.

Неінвазивна вентиляція легень у онкохворих після операцій на органах грудної клітки

У статті вірогідно доведена клінічна ефективність набувшої останнім часом широкої популярності серед спеціалістів у галузі інтенсивної терапії методики респіраторної терапії — неінвазивної вентиляції легень. Специфікою групи спостереження була онкопатологія органів грудної клітки у хворих у стані після оперативного лікування, оперованих в умовах тотальної внутрішньовенної анестезії із застосуванням штучної вентиляції легень. З метою визначення ефективності досліджуваного способу респіраторної терапії в наведеній групі хворих нами були застосовані методи визначення комфорту хворого з використанням візуально-аналогової шкали. Неінвазивна вентиляція довела свою ефективність як спосіб інтенсивної терапії та метод профілактики респіраторних розладів: у хворих, при веденні яких у постопераційному періоді застосовувалася методика неінвазивної вентиляції легень, було відзначено вірогідне покращання показників кислотно-лужного, газового складу крові та гемодинамічних показників. Під час спостережень були виділені такі показання до застосування методики, що розглядалася, у тактиці інтенсивної терапії хворих, прооперованих із приводу онкологічних утворень грудної порожнини: дихальна недостатність 1–2-го ст. у хворих із збереженою свідомістю, ателектази легеневої тканини, ризик розвинення вентиляторасоційованих пневмоній з урахуванням метаболічних та гемодинамічних порушень, особливо в ранньому післяопераційному періоді. У статті розглянуто й обґрунтовано рекомендації до проведення респіраторної терапії із застосуванням неінвазивної вентиляції легень, параметри режимів та строки вентиляції легень. Розглянута тактика респіраторного післяопераційного ведення онкохворих у стані після оперативних втручань значно скорочує строки перебування пацієнтів в умовах відділень інтенсивної терапії, а отже, зменшує вартість лікування, справляє позитивний психоемоційний ефект, що є дуже важливим у групі ракової патології.

RNA-seq analysis of peripheral blood dendritic cells maturated by dezocine in patients with lung cancer

Surgical resection is the most common and effective option for the clinical treatment of lung cancer. Postoperative pain may activate surgically induced stress response, leading to a decrease in human immune function. However, conventional analgesics such as morphine and its derivatives have been reported to have immunosuppressive side effects. In the critical period after surgery, the immunosuppressive effect of analgesics on patients with lung cancer could promote postoperative cancer recurrence and metastasis. Therefore, it will be an ideal scenario for postoperative pain management to maximize pain relief while minimizing immunosuppression side effects. In this study, we found that a novel mixed agonist-antagonist opioid analgesic, dezocine, significantly promoted the morphological maturation of dendritic cells (DCs), and increase the expression of DCs-related surface markers in postoperative peripheral blood of patients with lung cancer. Furthermore, dezocine-matured DCs increased the general immune response by promoting the secretion of IL-12 and IL-6 cytokines and enhancing the proliferation and cytotoxicity of CD8+ T cells. Then genome-wide transcriptomic profiling analyses were performed to identify the specific gene expression of dezocine-matured DCs. The results of transcriptomic analysis as well as in vitro validation showed that the upregulation of CXCL10, CD3G, and GRB2 were significantly associated with dezocine-induced DCs maturation. Overall, our data showed that dezocine might exhibit unique properties by acting as an immunostimulant, which provides new evidence for its application in postoperative pain management of patients with lung cancer.

Use of idarucizumab for emergency surgery in patients taking dabigatran

This article presents modern possibilities for the provision of emergency surgical care to patients with atrial fibrillation, who administered dabigatran etexilate. We describe two clinical situations, in which idarucizumab, a specific dabigatran antagonist, which is a monoclonal antibody fragment that binds dabigatran, was used to neutralize the anticoagulant effect of dabigatran etexilate before emergency surgery. In the first case, the patient developed acute gangrenous calculous cholecystitis, in the second a patient required an urgent epicystostomy. In both cases, the successful outcome of surgical interventions was due to the effective interactions of the team of specialists and adherence to the algorithm for providing emergency care to such patients, as well as the presence of idarucizumab in hospitals. The postoperative management of patients and the timely resumption of anticoagulant therapy to prevent thromboembolic complications is no less important. The presented clinical cases confirm the feasibility of using idarucizumab to provide emergency surgical care to patients on dabigatran etexilate, as well as the need to take into account the possible risk of emergency interventions when anticoagulant therapy is prescribed to patients with atrial fibrillation. This paper discusses special risk groups of patients in whom rapid reversal of anticoagulation is required due to altered hemostasis.We outline data of a prospective cohort study (RE-VERSE AD), which examined the efficacy and safety of idarucizumab in patients with uncontrolled bleeding and in patients requiring urgent surgery. We also present the RE-VECTO study data on the use of idarucizumab in real-life clinical practice.

A GEE model for predicting axial length after cataract surgery in children younger than 2years of age.

To develop a model for predicting postoperative axial length (AL) in children undergoing cataract surgery younger than 2years of age. The Eye Hospital of Wenzhou Medical University, Hangzhou, China DESIGN: Retrospective study. Children were included only if AL data were available before surgery and at least 1year after surgery. Eyes were divided into pseudophakic, aphakic, and unaffected eye groups. Variables that could influence axial growth were analyzed and a multivariable generalized estimating equation regression model was developed to predict postoperative AL. 333 eyes from 190 patients were included. We observed a logarithmic linear correlation between age and AL in the unaffected eye group, AL = (2.7924 × log of age in months) + 17.607, R2 = 0.6596. Meanwhile, The GEE model of eyes with cataracts can be written as follows: Postoperative AL = 6.408 + 0.611 × (baseline AL) + 0.007 × (baseline age) - -0.006 (baseline age) × (age at follow-up) - -0.391 × coefficient of surgery. The ages were recorded in months, the ALs were recorded in millimeter. The assessment of AL is one of the most important parts of successful postoperative management in congenital cataract patients. This study established an AL estimate formula for children aged ≤ 2years with congenital cataract who underwent cataract surgery. This model theoretically could be used to predict individual future AL for child undergoing cataract surgery.

Postoperative management of pediatric patients undergoing minimally invasive repair of pectus excavatum: Where are we now?

PurposeMinimally invasive repair of pectus excavatum (MIRPE) often leads to a painful and challenging recovery period. This study aims to describe the postoperative management of pediatric patients undergoing MIRPE and compare postoperative outcomes between patients using different routes of postoperative analgesia. MethodsRetrospective chart review of pediatric patients who underwent MIRPE from July 2003 to September 2019 at a single pediatric tertiary care center. Data on pain management and course of hospital stay were ascertained. Descriptive statistics, Mann-Whitney U and Pearson Chi-Square tests were used to analyze data. A p-value <0.05 was considered significant. ResultsOf the 115 patients identified, 58 (50.4%) managed pain postoperatively using thoracic epidural and 57 (49.6%) used intravenous patient-controlled analgesia (IVPCA). The transition from the predominant use of epidural to IVPCA for MIRPE occurred between 2012 and 2013. Higher pain scores were reported by the IVPCA group at 6 h (p<0.001) and 12 h (p<0.001) postoperative. Patients using IVPCA had lower postoperative opioid consumption (p<0.001) and switched to oral opioids sooner than the epidural group (p<0.001). Fewer patients in the IVPCA group required urinary catheterization (p<0.001). Patients using IVPCA had a shorter hospital stay (4 days [IQR 4–5]) compared to the epidural group (5.5 [IQR 5–6]; p<0.001). Readmission was comparable at 3.48% in the total sample. ConclusionPatients using intravenous patient-controlled analgesia reported higher pain scores however, this route of analgesia was associated with shorter hospital stay. Prospective studies designed to address moderator variables are required to confirm findings and develop standardized recovery protocols.

EVALUATION OF ANALGESIC EFFECT OF TAB TRAILOKYA VIJAYA VATI IN POST-OPERATIVE PAIN IN KSHARKARMA PATIENTS: AN OBSERVATIONAL STUDY

Despite the advances in technology and robotics, the basics of surgical management are not changed drastically. The science of life, Ayurveda has extensive knowledge of surgeries, including complicated procedures mentioned in the classical texts. However, with time, the ability of anaesthetics and analgesic agents has been lost. This resulted in the lagging of Ayurvedic Surgical wisdom and the rise of modern analgesics and anaesthetics in the market. These current products have potential side effects, and hence a safer and better alternative to these products can boost Ayurveda Surgery worldwide. Trailokya Vijaya Vati (TVV) is one such Ayurvedic formulation that is explained for its potent analgesic activity. The present study was conducted to evaluate the safety and efficacy of TVV in post-operative pain management in patients undergoing anorectal procedures. The observational trial suggested a reduction in time to sleep (p &lt; 0.05), less incidence of insomnia and undisturbed sleep in the treatment group than the control. The formulation was also well tolerated with no or minimal requirement of rescue analgesics. The efficacy observed in the study suggests the formulation can be explored further on a larger population with a diverse activity profile.

Early biochemical predictors of clinically relevant pancreatic fistula after distal pancreatectomy: a role for serum amylase and C-reactive protein.

Recent evidence suggests that pancreatic inflammation plays a pivotal role in the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy but few data are available for distal pancreatectomy (DP). The aim of this study was to evaluate the impact of early biochemical markers on the occurrence of CR-POPF after DP. Clinical and laboratory data for 432 consecutive DP patients were reviewed. Serum amylase was evaluated on postoperative day (POD) 1, and drain fluid amylase (DFA) and C-reactive protein (CRP) were evaluated on POD 2 and 3. Receiver operator characteristic (ROC) curves were performed for all biochemical markers and an area under the curve (AUC) was computed. Multivariable regression analyses to identify the factors associated with CR-POPF and severe postoperative morbidity (Clavien-Dindo grade ≥ 3) were performed. At 90 days after surgery, CR-POPF occurred in 155 (36%) patients, severe complications in 66 (15%) patients. ROC curve analyses showed that DFA on POD2 had the largest AUC (0.753, p < 0.001), followed by serum amylase on POD 1 (0.651, p < 0.001), serum CRP on POD3 (0.644, p < 0.001), and CRP change between POD 2 and POD 3 (0.644, p < 0.001). Multivariable analysis identified male gender (OR 2.29, 95% CI 1.36-3.86; p = 0.002), DFA ≥ 1500 U/Lon POD2 (OR 4.63, 95% CI 2.72-7.89; p < 0.001), serum amylase ≥ 100 U/L on POD 1 (OR 1.72, 95% CI 1.01-2.93; p = 0.046), and CRP increase by at least 25mg/L on POD 3 compared to the previous day (OR 1.89, 95% CI 1.11-3.21; p = 0.019) as independent predictors of CR-POPF, yielding a valid regression model (AUC 0.765, 95% CI 0.714-0.816, p < 0.001). Postoperative serum amylase and CRP trajectory represent useful early biochemical markers for CR-POPF in addition to DFA. Our findings suggest that these laboratory tests should be incorporated into clinical practice to aid postoperative patient and drain management.

Surgical treatment of acetabular fractures

Background. Acetabular fractures are severe intra-articular injuries that require anatomical reposition and early function, but they are often complicated by degenerative changes in both the acetabulum and the femoral head, leading to the development of post-traumatic coxarthrosis. The purpose was to study the clinical effectiveness of surgical treatment and postoperative management of patients using autologous platelet-rich plasma in patients with fractures of the acetabulum. Materials and methods. Twenty-eight patients with acetabular fractures of various degrees were operated at the City Emergency Hospital of Zaporizhzhia and the Municipal Clinical Hospital No 9 from 2017 to 2019. Gender composition: 22 men (78.57 %), 6 women (21.43 %), average age 46.64 ± 2.21 years, with a 95% confidence interval 42.31–50.96. Nineteen victims (67.86 %) had road traffic injuries, 7 (25 %) domestic injuries, and 2 (7.14 %) had industrial injuries. Results. In the main group of patients treated with platelet-rich plasma, radiologically visible adhesion of the injured area after 8 weeks occurred in 10 people (83.4 %). In one person (8.3 %), the adhesion occurred after 12, and in another (8.3 %) — 16 weeks after surgery. In the control group, adhesions at 8th week were registered in 14 patients (60.87 %), in 8 (34.78 %) — at 16th week. Given the general recovery of the body in the main group, the activation and social adaptation of patients occurred 2–3 weeks earlier. The assessment was performed radiologically and by the criteria of functional recovery.

Liposomal Bupivacaine Associated with Cost Savings during Postoperative Pain Management in Fragility Intertrochanteric Hip Fractures.

BackgroundIntertrochanteric hip fractures are among the most common and most expensive diagnoses in the Medicare population. Liposomal bupivacaine is a novel preparation of a commonly used analgesic agent that, when used intraoperatively, decreases narcotic requirements and hospital length of stay and increases the likelihood of discharge to home. The purpose of this investigation was to determine whether there was an economic benefit to utilizing intraoperative liposomal bupivacaine in patients with fragility intertrochanteric hip fractures in comparison to a group of patients who did not receive liposomal bupivacaine.MethodsThis is a retrospective observational study performed at two academic medical centers. Fifty-six patients with intertrochanteric hip fractures treated with cephalomedullary nail implant who received standard hip fracture pain management protocol were compared to a cohort of 46 patients with intertrochanteric hip fractures who received additional intraoperative injections of liposomal bupivacaine. All other standards of care were identical. A cost analysis was completed including the cost of liposomal bupivacaine, operating room costs, and discharge destination. Statistical significance was set at p < 0.05.ResultsAlthough the length of hospital stay was similar between the two groups (3.2 days vs. 3.8 days, p = 0.08), patients receiving intraoperative liposomal bupivacaine had a lower likelihood of discharge to a skilled nursing facility (84.8% vs. 96.4%, p = 0.002) and a longer operative time (73.4 minutes vs 67.2 minutes, p = 0.004). The cost-benefit analysis indicated that for an investment of $334.18 in the administration of 266 mg of liposomal bupivacaine, there was a relative saving of $1,323.21 compared to the control group. The benefit-cost ratio was 3.95, indicating a $3.95 benefit for each $1 spent in liposomal bupivacaine.ConclusionsDespite the increased initial cost, intraoperative use of liposomal bupivacaine was found to be a cost-effective intervention due to the higher likelihood of discharge to home during the postoperative management of patients with intertrochanteric hip fractures.

Лазерное лечение глаукомы: современные подходы и практические рекомендации

Glaucoma represents a significant medical, economical, and social burden for the healthcare system both in Russia and worldwide. Despite a variety of pharmacological, surgical and laser treatment options, the number of patients with irreversible glaucomatous damage to visual function is continuously rising. Currently, more emphasis has been made on laser micropulse techniques for the treatment of glaucoma. It is underpinned by several important advantages of this modality: it has demonstrated high efficacy; can be performed in outpatient settings without general anesthesia; is well-tolerated by patients; can be repeated over time and combined with surgeries; and is considered as a cost- effective treatment. There are different laser treatment options: laser trabeculoplasty, iridogonioplasty, laser iridectomy, goniopuncture, and laser cyclodestructive procedures, as well as their modifications. The article discusses specific features of these techniques, indications and contraindications, and laser characteristics. The article emphasizes the role of gonioscopy as an effective ocular assessment technique helping to create an individualized laser treatment plan for glaucoma patients. Also, the article focuses on pre- and postoperative management of patients and presents an algorithm for the management of patients with different glaucoma forms referred to the laser treatment. Keywords: glaucoma, gonioscopy, micropulse laser treatment, pre-operative management, intraocular pressure, pigment dispersion syndrome, trabeculoplasty, iridogonioplasty, iridectomy, goniopuncture, cyclocoagulation, bromfenac. For citation: Rabadanova M.H., Oganezova J.G., Egorov E.A. et al. Glaucoma laser treatments: modern approaches and practice guidelines. Russian Journal of Clinical Ophthalmology. 2022;22(4):265–272 (in Russ.). DOI: 10.32364/2311-7729-2022-22-4-265-272.

Modern possibilities of the surgeon in the diagnosis and treatment of trophic ulcers of venous etiology (literature review)

The review article presents literature data on the conservative and surgical treatment of trophic ulcers of venous etiology, taking into account modern views on the etiology and pathogenesis of the complicated course of chronic venous insufficiency. One of the mechanisms for increasing the size of trophic ulcers is the emergence of a fibrinoid necrosis zone with the rejection of overlying tissues. Current approaches in the diagnosis of this pathology have been reported. Various methods of treating trophic ulcers in varicose veins and their long-term results are compared, the peculiarities of the use of endovenous laser coagulation and obliteration in practice are considered. The question is raised about the need to unify algorithms for preparing patients with trophic ulcer for minimally invasive intervention, the principles of its implementation and postoperative management of patients in order to achieve good and excellent immediate and long-term results. The national clinical guidelines for phlebology are analyzed, in which until now the priority in the treatment of trophic ulcers is given to local treatment, which unreasonably delays and lengthens the process of their healing. Surgical treatment should be aimed at early elimination of the pathogenetic link in the development of trophic ulcers.

Postoperative management of patients with thoracic aorta diseases from the position of a cardiologist

Postoperative management of patients with thoracic aorta diseases from the position of a cardiologist

PERIPHERAL NERVE BLOCKS FOR HIP FRACTURES IN EMERGENCY MEDICINE.

SUMMARYHip fractures represent a major public health issue with increasing incidence as a population ages. The aim of this review is to describe peripheral nerve block techniques (the fascia iliaca compartment block and the pericapsular nerve group block) as pain management for hip fractures in emergency medicine, and to emphasize their benefits. Hip fractures are extremely painful injuries. The pain itself is unpleasant for patients and if left untreated it can lead to multiple complications during preoperative, operative and postoperative patient management. Pain management for elderly hip fracture patients is often challenging. Non-steroidal anti-inflammatory drugs are not recommended due to their side effects, the increased risk of gastrointestinal bleeding, renal function impairment and platelet aggregation inhibition. Paracetamol alone is often insufficient, and opioids have many potentially harmful side effects, such as delirium development. Peripheral nerve blocks for hip fractures are safe and effective, also in emergency medicine settings. The benefits for patients are greater pain relief, especially during movement, less opioid requirements and decreased incidence of delirium. Regional analgesia should be routinely used in hip fracture pain management.

Postoperative pain management in geriatric patients after cholecystectomy and studies of glycemia and cortisol levels.

The purpose of the study was to follow up the cortisol levels in relation to the postoperative pain intensity, its levels after treatment with opiate and non-opiate analgesics, and to monitor the relationship between the blood glucose and cortisol levels. Another goal was to optimize the postoperative analgesia of geriatric patients with the known combinations of analgesics. The cohort comprised 28 geriatric patients undergoing laparoscopic cholecystectomy. The patients were divided according to the intensity of postoperative pain into the groups with opiate and non-opiate analgesia. Furthermore, they were divided according to their physical condition (ASA classification) into two groups, ASA 2 and ASA 3. We evaluated three values ​​of blood glucose levels, on the day before surgery, on the operative and the first postoperative days and those of cortisol on the day of surgery. The patients had the blood glucose levels without significant deviation during the three days of measurements. The cortisol levels increased with the intensity of postoperative pain. High levels of cortisol were observed not only in the patients, who experienced acute pain after non-optimal postoperative analgesia, but also in those treated with strong opiates in the immediate postoperative period. The patients with mild pain intensity, treated with a combination of non-opiate analgesics, had the lowest values. The role of the patient's gender in both blood glucose and cortisol levels was not observed. The cortisol levels have not corresponded so much with the assessment of acute postoperative pain as with the stress that was evoked in the patient due to hospitalization and fear of surgery. It is crucial to eliminate as much as possible all the stressors that can affect the cortisol levels and thus the blood glucose levels (Fig. 6, Ref. 25).

Ambulatory Pain Management in the Pediatric Patient Population.

Outpatient surgery in the pediatric population has become increasingly common. However, many patients still experience moderate to severe postoperative pain. A poor understanding of the extent of pain after pediatric ambulatory surgery and the lack of randomized control studies of pain management of the outpatient necessitate this review of scientific evidence and multimodal analgesia. A multimodal approach to pain management should be applied to the ambulatory setting to decrease postoperative pain. These include non-pharmacological techniques, multimodal pharmacologics, and neuraxial and peripheral nerve blocks. Postoperative pain management in pediatric ambulatory surgical patients remains suboptimal at most centers due to limited evidence-based approach to postoperative pain control. Pediatric ambulatory pain management requires a multipronged approach to address this inadequacy.

Development and psychometric assessment of barriers to postoperative pain management in dementia scale: A mixed methods exploratory study

Background: Identifying the barriers to acute pain management in older adults with dementia needs appropriate instruments adapted to the cultural structure of each community. Such an instrument can help to provide effective interventions. Objectives: This study aimed to develop and psychometrically validate Barriers to Postoperative Pain Management in Dementia Scale (BPPMDS) from the nurses' point of view. Methods: This methodological study was conducted in 2019–2020. In the first phase, semi-structured interviews with 15 nurses and literature review were conducted for item generation. In the second phase, face, content, and construct validity and reliability of the instrument were assessed. Results: In the first phase, 67 items were produced. In the second phase, the number of items reduced to 39 after the assessment of face, content, and construct validity. Exploratory factor analysis showed that the BPPMDS has three factors (i.e., older adult-related factors, health care provider-related factors, and system-related factors), which explain 57.57% of the total variance. The Cronbach's alpha coefficient of the scale was 0.956. Conclusions: The BPPMDS can be used as a valid and reliable scale to measure postoperative acute pain management in older patients with dementia and hip fracture.

Comparison of analgesic consumption of hemophilic and non-hemophilic patients in knee arthroplasty.

Hemophilia is a rare hereditary bleeding disorder that develops as a result of factor VIII or IX deficiency. Long-term complications of hemophilia such as arthropathy, synovitis, and arthritis can lead to the development of recurrent chronic pain. Pain is therefore a critical aspect of hemophilia. The gold standard treatment for end-stage hemophilic knee arthropathy is total knee arthroplasty (TKA). The hypothesis of this study was that after knee replacement surgeries that cause severe post-operative pain, hemophilia patients with chronic analgesic consumption may experience higher levels of pain than non-hemophilic patients, and use more opioid and non-opioid drugs. This retrospective study included 82 patients who were hemophilic and non-hemophilic TKA patients operated under general anesthesia. Seventy-three patients were evaluated and divided into two groups according to the diagnosis of hemophilia: 36 patients were investigated in the hemophilic group and 37 patients in the non-hemophilic group. Post-operative tramadol consumption (p=0.002) and pethidine consumption (p=0.003) were significantly higher in the group hemophilia. The length of stay in the hospital was also significantly longer in the hemophilic group (p=0.0001). In the light of these informations, we think that acute post-operative pain management of hemophilia patients should be planned as personalized, multimodal preventive, and pre-emptive analgesia.

Post-operative management of hypertrophic obstructive cardiomyopathy.

Hypertrophic obstructive cardiomyopathy patients are at increased risk of sudden cardiac arrest due to dynamic left ventricular outflow tract obstruction, myocardial ischaemia and arrhythmias. Septal myectomy remains the gold standard therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) refractory to other therapy. This review comprehensively focuses on the post-operative management and complications of HOCM patients undergoing surgical correction. Although these patients are at risk of various perioperative complications from anaesthesia and surgery due to the underlying complexity of their disease, surgical myectomy is associated with excellent long-term outcomes if carried out in experienced centers.