Postoperative Vital Signs Research Articles

Validity and Reliability of Wearable Sensors for Continuous Postoperative Vital Signs Monitoring in Patients Recovering from Trauma Surgery

(1) Background: Wearable sensors support healthcare professionals in clinical decision-making by measuring vital parameters such as heart rate (HR), respiration rate (RR), and blood oxygenation saturation (SpO2). This study assessed the validity and reliability of two types of wearable sensors, based on electrocardiogram or photoplethysmography, compared with continuous monitoring of patients recovering from trauma surgery at the postanesthesia care unit. (2) Methods: In a prospective observational study, HR, RR, SpO2, and temperature of patients were simultaneously recorded with the VitalPatch and Radius PPG and compared with reference monitoring. Outcome measures were formulated as correlation coefficient for validity and mean difference with 95% limits of agreement for reliability for four random data pairs and 30-min pairs per vital sign per patient. (3) Results: Included were 60 patients. Correlation coefficients for VitalPatch were 0.57 to 0.85 for HR and 0.08 to 0.16 for RR, and for Radius PPG, correlation coefficients were 0.60 to 0.83 for HR, 0.20 to 0.12 for RR, and 0.57 to 0.61 for SpO2. Both sensors presented mean differences within the cutoff values of acceptable difference. (4) Conclusions: Moderate to strong correlations for HR and SpO2 were demonstrated. Although mean differences were within acceptable cutoff values for all vital signs, only limits of agreement for HR measured by electrocardiography were considered clinically acceptable.

Use of Baclofen Premedication as an Analgesic Adjuvant in Patients Undergoing Percutaneous Nephrolithotripsy: A Placebo-Controlled, Double-Blind Randomized Trial.

Baclofen, a clinically available GABAB receptor agonist, produces nonopioid analgesia in multiple models of pain but has had limited studies related to perioperative pain control.The present study seeks to study effects of baclofen on postoperative pain measures and opioid use in adult patients subjected to percutaneous nephrolithotomy (PCNL). Using a placebo-controlled, double-blind methodology, a single 10 mg oral dose of baclofen or placebo was given prior to a surgery in 34 patients undergoing PCNL.Standardized intraoperative and postoperative protocols related to opioid use were followed.Use of postoperative opioids in the post-anesthesia care unitand for the first 24 hours following surgery were recorded as were pain scores and other medication use. There was a significant positive correlation in the use of postoperative opioids in patients who had a preceding history of opioid use.However, there were no significant differences in opioid use which could be attributed to baclofen.There were also no differences in postoperative vital signs, side effects or other medication use. Analgesic benefits of preoperative baclofen were not observed at the dose employed.Safety of the drug was observed.

Effects of Nasal Packing on Patients' Post-operative Vital Signs.

Background Since bilateral nasal packing entails nasal and airway obstruction, this practice consequently leads to oral breathing. The resulting hypoxemia may then negatively impact vital signs, including blood pressure (BP), blood oxygen saturation (SpO2), and heart rate (HR). These systemic effects have a detrimental effect on patients. Objective The objective of this study is to observe the effects of bilateral nasal packing on patients' post-operative vital signs. Materials and methods This prospective study was conducted in the department of otolaryngology - head and neck surgery over a six-month period. The study included 83 post-operative patients with nasal surgery, in which bilateral merocele nasal packing was performed. The patients' pulse oximetry, systolic and diastolic BP, and HR were recorded four times the night before and after surgery. A statistical analysis was performed, and the mean values, standard deviation, and range were calculated. A paired sample t-test was also applied. The results are presented in figures and tables. Results The mean age of the participants was 27.65 ± 10.72 years, and 56 (67.5%) were male. Septoplasty was the most common surgery performed, with 63 participants having undergone this procedure (75.9%). When the pre-operative mean values of systolic and diastolic BP, SpO2, and HR were compared with the post-operative mean values, when a bilateral nasal pack was in place, a significant increase was found in all, with a p-value of <0.001 in each. Conclusion Bilateral nasal packing affects patients' vital signs by significantly increasing diastolic and systolic BP and decreasing SpO2. The HR is also significantly increased when packing is in place.

The effects of smoking on pain scores, vital signs, and analgesic consumption in patients undergoing tympanomastoidectomy surgery.

In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.

Music Therapy in Patients Undergoing Ambulatory Surgery: A Single-Blind Randomized Trial

Abstract Background Day surgery procedures constitute an essential part of surgical practices in hospitals worldwide. However, outpatients may experience anxiety, fear, and stress negatively impacting patients' ability to follow the established ambulatory surgery pathway. While medications are generally administered to reduce perioperative stress, there are several measures to avoid their use. Music therapy (MT) can be used as a complementary, drug-free, safe, and cost-effective intervention. Aims The purpose of our study was to evaluate the impact of MT on perioperative stress and patient satisfaction in patients undergoing ambulatory surgery. Methods We conducted a randomized study in patients undergoing ambulatory surgery. The MT group listened to relaxing music for the whole hospital stay, while the control group received the standard treatment. Both groups were managed in the pre- and postoperative periods according to current clinical practice and ultimately received the Leiden Perioperative care Patient Satisfaction (LPPS) questionnaire before hospital discharge. Results During the study period, 33 patients were included, 16 randomized to the MT arm and 17 to the control arm. The average age of the patients was 51.1±16.2 years, and 10 (31.2%) patients were women. The postoperative period was uneventful for almost all patients (95.8%), and we observed a high level of satisfaction. No patient required medication for anxiety treatment in the postoperative period. Pre- and postoperative vital signs were similar in both arms. A slightly higher LPPS score was noted in the MT group (179±8 vs. 171±20 pts, p=0.174). Conclusion Despite limitations, our study demonstrated that MT in patients undergoing ambulatory surgery might be advantageous in reducing perioperative stress, potentially increasing satisfaction, and enhancing patients' perception of being cared for in a multidisciplinary manner, without neglecting the emotional aspect.

How does circadian rhythm affect postoperative pain after pediatric acute appendicitis surgery?

This study aimed to evaluate the relationship between postoperative pain and circadian rhythm after pediatric acute appendicitis surgery. Two hundred patients, aged 6-18 years, undergoing acute appendicitis surgery were included in this prospective observational study. The patients were divided into four groups according to the time they underwent surgery: the night group, 01:01-07:00; morning group, 07:01-13:00; afternoon group, 13:01-19:00; and evening group, 19:01-01:00. Intraoperative and postoperative vital signs, postoperative 24-h Wong-Baker Faces Pain Rating Scale (FACEs) scores, and the amount of analgesic required were recorded. A total of 186 patients were analyzed in the study. There was no statistically significant difference in the demographic characteristics of the patient groups. Additionally, no differences were observed in intraoperative and postoperative vital signs among the four groups. However, patients in the night group had significantly higher FACEs values than those in the other groups at each time point (1st, 3rd, 6th, and 12th h) up to 12 h (P = 0.007, P = 0.023, P = 0.048, and P = 0.003, respectively). The amount of analgesic required in the night group was statistically higher than in the other groups until 12 h (P = 0.002, P < 0.001, P = 0.002, and P = 0.004, respectively). A relationship was found between acute appendicitis operations performed at night (01:01 to 07:00) under general anesthesia and circadian rhythm in children. We believe that considering circadian time in the relief of postoperative pain would be beneficial.

A case of pancreaticoduodenal artery bleeding after laparoscopic right colectomy requiring open hemostasis

BackgroundPancreatic and duodenal-related complications after right colectomy carry a higher risk of mortality.Case presentationA 64-year-old woman underwent laparoscopic right colectomy for a laterally spreading tumor in the cecum. On postoperative day 10, she experienced sudden hematemesis. Contrast-enhanced computed tomography (CT) of the abdomen showed a large amount of hemorrhage in the stomach, but no obvious extravasation. In addition, free air was observed near the duodenal bulb. Despite blood transfusion, vital signs remained unstable and emergency surgery was performed. The abdomen was opened through midline incisions in the upper and lower abdomen. A fragile wall and perforation were observed at the border of the left side of the duodenal bulb and pancreas, with active bleeding observed from inside. As visualization of the bleeding point proved difficult, the duodenum was divided circumferentially to confirm the bleeding point and hemostasis was performed using 4-0 PDS. The left posterior wall of the duodenum was missing, exposing the pancreatic head. For reconstruction, the jejunum was elevated via the posterior colonic route and the duodenal segment and elevated jejunum were anastomosed in an end-to-side manner. Subsequently, gastrojejunal and Brown anastomoses were added. Drains were placed before and after the duodenojejunal anastomosis. Postoperative vital signs were stable and the patient was extubated on postoperative day 1. Follow-up contrast-enhanced CT of the abdomen showed no active bleeding, and the patient was discharged home on postoperative day 21. As of 6 months postoperatively, the course of recovery has been uneventful.ConclusionsWe encountered a case of pancreaticoduodenal artery hemorrhage after laparoscopic right colectomy. Bleeding at this site can prove fatal, so treatment plans should be formulated according to the urgency of the situation.

Analgesic Effect of Addition of Pectointercostal Block to Serratus Anterior Plane Block in Breast Surgeries: A Randomized, Controlled Trial

BACKGROUND: Ultrasound-guided serratus anterior plane block (SAPB) is an efficient perioperative analgesic modality for breast surgeries. SAPB does not block the anterior cutaneous branches of the intercostal nerves; thus, it does not provide adequate analgesia for the parasternal region and the medial side of the breast. A new parasternal block, the pectointercostal fascial plane block (PIFB) has been developed to overcome this issue. OBJECTIVES: The study aimed to evaluate the perioperative analgesic effect of using PIFB in addition to SAPB. The primary outcome was to evaluate the postoperative pain score. The secondary outcomes were to assess perioperative opioid requirements, hemodynamic stability, and the satisfaction of the patient and surgeon. STUDY DESIGN: The current study was a prospective, double-blinded, randomized controlled study. The current study was registered at the Pan-African Clinical Trials Registry (PACTR202001789968542) and was designed after obtaining ethical institutional approval (Institutional Review Board No 00012098, Federalwide Assurance No 00018699). SETTING: The study involved 60 women between 21 and 69 years old with breast cancer who were scheduled for modified radical mastectomy or conservative breast surgeries in a university hospital. METHODS: After verbal and informed written consent, the patients were allocated to Group 1, which received SAPB, and Group 2, which received SAPB with PIFB. We assessed the Visual Analog Scale (VAS), perioperative opioid requirements, intraoperative hemodynamic stability, rescue analgesia, and complications. Patient and surgeon satisfaction were surveyed using a questionnaire where one is very dissatisfied and 5 is very satisfied. RESULTS: Intraoperative mean arterial blood pressure (MABP) and heart rate were significantly lower in Group 2 (SAPB+PIFB). The number of patients who needed intraoperative fentanyl was also significantly lower in Group 2 (SAPB+PIFB) (P value = 0.010). Postoperative VAS showed no significant difference in both groups. The number of patients who needed postoperative rescue morphine, time for the first rescue analgesia, first morphine dose (mg), and total opioid consumption were also comparable for both groups. Patient satisfaction and surgeon satisfaction were comparable for both groups (P values = 1.000 and 0.496, respectively). LIMITATIONS: VAS was not recorded during movements and no follow-up was done to detect the potential effect on chronic postmastectomy pain. Moreover, after reviewing the literature, there was no efficient data about adding PIFB with different regional blocks for breast surgery. CONCLUSIONS: The number of patients who needed intraoperative fentanyl, as well as the MABP and heart rate were significantly lower in Group 2 (SAPB+PIFB). Postoperative vital signs, VAS, postoperative analgesic requirements, and opioid consumption were comparable for both groups. Patient satisfaction was comparable for both groups, while surgeon satisfaction was higher in Group 2 (SAPB+PIFB) but statistically not significant. KEY WORDS: Pectointercostal, fascial plane block, serratus anterior plane block, breast surgery, regional analgesia for mastectomy

The future of postoperative vital sign monitoring in general wards: improving patient safety through continuous artificial intelligence-enabled alert formation and reduction.

Monitoring of vital signs at the general ward with continuous assessments aided by artificial intelligence (AI) is increasingly being explored in the clinical setting. This review aims to describe current evidence for continuous vital sign monitoring (CVSM) with AI-based alerts - from sensor technology, through alert reduction, impact on complications, and to user-experience during implementation. CVSM identifies significantly more vital sign deviations than manual intermittent monitoring. This results in high alert generation without AI-evaluation, both in patients with and without complications. Current AI is at the rule-based level, and this potentially reduces irrelevant alerts and identifies patients at need. AI-aided CVSM identifies complications earlier with reduced staff workload and a potential reduction of severe complications. The current evidence for AI-aided CSVM suggest a significant role for the technology in reducing the constant 10-30% in-hospital risk of severe postoperative complications. However, large, randomized trials documenting the benefit for patient improvements are still sparse. And the clinical uptake of explainable AI to improve implementation needs investigation.

Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy

BackgroundWhile complication rates after pancreaticoduodenectomy (PD) have improved in recent decades, surgical-related death remains a possibility. Postoperative vital signs offer an untapped opportunity to identify predictors of 90-day mortality. MethodsWe performed a retrospective chart review interrogating postoperative day (POD 0–7) vital sign measurements from patients undergoing a PD at Thomas Jefferson University Hospital, Philadelphia, PA (2009–2014). Five specific vital signs were examined as predictors of mortality: temperature, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure. Statistical analyses and logic algorithms were employed to rank vital sign parameters, with cut-points, to identify those associated with the highest risk of mortality and the most clinical relevance. ResultsIn our cohort, 11/750 patients (1.5%) died within 30 days of surgery, and 21/750 patients (2.8%) died within 90 days of surgery. Vital sign perturbations associated with the highest risk of mortality included mean SBP < 95 mmHg on POD 7 (odds ratio 51.46) and the mean temperature < 96.9℉ on POD 3 (odds ratio 22.63) with specificities exceeding 99%. The most clinically relevant predictor (i.e., a higher sensitivity) was DBP < 60.5 mmHg on POD 7 (odds ratio 12.45, sensitivity of 75%). These predictors remained statistically significant in a multivariable model. ConclusionsVital signs can be more effectively utilized to predict 90-day mortality after pancreaticoduodenectomy. Values beyond an informative threshold can potentially identify patients for more intensive monitoring with a goal of rescuing patients and preventing death.

A Clinical Study of Post-treatment Nursing Strategy for Venous Malformations in the Pharynx Region

Background: Post-treatment nursing care is essential for patients with venous malformations (VMs) after they have undergone treatment. Effective post-treatment nursing care requires adequate resources, effective communication, patient compliance, and addressing psychological distress. However, the clinical care plan for VMs in the pharyngeal isthmus is not clear. Objectives: The present study aims to explore the clinical nursing strategy after the treatment of VMs in the pharynx area. Methods: In this study, the patients with VM in the pharynx region who received anhydrous ethanol sclerosis injection and/or surgical treatment in our Hospital from January 2013 to November 2018 were recruited. A total of 143 patients who had completed medical records were included in this prospective cohort study. The patients' post-operative vital signs were closely observed, the respiratory tract was maintained, the oral cavity was cleaned, and the nursing care of indwelling endotracheal intubation or tracheotomy was performed. After the clinical follow-ups of one to five years, long-term efficacy was also observed. We summarized their nursing care treatments. Results: The results showed that there were 0 patients rated as grade I, 3 patients rated as grade II, 17 patients rated as grade III, and 123 patients rated as grade IV after long-term efficacy. Conclusion: Appropriate anhydrous ethanol sclerotherapy can be selected for patients with pharyngeal venous malformation, and this method combined with the clinical nursing strategy after treatment concluded in this study can effectively reduce the volume of VM, with fewer side effects, and can effectively improve breathing, swallowing, and vocal function.

Overexpression of Argonaute HIWI Gene in Colorectal Cancer Stem Cells and Colorectal Cancerous Tissue

Background: Post-treatment nursing care is essential for patients with venous malformations (VMs) after they have undergone treatment. Effective post-treatment nursing care requires adequate resources, effective communication, patient compliance, and addressing psychological distress. However, the clinical care plan for VMs in the pharyngeal isthmus is not clear. Objectives: The present study aims to explore the clinical nursing strategy after the treatment of VMs in the pharynx area. Methods: In this study, the patients with VM in the pharynx region who received anhydrous ethanol sclerosis injection and/or surgical treatment in our Hospital from January 2013 to November 2018 were recruited. A total of 143 patients who had completed medical records were included in this prospective cohort study. The patients' post-operative vital signs were closely observed, the respiratory tract was maintained, the oral cavity was cleaned, and the nursing care of indwelling endotracheal intubation or tracheotomy was performed. After the clinical follow-ups of one to five years, long-term efficacy was also observed. We summarized their nursing care treatments. Results: The results showed that there were 0 patients rated as grade I, 3 patients rated as grade II, 17 patients rated as grade III, and 123 patients rated as grade IV after long-term efficacy. Conclusion: Appropriate anhydrous ethanol sclerotherapy can be selected for patients with pharyngeal venous malformation, and this method combined with the clinical nursing strategy after treatment concluded in this study can effectively reduce the volume of VM, with fewer side effects, and can effectively improve breathing, swallowing, and vocal function.

Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery

Background &amp; Objective: The postoperative pain after spine surgery is almost always severe. A recently described loco-regional procedure called the erector spinae plane block (ESPB) has been claimed to be associated with positive outcomes. We evaluated the ESPB's efficacy for the relief of postoperative pain after lumbar spine surgery.&#x0D; Methodology: This randomized controlled clinical investigation was conducted at the Ain Shams University Hospitals during the course of a year starting January 2021. Patients were randomly allocated to one of the two groups: Group C (the control group) patients underwent lumbar spine surgery under conventional general anesthesia (GA) in accordance with hospital policy. Group ESP was administered GA similar to the control group, but the patients received bilateral ultrasound-guided ESPB before starting lumbar spine surgery. The primary objective was total morphine consumption. Numeric rating scale (NRS) scores were measured at rest on shifting to post-anesthesia care unit (PACU) and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward. Complications, e.g., PONV and hemodynamic parameters were recorded on shifting to PACU and then at 2 h, 6 h, 10 h, 14 h, 18 h and 24 h in the ward.&#x0D; Results: Total morphine consumption was higher in the control group than the Group ESP, at the 6th, 12th, and 18th hours postoperatively, the numeric rating scale scores in Group ESP were lower compared to the control group, and ESPB significantly reduced the time to first mobilization when compared to the control group. In terms of PONV and postoperative vital signs, there was no statistically significant difference; however, the patient satisfaction was higher in Group ESP was far more satisfied than the control group overall.&#x0D; Conclusion: We conclude that bilateral ultrasound guided ESPB is useful for postoperative analgesia in patients having lumbar spine operations. It lowered postoperative opioid consumption, decreased pain scores at various time intervals, and increased patient satisfaction while reducing the occurrence of PONV.&#x0D; Key words: Ultrasound; Erector spinae plane block; Pain; Pain management; Spine surgery&#x0D; Citation: Hamdi AA, Abo Zeid GSE, Al Shaer AN, Shoukry RA, Sayed AG. Bilateral ultrasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery. Anaesth. pain intensive care 2022;27(1):37−42; DOI: 10.35975/apic.v27i1.2115&#x0D; Received: August 28, 2022; Reviewed: December 20, 2022; Accepted: December 22, 2022

A comparative study between 1 and 3 mg of granisetron in the prevention of postoperative nausea and vomiting in strabismus ophthalmic surgeries during general anesthesia

Aims To compare the safety and efficacy of 1 and 3 mg of granisetron in the prevention of postoperative nausea and vomiting (PONV) in strabismus surgeries under general anesthesia. Settings and design This single-blinded, randomized, controlled trial was conducted at the ophthalmology operating theater of Kasr Al-Ainy Hospitals. Patients and methods We recruited 210 patients and allocated them randomly to receive either granisetron 1 mg (n=105) or 3 mg (n=105). The two groups were compared regarding demographic data, hemodynamic parameters, and percentage of patients with no complaints of PONV during the first 24 h. Results There was no statistically significant difference upon comparison of the two groups regarding PONV (P&gt;0.05). The two doses (1 and 3 mg) provided total control of nausea and vomiting in 46.7 and 43.8% of patients during the first 24 h postoperatively, respectively. Moreover, we found no significant difference between the two groups regarding mean values of the heart rate or mean arterial pressure both preoperatively and intraoperatively (P&gt;0.05). However, during the postoperative 24 h, both groups had significant differences regarding mean values of heart rate and mean arterial pressure at 2–4 h, 8–12 h, and 12–24 h postoperatively. Conclusions The comparison between two doses of granisetron (1 and 3 mg) showed no statistical difference regarding the total control of nausea and vomiting for 24 h postoperatively but showed a statistical difference regarding some postoperative vital sign readings.

Postoperative Overtriage to an Intensive Care Unit Is Associated With Low Value of Care.

We test the hypothesis that for low-acuity surgical patients, postoperative intensive care unit (ICU) admission is associated with lower value of care compared with ward admission. Overtriaging low-acuity patients to ICU consumes valuable resources and may not confer better patient outcomes. Associations among postoperative overtriage, patient outcomes, costs, and value of care have not been previously reported. In this longitudinal cohort study, postoperative ICU admissions were classified as overtriaged or appropriately triaged according to machine learning-based patient acuity assessments and requirements for immediate postoperative mechanical ventilation or vasopressor support. The nearest neighbors algorithm identified risk-matched control ward admissions. The primary outcome was value of care, calculated as inverse observed-to-expected mortality ratios divided by total costs. Acuity assessments had an area under the receiver operating characteristic curve of 0.92 in generating predictions for triage classifications. Of 8592 postoperative ICU admissions, 423 (4.9%) were overtriaged. These were matched with 2155 control ward admissions with similar comorbidities, incidence of emergent surgery, immediate postoperative vital signs, and do not resuscitate order placement and rescindment patterns. Compared with controls, overtraiged admissions did not have a lower incidence of any measured complications. Total costs for admission were $16.4K for overtriage and $15.9K for controls ( P =0.03). Value of care was lower for overtriaged admissions [2.9 (2.0-4.0)] compared with controls [24.2 (14.1-34.5), P <0.001]. Low-acuity postoperative patients who were overtriaged to ICUs had increased total costs, no improvements in outcomes, and received low-value care.

PD04-07 ANALYSIS OF HIGH-RISK FACTORS FOR ADRENAL CRISIS AFTER ADRENAL SURGERY

You have accessJournal of UrologyCME1 May 2022PD04-07 ANALYSIS OF HIGH-RISK FACTORS FOR ADRENAL CRISIS AFTER ADRENAL SURGERY Quanliang Liu, Yuhua Zou, Xiaofeng Zou, Guoxi Zhang, Yuanhu Yuan, Rihai Xiao, Gengqing Wu, Biao Qian, Xiaoning Wang, and Hui Xu Quanliang LiuQuanliang Liu More articles by this author , Yuhua ZouYuhua Zou More articles by this author , Xiaofeng ZouXiaofeng Zou More articles by this author , Guoxi ZhangGuoxi Zhang More articles by this author , Yuanhu YuanYuanhu Yuan More articles by this author , Rihai XiaoRihai Xiao More articles by this author , Gengqing WuGengqing Wu More articles by this author , Biao QianBiao Qian More articles by this author , Xiaoning WangXiaoning Wang More articles by this author , and Hui XuHui Xu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002519.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To summarize the clinical characteristics, diagnosis and treatment experience of secondary adrenal crisis after adrenal tumor resection, and to explore its related risk factors. METHODS: The clinical data of 235 patients undergoing adrenal tumor resection in theDepartment of Urology of the First Affiliated Hospital of Gannan MedicalUniversity from January 2015 to April 2021 were retrospectively analyzed.Logistic regression was used to analyze the related risk factors of adrenalcrisis after adrenalectomy.This study was approved by the Hospital Ethics Committee. RESULTS: The age ranged from 21 to65 years (mean 47 years). 136 males and 99 females. Among them, 149 casesunderwent retroperitoneal laparoscopic adrenalectomy, 69 cases underwenttransabdominal laparoscopic adrenalectomy, and 17 cases underwentrobot-assisted laparoscopic adrenalectomy. Among them, 80 cases were cortisoladenoma, 4 cases were adrenalcortical carcinoma, 115 cases were aldosteroneadenoma, 26 cases were pheochromocytoma, and 10 cases were bilateral adrenalcortical hyperplasia. The diameter of the tumor was 1.5-11 cm, including 16patients with adrenal crisis (9 males and 7 females). Logistic regressionanalysis showed that age, tumor size, operation side, operation mode, operationtime and intraoperative blood loss had no significant correlation with theoccurrence of adrenal crisis. Preoperative infection, adrenal cortical tumor,preoperative ACTH level, preoperative blood glucose abnormality, intraoperativenon-preventive corticosteroids and previous history of adrenal crisis were highrisk factors for adrenal crisis after adrenal tumor operation. CONCLUSIONS: Adrenal crisis is morelikely to occur after adrenal tumor resection in patients with preoperativeinfection, adrenal cortical tumors and low levels of ACTH, diabetes andprevious history of adrenal crisis. Postoperative vital signs should be closelyobserved and hormones should be supplemented in time to avoid adverse events. Source of Funding: National Natural Science Foundation of China (81860456, 81760462) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e51 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Quanliang Liu More articles by this author Yuhua Zou More articles by this author Xiaofeng Zou More articles by this author Guoxi Zhang More articles by this author Yuanhu Yuan More articles by this author Rihai Xiao More articles by this author Gengqing Wu More articles by this author Biao Qian More articles by this author Xiaoning Wang More articles by this author Hui Xu More articles by this author Expand All Advertisement PDF DownloadLoading ...

A comparative study between the efficacy of bupivacaine plus nalbuphine versus bupivacaine alone in pectoral nerve block for management of postoperative pain in patients undergoing breast fibroadenoma excision

BackgroundBreast surgeries, even the relatively minor ones, can be associated with significant postoperative pain affecting patients’ physical and psychological well-being. As a result, regional anaesthetic approaches have been used for breast surgery anaesthesia and analgesia. PECS I and II blocks have been proven to be relatively easy and safe in such regards. Moreover, using adjuvants, such as nalbuphine, have been proposed by many studies to intensify the block and decrease postoperative analgesic intake.This current study aims to assess the effects of using nalbuphine (20 mg) as a bupivacaine 0.25% (10 ml) adjuvant in PECS I block compared to injecting bupivacaine 0.25% (10 ml) alone in fibroadenoma excision patients.This trial enrolled 60 patients, 30 of whom received bupivacaine plus nalbuphine (group BN) and 30 in the bupivacaine only (group B). Postoperative VAS, SpO2 and vital signs at 0, 1, 2, 4, 6, 12 and 24 h as well as the amount of morphine consumed, the time it took for the first analgesic to be administered and adverse effects were both recorded and compared.ResultsRegarding postoperative outcomes, a statistically significant difference between the two groups was not detected regarding VAS, SpO2, vital signs and adverse effects. Similarly, there was no statistically significant difference in total morphine intake in the 24 h following surgery between the two groups (p-value = 0.65). Only 9 out of 60 patients needed analgesia, 5 in the BN group and 4 in the B group, and time to the first analgesic was not of statistically significant difference between BN and B groups (211.8 ± 71.29 and 183.5 ± 29.872 min respectively) (p-value = 0.73). In terms of postoperative complications, there was no statistically significant difference between the two groups.ConclusionsAdding nalbuphine (20 mg) to bupivacaine in PECS I block in fibroadenoma patients undergoing excision is not accompanied by a difference with statistical significance in postoperative VAS, morphine consumption and duration to the first analgesia when compared to bupivacaine alone.

Data Mining-Based Clinical Study on the Effect of Oral Restoration Film in Guiding Oral Bone Regeneration and Dental Implantation.

Oral repair membrane guided oral bone regeneration, particularly in dental implants, is a guided regeneration technology for bone tissue. The principle is based on the characteristics of rapid migration of epithelial cells and fibroblasts and slower migration of osteoblasts. Materials are placed in the bone defect, creating a relatively closed environment which is conducive to the growth of bone tissue. In this paper, we have evaluated clinical effects of Hai'ao oral repair membrane as a barrier membrane to guide bone regeneration in implants. For this purpose, certain treatment data are collected through data mining and patient's names with bone defects in the implantation area are selected. According to the randomness principles, these patients are divided into experimental and control groups and preoperative examinations along with basic periodontal treatments are performed on the selected cases. Furthermore, we have analyzed different effects by comparing treatment conditions. Experimental results, as a technical shielding film, verify that Hai'ao oral repair membrane meets requirements of safety and no immune rejection. It plays a role in promoting bone formation around the implant. Mid-to-long-term follow-up is satisfactory with no related complications. At the same time, it has the advantages of simple operation, reduced patient suffering, convenient transportation and storage, and longer validity period. Compared with the control group in terms of safety evaluation of postoperative vital signs, laboratory examinations, and incision healing, Hai'ao oral repair membrane has no significant difference. Postoperative osteogenesis effect is equivalent to that of the control group and meets requirements of superiority. Hai'ao oral repair membrane is used as a shielding membrane material in implant surgery technology to guide bone regeneration.

Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study.

This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier’s block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.

Effect of Intelligent Vital Sign Monitoring System on Postoperative Nursing Care of Severe Patients.

In order to study the observation of postoperative vital sign data of critically ill patients, this paper developed a set of vital sign data acquisition system based on intelligence and realized the design of vital sign data acquisition system APP based on Android Studio programming software, which was used to realize the information collection of vital sign data of patients. PDA is connected with a vital sign measuring equipment through Bluetooth. The patient's wristband is scanned with PDA to read the patient's information, and then the measured vital sign data are obtained automatically by measuring APP. The initial alarm value is set to be greater than 1%, and it needs more than 60 and less than or equal to 120 RR interval data to judge apnea. Information collection of intelligent vital sign detection can not only save the time of nursing staff but also improve the nursing quality.