Predictive Value Of Preoperative Testing Research Articles

Valor predictivo de los test preoperatorios para estimar la intubación difícil en pacientes sometidos a la laringoscopia directa para la cirugía de oído, nariz y garganta

Background and objectivesPredictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. MethodsPreoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. ResultsA total of 2.611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system class 4 (50%), Cormack–Lehane classification grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical range of motion) (75.8%), short thyromental distance (81.6%), vocal cord mass (849.5%) as indicated in parentheses (P<.0001). MS had a low sensitivity, while restricted cervical range of motion, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in Cormack–Lehane classification grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. ConclusionTest results predicting difficult intubations in cases with direct laryngoscopy had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

Valor preditivo dos testes pré‐operatórios para estimar a intubação difícil em pacientes submetidos à laringoscopia direta para cirurgia de ouvido, nariz e garganta

Background and objectivesPredictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. MethodsPreoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. ResultsA total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack–Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736‐fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. ConclusionTest results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

Background and objectivesPredictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. MethodsPreoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. ResultsA total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack–Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. ConclusionTest results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

Predictive value of preoperative tests in facectomy

To establish the prevalence of abnormal results in routine preoperative tests prior to facectomies and whether they influence the occurrence of perioperative clinical complications. This prospective study was developed in an academic medical center in Brazil. Besides a clinical evaluation, all patients were requested to undergo an electrocardiogram, complete blood work and fasting blood glucose test. Patients younger than 40 years of age who had had previous eye surgery, candidates for general anesthesia or who had suffered acute myocardial infarction up to three months before surgery were excluded from the study. Intraoperative medical events were recorded in a protocol form. Analysis was carried out using Fisher's test and ANOVA (analysis of variance). The sample was composed of 746 patients, 405 (54.3%) were men. The average age was 66.6+/-11.6 years. Intraoperative complications occurred in 71 (9.5%) patients. There were abnormal results in 13.5% (101 patients) of hemoglobin dosages and in 16.6% (124) of fasting blood glucose. As for electrocardiograms, abnormalities were found in 46.6% (348) of the subjects. There was a higher prevalence of electrocardiograms with abnormal values in patients who had perioperative clinical complications (p=0.02). There were no statistically significant differences between hemoglobin dosages (14.0+/-1.6 g/dL in patients without intraoperative complications and 14.3+/-1.3 g/dL in patients with complications - p=0.150) and fasting blood glucose (104+/-29 mg/dL in patients without complications and 105+/-41 mg/dL in patients with complications - p=0.850). Within the investigated routine of preoperative testing for facectomy, only the abnormal electrocardiogram results influenced the occurrence of complications in the perioperative period.

Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma

Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma

Predicting Postoperative Outcome

Pulmonary complications are the main source of postop erative morbidity and mortality, with respiratory failure and pneumonia resulting in 50% of postoperative deaths after lung surgery. Despite the high incidence of postop erative complications, pulmonary resection remains the only effective treatment for lung cancer. Substantial resources are ascribed for the perioperative care of these high-risk patients. Clinical experience would dic tate that predicting outcome could be of immense value in allocating resources. This review will consider the predictive value of preoperative testing, including spi rometry, split lung function, blood gas analysis, carbon monoxide diffusion capacity, pulmonary vascular resis tance, and exercise testing, as well as recent efforts to develop a combined cardiopulmonary index.

Cystic neoplasms of the pancreas. A clinicopathologic study, including DNA flow cytometry.

To review the classification, clinical behavior, and appropriate therapy for cystic neoplasms of the pancreas. We examined patient demographics, clinical parameters, preoperative imaging modalities, histologic findings, and tumor DNA content to determine which best predict outcome. Case series and survey of pathologic specimens. Tertiary care center. Twenty-two patients with cystic neoplasms of the pancreas treated at affiliates of Northwestern University Medical School, Chicago, Ill. Predictive value of preoperative testing, tumor DNA content, patient survival. In 20 patients undergoing computed tomographic scan, the tumor was visualized in every case. All other imaging studies evaluated were less likely to demonstrate the lesion. Eight of 10 patients with serous cystadenomas were alive with no evidence of disease at the time of this report; one patient was alive with local recurrence, and a second patient had died of unrelated causes. All patients with mucinous cystadenomas were alive with no evidence of disease. Three of seven patients with cystadenocarcinomas had aneuploid, high S-phase tumors, and one had a diploid, high S-phase tumor; all four died (mean survival, 4.8 months). Two patients with cystadenocarcinomas had diploid, low S-phase tumors; both were long-term survivors but died of their disease at 8.6 and 9.3 years. (1) Computed tomographic scan is the most valuable diagnostic imaging study for preoperative evaluation of these patients. (2) Precise preoperative determination of tumor type is not possible. (3) DNA flow cytometry may help identify patients with aggressive tumors who may benefit from adjuvant chemoradiation.

Management of the Bladder Outlet in Patients Requiring Enterocystoplasty

We reviewed 30 patients who required augmentation enterocystoplasty and a procedure to modify the bladder outlet for the treatment of intractable incontinence. Of the 30 patients 16 were treated with simultaneous cystoplasty and an outlet procedure, 6 initially underwent an outlet procedure followed by cystoplasty and in 8 cystoplasty was performed first with a subsequent operation to modify the bladder outlet. Continence was achieved in 29 patients. The current methods for evaluation of the bladder and its outlet are reviewed, focusing on the predictive value of preoperative testing to determine which patients require cystoplasty and an outlet modifying procedure.