Preoperative Management Of Patients Research Articles

Effects of Erythropoietin-Promoted Fracture Healing on Bone Turnover Markers in Cats.

In orthopaedics, erythropoietin (EPO) is applied in the preoperative management of anaemic patients, but also as a stimulating factor to assist bone regeneration due to its angiogenic and osteoinductive potential. Since orthopaedists mainly rely on their clinical experience to assess bone healing, additional and more objective methods such as studying the dynamics of bone markers are needed. Therefore, the aim of this study was to investigate the plasma activity of bone-specific alkaline phosphatase (BALP), the N-terminal propeptide of type I collagen (PINP), the C-terminal telopeptide of type I collagen (CTX), and deoxypyridinoline (DPD) during the first 2 months of healing of comminuted fractures in cats, either non-stimulated or locally stimulated with recombinant human erythropoietin (rhEPO). The study included twelve cats of mixed breeds, aged 7.2 ± 4 months, weighing 2.11 ± 1.1 kg, with comminuted diaphyseal fractures of the femur. Surgical treatment with plate osteosynthesis was performed in all animals. The cats were randomly divided into two groups-a control (n = 6) and an EPO group (n = 6). The locally applied EPO leads to the increased activity of bone formation markers (BALP and PINP) during the second week after the osteosynthesis, preceding the peaks in the control group by two weeks. The studied bone resorption markers (DPD, CTX) varied insignificantly during the studied period. In conclusion, erythropoietin could serve as a promoter of bone healing in comminuted fractures in cats.

21. Characteristics and Preoperative Management of Pediatric and Adolescent Patients with Pathology Proven Endometriosis

21. Characteristics and Preoperative Management of Pediatric and Adolescent Patients with Pathology Proven Endometriosis

Diagnostic Accuracy of MRI in Detecting Orbital Masses Keeping Histopathology as Gold Standard

Background: Orbital masses, encompassing a spectrum of benign and malignant lesions, pose significant diagnostic and therapeutic challenges. Magnetic resonance imaging (MRI) has been pivotal in the non-invasive evaluation of these lesions, owing to its superior soft tissue contrast and detailed anatomical resolution. The correlation between MRI findings and histopathological diagnosis remains crucial for accurate clinical decision-making. Objective: The study aimed to evaluate the diagnostic accuracy of MRI in identifying orbital masses, with a focus on differentiating between benign and malignant lesions, using histopathology as the gold standard. Methods: A prospective cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from January to December 2023. A total of 145 patients scheduled for surgery or biopsy, presenting with clinical symptoms indicative of orbital masses, were enrolled using a non-probability sequential sampling method. MRI evaluations were performed using a 1.5 Tesla machine. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of MRI in detecting orbital masses were calculated, comparing MRI findings with histopathological results. Results: Of the 145 patients, 55.2% were female, and 44.8% were male, with an age range predominantly between 18-30 years (87.6%). MRI identified 77.2% of cases as malignant and 22.8% as benign, whereas histopathology diagnosed 83.4% as malignant and 16.6% as benign. The diagnostic accuracy of MRI for benign masses showed a sensitivity of 81.82%, specificity of 96.43%, PPV of 87.10%, NPV of 94.74%, and an overall diagnostic accuracy of 93.10%. For malignant masses, MRI demonstrated a sensitivity of 90.16%, specificity of 86.90%, PPV of 83.33%, NPV of 92.41%, and a diagnostic accuracy of 88.28%. Conclusion: MRI exhibits a high diagnostic accuracy in identifying orbital masses, with excellent sensitivity and specificity. It proves to be a reliable diagnostic tool in differentiating between benign and malignant orbital lesions, supporting its integral role in the preoperative assessment and clinical management of patients with suspected orbital masses. Keywords: Orbital Masses, Magnetic Resonance Imaging, Diagnostic Accuracy, Histopathology, Benign Lesions, Malignant Lesions, MRI Sensitivity, MRI Specificity

Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques.

This study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients. Following the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979). This meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias. Our study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979].

Impact of maximum phonation time on postoperative dysphagia and prognosis after cardiac surgery

ObjectiveThe incidence of postoperative complications, including dysphagia, increases as the population undergoing cardiovascular surgery ages. This study aimed to explore the potential of maximum phonation time (MPT) as a simple tool for predicting postextubation dysphagia (PED) and major adverse cardiac and cerebrovascular events (MACCEs). MethodsThis retrospective study included 442 patients who underwent elective cardiac surgery at a university hospital. MPT was measured before surgery, and patients were stratified into 2 groups based on normal and abnormal MPTs. Postoperative complications, including PED and MACCEs, were also investigated. Swallowing status was assessed using the Food Intake Level Scale. ResultsMPT predicted PED with prevalence of 11.0% and 18.0% in the normal and abnormal MPT groups, respectively (P = .01). During the follow-up period, MACCEs developed in 17.0% of patients. Frailty, European System for Cardiac Operative Risk Evaluation II score, PED, and MPT were markedly associated with MACCEs (adjusted hazard ratios: 2.25, 1.08, 1.96, and 0.96, respectively). Mediation analysis revealed that MPT positively influenced PED and MACCEs, whereas PED positively influenced MACCEs. The trend in restricted cubic spline analysis indicated that the hazard ratio for MACCEs increased sharply when MPT was <10 seconds. ConclusionsThese findings underscore the potential of MPT as a valuable tool in the preoperative assessment and management of patients undergoing cardiac surgery. By incorporating MPT into routine preoperative evaluations, clinicians can identify patients at a higher risk of PED and MACCEs, allowing for targeted interventions and closer postoperative monitoring. This may improve patient outcomes and reduce the health care costs associated with these complications.

Consensus on the preoperative management of patients with chronic moderate-severe shoulder pain to improve postoperative outcomes. Delphi results

BackgroundAn appropriate preoperative management of patients with chronic moderate to severe shoulder pain who are candidates for surgery due to rotator cuff disease or glenohumeral osteoarthritis may improve surgery and patient outcomes, but published evidence in this regard is scarce. Therefore, the availability of recommendations on preoperative interventions based on expert consensus may serve as guidance. MethodsA Delphi study was conducted to develop a preoperative management algorithm based on a national expert consensus. A Delphi questionnaire was developed by a Scientific Committee following a systematic review using PRISMA criteria of the relevant literature published during the last 10 years. It consisted of 48 statements divided into five blocks (I. Assessment/diagnosis of preoperative pain; II. Preoperative function/psychosocial aspects; III. Therapeutic objectives; IV. Treatment; V. Follow-up/referral), and 28 experienced shoulder surgeons from across the country were invited to answer. ResultsAll participants responded to the Delphi questionnaire in the first round and 25 in the second round (89.3% of those invited). Overall, 46/49 final statements reached a consensus, based on which a final preoperative management algorithm was defined by the Scientific Committee. First, surgeons should assess shoulder pain intensity and characteristics, shoulder functionality and psychosocial aspects using specific validated questionnaires. Preoperative therapeutic objectives should include shoulder pain control, depression/nocturnal sleep improvement, opioid consumption adjustment and substance abuse cessation. Postoperative objectives regarding the degree of shoulder pain reduction or improvement in functionality/quality of life should be established in agreement with the patient. Treatment of preoperative chronic moderate to severe shoulder pain should comprise non-pharmacological as well as pharmacological interventions. Follow-up of shoulder pain levels, treatment adherence and mental health status of these patients may be carried out by the surgical team (surgeon and anesthesiologist) together with the Primary Care team. Patients with very intense shoulder pain levels may be referred to the Pain Unit, following specific protocols. ConclusionA preoperative management algorithm for patients with chronic moderate to severe shoulder pain who are candidates for surgery due to rotator cuff disease or glenohumeral osteoarthritis was defined based on a national expert consensus. Main points include a comprehensive patient management starting with an objective assessment of shoulder pain and function, quality of life, establishment of preoperative and postoperative therapeutic targets, prescription of individualized therapeutic interventions and multidisciplinary patient follow-up. Implementation of these recommendations to clinical practice may result in better preoperative shoulder pain management and more successful surgery outcomes and patient satisfaction.

Impact of preoperative pharmaceutical care consultation on medication errors in surgical patients: a comprehensive analysis

ABSTRACT Objective Assessing the impact of introducing preoperative pharmaceutical care consultations by analyzing the severity of prevented medication errors (MEs) and their potential effects on the surgical process. Methods Preoperative pharmaceutical care consultation was implemented in our hospital to assess the preoperative medication management of surgical patients between the pre-anesthesia consultation and the day of surgery. Pharmacists evaluated the appropriateness of medication management based on a consensus multidisciplinary institutional protocol. All errors identified between 2016 and 2020 were analyzed, and their severity and potential impact on surgery were standardized. A list of therapeutic groups was created to prioritize patients for consultations Results During the study period, 3,105 patients attended the consultations and 1,179 MEs were prevented. According to severity, 30.6% of MEs were classified as category E and 26.2% as D. The Number Needed to Treat to prevent a category E or higher ME (indicating potential harm to patients) was 5 patients. About 14.84% of MEs belonged to the prioritized drug groups. One hundred and thirteen errors would have resulted in a surgery delay of more than 24 h, and 175 errors were classified as G-H (irreversible damage). Conclusions This study highlights the effectiveness of pharmaceutical care consultations in preventing MEs and improving surgical outcomes.

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

» Chronic preoperative opioid use negatively affects outcomes after spine surgery, with increased complications and reoperations, longer hospital stays, decreased return-to-work rates, worse patient-reported outcomes, and a higher risk of continued opioid use postoperatively.» The definition of chronic opioid use is not consistent across studies, and a more specific and consistent definition will aid in stratifying patients and understanding their risk of inferior outcomes.» Preoperative weaning periods and maximum dose thresholds are being established, which may increase the likelihood of achieving a meaningful improvement after surgery, although higher level evidence studies are needed.» Spinal cord stimulators and intrathecal drug delivery devices are increasingly used to manage chronic back pain and are equivalent or perhaps even superior to opioid treatment, although few studies exist examining how patients with these devices do after subsequent spine surgery.» Further investigation is needed to determine whether a true mechanistic explanation exists for spine-related analgesia related to spinal cord stimulators and intrathecal drug delivery devices.

5-Aminolevulonic Acid, a New Tumor Contrast Agent: Anesthesia Considerations in Patients Undergoing Craniotomy

5-aminolevulinic acid (ALA) is used during resection of malignant gliomas due to its fluorescence properties and has been shown to render resection more effective than resection without ALA guidance. The aim of this narrative review is to categorize the adverse effects of ALA relevant to anesthesia providers. Intraoperative hypotension, porphyria-related side effects, alterations in blood chemistry and coagulation, photosensitivity, and increased levels of liver enzymes have all been reported. We also sought to examine the impact of dosage and timing of oral administration on efficacy of ALA and on these side effects. Twenty-seven studies met our inclusion criteria of patients undergoing craniotomy for glioma resection using ALA and occurrence of at least one adverse effect. The results of these studies showed that there was heterogeneity in levels of intraoperative hypotension, with some reporting an incidence as high as 32%, and that hypotension was associated with antihypertensive medication use. Clinical symptoms of porphyria, such as gastrointestinal disturbance, were less commonly reported. Photosensitivity of the skin after 5-ALA administration was well documented particularly in patients exposed to light; however, adverse effects on the eye were not adequately studied. Elevation in liver enzymes was a common finding postoperatively but was often clinically insignificant. The timing of oral administration presents practical issues for the preoperative management of patients undergoing resection with ALA. We provide guidance for perioperative management of patients who receive ALA for brain tumor resection. Controlled studies with adequate statistical power are required to further understand and prevent the adverse effects of ALA.

The Role of the Multiparametric MRI LiverMultiScanTM in the Quantitative Assessment of the Liver and Its Predicted Clinical Applications in Patients Undergoing Major Hepatic Resection for Colorectal Liver Metastasis.

Liver biopsy remains the gold standard for the histological assessment of the liver. With clear disadvantages and the rise in the incidences of liver disease, the role of neoadjuvant chemotherapy in colorectal liver metastasis (CRLM) and an explosion of surgical management options available, non-invasive serological and imaging markers of liver histopathology have never been more pertinent in order to assess liver health and stratify patients considered for surgical intervention. Liver MRI is a leading modality in the assessment of hepatic malignancy. Recent technological advancements in multiparametric MRI software such as the LiverMultiScanTM offers an attractive non-invasive assay of anatomy and histopathology in the pre-operative setting, especially in the context of CRLM. This narrative review examines the evidence for the LiverMultiScanTM in the assessment of hepatic fibrosis, steatosis/steatohepatitis, and potential applications for chemotherapy-associated hepatic changes. We postulate its future role and the hurdles it must surpass in order to be implemented in the pre-operative management of patients undergoing hepatic resection for colorectal liver metastasis. Such a role likely extends to other hepatic malignancies planned for resection.

Fundamentals of Plastic and Aesthetic Nursing: Preoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures.

Fundamentals of Plastic and Aesthetic Nursing: Preoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures.

Preoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures.

Preoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures.

726 Pre-Operative Glycaemic Control in Diabetic Trauma Patients

Abstract Aim To review the preoperative diabetic management of trauma patients pending theatre Method We analysed 2 months of trauma admissions including all patients with diabetes. We reviewed them against standards from our trust guidelines which state a blood glucose (BM), HbA1c, and urine analysis should be performed on admission. We reviewed which patients were commenced on variable rate insulin infusions (VRII) as the guidance states it should be considered when the patients’ BM is &amp;gt;12 or if the patient is to miss 2 or more meals. Results In our study population, 30% did not have a blood glucose on admission; and 80% did not have an HbA1c. Of those patients whose admission BM was over 12; 100% were started on a variable rate of insulin. The variation came with our tablet-controlled group as 33% were started on VRII and 77% were not. Of those not on VRII when it came to the day of surgery 18% had a BM of over 12. The average duration patients were kept nil by mouth was 14 hours Conclusions Polytrauma patients with diabetes are at higher risk of mortality; they are at increased risk of surgical site infections, poor wound healing, and non-union. This audit highlighted that the team recognise the importance of starting a VRII on those with hyperglycemia. However, going forward we need to ensure all patients have a BM on admission and this will direct our appropriate use of VRII and thus hopefully improve our trauma patients' outcomes.

Withholding of Hormone Replacement Therapy Prior to Total Joint Arthroplasty Surgery to Reduce the Risk of Postoperative Thromboembolic Events: Is It Justified?—A Systematic Review of Clinical Practice Guidelines

BackgroundHormone replacement therapy (HRT), menopausal hormone therapy (MHT), and estrogen-containing medications are frequently withheld before elective lower limb arthroplasty, based on a perceived risk of venous thromboembolism (VTE). However, evidence linking HRT, MHT, and an increased VTE risk is equivocal. This systematic review evaluated the concordance of international clinical practice guidelines (CPGs) on the withholding of HRT or MHT. MethodsThe PubMed, Google Scholar, Cochrane, and Ovid databases were searched for CPGs for the preoperative, perioperative, and postoperative management of patients on HRT and MHT undergoing elective lower limb arthroplasty. This was supplemented by an internet search. There were 7 international CPGs in English, from Europe and North America, published between January 2000 and February 2023 reviewed against the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE-II) criteria, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. ResultsThe guidelines reviewed revealed a mixed picture on HRT or MHT withdrawal and use in arthroplasty, with some featuring detailed advice on the preoperative and postoperative management of HRT or MHT (Scottish Intercollegiate Guidelines Network), while others featured no guidance (American College of Chest Physicians). The evidence referenced in these guidelines highlighted studies showing HRT or MHT to play a limited role in increasing VTE risk, with most studies from the 1990s and 2000s. ConclusionsBased on current evidence, non-estrogen-containing transdermal HRT or MHT should not be withheld in patients undergoing elective joint arthroplasty, though further evidence is required to justify withholding estrogen-containing forms.

Timing of Complications Following Surgery for Distal Femur Fractures in Older Adults.

The purpose of this study was to identify the timing and nature of complications associated with distal femur fracture surgery in patients aged 65 and older using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The ACS NSQIP database was queried for adults aged 65 and older who received surgical treatment for a distal femur fracture between 01 January 2015 and 31 December 2021. Cox regression models and risk tables adjusted for baseline clinical characteristics were created for 14 complications (Superficial Surgical Site Infection (SSI), Deep SSI, Organ/Space SSI, Pneumonia, Pulmonary Embolism (PE), Deep Venous Thrombosis (DVT), Urinary Tract Infection (UTI), Stroke/Cerebrovascular accident (CVA), Myocardial Infarction (MI), Renal Failure, Cardiac Arrest (CA), Re-operation, Sepsis, and Death within 30days of surgery). Model summaries were used to identify significant variables with a Bonferroni correction applied. A total of 3956 adults met inclusion criteria and were included in analysis. The most common complications were UTI (5.2%), death (4.1%), and pneumonia (3.4%). Complications typically occurred within 14days after surgery, except for SSI, which occurred between post-op days 11 and 24. Distal femur fractures are a substantial source of morbidity and mortality in the older adult population. Our findings underscore the need for comprehensive preoperative risk assessment and patient management strategies to mitigate the impact of identified risk factors in this vulnerable population.

Anesthesia and Pulmonary Hypertension: A Narrative Review

Pulmonary hypertension (PH) is a complex disease of the cardiopulmonary system. Perioperative management of PH is one of the most challenging issues for the anesthetists. Morbidity and mortality are significantly high in PH patients undergoing surgery due to right heart failure, arrhythmia, atrial fibrillation, ischemia, hemodynamic unstability, hypoxia, respiratory failure, renal failure, sepsis, and stroke. In PH patients, it is important that more than one physician, including anesthesiologist, intensivist, pulmonologist, cardiologist, and surgeon, discuss the patient’s possible difficulties and complications with a multidisciplinary approach and make a decision. In order to optimize the management of PH patients, it is necessary to comprehensively evaluate the underlying cause, pathophysiology, risk factors, course, and treatment of the disease. A balanced anesthesia technique, including inhalation or intravenous agents, appropriate regional anesthesia (RA), opioids, and α-2-adrenoceptor agonists, may provide the most uniform hemodynamic profile in these patients. The basis of anesthesia management should be to prevent and treat triggering factors, provide perfusion pressures, and optimize right ventricular functions. Advanced monitoring, pulmonary vasodilator therapies, adequate anesthesia and analgesia, and appropriate ventilator settings should be performed for patients with PH. Patients with PH should be followed in the intensive care unit in the first 48–72 h postoperatively. Our review aims to focus on appropriate preoperative preparation, perioperative monitoring, anesthesia and ventilator management, pain control, preventive methods, and treatment in patients with PH in light of the literature.

Preoperative Management of Diabetic Patients Undergoing Abdominal Surgery

Introduction: The management of diabetic patients undergoing abdominal surgery presents a multifaceted challenge that demands a comprehensive and tailored approach to ensure optimal perioperative outcomes Objectives: The basic aim of the study is to find the preoperative management of diabetic patients undergoing abdominal surgery Material and methods: A retrospective analysis was conducted, utilizing medical records from a cohort of 200 diabetic patients who had undergone various abdominal surgical procedures at Khyber Teaching Hospital Peshawar between August 2018 to March 2019. Ethical approval was obtained from the Institutional Review Board (IRB) prior to the commencement of data collection.Electronic medical records were meticulously reviewed to gather comprehensive patient information. Relevant demographic data, including age, gender, and body mass index (BMI), were documented. Preoperative glycemic status, measured through fasting blood glucose levels, HbA1c levels, and medication regimens, were recorded. Patient comorbidities, particularly cardiovascular conditions, were identified, and details of preoperative cardiovascular risk assessments were documented. Practical Implication: The prevalence of postoperative complications emphasizes the need for comprehensive management. These findings underscore the significance of holistic approaches to ensure safer surgeries and improved patient well-being. Conclusion: It is concluded that glycemic control, collaborative cardiovascular risk assessment, nutritional optimization, and patient education play pivotal roles in enhancing surgical outcomes. The prevalence of postoperative complications emphasizes the need for comprehensive management. Keywords: Diabetic, abdominal surgery, postoperative complications, nutritional optimization, cardiovascular risk, Nutritional Optimization

Integrated Care for Comprehensive Management of Patients with Osteoarthritis: Program Development and Implementation.

Treatment of symptomatic osteoarthritis (OA) is often complicated by comorbidities, which put patients at potentially higher risks following operative interventions. Management of these comorbidities is usually separate from orthopaedic care, with patients invited to return to their orthopaedic surgeon once surgical risk factors are better controlled. However, this practice can lead to disjointed care, resulting in uncertainty, mistrust, unmanaged pain, and dissatisfaction for patients. Integrated care teams provide an effective option for coordinated comprehensive nonoperative and preoperative management of patients with knee OA and medical comorbidities. The objective of this article is to summarize the process for implementation of an integrated program to manage patients with symptomatic knee OA and the initial outcomes at our institution as an example of the effects of integrated patient management in orthopaedics. At the author's institution, an integrated program was implemented, successfully addressing the unmet need for coordinated care for patients with bone and joint health problems and medical comorbidities. Patients who completed the full program experienced significant improvements in both pain and function. Potential applications for knee surgeons considering implementing integrated care models could include pre- and postoperative management programs, nonoperative management program, and programs seeking to meet key metrics such as improved readmission rates, patient satisfaction, or value-based care. For effective program implementation, careful planning with convenient referral mechanisms, leadership buy-in, and patient-centered communication protocols are required.

Preoperative management of patients with ectopic Cushing's syndrome caused by ACTH-secreting pheochromocytoma: a case series and review of the literature.

ACTH-secreting pheochromocytoma is a rare cause of ectopic Cushing's syndrome, posing a clinical challenge for the severity of its clinical presentation, the difficulty in the prevention and the management of surgical complications. Sparse data are currently available about the optimal preoperative management of the severe symptoms due to both hypercortisolism and catecholamine excess, especially regarding the role and timing of medical therapies. We present a series of three patients with ACTH-secreting pheochromocytoma. A brief review of the available literature evidence on the preoperative management of this rare clinical condition is also conducted. Patients with ACTH-secreting pheochromocytoma show peculiarities as compared to other forms of ACTH-dependent Cushing's syndrome, in terms of clinical presentation, preoperative management, and peri- and post-surgical short-term outcome. Pheochromocytoma should be ruled out in patient with ectopic CS of unknown origin because of the high anesthesiologic risk of proceeding to surgery with an undiagnosed pheochromocytoma. Proper preoperative recognition of complications of both hypercortisolism and catecholamines excess is the key to prevent the morbidity and mortality of an ACTH-producing pheochromocytoma. In these patients the absolute priority is to control excessive cortisol secretion since the rapid correction of the hypercortisolism is the most effective treatment of all the related comorbidities and it is mandatory to prevent severe complications during surgery, opting if necessary for a "block-and-replace" regimen. Our additional cases and this literature review could provide a better understanding of the complications to be evaluated at diagnosis and some suggestions on their management during the preoperative period.

Analysis of clinical series with the use of adjuvants to general anesthesia during elective caesarean section

Background. Caesarean section remains one of the most common surgical interventions in the world. The main disadvantages of the general anesthesia in caesarean section are a high risk of awareness during the operation and a pronounced hemodynamic reaction to the surgical trauma in a patient. The most dangerous period of intervention in terms of these complications is the period before the birth of a child. This article analyzes our own clinical cases of the general anesthesia during elective caesarean section with the addition of adjuvants and compares anesthetic management with world practices. In all cases from our own clinical practice, total intravenous anesthesia with artificial lung ventilation was performed. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg) and clonidine (100 μg), 30 minutes before the elective surgical intervention. The newborns were examined with the Apgar scale and umbilical venous blood gas analysis was carried out. Preoperative, intraoperative, and postoperative management of patients was based on recommendations of the Enhanced Recovery After Caesarean Section and guidelines of the PROSPECT working group. Results. The analysis of our own clinical cases revealed the presence of a hemodynamic reaction of the patient’s body to the operative injury (in the period before the birth of a child), which does not exceed safe levels; absence of anesthetic complications and cases of accidental awareness during surgery; absence of a negative influence of adjuvants on newborns; sufficient depth of anesthesia and reduction of the intraoperative doses of opioids and intravenous anesthetics (“on patient’s request”). Conclusions. The analysis of clinical cases argues for the need to use “safe adjuvants” (acetaminophen, clonidine) to general anesthesia during elective caesarean section and the necessity for further research.