Treatment In Postoperative Period Research Articles

The Impact of Different Antiemetics on the Nausea in Early Postoperative Period After Laparoscopic Holecystectomy

Abstract Postoperative nausea and vomiting (PONV) is a patient-important outcome; patients often rate PONV as worse than postoperative pain. This clinical study was aimed to asses the efficiency of standard aniemetics administration separately or in combination in prevention of PONV in patients who underwent to the same surgical procedure - laparoscopic cholecystectomy. Also, this article could provide a novel information about the best choice for prevention and treatment of PONV. This study included 87 patients divided into four groups according to the postoperative phramacological treatment: First group was control group without treatment, Second group was group of patients with ondasetron treatment in postoperative period, Third group was group of patients with ondasetron+dexamethasone treatment, and fourth group was group of patients with dexamethasone treatment in postoperative period for nausea. PONV was distributed in Ondansetron+Dexamethasone group in the lowest percent (4.5%), which means that this conbination of antiemetics was very effective. Than, Dexamethasone group was in relation with low incidence of PONV (14.3%), and after that were Ondansetron and Control groups. Also smokers and males has lower incidence of PONV, especially in combination with Ondansetron+Dexamethasone treatment. The incidence of PONV is lower in male smokers patients who were underwent to combination of two antiemetics, ondansetron and dexamethasone compared to monotherapy and female non-smokers. Preventive strategies for PONV must include risk stratification followed by prophylactic approach and also testing the newer antiemetics. Because of the high incidence of postoperative nausea and vomiting as a patient-important outcome, the preventive strategies should be considered as serious condition which requires multimodal approach.

Transjugular intrahepatic portosystemic stent-shunt as minimally invasive method of portal hypertension correction in multi-disciplinary clinic

Aim. Optimization of the tactics of management of patients with liver cirrhosis who underwent Transjugular Intrahepatic Portosystemic Shunt – TIPS based on own experience and literature data. Materials and methods. From 2014 to 2019 years 51 Transjugular Intrahepatic Portosystemic Shunt procedures were performed. Results. The indications for Transjugular Intrahepatic Portosystemic Shunt procedure were detailed. The tactics of treatment in post-operative period was assessed. Shot-term and long-term results of the treatment were discussed. Especial attention was put to persons who included in patient list of liver transplantation. Conclusion. Transjugular Intrahepatic Portosystemic Shunt allows obtaining stable decompression in portal system that reduces frequency of bleeding relapse from gastric and esophageal veins. The mortality was decreased, and patients can wait till liver transplantation.

Left lung and liver hydatid cyst: managed in single surgery

A 35 years male presented with history of pain left chest wall associated with cough, fever and blood in sputum on and off, complaint of pain in abdomen which was dull aching gradually progressive in nature since, 2 months. Radiologically diagnosed to have huge hydatid cysts both in left lung and liver. It is unusual to find such large cysts at multiple sites and organs as in this case. There are reports in the literature of staged management as well as simultaneous management of lung and liver hydatid cysts. Though concomitant cysts in lung and liver may be treated comfortably by one stage surgery. Here both cysts were enucleated in the same sitting by a combined thoracic and abdominal approach (left thoracotomy followed by laparotomy through right subcoastal incision). The technique is safe and results were comparable to two stage surgery. Albendazole treatment in post-operative period helps to prevent recurrence. This report emphasizes that surgical intervention for hydatid cysts at multiple sites done in a single stage is safe, lessens the financial burden and hospital stay by avoiding multiple surgeries and anaesthesia.

Diagnosis and Surgical Treatment of Orbital Tumors of Various Localizations and Histostructures.

The article reviews and analyzes the results of treatment of 32 patients with orbital tumors operated in the clinic, neurosurgery until the period from 2015 till September 2019. Goals and objectives: coverage of clinical signs and symptoms, histology, diagnostic methods and treatment of patients operated on with orbital tumors during the period 2015-2019. Determination of optimal surgical approach to the tumors with different localization for performing the radical organ-preserving surgery, with maximal saving of visual functions, minimization of oculomotor disorders, patient disability. Materials and Methods: we analyzed the clinical cases of 32 patients undergoing treatment in DOKTMO with orbital tumors for the period from 2015 till September 2019. Patients were operated on with various approaches - transcutaneous, subconjunctive (without orbitotomy), fronto-orbito-zygomatic, pterional, subfrontal (neurosurgical approaches), transmaxillary, transethmoidal (ENT approaches). The choice of surgical approaches were individual. In 2 cases we become a backset of tumor growth: one patient with aggressive adenocarcinoma, after 18 months, leading to orbital exentration and the child, 9 years old with rhabdomyosarcoma after non-radical removal of tumors of subconjunctival approach. In all other cases, relapses were not detected, operation were organ-preserving oriented. Conclusions: the results of treatment of patients with tumors directly depend on the choice of radicality tumor removal, which is associated with the choice of surgical approach, chemical, radiation treatment in postoperative period depending on the histological response. From our point of view, the most universal method for tumor removal with various localizations and sizes is fronto-orbito-zygomatic approach which provides the performance of radical organ-preserving operation with maximal vision saving, minimizing oculomotor disorders, disability of the patient, despite its technical complexity for ophthalmologist surgeons. In this regard, surgery of orbital tumors is subject to the competence of doctors of related specialties.

Відеоасистовані торакоскопічні лобектомії при туберкульозному, неспецифічному й онкологічному ураженні легенів

Мета. Поділитися власним досвідом виконання відеоасистованих торакоскопічних (ВАТС) лобектомій у пацієнтів з туберкульозним, неспецифічним і онкологічним ураженням легенів за період з 2014 по 2019 р.
 Матеріали і методи. За останні 5 років нами виконано 72 ВАТС резекції частки легені, у тому числі 30 (41,7%) типових ВАТС нижніх лобектомій з роздільною хірургічною обробкою елементів кореня частки. У 1 (1,4%) пацієнта вдалися до конверсії в торакотомію у зв’язку з геморагією. Серед пацієнтів переважали жінки – 46 (63,9%). Вік пацієнтів коливався від 17 до 85 років, у середньому становив (39,2 ± 6,2) року.
 Оперативні втручання було виконано з приводу туберкульозу легенів у 57 (79,2%) пацієнтів, з приводу раку - у 7 (9,7%), вродженої гіпоплазії легені - у 2 (2,8%), артеріовенозної мальформації - у 1 (1,4%), гамартохондроми великих розмірів – у 2 (2,8%), бронхоектатичної хвороби – у 2 (2,8%), внутрішньочасткової секвестрації – у 1 (1,4%) пацієнта.
 Результати. Інтраопераційні ускладнення діагностовані у 3 (4,2%) пацієнтів. Загалом післяопераційні ускладнення виникли у 12 (16,7%) пацієнтів. Загальна ефективність виконання ВАТС лобектомії становила 98,6%, середня тривалість резекційних оперативних втручань – (185,1 ± 72,2) хв, середній об’єм інтраопераційної крововтрати – (154,1 ± 73,8) мл, середня тривалість лікування в післяопераційному періоді – (29,2 ± 14,1) дня, частота конверсії в широку торакотомію - 1,4%.
 Висновки. ВАТС лобектомія є ефективним методом хірургічного лікування хворих, що потребують виконання торакальних операцій, у тому числі фтизіатричного та онкологічного профілів. Даний вид операцій перспективний, малотравматичний, забезпечує анатомічне препарування елементів кореня частки легені, його можна розглядати як альтернативу відкритій лобектомії. Широкому використанню даного методу перешкоджає виражений фіброз кореня легені і злуковий процес внаслідок тривалого запального процесу і тривалого медикаментозного лікування та вартість ендоскопічних інструментів.

Comparative Study between Outcomes of Abdominoplasty with or without Use of Diuretics in Postoperative Treatment

Background: Seroma formation is a common complication after abdominoplasty and is associated with delayed wound healing, infection, skin flap necrosis, patient discomfort and repeated visits to the outpatient clinic to deal with seroma and its sequelae. Closing the dead space after abdominoplasty seems to be key in reducing seroma and its complications. Objective: The aim of this study was to compare outcome amount of serous fluid in the drain and incidence of seroma post abdominoplasty with and without use of spironolactone in medical treatment in postoperative period. Patients and Methods: This study was conducted on 40 patients who underwent classical abdominoplasty without use of mesh, all laboratory and radiological investigations were done. Patients were divided into two groups group A involved 20 patients who didn't take spironolactone and group B included 20 patients that had taken spironolactone for 15 days postoperative. Results: In group A, there were 3 males and 17 females and mean age was 34 ± 8.6 years. Group B consisted of 5males and 15 females, their mean age was 40 ± 10.8. BMI was 13 patients >25 in group A and in group B was 6 cases >25. There is small paraumbilical hernia in 4 patients in group A and in 3 patients in group B. Group B who took spironolactone showed significant improvement in outcome including volume of fluid in the drain, time of removal of drain and no occurrence of flap edema. Conclusion: There was statistically significant decrease in the incidence of seroma formation after abdominoplasty with the use of spironolactone postoperative.

Low opioid anesthesia and opioid free anesthesia use in pain control treatment in postoperative period

Postoperative pain is a complex and multifactorial symptom that requires a well thought approach using different treatments to achieve the optimal outcome after surgery. Contemporary anaesthesiology, looking for an alternative to analgesia with the use of opioids, more often turns to the protocols of low-opioid and opioid free treatment and pain control. By replacing opioids with non-opioid analgesics, koanalgetics, as well as using local and regional anesthetic techniques, we limit or avoid adverse effects of opioids while maintaining a satisfactory level of analgesia for the patient. Methods of general anesthesia without or with the minimum amount of opioid drugs are of particular importance in bariatric surgery due to a reduction in the incidence of post-operative respiratory depression and excessive sedation. They also allow to achieve and maintain cardiovascular stability in the intraoperative and postoperative period, prevent the occurrence of opioid-induced hyperalgesia (the so-called opioid paradox), and improve the comfort of patients in the post-operative period due to the lower incidence of post-operative nausea and vomiting and constipation. The particular significance of regional and local analgesia techniques, which supplement general anesthesia and reduce the need for analgesics in the perioperative period, is emphasized. This analysis presents the theoretical foundations of multimodal analgesia and existing scientific evidence confirming its benefits in improving pain control after surgery.

Diagnostic and Prognostic Possibilities of the Redox-Potential Electrochemical Measurements in Blood Plasma

Determination of operating characteristics of the test based on blood plasma redox potential monitoring in patients with different patho- logical conditions associated with impaired oxygen metabolism during treatment in postoperative period and expanding the range of parameters of the developed method of investigation of blood plasma redox potential. It were examined healthy volunteers group as following group (n = 63), groups of patients with transplanted liver (n = 64), kidney (n = 59), and lungs (n = 7). Redox potential measurements were done by platinum electrode, reference electrode was silver-chlorine one. Potentiostate IPC-ProL was used to registrate and record a dependence redox potential via time. Time of measurement was 15 min. statistically significant differencees of redox potentials ranges was found in healthy volunteers and patients with transplanted kidney and liver. Ratio of measured redox potentials coincident with the values within the confidence interval in healthy volunteers was 12% in patients with transplanted kidney and 10% in patients with transplanted liver. We observed significant differences in the nature of changes of blood plasma's redox potential values in course of monitoring of subgroups of patients with and without complications after liver transplantation. It was found that sensitivity of electrochemical method was 85%, selectivity--69.8%, precision--85.2%. we discovered value ranges of blood plasma redox potential typicalfor different pathological states; we detected an interaction between the effect of treatment and quantitative changes in the values of the blood plasma redox potentials; criterion for early predicition of complications in patients with transplanted liver was proposed basing on redox potential monitoring during postoperative period.

Intravenous Paracetamol Reduces Postoperative Opioid Consumption after Orthopedic Surgery: A Systematic Review of Clinical Trials

Postoperative pain management is one of the most challenging jobs in orthopedic surgical population as it comprises of patients from extremes of ages and with multiple comorbidities. Though effective, opioids may contribute to serious adverse effects particularly in old age patients. Intravenous paracetamol is widely used in the postoperative period with the hope that it may reduce opioid consumption and produce better pain relief. A brief review of human clinical trials where intravenous paracetamol was compared with placebo or no treatment in postoperative period in orthopedic surgical population has been done here. We found that four clinical trials reported that there is a significant reduction in postoperative opioid consumption. When patients received an IV injection of 2 g propacetamol, reduction of morphine consumption up to 46% has been reported. However, one study did not find any reduction of opioid requirement after spinal surgery in children and adolescent. Four clinical trials reported better pain scores when paracetamol has been used, but other three trials denied. We conclude that postoperative intravenous paracetamol is a safe and effective adjunct to opioid after orthopedic surgery, but at present there is no data to decide whether paracetamol reduces opioid related adverse effects or not.

Recuperación ductular en el síndrome de los conductillos biliares evanescentes en paciente con linfoma de Hodgkin

We present the case of a 17-year-old male patient with Hodgkin's lymphoma (nodular sclerosis) in the mediastinum. During the postoperative period treatment with erythromycin was started and the patient developed progressive jaundice and cholestasis. Treatment modified for the lymphoma was initiated, which achieved complete remission and subsequent improvement and resolution of the cholestasis. Histological study of the liver revealed massive loss of bile ducts. After resolution of the cholestasis, consecutive biopsies revealed ductal proliferation. The present report therefore illustrates a case of ductopenia or vanishing bile duct syndrome (VBDS) with ad integrum regeneration of the bile ducts simultaneous with lymphoma remission. Because the 2 possible causes, erythromycin toxicity and Hodgkin's lymphoma, occurred simultaneously, the etiology of the VBDS cannot be definitively established.