[Postoperative jaundice. Procedure to follow].
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Decision Trees↗
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[Anesthesia procedure and postoperative ADH secretion].
44 patients undergoing major abdominal and thoracic surgery received different anaesthetic treatment and different pain therapy during the postoperative period (4 groups). Analysis of plasma vasopressin was performed in all patients pre-, intra- and five days postoperatively. In two groups of patients under neuroleptanalgesia (group A and B) ADH-levels increased markedly during the operation procedure, whereas those of patients under NLA plus epidural analgesia with bupivacaine 0.5% (group C and D) showed only a slight increase intraoperatively. During the postoperative period pain relief was provided by giving fentanyl epidurally (group B and D) or with systemic administration of piritramide (group A and C). During the investigation period vasopressin secretion in patients under epidural opiate therapy was significantly less pronounced as in patients under systemic opiate therapy.
Analgesia↗
Tracheal resection and reconstruction: indications, surgical procedure, and postoperative care.
Nursing management of the patient undergoing tracheal resection and reconstruction is not well described in the literature. Over the last 25 years, nurses in the respiratory surgical intensive care unit at Massachusetts General Hospital in Boston have cared for more than 600 patients who have undergone this procedure. Using a diagnostic format, we have developed a plan of care for this patient population. In this article, the etiology of tracheal obstruction, its diagnosis and surgical correction, and nursing care of the patient after tracheal resection and reconstruction are presented.
Humans↗
Postoperative complications following gingival augmentation procedures.
BACKGROUND: Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications. METHODS: Seventy-five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the chi2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together. RESULTS: The duration of surgical procedures was highly correlated with pain or swelling post-surgically (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). CONCLUSIONS: Long surgical procedures and smoking may increase the severity and frequency of certain post-surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.
Adult↗
[Autologous rib cartilage harvesting: operative procedure and postoperative pain reduction].
INTRODUCTION: In reconstructive surgery there is a growing demand for cartilage grafts. For small amounts of autologous tissue, cartilage from the nasal septum or ear concha is a sufficient and reliable tissue, but in cases of extensive defects or higher mechanical load autologous rib cartilage is a commonly used transplant. Nevertheless, a serious donor-site morbidity, especially postoperative pain, has to be taken into consideration. We present a modified technique for harvesting rib cartilage with a consecutive local pain therapy. TECHNIQUE: In contrast to the commonly used incision through all layers of tissue the described technique follows the anatomical structures of skin tension-lines, the fascial and muscle fibers and tissue sliding-planes. Starting with a transversal skin incisions 1.5 cm above the costal arch, longitudinal splitting of the rectus abdominis fascia and muscle, the rib cartilage of the ribs 6 to 8 can be exposed. Grafts in the size of at least 3 to 8 cm can be harvested under preservation of the perichondrium. This technique causes a high degree of stability and good function of the abdominal wall. POSTOPERATIVE PAIN THERAPY: After harvesting rib cartilage most patients complain about extensive postoperative pain. For adequate treatment the local application of a long-lasting anesthetic substance close to the intercostal nerves is helpful. The introduction of a peridural catheter opens the feasibility of continuously applying a local anesthetic for 3 to 4 days directly into the donor-site. This procedure reduces the need for general anesthetics dramatically and prevents further complications. DISCUSSION: This modified technique for harvesting rib cartilage diminishes the donor-site morbidity by reducing the risk of pneumothorax, hernias and functional deficits. Moreover, the local pain therapy assures postoperative wellness and mobility.
Anesthetics, Local↗
[Needle suspension of the bladder neck for stress urinary incontinence: surgical results of 394 patients operated on with quantitative procedures].
We have investigated surgical results of quantitative suspension of the bladder neck for stress urinary incontinence. Three hundred ninety-four female patients suffering from stress incontinence have been operated on with Stamey's or Gittes' procedures during the past 8 years. While the bladder neck was elevated by quantifying tension of nylon threads in 84 patients, 310 patients subsequently were operated on by quantifying both tension and length of nylon loops. A follow-up period averaged 51 months for a group of the Stamey's and 19 months for a group of Gittes' procedures. Postoperative continence rate was defined by patients' subjective evaluation. Those whose nylon loops were quantified as from 130 to 149 mm attained the highest continence rate, which was not related to age or severity of incontinence. Postoperative difficulty in urination was less in those who had nylon loops of 130 to 149 mm, and was more in those over 60 years of age. Eighty-eight percent of the patients stated very much satisfied or satisfied with the surgery they had undergone. Continence rate was 78% for those operated on with the Stamey's (51 months later) and 69% with the Gittes' procedures (19 months later). The 7-year continence rate was 77% for the former and the 3-year continence rate was 38% for the latter, indicating that the Stamey's procedure was significantly more useful than the Gittes' procedure. Postoperative complications were encountered with 17% of the patients. We conclude that quantitative suspension of the bladder neck is of value to obtain the high success rate of the needle suspension procedure.
Adult↗
Endovascular aortic aneurysm repair with the Zenith AAA Endovascular Graft: does gender affect procedural success, postoperative morbidity, or early survival?
The purpose of this study was to analyze the effect of gender on deployment, early morbidity, and survival after endovascular aortic aneurysm repair (EVAR) using the Zenith Endovascular Graft. Data were obtained from the U.S. Multicenter Zenith Endograft trial and complemented with results from the Zenith female registry, including 40 women (10.9%) and 326 men (89.1%). Data analysis included preoperative medical risk factors, aneurysm morphology, deployment, and postoperative morbidity data, and 30-day and 1-year results. Preoperatively, women more often had experienced thromboembolic events (13% vs 4.3%; P = 0.04), but less angina pectoris (24% vs 49%; P = 0.002) or myocardial infarction (18% vs 38%; P = 0.01) compared with men. Women had more angulated aneurysm necks and narrower iliac arteries compared with men. Procedural success, cardiovascular, pulmonary, renal, bowel-related, neurologic, or other adverse events were comparable, as were 30-day and 1-year survival. Females experienced more wound dehiscences (5.0% vs 0.0%; P = 0.01) and open surgical conversions in the first year (5%) compared with men (0.31%) (P = 0.03). With more challenging aneurysm morphologies, women were found to be at a higher risk for conversion in the first year after EVAR using the Zenith endograft. This however does not translate into inferior survival or higher overall morbidity compared with men.
Age Factors↗
Reducing trauma payment denials with computerized collaborative billing.
BACKGROUND: Trauma care demands constant physician availability, resulting in rotational coverage systems. Third-party payors consider separate trauma surgeon bills as originating from the same individual. Trauma surgeons may be unaware of their colleagues' billing history on jointly managed patients. Not all postoperative procedures and evaluation and management services are denied by global surgical package rules. We investigated whether a networked billing program designed to crosscheck for global package coding concerns would reduce payment denials. METHODS: A networked relational database was created for trauma surgeons to enter billable encounters, displaying global periods and operative diagnoses while prompting for postoperative modifiers. Denials were compared for equivalent time periods before and after program initiation. RESULTS: Payment denials fell from 361 to 16 for "bundled" evaluation and management services and from 55 to 13 for bundled postoperative procedures. Time spent on billing decreased and legibility improved. Overall savings totaled $183,404. CONCLUSION: Collaborative billing can improve payments for professional trauma care.
Forms and Records Control↗
An investigation of the clinical use of botulinum toxin A as a postoperative adjustment procedure in the therapy of strabismus.
Attempts to circumvent multiple surgical procedures are an integral part of the history of investigations in strabismus. In 1973, Botulinum toxin A (Oculinum) injections into human EOM was proposed as an alternate method to surgery for strabismus and has since proved to be effective. This article reports the results from a retrospective investigation of EOM Oculinum injection used in the postoperative period as an alternate to additional surgery. It is difficult to establish whether Oculinum altered the time span of the clinical course in these patients, but when it was effective, it provided unprecedented convenience.
Adolescent↗
[Sacrospinous ligament fixation of vaginal apex for repair operation of uterine prolapse--operative procedure and postoperative outcome evaluated with score system and X-ray subtraction colpography].
To preserve a snug vagina with complete repair, sacrospinous ligament fixation (SLF) to the vaginal apex was applied in operations for uterine prolapse from the April of 1983 to the April of 1984. SLF was added to 11 vaginal hysterectomies with anterior and posterior (A-P) colporrhaphy, 1 Manchester operation and 1 A-P colporrhaphy. SLF was performed at the stage of posterior colporrhaphy in each operation. The postoperative outcome was evaluated with a score system and an X-ray subtraction colpography. The score system describes the grade of vaginal relaxation in each part of the vagina before and after the operation. It showed that the vagina was repaired quite well by the SLF especially in the area of the vaginal apex and posterior wall. The subtraction colpography revealed the side view of the vagina and its movement on straining. It suggested that the SLF was a reasonable procedure for the prevention of recurrence. SLF also proved to have wide application to the repair of uterine prolapse including patients desiring the preservation of childbearing capability and elderly or poor-risk patients.
Adult↗
Lumbar sympathectomy in obliterative arteriosclerosis. Should it still be performed?
During the years 1967-1976, bilateral lumbar sympathectomy was performed in 241 patients with arteriosclerotic occlusions. A questionnaire was completed by 137 patients. Of the total, 68% seem to have improved in some way postoperatively. The material was analyzed with regard to age, sex, diabetes and regarding the effects on pregangrene, established gangrene, amputation, claudication and skin temperature. The operative mortality was 2.1% and postoperative complications were few. Bilateral operation in one stage does not give a higher postoperative mortality than unilateral procedures. Postoperative side-effects, such as neuritic pains, sexual and urological dysfunctions, are considered. Bilateral lumbar sympathectomy still seems to be an alternative procedure, which may be offered some patients with marginal peripheral circulation, when reconstructive arterial surgery is not feasible.
Amputation, Surgical↗
[Interventional radiologic procedures in postoperative complications after liver transplantation].
PURPOSE: Postoperative complications contribute significantly to the morbidity and mortality of liver transplant patients. The management of these complications requires a multidisciplinary approach in which interventional radiology plays an integral role. Indications, techniques, and results of radiological interventions in the management of the liver transplant patient are presented. MATERIAL AND METHODS: During a 10-year period, 52 out of 420 liver transplant recipients underwent radiological interventions, including angioplasty (n = 20), embolization (n = 2), percutaneous drainage (n = 11), and biliary interventions (n = 19). RESULTS: Nine out of ten arterial stenoses located at the anastomoses (n = 8), within the liver (n = 1) and in the coeliac trunk (n = 1) were successfully treated by balloon dilatation. Angioplasty of supra- or infrahepatic anastomotic stenoses of the i.c.v. (n = 5) provided long-term success only in combination with stent implantation. Portal vein stenoses and chronic thrombosis were treated by balloon dilatation and stent insertion via transhepatic catheterization of the portal vein. Late strictures of bile-duct anastomoses can be managed by ante- or retrograde interventions. If biliary complications are related to inflammatory or septic problems, the prognosis of graft survival is poor. CONCLUSION: Interventional radiological procedures are very useful in the management of vascular and biliary complications after liver transplantation. These techniques provide a cure in many situations, and thus, surgical interventions may be avoided in selected cases.
Anastomosis, Surgical↗
[Pre and postoperative orthodontic procedures in children with congenital cleft lip and palate].
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Adolescent↗
Consultation section. Refractive surgical problem: 3 issues to be discussed: the clinical indications, the surgical procedure, the postoperative findings.
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Adult↗
Flap perfusion after free musculocutaneous tissue transfer: the impact of postoperative complications.
In a previous study, the authors found persistence of pedicle blood flow up to 10 years after uncomplicated free latissimus dorsi transfer. In this study, the impact of postoperative complications (hematoma, thrombosis, infection) and successful surgical revision was tested. Since 1982, more than 1200 free tissue transfers have been performed at the authors' institution (Hannover Medical School). Of these, the authors selected two groups of 30 patients each who had received a free latissimus dorsi transfer to the lower leg without microsurgical nerve coaptation for wound coverage. All patients included in this study were carefully selected for clinical homogeneity, with one difference: group I comprised patients who had no postoperative complications after free latissimus dorsi transfer. Group II included only patients with major postoperative complications after the procedure. All flaps in group II survived after successful surgical revision. The arteries, which nourished the lower leg, were visualized and documented by means of a duplex scanner in both groups. Three different time intervals were chosen for measurements of blood flow: 4 to 6 months (groups I.I and II.I), 4 to 6 years (groups I.II and II.II), and 8 to 10 years (groups I.III and II.III). Quantitative measurements of local flap perfusion in milliliters per minute per 100 g tissue were performed by means of the hydrogen clearance technique. In each patient, a total of nine measurements was performed in three phases: phase A, before closing the vascular pedicle by manual compression (n = 3); phase B, with a closed pedicle (n = 3); and phase C, after releasing the vascular pedicle from manual compression (n = 3). Each measurement took approximately 10 minutes. One hundred percent closure of each pedicle in phase B was confirmed by the duplex scanner. Furthermore, all patients were monitored both clinically and by means of the hydrogen clearance technique during phase B for adequate blood supply to the lower leg. Lower leg perfusion showed no statistical differences for phases A, B, and C in all groups of patients. In group I, no statistical differences in local flap perfusion were encountered for phases A and C. In phase B, however, a statistically significant (p < 0.01) complete extinction of local flap perfusion was registered in all patients of group I at the site of the flap's skin paddle. In group II, however, persistent flap perfusion was registered during phase B in up to 50 percent of cases in one subgroup (II.III). No statistically significant alterations of local blood flow were registered in the surrounding tissue of group II during phases A, B, and C. Patients with thrombosis of the venous anastomosis (n = 7) seemed to have the highest incidence of loss of autonomous blood supply through the vascular pedicle (5 out of 11 cases). No inconstant results were found during the repetitive measurements (n = 3) for each patient in each phase. After uncomplicated free tissue transfer, the flap's intact vascular pedicle seems to play an important role in permanent flap survival up to 10 years after the procedure. Postoperative complications after free tissue transfer with successful surgical revision, especially venous thrombosis of the vascular anastomosis, may lead to loss of vascular flap autonomy over time.
Adult↗
A retrospective evaluation of the rectal pull-through technique. Procedure and postoperative complications.
Ten animals (8 dogs and 2 cats) with distal rectal lesions were treated by surgically resecting the affected segment of the rectum by the rectal pull-through technique. There were four malignant tumors, three benign tumors, two inflammatory lesions, and one malignant tumor that extended histologically to the margins of a previous surgical excision. Postoperative complications were tenesmus (7 animals), fecal incontinence (4 animals), rectal bleeding (4 animals), and abscess formation (1 animal). Dehiscence and stricture were not observed. The four animals with malignant tumors survived less than 12 months after surgery. One of the four animals still living has persistent fecal incontinence. The rectal pull-through technique is described and illustrated.
Animals↗
Behavioral and physiological indicators of procedural and postoperative pain in high-risk infants.
Nurses play a critical role in the assessment and management of infant pain. In this article, infant pain assessment tools that are valid, reliable, clinically sensitive, and developmentally appropriate are discussed. Their purpose, use in acute pain, and applicability for premature and newborn infant populations are described. Behavioral and physiological indicators of pain, sleep-wake states, and infant development are discussed as important considerations in pain assessment. Recommendations for improving pain assessment practices are offered in conclusion.
Humans↗
[Endocrine surgery series. 2. Surgical treatment for Graves' disease. Regarding preoperative preparation, operative procedure and postoperative management].
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Graves Disease↗