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[The value of music in postoperative care].

During the immediate postoperative period good monitoring, adequate analgesia and competent, comprehensive care are of paramount importance. The effect of music in the recovery room raised my interest as an additional "instrumentarium". It is my intent to motivate to take advantage of the many-fold uses of music in the postoperative phase.

Anesthesia Recovery Period↗

[Hormone therapy as postoperative care in patients with differentiated thyroid cancer].

TSH suppression therapy has been performed for 150 patients as postoperative care for differentiated thyroid cancer. L-thyroxine (LT4) was given in a dose of 2.1-4.8 micrograms/kg/day, per os. Serum thyroid hormone determinations were done after confirming that the drug had continually been taken for more than three months. Serum free T4 (FT4) values were elevated higher than the upper normal limits (1.9 ng/dl) in 127 of 150 cases (84.7%). In 100 cases of these, serum free T3 (FT3), reverse T3 (rT3) and TSH were estimated. In 98 cases (98%), serum FT3 was within the normal limits (3-6 pg/ml) and no correlation was found between values of FT4 and FT3. These serum rT3 values, however, were elevated higher than the normal range (13-43 ng/dl) in 41 cases (41%) correlating with FT4 values. Serum TSH, FT4 and FT3 showed no correlation with given LT4 doses. There was no correlation between the serum TSH and FT3. However, some correlation (r = -0.4046) was found between serum TSH and rT3 values. From these results the following conclusions were obtained: i) There must be some auto-regulating mechanisms to keep the serum FT3 values at the normal level by promoting a de-iodinating process from T4 to rT3 when serum T4 level increased, since rT3 has no hormone activity. ii) Administration of synthesized LT4 is safer and more adequately usable than synthesized L-triiodothyronine or desiccated thyroid, as the TSH suppression therapy, because the above mentioned autoregulating mechanism would take place.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗

Perioperative respiratory therapy (PORT). A program of preoperative risk assessment and individualized postoperative care.

In an effort to contain the expense of respiratory therapy modalities as well as to provide the level of respiratory care most appropriate for postoperative patients, we devised a perioperative respiratory therapy program (PORT). We describe the response of 1,476 consecutive patients treated by our Respiratory Care Department prior to and during the first year of PORT. Surgical procedures were divided into ten categories. The PORT group had significantly lower cost than the non-PORT group in two of the categories, with a significantly higher cost in one. We describe the advantages of PORT, which were identified by participating surgeons, respiratory therapists, and patients. We present a simple, bedside, risk assessment form which enabled us to predict the risk of postoperative pulmonary complications and to provide more aggressive respiratory therapy interventions to higher-risk patients.

Costs and Cost Analysis↗

Postoperative care following pituitary surgery.

Patients undergoing surgery for pituitary tumors represent a heterogeneous population each with unique clinical, biochemical, radiologic, pathologic, neurologic, and/or ophthalmologic considerations. The postoperative management of patients following pituitary surgery often occurs in the context of a dynamic state of the hypothalamic-pituitary-end organ axis. Consequently, a significant component of the postoperative care of these patients focuses on vigilant screening and observation for neuroendocrinologic perturbations such as varying degrees of hypopituitarism and disorders of water balance (diabetes insipidus and the syndrome of inappropriate antidiuretic hormone). Additionally, one must be cognizant of other potential complications specific to the transsphenoidal approach for tumor removal including cerebrospinal fluid leakage and meningitis. This review addresses the postoperative management of patients undergoing pituitary surgery with an emphasis on careful screening and recognition of complications.

Diabetes Insipidus↗

CVVH in postoperative care of liver transplantation.

OBJECTIVE: To evaluate CVVH (Continuous Veno-Venous Hemofiltration) as acute renal replacement treatment in postoperative care of liver transplantation. DESIGN: Retrospective study. SETTING: Intensive Care Unit, year 1995. PATIENTS: 86 OLT performed in 1995, 11 of them underwent acute renal replacement treatment. In the same period, in the ICU were admitted 237 patients, and 20 underwent acute renal replacement treatment (control group). Evaluation with SOFA (Sepsis-related Organ Failure Assessment) score. INTERVENTION: CVVH performed heparin free, pump system, polyamide or polysulphone 0.6 mq membrane hemofilter device, blood flow 150-200 ml/min, UF rate 1000-1200 ml/h, clearance 16-20 ml/min. MEASUREMENTS: Coagulation monitoring (PT as INR, PTT, fibrinogen, antithrombin III, d-dimer, platelet count) was performed 3 times a day or on variation of the clinical conditions. RESULTS: SOFA score did not differ between the two groups. Mortality was higher in the patients treated with CVVH. CVVH was performed from 16 to 18 hrs/day for 9.90 +/- 2.33 days. Three patients developed clinical bleeding before CVVH, 3 during CVVH but 1 of them underwent repeated surgical procedures. CONCLUSIONS: We cannot demonstrate that CVVH doesn't affect bleeding, but we can say that, for the complexity of the post OLT patients, CVVH can be the treatment of choice in case of renal replacement treatment.

Hemofiltration↗