The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Gerald W Smetana - One of the best experts on this subject based on the ideXlab platform.
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perioperative medicine update
Journal of General Internal Medicine, 2009Co-Authors: Amir K Jaffer, Steven L Cohn, Gerald W Smetana, Barbara SlawskiAbstract:Evidence-based preoperative risk stratification and implementation of therapies to decrease morbidity and mortality are the focus of the preoperative evaluation that internists often perform in the office or the hospital setting. In this paper, we summarize some recent key advances in the field of perioperative medicine. We used a systematic search strategy to survey the relevant literature for the Period January 1, 2007 through April 1, 2008. We performed a MEDLINE search using the medical subject heading (MeSH) terms Intraoperative complications, postoperative complications, preoperative care, Intraoperative care, perioperative care, postoperative care, Intraoperative Period, preoperative Period, acute renal failure, cirrhosis, venous thromboembolism, and surgery. We added the following text words: Intraoperative OR perioperative OR postoperative AND/OR complication OR event. As our target audience is general internists, we excluded studies of transplantation surgery, cardiac surgery, and pediatric surgery. We discuss studies that the four authors agreed had the most important practice implications for perioperative medicine. We have divided the articles into four sections: perioperative cardiac care, perioperative anticoagulant therapy, prevention of postoperative respiratory failure, and predicting postoperative risk of morbidity and mortality.
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update in perioperative medicine
Journal of General Internal Medicine, 2006Co-Authors: Kurt Pfeifer, Karen F Mauck, Steven L Cohn, Amir K Jaffer, Gerald W SmetanaAbstract:Preoperative medical consultation, including risk stratification and risk reduction strategies, is an important function of internists and hospitalists. This article is a summary of the Update in Perioperative Medicine presentation from the 33rd Annual Meeting of the Society of General Internal Medicine. We performed a Medline search of the relevant literature from February 1, 2009 through February 1, 2010 using the medical subject heading (MeSH) terms preoperative care, Intraoperative care, perioperative care, postoperative care, preoperative Period, Intraoperative Period, Intraoperative complications, postoperative complications, venous thromboembolism, and noncardiac surgery. We added the text words: Intraoperative OR perioperative OR postoperative AND/OR complication OR event and excluded studies of transplantation surgery, cardiac surgery, and pediatric surgery. We selected for review 11 articles most likely to shape the practice of perioperative medicine.
David T Wong - One of the best experts on this subject based on the ideXlab platform.
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the effectiveness of high flow nasal oxygen during the Intraoperative Period a systematic review and meta analysis
Anesthesia & Analgesia, 2020Co-Authors: Emily A Spence, Wesley Rajaleelan, Jean Wong, Frances Chung, David T WongAbstract:BACKGROUND High-flow nasal oxygen (HFNO) is increasingly being used in intensive care units for management of hypoxemia and respiratory failure. However, the effectiveness of HFNO for preventing hypoxemia in the Intraoperative Period is unclear. The purpose of this systematic review was to compare patient oxygenation and end-tidal CO2 (EtCO2), between HFNO and conventional oxygenation, during the Intraoperative Period in surgical patients. METHODS Standard databases were searched from inception to February 2020. Studies involving Intraoperative use of HFNO with 1 of the 4 outcomes: (1) oxygen (O2) desaturation, (2) minimum O2 saturation, (3) safe apnea time, or (4) EtCO2 were included. Intraoperative Period was divided into 2 phases: at induction with general anesthesia and during surgical procedure under sedation without tracheal intubation. RESULTS Eight randomized controlled trials (RCTs; 4 induction, 4 procedure, 2314 patients) were included for systematic review and meta-analyses. We found the risk of Intraoperative O2 desaturation was lower in HFNO versus conventional oxygenation control group; at induction with an odds ratio (OR; 95% confidence interval [CI]) of 0.06 (0.01-0.59, P = .02), and during procedure, OR (95% CI) of 0.09 (0.05-0.18; P < .001). The minimum O2 saturation was higher in HFNO versus conventional oxygenation; at induction by a mean difference (MD) (95% CI) of 5.1% (3.3-6.9; P < .001), and during procedure, by a MD (95% CI) of 4.0% (1.8-6.2; P < .001). Safe apnea time at induction was longer in HFNO versus conventional oxygenation by a MD (95% CI) of 33.4 seconds (16.8-50.1; P < .001). EtCO2 at induction was not significantly different between HFNO and conventional oxygenation groups. CONCLUSIONS This systematic review and meta-analysis show that, in the Intraoperative setting, HFNO compared to conventional oxygenation reduces the risk of O2 desaturation, increases minimum O2 saturation, and safe apnea time. HFNO should be considered for anesthesia induction and during surgical procedures under sedation without tracheal intubation in patients at higher risk of hypoxemia.
G Isik - One of the best experts on this subject based on the ideXlab platform.
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the influence of epidural volume extension on spinal block with hyperbaric or plain bupivacaine for caesarean delivery
European Journal of Anaesthesiology, 2008Co-Authors: Semih Kucukguclu, Hakki Unlugenc, Ferim Gunenc, Bahar Kuvaki, Necati Gokmen, Suhan Gunasti, S Guclu, F Yilmaz, G IsikAbstract:Dokuz Eylu¨l University,School of Medicine, Department of Obstetrics and Gynecology, I˙zmir, TurkeySummaryBackground and objective: Epidural volume extension via a combined spinal–epidural is the enhancement of asmall-dose intrathecal block by an epidural injection of physiological saline solution. We evaluated the effectof epidural volume extension on the combined spinal–epidural technique of providing spinal anaesthesia forCaesarean section with hyperbaric or plain 0.5% bupivacaine. Methods: Patients (n5240) with height.163cm received 9mg and patients ,163cm received 8mg of bupivacaine. Each study drug was combinedwith 20mg fentanyl. Using the combined spinal–epidural technique, Group A (n560) received hyperbaricbupivacaine, and Group B (n560) received hyperbaric bupivacaine and 10mL saline epidurally 5min aftersubarachnoid injection. Group C (n560) received plain bupivacaine and Group D (n560) received plainbupivacaine and 10mL saline epidurally 5min after subarachnoid injection. An anaesthetist blinded to theanaesthetic solution injected examined the level of analgesia by the pinprick method and motor block withthe modified Bromage scale for 30min after subarachnoid injection, during the Intraoperative Period andsubsequently every 15min for 135min during the recovery Period. Results: Time to reach a sensory block atT4 was significantly shorter in Groups C and D than in Groups A (P50.003 and 0.017) and B (P50.006and 0.048), respectively. During the Intraoperative Period, sensory block levels were significantly higher inGroup C than in Group A. Recovery was similar in all groups; only onset was faster in Groups C and D.Conclusion: There was no effect of epidural volume extension on the profile of spinal anaesthesia with thecombined spinal–epidural technique for Caesarean section using hyperbaric or plain bupivacaine.
Amir K Jaffer - One of the best experts on this subject based on the ideXlab platform.
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perioperative medicine update
Journal of General Internal Medicine, 2009Co-Authors: Amir K Jaffer, Steven L Cohn, Gerald W Smetana, Barbara SlawskiAbstract:Evidence-based preoperative risk stratification and implementation of therapies to decrease morbidity and mortality are the focus of the preoperative evaluation that internists often perform in the office or the hospital setting. In this paper, we summarize some recent key advances in the field of perioperative medicine. We used a systematic search strategy to survey the relevant literature for the Period January 1, 2007 through April 1, 2008. We performed a MEDLINE search using the medical subject heading (MeSH) terms Intraoperative complications, postoperative complications, preoperative care, Intraoperative care, perioperative care, postoperative care, Intraoperative Period, preoperative Period, acute renal failure, cirrhosis, venous thromboembolism, and surgery. We added the following text words: Intraoperative OR perioperative OR postoperative AND/OR complication OR event. As our target audience is general internists, we excluded studies of transplantation surgery, cardiac surgery, and pediatric surgery. We discuss studies that the four authors agreed had the most important practice implications for perioperative medicine. We have divided the articles into four sections: perioperative cardiac care, perioperative anticoagulant therapy, prevention of postoperative respiratory failure, and predicting postoperative risk of morbidity and mortality.
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update in perioperative medicine
Journal of General Internal Medicine, 2006Co-Authors: Kurt Pfeifer, Karen F Mauck, Steven L Cohn, Amir K Jaffer, Gerald W SmetanaAbstract:Preoperative medical consultation, including risk stratification and risk reduction strategies, is an important function of internists and hospitalists. This article is a summary of the Update in Perioperative Medicine presentation from the 33rd Annual Meeting of the Society of General Internal Medicine. We performed a Medline search of the relevant literature from February 1, 2009 through February 1, 2010 using the medical subject heading (MeSH) terms preoperative care, Intraoperative care, perioperative care, postoperative care, preoperative Period, Intraoperative Period, Intraoperative complications, postoperative complications, venous thromboembolism, and noncardiac surgery. We added the text words: Intraoperative OR perioperative OR postoperative AND/OR complication OR event and excluded studies of transplantation surgery, cardiac surgery, and pediatric surgery. We selected for review 11 articles most likely to shape the practice of perioperative medicine.
Injung Jun - One of the best experts on this subject based on the ideXlab platform.
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correction to mitral regurgitation detected during the Intraoperative Period after atrial septal defect closure a case report
Journal of Cardiothoracic Surgery, 2019Co-Authors: Joo Hyun Jun, Minkyung Kang, Joonsang Hyeon, Eunha Choi, Youngrok Kim, Ki Seok Kim, Mi Hwa Chung, Injung JunAbstract:The original article [1] contained a typo in author, Joo Hyun Jun’s name. This has now been corrected.
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mitral regurgitation detected during the Intraoperative Period after atrial septal defect closure a case report
Journal of Cardiothoracic Surgery, 2019Co-Authors: Joo Hyun Jun, Minkyung Kang, Joonsang Hyeon, Eunha Choi, Youngrok Kim, Ki Seok Kim, Mi Hwa Chung, Injung JunAbstract:Atrial septal defect (ASD) is a congenital cardiac defect often diagnosed in adult patients. Mitral regurgitation (MR) observed in ASD patients mostly improves after ASD closure. However, a subset of adult ASD patients present new-onset MR or aggravation of preexisting MR after ASD closure. Intraoperative MR aggravation after surgical ASD closure is a rare occurrence which has not been reported in the literature to date. A 54-year-old woman was referred to our center due to large secundum ASD with a diameter of 17 mm which was incidentally detected on pre-operative echocardiography at a local clinic. Surgical repair of ASD under mini-thoracotomy was performed. After completion of the operation, intra-operative transesophageal echocardiography showed newly developed Grade II MR which subsequently deteriorated to severe level on postoperative day 3. Because the patient was asymptomatic, we decided to observe closely and treat conservatively with diuretics. Thereafter, echocardiography was evaluated on postoperative day 10 and MR disappeared to trivial level. Intraoperative MR aggravation is a rare complication following ASD closure. The possibility of MR aggravation should be evaluated in all ASD patients prior to surgery. This case highlights the importance of mitral leaflet examination after ASD closure for early detection of MR.