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Preoperative Respiratory Risk Modification

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1. Preoperative Respiratory Risk Modification

Preoperative Respiratory Risk Modification Preoperative Respiratory Risk Modification Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Preoperative Respiratory Risk Modification Preoperative Respiratory Risk Modification Aka: Preoperative Respiratory Risk Modification , Preoperative COPD Risk Modification , Preoperative Sleep Apnea Risk Modification , Perioperative Pulmonary Risk Modification II. Management: COPD - Perioperative Pulmonary Risk Reduction Assess Consider delaying or canceling surgery when pulmonary risk exceeds potential surgical benefit Optimize Manage acute lung disease prior to surgery Optimize Nutritional Status <3.5 g

2018 FP Notebook

2. Preoperative Respiratory Risk Modification

Preoperative Respiratory Risk Modification Preoperative Respiratory Risk Modification Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Preoperative Respiratory Risk Modification Preoperative Respiratory Risk Modification Aka: Preoperative Respiratory Risk Modification , Preoperative COPD Risk Modification , Preoperative Sleep Apnea Risk Modification , Perioperative Pulmonary Risk Modification II. Management: COPD - Perioperative Pulmonary Risk Reduction Assess Consider delaying or canceling surgery when pulmonary risk exceeds potential surgical benefit Optimize Manage acute lung disease prior to surgery Optimize Nutritional Status <3.5 g

2015 FP Notebook

3. Routine preoperative tests for elective surgery

ull blood count count Yes Yes Yes Haemostasis Haemostasis Not routinely Not routinely Consider in people with chronic liver disease If people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance If clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing 1 Kidne Kidney y function function Consider in people at risk of AKI 2 Yes Yes Routine preoperative tests for elective surgery (...) /terms-and- conditions#notice-of-rights). Page 3 of 17This guideline replaces CG3. Ov Overview erview This guideline covers routine preoperative tests for people aged over 16 who are having elective surgery. It aims to reduce unnecessary testing by advising which tests to offer people before minor, intermediate and major or complex surgery, taking into account specific comorbidities (cardiovascular, renal and respiratory conditions and diabetes and obesity). It does not cover pregnant women or people

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

4. Routine preoperative testing in adults undergoing elective non-cardiothoracic surgery

National Institute for Health and Disability Insurance NRKP / CNPQ National Council for Quality Promotion OIS Optimal Information Size OR Odds Ratio OSA Obstructive Sleep Apnoea PCNL Percutaneous Nephrolithotomy PT Prothrombin Time PTT Partial Thromboplastin Time RBC Red Blood Cell RCT Randomized Controlled Trial RR Relative Risk RRR Relative Risk Reduction SD Standard Deviation SIRS Systemic Inflammatory Response Syndrome 8 Routine preoperative testing KCE Report 280 SR Systematic Review SUN Serum (...) in patients with abnormal ECG as those with normal ECG (OR = 0.63, 95%CI 0.28 to 1.42). Due to serious imprecision and high risk of bias, the level of evidence was very low. 26 Routine preoperative testing KCE Report 280 Secondly, a multicentre prospective cohort study (Van Klei 2007) including 2 967 patients found a postive association between right bundle branch block and postoperative myocardial infarction risk (OR = 2.1, 95%CI 1.0 to 4.41), while left bundle branch block was associated with a higher

2017 Belgian Health Care Knowledge Centre

5. Postoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea: A Single-Institution Cohort Study. (Abstract)

Postoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea: A Single-Institution Cohort Study. Obstructive sleep apnea (OSA) is a prevalent condition that is associated with early postoperative respiratory complications (PRCs). As the majority of patients with OSA are undiagnosed, preoperative screening remains the most efficient method to identify suspected OSA.This retrospective study was performed on patients undergoing anesthesia in a single academic medical (...) center. We assigned OSA risk class retrospectively to all patients in the study by using the Perioperative Sleep Apnea Prediction (PSAP) score. We evaluated the relationship between PSAP categories and early postoperative invasive airway placement after adjusting for several preoperative and intraoperative factors (including surgical risk) previously associated with PRC occurrence.A total of 108,479 patients were included in the final analysis with an incidence of PRC was 0.3% (n = 280). High PSAP

2017 Anesthesia and Analgesia

6. Modifications in endoscopic practice for pediatric patients

Modifications in endoscopic practice for pediatric patients GUIDELINE Modi?cations in endoscopic practice for pediatric patients Thisisoneofaseriesofstatementsdiscussingtheuseof GI endoscopy in common clinical situations. The Stan- dards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical liter- ature published 1980–2013 was performed by using PubMed. Additional references were obtained from (...) procedures is that routine tissue sampling is performed in children from at least the duodenum, stomach, and esoph- agus during endoscopy and from the colon and terminal ileum during colonoscopy with ileoscopy. 8,9 It is standard pediatricendoscopypracticetoerronthesideofobtaining biopsy specimens, even in the absence of gross abnormal- ities, because the risks of sedation and performing repeat endoscopy in pediatric populations are considered to outweigh the risks of obtaining biopsy specimens. 10

2014 American Society for Gastrointestinal Endoscopy

7. Modifications in endoscopic practice for the elderly

to the increase in sensitivity and sedation risk in geriatric patients. 23 Arterial oxygenation progressively deteriorates with age and has been attributed to a mismatch of ventilation and perfusion. 24 Cardiorespiratory stimulation in response to hypoxia or hypercarbia is blunted and delayed. Narcotic and non-narcotic central nervous system depressants produce greater respiratory depression and a greater incidence of transient apnea and episodic respira- tions.Theriskofaspirationalsoincreasesasaresultofasig (...) Modifications in endoscopic practice for the elderly GUIDELINE Modi?cations in endoscopic practice for the elderly This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. This guideline updates a previously issued guideline on this topic. 1 In preparing this guideline, a search of the medical literature was performed using PubMed

2013 American Society for Gastrointestinal Endoscopy

8. Responsible use of high-risk medical devices: the example of 3D printed medical devices

Responsible use of high-risk medical devices: the example of 3D printed medical devices 2018 www.kce.fgov.be KCE REPORT 297 RESPONSIBLE USE OF HIGH-RISK MEDICAL DEVICES: THE EXAMPLE OF 3D PRINTED MEDICAL DEVICES 2018 www.kce.fgov.be KCE REPORT 297 HEALTH TECHNOLOGY ASSESSMENT RESPONSIBLE USE OF HIGH-RISK MEDICAL DEVICES: THE EXAMPLE OF 3D PRINTED MEDICAL DEVICES IRM VINCK, AN VIJVERMAN, ERIK VOLLEBREGT, NILS BROECKX, KARLIEN WOUTERS, MARIEL PIËT, NATALIJA BACIC, JOAN VLAYEN, NANCY THIRY (...) , MATTIAS NEYT COLOPHON Title: Responsible use of high-risk medical devices: the example of 3D printed medical devices Authors: Irm Vinck (KCE), An Vijverman (Dewallens & partners), Erik Vollebregt (Axon lawyers), Nils Broeckx (Dewallens & partners), Karlien Wouters (Dewallens & partners), Mariel Piët (Axon lawyers), Natalija Bacic (Court of Justice of the European Union), Joan Vlayen (KCE), Nancy Thiry (KCE), Mattias Neyt (KCE) Project coordinator: Nathalie Swartenbroeckx (KCE) Reviewers: Irina

2018 Belgian Health Care Knowledge Centre

9. Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes Full Text available with Trip Pro

Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and management modifications is an important part of postoperative care. Patients with unanticipated respiratory decompensation requiring transfer (...) , OSA, preoperative psychotropic medications, and anesthesia time were associated with risk of RF in a multivariate analysis.Unanticipated RF after orthopedic surgery is associated with extended hospitalization, increased mortality, and higher cost of care. Hospital protocols that include risk factor assessment, enhanced monitoring, and a cautious approach to opioid use in high-risk patients may reduce the frequency of this complication.

2016 Perioperative Medicine

10. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression http://wrap.warwick.ac.uk/ Original citation: Sutcliffe, Paul A., Connock, M., Shyangdan, Deepson S., Court, Rachel A., Kandala, Ngianga-Bakwin and Clarke, Aileen, 1955-. (2013) A systematic review of evidence on malignant spinal metastases : natural history and technologies for identifying patients at high risk (...) a systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression P Sutcliffe, M Connock, D Shyangdan, R Court, N-B Kandala and A Clarke Appendix 5 reasons for exclusion at full sift ( n = 305) Appendix 6 Quality assessment forms: extracted data for each study First author: bayley Year: 2001 ID: 107 reviewer(s): pS/MC – Agreed First author: bernat Year: 1983 ID: 108 reviewer(s): pS/MC

2013 NIHR HTA programme

11. Preoperative evaluation and preparation of the morbidly obese patient. (Abstract)

signs of cardiovascular disease or were planned for intermediate or high-risk surgery. Spirometry should be limited to those patients with obstructive sleep apnea or other respiratory findings.Synthesis of proper medical history-taking and physical examination as well as detailed search for obstructive sleep apnea and metabolic syndrome are key components of preoperative evaluation. Further testing should be based on the findings of these steps and comprise the cardiac risk of the surgical procedure. (...) time before the day of surgery to allow modification of the perioperative management. Medical history-taking and physical examination ought to be performed following a standardized scheme especially focussing on the presence of obstructive sleep apnea. Routine testing for fasting glucose and lipoprotein levels should be performed in order to diagnose a metabolic syndrome. ECG recording should be limited to those patients having one or more additional cardiac risk factors or presenting clinical

2016 Current Opinion in Anaesthesiology

12. Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches Full Text available with Trip Pro

, and endothelial dysfunction/activation. , , , Perhaps most striking are the markedly elevated levels of inflammation that have been demonstrated in severe pediatric obesity. In the studies by Norris et al and Kapiotis et al, mean C-reactive protein levels exceeded 5 mg/L, a level considered to be high risk in adults. , In addition, oxidized low-density lipoprotein (LDL) is elevated in severe obesity, which likely increases risk of early atherosclerosis because oxidative modification of LDL cholesterol (...) the association of childhood obesity and increased cardiovascular risk in adulthood. , Treatment Approaches Lifestyle Modification/Behavioral Therapy Principles of Lifestyle Modification/Behavioral Therapy for Weight Management Derived from principles of classical conditioning and social learning theory, behavioral obesity interventions are based on the assumptions that eating and physical activity are the proximal mediators of body weight and that these behaviors can be modified by changing the environmental

2013 American Heart Association

13. Early repair of large infant ventricular septal defect despite respiratory syncytial virus-induced respiratory failure with postrepair chylous pericardial effusion requiring pleuropericardial window: a case report and review of the literature. (Abstract)

will increase the risk of postoperative pulmonary complications. We present an infant who developed acute respiratory failure related to RSV pneumonitis and required urgent mechanical ventilation. Cardiac evaluation revealed a large nonrestrictive ventricular septal defect (VSD), aortic arch hypoplasia, normally functioning bicuspid aortic valve, and hemodynamic instability associated with markedly increased pulmonary blood flow. Separation from mechanical ventilation was unsuccessful preoperatively. He (...) Early repair of large infant ventricular septal defect despite respiratory syncytial virus-induced respiratory failure with postrepair chylous pericardial effusion requiring pleuropericardial window: a case report and review of the literature. The surgical correction of congenital cardiac lesions that are complicated by intercurrent respiratory syncytial virus (RSV) pneumonitis has traditionally been deferred for at least 6 to 8 weeks. The presumption is that using cardiopulmonary bypass

2012 Pediatric Emergency Care

14. Evidence-based clinical practice guideline: Inhaled nitric oxide for neonates with acute hypoxic respiratory failure

then independently examined by at least two of the au- thors. The critiques were compared and differences were resolved using an iterative process. Recommendations were based on a modification of the GradingofRecommendationsAssessment,Development,and Evaluation (GRADE) scoring system. 4 The strength of the recommendationisgivenalevelof1whenthebenefitsclearly outweigh the risks and burdens (or vice versa) for nearly all patients. A level of 2 is weaker and given when risks (...) crossover use of INO in controls found a statistically significant reduction in the combined outcome of death and requirement for ECMO (relativerisk0.65,95%CI0.55–0.76,riskdifference0.20, 95% CI0.27 to0.13) (Fig. 2). None of the studies that reported mortality found a significant effect on this outcome alone (relative risk 0.91, 95% CI 0.60–1.37) (Fig. 3). Re- quirementforECMOwasreportedin8studies,andthemeta- INHALED NITRIC OXIDE FOR NEONATES WITH ACUTE HYPOXIC RESPIRATORY FAILURE 1722 RESPIRATORY CARE

2010 American Association for Respiratory Care

15. Effect of Preoperative Renal Insufficiency on Postoperative Outcomes after Pancreatic Resection: A Single Institution Experience of 1,061 Consecutive Patients. Full Text available with Trip Pro

(eGFR) was estimated by the Modification of Diet in Renal Disease formula. Severe CKD (stages 4-5) was defined as eGFR < 30 mL/min/1.73 m(2). Renal function also was analyzed using serum creatinine (sCr) dichotomized at 1.8 mg/dL. Primary outcomes were any complication, major complications, and respiratory failure. Multivariate models for each endpoint were constructed by including all variables with p value ≤ 0.10 on univariate analysis.There were 1,061 patients identified; 709 underwent (...) , severe CKD was associated with increased complications (odds ratio [OR] 5.5; 95% CI 1.3 to 25.5; p = 0.02) and respiratory failure (OR 6.1; 95% CI 1.8 to 20.5; p = 0.03), but not major complications. Using sCr ≥ 1.8 mg/dL as a surrogate marker for renal insufficiency, patients with sCr ≥ 1.8 mg/dL had increased risk of any complication (OR 3.5; 95% CI 1.3 to 9.3; p = 0.01), major complications (OR 2.2; 95% CI 1.04 to 4.8; p = 0.04), and respiratory failure (OR 4.7; 95% CI 1.8 to 12.6; p = 0.002).Few

2013 Journal of the American College of Surgeons

16. Continuous Supraglottic pH Monitoring in Prolonged Intubated Intensive Care Patients and High Risk Aspiration Intraoperative Patients

: accelerometer monitoring Not Applicable Detailed Description: Aspiration is a serious morbidity that leads to an increase in both patient mortality and duration of hospital stays. Many practices exist within the hospital setting whose goal is to help prevent clinically significant aspiration including preoperative starvation, pharmaceutically reducing gastric acidity, facilitating gastric drainage, postural changes, cricoid pressure, endotracheal cuff pressure modification, and maintenance of a competent (...) Continuous Supraglottic pH Monitoring in Prolonged Intubated Intensive Care Patients and High Risk Aspiration Intraoperative Patients Continuous Supraglottic pH Monitoring in Prolonged Intubated Intensive Care Patients and High Risk Aspiration Intraoperative Patients - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You

2015 Clinical Trials

17. Complex surgery and perioperative systemic therapy for genitourinary cancer of the retroperitoneum

responsibility for its use or application in any way. [Status] Guideline 3-20 Table of Contents Section 1: Recommendations 1 Section 2: Guideline – Recommendations and Key Evidence 6 Section 3: Guideline Methods Overview 17 Section 4: Systematic Review 20 Section 5: Internal and External Review 41 References 46 Appendix 1: Affiliations and Conflict of Interest Declarations 50 Appendix 2: Literature Search Strategy 55 Appendix 3: Prisma flow diagram 60 Appendix 4. Risk of Bias Table 61 Appendix 5: Amstar 2 (...) patients who have received retroperitoneal surgery, and doctors referring patients for retroperitoneal surgery. RECOMMENDATIONS Renal cell cancer and surgery Recommendation 1 ? Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. Immediate CN should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk when medical treatment is required. ? Removal of the primary

2019 Cancer Care Ontario

18. Guidelines on Supraventricular Tachycardia (for the management of patients with) Full Text available with Trip Pro

12.3.1 Atrial septal defect 42 12.3.2 Ebstein's anomaly 42 12.3.3 Transposition of the great arteries (dextro-transposition of the great arteries) after atrial switch operation (Mustard or Senning) 42 12.3.4 Tetralogy of Fallot 43 12.3.5 Fontan repairs 43 13 Supraventricular tachycardia in the paediatric population 43 13.1 Foetal arrhythmias 43 14 Supraventricular tachycardia in pregnancy 43 14.1 Maternal, obstetric, and offspring risk 44 14.2 Therapy 44 14.2.1 Antiarrhythmic drugs 44 14.2.2 (...) -entrant tachycardia. 32 Figure 16 The St George’s algorithm for localization of accessory pathways 33 Figure 17 Localization of accessory pathways in the presence of maximum (spontaneous or evoked) pre-excitation 34 Figure 18 Atrioventricular re-entrant tachycardia 35 Figure 19 Acute therapy of atrioventricular re-entrant tachycardia. 37 Figure 20 Acute therapy of pre-excited atrial fibrillation. 38 Figure 21 Chronic therapy of atrioventricular re-entrant tachycardia. 38 Figure 22 Risk stratification

2019 European Society of Cardiology

19. ERCP-related adverse events

]. TheoverallAEratewasassessedinameta-analysis;itreport- ed a nonsignificant trend for a lower risk of overall AEs in the NSAIDs vs. control groups (RR 0.80, 95%CI 0.47–1.36) [83]. Other meta-analyses that looked into specific AEs (e.g., bleed- ing, renal failure) found no difference [83,86,92,95–100]. NSAIDsmaycauseallergicandpseudoallergicreactionssuch as NSAID-exacerbated respiratory disease or skin disease. Among these, Stevens–Johnson and Lyell’s syndromes present thehighestmortality(5%–50%);bothsyndromesareextreme- ly rare (...) at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pan- creatic duct, double-guidewire cannulation). Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphinc- terotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for reliefof biliaryobstruction. Weak recommendation, moderate qualityevidence. Guideline Supplementary material Online content

2020 European Society of Gastrointestinal Endoscopy

20. Canadian Urological Association guideline for the diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction

in this patient population. Despite the frequency and potential severity of NLUTD, there are few high-quality studies in the literature to guide urological practices. Prior neurogenic guidelines vary in their clinical assess- ment, investigations used, and surveillance strategies. 2-6 The primary reason is that there is limited evidence to support a common strategy. The purpose of this guideline is to help urologists to identify high-risk patients with NLUTD and to provide an approach to the management (...) . The timing of this initial evaluation is variable and depen- dent on the severity of symptoms, underlying risk of serious urological complications, and the etiology of the neurogenic bladder. SB 24 and SCI 25 have a significant risk of renal dys - function and are acquired at birth (SB) or often as young adults (SCI); this makes patients particularly susceptible to renal dysfunction in their lifetime. This contrasts with slowly progressive diseases, such as relapsing-remitting MS, or the predominately

2019 Canadian Urological Association

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