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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. 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

3. 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

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. (PubMed)

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. Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes (PubMed)

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.

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2016 Perioperative Medicine

7. 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

8. Preoperative evaluation and preparation of the morbidly obese patient. (PubMed)

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

9. Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

, 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

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2013 American Heart Association

10. 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

11. 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. (PubMed)

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

12. Effect of Preoperative Renal Insufficiency on Postoperative Outcomes after Pancreatic Resection: A Single Institution Experience of 1,061 Consecutive Patients. (PubMed)

(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

13. European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis

: substantial; Consensus: very good. Does the presence of an angiomyolipoma affect lung transplant suitability? The detection of renal angiomyolipoma in LAM is important preoperatively, as the risk of bleeding associated with a large angiomyolipoma is well established. Renal angiomyolipomas were detected in 35–38% of patients during pre-transplant assessment [107, 108]. The presence of angiomyolipoma does not increase the incidence of post-transplant renal insufficiency [107, 108]. Recommendations 1 (...) ) Angiomyolipoma may not be a contraindication to lung transplantation but may affect transplant suitability, surgery and postoperative follow-up. Grade: B; Quality: low; Benefit: substantial; Consensus: very good. 2) The presence of renal angiomyolipoma should be sought in the preoperative assessment, and those at risk of bleeding should be treated prior to transplantation. Grade: B; Quality: low; Benefit: substantial; Consensus: very good. Should the possibility of recurrent LAM in the transplanted lung

2010 Tuberous Sclerosis Association

14. 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

15. Bariatric surgery: an HTA report on the efficacy, safety and cost-effectiveness

and lifestyle modifications, there is increasing interest in performing MBS in adolescents with severe or morbid obesity, especially in those at very high risk or those with associated co- morbidities like hypertension, diabetes and non-alcoholic steatohepatitis (NASH), as well as in those with extreme BMI values, who cannot be managed successfully otherwise. A particular medical challenge constitute children and adolescents with monogenic traits causing morbid or super- obesity. Psychopathology and social (...) review 69 4.3.3 Discussion 70 4.4 CLINICAL EFFECTIVENESS IN PATIENTS WITH DIABETES AND A BMI 2 SD from the median BMI for that age). 6 From a population point of view, obesity and overweight categories have been defined by examining longitudinal data that associate a given weight with future health effects or risks. 4, 5 22 Bariatric Surgery KCE Report 316 BMI is a surrogate measure for evaluating obesity as it neither takes into account body composition (relative amounts of fat mass/muscle/bone

2019 Belgian Health Care Knowledge Centre

16. Management of Stroke in Neonates and Children

and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results— Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke (...) but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions— Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic

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2019 American Heart Association

17. Heart Disease and Stroke Statistics

. Physical Inactivity e99 5. Nutrition e119 6. Overweight and Obesity e138 Health Factors and Other Risk Factors 7. High Blood Cholesterol and Other Lipids e161 8. High Blood Pressure e174 9. Diabetes Mellitus e193 10. Metabolic Syndrome e212 11. Kidney Disease e233 12. Sleep e249 Cardiovascular Conditions/Diseases 13. Total Cardiovascular Diseases e257 14. Stroke (Cerebrovascular Disease) e281 15. Congenital Cardiovascular Defects and Kawasaki Disease e327 16. Disorders of Heart Rhythm e346 17. Sudden (...) e511 26. Economic Cost of Cardiovascular Disease e516 Supplemental Materials 27. At-a-Glance Summary Tables e522 28. Glossary e526 Summary Each year, the American Heart Association (AHA), in conjunction with the National Institutes of Health and other government agencies, brings together in a single document the most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors in the AHA’s My Life Check − Life’s Simple 7 ( ), which include core health behaviors

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2019 American Heart Association

18. ACR–ASNR–SCBT-MR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Adult Spine

in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2018 (Resolution 19)* ACR –ASNR –SCBT-MR –SSR PRACTICE PARAMETER FOR THE PERFORMANCE OF MAGNETIC RESONANCE IMAGING (MRI) OF THE ADULT SPINE PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards (...) the presence of infections in other spinal regions, such as the facet joints, meninges, and spinal cord. MRI is useful to characterize postoperative changes, including fluid collections and bone and soft-tissue abnormalities that may suggest infection. C. Spinal Cord Herniation Spinal cord herniation is a rare cause of myelopathy that has been increasingly recognized. While it is rare, it can be diagnosed preoperatively on MRI with resolution of symptoms after surgery, thereby making it essential

2019 American Society of Neuroradiology

19. Global Vascular Guidelines for patients with chronic limb-threatening ischemia

countries ( LMICs ). x 1 Fowkes, F.G., Rudan, D., Rudan, I., Aboyans, V., Denenberg, J.O., McDermott, M.M. et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet . 2013 ; 382 : 1329–1340 ---- | ---- Fig 2.2 Odds ratios ( ORs ) for peripheral artery disease (PAD) in high-income countries ( HICs ) and low- and middle-income countries ( LMICs ). BMI, Body mass index; CRP, C-reactive protein; CVD (...) , cardiovascular disease; HDL, high-density lipoprotein. ---- | ---- Fig 2.3 Association of risk factors with the level of atherosclerotic target lesions. The red overlay on the anatomic cartoon illustrates the association of risk factor with patterns of atherosclerotic disease. x 217 Reinecke, H., Unrath, M., Freisinger, E., Bunzemeier, H., Meyborg, M., Lüders, F. et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J . 2015 ; 36 : 932

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2019 Society for Vascular Surgery

20. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults

ratio PTFE polytetrafluoroethylene RCT randomized controlled trial RD risk difference RR relative risk 95% CI 95% Confidence Interval SIGN Scottish Intercollegiate Guidelines Network SD standard deviation SMD standardized mean difference UKRA UK Renal Association VAS Vascular Access Society DEFINITIONS Interpreting evidence in the arteriovenous (AV) access literature is challenged by the heterogeneity in terminology and the lack of standardization in outcomes. Below some of the terms used (...) . The second part—under development when this guideline went to press—will cover aspects related to access choice, preoperative vessel assessment and central venous catheters. We hope the current and planned CPG will assist the professional community in making decisions about vascular access processes, pathways and care; help patients and caregivers gain insight and facilitate joint decision making in this field. SUMMARY OF THE RECOMMENDATIONS Chapter 1. Medical treatments for promoting arteriovenous

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2019 European Renal Best Practice

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