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Latest & greatest articles for surgery
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Blood & Clots Series: How do you stop warfarin for surgery? Blood & Clots Series: How do you stop warfarin for surgery? - CanadiEM Blood & Clots Series: How do you stop warfarin for surgery? In , by Kerstin de Wit March 19, 2019 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical Expert, Scholar Case Description You are assessing a 76 year old lady who takes warfarin for stroke prevention because she had a mechanical aortic valve replacement 4 years ago (...) . She was at the preoperative clinic this morning because she will have a knee replacement surgery in a weeks time. The anesthesiologist said they would like to perform a spinal block for the surgery, and the surgeon says the patient must come off her warfarin before he can operate. She tells you she is worried about having a stroke if she stops her warfarin. You are wondering how to advise her. Can you stop the warfarin for a week before her surgery? Do you need to prescribe ‘bridging
A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery. Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries.We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous (...) abortion would reduce pelvic infection among women and adolescents in low-resource countries. We randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Pelvic infection was defined by the presence of two or more of four clinical features (purulent vaginal discharge, pyrexia, uterine tenderness, and leukocytosis) or by the presence of one
Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers. Venous leg ulcers are complex, costly, and their prevalence is expected to increase as populations age. Venous congestion is a possible cause of venous leg ulcers, which subfascial endoscopic perforator surgery (SEPS) attempts to address by removing the connection between deep and superficial veins (perforator veins). The effectiveness of SEPS in the treatment of venous leg ulcers, however, is unclear.To assess (...) the benefits and harms of subfascial endoscopic perforator surgery (SEPS) for the treatment of venous leg ulcers.In March 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of included studies as well as reviews, meta-analyses
Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. General anaesthesia combined with epidural analgesia may have a beneficial effect on clinical outcomes. However, use of epidural analgesia for cardiac surgery is controversial due to a theoretical increased risk of epidural haematoma associated with systemic heparinization. This review was published in 2013, and it was updated in 2019.To determine the impact of perioperative epidural analgesia (...) in adults undergoing cardiac surgery, with or without cardiopulmonary bypass, on perioperative mortality and cardiac, pulmonary, or neurological morbidity.We searched CENTRAL, MEDLINE, and Embase in November 2018, and two trial registers up to February 2019, together with references and relevant conference abstracts.We included all randomized controlled trials (RCTs) including adults undergoing any type of cardiac surgery under general anaesthesia and comparing epidural analgesia versus another modality
Sacroiliac Joint Fusion Methodology - Minimally Invasive Compared to Screw-Type Surgeries: A Systematic Review and Meta-Analysis Sacroiliac (SI) joint fusion represents a unique area of orthopedic surgery with procedural literature dating to the early 1920s, showing limited innovation in either technique or hardware over the last 90 years. Recent improvements in the diagnosis and treatment of SI joint dysfunction warrant comparisons to older surgical techniques.To evaluate treatment efficacies (...) (r2 = 0.21, P < 0.01), where worse baseline pain was associated with better outcomes.There was a limited number of studies in this meta-analysis with treatments that could be properly classified as screw-type.In this analysis, compared to screw-type surgeries, the iFuse system showed statistically superior outcomes. This was the case when outcome measures were classified into 3 main categories - Pain, Disability/Physical Function, and Global/QOL.Meta-analysis, systematic review, sacroiliac joint
Association of Overlapping Surgery With Perioperative Outcomes. Overlapping surgery, in which more than 1 procedure performed by the same primary surgeon is scheduled so the start time of one procedure overlaps with the end time of another, is of concern because of potential adverse outcomes.To determine the association between overlapping surgery and mortality, complications, and length of surgery.Retrospective cohort study of 66 430 operations in patients aged 18 to 90 years undergoing total (...) knee or hip arthroplasty; spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy at 8 centers between January 1, 2010, and May 31, 2018. Patients were followed up until discharge.Overlapping surgery (≥2 operations performed by the same surgeon in which ≥1 hour of 1 case, or the entire case for those <1 hour, occurs when another procedure is being performed).Primary outcomes were in-hospital mortality or complications (major: thromboembolic event, pneumonia, sepsis, stroke
Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. Postoperative delirium is common following cardiac surgery and may be affected by choice of analgesic and sedative.To evaluate the effect of postoperative intravenous (IV) acetaminophen (paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on postoperative delirium among older (...) patients undergoing cardiac surgery.Randomized, placebo-controlled, factorial clinical trial among 120 patients aged 60 years or older undergoing on-pump coronary artery bypass graft (CABG) surgery or combined CABG/valve surgeries at a US center. Enrollment was September 2015 to April 2018, with follow-up ending in April 2019.Patients were randomized to 1 of 4 groups receiving postoperative analgesia with IV acetaminophen or placebo every 6 hours for 48 hours and postoperative sedation
Brainstem Cav Mal. Transcallosal Resection. 3D HD. ( Brain Surgery ) Brainstem Cav Mal. Transcallosal Resection. 3D HD. ( Brain Surgery ) - YouTube Skip navigation Sign in Search Loading... Choose your language. Close You're viewing YouTube in English (UK) . You can . You're viewing YouTube in English (United Kingdom) . You can . Close This video is unavailable. Watch Queue Queue Watch Queue Queue Remove all Disconnect The next video is starting stop Loading... Watch Queue Queue __count__ (...) /__total__ YouTube Premium Loading... Get YouTube without the ads. Working... Skip trial Brainstem Cav Mal. Transcallosal Resection. 3D HD. ( Brain Surgery ) Loading... Unsubscribe from San Francisco, Vascular Neurosurgery, Adib Abla MD? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 289 Loading... Loading... Working... Add to Want to watch this again later? Sign in to add this video to a playlist. Share More Report Need to report the video? Sign in to report inappropriate content
Association of Left Ventricular Ejection Fraction and Symptoms With Mortality After Elective Noncardiac Surgery Among Patients With Heart Failure. Heart failure is an established risk factor for postoperative mortality, but how left ventricular ejection fraction and heart failure symptoms affect surgical outcomes is not fully described.To determine the risk of postoperative mortality among patients with heart failure at various levels of echocardiographic (left ventricular systolic dysfunction (...) ) and clinical (symptoms) severity compared with those without heart failure and to evaluate how risk varies across levels of surgical complexity.US multisite retrospective cohort study of all adult patients receiving elective, noncardiac surgery in the Veterans Affairs Surgical Quality Improvement Project database from 2009 through 2016. A total of 609 735 patient records were identified and analyzed with 1 year of follow-up after having surgery (final study follow-up: September 1, 2017).Heart failure, left
Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial. To compare arthroscopic hip surgery with physiotherapy and activity modification for improving patient reported outcome measures in patients with symptomatic femoroacetabular impingement (FAI).Two group parallel, assessor blinded, pragmatic randomised controlled trial.Secondary and tertiary care centres across (...) seven NHS England sites.222 participants aged 18 to 60 years with symptomatic FAI confirmed clinically and with imaging (radiography or magnetic resonance imaging) were randomised (1:1) to receive arthroscopic hip surgery (n=112) or a programme of physiotherapy and activity modification (n=110). Exclusion criteria included previous surgery, completion of a physiotherapy programme targeting FAI within the preceding 12 months, established osteoarthritis (Kellgren-Lawrence grade ≥2), and hip dysplasia
Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline. Do adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery.SAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises (...) decompression surgery and (b) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC (www.magicapp.org) to support shared decisions and adaptation.Surgery did not provide important improvements in pain, function, or quality of life compared with placebo
Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and mortality. Open craniotomy haematoma evacuation has not been found to have any benefit in large randomised trials. We assessed whether minimally invasive catheter evacuation followed by thrombolysis (MISTIE
Thoracic endovascular repair (TEVAR) versus open surgery for blunt traumatic thoracic aortic injury. Blunt traumatic thoracic aortic injury (BTAI) is a life-threatening surgical emergency associated with mortality up to 8000 per year, most commonly caused by rapid acceleration/deceleration injury sustained through motor vehicle accident and/or blunt thoracic trauma. BTAI has high pre-hospital mortality following the primary injury, with only 10% to 15% of patients surviving long enough to reach (...) with conventional open surgery.The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 20 August 2018.We considered all published and unpublished randomised controlled trials (RCTs) comparing TEVAR and open surgery for BTAI.Two review authors independently reviewed all RCTs identified by the Cochrane
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures
Does Systemic Administration of Parathyroid Hormone After Noninstrumented Spinal Fusion Surgery Improve Fusion Rates and Fusion Mass in Elderly Patients Compared to Placebo in Patients With Degenerative Lumbar Spondylolisthesis? Prospective, randomized, double-blinded, placebo-controlled clinical trial.To evaluate whether 90-day subcutaneous injections with 20 μg teriparatide increases the volume and quality of the fusion mass compared to placebo based on 12-month postop fine cut computed (...) tomography scans. The secondary objective is to evaluate whether parathyroid hormone (PTH) increases fusion rates compared to placebo.Few studies have investigated the effects of PTH on fusion in patients undergoing spinal arthrodesis. Early studies showed a more robust fusion mass with PTH after spinal fusion surgery. But the efficiency of PTH on noninstrumented spinal fusion surgery remains unclear.Patients with degenerative spondylolisthesis scheduled for noninstrumented posterolateral fusion were
Low predictive power of comorbidity indices identified for mortality after acute arthroplasty surgery undertaken for femoral neck fracture Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a femoral neck fracture.We analyzed data from 42 354 patients from the Swedish Hip Arthroplasty Register between
Chemical thromboprophylaxis after hip fracture surgery Rapid Review 1 Chemical thromboprophylaxis after hip fracture surgery Citation Yap G., Joseph C. & Melder A. 2018. Chemical thromboprophylaxis after hip fracture surgery: Rapid Literature Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Contact firstname.lastname@example.org Background Few studies are available in the literature reporting on the prevention of venous thromboembolism in patients with a hip fracture (...) compared to those with hip arthroplasty  . The Director of Orthopaedic Surgery requested a review of the evidence around the most suitable chemical thromboprophylaxis for patients who have undergone hip surgery. Objectives To determine the recommended chemical thromboprophylaxis (choice, dose and duration) for patients after hip fracture surgery in the prevention of venous thromboembolism (VTE); and improvement outcomes related to deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding
Sutures v staples for skin closure in lower limb orthopaedic surgery: A Rapid Review Sutures vs staples for lower limb orthopaedic surgery: A Rapid Review 1 Sutures v staples for skin closure in lower limb orthopaedic surgery: A Rapid Review Citation Joseph, C. & Melder, A. March 2018. Sutures versus staples for skin closure in lower limb orthopaedic surgery: A Rapid Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Executive Summary Background & Objective (...) In orthopaedic surgery, common skin closure methods are staples and sutures. However, there is a lack of consensus in the literature regarding a method that reflects best-practice. Therefore, the objective of this review was to evaluate if a difference in complications exists between wound closure methods following lower limb arthroplasty. Findings Overall lower limb orthopaedic surgery (combined hip, knee and ankle) ? There is no difference in wound complications when comparing staples to sutures for lower
Pre-operative administration of tranexamic acid in hip fracture surgery Rapid Literature Review 1 Pre-operative administration of tranexamic acid in hip fracture surgery Citation Yap G. & Melder A. 2018. Pre-operative administration of tranexamic acid in hip fracture surgery: Rapid Literature Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Email: CCE@monashhealth.org Background The use of Tranexamic acid (TXA) as an antifibrinolytic agent is established (...) in reducing peri- and postoperative blood loss in surgery  . As the fibrinolytic system is activated after the injury and continues to increase during surgery, blood loss in interchochanteric fractures is substantially greater than that in elective total hip arthroplasties. Therefore, it is important to evaluate the safety and effectiveness of TXA in hip fractures  . The CCE was requested to undertake a review of the evidence around the safety and efficacy of pre-operative administration
Efficacy, Effectiveness, Safety, and Cost-effectiveness of Epidural Adhesiolysis for Treating Failed Back Surgery Syndrome. A Systematic Review Failed back surgery syndrome (FBSS) has a profound impact on patients' quality of life and represents a major clinical challenge and a significant economic burden for society. Adhesiolysis is used as a treatment to eliminate perineural/epidural adhesions in patients with chronic pain attributed to FBSS.To evaluate the efficacy, effectiveness, safety