PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Prophylactic Surgical Procedures”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMed2006

Fatal pulmonary microthrombi during surgical therapy for end-stage heart failure: possible association with antifibrinolytic therapy.

BACKGROUND: Maintaining hemostasis in patients with end-stage heart failure undergoing cardiac surgery is always challenging. These patients have chronic hepatic insufficiency, resulting in derangement of coagulation. In addition, they are commonly receiving both systemic anticoagulation (warfarin or heparin) and antiplatelet therapy. The introduction of antifibrinolytics has had a significant effect on postoperative coagulopathy. We report fatal pulmonary microthrombi in patients receiving antifibrinolytics who developed suprasystemic pulmonary artery pressures and right heart failure that was impossible to overcome despite insertion of a right ventricular assist device. METHODS: We reviewed the surgical procedure and autopsy reports to identify patients with high pulmonary artery pressures caused by pulmonary microthrombi after a cardiac surgical procedure for end-stage heart failure. Patient demographics and preoperative, intraoperative, and postoperative variables were collected from a retrospective review of the patients' medical records. RESULTS: We identified 9 patients (7 men and 2 women; mean age, 45 +/- 16 years) who died of pulmonary microthrombi after cardiac surgery between January 1997 and January 2004. Surgical procedures included 5 left ventricular assist device implantations, 2 heart transplantations, and 2 left ventricular reconstructions with mitral valve repair or replacement. Eight patients received aprotinin, and 1 patient received epsilon-aminocaproic acid immediately before and during cardiopulmonary bypass. All patients had severe suprasystemic pulmonary artery pressures after protamine administration for heparin reversal, a complication that proved fatal in all cases. Intraoperative wedge biopsy of the lungs revealed multiple microthrombi within capillaries and in the small- and medium-sized pulmonary arterioles. CONCLUSION: We report 9 cases for which fatal pulmonary microthrombi might be associated with the use of prophylactic antifibrinolytic therapy. Mortally ill patients with multiorgan failure who are receiving systemic anticoagulation and undergoing surgical procedures require careful perioperative monitoring to identify potential hazards. Anticoagulation and antifibrinolytic therapy protocols may require adjustment in such patients.

Adult↗
PubMed1986

[Prophylactic and therapeutic use of cefotetan, a cephem antibiotic, for infections in the field of obstetrics and gynecology].

This paper deals with results obtained from the cefotetan (CTT, Yamatetan) study group of department of obstetrics and gynecology in Yamagata prefecture. Efficacy of CTT, a new cephamycin antibiotic, was studied in 50 cases (39 cases of prophylactic use for postoperative infections and 11 cases of several different infections). CTT was administered to each of the patients at a daily dose of 2 grams. No other drugs such as antimicrobial agents, steroids and antiinflammatory drugs which might affect the efficacy of CTT were permitted during the study except for the drug therapy or surgical procedures required for treating underlying diseases. Fever index, one of the examination items to assess the prophylactic effect for postoperative infections as well as daily changes in maximum body temperature, was examined in the prophylactic group. Daily changes in febrile pattern were examined in the infection group. The fever index were 3.4 +/- 4.0 degree hours in cases subjected to cesarean sections in the prophylactic group, 3.7 +/- 3.0 degree hours in cases subjected to gynecological operations in the prophylactic group and 4.5 +/- 5.5 degree hours in the infection group. The clinical efficacy rate in the 11 cases of the infection group was 100%; excellent in 3 cases and good in 8 cases. Bacteriological examination was conducted in 3 of the 11 cases and bacteria were eliminated in all 3 cases. The overall clinical efficacy rate was also 100%; excellent in 5 cases and good in 6 cases. No abnormal laboratory findings nor side effects were observed in any of the cases.

Adult↗
PubMed2003

Kidney transplantation in rats: an appraisal of surgical techniques and outcome.

Renal transplantation in rats is an essential experimental tool in transplantation research. The surgical procedure per se could affect the outcome of an experiment, independent of the hypothesis addressed, therefore requiring a standardized method which should be comparable across studies. To date, however, there is little information on the optimal surgical technique. We performed a Medline search on original articles published between 1965-2001 in order to evaluate whether specific technical issues affecting the outcome of the procedure could be defined. Articles that reported on a novel microsurgical procedure, or whose main purpose was the outcome of a surgical technique itself, were included in the analysis. From 2,060 retrieved publications, 34 corresponded to the selection criteria (rats and microsurgery and technique and kidney or renal transplantation). Among the essential determining factors for a good outcome, body weight >200 g and warm ischemic time <30 min were identified. Other important factors were the techniques used for vascular (end-to-end and end-to-side procedure or sleeve technique) and ureteral (bladder patch or end-to-end procedure) anastomosis. Gender, animal strain, type of anesthesia, prophylactic administration of antibiotics, and type of flushing solution did not affect the success of renal allografts. In order to avoid a bias related to the surgical procedure in rat renal transplantation, a warm ischemia time <30 min in animals with a body weight >200 g seems to be essential. Also, end-to-end or end-to-side vascular anastomoses are preferable to the sleeve technique. Other factors do not influence the immediate function of the graft.

Anastomosis, Surgical↗
PubMed1991

[Preventive operations in intestinal abnormalities].

In intestinal anomalies, preventive surgical procedures include gastrostomies and enterostomies as well as some special operations such as ligature of the cardia and associated appendectomies. General indications for enterostomies are seen in life-threatening circumstances, i.e. prematurity, surfactant deficiency, major associated malformations and complications. Preventive surgical procedures are necessary in certain cases of esophageal atresia, complicated small bowel atresia, meconium ileus, anorectal malformations, Hirschsprung disease, neuronal intestinal dysplasia and necrotizing enterocolitis. Prophylactic surgery requires detailed knowledge of the definitive therapeutic procedure.

Abnormalities, Multiple↗
PubMed2004

Surgical treatment and outcome of patients with giant retinal tears.

OBJECTIVE: To report the management and outcome in retinal detachments associated with giant retinal tears (GRTs). METHODS: Retrospective, case note analysis of patients treated between November 1991 and June 2002 at a tertiary referral hospital. RESULTS: The case notes of 29 patients (24 males, 5 females) with a follow-up ranging from five months to 7 years were reviewed. In all, 25 eyes had retinal detachments with macular involvement and 10 patients had myopia more than 6 D. All patients underwent vitrectomy. A total of 23 patients had heavy liquid and 16 had scleral explants; 28 patients had silicone oil and one had C3F8 tamponade. Intraoperative complications included lens trauma and iatrogenic GRT. Six eyes had recurrent retinal detachment and needed multiple surgical procedures. At the last follow-up, 25 patients had anatomically attached retinas. In all, 18 fellow eyes were treated prophylactically. Three patients had total retinal detachment and marked PVR. The visual acuity improved in 20 eyes. CONCLUSION: GRTs are more common in patients with high myopia. With newer techniques of surgical treatment of GRTs, the anatomical and visual outcomes are more favourable.

Adolescent↗
PubMed1990

Reducing the duration of prophylactic antibiotic use through computer monitoring of surgical patients.

The use of antibiotic prophylaxis for unnecessarily prolonged periods after surgical procedures can contribute to increased health care costs and adverse drug reactions as well as the development of antibiotic-resistant infections. Hospitals are under economic pressures to develop methods to control the excessive use of these drugs. We expanded the capabilities of our hospital information system to monitor the duration of surgical antibiotic prophylaxis. For six months during one year we used the computer system to monitor antibiotics received by every surgical patient and to identify patients receiving antibiotic prophylaxis longer than was deemed necessary according to generally accepted guidelines. For six months in the following year we used the system to monitor and identify the same types of patients and clinical pharmacists placed antibiotic "stop orders" in the charts of the patients identified by the computer. Surgical patients received an average of 19 doses of antibiotics in the first year compared with 13 doses in the second year (p less than 0.001). The average cost of antibiotics received more than 48 hours after the operation was $42 less per patient in year 2 than in year 1, resulting in a potential cost savings of $44,562 in six months. The computer system was found to be an efficient tool for monitoring all antibiotics given to surgical patients and identifying patients receiving antibiotic prophylaxis longer than necessary. Clinical use of this system appears to have resulted in improved usage of antibiotic prophylaxis.

Anti-Bacterial Agents↗
PubMed2002

Adverse events in surgical patients in Australia.

OBJECTIVE: To determine the adverse event (AE) rate for surgical patients in Australia. DESIGN: A two-stage retrospective medical record review was conducted to determine the occurrence of AEs in hospital admissions. Medical records were screened for 18 criteria and positive records were reviewed by two medical officers using a structured questionnaire. SETTING: Admissions in 1992 to 28 randomly selected hospitals in Australia. STUDY PARTICIPANTS: Five hundred and twenty eligible admissions were randomly selected from in-patient database in each hospital. A total of 14,179 medical records were reviewed, with 8747 medical and 5432 surgical admissions. MAIN OUTCOME MEASURES: Measures included the rate of AEs in surgical and medical admissions, the proportion resulting in permanent disability and death, the proportion determined to be highly preventable, and the identification of risk factors associated with AEs. RESULTS: The AE rate for surgical admissions was 21.9%. Disability that was resolved within 12 months occurred in 83%, 13% had permanent disability, and 4% resulted in death. Reviewers found that 48% of AEs were highly preventable. The risk of an AE depended on the procedure and increased with age and length of stay. CONCLUSION: The high AE rate for surgical procedures supports the need for monitoring and intervention strategies. The 18 screening criteria provide a tool to identify admissions with a greater risk of a surgical AE. Risk factors for an AE were age and procedure, and these should be assessed prior to surgery. Prophylactic interventions for infection and deep vein thrombosis could reduce the occurrence of AEs in hospitals.

Adolescent↗
PubMed1975

Prophylactic use of tetracycline for first trimester abortions.

Because the efficacy of prophylactic antibiotic therapy has yet to be established and because numerous variables often hamper studies of such therapy, the results of prophylactic antibiotic therapy were studied in a homogeneous gynecologic population. The patients were 4000 women undergoing first trimester abortions. The surgical procedure, the gynecologists' skill, and the hospital environment were relatively uniform, as was the patient age range. Two groups of 1000 patients each received tetracycline; the other 2000 patients served as controls. The complications associated with abortion were then analyzed in those receiving tetracycline and in the 2000 controls. Complications were less frequent among patients receiving tetracycline. This finding supports the argument of those who favor the prophylactic use of antibiotics in the management of various high-risk surgical problems.

Abortion, Legal↗
PubMed1989

Antibody to endotoxin is associated with decreased frequency of postoperative infection.

According to previous studies the presence of preoperative antibodies to gram-negative lipopolysaccharides has a protective effect against postoperative infection and pyrexia in patients undergoing urologic and cardiac surgical procedures. Preoperative serum specimens collected from 86 women awaiting major gynecologic surgery were tested for the presence of antiendotoxin by a qualitative method. These patients were closely followed up in the postoperative period and any evidence of pyrexia or infection was noted. There were 21 (24%) patients who had preexisting antibodies. Of the women studied, 47 (55%) had some form of postoperative infection, of which 32 (37%) were exclusively a result of gram-negative bacteria. There was a significant association (p less than 0.05) between postoperative infection and the absence of preexisting antibodies. This association was particularly striking (p less than 0.02) when postoperative urinary tract infections were considered. There was no association between postoperative pyrexia and the absence of preexisting antibody. Our results confirm the findings of previous studies to evaluate the protective role of antiendotoxin in surgical procedures. In the future immunization may be considered an adjunct or alternative to prophylactic antibiotics.

Antibodies, Bacterial↗
PubMed1988

An approach to excision of congenital giant pigmented nevi in infancy and early childhood.

Complete prophylactic excision of "large" and "giant" congenital nevocellular nevi (CNCN) often involves multiple surgical procedures begun in early infancy and not completed until late adolescence. Timely use of combined modalities of excision and reconstruction, beginning in infancy, and recognizing the benefits and limitations of each technique in each body region may allow completion of the excision of even the most extensive lesions in early childhood. In addition to minimizing the risk of malignant transformation, early complete excision may minimize the late psychologic stress caused by the appearance of the lesion and the late decision to attempt total excision. Tissue expansion and extensive excision and grafting in infancy and early childhood may significantly improve the final cosmetic result following treatment of these extensive lesions.

Child↗
PubMed1998

Mycotic renal artery degeneration and systemic sepsis caused by infected renal artery stent.

A case of Staphylococcus aureus renal artery stent infection was studied. Fourteen days after the procedure, the patient had a fever, hypotension, and an elevated white blood cell (WBC) count. Blood cultures were positive for S. aureus on admission and during the patient's hospitalization, despite intravenous vancomycin therapy. Evaluation included serial CT scans, revealing increasing persistent inflammation with development of multiple renal intraparenchymal abscesses, and arteriography, showing marked degeneration of the renal artery. Therapy required resection of the renal artery/stent and nephrectomy. This case confirms the severe nature of S. aureus stent infection; we recommend prophylactic antibiotics before these procedures, as well as expeditious evaluation and consideration for aggressive surgical therapy if this complication is suspected.

Abscess↗
PubMed1995

Role of prophylactic antibiotics in the prevention of late infection of prosthetic joints. Results of a questionnaire and review of the literature.

A postal survey has revealed wide variation in attitudes towards the need for prophylactic antibiotics in patients with implants who develop intercurrent infections, or who undergo surgical procedures. The available evidence is insufficient to reach any firm conclusions, however any patient who has an implant should receive swift treatment for intercurrent infections.

Anti-Bacterial Agents↗
PubMed1988

Surgery in the management of the gastric side-effects of NSAIDs.

It is now accepted that the administration of non-steroidal anti-inflammatory drugs (NSAIDs) can result in peptic ulceration. Not infrequently, the first presentation of the ulcer is as a life-threatening complication such as a perforation or gastrointestinal bleed. Surgeons often become involved in management when one of these complications occurs. This paper discusses the ways in which NSAID-induced peptic ulceration may present to the surgeon and the special features that distinguish patients with NSAID-induced ulcers from the remainder of patients with peptic ulcer disease. It is pointed out how little has been written on the surgical management of this group of patients. The importance of the overall assessment of these patients, with the correction of nutritional deficiencies and the use of appropriate prophylactic therapeutic measures in their surgical management, is stressed. The criteria for determining what surgical procedure is used and results are described.

Adult↗
PubMedDate not supplied

Ahmed glaucoma valve implant for childhood glaucoma in Sturge-Weber syndrome with choroidal hemangioma.

We present our experience with implantation of an Ahmed glaucoma valve in a 9-year-old girl with Sturge-Weber syndrome with choroidal hemangioma. In this case of childhood glaucoma, the choice of surgical procedure should be based on the efficacy and elimination of intra-and post-operative complications. An Ahmed glaucoma valve offered safety and efficacy in controlling glaucoma. This technique avoided sudden drops in intraocular pressure and decreases the risk of intraoperative and postoperative choroidal effusion and hemorrhage. The surgical procedure was not complicated: a one-staged implant was satisfactory and a prophylactic sclerostomy was not required.

Child↗
PubMed1990

Perspectives on newborn male circumcision.

Routine newborn circumcision cannot be widely advocated until large prospective studies thoroughly document its prophylactic value. When circumcision is performed properly, it represents a low-risk surgical procedure. The nursing profession plays a pivotal role in counseling and educating parents. A nurse can adeptly intervene in the psychosocial dynamics of the family to facilitate a truly informed parental decision.

Circumcision, Male↗
PubMed2002

Use of prophylactic antibiotics in surgery at a medical center in southern Taiwan.

BACKGROUND AND PURPOSE: Use of prophylactic antibiotics to prevent postoperative infection (POI) is a common practice in surgery. This study investigated the amount and cost of surgical prophylaxis in a representative general hospital in Taiwan in order to determine an appropriate course of action to control antibiotic use and decrease the burden of resistance. METHODS: The use of antibiotic prophylaxis for a wide variety of surgical procedures over a 6-month period was retrospectively evaluated in 3,104 patients at a medical center in southern Taiwan. RESULTS: Timing of perioperative parenteral antibiotics was inappropriate in 738 (23.8%) patients. The average duration of antibiotic use was 6.4 days (2.4 days intravenous + 4.0 days oral). Only 4.9% of patients did not receive prophylactic antibiotics and only 9.2% received a single dose. Prophylaxis exceeded 1 day in 80% of patients and 3 days in 68.2%. The most common regimen was cefazolin plus gentamicin, used in 2,338 (75.3%) procedures. There were 146 POIs in 119 (3.8%) patients. The most common POI was at the surgical site. Aerobic gram-negative bacilli were most common among the 81 pathogens isolated (54.3%), followed by gram-positive cocci (34.6%), anaerobes (8.6%) and yeasts (2.4%). The total cost for prophylactic antibiotics was New Taiwan (NT)$5,860,242 (approximately US$ 169,862). Had a single dose of cefazolin been used for all patients, the cost would have been reduced by 92.1%. Had four doses of cefazolin been used, the cost would have been reduced by 68.5%. CONCLUSIONS: This study documented the excessive use and often inappropriate timing of administration of antibiotics for surgical prophylaxis in a representative medical center in Taiwan. Strategies are needed to improve the appropriate use of surgical antibiotic prophylaxis in Taiwan, not only to reduce costs but, more importantly, to delay the emergence of resistant microorganisms.

Antibiotic Prophylaxis↗
PubMed1997

The influence of preoperative antibiotics on success of endosseous implants up to and including stage II surgery: a study of 2,641 implants.

According to the American College of Surgeons, complex oral surgical procedures, including the transoral placement of endosseous implants, are of the type that may require prophylactic antibiotics. However, the routine use of prophylactic antibiotics in the field of dental implantology continues to be controversial, and their utilization varies widely. No data from a randomized prospective clinical study of the prophylactic use of antibiotics in implant surgery have been previously published. As part of the comprehensive Dental Implant Clinical Research Group clinical implant study, the preoperative or postoperative use of antibiotics, the type used, and the duration of coverage was left to the discretion of the surgeon. These data were recorded and correlated with failure of osseointegration during healing (stage I) and at stage II surgery (uncovering). The results showed that significantly fewer failures occurred when preoperative antibiotics were used.

Anti-Bacterial Agents↗