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At least 271 records · Page 15Linked to original sources
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↗
PubMedDate not supplied

[Antibiotic prophylaxis in oncologic surgery].

Perioperative antibiotic administration can decrease surgical morbidity, shorten hospitalization, while lowering the overall costs attributable to infections. Its use in surgery is widespread and often inappropriate. In this study, the authors evaluate the guidelines for selection and use of prophylactic antibiotics in surgical cancer patients at the Hospital of Cancer in Rio de Janeiro, Brazil. During 36 non-consecutive months, 1681 cancer patients submitted to surgical procedures were prospectively followed-up by members of the Hospital Infection Control Committee. The overall surgical site infection (SSI) and mortality rates were 17.7% and 4.8% respectively. Prophylactic antibiotics were used in 1262 elective surgeries (75.1%), and their use was not considered to be in accordance with the recommended protocol in 37.6% of the cases. The inadequate antimicrobial prophylaxis resulted in higher incidence of SSI than did prophylaxis in according to the protocol (21.7% vs. 16.4, Relative Risk 1.32; 95% Confidence Internal 1.05-1.67; p0.01). This study calls the attention for the need of a more strict and determined educational program in order to provide mechanisms for an adequate administration of prophylactic antibiotics to patients submitted to high-risk surgeries.

Adolescent↗
PubMedDate not supplied

[Effectiveness of partial splenectomy in the treatment of hereditary spherocytosis].

OBJECTIVES: To evaluate the hematological and clinical response to partial splenectomy in a group of children with hereditary spherocytosis. MATERIAL AND METHODS: We analyzed the main hematological and clinical features in 13 patients with hereditary spherocytosis submitted to partial splenectomy. The diagnosis of the disease and the hematological studies was made according to standard methods. To establish the inheritance pattern we also studied both parents. During the surgical procedure the upper two thirds of the spleen were removed and the lower pole was preserved. We use prophylactic penicillin (250 mg twice a day) during 3 years. RESULTS: The diagnosis of the disease was made during the first year of life in 11 patients, 76.9% had neonatal hyperbilirrubinemia, 53.8% showed hepatomegaly and in 69.2% we observed splenomegaly. 84.6% received blood transfusion. The hemoglobin level was significantly increased (p = 0.04) and the reticulocytes significantly diminished (p = 0.01) after splenectomy. No hemolytic crises, blood cell transfusion requirement neither infection was observed after surgery. CONCLUSIONS: Although the number of patients and the post-surgical follow-up is reduced, the hematological recovery observed in our cases suggest that partial splenectomy is a beneficial surgical procedure for the treatment of the typical and severe form of hereditary spherocytosis.

Adolescent↗
PubMed1976

The effect of furosemide on potassium balance in open heart surgery.

Potassium balance was investigated in forty-five patients who underwent open-heart surgery. The patients were divided into a short-perfusion group (SPG, 24 patients) with a perfusion time shorter than 60 minutes and a long-perfusion group (LPG, 24 patients) with a perfusion time longer than 60 minutes. Nine patients in the SPG and 13 in the LPG received furosemide prophylactically prior to the perfusion. The furosemide dose was 20-60 mg. During the perfusion andpostoperatively all patients were given furosemide when necessary, i.e. when the urine output declined below 0.5 ml/kg/h. In both the short- and the long-perfusion groups potassium balance was negative on the day of operation and the following day. On the day of operation the patients in the SPG with furosemide prophylaxis had a negative potassium balance of 116 mmol and without prophylaxis of 33 mmol. The corresponding values in the LPG were 35 and 31 mmol. On the first postoperative day the values were 33 mmol and 50 mmol in the SPG and 29 mmol and 36 mmol in the LPG, respectively. The serum potassium level declined slightly in all the groups; the greatest decline was recorded for the SPG patients with prophylactic furosemide administration.

Adult↗
PubMedDate not supplied

Effective and creative surveillance and reporting of surgical wound infections.

Surgical wound infections offer a major challenge to hospital infection control programs. Surgical procedures and host factors are independent variables which markedly influence the risk of infection. Frequently used categories of surgical procedures (clean, contaminated, and infected) are inadequate to identify the special risks and problems of individual procedures. In 1976, in conjunction with the practicing surgeons of a large, referral hospital, the Infections Control Committee instituted surveillance of selected clean surgical procedures and deep-versus-superficial wound infections. Major problems associated with the cleaning of sternal saws and the timing of the administration of prophylactic antibiotics have been detected by these methods. Conventional surveillance undoubtedly would have overlooked these problems. Effective surveillance and control of surgical wound infections requires a willingness to modify surveillance activities to meet the local needs, and a determination to include the operating surgeons in the planning of surveillance activities.

Hospital Bed Capacity, 500 and over↗
PubMed2005

Prophylactic versus therapeutic administration of intravenous lidocaine for suppression of post-extubation cough following cataract surgery: a randomized double blind placebo controlled clinical trial.

BACKGROUND: Post-extubation cough causes considerable patient discomfort and in certain surgical procedures may lead to postoperative surgical complication. Different drugs and techniques have been used for the prevention of post-extubation cough with variable success rates. Prophylactic administration of lidocaine has been tried for the prevention of post-extubation cough with controversial results. No previous study has been performed to evaluate the therapeutic effect of intravenous lidocaine for treatment of post-extubation cough. This study was designed to compare the prophylactic effect of intravenous lidocaine with that of the therapeutic lidocaine in a sample of adult patients undergoing general anesthesia for cataract surgery. METHODS: The study was performed in two phases. In the first phase 200 adult patients were consecutively included in the study. They were randomly divided into two groups to receive either intravenous lidocaine 1 mg/kg or the same volume of normal saline as placebo prior to extubation. Proportions of patient with post-extubation cough were compared between two groups. Patients with established cough comprised the sample of the second phase of the study in which they randomly divided into two groups to receive either intravenous lidocaine 0.5 mg/kg or placebo to abort the coughs. Proportions of patients with successful response to lidocaine were compared between two groups. RESULTS: Proportions of patients with post-extubation cough were not significantly different in two prophylactic groups as revealed by 19 (20.7%) in lidocaine vs. 27 (28.7%) in placebo. The efficacy of prophylactic lidocaine for suppression of post-extubation cough was estimated to be 28.1%. Proportion of patients who were successfully treated in the second phase of the study was significantly higher in therapeutic lidocaine group 20 (80%) vs. 10 (38.5%) in placebo group (P = 0.003). CONCLUSIONS: The outcome of this study shows that prophylactic administration of lidocaine prior to tracheal extubation may be ineffective to prevent post-extubation cough. Based on the results of this study it can be recommended that post-extubation cough should be treated upon occurrence instead of routine prophylactic administration of lidocaine.

Adult↗
PubMed1993

[Lumbar cerebrospinal fluid drainage for prevention of cerebrospinal fluid fistulas].

Leakage of cerebrospinal fluid may complicate surgical procedures of the temporal bone and skull base. This presentation details experience utilizing 7 days lumbar drainage in an attempt to prevent the occurrence of a postoperative CSF fistula. Thirty-nine patients underwent surgery for various intracranial pathologies and were felt to be at high risk for the development of postoperative CSF fistulae. None of the patients was given prophylactic antibiotics. Ten patients developed clinical and laboratory findings consistent with early meningitis and were treated with appropriate antibiotics. Three patients eventually developed a CSF fistula, with two resolving spontaneously and the third requiring a second surgical procedure to repair the dura (again using lumbar drainage postoperatively). Our conclusions suggest that prophylactic placement of a lumbar catheter in high risk patients increases the likelihood of successful dural closure with an acceptable morbidity. Is these patients routine antibiotic coverage is not indicated.

Cerebrospinal Fluid Otorrhea↗
PubMed2006

Necrotic complications after nipple- and areola-sparing mastectomy.

OBJECTIVE: The objective was to analyze the frequency and factors influencing necrotic complication in female patients undergoing nipple- and areola-sparing mastectomy. Nipple- and areola-sparing mastectomy has recently been shown to yield satisfactory results in a carefully selected group of breast cancer patients. The technique includes extensive undermining of the nipple-areola complex, which may result in an increased rate of necrotic complications. We report our early experience with necrotic changes after nipple- and areola-sparing mastectomy. METHODS: The medical records of 38 patients undergoing nipple- and areola-sparing mastectomy were analyzed retrospectively. RESULTS: Mean age of the patient was 44.5 years (range 26-65). Necrotic complications occurred in 15.8% of patients and included: skin flap necrosis (1 case), partial nipple-areola complex necrosis (2 cases), and complete nipple-areola complex necrosis (3 cases). Two cases of capsular contraction were also recorded. Statistical analysis showed age below 45 years to be associated with a lower risk of necrotic complications (OR 4.51, P<0.05). CONCLUSIONS: The nipple- and areola-sparing mastectomy, although resulting in a relatively high frequency of necrotic complications, is a valuable surgical option for patients with small, peripheral tumors and for women undergoing prophylactic mastectomy. The procedure seems to be safer for women under 45 years of age.

Adult↗
PubMed1983

Complications in surgery for stomal recurrences.

Stomal recurrences are diffuse epidermoid carcinomas of the tracheostoma. There is a 8.3% incidence associated with patients having a total laryngectomy. Most can be prevented by several prophylactic measures; however, surgery may be required. The procedure advocated is mediastinal dissection and its surgical technique is outlined. Recently the use of the pectoralis myocutaneous flap has greatly diminished morbidity and mortality associated with this procedure. The complications that may be encountered with mediastinal dissection have been categorized and analyzed. The dynamic interplay of these complications is stressed. Separately, each complication is formidible, but collectively, they may be overwhelming. This entire web of complications is synergistic and at times fatal. In essence, the motto of the surgeon when operating on a patient with a stomal recurrence should be eternal vigilance.

Carcinoma, Squamous Cell↗
PubMed2001

Ondansetron: a review of its use as an antiemetic in children.

UNLABELLED: Ondansetron, a selective serotonin (5-hydroxytryptamine; 5-HT) 5-HT3 receptor antagonist, is an antiemetic agent available for use in adults and children. In children receiving ondansetron (multiple 5 mg/m2 or 0.15 mg/kg intravenous and/or oral doses) in addition to chemotherapy in 2 large (n > 100) non-comparative analyses, < or =2 emetic episodes were observed in 33 and 40% of cisplatin recipients, 48 and 68% of ifosfamide recipients, and 70 and 72% of patients receiving other chemotherapeutic regimens. In comparative trials, ondansetron was significantly more effective at reducing nausea and vomiting than metoclopramide or chlorpromazine (both combined with dexamethasone), although the incidence of delayed symptoms were similar between children receiving ondansetron and metoclopramide. In addition, dexamethasone significantly improved the antiemetic efficacy of ondansetron in 1 randomised trial. When used in children undergoing conditioning therapy (including total body irradiation) prior to bone marrow transplantation, ondansetron was significantly better at controlling nausea and vomiting than combined perphenazine and diphenhydramine therapy. In dose-ranging and large placebo-controlled trials, intravenous (0.075 to 0.15 mg/kg) or oral (0.1 mg/kg) ondansetron was significantly more effective than placebo in preventing emesis in children undergoing surgery associated with a high risk of postoperative nausea and vomiting (PONV) including tonsillectomy or strabismus repair. In comparative studies, intravenous administration of ondansetron 0.1 to 0.15 mg/kg was significantly superior to droperidol 0.02 to 0.075 mg/kg or metoclopramide 0.2 to 0.25 mg/kg in preventing emesis in children undergoing various surgical procedures. In comparison with other antiemetics, including prochlorperazine and dimenhydrinate, ondansetron generally showed greater prophylactic antiemetic efficacy. Ondansetron combined with dexamethasone was significantly more effective than ondansetron or dexamethasone alone, as was the combination of ondansetron with a propofol-based anaesthetic compared with either agent alone. Ondansetron is generally well tolerated in children, rarely necessitating treatment withdrawal. The most frequently reported adverse events were mild to moderate headache, constipation and diarrhoea in patients receiving chemotherapy. Wound problems, anxiety, headache, drowsiness and pyrexia were reported most frequently in patients postsurgery. CONCLUSIONS: Ondansetron has shown good efficacy in the prevention of acute nausea and vomiting in children receiving moderately or highly emetogenic chemotherapy and/or irradiation, particularly when combined with dexamethasone. In the chemotherapy setting, ondansetron is significantly better than metoclopramide and chlorpromazine and has a more favourable tolerability profile. In children undergoing surgery, ondansetron demonstrated superior prophylactic antiemetic efficacy compared with placebo, droperidol and metoclopramide, and was relatively free of adverse events. Ondansetron is thus an effective first-line antiemetic in children undergoing chemotherapy, radiotherapy and surgery.

Adolescent↗