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PubMedDate not supplied

[Possibilities of management of dyspeptic symptoms in the immediate postoperative period].

Analysis of the postoperative course of 1276 patients has shown that the incidence of nausea and vomiting in the first hours after surgical intervention does not depend on the mode of analgesia. Dyspepsia in the immediate postoperative period occurred in more than 1/3 of the patients after surgery on the bile duct. Addition of metoclopramide or dimetpromide to premedication helped reduce the incidence of postoperative vomiting. An antiemetic drug should be an obligatory component of premedication.

Dyspepsia↗

PubMedDate not supplied

[Changes in hemostasis in the postoperative period].

Hemostasis was investigated in the postoperative stage (at 24 hours and at 5 days) in 20 patients that had underwent major surgical interventions. The test applied for study of blood coagulation included : thrombocyte counting, the test of Howell, the activated recalcification time, the activated partial thromboplastin time, the prothrombin time (Quick), the thrombin time, estimation of fibrinogen concentration, the protamine sulphate test. The activity of the fibrinolytic system was investigated by the euglobulin clot lysis test and by the method of fibrin plates, while fibrinolysis inhibitors were assessed by determination of serum antiplasmines. Also the fibrinolytic degratation products were evaluated. The results indicate a biological condition that can be classified as "thrombophilia", characterized by hyperfibrinogenemia, the presence of fibrin monomers, a decrease of the fibrinolytic activators and an increase in the amount of antiplasmins, as well as a high percentage of fibrinolytic degradation products. Although the patients did not show manifest signs of thrombosis in the postoperative period, the results obtained indicate a tendency to intravascular formation and deposition of fibrin and suggest the necessity to apply prophylactic therapy with anticoagulants in the postoperative period.

Anticoagulants↗

PubMed2004

Risk factors, morbidity, and mortality associated with atrial fibrillation in the postoperative period of cardiac surgery.

OBJECTIVE: To determine the incidence of atrial fibrillation in the postoperative period of cardiac surgery, its impact on morbidity, mortality, and hospital stay, and to analyze the risk factors in the pre, trans, and postoperative periods. METHOD: Contemporary cohort study with 158 adult patients undergoing cardiac surgery, of whom those with atrial fibrillation in the preoperative period were excluded. The patients were assessed with continuous cardiac monitoring and daily electrocardiograms. Any episode of irregular rhythm with the presence of f waves of variable morphology and amplitude was considered atrial fibrillation. RESULTS: The general incidence of atrial fibrillation was 28.5%, being 21.6% for revascularized patients and 44.3% for those undergoing valvular repair. Factors independently associated with atrial fibrillation were left heart failure in the preoperative period (p=0.05; RC=2.2), total fluid balance (p=0.01; RC=1.0), duration of surgery (p=0.03; RC=1.01) [and other associated factors, age > 70 years, aortic valvular disease, psychomotor agitation, length of installation of the drains, pulmonary congestion and respiratory insufficiency in the postoperative period]. The use of beta-blockers (p=0.01; RC=0.3) was a protective factor. Atrial fibrillation in the postoperative period was associated with an increase in the length of hospital stay (16.9+/-12.3 days versus 9.2+/-4.0 days, p<0.001) and a greater incidence of stroke or postoperative death (p=0.02). CONCLUSION: The incidence of atrial fibrillation in the postoperative period of cardiac surgery was high and caused a significant increase in morbidity, mortality, and the length of hospital stay. Among the independent risk factors, excessive fluid balance is significant. The use of beta-blockers was identified as a protective factor.

Adult↗

PubMed2001

Stroke in the postoperative period.

Stroke in the postoperative period requires a certain level of sophistication in dealing not only with the patient, but also with the family and significant others. The consultant who is called in to assess the patient must deal with the delicate matter of addressing a presumably unforeseen complication; this often requires political deftness when the surgeon is reluctant to acknowledge that anything possibly could go awry. It is the ultimate hope of all involved that the patient will have a speedy and full recovery. It is important for the patient to be evaluated properly and thoroughly in an effort to prevent a minor, reversible deficit from becoming a major, irreversible neurologic disability. Family members should have all findings and the implications of such findings thoroughly explained to them. Efforts to minimize the potential ramifications of a postoperative stroke generally are not well received and can lead to questions about the integrity of the surgical team as well as the quality of care.

Comorbidity↗

PubMed2001

Acute cholecystitis in the immediate postoperative period following esophagogastrectomy.

Postoperative acute cholecystitis (PAC) occurs after 0.06 per cent of all operations. However, PAC may occur in up to 3.1 per cent of patients after gastrectomy. This increased incidence of PAC is due to bile stasis and gall bladder ischemia promoted by vagotomy and gastrohepatic ligament dissection during gastrectomy. Despite similar factors during esophagogastrectomy PAC is rarely reported in large American series of patients undergoing esophagogastrectomy. We report two cases of PAC occurring after esophagogastrectomy.

Acute Disease↗

PubMedDate not supplied

Correlation of postoperative pain to quality of recovery in the immediate postoperative period.

BACKGROUND AND OBJECTIVES: It is unclear whether the severity of postoperative pain may affect patients' quality of recovery in the immediate postoperative period (within 2 weeks of surgery). METHODS: This was a prospective, observational study in patients undergoing elective radical retropubic prostatectomy. All patients received a standardized intraoperative general or spinal anesthetic followed by intravenous patient-controlled analgesia. Visual analog scores for pain at rest, pain with activity, and nausea along with the QoR, an instrument validated to assess quality of recovery in the postoperative period, and Brief Fatigue Inventory were assessed on postoperative days 1 to 3, 7, and 30. The Epworth Sleepiness Scale was assessed on postoperative days 7 and 30. RESULTS: We found that the severity of pain both at rest and with activity correlated with a decrease in quality of recovery as assessed by the QoR. CONCLUSIONS: Our findings suggest that an increase in postoperative pain is correlated with a decrease in a patient's quality of recovery in the immediate postoperative period.

Analgesia, Patient-Controlled↗

PubMed1999

Antifungal prophylaxis during the early postoperative period of lung transplantation. Valencia Lung Transplant Group.

INTRODUCTION: Fungal infections occur frequently in lung transplant patients, with the highest risk being in the early postoperative period (the initial hospitalization after lung transplantation). Aspergillus is responsible for more than half of all fungal infections, and Aspergillus has even been considered a contraindication for lung transplantation because of its difficult therapy and frequently fatal outcome. The aim of this article is to evaluate the success of an antifungal prophylaxis protocol to prevent fungal infection in the immediate postoperative period in lung transplant recipients. MATERIAL AND METHODS: From March 1994 to March 1997, we performed 52 lung transplants in 31 men and 21 women who received antifungal prophylaxis with fluconazole, 400 mg/d, and aerosolized amphotericin B, 0.6 mg/kg/d, during the postoperative period. RESULTS: The mean (+/- SD) postoperative period duration was 49 +/- 27.5 days. No fungal infections were observed during this period, and all patients provided negative cultures. We also found no toxicity related to antifungal drugs. The dose of cyclosporine was easily adjusted in every recipient according to blood levels so that effective immunosuppression was not compromised. DISCUSSION: In our study, the removal of the lungs and antifungal prophylaxis with fluconazole and aerosolized amphotericin B prevented fungal infection in the postoperative period in all 52 lung transplant recipients.

Adolescent↗

PubMed2003

The effect of pain on health-related quality of life in the immediate postoperative period.

UNLABELLED: The hypothesis of this study was to determine if the severity of postoperative pain would affect patients' health-related quality of life (HRQL) in the immediate postoperative period (within 2 wk of surgery). We designed this study as a prospective, nonrandomized observational trial in a tertiary academic care center. Patients undergoing elective total hip or knee replacement surgery were eligible. Patients received a standardized intraoperative general or epidural anesthetic followed by IV patient-controlled analgesia or patient-controlled epidural analgesia. Short Form (SF)-12, visual analog scores for pain at rest and pain with activity, nausea, and itching were assessed on postoperative days 1-5, 7, and 14. The severity of pain correlated with a decrease in both the physical and mental component of the SF-12. The severity of nausea correlated with a decrease in the mental but not physical component of the SF-12. The severity of itching did not correlate with a change in the SF-12. Our findings suggest that an increase in postoperative pain will decrease a patient's quality of life in the immediate postoperative period; however, several methodologic issues exist when assessing HRQL in the immediate postoperative period. IMPLICATIONS: Severity of postoperative pain may affect quality of life.

Aged↗

PubMed1978

[Postoperative period in previously irradiated lung cancer patients].

The postoperative period in 62 patients with lung cancer was studied in a comparative aspect. Preoperative use of radiotherapy influences but insignificantly the postoperative course. As a whole, the incidence of postoperative complications and mortality does not differ considerably from that in patients not irradiated with a Betatron. The state of blood coagulation was studied before and prior to surgery in 34 patients previously irradiated with a Betatron. Following the irradiation some changes indicative of hypocoagulation were revealed. In the early postoperative period (2d--10th day postoperatively) a marked increase in the fibrinogen "A" content is observed.

Blood Coagulation Disorders↗

PubMed2005

Continuous physostigmine combined with morphine-based patient-controlled analgesia in the postoperative period.

BACKGROUND: Recently, new drugs and techniques for the treatment of postoperative pain were introduced, with the goal of enhancing opiates' analgesia while minimizing their side-effects. Cholinergic agents play an antinociceptive role, but their clinical use is quite limited, due to side-effects. Physostigmine is a cholinesterase inhibitor, which crosses the blood-brain barrier and elevates brain acetylcholine level. Physostigmine can produce analgesia by itself, and enhance opiate analgesia; but these effects are of short duration following bolus administration. METHODS: We compared pain intensity and morphine consumption in two postoperative treatment groups: One group received continuous physostigmine infusion combined with morphine-based patient-controlled analgesia (PCA), and the other received PCA alone. Cholinergic anti-inflammatory pathways have recently been described. We therefore also compared changes in proinflammatory cytokine production in the two pain management groups. RESULTS: Continuous infusion of physostigmine combined with morphine-based PCA in the postoperative period significantly reduced opiate consumption, and enhanced the analgesic response. Patients in the physostigmine group also exhibited reduced ex-vivo production of the proinflammatory cytokine, IL-1beta. At the same time, physostigmine increased nausea and vomiting, mostly in the first 2 h of the postoperative period. CONCLUSIONS: Physostigmine combined with morphine in the postoperative period reduced morphine consumption, enhanced analgesia, and attenuated production of the proinflammatory cytokine, IL-1beta. This latter finding may account for the decreased pain observed in this group; this cytokine is known to mediate basal pain sensitivity and induce hyperalgesia in inflammatory conditions. Taking into account the other potential beneficial effects of physostigmine, we suggest that a continuous infusion of physostigmine should be considered as a useful component in multimodal postoperative analgesia.

Adult↗

PubMed1997

[Analgesics in the postoperative period of abdominal interventions. The Study Group on Postoperative Analgesia of the Spanish Society of Clinical Pharmacology].

BACKGROUND: Analgesics can avoid postoperative pain. The aim of this study was to evaluate their prescription after abdominal surgery. PATIENTS AND METHODS: Prospective study including patients who had undergone abdominal surgery in two hospitals in Barcelona, in 1993. Prescription and administration of analgesic drugs, and pain severity during the first 48 hours of the postoperative period were evaluated. RESULTS: One hundred and sixty-four patients (83 men) were included. The most frequently prescribed drugs were metamizol (111; 68%), pethidine (83, 51%), and diclofenac (44; 27%). A high percentage of analgesic prescriptions on an "as needed" basis was recorded. Administered doses were lower than those recommended, and lower than those prescribed. Fifty-three percent of patients suffered significant pain during the first day. CONCLUSION: A too low proportion of analgesic drugs is prescribed in a predetermined schedule, in contrast to "as needed" prescription. Opiate derivatives are underused. All analgesic drugs are prescribed at inadequate dosage. This prescription pattern is associated with a high prevalence of postoperative pain.

Abdomen↗

PubMed1994

[Blood gastrin changes in the late postoperative period after proximal gastric vagotomy].

Changes in serum gastrin levels in the late postoperative period have been studied in 24 patients with non-stenotic duodenal ulcer who underwent proximal gastric vagotomy. Twenty healthy volunteers were used as a control group. Serum gastrin levels were determined under basal conditions and after a high protein meal stimulation. Both measurements were done in the preoperative, early postoperative (12th day) and late postoperative periods (X = 5.5 yrs.). Regarding basal serum gastrin levels, the results show mean values of 46.2 pg/ml in the preoperative, 61.6 pg/ml in the early postoperative, 73.9 pg/ml in the late postoperative and 51 pg/ml in the control group. Early and late postoperative period values show statistical significant differences when compared with preoperative values (p < 0.05), but not with the control group ones. Stimulated gastrin levels show mean values of 75.7 pg/ml in the preoperative, 99.1 pg/ml in the early postoperative, 134.1 pg/ml in the late postoperative and 73.4 pg/ml in the control group. Late postoperative values show statistical significant differences when compared with preoperative and early postoperative values (p < 0.05), and also when compared with the control group (p < 0.05). Possible causes and the physiopathological effects of these variations are discussed.

Adolescent↗

PubMedDate not supplied

[The concentrations of somatotropic hormone and insulin in the blood of heart surgery patients with a complicated course of the postoperative period].

It has been shown that the course of the early postoperative period in cardiosurgical patients and its outcome is to a great extent related to adequate balance of adaptation hormones, whose levels and changes are determined by the functional state of compensatory-adaptive systems. Patients with favourable outcome of the complicated postoperative period along with synchronous activation of sympathoadrenal system (SAS), hypophyseoadrenal system (HAS) and an elevated somatotropic hormone (STH) level demonstrated adequately high blood insulin content, with the equilibrium in adrenalin/insulin and cortisol/insulin ratios retained, and moderate STH predominance over insulin. In 1/4 of patients with complicated postoperative period and unfavourable outcome an attenuated SAS response was accompanied by excessively high STH, ACTH, cortisol blood content and a lower insulin level, which determined relative insulin insufficiency.

Adolescent↗

PubMedDate not supplied

[The Bohr effect during an uncomplicated course of the early postoperative period in heart surgery patients].

48 patients have been examined in the early postoperative period after open heart surgery (25 patients after correction of acquired heart valve defects and 23 patients after aortocoronary bypass surgery on 2-6 coronary arteries). Gas exchange parameters, hemodynamics, hemoglobin, gases, acid-base balance were studied and P50 was determined with the Severinghaus blood gas analyzer. Using a multidimensional regression analysis, the regularities of P50 changes in uncomplicated postoperative period have been investigated (namely coefficients of temperature and Bohr's shifts of oxyhemoglobin dissociation curve have been studied). It has been shown that the main factors responsible for P50 changes in patients with uncomplicated postoperative period are Bohr's effect (i. e. the impact of pH and pCO2) and the body temperature. With pH and T changes, the coefficients were close to classical ones: -0.37, -0.42 and 0.035, respectively. In Bohr's effect the coefficient, as determined by multidimensional regression analysis, was not very reliable, which was due to its low value (about 0.001).

Cardiac Surgical Procedures↗

PubMed1976

CPK-MB isoenzyme: use in diagnosis of acute myocardial infarction in the early postoperative period.

The diagnosis of acute myocardial infarction (AMI) in the early postoperative period may be quite difficult in certain patients. Electrocardiograms fail to be diagnostic of AMI in as many as one third of patients with myocardial injury found at autopsy. Enzyme patterns commonly used to diagnose AMI in patients admitted to coronary care units are obscured by muscle injury, medications, cardioversion, surgical manipulation, and blood transfusion. The MB isoenzyme of creatinine phosphokinase (CPK) has been described as a specific indicator of myocardial injury. Therefore the CPK-MB isoenzyme level was evaluated as a potential aid in the diagnosis of AMI in the early postoperative period. Thirty patients undergoing cardiac surgery and 7 patients undergoing thoracic surgery not involving the heart were studied. CPK-MB isoenzyme was present in the serum in 10 of 30 patients after cardiac surgery but in none of 7 patients after thoracic surgery. The presence of CPK-MB isoenzyme was found to be a valuable adjunctive indicator in the diagnosis of AMI in the early postoperative period.

Adolescent↗

PubMed2005

Gossypiboma in the early postoperative period: computed tomography appearance.

Recognition of postoperatively retained foreign body, referred euphemistically as gossypiboma, is essential but is very often considerably delayed. Legal implications as well as confusing configuration patterns cause considerable dilemma in the accurate diagnosis. A good understanding of the radiological appearances of this foreign body helps in appropriate early management of such patients. We present computed tomographic features of gossypiboma in patient who presented with symptoms of fever and pain in the immediate postoperative period.

Adult↗

PubMed1994

The effect of epidural morphine on human intestinal motility in the early postoperative period.

The early postoperative recovery of intestinal motility and the response of motility to epidural morphine were investigated in 20 patients. Periodic motor activities in the jejunum were recovered within 32 hours in all cases. The length of these cycles increased gradually from the 1st (23.2 min) to the 4th (41.7 min) postoperative day. Morphine and lignocaine were given through an epidural catheter. Morphine induced premature migrating motor complexes (MMC) in all cases, whereas lidocaine failed to evoke this response in every case. The mean duration (19.8 min) and maximal amplitude (62.8 mmHg) of the burst activities induced by morphine were significantly longer and higher than those occurring spontaneously (7.7 min and 35.6 mmHg, respectively). The intervals between the induced and the subsequent spontaneous contractions were the same as the intervals between spontaneous contractions. These observations indicate that epidural morphine induced premature MMC without interrupting recovery patterns from postoperative gastrointestinal paralysis.

Adult↗

PubMedDate not supplied

[Structural changes in metabolism in the early postoperative period and the methods for their correction].

Surgery and general anesthesia involve changes in adaptive compensatory mechanisms manifesting by homeostasis disturbances, specifically metabolic disorders. This report describes the dynamic characteristics of structural metabolic disorders and the external respiratory function during the immediate and early postoperative period after surgery of different duration under different anesthesias and metabolic infusions. The results indicate that general anesthesia and any surgery involve structural disorders in energy expenditures during the early postoperative period. The duration of anesthesia and surgery and methods of anesthesia determine the metabolic disturbances and external respiratory changes during the postoperative period. Addition of opioids and hypertensive glucose infusions to general anesthesia and postoperative period decreases the severity of structural metabolic disorders and external respiratory function during the early postoperative period.

Analgesia↗