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 505 records · Page 28Linked to original sources
PubMedDate not supplied

New directions in surgical therapy of arrhythmias.

The success of the radiofrequency catheter ablation procedure for most types of supraventricular and ventricular tachycardia, particularly in young patients, largely eliminated the role of surgical therapy of arrhythmias. However, there remains a subset of arrhythmia patients in whom the catheter approach has not been successful and types of arrhythmias with high recurrence rates following initially successful catheter ablation procedures where surgery can provide more definitive therapy. In addition, the concepts of ablation therapy can be successfully incorporated into the concomitant repair of complex congenital heart disease, resulting in single-stage therapy for structural and rhythm abnormalities. Prospectively, knowledge of the role of anatomic barriers as substrates for future reentrant arrhythmia circuits provides the opportunity to alter these circuits prophylactically at the time of initial surgical repair of congenital heart disease in an attempt to avoid the late development of tachycardia. This article describes our experience during the past decade with 71 patients undergoing arrhythmia surgery using this approach.

Arrhythmias, Cardiac↗
PubMed2006

Initial experience with the use of intravenous eptifibatide bolus during endovascular treatment of intracranial aneurysms.

BACKGROUND AND PURPOSE: Despite systemic heparinization, thromboembolic complications remain a major concern related to endovascular treatment of intracranial aneurysms. We assessed the safety of intravenous eptifibatide administered during aneurysm coiling procedures to prevent such complications. METHODS: From August 2001 to November 2004, 298 coil embolization procedures were performed to treat intracranial aneurysms; eptifibatide was used in 84 endovascular coil embolization procedures to treat 79 aneurysms in 74 patients. We retrospectively reviewed medical charts, radiographic images, and procedure notes to evaluate periprocedural complications related to eptifibatide. RESULTS: The mean age of the 74 patients in our cohort was 55 +/- 9 years (range, 31-84) harboring 79 aneurysms (32 ruptured/47 unruptured). Eptifibatide was given prophylactically in 77 procedures, whereas in 7 procedures, it was given for treatment of a thromboembolic event (visualization of an arterial branch occlusion). A total of 5 (5.9% [total cohort]) bleeding complications related to eptifibatide occurred during 84 procedures. Two patients (2.4% [total cohort]/6.3% [ruptured group]) developed intracerebral hemorrhagic complications exacerbated by eptifibatide. The other 3 (3.6% [total cohort]) patients had groin hematomas requiring blood transfusions but had no surgical intervention. One thromboembolic event occurred in the 77 patients receiving eptifibatide prophylactically. CONCLUSIONS: Intravenous infusion of eptifibatide seems to be safe to administer in patients undergoing endovascular repair of an unruptured cerebral aneurysm. Caution must be used in patients harboring ruptured aneurysms as intracranial bleeding complications may occur. Further study is required to delineate the group of patients most likely to benefit from this therapy.

Adult↗
PubMedDate not supplied

A qualitative study of the information needs of high-risk women undergoing prophylactic oophorectomy.

This qualitative study sought to determine the information needs of high-risk pre-menopausal women who had undergone prophylactic bilateral oophorectomy to manage their inherited risk of ovarian cancer. In-depth interviews were carried out with 23 high-risk women following surgery. Although the benefit of risk reduction was perceived as out weighing the costs of surgery, many women reported that they would have liked more information about the physical and emotional after-effects of oophorectomy prior to and following surgery. The analysis identified five different types of information needed by women making surgical decisions, comprising information about ovarian function and the menopause, hormone replacement therapy (HRT), surgical procedures, convalescence and the risk of inheriting a genetic mutation and developing cancer. It is suggested that, in addition to genetic counselling for hereditary ovarian cancer, women should receive information about both the costs and benefits of prophylactic oophorectomy, and should have access to gynaecology nurse specialists both before and after surgery.

Adult↗
PubMed1995

[Increased intraocular pressure after cataract extraction--effect of surgical technique, surgical procedure and preventive drug administration. A prospective, randomized double-blind study].

BACKGROUND: We performed a double-masked, randomized and prospective study to compare the effect of surgical technique, surgeon's experience, and prophylactic medication on the intraocular pressure rise after cataract extraction. PATIENTS AND METHODS: Intraocular pressure of 120 patients was measured the day before, as well as two to four, five to seven and 22 to 24 hours after uncomplicated cataract extraction. 47 patients were operated with phacoemulsification and sclerocorneal sutureless tunnel (phaco/tunnel). 61 patients with phacoemulsification and corneoscleral incision and suture (phaco/suture), and 12 patients with extracapsular technique (ECCE). 48 operations were done by inexperienced surgeons (less than 200 intraocular operations), 72 by experienced surgeons (300-2000 intraocular operations). Patients were treated with either levobunolol, acetazolamide, apraclonidine, or placebo. Each treatment group contained 30 patients. RESULTS: In all groups, the mean intraocular pressure increased to a maximum at five to seven hours after surgery. The pressure rise was significantly higher in the ECCE group (20.6 mm Hg) than in the phaco/suture group (10.5 mm Hg) and in the phaco/tunnel group (5.4 mm Hg, p always < 0.05). Eyes operated by inexperienced surgeons had a significantly (p < 0.005) greater pressure rise (12.9 mm Hg) than eyes operated by experienced surgeons (7.1 mm Hg). Treatment had no significant (p = 0.41) effect on the intraocular pressure rise. CONCLUSION: The intraocular pressure rise after cataract extraction strongly depends on the surgical technique and to a lesser extent, on the surgeon's experience. At least for phacoemulsification, the effect of the prophylactic medication used in this study is small and appears to be clinically irrelevant.

Acetazolamide↗
PubMed2001

Prophylactic antibiotics are not indicated in clean general surgery cases.

BACKGROUND: In assigning risk of infection, the traditional wound classification system has been replaced by the National Nosocomial Infection Surveillance (NNIS) system. NNIS classification is determined by procedure length, wound cleanliness, and ASA status. To date, no prophylactic antibiotic guidelines have been proposed for the NNIS system. METHODS: Clean general surgery cases were retrospectively reviewed in our hospital for infection and prophylactic antibiotic use. These cases were then stratified per the NNIS system. RESULTS: One thousand twenty-three clean general surgery cases had 16 (1%) surgical site infections. The infection rate in NNIS class 0, 1, and 2 cases not given prophylactic antibiotics was 1.21%, 3.03%, and 0%, respectively. The infection rate in NNIS class 0, 1, and 2 cases given prophylactic antibiotics was 0.94%, 2.44%, and 6.67%, respectively. CONCLUSIONS: No statistically significant decrease in infection rate was demonstrated by us using prophylactic antibiotics, regardless of the NNIS classification in clean general surgery cases.

Antibiotic Prophylaxis↗
PubMed2006

Appropriateness of antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital.

OBJECTIVE: To evaluate the rate of appropriate prophylactic antibiotic use in gynecologic surgery at Srinagarind Hospital. DESIGN STUDY: Prospective descriptive study. SETTING: Srinagarind Hospital, Khon Kaen University, Thailand. MATERIAL AND METHOD: Medical records of 250 women who had undergone gynecologic surgery at Srinagarind Hospital during August 2004 and February 2005 were evaluated. The criteria of appropriate prophylactic antibiotics were based on ACOG recommendation 2001. Data on demographic information, surgery procedure and antibiotic use during surgery were extracted from these medical records and analyzed. MAIN OUTCOMES: Rate of appropriate prophylactic antibiotic use and type of inappropriate use. RESULTS: Two hundred and fifty women had undergone gynecologic surgery during the study period. There were 168 total abdominal hysterectomy (TAH), 12 vaginal hysterectomy (VH), 30 salpingooophorectomy (SO), 3 myomectomy, 30 diagnostic laparoscopy and 7 laparoscopic ovarian cystectomy (LOC). Twenty private staff and twenty residents conducted these operations. The overall rate of appropriate prophylactic antibiotic use was 75.2% (95% CI 69.28-80.33). Main type of inappropriate use were multiple doses and indication not fulfilled. The overall rate of appropriate antibiotic prophylaxis among surgeries conducted by private staff was 53.19% (95% CI 42.66-63.46) and the overall rate of appropriate antibiotic prophylaxis among surgeries conducted by residents was 88.46% (95% CI 82.13-93.83). The rate of early post operative infection between both groups was not different (p = 0.529). There was no drug complication in all subjects. CONCLUSION: The overall rate of appropriate antibiotic prophylaxis in gynecologic surgery at Srinagarind Hospital was 75.2% (95% CI 69.28-80.33). Residents used prophylactic antibiotics more appropriately than private staff.

Adult↗
PubMed1987

Local heat increases blood flow and oxygen tension in wounds.

The effect of local hyperthermia on subcutaneous tissue oxygen tension (Psqo2) and perfusion was investigated in eight patients (13 trials) using a subcutaneously implanted oxygen tonometer. Application of heat increased subcutaneous tissue temperature and Psqo2. Mean Psqo2 during oxygen breathing rose by 39.5 mm Hg, an 80% increase over the average baseline Psqo2. The corresponding mean subcutaneous temperature increased 4.0 degrees C. A significant linear correlation was found between the change in Psqo2 and subcutaneous temperature. There was an average threefold increase in local perfusion estimated by using the Fick principle. The data reaffirm the value of local hyperthermia in treating contaminated wounds and suggest a mechanism for its ability to ameliorate infections. The mechanism implies that local heat may have prophylactic value as well.

Blood Circulation↗
PubMed1999

The umbilical fold approach to pyloromyotomy: is it a safe alternative to the right upper-quadrant approach?

BACKGROUND: Hypertrophic pyloric stenosis has been approached using two standard incisions for pyloromyotomy: the circumumbilical (UMB) and the right upper quadrant (RUQ). The UMB approach produces an almost undetectable scar but has been associated with more complications. STUDY DESIGN: A 5-year retrospective analysis was performed on 344 patients (90 UMB and 254 RUQ) to compare technical and wound complications. The effect of prophylactic antibiotics on wound infection was also evaluated. RESULTS: The intraoperative complication rate was 5.5% (13.3% UMB versus 2.8% RUQ; p = 0.001). The mucosal perforation rate was 3.5% (8.9% UMB versus 1.6% RUQ; p = 0.003). Mucosal perforations increased the mean +/- SD length of hospitalization in UMB patients (3.9 +/- 0.8 versus 2.4 +/- 1.1 days; p < 0.001). The serosal tear rate was 2.0% (4.4% UMB versus 1.2% RUQ; p=0.08). The postoperative complication rate was 5.8% (14.4% UMB versus 2.8% RUQ; p < 0.001), and the wound infection rate was 2.6% (6.7% UMB versus 1.2% RUQ; p = 0.01). Antibiotic prophylaxis decreased the rate of wound infection to 1.8% and eliminated the statistical difference between the groups (4.5% UMB versus 0% RUQ; p=0.16). The rate of other postoperative complications was 3.2% (7.8% UMB versus 1.6% RUQ; p = 0.009). Duration of hospital stay did not differ between the groups overall (2.6+/-1.12 days for UMB versus 2.7+/-1.5 days for RUQ; p = 0.35). CONCLUSIONS: The UMB approach to pyloromyotomy was cosmetically superior but increased complication rates. Technical complications were easily corrected and length of stay was not affected. Wound infections were decreased in both groups by the use of prophylactic antibiotics.

Adult↗
PubMed1998

[Incidence and prevention of coronary complications after general surgery].

The frequency, the nature and physiopathological mechanisms of cardiac complications of general surgical patients are well known. Acute myocardial infarction, the main complication, occurs in 3 to 5% of high risk cases. Though usually subendocardial and asymptomatic, it jeopardizes short and medium term survival of patients. It occurs in the first 48 hours after surgery in the majority of cases, the diagnosis being confirmed by increased serum troponine I levels. The circulatory, mechanical and inflammatory changes and hypercoagulability, which are present during the perioperative period, interact, disturbing the energetic equilibrium of the myocardium and causing episodes of myocardial ischaemia which, if prolonged, result in necrosis of the subendocardial myocardium. These effects must be taken into consideration if the operative risk of coronary patients is to be reduced. It is essential to monitor the haemodynamic parameters which affect myocardial energy consumption both during and after surgery. Particular attention must be paid in the postoperative period which is characterised by metabolic stress and sympathetic hyperreactivity which predispose to prolonged episodes of silent myocardial ischaemia. Betablockers, which effectively prevent per and postoperative ischaemia without causing jeopardy to the haemodynamic status and which reduce the cardiac risk of general surgery have a role to play in the prevention of acute myocardial infarction in the postoperative period when prescribed before surgery and continued by oral administration during the first 6 postoperative days. The alpha-2-agonists affect sympathetic reactivity during and after surgery and are very well tolerated haemodynamically. If the current on-going multicenter trials show that they prevent postoperative cardiovascular complications, they could be prescribed prophylactically in patients at risk.

Coronary Disease↗