1.
[Perioperative management of patients on NOACs].
Kelm, C, Engels, K
Medizinische Klinik, Intensivmedizin und Notfallmedizin. 2017;(2):125-128
Abstract
Regarding thromboembolic events, non-vitamin K antagonists, so-called new oral anticoagulative agents (NOACs), have widely enlarged prophylaxis and therapy. In contrast to vitamin K antagonists they can be administered in a definite dose and do not need any regular control of coagulation parameters. Thus being simple in handling, these drugs have become enormously attractive for both patient and physician.In spite of all their advantages NOACs have to be considered carefully. They have a significant disadvantage: the plasma concentration is not detectable by a simple blood test, nor is there any antidote available. As a consequence the bleeding risk remains unknown.In this review we focus on two different settings in routine surgical work: the preoperative management of patients undergoing elective surgery differs significantly from that needed in urgent surgery.
2.
Perioperative management of severe anorexia nervosa.
Hirose, K, Hirose, M, Tanaka, K, Kawahito, S, Tamaki, T, Oshita, S
British journal of anaesthesia. 2014;(2):246-54
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Abstract
As the prevalence of anorexia nervosa (AN) increased, surgery in severe AN patients also increased in the 2000s. We experienced a surgical case of a patient with severe AN, showing an extremely low BMI of 8.6 kg m(-2). We investigated the problems associated with this case and propose criteria to manage severe AN. We endeavour to report on the perioperative management of rare and severe symptoms and surgical indications of severely malnourished patients. All published reports were identified through comprehensive searches using PubMed, BioMedLib, and the Japan Medical Abstracts Society with the following terms and keywords: 'anorexia nervosa', 'eating disorder', 'hypoglycaemia', 'leucocytopaenia', 'gelatinous bone marrow', 'surgery', and 'operation'. In cases of AN with a BMI under 13 kg m(-2), marked hypoglycaemia, leucocytopaenia <3.0×10(9) litre(-1), or both, potentially fatal complications frequently occur. Accordingly, patients need strict nutritional support to avoid re-feeding syndrome until surgery. During the course of anaesthesia, careless loading of glucose or catecholamine may lead to disturbance of electrolytes or fatal arrhythmia. Intensive care and early feeding as soon as possible after surgery are important to prevent surgical site infection. Although not many perioperative cases of AN have been reported, clinicians must be aware of the danger and the causes of mortality in critical cases. Thus, the decision to undertake surgery must be taken carefully and close perioperative coordination among physicians, surgeons, psychiatrists, anaesthesiologists, and intensivists is essential.
3.
Hepatic protection by perioperative metabolic support?
Hassanain, M, Schricker, T, Metrakos, P, Carvalho, G, Vrochides, D, Lattermann, R
Nutrition (Burbank, Los Angeles County, Calif.). 2008;(11-12):1217-9
Abstract
OBJECTIVE We report the case of a 63-y-old woman undergoing left hepatectomy for hilar cholangiocarcinoma who was at high risk of postoperative liver failure due to an atrophic right liver lobe. She participated in a randomized clinical trial investigating the effect of perioperative glucose infusion on hepatic function after major liver resection. METHODS Intravenous glucose was initiated the night before the operation at 2 mg x kg(-1) x min(-1). During and after the operation, glucose was administered with a continuous insulin infusion until the first postoperative day. Postoperative liver function was assessed by the score proposed by Schindl, evaluating total serum bilirubin and plasma lactate concentrations, prothrombin time, and the grade of encephalopathy. RESULTS The patient's liver dysfunction was classified as "mild" on postoperative day 1 and as "none" on postoperative day 2. Postoperative liver function scores were better than those observed in a control group of patients who underwent hepatic resection of similar magnitude without glucose/insulin therapy. CONCLUSION Perioperative glucose/insulin administration was associated with a surprisingly small deterioration of liver function after left lobe liver resection in the presence of an atrophic right lobe. A randomized clinical trial will have to determine whether glucose/insulin therapy can improve hepatic function after major liver resections.
4.
The perioperative challenge of nephrogenic diabetes insipidus: a multidisciplinary approach.
Moug, SJ, McKee, RF, O'Reilly, DS, Noble, S, Boulton-Jones, M
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 2005;(2):89-94
Abstract
Nephrogenic Diabetes Insipidus (NDI) is characterised by the inability of the kidneys to concentrate urine in response to arginine vasopressin (AVP). Such patients typically experience polyuria and polydipsia because of this inability to autoregulate their water balance. This provides a perioperative challenge that could lead to a life-threatening situation. This article documents a patient with NDI who underwent an elective bowel re-anastomosis. Two peak serum sodium values were attained. The first when the patient was retaining sodium due to an inappropriate fluid regimen and the second due to hypovolaemia. The literature is reviewed and principles for NDI perioperative management are proposed.