Does use of intraoperative diclofenac sodium increase postoperative bleeding after prosthetic breast reconstruction ?

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Effect of induced relative hypoxia on reticulocyte count in oncological abdominal surgery: a single–centre, controlled, randomized pilot study

Erythropoietin (EPO) stimulating agents are known as alternatives to transfusion. However, they expose patients to thrombosis and are expensive. A phenomenon, “the normobaric oxygen paradox” (NOP), has been described. A transient hyperoxia followed by a prolonged return to normoxia acts as an effective trigger for EPO production. The mechanism depends on free O2 radicals and on reduced gluthatione (GSH) availabilities. Also, N–acetylcystein (NAC) is known to regenerate the stock of GSH. Our study sought to determine whether a NOP regime administered alongside NAC could produce an increase in reticulocyte count via an increase of EPO production, in patients undergoing oncological abdominal surgery.Prospective, controlled trial randomized 78 patients in 3 parallel groups. The first group (NOP) received 60% oxygen for two hours on days 1,3 and 5 postoperatively via a venti–mask. The second group (NOP+NAC), in addition to the NOP oxygen regime, received 300 mg IV once a day of N–acetyl–cysteine (NAC) on the first day postoperatively and 200 mg orally once a day until the fifth day post–op. The third group received neither NOP nor NAC. On postoperative day 6, reticulocytes were measured and compared to the baseline values. The 95 percent confidence intervals of the mean percentage change from baseline revealed, that the increase in reticulocyte counts was statistically significant for the NOP Group and NOP+NAC Group, whereas it was not significant for the control group.These data suggest that relative hypoxia by means of oxygen gradient is an effective stimulus for reticulocyte production.info:eu-repo/semantics/publishe

Evaluation of the effect of epidural analgesia on flap healing after breast reconstruction with a pedicled Transverse Rectus Abdominis Muscle (TRAM): A matched pair analysis

Background: Pain control after breast reconstruction with pedicled TRAM often requires intravenous narcotic analgesia and inpatient hospitalization. Epidural analgesia is increasing in popularity because it decreases the use of intravenous analgesic medications and offer comparable pain relief without the systemic side effects. Purpose: To evaluate the effect of epidural analgesia on postoperative morbidity of pedicle TRAM and compare it with intravenous narcotic analgesia. Methods: 80 patients underwent immediate or delayed pedicled TRAM reconstruction after mastectomy, by the same surgeon, at Jules Bordet Institute. Patients receiving an epidural analgesia were matched 1:3 with patients undergoing intravenous narcotic analgesia for pain control in the same years by the same surgeon. Differences in peri- and postoperative complications across the two groups were assessed using the chi squared test. Cox regression models were constructed to assess differences in flap healing between the two groups. All of the tests were two-sided and performed with a 5% alpha risk. Results: Epidural analgesia was significantly associated with less frequent partial flap necrosis (p 25 kg/m2 and Hb level <9 were independently associated with flap necrosis. Conclusion: We found that epidural analgesia was associated with less flap necrosis than intravenous narcotic analgesia. Nonetheless, these results must be confirmed in large prospective multi-institutional studies.info:eu-repo/semantics/publishe

Thoracoscopic Talc Pleurodesis in Malignant Pleural Effusions: impact of high frequency jet ventilation on outcome

Malignant pleural effusion is a complication of several types of advanced malignancy, which may significantly reduce the quality of life of patients.Thoracoscopic talc pleurodesis is a feasible and effective treatment, but not devoid of complications such as respiratory complications. Airways management may play a role in the occurrence of these complications.The purpose of the study is to evaluate the efficacy and safety of high frequency jet ventilation in the management of Thoracoscopic Talc Pleurodesis in Malignant Pleural Effusionsinfo:eu-repo/semantics/publishe

Does the type of anesthesia influence the outcome after modular proximal mega prosthesis for bone metastases of the femur?

Background: Proximal femoral reconstruction with modular mega prosthesis after large oncologic resection is a long-lasting painful procedure associated with prolonged hospital stay and significant blood loss. We evaluated the influence of regional anesthesia on intraoperative and postoperative complications as well as length of hospital stay (LOS). Materials and Methods: We performed a retrospective study comparing three regimens of anesthesia on intraoperative and postoperative complications after proximal femoral reconstruction with mega prosthesis. Seventy-two patients were included. 26 of whom had general anesthesia (GA) alone (group 1), 21 had GA combined to lumbar epidural anesthesia (group 2) and 25 had GA combined to lumbar plexus block (group 3). Surgical procedures were similar and carried out by the same surgeon. Results: Demographic characteristics were equivalent between 3 groups, except for age and ASA score. Intraoperative variables were similar between groups except for intraoperative blood loss (p = 0.007), blood transfusion (p = 0.004) and opioids consumption (p = 0.01). Pulmonary infections were more frequent in group 1 compared to other groups (p = 0.036). Postoperative hypoventilations were less frequent in group 3 (p = 0.022). There were no difference for local complications, luxation and LOS. Type of anesthesia was found to be an independent predictive factor for intraoperative blood loss (p = 0.014), postoperative respiratory hypoventilation (p = 0.014) and respiratory infection (p = 0.011). Conclusion: Loco regional anesthesia, especially lumbar plexus block, may reduce blood loss, transfusion and postoperative complications after modular mega prosthesis for proximal femoral malignant lesions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Opioid-free anesthesia: What about patient comfort? A prospective, randomized, controlled trial

Background: We investigated the effect of a peri-operative opioid-free approach on postoperative patient comfort in patients undergoing breast cancer surgery. Subjects and Methods: From September 2014 to July 2015, 66 female patients of the Belgian Oncology Institut Jules Bordet were recruited. They were randomized into two groups: the first group received anesthesia with opioids for their breast cancer surgery, and the second group received opioid-free anesthesia. Patient comfort was evaluated 24 hours postoperatively through the QoR-40 score, with a difference of 15 points considered as being clinically relevant. Postoperative analgesia was provided through a piritramide patient-controlled analgesia device, during the first 24 hours. The hypothesis of this study was that opioid-free anesthesia would improve quality of recovery after anesthesia. Results: A statistically significant difference in postoperative QoR-40 score was observed between groups [Mean (SD) QoR-40 of 182.1/200 (13.9) in the opioid-free group, and 175.6/200 (14.80) in the opioid group; P = 0.04]. The clinical relevance of this finding is questionable, insofar as the difference of 15 points was not met. A statistically significant difference in postoperative piritramide usage was observed (8.1 (6.6) in the opioid-free group, and 13.1 (9.4) in the opioid group; P = 0.03). Conclusions: This randomized controlled trial shows, for the first time, equal comfort during the immediate postoperative period in patients having received opioid-free and conventional anesthesia for their breast cancer surgery. Opioid-free anesthesia in this indication appears safe, and may be associated with slightly reduced pain during the first 24 postoperative hours.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4.

To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery.Comparative StudyJournal ArticleRandomized Controlled TrialResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Deep Inferior Epigastric Perforator Flap (D.I.E.P) for Breast Reconstruction: Impact of Intraoperative Intrathecal Morphine on Outcome

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The Normobaric Oxygen Paradox-Hyperoxic Hypoxic Paradox: A Novel Expedient Strategy in Hematopoiesis Clinical Issues.

Hypoxia, even at non-lethal levels, is one of the most stressful events for all aerobic organisms as it significantly affects a wide spectrum of physiological functions and energy production. Aerobic organisms activate countless molecular responses directed to respond at cellular, tissue, organ, and whole-body levels to cope with oxygen shortage allowing survival, including enhanced neo-angiogenesis and systemic oxygen delivery. The benefits of hypoxia may be evoked without its detrimental consequences by exploiting the so-called normobaric oxygen paradox. The intermittent shift between hyperoxic-normoxic exposure, in addition to being safe and feasible, has been shown to enhance erythropoietin production and raise hemoglobin levels with numerous different potential applications in many fields of therapy as a new strategy for surgical preconditioning aimed at frail patients and prevention of postoperative anemia. This narrative review summarizes the physiological processes behind the proposed normobaric oxygen paradox, focusing on the latest scientific evidence and the potential applications for this strategy. Future possibilities for hyperoxic-normoxic exposure therapy include implementation as a synergistic strategy to improve a patient's pre-surgical condition, a stimulating treatment in critically ill patients, preconditioning of athletes during physical preparation, and, in combination with surgery and conventional chemotherapy, to improve patients' outcomes and quality of life.info:eu-repo/semantics/publishe

Postoperative C-reactive protein kinetics predict postoperative complications in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis

Background: Relatively high morbidity rates are reported after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). However, early predictors of complications after CRS plus HIPEC have not been identified. The aim of this study was to evaluate the predictive role of early postoperative serum C-reactive protein (CRP) level (Day 2–4) for the detection of post-operative complications. Patients and methods: We performed a retrospective study including 94 patients treated with complete CRS (R1) and HIPEC for PC from various primary origins (2011–2016). Post-operative complications were recorded. The values for postoperative inflammatory markers (white blood cells [WBC] and platelet counts, CRP) were compared between the different groups. Results: CRP on post-operative days 2–4 was significantly higher in patients with than without complications (124 mg/L vs 46 mg/L; p < 0.0001) and higher in those with more major complications (162 mg/L vs 80 mg/L; p < 0.0012). WBC and platelet counts showed no difference within 5 days postoperatively. Conclusion: CRP levels, and kinetics mainly, between post-operative day 2 and 4, are decisive predictive markers of early and late post-operative complications after CRS plus HIPEC. The presence of post-operative complications should be suspected in patients with a high CRP mean, and a plateau level (days 2–4).SCOPUS: ar.jinfo:eu-repo/semantics/publishe