Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduct...Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduction of the da Vinci Xi robot related to positioning operating room equipment, patient access and chance for unintended patient contact are described.展开更多
Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemeti...Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.展开更多
The administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is often associated with significant intraoperative electrolyte changes. We retrospectively examined the pre-HIPEC and post-HIPEC intraoperative ...The administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is often associated with significant intraoperative electrolyte changes. We retrospectively examined the pre-HIPEC and post-HIPEC intraoperative basic metabolic panel (BMP) values of the 20 patients who underwent HIPEC at our institution between December 2009 and January 2012. For the five patients who underwent HIPEC with oxaliplatin in 5% dextrose in water (D5W), there were statistically significant changes between the pre- and post-HIPEC values of sodium (135 to 124 mmol/L), chloride (105 to 94 mmol/L), glucose (143 to 388 mg/dl) and sodium corrected for hyperglycemia (135 to 127 mmol/L). For the 14 patients who received HIPEC with mitomycin C in normal saline (NS), there were statistically significant changes in bicarbonate (24 to 21 meQ/L), blood urea nitrogen (BUN) (10 to 9 mg/dl) and glucose (158 to 134 mg/dl). The BMP changes for the one patient who received doxorubicin/cisplatin in peritoneal dialysate are reported separately.展开更多
文摘Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduction of the da Vinci Xi robot related to positioning operating room equipment, patient access and chance for unintended patient contact are described.
文摘Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.
文摘The administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is often associated with significant intraoperative electrolyte changes. We retrospectively examined the pre-HIPEC and post-HIPEC intraoperative basic metabolic panel (BMP) values of the 20 patients who underwent HIPEC at our institution between December 2009 and January 2012. For the five patients who underwent HIPEC with oxaliplatin in 5% dextrose in water (D5W), there were statistically significant changes between the pre- and post-HIPEC values of sodium (135 to 124 mmol/L), chloride (105 to 94 mmol/L), glucose (143 to 388 mg/dl) and sodium corrected for hyperglycemia (135 to 127 mmol/L). For the 14 patients who received HIPEC with mitomycin C in normal saline (NS), there were statistically significant changes in bicarbonate (24 to 21 meQ/L), blood urea nitrogen (BUN) (10 to 9 mg/dl) and glucose (158 to 134 mg/dl). The BMP changes for the one patient who received doxorubicin/cisplatin in peritoneal dialysate are reported separately.
