• Title/Summary/Keyword: Postoperative Management

Search Result 838, Processing Time 0.03 seconds

Surgical Management of Ventricular Septal Defect in Infancy (영아기의 심실중격결손에 대한 이라완전교정술과 단계교정술의 비교)

  • 김병호
    • Journal of Chest Surgery
    • /
    • v.27 no.1
    • /
    • pp.24-30
    • /
    • 1994
  • Eighteen infants with a large ventricular septal defect[VSD] underwent primary surgical repair from January 1986 to December 1992. Operation was done because of failure to thrive, medically intractable heart failure, recurrent pneumonia, increased pulmonary vascular resistance[PVR]. Four patients[22.2%] died in the early postoperative period. Relief of heart failure and normalization of growth and weight gain was evident in all survivor. There was no late postoperative death. The results of primary surgical repair of VSD in infancy are compared with those of palliative pulmonary artery banding[PAB] and of VSD closure after PAB. Twenty-seven patients with isolated VSD or with VSD associated with atrial septal defect, patent ductus arteriosus, or coarctation of the aorta underwent initial palliative PAB. There were 3 early postoperative deaths[11.1%]. Severe elevation of PVR persisted in two patients. Closure of VSD and pulmonary artery debanding was done in twenty patients, with 2 early postoperative deaths[10.0%]. Placement of the PAB too close to the pulmonary annulus necessitated trasannular patching in one patient, but any problem caused by migration of the band was not developed. It is concluded that primary surgical repair of VSD in infancy is reasonable and that PAB is indicated only for those patients less than 6 months old with a complicated defect or in an emergency situation.

  • PDF

Pharyngocutaneous Fistula which Occurred During Postoperative Radiotherapy in Larynx Cancer Patient with Dementia (치매가 있는 후두암 환자에서 술 후 방사선치료 중 발생한 인두피부누공)

  • Kim, Jung Jun;Kang, Ju Yong;Choi, Ik Joon;Lee, Myung-Chul
    • Korean Journal of Head & Neck Oncology
    • /
    • v.35 no.2
    • /
    • pp.51-55
    • /
    • 2019
  • Pharyngocutaneous fistula is a relatively common, but serious complication after pharyngeal or laryngeal cancer surgery. It can cause wound infection, longer hospitalization period and sometimes carotid artery rupture which can be fatal. Recently, we experienced a 63-year-old larynx cancer patient who had dementia and alcoholic liver cirrhosis for underlying diseases. He underwent total laryngectomy and both neck dissection, and pharyngocutaneous fistula occurred during postoperative radiotherapy. Pharyngocutaneous fistula during postoperative radiotherapy has not yet reported in the literature, and there are few reports about pre and postoperative management of dementia patient after head and neck cancer surgery. Therefore, we report this case with a brief review of literature.

Preservation of Facial Nerve Function Repaired by Using Fibrin Glue-Coated Collagen Fleece for a Totally Transected Facial Nerve during Vestibular Schwannoma Surgery

  • Choi, Kyung-Sik;Kim, Min-Su;Jang, Sung-Ho;Kim, Oh-Lyong
    • Journal of Korean Neurosurgical Society
    • /
    • v.55 no.4
    • /
    • pp.208-211
    • /
    • 2014
  • Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed.

Evidence for Differentiation of Colon Tissue Microbiota in Patients with and without Postoperative Hirschsprung's Associated Enterocolitis: A Pilot Study

  • Arbizu, Ricardo A.;Collins, David;Wilson, Robert C.;Alekseyenko, Alexander V.
    • Pediatric Gastroenterology, Hepatology & Nutrition
    • /
    • v.24 no.1
    • /
    • pp.30-37
    • /
    • 2021
  • Purpose: To investigate the differences in the colon microbiota composition of Hirschsprung's disease (HSCR) patients with and without a history of postoperative Hirschsprung's associated enterocolitis (HAEC). Methods: Colon tissue microbiota was characterized by bacterial deoxyribonucleic acid (DNA) extraction and 16S rDNA sequencing for taxonomic classification and comparison. Results: The sequence diversity richness within samples was significantly higher in samples from patients with a history of postoperative HAEC. We observed an increased relative abundance of the phyla Bacteroidetes, Firmicutes and Cyanobacteria in HAEC patients and Fusobacteria, Actinobacteria and Proteobacteria in HSCR patients and, an increased relative abundance of the genera Dolosigranulum, Roseouria and Streptococcus in HAEC patients and Propionibacterium and Delftia in HSCR patients. Conclusion: Our findings provide evidence that the colon tissue microbiota composition is different in HSCR patients with and without postoperative HAEC.

Development of the Nursing Practice Guidelines for Preventing Postoperative Pulmonary Complications using the Guideline Adaptation Process (수용개작방법을 활용한 전신마취 수술 후 폐합병증 예방 간호실무지침 개발)

  • Choi, Jin Ju;Kim, Hyeon Jeong;Kang, Hye Min;Chu, Hee Young;Kim, Kyeong Sug
    • Journal of Korean Clinical Nursing Research
    • /
    • v.27 no.2
    • /
    • pp.187-198
    • /
    • 2021
  • Purpose: This study aimed to develop an evidence-based nursing practice guideline for preventing postoperative pulmonary complications (PPCs). Methods: The guideline adaptation process was conducted through the 24 steps based on the guideline adaptation manual of Korean Hospital Nurses Association. Results: The newly developed guideline to prevent PPCs consisted of four domains and 30 recommendations. The number of recommendations in each domain was 7 for assessment of PPCs, 17 for nursing interventions to prevent PPCs after general anesthesia, 4 for education (intended for patients and medical staff), and 2 for monitoring and recording. Conclusion: The developed guidelines will contribute in standardization of nursing practice and PPCs prevention and management. We recommend the dissemination and utilization of these guidelines nationwide to improve the quality of postoperative pulmonary complication prevention.

Preoperative Anxiety and Postoperative Pain Related to Donation Spontaneity in Living Donors Undergoing Liver Transplantation (간 공여자의 자발성 여부에 따른 수술 전 불안과 수술 후 통증 비교 연구)

  • Bea, Seng-Sim;Lee, Hyang-Yeon;Lee, Kook-Hyun
    • Journal of East-West Nursing Research
    • /
    • v.15 no.2
    • /
    • pp.82-90
    • /
    • 2009
  • Purpose: The purpose of this study was to compare the degree of preoperative anxiety and postoperative pain among volunteer and non-volunteer donors in living liver transplantation. Methods: The 32 volunteer and 32 non-volunteer donors were recruited from a university hospital after obtaining research approval. The data were analyzed by $x^2$, t, ANOVA tests and Pearson's correlation coefficients using SPSS 12.0 program. Results: There were no significant differences in pre-operative anxiety between the two groups. However, the non-volunteer donors had significantly more severe pain for 3 post-operative days, measured by visual analogue scale (VAS) and non-verbal pain behavior scale (non-VPBS), compared to that of the volunteer donors. There was a significant correlation between preoperative state anxiety and postoperative non-VPBS score. Conclusions: These results showed that liver donors who belonged to the non-volunteer group needed much more active postoperative pain management and psychological support than the volunteer group.

Limbal Lensectomy with or without Anterior Vitrectomy for the Management of Lens Subluxation (비외상성 수정체이탈 환자에서 시행한 윤부 수정체절제술)

  • Chang, Ju-Hee;Cha, Soon-Cheol
    • Journal of Yeungnam Medical Science
    • /
    • v.24 no.2
    • /
    • pp.243-251
    • /
    • 2007
  • Purpose : This study was conducted to assess the surgical outcomes of limbal lensectomy with or without anterior vitrectomy for the management of lens subluxation. Materials and Methods : The medical records of 20 consecutive patients (33 eyes) with lens subluxation who had undergone limbal lensectomy with or without anterior vitrectomy from February 1999 to January 2004 were retrospectively reviewed. Results : All the patients, except one high axial myopic patient, were implanted with scleral sutured posterior chamber intraocular lens. We evaluated the preoperative, postoperative visual acuity and postoperative complications and compared the results in group I (limbal lensectomy with anterior vitrectomy, 27 eyes) to those in group II (limbal lensectomy without anterior vitrectomy, 6 eyes). The preoperative best-corrected visual acuity was 0.21 and postoperative best-corrected visual acuity was improved by 2 lines or more in all 27 eyes in group I, and in 5 eyes in group II (p>0.05). The most frequent postoperative complication was intraocular lens dislocation in four eyes (14.8%) in group I alone. No retinal detachment occurred in either group, even in patients with high myopia. Conclusion : Limbal lensectomy without anterior vitrectomy improved visual acuity similarly to limbal lensectomy with anterior vitrectomy without significant increase of postoperative complications. This results of this study suggest that anterior vitrectomy is not necessarily required for the management of lens subluxation.

  • PDF

The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study

  • Moon, Jee Youn;Choi, Sang Sik;Lee, Shin Young;Lee, Mi Kyung;Kim, Jung Eun;Lee, Ji Eun;Lee, So Hyun
    • The Korean Journal of Pain
    • /
    • v.29 no.2
    • /
    • pp.110-118
    • /
    • 2016
  • Background: Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug. The concomitant use of opioids and nefopam is believed to have many advantages over the administration of opioids alone for postoperative pain management. We conducted a randomized, double-blind study to determine the fentanyl-sparing effect of co-administration of nefopam with fentanyl for postoperative pain management via patient controlled analgesia (PCA). Methods: Ninety female patients who underwent laparoscopic total hysterectomy under general anesthesia were randomized into 3 groups, Group A, fentanyl $1,000{\mu}g$; Group B, fentanyl $500{\mu}g$ + nefopam 200 mg; and Group C, fentanyl $500{\mu}g$ + nefopam 400 mg, in a total volume of 100 ml PCA to be administered over the first 48 h postoperatively without basal infusion. The primary outcome was total fentanyl consumption during 48 h; secondary outcomes included pain scores and incidence of side effects. Results: Eighty-one patients were included in the analysis. The overall fentanyl-sparing effects of PCA with concomitant administration of nefopam during the first 48 h postoperatively were 54.5% in Group B and 48.9% group C. Fentanyl use was not significantly different between Groups B and C despite the difference in the nefopam dose. There were no differences among the three groups in terms of PCA-related side effects, although the overall sedation score of Group B was significantly lower than that of Group A. Conclusions: The concomitant administration of nefopam with fentanyl for postoperative pain management may allow reduction of fentanyl dose, thereby reducing the risk of opioid-related adverse effects.