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Tang X, Liang J, Tan D, Chen Q, Zhou C, Yang T, Liu H. Value of carotid corrected flow time or changes value of FTc could be more useful in predicting fluid responsiveness in patients undergoing robot-assisted gynecologic surgery: a prospective observational study. Front Med (Lausanne) 2024; 11:1387433. [PMID: 38638936 PMCID: PMC11024293 DOI: 10.3389/fmed.2024.1387433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background The aim of this study was to evaluate the ability of point-of-care Doppler ultrasound measurements of carotid corrected flow time and its changes induced by volume expansion to predict fluid responsiveness in patients undergoing robot-assisted gynecological surgery. Methods In this prospective study, carotid corrected flow time was measured using Doppler images of the common carotid artery before and after volume expansion. The stroke volume index at each time point was recorded using noninvasive cardiac output monitoring with MostCare. Of the 52 patients enrolled, 26 responded. Results The areas under the receiver operating characteristic curves of the carotid corrected flow time and changes in carotid corrected flow time induced by volume expansion were 0.82 and 0.67, respectively. Their optimal cut-off values were 357 and 19.5 ms, respectively. Conclusion Carotid corrected flow time was superior to changes in carotid corrected flow time induced by volume expansion for predicting fluid responsiveness in this population.
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Affiliation(s)
- Xixi Tang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jingqiu Liang
- Chongqing Cancer Multi-Omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Dongling Tan
- Department of Anesthesiology, People’s Hospital of Shizhu, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chengfu Zhou
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tingjun Yang
- Department of Anesthesiology, People’s Hospital of Shizhu, Chongqing, China
| | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
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Al-Badawi IA, Alomar O, Alsehaimi SO, Jamjoom MZ, Abdulmalik NA, Bukhari IA, Alyousef A, Alabdrabalamir S, Baradwan S, Sayasneh A, Alqarni SMS, Abu-Zaid A. Cardiovascular Mortality in Ovarian Cancer Patients: An Analysis of Patient Characteristics Using the SEER Database. Medicina (Kaunas) 2023; 59:1476. [PMID: 37629766 PMCID: PMC10456264 DOI: 10.3390/medicina59081476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Cardiovascular disease (CVD) is a major contributor to the high mortality rate among individuals with ovarian cancer. Nevertheless, there is limited understanding regarding the specific patient attributes that might impact the risk of CVD in this group. Materials and Methods: A retrospective cohort study was performed using the SEER database to analyze primary ovarian cancer cases from 2000 to 2019. Multivariable logistic regression analysis was employed to identify patient characteristics linked to cardiovascular mortality. Results: The cohort included 41,930 cases of patients who were alive, 54,829 cases of cancer-related deaths, 3003 cases of cardiovascular-related deaths, and 10,238 cases with other causes of death. Poorly differentiated cancer cells and distant metastasis were associated with a higher risk of cardiovascular mortality. Logistic regression analysis identified age, year of diagnosis, race, laterality, and staging as significant risk factors for cardiovascular cause of death. The risk of cardiovascular cause of death was lower in patients aged 31-60 and higher in those aged over 60 years old, and the risk also increased with a later year of diagnosis. Patients who were not white were at a higher risk of cardiovascular cause of death. Additionally, bilateral ovarian cancer and distant staging disease were linked to elevated risks of cardiovascular cause of death. Conclusion: Cardiovascular mortality is a significant concern in ovarian cancer patients, and several patient characteristics are associated with an increased risk. Our study suggests that targeted interventions to improve cardiovascular health in high-risk patients, such as those with comorbidities or an advanced stage at diagnosis, may improve survival in this population.
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Affiliation(s)
- Ismail Abdulrahman Al-Badawi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia (S.O.A.)
| | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia (S.O.A.)
| | - Saud Owaimer Alsehaimi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia (S.O.A.)
| | - Mohammed Ziad Jamjoom
- Department of Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia
| | - Nadia Ahmed Abdulmalik
- Department of Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia
| | - Ibtihal Abdulaziz Bukhari
- Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Abdullah Alyousef
- College of Medicine, Almaarefa University, Riyadh 11597, Saudi Arabia
| | | | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah 23431, Saudi Arabia
| | - Ahmad Sayasneh
- Faculty of Life Sciences & Medicine at Guy’s, The School of Life Course Sciences, King’s College London, London WC2R 2LS, UK;
- Department of Gynaecological Oncology, Guys’ and St Thomas’s NHS Foundation Trust, London SE1 7EH, UK
| | - Saad M. S. Alqarni
- Department of Obstetrics and Gynecology, Abha Maternity and Children’s Hospital, Abha 62562, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
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Kim J, Yang SJ, Kim DG, Han WK, Na JC. Robotic ureter reconstruction using the native ureter to treat long-segment ureteral stricture of the transplant kidney utilizing Indocyanine green: The first Korean experience. Investig Clin Urol 2023; 64:154-160. [PMID: 36882174 PMCID: PMC9995958 DOI: 10.4111/icu.20220364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Ureteral strictures are a common complication after kidney transplantation. Open reconstruction is preferred for long-segment ureteral strictures that cannot be resolved endoscopically; however, it is known to have the potential to fail. We report 2 successful cases of robotic reconstruction surgery of a transplant ureter using the native ureter with the aid of intraoperative Indocyanine green (ICG). MATERIALS AND METHODS Patients were placed in semi-lateral position. Using Da Vinci Xi, the transplant ureter was dissected, and the stricture site was identified. End-to-side anastomosis of the native ureter to the transplant ureter was performed. ICG was utilized to identify the course of the transplant ureter and confirm the vascularity of the native ureter. RESULTS Case 1: A 55-year-old female underwent renal transplantation at another hospital. She had recurrent febrile urinary tract infections (UTIs) and a ureteral stricture requiring percutaneous nephrostomy (PCN). The PCN and ureteral stent were removed successfully after surgery. The patient had only 1 febrile UTI episode after surgery. Case 2: A 56-year-old female underwent renal transplantation at another hospital. She had acute pyelonephritis 1-month post-transplantation, and a long-segment ureteral stricture was identified. She developed a UTI with anastomosis site leakage in the early postoperative period, which resolved with conservative treatment. The PCN and ureteral stent were removed 6 weeks after surgery. CONCLUSIONS Robotic surgery for managing long-segment ureteral stricture after kidney transplantation is safe and feasible. The use of ICG during surgery to identify the ureter course and its viability can improve the success.
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Affiliation(s)
- Jinu Kim
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Seok Jeong Yang
- Department of Surgery, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Deok Gie Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woong Kyu Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Joon Chae Na
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea.
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Geer KD. Reconsidering the Trendelenburg position during intradialytic hypotension. Nursing 2022; 52:41-44. [PMID: 35196283 DOI: 10.1097/01.nurse.0000820060.94663.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Intradialytic hypotension (IDH) is the most common complication that patients experience during hemodialysis. This article discusses IDH and its emergency management, focusing on Trendelenburg position, which may create more risks than benefits.
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Affiliation(s)
- Kristine D Geer
- Kristine D. Geer is an RN with the Rochester Regional Health System in New York, N.Y
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Vahdatpour CA, Ryan JJ, Zimmerman JM, MacCormick SJ, Palevsky HI, Alnuaimat H, Ataya A. Advanced airway management and respiratory care in decompensated pulmonary hypertension. Heart Fail Rev 2021; 27:1807-1817. [PMID: 34476657 PMCID: PMC8412384 DOI: 10.1007/s10741-021-10168-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 12/19/2022]
Abstract
Meticulous risk stratification is essential when considering intubation of a patient with decompensated pulmonary hypertension (dPH). It is paramount to understand both the pathophysiology of dPH (and associated right ventricular failure) and the complications related to a high-risk intubation before attempting the procedure. There are few recommendations in this area and the literature, guiding these recommendations, is limited to expert opinion and very few case reports/case series. This review will discuss the complex pathophysiology of dPH, the complications associated with intubation, the debates surrounding induction agents, and the available options for the intubation procedure, with specific emphasis on the emerging role for awake fiberoptic intubation. All patients should be evaluated for candidacy for veno-arterial extracorporeal membrane oxygen as a bridge to recovery, lung transplantation, or pulmonary endarterectomy prior to intubation. Only an experienced proceduralist who is both comfortable with high-risk intubations and the pathophysiology of dPH should perform these intubations.
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Affiliation(s)
- Cyrus A Vahdatpour
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, P.O Box 100225 JHMHC, Gainesville, FL, 32610-0225, USA.
| | - John J Ryan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Zimmerman
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Samuel J MacCormick
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Harold I Palevsky
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Hassan Alnuaimat
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, P.O Box 100225 JHMHC, Gainesville, FL, 32610-0225, USA
| | - Ali Ataya
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, P.O Box 100225 JHMHC, Gainesville, FL, 32610-0225, USA
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Chachula K, Lieb F, Hess F, Welter J, Graf N, Dullenkopf A. Non-invasive continuous blood pressure monitoring (ClearSight™ system) during shoulder surgery in the beach chair position: a prospective self-controlled study. BMC Anesthesiol 2020; 20:271. [PMID: 33099306 DOI: 10.1186/s12871-020-01185-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023] Open
Abstract
Background The beach chair position that is commonly used in shoulder surgery is associated with relative hypovolemia, which leads to a reduction in arterial blood pressure. The effects of patient positioning on the accuracy of non-invasive continuous blood pressure monitoring with the ClearSight™ system (CS-BP; Edwards Lifesciences, Irvine CA, USA) have not been studied extensively. Our research aim was to assess agreement levels between CS-BP measurements with traditional blood pressure monitoring techniques. Methods For this prospective self-controlled study, we included 20 consecutively treated adult patients undergoing elective shoulder surgery in the beach chair position. We performed Bland-Altman analyses to determine agreement levels between blood pressure values from CS-BP and standard non-invasive (NIBP) methods. Perioperative measurements were done in both the supine (as reference) and beach chair surgical positions. Additionally, we compared invasive blood pressure (IBP) measurements with both the non-invasive methods (CS-BP and NIBP) in a sub-group of patients (n = 10) who required arterial blood pressure monitoring. Results We analyzed 229 data points (116 supine, 113 beach chair) from the entire cohort; per patient measurements were based on surgical length (range 3–9 supine, 2–10 beach chair). The mean difference (±SD; 95% limits of agreement) in the mean arterial pressure (MAP) between CS-BP and NIBP was − 0.9 (±11.0; − 24.0–22.2) in the beach chair position and − 4.9 mmHg (±11.8; − 28.0–18.2) when supine. In the sub-group, the difference between CS-BP and IBP in the beach chair position was − 1.6 mmHg (±16.0; − 32.9–29.7) and − 2.8 mmHg (±15.3; − 32.8–27.1) in the supine position. Between NIBP and IBP, we detected a difference of 3.0 mmHg (±9.1; − 20.8–14.7) in the beach chair position, and 4.6 mmHg (±13.3; − 21.4–30.6) in the supine position. Conclusions We found clinically acceptable mean differences in MAP measurements between the ClearSight™ and non-invasive oscillometric blood pressure systems when patients were in either the supine or beach chair position. For all comparisons of the monitoring systems and surgical positions, the standard deviations and limits of agreement were wide. Trial registration This study was prospectively registered at the German Clinical Trial Register (www.DRKS.de; DRKS00013773). Registered 26/01/2018.
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Buhre W. [Anti-Trendelenburg, beach chair and the sequelae : Positioning and the cardiorespiratory system]. Anaesthesist 2019; 68:803-804. [PMID: 31802139 DOI: 10.1007/s00101-019-00678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- W Buhre
- Klinik für Anästhesiologie und Schmerzmedizin, Universitätskliniken Maastricht, P. Debeyelaan 75, 6202 AZ, Maastricht, Niederlande.
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