Preoperative assessment of cardiac risk and perioperative cardiac management in noncardiac surgery.
Int J Surg. 2011;9(1):23-8
Authors: Arora V, Velanovich V, Alarcon W
More than 27 million Americans undergo noncardiac…

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The value of pre-operative magnetic resonance cholangiopancreatography (MRCP) in management of patients with gall stones.

Int J Surg. 2010;8(5):342-5

Authors: Bahram M, Gaballa G

OBJECTIVE: To analyze influence of pre-operative MRCP on the management of patients with gall stones. PATIENTS & METHODS: This prospective randomized study was carried on 250 patients who underwent laparoscopic cholecystectomy within 3 years. In group I, pre-operative MRCP was performed in 125 patients with age range of 18-62 years. Group II included 125 patients managed by laparoscopic cholecystectomy without doing pre-operative MRCP with age range of 21-65 years. RESULTS: In group I; pre-operative MRCP screening revealed clinically silent CBD stones in 5 patients (4%), accessory cystic duct in 2 (1.6%), abnormal insertion of cystic duct in 1 (0.8%). Postoperatively, bile duct injury was inflected in 1 patient in group I. On the other hand, there were 2 patients with bile duct injury and 5 patients with residual stones in group II. There was a statistically significant increase of post-operative complications in group II (p <or= 0.5). CONCLUSIONS: MRCP is diagnostically useful in management of patients with gall stones prior to laparoscopic cholecystectomy and its routine use can reduce the incidence of post-operative complications.

PMID: 20450989 [PubMed - indexed for MEDLINE]

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Bowel preparation: comparing metabolic and electrolyte changes when using sodium phosphate/polyethylene glycol.

Int J Surg. 2010;8(5):356-8

Authors: Shapira Z, Feldman L, Lavy R, Weissgarten J, Haitov Z, Halevy A

BACKGROUND: Many patients with various types of colonic pathology undergo invasive procedures that require mechanical bowel preparation. The most commonly used medications for bowel preparation include phosphate-containing drugs which are low cost and enable this procedure to be performed in an outpatient setting, as opposed to other medications, such as polyethylene glycol. Recent studies have suggested that freely using phosphate-containing drugs might lead to renal function impairment in a small group of patients. Despite this, many surgeons still use these drugs to prepare their patients. We conducted a comparative study to check the side effects of phosphate-containing drugs compared to polyethylene glycol when used for bowel cleansing. METHODS: We conducted a double blind prospective randomized study that included 40 patients undergoing surgery for colonic pathology, all of whom underwent bowel cleansing (20 with sodium phosphate and 20 with polyethylene glycol). During the perioperative course, electrolyte parameters were collected from serum and urine and compared between the two groups of patients. RESULTS: Changes in electrolyte and metabolic parameters were shown in both groups, but more prominently in patients prepared with sodium phosphate. In addition, early signs of renal function impairment appeared in this group. The differences in metabolic and electrolyte changes between the two groups were statistically significant. CONCLUSIONS: On the basis of this study, we propose that the wide use of phosphate-containing drugs for colonic preparation might be dangerous for the specific group of patients that is prone to develop renal failure or electrolyte abnormalities.

PMID: 20457286 [PubMed - indexed for MEDLINE]

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Prevention of venous thromboembolism: improving practice in surgical patients.

Int J Surg. 2009 Feb;7(1):50-3

Authors: McKenna GS, Karthikesalingam A, Walsh SR, Tang TY, Quick CR

AIMS: Venous thromboembolism (VTE) is the most common preventable cause of hospital-related mortality. There are major inadequacies internationally in administering appropriate prophylaxis. Our initial aim was to show whether our local effectiveness of administration was equally poor. With local inadequacy confirmed, our second aim was to design, implement and evaluate the efficacy of a new VTE protocol nested within a surgical clerking proforma. METHODS: A pilot audit of the prescription and administration of enoxaparin and thromboembolic deterrent stockings for VTE prophylaxis in 51 acutely admitted surgical inpatients (Round 1) was performed against local guidelines derived from the American College of Chest Physicians (ACCP) criteria. The authors then designed and implemented a VTE prevention protocol incorporating risk assessment and decision support within a new clerking proforma for acute surgical admissions. Local practice was audited against the same criteria in Round 2, which comprised 60 consecutive acute surgical admissions in the same district general hospital. RESULTS: In the pilot study, only (19/51) 37% of subjects received appropriate VTE prophylaxis. Over half of patients were at high risk for VTE; 18/29 high risk patients and 4/10 medium risk patients were not adequately protected. Following implementation of the quality improvement intervention, (53/60) 88% of subjects received appropriate prophylaxis (p<0.001). CONCLUSIONS: Implementation of a VTE protocol as part of a clerking proforma for acute surgical admissions is a simple and effective way of ensuring that surgical patients receive appropriate thromboprophylaxis. A similar strategy could be employed to broaden the scope of the National Institute of Clinical Excellence (NICE) guidelines to address VTE prevention in all hospitalised patients.

PMID: 19027374 [PubMed - indexed for MEDLINE]

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