Many surgical patients are taking regular cardiac medications and as a result, the perioperative management of cardiac medications poses challenges for anesthesiologists. Decisions must be made based on a risk-benefit analysis for each patient. In general, medications associated with known morbidity, if withdrawn abruptly, should be continued in the perioperative period. In contrast, medications that are thought to increase the risk of perioperative complications should be held. However, the lack of evidence is reflected by the large variation in perioperative management recommendations among anesthesiologists. This article focuses on cardiac medications known to have perioperative effects and also offers a guide to the perioperative management of cardiac management.
Humans ; Perioperative Period

No abstract available.
Magnesium ; Perioperative Period

No abstract available.
Magnesium ; Perioperative Period

Humans ; Pancreaticoduodenectomy ; Pathology, Clinical ; Perioperative Period ; Postoperative Period ; Preoperative Period

Pseudoaneurysm of the femoral artery is a rare complication following the fixation of the fracture of proximal femur or protruded bony fragment and reports injuring on superficial femoral artery is very rare compared to deep femoral artery complicated by the insertion of distal interlocking screw. The chance of injuring superficial femoral artery may increase by deep insertion of drill bit or the repetitive arterial pulsation on prominent distal interlocking screw tip during the perioperative period. Authors experienced one case of injury on the superficial femoral artery postoperative 42 hours followed by the use of proximal femoral nail advocated by the AO group recently and would like to call attention upon the possibilities of vessel injury complicated with the use of the distal interlocking screw.
Aneurysm, False* ; Femoral Artery* ; Femur ; Perioperative Period

The significant increase in the incidence of benign anal diseases is related to the fast-paced life style, the change of dietary structure, the increase of work pressure and social psychological factors. Surgery is one of the most important treatments for benign anal diseases, while perioperative defecation management is closely related to the efficacy of surgery. In current clinical practice, there is no consensus on the management of perioperative defecation for benign anal diseases. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the causes of perioperative defecation difficulties in perioperative anal benign diseases, the importance and specific strategy of defecation management. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.
Anal Canal/surgery* ; Anus Diseases/surgery* ; China ; Consensus ; Defecation ; Humans ; Perioperative Care ; Perioperative Period

Percutaneous endoscopic gastrostomy (PEG), which was first introduced in 1980, was quickly adopted for use in pediatric and adult patients. However, problems such as severe kyphoscoliosis, interposed organs, or other forms of distorted anatomy, may prevent effective and safe PEG tube placement. In such cases, laparoscopy-assisted PEG (LAPEG) is a useful optional procedure for patients with distorted anatomy and an initial unsuccessful PEG attempt. Furthermore, less invasive measures are preferable over surgical gastrostomy. We present a 27-year-old-male patient with severe kyphoscoliosis and a history of PEG-related complications with a colocutaneous fistula appearing 10 months earlier in whom a feeding tube was successfully placed by LAPEG. There were no LAPEG-related complications in the perioperative period, either technical or metabolic. After discharge, the patient was effectively fed using the bolus method.
Adult ; Endoscopy ; Fistula ; Gastrostomy* ; Humans ; Laparoscopy ; Perioperative Period

Stress-induced cardiomyopathy (SICM) presenting as an acute myocardial dysfunction is characterized by transient left ventricular wall motion abnormality, which has been known to be associated with excessive catecholamine production caused due to various types of stress. Sympathetic hyperactivity is common during the perioperative period, and reports of SICM occurring during this period have actually increased. We present a case of SICM following negative pressure pulmonary edema due to upper airway obstruction during emergence from anesthesia. Excessive catecholamine release in response to respiratory difficulty could have been the underlying inciting factor.
Airway Obstruction ; Anesthesia ; Cardiomyopathies ; Perioperative Period ; Pulmonary Edema

Although anaphylactic shock during the perioperative period is rare, it can be lethal due to severe cardiovascular and respiratory collapse. Midazolam is generally used as premedication for relieving anxiety about the operation, and the danger of anaphylactic shock after intramuscular injection is not widely recognized. We report the first case of anaphylactic shock occurring during the perioperative period after intramuscular injection of midazolam. Since anaphylactic shock after intramuscular injection can be of slow onset, the operation should be delayed if an anaphylactic reaction is suspected, even if the symptoms are limited. In addition, anesthesiologists should be prepared for the occurrence of anaphylaxis at any time in the perioperative period.
Anaphylaxis* ; Anxiety ; Injections, Intramuscular* ; Midazolam* ; Perioperative Period* ; Premedication

PURPOSE: Endoscopic transnasal correction of the blowout fractures has many advantages over other techniques. But after removal of packing material, there were some patients with recurrence of preoperative symptoms. Authors tried to make a quantitative anterograde analysis of orbital volume change over whole perioperative period which might be related with recurrence of preoperative symptoms. METHODS: 10 patients with pure medial wall fracture(Group I) and 10 patients with medial wall fracture combined with fracture of orbital floor(Group II) were selected to evaluate the final orbital volume change with 3 CT scans, preoperatively, postoperatively and 4 months after packing removal. By multiplying cross-section area of orbit in coronal view with section thickness, orbital volume were calculated. Then, mean orbital volume increment after trauma, mean orbital volume decrement after endoscopic correction and volume increment after packing removal were found out. And we tried to find correlations between type of fracture, initial correction rate and final correction rate. RESULTS: The mean orbital volume increase of the fractured orbits were 7.23% in group I and 13.69% in group II. After endoscopic surgery, mean orbital volume decrease were 11.0% in group I and 12.46% in group II. Mean volume increase after packing removal showed 3.10% in group I and 6.50% in group II. The initial correction rate(%) showed linear correlation with final correction rate(%) after packing removal. And there were negative linear correlation between increment percentage of orbital volume by fracture and final correction rate(%). CONCLUSION: Orbital volume was proved to be increasing after removal of packing or foley catheter and it was dependent upon type of fracture. Overcorrection should be done to improve the final result of orbital blowout fracture especially when severe fracture is present.
Catheters ; Endoscopy ; Humans ; Orbit ; Orbital Fractures ; Perioperative Period ; Recurrence