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简介：AbstractThe contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery. Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care. Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients. The many areas of potential variability in the pre, intra and post-operative timeline of pituitary surgery are readily identifiable. Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.

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简介：AbstractObjective:Management of postoperative pain after head and neck cancer surgery is a complex issue, requiring a careful balance of analgesic properties and side effects. The objective of this review is to discuss the efficacy and safety of multimodal analgesia (MMA) for these patients.Methods:Pubmed, Cochrane, Embase, Scopus, and clinicaltrials.gov were systematically searched for all comparative studies of patients receiving MMA (nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, anticonvulsants, local anesthetics, and corticosteroids) for head and neck cancer surgeries. The primary outcome was additional postoperative opioid usage, and secondary outcomes included subjective pain scores, complications, adverse effects, and 30-day outcomes.Results:A total of five studies representing 592 patients (MMA, n = 275; non-MMA, n = 317) met inclusion criteria. The most commonly used agents were gabapentin, NSAIDs, and acetaminophen (n = 221), NSAIDs (n = 221), followed by corticosteroids (n = 35), dextromethorphan (n = 40), and local nerve block (n= 19). Four studies described a significant decrease in overall postoperative narcotic usage with two studies reporting a significant decrease in hospital time. Subjective pain scores widely varied with two studies reporting reduced pain at postoperative day 3. There were no differences in surgical outcomes, medical complications, adverse effects, or 30-day mortality and readmission rates.Conclusion:MMA is an increasingly popular strategy that may reduce dependence on opioids for the treatment of postoperative pain. A variety of regimens and protocols are available for providers to utilize in the appropriate head and neck cancer patient.

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简介：Cimetidine(CIM)isahistaminetype2receptorantagonistwidelyusedtotreatpepticulcers.Italsohasimportanteffectsontheimmunesystem.TheadministrationofCIMhasbeenfoundtopreserve,tosomedegree,patient’sperioperativeimmunecapability.']However,whethertheuseofCIMca...

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简介：AbstractPancreatic surgery contains several major procedures of pancreatectomy. Surgical trauma, severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients. Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up, including preoperative nutritional screening, perioperative nutrition assessment and intervention. The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery. However, few high-grade evidences have been published and controversy still exists. This review aims to reflect the current situation, consensus and controversy of perioperative nutrition management in pancreatic surgery, expecting to provide necessary guidance for clinical research and practice.

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简介：AbstractSince December 2019, a pneumonia caused by a new coronavirus, i.e. COVID-19 occurred in Wuhan, Hubei Province, China. Although the epidemic in China has been bought under control, the global COVID-19 situation is still grim. Severe traumatic brain injury (TBI), as one of critical conditions in the department of neurosurgery, requires an early and effective treatment, especially surgery. There were currently no reliable guidelines on how to perform perioperative protection in TBI patients with suspected or confirmed coronavirus infection. According to the corresponding treatment regulations and guidelines issued by the authorities, we summarized the management strategy of TBI patients in perioperative period during the COVID-19 outbreak based on medical and nursing practice, in order to provide a reference for clinicians.

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简介：AbstractBackground:Perioperative neurocognitive disorders (PND) are a series of severe complications in the perioperative and anesthetic periods with a decline in memory, execution ability, and information processing speed as the primary clinical manifestation. This study aimed to evaluate the impact of edaravone (EDA) on PND and peripheral blood C-X-C motif chemokine ligand 13 (CXCL13) levels in elderly patients with hip replacement.Methods:A total of 160 elderly patients undergoing hip arthroplasty in Affiliated Dongguan People’s Hospital of Southern Medical University (from March 2016 to March 2018) were randomly and double-blindly categorized into an EDA group and a control group (CON). Group EDA was administered intravenously EDA 30 min before surgery, and group CON was administered intravenously saline. The cognitive function of the two groups was evaluated 1-day before the operation and at 1 and 12 months after surgery, and the incidence of post-operative delirium was tested on days 1, 3, and 7 after surgery using the Chinese version of the confusion assessment method. Serum CXCL13 and interleukin (IL)-6 concentrations were measured before anesthesia, during surgery (30 min after skin incision), and on days 1, 3, and 7 after surgery. The continuous variables in accordance with normal distribution were tested using the Student’s t test, the continuous variables without normal distribution using the Mann-Whitney U test, and categorical variables by the χ2 test or Fisher exact test.Results:The incidence of post-operative delirium within 7 days after surgery was significantly higher in group CON than that in group EDA (31.3% vs. 15.0%, t=-5.6, P < 0.001). The modified telephone interview for cognitive status and activities of daily life scores were significantly higher in the group EDA than those in the group CON at 1 month (39.63 ± 4.35 vs. 33.63 ± 5.81, t = -2.13, P < 0.05 and 74.3 ± 12.6 vs. 61.2 ± 13.1, t = -1.69, P < 0.05) and 12 months (40.13 ± 5.93 vs. 34.13 ± 5.36, t = -3.37, P < 0.05 and 79.6 ± 11.7 vs. 65.6 ± 16.6, t= -2.08, P < 0.05) after surgery; and the incidence of neurocognitive dysfunction was significantly lower in the group EDA than that in the group CON (P < 0.05). Serum CXCL13 and IL-6 concentrations were significantly lower in the group EDA than those in the group CON during and after surgery (P < 0.05).Conclusion:EDA can significantly reduce the serum concentrations of CXCL13 and IL-6 and improve the PND of patients.

简介：Objective:Anti-angiogenicdrugsareanemergingtreatmentoptionagainstmalignanttumors.Theaimofthisstudywastodeterminewhethertheadditionofperioperativerh-endostatintochemotherapycouldimprovetheprobabilityofdistantmetastasis-freesurvival(DMFS)andoverallsurvival(OS)inpatientsnewlydiagnosedwithnon-metastaticconventionalosteosarcoma.Methods:Thiswasacontrollednon-randomizedclinicalstudythatincluded388patientswithoutclinicallydetectablemetastaticdiseaseenrolledfromJanuary2008toApril2012.Thecontroltreatmentgrouphad272patients;180weremaleand92,female,withamedianageof17years.Thetreatmentgrouphad58patients;36weremaleand22,female,withamedianageof16years.Thecontrolgroupreceivedpreoperativechemotherapyfollowedbysurgeryandpostoperativechemotherapy.Thetreatmentgroupreceived4cyclesofrh-endostatinperioperativelyinadditiontochemotherapyasperthecontrolgroup.Patientswerefollowedupfrom6-101monthswithamedianfollow-upperiodof50.2months.Results:The5-yearDMFSofthecontrolgroup(61%)wassignificantlylowerthanthatoftherh-endostatingroup(79%)(P=0.013).The5-yearOSofthecontrolgroup(74%)wassignificantlylowerthanthatoftherh-endostatintreatmentgroup(87%)(P=0.029).Nodifferenceinadversedrugreactionswasfoundbetweenthese2groups.Conclusions:Theadditionofperioperativerh-endostatintochemotherapycouldsignificantlyimprovetheDMFSandOSofpatientswithnon-metastaticosteosarcoma.

简介：BackgroundIntra-aorticballoonpump(IABP)hasbeenwidelyusedatpresent.Wecanuseitatdifferentstagesofperioperativeperiodinoff-pumpcoronaryarterybypassgrafting(CABG).However,whentouseditwasseldomconfirmed.MethodsFromJanuary2008toJune2012,the89coronaryheartdisease(CHD)patientsacceptedimplantationofIABPatdifferentstagesofoff-pumpCABG,preoperativeandpostoperativeventricularsystolicfunction,leftventricularremodelingsituationandthechangesofmyocardialenzymeswereevaluated.ResultsAllthepatientshadleftheartinsufficiencyandmultivesseldisease.TheirpostoperativeleftventricularsystolicfunctionandventricularremodelingweresignificantlyimprovedwhilemyocardialenzymesdecreasedwithpreoperativeinterventionalimplantationofIABP.Theperioperativemortalitywas7.86%(7/89).NopatientshadcomplicationofIABP.ConclusionEarlierIABPimplantationatpreoperationisusefultoimproveheartfunction,improvethetolerabilityofsurgery,reducetheincidenceofpostoperativelowcardiacoutputsyndrome(LCOS)anddecreasethemortality.

简介：摘要：经导管主动脉瓣膜置换术具有创伤性小、术后并发症和致死率较低的优势，因此该手术具有极高的治疗安全性，成为了治疗复杂高危的主动脉瓣狭窄患者的主要治疗手段，根据相关学者的研究，为复杂高危主动脉瓣狭窄患者实施经导管主动脉瓣膜置换术治疗后的情况进行随访调查，证实了该手术用于治疗的安全性和与有效性。为患者实施手术治疗的时候，需要帮助患者完善各项检查，通过多学科协同评估患者的机体状态，制定合理的治疗方案，并且为患者实施个性化的护理方案，改善患者的心肾功能。护理人员需要充分了解经导管主动脉瓣膜置换术的流程、注意事项和潜在的危险，检测患者的病情，为患者术后实施呼吸支持，维持体循环等手段，降低并发症发病率。