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Non Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): Protocol for a single centre, pilot, randomised controlled trial

Non Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): Protocol for a single centre, pilot, randomised controlled trial

envelopes each containing an allocation card wrapped in aluminium foil. Allocation sequence is generated by a web-based computer program (http://www. randomizer. org/). Random allocation is stratified to planned postsur- gical destination (ICU and ward). One of the aims of this study is the feasibility of high-flow nasal oxygen therapy and NIV application. The ease of application could be biased towards it being more or less feasible in one loca- tion over another. Stratification ensures that there will be equal representation of participants at both locations. At our centre, historical data find that approximately 70% of high-risk upper abdominal surgery patients have a planned postoperative ICU admission. To manage this difference in location distribution, the total sample size of 130 is divided into two blocks with 90 in the ICU block and 40 in the ward block. The allocation sequence in each block is then determined in a 1:1 ratio, control and

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Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review

Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review

Methods/Design: A systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence.

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Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study

Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study

We used the cut-offs suggested by Martin et al. and found a significant association between sarcopenia and improved overall survival in the unadjusted analysis, but not in the multivariable adjusted analysis. We find it un- likely that sarcopenic patients have improved overall sur- vival following major upper abdominal surgery. There was no significant association when L3 Skeletal muscle index was analyzed as a continuous variable, nor was there any difference in five-year mortality between the different quartile categories of L3 SMI index. We suggest that this exemplifies the known hazards of using a dichot- omous variable in a heterogeneous cohort of patients [30]. We have indeed presented preoperative weight loss and serum-albumin as dichotomous variables, but the associ- ation between these variables and overall survival was con- firmed when analyzed as continuous variables. No cut-off values were applied when analyzing L3 VAT and L3 SAT indices. There was no association between these continu- ous variables and survival and to our knowledge, no cut- off values are established.

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Comparison of Nalbuphine with 0.125% Bupivacaine and Plain 0.125% Bupivacaine in Thoracic Epidural for Post Operative Analgesia in Upper Abdominal Surgery

Comparison of Nalbuphine with 0.125% Bupivacaine and Plain 0.125% Bupivacaine in Thoracic Epidural for Post Operative Analgesia in Upper Abdominal Surgery

Weksler N, Ovadia L et al, compared the use of Nalbuphine (0.15 mg/kg) and an equipotent dose of Morphine (0.1 mg/kg) in epidural analgesia in 45 patients undergoing upper abdominal surgery. Analgesic efficacy was found to be excellent in both groups with longer duration of analgesia in Morphine group (6.30±2.15 hrs vs 16.40±5.50 hrs), besides drowsiness, other significant side effects as respiratory depression were less in Nalbuphine group than with Morphine.

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Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature

Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature

(Bismuth I, IV, V), which occurred following three different upper abdominal surgical procedures and were very diffi- cult to manage. Complex BDIs represent complete bile duct transections with or without loss of biliary tissue. In such cases, typically classified according to the Bismuth- Strasberg classification (Fig. 1) [3, 4], no endoscopic and/or radiological therapy is feasible and the patients require sur- gical remedies [5]. These patients must be managed in ter- tiary hepatobiliary (HPB) centres where surgical expertise and experience in managing such injuries exist. Repair of BDI are at times also possible during the index surgery. However a majority of BDIs; approximately 75–80%, are not recognized at the time of cholecystectomy [6–8]. A specialist hepatobiliary surgeon is also usually not available on call for an immediate on-table repair of the injury. Therefore, early transfer of patients to a specialized HPB unit once the diagnosis of a BDI is recommended [9–12]. This has been shown to improve outcome, reduce morbid- ity, duration of hospital stay and costs [9–13]. A delayed diagnosis of BDI resulted in very complicated postoperative course, long hospital stay and poor quality of life for a long period of time in each of our patients. All efforts should therefore be made to diagnose and manage a biliary com- plication early by an experienced hepatobiliary team.

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Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial

Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial

Patients were randomly allocated into two groups by computer- generated random numbers. Group D patients received 50  μg dexmedetomidine with 10 ml of 0.125% bupivacaine via thoracic epidural catheter after induction of anaesthesia. Postoperatively, the patients used PCEA, each 1  ml containing 1  μg of dexmedetomidine in 0.125% bupivacaine. Group F patients received 50 μg fentanyl in addition to 10 ml 0.125% bupivacaine via thoracic epidural catheter during the intraoperative period, and the PCEA with each 1  ml containing 1  μg of fentanyl in 0.125% bupivacaine, postoperatively. The patients as well as the anaesthesiologist involved in the perioperative management and data collection were blinded to the group assignment. The patients underwent preoperative anaesthesia assessment on the previous evening and were premedicated with alprazolam 0.5 mg and ranitidine 150 mg orally the evening before and at 6:00 am on the morning of surgery. Inside the operating theatre routine monitors were attached and baseline readings of heart rate, non-invasive blood pressure (NIBP) and oxygen saturation (SpO 2 ) were taken. A thoracic epidural catheter was inserted at the T8–T9 or T9–T10 intervertebral space, with the patient in the sitting position with standard aseptic precautions using an 18-G Tuohy needle via a midline approach with a loss of resistance method. A test dose of 3  ml of 2% lignocaine with 1:200 000 adrenaline was given.

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Evaluation of Effect of Epidural Anaesthesia on Pulmonary Functions in Patients Undergoing Upper Abdominal Surgery Under General Anaesthesia: A Comparative Study on 82 Patients

Evaluation of Effect of Epidural Anaesthesia on Pulmonary Functions in Patients Undergoing Upper Abdominal Surgery Under General Anaesthesia: A Comparative Study on 82 Patients

Postoperative respiratory dysfunction is universally observed after abdominal and thoracic surgery. Abnormalities that contributes to reduced lung volume and hypoxaemia in postoperative period include impaired central ventilatory control, abnormal pulmonary mechanics due to limited abdominal, intercostals, and diaphragmatic muscle contraction and changes in pulmonary circulation and gas exchange. These abnormalities are due not only to sequele of operation itself, such as tissue injury or pain, but also to residual effects of anaesthesia and analgesia.

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EFFICACY OF ORAL CLONIDINE VERSUS DIAZEPAM AS A PREMEDICATION AND AS AN ADJUNCT TO GENERAL ANESTHESIA IN SELECTIVE UPPER ABDOMINAL SURGERY

EFFICACY OF ORAL CLONIDINE VERSUS DIAZEPAM AS A PREMEDICATION AND AS AN ADJUNCT TO GENERAL ANESTHESIA IN SELECTIVE UPPER ABDOMINAL SURGERY

Maintenance of anaesthesia in both groups included a balanced anaesthetic of nitrous oxides, oxygen and isoflurane.No additional doses of narcotics were given. The heart rate and blood pressure were noted every 5 minutes for 1 hour and every 10 minutes till the end of anaesthesia. If the blood pressure increased more than 30% of baseline, the inspired concentration of isoflurane from the flutec vaporizer was increased to 1%. The amount of fluids administered was recorded. At the end of surgery the neuromuscular blockade was reversed with atropine and neostigmine.

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EFFICACY OF ORAL CLONIDINE VERSUS DIAZEPAM AS A PREMEDICATION AND AS AN ADJUNCT TO GENERAL ANESTHESIA IN SELECTIVE UPPER ABDOMINAL SURGERY

EFFICACY OF ORAL CLONIDINE VERSUS DIAZEPAM AS A PREMEDICATION AND AS AN ADJUNCT TO GENERAL ANESTHESIA IN SELECTIVE UPPER ABDOMINAL SURGERY

Maintenance of anaesthesia in both groups included a balanced anaesthetic of nitrous oxides, oxygen and isoflurane.No additional doses of narcotics were given. The heart rate and blood pressure were noted every 5 minutes for 1 hour and every 10 minutes till the end of anaesthesia. If the blood pressure increased more than 30% of baseline, the inspired concentration of isoflurane from the flutec vaporizer was increased to 1%. The amount of fluids administered was recorded. At the end of surgery the neuromuscular blockade was reversed with atropine and neostigmine.

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Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence

Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence

We recognize that decisions made regarding the compi- lation of this Delphi panel could limit the external validity of the algorithm [43]. However the decision to limit the panel to researchers in this field was deliberate because it was expected that these researcher clinicians would be well informed on the clinical decision making factors per- taining to the management of patients following abdom- inal surgery [44]. We recognize that this decision necessarily implies the potential of a vested discipline spe- cific interest in the prophylactic use of physiotherapy intervention. The inclusion of the trauma surgeon and the international profile of the panelists should alleviate some concerns. Secondly, the majority of reports published in this field over the past 10 years have focused on secondary synthesis of primary studies. This could explain the small number of researchers who qualified for participation. Finally, the sample was limited to researchers with a track record in the specific subject area. New researchers in this specific area of interest were therefore not included. These decisions are in line with current recommendations for Delphi panel composition [43,44].

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Efficacy of Interpleural Analgesia in reducing Postoperative Pain and Parenteral Analgesic requirement in Patients undergoing Upper Abdominal Surgery

Efficacy of Interpleural Analgesia in reducing Postoperative Pain and Parenteral Analgesic requirement in Patients undergoing Upper Abdominal Surgery

After approval from local ethics committee and written informed consent 36 patients undergoing elective upper abdominal surgeries like open cholecystectomy, nephrectomy , pyelolithotomy and pyeloplasty at Government General Hospital, Chennai were enrolled in the study. The inclusion criteria were age 19 to 65 years ASA physical status 1 & 2 with no contraindications for the technique and drugs. These include pleural injury, pleural adhesion, fibrosis or effusion, COPD, local infection, bleeding diathesis and allergy to study drugs. The linear visual analog scales (VAS) were explained to the patients prior to the study.

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Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial

Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial

representative of the variety of public hospitals in developed countries; a small rural hospital, a medium sized regional tertiary referral hospital, and a large major metropolitan university affiliated hospital. Given this, our cohort is closely representative of the heterogeneous population having upper abdominal surgery. To further promote generalisability of results the intervention was delivered by physiotherapists of varying grades of experience and conducted within an environment reflective of modern perioperative practice where patients attend an outpatient assessment clinic weeks before surgery rather than admission the day before surgery. Assessors, postoperative physiotherapists, and participants were masked to group allocation. To our knowledge we are one of few trials to assess the success of masking (see appendix). We also recorded most known perioperative confounders, including preoperative functional status, intraoperative fluid administered, transfusions, ventilation strategies, and postoperative analgesia and antibiotic management, and we adjusted the results for baseline imbalances in variables known to influence PPCs. To establish efficacy of preoperative education alone, we standardised early mobilisation and successfully removed all postoperative chest physiotherapy modalities.

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The LIPPSMAck POP (Lung Infection Prevention Post Surgery   Major Abdominal   with Pre Operative Physiotherapy) trial: study protocol for a multi centre randomised controlled trial

The LIPPSMAck POP (Lung Infection Prevention Post Surgery Major Abdominal with Pre Operative Physiotherapy) trial: study protocol for a multi centre randomised controlled trial

Methods/design: The Lung Infection Prevention Post Surgery - Major Abdominal- with Pre-Operative Physiotherapy (LIPPSMAck POP) trial is a pragmatic, investigator-initiated, bi-national, multi-centre, patient- and assessor-blinded, parallel group, randomised controlled trial, powered for superiority. Four hundred and forty-one patients scheduled for elective open upper abdominal surgery at two Australian and one New Zealand hospital will be randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet, plus one additional pre-operative physiotherapy education and training session. The primary outcome is respiratory complication incidence using standardised diagnostic criteria. Secondary outcomes include hospital length of stay and costs, pneumonia diagnosis, intensive care unit readmission and length of stay, days/h to mobilise >1 min and >10 min, and, at 6 weeks post-surgery, patient reported complications, health-related quality of life, and physical capacity.

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A COMPARATIVE STUDY BETWEEN TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK AND OBLIQUE SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK FOR ANALGESIA FOLLOWING UPPER ABDOMINAL SURGERIES

A COMPARATIVE STUDY BETWEEN TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK AND OBLIQUE SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK FOR ANALGESIA FOLLOWING UPPER ABDOMINAL SURGERIES

Background: Ultrasound (US)-guided transmuscular quadratus lumborum (TQL) block and oblique subcostal transversus abdominis plane (OSTAP) block are components of multimodal analgesia for abdominal surgeries. The aim of the study is to compare the analgesic efficacy of US-guided TQL block versus US-guided OSTAP block after upper abdominal surgeries. Methods: This prospective randomized study was conducted on 40 patients scheduled for elective open upper abdominal surgery under general anesthesia. Patients were randomly allocated into 2 groups; OSTAP Group (20 patients) received US-guided OSTAP block, and TQL Group (20 patients) received US- guided TQL block. At the end of surgical procedure, while patients were still under general anesthesia, each group received 30 mL bupivacaine 0.25%. Postoperative measurements included pain scores, time to first opioid analgesic request, postoperative total opioid consumption, patient satisfaction, and complications.

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Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications

Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications

Patients and methods: We reviewed the medical records of COPD patients who under- went preoperative spirometry between April and August 2013 at a tertiary hospital in Korea. We divided the patients into GOLD groups according to the results of spirometry and self-administered questionnaires that assessed the symptom severity and exacerbation history. GOLD groups, demographic characteristics, and operative conditions were analyzed. Results: Among a total of 405 COPD patients, 70 (17.3%) patients experienced various post- operative complications, including infection, wound, or pulmonary complications. Thoracic surgery, upper abdominal surgery, general anesthesia, large estimated blood loss during surgery, and longer anesthesia time were significant risk factors for postoperative complications. Patients in high-risk group (GOLD groups C or D) had an increased risk of postoperative complications compared to those in low-risk group (GOLD groups A or B).

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Leakage of albumin in major abdominal surgery

Leakage of albumin in major abdominal surgery

Although albumin extravasation might promote edema and weight gain, there is no evidence as yet that this is actually the case, nor that it is important for patient out- come. In contrast, a low P-alb on the first postoperative day has been demonstrated to be an important risk factor after major abdominal surgery [10, 11]. Many fac- tors might contribute to postoperative weight gain, such as the degree of inflammation, differences in the surgical trauma, high- or low-risk anastomoses to the pancreas, effects of epidural block, and so forth. In our pragmatic pilot study protocol, infusions of albumin and crystalloids were given at the discretion of the attending doctors, rather than following a strict study protocol criteria. Therefore, it is not surprising that a correlation between cumulative albumin shift and fluid balance or weight gain could not be demonstrated in our group of patients.

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Techniques in Hand & Upper Extremity Surgery

Techniques in Hand & Upper Extremity Surgery

Patient position is supine with arm tourniquet inflated up to physiological pressure around 80 - 100 mmHg. Local an aesthesia marcaine 0.25% with 1:200.000 adrenaline is infiltrated around skin incision. The PT tendon is approached through a straight skin incision on the upper lateral aspect of the forearm, and its attachment to the radial shaft could be traced underneath the brachioradialis (BR) muscle from the volar aspect. An amount of radial periosteum is usually raised with the PT tendon.

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Advances in abdominal access for laparoscopic surgery: a review

Advances in abdominal access for laparoscopic surgery: a review

Several steps have been recommended in the literature in order to double check the correct placement of the Veress needle. To start, a 10 cc syringe containing sterile saline is connected to the Luer lock of the needle. The needle is aspirated to inspect for blood, bowel content, or urine. Then, 5 cc of sterile saline can be injected into the peritoneal cavity. This should flow without resistance, and ideally does not reaccumulate within the syringe if reaspiration is attempted. Next, the “drop test” is performed by detaching the syringe and instilling a drop of water at the end of the Luer lock. The drop of water should disappear rapidly if the needle is in the correct location. Finally, the needle should be freely mobile within the abdominal cavity, allowing for further advancement without appreciable resistance. 3

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Adequacy and quality of abdominal echographies requested by primary care professionals

Adequacy and quality of abdominal echographies requested by primary care professionals

We are therefore before an important problem since abdominal echography is a very advantageous examina- tion because of its innocuousness, low cost and diagnos- tic reliability. These advantages have led to increasing requests for abdominal echographies in primary care with the consequent rise in pressure on the radiodiag- nostic departments. The importance of this project lies in determining whether the professionals in our refer- ence area remit abdominal echographies well. On the other hand, it is also important to determine whether these requests are adequate or not. With the aim of establishing the latter, a work group will be created among general practitioners, gastroenterologists and radiologists. The results of this consensus and according to the results obtained we aim to create a guideline of recommendations to define the reasons and adequacy of abdominal echography and thereby avoid the undertak- ing of unnecessary tests, reduce costs and avoid over- crowding of the departments of radiodiagnosis.

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TachoSil use in abdominal surgery: a review

TachoSil use in abdominal surgery: a review

and human fibrinogen. The clinical efficacy of TachoSil was shown firstly by a clinical study of hepatic surgery. In the study, TachoSil proved to be superior to argon beamer in obtaining effective and fast intraoperative hemostasis. Following the study, many applications in different fields of surgery have been reported in the literature. The use of TachoSil in open abdominal surgery and its relevant results have encouraged the use of TachoSil in laparoscopic surgery. Unfortunately, its use in laparoscopy has not become as popular as it is in open surgery, due to a lack of efficacious techniques. Immunologic reactions to compounds of TachoSil and the transmission of infectious diseases are two major risks concerning topical hemostasis. Even though the risk of severe immunologic reactions to bovine material is low, TachoSil has gradu- ally replaced all bovine material with material of human origin and has therefore eliminated the associated risks of bovine material. TachoSil has a good satisfaction rate among surgeons and reduces both the operating time for patients and the time spent in intensive care units. Keywords: TachoSil, abdominal surgery, hemostasis

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