Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included pati...Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.展开更多
Objective To investigate the risk factors for postoperative arytenoid dislocation. Methods From September 2003 to August 2013, the records of 16 patients with a history of postoperative arytenoid dislocation were revi...Objective To investigate the risk factors for postoperative arytenoid dislocation. Methods From September 2003 to August 2013, the records of 16 patients with a history of postoperative arytenoid dislocation were reviewed. Patients matched in terms of date and type of procedures were chosen as the controls(n=16). Recorded data for all patients were demographics, smoking status, alcoholic status, preoperative physical status, airway evaluation, intubation procedures, preoperative laboratory test results, anesthetic consumption and intensive care unit stay. For arytenoid dislocation cases, we further analyzed the incidences of the left and right arytenoid dislocation, and the outcomes of surgical repair and conservative treatment. Categorical variables were presented as frequencies and percentages, and were compared using the chi-squared test. Continuous variables were expressed as means±SD and compared using the Student's unpaired t-test. To determine the predictors of arytenoid dislocation, a logistic regression model was used for multivariate analysis. Results Sixteen patients with postoperative arytenoid dislocation were enrolled, with a median age of 52 years. Most postoperative arytenoid dislocation patients(15/16, 93.75%) received surgical repair, except one patient who recovered after conservative treatment. None of the postoperative arytenoid dislocation patients were smokers. Red blood cell(P=0.044) and hemoglobin(P=0.031) levels were significantly lower among arytenoid dislocation cases compared with the controls. Conclusions Non-smoking and anemic patients may be susceptible to postoperative arytenoid dislocation. However, neither of them was independent risk factor for postoperative arytenoid dislocation.展开更多
Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clini...Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.展开更多
BACKGROUND Factor XI(FXI)deficiency,also known as hemophilia C,is a rare bleeding disorder of unpredictable severity that correlates poorly with FXI coagulation activity.This often poses great challenges in perioperat...BACKGROUND Factor XI(FXI)deficiency,also known as hemophilia C,is a rare bleeding disorder of unpredictable severity that correlates poorly with FXI coagulation activity.This often poses great challenges in perioperative hemostatic management.Thromboelastography(TEG)is a method for testing blood coagulation using a viscoelastic hemostatic assay of whole blood to assess the overall coagulation status.Here,we present the successful application of intraoperative TEG monitoring in an FXI-deficient patient as an individualized blood transfusion strategy.CASE SUMMARY A 21-year-old male patient with FXI deficiency was scheduled to undergo reconstructive surgery for macrodactyly of the left foot under general anesthesia.To minimize his bleeding risk,he was scheduled to receive fresh frozen plasma(FFP)as an empirical prophylactic FXI replacement at a dose of 15-20 mL/kg body weight(900-1200 mL)before surgery.Subsequent FFP transfusion was to be adjusted according to surgical need.Instead,TEG assessment was used at the beginning and toward the end of his surgery.According to intraoperative TEG results,the normalization of coagulation function was achieved with an infusion of only 800 mL FFP,and blood loss was minimal.The patient showed an uneventful postoperative course and was discharged on postoperative day 8.CONCLUSION TEG can be readily applied in the intraoperative period to individualize transfusion needs in patients with rare inherited coagulopathy.展开更多
INTRODUCTION The “cannot intubate, cannot ventilate” situation although rare is a nightmare for anesthesiologists. Difficult airway is defined as difficult facemask or supraglottic airway （SGA） ventilation, diffic...INTRODUCTION The “cannot intubate, cannot ventilate” situation although rare is a nightmare for anesthesiologists. Difficult airway is defined as difficult facemask or supraglottic airway （SGA） ventilation, difficult SGA placement, laryngoscopy, tracheal intubation, or failed intubation. We presented three cases of difficult airway and their airway management.展开更多
For the three cases listed in this article, difficult airway was anticipated preoperatively. We described how we intubated, but it did not mean what we did was the best choice.
文摘Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.
文摘Objective To investigate the risk factors for postoperative arytenoid dislocation. Methods From September 2003 to August 2013, the records of 16 patients with a history of postoperative arytenoid dislocation were reviewed. Patients matched in terms of date and type of procedures were chosen as the controls(n=16). Recorded data for all patients were demographics, smoking status, alcoholic status, preoperative physical status, airway evaluation, intubation procedures, preoperative laboratory test results, anesthetic consumption and intensive care unit stay. For arytenoid dislocation cases, we further analyzed the incidences of the left and right arytenoid dislocation, and the outcomes of surgical repair and conservative treatment. Categorical variables were presented as frequencies and percentages, and were compared using the chi-squared test. Continuous variables were expressed as means±SD and compared using the Student's unpaired t-test. To determine the predictors of arytenoid dislocation, a logistic regression model was used for multivariate analysis. Results Sixteen patients with postoperative arytenoid dislocation were enrolled, with a median age of 52 years. Most postoperative arytenoid dislocation patients(15/16, 93.75%) received surgical repair, except one patient who recovered after conservative treatment. None of the postoperative arytenoid dislocation patients were smokers. Red blood cell(P=0.044) and hemoglobin(P=0.031) levels were significantly lower among arytenoid dislocation cases compared with the controls. Conclusions Non-smoking and anemic patients may be susceptible to postoperative arytenoid dislocation. However, neither of them was independent risk factor for postoperative arytenoid dislocation.
文摘Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.
基金Education Reform Project Foundation for the Central Universities of Peking Union Medical College,No.2020zlgc0105Training Programme Foundation for Excellent Talent in Dongcheng District of Beijing,No.2019DCTM-08Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences,No.2019XK320018.
文摘BACKGROUND Factor XI(FXI)deficiency,also known as hemophilia C,is a rare bleeding disorder of unpredictable severity that correlates poorly with FXI coagulation activity.This often poses great challenges in perioperative hemostatic management.Thromboelastography(TEG)is a method for testing blood coagulation using a viscoelastic hemostatic assay of whole blood to assess the overall coagulation status.Here,we present the successful application of intraoperative TEG monitoring in an FXI-deficient patient as an individualized blood transfusion strategy.CASE SUMMARY A 21-year-old male patient with FXI deficiency was scheduled to undergo reconstructive surgery for macrodactyly of the left foot under general anesthesia.To minimize his bleeding risk,he was scheduled to receive fresh frozen plasma(FFP)as an empirical prophylactic FXI replacement at a dose of 15-20 mL/kg body weight(900-1200 mL)before surgery.Subsequent FFP transfusion was to be adjusted according to surgical need.Instead,TEG assessment was used at the beginning and toward the end of his surgery.According to intraoperative TEG results,the normalization of coagulation function was achieved with an infusion of only 800 mL FFP,and blood loss was minimal.The patient showed an uneventful postoperative course and was discharged on postoperative day 8.CONCLUSION TEG can be readily applied in the intraoperative period to individualize transfusion needs in patients with rare inherited coagulopathy.
文摘INTRODUCTION The “cannot intubate, cannot ventilate” situation although rare is a nightmare for anesthesiologists. Difficult airway is defined as difficult facemask or supraglottic airway （SGA） ventilation, difficult SGA placement, laryngoscopy, tracheal intubation, or failed intubation. We presented three cases of difficult airway and their airway management.
文摘For the three cases listed in this article, difficult airway was anticipated preoperatively. We described how we intubated, but it did not mean what we did was the best choice.
