Introduction:Apart from the complexity of procedure and surgeon's experience, surgical complication rates depend on case definition and method of recording data. We prospectively evaluated the complications of laparoscopic nephrectomy (LN) in a current cohort of patients, graded on the modified Clavien–Dindo (CD) scale and compared them with historical cohorts.Methods:In the Institutional Review Board approved protocol, all patients undergoing LN over a 30-month were enrolled in the study. Clinical parameters, operative data, inhospital course, and 30-day follow-up were recorded prospectively in an electronic database by a resident who did not perform any of the surgeries. The complications were analyzed using the CD scale.Results:A total of 103 patients (age 14–80 years) underwent LN (30 radical, 73 simple) during the study period. Forty-three of these procedures were for inflammatory conditions (stone disease or tuberculosis). Six procedures were converted to open surgery due to vascular injury (2), bowel injury (1), and adhesions (3). There were 45 (46%) complications in the 97 procedures completed laparoscopically including 34 low-grade (CD grade 1, 2) and 11 high-grade (CD grade 3, 4) complications. There was no mortality. Complications were similar in patients undergoing surgery for inflammatory or noninflammatory conditions.Conclusions:LN continues to be associated with postoperative complications in 46% of cases. However, the complication rates appear to be higher than historical series, possibly due to the more rigorous case-definition and prospective recording.
Background: Onset of hemodynamic changes is often associated with procedures such as laryngoscopy and tracheal intubation. This poses an increased risk of fatality in high-risk patients with diseases such as cardiovascular diseases. Several attempts utilizing singular parameters have been used to combat this clinical manifestation. In this study, we have used a holistic approach, in combination with the pre-recommended parameters, to attenuate the pressor responses during the procedure. Subjects and Methods: Sixty adult patients were randomized into two groups, receiving two different doses of dexmedetomidine (0.5 µg or 1 µg) per kilogram of the bodyweight. In addition, the quality of the intubation was also assessed using the scoring system adapted from McNeil et al., 2000. Longitudinal monitoring of various physiological parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and O2 saturation (SpO2) was performed at four different time points during the procedure. Results: Our results revealed that dexmedetomidine administration results in a transient decrease in these parameters in the patients from both the groups, with more prominent effects in the Group I patients, received 1 µg/kg of dexmedetomidine. Moreover, at time-point T3 (60 sec after intubation), a transient increase was observed in almost all the tested parameters. The assessment of the intubating conditions revealed no significant differences among the groups. Conclusion: A higher dosage of dexmedetomidine (1 µg/kg) showed better management of hemodynamic responses during laryngoscopy and intubation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.