Preoperative Period

Low-cost telemedicine is a viable and secure tool for preoperative evaluation of surgical mission patients. It increases efficiency and optimizes the use of existing resources. More specifically, it helps ensure an accurate assessment of patients before the surgical team arrives, reduces on-site prescreening time, and decreases the number of surgical candidates on the waiting list. Routine use of telemedicine in surgical missions most likely would reduce preoperative times and the number of operations canceled at the last minute. Moreover, it may be effectively used for long-term follow-up care, including the management of any postoperative complications.

There are various opinions regarding the factors motivating women to undergo breast augmentation. The aim of this study was to estimate motivation for augmentation mammaplasty (AM), self-esteem and body image perception in breast augmentation patients. This prospective study involved AM patients operated in the Clinical Center of Vojvodina during a 3-year period. A total of 45 patients responded to our package of questionnaires designed to assess motivation for surgery, self-esteem level and body image perception. Those patients were compared to the control group of women who did not want to change their breast size, and who were similar in their age, social status and education level. Our package of questionnaires included a general questionnaire, Photographic Figure Rating Scale (PFRS) and Rosenberg's Self-Esteem Scale. Differences in marital status, educational level, habitation and employment status were statistically insignificant, but there was a significantly lower body m...

The aim of this study was to describe the associations among pain, disability and psychosocial factors preoperatively as well as 3 and 24 months later for patients who undergo first time discectomy and to analyse the predictive value of psychosocial factors on the outcome 24 months after surgery. Fifty-nine patients, 41 % women, with a mean age of 40 years and without comorbidities were included, of whom 56 responded to the 24-month follow-up; at that point, they were divided into patients with complaints (C, n = 36) and patients without complaints (NC, n = 20). Correlations among the pain intensity, disability and psychosocial factors were analysed preoperatively, 3 and 24 months after discectomy, and regression analyses of psychosocial factors on the outcome at 24 months were performed. Psychosocial variables were weakly correlated with the pain intensity and disability preoperatively. High expectations on the return to work were predictive of both pain intensity (β = 8.0, p = 0.03) and disability (β = 9.1, p < 0.001) at 24 months. Associations between psychosocial variables and outcome variables were strengthened at the 3-month follow-up in the C group, and this association remained 24 months after surgery. Fear of movement was most strongly correlated with leg pain intensity (r (s) 0.64, p < 0.001) and the ability to decrease pain was the most correlated with disability (r (s) 0.78, p < 0.001). Having high expectations on the return to work after surgery was the strongest predictor for a favourable outcome. Therefore, low preoperative expectations on return to work convey an important prognostic signal.

The Guidelines to the Practice of Anesthesia Revised Edition 2011 (the guidelines) were prepared by the Canadian Anesthesiologists’ Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. Whereas previous versions of the guidelines appeared as special supplements to the Canadian Journal of Anesthesia (the Journal), this edition of the guidelines is published within the Journal. This allows for improved archiving and online access to complement the printed version—a new offering for CAS members and Journal subscribers. The Guidelines to the Practice of Anesthesia Revised Edition 2011 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her own professional judgement in determining the proper course of action for any patient’s circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia. Le Guide d’exercice de l’anesthésie, version révisée 2011 (le guide), a été préparé par la Société canadienne des anesthésiologistes (SCA), qui se réserve le droit de décider des termes de sa publication et de sa diffusion. Le guide étant soumis à révision, des versions mises à jour sont publiées chaque année. Alors que les versions précédentes du guide étaient publiées comme suppléments spéciaux du Journal canadien d’anesthésie (le Journal), cette édition du guide est publiée dans le Journal. Cette modification permet un archivage plus efficace ainsi qu’un accès en ligne pour compléter la version imprimée, une nouvelle offre aux membres de la SCA et aux abonnés au Journal. Le Guide d’exercice de l’anesthésie, version révisée 2011, remplace toutes les versions précédemment publiées de ce document. La SCA incite les anesthésiologistes du Canada à se conformer à son guide d’exercice pour assurer une grande qualité des soins dispensés aux patients, mais elle ne peut garantir les résultats d’une intervention. Chaque anesthésiologiste doit exercer son jugement professionnel pour déterminer la méthode d’intervention la mieux adaptée à l’état du patient. La SCA n’accepte aucune responsabilité de quelque nature que ce soit découlant d’erreurs ou d’omissions ou de l’utilisation des renseignements contenus dans son Guide d’exercice de l’anesthésie.

Many enterocutaneous fistulas (ECF) require operative treatment. Despite recent advances, rates of recurrence have not changed substantially. This study aims to determine factors associated with recurrence and mortality in patients submitted to surgical repair of ECF. Consecutive patients submitted to surgical repair of ECF during a 5-year period were studied. Several patient, disease, and operative variables were assessed as factors related to recurrence and mortality through univariate and multivariate analysis. There were 35 male and 36 female patients. Median age was 52 years (range, 17-81). ECF recurred in 22 patients (31%), 18 of them (82%) eventually closed with medical and/or surgical treatment. Univariate analyses disclosed noncolonic ECF origin (p = 0.04), high output (p = 0.001), and nonresective surgical options (p = 0.02) as risk factors for recurrence; the latter two remained significant after multivariate analyses. A total of 14 patients died (20%). Univariate analyse...

Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six ...