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Awake robotic liver surgery:A case report

World Journal of Gastrointestinal Surgery 2023年第12期15卷 2954-2961页

作者： Antonella Delvecchio Gaetano Pavone Maria Conticchio Claudia Piacente Miriam Varvara Valentina Ferraro Matteo Stasi Annachiara Casella Rosalinda Filippo Michele Tedeschi Carmine Pullano Riccardo Inchingolo Vito Delmonte Riccardo Memeo Unit of Hepato-Pancreatic-Biliary Surgery “F.Miulli”Regional General HospitalBari 70021Italy Unit of Anesthesia and Perioperative Medicine “F.Miulli”Regional General HospitalBari 70021Italy Villa Pia Hospital Rome 00151Italy Unit of Interventional Radiology “F.Miulli”Regional General HospitalBari 70021Italy

BACKGROUND In recent years,minimally invasive liver resection has become a standard of care for liver tumors.Considering the need to treat increasingly fragile patients,general anesthesia is sometimes avoided due to respiratory complications.Therefore,surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach.Epidural anesthesia has been shown to reduce respiratory complications,especially in elderly patients with pre-existing lung disease.CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma.The patient was suffering from hypertension,diabetes and chronic obstructive pulmonary disease.The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%.We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia.No modification of the standard surgical technique was necessary.Hemodynamics were stable and bleeding was minimal.The postoperative course was uneventful.CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.

关键词： Robotic surgery Awake surgery Liver resection frail patient Locoregional anesthesia Conscious sedation Case report

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Caregiver Burden in the Management of frail Elderly patients with Diabetes in Internal Medicine

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Health 2018年第10期10卷 1383-1391页

作者： Jose Miguel Segui Ripoll Vicente Jesús Segui Llinares Miguel J.Reig Pérez Carles García Cervera Juan Manuel Núnez Cruz Pedro Esteve Atiénzar Sara Banón Escandell Alberto López Serrano María Dolores Jover Ríos Juan Méndez Mora Carmen Segui Pérez María Josefa Navarro Navarro Pablo Roig Rico Department of Internal Medicine University Hospital of San JuanAlicanteSpain Department of Clinical Medicine Miguel Hernández UniversityElcheSpain Institute of Design and Manufacturing Polytechnic University of ValenciaCampus of AlcoyAlicanteSpain Department of Internal Medicine Hospital La Vega Baja of OrihuelaAlicanteSpain Secondary School Marist Brothers High SchoolAlicanteSpain Primary Medicine BenillobaSpain

Aim: Advanced age and fragility often lead to dependence, making caregiver assistance necessary for performing the activities of daily living. patients with diabetes are characterized by an elevated presence of comorbidities and subsequent frailty—a relevant consideration when making decisions regarding treatment goals. Health professionals may overlook the caregiver experience when assessing the circumstances surrounding frail elderly patients with diabetes, but this factor can have a large impact on relevant caregiver and patient outcomes. Methods: An observational, retrospective study was carried out to assess the impact of improved management in diabetes on caregiver burden. We assessed patients’ performance of activities of daily living using the Barthel scale. Our primary outcome was caregiver burden, as assessed using the Zarit scale. Results: At baseline, 81.4% of the caregivers reported severe overburden (>55 points on the Zarit scale). At three months, the proportion of caregivers reporting this level of burden had dropped to 76.7% and remained stable at six months (77.1%). In contrast, 8.5% of the caregivers reported moderate overburden (47 to 55 points) at baseline, compared to 13.3% at three months and 12.5% at six. The proportion of caregivers reporting no overburden (Conclusions: Caregiver burden remained persistently high, decreasing only slightly after six months.

关键词： Elderly Diabetes frail patient Overload Caregiver

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