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. J Lipid Res. 1973;14(2):178-88. 27. Lindh A, Lindholm M, Holmquist L, Carlson LA. Time course for the changes of serum lipoproteins and apolipoprotein T concentrations after major surgical trauma in man. J Parenter Enter Nutr. 1986;10(3):265-73. 28. Gui D, Spada PL, Gaetano A De, Pacelli F. Hypocholesterolemia and risk of death in the critically ill surgical patient. Intensive Care Med. 1996;22(8):790-4. 29. Memiş D, Gursoy O, Tasdogan M, Süt N, Kurt I, M, et al. High C-reactive protein and low cholesterol levels are prognostic markers of survival in severe

REFERENCES 1. May JR, DiPiro JT, Sisley JF. (1987). Drug interactions in surgical patients. Am J Surg, 153(3):327-35. 2. Hasan SS, Lim KN, Anwar M, et al. (2012). Impact of pharmacists' intervention on identification and management of drug-drug interactions in an intensive care setting. Singapore Med J, 53(8):526-31. 3. Janković SM, Pejčić AV, Milosavljević MN, et al. (2018). Risk factors for potential drug-drug interactions in intensive care unit patients. J Crit Care, 43:1-6. 4. Kheshti R, Aalipour M, Namazi S. (2016). A comparison of five common drug

anesthesia combined with epidural block. Ann Nutr Metab. 2012; 61: 1-6 22. Srceva M et al. Effects of preoperatively given amino acid infusion on blood glucose and C-peptide levels in surgical patients. Physioacta. 2015; 9(1): 131-141. 23. Kee J, Baxter R, Smith R. Parenteral amino acid promotes anabolic action in rats. Amer.Journ of Physy. 1999: 277: 63-72. 24. Preisssig CM, Hansen I, Roerig P, et al. A protocolised approach to identify and manage hyperglycemia in a pediatric critical care. Pediatr Crit Care Med. 2008; 9: 582-8.

, in 2015 as many as 1967 patients underwent surgery at the Emergency Cito OK[6]. (Medical Records Prof. Dr. R. D Kandou Hospital Manado, 2015 in Friscilia, 2015). Preliminary studies obtained at the Grand Medistra Lubuk Pakam Hospital, from July to October 2016 showed that there were 2,538 patients who underwent operations, ranging from minor operations, moderate to large operations[7]. (Medical Record, 2016). The Influence of The Element Warmer of Intravenous Fluid in Increasing The Body Temperature on Post-Surgical Patients in The Recovery Room Grandmed

, van der Ploeg T, van Leeuwen PA, Houdijk AP. Preoperative nutrition status and postoperative outcome in elderly general surgery patients: A systematic review. JPEN J Parenter Enteral Nutr 2013;37:37-43. 8. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945-8. 9. Estivariz CF, Grifflth DP, Luo M, Szeszycki EE, Bazargan N, Dave N, et al. Efflcacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr 2008


The alarming spread of the novel Coronavirus necessitated the cessation of elective therapeutic procedures in most health-care facilities. This strategy has limited the spread of the virus, but with a huge socio-economic impact. For this reason, the resumption of elective surgery in the context of the coronavirus pandemic is a difficult, but necessary process. Addressing this delicate situation requires interdisciplinary collaboration, so as to ensure high quality medical care for all patients, with consideration to protection of the staff involved in the care of the surgical patient.


The aim of this study was to investigate the influence of general anesthesia on selected blood parameters in 53 surgical patients belonging to five ASA groups. The venous blood pH during the preoperative period was under physiological values only in the ASA V group of dogs. The lowest average values of pH levels were found in all ASA groups during the 30th minute of the surgical procedure. The pre-operative measurements revealed the average concentration of calcium in the blood serum below the physiological range in the groups with higher anesthetic risk, ASA III, IV and V. Most dogs with hypocalcemia during the whole monitored period were in the ASA III group (69.2%). After premedication and sedation a decrease in the concentration of calcium in all groups was observed, except for the ASA IV group. Changes in the concentration of calcium were significant in the ASA II group (P ≤ 0.01). Between the groups, there were no significant differences reported in calcium concentrations during the monitored period. The lowest average value of phosphorus concentration was recorded in the ASA III group and the highest in the ASA V group. In the postoperative period the increase in phosphorus concentrations was observed in all groups except ASA III. Acidaemia, hypocalcaemia and hyperphosphatemia may present a potential risk mostly in endangered animals, so additional monitoring of these parameters, along with commonly used anesthetic monitoring, is essential and might be significantly helpful.


Preoperative preparation is an important stage both for the patient who is to undergo a surgical intervention and for the medical staff. The way in which it is performed can influence the evolution of the healing process by avoiding a major complication: the surgical wound infection.

The study, conducted within the Department of General Surgery I of the Clinical Emergency County Hospital Galati, includes patients who underwent abdominal surgical interventions, from whom the batch of those who subsequently developed infections of the surgical wound was selected. For this purpose, the medical documents of the department were consulted, and a questionnaire with inclusion criteria regarding the patient, the surgical wound, as well as the medical care provided was applied at the same time.

76% of the patients with postoperative infections included in the study were emergency admittances in the general surgery department. The preoperative preparation of these patients was influenced by the necessity of immediate surgical intervention (32%), the preexisting pathology, with the predominance of gastric and intestinal pathology (40.35%), the predominant 3 and 4 anesthesia risk evaluation scores of the patients increasing the infection risk.

The appearance of the surgical wound infection is influenced by the preoperative preparation of the patient, thus being imperative the adoption of standardized protocols applicable both in the elective and the emergency surgery, while guaranteeing a fair management of the surgical patient.


Several studies demonstrated induction of anesthesia with different plasma target-controlled infusion (TCI) of propofol for LMA insertion. However, there has been no study to compare the standard bolus propofol induction with the effective site TCI for LMA insertion. Objective: Compare the efficacy of induction of anesthesia with propofol for LMA insertion between the effective-site TCI, using 6 μg/mL, and the standard bolus propofol dose of 2.5 mg/kg in elective surgical patients. Methods: A randomized, prospective, single-blinded, clinical study was used for this study. Seventy-eight unpremedicated patients, American Society of Anesthesiologists (ASA) physical status I and II undergoing elective surgical procedure were randomly allocated between two groups. Group 1 received the standard bolus propofol dose of 2.5 mg/kg. Group 2 received effective site TCI (Schnider model) dose of 6 μg/mL for LMA insertion. The hemodynamics and anesthetic depth (Bispectral index score) were monitored and recorded during and immediately after LMA insertion. The number of insertion attempted, insertion quality score, induction time, and propofol doses used were recorded and compared between groups. Results: The success rate of first insertion attempt was equal in both groups (92.3%). There was no significant hemodynamic response difference between the groups during pre-induction, induction, insertion, and post insertion period. The BIS score was significantly lower during post insertion period in group 1 (51.4+11.0) than group 2 (58.4+3.2) (p=0.013). The propofol doses in group 2 were significantly lower than in group 1 (110.6+14.8 vs. 153.5+21.5) (p <0.001). Patients in group 2 required significantly more induction time than group 1 (146.9+42.3 vs. 103.4+33.6 (p <0.001). Conclusion: Propofol induction with TCI provided equal success rate as compared with standard bolus propofol induction for LMA insertion and insertion quality score. TCI significantly lowered the propofol consumption when compared with the standard 2.5 mg/kg propofol dose.


Introduction: Bariatric surgery has amply demonstrated its benefit in the treatment of morbidly obese patients. After surgery, there is a progressive and significant decrease in weight in a high percentage of patients. Most comorbidities resolve, improving quality of life and increasing life expectancy.

Methods and Objective: The literature review is based on a 10-year or longer follow-up of patients who underwent various bariatric surgery procedures. The long-term weight loss results and the clinical impact were evaluated.

Results: The applied surgical techniques, including Rouxen-Y gastric Bypass (RYBG), Biliopancreatic Diversion, Scopinaro type (BPD), and Duodenal Switch (DS), have contributed to achieving very satisfactory long-term and sustainable weight loss results. According to the reviewed literature, the percentage of excessive BMI Loss (%EBMIL) for the various techniques was 67.9%, 70.7%, and 71.5% for RYGB, BPD, and DS, respectively. Patients undergoing BGYR have lost much more weight than non-surgical patients and can maintain long-term weight loss, reaching a Percentage of Excessive Weight Loss (%EWL) as high as 56.4% in 10 years. Patients who underwent Adjustable Gastric Band (AGB) presented with a %EWL of 45.9% in 10 years, but with very high re-operation rate range (8-78%). There are few studies in the literature on Laparoscopic Sleeve Gastrectomy, reporting weight loss results over ten years. According to the study carried out by Arman G. A., Himpens J., et al. isolated Laparoscopic Sleeve Gastrectomy (LGS) produced a satisfactory weight loss over ten years, reachingEBMIL of 62.5%. Amending LSG with a new surgical design with malabsorbtive component (in 25% of patients) increased the weight loss, achieving %EBMIL of 81.7%.The Vertical Band Gastroplasty technique resulted in EWL of 38.1 ± 28.8%, as shown by a mean follow-up of 17.3 years, with a high rate of re-operations and conversions.