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PubMedDate not supplied

[Correlation between the effectiveness of premedication and neuroanatomic protection during surgery with NLA and the initial state of the autonomic nervous system].

The study was performed on 94 urological patients, aged 15 to 78 years, subjected to planned operations. The initial autonomic tone, autonomic reactivity, autonomic maintenance of the activity, ACTH and cortisol content have been investigated in the ward and in the operation room with concomitant premedication with pipolphen in combination with promedol and diazepam in combination with promedol. Tactile and pain thresholds were studied in patients on premedication in the ward and the operation room. It has been noted that positive effect of premedication, an increase in the pain threshold and adequate neuroautonomic protection do not only depend on the presence or absence of diazepam in premedication, but also on the initial autonomic tone, autonomic reactivity, and autonomic maintenance of the activity. The above parameters in their turn depend on the functional state of the autonomic nervous system, the patient's age, concomitant diseases, and other factors determining general physical status of the patient.

Adolescent↗
PubMed2003

Nerve sparing radical hysterectomy: latest developments and historical perspective.

Autonomic nerve damage during surgery is thought to play a crucial role in the aetiology of bladder dysfunction, sexual dysfunction and colorectal motility disorders which are seen in patients after radical hysterectomy. In order to prevent these complications, Japanese gynaecologists introduced a surgical technique with preservation of the pelvic autonomic nerves in the 1960s. In the 1980s the first English paper was published. Since then several surgical approaches have been described, i.e. liposuction, electrical stimulation to locate nerves intra-operatively and laparoscopically assisted techniques. Recently, more attention is being paid to the importance of sparing the sympathetic hypogastric nerve. All authors report results on small cohorts of patients. The incidence of urinary dysfunction seems very low after nerve sparing. Sparing the autonomic nerves during radical hysterectomy seems feasible and safe in both Japanese and Western patients. Literature review does not provide strong clues for a compromised radicality and cure due to nerve sparing. Future larger clinical trials will have to decide whether the technique of nerve sparing radical hysterectomy could be implemented as a standard treatment for cervical cancer patients.

Autonomic Pathways↗
PubMed2006

Intraoperative electrostimulation objectifies the assessment of functional nerve preservation after mesorectal excision.

BACKGROUND: To improve nerve-sparing surgery, intraoperative electrical stimulation of pelvic autonomic nerves (INS) has been proposed in urology, gynecology, and visceral surgery. The aim of this study was to assess the impact of INS while monitoring intravesical pressure on the accurate evaluation of pelvic autonomic nerve preservation (PANP) after mesorectal excision. It was sought to determine whether this confirmation is useful in the prediction of postoperative urinary function. METHODS: Sixty-two patients with mesorectal exzision for rectal cancer were examined prospectively. PANP was assessed visually by the surgeon and with INS. Bladder function was evaluated by post voiding residual volume measurement, rate of recatheterization, rate of long-term urinary catheterisation, and the international prostatic symptom score with quality of life index. RESULTS: INS confirmed bilateral preservation of parasympathetic nerves in 46 patients (74%), and in 10 patients (16%) in at least one side. In six patients (10%), INS failed to confirm PANP. Eleven patients (18%) developed urinary symptoms postoperatively. INS results had a higher sensitivity than visual assessment by the surgeon (82 vs 46%). Values for specificity ranged at 90 and 92%, respectively. Accuracy of INS in predicting PANP was higher (88 vs 83%). The correlation between urinary function and the findings on INS was good (kappa-value: 0.65), correlation between urinary function and visual assessment by the surgeon was fair (kappa-value: 0.40). CONCLUSION: INS, while monitoring intravesical pressure, accurately predicts bladder function after mesorectal excision. It may provide further insight into pelvic autonomic nerve sparing techniques.

Adult↗
PubMed2000

[Analyses of amyloid formation mechanism in familial amyloidotic polyneuropathy and therapeutic trial].

Familial amyloidotic polyneuropathy (FAP) is characterized by systemic accumulation of amyloid fibrils in the peripheral nerves and other organs. FAP ATTR Val30Met is the most common of the familial forms of amyloidosis. In the Kumamoto district, 5 different points of mutation in transthyretin (TTR) have been discovered. To make a diagnosis of FAP, histochemical analysis using ATTR Val30Met monoclonal antibody and FAP patients' hair, and mass spectrometry which can analyze TTR post-translational modifications in the blood circulation and cerebrospinal fluid. From our examinations, oxidative stress and beta protein metabolism is deeply connected with amyloid formation mechanism. Liver transplantation for FAP is only the therapy to save the life of FAP patients. By 1999, we had 17 FAP patients who underwent liver transplantation. They are all alive and showed some improvement predominantly in autonomic dysfunction after the surgery. Liver transplantation revealed that FAP does not progress if the TTR gene in the liver is normalized, suggesting the therapeutic possibility of gene therapy to the liver in FAP patients.

Amyloid Neuropathies↗
PubMed1995

Autonomous hyperparathyroidism in X-linked hypophosphataemia.

Four patients with familial hypophosphataemic rickets developed significant hypercalcaemia which persisted after discontinuation of vitamin D therapy. They had increased PTH levels and were operated for hyperparathyroidism at the ages of 18, 20, 24 and 45 years, respectively. Three of the patients had previously received phosphate treatment and one patient developed hyperparathyroidism 7 years after treatment with calcitriol. Histological evaluation revealed different degrees of parathyroid hyperplasia in all patients, with persistently increased PTH and/or calcium levels after surgery. The possibility of autonomous hyperparathyroidism should be evaluated in the follow-up of patients with X-linked hypophosphataemic rickets.

Adult↗
PubMed2006

No apparent effect of surgery for temporal lobe epilepsy on heart rate variability.

BACKGROUND: Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy (SUDEP). Clinical observations indicate that successful epilepsy surgery is associated with a reduced risk of SUDEP. However, in a previous study we found impaired cardiac control pre-surgically in patients with poor outcome of surgery, indicating an a priori lower risk in responders to epilepsy surgery. We have now examined the effect of surgery on cardiac autonomic control in the same patients. METHODS: We used 24 h EKG recordings to assess heart rate variability (HRV) by spectral analysis in 21 consecutive patients after temporal lobe epilepsy surgery. The HRV was compared with healthy controls, with pre-surgical HRV in the same patients, and analyzed in relation to seizure control 1 year after surgery. RESULTS: The patients with poor outcome after surgery had significantly lower SD of RR-intervals, total power, very low frequency power and low frequency power than matched healthy controls. The patients with favorable outcome did not differ from the controls, and the postoperative HRV was not different from HRV before surgery in any of the patient groups. CONCLUSION: We could not demonstrate any effect on HRV of temporal lobe epilepsy surgery in these patients. The observed lower HRV in the poor outcome group was present already before epilepsy surgery as previously reported. Although our results need confirmation in a larger study, the observations suggest that the increased risk of SUDEP in patients failing epilepsy surgery may be due to a common factor predisposing to surgical failure, impaired HRV as well as to an increased risk of SUDEP.

Autonomic Nervous System↗
PubMed2006

Heart rate variability following neonatal heart surgery for complex congenital heart disease.

BACKGROUND: Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV. METHODS: Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured. RESULTS: In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014). CONCLUSION: Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.

Arrhythmias, Cardiac↗
PubMed2001

Long-term outcome of urinary function after extended lymphadenectomy in patients with distal rectal cancer.

AIMS: Extended lymphadenectomy for rectal cancer has been superseded by autonomic nerve-sparing surgery, but it still has historical significance. It is useful to document the long-term outcome of urinary function in cases who had resection of the inferior hypogastric nerve plexus (pelvic nerve plexus). METHODS: The long-term urinary function following extended lymphadenectomy was studied retrospectively through the medical records of 83 patients who had been followed-up for more than 5 years after surgery. RESULTS: Forty-four per cent of the male patients and 17% of the female patients had to perform clean intermittent self-catheterization (CIC) for more than 1 year; these rates were almost the same at 3 years after the procedure. Urinary incontinence was reported in 34% of the male patients and 45% of the female patients. Complicated cystitis (eight patients), complicated pyelonephritis (two patients), bladder stones (five patients) that required surgical treatment, and chronic renal failure (two patients) were considered as adverse outcomes of extended surgery. In particular, one case needed to undergo urinary diversion. CONCLUSIONS: A surprisingly large proportion of patients suffered various urinary tract problems due to extended lymphadenectomy. The findings demonstrate the importance of selection of well-balanced operations that can encompass both radicality and quality of life. The extent of resection should be decided by the extent of the cancer and routine excision of the inferior hypogastric nerve plexus should not be performed.

Adult↗
PubMed1998

Transfusion timing and postoperative septic complications after gastric cancer surgery: a retrospective study of 179 consecutive patients.

BACKGROUND: Immunosuppression associated with homologous blood transfusion was first observed in renal allograft transplantation. Clinical effects of transfusion-induced immunosuppression in surgical patients have been debated in the literature for more than a decade with contradictory results. OBJECTIVE: To investigate whether homologous blood transfusions significantly affect postoperative septic morbidity and mortality in patients undergoing elective surgery for gastric cancer. DESIGN: Case series. SETTING: Hospitalized care. PATIENTS: The hospital records of 209 patients who underwent elective surgery for gastric cancer at the Department of Surgery of the Hospital del Mar, Autonomous University of Barcelona in Spain, and at the Department of Surgery of the Catholic University of Rome in Italy from April 1984 to December 1990 were reviewed, and 179 patients were included in the study. MAIN OUTCOME MEASURES: The following variables were entered into univariate and multivariate analyses to identify factors potentially affecting postoperative septic morbidity: demographic data, weight loss, preoperative serum albumin level and lymphocyte count, type and duration of operative procedure, amount and timing of blood transfusion, and stage of disease. RESULTS: Univariate analysis showed that a large quantity of blood transfused (> 1500 mL) and transfusion in the postoperative period (group C) were associated with a worse clinical outcome. Postoperative transfusion was an independent predictor of septic morbidity in multivariate analysis. CONCLUSIONS: Despite transfusion-induced immunomodulation, homologous blood transfusion should not be considered a risk factor for postoperative septic morbidity in patients undergoing elective major abdominal surgery. The timing-response relationship between transfusions and septic morbidity in multivariate analysis may be the effect of uncontrolled confounders such as variation of volemia induced by stress response in patients who were developing or had just developed infectious complications.

Adult↗
PubMed1996

Management of atrial fibrillation after coronary artery bypass graft.

More than 400,000 patients undergo coronary artery bypass graft surgery (CABG) each year in the United States. At least 20-30% of these patients have atrial fibrillation (Afib), making this arrhythmia one of the most common postoperative problems. This generally benign problem can increase surgical morbidity and the cost and length of hospital stay. If not treated promptly and effectively, Afib can delay a full and rapid recovery. Afib usually occurs in paroxysms between the second and fifth postoperative day and appears directly related to effects of surgery (pericarditis, changes in autonomic tone, cardioplegia, myocardial damage, fluid shifts, etc.). Although similar to Afib in other settings, beta-adrenergic blockade is more effective in preventing and terminating Afib in the postoperative setting. The unique circumstances that precipitate postoperative Afib may explain the favorable therapeutic and prophylactic actions of beta-adrenergic blockade. Other therapies such as amiodarone, sotalol, and digoxin are surprisingly ineffective for postoperative Afib, while intravenous diltiazem is not well tested in this setting. Despite the lack of proven benefit for some of these therapies, they are still frequently used in current clinical practice. Management of postoperative Afib is initially directed at ventricular rate control, but the ultimate goal is return to sinus rhythm. The approach to therapy depends on several clinical variables, including the time course of the arrhythmia, but hemodynamic stability of the patient is the key issue. Return to sinus rhythm may be difficult to achieve early after surgery, so opting for rate control is the best initial approach. If tolerated, beta-adrenergic blockade and calcium antagonism are the best first options. Class IA and III antiarrhythmic drugs should be reserved for persistent or poorly tolerated and prolonged episodes of Afib. Elective cardioversion, either by direct current or with drugs, should be delayed for as long as possible after surgery. Anticoagulation for post-CABG Afib remains controversial. More prudent use of presently available drugs to treat Afib could reduce morbidity, cost, and duration of hospital stay after CABG. More rapid-acting and reliably effective antiarrhythmic therapies with minimal adverse effects would greatly improve management of post-CABG Afib.

Adrenergic beta-Antagonists↗
PubMed2002

Endoscopic transthoracic sympathicotomy and peripheral microcirculation: effects of electric sympathetic chain stimulation, thermocoagulation and anaesthetic agents.

BACKGROUND: During endoscopic transthoracic sympathicotomy (ETS) in patients with hyperhidrosis it is useful to assess the effect of surgery peroperatively. However, the autonomic system is affected in various ways by different anesthetic agents. In the present study, the effect of ETS during either isoflurane or propofol anesthesia was evaluated by measuring changes in the finger pulp microcirculation using laser Doppler flowmetry (LDF). Electric stimulation of the sympathetic chain was used for identifying the sympathetic chain and to explore whether the anesthetic agents differentially influenced the LDF response to stimulation. METHODS: From a group of 12 patients with incapacitating palmar hyperhidrosis, six were randomly assigned to isoflurane and six to propofol anesthesia. LDF probes were attached to the ipsilateral finger pulp for continuous recording of peripheral blood flow during the ETS procedure. Electric stimulation (1 Hz, 10 Hz, and 100 Hz) was applied to the sympathetic paravertebral chain at the levels of the 2nd and 3rd sympathetic ganglia via a custom designed bipolar electrode. In eight of the patients LDF recordings were also performed in the awake state and compared with records obtained from eight healthy subjects. FINDINGS: In patients anesthetized with isoflurane, the base line finger pulp blood flow did not significantly differ from that of awake normal subjects, while those anesthetized with propofol had a lower base line flow, similar to that of awake subjects with hyperhidrosis. Stimulation of the sympathetic chain induced marked reduction of finger pulp microcirculation in both anesthetic groups, and this effect was frequency dependent during isoflurane anesthesia. After ETS a significant increase in flow was recorded only in the propofol group. Interpretation. The study demonstrates that the completeness of the sympathicotomy can only be peroperatively evaluated if an anesthetic agent with relatively low vasodilatory capacity, as e.g. propofol, is utilized.

Adult↗
PubMed2002

Endoscopic thoracic sympathectomy attenuates reflex tachycardia during head-up tilt in lightly anesthetized patients with essential plamar hyperhidrosis.

PURPOSE: Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS). METHODS: The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40 degrees; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure. RESULTS: The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 +/- 18 to 14 +/- 11 beats.min(-1); P < 0.001), but not in the control group (from 23 +/- 18 to 22 +/- 12 beats.min(-1); P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery. CONCLUSIONS: ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.

Journal Article↗
PubMed1993

Postoperative recovery: how diabetes complicates care.

Diabetic patients comprise a significant portion of the overall number of coronary artery bypass graft surgery patients. These patients are at greater risk to develop complications postoperatively because of associated changes in their cardiovascular system. Diabetic patients may respond differently to cardiac surgery if they have autonomic neuropathy, microvascular changes, and macrovascular disease. Nurses must be aware of the effect of diabetes on the cardiovascular system and how this can affect patient recovery.

Cardiac Output↗
PubMed1983

Distigmine bromide and post-prostatectomy voiding.

Distigmine bromide (Ubretid) is a long-acting anticholinesterase which is thought to improve detrusor function, restoring normal voiding patterns which may have been disturbed by autonomic overactivity, particularly after surgery. Ninety-three patients entered a double-blind study of the effect of distigmine bromide versus placebo on voiding after prostatectomy. The results demonstrated that there was a trend towards improvement but no statistically significant increase in post-operative flow rates, in reduction in bladder volume, and in the incidence of re-catheterisation in the patients treated with distigmine bromide.

Aged↗
PubMed1997

Treatment of vitamin D deficient osteomalacia may unmask autonomous hyperparathyroidism.

Two cases of vitamin D deficient osteomalacia with secondary hyperparathyroidism are presented. In both cases treatment with vitamin D replacement therapy resulted in elevated calcium levels and a failure of parathormone levels to normalise, indicating autonomous parathyroid activity. Subsequent surgery in one case resulted in removal of a parathyroid adenoma. The importance of osteomalacia and its complications are discussed.

Adult↗