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Results for “Intraoperative Awareness”

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At least 199 records · Page 11Linked to original sources
PubMed2005

Intraoperative consultation in gynecologic pathology.

CONTEXT: Gynecologic specimens are commonly submitted for intraoperative consultation, primarily to confirm the presence and histologic type of malignancy, as well as to determine the adequacy of resection by examining the surgical margins. OBJECTIVE: To review and discuss the application, indications, contraindications, and limitations of intraoperative consultation regarding gynecologic specimens, as well as the causes of false-positive or false-negative frozen section results. DATA SOURCES: Review of the pertinent literature and the authors' expertise and experience. CONCLUSIONS: In most instances, intraoperative consultation regarding gynecologic specimens accurately determines the type of malignancy, the status of the resection margins or the lymph nodes, and the extent and depth of involvement by a tumor. Although the pathologist and the surgeon must be aware of the limitations, the use of intraoperative consultation represents a highly sensitive and specific technique that can play a critical role in the management of gynecologic disease.

Diagnostic Errors↗
PubMed2001

A case of awareness with sevoflurane and epidural anesthesia in ovarian tumorectomy.

We experienced a case of awareness during ovarian tumorectomy in a patient who was anesthetized with sevoflurane and epidural anesthesia. A 74-year-old woman was scheduled for resection of an ovarian tumor. After epidural catheter insertion, anesthesia was induced with 60 mg of propofol and 6 mg of vecuronium, and anesthesia was maintained with epidural anesthesia (1% mepivacaine), 1 to 2% sevoflurane, and 66% nitrous oxide in oxygen. The operative course was uneventful and the total operation time was 2 hours and 50 minutes. Two days after the operation, we were surprised to learn that the patient complained of awareness during the surgery.

Aged↗
PubMed2002

Awake or asleep.

Explore the source record for details and available documents.

Analgesia, Epidural↗
PubMed1993

Midazolam-alfentanil: an anaesthetic? An investigation using the isolated forearm technique.

Thirty-two women underwent major gynaecological surgery with a midazolam-alfentanil total i.v. anaesthetic regimen. Adequacy of anaesthesia was assessed using a "pressure, rate, sweating and tears" (PRST) scoring system in conjunction with the isolated forearm technique (IFT). The IFT revealed that 72% of patients responded during surgery, but none had spontaneous, unprompted postoperative recall for the event. Three patients, on prompting, provided evidence of recall. The IFT, while indicating which patients are responsive, cannot be used to predict who will have postoperative recall. Lack of explicit postoperative recall does not indicate unconsciousness during surgery. Twenty patients, asked specifically during surgery to indicate the presence or absence of pain, experienced pain at some time during their surgical procedure. The PRST score could not be used to predict when a patient was awake. This low-dose i.v. anaesthetic technique cannot be recommended for general use.

Adult↗
PubMed1986

Awareness and recall.

Awareness and recall under anesthesia is a complication that appears to be related to the use of muscle relaxants. While little is known about unconscious awareness and its physical and psychological consequences, it is well known that recall can result in traumatic psychological sequelae under certain circumstances. The anesthesiologist must be aware of the possibility of awareness before it occurs and either try to avoid it or explain to the patient the possibility of awareness and the circumstances under which it might occur. In the event of unexpected awareness, the anesthesiologist must deal with the patient in an honest and forthright manner. Failure to do so may lead to dire psychological consequences for the patient and legal consequences for the anesthesiologist.

Anesthesia, General↗
PubMed2004

Nerve injury after laparoscopic varicocelectomy.

PURPOSE: Laparoscopic varicocelectomy is a minimally invasive option for varicoceles in children. Occasional reports of nerve injury after inguinal laparoscopic procedures have been published. There is anatomical variation in the sensory innervation of the anterior thigh and variable branching patterns of the nerves involved. We report a retrospective analysis of our patients, focusing on the incidence of sensory changes on the ipsilateral anterior thigh after laparoscopic varicocelectomy. MATERIALS AND METHODS: The medical records of all patients who underwent laparoscopic varicocelectomy at 1 institution performed by 2 of us (YR and DV) from 1997 to 2002 were retrospectively reviewed. Demographics, outcomes and any postoperative sensory complications were obtained by chart review and telephone interview. RESULTS: A total of 58 patients underwent laparoscopic varicocelectomy during this 5-year analysis and 51 with a total of 62 varicoceles were available for review. Three patients (4.8%) experienced transient numbness of the ipsilateral anterior thigh, which resolved or improved in an average of 8.0 months (range 6 to 9). Symptoms were not always noticed immediately postoperatively (range 0 to 10 days). In affected patients the sensory distribution was usually consistent with injury to the genitofemoral nerve. CONCLUSIONS: Laparoscopic varicocelectomy is a minimally invasive procedure that still has the potential for complications. Cautery or harmonic dissection of the peritoneum overlying the spermatic cord and excessive traction on the tissues surrounding the cord should be avoided intraoperatively. Patients and surgeons should be aware of the possibility of nerve injury and the resultant sensory deficit.

Adolescent↗
PubMed1989

Serious morbidity attributable to anaesthesia. Considerations for prevention.

The types and frequency of complications attributable solely to anaesthesia, and which caused serious morbidity and substantial negative outcome, were examined in a prospective study of 7306 anaesthetics. The analysis demonstrated that severe complications and mortality attributable to anaesthesia occurred in 0.59% (1:170) and 0.04% (1:2500) of patients respectively. The data suggest that "high-risk' patients are more likely to be affected by errors and a substantial negative outcome than more healthy patients. We judged one-third of the anaesthesia-related morbidity to be preventable. Anaesthetists are faced with an increasing number of patients who are at high risk, and who undergo increasingly extensive surgical interventions. Concomitant with the increasing complexity of care and increasing demands on the anaesthetists may be an expected increase in the incidence of errors. Recognition of the importance of human factors in morbidity and mortality attributable to anaesthesia is a necessary first step.

Adult↗