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PubMed2004

Cerebrospinal fluid rhinorrhea after thermometer insertion through the nose.

Cerebrospinal fluid (CSF) rhinorrhea is a rare clinical condition. Most leaks either are caused by traumatic head injury or are a complication of surgical procedures on the base of the skull. CSF rhinorrhea from nasal tube placement has been reported previously. We report a case of nasal thermometer placement during anesthesia complicated by a CSF leakage. We reemphasize that any material--including thermometers, nasogastric tubes, and endotracheal tubes--should be directed posteriorly after introduction into the external naris.

Aged↗
PubMed1994

Laparocholecystectomy. 6,865 cases from Italian institutions.

Data concerning 6,865 laparocholecystectomies have been collected retrospectively from 19 Italian groups. Only 5% of all patients were chosen for open cholecystectomy (OC). Acute cholecystitis was present in 5.6% of laparocholecystectomies (LC). Conversion to laparotomy occurred in 3.1% of patients. Mortality was 0.06%, morbidity 2.53% (general anesthesia complications 0.07%; general complications 0.07%; omphalitis 0.7%; abdominal complications 1.69%). Main duct lesions occurred in 0.26% of the patients, biliary leaks in 0.48%, bleedings in 0.75%, perforations in 0.2%. Data from literature concerning OC are compared to ours: mortality and morbidity have been lowered by LC; general and abdominal-wall complications have been drastically reduced; main duct lesions are not different.

Abdominal Muscles↗
PubMed1975

[Complications of peridural anesthesia].

Peridural anesthesia is believed to be a complicated kind of analgesia yielding grave complications (syncope, apnoe, collapse, persistant and pronounced hypotension, nematomyelia, paraplegia of the lower extremities, Brown--Seguard syndrome and many others). This king od anesthesia is permissible only in an anesthesiological or reanimatological department. The frequency of complications depends on a level of injecting the anesthetic, patient's status and age. The former is the greater the higher the level of the peridural space puncture. To combat against complications occurring while using this kind of analgesia everything necessary for reanimation provision (intubation of the trachea, closed and open heart massage, etc.) should be ready at hand.

Aged↗
PubMedDate not supplied

[A complication of local anesthesia during tooth extraction in children].

The authors describe a rare complication of local injection anesthesia, carried out in children for tooth removal: development of a specific granuloma due to Mucor and Nocardia mold fungi. The authors claim that the mycotic granuloma developed because of violation of the rules of asepsis, one of the possible violations being multiple use of disposable single-use syringes. No doubt, such complications can be easily prevented if asepsis regulations are strictly adhered to. The authors recommend the use of a separate sterile needle for every injection and treatment of the injection site with 1% iodine solution.

Anesthesia, Dental↗
PubMed2002

Post spinal meningitis and asepsis.

BACKGROUND: Post spinal meningitis (PSM) is a complication still currently being reported. After two PSM cases in our hospital an epidemiological study was initiated, which included a survey of techniques for asepsis that are applied in our department. METHODS: Cases defined as PSM comprised meningitis within a week after spinal anesthesia. Anesthesia records, anesthesia complication files and the records of the Hospital Commission for Infection Control from 1997 to 2000 were reviewed. Asepsis techniques applied were surveyed by a questionnaire answered by all our department's anesthesiologists. The equipment and procedures for spinal anesthesia were listed. Current anesthesia textbooks were reviewed for recommendations regarding asepsis techniques in conjunction with spinal anesthesia. RESULTS: Three cases of PSM were identified following 38,128 spinal anesthesias whereas none was observed in 12,822 patients subjected to other types of regional or general anesthesia (P>0.05). Culture of cerebrospinal fluid yielded Streptococcus in two patients and was negative in the other patient. The asepsis technique applied by the anesthesiologists varied considerably. The literature review showed that aspects on asepsis for spinal anesthesia are poorly covered. CONCLUSION: The incidence of meningitis was similar in patients subjected to spinal anesthesia and in those subjected to other anesthetic techniques. Asepsis techniques were found to differ considerably among our staff members, reflecting the lack of well-defined published standards for this procedure. We recommend that asepsis for spinal anesthesia should not be less rigorous than for surgical asepsis.

Adult↗
PubMed1989

Fatal and major complications secondary to nasal and sinus surgery.

The purpose of this study was to review 40 major or fatal complications secondary to nasal and sinus surgery that were referred to the author for consultation or other reasons. The most frequent complications were intracranial, which occurred in 13 cases, and resulted in four deaths. Blindness occurred in ten patients (two bilaterally). Three other fatalities resulted from internal carotid artery damage. Three patients died of anesthesia-related problems and one survived malignant hyperthermia. In all, ten patients died as a result of intracranial catastrophe, hemorrhage, or general anesthesia complications. Although some complications are preventable, others may be unavoidable, even in the hands of well-trained, experienced surgeons.

Adult↗
PubMed2004

Challenges associated with the integration of endovascular repair of abdominal aortic aneurysms in a community hospital.

PURPOSE: There has been considerable debate regarding the proper place for endovascular repair (ER) of abdominal aortic aneurysms (AAAs) versus traditional open repair (OR). Our study compared preoperative patient demographics and outcomes for elective, asymptomatic AAA repairs performed at our center over a 33-month period. METHODS: For this study, we selected 342 consecutive elective infrarenal AAA repairs performed between July 1, 2000, and March 31, 2003, at Riverside Methodist Hospital. The patients underwent either ER or OR, depending on patient and surgeon collaborative determinations. Ruptured and symptomatic AAAs were excluded from our study. Preoperative demographics, anesthesia, complications, and discharge status for the 2 groups were analyzed, and statistical analysis was done to determine statistically significant differences. RESULTS: The preoperative status of the ER and OR patient groups were essentially similar. There were only 3 significant differences between the 2 groups: alcohol use was higher for the OR group than for the ER group (12.0% versus 5.2%; P = .04), and the incidence of type II diabetes mellitus and peripheral vascular disease were lower for the OR group compared with the ER group (6.7% versus 13.4% [P = .04] and 18.3% versus 30.6% [P = .008], respectively). The OR group used more general anesthesia than the ER group (99% versus 86%; P < .001) and had more complications, including dysrhythmia (8.65% versus 1.59%; P = .005), ileus (13.94% versus 0.79%; P < .0001), infection (8.17% versus 0.0%; P = .0007), respiratory complications (12.50% versus 1.59%; P = .0003), and renal complications (5.29% versus 0.79%; P = .032). The ER group had a higher rate of wound hematoma (4.76% versus 0.48%; P = .007). ER patients also had significantly less blood loss (379 mL versus 1930 mL; P < .001), a better independent discharge status (P < .0001), a shorter length of stay (1.8 days versus 8.2 days; P < .001), and a lower mortality rate (0.75% versus 3.85%; P = .0954). CONCLUSIONS: From our study we cautiously continue to encourage the consideration of the ER of AAAs in our patient population while being mindful of its limitations.

Adult↗
PubMed1981

[Dangerous complications of sombrevin anesthesia].

The experience of using sombrevin anesthesia in 3644 cases and its 3 severe complications which resulted in the development of terminal states up to the clinical death (reanimation was successful) is analyzed. This anesthesia is shown to be necessary under conditions providing a possibility of immediate fulfillment of the complex of highly skilled reanimation measures, with early solution of problems of succession between the polyclinic link and the reanimation hospital. Special attention is called to strict observation of the principle of the preliminary (the day before operation) examination by an anesthesiologist of the patients who are to be subjected to planned short operative interventions, for the individual choice of the method of anesthesia and prevention of severe complications after narcosis.

Anaphylaxis↗
PubMed1986

Out-patient hand surgery. A prospective study of 588 patients.

The results of a prospective study of 588 patients operated on over a period of 4 months were analyzed. Of these patients, 6% only had to be hospitalized. The 555 other patients underwent out-patient surgery, 25% of which were emergencies. Thirty-four % of patients had one or more preexisting serious medical conditions. Ninety-one % underwent regional anesthesia. Complications were rare and did not seem to be preventable by hospitalization. While highlighting the many advantages associated with out-patient surgery, the authors stress the guidelines which must be followed as well as the pitfalls to be avoided in ambulatory surgery of the hand.

Adolescent↗
PubMed1976

Total spinal anesthesia: a rare complication of intrathoracic intercostal nerve block.

Total spinal anesthesia following intrathoracic intercostal nerve blocks with bupivacaine performed for postoperative pain relief during thoracotomy is described. Possible mechanisms for this complication include: (1) inadvertent placement of the needle through an intervertebral foramen, (2) puncture of a long dural cuff, and (3) intraneural injection with central spread. Recognition of this potential complication is important, and facilities for proper support must be available.

Bupivacaine↗
PubMed2000

A new procedure for frameless computer navigated stereotaxy.

OBJECTIVE: Stereotactic procedures using frame-based systems have become well established in neurosurgery. Later, stereotactic computers have provided the neurosurgeon with a broader range of applications. A new, frameless stereotactic guide which utilizes the navigational abilities of a computer has been developed. This clinical study evaluates the accuracy and safety of the system when applied for puncture of tumours and abscesses in the cerebrum. METHODS: Using a frameless setup 36 patients were operated on for a total of 39 intracranial processes over a period of two years. Three patients were operated on twice. Computer data, time of surgery, anesthesia, complications, tumour localization and tissue examinations were recorded. RESULTS: Biopsies were obtained from all lobes of the cerebrum and a diagnosis established in all cases except two. Mean age and total range was 52 years and 15-82 years, respectively. Median time of surgery was approximately 60 minutes including positioning of the patient and the registration process on the stereotactic computer. Local anesthesia was used for 25 operations and general anesthesia for 14 operations. There was one postoperative abscess formation in a previously immunosuppressed patient and a per-operative epileptic seizure caused by electrocoagulation of the dura in a second patient. CONCLUSIONS: Based on this clinical study a new procedure for obtaining stereotactic biopsies of intracranial processes is introduced. All tumours were successfully reached with two cases of complications.

Adolescent↗
PubMed2005

What determines and are the consequences of surveillance intensity after endovascular abdominal aortic aneurysm repair?

Follow-up examinations are advised 1, 3, 6, 12, 18, and 24 months and yearly thereafter by the European Collaborating Group on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROSTAR). The aim of this study was to evaluate the determinants and consequences of surveillance completeness. Patients who underwent endovascular abdominal aortic aneurysm repair between October 1996 and August 2004 and enrolled in the EUROSTAR registry were analyzed. Two groups were compared: patients who attended all scheduled visits (group A) and those who came infrequently (group B). Odds ratios and hazard rates (HRs) with 95% confidence intervals (CIs) were determined to detect which patient characteristics and complications were associated with follow-up intensity. Of the 4,433 patients, 1,538 (35%) attended all scheduled visits until the end of follow-up (group A). Analysis of patient characteristics demonstrated that intensive visitors were more often smokers, hyperlipemic, and considered unfit for open surgery or general anesthesia. Complications during follow-up, including endoleaks (24% vs. 20%), kinking (3.5% vs. 2.5%), and migration (4.9% vs. 3.5%), appeared significantly more frequently in group A. Despite intensive follow-up of this category, still a greater proportion died (12% vs. 9%, adjusted HR = 1.5, 95% CI 1.2-1.8). After 84 months of follow-up, the cumulative survival rates in groups A and B were 71% and 74%, respectively (p < 0.0001). It seems that follow-up intensity was based on baseline patient characteristics. High-risk patients had, despite more intensive surveillance, still more complications after adjustment for patient, morphological, and center-specific characteristics. Further assessment is indicated to evaluate the effectiveness of different frequencies of surveillance visits.

Aged↗
PubMedDate not supplied

[General complications of local anesthesia in dentistry: prevention and therapy].

The general complications of local anaesthesia in odontostomatology are reviewed and pathogenesis and symptomatology described. Mention is then made of prevention and treatment. Conclusions refer observation in more than 150,000 cases of local anaesthesia, a line of conduct being suggested to prevent complications, from the simplest to the most complex, and consequently medico-legal responsibilities for the specialist.

Anaphylaxis↗
PubMed2005

Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients.

BACKGROUND: Perioperative delirium is common in high-risk surgery and is associated with age, education, preoperative cognitive functioning, pre-existing medical conditions, and postoperative complications. We investigated these factors as well as lifestyle and demographic variables by using cognitive measures that were more sensitive than those used in previous studies. METHODS: Extensive medical and demographic data were collected on 102 patients between 41 and 88 years of age to identify comorbidities and lifestyle considerations preoperatively. Elective abdominal aortic aneurysm surgery was performed under combined general/epidural anesthesia with postoperative epidural analgesia. A battery of sensitive, cognitive measures was administered preoperatively, at the time of discharge from hospital, and 3 months postoperatively. Symptoms of delirium were assessed during the first 6 postoperative days using Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria. Intraoperative and postoperative data, including medications, vital signs, conduct of the surgery and anesthesia, complications, and details of pain control, were collected. RESULTS: Delirium occurred in 33% of the patients during the first 6 days after surgery. Longer duration of delirium was related to lower education, preoperative depression, and greater preoperative psychoactive medication use. Characteristics of the surgery and hospital stay were unrelated to the development of delirium. Patients who were diagnosed with delirium had lower cognitive scores during each of the three assessment periods, even when controlling for age and education. Logistic regression analysis indicated that the most powerful preoperative predictors of delirium were number of pack years smoked (P = .001), mental status scores (P = .003), and number of psychoactive medications (P = .005). CONCLUSION: A significant proportion of patients undergoing elective abdominal aortic aneurysm repair are susceptible to the development of delirium and are at risk for cognitive dysfunction after surgery. Our findings have implications for promoting long-term lifestyle changes, including smoking cessation and improved management of mental health as risk-reduction strategies.

Adult↗
PubMedDate not supplied

The role of the pedodontist in the multiple-procedure approach to general anesthesia for children: report of four cases.

The combining of elective procedures, including dentistry, in a single hospital admission, under general anesthesia, can be a very beneficial service for those patients, for whom such procedures are indicated. By minimizing the number of hospitalizations and the number of general anesthetic procedures for his patients, the pedodontist is reducing the risk of anesthesia complications, the possibility of psychological trauma, and the financial burden of hospital treatment. In addition, he promotes the role of the pedodontist in the community and in the hospital as an integral member of the child's health-care team.

Anesthesia, General↗
PubMed1999

A new technique of continuous interscalene nerve block.

PURPOSE: To describes a technique of indwelling interscalene catheter placement and to evaluate its complications. METHODS: One hundred and twenty patients undergoing major shoulder surgery received interscalene nerve block (ISNB) and were studied in three groups. Group 1 ISNB using Winnie's technique; group 2 by Winnie's technique with nerve stimulator and group 3 by epidural needle and catheter technique with nerve stimulator. All patients received 20 mL bupivacaine 0.5% and group 3 patients received an additional bupivacaine 0.25% infusion. Diaphragmatic movements were measured sonographically on emergence from anesthesia. Complications were noted. A visual analogue scale (0-10) was used to assess pain four hours postoperatively. RESULTS: Mean ipsilateral diaphragmatic movements were 4+/-8, 14+/-11 and 18+/-8 mm (mean +/- SD) in groups 1, 2 and 3 respectively. This was less than contralateral movements in all three groups (P < 0.05). None of the patients in groups 2 and 3 reported postoperative pain. The block failed in 10% of group 1 patients. Complete ipsilateral phrenic nerve block occurred in 85% of the patients in group 1, 35% of group 2 and 20% of group 3 (P < 0.05). Ipsilateral recurrent laryngeal nerve paralysis occurred in 20% of the patients in group 1, 5% of group 2 and in none of the patients in group 3 (P < 0.05). Horner's syndrome was noted in group 1 (30%), group 2 (12%) but not in group 3. None of the catheters in group 3 patients dislodged after an average use of 2.8+/-2.1 days. CONCLUSIONS: Indwelling catheter placement into the brachial plexus sheath as described in this communication was effective and associated with few complications.

Adult↗