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Results for “Intraoperative Awareness”

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At least 307 records · Page 17Linked to original sources
PubMed2006

[Klippel-Trénaunay syndrome. A rare cause of recurrent macrohematuria: case report].

A 37-year-old man with Klippel-Trénaunay syndrome presented with an episode of painless severe gross hematuria. Magnetic resonance imaging (MRI) revealed vessels of significant diameter in the bladder wall. Diagnostic imaging is mandatory in order to be aware of the extent of the lesion as the bleeding identified intraoperatively may only be the "tip of the iceberg." If conservative means fail, laser coagulation should be the treatment of choice.

Adult↗
PubMed1989

The syndrome of inappropriate antidiuretic hormone secretion and its effect on blood indices following spinal fusion.

Red blood cell indices in four adolescent and preadolescent patients with documented inappropriate antidiuretic hormone secretion (SIADH) following spinal fusion were examined for evidence of dilution. The blood indices in these preoperative patients demonstrated evidence of dilution on both the intracellular and extracellular levels. The major factors causing these dilutional effects were elevated ADH, intravenous fluid overloading, and mobilization of "third space" fluids. It appears that extracellular dilution secondary to these factors results in spuriously low blood indices (namely, hemoglobin, hematocrit, and red blood cells) during the postoperative period. These findings suggest that an awareness of SIADH and avoiding intravenous fluid overloads by accurately managing intraoperative and postoperative fluids will decrease the dilutional effects observed on blood indices and perhaps save patients from unwarranted transfusions.

Adolescent↗
PubMed1976

Self-curing methyl methacrylate: Is it safe?

Self-curing methyl methacrylate has been recently abandoned by some ophthalmic surgeons because of more than 20 deaths associated with its use in orthopedic surgery. The mechanism of cardiovascular collapse noted in orthopedic cases appears to relate to the surgical procedure as well as a direct vasodilation caused by free monomer. There are no reported cardiovascular complications with the facial uses of self-curing methyl methacrylate. Toxicities to this substance are noted. Ophthalmologists should be aware of these problems and their management. Careful preoperative cardiovascular evaluation, intraoperative patient monitoring, and a well-ventilated operating room are recommended with its use. The review finds no evidence to condemn the ophthalmic uses of self-curing methyl methacrylate because of cardiovascular complications. The search for more inert synthetic compounds should continue.

Bone Diseases↗
PubMed2005

Virilizing adrenal cancer and bail-out nephrectomy.

We report a rare case of virilizing adrenal cancer with tumorous invasion of the left renal vein in which a retroperitoneal adrenalectomy with bail-out nephrectomy was performed. A tumor thrombus infiltrated the wall of the left adrenal vein and extended into the left renal vein. Initially, a kidney sparing procedure with partial tangential excision of the involved renal vein wall was performed. After positive vein margins were confirmed with intraoperative histology, the indication for nephrectomy was made. To the authors' awareness, this is the first report of a virilizing adrenal cancer with a tumor thrombus infiltration of the renal vein and surgical tendency for kidney preservation.

Adrenal Cortex Neoplasms↗
PubMed1989

[Anesthesia for patients receiving hemodialysis--a report of 122 cases].

A hundred and twenty-two cases of anesthesia for patients receiving hemo-dialysis were reported and peri-operative management of them was analyzed, retrospectively. For the past ten years, most of the patients were anesthetized with neurolept-anesthesia and post-operative mechanical ventilation was continued until the patients regained stable hemodynamics and complete awareness. The procedures of pre-operative hemo-dialysis and intraoperative management were almost compatible with previous reports. In the cases of emergency operation, pre-operative control was not enough and intra-operative water intake was larger than that of scheduled cases. The detailed analysis of peri-operative management of water which affects the pathophysiological state of each patient will be the problem in future.

Adolescent↗
PubMed2003

Comparison of transthoracic and intraoperative transesophageal color flow Doppler assessment of mitral and aortic regurgitation.

BACKGROUND: We examined the agreement between transthoracic echocardiography (TTE) and intraoperative prepump transesophageal echocardiography (TEE) in the assessment of left-sided regurgitant lesions and echocardiographic variables associated with grading discrepancies. METHODS: The TTE and prepump TEE studies of 54 patients undergoing aortic-valve replacement for aortic stenosis were reviewed. Agreement and correlation in assessment of aortic (AR) and mitral regurgitation (MR) severity were evaluated. RESULTS: There was no significant difference between mean TTE and prepump TEE grading of MR (0.23 +/- 0.19 vs. 0.21 +/- 0.15 jet area/area of the left atrium, p = 0.49), but the correlation between the two methods was weak (r = 0.40, p = 0.003), with an exact agreement of 54%. Prepump TEE tended to grade AR as more severe (mean grade 1.43 +/- 0.94 vs. 1.24 +/- 0.75, p = 0.058). The correlation between the two methods in AR assessment was fair (r = 0.70, p = 0.0001) with an agreement of 59%. For MR and AR grading, no significant correlations between valvular regurgitation severity and blood pressure differences between preoperative TTE and prepump TEE were found. In 17% of cases, discrepancies in identifying severe mitral or aortic valve regurgitation could have affected patient management. CONCLUSIONS: There is modest agreement in MR and AR assessment between TTE and prepump TEE. Cardiologists, cardiac surgeons, and anesthesiologists must be aware of differences between these methods when using prepump TEE to guide intraoperative decisions.

Aged↗
PubMed2000

Awareness during anaesthesia: a prospective case study.

BACKGROUND: Patients who are given general anaesthesia are not guaranteed to remain unconscious during surgery. Knowledge about the effectiveness of current protective measures is scarce, as is our understanding of patients' responses to this complication. We did a prospective case study to assess conscious awareness during anaesthesia. METHODS: 11785 patients who had undergone general anaesthesia were interviewed for awareness on three occasions: before they left the post-anaesthesia care unit, and 1-3 days and 7-14 days after the operation. FINDINGS: We identified 18 cases of awareness and one case of inadvertent muscle blockade that had occurred before unconsciousness. Incidence of awareness was 0.18% in cases in which neuromuscular blocking drugs were used, and 0.10% in the absence of such drugs. 17 cases of awareness were identified at the final interview, but no more than 11 would have been detected if an interview had been done only when the patients left the post-anaesthesia care unit. Four non-paralysed patients recalled intraoperative events, but none had anxiety during wakefulness or had delayed neurotic symptoms. This finding contrasts with anaesthesia with muscle relaxants, during which 11 of 14 patients had pain, anxiety, or delayed neurotic symptoms. After repeated discussion and information, the delayed neurotic symptoms resolved within 3 weeks in all patients. Analysis of individual cases suggests that a reduced incidence of recall of intraoperative events would not be achieved by monitoring of end-tidal anaesthetic gas concentration or by more frequent use of benzodiazepines. INTERPRETATION: The inability to prevent awareness by conventional measures may advocate monitoring of cerebral activity by neurophysiological techniques. However, the sensitivity of such techniques is not known, and in the light of our findings, at least 861 patients would need to be monitored to avoid one patient from suffering due to awareness during relaxant anaesthesia.

Adult↗
PubMed1994

Management of a tracheal bronchus in a pediatric lung transplant recipient.

Successful pediatric lung transplantation requires intraoperative identification and management of unforeseen anomalies in the recipient. Effective technical improvisation combines awareness of bronchial anatomic anomalies with experience in recent modifications in airway anastomotic techniques. We report a case of successful bilateral sequential double-lung transplantation in a child with the right upper lobe bronchus arising from the trachea.

Anastomosis, Surgical↗
PubMed1999

Granular cell tumor of the parotid.

A case of granular cell tumor of the major salivary glands is presented. This tumor appeared as an expansive multinodular mass that arose from facial nerve trunks. The presenting symptoms of facial pain and paresis and the intraoperative findings of tumor adhesion to nerves led to the clinical impression of malignancy. At intraoperative consultation, the tumor resembled an acinic cell carcinoma. Pathologists should be aware that granular cell tumors may involve the major salivary glands and that it should be considered in the diagnostic differential diagnosis.

Female↗
PubMed2001

The Structured Clinical Operative Test (SCOT) in dental competency assessment.

INTRODUCTION: This paper describes a method of assessment of invasive clinical procedures which are currently being devised, and which are perceived to be a method that may be used to complement OSCEs in overall clinical skills assessment. OBJECTIVE: The objective of the Structured Clinical Operative Tests (SCOT) is to introduce a greater level of objectivity to the assessment of operative clinical skills. Invasive or irreversible clinical operative procedures from a large part of dental undergraduate training and are by their very nature precluded from OSCE scenarios. It is also important to test intraoperative skills, communication skills and contingency management, and performance of these with awareness of the psychosocial context and ethical framework. The paper describes the use of checklists in the monitoring of clinical operative skills in a more authentic clinical situation using the SCOT. FORMATIVE ASSESSMENT: Continuous assessment should a) record achievement of competency in as objective a manner as possible and b) should encourage continuous self-evaluation. In the SCOT the students reflect on their clinical performance and in consultation with their supervisors record their plans to improve their competence in that skill or procedure in the future. This is done immediately on completion of a clinical task while the experience is still fresh in the mind. This encourages deep reflective learning as opposed to superficial factual learning which is characteristic of the more traditional curriculum, and is described as supervisor validated self-assessment. DISCUSSION: The discussion outlines how SCOTs can be practically implemented and integrated into the undergraduate curriculum and an example of a SCOT is appended to the paper. The scope for using SCOTs in postgraduate assessment such as in VT/GPT is also described.

Clinical Competence↗
PubMed1985

Non-verbal response to intraoperative conversation.

In a double-blind study, 33 patients (herniorraphy, cholecystectomy and orthopaedic) were randomly assigned to either suggestion or control groups. Under known clinical levels of nitrous oxide and enflurane or halothane anaesthesia, suggestion patients were exposed to statements of the importance of touching their ear during a postoperative interview. Compared with controls, suggestion patients did touch their ear (tetrachoric correlation 0.61, P less than 0.001) and they did so more frequently (Mann-Whitney U test, P less than 0.02). All suggestion patients were completely amnesic for the intraoperative spoken suggestion, despite inquiries which included hypnotic regression to the operation.

Adult↗
PubMed2004

Awareness and the EEG power spectrum: analysis of frequencies.

BACKGROUND: Power spectral analysis is a well-established method for the analysis of EEG signals. Spectral parameters can be used to quantify pharmacological effects of anaesthetics on the brain and the level of sedation. This method, in numerous variations, has been applied to depth of anaesthesia monitoring and has been incorporated into several commercially available EEG monitors. Because of the importance of EEG spectral analysis, we evaluated the performance of each frequency in the power spectrum regarding detection of awareness. METHODS: Ninety artefact-free EEG segments of length 8 s were obtained from a database that contains perioperatively recorded EEG data. For the present analysis, EEG data were selected from 39 patients with propofol-remifentanil or sevoflurane-remifentanil anaesthesia with a period of awareness. Half of the EEG segments were recorded during periods of awareness as defined by an adequate response to the command 'squeeze my hand'. The other half were from unresponsive patients. The power spectral density was calculated for each segment. The performance of each frequency bin of the power spectrum as a detector of awareness was assessed with a remapped prediction probability rPK, i.e. the prediction probability PK mapped to a range of 0.5-1. RESULTS: The remapped prediction probability was high (rPK>0.8) for low frequencies (<15 Hz) and for high frequencies (>26 Hz), with a minimum (rPK<0.55) at 21 Hz. Indentations in the 'performance spectrum' occur at the power-line frequency (50 Hz) and its harmonics and at 78 Hz, probably caused by the continuous impedance measurement of another device used in parallel. With the exception of the indentations, the remapped prediction probability of the high frequencies (>35 Hz) was >0.95. CONCLUSIONS: The best performance for the detection of awareness was achieved by EEG power spectral frequencies from >35 Hz up to 127 Hz. This frequency band may be dominated by muscle activity. The frequency band between 15 and 26 Hz may be of limited value, as reflected by lower rPK values.

Anesthetics, Combined↗
PubMed2003

Current transfusion practices of members of the american society of anesthesiologists: a survey.

BACKGROUND: The last published survey of transfusion practices among members of the American Society of Anesthesiologists (ASA) was conducted in 1981. The ASA Committee on Transfusion Medicine conducted a new transfusion survey in 2002. METHODS: The survey was mailed to 2,500 randomly selected active ASA members. The previous survey was modified to incorporate questions based on the ASA Practice Guidelines for Blood Component Therapy. The chi-square test was used for comparisons. Two-tailed P values of 0.05 or less were considered as nonchance differences. RESULTS: A total of 862 survey responses were completed by anesthesiologists who provided or directly supervised anesthesia for patients who may have required transfusion. In a given week, 62% rarely or never transfused 3 or more units of blood to the same patient. The percentage of anesthesiologists who responded that it is never or rarely (1% or less of the time) necessary to cancel elective surgery because of unavailability of blood products was 96% in 2002. In 1981, 92% responded that it was rarely necessary, and 8% said that it was occasionally necessary. The percentage of anesthesiologists who required patients undergoing elective surgery to have a hemoglobin concentration of at least 10 g/dl decreased from 65% to 9% (P < 0.001). Before intraoperative erythrocyte transfusion, 89% of respondents performed hemoglobin or hematocrit determinations routinely or sometimes. Intraoperative autologous transfusion equipment availability increased from 39% to 95% (P < 0.001). Awareness of the ASA Guidelines was 72%. CONCLUSIONS: Transfusion practices have changed considerably since 1981. Current transfusion practices are, in general, consistent with the ASA Guidelines.

Anesthesiology↗
PubMed1998

Chance fracture after pedicle screw fixation. A case report.

STUDY DESIGN: A case of a Chance fracture through an instrumented pedicle is presented. The radiographic and intraoperative findings and management of this complication are reported. OBJECTIVE: To increase awareness of the complications of transpedicular screw fixation and to suggest a form of management of this unusual complication. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, this is the first reported case of such a vertebral fracture occurring after pedicle screw fixation. METHODS: A 44-year-old man with athetoid cerebral palsy and a progressive thoracic kyphosis sustained a Chance fracture at the caudal end of the segmental instrumentation construct. RESULTS: Surgical intervention, including fracture reduction and extension of the instrumented fusion to the pelvis, provided effective restoration of physiologic sagittal alignment. CONCLUSION: Chance fracture after pedicle screw fixation can be successfully managed with surgical intervention.

Adult↗