PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Intraoperative Awareness”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources
PubMed1998

Mild hypothermia: an alternative to deep hypothermia for achieving neuroprotection.

The role of excitotoxins in the ischemic cascade that results in ischemic neuronal death has been clearly defined and has brought about attempts to halt the progression of neurologic damage. Improved understanding of this process has allowed for the development of interventions to optimize neurologic outcome following periods of ischemia. Deep hypothermia (15-22 degrees C) has long been recognized as one method of achieving neuroprotection, but is not without serious implications and risks to the patient. Mild hypothermia (32-34 degrees C) is evolving as an alternative neuroprotective measure that has been shown to improve neurologic outcome in experimental models of ischemia and head injury, as well as in recent head injury clinical trials. It has been safely used intraoperatively in a large series of patients undergoing craniotomy. Mild hypothermia is a technique that may soon be commonly employed alone or in conjunction with other methods of neuroprotection. Nurses caring for patients undergoing this technique must be aware of the practice implications associated with this procedure and adapt their care accordingly.

Brain Ischemia↗
PubMed1984

Intraoperative failure of a Fluotec Mark II vapourizer.

A case report describing the failure of a Fluotec Mark II vapourizer to deliver the indicated anaesthetic concentration during surgery is presented. The failure was caused by a broken internal circlip which resulted in most of the fresh gas flow bypassing the vapourizer. The inspired halothane concentration was reduced to 0.1 per cent, irrespective of the vapourizer dial setting. This type of vapourizer failure may be identified by the unusually loose dial on the Mark II vapourizer. The complications resulting from a light level of anaesthesia include awareness, systolic and diastolic hypertension, movement, and their sequelae.

Adolescent↗
PubMedDate not supplied

Intraoperative progress reports to families of surgical clients: a missed opportunity.

The wait while a family member or loved one is undergoing surgery is stressful and anxiety-producing. Perioperative nursing contact during this period can result in positive outcomes of decreased anxiety, increased receptivity to postoperative information, and increased awareness of the professional practice. Perioperative nurses have the skills and the opportunity to provide progress reports to the client's family, at least once during surgery. Characteristics important to this role include motivation and commitment to be informative; caring; sensitivity and perceptivity; sense of humour; and education. Possible barriers to intraoperative communications include various lacks--of time; attention (related to monitoring requirements in the operating room); support from management, peers, and doctors; and therapeutic communication skills to alleviate anxiety. Progress reports to the family can decrease their physical stress and add to their satisfaction with the hospital.

Communication↗
PubMed2007

[Nonocclusive ischemia of the right colon].

BACKGROUND: Nonocclusive disease (NOD) is known to be a common cause of ischemic colitis, which is frequently underestimated. MATERIAL AND METHODS: A computer-assisted search of radiological reports at our institute over a period of 18 months, describing ischemic colitis of the ascending colon with an unimpaired perfusion of the superior mesenteric artery, was performed. RESULTS: A retrospective analysis of the clinical and radiological data of 14 patients was performed. In ten cases colonic ischemia was confirmed clinically or intraoperatively. Most of our patients needed intravenous catecholamines due to severe hypotension. However, no significant radiographic predictors could be identified. CONCLUSION: Awareness of NOD seems to be crucial. Especially in cases of acute abdominal pain associated with severe hypotension, renal insufficiency, or pancreatitis, one should include NOD as a differential diagnosis at an early stage.

Abdominal Pain↗
PubMedDate not supplied

Hypothermia in surgical patients.

During the perioperative period little attention is given to thermoregulation. This can lead to hypothermia which has severe physiological complications. This article discusses the causes and effects of hypothermia in surgical patients and describes a study that the author conducted to discover the level of awareness on the subject among operating department staff.

Humans↗
PubMed2004

Has evolution in awareness of guidelines for institution of damage control improved outcome in the management of the posttraumatic open abdomen?

HYPOTHESIS: Awareness of guidelines for damage control can improve patient outcomes after postraumatic open abdomen. DESIGN: Retrospective (November 1992 to December 1998), prospective (January 1999 to July 2001), 104-month study. SETTING: Los Angeles County and University of Southern California Medical Center, Los Angeles. PATIENTS: All patients undergoing damage control resulting in posttraumatic open abdomen. MAIN OUTCOME MEASURES: The main outcome measure was survival. Data were also collected on surgical findings and indications for damage control, including organs injured, intraoperative estimated blood loss, and intraoperative fluids, blood, and blood products administered. Postoperative complications, length of time patients had an open abdomen, and surgical intensive care unit and hospital length of stay were also recorded. RESULTS: No difference in mortality existed between patients admitted before awareness of guidelines (group 1; 21 [24%] of 86 patients died) and patients who underwent damage control following these suggested guidelines (group 2; 13 [24%] of 53 patients died) (P =.85). Of the 139 patients, 100 had penetrating injuries and 39 had blunt injuries. Estimated blood loss was 4764 +/- 5349 mL. Mean intraoperative fluid replacement was 22 034 mL. One hundred one patients (73%) experienced 228 complications, for a mean of 2.26 complications per patient. Group 1 patients spent a longer time in the operating room (mean, 4.09 +/- 1.99 hours; range, 0.4-9.5 hours) vs group 2 patients (mean, 2.34 +/- 1.50 hours; range, 0.3-6.2 hours; P<.001). The surgical intensive care unit length of stay was 23.5 +/- 18.3 days vs 8.7 +/- 14.9 days (P<.001), and the hospital length of stay was 37.4 +/- 27.5 days vs 12.4 +/- 21.0 days (P<.001) in survivors and nonsurvivors, respectively. CONCLUSIONS: We recommend close monitoring of intraoperative outcome predictors as validated within our guidelines and recommend following our model for early institution of damage control.

Abdominal Injuries↗
PubMed1999

[Unexpected hyperkalemia during general anesthesia in three patients undergoing hepatic, cholangioler or pancreatic surgery].

Three patients developed unaccountable hyperkalemia during general anesthesia for pancreatectomy, hepatectomy, and cholangio-jejunostomy. The patients had normal preoperative renal function, serum potassium values, and intraoperative urine output. The surgical manipulations might have reduced portal venous and/or hepatic arterial blood flow resulting in the hepatic ischemia. Consequently, hepatic intra-cellular potassium might have leaked into the blood causing hyperkalemia. Anesthesiologists should be aware of the potential risk of hyperkalemia caused by surgical interventions on the liver and/or pancreas.

Aged↗
PubMed1998

Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report.

STUDY DESIGN: Case report of a fatal complication of pedicle screw instrumentation and review of the literature. OBJECTIVE: To describe the clinical and postmortem findings in a 35-year-old man who sustained a T11 burst fracture that was managed by transpedicular posterior instrumentation and who died 12 days after surgery of cardiac tamponade caused by a prick injury of the right coronary artery. SUMMARY OF BACKGROUND DATA: Posterior pedicle screw instrumentation is considered a safe and effective method for stabilizing a spinal motion segment. Nevertheless, there are several rare but significant complications that may occur. This is the first report of a heart tamponade after transpedicular screw insertion. METHODS: A 35-year-old man was treated for a T11 burst fracture with posterior transpedicular stabilization. The surgery was uncomplicated. RESULTS: Twelve days after the intervention, the patient died of cardiogenic shock. Postmortem examination showed a heart tamponade of 350 mL blood originating in a prick injury of the right coronary artery. Histologic findings showed evidence that the injury was caused during surgery by a Kirschner wire. CONCLUSION: There are numerous possible intraoperative complications in posterior pedicle screw fixation, such as nerve root and spinal cord injuries. This case of a fatal heart tamponade after transpedicular screw insertion is rare. It shows that the surgeon must be aware of potential risks associated with such a procedure and have a comprehensive three-dimensional understanding of the anatomic structures involved.

Adult↗
PubMed2004

Bilateral acute epidural hematoma after evacuation of acute subdural hematoma: brain shift and the dynamics of extraaxial collections.

Acute epidural hematoma following supratentorial decompressive craniectomy is a very seldom described but serious complication. The occurrence of intraoperative brain swelling may suggest the development of a contralateral hematoma. A unique case of bilateral acute epidural following decompressive craniectomy and evacuation of acute subdural hematoma is presented. Awareness of unexplained elevation of intracranial pressure is of paramount importance when routine immediate postoperative computed tomography is not performed. This case provides insight into the well-known but poorly understood dynamic process of brain shift and extraaxial collections.

Aged↗
PubMed2003

Anaesthetists' attitudes towards awareness and depth-of-anaesthesia monitoring.

Advances in technology have resulted in the development of several depth-of-anaesthesia monitors. Whether any of these monitors can reduce the incidence of awareness is an important issue for anaesthetists and their patients. We therefore surveyed a random selection of anaesthetists, asking for their opinions of awareness and depth-of-anaesthesia monitoring in current clinical practice. Approximately half (52%) of the anaesthetists surveyed had experienced a patient with awareness. Anaesthetists considered that they had a lower incidence of awareness in their own practice when compared with others, 1:5000 vs. 1:10 000 (p < 0.001). Anaesthetists rated awareness on an 11-point scale as only a moderate problem, median (interquartile range) 5 (2-7). Older anaesthetists were less likely to rate the importance of awareness highly (p = 0.009) and to use awareness monitoring (p = 0.001). Anaesthetists are prepared to use depth-of-anaesthesia monitoring more widely if it can be shown to prevent most cases of awareness in routine practice.

Adult↗
PubMed2001

The auditory evoked response as an awareness monitor during anaesthesia.

We investigated the relationship between the latency of the Nb wave of the auditory evoked response (AER) and periods of awareness during propofol anaesthesia. In the anaesthetic room before cardiac surgery the AER was recorded continuously in 14 patients. Awareness was measured by the ability of the patient to respond to command using the isolated forearm technique (IFT). The Nb latencies were shorter when the patients were able to respond than at loss of response (P<0.001). In six patients who repeated this transition from response to loss of response, there was a high and significant correlation between Nb latencies. None of the patients had any recollection of events after the initial induction of anaesthesia as measured by explicit and implicit memory tests. These results suggest that the Nb latency of the AER may represent an indication of awareness in individual patients, but wide inter-patient variability limits its practical usefulness. In addition, because no evidence of memory was demonstrated, even when patients were known to be awake, the relationship between AER and memory processing remains unclear.

Aged↗
PubMed2006

Correlation of the A-Line ARX index with acoustically evoked potential amplitude.

BACKGROUND: Automated indices derived from mid-latency auditory evoked potentials (MLAEP) have been proposed for monitoring the state of anaesthesia. The A-Line ARX index (AAI) has been implemented in the A-Line monitor (Danmeter, V1.4). Several studies have reported variable and, in awake patients, sometimes surprisingly low AAI values. The purpose of this study was to reproduce these findings under steady-state conditions and to investigate their causes. METHODS: Ten awake unmedicated volunteers were studied under steady-state conditions. For each subject, the raw EEG and the AAI were recorded with an A-Line monitor (V1.4) during three separate sessions of 45.0 (1.6) min duration each. MATLAB (Mathworks) routines were used to derive MLAEP responses from EEG data and to calculate maximal MLAEP amplitudes. RESULTS: The AAI values ranged from 15 to 99, while 11.4% fell below levels which, according to the manufacturer, indicate an anaesthetic depth suitable for surgery. Inter-individual and intra-individual variation was observed despite stable recording conditions. The amplitudes of the MLAEP varied from 0.8 to 42.0 microV. The MLAEP amplitude exceeded 2 microV in 75.3% of readings. The Spearman's rank correlation coefficient between the MLAEP amplitude and the AAI value was r=0.89 (P<0.0001). CONCLUSIONS: The version of the A-Line monitor used in this study does not exclude contaminated MLAEP signals. Previous publications involving this version of the A-Line monitor (as opposed to the newer A-Line/2 monitor series) should be reassessed in the light of these findings. Before exclusively MLAEP-based monitors can be evaluated as suitable monitors of depth of anaesthesia, it is essential to ensure that inbuilt validity tests eliminate contaminated MLAEP signals.

Acoustic Stimulation↗
PubMed2005

Malignant peritoneal mesothelioma.

BACKGROUND AND OBJECTIVES: The incidence of malignant peritoneal mesothelioma (MPM) is rising. Our aim was to present our experience with this entity in order to increase the awareness about this disease to avoid misdiagnosis. METHODS: Records of seven patients with histologically confirmed MPM were retrospectively reviewed. Demographic and clinicopathological findings were studied in detail. RESULTS: There were two females and 5 males; mean age was 50.3 years (range 16-73). Asbestos exposure was recorded in two patients, familial Mediterranean fever in one and previous radiation in one. Main presentations were abdominal pain and distension. None of the patients was diagnosed preoperatively. The average delay in diagnosis was 10 months. Calretinin expression was identified in all tumors. Three patients were treated with cytoreductive surgery combined with systemic chemotherapy. Two patients who remain alive were young female patients who were diagnosed by laparoscopic incidental findings and were treated with cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Median survival was 19.7 months. The average survival time of the five patients who died of their diseases was 10.2 months. CONCLUSIONS: An awareness of MPM is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirming the diagnosis. MPM remains a difficult therapeutic challenge. Thorough cytoreductive surgery is the cornerstone of current treatment while HIIC is a promising strategy in suitable patients.

Adolescent↗
PubMed2005

Dreaming during anaesthesia in patients at high risk of awareness.

Dreaming during anaesthesia is commonly reported but remains poorly understood. In this study, adult surgical patients at high risk of awareness were randomly assigned to receive bispectral index (BIS)-guided anaesthesia or routine care, and were interviewed about dreaming three times postoperatively. Dreaming patients (n = 134) were compared with all other patients who were interviewed at least once (n = 2251). Intraoperative dreaming was reported by 4.2%, 3.9% and 3.4% of patients at 2-4 h, 24-36 h and 30 days after surgery, respectively. Fewer BIS-monitored patients reported intra-operative dreaming at 2-4 h than control patients (2.7% vs. 5.7%; p = 0.004). Reports of dreaming were similar in the two groups at 24-36 h and 30 days. Dreaming patients were younger (p = 0.001); healthier (p < 0.001) and more likely to be women (p < 0.001), and were less satisfied with anaesthetic care (p = 0.004) than other patients.

Adult↗
PubMed2006

A survey on the knowledge and attitudes of anaesthesia providers in the United States of America, United Kingdom and Singapore on visual experiences during cataract surgery.

BACKGROUND AND OBJECTIVE: To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. METHODS: Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. RESULTS: A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. CONCLUSIONS: The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.

Administration, Topical↗
PubMed1994

Will epidural with light general anesthesia increase the incidence of awareness with recall or dream postoperatively.

BACKGROUND: The incidence of awareness with recall during general combined with epidural anesthesia has not been previously reported. The purpose of this study was to quantify the incidence. MATERIALS & METHODS: One hundred patients were divided into two groups. Group 1 (N = 50) received general anesthesia (GA), Group 2 (N = 50) received GA and epidural anesthesia (EA) intraoperatively. No premedication was given. These patients were induced with thiopentol (5 mg/kg) or propofol (2.0 mg/kg) and anectine (1.2 mg/kg) for smooth tracheal intubation and maintained with N2O:O2 = 1.5:1.5, and isoflurane and muscle relaxant of either pavulon or atracurium. No sedatives was given. Before anesthesia, we introduced an epidural catheter into the group 2 patients. After induction, headphones with soft music were given to the patients, in both groups, throughout the operation. 20-36 hours after operation or when the patients were fully awake, we asked the patients if they had heard anything or dreamed intraoperatively. RESULTS: We found that not one of the one hundred patients heard anything or dreamed intraoperatively.

Adult↗
PubMed1986

Rare events associated with tubal sterilizations: an international experience.

The results from previous analyses of an international data set collected by Family Health International are reviewed in relation to the incidence, severity, risk factors, and outcomes of rare events associated with tubal sterilization. The rare events included for review, by sequence of their relationship to the tubal sterilization procedure are: luteal phase pregnancy, intraoperative complications (uterine perforation, unintended laparotomy required for completion of the laparoscopic procedure, and technical failure in tubal ring sterilization), deaths, early readmission following laparoscopic sterilization, hysterectomy after laparoscopic sterilization, and pregnancy (intrauterine and ectopic) conceived after tubal sterilization. The widespread use of this method of contraception has important public health implications, and awareness of these events will help clinicians minimize such incidences and better deal with them when they arise.

Female↗