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At least 577 records · Page 32Linked to original sources
PubMed2005

Comparative evaluation of the cerebral state index and the bispectral index during target-controlled infusion of propofol.

BACKGROUND: Cerebral state index (CSI) has recently been introduced as an intra-operative monitor of anaesthetic depth. We compared the performance of the CSI to the bispectral index (BIS) in measuring depth of anaesthesia during target-controlled infusion (TCI) of propofol. METHODS: Twenty Chinese patients undergoing general anaesthesia were recruited. CSI and BIS, and predicted effect-site concentration of propofol were recorded. The level of sedation was tested by Modified Observer's Assessment of Alertness/Sedation Scale (MOAAS) every 20 s during stepwise increase (TCI, 0.5 microg ml(-1)) of propofol. The loss of verbal contact (LVC) and loss of response (LOR) were defined by MOAAS values of 2-3 and less than 2, respectively. Baseline variability and the prediction probability (P(K)) were calculated for the BIS and CSI. The values of BIS(05) and CSI(05), BIS(50) and CSI(50), BIS(95) and CSI(95) were calculated at each end-point (LVC and LOR). RESULTS: Baseline variability of CSI was more than that of BIS. Both CSI and BIS showed a high prediction probability for the steps awake vs LVC, awake vs LOR, and LVC vs LOR, and good correlations with MOAAS values. CONCLUSION: Despite larger baseline variation, CSI performed as well as BIS in terms of P(K) values and correlations with step changes in sedation.

Adult↗
PubMed2004

Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial.

BACKGROUND: The risks that the presence of air microemboli implies in open-heart surgery have recently been emphasized by reports that their number is correlated with the degree of postoperative neuropsychological disorder. Therefore, we studied the effect of CO2 insufflation into the cardiothoracic wound on the incidence and behavior of microemboli in the heart and ascending aorta. METHODS AND RESULTS: Twenty patients undergoing single-valve surgery were randomly divided into 2 groups. Ten patients were insufflated with CO2 via a gas diffuser, and 10 were not. Microemboli were ascertained by intraoperative transesophageal echocardiography (TEE) and recorded on videotape from the moment that the aortic cross-clamp was released until 20 minutes after end of cardiopulmonary bypass (CPB). The surgeon performed standard de-airing maneuvers without being aware of TEE findings. Postoperatively, a blinded assessor determined the maximal number of gas emboli during each consecutive minute in the left atrium, left ventricle, and ascending aorta. The 2 groups did not differ in the usual clinical parameters. The median number of microemboli registered during the whole study period was 161 in the CO2 group versus 723 in the control group (P<0.001). Corresponding numbers for the left atrium were 69 versus 340 (P<0.001), left ventricle 68 versus 254 (P<0.001), and ascending aorta 56 versus 185 (P<0.001). In the CO2 group, the median number of detectable microemboli after CPB fell to zero 7 minutes after CPB versus 19 minutes in the control group (P<0.001). CONCLUSIONS: Insufflation of CO2 into the thoracic wound markedly decreases the incidence of microemboli.

Aged↗
PubMedDate not supplied

Kuttner tumor (chronic sclerosing sialadenitis).

Kuttner tumor (KT), known descriptively as chronic sclerosing sialadenitis, is a chronic inflammatory disease of the salivary gland. Clinically, it produces a firm swelling of the glands and may be difficult to distinguish from neoplasia. The diagnosis can only be made histologically and should not be difficult if the pathologist is aware of the condition's existence. Errors in diagnosis arise because KT is underrecognized and few cases have been reported in the English literature. We present a case of KT initially diagnosed as a primary salivary gland neoplasm that intraoperative frozen section revealed to be chronic sclerosing sialadenitis. Excision of the mass, usually carried out diagnostically, is adequate treatment.

Biopsy, Needle↗
PubMed2004

Regional audit: perioperative management of MRSA orthopaedic patients in the Oxford region.

AIM: Methicillin resistant staphylococcus aureus (MRSA) colonisation or infection is of particular importance in patients undergoing operations involving implantable materials, such as in orthopaedic surgery. An audit of the perioperative management of orthopaedic patients in the Oxford region was carried out to assess the level of clinician awareness and the uniformity of current guidelines between hospitals. METHODS: A postal questionnaire was designed for asking information on various aspects of perioperative management of MRSA patients and was sent to each hospital. RESULTS: Responses were obtained from nine of 10 hospitals in the region. The average response rate for each hospital was 75%, and the overall individual response rate was 67.5% (27/40). Seventy-eight per cent of respondents knew that there was a pre-admission screening policy. Fifteen per cent were unaware of any MRSA policy. Forty-four per cent indicated that teicoplanin was used for prophylaxis in implant surgery whilst 44% used vancomycin. Eighteen per cent believed that cefuroxime was used for prophylaxis. Forty-eight per cent of hospitals had an MRSA-free zone for orthopaedic patients. CONCLUSION: This study indicates a lack of uniformity in the perioperative management of MRSA-positive patients in the region and a lack of awareness of both MRSA guidelines and their implementation. Uniformity of MRSA guidelines is necessary to allow better clinician awareness and compliance, especially in surgical trainees who are travelling between different training hospitals in the region. Implementation of such a policy with re-audit of subsequent awareness and compliance is proposed.

Antibiotic Prophylaxis↗
PubMed1990

Cardiopulmonary bypass for resection of low tracheal haemangioma.

A 3 month old girl, weighing 4000 g, presented with a capillary haemangioma obstructing the lower trachea and left main bronchus; it was not responsive to steroids. Using cardiopulmonary bypass to maintain oxygenation the tumour was excised. We are not aware that this technique has been used before for the resection of such an obstructive haemangioma.

Cardiopulmonary Bypass↗
PubMed2005

Perioperative management for chronic schizophrenic patients.

Schizophrenic patients are at increased risk for perioperative complications, as their biological response to stress is impaired. The increased complications are associated with physical disorders, antipsychotic or hazardous health behaviors, and interactions between antipsychotics and anesthetic drugs. Thus, anesthesiologists must not only be aware of the perioperative problems of these patients but must also learn how to manage their perioperative course.

Antipsychotic Agents↗
PubMed2000

The rate of hydrocele perforation during vasectomy. Is perforation dangerous?

BACKGROUND: Hydroceles are not uncommon, are often occult, and may be associated with an inguinal hernia. The rate of hydrocele perforation during elective vasectomy has not been reported in the medical literature. Our objective was to estimate the frequency and consequences of hydrocele perforation incidental to vasectomy. METHODS: We retrospectively reviewed data from a series of patients undergoing vasectomy using the no-scalpel technique for the incidence of complications. A supplementary chart review was done to determine preoperative conditions, and telephone contacts were made if needed to assess later morbidity. RESULTS: We noted 7 perforations in 150 vasectomies. Only one patient had a hydrocele documented preoperatively. Three had histories of inguinal hernia and herniorrhaphy. Five patients had evidence of minor swelling early on, but none had additional morbidity or long-term associated complications. CONCLUSIONS: This small case series of vasectomies had a 4.7% incidence rate of perforated small or occult hydroceles. Physicians should be aware of this potentially alarming but apparently minor phenomenon that may accompany vasectomy.

Acute Disease↗
PubMed2006

[First report of malignant hyperthermia which occurred during laparoscopic surgery in Japan in a patient with typical family history].

We experienced a case of fulminant malignant hyperthermia during laparoscopic surgery, which is the first reported case of this kind. A 69-year-old man, weighing 69 kg, underwent laparoscopic colectomy for cecal colon cancer. He had a remarkable familial history of malignant hyperthermia (MH). His uncle had MH from enflurane. In addition, 6 male relatives died at operation, exercise or drinking. However, he hid it intentionally because of social concern about inheriting abnormal genes and of inadequate explanation from medical personnel. Anesthesia was induced with fentanyl 100 microg, propofol 60 mg and vecuronium 9 mg intravenousely and maintained with nitrous oxide, oxygen and sevoflurane. About 120 min after the induction of anesthesia (50 min after pneumoperitoneum), PETCO2 increased to 54 mmHg. Thirty min later, body temperature (BT), heart rate (HR), PETCO2 and airway pressure (Paw) increased rapidly to 37.5 degrees C, 92 beats x min(-1), 62 mmHg and 3/33 cmH2O, respectively. The diagnosis of MH was made. The inspiratory gas was changed to 100% O2, and a bolus of 100 mg dantrolene was given. He had BT of 39.7 degrees C, HR of 152 beats x min(-1), PETCO2 of 123 mmHg, Paw of 3/40 cmH2O at the worst point. Rise in Paw and arrhythmia turned up frequently as complications of laparoscopic surgery, but they are very similar to the first symptoms of malignant hyperthermia. The decrease in BT with CO2 pneumoperitoneum can mask symptoms of MH. Awareness of this fact is important not to delay the diagnosis.

Aged↗
PubMedDate not supplied

Risk factors in interface epithelialization after laser in situ keratomileusis.

PURPOSE: To identify risk factors associated with primary and recurrent epithelial ingrowth after laser in situ keratomileusis (LASIK) requiring surgical debridement. METHODS: Charts of patients who required single or multiple surgical debridements of epithelial ingrowth were reviewed retrospectively and analyzed to identify preoperative, intraoperative, and postoperative risk factors. RESULTS: Fourteen of 22 patients had epithelial ingrowth that required a single surgical removal. These were mostly associated with the surgeon's learning curve, epithelial injury, and enhancement by lifting the flap. Multiple surgical debridements were required in eight patients and some of these were associated with epithelial basement membrane degeneration and a history of type I diabetes. CONCLUSIONS: Refractive surgeons should be aware of surgical and non-surgical ocular and systemic risk factors associated with both primary and recurrent epithelial ingrowth after LASIK to appropriately consent patients seeking refractive surgery. Type I diabetes may increase the risk of epithelial downgrowth in LASIK.

Adult↗
PubMed2005

The initial use of free-running electromyography to detect early motor tract injury during resection of intramedullary spinal cord lesions.

OBJECTIVE: The resection of intramedullary spinal cord lesions (ISCLs) can be complicated by neurological deficits. Neuromonitoring has been used to reduce intraoperative risk. We have used somatosensory evoked potentials (SEPs) and muscle-derived transcranial electrical motor evoked potentials (myogenic TCE-MEPs) to monitor ISCL removal. We report our retrospective experience with the addition of free-running electromyography (EMG). METHODS: Thirteen patients underwent 14 monitored ISCL excisions. Anesthesia was maintained with minimal inhalant to reduce motoneuron suppression and enhance the myogenic TCE-MEPs. Free-running EMG was examined in the four limbs for evidence of abnormal bursts, prolonged tonic discharge, or sudden electrical silence. Warning of an electromyographic abnormality or myogenic TCE-MEP loss prompted interventions, including blood pressure elevation, a pause in surgery, a wake-up test, or termination of surgery. Pre- and postoperative neurological examinations determined the incidence of new deficits. RESULTS: The combined use of free-running EMG and myogenic TCE-MEPs detected all eight patients with a new motor deficit after surgery; there was one false-positive report. In three of the eight true-positive cases, an electromyographic abnormality immediately anticipated loss of the myogenic TCE-MEPs. Two patients with abnormal EMGs but unchanged myogenic TCE-MEPs experienced mild postoperative worsening of motor deficits; myogenic TCE-MEPs alone would have generated false-negative reports in these cases. CONCLUSION: During resection of ISCLs, free-running EMG can supplement motor tract monitoring by TCE-MEPs. Segmental and suprasegmental elicitation of neurotonic discharges can be observed in four-limb EMG. Abnormal electromyographic bursts, tonic discharge, or abrupt electromyographic silence may anticipate myogenic TCE-MEP loss and predict a postoperative motor deficit.

Adolescent↗
PubMed1985

[Anesthesiologic problems in unsuspected extra-adrenal pheochromocytoma].

Although surgical mortality associated with pheochromocytoma has been markedly reduced in recent years, due to improvements in medical and anesthesiologic management, surgery in patients with unsuspected pheochromocytoma is still accompanied by a high fatality rate. A 20-year-old man without history of hypertension and previously in good health is reported who presented for exploratory thoracotomy and removal of a highly vascular mediastinal tumor. Intraoperatively a pheochromocytoma was suspected. Problems associated with establishing the diagnosis as well as difficulties in treating rapid changes of sympathetic adrenergic activation and hypotension following tumor resection are discussed. Despite the comparative rarety of pheochromocytoma the anaesthesiologist should be aware of unusual clinical manifestations.

Adult↗
PubMed2004

Damage control in the abdomen and beyond.

BACKGROUND: Damage control is not a modern concept, but the application of this approach represents a new paradigm in surgery, borne out of a need to care for patients sustaining multiple high-energy injuries. METHODS: A Medline search was performed to locate English language articles relating to damage control procedures in trauma patients. The retrieved articles were manually cross-referenced, and additional academic and historical articles were identified. RESULTS AND CONCLUSION: Damage control surgery, sometimes known as 'damage limitation surgery' or 'abbreviated laparotomy', is best defined as creating a stable anatomical environment to prevent the patient from progressing to an unsalvageable metabolic state. Patients are more likely to die from metabolic failure than from failure to complete organ repairs. It is with this awareness that damage control surgery is performed, enabling the patient to maintain a sustainable physiological envelope.

Abdominal Injuries↗
PubMed1999

Management of hysteroscopic surgery complications.

Hysteroscopic surgery is considered a safe, routine gynecologic procedure performed in the OR and in office settings. Complications are rare; however, when complications do occur they can be severe and rapid. The surgical team members must understand the significance of patient monitoring and proper equipment operation to ensure positive patient outcomes. This article discusses complications from intravasation of various distending media used during hysteroscopy and the complication of hyponatremia. A physiologic approach to these problems enhances awareness of the significance of patient monitoring during hysteroscopic procedures.

Body Fluids↗
PubMed2006

Performing perioperative optimization of the high-risk surgical patient.

Perioperative risk of death after general surgery is quoted as overall less than 1%. However, each individual's risk varies widely according to many identified factors with some having a significantly increased risk of a worse outcome. The observation that manipulating and targeting certain physiological parameters in selected patients can influence this risk has been reported in numerous studies. Yet it is still not widely practised to assist the process, despite the availability of various invasive and non-invasive monitors. This may be in part because of a lack of experience with the practicalities of perioperative optimization, and lack of knowledge in applying currently available tools. This article aims to try and address this deficit and increase awareness of how and when to utilize monitoring equipment to achieve optimal results for the patients we treat.

Algorithms↗
PubMed2006

The multimodal world of medical monitoring displays.

A vision of the future of intraoperative monitoring for anesthesia is presented-a multimodal world based on advanced sensing capabilities. I explore progress towards this vision, outlining the general nature of the anesthetist's monitoring task and the dangers of attentional capture. Research in attention indicates different kinds of attentional control, such as endogenous and exogenous orienting, which are critical to how awareness of patient state is maintained, but which may work differently across different modalities. Four kinds of medical monitoring displays are surveyed: (1) integrated visual displays, (2) head-mounted displays, (3) advanced auditory displays and (4) auditory alarms. Achievements and challenges in each area are outlined. In future research, we should focus more clearly on identifying anesthetists' information needs and we should develop models of attention in different modalities and across different modalities that are more capable of guiding design.

Anesthesia, General↗
PubMed1993

Anaesthesia for coronary artery surgery--a plea for a goal-directed approach.

The purpose of the current literature review was to examine whether changes in current anaesthetic techniques are warranted for patients undergoing coronary artery surgery in light of recent information presented in the literature. The objectives of a cardiac anaesthetic technique are to maintain haemodynamic stability and myocardial oxygen balance, minimize the incidence and severity of ischaemic episodes, be aware of cardiopulmonary bypass-induced pharmacokinetic changes, and facilitate early tracheal extubation if appropriate. Many techniques have been utilized. Provided attention is paid to the details of managing myocardial oxygen supply and demand, none has emerged as superior in preventing intraoperative myocardial ischaemia. Silent myocardial ischaemia (i.e., ischaemia occurring in the absence of haemodynamic aberrations) is common throughout the perioperative period and may occur even in the presence of an appropriately used anaesthetic technique. The incidence and severity appear to be greatest in the postoperative period when the effects of anaesthesia are dissipating. The use of high-dose opioid anaesthesia may no longer be the most appropriate technique to facilitate the anaesthetic objectives. The role of pain management in altering the incidence of ischaemia requires further study. Increased waiting lists for cardiac surgery and ever-diminishing resources should prompt a re-evaluation of early extubation (i.e., within eight hours) as a method of improving utilization of scarce ICU resources. It is suggested that this should be possible with currently available agents to achieve the anaesthetic objectives. Future suggestions for research in this area are made.

Anesthesia, General↗
PubMed1995

Ischemic optic neuropathy following lumbar spine surgery. Case report.

This 48-year-old hypertensive man, a cigarette smoker, awoke in the recovery room with visual loss in the right eye after uncomplicated lumbar spine surgery. His intraoperative blood pressure had been maintained at relatively low levels to reduce bleeding; a loss of 1500 cc of blood was reported. Postoperative hemoglobin was 4.2 g/dl less than the preoperative hemoglobin; however, the patient did not receive a blood transfusion. A postoperative ophthalmological examination revealed decreased visual acuity, color vision, and visual field in the right eye. The right optic nerve and retina were initially normal but the patient eventually developed optic nerve atrophy consistent with the clinical diagnosis of ischemic optic neuropathy. Neurosurgeons should be aware that this condition may follow uncomplicated lumbar spine surgery and should obtain prompt ophthalmological consultation when patients develop postoperative visual loss. Aggressive and rapid correction of blood pressure and hematocrit may be helpful in individuals who develop ischemic optic neuropathy after lumbar spine surgery.

Anemia↗