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At least 649 records · Page 36Linked to original sources

PubMed1996

Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness.

We have investigated the relationship between changes in the middle latency auditory evoked potentials during alternating periods of consciousness and unconsciousness produced by propofol infusion combined with spinal anaesthesia for total knee replacement. Eleven patients completed the study, of whom two had recollection of events after the onset of the anaesthetic. There were no significant differences in heart rate or systolic arterial pressure between any conscious and unconscious period. With the first change from consciousness to unconsciousness, latencies of Na, Pa and Nb increased from mean (SD) starting values of 20.0 (1.4), 31.7 (1.0) and 42.8 (1.6) ms to 22.5 (2.0), 39.3 (2.1) and 57.8 (4.4) ms, respectively. During successive transitions from unconsciousness to consciousness, awake latencies were slightly higher than those of baseline awake, whereas anaesthetised latencies were similar to the ones obtained during the first period of unconsciousness. The consistent changes demonstrated, suggest that the auditory evoked potentials could represent a reliable indicator of potential awareness during anaesthesia.

Aged↗

PubMedDate not supplied

Retrieval of a dropped corneal button from a vitrectomized eye.

A successful retrieval of a dropped corneal button from an aphakic vitrectomized eye during penetrating keratoplasty is reported. A 52-year-old female patient underwent penetrating keratoplasty for aphakic corneal edema in a vitrectomized eye. The donor button inadvertently dropped into the vitreous cavity and was retrieved successfully. The dropped corneal button was visualized after focusing the operating microscope on the retina. The visualization significantly improved after aspiration of the fluid from the vitrectomized eye. The donor button was picked up by McPherson's forceps and subsequently sutured to the recipient's cornea. Corneal surgeons need to be aware of this rare complication in aphakic vitrectomized eyes and its retrieval after accurate visualization.

Aphakia↗

PubMed2003

Comparison of measured and estimated angles of table tilt at Caesarean section.

BACKGROUND: Lateral maternal tilt reduces aortocaval compression and the consequent cardiovascular instability. METHODS: We measured the angle of table tilt used by 16 anaesthetists during uncomplicated, elective Caesarean section. After initiating anaesthesia, they were asked to position the patient and estimate the angle of tilt, which was then measured. RESULTS: Almost every anaesthetist positioned the patient less than 15 degrees because they overestimated the angle of tilt. When questioned on their knowledge of the current advice for lateral tilt, 11 of the 16 anaesthetists were aware of the 15 degrees recommendation. CONCLUSION: Estimation of the angle of table tilt is unreliable.

Anesthesia, Obstetrical↗

PubMed1996

Iatrogenic facial nerve injury: the role of facial nerve monitoring.

Intraoperative facial nerve monitoring has emerged as a powerful tool for facilitation of surgery involving the facial nerve. This tool must be properly applied and maintained, however, in order to avoid untoward results and to maximize its potential benefits. Facial nerve monitoring is best suited for prevention of iatrogenic injury. Once injury has become established, its value may be severely limited, especially for moderate to severe injury, in which visual assessment of injury is still the most effective means to determine the need for repair. The most valuable derivative of facial nerve monitoring is enhanced awareness of the edge of the facial nerve contour. This allows strategic alterations in surgical technique for improved facial nerve functional preservation. Although facial nerve monitoring appears to have already had a favorable influence on facial nerve preservation, further improvement seems likely over time through an ongoing process of trial and error.

Ear Diseases↗

PubMed2004

Transient hemiplegia in posterior instrumentation of scoliosis.

STUDY DESIGN: A case of transient hemiplegia during posterior correction and instrumentation of scoliosis in an 18-year-old woman. OBJECTIVE: To present a case of transient hemiplegia most probably resulting from an arteriovenous fistula. SUMMARY OF BACKGROUND DATA: Neurologic impairment in spinal surgery is a feared complication. Common reasons are direct or indirect trauma to neural elements, intraoperative hypotension, ischemia, bleeding, metabolic dysbalances, or drug effects. Review of the literature did not reveal any case of transient hemiplegia similar to the presented one in which none of the mentioned pathologies could be found. CASE SUMMARY: An 18-year-old woman with a right long thoracic lordoscoliosis measuring 67 degrees Cobb angle and a marfanoid phenotype underwent posterior correction and transpedicular instrumentation from T3 to L2. After uneventful correction of the deformity through rod rotation, the wake-up test revealed a right-sided hemiplegia without facial asymmetry or other neurologic abnormalities affecting structures above the spinal cord. The rods were removed, the pedicle screws left in place, and the patient was turned on her back. Within 30 minutes after extubation, the neurologic deficits disappeared completely. Extensive diagnostic workup, including magnetic resonance angiography, did not show any pathologic findings explaining the transient hemiplegia. Two weeks later, the surgical correction was completed. After rod rotation again, right-sided hemiplegia was found in the wake-up test. Leaving the correction and after finalizing surgery, the patient was turned on her back and a 5 x 3-cm mass became apparent in her right sternocleidomastoid region. Color-coded duplex sonography revealed an arteriovenous fistula between the right external carotid artery and the right internal jugular vein. After extubation, the mass disappeared and within minutes all neurologic functions returned to normal again. CONCLUSIONS: Spine surgeons should be aware of arteriovenous malformations as a potential cause of neurologic disturbances.

Abnormalities, Multiple↗

PubMed1993

[Anesthesia in familial hyperkalemic periodic paralysis].

A 53-year-old woman was scheduled for elective surgery of a L4-L5 lumbar disc prolapse. Preoperatively, she reported of a hereditary muscle disease in her family which could be identified as familial hyperkalaemic periodic paralysis. In patients with familial periodic paralysis, only limited information is available in the current anaesthesiological literature. This is especially true of the hyperkalaemic form which was separated from the hypokalaemic form in 1957. Most patients suffering from periodic paralysis will develop myotonic symptoms in time, but evidence is lacking that the incidence of malignant hyperthermia (MH) is higher than in normals. However, abnormalities of the electrocardiogram (ECG) due to changes in the potassium serum levels are not unusual, and the anaesthesiologist must be aware of cardiac arrhythmias. In the present case, the patient was anaesthetized using fentanyl, midazolam, and vecuronium, and ventilated with 66% nitrous oxide in oxygen. Radial artery blood pressure, end-tidal CO2, and nasopharyngeal temperature were monitored continuously. Surgery was completed after 2 hours with no abnormalities in the intraoperative course. Recovery from anaesthesia was uneventful. During the postoperative follow-up for 1 week, further attacks of paralysis, intermittent sodium-potassium imbalance of the muscle cell membrane appears to be the primary pathogenetic factor. In this special disease, prevention of carbohydrate depletion and the avoidance of muscle relaxants are recommended in the anaesthesiological literature. However, a specified regimen of general anaesthesia has not yet been outlined. In our special case, the use of anaesthetics deemed to be safe in MH susceptible patients produced an uneventful perioperative course.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗

PubMed1990

Molteno rip-cord suture hypopyon.

Seven of 27 eyes developed hypopyons following removal of a 4-0 chromic suture that had been placed intraoperatively in the lumen of the tube of a Molteno implant as a temporary occlusion device. The hypopyons were sterile to anterior chamber tap and in six of seven cases resolved with only routine antibiotic coverage. Surgeons contemplating using an internal chromic suture occlusion in Molteno implants, however, should be aware of this potential problem and adopt a conservative, noninvasive approach.

Adolescent↗

PubMed1993

Hypothermia and rewarming after cardiac surgery.

Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is an important operative challenge during cardiac surgery. The state of the art in myocardial preservation in the 1990s has evolved to include pretreatment of the myocardium; intraoperative use of systemic hypothermia with cardiopulmonary bypass (CPB), topical cooling of the myocardium, cold cardioplegia, and myocardial reperfusion; and postoperative oxygen transport support. These techniques optimize myocardial preservation while providing adequate cardiac surgery operative times by decreasing the myocardial ischemic period, decreasing cellular metabolic requirements, and preserving energy stores. Awareness of the physiologic consequences of hypothermia in the postoperative cardiac patient improves nursing assessment of the hypothermic patient. Appropriate temperature monitoring and reporting support timely medical and nursing interventions for hypothermia, such as internal and external rewarming techniques or drug administration to facilitate the rewarming process and suppress or treat shivering. This article addresses the physiologic condition of hypothermia, the elective hypothermia techniques used during cardiac surgery, and the medical or nursing rewarming and management techniques for the postoperative cardiac surgery patient.

Aged↗

PubMed1999

Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve.

BACKGROUND: Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve. METHODS: Intra-operative BAEP were monitored in a consecutive series of over 300 microvascular decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura. RESULTS: The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss. CONCLUSION: These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. Awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery.

Aged↗

PubMed1999

The recurrent laryngeal nerve related to thyroid surgery.

BACKGROUND: Iatrogenic injury of inferior laryngeal nerve is one of the most serious concerns in thyroid surgery. Paralysis of vocal cords is a common sequela of thyroidectomy. It represents a serious complication inducing, when bilateral, serious functional sequelae such as phonatory, respiratory and psychological problems that limit working capacities and social relationships of patients. We carried out an intraoperative study aimed to define anatomical relationships between the recurrent laryngeal nerve and the adjacent structures (the inferior thyroid artery in particular), intraoperative identification of which may allow prevention of iatrogenic injuries of the laryngeal nerve. METHODS: One hundred ninety-two patients (165 females, 27 males whose age was between 18 and 90 years, median age 55) who had undergone thyroidectomy in our department in the last 3 years. Among them, 179 patients underwent total extracapsular thyroidectomy, and of the 13 remaining, 12 were completions of thyroidectomy in patients who had previously undergone a first thyroid surgical intervention and underwent istmo-lobectomy. RESULTS: Despite a systematic intraoperative search, we identified the recurrent laryngeal nerve in 158 of 192 patients (82.3%), while in the remaining 34 (17.7%), the recurrent laryngeal nerve was not identified. In 122 out of the 158 patients (77.2%) in whom the recurrent laryngeal nerve had been detected, the nerve was identified bilaterally: in 19 of 158 (12%) only on the right side; in 17 of 158 (10.7%) only on the left. Concerning the postoperative results we noticed only one case (0.5%) of recurrent laryngeal nerve injury for neoplastic infiltration of its own branch, one case (0.5%) of monolateral cordal hypomotility, and two cases (1.04%) of bilateral cordal hypomotility with temporary disphonia, which regressed in 6 months of time. CONCLUSION: The results of our study may confirm that iatrogenic injury to the recurrent laryngeal nerve, or to its branches, might be better avoided by searching, identifying, and exposing the nerve itself and by following its course with care. In our view, total extracapsular thyroidectomy, with systematic search for the nerve, is the best approach. We believe that deep knowledge of the thyroid region's surgical anatomy and the awareness of the extremely varying course of the recurrent laryngeal nerve and the inferior thyroid artery and their relations should be taken into account by surgeons.

Arteries↗

PubMed1996

Vascular complications in lumbar disk surgery: report of four cases.

Vascular injuries in lumbar disk surgery, although rare, are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be aware of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single institution, for postoperative vascular complications. We identified four patients (0.05%) with lumbar disk surgery-related vascular complications: intraoperative lacerations of the abdominal aorta and median sacral artery, an arteriovenous fistula between the left common iliac artery and vein detected 19 days postdiskectomy, and a partially thrombosed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The majority of cases in the literature of vascular injury in lumbar disk surgery were reported prior to 1965. Diagnostic approaches described in that period do not reflect the great range of diagnostic techniques available today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion based on clinical signs and/or the use of sonography or CT is important in the detection of these complications.

Aged↗

PubMed2004

Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case.

Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.

Aged↗

PubMed1989

Reflex bradycardia in facial surgery.

Traction on, or stretching of, any structure innervated by the trigeminal nerve can cause reflex slowing of the pulse, inappropriately known as the "oculocardiac reflex" because it is well-known to result from traction on the extra-ocular muscles. This phenomenon can cause problems in surgery of the face and cranium as well as the orbit. An awareness of its management can obviate morbidity and mortality. An account of the phenomenon, its treatment and illustrative case histories are presented.

Adult↗

PubMed1987

Atheroembolic perioperative infarction during repeat coronary bypass surgery: angiographic documentation in a survivor.

We report the case of a patient in whom a myocardial infarction complicated a coronary bypass reoperation. We believe the infarction was associated with embolic occlusion of a large coronary branch by atheroma, which we demonstrated in a previous bypass graft preoperatively and did not see in the postoperative study. We are not aware that atheroembolism of a large coronary branch has been reported before in a survivor of reoperation.

Adult↗

PubMed2002

Congenital anteroposterior spinal dissociation in Larsen's Syndrome: report on two operated cases with long-term follow-up.

STUDY DESIGN: The outcome of two patients with Larsen's syndrome after spinal surgery was evaluated after follow-up for 9 and 16 years. OBJECTIVE: To report on a new phenomenon of anteroposterior dissociation of the vertebrae in Larsen's syndrome. To demonstrate that it can be visualized before surgery with imaging and also seen intraoperatively. To show that the neurologic recovery after surgery is sustained and to review the technical reasons for the difficulties in achieving a surgical fusion. The critical role of CT scanning will be illustrated. SUMMARY OF BACKGROUND DATA: The results of preoperative and postoperative radiologic investigations and intraoperative findings are presented to support this new phenomenon. METHODS: Two patients underwent multiple spinal surgeries because of a deteriorating myelopathic clinical status. Intraoperatively, anteroposterior dissociation was documented in both patients. There was great difficulty in obtaining a surgical fusion, and an unusually long circumferential fusion was eventually necessary to obtain stability. Prolonged halo-vest immobilization was essential. RESULTS: Neurologic recovery was sustained over time, and the spinal deformity did not deteriorate. CONCLUSION: Awareness of this phenomenon is essential to the management of spinal deformities in Larsen's syndrome when presenting with myelopathy. Special features in the radiologic workup should be sought after so as to plan staged surgical procedures. Conventional principles of planning of fusion levels are inadequate. Early treatment is advocated, as the neurologic compromise is reversible.

Bone and Bones↗

PubMed1997

Perioperative collapse: prevalence of latex allergy in patients sensitive to anaesthetic agents.

The evidence in the literature suggests that the prevalence of latex allergy in the general population is approximately 1%. With increasing awareness of transmission of HIV and other infections such as hepatitis B, the use of latex gloves and condoms has escalated in recent years. As cheaper latex gloves of variable and doubtful quality flood the market, health care workers and patients are being increasingly sensitized by these latex products. A retrospective study investigated the prevalence of latex allergy in a cohort of 26 patients who suffered perioperative anaphylactoid reactions. 84% of these patients were hypersensitive to at least 1 anaesthetic-related agent. 7.7% were also allergic to latex (p = 0.028). Atopy is a strong predisposing factor (p = 0.006). An accurate preoperative history of atopy and past reactions to latex will identify most at-risk patients. Prick test and RAST to latex will confirm the latex allergy. Anaesthetists, surgeons, allergists and other health practitioners should be aware of this problem.

Adolescent↗

PubMed2001

[A case of awareness during propofol anesthesia using bispectral index as an indicator of hypnotic effect].

A 77-year old, woman weighing 44 kg with mild liver dysfunction underwent lower abdominal surgery. Anesthesia was induced with propofol 60 mg and fentanyl 0.1 mg. Tracheal intubation was facilitated with vecuronium 8 mg, and the lungs were ventilated with 33% oxygen in air. The bispectral index (BIS) was continuously monitored. Anesthesia was maintained with propofol infusion and analgesia was provided by thoracic epidural infusion of lidocaine 1.5%. The infusion rate of propofol was altered to maintain the BIS value between 40 and 50. The patient was hemodynamically stable with propofol 1.5 mg.kg-1.hr-1 and the BIS value was maintained about 40 during the operation. Near the end of the operation the patient moved suddenly. Suspecting inadequate anesthesia, a total of 40 mg of propofol i.v. and 5 ml of the epidural infusion were given. Immediately before the movement the BIS value was about 40. The operation was completed 30 min later. On discharge from the operating room the patient declared that she had been awake. She had heard voices and felt the surgeon working, but had suffered no pain. The BIS is a useful indicator for hypnotic effect, but this case demonstrates that awareness might occur even when BIS value indicates adequate hypnotic state.

Aged↗

PubMed1992

Injury to the superior mesenteric artery during pancreatectomy for chronic pancreatitis.

Four cases are described of injury to the superior mesenteric artery (SMA) during pancreatectomy for chronic pancreatitis. Review of the literature indicates that this is a rare event. In three patients (arterial ligation, 2; haemorrhage, 1), the injury was immediately recognised and successfully repaired. In the fourth (with probable occlusion of the vessel), the problem was not appreciated at operation and the patient eventually died. Vessels adherent to a pseudocyst are at particular risk of injury, as in two of our patients. Two patients had ectopic origin of the right hepatic artery. Since awareness of such vascular anomalies is important, we now perform selective mesenteric angiography in all patients requiring pancreatic resections, whether proximal or distal.

Adult↗