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At least 703 records · Page 39Linked to original sources
PubMed1998

Thoracoscopic sympathectomy: a case report.

Thoracoscopic sympathectomy was first described in 1951 but was not popularized until this decade. With the advent of videoendoscopic techniques and advances in minimally invasive surgery, thoracoscopic sympathectomy has been shown to be a safe and effective therapy in the treatment of various autonomically mediated disorders. Furthermore, numerous investigators have reported high rates of technical success and patient satisfacrion. These minimally invasive techniques used to resect the sympathetic ganglia significantly reduces the morbidity and mortality often associated with conventional open procedures. In addition, endoscopic techniques provide a magnified view of the surgical field and allow for precise identification of the sympathetic chain and points of resection.

Journal Article↗
PubMedDate not supplied

[The surgical treatment of erythromelalgia by the destruction of the inlet areas of the posterior spinal nerve roots].

The paper presents a 13-year-old patient suffering from erythromelalgia in whom arm pain and burning ceased for 3 years after unilateral stereotactic cryodestruction of the thalamic ventrolateral nuclei. Following a relapse, reoperation on the other side turned out to be ineffective. Then the patient underwent destruction of the inlet areas of the spinal dorsal roots by breaking the cervical pain-conducting tracts. Pain and other autonomic manifestations of the disease came to an end. The authors give an anatomic and neurophysiological rationale for surgery.

Acute Disease↗
PubMed1979

Autonomic arousal as a cognitive cue in stressful situations.

The need for further investigation and integration in a real world situation is demonstrated in a critical review of the literature on autonomic feedback and attribution of arousal in stressful situations. In the present study, actual autonomic arousal, arbitrary feedback of arousal, and attributions for arousal were manipulated in a dental clinic where the subjects were awaiting oral surgery. The main prediction was that cognized arousal (due either to perception of actual arousal or to arbitrary feedback about arousal level) in the absence of a nonemotional attribution for that cognized arousal would lead to higher subjective report of anxiety and to greater avoidance than would be found with either of these conditions unmet. The results on the subjective report measure generally supported this hypothesis. In addition, arbitrary feedback about arousal level did not interact with the actual arousal manipulation; nor did it produce changes in pulse rate or blood pressure, further supporting a cognitive interpretation of the effects of autonomic arousal on subjective report. However, the study illustrates difficulties in inducing beneficial beliefs in the real world. And the manipulations generally did not affect the behavioral measure, probably due to the expected consequences of that behavior.

Adolescent↗
PubMed1991

Neuroleptic malignant syndrome: occurrence in a child after reconstructive surgery.

The occurrence of the rare but potentially fatal neuroleptic malignant syndrome must be considered by the surgeon treating a patient who develops hyperthermia, mental abnormalities, autonomic instability, and muscle rigidity after exposure to phenothiazines or other neuroleptic drugs. The dopamine agonist bromocriptine appears to be the treatment of choice in adults and seemed to be effective and well tolerated in our patient. Although the syndrome cannot be prevented, recognition is crucial, since effective general and specific therapy is available. Differentiating neuroleptic malignant syndrome from malignant hyperthermia allows early appropriate treatment with bromocriptine.

Child↗
PubMed2005

Scale-invariant registration of monocular endoscopic images to CT-scans for sinus surgery.

In this paper, we present a novel method for intra-operative registration directly from monocular endoscopic images. This technique has the potential to provide a more accurate surface registration at the surgical site than existing methods. It can operate autonomously from as few as two images and can be particularly useful in revision cases where surgical landmarks may be absent. A by-product of video registration is an estimate of the local surface structure of the anatomy, thus providing the opportunity to dynamically update anatomical models as the surgery progresses. Our approach is based on a previously presented method [Burschka, D., Hager, G.D., 2004. V-GPS (SLAM):--Vision-based inertial system for mobile robots. In: Proceedings of ICRA, 409-415] for reconstruction of a scaled 3D model of the environment from unknown camera motion. We use this scaled reconstruction as input to a PCA-based algorithm that registers the reconstructed data to the CT data and recovers the scale and pose parameters of the camera in the coordinate frame of the CT scan. The result is used in an ICP registration step to refine the registration estimates. The details of our approach and the experimental results with a phantom of a human skull and a head of a pig cadaver are presented in this paper.

Algorithms↗
PubMed2003

Remifentanil infusion for cleft palate surgery in young infants.

BACKGROUND: The residual depressant effect of opioid is a major concern in infants scheduled for cleft palate repair. Remifentanil is associated with a fast and predictable recovery, independent of age. METHODS: About 40 infants in the 2-12 month age range were prospectively enrolled in this open study, to receive either remifentanil (infusion starting at 0.25 microg x kg(-1) x min(-1)) or sufentanil as part of a balanced anaesthesia regimen. Isoflurane was maintained at an endtidal concentration of 1.2% in oxygen and nitrous oxide and the opioid dosing was titrated to autonomic responses. Postoperative pain relief was provided by morphine infusion. Morphine administration started intraoperatively in the remifentanil group. RESULTS: Consistent haemodynamic stability was achieved throughout surgery in both groups. Infants of the remifentanil group required, on average, lower concentrations of isoflurane than children of the sufentanil group (1.2 +/- 0.2% vs 1.7 +/- 0.3%, P < 0.001). The median time from last suture to tracheal extubation was 12.5 min (5-25 min) in the remifentanil group and 15.0 min (10-30 min) in the sufentanil group. There was no evidence of hyperalgesia or enhanced morphine consumption in the remifentanil group compared with the sufentanil group. Postoperative pain scores were even lower in the remifentanil group, compared with the sufentanil group, soon after arrival in the postanaesthesia care unit. CONCLUSIONS: Remifentanil-based anaesthesia appeared well suited for primary cleft palate repair in young infants.

Analgesics, Opioid↗
PubMed1994

[Differential effects of isoflurane, sevoflurane and halothane on autonomic function determined by spectral analysis of heart rate variability].

The effects of isoflurane, sevoflurane and halothane on heart rate variability were studied in 18 patients scheduled for minor otolaryngeal surgery. After the surgery, R-R intervals were determined at minimum alveolar concentrations of 2.0, 1.5, 1.0 and 0.5 under mechanical ventilation. The data were plotted on a one-dimensional map and analyzed further by autoregressive spectral analysis. All three anesthetics suppressed both the low frequency component (Mayer wave related sinus arrhythmia; MWSA) and the high frequency component (respiratory sinus arrhythmia; RSA). The MWSA reflecting sympathetic activity was less affected by sevoflurane while the RSA reflecting parasympathetic function was less influenced by halothane. The one-dimensional map was useful to visualize the depth of anesthesia.

Adolescent↗
PubMed2001

Familial carpal tunnel syndrome: a report of a Finnish family.

The existence of familial carpal tunnel syndrome (FCTS) as a separate autonomic entity has been discussed during the last few years. In order to contribute with more data to the literature, we report here the results of clinical. electrophysiological, pathological and radiological studies performed in 5 patients belonging to the same Finnish pedigree. The disease appeared usually before the second decade with numbness and pain on the I--III digits. In most patients symptoms were unilateral but within 2 years they became bilateral. In all patients typical electrophysiological features of median nerve entrapment have been recorded. X-rays of the wrist showed narrow carpal tunnel in all patients. In all patients the possibility of having HNPP as well as familial amyloidosis has been excluded by molecular genetic and pathological studies. All patients underwent surgery and at postoperative stage symptoms were relieved or completely disappeared. Our study supports the theory that FCTS exists as a separate autonomic entity, therefore it is important in front of a sporadic case to investigate the family occurrence of CTS.

Adolescent↗
PubMed1999

Advocacy--answering old mail. Canadian Association of General Surgeons.

Since its inception in 1977, the Canadian Association of General Surgeons (CAGS) has struggled with its responsibility to represent general surgeons in practices across this country. The CAGS has tended to be mute in the presentation of many of its accomplishments, which have improved the role of specialists in community practice, training programs and the subspecialties of general surgery. With the forthcoming changes in direction for the Royal College of Physicians and Surgeons of Canada, based on a recent external survey, the CAGS has a golden opportunity to advocate for a clear identity, autonomous from the Royal College for the purposes of scientific meetings, continuing professional development, scientific and practice affiliation with other surgical specialty societies, and new developments with corporate sector support for advancements in science technology and education. Advocacy for general surgery must be stressed as the priority for the CAGS into the future.

Budgets↗
PubMed1978

[Advances in the prevention and control of urologic complications of cervix cancer. 2. Bladder-function disorders].

By means of 386 comparative cystometries hypertensive reactions were recorded from the urinary bladder both following total and radical vaginal hysterectomy. Hypertension was most strongly pronounced over the first two weeks after operation and receded spontaneously during the third and fourth weeks. That increased intravesical pressure, therefore, was attributed primarily to the surgical trauma and its inevitably accompanying irritation of the bladder. Predominant parasympathetic denervation of the bladder by radical surgery was found to be relevant, first of all, during micturation. Reduced sense of emptying the bladder and sympathetically induced disturbances in the correlations between detrusor and the urethrovesical region favoured the formation of residual urine. Its early therapy, using cholinergics, is becoming increasingly problematic. Intensive control of infections and persistent continuation of catheterisation, until the autonomously functioning bladder has got adjusted to its changed conditions, so far remain to be the most dependable approaches to prophylaxis and therapy of micturation disorders following radical surgery. In severe cases more recent pharmacological and neurohistochemical findings regarding selective effectiveness of alpha-receptor blockers and beta-stimulators in neurogenic bladder may open new therapeutic ways.

Female↗
PubMed1984

Cardiovascular autonomic response during preoperative stress and postoperative pain.

Heart rate response to physiologic maneuvers was used to evaluate autonomic nervous system (ANS) function in normal control subjects and during the stress and pain experienced by patients before and after surgery. In preoperative patients (stressed without pain) and postoperative patients (stressed with pain), maneuvers which routinely increase activity in the parasympathetic or sympathetic divisions of the ANS produced only 50% of the response seen in control subjects. The heart rate response was not further reduced in patients with pain compared to patients with stress alone. The difference in heart rate response between surgical patients and control subjects was not accompanied by a difference in baseline heart rate. The data suggest that tonic stress impairs the ability of the ANS to respond fully to perturbing influences.

Adolescent↗
PubMed2005

Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery.

Atrial fibrillation (AF) is one of the most frequent complications of cardiac surgery, affecting more than one third of patients. The mechanism of this arrhythmia is believed to be reentry. The electrophysiologic substrate may be preexisting or may develop due to heterogeneity of refractoriness after surgery. Multiple perioperative factors have been proposed to contribute to the latter, including operative trauma, inflammation, elevations in atrial pressure (including that due to left ventricular diastolic dysfunction), autonomic nervous system imbalance, metabolic and electrolyte imbalances, or myocardial ischemic damage incurred during the operation. Whether ectopic beats originating in the pulmonary veins explain at least some episodes of postoperative AF, as has been shown for nonsurgical patients with the arrhythmia, is of current interest as such sites could easily be isolated at the time of surgery. The development of postoperative AF is associated with a higher risk of operative morbidity, prolonged hospitalization, and increased hospital cost compared with that in patients remaining in sinus rhythm. Many factors have been identified as being associated with postoperative AF, but the most consistent variable across studies is increasing patient age. It is speculated that age-related pathologic changes in the atrium contribute to arrhythmia susceptibility. An important modifiable risk factor for postoperative AF is the failure to resume therapy with beta-adrenergic receptor blockers after surgery. The stratification of patients who are at higher risk for AF would focus preventative strategies on patients who are most likely to benefit from such therapy. Nonetheless, since postoperative AF often develops in patients with comorbidities who are predisposed to other complications and prolonged hospitalization, it is presently unclear whether the prevention of postoperative AF will result in improved patient outcomes, particularly shorter hospitalizations.

Age Factors↗
PubMed1989

[A study of autonomic nerve dysfunction in patients with thoracic outlet syndrome].

The function of the autonomic nerve system in sixty-seven patients with thoracic outlet syndrome was examined by a non-invasive and quantitative technique assessing the mean (M) and coefficient of variation (CV) or R-R interval in ECG. The first group of patients (28 cases) with autonomic nervous disorder and complaints of general discomfort showed a significantly shorter M and smaller CV. The second group (39 cases), those without general discomfort, exhibited a normal range of M and CV. In four of the first group with the diagnosis of schizophrenia and anxiety neurosis, furthermore, M and CV were nearly the same as those in the second group. In eight of the first group undergoing decompression operation, their complaints decreased or disappeared after surgery, with recovery of M and CV almost to the normal level. According to these results, this method appears to be useful in differentiating between autonomic nervous disorders and psychological disorders, facilitating disappearance of general discomfort due to autonomic nervous disorders.

Adolescent↗
PubMed1995

Diabetic autonomic neuropathy and the haemodynamic actions of vecuronium and pancuronium during vitrectomy.

In order to clarify whether autonomic neuropathy modifies the haemodynamic effects of alfentanil, vecuronium and pancuronium, twenty-seven patients with diabetes mellitus were studied at thiopentone induction, and during nitrous oxide anaesthesia for ophthalmic vitreous surgery. Heart rate was lower in the diabetic patients receiving vecuronium compared with those receiving pancuronium, but no difference was seen in arterial pressure. During and after anaesthesia induction, the profiles of heart rate and arterial pressure resembled those found in healthy controls. Even in patients with advanced autonomic neuropathy, anaesthetics may exert their inherent vagotonic or sympathicotonic actions.

Adult↗
PubMed1994

Propofol-fentanyl anesthesia: a comparison with isoflurane-fentanyl anesthesia in coronary artery bypass grafting and valve replacement surgery.

The hemodynamic effects of propofol-fentanyl and isoflurane-fentanyl anesthesia during the prebypass period were compared in 42 patients undergoing coronary artery bypass grafting (CABG) and 22 patients undergoing valve replacement (VR) for stenotic lesions. Anesthesia was induced with fentanyl, 25 micrograms/kg, and pancuronium, 0.1 mg/kg, and was maintained with a propofol infusion commenced at 4 mg/kg/h (range 1 to 10 mg/kg/h) or with isoflurane commenced at 1% (range 0 to 2%). Additional fentanyl, 7.5 micrograms/kg, was given before sternotomy. Hemodynamic measurements were made before induction of anesthesia and at various times in the prebypass period. In the VR group, there were no significant differences between the two anesthetics in any hemodynamic variables during the study. Significant decreases (P < 0.05) in mean arterial pressure (MAP 14%), left ventricular stroke work index (LVSWI 29%), and stroke volume index (SVI 24%) occurred after 15 minutes of propofol anesthesia in the CABG group. With isoflurane MAP was well maintained with reductions in LVSWI and SVI of 22% and 20%, respectively. Isoflurane was, however, associated with a significant increase in heart rate (HR) in the CABG group (P < 0.05), whereas no significant change in HR occurred in CABG or VR patients receiving propofol. With both techniques there were no significant changes in right-sided or left-sided filling pressures or in systemic vascular resistance index in the CABG or VR groups, except for a decrease in pulmonary artery occlusion pressure in the propofol VR group and isoflurane CABG group at the time of aortic cannulation. Propofol produced similar hemodynamic changes in the CABG and VR groups. Both anesthetic techniques caused myocardial depression and effectively controlled the autonomic responses to sternotomy in both groups. The study suggests that propofol-fentanyl anesthesia is an acceptable technique for CABG surgery and for VR in patients with stenotic valvular heart disease.

Adolescent↗