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PubMedDate not supplied

[Features of the surgical treatment and immediate postoperative period of patients in the acute period of rupture of arterial aneurysms of the cerebral vessels].

The authors analyse the course of the immediate postoperative period in 27 patients with ruptured arterial aneurysms of the cerebral vessels. The dynamics of the local cerebral blood flow and electric resistance of the brain matter were examined for a comprehensive study of changes in cerebral circulation and metabolism. Intracranial pressure (ventricular and subdural) and mechanical resistance of the brain matter were measured with the M-34 mingograph. Such combination of the examination methods and the findings of neurological examination made it possible to study over time the pathological processes which are interconnected (circulation-metabolism-edema and swelling of the brain) and determine the course of the postoperative period. A dependence between the preoperative condition of patients and the course of the immediate postoperative period was revealed, adequate methods for correction of the pathological reactions are suggested, and the specific features of a complex clinico-physiological control in this category of patients and the informativeness of the different methods of examination are discussed.

Brain Edema↗
PubMedDate not supplied

[Characteristics of the development of respiratory insufficiency in the early postoperative period following surgery of cancer of the esophagus and the cardia].

Acute respiratory failure (ARF) in the earliest postoperative period after radical surgery for esophageal cancer is characterized by staged development. Its severity is determined by the degree of ventilation-perfusion disorders and the accompanying diffusion disturbances. The following factors are considered to be ARF-provoking: postaggressive circulation centralization, predominant administration of crystalloid plasma substitutes, persistence of hypoproteinemia in the earliest postoperative period, as well as extended lymph dissection involving cardiopulmonary plexus located in the area of bifurcation. The latter factor is the peculiarity of surgery caused by oncological considerations, while three former factors should be taken into account during management of patients in the intra- and postoperative periods.

Cardia↗
PubMed2002

[Successful catheter-guided local thrombolysis in acute pulmonary embolism in the early postoperative period after pancreatic head resection].

Pulmonary embolism in the early postoperative period is characterized by high morbidity and mortality. Systemic application of thrombolytic agents during this time is contraindicated; operative thrombectomy also has a high mortality rate. We report a case of successful local lysis in combination with catheter fragmentation of a massive two-sided pulmonary embolism diagnosed on the 4th postoperative day after pylorus-preserving duodenopancreatectomy for distal carcinoma of the common bile duct. Thrombolysis was performed in three sessions by a combination of catheter-supported interventional fragmentation of the thrombus with local rt-PA lysis. There were no bleeding complications or disturbances of anastomotic healing. The patient was discharged from the hospital on the 23rd postoperative day after changing anticoagulation to a vitamin K antagonist. The case presented demonstrates the possibility of local lysis in combination with interventional methods as a therapeutic option for pulmonary embolism in the early postoperative period as an alternative to surgical strategies.

Adenocarcinoma↗
PubMed1995

Closed mitral valvotomy and elective ventilation in the postoperative period: effect of mild hypercarbia on right ventricular function.

OBJECTIVES: It is customary to extubate patients immediately after closed mitral valvotomy. These patients often have deranged respiratory function caused by chronic lung congestion. The left ventricular function may also be subnormal after valvotomy in some patients. Therefore, elective ventilation for some duration in the postoperative period can be beneficial to these patients. This work is an attempt to find whether elective ventilation should be preferred over immediate extubation in these patients. DESIGN: A prospective randomized study. SETTING: The study was performed in a tertiary care hospital, and the patients are referred from the northern states of India. PARTICIPANTS: One hundred patients undergoing elective closed mitral valvotomy were included in the initial part of the study. Ten more patients were studied to evaluate the effect of mild hypercarbia on right ventricular function after closed mitral valvotomy. INTERVENTIONS: One hundred patients were divided into two groups of 50 each. Group 1 consisted of patients in whom the neuromuscular blockade was reversed at the end of surgery with neostigmine and atropine and the trachea was extubated. In group 2, the residual neuromuscular paralysis was not reversed and the patients were electively ventilated in the postoperative period for an average duration of 5 hours and 29 minutes +/- 1 hour and 58 minutes. In all the patients in both the groups, electrocardiogram, direct arterial blood pressure, and oxygen saturation were continuously monitored, and arterial blood gases were measured intermittently throughout the study period. Because the results showed that there was mild hypercarbia, 30 minutes after extubation in group 1, 10 more patients were studied to evaluate the effect of mild hypercarbia on right ventricular function after surgery. Patients were ventilated after surgery (F1O2 = 1) to maintain normocarbia (PaCO238.6 +/- 3.4 mmHg). Mild hypercarbia PaCO251.5 +/- 3.7 mmHg) followed by normocarbia (PaCO2 40 +/- 2.5 mmHg) was induced by adjusting the ventilator rate with a constant tidal volume. Standard hemodynamic measurements were performed at each stage. MEASUREMENTS AND MAIN RESULTS: Although all the patients maintained satisfactory and stable hemodynamics in the postoperative period, the PaCO2 at the end of 30 minutes of extubation was significantly higher in group 1 (48.1 +/- 5.3 mmHg) as compared with group 2 (40.2 +/- 4.3 mmHg, p < 0.001). Mild hypercarbia significantly increased pulmonary vascular resistance (p < 0.01), mean pulmonary arterial pressure (p < 0.001), right ventricular stroke work (p < 0.01), right ventricular systolic pressure (p < 0.01), and right ventricular end-diastolic pressure (p < 0.001). The effect was not totally reversible with CO2 washout as all parameters except right ventricular end-diastolic pressure and pulmonary vascular resistance continued to remain significantly higher when normocarbia was restored. The significant changes in systemic hemodynamics produced by hypercarbia were increases in cardiac index, mean arterial pressure, and pulmonary capillary wedge pressure. CONCLUSIONS: Avoidance of even mild hypercarbia, therefore, appears advisable in the early postoperative period because of potential impedence to right ventricular ejection. Continuous monitoring of end-tidal CO2 and frequent blood gas analyses should be practiced, and elective ventilation should be considered in patients with long-standing disease and pulmonary hypertension.

Adolescent↗
PubMedDate not supplied

[Diagnostic value of some markers of infection in cardiosurgical patients in the early postoperative period].

The diagnostic value of traditional markers of infection and procalcitonin test (PCT) in the early postoperative period was compared in 60 cardiosurgical patients with acquired cardiac diseases and at risk for postoperative infectious complications. The mean age of the patients was 51 +/- 11 years. Preoperatively, all the patients had no signs of infections. The patients were examined before and on days 1, 2, 3, and 6 after surgery. Along with the routine studies (thermometry, general blood analysis), the plasma concentration of PCT was determined by immunoluminometric technique (LUMI-test PCT, Brahms Aktiengesellschaft, Germany). The preoperative level of PCT did not exceed the normal values ( < 0.5 ng/ml). On postoperative days 2 to 17, 14 (23.3%) patients developed infectious complications (Group 2); the other patients were included into a group of comparison (Group 1). Just within the first postoperative days, the levels of PCT were significantly higher in Group 2 patients than in Group 1 (7.58 +/- 2.34 and 3.51 +/- 0.71 ng/ml, respectively; p < 0.05). A difference was found in the count of white blood cells between the groups only from day 3. There were no significant differences in body temperature between the groups. At the second stage of analysis of the data, in accordance with the level of PCT on the first day after surgery and its subsequent changes, all the patients were divided into 4 groups (A-D). The level of PCT on postoperative day was less than 0.5 ng/ml in Group A (n = 6), 0.5-2 ng/ml in Group B (n = 23) and more than 2 ng/ml in groups C (n = 26) and D (n = 5). Subsequently, it was in the normal range in Group A, decreased to the normal values in Groups B and C by day 6 following surgery. The persistence of the high level of PCT was observed in Group D where there were the bulk (60%) of infectious complications. As compared with the traditional clinical and laboratory criteria (fever, leukocytosis), PCT is the earliest and most specific marker of bacterial infection in cardiosurgical patients in the early postoperative period. The level of PCT > 3.5 ng/ml within the first 24 hours after surgery is shown to be a predictor of postoperative infectious complications.

APACHE↗
PubMedDate not supplied

[Beta-endorphin in pituitary adenomas before surgery and in the postoperative period].

The content of beta-endorphin, ACTH, and cortisol was studied in 20 patients with hormonally-active, somatotropic hormone-secreting, prolactin-secreting, and hormonally inactive adenomas of the hypophysis before operation and in the early postoperative period. Before operation the basal level of hormones was within normal physiological fluctuations. In a favourable postoperative period the beta-endorphin level increased, while the ACTH content was low. In patients with an unfavourable postoperative period the content of beta-endorphin and ACTH was reduced as compared to the content before the operation. These data suggest that beta-endorphin plays an important role in the development of the organism's adaptation reactions to the surgical intervention.

Adenoma↗
PubMedDate not supplied

Influence of pre- or intraoperational use of tramadol (preemptive or preventive analgesia) on tramadol requirement in the early postoperative period.

The aim of this study was to assess the influence of iv tramadol on opioid requirement in the early postoperative period. The subjects were 90 patients scheduled for colon surgery (hemicolectomy) who received general anesthesia using the (N2O/O2) isoflurane technique. Thirty patients (group I) were administered 100 mg of tramadol iv before induction of general anesthesia (preemptive analgesia). Group II (30 patients) was administered 100 mg of tramadol iv immediately after peritoneal closure (preventive analgesia) and control group (30 patients) received 100 mg of tramadol iv immediately after operation. Following the operation, all patients were administered tramadol in the PCA-iv mode in order to treat postoperative pain. In the postoperative period, the following parameters were measured: pain intensity (using VAS), total consumption of tramadol, time until the first PCA activation, and frequency of side effects (drowsiness, nausea, vomiting). In patients of groups I and II who had received preemptive or preventive analgesia, a significantly lower total consumption of tramadol, as compared with control group, was observed in the early postoperative period. However, the time until the first PCA activation was significantly shorter in group I as compared to the other two groups. No significant differences between the groups were found regarding pain intensity and frequency of side effects.

Adult↗
PubMed1993

[Value of basal cortisol and ACTH in the immediate postoperative period of hypophyseal surgery in non-ACTH secretory adenomas].

BACKGROUND: The aim of this study was to evaluate the usefulness of basal cortisol and ACTH in the immediate postoperative period of pituitary surgery as indicators of definitive adrenocorticotropin function. METHODS: Twenty-one patients with pituitary, non producers of ACTH, adenomas, three microadenomas and 18 macroadenomas treated by adenomectomy by a trans-sphenoidal route were respectively studied. The basal cortisol and ACTH were compared in the first week following surgery with the definitive results obtained after one month by dynamic tests (stimulation with ACTH or insulin hypoglycemia). RESULTS: The six patients with secondary adrenal failure (AF) in the definitive evaluation had lower basal cortisol in the immediate postoperative period than the patients with AF (135.3 +/- 225.3 nmol/l versus 473.6 +/- 147.2 nmol/l; p < 0.05). The values of ACTH were also lower (2.3 +/- 1.6 nmol/l versus 4.8 +/- 3.4; p < 0.05). In all the patients with definitive AF except one, the basal cortisol in the first week was lower than 130 nmol/l and in those who did not present AF it was greater than 220 nmol/l. CONCLUSIONS: In the immediate postoperative period after pituitary surgery cortisol is a good indicator of definitive adrenocorticotropin function. This parameter may identify the patients requiring posterior substitutive treatment.

Adenoma↗
PubMed1976

Effects of some drugs on electrical activity of the gut in the postoperative period.

Myoelectrical activity of the gut has been studied in the postoperative period on 54 patients who underwent cholecystectomy. They have been divided into one control group and four other groups which were treated with pentagastrin, cholecystokinin, prostigmine or coherin (a posterior pituitary extract). In all patients, bursts of spikes were recorded during the early postoperative period. However, the slow waves were strongly disturbed at this time. Pentagastrin, CCK-PZ and prostigmine had no effect on the slow waves, while they increased the frequency of the spikes. These substances did not reduce the duration of the 'physiological' ileus. On the contrary, coherin was found to improve the regularity of the slow waves and to reduce the duration of the 'physiological' ileus.

Cholecystectomy↗
PubMed2005

Heart transplantation in children: clinical outcome during the early postoperative period.

As improved understanding of transplant-related death should improve survival, we report a single center's experience with pediatric heart transplantation including potential risk factors and causes of death during the early postoperative period. This prospective longitudinal study involved 51 pediatric patients ranging in age from 12 days to 15.1 yr (median: 3 yr). The following pretransplant risk factors were evaluated: diagnosis, age at transplantation, recipient sex, weight and blood type, blood type match, donor/recipient sex match, weight ratio, ischemic time, recipient's status, requirement for mechanical ventilation or circulatory support, dialysis, or inotropic support at transplantation. We also determined the actuarial survival, clinical outcomes, and causes of death in this population. Survival was 86% during the early postoperative period (</=30 days), 79.3% at 1 yr, and 76.8% at 3 yr. Seven patients died during the early postoperative period (primary graft failure, rejection, and infection). However, there was no difference in the frequency of any of the risk factors analyzed between these patients and those who did not experience early death. There was a correlation between the duration of intubation after transplantation and pretransplant risk factors (diagnosis, recipient status, requirement for dialysis, inotropic and mechanical ventilation support). Our findings indicate that promising short-term results can be obtained with pediatric transplantation. Although we identified no specific risk factors in this study for death, improved rejection surveillance and treatment strategies remain important goals in pediatric heart transplantation. Retransplantation had high mortality during the perioperative period.

Adolescent↗
PubMed1997

Anterior cervical myelopathy in the early postoperative period.

PURPOSE: The onset of anterior cervical myelopathy in the early postoperative period is an unusual complication after cardiac surgery without extracorporeal circulation in which haemodynamic stability was maintained. We report a patient who developed anterior cervical myelopathy after cardiac surgery. CLINICAL FEATURES: A 53-yr-old man with no serious associated medical problems underwent cardiac surgery without extracorporeal circulation to repair a ruptured left ventricle. Haemodynamic stability was maintained throughout the procedure but the patient developed flaccid paraparesis and dissociated sensory loss, three hours later. Early recognition of the clinical picture and prompt initiation of steroid treatment facilitated a successful outcome. The definitive diagnosis was based on magnetic resonance findings days after surgery. CONCLUSION: The onset or aggravation of neurological symptoms in the postoperative period may be avoided by thorough search for medullary pathology in the patient's background and by using particular care when performing manoeuvres during the perioperative period, not only to ensure haemodynamic stability, thus preserving medullary perfusion, but also to avoid mechanical compression of a spinal segment.

Cardiac Surgical Procedures↗
PubMedDate not supplied

[The status of the receptor-controlled calcium metabolism of the thrombocytes in patients in the early postoperative period].

Basic changes in receptor-controlled platelet calcium metabolism that occur in the early postoperative period under the effect of aggregation-inducing hormones--platelet activation factor (PAF), adenosine phosphate (ADP) and vasopressin--are reviewed. Patients after lung surgery and patients with ischemic heart disease after aortocoronary bypass surgery have been examined. Patients operated on for malignant lung tumours developed increased postoperative sensitivity to ADP, while in patients after aortocoronary bypass surgery the early postoperative period was characterized by decreased sensitivity to PAF and vasopressin.

Adenosine Diphosphate↗
PubMed2000

The value of gastric intramucosal pH in the postoperative period of cardiac surgery in pediatric patients.

OBJECTIVE: To examine the usefulness of gastric intramucosal pH (pHi) to predict adverse events during the postoperative period after cardiac surgery in pediatric patients. DESIGN: Prospective, observational clinical study. SETTING: Multidisciplinary pediatric intensive care unit, university hospital. PATIENTS: A total of 70 patients who had elective cardiac surgery and cardiopulmonary bypass; mean age, 4.0 yrs. INTERVENTIONS: Gastric tonometry. MEASUREMENTS AND MAIN RESULTS: In all cases, the pHi was determined within the first 2 hrs and again within the first 12 hrs of the postoperative period after cardiac surgery. The following adverse events were considered: mortality, multiple organ failure (MOF), and infectious complications. Patients were divided into three groups: Group A, patients having the two pHi measurements < or =7.32 (n = 15); Group B, patients having the two pHi determinations >7.32 (n = 28); and Group C, patients having one pHi determination < or =7.32 and the other >7.32 (n = 27). Of the total sample, 5 (7.1%) patients died; 4 (5.7%) had MOF, and 13 (18.5%) had infectious complications. When the rate of adverse events was analyzed in the three groups, significant differences were found in mortality (p < .035) and MOF (p < .029). This was not the case for infectious complications (p = .071). In Group A, three patients died and three had MOF. The standardized chi-square values were 1.87 and 2.31 respectively, causing the authors to consider that this group accounted for the differences found in the global analysis. CONCLUSIONS: Two pHi determinations < or =7.32, one at admission and one at 12 hrs of the postoperative period after cardiac surgery and cardiopulmonary bypass, were associated with a higher rate of mortality and MOF, but not with a higher rate of infectious complications. It is not yet possible to recommend the use of this finding as a treatment objective to guide hemodynamic optimization in this group of patients.

Acid-Base Equilibrium↗
PubMed2004

Urinary catecholamines and metabolites in the immediate postoperative period following major surgery.

BACKGROUND: Induction of anaesthesia can precipitate catecholamine release from an undiscovered pheochromocytoma and induce a hypertensive crisis. However, it is assumed that catecholamine and metabolite values resulting from the effects of surgery per se in the early postoperative period would overlap with the values generated by a tumour, and it is not known how soon after biochemical investigations can be carried out. AIM: To study patterns of urinary catecholamine excretion and the feasibility of biochemical screening for phaeochromocytomas in the immediate postoperative period in otherwise healthy subjects undergoing a single type of major surgical procedure. METHODS: Catecholamines and metabolites were measured for each mole of creatinine in single voided urine on one preoperative and four postoperative days in five subjects who underwent elective coronary artery bypass graft surgery with an uncomplicated postoperative course. Reference ranges were established from 33 healthy normotensive volunteers. RESULTS: Excretion of adrenaline, noradrenaline, dopamine, vanillylmandelic acid, and metadrenaline was within normal limits. Normetadrenaline excretion was mildly raised in four patients, but did not exceed 1.5 times the upper reference limit, and returned to normality by the fourth postoperative day. CONCLUSION: It is feasible to perform simple urinary screening for possible phaeochromocytoma in the immediate postoperative period.

Adrenal Gland Neoplasms↗