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 919 records · Page 51Linked to original sources

PubMed1998

Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration.

The bispectral index, a new processed electroencephalographic parameter which may give information on depth of anaesthesia, was used in 58 patients undergoing outpatient gynaecological surgery in order to study if the addition of bispectral index monitoring to standard clinical monitoring could improve the titration of target propofol concentration when using effect-site target-controlled propofol infusion for sedation. In Group 1 (n = 30), the bispectral index was recorded but the anaesthetist was unaware of the readings and therefore only classical signs of depth of anaesthesia were used to guide the anaesthetist in controlling the effect-site concentration. In Group 2 (n = 28), bispectral index readings were available to the anaesthetist and effect-site concentration was adjusted to ensure that bispectral index was maintained between 40 and 60. Similar propofol induction and maintenance doses, blood and effect-site concentrations and mean bispectral index were found in the two groups. A greater percentage of bispectral index readings lying outside the target range (i.e. < 40 or > 60) and more movement at incision and during maintenance were found in Group 1. There was a trend towards more implicit awareness in patients in Group 1. Bispectral index was found to be useful for measuring depth of sedation when using propofol target-controlled infusion. Propofol dosage could not be decreased but a more consistent level of sedation could be maintained due to a more satisfactory titration of target effect-site concentration.

Adolescent↗

PubMed1989

Preoperative and surgical management of pheochromocytoma.

The clinical awareness of the various presentations of pheochromocytoma, along with newer monitoring and anesthetic techniques, has enabled early diagnosis and less fluctuation of blood pressure during operation. The use of meticulous surgical technique through the various incisions outlined in this article has made the excision of pheochromocytoma an expeditious operation and the accompanying hypertension surgically curable. Thus, pheochromocytoma is less likely to be a fatal lesion.

Adrenal Gland Neoplasms↗

PubMedDate not supplied

Three-dimensional ultrasound and magnetic resonance imaging of pelvic anatomy: potential for complications from minimally invasive procedures.

OBJECTIVE: Several new minimally invasive therapies have recently been popularized for both malignant and benign prostate disorders, including interstitial implantation of radioactive seeds and high-radiofrequency wires, cryoablation, transurethral thermotherapy, and laser prostatectomy. Complications can be incurred during the various procedures, often as a result of injury to adjacent anatomic structures. Some of the complications are inadvertent, whereas others are inherent in the particular treatment process. We hope to increase awareness and understanding of some of the potential complications. METHODS AND MATERIALS: Magnetic resonance (MR) and three-dimensional transrectal ultrasonography (TRUS) imaging were utilized to illustrate the relevant pelvic anatomy in, respectively, a healthy volunteer and four patients undergoing evaluation for prostate symptoms. In addition, data from the Visible Human dataset (the Visible Human Project is part of the National Library of Medicine 1986 Long-Range Plan) were used. RESULTS: The potential complications relating to urinary sphincter and anal sphincter control, sexual function, pelvic musculature, and pelvic nerve physiology could be explained on the basis of the MR and TRUS findings using cryoablation for illustrative purposes. CONCLUSION: A clear understanding of the relevant anatomy and physiology is essential for the physician to provide patient counseling preoperatively regarding anticipated sequelae and to avoid preventable intraoperative complications related to minimally invasive therapeutic procedures for the prostate.

Adult↗

PubMed1991

The cervical sympathetic nerves in surgery of the neck.

The otolaryngologist-head and neck surgeon is aware that the cervical sympathetic nerves lie behind the carotid artery and should be avoided during neck surgery. To render this sketchy dictum more tangible, relevant anatomy and physiology of the autonomic supply to the head and neck is reviewed, as are aspects of site-of-lesion testing, with respect to Horner's syndrome. Examples of neck operations during which the cervical sympathetic chain--from the base of skull to the root of the neck--may be injured are illustrated.

Autonomic Nervous System↗

PubMed2006

[Effects of different fresh gas flow on pharmacodynamics of isoflurane during anesthesia induction].

OBJECTIVE: To investigate the effect of different fresh gas flows (FGFs) on the pharmacodynamics of isoflurane during anesthesia induction. METHODS: Sixty female ASA class I or II patients (aged from 18 to 49 years) scheduled for gynecologic laparoscopic surgery were randomly divided into groups I, II, and III (n=20). The FGFs for group I, II, and III was 1, 2 and 3 L/min, respectively, and each group was further divided into two equal subgroups according to the setting concentrations of isoflurane vaporizer (Co), which was 1% in groups I1, II1, and III1 and 2% in groups I2, II2, and III2. Isoflurane at different setting concentration was administered under different FGF in the patients after tracheal intubation following anesthesia induction. The systolic blood pressure (SBP), diastolic blood pressure (DBP), main arterial blood pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded before anesthesia induction and every 3 min after tracheal intubation. Patients given ephedrine and atropine were also recorded. The patients' consciousness during anesthesia were followed up and recorded. The inspiratory concentration (CIiso) and expiratory concentration (CEiso) of isoflurane in the airway were monitored and recorded every 3 min. The observation after intubation lasted for 18 min, during which stimulation of the patients was avoided, and the operation began after the observation. RESULTS: There was a close correlation between BIS and CIiso and between BIS and CEiso (r=-0.904 and -0.893, respectively). The incidence of hypotension was significantly different between groups III and I (P<0.01), and between the subgroups in groups II and I (P<0.05). No bradycardia occurred and no consciousness reported awareness during anesthesia. CONCLUSIONS: Between the completion of tracheal intubation and beginning of the surgery, 1% or 2% Co under a moderate FGF (1-3 L/min) may guarantee the patients' unconsciousness, but hypotension is less likely under a relatively low flow (1-2 L/min) than a higher flow (3 L/min). Higher FGF and Co result in faster induction of deep anesthesia and higher incidence of hypotension.

Adolescent↗

PubMed2002

Demyelinating pseudotumor.

Demyelinating disease presenting as a solitary contrast-enhancing mass poses a diagnostic challenge for both radiologists and surgical pathologists. We report the cases of two female patients, aged 23 and 37 years, who exhibited the clinical and radiologic features of a space-occupying mass strongly suggestive of neoplasia. In both patients, magnetic resonance imaging showed a ring-enhancing parietal lesion. Intraoperative frozen sections in both patients displayed histologic features strongly suggestive of a glial neoplasm, including marked hypercellularity, a prominent astrocytic component, and easily identifiable mitotic figures. However, permanent sections showed additional and helpful histologic findings that included Creutzfeldt astrocytes and granular mitoses. Subsequent immunostaining showed that the hypercellularity was principally caused by macrophage infiltration (HAM-56 and CD68) and an associated reactive astrocytosis (glial fibrillary acidic protein). Additional confirmatory tests included special stains for myelin (Luxol-fast-blue), which demonstrated focal, sharply marginated loss of myelin, and for axons (silver stain for axons and neurofilament protein immunohistochemistry), which showed relative preservation of axons in areas of myelin loss. Together, the special stains confirmed the demyelinating nature of the lesions. The keys to avoiding misdiagnosing a demyelinating pseudotumor as a diffuse glioma include a general awareness of this potential pitfall, including the radiologic appearance of demyelinating pseudotumors as contrast-enhancing solitary masses that mimic tumor; knowledge of the characteristic histologic features, including Creutzfeldt astrocytes and granular mitoses; and a high index of suspicion for macrophage infiltration combined with a willingness to use appropriate confirmatory immunohistochemical studies in suspicious or uncertain cases. This approach will minimize the chance of misdiagnosis and subsequent use of inappropriate and deleterious therapies.

Adult↗

PubMed1999

Airway obstruction due to late-onset angioneurotic edema from angiotensin-converting enzyme inhibition.

PURPOSE: Angioneurotic edema is a well-documented complication of angiotensin-converting enzyme inhibitors (ACEI). We report a case of acute airway obstruction from a late-onset, probable ACEI-related angioneurotic edema and its subsequent management. CLINICAL FEATURES: A 48-yr-old obese man presented for transurethral resection of a bladder tumour (TURBT). His past medical history included hypertension controlled with hydrochlorothiazide and quinapril which had been started 13 mo earlier. Previous surgery was uncomplicated. Midazolam was used for premedication and for intraoperative sedation together with fentanyl and propofol. After uneventful spinal anesthesia with bupivacaine, operation and recovery, he was transferred to the floor. Five hours later he developed severe edema of his face, tongue and neck, with drooling, that progressed into airway obstruction and respiratory arrest. Ventilation was restored via immediate cricothyroidotomy, and a subsequent tracheotomy was completed uneventfully in the operating room. His serum C1 esterase inhibitor levels at 1, 5 and 23 days later were normal. The angioneurotic edema was attributed to the ACEI treatment. The edema resolved after 48 hr, and further follow-up was unremarkable. CONCLUSION: This observation is consistent with other reports that angioneurotic edema from ACEI can occur many months after the initiation of treatment. This can involve the airway and may produce life-threatening respiratory compromise. Physicians should be aware of this association and the possible need for immediate surgical intervention for the establishment of an airway in case of worsening edema or respiratory arrest.

Airway Obstruction↗

PubMed1988

Peri-operative dreaming in paediatric patients who receive suxamethonium.

A prospective study is described of peri-operative dreaming in 144 paediatric patients aged 5-14 years who received suxamethonium for day case surgery. No case of awareness was elicited. One group received pretreatment with 80 micrograms/kg [corrected] tubocurarine. The incidence of dreaming in the 72 patients who were not pretreated was 16.7% compared with 2.8% in the patients pretreated with tubocurarine. This difference is statistically significant. The use of an intermittent suxamethonium technique gives a high incidence of dreaming which may be caused by muscle spindle discharge that produces cerebral arousal. Pretreatment with a non-depolarizing agent decreases this risk of dreaming.

Adolescent↗

PubMed2006

[Auditory evoked potentials].

Auditory evoked potentials (AEPs) are an electrical manifestation of the brain response to an auditory stimulus. The waveform represents the passage of electrical activity provoked by auditory stimuli from the cochlea to cortex. The waves represented by I-VII are generated mainly in the brainstem. These waves are called the brain stem auditory evoked potentials (BAEPs) or the auditory brain stem response (ABR). The middle latency AEPs (MLAEP) are generated from the medial geniculate and primary auditory cortex. The long latency AEPs (LLAEP) are generated from the frontal cortex and association areas. The BAEPs appear to be an exquisitely sensitive monitor for pathological events during surgery. Anesthetics and mild hypothermia have minimum effect, if any, on the BAEPs. The BAEPs are useful during the microvascular decompression of the fifth or seventh cranial nerve, resection of acoustic neuroma and posterior fossa operations. Because the auditory pathway occupies a small area in the brainstem, combined use of other evoked potentials such as short latency sensory evoked potentials is recommended. The MLAEPs are most promising evoked responses for monitoring awareness or depth of anesthesia. When the concentration of anesthetics is increased, the amplitudes of the MLAEP's peaks are decreased and their latencies are elongated. Commercially developed A-line AEP monitor or aepEX can extract the AEPs waveform in a short period and automatically analyze the changes in the MLAEPs. These AEP based monitors may be superior to bispectral index (BIS) in detecting the transition from unconsciousness to consciousness.

Anesthesia↗

PubMed2002

[Complications and failures in orthognathic surgery].

This paper reviews the literature about the most relevant complications in daily orthognathic surgery. Although orthognathic surgery has proven to be relatively safe, patients who undergo such maxillofacial orthopaedic surgery must be aware of the side effects of this combined treatment. Immediate life-threatening complications are very rare. They can in most cases be avoided by good anaesthetic and surgical techniques and adequate postoperative care. The most frequently encountered perioperative problem in maxillary surgery is excessive blood loss, whilst subjective neurosensory disturbance is the most frequent complication in mandibular surgery. Good co-operation between orthodontist and surgeon is essential to prevent most immediate and late postoperative problems and nearly all unsatisfactory results.

Blood Loss, Surgical↗

PubMedDate not supplied

[Aorto-caval fistula due to abdominal aortic aneurysm rupture].

INTRODUCTION: Most frequently, abdominal aortic aneurysm (AAA) ruptures into retroperitoneal space. The rupture of AAA into inferior vena cava is an uncommon event. The incidence of this complication of AAA is 2 to 10%. Surgeons' awareness of this rare entity is the most important factor for the early diagnosis and treatment. In this paper we report two cases of AAA rupture into inferior vena cava. As to our knowledge, in domestic literature such cases have not been previously reported. CASE REPORT: Patient 1. A 65-year-old man was admitted to the hospital because of low back pain and haemorrhagic shock. He was anaemic with haemoglobin of 80 g/l, systemic blood pressure was 70 mmHg, pulse rate 100/min, and central venous pressure 12 cm H2O. Pulsatile abdominal mass with continuous bruit and thrill and leg oedema were present. Physical examination revealed global heart failure. The patient was anuric. Because of the critical condition and evident clinical signs of ruptured AAA, the patient was operated on immediately without any other diagnostic procedure. Transperitoneal approach was used. Intraoperative findings were consistent with the rupture of the frontal aneurysmal wall into retroperitoneal space, with large retroperitoneal haematoma and aorto-caval (AC) fistula on the posterior aneurysmal wall, large 2 cm in diameter. Using digital compression for venous bleeding control, the fistula was closed with interrupted polypropylene 2-0 sutures with patches. After closure of the fistula, the urine flow resumed. Then, the aneurysm was replaced with bifurcated Dacron graft. The postoperative recovery was successful. The patient has a 13-year follow-up, without any sign of cardiac or renal failure as well as arterio-venous insufficiency of legs. Patient 2. A 62-year-old man was admitted to the Zemun Clinical Hospital Cenre because of suddenly occurred tachycardia, dyspnea and low back pain. Abdominal ultrasound examination revealed the existence of a possible fistula between the abdominal aorta and inferior vena cava. The patient was immediately transported to our institute. At admission, he was anaemic (haemoglobin was 85 g/l), with systolic blood pressure of 100 mmHg, pulse rate of 100/min and central venous pressure of 20 cm H2O. Also, he had pulsatile abdominal mass with continuous bruit and thrill, as well as legs and scrotal oedema. He was oliguric and haematuric. Translumbar aortography showed AAA with AC fistula (Figure). Transperitoneal approach was used for the operation. Intraoperatively, a small retroperitoneal haematoma without retroperitoneal rupture was found. After aneurysmal opening, a massive venous bleeding started, followed with cardiac arrest. The bleeding was controlled using digital compression and cardiopulmonary resuscitation was successful. AC fistula, large 3 cm in diameter, was on the posterior aneurysmal wall, and it connected the inferior vena cava and the left common iliac vein with AAA. The fistula was closed with interrupted polypropylene 2-0 sutures with patches. The aneurysm was replaced with impregnated tubular Dacron graft 16 mm. The postoperative recovery was successful. The patient was followed-up for 2.5 years, and there were no signs of cardiac or renal failure and arterio-venous insufficiency of legs. DISCUSSION: AC fistula as a complication of ruptured AAA was reported for the first time by Syme in 1831. The first attempt to repair this lesion was done by Lehman in 1935, but it was unsuccessful. In 1954, the first successful repair was performed by Cooley. According to Matsubara, by the end of 1989, 250 cases of this lesion were reported in England, German and French literature, and only 25 in Japanese. In 1991, Brewster et al. reported 14 new cases, while Italian authors reported 36 new cases in 1994. Retroperitoneal and intraperitoneal ruptures of AAA have different clinical presentation comparing with the rupture of AAA into inferior vena cava. (ABSTRACT TRUNCATED)

Aged↗

PubMed2006

Surgical fires: a patient safety perspective.

A surgical fire is a fire that occurs on or in a surgical patient. Such fires are rare--they occur in only an extremely small percentage of surgical cases. Nevertheless, the actual number of incidents that occur each year may surprise many healthcare professionals. ECRI estimates that 50 to 100 or more surgical fires occur each year in the United States alone. And such fires can have devastating consequences, not only for the patient, but also for the surgical staff and for the healthcare facility. Fortunately, through awareness of the hazards-and with emphasis placed on following safe practices-virtually all surgical fires can be prevented. Thus, it's important that surgical fire safety be incorporated into formal patient safety initiatives. In this article, we describe a few surgical fire patient safety initiatives that have been instituted in recent years. In addition, we describe in detail the causes of surgical fires and the preventive measures that are available for healthcare personnel to follow. In addition, we review how staff should respond in the event of a surgical fire.

Fires↗

PubMed2004

Gastric neuroendocrine carcinoma arising from heterotopic pancreatic tissue.

An 85 year old man presented with symptoms of dyspepsia and increase in stool frequency of two months duration. Upper endoscopy revealed an ulcer and the biopsy was interpreted as carcinoma with endocrine features. A formal distal gastrectomy was planned, but intraoperatively, because of the patient's condition, a wedge resection was performed. Histology revealed a neuroendocrine tumour (grade 1), located mainly in the submucosa, which had caused mucosal attenuation and ulceration. Associated with the tumour and at its periphery was heterotopic pancreatic tissue composed of acini, ducts, and endocrine cells. The tumour was strongly positive for chromogranin and focally for synaptophysin. There was no associated chronic atrophic gastritis or G cell hyperplasia. A discrete focus of high grade neuroendocrine carcinoma (grade 3) within the typical (grade 1) neuroendocrine tumour was also present. This case illustrates a grade 1 neuroendocrine carcinoma, with a small grade 3 focus, arising within or intimately associated with heterotopic pancreatic tissue in the stomach. Although the two entities may be separate, their close topographical association favours the possibility of neuroendocrine carcinoma arising from the heterotopic pancreas. Pathologists should be aware of the occurrence of pancreatic heterotopia in the stomach and the association of carcinoma with it.

Aged↗

PubMed2000

[Primary cesarean section. Use of phenylephrine during anesthesia in a patient with hypertrophic obstructive cardiomyopathy].

We report on anaesthesia management for elective Caesarean section in a parturient woman with hypertrophic obstructive cardiomyopathy (HOCM). Special considerations for anaesthesia are associated with this condition. Women with HOCM need a closed diagnostic and therapeutic follow-up during pregnancy. Anaesthesiologists have to be aware of the cardiac peculiarities. Special risks may arise from endogenous catecholamine release during labour or from therapy with beta-adrenergic drugs for treatment of blood pressure drops or suppression of uterine contractions. Epidural anaesthesia is an appropriate anaesthesia method for Caesarean section, also in patients with HOCM. Adequate hemodynamic monitoring is essential. Phenylephrine is a pure alpha-adrenergic vasoconstrictor without inotropic effects. It is suitable for therapy of blood pressure drops induced by peripheral vasodilation.

Adult↗

PubMed2000

CRNA awareness and experience with perioperative DNR orders.

Despite 2 decades of experience with do-not-resuscitate (DNR) orders, some controversy regarding their use still remains. By using a mailed questionnaire to a randomized sample of 500 active members of the American Association of Nurse Anesthetists, the present study explored the awareness, experiences, and opinions of nurse anesthetists regarding DNR orders for patients undergoing surgery. The purpose of the study was to evaluate the need for further education and discussion in this area. Of the 228 (45.6%) respondents, more than half had DNR policies at their facility, while the remainder reported no policy or were unsure whether a policy existed. Of those having policies, 67.2% indicated a policy of routine DNR suspension, approximately 20% had a policy of reevaluation, and the remainder were unsure of the type of policy. However, when asked what type of policy respondents thought was most appropriate, 54.2% favored a policy of reviewing the DNR order, with 95% advocating patient involvement in the reevaluation. Moreover, almost 90% of responding CRNAs indicated they would discuss DNR status with the patient before surgery. When a patient with a DNR order subsequently had an intraoperative cardiac event, 13% initiated resuscitation. Responding to a hypothetical question involving a patient with a DNR order, 42% to 48% of respondents indicated they would initiate resuscitative measures in such a situation depending on the cause of arrest.

Ethics, Nursing↗

PubMed1987

Perioperative right heart failure: etiology and pathophysiology.

A considerable amount of literature has been devoted to compromise of the right ventricle in spontaneous myocardial infarction. Little information is available regarding disproportionate dysfunction of the right ventricle associated with cardiac operation and the recovery period therefrom. Recognition of the problem is of paramount importance, if support measures are to be implemented. A great deal has yet to be learned regarding the appropriate support for the acutely failing right ventricle. Much remains to be accomplished regarding the assessment of right ventricle reserve, defining the role of risk factors, and quantitating the value of measures to optimally protect the right ventricle from injury during the perioperative period. Recognizing that the integrity of the right ventricle can be altered by numerous preoperative, perioperative and postoperative factors will provide an enlightened disposition on the part of the surgical team. Awareness of these considerations in the planning and conduct of surgical procedures should reduce morbidity and mortality from perioperative right ventricular failure. The imposition of new or unexpected morbidity during operation on a relatively unrelated problem represents surgical imperfection. Appropriate effort toward minimizing insult of the right ventricle could result in significantly decreasing the incidence and severity of perioperative right ventricular failure before the impetus of the continuing clinical problem dictates improvement in techniques to more appropriately treat this frequently preventable problem.

Coronary Disease↗

PubMed1988

Complications of genioplasty done alone or in combination with sagittal split-ramus osteotomy.

Thirty-one patients who had genioplasty done alone or in combination with bilateral sagittal split-ramus osteotomy of the mandible (BSSRO) were examined within 12 to 68 months after surgery. Neurosensory tests revealed that 10% of the mental nerves in patients who had had isolated genioplasties showed altered sensation of the lower lip, compared to 28.5% of the nerves in patients who had genioplasties and bilateral sagittal split-ramus osteotomies. However, when questioned, 71% of the patients in the latter group indicated awareness of abnormal feeling in the lower lip. Fourteen teeth in isolated genioplasty cases gave an abnormal response to electric pulp testing. The incision lines healed satisfactorily in most patients. Of the intraosseous wires used for fixation, 5.38% were removed 3 to 10 months after surgery. A notch at the osteotomy site on the lower border of the mandible was noted radiographically in 72.5% of the sites. Chin ptosis was noted in one patient. The cosmetic results satisfied 93.6% of the patients.

Adolescent↗

PubMed1989

Aberrant intratympanic internal carotid artery: a potentially hazardous anomaly.

A case is presented of a 3-year-old girl with no previous history of ear disease or developmental defects who bled profusely upon (right) myringotomy. The haemorrhage could only be stopped with the aid of an ear insert and a nasopharyngeal balloon catheter. The balloon catheter was removed the following day but the girl had to use an ear insert for a total of 76 days following myringotomy because of repeated haemorrhage from the ear. The subsequent investigation using CT and angiography revealed an aberrant internal carotid artery in the middle ear. It is concluded that the one most important factor in the handling of these cases is to be aware of the existence of aberrant internal carotid arteries and to have a high degree of suspicion when encountering any abnormal clinical or radiological findings which might point in the direction of vascular abnormalities. The failure to detect this condition before any surgical intervention on the affected ear can have disastrous consequences. The method of choice in handling these cases is one of avoidance of middle ear manipulation in order not to cause haemorrhage from the aberrant artery.

Carotid Artery, Internal↗