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PubMed2000

Transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperplasia.

PURPOSE: We assessed the clinical value of transabdominal pelvic sonography in the preoperative evaluation of patients with congenital adrenal hyperplasia (CAH) who required feminizing genitoplasty. METHODS: From 1987 to 1998, 31 patients with female pseudohermaphroditism due to CAH underwent feminizing genitoplasty. The median age of the patients was 9 months (range, 1-18 years). Radiologic evaluation performed before surgical reconstruction included retrograde genitography in the first 10 patients and sonographic examination in all 31 patients. Imaging was used to evaluate the anatomic positions and the length of the vagina, whether the junction of the vagina and the urogenital sinus occurred distal or proximal to the pelvic floor, and the presence of internal genitalia. RESULTS: Abdominal sonography identified internal female genitalia in all 31 patients, identified the anatomic shape and position of the vagina in 30 patients (97%), and confirmed the site of communication between the vagina and the urogenital sinus relative to the pelvic floor in 28 patients (90%). Sonographic findings were confirmed by intraoperative panendoscopy. Genitography was less useful than sonography, identifying the site of communication between the vagina and urogenital sinus in only 6 (60%) of 10 patients. CONCLUSIONS: In patients with CAH undergoing vaginal reconstruction, sonography provides adequate information about the anatomy of the vagina and urogenital sinus for surgical decision-making.

Adolescent↗
PubMed2006

Aorto-right atrial fistula following acute type A aortic dissection repair.

This report describes a rare case of aorto-right atrial fistula caused by rupture of a huge pseudoaneurysm that developed at the proximal aortic anastomotic site after total aortic arch replacement for acute type A aortic dissection. Preoperative aortography revealed that the fistula communicated with the right heart, but it was intraoperative Doppler transesophageal echocardiography that confirmed its course into the right atrium. Repeat total aortic arch replacement with concomitant direct closure of the fistula was performed successfully. The underlying cause of the pseudoaneurysm was the dehiscence of sutures at the proximal aortic anastomotic site, probably due to gelatin-resorcin-formaldehyde glue.

Acute Disease↗
PubMed1996

Intraoperative progress reports decrease family members' anxiety.

The researcher used a four-group quasi-experimental posttest design to examine the effect of intraoperative progress reports on 200 family members' anxiety. Group one (ie, control group) received standard perioperative care, which did not include intraoperative progress reports. Group two received in-person progress reports from perioperative nurses. Group three received an "attention" protocol (ie, checklist explaining hospital routines, waiting room procedures). Group four received progress reports delivered by telephone. The researcher compared family members' state anxiety scores, mean arterial pressures (MAPs), and heart rates measured halfway during their relatives' surgical procedures, measuring these dependent variables after providing the interventions. The in-person intraoperative progress report group reported lower state anxiety scores (P < .001) and had significantly lower MAPs and heart rates (P < .05) than the other three groups. In-person progress reports appear to be the most beneficial perioperative nursing intervention for reducing family members' anxiety during the intraoperative waiting period.

Adolescent↗
PubMed1991

Coordinating clinical research. A collaborative approach for perioperative nurses.

Overall, the study progressed smoothly during the six months it took to collect data on 125 patients. A number of factors contributed to the success of the study. By using a collaborative approach, we assembled a team with expertise in the content area, the clinical setting, and research design and methodology. This diverse mixture of knowledge, experience, and skills enabled us to plan carefully and anticipate many problems when writing the proposal and designing the study. While planning and implementing the study, we made an effort to keep communication flowing at all levels so problems could be quickly detected and addressed. We worked from the premise that we were collaborating with all of the OR nursing staff. We tried to use their time wisely, give them a meaningful role, respect their other responsibilities and commitments, and provide them with opportunities to share in the positive feelings that come from successfully completing a difficult job. We believe we achieved some measure of success. Since finishing the study, many staff members expressed an interest in participating in future studies--a good indication that they find research less formidable. They view participation in studies as a way to progress through the clinical ladder system and realize a full professional role. Most importantly, they see participating in research as a way to improve the quality of patient care they provide.

Clinical Nursing Research↗
PubMed1995

Written information for transurethral resection of the prostate--a national audit.

OBJECTIVES: To assess the use and content of written information relating to transurethral resection of the prostate (TURP). MATERIALS AND METHODS: All 328 full members of the British Association of Urological Surgeons (BAUS) were requested to submit any information sheets or specialized consent forms given to patients about to undergo TURP. They were asked to record when the information was given and whether this was recorded in the notes. The sheets were analysed with reference to a nominally comprehensive list of topics suitable for inclusion in such sheets. RESULTS: One-hundred and eleven replies were received (34%) which represents 44% of urological departments. Of those replying, only 56 used information sheets for TURP. The overall comprehensiveness of the information was surprisingly poor, with 12% omitting to mention retrograde ejaculation and 19% failing to discuss the need for a catheter. CONCLUSION: The written information given to patients about to undergo TURP appears inadequate. There is a need for a nationally accepted information sheet that can be edited locally.

Communication↗
PubMedDate not supplied

[Multiple cerebral aneurysms].

BACKGROUND: To define risk factors for the multiplicity of cerebral aneurysms, as well as clinical and therapeutical characteristics of patients with single aneurysms (SA) and multiple aneurysms (MA). METHODS: Retrospective study on 95 patients with SA and 22 patients with MA. For patients with SA and MA the following parameters were compared: gender, age, clinical state, aneurysmal localization and size, incidence of rebleeding and vasospasm, manner and outcome of treatment, preoperative interval, intraoperative rupture and postoperative complications. RESULTS: Aneurysms on anterior communicating artery existed in 37.4% of SA and in 17.8% of all MA (p < 0.05). As much as 44.2% of all aneurysms on middle cerebral artery and only 19% of all aneurysms on anterior communicating artery were associated with some other aneurysm (p < 0.02). The average size of SA was 15.4 +/- 11.8 mm, and 9.8 +/- 9 mm for MA (p < 0.05). Surgery was performed in 77.3% of patients with MA and 78.9% of patients with SA (p > 0.05), but complete surgical clipping was performed in 89.3% of patients with SA and in 47.1% of patients with MA (p < 0.01). Among operated patients with MA and SA, intraoperative rupture occurred in 36% and 17.6% of cases, respectively (p < 0.05) and ischemic postoperative complications were found in 29.4% and 17.3% of the cases (p > 0.05). Among 72.7% of all patients with MA and in 69.5% of all patients with SA the outcome was good, while among surgically treated patients it was good in 76.5% and 70.7% of cases, respectively. CONCLUSION: The treatment outcome was similar for patients with MA and SA, but complete operative treatment is significantly more frequent for SA. Multiple aneurysms were considerably smaller and with different anatomical distribution in relation to solitary aneurysms.

Aneurysm, Ruptured↗
PubMed1989

Postoperative recovery of third nerve palsy due to posterior communicating aneurysms.

Postoperative recovery of third nerve palsy due to a posterior communicating artery aneurysm was correlated with pre- and intraoperative factors. The only significant factor determining recovery was the degree of preoperative deficit. The presence of subarachnoid haemorrhage, timing of surgery and aspiration of the aneurysmal sac did not influence recovery.

Adolescent↗
PubMedDate not supplied

Pediatric ophthalmology and anesthesia pearls in the operating room.

Providing nursing care to pediatric patients is both challenging and rewarding. The pediatric ophthalmic caregiver must remain acutely aware of physiologic changes, which may be subtle. Though most pediatric procedures are performed by an anesthesiologist using general anesthesia, the ophthalmic nurse needs to remain vigilant. Problems that arise must be attended to within mere seconds. This paper discusses distraction techniques and gives an overview of the care provided to children under general anesthesia at a major pediatric specialty hospital. This paper relates one ophthalmic nurse's experiences in a hospital-based outpatient surgery center that employs 14 board-certified faculty pediatric anesthesiologists as well as rotational anesthesia residents in their first, second, third, and fellowship years. The outpatient center has five operating rooms, and the inpatient surgery area has 14 operating rooms. Nearly 800 pediatric ophthalmology procedures are done in the outpatient area each year; approximately 20 ophthalmology procedures are done at the inpatient surgery area annually.

Anesthesia↗
PubMed1994

[The difficulties in communication through RS-232C interface between monitor devices and a personal computer--the difference of data output format and transmit mode].

We investigated data output format and transmit mode of communication through RS-232C interface between monitor devices and a personal computer. The baud rate, start bit, data bits, parity bit and stop bits are listed with transmit mode of six companies' monitor devices which are now widely sold in Japan. Each monitor device has its own data output format and transmit mode, which are quite different from the others and make it somewhat difficult to import data from different monitor devices to a personal computer. We suggest that, because two or three different monitor devices are commonly used during anesthesia, some general standard should be established to make an easy communication between monitor devices and a personal computer for ordinary users.

Anesthesia↗
PubMed1995

Effects of intraoperative progress reports on anxiety levels of surgical patients' family members.

A three-group quasi-experimental posttest-only design was used to examine the effectiveness of intraoperative progress reports by comparing family members' state-anxiety score, mean arterial pressure level (MAP), and heart rate during elective surgical procedures. Control-group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. An additional group of family members (n = 50) received an attention protocol. Family members in the experimental group reported lower state-anxiety scores (p < .001) and had significantly lower MAP levels (p < .001) and heart rates (p < .01) compared with the control and attention groups. Progress reports appear to be a beneficial independent nursing intervention for reducing anxiety in family members during the intraoperative waiting period.

Adult↗
PubMed2006

Arterial to end-tidal CO2 laparoscopic gradient reversal during pheochromocytoma resection.

PURPOSE: We report the development of severe intraoperative hypercarbia and a pronounced arterial to end-tidal gradient reversal during laparoscopic pheochromocytoma resection. Although complex physiologic mechanisms may be responsible for this finding, anatomic alterations such as a direct communication between a capnoperitoneum and/or capnothorax and the airways resulting from prior pathology and the type of procedure should also be considered. CLINICAL FEATURES: During anesthesia for laparoscopic pheochromocytoma removal we noticed an abrupt, extensive increase of the end-tidal CO(2) accompanied by a change of the capnographic CO(2) tracing and reversal of the normal arterial-to-end-tidal gradient. These changes consistently disappeared by intermittent deflation of the abdomen and at the end of surgery. A chest x-ray revealed a right-sided loculated pneumothorax with pleural thickening. Peritoneo-thoracic CO(2) tracking and pleural scaring with pulmonary adhesions resulting in a unidirectional communication between the pleural space and airways may best explain the chest x-ray and clinical findings. CONCLUSION: Severe intraoperative hypercarbia and arterial to end-tidal CO(2) gradient reversal represents an intraoperative challenge. The possibility of a direct communication between the pleural space and the bronchial tree should be considered when other etiologies have been excluded. Simple maneuvers such as abdominal de- and re-inflation and analysis of the end-tidal capnographic tracing might aid in the differential diagnosis and management.

Acidosis, Respiratory↗
PubMed1998

The Arab Muslim client: implications for anesthesia.

The Arab Muslim client has unique cultural characteristics that should be incorporated into anesthetic care. In obtaining a preoperative assessment and consent, issues such as privacy, family roles, body language, group decision making, communication distances, and use of translators should be addressed. Intraoperatively, the need for modesty and the client's possible adherence to folk beliefs should also be recognized. Postoperatively, pain and overall needs assessments are a continuing challenge. The anesthetist must also understand the underlying family roles, the high correlation between fear and pain, and the possible coexisting folk beliefs when working within the labor and delivery setting. By addressing these unique issues, the anesthetist can provide appropriate and safe anesthetic care.

Anesthesia↗
PubMed1986

[Surgical treatment of AVMs occluding these feeders during removal--utilizing the intraoperative balloon catheter and brain protective substances ("Sendai cocktail"].

The ideal treatment of cerebral arteriovenous malformations (AVMs) is thought to be the total resection of nidus. We have been reporting the importance of temporary occlusion of the feeding arteries with the aid of the brain protective substances to prolong the permissible time of occluding these arteries. Because of the difficulty of access to the feeding arteries, some cases are difficult or even impossible to operate. In this communication, four cases of AVM which were successfully resected utilizing intraoperative balloon occlusion of feeders under the administration of the brain protective substances are reported. Case 1. A 14-year-old female was admitted to our clinic because of subarachnoid hemorrhage with ventricular rupture and left cerebellar hemorrhage. Angiography disclosed a large left cerebellopontine angle AVM fed by left anterior inferior cerebellar artery (AICA) and left superior cerebellar arteries (SCAs). Prior to the operation, two balloon catheters were introduced via transfemoral approach; one into the AICA and the other into the basilar artery where left SCAs originated. To prolong the permissible time of occluding these arteries, "Sendai cocktail" (20% mannitol, vitamin E and dexamethazone) and perfluorochemicals were administered. Auditory brain stem response (ABR) was monitored continuously during the operation. The nidus was resected totally with safe using temporary inflation of these balloon catheters. The patient returned to normal life. Case 2. A 35-year-old male was admitted to our clinic complaining of the attack of generalized convulsive seizure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Perioperative management of burn patients.

Burns continue to be a leading cause of death in the United States. Survivability of burn patients has increased since 1988 because of significant changes in the management of life-threatening injuries. Advances include rapid removal of eschar, skin grafting, and early enteral feeding. Pathophysiologic changes occur in every major organ system of the burn patient and must be aggressively treated. Perioperative care of the burn patient begins in the immediate postburn period and continues throughout the patient's care. Intraoperative management of the patient requires organization, planning, and, above all, communication between the OR team members and anesthesia care providers to ensure optimum results.

Anesthesia↗
PubMed2001

[An automated electronic anesthesia record and automated urine output measurement].

We can now collect many parameters (NIBP, HR, ABP, SpO2, EtCO2, CCO, etc) from an anesthesia monitor in an automated electronic anesthesia record system. The function of automated urine output measurement has been added to an automated electronic anesthesia record system. A digital weight meter connected with a personal computer by RS-232 C is used to measure the weight of urine. We convert the weight to the volume hypothesizing that the density of urine is 1 g.ml-1. Physiologic parameters are recorded every 10 seconds from an anesthesia monitor and we can set the period of automated urine output measurement we like. We must enter the initial and final urine output but the intraoperative urine output is collected automatically to an automated electronic anesthesia record and visualized in urine bar graph. The total volume of urine is calculated. Computerized urine output measurement can record data more frequently, for example, every 10 minute. At the end of the operation, intraoperative data are sent to a host computer and the anesthesia record is printed. Combining the automated urine output measurement with an automated electronic anesthesia record system is useful in anesthesia practice of a long operation.

Anesthesia↗