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At least 1,225 records · Page 68Linked to original sources

PubMed2004

Relationships between a proprietary index, bispectral index, and hemodynamic variables as a means for evaluating depth of anesthesia in dogs anesthetized with sevoflurane.

OBJECTIVE: To evaluate relationships among various techniques for monitoring anesthetic depth in sevoflurane-anesthetized dogs undergoing orthopedic surgery. ANIMALS: 10 dogs. PROCEDURE: Dogs were medicated with acepromazine (0.05 mg/kg, IM), buprenorphine (0.01 mg/kg, IM), and atropine (0.04 mg/kg, IM). Anesthesia was induced and maintained with sevoflurane. Cardiovascular and respiratory responses were monitored. Anesthetic depth was monitored by use of the bispectral index (BIS), and a proprietary index was used to monitor activity of the autonomic nervous system. RESULTS: A significant decrease in BIS was seen after induction but concurrent changes were not observed for the other techniques. The proprietary index increased significantly after intubation, but no changes were seen for the other techniques. No significant changes were detected during incision or when higher nociceptive stimuli were applied. We did not identify a correlation between BIS and the proprietary index, the proprietary index and hemodynamic variables, or the BIS and hemodynamic variables during induction and maintenance. A significant increase in the proprietary index and BIS was detected at the time of resumption of reflexes. During anesthetic recovery, a correlation was found between the proprietary index and BIS but not between hemodynamic variables and the other techniques. CONCLUSIONS AND CLINICAL RELEVANCE: A significant increase in the proprietary index, but not the BIS or hemodynamic variables, was detected during intubation. Anesthetic induction with sevoflurane did not prevent the sympathetic stimulus attributable to tracheal intubation. Monitoring of hemodynamic variables does not provide sufficient information to allow clinicians to evaluate stress during anesthetic recovery.

Acepromazine↗

PubMed1999

[Acute pancreatitis of uncommon etiology: a physiopathologic approach].

A review of 73 cases of acute pancreatitis (A.P.) of *A in frequent etiology is critically analyzed. The patients were allocated to the following categories: post ingestion of a large meal, dyslipemic, post ERCP, post operative, pregnancy, and puerperium linked., post urlian parotiditis, post stress, idiopathic, drug associated, post traumatic. In each of the above groups those hypotheses that are currently primarily accepted as been mainly concerned with the etiopathogenesis of the inflammatory episode were given preference. One factor upon which the authors has put special emphasis is that of frequent involvement of the nervous system through different types of autonomic are reflexes. This pathogenic mechanism is surprisingly disregarded in the literature. The interrelation ship between the severity of an AP episode and the background provided by the "pancreon" secretory activity is also emphasized. The mortality rate of the whole series was of 7 cases (9.6%). The groups that disclosed the highest rates were related to abdominal surgery (50%) and to dyslipemia (17%).

Acute Disease↗

PubMed2003

Unique considerations for the spinal cord injured patient undergoing cardiac surgery utilizing cardiopulmonary bypass.

A 37-year-old male with mitral valve regurgitation presented for mitral valve replacement. He has been a C5 quadriplegic for 13 years. The patient had been discharged 2 months before to this admission after a complicated hospital course for Staphylococcus aureus infection of the left hip. His course was complicated by adult respiratory distress syndrome (ARDS) requiring prolonged intubation, acute renal failure (ARF) requiring dialysis, 10-day coma, and bacterial endocarditis now requiring mitral valve replacement. After initial stabilization with antibiotics and gradual improvement of the multiorgan system failure, the patient presented for valve replacement and worsening congestive heart failure (CHF). Para- and quadriplegic patients rarely undergo cardiac surgery requiring cardiopulmonary bypass (CPB). The explanation for this low incidence of heart surgery in this patient population ranges from physiologic changes from the spinal cord injury to their relatively short life span. Therefore, there is no vast knowledge of how these patients with spinal cord injury will physiologically respond to CPB. Chronic paraplegia presents unique anesthetic and perfusion challenges. General anesthesia for a patient with prolonged spinal cord damage can be difficult because of dysreflexia, muscle wasting, and potassium changes with depolarizing muscle relaxants. For the perfusionist, chronic paraplegia also accentuates hemodynamic responses to nonpulsatile flow with low peripheral vascular resistance common and difficult to treat. Dramatic increases in circulating catecholamine levels are a secondary result of the initiation of CPB that can cause a hypo- and hypertensive state. Depending on the level of spinal cord injury, one might expect acute hypo- or hypertension with the various phases of open-heart surgery and CPB. A viscous circle may occur because the hypertensive state is exaggerated because of inhibitory signals not passed below the spinal cord lesion and, therefore, the vasoconstrictive reflex continues unabated. The attack usually occurs abruptly and can lead to cerebrovascular hemorrhage and death if not controlled. Fortunately, we found this patient did not develop mass autonomic dysreflexia and was not difficult to wean from CPB. The problems associated with spinal cord injury present potential complications to this patient population. Numerous triggering mechanisms may lead to a variety of clinical complications. Consideration of a response/ treatment management plan for potential problems must be exercised by the surgical team.

Adult↗

PubMed1988

[Historical course of surgery in rectal cancer in Japan].

Rectal cancer surgery in Japan started to first step of Lisfranc type resection by T. Sato in 1887. Since H. Ito (1902) published in success of three cases of abdominosacral excision (ASE), ASE occupied the main position of rectal cancer surgery in Japan. In 1944, however, M. Kuru reported the superiority of abdominoperineal resection (APR), an orient of surgery had changed to APR from ASE with time. His operative mortality was 2.0% or less, and 5-year survival rate was more than 50%. D. Jinnai (1961) introduced endorectal pull-through operation, and in 1972 he exhibited an excellent survival and satisfying function following sphincter preserving operation, such as anterior resection and pull-through, for mid and upper rectal cancer. T. Kajitani (1975) and Y. Koyama (1977) improved the survivals through an extended pelvic nodes dissection. Today, the principle of rectal cancer surgery in Japan is a limited resection for early cancer, sphincter preserving operations for upper and mid-rectal cancer and extended pelvic nodes dissection for advanced lower rectal cancer.

Autonomic Nervous System↗

PubMed1996

Anatomy of the extrinsic motor nerve supply to mobilized segments of the oesophagus disrupted by dissection during repair of oesophageal atresia with distal fistula.

Atresia of the oesophagus occurs near to the site of convergence of the foregut with structures of branchial arch origin. This is a confluence of a striated muscle tube with a somatic nerve supply and a smooth muscle tube with an autonomic nerve supply. The implications, with regard to function, of denervating the oesophagus during operation are influenced by this anatomy. During dissection of a cadaver with oesophageal atresia and distal fistula, the sites of potential nerve injury were displayed. Damage to these nerves occurs during routine primary repair and may contribute to oesophageal motor dysfunction after successful surgery.

Cadaver↗

PubMed1995

Autonomous proliferation of neural precursors in the tadpole retina revealed after partial removal of the embryonic eyebud.

The cellular mechanisms that regulate cell division in the developing vertebrate nervous system are essentially unknown. Using the frog retina as a model system, we tested the hypothesis that proliferation is regulated by feedback signals that encode the total number of cells in the population. To alter the number of cells in the retina, we surgically removed approximately half of the embryonic eyebud. In a previous study, cell counts made immediately after partial ablation showed that the number of proliferating, undifferentiated cells was reduced to 70% of the number in the contralateral control eye, while the number of postmitotic, differentiated cells was reduced to 47%. In this study, we sought to determine whether these reduced cell number of affected proliferation, which was assessed by counting the total number of cells present at various times after surgery. The partially ablated retinas consistently had fewer cells than the contralateral retinas. Analyses of the cell numbers suggested that there was little or no change in mitotic rate in the partially ablated retinas and that the decreased production of both differentiated and undifferentiated cells was due almost entirely to the reduction in the number of dividing cells. There is thus no evidence that retinal stem cells up-regulate their production of new cells in response to a reduction of either the stem cells themselves or of their descendants. This lack of response to population size indicates that, in contrast to many non-neural stem cell systems, proliferation of neural stem cells is not regulated by a feedback mechanism but instead is largely autonomous.

Animals↗

PubMed2004

[Neuroendocrine tumours of the gastrointestinal tract].

Gastrointestinal neuroendocrine tumours are classified as functioning or non-functioning according to the presence or absence of a clinically evident hypersecretion syndrome. In foregut tumours the presence of autonomous hormone secretion and the respective hypersecretion syndrome indicate functionality. Abdominal ultrasound (US), computed tomography (CT), magnetic resonance tomography (MRT) and somatostatin receptor scintigraphy (SRS) are used for localisation of the primary tumour and metastasis. Invasive procedures such as endoscopic US, intraoperative US or intraoperative duodenal transillumination are useful to localise small (< 1 cm) tumours. For localised tumours surgery is the first line treatment. In metastatic disease symptomatic therapy, biotherapy and chemotherapy are available. Cytoreductive therapy such as embolisation, chemoembolisation, thermo- or cryotherapy, or radio-receptor therapy are additional options. The first symptom of most neuroendocrine midgut tumours is abdominal pain. An increased chromogranin-A plasma concentration or 5-hydroxyindoleacetic acid 24-h urinary excretion indicates the neuroendocrine origin of the tumour or the possibility of a carcinoid syndrome, respectively. Surgical therapy prolongs survival but is rarely curative. Biotherapy is effective as symptomatic therapy. However, its cytoreductive potency is low. Chemotherapy is less effective in midgut tumours compared to foregut tumours. Cytoreductive strategies (chemoembolisation, thermo- or cryotherapy, cytoreductive surgery) and radio-receptor therapy may offer new therapeutic options. However, their definitive value has yet to be defined.

Antineoplastic Agents↗

PubMed2006

A marked decrease in heart rate variability associated with junctional rhythm during anesthesia with sevoflurane and fentanyl.

Heart rate variability (HRV) was investigated using a new technique for time series analysis combining the maximum entropy method and non-linear least squares method -- the 'MemCalc method' -- in patients undergoing general anesthesia with sevoflurane and fentanyl for elective surgery. As the occurrence of junctional rhythm coincided with the measurement of these variables in two patients, we successfully evaluated the entropy, low (LF) and high (HF) frequency component of the HRV during junctional rhythm and found that the occurrence of junctional rhythm is associated with marked decreases in the entropy, LF and HF of HRV. When evaluating autonomic control of the heart using HRV analysis, the decrease in HRV caused by the occurrence of junctional rhythm must be taken into account.

Adult↗

PubMed1991

Electrophysiology: the Wolff-Parkinson-White syndrome.

Though tachyarrhythmias occur commonly in patients with the Wolff-Parkinson-White syndrome, many patients remain asymptomatic. Recent studies suggest that routine electrophysiologic testing in these individuals is of limited value. However, electrophysiologic testing remains very helpful in the symptomatic patient for predicting arrhythmia recurrence and for determining accessory pathway location and function. Unfortunately, noninvasive tests to predict high-risk WPW patients has not been proven helpful because of their low specificity. A number of recent studies have shown that autonomic function can markedly improve accessory pathway function and even counteract the effect of antiarrhythmic drugs. Given the frequent failure of antiarrhythmic therapy in the WPW syndrome, there has been increasing interest in nonpharmacologic therapies, including high-energy DC shock and radiofrequency catheter ablation of accessory pathways, which may prove to be more cost-effective than surgery.

Anti-Arrhythmia Agents↗

PubMed2005

Semantic challenges in database Federation: lessons learned.

In this project an integrated analysis of data from disparate surgery and anaesthesiology departmental information systems was carried out. Due to the lack of shared primary keys, a multi-stage "soft" matching method was implemented. Results of the matching steps are described in detail. Inconsistencies were shown to exist for identifying data, semantic definition of documentation content and documented data itself. Minimum requirements for interdisciplinary documentation in autonomous systems should include shared semantic definitions of documentation content as well as robust and regularly validated interfaces for identifying data.

Database Management Systems↗

PubMed1989

Comparison of arterial baroreflex function in humans anesthetized with enflurane or isoflurane.

To compare the depressive effects of isoflurane and enflurane on the arterial baroreflex function, we examined baroreflex control of heart rate during the entire course of clinical anesthesia. Isoflurane and enflurane were found to have similar depressive effects on the baroreflex control of heart rate when used in combination with N2O and O2. Suppression in the baroreflex sensitivity, defined by the slopes of regression line (change in msec of RR interval per mm Hg increase or decrease in systolic blood pressure) was from 7.1 +/- 3.9 to 1.8 +/- 0.7 msec/mm Hg in patients given isoflurane and from 7.8 +/- 4.3 to 3.0 +/- 1.9 msec/mm Hg in those given enflurane when evaluated by a pressor test (bolus IV phenylephrine). The slope of the depressor test (bolus IV nitroglycerin) also decreased from 4.7 +/- 2.8 to 1.9 +/- 1.5 msec/mm Hg with isoflurane and from 5.6 +/- 3.2 to 2.3 +/- 1.2 msec/mm Hg with enflurane. During surgery in which anesthetic concentration invariably needed to be increased, the suppression of the baroreflex sensitivity remained unchanged in both groups of patients. During recovery, the arterial baroreflex function in patients given isoflurane recovered more rapidly than that in patients given enflurane. This difference may be related to a more minor degree of suppression of isoflurane on the autonomic nervous system compared to enflurane.

Adult↗

PubMedDate not supplied

Cerebrotendinous xanthomatosis diagnosed after traumatic subdural haematoma.

We report the case of a 34-year old man, who, after presenting with subacute traumatic subdural haematoma, was diagnosed as CTX. He presented a ten year history of progressive deterioration of cognitive functions, unsteadiness of gait and surgery for bilateral cataracts at age 21. Cholestanol level in serum was 120.7 mmol/liter, and cholestanol/cholesterol ratio 2.52%. Bile alcohols in urine were 23, 25-pentol: 2.2665 mg/mmol creatinine, 24, 25-pentol: 1.3226 mg/mmol creatinine, and 27-nor-24, 25-pentol: 0.7363 mg/mmol creatinine. Electrophysiological study was consistent with a mixed demyelinating and axonal neuropathy. The assessment of autonomic nervous system (ANS) showed a postganglionic cholinergic failure accompanying somatic peripheral neuropathy. Brain-stem auditory evoked potentials (BAEPs) demonstrated markedly low amplitude and poorly defined waves, and almost symmetrical peak V and I to V interpeak latency (IPL) slight delays. Two nodular, bilateral, symmetrical lesions, strongly suggestive of calcifications, in the cerebellar white matter on CT and MRI were noted. On T2-weighted images diffuse high signal lesions were found in the cerebellar white matter, and multiple, hyperintense cerebral foci of demyelination or gliosis. MRI study of the Achilles tendon showed neither enlargement of the tendon, nor areas of lipid deposits. After ten months of treatment with chenodeoxycholic acid (CDCA) (750 mg/d) the clinical course was unaffected and the neurophysiological measures, CT and MRI remained unchanged.

Adult↗

PubMed1996

Hydroxyzine premedication--does it provide better anxiolysis than a placebo?

OBJECTIVES: To determine how effective hydroxyzine is compared with a placebo in providing pre-operative anxiolysis in our hospital population, and to assess the anxiolytic effect of our pre-operative visit. DESIGN: Double-blind, randomised, prospective, controlled trial. Anxiety levels assessed with visual analogue scales (VAS), by patient and investigator. Haemodynamic parameters measured: heart rate, blood pressure, respiratory rate. SETTING: Hillbrow Hospital, Johannesburg. PARTICIPANTS: Sixty female patients aged 20-60 years, American Society of Anesthesiologists status I-III, scheduled for elective gynaecological surgery under general anaesthesia. The overall participation rate was 100%. All cases were randomly selected. INTERVENTION: Hydroxyzine (Aterax) 1-2 mg/kg, or a placebo administered orally as anaesthetic premedication. OUTCOME MEASURES: Anxiolytic effect of agents and of pre-operative visit. Time interval between premedication and induction of anaesthesia. Blood pressure, heart rate, respiratory rate, other signs of autonomic hyperactivity (restlessness, tremors, sweating). RESULTS: A statistically significant reduction in anxiety followed the administration of hydroxyzine (P < 0.05) and the placebo (P < 0.03); however, no statistically or clinically significant difference could be demonstrated between the two agents. No significant anxiolysis occurred following the premedication visit. The average premedication-induction interval was 72 minutes. There were no significant differences in haemodynamic parameters between the two groups. CONCLUSIONS: Hydroxyzine, in the dose administered and after an appropriate premedication-induction interval, provided no better anxiolysis than a placebo in the pre-operative period. No significant anxiolytic effect was demonstrated by our routine premedication visit.

Administration, Oral↗

PubMed1998

[Motor-evacuation disorders of the digestive tract in the early period after stomach surgery. 3. Motor-evacuation disorders of the large intestine].

The balloonographic method was used for studying the motor function of the sigmoid in 15 healthy volunteers, 15 patients with peptic ulcer before operation and in 25 patients at early terms after truncal vagotomy or resection of the stomach. During the first 2-3 days independent of the type of surgical intervention and of the degree of extra-organic denervation of the digestive tract, the motor activity of the sigmoid has the autonomic regimen of regulation, pathognomic structure of the motor cycle and is characterized by a sufficiently high contractile activity at the expense of frequent and regular generation of the migrating motor complexes. The restoration of the motor function is completed by the 5th-6th day. The states of normo-, hypo- and adynamia of the sigmoid were established on the basis of the contraction activity coefficient. The functional motor-evacuatory disorders of the intestine of the middle and grave degree are always accompanied by hypodynamia and transitory adynamia of the sigmoid.

Colon, Sigmoid↗

PubMed1987

Bradycardia associated with hiatal hernia and gastroesophageal reflux relieved by surgery.

A man known to have familial dysautonomia presented with a cardiac arrhythmia due to development of hiatal hernia and gastroesophageal reflux. Preoperative symptoms and assessment are described including use of power spectrum analysis of heart rate fluctuations which was consistent with enhanced parasympathetic stimulation. After surgical repair of hiatal hernia and fundoplication, bradycardia resolved, gastroesophageal reflux symptoms subsided, and the power spectrum analysis of heart rate confirmed decreased parasympathetic influence. Power spectrum analysis proved to be a useful adjunct in confirming preoperative autonomic imbalance and assessing the postoperative result. It is concluded that in individuals with disorders such as familial dysautonomia that are associated with autonomic dysfunction, cardiac arrhythmias may be a sign of esophageal pathology. Thus, cardiac evaluations should be accompanied by investigation of gastroesophageal structure and function and appropriate treatment may prevent a catastrophic arrhythmia.

Adult↗

PubMed2006

Current strategies in the management of atrial fibrillation.

Treatment of atrial fibrillation (AF) has been undergoing significant changes recently. This is due partly to different mechanisms proposed for persistent and permanent AF and partly due to the introduction of energy-based techniques, providing less invasive procedures. This article aims to review the mechanisms of AF leading to the changes in clinical practice and to review the results of surgery, energy-based, and percutaneous techniques. It is difficult to compare and contrast the results of reported series in the literature due to different definitions of AF; freedom from and recurrence of it. Furthermore, in most series it is difficult to distinguish results of surgery for lone AF and AF associated with valvular heart disease and coronary artery disease.

Atrial Fibrillation↗

PubMed1997

Spermatic-cord block improves analgesia for day-case testicular surgery.

OBJECTIVE: To assess whether the use of a spermatic-cord block contributes any additional analgesia to that of a conventional analgesic regimen in day-case testicular surgery. PATIENTS AND METHODS: In a randomized, double-blind controlled study, 48 patients undergoing day-case testicular surgery received general anaesthesia together with fentanyl and diclofenac for analgesia. In addition, 22 of these patients received 10 mL of 0.5% plain bupivacaine into the spermatic cord at the conclusion of surgery. Visual-analogue pain scores were recorded for each group over the following 24 h. RESULTS: The visual-analogue pain scores were significantly lower in the immediate recovery period in patients receiving the spermatic-cord block. CONCLUSION: The spermatic-cord block reduced discomfort in the immediate post-operative period in patients undergoing testicular surgery and the procedure should be encouraged to improve the quality of post-operative pain management in such procedures.

Adult↗

PubMedDate not supplied

[Combined regional anesthesia of the lower extremities in children with cerebral paralysis].

The authors share their first experience of combined regional anesthesia during surgical interventions into the lower extremities in children with infantile cerebral paralysis (ICP). A hundred and twenty-five blocks were performed in patients aged 5 to 20 years. Lidocaine, marcaine, naropine, or a mixture of lidocaine and marcaine mixture, were used. The paper describes the specific features of techniques for femoral-sciatic nerve blocks in these patients, shows the adequacy of anesthesia at surgery and the very good course of the postoperative period due to continuous analgesia and the alleviation of muscle spasticity in the operated limb.

Adolescent↗