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At least 19 recordsLinked to original sources
PubMedDate not supplied

[The prevention of undesirable changes in the endocrine system in patients in the intraoperative period using stress-preventive preparations].

The functions of the adrenal cortex, thyroid gland and carbohydrate metabolism have been analysed in 20 patients to whom current schemes of premedication and anesthesia have been applied, 20 patients who in the nearest preoperative period and intraoperatively have been administered ganglioblockers and adrenolytics, and 20 patients in whom clophelin has been used during premedication and anesthesia. It has been established that the use of stress-protecting agents for premedication and anesthesia almost prevents hyperergic reaction of the adrenal cortex, thyroid gland and carbohydrate metabolism.

Adrenal Cortex↗
PubMedDate not supplied

A "twilight period" of coronary perfusion: the risk of intraoperative infarction in surgery for main left coronary obstruction.

UNLABELLED: This study investigates the significance of an intraoperative period of low coronary perfusion pressure which may lead to ischemia, infarction, or both, in patients undergoing coronary bypass surgery for tight left main obstruction. "Twilight Period" (TP) was defined as the time interval from initiation of cardiopulmonary bypass to implementation of cold cardioplegia. Fifty-four patients with main left coronary obstruction (greater than 50%) were divided in three groups: Group I (20), TP less than 5 minutes; Group II (15), TP = 5-15 minutes; and Group III (19), TP greater than 15 minutes. Monitoring parameters included: systemic perfusion pressure during TP, perfusion flows, length of TP, time of ischemia, myocardial temperatures during ischemia, postoperative CK-MB level, EKG-detectable infarction, and postoperative therapeutic support requirements. RESULTS: Intraoperative myocardial infarction by EKG was 0% in Group I, 7% in Group II, and 26.3% in Group III; mortality was 0%, 0%, and 15.7%, respectively. CK-MB values were 18 +/- 3.2 IU, Group I; 18.3 +/- 2.5 IU, Group II; and 49.4 +/- 10.3 IU, Group III. Group I vs. III: P 0.01. Levels of postoperative support: Level A, less than 12 hours; Level B, 12-36 hours; and Level C, greater than 36 hours. Intra-aortic balloon pump (IABP) was considered Level C. In Group I, 75% (15/20) fell in Level A; 15% (3/20) in Level B and 10% (2/20) in Level C. In Group II, 60% (9/15) fell in Level A; 26.7% (4/15) in Level B; and 13% (2/15) in Level C. In Group III, 36.8% (7/19) fell in Level A; 15.8% (3/19) in Level B; and 47.4% (9/19) in Level C.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1975

A master nurse clinician for intraoperative care.

The intraoperative period has long been the missing link in the chain of continuity of care for the surgical patient. An intraoperative clinical nurse specialist who is able to work with patients, families, and health care team members preoperatively, intraoperatively, and postoperatively can effectively bridge the gap in care. Nursing care given to patients in the O.R. should be no different qualitatively from nursing care given sedated and/or unconscious patients in other nursing units. The C.N.S. in the O.R. can help make such care a reality through giving care to patients and families as a role model, directing care as an expert through written care plans or physical presence, doing formal and informal teaching of patients, families, and staff, and through research. Operationalizing the role of the C.N.S. for surgical patients during the intraoperative period requires the specialist to move out of the O.R. to assess patients and families preoperatively and to evaluate the postoperative results of care. Implementation of the specialist role in the O.R. clinical nursing setting is accompanied by the same frustrations and problems met by master clinicians in other nursing specialty areas.

Family↗
PubMedDate not supplied

[The choice of a method of general anesthesia for patients with cancer of the abdominal cavity].

Two variants of anesthesiological management have been used in 135 patients with gastrointestinal tumors. The first variant was intubation anesthesia with N2O+O2, ketamine or sodium hydroxybutyrate combined with classical neuroleptanalgesia technique. Pentamine was used to potentiate protection. This anesthesia technique was used in patients under 50 who had no concomitant diseases. The second variant was used in patients over 50 with concomitant diseases. In these cases combined prolonged epidural anesthesia was accompanied in the intraoperative period with intubation anesthesia with controlled lung ventilation using N2O+O2 and additional administration of promedol and droperidol. The second variant of anesthesia not only ensured a safe intraoperative period but also optimized the management of patients in the postoperative period.

Abdominal Neoplasms↗
PubMed1991

[Beta-endorphin and substance P in the perioperative period].

The modifying impact of anaesthesia on the stress reaction related to surgical trauma was investigated on the basis of the neuropeptidergic parameters of 66 patients who had to undergo a gynaecological radical operation. Anaesthesia was either performed as neuroleptanaesthesia or as epidural analgesia by using bupivacaine in combination with general anaesthesia. The plasma concentrations of substance P and beta-endorphin were taken as neuropeptidergic parameters. Both regulatory peptides show numerous corresponding synergisms. An acceleration of these neuropeptide systems is assumed to be present in severe disturbance of homeostasis. Plasma concentrations of substance P and beta-endorphin were examined at 11 measuring points in the perioperative and intraoperative periods. The plasma concentration of substance P significantly declines in the preoperative period while the concentration of beta-endorphin in the plasma remains at a relatively constant level. In the dynamics of beta-endorphin in the plasma significant differences between the two anaesthetic techniques become apparent in the intraoperative period. Those patients given epidural analgesia have a significantly higher maximum concentration at a later date. This difference is attributed to the possible loss of the adrenal medullary function due to partial sympathetic blocking. Single observations in patients pregnant in the last trimester testify to an extraordinary adaptability at the end of pregnancy.

Adult↗
PubMed1992

Perioperative myocardial ischemia and infarction.

The association between perioperative myocardial ischemia and infarction has clearly been established. In patients undergoing CABG, myocardial ischemia that occurs during the intraoperative period has the strongest correlation with perioperative MI. In noncardiac surgery, myocardial ischemia during the postoperative period is more significantly associated with ischemic cardiac morbidity than is ischemia that develops pre- or intraoperatively. Much of the descriptive phase of this research is complete. It is important next to determine the etiology of perioperative myocardial ischemia and to design treatment regimens that will tell us whether MI is merely associated with perioperative ischemia or is also the cause of cardiac morbidity.

Coronary Disease↗
PubMed1991

Flow cytometric detection of tumor metastases during urologic surgery.

Flow cytometric studies were performed on peripheral blood obtained before, during, and subsequent to urologic surgery. The results suggest that 7 of 11 patients had a brief period during surgical manipulation when they had cells from the primary surgical site in the peripheral blood. Concentration of such cells was generally less than 10(2)/mL even during the intraoperative period. These findings suggest that perioperative tumor seeding is a real concern, and that flow cytometry can be used to study maneuvers to reduce its incidence.

DNA, Neoplasm↗
PubMedDate not supplied

Perioperative awareness and recall.

This study was designed to introduce a relevant stimulus at successive time intervals during the entire anesthetic period, including the pre- and postanesthetic periods. Using galvanic skin responses, the authors were able to recognize a plane of light anesthesia and arousal, at which time it is considered that sensory input might be perceived. Presenting to the patient a stimulus of some relevance, but one not likely to be psychically traumatic, they investigated the correlation between the ability to maintain an attention span and to recall in the postoperative period. No recall was obtained during the intraoperative period, the first occurrence of recall being in the immediate postanesthetic period and the incidence of recall increasing with increasing time intervals after the end of anesthesia. The authors conclude, however, that since intraoperative awareness without recall is a possibility, care should be taken to avoid emotionally disturbing auditory stimuli throughout the anesthetic procedure.

Adolescent↗
PubMedDate not supplied

[The effect of the graft contraction rate on the intraoperative hemodynamics in orthotopic heart transplantation].

Intraoperative hemodynamics has been studied during orthotopic heart transplantation (OHT) in 36 recipients, aged 14 to 56 years, with spontaneous contractions of the graft. It has been established that patients with HR greater than 110 beats per min were in most cases characterized by normal central venous pressure (CVP) and venous blood oxygenation parameters. In lower HR, CVP is considerably higher and the indexes characteristic of the adequacy of cardiac output to body oxygen requirements are deteriorated. Right after OHT there is a reverse dependence between HR and CVP, with the lowest CVP values corresponding to HR intervals 101-120 and 121-140 per min. It has been concluded that tachycardia in the intraoperative period ensures a more effective function of the transplanted heart.

Adolescent↗
PubMed1992

Improvements in hepatocellular carcinoma resection by intraoperative ultrasonography and intermittent hepatic inflow blood occlusion.

From September, 1989, to December, 1990 (late period), intraoperative ultrasonography (IOU) and intermittent hepatic inflow blood occlusion were introduced in hepatectomy. Compared with the early period from January, 1983, to August, 1989, the resectability of hepatocellular carcinoma (HCC) increased from 12.1 to 62.1% (P less than 0.0001). More resections on cirrhotic patients (P less than 0.05) and more combined resections with other organs (P less than 0.005) were carried out. Although the operation time was longer (P less than 0.01), less blood loss during surgery and fewer perioperative blood transfusions (P less than 0.001) were found during the late period. Since the rate at which classical resections were performed has reduced (P less than 0.001), postoperative morbidity has also decreased (P less than 0.05). Although the surgical mortality did not differ between the two periods, most deaths in the early period were caused by postoperative hepatic failure which was not found in the late period. Since IOU can clarify the intrahepatic vasculature and identify impalpable and invisible tumors, more precise resections can now be carried out. Intermittent hepatic inflow occlusion reduces blood loss during surgery without increasing risk. We suggest both techniques should be mandatory in hepatectomy for HCC in order for the safety range of resections to be broadened.

Adolescent↗
PubMed1991

[The ambulatory anesthesia unit: a problem of organization].

A specialized unit in outpatient anaesthesia and surgery needs an adapted planning. During the preoperative period, it is particularly important to preserve the time of the patients. Different types of structures are possible for the intraoperative period depending on their degree of independence to a hospital. The hospital based unit, with independent facilities, offers various advantages. Its size and its conception must be adapted to the constraints of ambulatory technique, and to the expected needs. During the postoperative period, a special medical organization must be planned to help the patient if necessary. The part of the secretarial work is important for the success of such a unit. Its efficiency may be improved by computerised treatment of part of the information.

Ambulatory Surgical Procedures↗
PubMed1992

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

The purpose of this experimental study was to examine the effects of intraoperative progress reports on family members' state anxiety level (STAI S-Anxiety), mean arterial pressure (MAP), and heart rate during elective surgical procedures. Family members of randomly selected surgical patients were eligible to participate. 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. Families' STAI S-Anxiety scores, MAP, and heart rates were compared between the control and experimental groups using multivariate analysis of variance (MANOVA). Family members in the experimental group reported lower STAI S-Anxiety scores (p < .001), and had significantly lower MAP and heart rates than did the control group (p < .001). Progress reports appear to be a beneficial nursing intervention for reducing anxiety in family members during the intraoperative period.

Adolescent↗
PubMed1992

Electromyographic monitoring of profound surgical muscle relaxation during cardiac anesthesia.

Quantitative assessment of neuromuscular block produced by large doses of nondepolarizing neuromuscular blocking agents during cardiac surgery is not possible with conventional methods of monitoring. Various "posttetanic responses" can, however, be elicited, even when no twitch response is present. Posttetanic responses measured by electromyography were used in this study. Twenty-four male patients undergoing coronary bypass surgery were anesthetized with sufentanil plus diazepam. Neuromuscular block was provided either with pancuronium 0.1 mg/kg or with vecuronium 0.07 mg/kg initially and supplemented with small increments when indicated. Neuromuscular block was monitored from the hypothenar muscle. The ulnar nerve was stimulated by train-of-four, with superimposed periodic tetanic stimuli to evoke posttetanic responses, once every 7 to 15 minutes. The tetanically potentiated responses were detectable during 96% +/- 3.6 (vecuronium) and during 97% +/- 3.7 (pancuronium) of the entire intraoperative period, while the non-potentiated electromyographic responses were present for less than 50% of the time. The sum (of the amplitudes) of 6 posttetanic responses is significantly (p less than 0.05) greater than the sum of 6 nonpotentiated responses and than the size of a single-peak posttetanic response when compared with the normal, nonpotentiated responses. Higher-frequency tetanic stimuli (100 or 200 Hz) produced greater posttetanic responses (p less than 0.05) than did the 50-Hz tetanic stimulus. There were only slight or no significant differences in the degree of posttetanic potentiation between pancuronium and vecuronium either before, during, or after cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1991

[Conscious and unconscious acoustic perception during general anesthesia].

The possibility of processing sensory information during general anesthesia and the ability to recall it postoperatively is of major ethical, medical and even theoretical importance. Auditory stimuli especially are perceived intraoperatively and remembered postoperatively. Neuropsychological experiments indicate that sensory information can be processed and recalled both at a conscious and at an unconscious level. Therefore, we have to distinguish between explicit and implicit memory. Explicit memory is characterized by an active and conscious recall of space- and time-related events, i.e., episodes in a person's life. In contrast, implicit memory recalls passively and unconsciously without being related to space and time, i.e., language and general knowledge. Experimental results from amnesic patients indicate that these two memory systems work independently from each other. Even when explicit memory is grossly impaired the function of the implicit memory may still be completely preserved. Various studies on intraoperative awareness show that explicit memory is widely eliminated during general anesthesia. The incidence of conscious awareness that can be actively recalled postoperatively is reported to be 1-3%. In contrast, the implicit memory function can be partially preserved. When implicit memory tasks or hypnosis are employed, traces of unconscious memory of intraoperative auditory information can be shown in 20-30% of the patients. These observations are of important clinical relevance, because the unconsciously recalled information about the intraoperative procedure may have a negative influence on the patient's postoperative recovery and well-being. So far it is still not known which anesthetics most reliably suppress auditory perception and conscious and unconscious memory during the intraoperative period. Therefore, future studies should focus on several different points. The anesthetic state should be defined exactly and the functional state of the auditory modality should be monitored when auditory information is presented to the patients. The recollection of intraoperative events should be investigated using implicit memory tests, because these are regarded as more sensitive than explicit memory tests.

Anesthesia, General↗
PubMed1978

Epidemiologic features and phage types associated with nosocomial infections caused by Staphylococcus epidermidis.

An apparent problem with increased numbers of nosocomial infections caused by Staphylococcus epidermidis at a large hospital was studied in a clinical-epidemiological investigation. Thirty-six cases of S. epidermidis infection were confirmed on the thoracic surgery, general surgery, nursery and pediatric services during a 3-year period. Nine cases were fatal and six of these occurred in patients following cardiovascular surgery with implanted prothesis. The majority of cases (25/36) occurred following cardiovascular surgery. The median onset of infection was six days from the date of surgery, suggesting infection during the intraoperative period. Although the number of cases studied remains small, two phage types, 71/108/275a/459 and 407-2, did predominate among these clinical infections. Interestingly, during this same time interval these same types predominated among surgical staff members closely associated with these patients. Resistance to antimicrobials was high among isolates tested, with more than 50% of the strains resistant to six or more antimicrobial agents.

Adolescent↗
PubMed1991

Endoscopic laser therapy for obstructing tracheobronchial lesions.

The Lahey Clinic experience using laser bronchoscopy for relief of obstructive tracheobronchial lesions during a 7-year period from 1982 to 1989 involves 269 patients treated with 400 procedures. The carbon dioxide (CO2) laser was used for tracheal stenosis and granulation tissue. The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used for all obstructing endobronchial neoplasms. Indications for therapy included severe dyspnea, hemoptysis, and postobstructive pneumonitis. All patients had relatively central lesions. A rigid bronchoscope was used to treat 88% of patients, and 12% of patients were treated with a flexible bronchoscope. One death occurred during the intraoperative period. Eleven deaths occurred within 1 week of therapy and were related to the presence of extensive malignant lesions or to coronary artery disease. Our experience indicates that bronchoscopic application of the CO2 or Nd:YAG laser affords effective palliation for patients with obstructive tracheobronchial lesions. The Nd:YAG laser is recommended for patients with bulky vascular endobronchial neoplasms, and the CO2 laser is best reserved for patients with benign tracheal stenosis and granulation tissue.

Bronchial Diseases↗