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At least 235 records · Page 13Linked to original sources
PubMed2004

[Monitoring of blood pressure during phacotrabeculectomy].

PURPOSE: To evaluate systolic and diastolic blood pressure during phacotrabeculectomy performed under regional anaesthesia with retrobulbar block and intravenous analgosedation with midazolam and fentanyl. MATERIAL AND METHODS: 68 patients were involved into the study: I Group: 37 patients with chronic cardiovascular and metabolic diseases: 22 women and 15 men (45 operations), mean aged 72.02 years, mean weight 73.4 kg, II Group: 31 patients without additional diseases: 20 women and 11 men (44 operations), mean aged 70 years, mean weight 68.9 kg. Systolic and diastolic arterial blood pressure was recorded at 5-minute intervals throughout the intraoperative period and anesthetist intervened medically when necessary. RESULTS: In I Group statistically significant mean systolic BP decrease was observed in 5 and 20 minutes after injection of midazolam and fentanyl and mean diastolic BP decrease was observed in 5 and 15 minutes after analgosedation. In II Group statistically significant mean systolic BP decrease was noted in 5 minutes and mean diastolic BP decrease in 5 and 35 minutes. During phacotrabeculectomy mean systolic and diastolic BP was statistically higher in I group. In I group 12 patients and in II group 4 patients required additional antihypertensive drug. CONCLUSIONS: Regional anaesthesia with retrobulbar block and intravenous analgosedation provides hemodynamic stability. Patients with cardiovascular and metabolic diseases required acute observation during phacotrabeculectomy.

Aged↗
PubMedDate not supplied

Surgical treatment for liver metastases from colorectal carcinoma: results of 228 patients.

BACKGROUND/AIMS: Liver metastases are a very common event. Multiple choices of therapies can be used. The aim of this paper is to analyze results and methods of a single institution series of 228 consecutive patients with colorectal liver metastases. METHODOLOGY: 228 consecutive patients underwent hepatic resection for colorectal liver metastases. From different periods intraoperative ultrasound, intraoperative histological examination, locoregional intra-arterial chemotherapy, and radiofrequency thermal ablation were introduced. RESULTS: Operative mortality was 0.9%. Mean follow-up was 29.5 months. Overall survival was 16% and 9% at 5 and 10 years. 5-year survival was 23% and 6% for patients with single and multiple metastases respectively. For patients with extrahepatic metastatic single lesion 5-year survival was 15%. From the start of intraoperative ultrasound use, 5-year survival was 9% and 27% for patients with multiple and single metastases. Five-year survival for re-resected patients was 13%. Overall survival at 1 and 3 years was 90% and 58% in patients treated with HAI and systemic chemotherapy (disease-free 70% and 47%) and 94% and 12% in patients treated with systemic chemotherapy alone after radical resection (disease-free 53% and 0%). CONCLUSIONS: Aggressive approach, re-resections, intraoperative ultrasound staging, intra-arterial chemotherapy and radiofrequency thermal ablation are justified in multimodal therapeutic strategy of colorectal metastases and seem to improve patients' survival.

Adult↗
PubMed1992

[Hereditary prolonged QT interval (Romano-Ward syndrome) in a female patient with non-elective cesarean section].

In the Romano-Ward syndrome, an inherited form of abnormally prolonged QT duration is the matter of concern. The frequency-corrected QTc value in the ECG amounts to more than 0.44 s (upper mean value: 0.44 s). Persons suffering from Romano-Ward syndrome are vitally endangered by attacks of arrhythmia, syncope, and cardiac arrest that are triggered or aggravated by stress or certain drugs. In obstetrical anesthesia, attention should be paid to the fetus, which, due to the genetic dominance, will have a 50% probability of having the disorder. A 28-year-old para I was admitted with cervical dilation on her predetermined date of delivery. Romano-Ward syndrome had been diagnosed 10 years earlier; the patient had been free of complaints and had received no treatment. Due to cephalopelvic disproportion and the cardiac syndrome, a primary cesarean section was performed. Following premedication and provision of a beta-blocker, defibrillator, and drugs for resuscitation, intubation anesthesia with methohexital, nitrous oxide, enflurane, and succinylcholine was carried out. The QTc values were pathologically prolonged (0.47 s; 0.48-063 s) during the pre- and intraoperative period. Hemodynamic irregularities did not occur in the perioperative period. The newborn was vital (3,830 g, 50 cm; Apgar scores 10/10/10; umbilical cord pH 7.29). Directly postpartum isolated supraventricular extrasystoles occurred, and the QTc duration increased to 0.51 s. Simultaneous registration of the ECG and phonocardiogram showed premature occurrence of the second cardiac sound, which is typical of Romano-Ward syndrome.

Adult↗
PubMed2005

The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: I. Description of methods and populations.

BACKGROUND AND RATIONALE: Since anesthesia, unlike medical or surgical specialties, does not constitute treatment, The Royal College of Anesthesiologists of Thailand host the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes to determine factors related to anesthesia related adverse events. MATERIAL AND METHOD: A prospective descriptive study of occurrence screening was conducted in 20 hospitals comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia personnels were required to fill up patient-related, surgical-related, anesthesia-related variables and adverse outcomes on a strutured data entry form. The data included preanesthetic evaluation intraoperative period and 24 hr postoperative period. Adverse events specific form was recorded when adverse events occurred. All data were keyed in data management unit with double entry technique and descriptive statistics was used in the first phase of this study. RESULTS: A total of 163403 consecutive cases were recorded in one year. The mean (S.D.) of age, weight and height of patients were 38.6(2.3) yrs, 53.9(17.7) kgs and 153.4(22.7) cm respectively. There were more female (52.9%) than male (47. 1%) patients with ASA PS 1, 2, 3, 4, 5 = 50.8%, 36.3%, 10.7%, 2.0%, 0.2% respectively. Hypertension (11.6%), anemia (7.7%) and diabetes melitus (6.8%) were the three most common abnormalities in preanesthetic history taking. Mallampati score of 111870 patients grade 1, 2, 3, 4 were 54.0%, 39.7%, 5.6%, 0.7% and laryngoscopic grade 1, 2, 3, 4 of 74888 patients were 81.0%, 15.5%, 3.0% and 0.5% respectively. CONCLUSION: The first phase of THAI study epidemiological project can represent both the anesthesia and surgical profiles in Thailand. The collected data available should be useful for the improvement of the quality of anesthesia, guidelines for clinical practices, medical education and for further research.

Adolescent↗
PubMed2005

The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: II. Anesthetic profiles and adverse events.

BACKGROUND AND RATIONALE: The purposes of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes were to survey patients, surgical, anesthetic profiles and determine factors related to adverse events. MATERIAL AND METHOD: A prospective descriptive study of occurrence screening was conducted in 20 hospitals comprised of 7 university, 4 general and 4 district hospitals across Thailand. Anesthesia personnel were required to fill up patient-related, surgical-related, anesthesia-related variables and adverse outcomes on a structured data entry form. The data were collected during the preanesthetic evaluation, intraoperative period and 24 hr postoperative period. Adverse events specific forms were used to record when they occurred. All data were keyed at data management unit with double entry technique and descriptive statistics was used in the first phase of this study. RESULTS: A total of 163403 consecutive cases were recorded during first 12 months. MD. anesthesiologists involved with 82%, 89%, 45% and 0.2% of cases in university hospitals, regional hospitals, general hospitals and district hospitals respectively. Nurse anesthetists took a major involvement in hospitals run by the Ministry of Public Health. Two-thirds of cases did not receive any premedication (67%) and midazolam was most frequent premedication administered (20%). Common monitoring were non invasive blood pressure (NIBP) (97%), pulse oximetry (96%), electrocardiography (80%), urine output (33%), airway pressure (27%) and capnometry (19%) respectively. The choices of anesthesia were general anesthesia (62%), spinal anesthesia (23%), total intravenous anesthesia (6%), monitor anesthesia care (4%), brachial plexus block (3%) and epidural anesthesia (1%). The adverse events were oxygen desaturation (31.9:10000), cardiac arrest (30.8:10000), death within 24 hr. (28.3:10000), difficult intubation (22.5:10000),re-intubation (19.4:10000), unplanned ICU admission (7.2:10000), coma/cva/convulsion (4.8:10000), equipment malfunction/failure (3.4:10000), suspected myocardial ischemia or infarction (2.7:10000), awareness during anesthesia (3.8:10000), late detected esophageal intubation (4.1:10000), failed intubation (3.1:10000), anaphylaxis or anaphylactoid reaction (2.1:10000), nerve injury (2:10000), pulmonary aspiration (2.7:10000), drug error (1.3:10000), hazard to anesthesia personnel (1.5:10000), unplanned hospital admission (0.1:10000), total spinal block (1.3:10000) and mismatch blood transfusion (0.18:10000) CONCLUSION: Respiratory adverse events were common anesthesia direct related events. High incidence of cardiac arrest and death within 24 hr highlighted concerns for prevention strategies. Incidents of adverse events can be used for institutional quality improvement, educational quality assurance and further research for patient safety in anesthesia.

Adolescent↗
PubMedDate not supplied

[Anesthesiological provision of surgical correction of dilated cardiomyopathy in patients with chronic heart failure].

When dilated cardiomyopathy (DCM) is surgically corrected, intraoperative intracardiac hemodynamic changes and additional ischemia of the disabling myocardium make special demands for anesthesia, prevention of cardiovascular insufficiency, and maintenance of circulatory oxygen-transporting function (COTF). For the development and evaluation of an anesthetic support protocol for patients with DCM, clinical parameters, hemodynamics and oxygen transport was comprehensively analyzed in 50 DCM patients aged 16-68 years in the intraoperative period of surgical correction of myocardial pathology. All the patients underwent implantation of an extracardiac mesh framework in combination, if required, with correction of mitral insufficiency under extracorporeal circulation (EC), drug-induced cold cardioplegia. Analysis of comprehensive clinical studies made it possible to provide scientific evidence and to successfully use the anesthetic support protocol for correcting operations of chronic heart failure in patients with DCM, the basic principles of the support being an effective preoperative preparation of a patient to attenuate the signs of congestive heart failure; preventive intraaortic balloon contrapulsation before surgery; overall monitoring of hemodynamics and oxygen transport; balanced use of anesthetic agents in the doses that exert no cardiosuppressive effect; preload optimization and postload reduction; the minimum use of catecholamines; prevention of arrhythmias; and a reduction in the duration of myocardial ischemia.

Adolescent↗
PubMed1991

Local anaesthesia with intravenous analgesia as an alternative to general anaesthesia for medically compromised patients undergoing oral surgery. A retrospective study of sixty-two cases.

The purpose of this retrospective study was to evaluate the combined use of intravenous analgesia, with a potent opiate alone, supplemented by local anaesthesia as an alternative to general anaesthesia for medically compromised patients. Sixty-two in-patients, aged between 32 and 80 years, with an ASA physical status of III and IV, were involved in this study. The local anesthetic used was 4% articain with epinephrine (1:200,000) and narcotic analgesics were Fentanyl or Alfentanil. Surgical procedures included multiple dental extractions, cystectomy and the removal of impacted teeth. All patients completed the surgery without deeper anaesthesia and mostly enjoyed a comfortable intraoperative period. Only one respiratory depression was observed, but quickly reversed. Other adverse effects were few and without consequences, hemodynamic changes remained in tolerable limits. In conclusion this anaesthetic technique can be a suitable alternative to general anaesthesia in oral surgery for high-risk patients.

Adult↗
PubMed1991

The release of interleukin-1 beta (IL-1) precedes that of interleukin 6 (IL-6) in patients undergoing major surgery.

The cytokine response to major surgical trauma has been studied in six patients undergoing elective aortic surgery. Peripheral blood was sampled frequently before, during, and after surgery and the plasma cytokines interleukin-1, interleukin-6, tumor necrosis factor-alpha, and interferon-gamma were measured using enzyme-linked immunosorbent assays. These results were reviewed together with the operative details, clinical course, and C-reactive protein levels. Tumor necrosis factor-alpha and interferon-gamma were not detected in these patients. An early and short-lived interleukin-1 beta response to major surgery was detected only by intensively sampling the intraoperative period. This was a consistent finding that preceded the rise in interleukin-6. Interleukin-6 rose steeply from 2 h, peaking between 4 and 24 h. It had fallen sharply by 48-72 h in five patients who had an uneventful postoperative course. It remained high in one patient who developed complications and fell only when a severe septicemia was treated successfully. His interleukin-6 levels were considerably higher than the other patients even during the operation itself. There was no obvious relation between the interleukin-6 peak and the duration of operation. A sequential interleukin-1 beta and interleukin-6 response has not been noted before in vivo, and would seem to provide evidence supporting the in vitro observation that interleukin-1 induces interleukin-6 synthesis and release. It also provides evidence of an important role for interleukin-6 in the body's response to injury. A larger study is in progress.

Aged↗
PubMed1990

Blood conservation in major orthopedic surgery.

During an eight-year period, intraoperative autotransfusion was performed in 1922 operations. There were 476 primary hip arthroplasties, 1017 revision hip arthroplasties, 339 spinal procedures, and 90 vascular cases. There were no known complications related to autotransfusion in any of the cases. With proper technique, red cell salvage is approximately 58% effective, and intraoperative blood loss can be reduced by that amount. The first four years' experience with the preoperative autogeneic blood program is as follows. Using a combined program of predonation and primary hip arthroplasty, 72% of the revision hip arthroplasties and 81% of the spinal instrumentations required only autologous blood. A combined program of autologous donation and intraoperative autotransfusion is an excellent alternative to allogeneic blood replacement and a means of eliminating transfusion-related disease.

Blood Preservation↗
PubMedDate not supplied

[A bupivacaine-morphine combination by intrathecal route: correlation between pain relief and postoperative neuroendocrine response].

The purpose of the present study was to assess the repercussion of morphine injected in the intrathecal space on postoperative neuroendocrine response and the correlation with pain relief in the postop period. We studied 50 healthy patients (ASA I-II) submitted to orthopaedic surgery under general anaesthesia (N = 25) or spinal anaesthesia (N = 25). In the group under general anaesthesia we observed a hypersecretion of ADH, ACTH, cortisol and aldosterone during and after surgery. In the group un spinal anaesthesia, it was evident, on the contrary, a blockade of the neuroendocrine response during surgery, as well as an attenuation during postoperative period. Intraoperative and postoperative bleeding with spinal anaesthesia was significantly lower (p less than 0.01; p less than 0.05 respectively) than with general anaesthesia. Postoperative analgesia was excellent in group with spinal anaesthesia; the average duration of analgesia was 16.3 hours. We conclude that small intrathecal doses of morphine have beneficial effects and may be used usefulness in orthopaedic surgery.

Adrenocorticotropic Hormone↗
PubMed1986

Bacterial infections of the central nervous system in neurosurgery.

CNS infections following clean neurosurgery are uncommon but occur with increased frequency following neurotrauma and placement of CSF shunts and ventriculostomies. When faced with the possibility of meningitis or brain abscess in these settings, the clinician must aggressively seek definitive diagnostic information by means of CT scanning and cell counts, Gram stain, and culture of the CSF. Appropriate empiric therapy should then be administered promptly to achieve cidal activity in the CSF against the most likely infecting pathogens. Prophylaxis for clean neurosurgery and for placement of CSF shunts has been advocated by several investigators. However, regimens are many, and data are few and conflicting. When given, prophylaxis should be administered only during the intraoperative period. There is, at best, a weak scientific basis for what remains a widespread practice.

Anti-Bacterial Agents↗
PubMed1987

Major ambulatory surgery of the gynecologic and obstetric patient.

Many gynecologic and obstetric procedures can be done on an ambulatory basis. There is little difference in care between ambulatory and inpatient surgery during the preoperative and intraoperative periods. Thus, the primary deciding factor as to the appropriateness of ambulatory care rather than hospitalization lies in the postoperative requirements. These include the type and amount of analgesia that will be required, the intensiveness of nursing care needed, the need for unusual postoperative monitoring, the potential for complications, and the necessity for frequent postoperative evaluation by the surgeons.

Ambulatory Surgical Procedures↗
PubMed1983

Effect of preoperative colon preparation on serum potassium.

Although surgeons and anesthesiologists are constantly warned of the danger of hypokalemia following mechanical bowel preparations during the peri- and intraoperative periods, the amount and significance of this problem have not been quantitated. Therefore, the magnitude of the potassium (K+) depletion resulting from three to four days of mechanical bowel preparation was measured in a randomized, prospective fashion in 53 patients. The 27 patients in Group I received intravenous and/or oral potassium chloride supplementation during the preoperative bowel preparation, while the 26 patients in Group II received no supplementation. In an additional five patients, renal and colonic excretory potassium losses were measured to determine if they correlated with preoperative serum potassium levels. All patients had a standard preparation consisting of clear liquid diet (15 mmol K+/day), magnesium citrate orally, enemas, and oral antibiotics. Serum K+ levels in patients in Group I decreased from control levels of 4.01 + 0.41 mmol/1 to 3.71 +/- 0.58 (P less than 0.01) despite an average of 60 mmol potassium chloride supplementation during the preparation. The serum potassium levels in patients in Group II decreased from 4.13 + 0.69 mmol/1 to 3.43 +/- 0.53 (P less than 0.001) during the preparation. Measurement of stool K+ content revealed values that varied considerably between patients and that did not correlate with immediate preoperative serum levels. Urinary K+ measurement showed little renal compensation during the preparation and it did not significantly correlate with preoperative serum levels either.

Colon↗
PubMed1982

[Report of 2 cases of irreversible Horner syndrome after puncture of the internal jugular vein].

Two cases are presented with irreversible Horner's syndrome after cannulation of the internal jugular vein during the intraoperative period. In the first case the cannulation succeeded only after several attempts. In the second case the cannulation succeeded the first time. All cannulations were performed by experienced anaesthesiologists. This means, that a strict indication for the cannulation of the internal jugular vein must be considered, because of the possibility of irreversible damage, even if the cannulation is performed by an experienced physician.

Adult↗
PubMed1978

Epidemiologic Surveillance for Staphylococcus epidermidis infections related to cardiopulmonary bypass.

Epidemiologic investigation of 20 Staphylococcus infections among valvular and aortocoronary bypass graft patients indicated a broad spectrum of clinical illness in these two groups. The highest infection rate (9.3%) and case specific mortality rate (54.5%) were noted among those patients undergoing cardiovalvular replacement surgery with protheses. The median onset of infection was 6 days suggesting infection during the intraoperative period. Using the epidemiologic data from this investigation, a transmission pattern was formulated and a series of control measures designed to interdict the routes of transmission were instituted wigh marked success. These measures significantly reduced the incidence of S. epidermidis infections among these high risk patients.

Bacteriophage Typing↗
PubMed1980

[Intraoperative peridural opiate analgesia (author's transl)].

Epidural injection of small doses of opiates causes a reduction of pain in the lower parts of the body. The use of epidural opiate-analgesia for surgical anesthesia, combined with controlled ventilation (oxygen-nitrous oxide), was investigated in 170 patients undergoing surgery, especially long lasting gynaecological operations. Haemodynamic monitoring demonstrated a constant cardiovascular situation, underlining the sufficiency of analgesia. Blood gas analyses for one hour after the operation revealed no signs of respiratory depression. The epidural opiate-analgesia outlasted the intraoperative period, covering even the postoperative phase.

Anesthesia, Epidural↗
PubMed1995

[Risk factors of late ventricular arrhythmias after total correction of tetralogy of Fallot in children].

The authors present an analysis of pre-, intra- and postoperative risk factors of late ventricular arrhythmias in 100 children in 5-12 years after total correction of the tetralogy of Fallot. Complex arrhythmias (III-V class according to Lown classification) were found in 19% of patients. Risk factors were: in the pre- and intraoperative period--marked endocardial fibrosis of the right ventricular outflow tract, long bypass time (> 180 min) and aortic cross-clamp (> 90 min), in the post-operative period-left ventricular dysfunction in echocardiographic examination and age > 10 years at time of the study. Complex ventricular arrhythmias were more frequent in patients with associated supraventricular arrhythmias and with progressive bundle branch block.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[The use of the Dreimlich probe for obtaining samples in a postoperative study of biliopancreatic function in cholecystectomized patients].

We have performed a clinical study involving patients with symptomatic gallstones and indications for surgery, to analyze the biliary and pancreatic response to the quality of dietary fat (degree of unsaturation). As part of the investigative method, we have designed a clinical protocol adapted to the needs of the study, in this respect, we have used gastrointestinal intubation to obtain independent samples of gastric and duodenal juices, by means of a long nasoduodenal tube or a modified Dreimlich tube, placed manually in the intraoperative period, during the cholecystectomy. The characteristics of the tube are such that its manipulation is difficult, which led to situations postoperatively and during sampling, which may alter or invalidate the obtained drainage material. In the present study we define the protocol and the phases of the investigation, and we reflect on the usefulness of the Dreimlich tube as a method, analyzing its advantages and disadvantages.

Biliary Tract↗