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PubMedDate not supplied

[The surgical treatment of meningiomas of the superior sagittal sinus (the surgical approach and technic)].

The authors analyze the results of surgical management of 242 patients with upper sagittal sinus meningiomas who have been treated in the past 20 years. All the patients were divided into 3 groups in accordance with the surgical policy and techniques of interventions and anesthesiological support. The type of sinus wall tumor lesion and its associated cerebral blood outflow disorders detected by electrophysiological studies in pre- and intraoperative periods determined surgical policy which along with microsurgical technique of recovery of the intact sinus and superficial veins of the brain enhanced the efficiency of operations up to 92.2% and reduced fatal outcomes to zero.

Adolescent↗
PubMedDate not supplied

[Anesthesiological management in transplantation of the heart after temporary mechanical substitution of its function].

The first experience of anesthesiological management of three two-step orthotopic heart transplantations is reviewed. As the first step of surgical treatment one recipient was implanted an artificial heart "POISK-IOM" (Russia), in 2 other patients left ventricular bypass was achieved using a "Biopump" ("Biomedics", USA). Anesthesia techniques, methods of infusion-transfusion therapy, and other components of intraoperative management are described. Hemodynamics, donor heart function recovery, and other homeostasis parameters have been analysed. It has been noted that high doses of fentanyl in combination with ketamine and diazepam ensured satisfactory course of general anesthesia. There were no cases of intraoperative lethality. A more complex aspect of anesthesiological management was correction of various homeostasis disturbances which progressed during surgery in patients with left ventricular bypass. In two cases the intraoperative period was characterized by the onset of multiorgan failure (heart, respiratory, renal failure, metabolic disorders, coagulopathy), which played a negative part for the postoperative period of heart transplantations. It is concluded that prediction of possible complications during temporary mechanical replacement of the cardiac function and timely determination of contraindications for the second step of two-step heart transplantations are the most important trends of investigations for anesthesiologists, intensive care specialists, and transplantologists.

Adult↗
PubMed1994

Experience with the Mitroflow aortic bioprosthesis.

From October 1985 to May 1990, the Mitroflow bovine pericardial valve was placed in the aortic position in 168 patients (97 men, 71 women) with a mean age of 69.7 years. Eighty-nine patients had isolated aortic valve replacement, and 79 had aortic valve replacement and additional procedures. Follow-up over 7 1/2 years includes 781 patient years (426 for isolated aortic valve replacement). Mean follow-up time is 56 months. Peak-to-peak gradients (in millimeters of mercury) measured in the intraoperative period averaged 11.0 +/- 8.7, 11.8 +/- 10.8, and 8.6 +/- 8.2 for 19 mm, 21 mm, and 23 mm valves, respectively. Hospital mortality was 7.3% (14 patients); all deaths were non-valve related. Late mortality of 20.1% in 31 patients resulted from cardiac failure (n = 8), sepsis (n = 4), valve reoperation (n = 1), non-cardiac causes (n = 15) and sudden, unknown causes (n = 3). Fifteen thromboembolic episodes occurred, but only three late thromboembolic episodes occurred in isolated aortic valve replacement without other risk factors. Four early and four late episodes of endocarditis occurred. Seven patients had clinical valve dysfunction, and five others required reoperation for structural deterioration, with one death. At 94 months, overall survival was 64% +/- 5%. Freedom from thromboembolic episode was 87% +/- 3% and 90% +/- 4% for isolated aortic valve replacement. Freedom from combined reoperation or clinical dysfunction was 75% +/- 8%: 64% +/- 15% for those under 70 years of age, and 87% +/- 7% for those 70 years of age and older. The valve has favorable hemodynamics. Durability begins to decline during the sixth year after implantation, possibly at a slower rate in patients older than 70 years of age.

Adolescent↗
PubMed1994

Total circular annuloplasty with absorbable suture for the repair of left atrioventricular valve regurgitation in atrioventricular septal defect.

To obtain a better control of left atrioventricular valve regurgitation, we applied total circular annuloplasty with the use of absorbable sutures to 14 children with atrioventricular septal defect (six complete forms and eight incomplete forms). In the intraoperative period, a good coaptation of the leaflets was achieved and the regurgitation was minimized or disappeared. Follow-up studies with echocardiography for 13 survivors showed a gradual increase of annular size during the postoperative period. Ten patients of the survivor group (77%) maintained good valvular competency in a long-term period. Total circular annuloplasty is a simple and effective procedure to reduce the regurgitation and prevent the annular dilatation during the immediate postoperative period.

Cardiac Surgical Procedures↗
PubMed1976

[Is ventricular fibrillation during cardiac surgery a hasard?].

The late consequences of induced ventricular fibrillation electrically non maintained have been analysed in a series of 547 operations under extracoporeal circulation and moderate hypothermia in the adult; the length of the intraoperative period of fibrillation has been found to have no effect upon the mean postoperative left atrial pressure -- itself a sure indicator of left ventricular function. This is equally true of the variations of the factor both in the operated cases taken together, and between the various groups of operated cases. There is no evidence that ventricular fibrillation has a harmful effect when, in addition, a study is made of the postoperative myocardial complications and of the early deaths. The mean duration of ventricular fibrillation does not differ significantly statistically between the group with complications and deaths, and the group with uncomplicated operations and no mortality.

Adolescent↗
PubMed1993

[The differential diagnosis and therapeutic procedure in nontumorous mechanical jaundice and cholangitis].

The results of operative treatment of 2,875 patients with obstructive jaundice and cholangitis of nonneoplastic genesis are generalized. On the basis of rich clinical experience, the authors substantiate the principles of differential and topical diagnosis in obstructive jaundice and purulent cholangitis as well as the optimal therapeutic tactics in obstruction of the bile ducts of various levels and types. Problems are elaborated with respect of complex antibacterial therapy with the use of various routes of administration, including administration in the pre- and intraoperative period for preventive purposes.

Cholangitis↗
PubMed1993

[Psychologic implications in loco-regional anesthesia].

A patients, who undergoes surgery, bears so stressful an emotional charge that his personality layout and life conflicts may emerge. When a patient is scheduled for loco-regional anaesthesia, the above mentioned issues should be taken into account to get a proper relation between the patient and the anaesthetist both in the pre- and intraoperative period. The following survey deals with psychological dynamics which compel the patient to ask for or reject a loco-regional anaesthetic procedure. Suggestions are also provided in order to manage adequately the anxiety and the hidden fears of the patient.

Anesthesia, Conduction↗
PubMed1996

[Clinical experience of laryngeal mask airway combined with continuous intravenous propofol infusion during general anesthesia].

BACKGROUND: Propofol's greatest attributes are its pharmacokinetic properties which result in a rapid, clear emergency and lack of cumulative effects even after prolonged administration. It is a drug of popular choice for the maintenance of general anesthesia. The laryngeal mask airway (LMA), originally described by Dr. Brain is now a good alternative as the airway management technique. Because of its high success rate in securing a clinically acceptable airway in anesthetized patients, LMA has been proposed as a practical airway and conveyer for general anesthesia. This study was designed to observe and evaluate the feasibility of propofol infusion combined with N2O for maintenance of anesthesia, with a LMA as airway and conveyer during general anesthesia. METHODS: Sixty patients, ASA class I-II, aged 15-59 years, were selected for this study. They were scheduled for upper-limb orthopedic surgeries in supine position. No patient was premedicated. Intraoperative monitoring included electrocardiography, pulse oximetry, end-tidal carbon dioxide and automatic non-invasive blood pressure. The agents for induction of anesthesia included atropine 0.01 mg/kg, atracurium 5 mg, fentanyl 2-3 micrograms/kg, 2% lidocaine 1.5-2 mg/kg, propofol 2 mg/kg, and succinylcholine 1-1.5 mg/kg, all of which were given intravenously in sequence. After that laryngeal mask airway (LMA) was inserted. The position of LMA was confirmed by even undulation of chest wall and breathing sound. Anesthesia was then maintained with nitrous oxide in 40% oxygen and continuous propofol infusion. The pumping rate was set to start at 6 mg/kg/h. Muscle relaxation was achieved by intravenous tracrium given intermittently. All patients were mechanically ventilated with a ventilator incorporated to the anesthesia machine. The ventilator was set to give a tidal volume of 8 ml/kg at a rate of 12-14/min. At the end of the operation, the propofol infusion and nitrous oxide were simultaneously discontinued. The effect of muscle relaxant was antagonized by atropine 1.0 mg and neostigmine 2.5 mg intravenously. The LMA was removed while the patient was awake and able to open mouth at request. They were followed 24 h postoperatively for inquiring intraoperative awareness and other complaints. RESULTS: No patient was noted to experience awareness during the intraoperative period. Regarding LMA insertion, success in the first attempt was seen in 55 patients (90.2%). Success in the second attempt was seen in 5 patients (8.2%). Failure was encountered in one patient (1.6%). The average time of emergence was 92 +/- 3.4 min. The average rate of speed of propofol infusion was 6.29 +/- 0.97 mg/kg/h. CONCLUSIONS: The combination of propofol infusion and N2O with laryngeal mask as airway and recovery was a good alternative in administration of general anesthesia.

Adolescent↗
PubMed1997

[The effect of low-rose prostaglandin E1 on circulation, respiration and body temperature during surgical anesthesia].

We investigated the effects of low-dose prostaglandin E1 (PGE1) on circulation, respiration, and body temperature during surgical anesthesia. We studied 109 adult patients undergoing upper abdominal operations under thoracic epidural combined with inhalational anesthesia. Patients were divided into 2 groups; Control group (n = 42) and PGE1 group (n = 67). In PGE1 group, PGE1 infusion was started at the rate of 0.02 microgram.kg-1.min-1 before the induction of anesthesia and was terminated at the end of surgery. There were no differences between the groups in demographic, anesthetic and surgical characteristics. After treatment with PGE1, arterial pressure decreased slightly but significantly, resulting in lower arterial pressure in PGE1 group than in control group before the induction of anesthesia. After the induction of anesthesia, however, arterial pressure decreased significantly in both groups, and the differences in arterial pressure between the groups were not observed any more during surgery. Heart rate was not different between the groups throughout the study period. Intraoperative urine output was greater in PGE1 group than in control group. PaO2/FIO2 ratio was not different between the groups both before and during anesthesia. Rectal temperature remained slightly but significantly lower in PGE1 group throughout surgery. Rectal-to-palm temperature gradient tended to be smaller in PGE1 group 1 hour after the induction of anesthesia. Low-dose PGE1 reduced arterial pressure. However, the difference in arterial pressure between the groups was so small that the difference disappeared during surgery. Meanwhile, low-dose PGE1 increased urine output, suggesting that renal blood flow was better-maintained with PGE1. In spite of several investigations reporting an unfavorable effect of PGE1 on PaO2, low dose PGE1 did not affect PaO2 in this study. Finally low-dose PGE1 reduced core temperature, though slightly, probably through redistribution of the body heat.

Adult↗
PubMed1997

Clinically significant drug interactions with general anesthetics--incidence, mechanims and management.

The frequency of adverse drug interactions increases disproportionately with the increase in the number of drugs given to patients. It was shown that 40% of patients given 16 drugs experienced an adverse drug interaction, compared with 5% of patients given fewer than 6 drugs. The magnitude of the drug interaction problem increases substantially in anesthetised patients because of: (i) the increased use of multiple drugs in the preoperative and intraoperative periods; and (ii) the growing population of geriatric patients who, in addition to having diminished drug metabolising capacity, are often prescribed multiplied medications for concomitant medical illness. Drug interactions with volatile and intravenous anesthetics can be divided into those that are pharmacokinetic and pharmacodynamic in nature. Pharmacokinetic interactions occur when the absorption, distribution, metabolism or excretion of a drug is altered by the coadministration of a second drug. Pharmacodynamic interactions involve a change in the pharmacological effect of a drug as a result of the action of second drug at receptor sites.

Anesthetics, Inhalation↗
PubMed1998

Experimental and clinical studies about the preemptive analgesia with local anesthetics. Possible reasons of the failure.

Though we fully agree with the truthfulness of the physiopathological sequences proving the phenomena of the hyperalgesia onset and therefore a prolongation of the postoperative pain, we do not believe, as stated by some authors that the studies carried out up to now, both experimental and clinical, are sufficient, the first ones to confirm the preemptive analgesia, while the second ones to be defined as contrasting and totally inadequate to confirm the preemptive analgesia effect. The lack of positive clinical data is why some authors have suggested a "revision" and a "reduction" of the word preemptive analgesia. On the contrary, we believe that differences which seem to originate from the clinical works can also be found in the experimental ones if we examine them with the same methodological principle. In order to classify better such an important treatment like the preemptive analgesia, the aim of this note is to focus the attention on the experimental and clinical data. Our criterion to select the works has based on a backwards research taking into consideration the last reviews and studies about the preemptive analgesia. Since the results obtained with local anesthetics or with opioids seem to counterbalance each other, we have reexamined the experimental and clinical works limiting our attention to the local anesthetics. On a total of 19 assessments carried out in 16 experimental studies, only three of the eight ones comparing pre-vs post-administration prove a real preemptive analgesia effect of the local anesthetic (block of the first and second phase of hyperexcitability) whereas four of the eleven clinical studies examined seem to confirm the validity of the preemptive analgesia effect. These data show how the results of the experimental studies are equal to the results of the clinical ones. However, an important characteristic that seems to come out from these works is connected to two elements strictly linked each other: the intensity and the duration of the nociceptive impulse produced and the level and the type of the induced block. In our opinion, the failure of many of these works can be attributed to the inadequacy of the analgesic levels (intensity of the block) reached and maintained in the pre-and intraoperative period. Therefore we believe that before thinking of a "review" and "reduction" of the word preemptive analgesia is necessary to take a step backward and to face again the methodological problems of the preemptive analgesia.

Anesthetics, Local↗
PubMed2005

Thoracic epidural anesthesia preserves myocardial function during intraoperative and postoperative period in coronary artery bypass grafting operation.

AIM: The purpose of this study was to investigate the effect of thoracic epidural anesthesia (TEA) in patients with poor ventricular function undergoing conventional coronary artery bypass graft surgery (CABG) during the intraoperative and the postoperative period. METHODS: Eighty patients (n = 80) undergoing elective CABG surgery with cardiopulmobary bypass (CPB) were divided into 4 groups: 1) General anesthesia (GA) plus poor ventricular (PV) function patients (Group GA plus PV) (n = 20), ejection fraction (EF) = or <40%; 2) GA plus good ventricular (GV) function patients (Group GA plus GV) (n = 20), EF >40%; 3) Thoracic epidural anaesthesia (TEA)+GA, poor ventricular function patients (Group TEA+GA plus PV) (n = 20), EF = or <40%; 4) TEA+GA, good ventricular function patients (Group TEA+GA plus GV) (n = 20), EF >40%. RESULTS: Within groups, at 4 h after the end of CPB, in the Group TEA+GA plus PV and Group TEA+GA plus GV, the cardiac index values were significantly higher than baseline values; P < 0.05, whereas no difference was found in the Group GA plus PV and Group GA plus GV. According to Tukey test, using repeated measures, between trend of groups, the cardiac index values were significantly different P < 0.05. In the Group TEA+GA plus PV, cardiac index values were significantly higher than the Group GA plus PV, P < 0.05. But in the Group GA plus GV, cardiac index values were not significantly different than the Group TEA+GA plus GV. The incidence of reperfusion ventricular fibrillation (VF) after release of aortic cross-clamp, in the Group TEA+GA plus PV (4 of 20 patients: 20%) was significantly lower than in the Group GA plus PV (11 of 20 patients: 55%); P < 0.05. The incidence of reperfusion VF after release of aortic cross-clamp, in the Group TEA+GA plus GV (5 of 20 patients: 25%) was not significantly different than in the Group GA plus GV (10 of 20 patients: 50%); NS. CONCLUSIONS: TEA seems to be effective in patients with poor left ventricular function. Our results (improved cardiac index, reduced arrhythmias after release of aortic clamp and decreased inotropic requirement) are better with TEA, particularly in patients with poor left ventricular function.

Adult↗
PubMed1983

Transcutaneous gas tension monitoring in the management of intraoperative apnea.

Periods of apnea or severe hypoventilation may occur during procedures which involve the airway or during thoracic operations. Routine vital signs and ECG monitoring of these situations are incapable of quantitating the severe tissue hypoxia and acidosis which develop under these circumstances; rather, they only reflect the morbid complications of hypoxia and acidosis (i.e., bradycardia, ectopy, and hypotension). Transcutaneous oxygen and carbon dioxide sensors directly measure tissue gas tensions with a short sensor response time. This report documents the efficacy of transcutaneous gas tension monitoring in the management of these high-risk situations.

Adult↗
PubMed2002

Saliva cyclic GMP increases during anaesthesia.

BACKGROUND: Cyclic GMP (cGMP) has been implicated in modulating the effects of general anaesthesia. Changes in cGMP in humans undergoing anaesthesia have not been reported previously. METHODS: In this pilot study we measured cGMP in the saliva of six healthy volunteers and eight patients undergoing general anaesthesia for minor gynaecological procedures. Samples were obtained using a commercially available sampling device and cGMP was determined with an enzyme immunoassay and results expressed as a cGMP per mg protein. RESULTS: There was no statistically significant variation in salivary cGMP either day-to-day or between time points in healthy volunteers. Analysis of variance of salivary cGMP of patients undergoing general anaesthesia showed that cGMP increased significantly intraoperatively and returned to preoperative levels after surgery (P=0.03). CONCLUSIONS: This is the first time that real time in vivo changes in salivary cGMP levels during general anaesthesia in humans have been demonstrated and may allow an alternative technique for measuring depth of anaesthesia in the future.

Adult↗
PubMedDate not supplied

[The central hemodynamics and hormonal status before, during and after urologic operations in children].

Urological operations in children are made as a rule to correct congenital malformations. The prevention of operative injury to the child' body is secured only in conditions of adequate anesthesiological defense. This is possible only in availability of rapid information on cardiovascular, oxygen metabolic and hormonal statuses. Central hemodynamics, oxygen metabolism and hormonal findings have been summarized for 89 children. The above parameters were measured before and during plastic reconstruction of the upper urinary tract. Initially hyperkinetic hemodynamics because of inadequate premedication to control psychoemotional lability, changed for stable and hypokinetic circulation to the end of the operative intervention as a result of neuroleptanalgesia. Eukinetic trends were induced by balanced promedol analgesia throughout the operation. Concentrations of hydrocortisone, aldosterone and STH were on the increase, while T3 and T4 levels lowered. Hyperkinetic and eukinetic hemodynamics were observed postoperatively after neuroleptanalgesia and balanced promedol-including analgesia, respectively.

Child↗
PubMed2004

Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome.

Intraoperative parathyroid hormone (PTH) assay (QPTH) has made possible less invasive operative approaches in the treatment of primary hyperparathyroidism with stated advantages. When compared to the traditional bilateral neck exploration (BNE), only the targeted, hypersecreting gland is excised, leaving in situ non-visualized but normally functioning parathyroids. The QPTH-guided limited parathyroidectomy (LPX) must be able to identify multiglandular disease (MGD), predict a successful outcome, and have a low recurrence rate. In our series, 421 patients who underwent LPX were compared to 340 undergoing BNE; all operative failures and patients followed for 6 months or longer were included. Operative failure occurred if serum calcium and PTH levels were elevated within 6 months of parathyroidectomy. Multiglandular disease was defined in the LPX group as more than one gland excision guided by QPTH or operative failure after removal of a single abnormal gland; in the BNE group it was defined as excision of more than one enlarged gland. Recurrence was defined as elevated calcium and PTH after 6 months of eucalcemia. Operative failure and MGD rates were compared using chi-squared analysis. The method of Kaplan-Meier and the log-rank test were used to compare recurrence rates. Operative success was seen in 97% of LPX patients and in 94% of the BNE group ( p = 0.02). Multiglandular disease was identified in 3% of LPX patients and 10% of BNE patients ( p < 0.001). There was no statistical difference in the overall recurrence rates ( p = 0.23). The QPTH-guided parathyroidectomy identifies MGD and allows an improved success rate with the same low recurrence rate when compared to the results of BNE.

Humans↗
PubMed2001

Ion channel remodeling is related to intraoperative atrial effective refractory periods in patients with paroxysmal and persistent atrial fibrillation.

BACKGROUND: Sustained shortening of the atrial effective refractory period (AERP), probably due to reduction in the L-type calcium current, is a major factor in the initiation and maintenance of atrial fibrillation (AF). We investigated underlying molecular changes by studying the relation between gene expression of the L-type calcium channel and potassium channels and AERP in patients with AF. METHODS AND RESULTS: mRNA and protein expression were determined in the left and right atrial appendages of patients with paroxysmal (n=13) or persistent (n=16) AF and of 13 controls in sinus rhythm using reverse transcription polymerase chain reaction and slot-blot, respectively. The mRNA content of almost all investigated ion channel genes was reduced in persistent but not in paroxysmal AF. Protein levels for the L-type Ca(2+) channel and 5 potassium channels (Kv4.3, Kv1.5, HERG, minK, and Kir3.1) were significantly reduced in both persistent and paroxysmal AF. Furthermore, AERPs were determined intraoperatively at 5 basic cycle lengths between 250 and 600 ms. Patients with persistent and paroxysmal AF displayed significant shorter AERPs. Protein levels of all ion channels investigated correlated positively with the AERP and with the rate adaptation of AERP. Patients with reduced ion channel protein expression had a shorter AERP duration and poorer rate adaptation. CONCLUSIONS: AF is predominantly accompanied by decreased protein contents of the L-type Ca(2+) channel and several potassium channels. Reductions in L-type Ca(2+) channel correlated with AERP and rate adaptation, and they represent a probable explanation for the electrophysiological changes during AF.

Atrial Fibrillation↗
PubMed2006

[The changing role of intraoperative mammary frozen sections in breast cancer: comparison of data from East and West Germany before and after reunification].

The goal of the present study lies in the comparison of differently funded health care structures, with emphasis on certain aspects regarded to be essential for medical progress. For this purpose, mammary intraoperative frozen sections pooled from a total of 4163 intraoperative frozen sections obtained from representatively selected departments of pathology from East and West Germany before and after reunification were analysed comparatively. Our results clearly demonstrate a profound change in the role of intraoperative mammary frozen sections, with a predominantly diagnostic function in the former German Democratic Republic as a tool for histopathologically evaluating "questionable" mammary lesions. The use of such sections changed towards a predominantly therapeutic function during surgical treatment as a means of organ preservation after the German reunification.

Breast Neoplasms↗