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At least 307 records · Page 17Linked to original sources
PubMed1995

Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy.

The effects of artificial pneumoperitoneum on intracranial pressure have not been clearly defined. Initial animal studies indicate that elevated intra-abdominal pressure might have a deleterious effect on intracranial pressure. We report a case in which intracranial pressure was monitored intraoperatively during laparoscopic cholecystectomy. Intracranial pressure increased abruptly when the peritoneal cavity was insufflated, with the operating table in the Trendelenburg position, and decreased slightly with elevation of the head of the operating table. Initial opening intracranial pressure values were re-established on desufflation of the abdomen. Intracranial pressure monitoring should be considered when planning a laparoscopic procedure on patients with the potential for decreased intracranial compliance.

Adult↗
PubMed2000

Intra-operative tracking of the trunk during surgical correction of scoliosis: a feasibility study.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of a technique for intra-operative tracking of the trunk during scoliosis surgery. MATERIALS AND METHODS: Eleven magnetic sensors placed on specific anatomical landmarks are used to compute 11 geometric indices of the trunk. This technique was assessed on a cohort of 40 subjects (19 normal, 21 scoliotic) using an experimental set-up simulating the position of patients during scoliosis surgery. RESULTS: The indices varied less than 2 mm and 1 degrees when breathing (except for chest AP diameter), and less than 1 mm and 1 degrees after transient displacement from the initial positioning of the subjects. No significant changes were observed for most of the indices between two acquisition sessions. Comparison between normal and scoliotic subjects demonstrated that the trunk geometry is more influenced by the positioning of each subject on the operating table than by the magnitude of the spinal deformity. CONCLUSION: The proposed technique will allow intra-operative tracking of the trunk and enable the surgeon to optimize the correction of both spinal and trunk deformities. The technique can also be used to evaluate the adequacy of patient positioning on the operating table, and to obtain a complete follow-up of patients in pre-, intra-, and post-surgical conditions.

Adolescent↗
PubMed1993

[Influence of posture changes on hemodynamics under fentanyl-diazepam anesthesia--effects of nitrous oxide].

Patients for myocardial revascularization were divided into 50% oxygen-50% nitrogen group (group A) and 50% oxygen-50% nitrous oxide group (group B) according to the kind of gas administered after the induction of anesthesia. Anesthetic induction was carried out with fentanyl and diazepam in both groups. With sufficient hemodynamic stabilization following the induction of anesthesia, the hemodynamic parameters were measured in supine position for baseline data (BASELINE). The operating table was kept at Trendelenburg position (TREND), i.e., head down position, to measure hemodynamic parameters. Next, the operating table was kept at Fowler position (FOW), i.e., head up position, and hemodynamic parameters were measured. Heart rate was little influenced by posture change in both groups. While mean arterial pressure, mean pulmonary arterial pressure, central venous pressure and pulmonary capillary wedge pressure increased significantly in TREND in both groups, and decreased significantly in FOW. Cardiac index increased significantly in TREND in group A, but no such change occurred in group B. In FOW, cardiac index showed no significant change in group A, but decreased significantly in group B. Systemic vascular resistance was little influenced by posture change in both groups. This study suggests that it is necessary to exert a great caution in administering nitrous oxide when posture change is needed under fentanyl-diazepam anesthesia.

Anesthesia↗
PubMed2005

Pillow case.

An 80-year-old man with severe kyphosis and visually significant cataracts in both eyes came to us for care. He had been scheduled for cataract surgery elsewhere, but his surgery was cancelled in the operating room when he could not be positioned adequately beneath the operating microscope. As he sat in a chair in our examining room, he was only able to elevate his head to a position 30 degrees below the horizontal. His cataract surgery was performed safely and effectively by padding the operating table with 14 pillows. Eleven pillows were placed under his buttocks and legs and 3 pillows beneath his head and neck. The operating table was also positioned in maximum reverse Trendelenburg to obtain a good red reflex.

Aged, 80 and over↗
PubMed1980

Lengthened intraaortic balloon tubing for intraoperative use.

The intraaortic balloon pump (IABP) is being used with increasing frequency during surgical procedures. The standard length of balloon tubing requires the IABP console to be close to the operating table. This creates a possibility of contamination. A longer balloon tubing is described that permits an increased distance between console and operating table without decreasing effective augmentation.

Assisted Circulation↗
PubMed2002

Gluteal compartment syndrome following posterior cruciate ligament repair.

Compartment syndrome is a rare but important complication which may occur following injury or surgery to the lower limb. We present a case of contralateral gluteal compartment syndrome following arthroscopic posterior cruciate ligament repair. In order to gain a greater understanding of this complication, we undertook a limited study to investigate the effect of patient position on gluteal compartment pressures. Three volunteers were positioned in such a way as to recreate the intra-operative position of the patient described. Gluteal compartment pressures were calculated by placing weighing scales under each buttock and measuring the surface area over which the weight was distributed.Mean pressures exerted on the gluteal compartment of the non-operated leg were significantly higher (mean=44 mmHg) than those of the operated leg (mean=24 mmHg). The difference was significant with P<0.001. This limited study has shown that care should be taken when positioning patients on an operating table to reduce the risk of compartment syndrome. Factors that should be taken into account include mean diastolic pressure, length of operation and the surface area in contact with the operating table.

Adult↗
PubMed1995

[Comparison of perforated metal ceiling systems (supported airflow ceilings) with laminar airflow ceilings in type A (DIN 1946 T.4) operating rooms under surgical conditions].

In eleven centrally ventilated operating theatres the concentration of particles and airborne germs in wound vicinity was measured on three workdays. Five theatres were equipped with air supply ceilings with supporting flow outlets (supporting flow ceilings), five with laminar air flow ceilings and one with an air supply ceiling, a body exhaust system and a partition wall between the anesthetic and operating areas. Under routine conditions the air supply of the laminar air flow ceiling with its lower turbulence shielded the operating field from the largely staff-related air contamination in the rest of the theatre better than in the case of the supporting flow ceilings. Particles and airborne germs were removed from the endangered wound area faster. A spatial separation between the anesthetic and the operating areas as well as a body exhaust system lead to a considerable reduction of the contamination. Two theatres were conspicuous by reason of their considerably raised values due to defective control engineering and the wrongly positioning of the operating table. From the point of view of ventilation technique the laminar air flow ceilings with lower turbulence are superior to air supply ceilings with supporting flow outlets in the working day of an operating theatre. In order to minimize the influence of the staff, which up till now has been neglected in testing specifications, constructional possibilities such as the size of ceiling, the partitioning off of operating and anaesthetic areas and the positioning of the operating table in relation to the incoming air should be coordinated rationally. Taking measurements regularly during operations can provide the impulse for considerable improvements in both operational and planning phases.

Air Microbiology↗
PubMed1997

[Labor status of anesthesia in general hospitals in Japan Committee on Human Resources, the Japan Society of Anesthesiology].

AIMS: Investigating the labor by anesthetists in general hospitals with more than 600 beds during the month of September 1995. METHOD: Using MS/EXCEL spread sheet soft wear, we have analyzed daily OR anesthesia activities in 33 hospitals based on personal attendance of anesthesiologists. We defined anesthesia performing hours i.e. actual working hours as the time between the onset and the end of anesthesia for each anesthetist. RESULTS: An average number of monthly anesthesia cases was 961 in the first 10 hospitals we surveyed. We obtained two frequency graphs on weekly 5-day working 138 anesthetists whose anesthesia performed, and their occupied hours were as shown in fig. 1 and 2. for those who worked other less than 5 days per week, they showed the shorter hours on the frequency distribution graph as shown in fig. 3 to 7. The 5-day working anesthetists have spent more than 5 hours giving anesthesia in the 93.2% of all anesthesia times in the first 10 hospitals, while 28.1% of the times in the last 10 hospitals. There were an average of 11.6 operating tables, in the first 10 hospitals. And we have analyzed ratios of the number of 5 day working persons to the number of operating tables. The ratio was 0.86 in the first 10 hospitals, while 0.21 in the last 10 hospitals. CONCLUSIONS: There must be overwork of 5-day working anesthetists, who are working for too many hours for anesthesia. It is necessary to have better quality service in the OR.

Anesthesia↗
PubMed2001

[Virtual reality in ophthalmological education].

We present a computer-based medical training workstation for the simulation of intraocular eye surgery. The surgeon manipulates two original instruments inside a mechanical model of the eye. The instrument positions are tracked by CCD cameras and monitored by a PC which renders the scenery using a computer-graphic model of the eye and the instruments. The simulator incorporates a model of the operation table, a mechanical eye, three CCD cameras for the position tracking, the stereo display, and a computer. The three cameras are mounted under the operation table from where they can observe the interior of the mechanical eye. Using small markers the cameras recognize the instruments and the eye. Their position and orientation in space is determined by stereoscopic back projection. The simulation runs with more than 20 frames per second and provides a realistic impression of the surgery. It includes the cold light source which can be moved inside the eye and the shadow of the instruments on the retina which is important for navigational purposes.

Computer Graphics↗
PubMed1993

Intraoperative localization using an armless, frameless stereotactic wand. Technical note.

A technique of "frameless" stereotaxy that allows real-time intraoperative neurosurgical localization is described. The system is composed of four components: a hand-held probe containing two ultrasonic emitters, a microphone array that is rigidly affixed to the operating table in proximity to the surgical field, hardware to control and detect timing of signal production and reception, and a color graphics computer workstation with software to calculate and present the location of the probe tip on reconstructed neuroimaging studies. Unlike previously reported mechanical or sonic navigational devices, this system is adaptable to a wide array of neurosurgical instruments, allows free movement of the operating table and conventional patient draping, and has accuracy in the hostile operating room environment that rivals that of frame stereotaxy. In the operating room environment, using four pulse pairs with the wand positioned optimally, reproducibility of a point in space is +/- 0.6 mm. The wand has a broad range of orientations that maintain error at or below 1.0 mm. The mean error when measuring distances within a 1000-cu cm cube is 1.1 +/- 1.0 mm (1.0% +/- 0.7%). The ability to localize a fourth point (a target) in space is typically within 1.5 mm (using computerized tomography scans with a 1-mm slice thickness) but is dependent on several variables. This technology provides a powerful yet flexible tool in the neurosurgical operating room.

Brain↗
PubMed1991

The prone position for the surgical patient: a historical review of the principles and hazards.

Since the 1940s there has been an increase in the number of patients submitted for surgery of the spinal axis necessitating use of the prone position. Specifically designed operating tables were both rare and expensive, and probably only existed in a few highly specialized centres. Apparatus which could be easily made locally and used in conjunction with normal operating tables has been invented and generally used to good effect. The important historical landmarks in these developments are traced and a review of the methods and hazards is presented. Similar methods evolved almost simultaneously in differing centres. It is recommended that the Tarlov "seated prone" position should be widely used, in view of its physiological advantages and lack of adverse reports.

History, 20th Century↗
PubMed2004

"On table" positioning for optimal access for cancer excision in the lower rectum.

Poor visualization and restricted access often make tumor lesions in the lower rectum difficult to excise, particularly in a narrow male pelvis. The aim of this study was therefore to study whether (and if so to what extent) different positions of the patient on the operating table might improve accessibility. Twenty consecutive patients (men and women) undergoing laparotomy with surgery of the lower rectum were studied. The geometric configuration of the pelvis was studied and compared on lateral radiographs obtained at the operating table in each of four positions. Compared with the conventional lithotomy position, "the thighs-flat" position caused significant extension movement of the lumbosacral joint. Augmentation of the lumbar lordosis widened the pelvic view and enabled a more vertical view of the lower rectum (27.5 degrees in lithotomy position, 13.0 degrees in the thighs-flat position). Insertion of a "lumbar pad" contributed further to the augmentation (7 degrees). When compared on radiographic studies, the thighs-flat position is preferable to the conventional lithotomy position in terms of facilitating low rectal surgery by improving both visibility and accessibility to the pelvic cavity.

Adult↗
PubMed1983

The use of operative prebypass arteriography and Doppler ultrasound recordings to select patients for extended femoro-distal bypass.

Of 113 preoperative arteriograms analyzed, 46 (40%) were unsatisfactory to determine operability for femoral-distal bypass. In 23 of these 46 arteriograms, there was complete nonvisualization of calf vessels (Group A) and in the remaining 23, there was limited visualization (Group B). Both prebypass, on-table operative arteriography and Doppler ultrasound recordings were helpful in predicting the best available artery for bypass in all but one patient (4%) in Group A. In Group B, 7 of 23 patients had the site of distal anastomosis altered after prebypass, ontable arteriography. There was no statistical difference in the patency rates of grafts in patients with inadequate visualization (Groups A and B) and those with adequate visualization (67 patients, Group C). Prebypass, on-table operative arteriography, supplemented by preoperative Doppler ultrasound recordings, helps to extend operability and to avoid unnecessary amputation.

Angiography↗