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At least 325 records · Page 18Linked to original sources
PubMed2003

Changes in nerve root motion and intraradicular blood flow during an intraoperative straight-leg-raising test.

STUDY DESIGN: An intraoperative straight-leg-raising (SLR) test was conducted to investigate patients with lumbar disc herniation to observe the changes in intraradicular blood flow, which then were compared with the clinical features. OBJECTIVE: The legs of each patient were hung down from the operating table as a reverse SLR test during surgery, and intraradicular blood flow was measured. SUMMARY OF BACKGROUND DATA: It is not known whether intraradicular blood flow changes during the SLR test in patients with lumbar disc herniation. METHODS: The subjects were 12 patients with lumbar disc herniation who underwent microdiscectomy. The patients were asked to adopt the prone position immediately before surgery, so that their legs hung down from the operating table. A reverse SLR test was performed to confirm the angle at which sciatica developed. During the operation, the nerve roots affected by the hernia were observed under a microscope. Then the needle sensor of a laser Doppler flow meter was inserted into each nerve root immediately above the hernia. The patient's legs were allowed to hang down to the angle at which sciatica had occurred, and the change in intraradicular blood flow was measured. After removal of the hernia, a similar procedure was repeated, and intraradicular blood flow was measured again. RESULTS: Intraoperative microscopy showed that the hernia was adherent to the dura mater of the nerve roots in all patients. The intraoperative reverse SLR test showed that the hernia compressed the nerve roots, and that there was marked disturbance of gliding, which was reduced to only a few millimeters. During the test, intraradicular blood flow showed a sharp decrease at the angle that produced sciatica, which lasted for 1 minute. Intraradicular flow decreased by 40% to 98% (average, 70.6% +/- 20.5%) in the L5 nerve root, and by 41% to 96% (average, 72.0% +/- 22.9%) in the S1 nerve roots relative to the blood flow before the test. At 1 minute after completion of the test, intraradicular blood flow returned to the value obtained at baseline. After removal of the hernia, all thepatients showed smooth gliding of the nerve roots during the second intraoperative test, and there was no marked decrease in intraradicular blood flow. CONCLUSIONS: This study demonstrated that the blood flow in the nerve root is reduced when the nerve root is compressed in vivo.

Adult↗
PubMed2001

Computer-aided 3-D simulation and prediction of craniofacial surgery: a new approach.

Background: In plastic and reconstructive craniofacial surgery, careful preoperative planning is essential. In complex cases of craniofacial synostosis, rapid prototyping models are used to simulate the surgery and reduce operating time. Recently, 3-D CT model surgery has been introduced for presurgical planning and prediction of the postoperative result. Objective: For simulation of craniofacial surgery a computer-based system was developed that allows visualization and manipulation of CT-data using computer graphics techniques. Surgical procedures in all areas of the bony skull can be performed interactively. Results: The case of a child with scaphocephalus is presented. Surgery is planned using the craniofacial surgery simulator described above. Conclusion: The computer-based interactive surgery simulation systems presented here allow precise visualization of craniofacial surgery. The accurate computer-aided 3-D simulation of bone displacements is also the prerequisite for transfer of the simulated surgery using a navigation system for surgery. Thus the preoperatively planned procedure could be transferred directly to the operating table. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed1978

General anaesthesia for periodontal surgery.

A technique is described in which full-mouth periodontal surgery is carried out under general anaesthesia. The use of an endotracheal tube with inflatable cuff allows good visibility and access to all parts of the mouth unhampered by a throat pack; access is further improved by sloping the operating table foot-down. A system of haemorrhage control is used involving a combination of procedures: smooth anaesthetic induction and controlled carbon dioxide levels; intravenous injection of a fibrinolytic inhibitor (epsilon amino-caproic acid); foot-down tilt to the operating table and infiltration with local analgesic solution. The advantages and disadvantages of the technique are discussed.

Anesthesia, Dental↗
PubMed1994

Walk-in, walk-out day case genito-scrotal surgery with sedation reversal. A survey of patient attitudes and morbidity.

OBJECTIVES: To survey patient attitudes and assess the extent of patient morbidity in the first 24 h following walk-in, walk-out day case genito-scrotal surgery with sedation reversal. PATIENTS AND METHODS: One hundred patients who were undergoing genito-scrotal surgery were eligible for inclusion in the study. All patients walked into theatre, positioned themselves on the operating table and were sedated with intravenous (i.v.) midazolam (Hypnovel, Roche Products Ltd, Welwyn, UK) following which the appropriate local anaesthetic block was performed. One minute before the end of surgery sedation was reversed with an i.v. injection of 0.5 mg flumazenil (Anexate, Roche Products Ltd). When conscious and alert (approx. 2 min), patients were allowed to get themselves up off the operating table and walk from theatre. All patients were given a questionnaire to complete and were reviewed 2 weeks after surgery. RESULTS: Eighty-six of 100 patients returned questionnaires. Fifty-five patients were asymptomatic and no patient experienced nausea or vomiting in the first 24 h post-operatively. Other symptoms such as headache (2%), drowsiness (20%) and dizziness (11%) were uncommon and significantly less frequent than seen with general anaesthetic procedures. Seventeen patients described minor wound complications and one patient with a scrotal haematoma was readmitted for overnight observation. Nearly all patients (98%) expressed their satisfaction with the technique. CONCLUSION: Walk-in, walk-out day case surgery as described is a well-tolerated technique with a low morbidity and towards which patients have a positive attitude.

Adolescent↗
PubMed2004

Premedications and peribulbar analgesia--a prospective audit.

PURPOSE: After peribulbar block analgesia (PBA) instituted in the preoperative anesthetic room, patients are often anxious, developing increased heart rate (HR) and blood pressure (BP) upon their arrival to the operating room and during subsequent surgery. The efficacy of premedication in attenuating these stress responses has not been examined. A prospective audit was undertaken to examine the relationship between the premedication schedules most commonly prescribed at the King Khaled Eye Specialist Hospital and increases in HR and BP during surgery in response to the stress of surgery, and the requirements for intravenous (IV) benzodiazepine, opioid or NSAID medication to treat these increases, or any complaint of pain or positional discomfort on the operating table, respectively. METHODS: The preoperative and intraoperative anesthesia course of 1,064 patients > or = 50 years of age who underwent ocular surgery under PBA was prospectively examined. The following data were recorded: (i) patient characteristics, state of health or disease, medications and premedications; (ii) heart rate (HR), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) at 0600 hrs before surgery (baseline), on admission to the operating room, maximum and minimum values of HR, SAP and DAP recorded at the start of, and during, surgery; and (iii) all instances of benzodiazepine, opioid or NSAID drug administration during surgery, according to standard protocols. RESULTS: Five premedication schedules were identified: Group 1 hydroxyzine po alone (n = 302); Group 2 hydroxyzine, paracetamol with codeine (Revacod), diclofenac po (N = 173); Group 3 hydroxyzine, diclofenac, ranitidine po (N = 94); Group 4 hydroxyzine, cimetidine or ranitidine po, morphine or pethidine IM (N = 340); and Group 5 lorazepam (nocte), hydroxyzine, diclofenac, ranitidinepo, morphine or meperidine IM (N = 155). The five groups of patients were comparable for age, sex, weight and health. Healthy, diseased (with concurrent hypertension, diabetes, ischemic heart disease) and all patients in each premedication group had similar baseline HR, SAP and DAP. In the operating room, the maximum and minimum mean HR in each group was similar, except that more patients in Group 1 developed SAP exceeding 160 mmHg and DAP exceeding 90 mmHg than in Group 5 (p<0.002 and <0.0005, respectively). The requirements for medication at the commencement of, and during, surgery in the five groups to treat increases in HR/BP, eye pain and positional discomfort on the operating table were similar. CONCLUSION: Each of the five premedication schedules described appear to confer similar effects on cardiovascular changes in anticipation of, and during, surgery, except that those given the lightest premedication, Group 1, showed greater increases in BP at the start of surgery than did those given the heaviest premedication, Group 5. The requirements in the operating room for IV medication were similar in the five premedication groups, and no greater benefit was discernible for any one of the five premedication schedules on the objective features assessed. These data suggest that simple oral premedication of hydroxyzine, with or without an H2 receptor antagonist and NSAID, may suffice as premedication in middle-aged to elderly patients undergoing anterior segment surgery.

Analgesia↗
PubMed1993

[CT guided transsphenoidal surgery: report of nine cases].

We have developed a Computed Tomography system for use in the operating room and applied this CT system to intraoperative monitoring during transsphenoidal surgery. This system includes Toshiba TCT-300 CT system, mobile CT scanner gantry, digitally controlled operating table and head fixation system. Between June 1989 and Dec. 1989, CT guided transsphenoidal surgery was carried out in 9 cases in our department. The suprasellar masses were visualized directly during transphenoidal surgery and were removed safely and efficiently. Under this CT monitoring system the surgeon can obtain accurate information about the location and volume of residual tumor as well as about the important surrounding deeper structure. Another advantage of this system is that the digitally controlled operating table makes it possible to keep the patient in a head-up position, which lessens oozing from the parasellar region during transsphenoidal surgery. We believe the best application of this method is that for pituitary tumor with moderate suprasellar extension. Nine cases were reported in this paper which were operated on using this system. To our knowledge, this is the first report of use of intraoperative CT monitoring during transsphenoidal surgery.

Adenoma↗
PubMed1993

Absorption of irrigating fluid and height of fluid bag during transurethral resection of the prostate.

The purpose of this study was to examine the relationship between the static pressure and the absorption of irrigating fluid during transurethral resection of the prostate. We measured the absorption by the ethanol method in 550 operations during which the fluid bags were placed randomly at distances of 60-65, 70-75, 80-85 or 90-100 cm above the operating table. There was no difference in the volume of irrigant absorbed at different bag heights or any association between fluid height and absorption when different ranges of fluid absorption were analyzed. This suggests that irrigant absorption cannot be prevented by placing the fluid bags at a certain height within the range of 60 to 100 cm above the operating table.

Absorption↗
PubMed1996

Large-sized bladders reduce intravesical pressure and fluid absorption during TURP using the suprapubic trocar.

We studied whether the height of the irrigating fluid bags above the operating table and the capacity of the bladder influence intravesical pressure and fluid absorption during transurethral resection of the prostate (TURP) when evacuation is performed with Reuter's trocar. For this purpose, the intravesical pressure was recorded continuously, and the fluid absorption was measured by the ethanol method during 30 TURP procedures. The bags were placed between 60 and 95 cm above the operating table, and the bladder capacity was measured before surgery started. The results show that the bladder capacity, but not the bag height, correlated with the intravesical pressure and the fluid absorption. Large-sized bladders were associated with lower pressures and smaller absorption. Rapid absorption (>30 ml/min) occurred at a maximum pressure of 2-3 kPa and a mean pressure of between 1 and 2 kPa. In conclusion, the size of the bladder is important to the intravesical pressure and to the fluid absorption during TURP when using the suprapubic trocar.

Absorption↗
PubMed1990

Factors that contribute to pressure sores in surgical patients.

In this prospective study examination was made of whether (a) time on the operating table, (b) proportion of intraoperative diastolic hypotensive episodes, (c) age, (d) preoperative serum albumin, (e) preoperative total protein levels, and (f) preoperative Braden scores could identify those patients who do and do not develop pressure sores during elective surgery. The stratified sample consisted of 125 adult patients. Fifteen patients (12%) developed a total of 23 pressure sores. A discriminant function using time on the operating table, extracorporeal circulation, and age emerged as the best predictor correctly classifying 12 of 15 patients who developed pressure sores and 83 of 110 patients who remained pressure sore free.

Adult↗
PubMed1987

New kneeling attachment and cushioned face rest for spinal surgery.

Surgical frames, kneeling attachments, and special operating tables for lumbar spinal surgery are designed to promote good positioning, lower the intraabdominal pressure, and reduce epidural bleeding. The frame reported here fulfills these objectives and produces either lumbar spinal extension to reduce paraspinal muscle tension or mild flexion to distract the neural arches. The new frame unit is made of lightweight fiberglass and aluminum, weighing only 14 lb (6.5 kg), and utilizes the hydraulic elevator pump of the operating table as a means to raise or lower the frame. Thus, adjusting the horizontal plane of the lumbar spine requires no separate crank system. The anterior tibial cushions, lying in hemicylindrical troughs, and the ergonomically designed cushions for chest and buttocks improve the distribution of body weight. A new, fully adjustable, cushioned face rest is used to maintain the neck in a neutral position, with the patient placed fully face-down.

Humans↗
PubMed1990

[Mitral valve prosthesis with preservation of the chordae and papillary muscles in patients with mitral insufficiency].

Mitral valve (MV) prosthetics was performed in 14 patients in its insufficiency. In MV replacement the chordopapillary apparatus (CPA) of the posterior cusp was left intact. The EMIKS or LIKS disk prosthesis was implanted in most cases (6 and 6 patients, respectively), the biological BAKS prosthesis was implanted in 2 patient. Orientation of the large semicircumference in the direction of the anterior or posterior commissure was the optimal orientation for the disk prostheses. Measurement of the parameters of hemodynamics on the operating table showed that reduction of the rigidity of the left-ventricular myocardium and the increase of the stroke index in patients with an intact chordopapillary apparatus of the posterior cusp differed significantly from those in patients with completely excised MV. Preservation of the CPA during MV replacement in patients with mitral insufficiency leads to reduction of the rigidity of the left-ventricular myocardium and improvement of its function immediately on the operating table.

Adolescent↗
PubMed2005

Strabismus surgery under augmented topical anesthesia.

PURPOSE: Recently, topical lidocaine 2% jelly had been used in phacoemulsification and trabeculectomy surgeries. The purpose of this study is to evaluate the efficacy and stability of one-stage adjustable suture using topical lidocaine jelly 2% in combination with intravenous nalbuphine (Nubain). METHODS: Forty adult patients aged 16 to 46 years (median, 24 years) underwent adjustable rectus muscle surgery under topical lidocaine jelly 2% and intravenous 10 mg nalbuphine given 10 minutes before surgery. Adjustment was performed on the operating table before conjunctival closure. The stability of adjustment was studied by comparing the postadjustment deviation to that at 1 day, 1 week, and 3 weeks postoperatively. Success was defined as alignment within 10 prism diopters on distant fixation. Analgesia was assessed using Verbal Description Scale. Changes in vital signs were recorded during surgery to evaluate the oculocardiac reflex. RESULTS: Forty rectus muscles were recessed, 22 muscles were resected, 3 muscles were tucked, and 2 muscles were retrieved. During the operation, 35 patients expressed no pain, 3 patients complained of discomfort, and 2 patients complained of distressing pain and required an additional 10 mg of intravenous nalbuphine. Thirty-eight patients (95%) were successfully aligned during the first postoperative day, 37 patients (92.5%) after 1 week, and 36 patients (90%) after 3 weeks. Intraoperative cardiac monitoring did not record positive oculocardiac reflex in any patient. CONCLUSION: Lidocaine jelly in combination with intravenous nalbuphine is an effective topical anesthesia strategy that provides for the patient's comfort and the surgeon's ability to fine-tune ocular alignment on the operating table.

Adolescent↗
PubMed2003

Stereoscopic navigation-controlled display of preoperative MRI and intraoperative 3D ultrasound in planning and guidance of neurosurgery: new technology for minimally invasive image-guided surgery approaches.

OBJECTIVE: This paper demonstrates a method that brings together three essential technologies for surgery planning and guidance: neuronavigation systems, 3D visualization techniques and intraoperative 3D imaging technologies. We demonstrate the practical use of an in-house interactive stereoscopic visualization module that is integrated with a 3D ultrasound based neuronavigation system. MATERIALS AND METHODS: A stereoscopy volume visualization module has been integrated with a 3D ultrasound based neuronavigation system, which also can read preoperative MR and CT data. The various stereoscopic display modalities, such as "cut plane visualization" and "interactive stereoscopic tool guidance" are controlled by a pointer, a surgical tool or an ultrasound probe. Interactive stereoscopy was tested in clinical feasibility case studies for planning and guidance of surgery procedures. RESULTS: By orientating the stereoscopic projections in accordance to the position of the patient on the operating table, it is easier to interpret complex 3D anatomy and to directly take advantage of this 3D information for planning and surgical guidance. In the clinical case studies, we experienced that the probe-controlled cut plane visualization was promising during tumor resection. By combining 2D and 3D display, interpretation of both detailed and geometric information may be achieved simultaneously. The possibilities of interactively guiding tools in a stereoscopic scene seemed to be a promising functionality for use during vascular surgery, due to specific location of certain vessels. CONCLUSION: Interactive stereoscopic visualization improves perception and enhances the ability to understand complex 3D anatomy. The practical benefit of 3D display is increased considerably when integrated with surgical navigation systems, since the orientation of the stereoscopic projection corresponds to the orientation of the patient on the operating table. Stereoscopic visualizations work well on MR and CT images, although volume rendering techniques are especially suitable for intraoperative 3D ultrasound image data.

Brain Neoplasms↗
PubMed2001

Routine cystoscopy before radical prostatectomy: is it justified?

OBJECTIVES: The extent of the required preoperative workup of patients who are candidates for radical prostatectomy is still controversial. Traditionally, cystoscopy has been reserved only for those patients who present with hematuria. However, several investigators have reported significant incidental cystoscopic findings among these patients and advocated the routine use of cystoscopy before radical prostatectomy. In view of the conflicting recommendations, we elected to assess the role of routine cystoscopy in a series of patients with prostate cancer at our institute. METHODS: We retrospectively reviewed the cystoscopic findings of 225 consecutive patients with organ-confined prostate carcinoma scheduled for radical prostatectomy. Rigid cystoscopy was performed before surgery either in an outpatient setting or on the operating table just before the operation. RESULTS: Significant cystoscopic findings were noted in 3 (1.3%) of 225 patients. These included a bladder stone in 1 patient, superficial bladder tumor in 1 patient, and a post-sphincteric urethral polyp containing prostatic adenocarcinoma in a third patient. This polyp was resected transurethrally and the patient was treated thereafter with irradiation because of local extension. None of the 3 patients had microscopic hematuria on urinalysis to suggest the findings. Cystoscopy was uneventful in all patients, apart from occasional mild hematuria. CONCLUSIONS: These results show that the treatment of patients who were candidates for radical prostatectomy was affected by the findings of preoperative cystoscopy in less than 1% of the cases. We believe that in view of the low yield of cystoscopic findings in these patients, in an era in which cost effectiveness is a major issue, the routine use of cystoscopy before radical prostatectomy is not justified.

Adenocarcinoma↗
PubMed1993

Neurosurgeon as innovator: William V. Cone (1897-1959).

Neurosurgeons are well known for being productive researchers and innovators. Few, however, have possessed the prolific ingenuity of William Cone. In 1934, he and William Penfield were cofounders of the Montreal Neurological Institute where, until 1959, he filled the twin roles of neurosurgeon-in-chief and neuropathologist. Because he did not find writing easy, many of his technical inventions and refinements remained unpublished. His numerous innovations included the extensive use of twist-drill technique for biopsy, drainage for subdural hematoma and cerebral abscess, and ventriculography. In the mid-1940's, he developed power tools driven by nitrogen that led to the modern, universally used air-driven tool systems. He had a special interest in the treatment of spinal dysfunction, for which he invented the Cone-Barton skull-traction tongs along with the Cone spinal operating table. He also devised operative procedures for vertebral fracture-dislocation and craniospinal anomalies. For the maintenance of muscle tone in the paralyzed bladder, he constructed a tidal drainage system. He introduced and popularized ventriculoperitoneal shunting techniques and carried out some of the earliest experimental trails to treat brain infections with sulphonamide and antibiotic drugs. He designed his own set of surgical suction devices, bone rongeurs, and a personal suction "air-conditioning" system for each surgeon. He had a keen early interest in intracranial tumors, and also demonstrated on monkeys how subdural mass lesions caused pupillary dilation and mesial temporal lobe damage due to cerebral compression. His work for the military during World War II on effects of altitude on brain pressure remained classified for many years. The first clipping and excision of an intracranial aneurysm is attributed to Cone. Although Penfield was known as "the Chief," Cone was referred to as "the Boss." His fervent dedication to provide total care to his patients was expressed in round-the-clock vigils; he did not separate "nursing" from "surgical" care. Ultimately, Cone's driving passion for perfection led in part to his tragic death. His accomplishments, inventions, and his example as teacher and physician have become part of neurosurgery's collective legacy.

Canada↗
PubMed1993

Modular insert for use on a standard operating room table for performing shoulder surgery in the sitting position.

The use of the sitting position for performing shoulder surgery is not a new concept. However, a standard surgical table cannot be readily converted for shoulder surgery without extensive and expensive modifications. A modular insert is described that is inexpensive and can easily be built for use in converting, in less than one minute, a standard surgical table into a table for performing shoulder surgery.

Equipment Design↗
PubMed2001

[Hjalmar Maag: a Danish pioneer].

In the year 1900 a young man was on the operating table for a minor operation at the hospital in the small provincial town of Naestved. He was anaesthetized with Chloroform. After 15 minutes his pulse and respiration suddenly failed. All the usual methods of resuscitation were tried, but to no avail. Afterwards a tracheostomy and an inflation with air through the cannula were performed, also without success. The surgeon then decided to open thorax and perform direct internal heat massage. The heart was reactivated and went on working for 8 hours. Dr. Maag did not succeed in saving his patient's life, but he is rightly considered to be the first person to have revived a heart that had completely ceased to work.

Denmark↗