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At least 469 records · Page 26Linked to original sources
PubMed2000

Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results.

This study reports the collective effect of the positions of the operating table, head, and neck on intracranial pressure (ICP) of 15 adult patients scheduled for elective intracerebral surgery. Patients were anesthetized with propofol, fentanyl, and maintained with a propofol infusion and fentanyl. Intracranial pressure was recorded following 20 minutes of stabilization after induction at different table positions (neutral, 30 degrees head up, 30 degrees head down) with the patient's neck either 1) straight in the axis of the body, 2) flexed, or 3) extended, and in the five following head positions: a) head straight, b) head angled at 45 degrees to the right, c) head angled at 45 degrees to the left, d) head rotated to the right, or e) head rotated the left. For ethical reasons, only patients with ICP < or = 20 mm Hg were included. Intracranial pressure increased every time the head was in a nonneutral position. The most important and statistically significant increases in ICP were recorded when the table was in a 30 degree Trendelenburg position with the head straight or rotated to the right or left, or every time the head was flexed and rotated to the right or left-whatever the position of the table was. These observations suggest that patients with known compromised cerebral compliance would benefit from monitoring ICP during positioning, if the use of a lumbar drainage is planed to improve venous return, cerebral blood volume, ICP, and overall operating conditions.

Adult↗
PubMed1978

Concentration elimination of anaesthetic gases in operating theratres. Influence of anaesthesia apparatus leakages.

Halothane and nitrous oxide (N2O) concentrations were measured in operating theatres, in the areas corresponding to theinhalation zones of the anaesthetists and operating nurses. The measurements were performed in an operating theatre with a non-recirculating air exchange rate of 20/h. This was performed partly in model experiments and partly during the administration of anaesthesia by intubation. In the model experiments. the measurements were taken both with and without a specially constructed scavenging system. During anaesthesia, the measurements were taken exclusively with the scavenging system, although well-defined leakages were fitted into the otherwise gas-tight anaesthetic system. The results were supplemented by smoke experiments which showed the air distribution patterns. The investigation showed that the gases were concentrated over and around the operating table. Activities during surgery diluted this concentration. Furthermore, it was shown that leakage in the anaesthetic system significantly influences the achieving of a low gas-air mixture. Halothane concentrations in the inhalation zone of the anaesthetist and operating nurse can be reduced to 0.02 and 0.01 p.p.m. respectively, if the anaesthetic system is completely gas-tight.

Air Pollutants↗
PubMedDate not supplied

The new imaging-based classification for describing the location of lymph nodes in the neck with particular regard to cervical lymph nodes in relation to cancer of the larynx.

For over five decades, the principle landmarks used in cervical nodal classification were clinical and defined either by palpation or found at the operative table. However during the past two decades, sectional imaging has consistently improved its quality and resolution and it has been shown that imaging can identify deep structures and adenopathy not amenable to palpation. Such disease can alter planned operative or radiation fields. In the April 1999 issue of the Archives of Otolaryngology-Head Neck Surgery, for the first time an imaging-based classification was published that gave precise anatomic landmarks for use in classifying metastatic cervical adenopathy. This classification was developed in consultation with head and neck surgeons so that the nodal levels classified by this imaging-based system would correspond closely with the nodal levels determined by utilizing the most commonly employed clinically-based classifications. This article describes this imaging-based classification and demonstrates its use with axial diagrams.

Head and Neck Neoplasms↗
PubMed1987

IOL power determination by retinoscope.

IOL power prediction was performed by streak retinoscopy on the operating table after taking the previous refractive status of the patient into consideration. In 180 eyes posterior chamber lenses were implanted after determining the power of the IOL by retinoscopy on the table and selecting a suitable lens. The method though not so accurate as A scan ultra sonography and use of the SRK formula and the Colebrander formula is a good substitute to these methods particularly for avoiding high post operative refractive errors.

Eyeglasses↗
PubMed1977

[The post-cholecystectomy cystic-stump syndrome].

A study was made of five patients, all of female sex, suffering from cystic stump syndrome, occurring among a total of 726 operations on the biliary ducts performed from January 1959 to June 1975, and hence with the incidence of 0.7%. The diseases which brought the patients to the operating table consisted of two cases of long cystic stump, two cases of neuroma of the cystic stump, and one case of asymptomatic long cystic stump with the presence of a serous cyst of the head of the pancreas. The surgical operation always consisted in the removal of the long cystic stump or the neuroma and led to the patient's cure in each case. It is asserted that the cystic stump syndrome must be considered as a nosological entity in itself, affecting patients operated on the bile ducts with a by no means negligible frequency. After considering the various pathogenetic hypotheses covering this syndrome, the Authors finally conclude by reiterating the necessity of careful isolation of the cystic duct during a cholecystectomy operation and of its resection very close to the hepatocholedochus, and then to carry out reliable and effective prophylaxis of the often considerable disturbances which may threaten the results of the operation. Once the syndrome has established itself, however, removal of the cystic stump becomes essential to cure of these patients.

Acute Disease↗
PubMedDate not supplied

Surgical considerations of univentricular heart with total anomalous pulmonary venous connection.

Out of the 600 patients undergoing univentricular repair during the last 11 years, 20 children had associated total anomalous pulmonary venous connection. The objective was to outline the clues to establish the diagnosis of this rare disease combination and the various surgical options available to manage the same. Bidirectional Glenn, bilateral bidirectional Glenn, total cavopulmonary connection and atriopulmonary connection were performed in combination with rechannelling of various types of total anomalous pulmonary venous connection in 20 children aged 6 months to 36 months (mean +/- SD 17.65 +/- 9.02 months). Diagnosis could be established pre-operatively in only 13 (65%) patients. Out of 6 early deaths (30%), 4 were directly attributable to missed diagnosis. No late deaths occurred over a follow-up period ranging from 1 month to 132 months. None of the surviving children required reoperation and all are in NYHA functional class I. Doppler echocardiography of the surviving children revealed unrestricted atrio/cavopulmonary anastomosis and pulmonary vein to atrium connection in all survivors. Our own experience, coupled with a review of the literature, indicates that a missed diagnosis increases the hospital mortality. Cross sectional 2D echocardiography is a superior method of detection of associated total anomalous pulmonary venous connection compared to angiocardiography. Exclusion of the diagnosis of anomalous pulmonary venous connection is imperative in all univentricular hearts pre-operatively and on operation table. Failure to recognise this disease combination results in formation of a closed systemic circuit after bidirectional Glenn or a modified Fontan of connection and is lethal as happened in our early experience. It is suggested that one-stage Fontan operation should be performed only if other criteria for Fontan procedure are satisfied.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Trends in operating room devices.

Although trends in the use of operating room devices have generally followed advances in technology, the trends are not always influenced as much by surgical need as they are by industrial expediency and commercial promotion. Nonetheless, a broad view of trends in OR devices definitely points to efforts at greater compatibility between devices made by different manufacturers. To mention a few examples, operating tables are being made more compatible with OR X-ray equipment; surgical lighting is being designed for greater compatibility with air-handling systems and video equipment; power consoles have reduced the clutter of tubes, hoses, and wires in complicated operations, and have become more functional in keeping with the trend away from electrical power and toward nitrogen power for driving surgical tools; cabinetry is being designed to employ clean-air principles; and surgical apparel and barrier materials are undergoing close scrutiny for their effectiveness against moist bacterial strike-through in lengthy wet operations. Operating room devices form an important segment of the devices classified by the FDA, and are expected to benefit by the application of standards in performance and safety. This trend will affect not only the devices themselves, but all other facets of operating room design and engineering.

Humans↗
PubMed1976

[Caesarean section in sows anesthetized with Azaperone and Metomidate (author's transl)].

213 caesarean sections and 157 hysterectomies were carried out in gilts and sows with different body weight (table I). The neuroleptic Azaperone and the hypnotic Metomidate were used for anaesthesia with different administration (table II). Local analgesia and premedication with Atropine. The duration of the anaesthesia was 45 minutes and where prolongation was necessary, Metomidate, Azaperone or barbiturates were used alone or in combinations once or more. The indications (table III) for caesarean section were retarded birth in 70 sows, dislocation of uterus in 74 sows and in 69 sows by other indications. Hysterectomy was indicated by retarded birth in 93 sows, dislocations of uterus in 40 cases and in 24 cases by other indications. In 183 operations (table IV) 1006 living piglets were delivered, and 703 were alive at discharge (70%). The chances of survival depends on the composition of the litter, in litters of piglets alive only, 76% survived at discharge; in litters consisting of both alive and stillborn 69% survived and 59% survived in litters consisting of piglets alive and post mortem piglets. The total survival of the sows was 78%, 80% after caesarean section and 76% after hysterectomy. It is pointed out that most of the patients operated were in a very late phase of birth.

Anesthesia, Obstetrical↗
PubMed2004

Improved physical ergonomics of laparoscopic surgery.

One of the main and basic ergonomic problems associated with laparoscopy is the surgeon's non-neutral posture during laparoscopic procedures. There are five main issues that influence the posture of the surgeon: the (hand-held) instrument design, the position of the monitor, the use of foot pedals to control diathermy, the poorly adjusted operating table height, and the static body posture. This paper gives an overview of the ergonomic guidelines that have been developed in these five areas and shows product solutions that have been developed according to these guidelines. The guidelines can be used by operating room (OR) staff to evaluate the ergonomics of their OR environment and to improve issues that do not satisfy the ergonomic guidelines. When designers use these guidelines to design new OR equipment, the new designs are an improvement in the field of human factors compared to the currently used laparoscopic products. When all these products are applied in the laparoscopic operating room, a new and ergonomic environment is created for the surgeon as well as for the assistants.

Journal Article↗
PubMed1989

[A new positioning aid for administering axillary plexus anesthesia].

A "plexus-table" is introduced as a new help to place an arm for application of the axillary plexus block. A modified Maquet arm posturing device offers a sufficient big plate, which is adjustable in all planes. The plate is fixed closely to the operation table. A more comfortable placement of the patient's arm is possible, due to the reduction of the externally rotation of the shoulder. The new table can be adapted to patients with restrictions of the movements of the shoulder. For the anaesthetist this results in a good presentation of the axillary region.

Anesthesia, Conduction↗
PubMed1975

Renal trauma during laparotomy for intra-abdominal injury.

The advantages of nonsurgical or surgical management of renal injuries are important when the renal trauma is found during a laparotomy for intra-abdominal injury. Blunt external trauma caused 85.5 percent of the renal injuries found during laparotomy in 194 patients. A large dose or infusion intravenous pyelogram on a modified operating table has allowed immediate evaluation of the renal injury during a laparotomy. When the degree of renal injury was more severe, renal tissue and function were saved by early surgical management. In this group, lowered morbidity and a sharp reduction in delayed renal operations followed the introduction of immediate surgical management. The nephrectomy rate was 11 percent, which compares favorably with that of nonsurgical management. Clamping of the renal vessels prior to opening Gerota fascia prevented reactivation of hemorrhage and allowed for a deliberate operation with conservation of undamaged renal tissue.

Abdominal Injuries↗
PubMed2003

Laser-scan-based navigation in cranio-maxillofacial surgery.

BACKGROUND: In computer-assisted surgery, a correlation between a volume data set and the surgical site is required in order to localize the patient's head on the operating table. Registration markers are commonly used for this procedure. However, the marker registration is associated with high logistics, since the markers have to be placed prior to data set acquisition and have to be kept in their position until the patient enters the operating room. This study deals with a new markerless registration method in cranio-maxillofacial surgery that is based on a high-resolution laser-scan of the patient's (relaxed) skin surface. PATIENTS: 20 patients with tumours, bone malformations or foreign bodies, scheduled for computer-assisted surgery, were involved in the study. STUDY DESIGN: The clinically applied accuracy of the laser-scan-based registration was measured through additionally placed registration markers. The inherent precision of the laser-scan registration system was controlled in phantom studies. RESULTS: The clinically applied accuracy of the new laser-scan-based registration technique ranged between 0.2 and 1.8 mm with a mean deviation of 1.1mm and a standard deviation of 0.3 mm. CONCLUSION: The facial skin surface can serve as a sufficiently stable and invariable reference base in order to register patients for computer-assisted cranio-maxillofacial surgery.

Algorithms↗
PubMed1980

[Rehabilitation problems of patients who have undergone surgery for malignant tumors of the locomotor system].

The paper is concerned with definite trends in rehabilitation following such kind of operations as amputation of the lower extremities, exarticulation in the coxa, interiliac-abdominal exarticulation and interscapular-thoracic amputation for malignant tumors. The method of prosthetic replacement on the operating table after amputation of the lower extremities and early application of medico-physical therapy after exarticulation and interiliac-abdominal exarticulation shortens the time of stump formation, thus enabling patients to resume their socio-labour activities in early terms after the operation.

Adolescent↗
PubMedDate not supplied

[Stereotaxic destruction of the ventrolateral thalamic nucleus in combination with the transplantation of fetal and xenogeneic tissue in Parkinson's disease].

Four patients with Stage III-IV Parkinson's disease were operated on. Stereotactic cryodestruction of the ventrolateral nucleus was made, followed 10 minutes later by implantation of mixed fetal and xenogenic nerve tissue cells. The nerve cells-the fetal part-are obtained from human fetuses in the age range of 14-18 weeks of development. Tissues from the ventral portion of the midbrain and basal ganglia of the forebrain were used. Neurogenic layings of Notch Drosophila melanogaster mutants serve as a xenograft. The mixture of nerve cells were prepared in ratios of 1000:20 and 1000:12. The follow-up of the patients lasted a year. Relapses were absent. The effect occurred on the operating table (in the combination of nuclear destruction and nerve cell transplantation) and only 6 months later only during transplantation of nerve cells (without destruction). An attempt of transplanting the above fetal xenogenic mixture of nerve cells to patients previously undergone 2 ineffective stereotactic operations provided no significant clinical effect. The concurrent destruction of ventrolateral nuclei in combination with fetal xenogenic tissue grafting is considered to be promising.

Animals↗
PubMed2006

Hip arthroscopy without a perineal post: a safer technique for hip distraction.

Pudendal nerve palsy is a reported complication of hip arthroscopy. We report a technique using a deflated taped beanbag rather than a perineal post. The patient is placed in the supine or lateral position on a fracture table. The beanbag is contoured around the patient's flank and thorax. The distal aspect of the beanbag is placed no further than the iliac crest, and care is taken to avoid compression of the posterior aspect of the axillary region or the posterior humerus. The molded beanbag is deflated, a blanket is positioned over the abdomen and lower thorax, and with the use of 3-in-wide cloth tape, the patient and beanbag are secured to the operative table circumferentially. The superior margin of the deflated beanbag remains firm, preventing compression of the thorax and avoiding compromised ventilation. The arm on the operative side is placed across the chest and secured to avoid obstruction of the operative field. This patient positioning provides sufficient stability for adequate traction and good visualization while minimizing the risk of a pudendal nerve palsy.

Arthroscopy↗
PubMedDate not supplied

The telecommunication revolution in the medical field: present applications and future perspective.

In the present review, we analyze the achievements of telecommunication innovations in the medical field focusing on patient care and medical-education aspects. In this regard, the telecommunication revolution has offered medical professionals the possibility to transmit information of any sort zeroing transmission time latency and annihilating spatial distances. Although telemedicine is still in its infancy, multiple applications of this science have already been successfully tested. As an example, robotically mediated telesurgery has it made possible for surgeons to operate standing at a considerable distance from the operating table without even touching or directly seeing the surgical field. Moreover, medical education and medical consulting have acquired new and wider ranges of applicability thanks to the introduction of teleproctoring, telementoring, and teleconsulting. Finally, in the very near future, telepresence surgery will permit "virtual" operations on patients where surgeons can project their manual dexterity, psychomotor skills, and problem-solving ability to remote locations. In this context, telemedicine will support a more equal distribution of medical knowledge and promote excellence in patients' care even in the most disadvantaged environments.

Humans↗
PubMedDate not supplied

Intra-operative cardiac arrest--a tropical experience.

In order to determine the pattern of intra-operative cardiac arrests in a developing country, we reviewed 40 consecutives cases of cardiac arrests at the Jos University Teaching Hospital between January 1993 and December 1997. During this period 15,060 minor cases and 9800 medium/major surgical procedures were performed and an arrest rate of 1:15,060 for minor cases and 1:251 for medium/major cases were obtained. The age ranged between one day and 65 years with a mean of 29.8 years and a male/female ratio of 1:1.3 as there were 18 males and 22 females. Twenty-five (62.5%) arrests occurred outside work hours while fifteen (37.5%) cases arrested during work hours. The surgical procedures with high arrest rates in this study were: emergency laparotomy 8 (20%), emergency caesarian sections 7 (17.5%), thoracotomy 6(15%), emergency craniotomy 5(12.5%), emergency hysterectomy 4(10%) and therapeutic bronchoscopy for foreign bodies in the airway 4(10%). The arrests occurred in 30(75%) emergency procedures as opposed to 10(25%) elective cases. Only in 3 out of the 18, 318 day case procedures did the patients arrest. One patient arrested during local infiltration of lignocaine while the other 39(97.5%) arrested under general anaesthesia. There was no arrest with spinal anaesthesia. The predisposing factors for a patient to arrest on the operating table in our environment include emergency major surgery, poor risk patients with ASA 111 and above, surgery performed outside work hours, under general anaesthesia administered by nurse anaesthetists or junior anaesthetic residents. The success rate at resuscitation is highest with patients with ASA 1 & 11, operations performed during work hours and by senior surgeons and anaesthetists.

Adolescent↗
PubMed2003

Major digestive surgery using a remote-controlled robot: the next revolution.

HYPOTHESIS: A remote-controlled robot can be used to perform computer-enhanced major digestive laparoscopic surgery. DESIGN: Cases series for assessment of the feasibility and safety of this technology in major digestive surgery. SETTING: Tertiary care referral center. PATIENTS: Between September 5, 2001, and December 20, 2001, 5 patients (4 men and 1 woman; mean +/- SD age, 66 +/- 5 years) underwent laparoscopic sigmoidectomy, proctectomy, restoration of continuity after Hartmann operation, Whipple procedure, and right liver lobectomy. In each of the procedures, a remote-controlled robot was used to perform some stages of the surgery. During these stages, the surgeon was seated at a distance from the operating table and performed the surgery using the robot, which offers enhanced intracorporeal tool manipulation and spatial vision. RESULTS: Sigmoidectomy was the only procedure that was completely performed with the robot. For the other procedures, the mean +/- SD duration of robot use was 25% +/- 10% of the operative time. Stages of colorectal surgery, retroportal dissection, 2 anastomoses during a Whipple procedure, hepatic pedicle dissection, and initial hepatotomy were performed using the robot. This technology facilitates laparoscopic anastomoses. The principal drawbacks were the time required for robot mobilization, absence of grip strength feedback, limited availability of adapted surgical tools, and the cost of the system. There was no mortality. Two of the 5 patients experienced complications, a postoperative ileus and unexplained sepsis after the Whipple procedure, both of which were treated medically. CONCLUSIONS: For these procedures, laparoscopic computer-enhanced surgery seems safe and feasible. This introduction of computing to major digestive surgery opens the door to enhanced-reality surgery and new types of surgical education.

Aged↗