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PubMed1999

Perioperative allogenic blood transfusion and serum levels of immunosuppressive acidic protein in patients undergoing resection of colorectal carcinoma.

Serum levels of immunosuppressive acidic protein (IAP) were determined in 68 patients undergoing resection of colorectal cancer and 21 healthy subjects. Eighteen patients had perioperative transfusion of allogeneic blood (transfused patients) and 50 patients had no blood transfusion (nontransfused patients). Transfused patients had a higher incidence of nodal involvement, advanced disease, and noncurative surgery compared to nontransfused patients, but the difference did not reach a statistical significance. Hemoglobin concentration and serum albumin level were lower in transfused patients, although there was no statistically significant difference. Preoperative serum IAP level was higher in the patients with nodal involvement and advanced disease and those with moderately or poorly differentiated tumor, though this was not statistically significant. The preoperative serum IAP level was higher in patients than in controls, but the difference did not reach statistical significance. Serum IAP level rose immediately after the operation. In nontransfused patients, the serum IAP level returned to the preoperative value by three months after the operation. In contrast, the serum IAP level of transfused patients remained significantly higher than the preoperative value (P < 0.05) at three months after the operation. These findings indicated that perioperative transfusion of allogeneic blood elevated the serum IAP level for a considerable period after the operation.

Adult↗
PubMed1998

Systemic hypothermia after spinal cord compression injury in the rat: does recorded temperature in accessible organs reflect the intramedullary temperature in the spinal cord?

This article addresses one basic issue regarding the use of systemic hypothermia in the acute management of spinal cord injury, namely, how to interpret temperature recordings in accessible organs such as the rectum or esophagus with reference to the spinal cord temperature. Thirty-six rats, divided into six groups, were randomized to laminectomy or to severe spinal cord compression trauma, and were further randomized to either a cooling/rewarming procedure or continuous normothermia (esophageal temperature 38 degrees C) for 90 min. The first procedure comprised normothermia during the surgical procedure, followed by lowering of the esophageal temperature from 38 degrees C to 30 degrees C (the hypothermic level), a 20-min steady-state period at 30 degrees C, rewarming to 38 degrees C, and finally a 20-min steady-state period at 38 degrees C. The esophageal, rectal, and epidural temperatures were recorded in all animals. The intramedullary temperature was also recorded invasively in four of the six groups. We conclude that the esophageal temperature is safe and easy to record and, in our setting, reflects the epidural temperature. The differences registrated may reflect a true deviation of the intramedullary temperature due to initial environmental exposure and secondary injury processes. Our results indicate that the esophageal temperature exceeds the intramedullary temperature during the initial recording and final steady state following rewarming, but not during the most crucial part of the experiment, the hypothermic period. The core temperature measured in the esophagus can therefore be used to evaluate the intramedullary temperature during alterations of the systemic temperature and during hypothermic periods.

Animals↗
PubMed1989

Experience with 7,604 bone scintigraphies at time of operation for breast cancer 1977-1987.

From 1977 to 1987, 7,604 out of a total of 20,483 Danish breast cancer patients had a bone scintigraphy in order to exclude or localise osseous metastases. The scintigrams were performed and interpreted at 14 local hospitals. In 1979, standardised guidelines for interpretation were agreed upon. Until 1983, the scintigrams were described centrally, based on the local reports. From 1979, the frequency of positive bone scintigrams suggesting bone metastases stabilised at about 5% of the patients compared with 12 and 20% in 1977-78. The local take-over of description did not change the frequency. The frequency was also stable from 1979 when evaluated in age groups. With increasing age the frequency of positive scintigrams increased. The frequency of positive scintigrams was significantly lower in patients entering a protocol than in those not entering a protocol. The conclusion is that on a nation-wide basis it is possible to establish a stable, uniform interpretation of bone scintigrams after a two-year introduction period.

Adult↗
PubMed1998

Predictive value of interleukin 6 (IL-6), interleukin 8 (IL-8) and gastric intramucosal pH (pH-i) in major abdominal surgery.

OBJECTIVE: To study plasma concentrations of interleukin 6 (IL-6) and interleukin 8 (IL-8) in patients with splanchnic hypoxia, as documented by gastric intramucosal measurements (pH-i), during major abdominal surgery and the relationship between IL-6 and IL-8 concentrations and postoperative complications as well as clinical outcome. DESIGN: A prospective study. PATIENTS: Twelve patients scheduled for major abdominal surgery with no evidence of coexisting infectious disease. RESULTS: Six out of seven samples from patients with postoperative complications showed intraoperative pH-i levels lower than 7.32 and IL-6 levels higher than 300 pg/ml. Seven out of nine samples from patients without complications showed pH-i levels higher than 7.32 and IL-6 levels lower than 300 pg/ml. The difference in the pattern of distribution was statistically significant (p < 0.01). Only two out of seven samples of patients with postoperative complications showed intraoperative pH-i levels lower than 7.32 and IL-8 levels higher than 60 pg/ml. It was not possible to identify a clear distribution pattern of data points for IL-6 and IL-8 during the postoperative period. CONCLUSIONS: Intraoperative splanchnic ischemia, as documented by gastric intramucosal pH-i, is directly correlated to the increase of IL-6 plasma levels and to the incidence of postoperative complications, while IL-8 levels showed no correlation with surgical complications.

Adult↗
PubMed2003

Perioperative anxiety and postoperative behavioural disturbances in children undergoing intravenous or inhalation induction of anaesthesia.

BACKGROUND: There are few published data comparing the psychological effects of intravenous (i.v.) and inhalation methods of anaesthesia induction in children. In the present study, we compared perioperative anxiety and postoperative behavioural changes in children undergoing standardized i.v. induction with thiopental and inhalation induction with sevoflurane for routine ear, nose and throat surgery. METHODS: Children were randomly assigned to receive inhalation induction with sevoflurane or i.v. induction with thiopental. Anxiety was assessed on arrival, at induction and 30 min after transfer to the recovery room using a four-point scale. The incidence of postoperative behavioural disturbances was determined using a postoperative questionnaire. RESULTS: Significantly more children were anxious during induction in the i.v. group than in the inhalation group [23 of 50 (46%) versus 5 of 50 (10%); P = 0.0001]. Mean induction time was shorter (5.6 versus 7.0 min; P = 0.0001) and recovery time longer (30.5 versus 10.4 min; P = 0.0001) in the i.v. group compared with the inhalation group. Problematic behavioural changes were reported in the first 2 weeks after surgery in nine of 32 children (28%) in the i.v. group and 16 of 34 (48%) children in the inhalation group (P = 0.13). CONCLUSIONS: Although children were more anxious during i.v. induction than inhalation induction, there was no difference in the incidence of behavioural disturbances in the first 2 weeks postoperatively.

Adolescent↗
PubMed1994

Sevoflurane anaesthesia for major intra-abdominal surgery.

The cardiovascular effects and recovery characteristics of sevoflurane and isoflurane anaesthesia were compared in 30 gynaecological and 20 general surgical patients undergoing elective intra-abdominal surgery. Patients were randomly allocated to receive either sevoflurane or isoflurane as the volatile agent, in a balanced anaesthetic technique including morphine and atropine premedication and thiopentone, fentanyl, vecuronium and nitrous oxide. The concentration of volatile agent was titrated according to clinical variables. Mean heart rate, systolic and diastolic arterial pressure and duration of surgery did not differ between the two groups. Time to emergence from anaesthesia in the gynaecological patients was significantly faster after sevoflurane compared with isoflurane (p < 0.005). Sevoflurane provided stable anaesthesia during major intra-abdominal surgery.

Abdomen↗
PubMed1990

[Perioperative infusion therapy in children].

An incorrect fluid therapy can lead to serious complications considerably more rapidly in children, especially in newborns and infants, than in adults. The pediatric patient has a limited range of compensation for maintenance of fluid and electrolyte balance. Precise knowledge of the physiological age-dependent fluid balance, i.e. the large extracellular space, the developing renal function, the increased metabolism, the acid-base state, the electrolyte balance with the relatively higher sodium and chloride requirements must be the basis of an adequate fluid therapy. The basic fluid requirement (normal fluid and electrolyte requirement) varies with age and is influenced considerably by environmental conditions, body temperature and metabolism. For substitution of this basic fluid requirement one-third to one-half strength electrolyte solution in 5% dextrose is used, the amount depending on age. The perioperative fluid requirement, however, has to be calculated with due consideration for the characteristic changes in fluid and electrolyte balance during anaesthesia and surgery, the preoperative fasting period, drug effects of anesthetics, hormonal changes and ventilation; it is higher than the basic fluid requirement (infants 6-8 ml.kg-1.h-1, toddlers 4-6 ml.kg.h-1, schoolchildren 2-4 ml.kg-1.h-1). For intraoperative fluid therapy infusions with an increased sodium concentration (70-100 mmol/l) or Ringer's lactate (Na+ = 130 mmol/l) must be used. On no account must electrolyte-free solutions, e.g., 5-10% glucose, be used intraoperatively, as they can lead to water intoxication. The third-space requirements compensate for the additional losses by drainage, third-space deficits by evaporation and gastric and enteral secretions.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1997

Vagus nerve stimulation as a method to temporarily slow or arrest the heart.

BACKGROUND: Electrical stimulation of nerves is used to study nervous system and body function relationships. Electrical stimulation of the vagus nerve was used to slow the heart during coronary artery bypass grafting. METHODS: A 48-year-old man with multivessel coronary artery disease, scheduled for revascularization, gave informed consent for the surgeon to stimulate his vagus nerve. As part of the operation the left internal mammary artery was harvested as a pedicle and the patient was placed on cardiopulmonary bypass. The vagus nerve was isolated as it crossed the aorta just lateral to the phrenic nerve. Pacing wires were placed (1 cm apart) allowing prodromic conduction. With the patient fully supported by cardiopulmonary bypass and after administration of neostigmine (2.5 mg intravenously) eight separate continuous 5-second electrical pulse trains (25 Hz, 20 V, pulse width of 0.1 ms) were delivered to the nerve with 30-second rest periods between each stimulation. During the periods of stimulation the mammary artery to left anterior descending artery anastomosis was completed. RESULTS: Electrical stimulation caused cessation of the heartbeat, termination of the same resulted in normal sinus rhythm, although it was slowed by the neostigmine. Suturing of the anastomosis was done during periods of stimulation. Additional anastomoses were completed using cardiopulmonary bypass-delivered cardioplegia and aortic cross-clamping. CONCLUSIONS: Electrical stimulation of the vagus nerve slowed and temporarily arrested the heart for brief periods to allow critical placement of anastomotic sutures.

Adult↗
PubMed1997

Analgesic efficacy of peripheral opioids (all except intra-articular): a qualitative systematic review of randomised controlled trials.

Anaesthetists, using basic scientific concepts of peripheral opioid activity, try to improve regional anaesthesia and postoperative analgesia by injecting opioids, with or without local anaesthetic, close to nerve trunks or nerve endings. To test the evidence that peripherally applied opioids (all except intra-articular) have an analgesic effect outside the knee joint. Systematic search for published reports of randomised controlled trials in the period 1966-1996 (MEDLINE, EMBASE, Oxford Data Base, reference lists) which compared efficacy of peripheral opioids with placebo, local anaesthetic, or systemic opioids in acute pain. Reports of pethidine or intra-articular opioids were not included. Data on intraoperative efficacy (onset, quality, duration of sensory block), and postoperative efficacy (pain intensity, analgesic consumption) were extracted. Statistical significance as indicated in the original reports and clinical relevance of differences between opioids and controls were taken into account to estimate qualitatively overall efficacy. Twenty-six trials with data from 952 patients were analysed. Opioids used were morphine (16 trials), fentanyl (8), alfentanil (1), buprenorphine (1), and butorphanol (1). Of four experimental pain trials, two reported a statistically significant difference in favour of the opioid. In 22 clinical trials efficacy of opioid injections into the brachial plexus (10), Bier's block (4), perineural (3), or other sites (5) was tested. Five of 10 clinical trials measuring intraoperative efficacy reported statistically significant efficacy with opioids compared with control; none of them were judged to be clinically relevant. Five of 17 clinical trials measuring postoperative efficacy reported a significant difference in favour of the opioid; none was judged to be clinical relevant. Trials of lower quality were more likely to report increased efficacy with opioids. Adverse events related to the route of administration were not reported. These trials provide no evidence for a clinically relevant peripheral analgesic efficacy of opioids in acute pain.

Analgesics, Opioid↗
PubMed1982

Propranolol and thyroidectomy in the treatment of thyrotoxicosis.

For decades, the preparation of a hyperthyroid patient for surgery took several weeks or months utilizing thyroid blocking agents and iodine. In 1973, a preliminary report of 20 patients with hyperthyroidism treated with propranolol and thyroidectomy was presented. It was found that a thyrotoxic patient could be prepared for surgery, in an emergency, by intravenous propranolol in less than an hour, or electively by oral propranolol within 24 hours. Since then, 140 additional patients have been similarly treated. It continues to be true at this institution that propranolol, a beta-adrenergic blocking agent, effectively neutralizes the symptoms of autonomic hyperactivity, including sweating, tremor, fever, dilation of blood vessels, and increased pulse rate without significantly affecting thyroid function. An average dose of 160 mg/day was used, with a range of 40 to 320 mg/day. In none of these patients was iodine used; in fact, its use with propranolol is considered unnecessary. A subtotal, near total, or total thyroidectomy was done in all patients, resulting in a 55% incidence of hypothyroidism. There was no postoperative thyroid storm, nerve injury, or permanent hypoparathyroidism. It is believed that the administration of propranolol alone provides a rapid, safe, and effective preparation of the thyrotoxic patient for thyroidal or extrathyroidal surgical procedures during the perioperative period.

Adolescent↗
PubMed2001

[A case of protruding atherosclerotic plaque with mobile projections in the sino-tubular junction].

A 66-year-old woman who received maintenance hemodialysis for the last 14 years was referred to our hospital due to the sudden onset of ischemic stroke and systemic emboli. Transthoracic echocardiography before surgery showed large protruding masses measuring 2 cm which projected into the lumen of the aortic root. The plaque originated on a wide base of the posterior aspect of the ascending aorta at its junction with the sinus of Valsalva. The mobile plaque was surgically removed by endarterectomy from the posterior wall of sino-tubular junction under cardiopulmonary bypass. Pathologic examination of the masses removed at the time of surgery showed that they were atherosclerotic plaque with superimposed thrombi. During operation, transesophageal echocardiography appears to be useful for the rapid detection of a protruding aortic atheroma especially in the initial period of cardiopulmonary bypass until aortic cross clamp.

Aged↗
PubMed2006

[Changes in cardio-pulmonary function during laparoscopic colectomy and postoperative quality of life--comparison with laparotomy].

BACKGROUND: We investigated whether laparoscopic colectomy would affect the degree of respiratory and circulatory changes during surgery and could improve postoperative quality of life (QOL) as compared with laparotomy. METHODS: Fifty-one patients (ASA 1-3) scheduled for elective colectomy under general anesthesia with epidural anesthesia were enrolled in the study. All patients were divided into two groups (laparoscopic group: n = 33 and laparotomy group: n = 18) by surgical indication. Respiratory functions and hemodynamic changes were measured during surgery. Postoperative complications, pain scores, the time to start of walking and the period of hospital stay were examined. The serum concentrations of inflammatory cytokines (IL-6, IL-1 ra) and KL-6 were measured perioperatively. RESULTS: It was demonstrated that pneumoperitoneum and postural tilt had a bad influence on respiratory functions especially on pulmonary compliance and a-ET(D)co2 in laparoscopic group. The serum concentrations of inflammatory cytokines were significantly lower and the number of rescue for postoperative pain were less in laparoscopic group. The patients in laparoscopic group could begin to walk and leave hospital earlier after surgery. CONCLUSIONS: Severe complication did not occurr in both groups during the perioperative period. Laparoscopic surgery could improve postoperative QOL.

Aged↗
PubMed1989

[Cerebral blood flow and CO2-responsiveness in early aneurysmal surgery].

The purpose of our study was to investigate the fact that, during aneurysmal surgery, the degree of reduced cerebral blood flow (CBF) and disturbed CO2 responsiveness due to subarachnoid hemorrhage (SAH) were influenced by the elapse of time from SAH to surgery. Fifteen patients with SAH, between 26 and 63 years of age (44 +/- 16) were in grade-I according to the Hunt & Hess scale. These patients were divided into three groups according to the time lapse from onset of SAH to aneurysmal surgery. In group A (G-A: n = 4) the operations were performed within 12 hours from the onset of SAH. In group B (G-B: n = 4) the operations were performed between 12 and 24 hours after SAH, and in group C (G-C: n = 7) between 24 and 72 hours after the onset of SAH. All these operations were done under general anesthesia with N2O 4 l/min, O2 3 l/min and halothane 0.3-0.8%, and ventilation was controlled with pancuronium bromide. After about three hours from induction of anesthesia, but restricted within microsurgical maneuver, our study was performed. CBF and CO2 responsiveness were estimated with the cerebral circulatory index (inverse of arterial oxygen content minus jugular venous oxygen content: CCI). The O2 content and CCI were calculated with the following formula: Cont. O2 = 1.39 X Hb (g/dl) X O2 Sat + 0.003 X PO2, CCI = 1/CaO2-CjO2 where CaO2 is the content of O2- in arterial blood and CjO2 in jugular blood. To estimate the cerebral CO2 responsiveness, we changed the tidal volume during the period studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Arterial and venous parathyroid hormone levels in minimally invasive surgery.

OBJECTIVE: To establish if venous and arterial parathyroid hormone (PTH) levels are similar during minimal access parathyroid surgery. DESIGN: Prospective study. SETTING: Marshfield Clinic, a large multispecialty tertiary care referral center in central Wisconsin. PATIENTS: All patients who underwent minimally invasive parathyroid surgery over a 10-month period. RESULTS: Fifteen consecutive patients were evaluated. There were 11 women and 4 men, with an average age of 65 years. All patients underwent a preoperative technetium Tc 99m sestamibi scan, with 11 localizing to the site of a probable adenoma. Mean ionized calcium levels were 5.95 mg/dL (1.49 mmol/L) preoperatively and 4.84 mg/dL (1.21 mmol/L) postoperatively. Of 13 patients undergoing both arterial and venous sampling, mean baseline venous PTH level was 221 pg/mL and 37 pg/mL at 10 minutes after excision of suspected adenoma (83% decline). Mean baseline arterial PTH level was 247 pg/mL and 38 pg/mL at 10 minutes after excision (84% decline). Using the Wilcoxon signed rank test, there was no significant difference in the arterial vs venous levels at baseline (P = .70) or 10 minutes (P = .48). CONCLUSIONS: Intraoperative PTH levels during minimal access parathyroid surgery are similar for venous and arterial samples. Blood samples for PTH level monitoring can be obtained using a temporary indwelling arterial line.

Aged↗
PubMed1991

Effects of a three-drug antineoplastic protocol of wound healing in rats: a biomechanical and histologic study on gastrointestinal anastomoses and laparotomy wounds.

Using biomechanical and histologic approaches, the effect of perioperative administration of a drug protocol containing 5-fluoruracil, Adriamycin, and mitomycin C (FAM) on the healing of gastrointestinal anastomoses and laparotomy wounds in rats was examined. Application of FAM immediately before operation resulted in significant impairment of wound healing in the early postoperative period. Once the proliferation of fibroblasts and collagen synthesis had led to an increase of mechanical strength, no negative effect on wound healing could be detected applying the same chemotherapeutic agents. These findings indicate the early inflammatory phase of the wound healing process to be most vulnerable to the chemotherapeutic effects. This has significant implications if the theoretical advantages of starting adjuvant chemotherapeutic treatment in the immediate postoperative period are implemented.

Anastomosis, Surgical↗
PubMed1988

Effect of total intravenous anaesthesia with midazolam/alfentanil on the adrenocortical and hyperglycaemic response to abdominal surgery.

The effect of anaesthesia on the hyperglycaemic and adrenocortical response induced by surgery was studied in patients undergoing abdominal hysterectomy. The study group was anaesthetized with midazolam and alfentanil using a totally intravenous anaesthetic technique. A reference group received anaesthesia with thiopentone, alfentanil and nitrous oxide. Midazolam 0.42 mg.kg-1 was given as a loading infusion followed by a maintenance infusion of 0.125 mg.kg-1.h-1. Alfentanil was given as a bolus dose of 0.075 mg.kg-1 in both groups, followed by a loading infusion of 0.3 mg.kg-1.h-1 for 15 min and a maintenance infusion of 0.065 mg.kg-1.h-1. Increments of alfentanil were given whenever heart rate or systolic blood pressure exceeded pre-induction values by more than 10%. During anaesthesia mean arterial pressure and heart rate were similar in both groups and there was no difference in alfentanil requirement. An immediate increase in blood glucose concentrations was seen following incision, but maximum concentrations were measured in the early postoperative period. Serum cortisol concentrations decreased after induction of anaesthesia. During surgery they returned to pre-induction values, and in the postoperative period they increased to about twice the pre-induction values. It is concluded that midazolam/alfentanil anaesthesia is as effective as anaesthesia induced by thiopentone, alfentanil and nitrous oxide in suppressing the stress-response to surgery until the postoperative period. No signs of prolonged adrenocortical depression were observed.

Alfentanil↗
PubMed1990

[Ultrastructure of myocardial microcirculatory bed in patients with ischemic heart disease at various stages of aortocoronary bypass].

Changes in the ultrastructure of microcirculatory vasculature were studied on 136 puncture biopsy samples of the left ventricular myocardium taken from 56 ischemic heart disease patients before aortic compression, at terminal cardioplegia, and after coronary flow reconstruction. It was found, that changes in the endothelial cells gradually grow during cardioplegia, becoming statistically significant in the reconstructive post-cardioplegia period lasting over 60 min, which affects the capillary permeability, status of homeostasis and metabolism, and contractility of cardiomyocytes in the postoperative period.

Adult↗