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At least 487 records · Page 27Linked to original sources
PubMed1982

[Clinical studies on prevention of spinal hypotension and aortocaval compression during elective cesarean section (author's transl)].

Maternal blood pressures, maternal and fetal blood-gas values, induction delivery intervals (I-D intervals) and Apgar scores were determined in 60 cases of elective cesarean section under spinal anesthesia. The procedures were as follows: In the right lateral position on an operating table, the intravenous drip infusion of 6 per cent hydroxyethyl starch solution (12 ml/kg) for 30 minutes prior to spinal anesthesia and the intramuscular injection of ephedrine (0.5 mg/kg) 15 minutes before spinal anesthesia were performed. Immediately after the anesthesia, on the left semilateral position the operation was started (group S). The same studies as group S were made in cases of no reduced blood pressure without ephedrine (group E), and cases of combined use of oxygen inhalation (group O and OII). No significant reduction of blood pressure was noted in group S and O. Fetal acid-base status and Apgar scores were favorable and had no correlation with I-D intervals in any groups. It is suggested that the uteroplacental circulation in group O and E was maintained more or less smoothly than that in group S. Oxygen inhalation led to a significant increase in fetal PO2 and the improvement of 5 minutes Apgar score. On performing elective cesarean section under spinal anesthesia, it may be advisable to take the procedures of group OII (Oxygen flow: 31/min., through a nasal cannula) and to make mother respire closing their mouths.

Acid-Base Imbalance↗
PubMedDate not supplied

A refined method of trans-thoracoabdominal hepatectomy for cirrhotic patients with hepatocellular carcinoma.

A hepatectomy in cirrhotic patients with hepatocellular carcinoma, located in either the posterior or superior part of the right lobe, inevitably requires a forced mobilization of the right lobe. Such a forced procedure causes a decreased hepatic blood flow resulting in postoperative morbidity and mortality, as well as an increased risk of the intrahepatic dissemination of cancer cells during the operation. We have thus refined the method of trans-thoracoabdominal hepatectomy to minimize those demerits of conventional transabdominal hepatectomies. The main characteristics of our refinements are as follows; (1) an optimal incision for the best short-cut to the hepatocellular carcinoma is determined by a three-dimensional imaging of either helical computed tomography and/or magnetic resonance imaging before operation; (2) a complete view of the operative field is obtained by the pertinent use of rotating the operation table, on which the patient is placed in a left semi-lateral position; (3) this method is suitable for resecting a tumor located in the posterior segment such as a posterior segmentectomy. This refined method is considered to decrease the postoperative morbidity including post-operative hepatic dysfunction and is also useful for cirrhotic patients with hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed2001

Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager.

OBJECT: In this article the authors report on a novel, compact device for magnetic resonance (MR) imaging that has been developed for use in a standard neurosurgical operating room. METHODS: The device includes a permanent magnet with a field strength of 0.12 tesla. The poles of the magnet are vertically aligned, with a gap of 25 cm. When not in use the magnet is stored in a shielded cage in a corner of the operating room; it is easily moved into position and attaches to a regular operating table. The magnet is raised for imaging when needed and may be lowered to allow surgery to proceed unencumbered. Surgical navigation with optical and/or magnetic probes is incorporated into the system. Twenty-five patients have undergone removal of intracranial lesions with the aid of this device. Operations included craniotomy for tumor or other lesion in 18 patients and transsphenoidal resection of tumor in seven. The number of scans ranged from two to five per surgery (average 3.4); image quality was excellent in 45%, adequate in 43%, and poor in 12%. In four patients MR imaging revealed additional tumor that was then resected; in five others visual examination of the operative field was inconclusive but complete tumor removal was confirmed on MR imaging. In 21 patients early postoperative diagnostic MR studies corroborated the findings on the final intraoperative MR image. Using a water-covered phantom, the accuracy of the navigational tools was assessed; 120 data points were measured. The accuracy of the magnetic probe averaged 1.3 mm and 2.1 mm in the coronal and axial planes, respectively; the optical probe accuracy was 2.1 mm and 1.8 mm in those planes. CONCLUSIONS: This device provides high-quality intraoperative imaging and accurate surgical navigation with minimal disruption in a standard neurosurgical operating room.

Adult↗
PubMed1990

Operating room acquired pressure ulcers.

Six patients developing sacral pressure ulcers during vascular, cardiovascular and orthopedic surgical procedures are presented. Neither risk rating score nor time spent on the operating table identified these patients at unusual risk. The ulcers were usually not evident until the second postoperative day. The ulcers all had an initial bruise-like appearance or ecchymotic perimeter. They became larger and necrotic despite treatment. Healing did not begin until 12-14 days post-operatively or even longer if additional surgeries were required. A discussion of pressure ulcer development during surgery and recommendations for further study are included.

Adult↗
PubMed1995

Management of difficult intra operative bleeding by abdominal packing: report of four cases.

Difficult perioperative bleeding in four obstetric and gynaecology patients was managed with temporising abdominal packs left in place with abdominal closure for 48-72 hours in order to avoid deaths on the operating table when blood loss could not be adequately replaced and hemostasis could not be secured. Abdominal re-opening to remove the packs was undertaken. Three of the patients were eventually discharged home after satisfactory recovery. The fourth died of sepsis three weeks after the fourth re-operation and bilateral internal iliac artery ligation. Abdominal packing thus has a place in the management and salvage of patients with difficult obstetric and gynaecologic perioperative bleeding.

Adolescent↗
PubMed1999

Use of the laryngeal mask airway during repair of atrial septal defect in children.

We describe the elective use of the laryngeal mask airway in two children undergoing cardiopulmonary bypass for repair of an atrial septal defect. Total surgical time was short and cardiopulmonary bypass performed at normothermia allowing removal of the laryngeal mask airway on the operating table on completion of surgery. We were able to adequately oxygenate and ventilate the children throughout the procedure using positive pressure ventilation and spontaneous ventilation. The use of caudal fentanyl and rectal diclofenac aided postoperative pain management. Atrial septal defect repair has become one of the more straightforward cardiac operations partly as a result of new cardiopulmonary bypass techniques. Avoidance of intubation and postoperative ventilation in appropriate patients would make this procedure ideal for 'fast tracking' and offers the potential advantages of decreased length of stay in hospital and reduction in overall costs.

Administration, Rectal↗
PubMed1999

Spontaneous spinal subdural hematoma in a young adult with hemophilia.

Spontaneous spinal subdural hemorrhage is a rare clinical problem that usually manifests with a sudden onset of pain and paralysis. This article reports on an 18-year-old male with hemophilia A and cerebral palsy, who experienced a several month history of transient back, hip, and leg pain accompanied by gait difficulties that ultimately culminated in a more striking episode of lower extremity weakness, irritability, and diffuse pain involving the neck, back, and legs. In the absence of any clinical or radiographic evidence of hemarthrosis, osteomyelitis, or intracranial hemorrhage, imaging of the spine disclosed a large, apparently multicompartmentalized intraspinal lesion, consistent with old hemorrhage. This extended from the thoracic to the sacral region, with the largest extent at the lumbosacral junction. Following correction of factor VIII levels, surgical exploration was undertaken and demonstrated liquefied blood within the subdural space without violation of the underlying arachnoid. Because the chronic subdural blood flowed quite easily through the dural opening by simply angling the operating table, a limited exposure was required to achieve a substantial evacuation of the clot. This case calls attention to the often protean manifestations of this process, the potential for a chronic course to the clinical symptoms, and the possibility of achieving substantial clot evacuation and clinical recovery with a limited operative approach.

Adolescent↗
PubMedDate not supplied

[Perioperative CTG in cesarean section].

In 30 cases each of primary (intact amnion) and secondary (ruptured amnion) cesarean section continuous perioperative cardiographic monitoring of the fetus was performed. When primary cesarean section is performed, perioperative monitoring extending to delivery of the fetus is not generally necessary, provided the preoperative CTG is normal and the patient is positioned on her left on the operating table. In secondary cesarean section with normal CTG continuous perioperative monitoring of the fetus is also unnecessary. If secondary cesarean section is performed when the amnion is ruptured and the CTG is pathologic, the fetus should be cardiotocographically monitored up to delivery, to permit the speed of preparation and performance of the operation to be adapted to the condition of the fetus and any necessary preparations for reanimation to be made.

Cesarean Section↗
PubMed1993

A pressure care survey in the operating theatres.

During 1988 and 1989 several patients developed severe pressure areas post operation. The patients all underwent major surgery lasting a few hours and experienced haemodynamic complications as a result of their condition in the peri-operative period. Although these pressure areas did not develop while the patients were in the operating theatres it was thought that the duration of their surgery contributed to the problem. In order to determine the extent of pressure area development on patients undergoing surgery it was decided to undertake an extensive quality assurance audit over a 3 month period. The sample of 108 patients included patients from cardiothoracic, orthopaedic and plastic microvascular, ear, nose and throat, ophthalmology, vascular, urology and general surgery plus a control group of patients whose surgery was less than 1 h duration. The patients were visited pre-operatively to assess their skin integrity. Intra-operative pressure care management plus other relevant information was documented. A second visit at 24 h post operation determined whether any changes in skin integrity had developed. The results of the surgery were not significant when the whole sample was looked at. However, they did become statistically significant when broken down into specialty groups. The recommendations of the survey included research into the improvement of operating table mattresses and contoured positioning devices. An education programme of staff was to be undertaken to develop greater awareness of the problem.

Adolescent↗
PubMed1996

[Desflurane and isoflurane. A comparison of recovery and circulatory parameters in surgical interventions].

OBJECTIVES: The new volatile anaesthetic desflurane is characterized by very low blood-gas and tissue-blood partition coefficients, so that rapid induction of anaesthesia and shorter recovery times can be expected. The aim of this investigation was to compare the effects of desflurane and isoflurane on haemodynamics and recovery time when used as part of a balanced anaesthesia technique for elective surgery. METHODS: Fifty patients (18 years and older, ASA status I-III) scheduled for elective surgery (no laparoscopies) of at least 60 min duration were included in this open, randomised, phase-III clinical trial. After oral premedication with midazolam 7.5 mg 45 min before transfer to theatre, anaesthesia was induced with fentanyl 0.1 mg and thiopental 5 mg/kg; succinylcholine or vecuronium facilitated intubation. Desflurane and isoflurane, respectively, were used for maintenance of anaesthesia, both in 50% N2O, with the inspired concentration adapted to the degree of stimulation. All patients were ventilated in a semi-closed system; muscle relaxation was achieved with vecuronium. The electrocardiogram, heart rate (HR), and direct arterial blood pressure (BP) were recorded continuously and anaesthetic gas detection was performed by an infrared absorption technique. With termination of surgery the volatile anaesthetic was discontinued and the following emergence times recorded: spontaneous ventilation (VT > 300 ml), extubation, eye opening, correctly answering the date of birth, arrival in and possible discharge from the post-anaesthesia care unit (PACU). RESULTS: In all, 49 patients were studied at random (desflurane n = 24, isoflurane n = 25). Data of demographics and anaesthetic technique were comparable in both groups (Tables 2 and 3). Anaesthetic elimination (expressed as FA/FAO) was significantly more rapid in the desflurane group 3 min after termination of anaesthesia (Fig. 1). Comparing the emergence times, there was no significant difference between desflurane and isoflurane: in both groups patients opened their eyes 12 min (median time) after termination of the operation (Table 4). Haemodynamics (HR, systolic and diastolic BP) were comparable at intubation, skin incision, end of surgery, extubation, and in the PACU (Fig. 2a, b). In 2 patients a rapid increase in the inspired concentration of desflurane during induction of anaesthesia produced a profound sympathoadrenergic reaction with an excessive increase in BP and HR. Similar reactions in other patients did not occur when the inspired concentration of desflurance was slowly increased. CONCLUSIONS: Despite the physicochemical properties of the new agent, emergence times were similar for desflurane and isoflurane in our study. These results, which are in contrast to those of some other authors, are most probably due to the study design, which included the use of premedicants (midazolam) and a low dose of fentanyl. The reported sympatho-adrenergic reactions after rapid changes in the inspired concentration of desflurane during induction of anaesthesia have been observed by others as well. It seems that this initial cardiovascular stimulation can be avoided by slow increases in desflurane concentration. In summary, desflurane compares to isoflurane in balanced anaesthesia for general surgical procedures with regard to haemodynamics, while the time to awakening is not necessarely reduced.

Adolescent↗
PubMed2005

A spine frame for intra-operative fixation to increase accuracy in spinal navigation and robotics.

OBJECTIVE: Intra-operative movements due to mechanical ventilation or manipulations are a limiting factor for accurate spinal navigation or robotic-assisted spinal surgery. The purpose of this study was to assess the accuracy of an intra-operative spinal fixation device in an experimental setup. MATERIALS AND METHODS: We developed a fixation device, attached to the operating table, that combines soft tissue retraction with spinal process fixation. Using a lumbar spine cadaver, tightness of fixation was evaluated using two measurement systems. Accuracy measurements using changes in spatial co-ordinates of implanted reference markers were performed in three segments, following different manipulations of the spine. In addition, for intra-operative movements of the spine during mechanical ventilation, the range of motion was determined in 10 patients during lumbar interbody fusion. RESULTS: The spine frame was easy to use and did not restrict screw insertion. Mean deviations of the markers' in all segments were measured at between 0.35 and 0.8 mm, following pedicle screw insertion and lateral traction. Intra-operative range of motion of the spine was measured with a mean value of 8.7 +/- 3.3 mm. CONCLUSION: Using our spine frame, a rigid fixation following manipulation of the spine was demonstrated. By overcoming the intra-operative movement-dependent inaccuracy, safety in navigated spine surgery and robotic-assisted procedures might be improved.

Analysis of Variance↗
PubMed1988

Joint surgery in severe ankylosing spondylitis.

Twenty-three patients with ankylosing spondylitis with severe deformities of hips, knees, and ankles were treated by a variety of surgical procedures followed by a comprehensive rehabilitation program. The surgery included 35 total hip replacements, six knee arthroplasties, and seven femoral osteotomies. Elongation of the Achilles tendon (eight procedures) was done on 6 patients. Shortening of the femur was performed in patients with long-standing flexion contractures when straightening of the limb during the operation caused traction on the vessels and the nerves. When there was both hip and knee involvement, hip arthroplasty was performed first. Preoperative planning aimed at obtaining plantigrade position of the feet and lower limb-length equality. Availability of custom-made and miniaturized components was essential. Positioning of patients on the operating table necessitated special supports. Six patients were completely bedridden before surgery and 17 were severely disabled or deformed. All the patients but 2 improved markedly, became mobile, independent, and self-supporting. Revision arthroplasty was performed in 4 patients; 3 others deteriorated functionally, but refused further treatment. Heterotopic bone formation was observed after operation in 6 patients. Surgery for severe ankylosing spondyloarthritis requires highly specialized and well-equipped centers.

Activities of Daily Living↗
PubMed1998

The viability of soft tissues in elderly subjects undergoing hip surgery.

AIMS: To assess the viability of soft tissues in elderly patients subjected to prolonged support pressures. DESIGN: measurements were performed on the soft tissues of patients undergoing surgery for fracture of the proximal femur. METHODS: 10 subjects, mean age 84 years, participated. Transcutaneous gas tensions were continuously monitored in an area adjacent to the contralateral greater trochanter, which was loaded with an external applicator. Subcutaneous interstitial pressures using a slit catheter were also measured. RESULTS: Transcutaneous oxygen partial pressure fell in some patients to critically low levels, defined as below 2.7 kPa (20 mmHg), whilst they were subjected to normal interface pressures on the operating table. Transcutaneous partial carbon dioxide pressures rarely rose above 8.0 kPa (60 mmHg). The measured interstitial pressures could lead to local occlusion of skin microvessels. CONCLUSIONS: This study confirms that tissue viability could be compromised in elderly patients undergoing surgical procedures. The methods employed may be of value in assessing support surfaces in the operating theatre to reduce the incidence of pressure sores in this high-risk patient group.

Aged↗
PubMedDate not supplied

Ventral abdominal approach for laparoscopic ovariectomy in horses.

Eleven mares and four mules were ovariectomized by a ventral abdominal laparoscopic technique. This approach required tilting the operative table about 30 degrees elevating the pelvis to allow observation of the ovaries. A triangulation technique with a single laparoscopic portal and four instrument portals was used. The ovarian pedicles were ligated and the ovaries were removed through a single enlarged instrument portal. Females ranged in age from 5 months to 18 years. Mean operative time was 44 minutes (range 20 to 90 minutes); mean operative time of the last seven animals was 26 minutes. Signs of abdominal pain occurred in three mules and one mare in the immediate postoperative period. Peritoneal fluid collected from six animals 48 hours after surgery had a mean leukocyte count of 34,463/microL: (range, 21,000 to 62,800/microL), mean protein concentration of 3.1 g/dL (range, 2.2 to 4.6 g/dL), and mean differential leukocyte count of 74% neutrophils and 26% mononuclear cells. The animals were confined for 2 weeks after surgery. Signs of estrus were observed in two mares within 6 months after ovariectomy. All owners reported satisfaction with the results of laparoscopic ovariectomy. The ventral abdominal laparoscopic approach permitted efficient and safe ovariectomy of foals and adults.

Animals↗
PubMed2005

Outbreak of infection with a multiresistant Klebsiella pneumoniae strain associated with contaminated roll boards in operating rooms.

An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands was investigated. Epidemiologic investigations revealed a short delay between an operation and the acquisition of the MRKP strain. A case-control study comprising 7 cases and 14 controls was conducted to identify the risk factors associated with the acquisition of the MRKP strain. An operation at each of two operation rooms was strongly associated with the acquisition of the MRKP strain: odds ratio of 36 (95% confidence interval, 2.7 to 481.2; P=0.003, Fisher exact two-tailed test). Cultures of environmental specimens of the operation rooms revealed contamination of the roll boards used to transport patients from the bed to the operation table with the MRKP strains. Molecular genotyping of the isolates revealed clonal similarity between the isolates of the seven cases, isolates from environmental specimen cultures, and in addition, an MRKP isolate from a re-patriated ICU patient from earlier that year. The outbreak ended after cleaning and replacement of the roll boards in the operation rooms and implementation of additional barrier precautions for colonized or infected patients. It was concluded that two operation rooms played a significant role in the transmission of an MRKP strain between ICU patients during the presented outbreak.

Adult↗
PubMed2000

[Gasless laparoscopic cholecystectomy. Our experience with 130 cases compared with 450 cases treated with the CO2 technique].

Alongside the technique based on the creation of an abdominal cavity for surgery following the introduction of gas (usually CO2) into the peritoneal cavity, a new method has been developed. This involves the use of an atraumatic mechanical lifting device connected to the same abdominal wall (gasless laparoscopy). The authors report a technique that uses an inflatable cushion inserted into the abdomen through a periumbilical incision. The cushion is connected to an external motorized hydraulic jack fixed to the operating table, fitted with an electric motor and friction gear. Between May 1991 and June 1998, 580 patients underwent laparoscopic cholecystectomy. Since December 1995 a total of 130 patients have undergone surgery using gasless laparoscopy. Shoulder pain and pain in the upper abdominal quadrant were no longer reported; pain was present in 70% of the patients operated using the CO2 technique. There was also a marked reduction in the anesthesiological risks, above all in elderly patients with cardiopulmonary insufficiency. Surgical manoeuvres are made easier owing to the possibility of using traditional surgical instruments. Washing and continuous aspiration allow a good control of intraoperative hemostasis, and reduce the phenomenon of lens misting without the risk of losing pneumoperitoneum. Less visibility of the surgical field was reported, particularly in obese patients, above all because of the reduced diaphragmatic distension and the lack of displacement of the intestinal loops. In the authors' opinion the gasless technique is suitable above all in patients affected by cardiopulmonary disorders in whom hypercapnia might represent a significant operating risk.

Carbon Dioxide↗
PubMed2000

[Computer-assisted surgery].

The term "computer-assisted surgery" (CAS) contains a variety of different applications. Priorities in trauma surgery have navigation systems. In fact, two basically different developments can be distinguished: on one hand, the possibility of navigation, based on preoperative CT data sets; and on the other hand navigation in intraoperative C-arm images. With the present available navigation technology, it can be assumed that intraoperative CT-based tracking in the field of spinal surgery can be performed accurately, regardless of whether active or passive markers are used. Another navigation option is C-arm-based osteosynthesis of the proximal femur. An application of navigation assistance in the field of pelvic surgery is osteotomy and placement of iliosacral screws. Future developments will have to concentrate on the technical characteristics of each navigation system. Advantageous concepts of visualization may generate required information to the surgeon in a way that unconstrained interaction at the operation table is combined with simultaneous integration of virtual and computer-aided visual information. New tracking systems will allow the reconstruction of data sets after reposition of segmented bone fragments, so that also in complex pelvic fractures the implantation of screws after reposition will be possible. Computer-aided surgery is able to improve the precision of operations in trauma surgery. In future, further developments of navigation systems can be expected. This fact is supported by the establishment of faster and cheaper hardware, as well as more intelligent and user-friendly software.

Bone Screws↗
PubMed2004

Joint replacement-total hip replacement with CT-based navigation.

UNLABELLED: Correct orientation of the cup optimizes the range of motion of total hip arthroplasty (THA) and reduces the risk of dislocation, wear, impingement,and pelvic osteolysis. Therefore, CT-based navigation is used to position the acetabular cup precisely in a planned orientation relative to predefined bony landmarks in order to increase the function and longevity of THA. METHODS: Fourteen patients were operated on using CT-based navigation for acetabular cup positioning. After scanning the patient's pelvis in a preoperative CT, a3-D plan was developed before surgery. Intraoperatively, the CT/3-D model is registered to coincide with the actual position of the patient on the operating table. RESULTS: Mean time for surgery increased by an average of 46 minutes and mean blood loss increased by 140 ml. Positioning of the cup was optimized, ie, it was close to the predefined target. There were no complications related to the use of CT-based navigation. Due to some technical failures at the beginning, two operations were completed manually. CONCLUSION: CT-based navigation greatly enhanced the precision of cup positioning,thus eliminating malpositioning. Although CT-based navigation does support the surgeon in controlling cup orientation, it increases time for surgery, blood loss, radiation of the patient, and total costs of the whole procedure. Furthermore,navigation of the acetabular cup alone is not sufficient for optimizing the range of motion in THA.

Aged↗