Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Intraoperative Period”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMed1986

Comparison of perioperative and postoperative phasic blood flow in aortocoronary venous bypass grafts by means of pulsed Doppler echocardiography with implantable microprobes.

Although graft dimension and hemodynamic variables have been suggested as important determinants of the functional results of aortocoronary bypass grafting, there is no easy-to-use bedside method of monitoring phasic blood flow in coronary bypass grafts. We developed a miniaturized implantable silicone pulsed Doppler flow probe linked to a classic 8 MHz pulsed Doppler system. This apparatus has an adjustable range-gated time system that permits accurate measurement of diameter (D, in mm), cross-sectional blood flow velocity (Vm, in cm/sec), and coronary bypass graft flow (CBGF, in ml/min) as pi D2/4 X Vm X 60. Ten patients (55 +/- 7.2 years SD) with preoperative left ventricular ejection fractions over 45% received the implantable flow probes during the aortocoronary venous bypass procedure. Closure of the chest altered systolic and diastolic components of flow velocity and CBGF decreased from 131 +/- 65.8 to 94 +/- 55 ml/min (-28%; p less than .01). Comparison between early postoperative values (intensive care unit) and values 6 days later showed significant increases in diameter from 4.2 +/- 0.9 to 5.3 +/- 0.9 mm (p less than .01) and in CBGF from 130 +/- 112 to 204 +/- 86 ml/min (p less than .01). We conclude that the implantable pulsed Doppler microprobe is a sensitive bedside method for monitoring aortocoronary bypass graft diameter and blood flow in the postoperative period.

Blood Flow Velocity↗
PubMed1999

[A new concept for treatment of supraventricular tachycardia after heart operations: low energy internal cardioversion using a temporary atrial electrode].

Supraventricular tachycardia (SVT) is a common complication early after cardiac surgery. A novel temporary atrial patch electrode (TAPE) for low energy atrial defibrillation was first implanted for intraoperative testing and subsequently removed during open heart surgery in 10 patients (Phase I). After the intraoperative testing period, the TAPE was implanted in 20 patients for postoperative termination of spontaneous episodes of supraventricular tachycardia (Phase II). In case of supraventricular tachycardia (SVT), biphasic shocks (1.2-5.0 J) were applied, measuring the atrial defibrillation thresholds. Phase I: The mean intraoperative atrial defibrillation threshold was 1.6 +/- 1.4 J with a mean shock-impedance of 64.0 +/- 7.3 Ohms. Phase II: Postoperatively, 6 out of 20 patients (30%) developed 7 episodes of atrial fibrillation (n = 6) and atrial flutter (n = 1). In 5 patients, SVT could be converted to sinus rhythm (n = 5) or junctional rhythm (n = 1). The mean postoperative defibrillation threshold (DFT) was 2.7 +/- 2.1 J with a mean shock-impedance of 50.2 +/- 6.8 Ohms. In conclusion, the TAPE allows low-energy defibrillation of atrial fibrillation. It seems to be a useful alternative in the treatment of supraventricular tachycardia.

Adult↗
PubMed2002

Anaesthetic management and outcome in right-lobe living liver-donor surgery.

BACKGROUND AND OBJECTIVE: We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation. METHODS: After preoperative psychiatric evaluation, eight ASA I-II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8-1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma--four lesions, involving both liver lobes--of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h(-1) and sufentanil 0.3 microg kg(-1) intravenously; cisatracurium, 0.15 mg kg(-1), was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (<80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived. RESULTS: Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525-780)min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5-25)h after arrival. The estimated blood loss was 967 (550-1,600)mL. No homologous blood was administered; five donors received autologous blood, intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1,472 (700-3100)mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately postoperative haemoglobin concentration averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0)gdL(-1), respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4-15.1)gdL(-1). The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1-3) days. The hospital stay was 13 (7-17) days. There was no morbidity or mortality. CONCLUSIONS: The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.

Adult↗
PubMed1987

Arterial oxygen desaturation during postoperative transportation: the influence of operation site.

Arterial oxygen saturation in 132 patients was measured using a Biox IV oximeter with an ear probe, during transfer from theatre to recovery room following a variety of surgical procedures. Oxygen saturation decreased to 85% or less in 21.9% of patients and to 90% or less in 61.4%. No predictive factors were identified. It is recommended that supplementary oxygen be given to all patients in the immediate postoperative period, including the period of transit to the recovery room.

Adolescent↗
PubMed1997

Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children.

Functional hemispherectomy techniques have been designed to minimize the long-term complications of anatomical resection without reducing the effectiveness of seizure control. The authors have used an ultrasound-guided approach tailored to combine temporal lobectomy with frontal and occipital disconnections with a central topectomy of the lateral, insular, and interhemispheric cortex. This technique achieves a comprehensive functional disconnection and minimizes entrance and manipulation within the body of the lateral ventricle. Eight patients ranging in age from 10 months to 23 years with congenital paresis and medically intractable seizures underwent functional hemispherectomy via this technique. The average surgical time was 4.5 hours, and blood loss ranged from 90 to 400 ml. All but one patient was discharged after 5 days. Postoperative fever syndromes, aseptic meningitis, and infection were avoided. On long-term follow-up evaluation (range 18-60 months, mean 38 months), seven of eight patients remain seizure free and were not on a course of anticonvulsant agents. Advantages of this technique include avoiding entrance into the ventricle, a more predictable postoperative period, and reduced postoperative complications.

Adolescent↗
PubMed1987

Fluid and electrolyte concerns in intestinal surgical procedures.

All surgical patients are at risk for fluid and electrolyte imbalances. This risk increases when a patient undergoes intestinal surgery, because of the role of the gastrointestinal system in providing the body with water and electrolytes. Therefore, throughout the perioperative period the nurse acts to prevent such disturbances. The nurse who is aware of preoperative factors that contribute to fluid and electrolyte imbalances, including pre-existing patient factors, iatrogenic causes, and the body's response to stress, can help prevent disastrous intraoperative events. Furthermore, postoperative patient assessment can prevent complications such as fluid overload and potassium and sodium imbalances.

Fluid Therapy↗
PubMed1987

Hemodynamic effects of portal triad clamping in humans.

The hemodynamic effects of portal triad clamping (PTC) were studied in 48 adult patients scheduled for elective liver resection. Prior to hepatic resection the effects of a short period of PTC (3-5 min) were evaluated in all 48 patients: mean arterial pressure increased 21%, whereas pulmonary capillary wedge pressure and cardiac index decreased 10 and 17%, respectively. Systemic vascular resistance increased 48%. In 34 patients a liver resection was performed during PTC and hemodynamic measurements were repeated throughout the duration of liver ischemia, which ranged from 14 to 68 min. Hemodynamic changes occurred in the first 3 min and persisted thereafter. After releasing the clamp, hemodynamic parameters returned to initial values in 3 min. These results confirm that PTC does not induce the cardiovascular collapse in humans that it does in common laboratory animals and demonstrate that humans tolerate PTC for periods up to 1 hr.

Adult↗
PubMed1992

The effects of hypothermia and injury severity on blood loss during trauma laparotomy.

To assess the relationships between core temperature (T) and other factors relating to operating room (OR) blood loss and mortality following abdominal injury, the records of 122 patients undergoing laparotomy for trauma at Detroit Receiving Hospital over a 1-year period (1989) were reviewed. Most injuries were penetrating (86%) and the mortality rate was 8.2%. Overall, 57 of 122 (47%) had hypothermia (T < or = 35 degrees C) upon arrival in the OR. There was a significant correlation between admission blood pressure and lowest intraoperative temperature (r = 0.60; p < 0.001). Multiple regression analysis revealed that the patient's lowest temperature (p < 0.001) and Trauma Score (TS); p < 0.0015), but not Abdominal Injury Severity Score (AISS) (p = 0.25) correlated with OR blood loss. The 28 patients with high TS (15 or 16) and AISS > or = 9 had significantly less blood loss when the OR temperature was maintained above 35 degrees C versus 33 degrees-35 degrees C (540 +/- 580 mL vs. 1820 +/- 1160 mL; p < 0.003). This suggests that hypothermia may exacerbate OR blood loss independent of degree of physiologic or anatomic injury. Thus hypothermia is common in patients undergoing a laparotomy for trauma. Trauma scores and the presence of shock preoperatively correlate with the development of intraoperative hypothermia. Hypothermic patients with similar injury severity have greater blood loss. Prevention and rapid correction of hypothermia during resuscitation and surgery appear to be extremely important in reducing blood loss in this patient population.

Abdominal Injuries↗
PubMed1997

Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation.

BACKGROUND: Epidural analgesia before limb amputation is commonly used to reduce postamputation pain. But there have been no controlled studies with large numbers of patients to prove such a pre-emptive effect. We investigated whether postamputation stump and phantom pain in the first year is reduced by preoperative epidural blockade with bupivacaine and morphine. METHODS: In a randomised, double-blind trial, 60 patients scheduled for lower-limb amputation were randomly assigned epidural bupivacaine (0.25% 4-7 mL/h) and morphine (0.16-0.28 mg/h) for 18 h before and during the operation (29 patients; blockade group) or epidural saline (4-7 mL/h) and oral or intramuscular morphine (31 patients; control group). All patients had general anaesthesia for the amputation and were asked about stump and phantom pain after 1 week and then after 3, 6, and 12 months by two independent examiners. Study endpoints were rate of stump and phantom pain, intensity of stump and phantom pain, and consumption of opioids. FINDINGS: Two patients in each group were withdrawn before amputation. The groups were well matched in baseline characteristics. Median duration of preoperative saline treatment was 18.5 h (IQR 17-20). Median duration of preoperative epidural blockade in the blockade group was 18 h (15-20.3). The combined median duration of postoperative epidural pain treatment in both groups was 166 h (89.3-308.3). After 1 week, 14 (52%) patients in the blockade group and 15 (56%) in the control group had phantom pain (95% CI - 30.6 to 22.7, p = 0.9). The figures for blockade versus control group were: 14 (82%) vs ten (50%; 4.0 to 60.8, p = 0.09) at 3 months; 13 (81%) vs 11 (55%; -2.7 to 55.3, p = 0.2) at 6 months; and nine (75%) vs 11 (69%; -27.0 to 39.6, p = 1.0) at 12 months. Intensity of stump and phantom pain and consumption of opioids were similar in both groups at all four postoperative interviews. INTERPRETATION: Perioperative epidural blockade started a median of 18 h (15-20.3) before the amputation and continued into the postoperative period does not prevent phantom or stump pain.

Analgesia, Epidural↗
PubMed1989

Metabolism of D lactate in patients receiving hypertonic sodium lactate solution.

The use of hypertonic saline solutions for resuscitation of patients with a decreased extracellular fluid volume is generating more clinical interest. One of the solutions, hypertonic lactated Ringer's solution (HLS), contains lactate in both the D(-) and L(+) forms. Because humans lack D lactate dehydrogenase, the metabolism of D lactate in patients receiving large amounts of lactate in a clinical setting was examined. Three patients undergoing extensive aortic surgical procedures and receiving HLS for replacement of perioperative fluid loss were studied. These patients were given an average of 27 grams of D lactate in a 24 hour period and excreted 8 per cent of the total dose in the urine. The average maximum elevation of D lactate in the serum of 3.53 millimoles per liter. Pharmacokinetic analysis revealed a half-life of D lactate in the serum of 36.4 minutes. The volume of distribution was 20 per cent of the body weight. These results demonstrate that D lactate is metabolized rapidly even when given in large amounts to humans during the perioperative period. Whether or not this metabolism occurs during hypoperfusion is not known.

Aorta↗
PubMed1998

Evaluation of perioperative myocardial tissue damage in ischemically preconditioned human heart during aorto coronary bypass surgery.

BACKGROUND: Preconditioning myocardium with short periods of ischaemic stress interspersed with reperfusion increases its resistance to infarction. Ischaemic preconditioning protection occurred in human beings during unstable angina preceding myocardial infarction, during percutaneous transluminal coronary angioplasty and during aorto coronary bypass surgery. The purpose of this study was to test (utilised cardiac troponin T measurement) whether ischaemic preconditioning was able to protect myocardial tissue during the perioperative period and how long that protection lasted. METHODS: Patients were recruited to the preconditioned group (n=29), received 4-min of aortic cross-clamping and 6 min reperfusion prior to CABG performed with intermittent ischaemic arrest and the control group (n=27) received only an ischaemic insult of operating procedure. TnT measurements were determined from blood samples taken before surgery (A), 1 hour after onset of CPB (B), 4 hours (C), 8 hours (D), 12 hours (E), 24 hours (F), 48 hours (G) and 72 hours after CPB (H). RESULTS: Results were expressed as the median, range and standard deviation (SD) of TnT concentration (microg/l). Ischaemic preconditioning decreased TnT concentration with statistical significance 1 hour after onset of CPB (preconditioned B: median 0.12+/-0.25 vs control B: median 0.32+/-0.43, p=0.03). There were notable differences in TnT concentration in C, D, E, F, G, H blood samples between the control and the preconditioned group but with p value of no statistical significance. CONCLUSIONS: These data illustrate that ischaemic preconditioning limits myocardial damage during operative procedure and it may probably afford protection during a postoperative period.

Aged↗
PubMed2003

Burch colposuspension performed at cesarean delivery in pregnancies complicated by genuine stress urinary incontinence.

OBJECTIVE: To investigate the efficiency and reliability of performing Burch colposuspension at the time of cesarean delivery for genuine stress urinary incontinence diagnosed before pregnancy. STUDY DESIGN: Eight women diagnosed with genuine stress urinary incontinence before pregnancy were included in this prospective, descriptive study. They underwent Burch colposuspension at the time of elective cesarean delivery. Sociodemographic characteristics of the patients, total operation time, intraoperative blood loss, amount of fluid flowing from the hemovac drain in the space of Retzius, postoperative analgesic need and length of hospitalization were recorded. Patients were reevaluated on postoperative week 6, as well as at 6 and 12 months. The descriptive statistics of the patients were performed using the SPSS 9.0 statistical program (SPSS, Chicago, Illinois). RESULTS: Total operation time was 37 +/- 7 minutes, average intraoperative blood loss was 345 +/- 23 mL, amount of serosanguineous fluid flowing from the hemovac drain placed in the space of Retzius was 31 +/- 3.6 mL, and the length hospitalization was 5 +/- 0 days. None of the patients needed additional analgesics during the postoperative period. No intraoperative or postoperative complications occurred. When the patients were evaluated during follow-up, they had no symptoms of incontinence. The cotton-tipped-swab and stress test findings were normal. CONCLUSION: The results of this pilot study indicate that Burch colposuspension performed at the time of cesarean delivery for genuine stress urinary incontinence diagnosed before pregnancy is effective and reliable.

Adult↗
PubMed1993

Does platelet size correlate with function in patients undergoing cardiac surgery?

OBJECTIVE: Platelet dysfunction secondary to cardiopulmonary bypass (CPB) is one of the major reasons for nonsurgical post-operative bleeding in cardiac surgery. Whether platelet size is an indicator for platelet function was investigated in patients undergoing coronary artery bypass grafting. DESIGN: Prospective study. SETTING: Intra-operative, cardiac surgery operations. PATIENTS: 80 consecutive patients undergoing coronary artery bypass grafting. Excluding criteria were pre-operative coagulation disorders and medication with anticoagulants within the last 10 days before the operation day. MEASUREMENTS AND RESULTS: Platelet function was assessed by aggregometry using a turbidimetric method (inductors: ADP 2.0 mumol/l, collagen 4 micrograms/l, epinephrine 25 mumol/l). Mean platelet volume (MPV) was measured by an electrical conductivity method. Measurements were carried out before, during, and after CPB until the 1st post-operative day on intensive care unit (ICU). Platelet size decreased significantly during CPB (max. -25% after weaning from bypass) and returned to baseline values on the 1st post-operative day. Platelet count (ranging from 93 - 304 x 10(9)/l) did not correlate significantly with MPV or aggregation variables. Maximum aggregation and maximum gradient of aggregation induced by ADP and collagen were significantly decreased by CPB with the most pronounced reduction at the end of CPB (ranging from -25% to -45%). Analyses of co-variance revealed a significant correlation between changes in MPV and changes in aggregation variables (ADP, collagen). CONCLUSIONS: Platelet volume is easy to measure even in the operation room or in ICU and may indicate abnormalities in platelet function in the post-bypass period of cardiac surgery patients.

Adult↗
PubMed1988

Simplified peroperative placement of temporary right atrial pacing leads.

A simple technique for securing right atrial pacing leads is described. The method relies on pressure fixation by haemostatic clips. Clinical experience over a 2 year period has demonstrated that this system provides safe, reliable and rapid lead attachment. No problems with lead removal have been encountered.

Cardiac Pacing, Artificial↗
PubMed1984

Perioperative beta blockade with propranolol: reduction in myocardial oxygen demands and incidence of atrial and ventricular arrhythmias.

To determine the effect of beta blockade with propranolol on myocardial oxygen demands and postoperative arrhythmias in patients having coronary bypass operations, 50 patients with chronic stable angina undergoing operation were randomized in a double-blind fashion to receive either propranolol (60 mg every 6 hours) or a placebo. Drug administration began 24 to 48 hours prior to operation and continued through the operative period and for one month after operation. There were no deaths. Two perioperative myocardial infarctions occurred, both in patients receiving a placebo. Myocardial oxygen demand as measured by the rate-pressure product (heart rate X mean arterial pressure) was significantly reduced during induction of anesthesia (7,658 +/- 451 versus 5,786 +/- 340; p less than 0.002) and during sternotomy (8,400 +/- 550 versus 6,756 +/- 384; p less than 0.02) in propranolol-treated patients. In the first two postoperative days, nitroprusside was required for control of hypertension of 10 patients in the placebo group but in only 3 patients given propranolol (p less than 0.05). Postoperatively, 15 of the 26 patients who received a placebo had 45 episodes of arrhythmia. Seven of the 24 propranolol-treated patients had 17 episodes (p less than 0.04). We conclude that propranolol given perioperatively in doses large enough to induce beta blockade significantly reduces myocardial oxygen demands in the vulnerable period during induction of anesthesia and sternotomy, reduces the need for antihypertensive therapy in the immediate postoperative period, and causes a marked reduction in the incidence and frequency of both supraventricular and ventricular arrhythmias in the postoperative period.

Angina Pectoris↗