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 55 records · Page 3Linked to original sources
PubMed1998

[Phenomenon of preoperative stress in patients with ischemic heart disease. Assessment of its clinical and prognostic significance].

AIM: To assess preoperative stress in patients with ischemic heart disease (IHD) and its influence on the course of early intraoperative period. MATERIALS AND METHODS: 79 patients scheduled for aortocoronary bypass operation were studied to assess the phenomenon of preoperative psychoemotional stress (clinical characteristics, personal anxiety, humoral and vegetative regulation. RESULTS: 24 hours before operation IHD patients became anxious, coronary insufficiency and arrhythmia aggravated as shown by Holter ECG monitoring. Initial insufficiency of the antioxidant system, disturbances of the platelet-vascular hemostasis, hyperlipidemia and dyslipoproteinemia enhanced. Preoperative changes due to stress reaction affected the course of early intraoperative period. CONCLUSION: It is necessary to apply individual schemes of stress-limiting preoperative preparation in IHD patients.

Adult↗
PubMed2003

Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy.

OBJECTIVE: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. MATERIAL AND METHODS: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I (n = 30) received oral ephedrine 50 mg in addition to premedication whilst those in Group II (n = 30) received only premedication 30 min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 mmHg and <20% of baseline value. Hypotension was treated with 3 mg ephedrine and bradycardia was corrected with atropine 0.5 mg, given as an i.v. bolus. RESULTS: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods (p < 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 +/- 0.97 mg in Group I and 8.86 +/- 1.24 mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p = 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. CONCLUSIONS: We conclude that a prophylactic oral dose of ephedrine 50 mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.

Administration, Oral↗
PubMed2002

The use of the cuffed oropharyngeal airway in paediatric patients.

BACKGROUND: The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suitable for anaesthetized adult patients undergoing either spontaneous or mechanical ventilation. There are few reports on the use of the COPA in children. In this study, the authors assessed the COPA in paediatric patients undergoing minor surgery. METHODS: The same anaesthesiologist inserted the COPA in 40 consecutive paediatric patients, ASA I and II, aged 1.8-15.3 years. (7.4 +/- 3.9), after induction of anaesthesia with N2O/O2/sevoflurane. COPA size was chosen by measuring the distal tip of the device at the angle of the jaw with the COPA perpendicular to the patient's bed. The proper positioning of the COPA was assessed by observing thoracoabdominal movements, regular capnograph trace, the reservoir bag movements and SpO2 > 94% with a fraction of inspired oxygen of 0.5. Anaesthesia was maintained with 1 MAC halothane, sevoflurane, or isoflurane in N2O/O2 (50%) and the patients were spontaneously breathing. The stability of the COPA following changes in head, neck and body position was tested. We recorded the duration time for COPA insertion, the side-effects of placement of the COPA and during the intraoperative period, the number of attempts, the type of manipulation in order to provide an effective airway and postoperative symptoms, such as the presence of blood on the device, sore throat, neckache, jaw pain and PONV. RESULTS: Successful COPA insertion at the first attempt was 90% and at the second attempt in the remaining 10%. The most frequent airway manipulations were head tilt in 27.5% (obtained by a pillow under shoulders) and chin lift in 5%. No complications both at COPA placement nor during the intraoperative period were observed. On the basis of weight and age, the COPA size was no. 8 in 50%, no. 9 in 30%, no. 10 in 12.5%, and no. 11 in 7.5%. The COPA demonstrated stability after changes in head, neck and body position. Postoperative complications were the presence of blood stains in one case and PONV in six cases (15%). CONCLUSIONS: The COPA is an extratracheal airway device suitable in paediatric patients undergoing general anaesthesia with spontaneous ventilation for minor surgery and other painful procedures. This study shows that for paediatric patients: (i) complications seem to be rare; (ii) the COPA allows hands free anaesthesia; (iii) specific indication for the COPA could be obese patients with a small mouth; and (iv) COPA sizing can be easily established by the weight or age of the patients.

Adolescent↗
PubMed2006

The effect of passive foot flexion on blood circulation in sports and clinical medicine.

UNLABELLED: The aim of the study was to analyze the effect of the passive foot flexion on peripheral and systemic blood circulations in the state of rest of persons adapted to endurance physical loads, and on patients during surgery. METHODS: In the first series of experiments which included 16 males in recumbent supine position adapted to endurance physical loads, the effect of the passive foot flexion by applying a leg muscle activator on the systemic and peripheral blood circulations was analyzed. In the second series of experiments conducted with 6 males and 12 females, the passive foot flexion was aimed at preventing thromboembologenesis during the intraoperative period. RESULTS: After a session of the passive foot flexion applied to persons adapted to endurance physical loads, the venous reserve volume in them increased to 1.68+/-0.3 mL/100 mL (p<0.05). The maximal venous emptying rate increased to 48.3+/-8.8 mL/100 mL/min (p<0.05). After 15 min of the passive foot flexion, the indices of the systemic blood circulation were analogous to the ones before passive foot flexion. The maximal venous emptying rate in the calves of the left and right legs at the end of the surgery decreased to 59.7+/-4.7 mL/100 mL/min (p>0.05) and to 62.9+/-4.0 mL/100 mL/min (p>0.05), respectively. CONCLUSIONS: The passive foot flexion applied to persons adapted to endurance physical loads increases venous reserve volume and maximal venous emptying rate. During the intraoperative period, the passive foot flexion increases maximal venous emptying rate from the triceps muscle of the calf thus decreasing the possible danger of thromboembologenesis.

Adult↗
PubMed1999

Comparison of adenosine and remifentanil infusions as adjuvants to desflurane anesthesia.

BACKGROUND: Because adenosine has been alleged to produce both anesthetic and analgesic sparing effects, a randomized, double-blinded study was designed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major gynecologic procedures. METHODS: Thirty-two women were assigned randomly to one of two drug treatment groups. After premedication with 0.04 mg/kg intravenous midazolam, anesthesia was induced with 2 micro/kg intravenous fentanyl, 1.5 mg/kg intravenous propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desflurane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infusion of either remifentanil (0.02 microg x kg(-1) x min(-1)) or adenosine (25 microg x kg(-1) x min(-1)) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10-15% of the preincision values. RESULTS: Adenosine and remifentanil infusions were effective anesthetic adjuvants during lower abdominal surgery. Use of adenosine (mean +/- SEM, 166+/-17 microg x kg(-1) x min(-1)) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean +/- SEM, 0.2+/-0.03 microg kg(-1) x min(-1)). Total postoperative opioid analgesic use was 45% and 27% lower in the adenosine group at 0-2 h and 2-24 h after surgery, respectively. CONCLUSIONS: Adjunctive use of a variable-rate infusion of adenosine during desflurane-nitrous oxide anesthesia was associated with acceptable hemodynamic stability during the intraoperative period. Compared with remifentanil, intraoperative use of adenosine was associated with a decreased requirement for opioid analgesics during the first 24 h after operation.

Adenosine↗
PubMed1995

Compartment pressure monitoring during intramedullary fixation of tibial fractures.

Twenty-six legs in 25 patients were monitored prospectively for compartment pressures during intramedullary nailing of open and closed tibial shaft fractures. Twenty-three patients were treated within 24 hours of admission. Twenty-three unreamed and three reamed intramedullary rods were utilized. Compartment pressures were measured initially, following fracture reduction, and during reaming. Pressures were also measured at the completion of nailing with the ankle dorsiflexed and at rest (plantar flexed) to determine positional effects on compartment pressures. Nine fractures (35%) were found to have persistently elevated pressures (> 40 mm Hg) and underwent immediate four-compartment fasciotomy. The remaining group of 17 fractures (65%) was monitored throughout the intraoperative period. No patient monitored intraoperatively developed postoperative compartment syndrome.

Adolescent↗
PubMedDate not supplied

[Recovery Room. Organization and clinical aspects].

Correct administration in the early postoperative phase is decisive in the final outcome of surgery and the presence of the Recovery Room (RR) contributes significantly to a reduction in the post-operative risk rate. The objectives of the RR are: removal of the pharmacological effect of general anaesthesia; stabilization of vital parameters (circulation and ventilation); stabilization of body temperature; control of the hydro-electrolytic balance; intensive intervention in the case of an acute complication; prescribing a suitable postoperative analgesia; recovering movement in the case of loco-regional anesthesia. Organization of RR must take into consideration: 1) aspect of environment and location; 2) transport of the patient from the operating room to the RR; 3) definition of the equipment necessary for the RR; 4) definition of the role and qualification of the medical and nursing staff; 5) definition of regulations of assistance and the clinical file; 6) definition of criteria for discharge and transfer; 7) definition of means of adjournment, improvement and comparison with other similar structures. RR is administered by an Anesthetist with clinical, therapeutic and decision-making responsibility for the discharge of patients, while the supervision and assistance patients is entrusted to specialised professional nurses. From a clinical point of view the following data are monitored and recorded: the vital signs (passage of air-ways, cardiac and respiratory frequency, arterial pressure, saturation of O2, EtCO2 (in patient with air-way support), body temperature and the state of consciousness, instrumental monitoring of the patient (at pre-established time intervals), control of the skin, the peripheral circulation, surgical wounds, drainage and catheters. The percentage of incidence of complications in RR varies from 6-7 to 30% depending on various studies, probably in relation to the diversity of criteria in defining the complication. The principal complications which can be found in RR, reported in several studies are: respiratory (obstruction of the air-way, hypoxemia, hypoventilation, inhalation), cardio-circulatory (hypotension, hypertension, arrhythmia, myocardial ischemia), postoperative nausea and vomiting, hypothermia and hyperthermia, delayed re-awakening, disorientation and hyper-excitability, postoperative shivering. As long as the patient can be discharged from the RR the following requisites must be satisfied: return of a state of consciousness, stable cardio-circulatory parameters, absence of respiratory depression, absence of bleeding, absence of nausea and vomiting, good analgesia and recovery of movement in the case of loco-regional anesthesia (on this last point not all authors agree). What has been said until now shows the function, usefulness and importance of RRs which must not replace the Intensive Therapy Units. In fact, they are places where the cure must be concluded, in which the Anesthetist is responsible for the whole process. This cure must begin in the preoperative period, continue in the intraoperative period and it is compulsory to proceed in the immediate postoperative period until such a time that, because of the anesthesia administered, the clinical situation of the patient ceases to be considered a potential medical-surgical urgency-emergency .

Anesthesiology↗
PubMed1996

[The effect of convection warming during abdominal surgery on the early postoperative heat balance].

UNLABELLED: Hypothermia (core temperature < 36 degrees C) is common after longer-lasting surgical procedures. Heat loss mainly occurs during anaesthesia and surgery and leads to increased risk, especially in the early recovery period of elderly patients. In the present study we investigated the effects of intraoperative forced-air warming, administered via an upper-body blanket ("Warm Touch", Mallinckrodt, USA), with the specific aims of: (1) drawing up heat balances; and (2) analysing postoperative thermoregulation, oxygen consumption (VO2) and cardiovascular reactions of mechanically ventilated patients. The general aim of our study was to compare intraoperative forced-air-warming and conventional patient-insulation with cotton blankets. METHODS: Twenty four ASA II and III patients scheduled for elective colon surgery were randomly assigned to a control group (n = 12, no warming therapy, upper body covered with a cotton hospital blanket) or a convective warming group (n = 12). Anaesthesia was administered with etomidate (0.2 mg/kg), fentanyl (approximately 10 micrograms/kg) and vecuronium bromide (0.1 mg/kg). During surgery the lungs were mechanically ventilated with 70% nitrous oxide in oxygen and enflurane (end-tidal-concentration max. 0.7%) using a semiclosed circuit with a fresh gas flow of 3 l/min. A hygrophobe heat and moisture exchanger ("Sterivent," Darex Corp., Italy) was used. At the end of surgery patients were transferred to the ICU, covered with a hospital cotton-quilt and normo-ventilated using a Bennett 7200 a. Patients were sedated/kept free of pain by administering titrated doses of midazolam and/or piritramide. Postoperative oxygen consumption (VO2) was recorded continuously with a Deltatrac Metabolic Monitor (Datex Corp., Finland). Pre-, intra- and postoperative measurements included heart rate, invasive blood pressure, core-temperature (before and after operation: urinary bladder-temperature, during surgery: oesophageal temperature) and mean-skin-temperature (according to Ramanathan) up to 180 min from the end of surgery. Shivering, pharmacological interventions (e.g. pethidine) and time of extubation were noted. Data are presented as median, minima and maxima. The results were analysed using the Mann-Whitney U test or Chi-Square test (shivering). Statistical significance was assumed when P < 0.05. RESULTS: Both groups were comparable for gender, body weight, height, age, duration of their operations and amount of intraoperative fluids, narcotics and muscle relaxants. Room temperatures in the control group were significantly higher than in the forced air group (24 vs 22 degrees C). Initial setting of the forced-air blower was "high" (42-46 degrees high air flow). When the oesophageal-temperature reached 36.5 degrees C, the blower temperature was reduced to 36-40 degrees C. Reduction was necessary approximately 60 min from start in the operation. At the end of surgery/administration to the ICU core-temperatures of both groups differed significantly (35.2/ 35.4 degrees C vs 36.3/36.2 degrees C). Mean-skin temperatures were higher, too, but no statistical analysis was carried out for the intraoperative period, because warm air influenced skin thermometers located on the upper body. At admission to the ICU patients in the control group had a heat loss of 4.4 kJ/kg; those in the convective warming group had a heat-gain of 0.8 kJ/kg. Further measurements of postoperative core temperatures did not differ significantly, but the skin-temperatures of patients who received forced-air warming in the theatre remained higher (P < 0.05) until 120 min from the end of surgery. Shivering was more frequent and lasted longer in the control group (8 patients, 20 min vs 4 patients, 9 min; P < 0.05). Patients in the control group needed more drugs to stop increased cardiovascular reactions (hypertension, tachycardia) or shivering.(ABSTRACT TRUNCATED)

Adult↗
PubMed1985

Continuous polarographic monitoring of intra-arterial oxygen in the perioperative period.

Intra-arterial PO2 (PiO2) was polarographically monitored in ten critically ill patients during induction of anesthesia, the intraoperative period, extubation, and the immediate postoperative period; 147 PiO2 values were then paired with simultaneous measurements of PaO2. Mean PiO2 closely followed mean PaO2 over a wide range of values (r = .97), and the continuous, online real-time PiO2 readings provided a useful early warning system for hypoxemia during crisis periods. Technical problems included catheter clotting from improper flushing, changes in PiO2 due to changes in body temperature, the need for in vitro and in vivo calibration, and sensor drift. However, these problems were resolved by appropriate catheter management and sensor calibration.

Blood Gas Analysis↗
PubMedDate not supplied

Operative results in 143 patients with hepatocellular carcinoma.

A total of 143 patients who underwent hepatic resection for hepatocellular carcinoma in our department were reviewed. The review was conducted for two periods: 1970-1982 (early period) and 1983-1990 (late period), that is, the periods before and after introduction of the hepatic surgical technique involving the use of a microwave tissue coagulator and ultrasonic dissector. One patient underwent extended lobectomy, 12 lobectomy, 9 segmentectomy, and 26 partial hepatectomy during the early period. Two patients underwent extended lobectomy, 7 lobectomy, 9 segmentectomy, 36 subsegmentectomy, and 41 partial hepatectomy during the late period. Operative mortality and hospital mortality were 16.7% and 22.9% during the early period and 1.1% and 8.4% during the late period, respectively. The overall mortality rate was significantly lower during the late period than during the early period. Postoperative complications developed in 62.5% of the patients with hepatic resection during the early period and in 48.4% of the patients during the late period. The size of tumors during the early period was significantly greater than that during the late period. Intraoperative blood loss during the late period was significantly lower than that during the early period. The survival curve was better among patients who underwent hepatic resection during the late period than among those during the early period. The satisfactory results during the late period are due to the introduction of intraoperative ultrasonography, microwave tissue coagulation, and ultrasonic dissection for hepatic surgery.

Adolescent↗
PubMed1999

The safety and effectiveness of esmolol in the perioperative period in patients undergoing abdominal aortic surgery.

OBJECTIVES: To determine (1) if perioperative use of esmolol in major vascular surgery patients provides strict heart rate (HR) control, (2) what doses of esmolol are required to do this, and (3) does this control influence myocardial ischemia or result in adverse consequences. DESIGN: Prospective study of 40 patients randomized to two groups: The HR was controlled to either less than 80 beats/min (group 80) or less than 110 beats/min (group 110) using esmolol. Patients were monitored continuously for electrocardiographic changes perioperatively. HR control began after induction of anesthesia and continued for 48 hours thereafter. SETTING: Operating room and intensive care unit. PATIENTS: Patients undergoing abdominal vascular surgery involving aortic cross-clamping. INTERVENTIONS: Esmolol was titrated until the target HR was met. MEASUREMENTS AND RESULTS: Only one patient demonstrated an adverse effect. The median infusion rates were 100 and 12.5 microg/kg/min for groups 80 and 110. Target HR was met less in group 80 than in group 110, primarily in the postoperative period. Ischemia patterns were not significantly different between groups. CONCLUSION: Using esmolol for HR control in the intraoperative period for abdominal vascular surgery patients is effective and safe. HR control was much less effective in the postoperative period, but esmolol is safe when used at recommended doses. Further study with a larger number of patients is necessary to determine whether strict HR control with esmolol affects the incidence of myocardial ischemia or infarction in this patient population.

Adrenergic beta-Antagonists↗
PubMed1992

Perioperative myocardial ischemia and infarction.

The association between perioperative myocardial ischemia and infarction has clearly been established. In patients undergoing CABG, myocardial ischemia that occurs during the intraoperative period has the strongest correlation with perioperative MI. In noncardiac surgery, myocardial ischemia during the postoperative period is more significantly associated with ischemic cardiac morbidity than is ischemia that develops pre- or intraoperatively. Much of the descriptive phase of this research is complete. It is important next to determine the etiology of perioperative myocardial ischemia and to design treatment regimens that will tell us whether MI is merely associated with perioperative ischemia or is also the cause of cardiac morbidity.

Coronary Disease↗
PubMed2002

Clonidine as coadjuvant in eye surgery: comparison of peribulbar versus oral administration.

STUDY OBJECTIVE: To determine whether the administration of peribulbar or oral clonidine would enhance analgesia and anesthesia in ophthalmologic surgery. DESIGN: Randomized double-blind study. SETTING: Teaching hospital. PATIENTS: 60 ASA physical status I and II adult patients scheduled for unilateral ophthalmologic surgery with peribulbar block. INTERVENTIONS: Patients were assigned to one of 4 groups, and premedicated with oral 2 mL volume (clonidine or placebo). The peribulbar eye block consisted of local anesthetics plus 1 mL of the test drug. The control group (CG) received oral saline as premedication and peribulbar saline as the test drugs. The clonidine eye group (Clo-eye G) received oral saline and peribulbar 30 microg clonidine. The clonidine oral group (Clo-oral G) received oral 150 microg clonidine and peribulbar saline. The clonidine eye+oral group (Clo eye+oral G) had oral 75 microg clonidine and peribulbar 15 microg clonidine. MEASUREMENTS AND MAIN RESULTS: Perioperative assessment included anesthesia, analgesia, blood cortisol; and adverse effects. The groups were demographically similar. The latency time to the onset of the peribulbar block was shorter in the Clo-eye G compared to the CG (p < 0.05). The CG presented higher blood pressure levels throughout surgery, compared to the others (p < 0.05). The time to first rescue analgesics was longer in all patients who received peribulbar clonidine compared to the CG (p < 0.05). Analgesic consumption was lesser in the Clo-eye G compared to the CG (p < 0.05). The blood cortisol level was higher during the intraoperative period in all groups (preoperative vs. intraoperative values) (p < 0.01). CONCLUSION: Despite the higher intraoperative blood cortisol levels, 30 microg peribulbar clonidine decreased the onset time to anesthesia, while 15 and 30 microg peribulbar clonidine prolonged the time to first rescue analgesics in patients under peribulbar block, without increasing the frequency of adverse effects. Conversely, oral administration of clonidine alone did not enhance anesthesia or analgesia following eye block, suggesting a local mechanism of action of clonidine.

Adjuvants, Anesthesia↗
PubMed1991

Flow cytometric detection of tumor metastases during urologic surgery.

Flow cytometric studies were performed on peripheral blood obtained before, during, and subsequent to urologic surgery. The results suggest that 7 of 11 patients had a brief period during surgical manipulation when they had cells from the primary surgical site in the peripheral blood. Concentration of such cells was generally less than 10(2)/mL even during the intraoperative period. These findings suggest that perioperative tumor seeding is a real concern, and that flow cytometry can be used to study maneuvers to reduce its incidence.

DNA, Neoplasm↗
PubMed1988

Global tests on coagulation and fibrinolysis in systemic and pulmonary circulation accompanying hip arthroplasty with acrylic cement.

Sudden cardio-respiratory collapse (CRC) within seconds after implantation of methylmethacrylate cement and femoral prosthesis during hip replacement surgery, accounted at our hospital among 315 patients for a mortality of 0.6%. This prompted our pathophysiological studies concentrating on the critical intraoperative period for this complication. This series of 6 patients with osteoarthrosis was followed with established parameters on coagulation and fibrinolysis in arterial and mixed venous blood withdrawn frequently during and after total hip arthroplasty. The surgical procedure induced activation in both systems as evidenced by a gradual and statistically significant drop in level of blood platelets, fibrinogen, vitamin K dependent clotting factors. At the end of operation soluble fibrin and moderately elevated concentrations of FDP/FRA were demonstrated. The results were similar in corresponding arterial and mixed venous blood specimens. The perioperative changes were not potentiated by the introduction of cement and the implantation of the prosthetic components. The postoperative changes had the same pattern and the same magnitude as those following other types of major surgery. The present results do not indicate marked alterations in coagulation and/or fibrinolysis in the critical period for CRC to develop.

Blood Coagulation↗
PubMed1994

Bi-ventricular function assessed intraoperatively before and after anatomical correction of transposition of the great arteries.

After anatomical correction of transposition of the great arteries (TGA), the left ventricle (LV) is forced to develop systemic pressures without having had time for adaptation. Thus, one might expect dilatation of the LV at least in the very early intraoperative period following the operation. In nine patients with TGA aged 8-24 days (median 9.5 days) which were selected for arterial switch operation (ASO), Dacron-patch mounted thin piezoceramic transducers were attached intraoperatively by fibrin glue to opposite epicardial surfaces of the right (RV) and/or LV for continuous assessment of external minor diameters (RVD, LVD; sonomicrometry) before and after correction. Right and left ventricular pressures (RVP, LVP) were measured simultaneously and pressure-diameter loops were generated. Right and left ventricular power indices (RVPi, LVPi: = HRxVPxVsD) was calculated from heart rate, ventricular pressures, and systolic shortening of the respective ventricular diameter (RVsD, LVsD). Data obtained during circulatory steady-state immediately before extra-corporeal circulation (ECC) and up to 45 min after ECC were compared. By avoiding volume overload (CVP < or = 10 mmHg) at weaning off ECC and by lowering the systemic vascular resistance and, thus, LV afterload (approximately 8 micrograms.kg-1 min-1 dobutamine), the LV developed systemic pressure (70 +/- 7 vs. 41 +/- 4 mmHg) at unchanged diastolic LV end-diastolic pressure (LVedP) (10 +/- 3 mmHg). Left ventricular power index increased by 45 +/- 25%, although the extent of systolic shortening of LVD was reduced by 20 +/- 10%. Simultaneously, the RV was effectively unloaded (RVedP: 8 +/- 3 vs 11 +/- 6 mmHg; RVP: 39 +/- 7 vs 53 +/- 9 mmHg; RVPi: -42 +/- 27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Extracorporeal Circulation↗
PubMedDate not supplied

Perioperative awareness and recall.

This study was designed to introduce a relevant stimulus at successive time intervals during the entire anesthetic period, including the pre- and postanesthetic periods. Using galvanic skin responses, the authors were able to recognize a plane of light anesthesia and arousal, at which time it is considered that sensory input might be perceived. Presenting to the patient a stimulus of some relevance, but one not likely to be psychically traumatic, they investigated the correlation between the ability to maintain an attention span and to recall in the postoperative period. No recall was obtained during the intraoperative period, the first occurrence of recall being in the immediate postanesthetic period and the incidence of recall increasing with increasing time intervals after the end of anesthesia. The authors conclude, however, that since intraoperative awareness without recall is a possibility, care should be taken to avoid emotionally disturbing auditory stimuli throughout the anesthetic procedure.

Adolescent↗
PubMed1999

Anesthesia for endobronchial laser surgery: a modified technique.

UNLABELLED: We describe a technique for endobronchial surgery with the neodynium:yttium-aluminum-garnet laser, in which an insufflation catheter with side holes placed into the contralateral mainstem bronchus is used for high-frequency positive pressure ventilation. Thirty-five patients (45 procedures) were treated during general anesthesia using a rigid bronchoscope in combination with a fiberoptic bronchoscope. Perioperatively, oxygen saturation (SaO2), mean arterial pressure, and heart rate were recorded. SaO2 during the recovery period was comparable to that during the intraoperative period but was significantly (P < 0.05) higher than that before the induction of anesthesia. There was a considerable (> or = 5%) increase in SaO2 at the end of the treatment in six patients, which indicates that the recanalization of the treated airway was successful. Our data support the assumption that, during endobronchial resection, selective ventilation of the nonaffected lung was adequate; in addition, subcarinal placement of the insufflation catheter with side holes was advantageous. We conclude that this technique contributes to the prevention of lung complications during endobronchial laser surgery. IMPLICATIONS: We describe a technique in which an insufflation catheter with side holes placed into the contralateral mainstem bronchus largely prevented inhalation of laser smoke and aspiration of blood and debris.

Adult↗