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At least 721 records · Page 40Linked to original sources
PubMed2004

Retroperitoneoscopic partial nephrectomy with transient occlusion of renal artery for treatment of small renal tumors.

OBJECTIVES: To evaluate the results of retroperitoneoscopic partial nephrectomy with transient occlusion of the renal artery for treatment of patients with small renal tumors. METHODS: From May 2002 to March 2003, 12 consecutive patients with T1N0M0 renal tumors with a median diameter of 3.0 cm underwent retroperitoneoscopic partial nephrectomy. The renal artery was clamped transiently without occlusion of the renal vein and the tumor was excised with scissors. Intracorporeal renal cooling was achieved by cold saline perfusion of the renal pelvis through a single-J ureteral catheter. Hemostasis was achieved by approximating the renal parenchyma over the perirenal fatty tissue using a retroperitoneoscopic suturing technique. RESULTS: Of the 12 patients, 11 successfully underwent partial nephrectomy retroperitoneoscopically. The median operative time, renal ischemic time, and amount of blood loss in the successful procedures was 220 minutes (range 132 to 340), 50 minutes (range 16 to 115), and 150 mL (range 50 to 800), respectively. The renal calix was opened and repaired in 10 patients. The surgical margin was negative in all patients. The postoperative course was uneventful in all patients, and the return to work was achieved in a median of 18 days (range 9 to 39). The renal function of the affected kidney was well preserved postoperatively, when examined by renal scintigraphy. Neither local recurrence nor distant metastasis was found during the median follow-up period of 10 months (range 1 to 18). CONCLUSIONS: Retroperitoneoscopic partial nephrectomy with transient occlusion of the renal artery is a useful and less-invasive method for resection of small renal tumors. Additional technologic developments to reduce ischemic times and to cool the kidneys laparoscopically are required.

Aged↗
PubMed1985

The need for analgesic cover after ENT surgery--comparison of nefopam and papaveretum.

Intra-operative intramuscular injections of either papaveretum 0.3 mg/kg or nefopam 0.4 mg/kg were given to alternate patients to promote smooth emergence from ENT anaesthesia in a consecutive series of 40 children. Observations over a period of 30 minutes following completion of surgery showed that emergence was satisfactory in 19 out of 20 children given papaveretum, and in 15 out of 20 children given nefopam. The study confirms that this indication for papaveretum is justifiably popular and that nefopam is a useful alternative mainly because it does not cause respiratory depression. There are no previous reports of the use of nefopam in children.

Child↗
PubMed1985

Cardiac transplantation at Harefield. A review from the anaesthetist's standpoint.

In the period January 1980 to February 1984, 91 heart transplant operations were performed at Harefield Hospital. The current statistics of the transplantation programme are presented. The survival rate since the introduction of the immunosuppressive agent Cyclosporin A is 78% at one year. This paper summarises the special care required for these patients with particular reference to the anaesthetic management.

Adolescent↗
PubMed1995

[Effect of controlled hypotension using sodium nitroprusside on platelet aggregation].

OBJECTIVE: To determine the influence of sodium nitroprusside (SNP) on platelet aggregation when this agent is used to induce hypotension during surgery. PATIENTS AND METHODS: Spontaneous platelet aggregation (SPA) determined by impedance measurement and induced platelet aggregation (IPA) determined by turbidimetry were studied in 30 subjects scheduled for elective ear, nose or throat surgery. Fifteen patients in the SNP group (SNPG) received SNP in doses adjusted to maintain a mean arterial pressure of 50 mmHg. Another 15 patients who did not receive SNP served as controls. RESULTS: SPA increased progressively in both groups. The greatest increase occurred after anesthetic induction (control group +172%, SNPG +48%); the highest level recorded was reached on the morning of the first day after surgery (control group +215%, SNPG +46%). IPA decreased after anesthetic induction (control group -21%, SNPG -40%) and stayed down throughout surgery. IPA was higher on the first morning after surgery than before the operation (control group +35%, SNPG +2%). SPA was significantly higher 60 minutes after start of surgery than before surgery in the control group; IPA and SPA were likewise higher in these patients the morning after surgery. CONCLUSIONS: Platelet aggregation increases during surgery and in the immediate postoperative period. This increase is attenuated when SPA is given to induce hypotension. SPA should be determined by measurement of impedance in whole blood when the nature of platelet aggregation during surgery is being studied, given that early increases in IPA can be masked as a result of the low sensitivity of turbidimetry.

Blood Coagulation Disorders↗
PubMed2006

[Peri-uvulopalatopharyngoplasty electroencephalogram spectral power analysis in patients with obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To study the peri-uvulopalatopharyngoplasty (UPPP) effects on EEG spectral power changes in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHOD: Fifty-four cases were included. The diagnosis was made by polysomnography (PSG). C3/A2 was analyzed by using fast Fourier transform (FFT). Spectral edge frequency (SEF), median power frequency (MPF). a-index, beta-index, delta-index and theta-index were compared with those peri-UPPP treatment. RESULT: Sleep architecture was improved after UPPP. The ratio of slow wave sleep increased. A decrease of mean SEF in total sleep period. The mean MPF was decreased during stage IV. a-index and beta-index were decreased, delta-index and theta-index were increased after the therapy. CONCLUSION: The UPPP therapy has an acute effect in improving the sleep architecture and EEG power spectrum. These changes may be related to the recovery of cerebral function in patients with OSAHS.

Adult↗
PubMed1991

[Allergic and pseudo-allergic reactions in the perioperative period].

Most drugs or infusions are potent inducers of allergic or pseudoallergic reactions. During the perioperative period the patient is usually on multiple medication. Thus, life-threatening reactions can be expected. In this publication these adverse reactions are considered from an allergological point of view. A review of the literature is given. Four case reports point out the variety of possible allergens, the difficulties in definite causal identification and the necessity of referring the patient to an allergological work-up.

Adult↗
PubMed1983

[Effect of neuroleptanalgesia on operation-induced rise in the antidiuretic hormone].

Plasma-levels of antidiuretic hormone were measured in patients undergoing major abdominal surgery pre-, intra- and postoperatively. All patients (n=20) received neuroleptanalgesia as anaesthetic procedure; 10 of them received etomidate additionally. Initial value of vasopressin as well as values after induction of anaesthesia stayed within normal range in all patients. The operation period was accompanied by elevated ADH-levels with a maximum of 500% above initial values. 5 patients having been antagonized postoperatively with naloxone 0.005 mg/kgbw showed marked increase in ADH-level. In comparison to former investigations we conclude that NLA can not block stress-induced rise in vasopressin-concentration effectively as seen under the combination of NLA plus epidural analgesia.

Abdomen↗
PubMed1999

The changes of ventilatory parameters in laparoscopic colecystectomy.

We investigated the ventilatory changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in the head-up position. During surgery, intraabdominal pressure was maintained at 15 mmHg by a CO2 insufflator, and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. PETCO2 was monitored continuously and recorded every minute. Basic hemodynamic and ventilatory parameters were measured before anesthesia; after induction of anesthesia; at 5 min, 10 min and 30 min after peritoneal insufflation; and 5 min and 10 min after exsufflation. Arterial blood samples were obtained 3 times to calculate D(a-A)CO2, VD/VT, and Vco2. The latent period of PETCO2 change was 2.9 min, the ascending period was 12.6 min, and the descending period was 12.2 min. During the 71.5 min of pneumoperitoneum, V(I), VE, peak and plateau Paw increased, while Cdyn decreased significantly. Peritoneal insufflation or exsufflation also resulted in a significant change of D(a-A)CO2, D(a-A)O2, and Vco2. The anesthesiologist must be aware of both hemodynamic and ventilatory changes and must be ready to respond promptly and adequately.

Adolescent↗
PubMed1998

Management of cardiac arrest in operation theatre.

Cardiac arrest is better prevented than treated. Cardiac arrest in operation theatre is reversible in 90% cases. So as soon as cardiac arrest occurs immediate treatment should be started. Time is very important factor. Cardiac arrest in patient with cardiac diseases, other medical diseases, electrolyte disturbances are difficult to reverse. The time interval between cardiac arrest and the death of tissue in the central nervous system is approximately three and half minutes and there is ample clinical justification for accepting this period, though patients have survived intact for longer intervals. It can, however, only be completely acceptable on the basis that the patient is adequately oxygenated up to the moment of cardiac arrest. If hypoxia is present before this occurs, then severe neurological damage may result from even shorter periods of ischaemia than three and a half minutes. Resuscitation will often be ineffective if the precipitating cause is not recognised and treated. It requires a calm and logical mind with a good understanding of medicine to sort out and treat the underlying condition while at the same time performing emergency resuscitation. A review of management of cardiac arrest in operation theatre is presented.

Cardiopulmonary Resuscitation↗
PubMed1988

[Peroperative angiography in reparative surgery of the lower limbs. Apropos of experience with 1099 cases].

The authors report their experience of per-operatory angiography in a series of 1,099 cases over 13 consecutive years. The main interest is the limitation in the rate of early reintervention, which frequently causes morbidity and mortality in this type or surgery. The serial nature of the technique is emphasized, and is most comparable to pre-operatory exploration. The various technical details are specified. Some hemodynamic troubles noted during injection (aortography) contraindicate the method in high-risk subjects. The main indications are, above all, control of restorative acts, but also a per-operatory diagnosis of a lesion, and the assessment of blood stream at a lower level. The results are morphological and the various anomalies discovered are reviewed, with iconography, in relation to each type of surgical act (disobliteration, bypass). In situ bypasses are considered separately. The data are also hemodynamic, and justify the six successive X-ray film technique. Deblocking (embolectomy with a balloon catheter) and endarterectomies were found to give more technical imperfections than bypasses. The rate of extemporaneous corrections tripled during the second period (1978 to 1986), and this was no doubt due to an extension in operative indications (19% versus 6% at the beginning). Dacron bypasses (fibrinous debris) and in situ bypasses (detection of anatomical abnormalities, location of shunts) were more often incriminated in immediate reinterventions than Dardik homografts or PTFE.

Angiography↗
PubMed1988

Effect of blood conservation efforts in cardiac operations at the Mayo Clinic.

In a retrospective study of 388 patients who had undergone cardiac operations at our institution during two time periods-before (1982) and after (1984) introduction of autologous transfusion-we analyzed the effect of blood conservation efforts and autologous transfusion on blood usage, postoperative complications, and duration of hospitalization. Cell salvage techniques resulted in a significant reduction (P less than 0.0001) in use of not only homologous blood (from a mean of 9.6 units per patient in 1982 to 3.2 units in 1984) but also fresh-frozen plasma and platelet concentrates. We found no significant difference in morbidity or mortality for the two study periods. Although the mean duration of hospitalization decreased from 11.7 days in 1982 to 9.6 days in 1984, this change was probably related to factors other than the introduction of blood conservation efforts. Thus, techniques used to decrease the amount of blood replacement needed for cardiac surgical procedures are beneficial.

Blood Transfusion↗
PubMed1992

A survey of the use of blood and blood components among South African anaesthetists working in teaching hospitals.

A survey of the peri-operative policies for blood and blood component therapy was carried out among anaesthetists in the nine South African teaching hospitals. All anaesthetists completed the questionnaire, without recourse to books or discussion. The survey revealed a possible over-utilisation of blood and blood components in the peri-operative period. There were significant deficiencies in the pre-operative assessment of blood and platelet requirements and the specific indications for platelet, fresh frozen plasma and blood transfusions. A significant number of respondents exhibited poor knowledge of the potential dangers and expense that the use of blood and blood components entails. Educational effort was perceived to be the main method of rationalising the anaesthetist's usage of blood and blood components.

Anesthesiology↗
PubMed1987

[Bacteriological, clinical, and pharmacokinetic studies of perioperative antibiotic prophylaxis in head and neck surgery].

The point of this study was to analyze the possible benefits of perioperative antibiotic prophylaxis in patients from whom oral cavity or throat tumors are removed. The criteria used to judge the efficacy of each treatment included the clinical course of the treatment, the bacterial colonization of the surgical area as well as the growth of bacteria during the postoperative phase. 50 patients were chosen and grouped according to their surgical treatment: laryngectomy (n = 20), partial laryngectomy (n = 22) or tongue, floor of the mouth, soft palate, gum or base of the tongue partial resection (n = 8). Within each surgical group, patients were randomly chosen for antibiotic prophylaxis; others constituted the untreated control group. The antibiotic prophylaxis consisted of 5 g Mezlocillin administered at the time of narcosis for 20 min followed by 0.5 g Metronidazol for 10 min. These medications were given in 8-hour intervals for three days following surgery. Investigation of the first 20 patients (prophylaxis group n = 7, control group n = 13) revealed that the combination of Mezlocillin and Metronidazol positively influenced post-operative recovery (no complications) while the patients without prophylactic antibiotic treatment suffered general or local complication leading to, in 10 cases, the necessity of postoperative therapy. On the basis of these results, the random grouping of the patients was ended and all 30 remaining patients were given the antibiotic prophylaxis. Regardless of antibiotic treatment, the great majority of microbes isolated from throat swabs and tracheal secretions were gram-negative, aerobic bacteria. A prerequisite for efficacious prophylaxis is that the antibiotics be applied before the operation, so that a sufficient concentration is present at the time of pharyngotomy. On the basis of pharmacokinetic investigations, administration of the antibiotic 30 min preoperatively fulfills this requirement. Further, our recommendation, based on our measurement of the spectrum of bacteria present and their growth is that the antibiotics be applied over a period of three days postoperatively. This recommendation is also based on the fact that some patients (those having undergone partial laryngectomy or tongue, floor of the mouth, base of the tongue partial resections) have suffered loss of the swallowing reflex so that there exists a continuous contamination of the surgical area with pathogens or facultative pathogens coming from the nasal or oral cavities.

Adult↗
PubMedDate not supplied

Intraoperative magnetic resonance imaging and meningioma surgery.

OBJECTIVE: To determine if intraoperative magnetic resonance imaging improves surgical resection and postoperative outcome of intracranial meningioma. STUDY DESIGN: Prospective, non-randomized, cohort study. METHOD: Intraoperative Magnetic Resonance Imaging (iMRI) was used to evaluate patients with meningioma undergoing surgery. Images were obtained after induction of anaesthesia and at various stages of tumour resection. Extent of surgical resection was graded using Simpson grading system for meningioma. The images were reviewed together with histopathology and early outcome. Primary outcome measure was determined by finding unexpected tumur in interdissection images. Secondary outcome measures were determined by postoperative complications including infections and mortalities. RESULTS: There were 39 procedures in 38 patients from January 1998 to December 2002. Surgical-planning images helped to optimize craniotomy placement. Interdissection images revealed unexpected residual tumour in only 1 patient. Complete resection (Simpson grades 1-3) was achieved in 33 procedures. The average follow up period was 16.4 months. Tumour recurrence has been observed in three patients. Two of these patients had anaplastic meningioma. There was no mortality in the 30-day postoperative period. CONCLUSION: Intraoperative MRI was beneficial in siting the craniotomy in addition to providing anatomical relationships between the tumour and adjacent structures in lesions located at the skull base though the full benefit of these is yet to be determined. The low morbidity and zero mortality recorded in the study may be related to all these factors.

Adult↗
PubMed2005

[Change in plasma free 15 - F2t - isoprostane concentrations in smoking patients undergoing coronary artery bypass grafting and its clinical significance].

OBJECTIVE: To investigate the change in plasma free 15-F2t-isoprostane fn(15-F(2t)-IsoP) concentration and its relationship with postoperative cardiac function of smoking patients who underwent coronary artery bypass grafting (CABG). METHODS: Sixty patients with coronary artery heart disease were divided into smoking group [n=30, age 54-69 years old, American Heart Association (AHA)II-III] and non-smoking group(n=30, age 58-70 years old, ASA II-III). All the patients were scheduled for CABG under combination anesthesia with isoflurane and fentanyl and conventional cardiopulmonary bypass. Blood samples were drawn from the central vein to measure 15-F(2t)-IsoP at the following time points: before operation (T0); 30 minutes after aortic clamping for cardiopulmonary bypass(T1); 10 and 30 minutes after aortic declamping(T2,T3). RESULTS: There was no statistical difference in 15-F(2t)-IsoP between two groups at T0, but contents of 15-F(2t)-IsoP in the two groups was increased markedly at T1, compared to those at T0 (P<0.05 and P<0.01 for smoking and non-smoking groups, respectively), and the degree of increase of 15-F(2t)-IsoP in smoking group was significantly higher than that in non-smoking group(P<0.05). During reperfusion period (at T2,T3), the rate of lowering of 15-F(2t)-IsoP in smoking group was slower than that in non-smoking group(P<0.05), and moreover, these patients needed more inotropic support than those in non-smoking group. CONCLUSION: Smoking patients have weaker anti-oxidation capability during CABG, therefore they have higher incidence of low cardiac function.

Aged↗
PubMed2002

The inhibition of pro-inflammatory cytokines with pentoxifylline in the cardiopulmunary bypass lung.

In addition to preventing tissue energy loss during cardiopulmonary bypass, pentoxifylline (Ptx) prevents the production of pro-inflammatory cytokines as well. The aim of this study was to investigate whether Ptx decreases the inflammatory effects of cardiopulmonary bypass on the lungs during open-heart surgery. The patients in the study group (n = 15) who were going through an open-heart surgery had 500 mg l(-1) of Ptx added to their prime solution, whereas the patients in the control group (n = 10) only received prime solution. Pre-pump and post-pump blood samples were obtained from both groups and assayed for interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor alpha (TNFalpha). Lung tissue samples that were obtained after the pump were examined with light microscopy and stained for tissueTNFalpha. Non-parametric Wilcoxon test was utilized for statistical evaluation. In the post-pump period, the difference in the IL-6, IL-8 and TNFalpha levels of the two groups was found to be statistically significant (P<0.005). The tissue samples from the control group had significant staining with TNFalpha. We think that Ptx has important protective effects on the lungs during cardiopulmonary bypass.

Adult↗
PubMed1982

Perioperative noninvasive recognition of the TUR-syndrome in transurethral resections.

Easily manipulable, noninvasive techniques for the immediate recognition of absorption of irrigating solution in transurethral prostate resections have not previously been available. For this reason, a way was sought to bring about an improvement in this situation: changes in the thoracic ground impedance were studied perioperatively by use of impedance cardiography during 16 transurethral resections. Furthermore, measurement of central venous pressure and arterial blood gases was done simultaneously as well as registration of myocardial function by systolic time intervals. Most important among the changes caused by absorption of irrigating solution which were registered with impedance cardiography are a significant increase in cardiac output and a considerable decrease in arterial oxygen pressure. Furthermore, a strong correlation was found between the increase of central venous pressure and the decrease of thoracic ground impedance. The relation of the preejection period to the left ventricular ejection time showed a significant increase due to impairment of myocardial function. The results show that impedance cardiography can monitor the time and extent of absorption of irrigating solution exactly and immediately and thus allows immediate therapy. This noninvasive technique can thus be used for perioperative supervision of the patient during transurethral prostate resections.

Absorption↗
PubMed1992

Six months of shivering in a district general hospital.

Of 2595 patients admitted to a recovery room in Derbyshire Royal Infirmary over a 6-month period, 164 (6.3%) shivered postoperatively. Data regarding the anaesthetic techniques to which these patients had been subjected were gathered from the Derby Anaesthetic Audit System. Subsequent analysis demonstrated the importance of a number of factors that led to shivering, including male gender, anaesthetic techniques involving spontaneous ventilation, and anticholinergic premedication. The administration of pethidine, alfentanil or morphine intra-operatively reduced the incidence of shivering postoperatively.

Adolescent↗