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At least 1,135 records · Page 63Linked to original sources
PubMed1979

Variable manifestations of vascular injury during lumbar disk surgery.

Major vascular injury is an unusual but well-recognized complication of lumbar disk surgery. Clinical manifestation of such injuries may be extremely variable. Isolated arterial laceration is most common, with early manifestation due to retroperitoneal hemorrhage. There are often few external signs of blood loss, however, and the diagnosis may not be recognized initially. Formation of an arteriovenous fistula or false aneurysm produces even fewer early signs, and diagnosis is often delayed for weeks or years. Six cases are described that illustrate the full spectrum of acute and chronic manifestations of such injuries. Two cases of acute hemorrhage due to arterial trauma were seen; one case was recognized intraoperatively and one in the recovery room. In four cases arteriovenous fistulae developed and were diagnosed from eight hours to eight years postoperatively. Two cases also had associated false aneurysms, one the probable source of pulmonary emboli and one the principal manifestation of the vascular injury.

Abdomen↗
PubMed1980

Postponement of operations: its prevention in patients found to be mildly hypertensive.

Changes of arterial blood pressure (ABP) and heart rate (HR) occurring during anesthesia and in the immediate postoperative period were recorded in three groups composed of 30 hypertensive patients each, having noncardiac surgery. Group 1 was untreated, group 2 received 100 mg of phenytoin orally the evening before and on the morning of the operation, whereas group 3 received 200 mg of phenytoin orally at the same intervals. During anesthesia and in the recovery room, there were more moderate and severe alterations of ABP and HR in the control group than in the treated grups, with the only statistically significant differences being those between group 1 and group 3. This pattern continued for up to 24 hours after surgery. The administration of 200 mg of phenytoin orally the night before and on the morning of surgery seems to provide greater hemodynamic stability to mildly hypertensive patients during the surgical and anesthetic experiences.

Anesthesia↗
PubMed2004

Patient-controlled transdermal fentanyl hydrochloride vs intravenous morphine pump for postoperative pain: a randomized controlled trial.

CONTEXT: Patient-controlled analgesia (PCA) with morphine is commonly used to provide acute postoperative pain control after major surgery. The fentanyl hydrochloride patient-controlled transdermal system eliminates the need for venous access and complicated programming of pumps. OBJECTIVE: To assess the efficacy and safety of an investigational patient-controlled iontophoretic transdermal system using fentanyl hydrochloride compared with a standard intravenous morphine patient-controlled pump. DESIGN, SETTING, AND PATIENTS: Prospective randomized controlled parallel-group trial conducted between September 2000 and March 2001 at 33 North American hospitals, enrolling 636 adult patients who had just undergone major surgery. INTERVENTIONS: In surgical recovery rooms, patients were randomly assigned to intravenous morphine (1-mg bolus every 5 minutes; maximum of 10 mg/h) by a patient-controlled analgesia pump (n = 320) or iontophoretic fentanyl hydrochloride (40- microg infusion over 10 minutes) by a patient-controlled transdermal system (n = 316). Supplemental analgesia (morphine or fentanyl intravenous boluses) was administered as needed before and for the first 3 hours after activation of the PCA treatments. Patients then used the PCA treatments without additional analgesics for up to 72 hours. MAIN OUTCOME MEASURES: The primary efficacy variable was patient global assessment of the method of pain control during the first 24 hours. Additional efficacy measures were the proportion of patients discontinuing the study because of inadequate analgesia for any reason, patient-reported pain intensity scores on a 100-mm visual analog scale (VAS), and patient global assessments at 48 and 72 hours. Adverse effects were also recorded. RESULTS: Ratings of good or excellent after 24 hours of treatment for the method of pain control were given by 73.7% of patients (233/316) who used transdermal fentanyl PCA and 76.9% of patients (246/320) who used intravenous morphine PCA; treatment difference was -3.2% (95% confidence interval, -9.9% to 3.5%; P =.36). Early patient discontinuations (25.9% fentanyl vs 25.0% morphine; P =.78) and last pain intensity scores (32.7 fentanyl vs 31.1 morphine on the VAS; P =.45) were not different between the 2 treatments. With continued treatment for up to 48 or 72 hours, more than 80% of patient assessments in each treatment group were good or excellent. The incidence of opioid-related adverse events was similar between the groups. CONCLUSION: An investigational PCA transdermal system using iontophoresis to deliver fentanyl provided postsurgical pain control equivalent to that of a standard intravenous morphine regimen delivered by a PCA pump.

Administration, Cutaneous↗
PubMed1975

Butorphanol and pentazocine in patients with severe postoperative pain.

Either butorphanol tartrate (1, 2, or 4 mg) or pentazocine (30 or 60 mg) was given intramuscularly (5 dose groups) to 262 patients, who were scheduled for major operations, if they had severe pain after full awakening in the recovery room, postoperatively under double-blind conditions. There were at least 50 patients in each of the five dosage groups. Pain intensity and relief were scored numerically for each treated patient at 1/2 1, 2, 3 and 4 hr, while under direct surveillance, and the patients were seen again for follow-ups during the first 24 hr postoperatively. Appreciable pain relief developed within 30 min at all dose levels, with a peak analgesic effect apparent at about 1 hr. Satisfactory relief persisted for 4 hr in the majority of patients in each group. With the lowest dose of butorphanol tartrate (1 mg), which gave good pain relief for only 2 to 4 hr, approximately 60% of the patients had to be remedicated within 4 hr. Vital signs were not appreciably affected, but the patients who received the high dose of analgesics (butorphanol tartrate 4 mg or pentazocine lactate 60 mg) were often quite drowsy. The incidence of other side effects was negligible. The relative potency assay showed that butorphanol was approximately 20 times as potent as pentazocine for up to 4 hr.

Adolescent↗
PubMedDate not supplied

Operative treatment of substernal goiters.

This report describes the operative experience in 72 patients with substernal goiters treated over the past 5.5 years. Even though the incidence of multinodular goiter has decreased in the United States due to the routine use of iodized salt, we continue to see a large number of patients with massive goiters, predominantly from Caribbean Islands. The diagnosis of substernal goiter was made on clinical examination augmented by such radiologic studies, as chest x-ray, barium esophagograms, airway films, and CT scans. Computed tomographic (CT) scanning was particularly helpful in evaluating the extent of substernal extension. Confirmation of the extent of disease was made at the time of operation. Ninety percent of the patients had tracheal deviation and 85% were symptomatic from airway compression. Esophageal compression was noted in 60% of the patients. All patients had a long history of goiter with recent onset of pressure symptoms. Flow-volume-loop studies were performed in 44% of the patients and were useful in the evaluation of pressure symptoms. However, the decision for operation was made primarily based on clinical evaluation of signs and symptoms. Sixteen patients in this group were admitted with acute airway distress requiring airway intubation or semi-emergency decompression. Only 1 patient required mediastinal splitting, while all others were operated by the cervical approach. The decision as to the extent of thyroidectomy was made at the time of operation. Drains were routinely used because of the large dead space. One patient developed a hematoma in the recovery room and required re-exploration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Outpatient and short-stay thyroid surgery.

With the realization that simple thyroid procedures had a very low rate of complication and that patients often seemed well enough to go home from the recovery room, we began performing them in an ambulatory surgery setting. We review here 134 consecutive thyroid procedures performed at Columbia Presbyterian Medical Center between July 1987 and July 1989. Patients undergoing reoperation, neck dissection, sternal splits, or other concomitant procedures were excluded. There were 105 women and 29 men with an average age of 47 years. Fifty percent of the operations were performed for benign disease, although the most common diagnosis was papillary cancer (44%). Twenty-one operations (16%) were performed under local anesthesia. Most patients underwent surgery in our ambulatory surgery unit and 76 were discharged the day of surgery. Of these patients, 21 underwent total thyroidectomy, 13 subtotal thyroidectomy, and 42 simple thyroid lobectomy. Of the 58 patients who were admitted, 53 were discharged on the day following surgery. The average length of stay was 0.49 days. Extensive pre- and postoperative teaching was given regarding the signs and symptoms associated with the complications of thyroid surgery. All patients were felt to be reliable and capable of understanding the procedure and of complying with the postoperative plans. Postoperative complications included 8 patients (6%) with transient hypocalcemia and 1 patient (0.75%) with permanent unilateral recurrent laryngeal nerve paralysis. All complications occurred in patients who underwent total thyroidectomies. No patient had a postoperative complication requiring reoperation or readmission. We conclude that by using specific selection criteria, thyroid lobectomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.

Adolescent↗
PubMed1995

Ceftizoxime use in trauma celiotomy: pharmacokinetics and patient outcomes.

Seriously injured patients undergo vigorous resuscitation upon arrival at the emergency department and through the immediate perioperative period. Although resuscitation leads to volume loading and fluid shifts, drug dosing and dosing intervals are often not altered to account for changes in total body volume or circulatory volume. To address this, a prospective study of pharmacokinetics of ceftizoxime in 53 injured adults who underwent emergency celiotomy was conducted. Further, the relationship between serum ceftizoxime concentrations and infectious outcomes was evaluated. Per protocol, injured adults undergoing emergency celiotomy received prophylactic ceftizoxime treatment according to standard dosing regimens. Of the patients, 6 (11.5%) experienced postoperative infections and had lower peak serum ceftizoxime levels in the recovery room than patients not experiencing infection. For severely injured adults with extensive blood loss or undergoing lengthy operations requiring rigorous volume resuscitation, doses of ceftizoxime, and indeed all antibiotics, may need to be increased beyond conventional standards to minimize infectious complications.

Abdominal Injuries↗
PubMedDate not supplied

Implementation of a successful outpatient laparoscopic sterilization program in Calcutta.

This study presents data on 109 women undergoing laparoscopic sterilization by tubal rings at the Calcutta Medical Research Institute and Hospital. The average operating time was 15 minutes and the average stay in the recovery room was 4 hours. The overall complication rate was 18%, including surgical and early postoperative complications. All patients returned for follow-up. Long-term follow-up will be required to determine the rates of delayed complications and the efficacy of the procedure.

Adult↗
PubMed1985

Early onset of tetany following thyroidectomy: report of two cases.

The most common complication of total thyroidectomy is hypocalcemia. Following thyroidectomy, especially total thyroidectomy, the serum calcium usually falls gradually and patients do not usually require supplementary medication before 24 hours. Two cases of total thyroidectomy are presented in which the preoperative serum calcium levels were normal and hypocalcemic tetany developed in the recovery room immediately after the operation. The hypocalcemia was a temporary phenomenon, and neither patient requires supplementary calcium at the present time. There is no good explanation for this precipitous drop in the serum calcium levels in these two patients.

Adult↗
PubMed2004

Increased prothrombin time and platelet counts in living donor right hepatectomy: implications for epidural anesthesia.

The risks and benefits of adult-to-adult living donor liver transplantation need to be carefully evaluated. Anesthetic management includes postoperative epidural pain relief; however, even patients with a normal preoperative coagulation profile may suffer transient postoperative coagulation derangement. This study explores the possible causes of postoperative coagulation derangement after donor hepatectomy and the possible implications on epidural analgesia. Thirty donors, American Society of Anesthesiology I, with no history of liver disease were considered suitable for the study. A thoracic epidural catheter was inserted before induction and removed when laboratory values were as follows: prothrombin time (PT) > 60%, activated partial thromboplastin time < 1.24 (sec), and platelet count > 100,000 mmf pound sterling (mm3). Standard blood tests were evaluated before surgery, on admission to the recovery room, and daily until postoperative day (POD) 5. The volumes of blood loss and of intraoperative fluids administered were recorded. Coagulation abnormalities observed immediately after surgery may be related mostly to blood loss and to the diluting effect of the intraoperative infused fluids, although the extent of the resection appears to be the most important factor in the extension of the PT observed from POD 1. In conclusion, significant alterations in PT and platelet values were observed in our patients who underwent uncomplicated major liver resection for living donor liver transplantation. Because the potential benefits of epidural analgesia for liver resection are undefined according to available data, additional prospective randomized studies comparing the effectiveness and safety of intravenous versus epidural analgesia in this patient population should be performed.

Adult↗
PubMed1987

Body temperature in elderly surgical patients.

Body temperatures of 37 elderly surgical patients with fractured hips were measured using tympanic membrane probes. Comparisons were made between patients having the usual body coverings, eight were hypothermic as compared with one of 16 patients with extra body coverings. Temperatures were significantly different between groups intraoperatively (p less than .001) and in the recovery room p less than .002) where the lowest temperatures were recorded. Anxiolytics given preoperatively had a significant negative relationship with lower body temperatures. Careful monitoring of temperatures and extra coverings are recommended for elderly hip fractured patients perioperatively.

Aged↗
PubMed2003

CT-guided neurosurgery: preliminary experience.

BACKGROUND: With the possibility of CT systems becoming more handy and sophisticated, intraoperative CT was introduced in a few neurosurgical Centres with better results in lesion removal and surgical outcome. METHOD: At our Institution a mobile CT scanner was recently used for intraoperative evaluation (Philips Tomoscan M). For 27 tumour resections performed with a neuronavigation system, and 23 deep brain electrode positioning examinations, an intraoperative CT was employed. In addition the CT scanner was used in the recovery room for a postoperative control in 198 patients. FINDINGS: Our preliminary experience used for a real time evaluation of the treated patients, permitted to verify an incomplete removal in 23/27 cases. Evaluation of stereotactic electrode position in relation to the planned target was also possible and demonstrated a correct position in 21 cases. INTERPRETATION: Intraoperative CT scan is a useful system that permits to modify neuronavigation planning and is able to give information to the surgeon for better tumour removal, rule out possible hemorrhagic complications, and suitable deep brain electrode positioning.

Adolescent↗
PubMed1989

Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system.

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 micrograms/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.

Fentanyl↗
PubMedDate not supplied

INFORM: development of information management and decision support systems for High Dependency Environments.

The long-term aim in the INFORM Project is to develop, evaluate and implement a new generation of Information Systems for hospital High Dependency Environments (HDE-Intensive Care Units, Neonatal Units, Burns Units. Operating and Recovery Rooms, and other specialised areas). The distinguishing feature of the HDE is the very large amount of data that is collected through monitors and paper records about the state of critically ill patients; this has made the role of the staff a technical one in addition to a caring one. The INFORM System will integrate Decision Support with on-line, off-line and observed patient data and, in addition, will incorporate and integrate unit management features. In the Exploratory Phase of the Project, functional requirements have been set out. These are based on four components: conceptual model of the HDE; evaluation of existing HDE Information Systems; development of a novel software architecture using a Knowledge-Based Systems (KBS) methodology, and based on a critical review of KBS applied to the HDE: monitoring of appropriate leading-edge technological developments. The conceptual model has two components: a patient-related information model, and a department-related cost model. The patient-related model is identifying key and difficult areas of decision making. A key aspect of INFORM is integration of clinical Decision Support for these areas into the Information System through a layered software architecture. The lower layers are concerned with monitoring and alarming and the higher levels with patient assessment and therapy planning. The functionality and interconnection of these layers are being determined.

Decision Support Systems, Management↗
PubMed1986

The automated anesthesia record.

Many phases of modern anesthesia keep the anesthetist too busy to obtain and plot physiologic data or to record anesthetic events. Yet the anesthesia record serves as a log book, a clinical management tool, a trend and pattern plotter, as well as a medical-legal document. If these functions are important, an automated anesthesia recording system is needed for charting the data reliably and accurately. Automating the anesthesia record also lays the ground work for abstracting the data and generating records with specific information sought by the anesthetist, the physicians in the recovery room and intensive care unit, the administrators of the hospital, as well as representatives with interest in medical-legal problems.

Anesthesia↗
PubMed1993

Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management.

PURPOSE: Many anorectal procedures are currently being performed on an outpatient basis, hemorrhoidectomy being the exception because of the need for parenteral narcotics postoperatively. We investigated the effectiveness of a subcutaneous morphine pump (SQMP) for outpatient posthemorrhoidectomy pain control. METHODS: In Phase 1 of our study, 22 patients undergoing radical hemorrhoidectomy were started on an SQMP protocol postoperatively. Twenty-nine patients received conventional postoperative narcotic dosing. In Phase 2, 19 patients enrolled in an SQMP protocol underwent hemorrhoidectomy in an ambulatory setting. Length of hospitalization, catheterization rate, and pain control were evaluated. RESULTS: In Phase 1, zero patients in the study group and two in the control group required additional hospitalization beyond 23 hours for pain control. The rates of catheterization were similar between the two groups. Pain control was considered satisfactory in 21 of 22 study patients. There was no correlation between pain level and morphine dose. Eighteen of 22 patients experienced minor side effects, necessitating pump removal in two patients. In Phase 2, 18 of 19 patients on the SQMP were discharged from the recovery room. Cost analysis shows the combination of outpatient hemorrhoidectomy and the SQMP to be cost-effective in comparison with an inpatient stay. CONCLUSIONS: The SQMP enables hemorrhoidectomy to be done on an outpatient basis. It provides effective pain control, enjoys high patient acceptance, and is cost-effective.

Adult↗
PubMed1997

Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery.

PURPOSE: Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients. METHODS: We conducted a prospective, randomized trial of patients undergoing their first elective colorectal surgery at a tertiary care center. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and Group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Both groups had postoperative patient-controlled analgesia. All patients rated their levels of pain and anxiety daily, on a linear analog scale of 0 to 100. Total narcotic consumption, time to first bowel movement, length of stay, and number of patients with complications were also recorded. RESULTS: Groups were similar in age and gender distribution, diagnoses, and surgery performed. Median baseline anxiety score was 75 in both groups. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30; P < 0.001). Postoperatively, median increase in the worst pain score was 72.5 for the control group and 42.5 for the imagery group (P < 0.001). Least pain was also significantly different (P < 0.001), with a median increase of 30 for controls and 12.5 for the imagery group. Total opioid requirements were significantly lower in the imagery group, with a median of 185 mg vs. 326 mg in the control group (P < 0.001). Time to first bowel movement was significantly less in the imagery group (median, 58 hours) than in the control group (median, 92 hours; P < 0.001). The number of patients experiencing postoperative complications (nausea, vomiting, pruritus, or ileus) did not differ in the two groups. CONCLUSION: Guided imagery significantly reduces postoperative anxiety, pain, and narcotic requirements of colorectal surgery and increases patient satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients undergoing elective colorectal surgery.

Adult↗