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At least 19 recordsLinked to original sources
PubMedDate not supplied

Efficacy of gastric blood supply redistribution by transarterial embolization: preoperative procedure to prevent postoperative anastomotic leaks following esophagoplasty for esophageal carcinoma.

PURPOSE: The aim of this study was to evaluate the effect of preoperative redistribution of gastric blood supply on the prevention of anastomotic leakage following surgical reconstruction of the esophagus. METHODS: In 37 patients with esophageal carcinoma, transarterial embolization (TAE) of the left gastric, right gastric, and splenic arteries was preoperatively performed with coils so that gastric blood supply was dependent only on the right gastroepiploic artery. RESULTS: In 34 of 37 patients, preoperative redistribution was successfully performed. The gastric tissue blood flow (TBF) of a gastric tube was higher than in 12 nonredistributed patients. Reduction in the gastric TBF during preparation of a gastric tube was 27.5% in successful patients, in contrast to 68.9% in 12 nonredistributed patients (p < 0.005). CONCLUSION: Preoperative redistribution by TAE reduced the drop in gastric TBF during preparation of a gastric tube and helped prevent postoperative anastomotic leakage in esophageal reconstruction.

Adult↗
PubMed2003

Pre-emptive analgesia in gynecologic surgical procedures: preoperative wound infiltration with ropivacaine in patients who undergo laparotomy through a midline vertical incision.

OBJECTIVE: We tested the hypothesis that local anesthetic that is injected before a vertical midline abdominal incision would decrease the use of postoperative opioids. STUDY DESIGN: Patients who would undergo abdominal surgical procedures with general anesthesia by a planned vertical midline incision were enrolled in the study. Patients were assigned randomly to receive either 0.5% ropivacaine or normal saline solution placebo that was injected in the subcuticular tissue and fascia before the incision of each. All patients received morphine after the operation with a patient-controlled analgesia device. Morphine consumption was measured during the postoperative period at intervals of 0 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours. Postoperative pain was assessed at 6, 12, 24, and 48 hours after the conclusion of the procedure with a visual analog scale. RESULTS: Eighty-four patients were enrolled in the study; 16 patients were excluded; therefore, 68 patients had useable data. The two treatment groups did not differ in age, height, weight, the length of the operation, the length of the incision, the position of the incision, the placement of drains, or the procedure that was performed. There was no significant difference in morphine consumption for any of the four intervals. The visual analog scale was not significantly different between the two groups at 6, 12, or 24 hours after operation. The visual analog scale at 48 hours was lower in the group that received ropivacaine (2.69 vs 4.26, P =.02). Data were analyzed by the Student t test. CONCLUSION: Pre-emptive analgesia with 0.5% ropivacaine given before skin incision does not decrease the postoperative analgesic use in patients who undergo laparotomy by a midline vertical skin incision.

Amides↗
PubMed1984

Colonoscopy as a routine preoperative procedure for carcinoma of the colon.

Ninety patients with cancer of the colon who had total colonoscopy in the perioperative period have been reviewed. Almost half of the examinations revealed positive findings, three being unsuspected synchronous carcinomas in an area that would not have been resected with the proposed primary cancer. In addition, 79 polyps in 36 patients, the majority of which were also undetected by barium enema, were found and removed at colonoscopy. Thus, patients with carcinoma of the colon, in view of its tendency to be associated with synchronous polypoid disease, should have colonoscopy in the perioperative period. Whenever possible, this should be carried out preoperatively to confirm the diagnosis, to remove suspected or unsuspected polyps, and to detect unsuspected synchronous carcinoma.

Adenocarcinoma↗
PubMed2002

[Is mediastinoscopy a necessary preoperative procedure in non-small cell lung cancer?].

BACKGROUND AND METHODS: Over the decade 1990 to 2000, our hospital performed 149 mediastinoscopies in order to support CT scans in the staging on mediastinal lymph nodes in non-small cell lung cancer. RESULTS: CT scans indicated N0-N1 tumours in 64 patients; mediastinoscopy showed that eight of these had N2 disease. Another seven N2 tumours were found in the postoperative histological diagnosis. N2 tumours were indicated by CT scans in 79 patients. Mediastinoscopy proved 53 of these to be N0-N1 tumours; 46 cases were operated, 33 proved to be N0-N1. N3 tumours were indicated by CT scans in six patients. Mediastinoscopy proved this wrong in establishing that three had N0, which was confirmed in the postoperative findings. INTERPRETATION: Only one serious bleeding occurred in a total of 193 mediastinoscopies over the ten-year period. No other complications were reported, hence our material shows that mediastinoscopy is a fairly safe procedure. It is a necessary diagnostic supplement when N2 and N3 tumours are found by CT scan. The benefit of mediastinoscopy is more uncertain when the CT findings are N0-N1 tumours.

Carcinoma, Non-Small-Cell Lung↗
PubMed2006

A randomized prospective controlled trial of antibiotic prophylaxis in intraoral bone-grafting procedures: preoperative single-dose penicillin versus preoperative single-dose clindamycin.

In this comparative study, 150 consecutive patients undergoing local intraoral bone grafting randomly received either an oral single dose of 600 mg clindamycin or 2 g of the penicillin phenethicillin 1 h before incision. Primary endpoint was wound infection at the receptor site within 8 weeks of surgery. Secondary outcome measurements included postoperative infections at the donor site and adverse events as a result of antibiotic administration. Mean age of the patients was 36.8+/-12.7 years (range 18-67 years), and 98 patients were females (65.3%) and 52 males (34.7%). Infections at the receptor site were seen in 4 patients (5.3%; 95% CI 0.23-10.4%) of the phenethicillin group and in 2 patients (2.7%; 95% CI 0-6.36%) of the clindamycin group. In both groups, 3 patients had an infection at the donor site. Postoperative infections were predominantly caused by alpha-haemolytic Streptococci sensitive to penicillin. No significant difference was found between prophylactic single doses of phenethicillin and clindamycin with regard to postoperative infection in patients undergoing local bone augmentation procedures.

Adolescent↗
PubMed1978

[End-to-side mesenteric caval in children - significance of blood flow physics in defining the surgical procedure preoperatively (author's transl)].

Elevated blood pressure of the portal circulation in children may be lowered to defined levels by end-to-side shunting of the mesenteric and the portal vein. The question is, whether an optimal geometry of the ellipsoid anastomosis can be calculated preoperatively. A simplified model of the shunt system is presented using electric and hydraulic analogs of the real blood flow physics. It is not taken into account in this model, that there are two capillary beds connected in series in the portal circulation, which both exhibit high blood flow resistance. Shunt resistance as being calculated on the basis of this model in 6 children, and real shunt resistance as being measured in these patients intraoperatively actually turned out to be in the same order of magnitude inspite of the handicaps of the model. Thus to our opinion the calculations presented are suited to determine preoperatively the optimal geometry of an ellipsoid shunt anastomosis intended to lower blood pressure in the portal circulation to levels as desired.

Arteriovenous Shunt, Surgical↗
PubMed2000

[Review of patients with congenital heart anomalies treated at the University Clinical Center in Sarajevo 1997-2000].

During April 1997 to October 2000, 65 children (61.5% female and 38.5% male) have been operated at KCU Sarajevo at the Hospital for Cardiac surgery. Diagnostic procedures, preoperative and postoperative treatment have been carried out at Pediatric hospital, Clinical center University of Sarajevo. The average age of establishing the diagnosis was 20 months and 4.5 years was the average age of surgical treatment. The most frequent defects were: Atrial septal defect 27.69%, Tetralogy of Fallot 16.92%, Patent ductus arteriosus 16.92%, Coarctatation of the aorta 7.69%, combination of more simple defects 7.69%, Atrioventricular septal defects 6.15%, Ventricular septal defect 4.61%, Pulmonary stenosis 4.61%, Anomalous pulmonary venous connection 4.61% and the other complex defects 3.07%. Among all cases 10.76% were associated with some of the syndromes. In 86.13% of cases total correction have been performed and palliative in 13.84% of cases. Death rate was 10.76%, and postoperative complications 21.53%. Catheterizations was performed on 14 patients (21.53%), and three of them had therapeutic interventional cardiac catheterization (coil, umbrella, balloon dilatation). The average timing of: preoperative procedures was 3.5 days, postoperative following 7.5 days and intensive care 2.2 days.

Child↗
PubMed1995

[Outpatient preoperative examination by the anesthesiologist. I. Fewer procedures and preoperative hospital days].

OBJECTIVE: To study the effect of the reorganisation of the preoperative screening on the volume of laboratory and function tests, and on preoperative hospital days. SETTING: General Hospital De Weezenlanden, Zwolle, The Netherlands. DESIGN: Retrospective study. METHOD: In The Netherlands the surgeon is responsible for the preoperative screening (anamnesis and general examination). In 1992 the preoperative screening was reorganised and it was carried out in the outpatient department under the responsibility of the anaesthesiologist. Laboratory and function tests were only performed if indicated. Data on 3122 patients, operated in 1991, were compared with the data on 3258 patients from 1992. Multiple regression analysis and chi-square test were used. RESULTS: The proportions of the patients subjected to laboratory tests, ECG or a chest X-ray decreased from 90%, 55%, and 50% respectively in 1991 to 53%, 43% and 10% in 1992 (p < 0.05). Admission on the day of surgery increased from 13% in 1991 to 21% in 1992 (p < 0.01). Clinical preoperative evaluation with admission more than 1 day before surgery, decreased from 5% in 1991 to 4% in 1992 (p = 0.02). The mean duration of the hospital stay before the operation decreased from 0.79 day per patient in 1991 to 0.65 in 1992 (p = 0.02). CONCLUSION: If the preoperative screening is carried out by the anaesthesiologist, all the patients have the opportunity to meet the anaesthesiologist before the operation. The number of preoperative hospital days can be reduced by outpatient preoperative screening. Laboratory and function testing on only if indicated reduces the volume of the laboratory tests, ECGs and chest X-rays.

Adolescent↗
PubMed2000

[Preoperative diagnostic procedures before cochlear implantation].

About 200 patients are considered each year for cochlear implant recipiency. Only 1/4 of these candidates actually receive an implant. The aim of the study is to discuss the preoperative procedure we use, which is aimed to exclude patients who would not benefit from an implant. A cochlear implant is an example of very expensive high-profile medical therapy, a single implant costing about 280,000 Austrian schillings. The aim of the preoperative diagnostic procedure is to select the right patients, with a view to providing the best audiologic outcome. During the past 20 years, important parameters have been identified to determine suitable patients. Candidates for a cochlear implant are infants and children (independent of the etiology of deafness or high-grade hearing loss), as well as postlingual deaf adults. Congenitally deaf adults or teenagers are considered unsuitable to receive an implant.

Acoustic Impedance Tests↗
PubMed1958

Diagnosis of hemorrhagic diseases; evaluation of procedures. II. Preoperative tests.

Routine preoperative tests such as the determination of bleeding time and coagulation time are unnecessary and are not recommended. Rulings which require routine preoperative tests result in the adoption of inferior and unreliable time-saving methods in the laboratory. If the clinical staff insists that laboratory procedures to predict hemorrhage be performed on every patient scheduled for operation, approved methods of performing the tests should be employed. Preoperative procedures should include a personal and a family history, a careful and complete physical examination and screening laboratory tests such as urinalysis, hematocrit, leukocyte count and smear examination, including estimation of the number of thrombocytes. Special hemorrhagic studies are indicated on selected patients. These selected patients include those who have a history of abnormal bleeding, those who consider themselves "easy bleeders" or who have apprehension concerning hemorrhage at the time of operation, and those who have physical signs of hemorrhage. Special hemorrhagic studies should also be performed on patients who have diseases that are known to be associated with vascular and coagulation abnormalities, infants who have not been subjected to tests of trauma and on patients from whom a reliable history cannot be obtained. Extra precaution should be taken if operation is to be performed in hospitals or clinics that do not have adequate blood banking facilities and if the operation to be performed is one in which difficulty in hemostasis is anticipated. THE PREOPERATIVE TESTS THAT ARE INDICATED ON SELECTED PATIENTS SHOULD INCLUDE AS A MINIMUM: The thrombocyte count, determination of the bleeding time by the Ivy method, determination of the coagulation time by the multiple tube method and the observation of the clot. Where facilities are available, the hemorrhagic study should also include the plasma and serum prothrombin activity tests.

Bleeding Time↗