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https://www.readbyqxmd.com/read/29221814/use-of-interventional-radiology-as-initial-hemorrhage-control-to-improve-outcomes-for-potentially-lethal-multiple-blunt-injuries
#1
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
INTRODUCTION: Recently, trauma management has been markedly improved with interventional radiology (IVR) and damage-control strategies. However, the indications for its use in hemodynamically unstable patients with severe trauma remains unclear. In some cases, IVR may be more effective than surgery for damage-control hemostasis; however, performing IVR in life-threatening trauma settings is challenging. To address this, we practiced and evaluated a trauma-management system with emergency physicians who trained for both severe trauma management, and techniques of surgery and IVR...
December 6, 2017: Injury
https://www.readbyqxmd.com/read/29221351/extracorporeal-membrane-oxygenation-system-as-a-bridge-to-reparative-surgery-in-ventricular-septal-defect-complicating-acute-inferoposterior-myocardial-infarction
#2
Jose Rozado, Isaac Pascual, Pablo Avanzas, Daniel Hernandez-Vaquero, Ruben Alvarez, Rocio Díaz, Beatriz Díaz, María Martín, Amelia Carro, Guillermo Muñiz, Jacobo Silva, Cesar Moris
Post-infarction ventricular septal defect (VSD) is a rare but potentially lethal complication of acute myocardial infarction. Medical management is usually futile, so definitive surgery remains the treatment of choice but the risk surgery is very high and the optimal timing for surgery is still under debate. A 55-year-old man with no previous medical history attended the emergency-room for 12 h evolution of oppressive chest pain and strong anginal pain 7 days ago. On physical examination, blood pressure was 96/70 mmHg, pansystolic murmur over left sternal border without pulmonary crackles...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29219787/modification-of-the-biomedicus-centrifugal-pump-to-provide-continuous-irrigation-for-neuroendoscopy-technical-note
#3
Joyce Koueik, Brandon G Rocque, Jordan Henry, Taryn Bragg, Jennifer Paul, Bermans J Iskandar
Continuous irrigation is an important adjunct for successful intraventricular endoscopy, particularly for complex cases. It allows better visualization by washing out blood and debris, improves navigation by expanding the ventricles, and assists with tissue dissection. A method of irrigation delivery using a centrifugal pump designed originally for cardiac surgery is presented. The BioMedicus centrifugal pump has the desirable ability to deliver a continuous laminar flow of fluid that excludes air from the system...
December 8, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29217323/noninvasive-monitoring-of-physiologic-compromise-in-acute-appendicitis-new-insight-into-an-old-disease
#4
Young Mee Choi, David Leopold, Kristen Campbell, Jane Mulligan, Greg Z Grudic, Steven L Moulton
INTRODUCTION: Physiologic compromise in children with acute appendicitis has heretofore been difficult to measure. We hypothesized that the Compensatory Reserve Index (CRI), a novel adjunctive cardiovascular status indicator, would be low for children presenting with acute appendicitis in proportion to their physiological compromise, and that CRI would rise with fluid resuscitation and surgical management of their disease. METHODS: Ninety-four children diagnosed with acute appendicitis were monitored with a CipherOx CRI™ M1 pulse oximeter (Flashback Technologies Inc...
November 13, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29216820/comparison-of-the-effect-of-different-infusion-rates-of-sufentanil-on-surgical-stress-index-during-cranial-pinning-in-children-under-general-anaesthesia-a-randomized-controlled-study
#5
In-Kyung Song, Sang-Hwan Ji, Eun-Hee Kim, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim
BACKGROUND: Surgical stress index (SSI) is an established indicator for intraoperative nociception. Opioids are used to block stimulus of cranial pinning in neurosurgery. We investigated the effect of different infusion rates of sufentanil on SSI during cranial pinning in children under general anaesthesia. METHODS: Forty-nine children (2-12 years of age) underwent neurosurgery with pinning. The children were randomized into three groups based on the rate of sufentanil infusion: 0...
December 8, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29215365/physiologic-evaluation-of-ventilation-perfusion-mismatch-and-respiratory-mechanics-at-different-positive-end-expiratory-pressure-in-patients-undergoing-protective-one-lung-ventilation
#6
Savino Spadaro, Salvatore Grasso, Dan Stieper Karbing, Alberto Fogagnolo, Marco Contoli, Giacomo Bollini, Riccardo Ragazzi, Gilda Cinnella, Marco Verri, Narciso Giorgio Cavallesco, Stephen Edward Rees, Carlo Alberto Volta
BACKGROUND: Arterial oxygenation is often impaired during one-lung ventilation, due to both pulmonary shunt and atelectasis. The use of low tidal volume (VT) (5 ml/kg predicted body weight) in the context of a lung-protective approach exacerbates atelectasis. This study sought to determine the combined physiologic effects of positive end-expiratory pressure and low VT during one-lung ventilation. METHODS: Data from 41 patients studied during general anesthesia for thoracic surgery were collected and analyzed...
December 6, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29214434/risk-factors-for-intraoperative-bradycardia-during-ear-nose-throat-and-maxillofacial-surgery
#7
Tjaša Ivošević, Biljana Miličić, Milovan Dimitrijević, Branislava Ivanović, Aleksandar Pavlović, Marina Stojanović, Mirko Lakićević, Ksenija Stevanović, Nevena Kalezić
Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery...
December 6, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29213129/deep-tissue-analysis-of-distal-aqueous-drainage-structures-and-contractile-features
#8
Jose M Gonzalez, Minhee K Ko, Young-Kwon Hong, Robert Weigert, James C H Tan
Outflow resistance in the aqueous drainage tract distal to trabecular meshwork is potentially an important determinant of intraocular pressure and success of trabecular bypass glaucoma surgeries. It is unclear how distal resistance is modulated. We sought to establish: (a) multimodal 2-photon deep tissue imaging and 3-dimensional analysis of the distal aqueous drainage tract (DT) in transgenic mice in vivo and ex vivo; (b) criteria for distinguishing the DT from blood and lymphatic vessels; and (c) presence of a DT wall organization capable of contractility...
December 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29212582/benefits-of-intraluminal-agarose-stents-during-end-to-end-intestinal-anastomosis-in-new-zealand-white-rabbits
#9
Wen-Yao Kuo, Hsiao-Chun Huang, Shih-Wei Huang, Kuan-Hua Yu, Feng-Pang Cheng, Jiann-Hsiung Wang, Jui-Te Wu
In the present study, we evaluated the utility of an intraluminal agarose stent (IAS) for end-to-end intestinal anastomoses in rabbits. Female New Zealand white rabbits (n = 14) underwent conventional sutured anastomosis (CSA) with or without an IAS. IAS were used to maintain the luminal diameter for more rapid and accurate suturing, and then was squeezed transluminally to crush it into fragments, which passed through the intestines and were eliminated. The rabbits were euthanized on postoperative day 21. At necropsy, the anastomoses were assessed for adhesion formation, stenosis, and bursting pressure and were examined histologically for collagen content and blood vessel formation...
December 1, 2017: Comparative Medicine
https://www.readbyqxmd.com/read/29210860/aortic-dilatation-in-marfan-syndrome-role-of-arterial-stiffness-and-fibrillin-1-variants
#10
Paolo Salvi, Andrea Grillo, Susan Marelli, Lan Gao, Lucia Salvi, Maurizio Viecca, Anna Maria Di Blasio, Renzo Carretta, Alessandro Pini, Gianfranco Parati
OBJECTIVE: Marfan syndrome (MFS) is an autosomal dominant genetic disorder characterized by aortic root dilation and dissection and an abnormal fibrillin-1 synthesis. In this observational study, we evaluated aortic stiffness in MFS and its association with ascending aorta diameters and fibrillin-1 genotype. METHODS: A total of 116 Marfan adult patients without history of cardiovascular surgery, and 144 age, sex, blood pressure and heart rate matched controls were enrolled...
January 2018: Journal of Hypertension
https://www.readbyqxmd.com/read/29210724/anesthetic-management-of-a-pacemaker-with-a-rate-drop-response-setting-a-case-report
#11
Alex K Saltzman, Peter J Fu, Brian Egan
Permanent pacemakers are used for a variety of conditions and are commonly encountered in the perioperative period. This report describes the anesthetic management of a patient with a permanent pacemaker with a rate drop response (RDR) who presented for a laparoscopic left adrenalectomy. The RDR setting is a novel pacemaker mode often used in patients with a history of vasovagal syncope. There are no previous reports describing the anesthetic management of such a pacemaker. This case report describes the features of the RDR setting with the goal of educating clinicians who may encounter patients with this type of pacemaker...
November 27, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29208756/neurally-adjusted-ventilatory-assist-after-pediatric-cardiac-surgery-clinical-experience-and-impact-on-ventilation-pressures
#12
Benjamin Crulli, Mariam Khebir, Baruch Toledano, Suzanne Vobecky, Nancy Poirier, Guillaume Emeriaud
INTRODUCTION: After pediatric cardiac surgery, ventilation with high airway pressures can be detrimental to right ventricular function and pulmonary blood flow. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interactions, helping maintain spontaneous ventilation. This study reports our experience with the use of NAVA in children after a cardiac surgery. We hypothesize that using NAVA in this population is feasible and allows for lower ventilation pressures. METHODS: We retrospectively studied all children ventilated with NAVA (invasively or noninvasively) after undergoing cardiac surgery between January 2013 and May 2015 in our pediatric intensive care unit...
December 5, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29207845/two-episodes-of-trigeminocardiac-reflex-during-a-pan-facial-fracture-surgery-a-rare-phenomenon-case-report-and-review-of-literature
#13
Abhishek Bhattacharjee, Prashanth Rajaram, Abhishek Khatua, K B Rudresh, Pallavi B Krishnamurthy
Trigeminocardiac reflex is a sudden physiologic response due to mechanical manipulation of any of the branches of trigeminal nerve. Trigeminocardiac reflex occurs due to pressure effect or stretching of trigeminal nerve which causes fall in blood pressure and decrease in heart rate. In this reflex arc, the trigeminal nerve serves as afferent pathway and vagus nerve, which is cardio inhibitory in nature, serves as efferent pathway. Two episodes of trigeminocardiac reflex during maxillofacial trauma surgery is not a common phenomenon...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29207810/comparative-study-of-the-effect-of-dexmedetomidine-vs-fentanyl-on-haemodynamic-response-in-patients-undergoing-elective-laparoscopic-surgery
#14
Jayshree P Vaswani, Debasis Debata, Varsha Vyas, Surekha Pattil
Introduction: Dexmedetomidine and fentanyl, both have sedative and analgesic effects. They are often used as adjunct during anaesthesia to attenuate pressor response during tracheal intubation. Limited study has been done comparing the effect of both drugs on haemodynamic response in patients undergoing laparoscopic surgery. Aim: The study was designed to compare the effect of dexmedetomidine Vs fentanyl on haemodynamic response to tracheal intubation, following pneumoperitoneum and intraoperative period in patients undergoing laparoscopic surgery...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29205687/ultrasound-guided-pudendal-nerve-block-in-children-a-new-technique-of-ultrasound-guided-transperineal-approach
#15
Isabelle Gaudet-Ferrand, Pablo De La Arena, Sophie Bringuier, Olivier Raux, Laurent Hertz, Nicolas Kalfa, Chrystelle Sola, Christophe Dadure
BACKGROUND: Transperineal pudendal nerve block guided by nerve stimulator is used in pediatric anesthesia as an alternative to caudal analgesia in perineal surgery. The risk of rectal puncture or intravascular injection is inherent to this blinded technique. We described a new technique of transperineal pudendal nerve block, with ultrasound guidance, to improve safety of the technique. AIMS: The first goal of this study was to describe this new technique and to test its feasibility...
December 5, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29205668/cerebrovascular-blood-pressure-autoregulation-monitoring-and-postoperative-transient-ischemic-attack-in-pediatric-moyamoya-vasculopathy
#16
Jennifer K Lee, Monica Williams, Michael Reyes, Edward S Ahn
BACKGROUND: Children with moyamoya vasculopathy are at high risk of perioperative cerebral ischemia or hyperperfusion. Maintaining blood pressure within the range of functional cerebrovascular blood pressure autoregulation might reduce the risk of perioperative neurologic injury. AIMS: We tested whether blood pressure autoregulation is associated with postoperative transient ischemic attack in a study of patients with pediatric moyamoya vasculopathy. METHODS: We conducted an observational study of 15 pediatric patients undergoing surgical revascularization with pial synangiosis...
December 5, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29204425/continuous-non-invasive-arterial-pressure-assessment-during-surgery-to-improve-outcome
#17
REVIEW
Alena Stenglova, Jan Benes
Blood pressure (BP) is one of the most important variables evaluated during almost every medical examination. Most national anesthesiology societies recommend BP monitoring at least once every 5 min in anesthetized subjects undergoing surgical procedures. In most cases, BP is monitored non-invasively using oscillometric cuffs. Although the risk of arterial cannulation is not very high, the invasive BP monitoring is usually indicated only in the case of high-risk patients or in complex surgical procedures...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/29203313/determining-the-lower-limit-of-cerebral-perfusion-pressure-in-patients-undergoing-decompressive-craniectomy-following-traumatic-brain-injury
#18
Jin Eun, Joon Huh, Seo-Yeon Yang, Han-Yong Huh, Jae-Kun Ahn, Kwang-Wook Cho, Young-Woo Kim, Sung-Lim Kim, Jong-Tae Kim, Do-Sung Yoo, Hae-Kwan Park, Cheol Ji
OBJECTIVE: In the severe traumatic brain injured (TBI) patient, maintaining the systolic blood pressure (BP) over 90 mmHg, the intracranial pressure (ICP) under 20 mmHg and the cerebral perfusion pressure (CPP) greater than 60∼70 mmHg is recommended to improve clinical outcomes. But a recommended CPP value for patients treated with decompression craniectomy (DC) is not clearly studied. The authors tried to determine whether the targeted CPP can be lowered in patients with DC. METHODS: 191 patients underwent DC for TBI included in this retrospective analysis...
December 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29203173/evaluation-of-the-dynamic-predictors-of-fluid-responsiveness-in-dogs-receiving-goal-directed-fluid-therapy
#19
Maja J Drozdzynska, Yu-Mei Chang, Giacomo Stanzani, Ludovic Pelligand
OBJECTIVES: Goal-directed fluid therapy (GDFT) based on pulse pressure variation (PPV) was used in anaesthetized dogs undergoing abdominal surgeries. The aims were 1) to evaluate the success rate of the PPV ≥13% in detecting fluid responsiveness [delta stroke volume (ΔSV) ≥10%]; 2) to assess the correlation between PPV, systolic pressure variation (SPV), Plethysmograph Variability Index (PVI) and central venous pressure (CVP) and 3) to establish the threshold value for the PVI that would predict a PPV value of ≥13% and indirectly discriminate responders from nonresponders to fluid therapy...
June 17, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29203153/focused-ultrasound-subthalamotomy-in-patients-with-asymmetric-parkinson-s-disease-a-pilot-study
#20
Raul Martínez-Fernández, Rafael Rodríguez-Rojas, Marta Del Álamo, Frida Hernández-Fernández, Jose A Pineda-Pardo, Michele Dileone, Fernando Alonso-Frech, Guglielmo Foffani, Ignacio Obeso, Carmen Gasca-Salas, Esther de Luis-Pastor, Lydia Vela, José A Obeso
BACKGROUND: Ablative neurosurgery has been used to treat Parkinson's disease for many decades. MRI-guided focused ultrasound allows focal lesions to be made in deep brain structures without skull incision. We investigated the safety and preliminary efficacy of unilateral subthalamotomy by focused ultrasound in Parkinson's disease. METHODS: This prospective, open-label pilot study was done at CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur in Madrid, Spain...
December 1, 2017: Lancet Neurology
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