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Jeffrey E Keenan, Ehsan Benrashid, Emily Kale, Alina Nicoara, Aatif M Husain, G Chad Hughes
Circulatory management during replacement of the aortic arch is complex and involves a period of circulatory arrest to provide a bloodless field during arch vessel anastomosis. To guard against ischemic brain injury, tissue metabolic demand is reduced by systemically cooling the patient prior to circulatory arrest. Neurophysiological intraoperative monitoring (NIOM) is often used during the course of these procedures to provide contemporaneous assessment of brain status to help direct circulatory management decisions and detect brain ischemia...
October 4, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Levi Bassin, David Bell
The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable...
September 2016: Best Practice & Research. Clinical Anaesthesiology
Douglas A Hardesty, Sean Doerfler, Sukhmeet Sandhu, Robert G Whitmore, Patricia Ford, Scott Rushton, Peter D LeRoux
BACKGROUND: Jehovah's Witnesses (JW) are a Christian faith with > 1 million members in the United States who do not accept autologous blood transfusions. The optimal management of these patients undergoing neurosurgical procedures is not well defined. Here, we examined the feasibility and safety of JW undergoing neurosurgery in a blood management program. STUDY DESIGN AND METHODS: Sixty-eight JW patients including 23 males and 45 females (mean age 53 +/- 12 years) who underwent a variety of cranial (n=19) and spinal (n=49) neurosurgical procedures over a 5-year period were identified retrospectively and their hospital charts, anesthetic records and operative reports reviewed...
September 15, 2016: World Neurosurgery
Dang Tang, Cheng Wang, Yongjun Gao, Jun Pu, Jiang Long, Wei Xu
Deep hypothermia is known for its organ-preservation properties, which is introduced into surgical operations on the brain and heart, providing both safety in stopping circulation as well as an attractive bloodless operative field. However, the molecular mechanisms have not been clearly identified. This study was undertaken to determine the influence of deep hypothermia on neural apoptosis and the potential mechanism of these effects in PC12 cells following oxygen-glucose deprivation. Deep hypothermia (18°C) was given to PC12 cells while the model of oxygen-glucose deprivation (OGD) induction for 1h...
October 6, 2016: Neuroscience Letters
Minja Milovanovic, Noah Taruberekera, Karin Hatzold, Neil Martinson, Limakatso Lebina
PrePex™ (Circ MedTech Ltd., Tortola, British Virgin Islands) devices are being evaluated in several countries for scale-up of medical male circumcision (MMC) as an HIV prevention intervention. Health care workers' perceptions should be considered prior to scale-up. A cross-sectional open-ended questionnaire was administered to health care workers from nine MMC programs in South Africa that provided either PrePex™ and surgical circumcision (mixed sites) or surgical circumcision only (surgery-only sites)...
November 2016: Journal of the Association of Nurses in AIDS Care: JANAC
John Gade, Gorm Greisen
UNLABELLED: The study created an 'ex vivo' model to test different algorithms for measurements of mucosal haemoglobin saturation with visible light spectrophotometry (VLS). The model allowed comparison between algorithms, but it also allowed comparison with co-oximetry using a 'gold standard' method. This has not been described before. Seven pigs were used. They were perfused with cold Haemaxel, and thus killed, chilled and becoming bloodless. The bronchial artery was perfused with cold blood with known saturation and spectrophotometrical measurements were made through a bronchoscope...
September 2016: Physiological Measurement
Tullio Piardi, Martin Lhuaire, Riccardo Memeo, Patrick Pessaux, Reza Kianmanesh, Daniele Sommacale
Laparoscopic liver resection (LLR) is technically possible with new devices which allow a relatively bloodless liver parenchymal transection. Despite, the main concern remains intraoperative hemorrhage. Currently, perioperative excessive blood loss during LLR is difficult to control with necessity of laparotomy conversion. Moreover, major blood loss requires transfusion and increases postoperative morbidity and mortality. When in-flow is limited by the hepatic pedicle clamping, it reduces intraoperative blood loss...
August 2016: Hepatobiliary Surgery and Nutrition
Linda M S Resar, Elizabeth C Wick, Talal Nael Almasri, Elizabeth A Dackiw, Paul M Ness, Steven M Frank
BACKGROUND: Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery. STUDY DESIGN AND METHODS: Here, we review prior studies and summarize current strategies for bloodless care used at our institution. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses...
October 2016: Transfusion
Gabriel Ferreira Nicoloso, Iuri Silveira dos Santos, Jorge Abel Flores, Bruno Lopes da Silveira, Marta Dutra Machado Oliveira
Ankyloglossia entails short lingual frenum, impairing satisfactory tongue movement and leading to problems related to deglutition, feeding and diction. This clinical report uses laser technology, rather than traditional surgical procedure with scalpel, to perform a lingual frenulotomy on a 9-year old child diagnosed with ankyloglossia, aiming to investigate more conservative and less traumatic dental procedures. Due to the many advantages of the laser device, such as bloodless surgical field, absence of sutures, minimal swelling and post-surgical pain, the high intensity diode laser is a viable alternative technique in soft tissue surgeries...
2016: Journal of Clinical Pediatric Dentistry
Suleiman Hussein Suleiman, El Sammani Wadaella, Ahmed Hassan Fahal
Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome...
June 2016: PLoS Neglected Tropical Diseases
W-F Li, T-L Lin, T-J Tan, R B Alikhanov, C-C Yong, S-H Wang, C-C Lin, Y-W Liu, C-C Wang, C-L Chen
BACKGROUND: Recipient hepatectomy can be complicated by severe bleeding during caudate lobe dissection in living-donor liver transplantation (LDLT), especially when the inferior vena cava is encased or with dense adhesions from prior interventions. Total hepatic vascular exclusion (TVE) including total hepatic inflow (Pringle maneuver) and occlusion of supra- and infra-hepatic inferior vena cava during the partial hepatectomy has been studied well, but it has not been mentioned regarding recipient hepatectomy in LDLT...
May 2016: Transplantation Proceedings
Charles W Sauer, Krishelle L Marc-Aurele
BACKGROUND: Infants born at 23 weeks' gestation have a poor prognosis and require intensive care, including blood transfusions, to survive. Generally speaking, the decision to forgo life support is acceptable. Jehovah's Witnesses believe that life is sacred and want lifesaving interventions except for blood transfusions. Therefore, an ethical dilemma exists when a baby is born on the edge of viability to parents that are Jehovah's Witnesses. In this case, if parents and healthcare professionals disagree on the best interests of the child, the medical team should obtain a court order from the state to intervene...
2016: American Journal of Case Reports
Nathaniel J Jellinek, Nicole F Vélez
Nail surgery is a fundamental component of podiatric surgery. Nail disorders are common and may cause significant morbidity and occasionally mortality. Diagnosis of inflammatory and infectious conditions, and of benign or malignant tumors, often requires a biopsy of the nail unit. Excisional surgery may also be curative for certain tumors. This article reviews key elements of nail anatomy, surgical preparation, local anesthesia, and methods to achieve and maintain a bloodless field. A familiarity with these concepts should allow clinicians to develop a surgical plan and approach when patients present with a nail disorder requiring biopsy or surgical treatment...
July 2016: Clinics in Podiatric Medicine and Surgery
Michał Michalec, Łukasz Tymecki, Robert Koncki
A general concept for the development of flow analysis system for non-invasive, bloodless monitoring of uremic toxins' removal in the course of clinical hemodialysis treatment is presented. The monitor operates in both (discrete and continuous) modes of measurements. In this study as a model uremic marker creatinine has been chosen. The monitor is based on solenoid operated microdevices (pumps and valves) and an optoelectronic flow-through detector made of paired light emitting diodes allowing photometric determination of this metabolite using Jaffé method...
September 5, 2016: Journal of Pharmaceutical and Biomedical Analysis
Robert A Sorabella, Laura Guglielmetti, Amanda Bader, Andres Gomez, Koji Takeda, Paul J Chai, Hiroo Takayama, Emile A Bacha, Yoshifumi Naka, Isaac George
BACKGROUND: Hypothermic circulatory arrest (HCA) has been used as an adjunct to cardiopulmonary bypass for decades, both electively and emergently, to facilitate a bloodless operative field while maintaining cerebral protection. The aim of this study is to determine the impact of HCA during heart transplantation on posttransplant outcomes. METHODS: All adult patients undergoing orthotopic heart transplantation at our institution between 2000 and 2012 were retrospectively reviewed...
October 2016: Annals of Thoracic Surgery
Oktay Irkorucu
BACKGROUND: Zuckerkandl tubercle (ZT) is a lateral projection from the lateral thyroid lobe which is a constant landmark for finding the recurrent laryngeal nerve during thyroid surgery. It is the condensed thyroid parenchyma located in the cricothyroid junction. Even today, ZT and its relationship with recurrent laryngeal nerve (RLN) is not well known by all surgeons. The objectives of the present study were to find out the incidence of ZT in our thyroidectomies and to investigate whether the ZT has a relationship with RLN...
May 2016: Annals of Medicine and Surgery
I Chatzipapas, D Zacharakis, L Michala, T Grigoriadis, P Antsaklis, A Protopapas
PURPOSE OF INVESTIGATION: To describe a novel approach for longitudinal vaginal septum (LVS) resection. Materials and Methods: Two cases of young girls with a uterus didelphys and a longitudinal vaginal septum. The technique consisted in grasping the vaginal septum with a laparoscopic 33-cm long bipolar cutting forceps, five-mm in diameter, and divided it to its midportion towards the two cervices. RESULTS: In both cases, the procedure was straightforward, uncomplicated, completed within three minutes and the patients were discharged four hours later...
2016: Clinical and Experimental Obstetrics & Gynecology
Marco Rispoli, Carlo Bergaminelli, Moana Rossella Nespoli, Mariana Esposito, Dario Maria Mattiacci, Antonio Corcione, Salvatore Buono
INTRODUCTION: A bloodless surgery can be desirable also for non Jehovah's witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. PRESENTATION OF THE CASE: Our patient, a Jehovah's witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. DISCUSSION: Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation...
2016: International Journal of Surgery Case Reports
Omar Tujjar, Angelo Raffaele De Gaudio, Lorenzo Tofani, Alessandro Di Filippo
Near-infrared spectroscopy (NIRS) has been used to detect in vivo microvascular alterations by means of a vascular occlusion test. We sought to analyse by NIRS the microcirculatory profile of patients undergoing prolonged tourniquet-induced bloodless condition for extremity surgery, and compare the results with time of ischemia and comorbidities. We conducted a prospective observational study on 42 patients undergoing upper limb surgery. Regional anaesthesia was achieved and ischemia was induced by a tourniquet cuffed at 250 mmHg...
April 12, 2016: Journal of Clinical Monitoring and Computing
D A Lees, J B Penny, P Baker
AIMS: The aim of this study was to compare the pain caused by the application of a tourniquet after exsanguination of the upper limb with that occurring after simple elevation. PATIENTS AND METHODS: We used 26 healthy volunteers (52 arms), each of whom acted as their own matched control. The primary outcome measure was the total pain experienced by each volunteer while the tourniquet was inflated for 20 minutes. This was calculated as the area under the pain curve for each individual subject...
April 2016: Bone & Joint Journal
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