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colloid spine surgery

J Matthias Walz, Ottokar Stundner, Federico P Girardi, Bruce A Barton, Aimee R Koll-Desrosiers, Stephen O Heard, Stavros G Memtsoudis
AIM: To investigate the microvascular (skeletal muscle tissue oxygenation; SmO2) response to transfusion in patients undergoing elective complex spine surgery. METHODS: After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3 level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume (SV), cardiac output (CO), cardiac index (CI), and stroke volume variability (SVV) was performed...
January 18, 2017: World Journal of Orthopedics
Nancy E Epstein
BACKGROUND: Postoperative visual loss (POVL) following prone spine surgery occurs in from 0.013% to 1% of cases and is variously attributed to ischemic optic neuropathy (ION: anterior ION or posterior ION [reported in 1.9/10,000 cases: constitutes 89% of all POVL cases], central retinal artery occlusion [CRAO], central retinal vein occlusion [CRVO], cortical blindness [CB], direct compression [horseshoe, prone pillows, and eye protectors Dupaco Opti-Gard]), and acute angle closure glaucoma (AACG)...
2016: Surgical Neurology International
Julien Picard, Damien Bedague, Pierre Bouzat, Céline Ollinet, Pierre Albaladejo, Jean-Luc Bosson, Jean-François Payen
BACKGROUND: Intraoperative use of oesophageal Doppler (OD) was associated with improved postoperative outcomes through the optimization of perioperative fluid management. We studied the effect on haemodynamics of a goal-directed fluid management approach, guided by OD, during elective spine surgery in the prone position. METHODS: Intraoperative fluid and vasopressor administration were directed according to one of two randomly chosen decision-making algorithms driven by either OD (OD group; n=33 patients) or standard parameters (standard group; n=34 patients)...
August 2016: Anaesthesia, Critical Care & Pain Medicine
Koffi M Kla, Lorri A Lee
Perioperative visual loss is an infrequent, devastating complication associated with spine surgery, most commonly from ischemic optic neuropathy. Current research and expert opinion indicate that it is associated with procedures that create elevated venous pressure in the head for prolonged periods of time. The largest case-control study on ischemic optic neuropathy associated with spine surgery found six independent and significant risk factors including male sex, obesity, Wilson frame use, longer operative times, greater blood loss, and a lower colloid to crystalloid ratio in the non-blood fluid administration...
March 2016: Best Practice & Research. Clinical Anaesthesiology
Manee Raksakietisak, Benjabhorn Sathitkarnmanee, Peeranat Srisaen, Tithiganya Duangrat, Thitima Chinachoti, Pranee Rushatamukayanunt, Nuchanat Sakulpacharoen
STUDY DESIGN: Prospective, double-blinded, randomized controlled study. OBJECTIVE: To determine whether the use of 2 doses of tranexamic acid (TXA) can reduce perioperative blood loss and blood transfusions in low-risk adult patients undergoing complex laminectomy. SUMMARY OF BACKGROUND DATA: Complex laminectomy (multilevel laminectomy or laminectomy and instrumentation) is a procedure with a medium risk of blood loss, which may require allogeneic blood transfusion...
December 2015: Spine
Travis J Nickels, Mariel R Manlapaz, Ehab Farag
Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases...
April 18, 2014: World Journal of Orthopedics
Fenghua Li, Reza Gorji, Richard Tallarico, Charles Dodds, Katharina Modes, Sukhpal Mangat, Zhong-Jin Yang
PURPOSE: Extubation may be delayed after spine surgery mainly for the concerns of airway safety. Risk factors for delayed extubation in cervical spine surgery have been described to include prolonged surgery time and amount of crystalloids or blood transfused. To date, risk factors for delayed extubation in thoracic or lumbar spine surgery have not been investigated. We retrospectively reviewed 135 consecutive patients from 2006 to 2009 who underwent thoracic or lumbar spine surgery by one particular surgeon to identify risk factors for delayed extubation...
April 2014: Journal of Anesthesia
Ramamani Mariappan, Pirjo Manninen, Eric M Massicotte, Anuj Bhatia
A hypersensitivity reaction, either anaphylactic or anaphylactoid, is a well-known adverse effect following intravenous and oral administration of vancomycin. The authors report a case of circulatory collapse and its management after the topical application of vancomycin powder during spinal instrumentation surgery. A 52-year-old woman with breast cancer and metastasis to her spine underwent a vertebrectomy of the T-10 vertebra with instrumented reconstruction from T-8 to T-12. The patient was hemodynamically stable during most of the procedure despite a 2-L blood loss requiring administration of crystalloids, colloids, packed red blood cells, and fresh-frozen plasma...
September 2013: Journal of Neurosurgery. Spine
Jeremy A Lieberman, John Feiner, Russ Lyon, Mark D Rollins
BACKGROUND: Transcranial motor-evoked potentials (TcMEPs) monitor spinal cord motor tract integrity. Using a swine model, the authors studied the effects of vasodilatory hypotension, hemorrhage, and various resuscitation efforts on TcMEP responses. METHODS: Twelve pigs were anesthetized with constant infusions of propofol, ketamine, and fentanyl. Animals were incrementally hemorrhaged, until bilateral tibialis anterior TcMEP amplitude decreased to less than 40% of baseline or until 50% of the blood volume was removed...
November 2013: Anesthesiology
Lorri A Lee
PURPOSE OF REVIEW: Perioperative visual loss (POVL) is an uncommon complication primarily associated with cardiac, spine, and head and neck surgery that can have a potentially severe impact on quality of life. The largest multicenter case control study to date on POVL recently identified risk factors associated with ischemic optic neuropathy and prone spinal fusion surgery. This review will summarize these findings and the updated American Society of Anesthesiologists practice advisory on POVL to provide guidance on identification and management of high-risk patients undergoing prone spine surgery...
June 2013: Current Opinion in Anaesthesiology
S-Y Yang, J-K Shim, Y Song, S-J Seo, Y-L Kwak
BACKGROUND: The aim of this prospective trial was to investigate the ability of pulse pressure variation (PPV) and corrected flow time (FTc) to predict fluid responsiveness in the prone position. METHODS: Forty-four patients undergoing lumbar spine surgery in the prone position on a Wilson frame were prospectively studied. PPV and FTc were measured before and after a colloid bolus (6 ml kg(-1)) both in the supine and in the prone positions. Fluid responsiveness was defined as an increase in the stroke volume index of ≥ 10% as measured by oesophageal Doppler...
May 2013: British Journal of Anaesthesia
Martín Granados-García, Jesús Cabrera-Rojas, Gerardo Guzmán-Flores, Enrique Estrada-Lobato, Ana María Cano-Valdés, Erik Santamaría-Linares
BACKGROUND: Bone reconstruction is a common problem in the oncological setting. Mandibular reconstruction is done with microvascularized free flaps, but noticeable differences in shape and size exist in relation to the normal mandible; consequently, new reconstructive methods are desirable. We explored the feasibility of recovering osseous viability using a sterilized mandibular segment reconstituted with autologous bone marrow. METHODS: A 6- to 7-cm mandibular segment was excised in three Creole dogs...
May 2011: Cirugia y Cirujanos
Ehab Farag, Daniel I Sessler, Bledar Kovaci, Lu Wang, Edward J Mascha, Gordon Bell, Iain Kalfas, Edward Rockwood, Andrea Kurz
BACKGROUND: Volume replacement with colloid solution and topical α-2 agonists may each moderate the progressive increase in intraocular pressure (IOP) during prone surgery. The authors tested the hypotheses that during prolonged prone surgery, IOP increases less with goal-directed intravenous administration of 5% albumin than with goal-directed administration of lactated Ringer's solution, and with topical α-2 agonist brimonidine than with placebo eye drops. METHODS: Patients having complex prone spine surgery were factorially randomized to albumin and topical placebo (n = 15); albumin and topical brimonidine (n = 16); lactated Ringer's solution and topical placebo (n = 13); and lactated Ringer's solution and topical brimonidine (n = 16)...
April 2012: Anesthesiology
Krzysztof Siemionow, Jacek Cywinski, Krzysztof Kusza, Isador Lieberman
The purpose of this study was to evaluate the effects of intraoperative fluid therapy on length of hospital stay and pulmonary complications in patients undergoing spine surgery. A total of 1307 patients were analyzed. Sixteen pulmonary complications were observed. Patients with a higher volume of administered crystalloids, colloids, and total intravenous fluids were more likely to have postoperative respiratory complications: the odds of postoperative respiratory complications increased by 30% with an increase of 1000 mL of crystalloid administered...
February 2012: Orthopedics
Micha Y Shamir, Leonid Kaplan, Rachel S Marans, Dafna Willner, Yoram Klein
BACKGROUND: Noticeable changes in vital signs indicating hypovolemia occur only after 15% of the blood volume is lost. More sensitive variables (e.g., cardiac output, systolic pressure variation and its Δdown component) are invasive and difficult to obtain in the early phase of bleeding. Lately, a new technology for continuous optical measurements of minute-to-minute urine flow rates has become available. We performed a preliminary evaluation to determine whether urine flow can act as an early and sensitive warning of hypovolemia...
March 2011: Anesthesia and Analgesia
Nancy E Epstein
BACKGROUND: "Bloodless spinal surgery" predominantly refers to NH, a procedure that minimizes blood transfusion requirements. By limiting or eliminating allogeneic transfusions, NH reduces the risk of transmitting HIV or hepatitis, and the need for predonating autologous blood with the risks of blood bank contamination, misidentification, or the removal of coagulation factors (fresh frozen plasma, platelets). METHODS: The NH technique technically requires the controlled removal of a volume of whole blood at the beginning of surgery...
December 2008: Surgical Neurology
Markus Mittermayr, Werner Streif, Thorsten Haas, Dietmar Fries, Corinna Velik-Salchner, Anton Klingler, Elgar Oswald, Christian Bach, Mirjam Schnapka-Koepf, Petra Innerhofer
BACKGROUND: To explore whether disturbed fibrin polymerization is the main problem underlying dilutional coagulopathy and can be reversed by fibrinogen administration, we conducted a prospective study using modified thrombelastography (ROTEM). METHODS: Sixty-six orthopedic patients randomly received modified gelatin solution, hydroxyethyl starch 130/0.4, or exclusively Ringer lactate solution. ROTEM analysis was performed, concentrations of coagulation factors and markers of thrombin generation were measured...
October 2007: Anesthesia and Analgesia
C Fenger-Eriksen, C Hartig Rasmussen, T Kappel Jensen, E Anker-Møller, J Heslop, J Frøkiaer, E Tønnesen
BACKGROUND: Hypotensive anaesthesia (HA) and acute normovolaemic haemodilution (ANH) are used separately to decrease per-operative blood loss. Reducing blood viscosity by adding ANH to HA may appear profitable in a situation with lowered perfusion pressure and concern about organ ischemia. The aim of this study was to clarify the influence of HA in combination with ANH using crystalloid or colloid as replacement fluid on renal function. METHODS: Hypotensive anaesthesia was induced in 11 patients referred to major spine surgery using sevoflurane in combination with fentanyl/remifentanil...
August 2005: Acta Anaesthesiologica Scandinavica
Vivien T-G Ho, Nancy J Newman, Suzan Song, Susan Ksiazek, Steven Roth
Perioperative visual loss (POVL) is a devastating injury that has been reported infrequently after nonocular surgery. The most common cause of POVL is ischemic optic neuropathy (ION). Increasing numbers of cases of ION are being reported after spine surgery, but the etiology of postoperative ION remains poorly understood. After a MEDLINE search of the literature, we reviewed published case reports of ION, specifically those reported after spine surgery performed with the patient in the prone position. Most of the cases involved posterior ION (PION, n = 17), and the remainder anterior (AION, n = 5)...
January 2005: Journal of Neurosurgical Anesthesiology
K O Ng, L H Chow, C C Wang, Y C Yang, K Liu, T Y Lee
Blood transfusion is absolutely indicated in acute anemia when the hemoglobin concentration falls below 6 g/dL. Sometimes it challenges the anesthesiologists if the blood intended for urgent transfusion is not readily or quickly available. In this case report, we describe an 81-year-old lady who accidentally sustained acute anemia after spinal surgery with the hemoglobin concentration falling to 1.4 g/dL. During the long wait for the process of cross-matching tests and delivery of blood from the blood bank in the city remote from the hospital, we could do nothing but administer crystalloid and colloid solutions to maintain the circulatory volume to prevent low cardiac output...
June 2000: Acta Anaesthesiologica Sinica
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