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staged extubation

Eduardo Barbin Zuccolotto, Eugenio Pagnussatt Neto, Glínia Cavalcante Nogueira, José Roberto Nociti
BACKGROUND AND OBJECTIVES: HELLP syndrome, characterized by hemolysis, high levels of liver enzyme, and low platelet count, is an advanced clinical stage of pre-eclampsia, progressing to high maternal (24%) and perinatal (up 40%) mortality, despite childbirth care in a timely manner. The goal is to describe the anesthetic management of a case with indication to emergency cesarean. CASE REPORT: Female patient, 36 years old, gestational age of 24 weeks, with hypertensive crisis (BP 180/100mmHg) and severe headache, was admitted to the operating room for a cesarean section after diagnosis of HELLP syndrome...
November 2016: Brazilian Journal of Anesthesiology
Aditya Bansal, Jay K Bhama, Rajan Patel, Sapna Desai, Stacy A Mandras, Hamang Patel, Tyrone Collins, John P Reilly, Hector O Ventura, P Eugene Parrino
BACKGROUND: Outcomes of traditional mechanical support paradigms (extracorporeal membrane oxygenation, intraaortic balloon pump [IABP], and permanent left ventricular assist device [LVAD]) in acute decompensated heart failure have generally been suboptimal. Novel approaches, such as minimally invasive LVAD therapy (Impella 5.0 device), promise less invasive but equivalent hemodynamic support. However, it is yet unknown whether the outcomes with such devices support widespread acceptance of this new technology...
2016: Ochsner Journal
Q Wang, Y H Liu, G Q Hu, Y Zhao
OBJECTIVE: To sum up the efficacy of treatment of pharyngeal fistula through pectoralis major myocutaneous flap combined with fistula local skin inversion in 20 patients. METHODS: A retrospective analysis of the therapeutic efficacy in 20 cases of laryngeal and laryngopharyngeal cancer with postoperative pharyngeal fistula, to whom double-deck repairing were operated on through pectoralis major myocutaneous island flap combined with inversion of skin around fistula from January 2010 to December 2013...
August 2016: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
Itaru Yugué, Seiji Okada, Muneaki Masuda, Takayoshi Ueta, Takeshi Maeda, Keiichiro Shiba
BACKGROUND CONTEXT: Neurologic motor deficit is a serious complication of spinal surgery. Early diagnosis of complications by neurologic examination immediately after spinal surgery is mandatory. However, patients cannot always cooperate with the physician in the very early stages of recovery. PURPOSE: The aim of the present study is to prospectively investigate the usefulness of the "knee-up test" for easy detection of postoperative motor deficits. STUDY DESIGN: A prospective clinical study was carried out...
August 9, 2016: Spine Journal: Official Journal of the North American Spine Society
Carina Isabel Ferreira Martinho, Inês Tello Rato Milheiras Rodrigues
OBJECTIVE: The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. METHODS: This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units...
June 2016: Revista Brasileira de Terapia Intensiva
Sarah Derieg
Care of pediatric surgical patients is not limited to pediatric facilities, and all perioperative RNs should have a basic understanding of the specialized care that children require. This knowledge set includes an understanding of the basic terminology used to describe this patient population as well as the developmental stages of pediatric patients. Preoperatively, the nurse should conduct a thorough assessment and evaluation and address the anxieties and questions of the patient and his or her parent or guardian...
July 2016: AORN Journal
Mete Gungor, Ozguc Takmaz, Selim Afsar, Esra Ozbasli, Savas Gundogan
STUDY OBJECTIVE: To report the feasibility of bulky pelvic lymph node resection with robotic-assisted single-port laparoscopy in cervical cancer before chemoradiation therapy.. DESIGN: Showing resection of pelvic bulky lymph node with a narrated video in da Vinci Single-port platform surgery. (Canadian Task Force Classification III ). PATIENT: A 46-year-old patient diagnosed with advanced stage cervical cancer (FIGO Stage IIIB) was presented with bilateral pelvic lymph node metastasis revealed by pelvic magnetic resonance imaging (MRI)...
June 13, 2016: Journal of Minimally Invasive Gynecology
Kathleen Kerrigan, Abigail Shoben, Gregory Otterson
BACKGROUND: Patients with advanced-stage non-small-cell lung cancer (NSCLC) have high mortality rates in the intensive care unit (ICU). Although the benefit of chemotherapy for hematologic malignancies in the ICU has previously been explored, few data exist regarding the use of targeted therapy for NSCLC in such settings. The primary objective of the present study was to report our experience with the use of targeted therapy in patients with NSCLC in the ICU. MATERIALS AND METHODS: We performed a single-institution, retrospective medical record review...
November 2016: Clinical Lung Cancer
Daniel Felbaum, Hasan R Syed, Joshua E Ryan, Walter C Jean, Amjad Anaizi
Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion...
2016: Curēus
Chris Yin Wei Chan, Chiao Yee Lim, M Shahnaz Hasan, Mun Keong Kwan
PURPOSE: Patients with Fontan circulation have increased cardio-respiratory risk during major spinal surgery. We report a case of severe scoliosis with a Cobb angle of 123.3° in a 16-year-old boy with Fontan circulation treated with single stage posterior segmental pedicle screw instrumentation and fusion. METHODS: Case report. RESULTS: The use pre-operative halo-ring traction for a duration of 6 weeks in this case lead to improvement in cobb angle from 123...
May 2016: European Spine Journal
Eoin M Twohig, Ross Leader, Richard J Shaw, Peter Charters
Management of the airway after operations on the head and neck is potentially problematic. We describe leaving a guidewire in the trachea after successful extubation in two patients, to make reintubation easier if the airway was later compromised.
March 11, 2016: British Journal of Oral & Maxillofacial Surgery
Eliana C M Sudré, Priscila R de Batista, Yara M M Castiglia
BACKGROUND: We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. METHODS: We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine)...
November 2015: Obesity Surgery
Takatoshi Sato, Terumi Murakami, Kumiko Ishiguro, Minobu Shichiji, Kayoko Saito, Makiko Osawa, Satoru Nagata, Keiko Ishigaki
BACKGROUND: Fukuyama congenital muscular dystrophy (FCMD), characterized by intellectual impairment associated with cortical migration defects, is an autosomal recessive disorder caused by mutation in the fukutin gene. It is the second most common type of muscular dystrophy in Japan. Respiratory dysfunction, along with cardiomyopathy, can be life-threatening in patients with advanced-stage FCMD. However, few reports have focused on this issue. METHODS: We retrospectively studied respiratory dysfunction and therapeutic management in 48 genetically diagnosed FCMD patients (mean age 11...
March 2016: Brain & Development
Xiao Tang, Bing Sun, Hangyong He, Hui Li, Bin Hu, Zewu Qiu, Jie Li, Chunyan Zhang, Shengcai Hou, Zhaohui Tong, Huaping Dai
CONTEXT: Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances. CASE DETAILS: A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat...
November 2015: Clinical Toxicology
Haifeng Wang, Cameron D Wright, John C Wain, Harald C Ott, Douglas J Mathisen
BACKGROUND: Idiopathic subglottic stenosis is a rare inflammatory condition affecting the subglottic larynx. We have treated 263 patients (only 2 were male) with this condition. The purpose of this study is to determine factors affecting outcome and predisposing to complications. METHODS: Information was gathered from chart reviews, surveys, and a prospective database. RESULTS: Median time from diagnosis to surgery was 24 months. Antinuclear antibodies when measured were positive in 76 patients (47%)...
November 2015: Annals of Thoracic Surgery
A Demir, B Aydınlı, H I Toprak, Ü Karadeniz, F M Yılmaz, C Züngün, P Uçar, Ç Y Güçlü, E B Bostancı, S Yılmaz
BACKGROUND: Since the first liver transplantation, pretransplantation or post-transplantation renal problems are still among the main causes of mortality and morbidity. The aim of this study was to evaluate the effects of fluid replacement solutions used intraoperatively on renal functions in elective living-donor liver transplantation. METHODS: After Ethics Committee approval, informed consents were obtained from patients. Patients with normal renal functions and scheduled for elective living-donor-liver transplantation were included in the study...
July 2015: Transplantation Proceedings
Sigrid Bairdain, Brenda Dodson, David Zurakowski, David B Waisel, Russell W Jennings, Karen R Boretsky
BACKGROUND: Infants with long-gap esophageal atresia (LGEA) undergo repeated thoracotomies for staged surgical repair known as the Foker process (FP). Associated prolonged mechanical ventilation results in exposure to high doses of opioids and benzodiazepines, and prolonged weaning times and ICU stays. AIM: The aim of this study was to determine the effectiveness of short-term paravertebral nerve block (PVNB) catheters in reducing opioid/benzodiazepine exposure and effects on clinical variables...
November 2015: Paediatric Anaesthesia
Yi Yang, Lizhong Sun, Nan Liu, Xiaotong Hou, Hong Wang, Ming Jia
BACKGROUND: Hypoxemia is a severe perioperative complication that can substantially increase intensive care unit and hospital stay and mortality. The aim of this study was to determine the effects of non-invasive positive-pressure ventilation (NIPPV) in patients with hypoxemia after surgery for Stanford type A aortic dissection, and to compare the effects of helmet and mask NIPPV. MATERIAL AND METHODS: We recruited 40 patients who developed hypoxemia within 24 h after extubation after surgery for Stanford type A aortic dissection in the Beijing Anzhen Hospital...
August 7, 2015: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Alain Carpentier, Christian Latrémouille, Bernard Cholley, David M Smadja, Jean-Christian Roussel, Elodie Boissier, Jean-Noël Trochu, Jean-Pierre Gueffet, Michèle Treillot, Philippe Bizouarn, Denis Méléard, Marie-Fazia Boughenou, Olivier Ponzio, Marc Grimmé, Antoine Capel, Piet Jansen, Albert Hagège, Michel Desnos, Jean-Noël Fabiani, Daniel Duveau
BACKGROUND: The development of artificial hearts in patients with end-stage heart disease have been confronted with the major issues of thromboembolism or haemorrhage. Since valvular bioprostheses are associated with a low incidence of these complications, we decided to use bioprosthetic materials in the construction of a novel artificial heart (C-TAH). We report here the device characteristics and its first clinical applications in two patients with end-stage dilated cardiomyopathy. The aim of the study was to evaluate safety and feasibility of the CARMAT TAH for patients at imminent risk of death from biventricular heart failure and not eligible for transplant...
October 17, 2015: Lancet
Wei Zhang, Mingyue Li, Ning Liu, Fangwen Chen, Qingzhi Meng
OBJECTIVE: To explore the application of double pedicle blood supply pectoralis major myocutaneous flap in reconstruction of laryngeal and hypo pharyngeal defect after carcinoma resection. METHOD: All the patients received initial treatment. Pectoralis major myocutaneous flap was Applied in one-stage reconstruction in 22 cases of laryngocarcinoma and hypopharyngeal carcinoma with post-operation defect. During operation, pectoral branches of thoracoacromial vessels and branch of lateral thoracic vessels were reserved and prepared to be double pedicle vessel fascia bundle without muscle at the beginning part, rearched to defect area through subclavian tunnel...
April 2015: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
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