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Intraoperative awareness

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https://www.readbyqxmd.com/read/29790076/a-case-of-jackhammer-esophagus-caused-by-eosinophilic-esophagitis-in-which-per-oral-endoscopic-myotomy-resulted-in-symptom-improvement
#1
Shinwa Tanaka, Takashi Toyonaga, Fumiaki Kawara, Daisuke Watanabe, Namiko Hoshi, Hirohumi Abe, Ryusuke Ariyoshi, Yoshiko Ohara, Tsukasa Ishida, Toshitatsu Takao, Yoshinori Morita, Eiji Umegaki
A 73-year-old female with a 6-month history of progressive dysphagia and chest pain was referred to our hospital. She underwent esophagogastroduodenoscopy, which revealed abnormally strong contractions in the distal esophagus. Esophageal biopsy specimens showed massive eosinophil infiltration into the epithelium, and high-resolution manometry (HRM) also demonstrated abnormally strong contractions in the distal esophagus. Based on these results, she was diagnosed with Jackhammer esophagus (JHE) due to eosinophilic esophagitis (EoE)...
May 22, 2018: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/29787410/the-effect-of-dexmedetomidine-on-propofol-requirements-during-anesthesia-administered-by-bispectral-index-guided-closed-loop-anesthesia-delivery-system-a-randomized-controlled-study
#2
Amitabh Dutta, Nitin Sethi, Jayashree Sood, Bhuwan C Panday, Manish Gupta, Prabhat Choudhary, Goverdhan D Puri
BACKGROUND: Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia using bi-spectral index (BIS) feedback and attain general anesthesia (GA) steady state with greater consistency. This study assessed whether dexmedetomidine is effective in further lowering the propofol requirements for total intravenous anesthesia facilitated by CLADS...
May 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29786598/-hypertrophic-cardiomyopathy-an-intraoperative-death-case-analysis-and-substantiation-of-the-standards-of-perioperative-anesthetic-management-in-a-non-cardiosurgery-clinic
#3
Roman N Fedosiuk, Liliia O Shchupachynska
The article is based on the case analysis of a sudden and unexpected intraoperative death of a 51-year-old female patient with hypertrophic cardiomyopathy, who was undergoing a non-cardiac operation in a non-cardiosurgery clinic, from acute precipitation of left ventricular outflow tract obstruction provoked by surgery and anesthesia. It emphasizes the importance of raising non-cardiac anesthesiologists' awareness of the issue and having clear standards of pre-operative evaluation and perioperative management of patients with hypertrophic cardiomyopathy in order to avoid fatal medical errors...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29781847/identification-of-the-critical-nontechnical-skills-for-surgeons-needed-for-high-performance-in-a-variable-resource-context-notss-vrc
#4
John W Scott, Yihan Lin, Georges Ntakiyiruta, Zeta Mutabazi, William A Davis, Megan A Morris, Douglas S Smink, Robert Riviello, Steven Yule
OBJECTIVE: To identify the critical nontechnical skills (NTS) required for high performance in variable-resource contexts (VRC). BACKGROUND: As surgical training and capacity increase in low- and middle-income countries (LMICs), new strategies for improving surgical education and care in these settings are required. NTS are critical for high performance in surgery around the world. However, the essential NTS used by surgeons operating in LMICs to overcome the challenges specific to their contexts have never been described...
May 17, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29780071/symptomatic-remote-cyst-after-bcnu-wafer-implantation-for-malignant-glioma
#5
Hideaki Matsumura, Eiichi Ishikawa, Masahide Matsuda, Noriaki Sakamoto, Hiroyoshi Akutsu, Shingo Takano, Akira Matsumura
A 43-year-old man was operated on for right frontal oligoastrocytoma. 14 years after the surgery, magnetic resonance imaging and positron emission tomography revealed a new lesion near the surgical cavity. He underwent gross total resection of the lesion and implantation of bis-chloroethylnitrosourea (BCNU) wafers after intraoperative pathological diagnosis of recurrent high-grade glioma. A few days after the operation, the level of consciousness gradually worsened and left hemiparesis developed. A computed tomography scan revealed a cyst remote to the surgical cavity which did not exist 3 days prior...
May 21, 2018: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/29772562/using-neuroimaging-to-uncover-awareness-in-brain-injured-and-anesthetized-patients
#6
Mackenzie Graham, Adrian M Owen, Charles Weijer, Lorina Naci
We cast a novel perspective on two distinct populations: patients who become accidentally intraoperatively aware after receiving general anesthesia and severely brain-injured patients who are diagnosed as being in a vegetative state. In both cases, patients are behaviorally non-responsive -and on this basis presumed to lack consciousness- yet, retain covert awareness. In both contexts, detecting consciousness is highly challenging, yet highly important for ensuring adequate patient care. Although great strides have been made in the development of depth-of-anesthesia monitors, these monitors have significant limitations...
June 1, 2018: Frontiers in Bioscience (Scholar Edition)
https://www.readbyqxmd.com/read/29751786/meconium-peritonitis-due-to-fetal-appendiceal-perforation-two-case-reports-and-a-brief-review-of-the-literature
#7
Yi Wang, Yeming Wu, Wenbin Guan, Wenbo Yan, Yuhua Li, Jin Fang, Jun Wang
BACKGROUND: Meconium peritonitis is an infrequent congenital disease usually caused by perforation of the fetal digestive tract. Meconium peritonitis resulting from intrauterine appendiceal perforation has been rarely reported and is often overlooked during pregnancy. We herein report two cases of fetal appendiceal perforation. CASE PRESENTATION: Two neonates were found to have intestinal distension and gradually increasing ascites antenatally. After birth, diagnostic abdominal punctures revealed meconium peritonitis...
May 11, 2018: BMC Pediatrics
https://www.readbyqxmd.com/read/29741921/how-variable-are-achilles-allografts-used-for-anterior-cruciate-ligament-reconstruction-a-biomechanical-study
#8
Alexander E Weber, Erik N Mayer, Amit Nathani, Dan X Chen, Anne M Kelly, Scott A Rodeo, Asheesh Bedi
BACKGROUND: Allograft tendon used in anterior cruciate ligament reconstruction (ACLR) requires sterilization before implantation. Low-dose gamma irradiation is a means of sterilization that may minimize tissue damage. PURPOSE: To quantify the variability in mechanical properties between low-dose irradiated Achilles tendon allografts used for ACLR. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 15 intact outer-third Achilles tendon allograft specimens were collected from the remains of full Achilles allografts used for intraoperative ACLR at a single hospital...
May 1, 2018: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29736726/high-incidence-of-intraoperative-calcar-fractures-with-the-cementless-cls-spotorno-stem
#9
Carla Timmer, Davey M J M Gerhardt, Enrico de Visser, Marinus de Kleuver, Job L C van Susante
INTRODUCTION: This study reports on the incidence of intraoperative calcar fractures with the cementless Spotorno (CLS) stem, and the potential role of a learning curve and implant positioning is investigated. METHODS: After introduction of the CLS stem, 800 consecutive cementless total hip arthroplasties (THA) were analyzed. The incidence of calcar fracture in the first 400 THA was compared with the second 400 THA, in order to study a potential learning curve effect...
May 7, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/29704693/cardiac-arrest-during-spine-surgery-in-the-prone-position-case-report-and-review-of-the-literature
#10
REVIEW
Victor E Staartjes, Shiva A Schillevoort, Patricia G Blum, J Peter van Tintelen, Wouter E Kok, Marc L Schröder
OBJECTIVE: Intraoperative cardiac arrest (CA) is usually attributable to pre-existing disease, or to intraoperative complications. In rare cases, intraoperative stress can demask certain genetic diseases, such as Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). It is essential that neurosurgeons are aware of the etiologies, risk factors, and initial management of CA during surgery in the prone position. METHODS: We present a case of CA directly after spinal fusion for lumbar spondylolisthesis, and review the literature on cardiac arrests during spinal neurosurgery in the prone position...
April 26, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29696118/anesthetic-considerations-for-angelman-syndrome-case-series-and-review-of-the-literature
#11
Mary Ellen Warner, David P Martin, Mark A Warner, Ralitza H Gavrilova, Juraj Sprung, Toby N Weingarten
Background: Angelman syndrome is a rare neurodevelopmental disorder characterized by intellectual disability, severe speech impairment, ataxia, seizures, happy demeanor, distinctive craniofacial features, high vagal tone, and gamma-amino butyric acid receptor abnormalities. The aim of this report is to review our experience of patients with Angelman syndrome undergoing anesthetic management. Methods: We retrospectively reviewed perioperative course of patients with Angelman syndrome who underwent procedures under anesthesia from 2000 to 2016...
October 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29692530/primary-presentation-of-jeune-s-syndrome-as-gastric-motility-disorder-in-an-infant-a-case-report
#12
Amit Katyan, Shabnam Bhandari Grover, Heena Rajani, Deepak Bagga, Neha Antil
We report a case of a 4-week-old female neonate with Jeune's asphyxiating thoracic dystrophy (JATD) and coexistent situs anomaly, primarily presenting as gastric motility disorder. The child presented with abdominal distension and nonbilious vomiting since birth with failure to thrive. However, skeletal survey revealed JATD. Upper gastrointestinal contrast study showed situs inversus with delayed gastric emptying. Pyloric biopsy and intraoperative antro-duodenal manometry confirmed association of gastric motility disorder...
January 2018: Indian Journal of Radiology & Imaging
https://www.readbyqxmd.com/read/29687315/incidental-intraoperative-diagnosis-of-mycobacterium-abscessus-meningeal-infection-a-case-report-and-review-of-the-literature
#13
REVIEW
Francesca Giovannenze, Vito Stifano, Giancarlo Scoppettuolo, Fernando Damiano, Federico Pallavicini, Giovanni Delogu, Ivana Palucci, Alessandro Rapisarda, Cosimo Sturdà, Angelo Pompucci
PURPOSE: Mycobacterium abscessus, and rapidly growing mycobacteria in general, are rare but increasing causes of central nervous system (CNS) infections. The aim of this study is to highlight the importance of considering these microorganism in the differential diagnosis of CNS infections, obtaining a prompt diagnosis, and improving clinical outcomes. METHODS: Case report and literature review. RESULTS: We report a case of meningeal infection in a patient who underwent decompressive craniectomy after a craniofacial trauma...
April 23, 2018: Infection
https://www.readbyqxmd.com/read/29683857/management-of-tibial-bow-in-fibular-deficiency
#14
David E Westberry, Ashley M Carpenter, John Barrera, Alison Westberry
BACKGROUND: Deformity of the tibia, including shortening and angulation, may accompany severe forms of postaxial hypoplasia (fibular deficiency). The current literature reflects varying opinions on the appropriate management for tibial deformity in the setting of fibular deficiency. METHODS: We performed a retrospective review to determine outcomes of tibial deformity correction in patients with a primary diagnosis of fibular deficiency. Clinical and radiographic outcomes of patients treated with foot ablation were reviewed to establish indications for tibial deformity correction, identify occurrence of additional surgical procedures related to limb alignment or deformity, and characterize difficulties with prosthetic wear potentially related to residual or recurrent tibial deformity...
April 20, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29682274/displacement-of-the-recurrent-laryngeal-nerve-in-patients-with-recurrent-goiter-undergoing-redo-thyroid-surgery
#15
Emin Gurleyik, Fuat Cetin, Sami Dogan, Erman Yekenkurul, Ufuk Onsal, Fatih Gursoy, Alper Ipor
Thyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38...
2018: Journal of Thyroid Research
https://www.readbyqxmd.com/read/29679726/late-presenting-dural-tear-incidence-risk-factors-and-associated-complications
#16
Wesley M Durand, J Mason DePasse, Eren O Kuris, JaeWon Yang, Alan H Daniels
BACKGROUND CONTEXT: Unrecognized and inadequately repaired intraoperative durotomies may lead to cerebrospinal fluid leak, pseudomeningocele, and other complications. Few studies have investigated durotomy that is unrecognized intraoperatively and requires additional postoperative management (hereafter, late-presenting dural tear [LPDT]), though estimates of LPDT range from 0.6 - 8.3 per 1,000 spinal surgeries. These single-center studies are based on relatively small sample sizes for an event of this rarity, all with <10 patients experiencing LPDT...
April 18, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29661242/use-applicability-and-reliability-of-depth-of-hypnosis-monitors-in-children-a-survey-among-members-of-the-european-society-for-paediatric-anaesthesiology
#17
Yuen Man Cheung, Gail Scoones, Robert Jan Stolker, Frank Weber
BACKGROUND: To assess the thoughts of practicing anaesthesiologists about the use of depth of hypnosis monitors in children. METHODS: Members of the European Society for Paediatric Anaesthesiology were invited to participate in an online survey about their thoughts regarding the use, applicability and reliability of hypnosis monitoring in children. RESULTS: The survey achieved a response rate of 30% (N = 168). A total of 138 completed surveys were included for further analysis...
April 16, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29619273/are-cephalomedullary-nail-guides-accurate-a-case-report-of-an-unexpected-complication-after-nailing-an-intertrochanteric-femoral-fracture
#18
Rayan Fairag, Fahad H Abduljabbar, Alex Page, Ron Dimentberg
Intramedullary nailing is the mainstay of treatment for unstable intertrochanteric hip fractures. Various complications have been described with the use of these nails. We report an unusual complication whereby the lag screw completely missed the nail. We hypothesize that this previously unreported complication may be related to a specific flexible carbon fiber aiming device. Surgeon awareness and thorough intraoperative imaging are crucial to avoiding this complication.
2018: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29616107/awareness-of-hepatic-arterial-variants-is-required-in-surgical-oncology-decision-making-strategy-case-report-and-review-of-literature
#19
Robert Sitarz, Monika Berbecka, Jerzy Mielko, Karol Rawicz-Pruszyński, Grzegorz Staśkiewicz, Ryszard Maciejewski, Wojciech Polkowski
Surgery for the treatment of pancreatic cancer remains the gold standard, however, the identification of the vascular supply of the pancreas and the nearby organs remains a crucial difficulties in a curative resection. During pancreatic head resection for carcinoma dissection of regional arterial vasculature is mandatory. Normal coeliac and hepatic arterial anatomy occurs in ~50-70% of patients and multiple variations have been described. Knowledge of multiple arterial anomalies is essential in hepato-pancreatico-billary surgery to avoid unnecessary complications...
May 2018: Oncology Letters
https://www.readbyqxmd.com/read/29615397/deep-anterior-lamellar-keratoplasty-dissection-plane-with-viscoelastic-and-air-can-be-different
#20
Andrew R Ross, Dalia G Said, Abdalla El-Amin, Saif Altaan, Javier Cabrerizo, Mario Nubile, Emily Hogan, Leonardo Mastropasqua, Harminder Singh Dua
AIMS: To investigate and define the nature of big bubbles (BB) formed by injection of viscoelastic in deep anterior lamellar keratoplasty. METHODS: Intrastromal injections of 0.1 and 0.3 mL of sodium hyaluronate 1.2% and 0.6% were made into sclera-corneal discs (n = 32) at superficial (anterior-third), midstromal (middle-third) and deep (posterior-third) levels to simulate deep anterior lamellar keratoplasty. Postinjection optical coherence tomograms (OCT) were obtained with the needle in situ...
April 3, 2018: British Journal of Ophthalmology
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