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anaesthesia for vascular surgery

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https://www.readbyqxmd.com/read/27744107/a-targeted-remifentanil-administration-protocol-based-on-the-analgesia-nociception-index-during-vascular-surgery
#1
Georges Daccache, Edouard Caspersen, Michel Pegoix, Kelly Monthé-Sagan, Ludovic Berger, Dominique Fletcher, Jean-Luc Hanouz
BACKGROUND: The intraoperative modulation of opioids continues to be based on clinical signs. This may result in adverse events such as sympathetic reactivity or opioid induced hyperalgesia. Recently, the Analgesia/Nociception Index (ANI), a non-invasive 0-100 index derived from heart rate variability analysis, has been proposed for nociception assessment. However, the ability of the ANI to adequately guide intraoperative opioid administration has never been demonstrated. We designed a prospective study to evaluate the ability of the ANI to guide remifentanil administration in vascular surgery...
October 12, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27687921/effects-of-preoperative-carprofen-on-cardio-respiratory-hormonal-and-metabolic-stress-response-in-calves-during-umbilical-surgery-under-isoflurane-inhalation-anaesthesia
#2
I Schulze, E M Poos, H Meyer, A K List, S B R Kaestner, J Rehage
The aim of this study was to examine the effects of preoperative carprofen on the cardiorespiratory, hormonal and metabolic stress response during umbilical surgery under isoflurane anaesthesia combined with local anaesthesia, in calves. A randomised, blinded experimental study was conducted in 24 calves. Carprofen (n = 12; 1.4 mg/kg) or physiological saline solution (controls; n = 12) was administered 1 h prior to surgery. Anaesthesia was induced with xylazine (0.1 mg/kg, IM) and, after the onset of sedation (i...
October 2016: Veterinary Journal
https://www.readbyqxmd.com/read/27604388/high-dose-methylprednisolone-and-endothelial-glycocalyx-in-paediatric-heart-surgery
#3
E Pesonen, J Keski-Nisula, S Andersson, R Palo, J Salminen, P K Suominen
BACKGROUND: Corticosteroids are used in paediatric heart surgery to attenuate systemic inflammatory response. Glycocalyx regulates vascular permeability, shear stress and cell adhesion on the endothelium. Syndecan-1 serves as a biomarker of glycocalyx degradation. Hydrocortisone decreased endothelial glycocalyx degradation in an experimental model. Our hypothesis was that high-dose methylprednisolone decreases glycocalyx degradation as measured by plasma sydecan-1 concentration in children undergoing cardiac surgery...
November 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27589694/single-double-or-multiple-injection-techniques-for-non-ultrasound-guided-axillary-brachial-plexus-block-in-adults-undergoing-surgery-of-the-lower-arm
#4
Ki Jinn Chin, Javier E Cubillos, Husni Alakkad
BACKGROUND: Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This is an update of a review first published in 2006 and previously updated in 2011 and 2013. OBJECTIVES: To compare the relative effects (benefits and harms) of three injection techniques (single, double and multiple) of axillary block of the brachial plexus for distal upper extremity surgery. We considered these effects primarily in terms of anaesthetic effectiveness; the complication rate (neurological and vascular); and pain and discomfort caused by performance of the block...
September 2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27542789/transfemoral-aortic-valve-implantation-with-the-repositionable-lotus-valve-for-treatment-of-patients-with-symptomatic-severe-aortic-stenosis-results-from-a-single-centre-experience
#5
Jochen Wöhrle, Birgid Gonska, Christoph Rodewald, Julia Seeger, Dominik Scharnbeck, Wolfgang Rottbauer
AIMS: The aim of the study was to evaluate the procedural and 30-day results for the repositionable Lotus valve in patients undergoing transfemoral aortic valve implantation in a single-centre experience. METHODS AND RESULTS: We prospectively enrolled 110 patients with severe symptomatic aortic stenosis (NCT02162069). All procedures were performed without general anaesthesia by the transfemoral approach. Patients were followed for 30 days. Patients received the 23 mm (n=20), 25 mm (n=43) or 27 mm (n=47) Lotus device...
August 20, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27440632/microcirculatory-changes-in-children-undergoing-cardiac-surgery-a-prospective-observational-study
#6
S Scolletta, D Marianello, G Isgrò, A Dapoto, V Terranova, F Franchi, E Baryshnikova, C Carlucci, M Ranucci
BACKGROUND: The effects of cardiac surgery on the microcirculation of children are unknown. The aim of this study was to assess the microcirculatory changes in children undergoing surgery for correction of congenital heart disease. METHODS: We used a videomicroscope (Sidestream Dark Field, SDF) in a convenience sample of 24 children <five yr old. Total vascular density (TVD, vessels mm(-2)), microvascular flow index (MFI, arbitrary units), proportion of perfused small vessels (PPV, percentage), and perfused vessel density (PVD) were obtained after induction of anaesthesia (T1), at the end of the surgical procedure (T2), after intensive care unit (ICU) admission (T3), and at six h (T4) and 12h (T5) after ICU admission...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27401083/aortic-cross-clamping-phase-of-cardiopulmonary-bypass-is-related-to-decreased-microvascular-reactivity-after-short-term-ischaemia-of-the-thenar-muscle-both-under-intravenous-and-volatile-anaesthesia-a-randomized-trial
#7
Aleksandra Biedrzycka, Maciej Kowalik, Rafał Pawlaczyk, Dariusz Jagielak, Dariusz Świetlik, Wiktor Szymanowicz, Romuald Lango
OBJECTIVES: The purpose of the present study was to assess, by near-infrared spectroscopy with an INVOS oximeter during the vascular occlusion test (VOT), the influence of cardiopulmonary bypass (CPB) on tissue saturation in the thenar muscle. The secondary aim was to compare the effects of propofol and sevoflurane anaesthesia on tissue saturation. METHODS: This was a prospective, randomized, open-label study. Sixty cardiac surgery patients received either propofol or sevoflurane anaesthesia...
November 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27366556/perioperative-management-of-severe-hypertension-during-laparoscopic-surgery-for-pheochromocytoma
#8
Mehmet Ali Erdoğan, Muharrem Uçar, Ahmet Selim Özkan, Ülkü Özgül, Mahmut Durmuş
Phaeochromocytoma is a catecholamine-secreting vascular tumour that is derived from chromaffin cell. Lethal cardiovascular complications, such as serious hypertension, myocardial infarction and aortic dissection, may occur because of uncontrolled catecholamine release. Each stage of anaesthesia management has vital importance because of this destructive catecholamine secretion that may occur during induction, perioperative stage and surgical manipulation. In this study, we report regarding the preoperative preparation and severe, persistent hypertension attack management with a combination of α-adrenergic blockade, β-adrenergic blockade, sodium nitroprusside and remifentanil in a patient who underwent laparoscopic surgery for phaeochromocytoma...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27312841/automated-continuous-and-non-invasive-assessment-of-pulse-pressure-variations-using-cnap-%C3%A2-system
#9
Matthieu Biais, Laurent Stecken, Aurélie Martin, Stéphanie Roullet, Alice Quinart, François Sztark
Non-invasive respiratory variations in arterial pulse pressure using infrared-plethysmography (PPVCNAP) are able to predict fluid responsiveness in mechanically ventilated patients. However, they cannot be continuously monitored. The present study evaluated a new algorithm allowing continuous measurements of PPVCNAP (PPVCNAPauto) (CNSystem, Graz, Austria). Thirty-five patients undergoing vascular surgery were studied after induction of general anaesthesia. Stroke volume was measured using the Vigileo(TM)/FloTrac(TM)...
June 16, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27177589/conjunctival-myxoma-atypical-presentation-of-a-rare-tumour-case-report-and-review-of-literature
#10
Neharika Sharma, Stephen O'Hagan, Gael Phillips
BACKGROUND: Conjunctival myxomas are rare, benign, connective tissue tumours that classically present as slow-growing, painless, well-circumscribed masses (Arch Ophthalmol 124:735-8, 2006; Case Rep Ophthalmol 3:145-50, 2012). There have been 29 cases reported in the literature (Arch Ophthalmol 124:735-8, 2006; Malays J Med Sci 20(1):92-4, 2013; Case Rep Ophthalmol 3:145-50, 2012; Middle East Afr J Ophthalmol 19(3):353-3, 2012). We present a case with atypical features, and emphasize the importance of excisional biopsies for diagnosing indeterminate conjunctival lesions...
2016: BMC Ophthalmology
https://www.readbyqxmd.com/read/27126092/osler-weber-rendu-syndrome-an-anaesthetic-challenge
#11
Diana Chieira, Luis Conceição, Edgar Semedo, Valentina Almeida
Osler-Weber-Rendu syndrome, or hereditary haemorrhagic telangiectasia (HHT), is an autosomal dominant vascular dysplasia characterised by mucocutaneous telangiectases and arteriovenous malformations (AVMs). Diagnosis is clinical and treatment is supportive. The authors demonstrate a safe anaesthetic approach for a patient with HHT. A 53-year-old woman with a left trochanteric fracture was scheduled for urgent orthopaedic surgery. She was diagnosed as having HHT and presented with recurrent epistaxis, telangiectases and gastrointestinal AVMs...
April 28, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27072990/effects-of-prolonged-ischemia-on-human-skeletal-muscle-microcirculation-as-assessed-by-near-infrared-spectroscopy
#12
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
https://www.readbyqxmd.com/read/27057213/evaluation-of-hyperglycaemic-response-to-intra-operative-dexamethasone-administration-in-patients-undergoing-elective-intracranial-surgery-a-randomised-prospective-study
#13
Rakesh Sethi, Imtiaz A Naqash, Sukhminder Jit Singh Bajwa, Vikas Dutta, Altaf Umar Ramzan, Syed Amir Zahoor
BACKGROUND AND AIM: The glucocorticoid dexamethasone in a bolus dose of 8-10 mg followed by quarterly dose of 4 mg is commonly used during intracranial surgery so as to reduce oedema and vascular permeability. However, the detrimental hyperglycaemic effects of dexamethasone may override its potentially beneficial effects. The present prospective, randomised study aimed at comparing the degree and magnitude of hyperglycaemia induced by prophylactic administration of dexamethasone in patients undergoing elective craniotomy...
April 2016: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/27056026/30-day-mortality-after-haemodialysis-vascular-access-surgery-a-retrospective-observational-study
#14
Thomas Jorna, Shona Methven, Rommel Ravanan, Andrew R Weale, Ronelle Mouton
PURPOSE: The prevalence of haemodialysis is increasing globally. There is a consensus of international opinion that permanent vascular access is preferred for haemodialysis. Patients with end-stage renal disease carry a high burden of cardiovascular comorbidity. There is a lack of data to quantify the post-operative risk of vascular access surgery. This study looked to establish the 30-day post-operative mortality for patients undergoing surgery to create vascular access and to measure for differences between the types of access created and the mode of anaesthesia...
May 7, 2016: Journal of Vascular Access
https://www.readbyqxmd.com/read/27053692/diagnostics-monitoring-and-outpatient-care-in-children-with-suspected-pulmonary-hypertension-paediatric-pulmonary-hypertensive-vascular-disease-expert-consensus-statement-on-the-diagnosis-and-treatment-of-paediatric-pulmonary-hypertension-the-european-paediatric
#15
REVIEW
Astrid E Lammers, Christian Apitz, Peter Zartner, Alfred Hager, Karl-Otto Dubowy, Georg Hansmann
Pulmonary hypertension (PH) is a condition of multiple aetiologies with underestimated prevalence and incidence. Indeed, despite access to modern therapies, pulmonary hypertensive vascular disease (PHVD) remains a progressive, usually life-limiting condition, severely impacting on the patients' well-being. We herein provide practical, expert consensus recommendations on the initial diagnostic work-up, clinical management and follow-up of children and adolescents with PH/PHVD, including a diagnostic algorithm...
May 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27028996/volatile-anaesthetics-enhance-the-metastasis-related-cellular-signalling-including-cxcr2-of-ovarian-cancer-cells
#16
Masae Iwasaki, Hailin Zhao, Tanweer Jaffer, Sandeep Unwith, Laura Benzonana, Qingquan Lian, Atsuhiro Sakamoto, Daqing Ma
The majority of ovarian cancer patients relapse after surgical resection. Evidence is accumulating regarding the role of surgery in disseminating cancer cells; in particular anaesthesia may have an impact on cancer re-occurrence. Here, we have investigated the metastatic potential of volatile anaesthetics isoflurane, sevoflurane and desflurane on ovarian cancer cells. Human ovarian carcinoma cells (SKOV3) were exposed to isoflurane (2%), sevoflurane (3.6%) or desflurane (10.3%) for 2 hours. Metastatic related gene expression profiles were measured using the Tumour Metastasis PCR Array and qRT-PCR...
May 3, 2016: Oncotarget
https://www.readbyqxmd.com/read/27004331/predictive-parameters-for-successful-functional-maturation-of-native-arteriovenous-fistula
#17
Muhammad Jamil, Rashid Usman
BACKGROUND: Successful arteriovenous fistula (AVF) significantly reduces both the morbidity as well as mortality of the patients who have end stage renal disease, and significantly improve their survival rate. The objective of the study was to high light the role of various parameters in the functional maturation of arteriovenous fistula (AVF). METHODS: This descriptive analytical study conducted at Department of Vascular Surgery, Combined Military Hospital Lahore from January 2014 to January 2015...
October 2015: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/26981316/a-homemade-snare-an-alternative-method-for-mechanical-removal-of-dirofilaria-immitis-in-dogs
#18
Ana Margarida Alho, António Fiarresga, Miguel Landum, Clara Lima, Óscar Gamboa, José Meireles, José Sales Luís, Luís Madeira de Carvalho
Canine dirofilariosis is a life-threatening parasitic disease that is increasingly reported worldwide. Once diagnosed the main treatment goals are to improve the animal's clinical condition and to eliminate all life stages of the parasite with minimal posttreatment side effects. This can be achieved through mechanical, surgical, or chemotherapeutical approaches. Currently, manual extraction is the preferred method to remove adult heartworms due to its diminished invasiveness, reduced damage to the vascular endothelium, and shortened anaesthesia duration...
2016: Veterinary Medicine International
https://www.readbyqxmd.com/read/26981239/clinical-audit-of-ankle-fracture-management-in-the-elderly
#19
Langhit Kurar
INTRODUCTION: Ankle fractures in the osteoporotic patient are challenging injuries to manage, due to a combination of poor soft tissue, peripheral vascular disease and increased bone fragility, often resulting in more complex fracture patterns. I aim to audit current practice and introduce change by producing recommendations to help improve longer-term functional outcomes. PATIENTS AND METHODS: A retrospective 3-week audit was conducted reviewing results of ankle fracture management in 50 patients aged between 50 and 80 years...
March 2016: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/26966109/tissue-oximetry-in-anaesthesia-and-intensive-care
#20
Aleksandra Biedrzycka, Romuald Lango
Conventional monitoring during surgery and intensive care is not sufficiently sensitive to detect acute changes in vital organs perfusion, while its good quality is critical for maintaining their function. Disturbed vital organ perfusion may lead to the development of postoperative complications, including neurological sequel and renal failure. Near-infra-red spectroscopy (NIRS) represents one of up-to-date techniques of patient monitoring which is commonly used for the assessment of brain oximetry in thoracic aorta surgery, and - increasingly more often -in open-heart surgery...
2016: Anaesthesiology Intensive Therapy
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