scholarly journals Low-dose combined spinal-epidural anesthesia for a patient with a giant hiatal hernia who underwent urological surgery

2018 ◽  
Vol 46 (10) ◽  
pp. 4354-4359 ◽  
Author(s):  
Mi Kyeong Kim ◽  
Junoik Shin ◽  
Jeong-Hyun Choi ◽  
Hee Yong Kang
Keyword(s):  
Hiatal Hernia ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Low Dose ◽  
Intrathecal Injection ◽  
Vital Signs ◽  
Esophageal Hiatus ◽  
Urological Surgery ◽  
Gastrointestinal Problems ◽  
Giant Hiatal Hernia

A hiatal hernia refers to herniation of the abdominal organs through the esophageal hiatus of the diaphragm. A giant hiatal hernia affects digestive and cardiopulmonary function by compressing the organs. We report a patient who had low-dose combined spinal and epidural anesthesia (CSEA) for safe and effective anesthesia for conservative treatment of a giant hiatal hernia. An 84-year-old woman who had a giant hiatal hernia was scheduled for ureteroscopic removal of a ureteral stone. CSEA was performed at the L4 to L5 lumbar interspace and an epidural catheter tip was placed 5 cm cephalad from the inserted level. The T12 block was checked after 10 minutes of intrathecal injection of 6 mg of 0.5% bupivacaine. The T10 block was checked after additional injection of 80 mg of 2% lidocaine through the epidural catheter. During anesthesia and surgery, the patient's vital signs remained stable and the operation was completed within 1 hour without any problems. In conclusion, low-dose CSEA may be safely used without any cardiopulmonary and gastrointestinal problems in patients with a giant hiatal hernia undergoing urological surgery.

scholarly journals Resorbable Synthetic Mesh Supported With Omentum Flap in the Treatment of Giant Hiatal Hernia

2014 ◽  
Vol 99 (5) ◽  
pp. 551-555
Author(s):  
F. J. Pérez Lara ◽  
R. Marín ◽  
A. del Rey ◽  
H. Oliva
Keyword(s):  
Hiatal Hernia ◽  
Synthetic Mesh ◽  
Omental Flap ◽  
Esophageal Hiatus ◽  
Complication Rates ◽  
Esophageal Erosion ◽  
Basic Procedure ◽  
Giant Hiatal Hernia ◽  
Omentum Flap

Abstract Covering a large hiatal hernia with a mesh has become a basic procedure in the last few years. However, mesh implants are associated with high complication rates (esophageal erosion, perforation, fistula, etc.). We propose using a synthetic resorbable mesh supported with an omental flap as a possible solution to this problem. A 54-year-old female patient with a large hiatal defect (9 cm) was laparoscopically implanted with a synthetic resorbable mesh supported with an omental flap. The surgical procedure was successful and the patient was discharged on postoperative day 2. On a follow-up examination 6 months after surgery, she remained free of relapse or complication signs. Supporting an implanted resorbable mesh with an omental flap may be a solution to the problems posed by large esophageal hiatus defects. However, more studies based on larger patient samples and longer follow-up periods are necessary.

P73 CONTRIBUTION TO THE IMPROVEMENT OF CARDIAC LOAD BY RADICAL SURGERY FOR ADVANCED ESOPHAGEAL HIATAL HERNIA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Tanabe Shunsuke ◽  
Shirakawa Yasuhiro ◽  
Maeda Naoaki ◽  
Noma Kazuhiro ◽  
Fujiwara Toshiyoshi
Keyword(s):  
Hiatal Hernia ◽  
Mixed Type ◽  
Radical Surgery ◽  
Circulatory System ◽  
The Elderly ◽  
Esophageal Hiatus ◽  
Esophageal Hiatal Hernia ◽  
Before And After ◽  
Giant Hiatal Hernia ◽  
Suture Closure

Abstract Aim The aim of this study is to clarify whether radical surgery for advanced esophageal hiatal hernia contribute to the improvement of cardiac load. Background & Methods In Japan, endoscopic surgery for esophageal hiatal hernia is increasing. In many cases, patients with mixed type hernia have the main symptom of meal passage disorder due to gastric torsion. On the other hand, there are cases in which the contents of hernia squeeze the heart and lung and the symptoms of respiratory and circulatory system get worse. And there are cases where cardiac load is exacerbated and QOL is got worse. Therefore, in addition to conventional surgical adaptation criteria such as vomiting and food loss, cardiac load aggravation may be added to the new surgical adaptation criteria. In this study, we measured BNP before and after surgery in the case of mixed type hiatal hernia who underwent surgery at our hospital, and examined changes in cardiac load. Our surgical procedure of laparoscopic fundoplication is basically toupet fundplication. In the elderly patients, the formation of toupet fundplication is about half a cycle, which is slightly looser than usual, in order to avoid passage obstruction of the wrap. If the esophageal hiatus is too large and it is difficult to suture closure, try to reduce the air pressure of laparoscopic surgery as much as possible to reduce the resistance to the suture closure. And we try not to damage the diaphragm leg. Results We experienced 70 esophageal hiatal hernia surgeries in 2012-2018 and 45 patient had mixed type hiatal hernia. In mixed type hiatal hernia case, 18 cases (40.0%) had chest symptoms such as fatigue and dyspnea on exertion. And there were 12 cases in which BNP could be measured before and after surgery as an evaluation for the presence of cardiac load. Postoperative BNP decreased in 11 of 12 cases from preoperative values. Almost all cases chest symptoms improved. In the above 45 cases, there have been no cases of reoperation and very few cases have taken proton pump inhibitors after surgery. Conclusion Surgical cases of giant hiatal hernia may increase in the future, especially in the elderly. Surgery for giant hiatal hernia can contribute to the improvement of cardiac load.

The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

1992 ◽  
Vol 68 (04) ◽  
pp. 436-441 ◽  
Author(s):  
Nigel E Sharrock ◽  
George Go ◽  
Robert Mineo ◽  
Peter C Harpel
Keyword(s):  
Heart Rate ◽  
Deep Vein Thrombosis ◽  
Cardiac Index ◽  
Total Hip Replacement ◽  
Epidural Anesthesia ◽  
Hip Replacement ◽  
Low Dose ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

scholarly journals Spinal subdural hematoma and subdural anesthesia following combined spinal–epidural anesthesia: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanmei Bi ◽  
Junying Zhou
Keyword(s):  
Epidural Anesthesia ◽  
Subdural Hematoma ◽  
Cauda Equina ◽  
Vital Signs ◽  
Epidural Administration ◽  
Single Shot ◽  
Combined Spinal Epidural ◽  
Spinal Subdural Hematoma ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background Subdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal–epidural anesthesia. Case presentation A 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34+ 5 weeks underwent cesarean delivery. Routine combined spinal–epidural anesthesia was planned; however, no cerebrospinal fluid outflow was achieved after several attempts. Bupivacaine (2.5 mL) administered via a spinal needle only achieved asymmetric blockade of the lower extremities, reaching T12. Then, epidural administration of low-dose 2-chlorprocaine caused unexpected blockade above T2 as well as tinnitus, dyspnea, and inability to speak. The patient was intubated, and the twins were delivered. Ten minutes after the operation, the patient was awake with normal tidal volume. The endotracheal tube was removed, and she was transferred to the intensive care unit for further observation. Postoperative magnetic resonance imaging suggested a spinal subdural hematoma extending from T12 to the cauda equina. Sensory and motor function completely recovered 5 h after surgery. She denied headache, low back pain, or other neurologic deficit. The patient was discharged 6 days after surgery. One month later, repeat MRI was normal. Conclusions All anesthesiologists should be aware of the possibility of SSDH and subdural block when performing neuraxial anesthesia, especially in patients in whom puncture is difficult. Less traumatic methods of achieving anesthesia, such as epidural anesthesia, single-shot spinal anesthesia, or general anesthesia should be considered in these patients. Furthermore, vital signs and neurologic function should be closely monitored during and after surgery.

VS02.06: ROBOTIC RE-DO GIANT HIATAL HERNIA WITH MESH

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 47-47
Author(s):  
Rubens Sallum ◽  
Flavio Takeda ◽  
Marco Santo ◽  
Ivan Cecconello
Keyword(s):  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Barbed Suture ◽  
Ultrasonic Scalpel ◽  
Robotic Arms ◽  
Total Fundoplication ◽  
Giant Hiatal Hernia ◽  
Hiatal Repair

Abstract Description The authors present a video of reoperation of relapsed giant hiatal hérnia (twice). Tactics of static presentation of 2 robotic arms allowing safe dissection with 2 concomitant energy modalities: ultrasonic scalpel and bipolar. The endowrist movments allow intrathoracic safe dissection. The hiatal repair with barbed suture at different angles was followed by a biological U-shape mesh. Total fundoplication with 3 lines of suture and hiatal fixation are highlighted. Disclosure All authors have declared no conflicts of interest.

Surgical Management of Hiatal Hernia in Children with Asplenia Syndrome

2016 ◽  
Vol 27 (03) ◽  
pp. 274-279
Author(s):  
Koji Fukumoto ◽  
Masaya Yamoto ◽  
Hiroshi Nouso ◽  
Masakatsu Kaneshiro ◽  
Mariko Koyama ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Duodenal Obstruction ◽  
Abdominal Cavity ◽  
The Other ◽  
Esophageal Hiatus ◽  
Thoracic Cavity ◽  
Toupet Fundoplication ◽  
Cavity Volume ◽  
Upper Gastrointestinal ◽  
Asplenia Syndrome

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

Could Emesis from Epidural Anesthesia for a Cesarean Section be Controlled by Prophylactic Low-Dose Granisetron?

2002 ◽  
Vol 43 (6) ◽  
pp. s13
Author(s):  
Youn Woo Lee ◽  
Jeong Yeon Hong ◽  
Hea Jo Yoon ◽  
Soo Mie Kim
Keyword(s):  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Low Dose
Sign in / Sign up

Export Citation Format

Share Document