scholarly journals Anesthesia for surgery in a patient with Knist's dysplasia for severe scoliotic deformity

2020 ◽  
Vol 10 (3) ◽  
pp. 299-308
Author(s):  
Igor V. Smirnov ◽  
Grigorij E. Rojtberg ◽  
Leonid E. Tsypin ◽  
Vladimir V. Lazarev
Keyword(s):  
Surgical Treatment ◽  
Tracheal Intubation ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Abdominal Cavity ◽  
Sensorineural Deafness ◽  
Intraoperative Blood Loss ◽  
Airway Patency ◽  
Scoliotic Deformity ◽  
Kniest Dysplasia

Kniest dysplasia is a disease that is inherited in an autosomal dominant manner. It manifests itself as dwarfism, scoliotic deformity of the spine, impaired joint mobility, muscle weakness, visual impairment, and sensorineural deafness. As a result of disproportionate trunk shortening, lumbar hyperlordosis and kyphoscoliosis develop, leading to internal organs (respiratory, cardiovascular system) disorders, disability, and reduced life expectancy. A case of surgical treatment of a patient with Kniest dysplasia for severe kyphoscoliotic spinal deformity is described. Posterior corrective cross-rod transpediculocorporal screw spondylodesis T3-L5 with bone autoplasty was performed. While planning anesthesia, difficult tracheal intubation was evaluated on the LEMON scale of 7 points high-risk. While performing tracheal intubation, endoscopic techniques were used: videolaryngoscope, intubation bronchoscope, enabling success. Management of intraoperative blood loss was conducted by a complex of measures: laying the patient in the prone position with the release of the abdominal cavity, normothermia, intraoperative hemodilution of azlactone-balanced polyionic solutions to achieve the target hematocrit in the range of 24%26%, and controlled hypotension with blood pressure decreased by 30% from the original hardware blood reinfusion during surgery. Also, on the first postoperative day, fusing tranexamic acid, correcting anemia and deficiency of blood coagulation factors donor components contributed to the success. Discussion. When planning surgery and anesthesia, it is necessary to consider the risk of developing malignant hyperthermia, predicting difficult intubation, and complying with the algorithm to ensure airway patency and prevent massive intraoperative blood loss. With a comprehensive approach to patient management, it is possible to achieve rapid rehabilitation and discharge for outpatient treatment. Surgical treatment for rapidly progressing severe kyphoscoliathical spinal deformity can change the quality and duration of life in patients with Kniest syndrome.

scholarly journals Surgical Treatment of Tensile Effusion in Postoperative Cavity after Glioma Resection

2020 ◽  
pp. 1-7
Author(s):  
Sheng-Qing Lv ◽  
Guo-Hao Huang ◽  
Lin Yang ◽  
Sheng-Qing Lv ◽  
Xun Qin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Subdural Hematoma ◽  
Burr Hole ◽  
Intraoperative Blood Loss ◽  
Gcs Score ◽  
Glioma Resection ◽  
Time Of Operation ◽  
Better Than

Objectives: To explore the clinical surgical methods for the treatment of tensile effusion in postoperative cavity after glioma resection. Methods: Clinical data of 26 cases of tensile effusion in postoperative cavity after glioma resection were analyzed retrospectively. All 26 patients underwent surgical treatment, including 16 cases who underwent puncture and drainage (P&D), and 10 cases who underwent craniotomy decompression (CD). Among the cases of P&D, postoperative cavity in 7 cases were punctured through the burr hole for creating the skull flap for intraoperative resection of glioma, and postoperative cavities in 9 cases were punctured through a burr hole for the dura mater suspended under the skull flap. Glasgow Coma Scale (GCS) was used to evaluate the consciousness status of the two groups of patients before and after surgery. Moreover, time of operation, intraoperative blood loss, postoperative hospital duration, and postoperative complications were also adopted for evaluation of the merits of the two methods for treatment of tensile effusion in postoperative cavity after glioma resection. Results: The consciousness of the patients in both groups improved within 24 hours after the operation, and there were no death cases. In the P&D group, the GCS score within 24 hours after surgery was (14.38±0.20), the time of operation time was (7.81±0.64) mins, intraoperative blood loss was (6.25±0.56) ml, and postoperative hospital duration was (6.69±0.54) days. There were 3 cases with postoperative complications (1 case of puncture tract hemorrhage, 1 case of subdural hematoma and 1 case of intracranial infection) in the P&D group. All of the puncture tract hemorrhage and subdural hematoma did not require surgical treatment, and the intracranial infection was cured after antibiotic treatment and lumbar puncture for cerebrospinal fluid replacement. In the CD group, the GCS score within 24 hours after surgery was (13.70±0.21), the time of operation was (124.10±8.96) mins, intraoperative blood loss was (260±30.55) ml, and postoperative hospital duration was (11.30±0.60) days. There were 2 cases with postoperative complications (both of them were with subdural hematoma), none of which required surgical treatment. The GCS score, time of operation, intraoperative blood loss and postoperative hospital duration in the P&D group were better than those in the CD group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P >0.05). Conclusion: The P&D and CD for tensile effusion in postoperative cavity after glioma resection can both achieve ideal results, but P&D in line with the concept of micro-invasive neurosurgery was better than CD in terms of postoperative GCS score within 24 hours, duration of operative, intraoperative blood loss, and postoperative hospital duration.

scholarly journals Evaluation of the volume of intraoperative blood loss during endovideo-assisted surgical treatment in urology

2020 ◽  
Vol 12 (1) ◽  
pp. 66-72
Author(s):  
S.V. Popov ◽  
◽  
R.G. Guseynov ◽  
K.V. Sivak ◽  
O.N. Scriabin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Intraoperative Blood Loss

scholarly journals Impact of intraoparetive parametres on survival of patients with ruptured abdominal aortic aneurysm

2004 ◽  
Vol 132 (1-2) ◽  
pp. 5-9
Author(s):  
Miroslav Markovic ◽  
Lazar Davidovic ◽  
Zivan Maksimovic ◽  
Dusan Kostic ◽  
Sinisa Pejkic ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Blood Loss ◽  
High Mortality ◽  
Surgical Procedure ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Intraoperative Blood Loss ◽  
Lethal Outcome ◽  
Abdominal Aortic

Ruptured abdominal aortic aneurysm is one of the most urgent surgical conditions with high mortality that has not been changed in decades. Between 1991-2001 total number of 1058 patients was operated at the Institute for Cardiovascular Diseases of Clinical Center of Serbia due to abdominal aortic aneurysm. Of this number, 288 patients underwent urgent surgical repair because of ruptured abdominal aortic aneurysm. The aim of this retrospective study was to show results of the early outcome of surgical treatment of patients with ruptured abdominal aortic aneurysm, and to define relevant intraoperative factors that influence their survival. There were 83% male and 17% female patients in the study, mean aged 67 years. Mean duration of surgical procedure was 190 minutes (75-420 min). Most common localization of aneurysm was infrarenal - in 74% of patients, then juxtarenal (12.3%). Suprarenal aneurysm was found in 6.8% of patients, as well as thoracoabdominal aneurysm (6.8%). Retroperitoneal rupture of aortic aneurysm was most common - in 65% of patients, then intraperotineal in 26%. Rare finding such as chronic rupture was found in 3.8%, aortocaval fistula in 3.2% and aorto-duodenal fistula in 0.6% of patients. Mean aortic cross-clamping time was 41.7 minutes (10-150 min). Average intraoperative systolic pressure in patients was 106.5 mmHg (40-160 mmHg). Mean intraoperative blood loss was 3700 ml (1400-8500 ml). Mean intraoperative diuresis was 473 ml (0-2100 ml). Tubular graft was implanted in 53% of patients, aortoiliac bifurcated graft in 32.8%. Aortobifemoral reconstruction was done in 14.2% of patients. These data refer to the patients that survived surgical procedure. Intrahospital mortality that included intraoperative and postoperative deaths was 53.7%. Therefore, 46.3% patients survived surgical treatment and were released from the hospital. Intraoperative mortality was 13.5%. Type of aneurysm had no influence on outcome of patients (p>0.05), as well as type of rupture and level of aortic cross-clamping. Aortic cross-clamping time was significantly shorter in survivors, and longest in patients that died intraoperatively (p<0.05). Intraoperative systolic tension value influenced the outcome in patients; it was significantly higher in survivors (p<0.01). Interposition of tubular graft gave better results compared with aorto-iliac and aorto-femoral reconstruction (p<0.01). Duration of surgery was significantly higher in patients with lethal outcome (p<0.05), as well as intraoperative blood loss (p<0.05). Intraoperative diuresis was significantly lower in patients with lethal outcome (p<0.05). Ruptured abdominal aortic aneurysm still remains one of the most dramatic surgical states with very high mortality. Important intraoperative factors that influence the outcome of surgical treatment can be defined. Therapeutic efforts should be concentrated on those factors that are possible to correct, which would hopefully lead to better survival of patients. Nevertheless, screening for abdominal aortic aneurysm and elective surgical intervention before rupture occurs should be the best solution for this complex problem.

245. Predicting massive intraoperative blood loss in adult spinal deformity surgery

2020 ◽  
Vol 20 (9) ◽  
pp. S121
Author(s):  
Alexandra Soroceanu ◽  
Justin K. Scheer ◽  
Themistocles S. Protopsaltis ◽  
Munish C. Gupta ◽  
Peter G. Passias ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Intraoperative Blood Loss ◽  
Spinal Deformity Surgery

Value of pre-operative embolization in surgery for nasopharyngeal angiofibroma

1993 ◽  
Vol 107 (6) ◽  
pp. 514-521 ◽  
Author(s):  
Topi M. J. Siniluoto ◽  
Jukka P. Luotonen ◽  
Tapani A. Tikkakoski ◽  
Aaro S. S. Leinonen ◽  
Kalevi E. Jokinen
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Tumour Recurrence ◽  
Surgical Results ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma ◽  
Primary Surgery

The value of embolization in surgery for nasopharyngeal angiofibroma is a controversial matter. We analysed retrospectively the results of surgical treatment in ten patients with a nasopharyngeal angiofibroma, the last five of whom underwent pre-operative embolization with Gelfoam®. Embolization reduced the intraoperative blood loss at primary surgery from an average of 1510 ml in the non-embolized patients to 510 ml in the embolized patients and transfusions from an average of 4.4 units to none. Seven reoperations were performed on four non-embolized patients on account of tumour recurrence, while no recurrences were diagnosed among the pre-operatively embolized patients. Blood loss in the reoperations averaged 4065 ml, and transfusions 7.1 units. The results indicate that embolization is effective in reducing intraoperative blood loss and contributes to improved surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Frequency and risk factors of surgical complications in patients with locally advanced cervical esophageal cancer

2022 ◽  
pp. 37-40
Author(s):  
Z. A-G. Radzhabova ◽  
M. A. Kotov ◽  
E. V. Levchenko
Keyword(s):  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Blood Loss ◽  
Locally Advanced ◽  
Fistula Formation ◽  
Intraoperative Blood Loss ◽  
Cervical Esophageal Cancer ◽  
Simultaneous Reconstruction ◽  
Increased Risk ◽  
Duration Of Surgery

Objective. Analyze the frequency and prognostic factors of complications in patients with locally advanced cervical esophageal cancer after pharyngolaryngoesophagectomy with simultaneous reconstruction of the defect.Material and methods. The retrospective study included patients with a verified locally advanced cervical esophageal cancer who were treated at the N. N. Petrov National Research Institute of Oncology in the period from 2009 to 2018, who underwent surgical treatment followed by chemoradiotherapy. The end point of the study was the frequency of postoperative complications.Results. Forty-eight patients were included in the study. All patients underwent laryngopharyngoesophagectomy with simultaneous reconstruction of the digestive tract. Forty-one patients (85.4 %) underwent the reconstructive stage using a narrow gastric stalk, and a wide gastric stalk and a small intestine graft were used in 5 (10.4 %) and 2 (4.2 %) patients, respectively. The average duration of the operation was 390 (337.5–525.0) minutes, the volume of blood loss was 300 (200–500) ml, and the average time of hospitalization and the patient’s stay in the intensive care unit was 21.5 (16.00–36.00) and 3 (1.000–6.75) days, respectively. Complications within 30 days after surgical treatment were observed in 54.1 % of patients, while anastomosis failure, fistula formation and pneumonia were observed in 22.9 %, 12.5 % and 18.8 % of cases, respectively. Factors slightly increasing the likelihood of pneumonia in the early postoperative period were: duration of surgery [OR = 1.0 (95 % CI: 1.00–1.01), p = 0.0131] and intraoperative blood loss [OR = 1.0 (95 % CI: 1.00–1.01), p = 0.0017].Conclusion. The overall complication rate after pharyngolaryngoesophagectomy with simultaneous repair of the defect by bioengineered graft was 54.1 %. Intraoperative blood loss and duration of surgery were associated with an increased risk of complications.

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