scholarly journals Intraoperative anaphylaxis

2018 ◽  
Vol 5 (2) ◽  
pp. 62-65
Author(s):  
Sujita Manandhar
Keyword(s):  
Standard Protocol ◽  
Recurrent Tonsillitis ◽  
Upper Eyelid ◽  
Anesthetic Agents ◽  
Anesthetic Drugs ◽  
Eyelid Swelling ◽  
History Of ◽  
Facial Area ◽  
American Society ◽  
American Society Of Anesthesiologists

A 24 years lady was scheduled for tonsillectomy for recurrent tonsillitis had anaphylaxis and asystole before extubation, she was revived successfully.She had no known history of allergy and exposure to anesthetic agents and was classified as an American Society of Anesthesiologists, ASA I. In the operating theatre, her baseline vitals were unremarkable and remained hemodynamically stable on receiving antibiotic and anesthetic drugs. The anesthetic course remained uneventful throughout the surgery. Upon removal of surgical drapes, upper eyelid swelling was noted, that rapidly progressed to facial area within minutes, and she developed cardiac arrest which was managed with standard protocol and resuscitated successfully.  

scholarly journals Migration of Silicone Oil into the Orbit and Eyelid as a Cyst

2020 ◽  
Vol 11 (2) ◽  
pp. 217-221
Author(s):  
Mohammad Sharifi ◽  
Mohammad Reza Ansari Astaneh
Keyword(s):  
Silicone Oil ◽  
Excisional Biopsy ◽  
Upper Eyelid ◽  
Oil Migration ◽  
Eyelid Swelling ◽  
Mobile Mass ◽  
History Of ◽  
Pars Plana ◽  
Computed Topography ◽  
Oil Injection

A 7-year-old female presented with left upper eyelid swelling following pars plana deep vitrectomy and silicone oil injection 1 year before admission. The left upper eyelid had mechanical ptosis and on palpation there was a lobulated mobile mass in the lateral portion of eyelid. Computed topography scan showed multiple isodense masses with silicone oil in vitreous in the eyelid and orbit; histopathology after excisional biopsy proved the silicone oil migration. Silicone oil migration followed by vitrectomy may be due to leakage from the site of initial wounds or vitrectomy ports. It is important to suspect extraocular silicone oil migration in patients who presented with eyelid mass-like lesions with a history of silicone oil injection following pars plana deep vitrectomy.

scholarly journals Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

A Method to Compare Costs of Drugs and Supplies among Anesthesia Providers 

1998 ◽  
Vol 88 (5) ◽  
pp. 1350-1356 ◽  
Author(s):  
Franklin Dexter ◽  
David A. Lubarsky ◽  
Bill C. Gilbert ◽  
Christine Thompson
Keyword(s):  
Tertiary Hospital ◽  
Demographic Variables ◽  
Drug Supply ◽  
Anesthetic Drugs ◽  
Anesthesia Providers ◽  
Relative Value ◽  
American Society ◽  
The Cost ◽  
American Society Of Anesthesiologists ◽  
Pearson Correlations

Background Comparison of costs among anesthesia providers using "cost per case" does not adjust for variations in casemix (such as the type of procedure and patient condition). The authors propose an alternative method for comparing costs using the American Society of Anesthesiologists' Relative Value Scale (ASARVS) system, which incorporates basic units (for the procedure), modifier units (for the patient's physical condition), "other" units (such as for the placement of invasive monitors), and time units (proportional to the case duration). Methods Data were obtained from a series of 3,340 anesthetics performed at a tertiary hospital. Administered and discarded drug, supply, and fluid costs were used. Results Costs expressed as dollars per ASARVS unit had 54% less variability than costs expressed as dollars per case (P < 0.0001). Pearson correlations between demographic variables and cost per ASARVS unit ranged from -0.10 to 0.13. Total (e.g., quarterly) costs for simulated sets of cases were predicted within 0.0 +/- 2.3% by multiplying (1) their sum of units and (2) a like set of case's sum of costs divided by sum of units. Conclusions Costs of anesthetic supplies and drugs of a case were more accurately reported as "cost per unit" than as "cost per case." This method of calculating the cost of anesthetic drugs and supplies has several applications, including (1) comparison of costs among anesthesia providers and (2) benchmarking costs among hospitals and anesthesia groups. By design, anesthesia providers' time is quantified by their ASARVS units. Together anesthesia costs (personnel, supplies, and drugs) are better reported as "cost per unit" than as "cost per case."

scholarly journals Risk factors for postoperative spinal infection: A retrospective analysis of 5065 cases

2019 ◽  
Vol 10 ◽  
pp. 121
Author(s):  
Matt El-Kadi ◽  
Erin Donovan ◽  
Laurel Kerr ◽  
Coby Cunningham ◽  
Victor Osio ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Infection Rate ◽  
Immunosuppressive Drugs ◽  
Smoking History ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Record Review ◽  
Subsequent Introduction ◽  
Retrospective Medical Record Review

Background: Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism. Methods: Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk. Results: The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time. Conclusions: Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.

Cervical Corpectomy: Complications and Outcomes

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS295-ONS302 ◽  
Author(s):  
Maxwell Boakye ◽  
Chirag G. Patil ◽  
Chris Ho ◽  
Shivanand P. Lad
Keyword(s):  
Type 1 Diabetes ◽  
Multivariate Analysis ◽  
Mortality Rates ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Corpectomy ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Objective: Previously, information on cervical corpectomy complication rates has been obtained from retrospective analysis of single-institution data. The aim of this study was to report 30-day mortality and complication rates after cervical corpectomy using multicenter prospective data from the Veterans Affairs National Surgical Quality Improvement Program database. Methods: The National Surgical Quality Improvement Program database was used to identify 1560 patients who underwent cervical corpectomy in United States Veterans Affairs hospitals from 1997 to 2006. Multivariate analysis was performed to analyze the effects of patient and hospital characteristics on morbidity and mortality rates. Results: A total of 1560 patients underwent corpectomy, with an overall in-hospital mortality rate of 1.6%, a complication rate of 18.4%, and a mean length of stay of 6 days. Multivariate analysis identified age older than 80 years (odds ratio [OR], 21.24), history of Type 1 diabetes (OR, 2.36), American Society of Anesthesiologists class greater than 3 (OR, 6.93), and dependent functional status (OR, 3.17) as the most significant preoperative predictors of complications. Three or more corpectomy levels (OR, 2.46) and operative duration longer than 6 hours (OR, 3.45) were also found to be significant predictors of postoperative complications. Patients who underwent 3 or more levels of corpectomy had a return-to-operating room rate of 17.9% and a graft/instrumentation failure rate of 5.4% compared with those who underwent single-level corpectomy, who had rates of 6.2 and 1.87%, respectively. Patients who were returned to the operating room had significantly higher mortality rates (7.0 versus 1.2%) and accounted for 39.9% of the total number of complications. Multivariate analysis identified age, American Society of Anesthesiologists class, history of disseminated cancer, and diabetes as the most significant predictors of mortality. Patients with Type 1 diabetes had 4-fold higher mortality rates compared with patients with no history of diabetes or diet-controlled diabetes. Conclusion: We have analyzed the morbidity and mortality data on the largest series of corpectomy reported to date. We have demonstrated the impact of age, American Society of Anesthesiologists class, and number of operated levels on complication rates. Type 1 diabetes was established as a strong risk factor for 30-day mortality after cervical corpectomy.

scholarly journals Adult-Onset Orbital Sinus Pericranii with T2 Hyperintensity Lesion: A Case Report

2018 ◽  
Vol 10 (1) ◽  
pp. 112-117 ◽  
Author(s):  
Toshiya Osanai ◽  
Kiyohiro Houkin
Keyword(s):  
Vascular Anomaly ◽  
Digital Subtraction ◽  
Adult Onset ◽  
Resonance Imaging ◽  
Upper Eyelid ◽  
Sinus Pericranii ◽  
Eyelid Swelling ◽  
History Of ◽  
T2 Hyperintensity

Sinus pericranii is a rare vascular anomaly, and most cases occur in children and develop at the midline. In previous reports of sinus pericranii, T2 hyperintensity lesion has not been regarded as a common sequela. We report an extremely rare case of orbital sinus pericranii with associated T2 hyperintensity lesion. A 50-year-old man was admitted to our hospital with a history of right upper eyelid swelling that had been present for several years. Computed tomography, magnetic resonance imaging, and digital subtraction angiography demonstrated a connection between the lesion and normal cerebral venous system. Thus, we diagnosed the lesion as a sinus pericranii despite its atypical features. We elected to observe the patient, and the lesion had remained the same size without any adverse events, such as hemorrhage, occurring throughout the 5-year follow-up. An atypical sinus pericranii should be considered in patients with a soft compressible swelling on the head, even if the lesion is located off the midline.

Targeting Effect Compartment or Central Compartment Concentration of Propofol 

1999 ◽  
Vol 90 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Howard G. Wakeling ◽  
John B. Zimmerman ◽  
Scott Howell ◽  
Peter S. A. Glass
Keyword(s):  
Central Compartment ◽  
Pharmacokinetic Parameters ◽  
Effect Compartment ◽  
Effect Site ◽  
Anesthetic Drugs ◽  
Effect Site Concentration ◽  
American Society ◽  
Target Effect ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background An effect compartment has been postulated, and the ke0 has been quantified for several intravenous anesthetic drugs using electroencephalography (EEG) as the measure of effect. The authors wanted to validate that loss of responsiveness (LOR) was related to targeting an effect compartment concentration rather than a central compartment (plasma) concentration. Methods Twenty American Society of Anesthesiologists physical status I and II patients were randomized to receive propofol administered to a target central compartment or target effect compartment site concentration of 5.4 microg/ml propofol administered by a target-controlled infusion (TCI) using a previously validated set of pharmacokinetic parameters and a ke0 of 0.63 min(-1). Every 30 s for the first 5 min and every minute for the second 5 min the patients were asked to open their eyes. The time to LOR was measured by a blinded investigator. The authors also simulated the time to reach the desired target effect site concentration using varying ke0 values. Results The median time to LOR in the group targeted to a predicted plasma propofol concentration was 3.02 min and 1.23 min in the group targeted to a predicted effect compartment propofol concentration (P < 0.05). LOR to command in both groups occurred at a predicted median effect compartment concentration of 4.55 microg/ml. Simulations demonstrated that the time predicted to LOR targeting an effect site concentration of 5.4 microg/ml is markedly altered by the value chosen for the ke0. Conclusions This study confirms the utility of the ke0 value to describe the effect compartment for propofol. The authors also illustrate the importance of selecting the correct ke0 value for the pharmacokinetic parameters used within the TCI system.

Three-Port, Two Located on the Pfannenstiel Line, Laparoscopic Cholecystectomy Comparison with Traditional Laparoscopic Cholecystectomy

2017 ◽  
Vol 83 (3) ◽  
pp. 260-264
Author(s):  
Musa Akoglu ◽  
Erdal Birol Bostanci ◽  
Muhammet Kadri Colakoglu ◽  
Erol Aksoy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Results ◽  
Conversion To Open Surgery ◽  
Included Patient ◽  
History Of ◽  
Abdominal Operations ◽  
American Society ◽  
American Society Of Anesthesiologists

Laparoscopic cholecystectomy (LC) is seen as a gateway to minimally invasive surgery. We defined a new three-port technique with different port sites and compared the postoperative results with traditional four-port LC procedure in a case-match study. Between June 2012 and May 2013, 104 consecutive patients underwent three-port LC by same experienced surgeon. In the same center, 2963 consecutive patients underwent four-port LC, and of these 2963 patients, a matched group of 104 patients was selected. Data included patient age, gender, body mass index, American Society of Anesthesiologists score, history of abdominal operations, intraoperative data about operating time and conversion to open surgery, and postoperative data about length of hospital stay and postoperative complications were recorded prospectively. We concluded that our new three-port technique with different port sites is as feasible and safe as traditional four-port technique.

Absence of Bronchodilation during Desflurane Anesthesia

2000 ◽  
Vol 93 (2) ◽  
pp. 404-408 ◽  
Author(s):  
Mitchell J. Goff ◽  
Shahbaz R. Arain ◽  
David J. Ficke ◽  
Toni D. Uhrich ◽  
Thomas J. Ebert
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Volatile Anesthetics ◽  
Smoking History ◽  
Respiratory Resistance ◽  
Volatile Anesthesia ◽  
History Of ◽  
Respiratory System Resistance ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Bronchospasm is a potential complication in anyone undergoing general anesthesia. Because volatile anesthetics relax bronchial smooth muscle, the effects of two newer volatile anesthetics, desflurane and sevoflurane, on respiratory resistance were evaluated. The authors hypothesized that desflurane would have greater bronchodilating effects because of its ability to increase sympathetic nervous system activity. Methods Informed consent was obtained from patients undergoing elective surgery with general anesthesia. We recorded airway flow and pressure after thiopental induction and tracheal intubation (baseline) and for 10 min after beginning volatile anesthesia ( approximately 1 minimum alveolar concentration inspired). Respiratory system resistance was determined using the isovolume technique. Results Fifty subjects were randomized to receive sevoflurane (n = 20), desflurane (n = 20), or thiopental infusion (n = 10, 0.25 mg. kg-1. h-1). There were no differences between groups for age, height, weight, smoking history, and American Society of Anesthesiologists physical class. On average, sevoflurane reduced respiratory resistance 15% below baseline, whereas both desflurane (+5%) and thiopental (+10%) did not decrease respiratory resistance. The respiratory resistance changes did not differ in patients with and without a history of smoking during sevoflurane or thiopental. In contrast, administration of desflurane to smokers resulted in the greatest increase in respiratory resistance. Conclusions Sevoflurane causes moderate bronchodilation that is not observed with desflurane or sodium thiopental. The bronchoconstriction produced by desflurane was primarily noted in patients who currently smoked. (Key words: Bronchospasm; respiratory resistance; volatile anesthetics.)

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