Rate and reasons for elective ventilation in patients undergoing intracranial tumour surgery

Abstract Background: Mechanical ventilation (MV) after neurosurgery is often decided by the preoperative neurological status of the patient. However, there is paucity of information regarding factors responsible for continuation of MV in these patients. This study was carried out to identify the indications and risk factors for elective ventilation after intracranial tumour surgery. Materials and Methods: A prospective observational study was carried out on consecutive adult patients who underwent elective craniotomy for tumour excision, and postoperatively required MV. Data on anaesthesia technique, duration of anaesthesia and surgery, blood loss and transfusion and volume of fluids infused were noted. Intraoperative complications like tight brain, massive blood loss, brainstem handling, cranial nerve handling, haemodynamic instability, cardiac arrhythmias, venous air embolism, electrolyte abnormality and hypothermia were also recorded. Statistical analysis was done using Strata 9.0 software. Categorical data was analysed using Chi-square test or Fisher's exact test and continuous data by Student's t-test. Results: A total of 709 patients enrolled for the study over a period of one year out of which 347 patients (48.9%) required continuation of MV during the postoperative period. The mean duration of MV was 29.7 ± 39.7 hrs. The most common causes for postoperative MV were ‘not responding to commands’ (43.2%), and neurosurgeon's advice (41.8%). The mean ICU and hospital stays were 92.2 ± 134.0 hrs and 13.8 ± 16.5 days, respectively. 47.6% of patients who required postoperative MV on neurosurgeon's advice developed complications whereas it was 33.2% for those ventilated other reasons (P < 0.05). Glasgow outcome scale (GOS) at discharge was poor in 12.4%. On multivariate analysis, intraoperative blood transfusion, tracheostomy and duration of ventilation more than 48 hrs were the independent risk factors associated with poor outcome. Conclusions: Although the neurosurgeon's advice for elective ventilation should not be ignored, but prolonged and avoidable MV may exacerbate the postoperative morbidities apart from increasing the cost of treatment. Hence, a complete understanding of intraoperative events, cerebral physiology and various factors influencing it during the perioperative period may not be overemphasised.

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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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Endoscopy-assisted wide-vertex craniectomy, “barrel-stave” osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis

Neurosurgical FOCUS ◽

10.3171/foc.2000.9.3.3 ◽

2000 ◽

Vol 9 (3) ◽

pp. 1-6 ◽

Cited By ~ 49

Author(s):

David F. Jimenez ◽

Constance M. Barone

Keyword(s):

Blood Loss ◽

Operative Time ◽

Intraoperative Complications ◽

Hospital Length Of Stay ◽

Hospital Charges ◽

Sagittal Suture ◽

Reconstructive Procedures ◽

Early Management ◽

Custom Made ◽

The Mean

Object The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and “barrel-stave” osteotomy were performed. Methods During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stave–like osteotomies, and postoperatively were fitted with custom-made molding helmets. Data on operative time, blood loss, transfusion rates, hospital length of stay, complications, and hospital charges were collected prospectively. The mean patient age at the time of surgery was 3.7 months. The average blood loss was 31.8 ml; and only one patient required an intraoperative blood transfusion. Nine patients received transfusions of donor blood postoperatively. The mean operative time was 50 minutes, and all but three patients were discharged from the hospital the morning following surgery. There were no intraoperative complications. Normocephaly as well as normal cephalic indices were observed at latest follow up. Conclusions The authors conclude that early treatment of infants with sagittal suture craniosynostosis by using minimally invasive, endoscopy-assisted wide-vertex craniectomies provides excellent results and a significantly lower morbidity rate than traditional calvarial vault reconstructive procedures.

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Three Ports Laparoscopic Resection for Colorectal Cancer: A Step on Refining of Reduced Port Surgery

ISRN Surgery ◽

10.1155/2014/781549 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Anwar Tawfik Amin ◽

Tarek M. Elsaba ◽

Gamal Amira

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Colorectal Resection ◽

Intraoperative Complications ◽

Perioperative Period ◽

Reduced Port Surgery ◽

Estimated Blood Loss ◽

The Mean ◽

Reduced Port ◽

Mean Time

Background. Reduced port surgery (RPS) is becoming increasingly popular for some surgeries. However, the application of RPS to the field of colectomy is still underdeveloped. Patients and Methods. In this series, we evaluated the outcome of laparoscopic colorectal resection using 3 ports technique (10 mm umbilical port plus another two ports of either 5 or 10 mm) for twenty-four cases of colorectal cancer as a step for refining of RPS. Results. The mean estimated blood loss was 70 mL (40–90 mL). No major intraoperative complications have been encountered. The mean time for passing flatus after surgery was 36 hours (12–48 hrs). The mean time for oral fluid intake was 36 hours and for semisolid food was 48 hours. The mean hospital stay was 5 days (4–7 days). The perioperative period passed without events. All cases had free surgical margins. The mean number of retrieved lymph nodes was 14 lymph nodes (5–23). Conclusion. Three ports laparoscopy assisted colorectal surgeries looks to be safe, effective and has cosmetic advantages. The procedure could maintain the oncologic principles of cancer surgery. It’s a step on the way of refining of reduced port surgery.

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Perioperative anaesthesia and coagulation management of haemophilia patients receiving total hip and knee replacement arthroplasty: Experience from a case series

Journal of Orthopaedic Surgery ◽

10.1177/2309499019874931 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901987493

Author(s):

Sibei Li ◽

Bo Qu ◽

Wuhua Ma ◽

Yuhui Li

Keyword(s):

Blood Loss ◽

Perioperative Complications ◽

Case Series ◽

Perioperative Period ◽

Clotting Factor ◽

Coagulation Management ◽

Total Hip ◽

Replacement Arthroplasty ◽

Transfusion Volume ◽

The Mean

Purpose: To report 13 consecutive cases of successful triad of anaesthesia, blood and coagulation management (ABC protocol) in haemophilic total joint arthroplasty (TJA) and its feasibility and safety on haemophilic TJA. Methods: All the clinical data of 13 consecutive cases were descend from electronic medical record. Patients who suffered from haemophilia A, undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) with ABC protocol at the academic hospital from December 2014 to November 2018 were included, and demographic, perioperative characteristics according to the classified method were further analysed. Results: All 13 haemophilic patients had undergone successful surgery with ABC protocol. No massive blood loss was observed in perioperative period. The mean external blood loss was 876.92 ± 592.86 mL. The mean change in haemoglobin was 5.42 ± 2.43 g dL−1 at 5 days post-operatively. The mean allogeneic transfusion volume was 1.23 ± 1.35 units, and the mean volume of autotransfusion was 237.5 ± 76.93 mL. The average clotting factor consumption for per operated joint was 458.26 ± 226.45 IU kg−1 in all cases. No severe perioperative complications were occurred. Conclusion: ABC-related series of measures were appropriate management mode for patients received THA and/or TKA with mild or moderate haemophilia. However, more robust evidence came from larger samples is needed.

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Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

Minimally Invasive Surgery ◽

10.1155/2012/173685 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Michael Y. Wang

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Intraoperative Complications ◽

Ct Scanning ◽

Iliac Screws ◽

Fusion Site ◽

Spinal Deformity Surgery ◽

The Mean

Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws.Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body.Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation.Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

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Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation

Journal of Neurosurgery Spine ◽

10.3171/2009.11.spine09308 ◽

2010 ◽

Vol 12 (5) ◽

pp. 540-546 ◽

Cited By ~ 76

Author(s):

Masahiko Watanabe ◽

Daisuke Sakai ◽

Daisuke Matsuyama ◽

Yukihiro Yamamoto ◽

Masato Sato ◽

...

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Surgical Site Infection ◽

Hospital Stay ◽

Spine Surgery ◽

Patient Characteristics ◽

Site Infection ◽

The Mean ◽

Preoperative Hospital Stay ◽

Duration Of Operation

Object The purpose of this study was to identify risk factors for surgical site infection after spine surgery, noting the amount of saline used for intraoperative irrigation to minimize wound contamination. Methods The authors studied 223 consecutive spine operations from January 2006 through December 2006 at our institute. For a case to meet inclusion criteria as a site infection, it needed to require surgical incision and drainage and show positive intraoperative cultures. Preoperative and intraoperative data regarding each patient were collected. Patient characteristics recorded included age, sex, and body mass index (BMI). Preoperative risk factors included preoperative hospital stay, history of smoking, presence of diabetes, and an operation for a traumatized spine. Intraoperative factors that might have been risk factors for infection were collected and analyzed; these included type of procedure, estimated blood loss, duration of operation, and mean amount of saline used for irrigation per hour. Data were subjected to univariate and multivariate logistic regression analyses. Results The incidence of surgical site infection in this population was 6.3%. According to the univariate analysis, there was a significant difference in the mean duration of operation and intraoperative blood loss, but not in patient age, BMI, or preoperative hospital stay. The mean amount of saline used for irrigation in the infected group was less than in the noninfected group, but was not significantly different. In the multivariate analysis, sex, advanced age (> 60 years), smoking history, and obesity (BMI > 25 kg/m2) did not show significant differences. In the analysis of patient characteristics, only diabetes (patients receiving any medications or insulin therapy at the time of surgery) was independently associated with an increased risk of surgical site infection (OR 4.88). In the comparison of trauma and elective surgery, trauma showed a significant association with surgical site infection (OR 9.42). In the analysis of surgical factors, a sufficient amount of saline for irrigation (mean > 2000 ml/hour) showed a strong association with the prevention of surgical site infection (OR 0.08), but prolonged operation time (> 3 hours), high blood loss (> 300 g), and instrumentation were not associated with surgical site infection. Conclusions Diabetes, trauma, and insufficient intraoperative irrigation of the surgical wound were independent and direct risk factors for surgical site infection following spine surgery. To prevent surgical site infection in spine surgery, it is important to control the perioperative serum glucose levels in patients with diabetes, avoid any delay of surgery in patients with trauma, and decrease intraoperative contamination by irrigating > 2000 ml/hour of saline in all patients.

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Peripartum Embolism

10.1093/med/9780190226459.003.0046 ◽

2017 ◽

Author(s):

Elizabeth M. S. Lange ◽

Paloma Toledo

Keyword(s):

Risk Factors ◽

Amniotic Fluid ◽

Maternal Morbidity ◽

Clinical Presentation ◽

Air Embolism ◽

Common Type ◽

Amniotic Fluid Embolism ◽

Maternal Risk ◽

Venous Air Embolism ◽

Maternal Morbidity And Mortality

Embolic disease during pregnancy is a significant contributor to maternal morbidity and mortality. The most common type of embolism is venous air embolism, but this is rarely symptomatic or hemodynamically significant. However, both thromboembolism and amniotic fluid embolism (AFE) are associated with significant maternal risk, and in the case of AFE, frequent major hemodynamic sequelae and fatal results ensue. As each class of embolic disease has slightly different risk factors, pathophysiology, clinical presentation, and treatment, they will each be discussed in separate sections in this chapter with an overview of these components.

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Neuroprotection for Vascular and Endovascular Neurosurgery

10.1093/med/9780190280253.003.0019 ◽

2017 ◽

Author(s):

Travis R Ladner ◽

Nishant Ganesh Kumar ◽

Lucy He ◽

J Mocco

Keyword(s):

Risk Factors ◽

Intracranial Pressure ◽

Perioperative Period ◽

Neurological Status ◽

Secondary Injury ◽

Hemodynamic Parameters ◽

Endovascular Techniques ◽

Pharmacological Interventions ◽

Hemodynamic Status ◽

Abrupt Changes

The complexity of neurovascular disease presents a challenge to the surgical and anesthesia teams managing patients with such conditions. With open or endovascular techniques, abrupt changes in hemodynamic status and intracranial pressure are an ever-present concern throughout the perioperative period. Monitoring of neurological status, hemodynamic parameters, and intracranial pressure are important adjuncts. Targeted physiologic and pharmacological interventions are critical to ensuring safe completion of complex procedures and the prevention secondary injury. This chapter reviews common complications of cerebrovascular and endovascular operations and their risk factors and summarize clinical principles, strategies, and considerations for maximizing neuroprotection in the treatment of neurovascular disease.

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Role of minimally invasive percutaneous fixation in thoracolumbar fractures: a prospective study

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0063-6 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Sherief Ahmed Elenany ◽

Hazem Adel Alkosha ◽

Mohamed Safwat Ibrahiem

Keyword(s):

Blood Loss ◽

Intraoperative Complications ◽

Neurological Status ◽

Fusion Rate ◽

Thoracolumbar Fractures ◽

Transpedicular Fixation ◽

Angle Correction ◽

Flexible Segment ◽

A Prospective Study ◽

Fracture Types

Abstract Background Each year, there are approximately 5 million new vertebral fractures worldwide. Being a mobile flexible segment that is prone to severe stresses and loads, thoracolumbar fractures are considered one of the most controversial and challenging fracture types to manage. Objective The aim of this study is to explore the technique and to evaluate feasibility, safety, and outcome of percutaneous transpedicular fixation in the management of thoracolumbar fractures. Methods This study was carried out in the period between May 2016 and June 2017, where 20 consecutive patients with thoracolumbar fractures, based on TLICS scoring and neurological status, underwent a posterior percutaneous transpedicular fixation. The mean age was 33.85 years, range 20–49 years. Patients were followed up for 12 months. Patients had their clinical outcomes reviewed and evaluated in terms of cosmesis by visual analog scale (VAS) and in terms of Cobb angle correction. Results The length of the procedure varied from 120 to 180 min with mean time of 154.50 min. There was no significant blood loss in all cases. The volume of blood loss ranged from 150 to 200 cc with mean loss of 174.25 cc. No major intraoperative complications happened in our study cases. Six cases had only one laterally malpositioned screw each. All cases returned to their previous activity without limitations (E5). Those who were completely pain free (F5) were 15 patients. Only five patients were suffering from moderate pain (F4). The Prolo scale was either 9 or 10 with mean of 9.60. Conclusion By comparing our results with other studies, we found more or less equivalence in terms of neurological recovery, functional outcome, fusion rate, and maintenance of correction gain. However, the cosmesis scores for patients in the study were great.

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Hidden blood loss and its possible risk factors in cervical open-door laminoplasty

Journal of International Medical Research ◽

10.1177/0300060519856987 ◽

2019 ◽

Vol 47 (8) ◽

pp. 3656-3662 ◽

Cited By ~ 2

Author(s):

Chao Jiang ◽

Tian-He Chen ◽

Ze-Xin Chen ◽

Ze-Ming Sun ◽

Hui Zhang ◽

...

Keyword(s):

Risk Factors ◽

Soft Tissue ◽

Blood Loss ◽

Perioperative Period ◽

Haematocrit Level ◽

Open Door ◽

Total Blood ◽

Hidden Blood Loss ◽

Perioperative Blood Loss ◽

Multilevel Cervical Spondylotic Myelopathy

Objectives To evaluate hidden blood loss (HBL) and its possible risk factors among patients following expansive open-door laminoplasty (EOLP) for multilevel, cervical spondylotic myelopathy. Methods This was a retrospective analysis of data from patients over 18 years of age who underwent posterior cervical EOLP (from C3-C6) in our department from January 2017 to July 2018. HBL was calculated by deducting the observed perioperative blood loss from the calculated total blood loss (TBL) based on the fall in haematocrit level. Results 45 patients (35 men and 10 women) were identified. Mean ± SD HBL was 337.2 ± 187.8 ml, which was 46.8% of the total perioperative blood loss (705.2 ± 269.6 ml). Twenty-three patients developed postoperative anaemia. Posterior cervical soft tissue was positively correlated with both TBL and hidden blood loss (HBL) and hypertension was positively correlated with TBL. Conclusions HBL following cervical EOLP was significant and should be recognised as a detrimental factor to patient safety during the perioperative period, especially in patients with thick posterior cervical soft tissue.

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