prolonged surgery
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Author(s):  
Aarti Maharaj ◽  
Kundan Jana ◽  
Kalyana Janga ◽  
Sheldon Greenberg ◽  
Elie Fein

Post-operative polyuria due to Diabetes Insipidus is a commonly reported complication of pituitary surgery. However, central DI post abdominal surgery is rare and may be related to pre-existing DI or prolonged surgery with intraoperative blood loss. A thorough workup needs to be done to exclude central DI in such patients.


Author(s):  
S Park ◽  
JE Lee ◽  
GS Choi ◽  
JM Kim ◽  
JS Ko ◽  
...  

Introduction: Despite several advantages over endotracheal tube (ETT), laryngeal mask airway (LMA), which is used in emergencies under difficult airway maintenance conditions, is rarely utilized in prolonged surgery. We compared the variables representing intraoperative gas exchange with second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. Methods: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. Parameters including end-tidal pressure of carbon dioxide (ETCO2), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO2), pH, and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery were compared between the two groups. In addition, the incidence of postoperative pulmonary complications (PPC) including pulmonary aspiration was also compared. Results: The values of ETCO2, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO2 at 2 h after induction was higher in patients with LMA (40.5 vs. 38.5 mmHg, p < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was not different. Conclusion: During prolonged laparoscopic abdominal surgery, the second-generation LMA facilitates adequate intraoperative gas exchange and represents an alternative to ETT.


2021 ◽  
Vol 7 (4) ◽  
pp. 267-271
Author(s):  
Alvin Saverymuthu ◽  
Rufinah Teo ◽  
Jaafar Md Zain ◽  
Saw Kian Cheah ◽  
Aliza Mohamad Yusof ◽  
...  

Abstract Introduction Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. Aim To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. Methods All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Results Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001]. Conclusions One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.


2021 ◽  
Vol 12 (1) ◽  
pp. e19-e19
Author(s):  
Kousuke Matsumoto ◽  
Makiko Tanakura ◽  
Izumi Mitani ◽  
Akira Kimoto ◽  
Masaya Akashi

Introduction: Salivary stones inside the Wharton’s duct adjacent to the mylohyoid muscle are often removed by a little incision of the mouth floor under local anesthesia. However, in the case of relatively large salivary stones, a large incision is required, which is commonly accompanied by hemorrhage and the need for surgical hemostasis, resulting in prolonged surgery. Furthermore, troublesome sequelae such as ranula and lingual nerve paralysis can occur after surgical procedures. Methods: Two patients who had relatively large salivary stones (>1 cm diameter) in the Wharton’s duct were underwent incision of the mouth floor soft tissues with a CO2 laser. Results: In both patients, the stone was removed in a few minutes without causing abnormal bleeding, nerve injury, or sublingual gland disorders and was completely healed. Conclusion: We report the usefulness and safety of the CO2 laser in two patients with relatively large salivary stones, who underwent successful surgical removal.


Author(s):  
O. M. Strogush

Introduction. The task of providing anesthesia for long-term operations on the lower extremities in the traumatology and orthopedics is resolved by different ways. Prolonged systemic spinal anesthesia (SA) using oral clonidine (clophelin) deserves a special attention. Aim is to study the duration of SA using oral clonidine (clophelin) in orthopedic and traumatic patients who were undergoing prolonged surgery on the knee joint and the proximal tibia epi-metaphysis. Materials and Methods: The study involved 43 patients who were divided into two groups - group without clophelin (22 patients) and group with clophelin (21 patients) use. Operations in both groups were performed under conditions of SA (0.5% solution of isobaric bupivacaine at a dose of 13 mg in combination with 40 mg of 2% solution of lidocaine). In group with clophelin the premedication included the addition appointment of oral clophelin at a dose of 4 μg / kg (approximately 300 μg) 60 minutes before surgery. There were determined the SA duration, the total duration of intraoperative anesthesia, the total duration of the pneumatic harness action, a state of hemodynamics during the operation and postoperative period. Results and Discussions. There were no statistically significant differences in duration of operations in the group without clophelin and in group with clophelin that amounted to 228.63 ± 51.59 minutes and 241.04 ± 48.46 minutes, respectively (p = 0.24). SA duration in the group with clophelin statistically significantly exceeded the duration in group without clophelin and consisted of 236.38 ± 39.76 minutes and 204.77 ± 38.92 minutes, respectively (p = 0.011). The pulse rate in the clophelin group, comparing to the group without clophelin was significantly lower during the operation, in 6 hours after surgery and did not reach the level of critical bradycardia. The mean arterial pressure in the group with clophelin, comparing with group without clophelin was significantly lower during the operation, in 24 hours after surgery and did not reach the level of critical hypotension.Conclusions. The duration of SA by bupivacaine in combination with lidocaine using oral clonidine (clophelin) before surgery at a dose of 4 μg / kg (about 300 μg) in orthopedic and traumatic patients undergoing the knee joint surgery was increased by an average of 32 minutes. Against the background of prolonged systemic SA with the use of oral clonidine (clophelin), these operations can be performed for up to 4 hours. The detected hemodynamic changes against the background of clonidine use were not critical and are not considered as complications.


2021 ◽  
Vol 8 (1) ◽  
pp. 62-73
Author(s):  
Rahul Yadav ◽  
Manish Honwad ◽  
Raj Kumar Choubey ◽  
Kirti Bhushan ◽  
Geetanjali Singh ◽  
...  

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Hiromitsu Takizawa ◽  
Naoki Miyamoto ◽  
Shinichi Sakamoto ◽  
Mika Takashima ◽  
Daisuke Matsumoto ◽  
...  

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