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Vascular surgery anaesthesia

Tomohiro Yamamoto, Miriam Flenner, Ehrenfried Schindler
To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial surgeries[1-3]. It provides an uninhibited access to the mouth and plays an important role when dealing with difficult airways[4-6]. It is also used in patients with cervical spine instability owing to injury[7] or in patients with a cervical spine fixation owing to a disease or previous operation[8]. Moreover, it is selected for patients who require prolonged intubation for intensive care[9]...
February 6, 2019: Anaesthesiology Intensive Therapy
Srdjan Babić, Slobodan Tanasković, Mihailo Nešković, Predrag Gajin, Dragoslav Nenezić, Predrag Stevanović, Nikola Aleksić, Milorad Ševković, Nenad Ilijevski, Predrag Matić, Petar Popov, Goran Vučurević, Dragana Unić-Stojanović, Djordje Radak
Purpose: To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods: From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA)...
2019: Surgery Research and Practice
Silvia Loggi, Nicoletta Mininno, Elisa Damiani, Benedetto Marini, Erica Adrario, Claudia Scorcella, Roberta Domizi, Andrea Carsetti, Simona Pantanetti, Gabriele Pagliariccio, Luciano Carbonari, Abele Donati
BACKGROUND: In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia. METHODS: Prospective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician's decision...
January 5, 2019: BMC Anesthesiology
Osama Abou Arab, Marc Olivier Fischer, Alexis Carpentier, Christophe Beyls, Pierre Huette, Abdel Hchikat, Amar Benammar, Beatris Labont, Yazine Mahjoub, Stéphane Bar, Pierre-Grégoire Guinot, Emmanuel Lorne
INTRODUCTION: Anaesthesia frequently induces hypotension. Several recent studies have analysed arterial elastance (Ea) in order to describe clinical variations of mean arterial pressure (MAP). The objective of the study was to assess Ea to explain MAP variation following etomidate induction. METHODS: We conducted a prospective single-centre study. Inclusion criteria were patients undergoing elective cardiac surgery with invasive blood pressure monitoring. Ea was expressed as Pes/SV (Pes: end systolic pressure, SV: stroke volume)...
December 21, 2018: Anaesthesia, Critical Care & Pain Medicine
Qian-Jin He, Xiao-Meng Dai, Chao Yu, Sheng-Li Yang
OBJECTIVES: To introduce a new laparoscopic splenectomy (LS) approach. METHODS: Sixteen patients underwent LS with general anaesthesia and carbon dioxide pneumoperitoneum. The details of the surgery are as follows: 1. The omentum was incised along the greater curvature and retracted as much as possible to expose the pancreatic body and tail. 2. The right arteriovenous root in the gastric omentum was ligated to sufficiently expose the pancreatic body and tail. 3...
November 29, 2018: Clinics
Steven Young, Fred E Shapiro, Richard D Urman
PURPOSE OF REVIEW: The purpose of this review is to provide an update on the current knowledge about patient safety and outcomes in the office-based setting. Ambulatory procedures performed outside the hospital are steadily increasing, resulting in an increasing number and complexity of office-based procedures and patient comorbidities over the past two decades. In this review we focus on most recent outcomes studies encompassing different surgical specialties and patient populations...
December 2018: Current Opinion in Anaesthesiology
Pedro Videira Reis, Mariana Morgado, Inês Valdoleiros, Marina Dias Neto, Joana Mourão
Objective: Patients undergoing endovascular aneurysm repair (EVAR) have comorbidities that increase the risk of death, myocardial infarction (MI) and acute kidney injury (AKI). Our aim was to evaluate the incidence and predictors of mortality, MI and AKI after EVAR and to compare AKI incidence with Vascular Surgery Kidney Injury Predictive Score (VSKIPS). Methods: We conducted a retrospective study of EVAR procedures performed between March 2006 and November 2013...
June 2018: Turkish Journal of Anaesthesiology and Reanimation
R Mouton, C A Rogers, R A Harris, R J Hinchliffe
BACKGROUND: Case series and a post hoc subgroup analysis of a large randomized trial have suggested a potential benefit in treating ruptured abdominal aortic aneurysms (rAAAs) using endovascular aneurysm repair (EVAR) with local anaesthesia (LA) rather than general anaesthesia (GA). The uptake and outcomes of LA in clinical practice remain unknown. METHODS: The UK National Vascular Registry was interrogated for patients presenting with rAAA managed with EVAR under different modes of anaesthesia between 1 January 2014 and 31 December 2016...
August 23, 2018: British Journal of Surgery
Jonas Keuler, Carsten Weiß, Klaus Klemm, Julius Pochhammer, Rene Schmidt, Christoph Ilies
BACKGROUND: Near-infrared spectroscopy (NIRS) can be used to measure tissue oxygen saturation (StO2) in different sites and in a wide range of clinical scenarios. Peripheral regional anaesthesia induces vascular changes causing increased arterial blood flow and venodilatation, but its effect on StO2 is still under debate. This is especially so for patients undergoing arteriovenous fistula surgery, wherein latest data suggest an improved outcome under brachial plexus block (BPB) compared with local anaesthesia, but no data are available...
October 2018: European Journal of Anaesthesiology
Kenichi Takechi, Sakiko Kitamura, Ichiro Shimizu, Toshihiro Yorozuya
BACKGROUND: Decreased perfusion in the lower extremities is one of the several adverse effects of placing patients in a lithotomy or Trendelenburg position during surgery. This study aimed to evaluate the effects of patient positioning in lower limb perfusion patients undergoing robotic-assisted laparoscopic radical prostatectomy (RARP) using near-infrared spectroscopy (NIRS). METHODS: This observation study comprised 30 consenting males with American Society of Anaesthesiologists physical status classes I and II (age range, ≥20 to < 80 years)...
August 18, 2018: BMC Anesthesiology
E Álvarez-Fuente, A Fadrique Fuentes, R Poves-Álvarez, E Gómez-Pesquera, A Hernández Lozano
Median arcuate ligament syndrome, also known as celiac artery compression syndrome, is a rare and unusual clinical disorder. Its symptoms are non-specific, which complicates its diagnosis, and a multidisciplinary approach is required to treat the disorder. The ligament is circumferentially cleared by laparoscopy. Selective angiography and endovascular techniques may be used after laparoscopy. Vital organs and important vascular structures can be injured during the surgery. The combination of different procedures, as well as the high risk of damage, make this process a significant challenge for the anaesthetist...
July 23, 2018: Revista Española de Anestesiología y Reanimación
Serge Molliex, Sylvie Passot, Emmanuel Futier, Marlène Bonnefoi, Florence Rancon, Yannick Lemanach, Bruno Pereira
INTRODUCTION: Elderly patients constitute an increasingly large proportion of the high-risk surgical group. In adult patients, several specific intraoperative approaches such as cardiac output-guided haemodynamic therapy, depth of anaesthesia monitoring (DAM) or lung-protective ventilation (LPV) are designed to reduce postoperative mortality and surgical complications. However, none of these approaches has been specifically performed in the elderly, and no evaluation of a multimodal optimisation strategy for general anaesthesia has been achieved in this population...
June 19, 2018: BMJ Open
Thenmoly Damodaran, Byorn Wei Liang Tan, Ping Liao, Surash Ramanathan, Gin Keat Lim, Zurina Hassan
ETHNOPHARMACOLOGICAL RELEVANCE: Clitoria ternatea L. (CT), commonly known as Butterfly pea, is used in Indian Ayurvedic medicine to promote brain function and treat mental disorders. Root of CT has been proven to enhance memory, but its role in an animal model of chronic cerebral hypoperfusion (CCH), which has been considered as a major cause of brain disorders, has yet to be explored. AIM OF THE STUDY: To assess the motor and cognitive effects of acute oral administration of CT root methanolic extract and hippocampal long-term plasticity in the CA1 region of the CCH rat model...
October 5, 2018: Journal of Ethnopharmacology
Serge Molliex, Sylvie Passot, Jerome Morel, Emmanuel Futier, Jean Yves Lefrant, Jean Michel Constantin, Yannick Le Manach, Bruno Pereira
INTRODUCTION: In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years. PATIENTS AND METHODS: A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included...
February 2019: Anaesthesia, Critical Care & Pain Medicine
Pinar Ulug, Robert J Hinchliffe, Michael J Sweeting, Manuel Gomes, Matthew T Thompson, Simon G Thompson, Richard J Grieve, Raymond Ashleigh, Roger M Greenhalgh, Janet T Powell
BACKGROUND: Ruptured abdominal aortic aneurysm (AAA) is a common vascular emergency. The mortality from emergency endovascular repair may be much lower than the 40-50% reported for open surgery. OBJECTIVE: To assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality (including costs and cost-effectiveness) among patients with a suspected ruptured AAA. DESIGN: Randomised controlled trial, with computer-generated telephone randomisation of participants in a 1 : 1 ratio, using variable block size, stratified by centre and without blinding...
May 2018: Health Technology Assessment: HTA
Hugo Silva, Andreia Fernandes, João Rodrigues, Daniel Brandão, Manuela Vieira, Catarina Celestino
INTRODUCTION: Endovascular aortic interventions are suitable alternatives to open surgery, being less invasive and having lower mortality and complications. Accurate positioning of the stent graft is a critical point because of systolic thrush. Techniques used to prevent it include pharmacological (antihypertensive drugs, nitroglycerin, adenosine) and mechanical methods (temporary caval occlusion by balloon). Rapid Right Ventricular Pacing (RRVP) is an emerging alternative with good patient tolerance and low level of complications...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Luca Luzzi, Federico Franchi, Annarita Dapoto, Marco Ghisalberti, Roberto Corzani, Daniele Marrelli, Luca Marchetti, Piero Paladini, Sabino Scolletta
Background: In the treatment of malignant pleural mesothelioma the Hyperthermic Intra THOracic Chemotherapy (HITHOC) can improve the efficacy of pleurectomy and decortication with a local cytotoxic effect. However its biological impact in patient's hemodynamic and microcirculatory changes were rarely investigated. Aim of this study is to describe our experience with HITHOC after pleurectomy and decortication evaluating the role of sublingual video-microscopy in assessing the microcirculatory changes in the perioperative period...
January 2018: Journal of Thoracic Disease
J C Luis-Navarro, M Seda-Guzmán, C Luis-Moreno, J L López-Romero
Multimodal anaesthesia, combining epidural catheter and general anaesthesia, is a common technique in thoracic surgery, however, epidural catheter placement is not always possible. Recently, erector spinae plane block has been described, which provides analgesia like that of the epidural block, although unilateral, and which has been used in various procedures at thoracic level. At present, there are no studies comparing the efficacy or safety of this block with those commonly used in thoracic surgery. However, its safety profile and contraindications seem different from those of the epidural catheter, since its placement is done under ultrasound view, the needle introduction is done in plane and the ultrasound target, the transverse process, is easily identifiable and is relatively remote from major neural or vascular structures and the pleura...
April 2018: Revista Española de Anestesiología y Reanimación
Vincenza La Fauci, Gaetano Bruno Costa, Adriana Arena, Elvira Ventura Spagnolo, Cristina Genovese, Maria Angela Palamara, Raffaele Squeri
Healthcare-associated infections (HAI) continue to be a major public health concern. A number of epidemiologically relevant HAI microorganisms are multidrug-resistant (MDR) germs that can spread rapidly and/or carry multiple resistance to antibiotics. They are the cause of high mortality and possible nosocomial epidemics. For this reason, we implemented microbiological surveillance acquiring samples from patients with HAI and environmental samples from the surfaces surrounding those patients. A retrospective study was carried out from January 2014 to December 2016 in two departments of the University Hospital in Messina, Italy: the Microbiology and the Hygiene Laboratories...
January 2018: New Microbiologica
Shahab Hajibandeh, Shahin Hajibandeh, George A Antoniou, James Rh Scurr, Francesco Torella
BACKGROUND: Venous thromboembolism (VTE) is a serious but preventable cause of morbidity and mortality. Neuromuscular electrical stimulation systems (NMES) for the prevention of VTE may be beneficial for patients in whom pharmacological or standard mechanical prophylaxis methods are contraindicated or are regarded as unsafe or impractical. Although findings of experimental studies suggest that NMES reduce venous stasis, the clinical utility and effectiveness of NMES in VTE prevention remain controversial...
November 21, 2017: Cochrane Database of Systematic Reviews
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