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Abstract
The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient's safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.
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Affiliation(s)
- David Lagier
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Congli Zeng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Marcos F. Vidal Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kim JH, Lim H, Kim HM, Lim JA. Intraoperative development of pulmonary thromboembolism in a bedridden patient owing to a pelvic bone fracture with negative preoperative computed tomography pulmonary angiographic findings: A case report. Medicine (Baltimore) 2021; 100:e26658. [PMID: 34398025 PMCID: PMC8294909 DOI: 10.1097/md.0000000000026658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pulmonary thromboembolism (PTE) is a potentially life-threatening condition with high morbidity and mortality, and computed tomographic pulmonary angiography (CTPA) is an important diagnostic tool for patients in whom PTE is suspected; however, intraoperative PTE is very difficult to diagnose and often has a rapid clinical course. We experienced a case of intraoperative PTE with persistent tachycardia refractory to conventional treatments despite negative preoperative CTPA findings. PATIENT CONCERNS A 53-year-old man with a pelvic bone fracture who had been on bed rest for 10 days underwent open reduction and internal fixation under general anesthesia. He remained tachycardic (heart rate of 120 beats/min) despite treatments with fluid resuscitation, analgesics, and beta-blockers. DIAGNOSES Preoperative CTPA, computed tomography (CT) venography, and transthoracic echocardiography showed no signs of deep vein thrombosis and PTE. However, the levels of D-dimer were elevated. After the start of the surgery, tachycardia (heart rate between 100 and 110 beats/min) could not be treated with fluid resuscitation. Systolic blood pressure was maintained between 90 and 100 mm Hg using continuous infusion of phenylephrine. Ninety minutes after the surgery, systolic and diastolic blood pressures suddenly dropped from 100/60 to 30/15 mm Hg with a decrease in end-tidal carbon dioxide concentration from 29 to 13 mm Hg and development of atrial fibrillation. Arterial blood gas analysis revealed hypercapnia. Under the suspicion of PTE, cardiopulmonary resuscitation (CPR) was immediately initiated. Three CPR cycles raised the blood pressure back to 90/50 mm Hg with sinus tachycardia (115 beats/min). Transesophageal echocardiography showed right ventricular dysfunction and paradoxical septal motion. However, emboli were not found. Postoperative chest CT revealed massive PTE in both pulmonary arteries. INTERVENTIONS Immediately, surgical embolectomy was performed uneventfully. OUTCOMES The patient was discharged from the hospital 1 month later without any complications. LESSONS The patient with moderate risk for PTE (heart rate > 95 beats/min and immobilization, surgery under general anesthesia, and lower limb fracture within 1 month) should be closely monitored and managed intraoperatively even if preoperative CTPA findings are negative. The development of PTE needs to be expected if tachycardia is refractory to conventional treatments.
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Affiliation(s)
- Jong Hae Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University
| | - Hyungseop Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University
| | - Hyun Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung A. Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University
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Lim EJ, Sakong S, Choi W, Oh JK, Cho JW. Which radiograph is most accurate for assessing hip joint penetration in infra-acetabular screw placement? Medicine (Baltimore) 2021; 100:e26392. [PMID: 34128903 PMCID: PMC8213270 DOI: 10.1097/md.0000000000026392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
Although infra-acetabular screws have been used for anterior and posterior column transfixation, a screw penetrating the hip joint can result in harmful complications. However, the most accurate intraoperative radiologic imaging tool for identifying articular penetration has not been established. The purpose of the present study was, therefore, to evaluate the consistency with which standard pelvic radiographs compared with computed tomography (CT) can be used for demonstrating articular penetration.This retrospective review was performed between January 2015 and December 2020. We evaluated the records of patients with acetabular or pelvic fractures who underwent open reduction and internal fixation with infra-acetabular screw placement. We collected demographic data and described infra-acetabular screw placement as follows: ideal placement, articular penetration, and out of the bone. Articular penetration was assessed independently on each pelvic radiograph and compared statistically with the CT scans. Sensitivity, specificity, correct interpretation rate, and prevalence-adjusted bias-adjusted kappa (PABAK) were calculated for each radiograph.Thirty-nine patients underwent infra-acetabular screw placement. The mean age of patients was 55 years (range, 27-90 years); there were 29 men and 10 women. One patient underwent bilateral infra-acetabular screw placement; therefore, 40 infra-acetabular screws were included in total. Six (6/40, 15%) infra-acetabular screws showed articular penetration on CT and two (2/40, 5%) showed infra-acetabular screws extending out of the bone. Hip joint penetration was correctly identified at a rate of 92.5% (95% confidence interval [CI], 79.6-98.4%) on the outlet view and 87.5% (95% CI, 73.2-95.8%) on the anteroposterior (AP) view. The PABAK for the agreement between pelvic radiographs and CT scans was 0.85 in the outlet view and 0.75 in the AP view.The outlet view is an accurate method for detecting articular penetration of infra-acetabular screws. We recommend the insertion of an infra-acetabular screw under fluoroscopic outlet view to avoid articular penetration intraoperatively.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju
| | - Seungyeob Sakong
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Wonseok Choi
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea
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Ko HC. Rescue balloon-assisted remodeling technique for protrusion of coil loop: A case report. Medicine (Baltimore) 2021; 100:e25783. [PMID: 34106612 PMCID: PMC8133059 DOI: 10.1097/md.0000000000025783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop. PATIENT CONCERNS A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coils. DIAGNOSIS A small loop protruded into the parent artery during the removal of the microcatheter. INTERVENTIONS We performed successful repositioning of the protruded coil loop using balloon inflation. CONCLUSION The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Stroke and Neurological Disorders Centre, Kyung Hee University Hospital at Gangdong
- College of Medicine, Kyung Hee University, Seoul, Korea
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Kuhlmann PK, Dallas K, Masterson J, Patel DN, Chen A, Castaneda P, Ackerman AL, Anger JT, Eilber KS. Risk Factors for Intraoperative Bladder Perforation at the Time of Midurethral Sling Placement. Urology 2020; 148:100-105. [PMID: 33227306 DOI: 10.1016/j.urology.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate patient-specific and perioperative factors that may be predictive of bladder perforation during midurethral sling placement. METHODS A retrospective chart review of women who underwent a midurethral sling procedure at our institution between 2013 and 2017 was completed. All cases with bladder perforation were included. Patient demographics and perioperative factors were explored for associations with perforation. Bivariate analysis was used to compare baseline characteristics between those with and without perforation. Logistic regression modeling was used to identify predictors of perforation and associations between bladder perforation and postoperative sequelae. RESULTS Four hundred and ten women had a urethral sling procedure at our institution between 2013 and 2017. Of these, 35 (9%) had evidence of bladder perforation on cystoscopy. This rate was higher for retropubic slings (15%) compared to transobturator slings (2%). Those with a perforation were younger (54 vs 61 years, P= .004) and had a lower average BMI (24.1 kg/m2 vs 26.3 kg/m2, P = .022). Other risk factors included lack of pre-existing apical prolapse (11% vs 4%, P = .012) and concomitant urethrolysis (27% vs 8%, P = .024). In multivariable analysis, age, BMI, and sling type were significantly associated with perforation. In univariate analysis, perforation was associated with postoperative lower urinary tract symptoms (OR 2.3, P = .21) and urinary tract infection within 30 days of surgery (OR 2.2, P = .047). CONCLUSIONS Intraoperative bladder perforation was associated with younger patient age and lower BMI. Additionally, bladder perforation is a risk factor for postoperative urinary tract infection and lower urinary tract symptoms.
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Affiliation(s)
- Paige K Kuhlmann
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Kai Dallas
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Devin N Patel
- Department of Urology, University of California San Diego, San Diego, CA
| | - Andrew Chen
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peris Castaneda
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - A Lenore Ackerman
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Karyn S Eilber
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
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Menger R, Lin J, Cerpa M, Lenke LG. Epidural hematoma due to Gardner-Wells Tongs placement during pediatric spinal deformity surgery. Spine Deform 2020; 8:1139-1142. [PMID: 32314179 DOI: 10.1007/s43390-020-00116-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To our knowledge, this is the first documented report of an operative cranial epidural hematoma secondary to skull fracture due to placement of Gardner-Wells Tongs (GWT) in the setting of a spinal deformity reconstruction. PURPOSE The objective is to illustrate the possibility of cranial pathology secondary to GWT placement and the need to properly correlate intraoperative neuromonitoring findings. STUDY DESIGN Case report. METHODS A 14-year-old male with Marfan's Syndrome presented for three-column osteotomy spinal reconstruction for a large and stiff thoracic kyphoscoliosis. Gardner-Wells Tongs (GWT) was placed prior to prone positioning to provide neck stability without issue. During the lumbar posterior column osteotomies the patient began to lose upper and lower extremity motor data. This indicated a cranial pathology. A temporary rod was placed on the concavity and an emergent flip without closure was performed. Upon flip, the patient was fixed and dilated with only right corneal reflex. The patient was rushed to the CT scanner where a large right-sided epidural hematoma was noted with a temporal bone fracture at the pin site, with the patient's right temporal bone noted to be only 1.3 mm in thickness. RESULTS The patient underwent emergent epidural hematoma evacuation by the Neurosurgical team. The patient was discharged to rehabilitation 1 week after his cranial epidural hematoma surgery with a complete recovery including with full strength examination of all extremities. He subsequently underwent a definitive posterior spinal fusion with posterior column osteotomies 8 weeks later. CONCLUSION Cranial pin fixation has the rare possibility to produce cranial pathology and has a specific complication protocol. Proper utilization and interpretation of neuromonitoring is essential to aid in intraoperative decision-making.
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Affiliation(s)
- Richard Menger
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| | - James Lin
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA.
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
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Sakakura K, Fujimoto A, Ishikawa E, Enoki H, Okanishi T. Intraoperative Head Slippage with the Head Clamp System Can Occur During Epileptic Surgery. World Neurosurg 2020; 142:e453-e457. [PMID: 32682999 DOI: 10.1016/j.wneu.2020.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND During neurosurgery, we use a head clamp system for firm head fixation. However, we have encountered slippage using the head clamp system, although this has not been adequately studied. In the present study, to increase the reliability of the analysis using a more homogeneous type of patient data, we conducted a prospective study of patients who had undergone epileptic surgery. We examined the potential risk factors for head slippage and postulated that the location of the pins might be important. METHODS We reviewed and compared the positions of the fixed head of the patients on fused preoperative and postoperative computed tomography images. We measured the distance between the corresponding head pins to determine the association with head slippage. We statistically compared the relationship between each head pin and the nasion-inion line. We also assessed age, sex, body weight, body mass index, surgical position, surgical duration, and craniotomy volume as potential risk factors for slippage. RESULTS Head slippage was observed in 3 of 21 patients (14%) in the present prospective study. The most caudal head pin position was not associated with head slippage in the present study. However, the center point between the most caudal point and the most cranial point was significant (P = 0.014). A center point between the most caudal and most cranial pins from the nasion-inion line that was >6.5 cm was more likely to result in slippage. CONCLUSIONS We should consider that head clamp slippage could occur intraoperatively.
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Affiliation(s)
- Kazuki Sakakura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
| | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Zhang D, Yang H, Chen M, Zheng Z, Zhou W, Song H. Transesophageal echocardiography (TEE) in the detection of intraoperative cardiac arrest: A case report. Medicine (Baltimore) 2020; 99:e19928. [PMID: 32358362 PMCID: PMC7440279 DOI: 10.1097/md.0000000000019928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Point-of-care ultrasound is widely used in patients with cardiac arrest, allowing for diagnosing, monitoring, and prognostication as well as assessing the effectiveness of the chest compressions. However, the detection of intraoperative cardiac arrest by Point-of-care ultrasound was rarely reported. PATIENT CONCERNS A 21-year-old male with Marfan syndrome which manifested Valsalva sinus aneurysms was admitted for aortic valve replacement. After endotracheal intubation, TEE transducer was inserted to evaluate the cardiac structure and function with different views. Severe aortic valve regurgitation was observed in the mid-esophageal aortic valve long and short axis view. DIAGNOSIS TEE showed that cardiac contraction was nearly stopped, the spontaneous echo contrast was obvious in the left ventricular and hardly any blood was pumped out from the heart despite the ECG showing normal sinus rhythm with HR 61 beats/min. Meanwhile, the IBP was dropped to 50/30 mm Hg. INTERVENTIONS Chest compressions were started immediately and epinephrine 100 μg was given intravenously. After 30 times of chest compressions, TEE showed that cardiac contractility increased and the stroke volume was improved in the TG SAX view. OUTCOMES The patient was discharged 18 days later in a stable condition. LESSONS Continuous echocardiography monitoring may be of particular value in forewarning and detecting cardiac arrest in high-risk patients.
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Affiliation(s)
- Donghang Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Hui Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Mingjing Chen
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Zihao Zheng
- Department of Anesthesiology, Shenzhen People's Hospital, Shenzhen, China
| | - Wenying Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan
| | - Haibo Song
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan
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Marinho S, Frias P, Oliveira I, Silva R, Rodrigues F, Paiva A. Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:212-214. [PMID: 32178913 DOI: 10.1016/j.redar.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.
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Affiliation(s)
- S Marinho
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
| | - P Frias
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - I Oliveira
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - R Silva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - F Rodrigues
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Paiva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
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Ji P, Jiang Y, Hou W, Li Q, Kang Y. A Rare Case of Fatal Pulmonary Embolism in a Pediatric Spine Surgery. World Neurosurg 2020; 137:183-186. [PMID: 32035204 DOI: 10.1016/j.wneu.2020.01.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND An 11-year-old girl had undergone posterior spinal fusion surgery for scoliosis. The surgery was complicated by intraoperative bleeding, and hemostasis was achieved by topically applying gelatin sponges. CASE DESCRIPTION She developed acute pulmonary embolism and cardiac arrest during the surgery, which was confirmed by transesophageal echocardiography. CONCLUSIONS Autopsy shortly after revealed that her death was associated with unintended intravascular entry of gelatin sponge fragments, resulting in an embolic event and secondary cardiopulmonary collapse.
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Affiliation(s)
- Peng Ji
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yingying Jiang
- Department of Anesthesiology, West China Hospital, Sichuan University and the Research Units of West China, Chinese Academy of Medical Sciences, Sichuan University, Chengdu, Sichuan, China
| | - Wei Hou
- Department of Spinal Surgery, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, China
| | - Qin Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Navarro-Ripoll R, Aliaga Medina JL, López-Baamonde M, López Hernández A, Perdomo Linares JM. Lung recruitment maneuvers: opening the door to a hidden enemy. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:99-102. [PMID: 31955890 DOI: 10.1016/j.redar.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
Recruitment manoeuvres (RM) are common practice in anaesthesiology; however, they can have adverse effects. We present an unforeseen complication in a patient undergoing surgical resection of a bronchial tumour who presented cardiac arrest due to pulseless electrical activity immediately after RMs. A transoesophageal echocardiogram performed after return of spontaneous circulation showed a patent foramen ovale (PFO), left ventricular dysfunction with segmental changes, and air in the left ventricle, leading to suspicion of paradoxical air embolism. The contractility changes normalised spontaneously, and postoperative evolution was uneventful. RMs cause changes in intracavitary pressures that can lead to opening of a PFO (present in up to 30% of the population) and reversal of the physiological left-right shunt. Transoesophageal echocardiography facilitated immediate diagnosis and follow-up.
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Affiliation(s)
- R Navarro-Ripoll
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - J L Aliaga Medina
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - M López-Baamonde
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - A López Hernández
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - J M Perdomo Linares
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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Talanas G, Siciliano R, Parodi G. Coronary Guidewire Fracture Into a Radial Artery Loop: A New Complication in the Transradial Era? J Invasive Cardiol 2019; 31:E398. [PMID: 31786537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To date, complete fracture of a coronary wire into a radial artery loop has never been reported. We describe the occurrence of a new complication in the transradial intervention era.
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Affiliation(s)
- Giuseppe Talanas
- Clinical and Interventional Cardiology Unit, Sassari University Hospital, Via De Nicola 14, 07100 Sassari, Italy.
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Yun HH, Lim JT, Yang SH, Park PS. Occult periprosthetic femoral fractures occur frequently during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA. PLoS One 2019; 14:e0221731. [PMID: 31536499 PMCID: PMC6752856 DOI: 10.1371/journal.pone.0221731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/13/2019] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal femoral geometry were analyzed. We also assessed the differences in thigh pain and stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. Occult intra-operative periprosthetic femoral fractures were found in 13 of 113 hips (11.5%). In 9/13 (69.2%) of occult fractures, fracture lines were started from the region below the tip of the lesser trochanter. Six periprosthetic femoral fractures (5.3%) were found during the operation. Out of the five hips that had detected femoral fractures around the lesser trochanter intra-operatively, four hips (80%) showed concurrent occult fractures on different levels. The female sex (P = .01) and canal filling ratio at 7 cm below the tip of the lesser trochanter (P = .01) were significantly different between the patients with and without occult periprosthetic femoral fracture. The sex was significantly associated with an increased risk in predicting an occult intra-operative periprosthetic femoral fracture (odds ratio of male, 0.25 compared with the female; 95% CI, 0.08-0.85; p = .02). There was a significant difference in the incidence of thigh pain between occult fracture group and non-occult fracture group (P < .05). There were no significant differences in stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. All 13 cases of occult intra-operative periprosthetic femoral fractures were healed at the final follow-up. Occult periprosthetic femoral fractures are common during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA, that CT scans are helpful to identify them, and that these fractures do not adversely affect the implant's survival if a rigid fixation of the implants has been achieved.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
- * E-mail:
| | - Jung Taek Lim
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Se-Hyun Yang
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Phil Sun Park
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
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Chen W, Zhu XN, Wang J, Zhu LL, Gan T, Yang JL. Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms. World J Gastroenterol 2019; 25:5174-5184. [PMID: 31558865 PMCID: PMC6747285 DOI: 10.3748/wjg.v25.i34.5174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation. AIM To investigate the incidence and risk factors of the MWT during esophageal ESD. METHODS From June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored. RESULTS A total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration. CONCLUSION The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.
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Affiliation(s)
- Wei Chen
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Nan Zhu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin Wang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lin-Lin Zhu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Gan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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15
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Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour YM, Krishnaswamy A, Jaber WA, Mick S, Svensson LG, Kapadia SR. Time-Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival. J Am Heart Assoc 2019; 8:e012430. [PMID: 31269863 PMCID: PMC6662132 DOI: 10.1161/jaha.119.012430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Balloon postdilation (BPD) has emerged as an effective strategy to reduce paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR). We investigated the utility of a time‐integrated aortic regurgitation index (TIARI) to guide balloon postdilation (BPD) after valve deployment. Methods and Results All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during TAVR were included in the study. Catheter‐derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent TAVR, 49 (32%) patients required BPD to reduce significant PVR after valve deployment. Two experienced operators decided whether the patients required BPD for significant PVR. Median TIARI measured immediately after valve deployment was significantly lower in patients who required BPD when compared with patients who did not require BPD (P<0.001). In a multivariable analysis, lower TIARI (odds ratio: 0.81; P=0.003) and higher PVR grade on aortography and echocardiography (P<0.001 for both) were associated with BPD. Adding TIARI to echocardiography and aortographic PVR assessment resulted in a significant increase in global χ2 (P<0.001), an integrated discrimination index of 9% (P=0.002), and combined C‐statistics of 0.99 for predicting BPD. Higher TIARI after valve deployment was associated with better survival (hazard ratio: 0.94, P=0.014), while other hemodynamic and imaging parameters did not predict mortality after TAVR. Conclusions Among patients undergoing TAVR, a TIARI measured immediately after valve deployment adds incremental value to guide BPD over aortography and echocardiography. Higher residual TIARI is associated with better survival after TAVR.
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Affiliation(s)
- Arnav Kumar
- Division of CardiologyAndreas Gruentzig Cardiovascular CenterEmory University School of MedicineAtlantaGA
| | - Kimi Sato
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Yash Jobanputra
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Jorge Betancor
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Mohamed Halane
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Robin George
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Kinjal Banerjee
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | - Vivek Menon
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | | | - Wael A. Jaber
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Stephanie Mick
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Lars G. Svensson
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Samir R. Kapadia
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
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Abstract
RATIONALE Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS A 40-year-old woman presented with repeated chest pain. DIAGNOSIS Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.
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Affiliation(s)
| | - Hui Pan
- Department of Lung Transplantation
| | | | | | - Liang Ma
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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Long A, Mahoney P. TAVR Complicated by Thoracic Aortic Perforation and Intussusception of the Right Iliac: Report of Successful Emergent Management With Endovascular Techniques. J Invasive Cardiol 2019; 31:E97. [PMID: 31034445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Percutaneous approaches have become routine in transcatheter aortic valve replacement (TAVR). Despite numerous advantages, vascular complications associated with percutaneous access can occur during and after TAVR, and increase morbidity and mortality significantly. Effective management of potentially catastrophic vascular complications often requires prompt recognition, diagnosis, and management by multidisciplinary teams.
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Affiliation(s)
| | - Paul Mahoney
- Sentara Heart Valve and Structural Disease Center, 600 Gresham Dr, Norfolk, VA 23507 Email.
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18
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Wang C, Hsu SK, Chang CJ, Chen MH, Huang CT, Huang JS, Su IC. Transfemoral Approach for Intraoperative Angiography in the Prone or Three-quarter Prone Position : A Revisited Protocol for Intracranial Arteriovenous Malformation and Fistula Surgery. Clin Neuroradiol 2019; 30:373-379. [PMID: 31037364 DOI: 10.1007/s00062-019-00783-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/12/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Among the different arterial accesses, the femoral access is the main approach for intraoperative angiography (IOA) performed in a prone position. Without a standardized protocol, however, the application of prone IOAs in intracranial arteriovenous malformation (AVM) or arteriovenous fistula (AVF) surgery remains limited by its procedural complexity. This study describes the detailed protocol for prone IOA through a transfemoral approach and highlights several refinements in preparing this procedure. METHODS This study retrospectively reviewed the intracranial or high cervical AVM/AVF surgical cases in which both resection and IOA were performed in the prone or three-quarter prone position. Extended femoral sheath approaches and radiolucent head clamps were used in all cases. An aneurysm clip, serving as a localization landmark in IOA, was routinely placed within the surgical field. The IOA imaging, clinical impact of IOA, and complications related to the procedure were recorded. RESULTS A total of six AVM and three AVF cases, operated on in the prone (n = 7) or three-quarter prone (n = 2) positions, were included. Multiple vessel injections were required in 66.7% of cases, and IOA was successfully performed in every intended vessel. All IOA images were adequate for interpretation, except for two cases in which the non-radiolucent component of the head clamp obscured the region of interest in the lateral views. Incomplete occlusion was identified in two patients, and the aneurysm clip provided precise guidance in localizing the residual nidus. Final IOA confirmed complete lesion removal in all cases, and there were no IOA-related complications. CONCLUSION Three key steps in setting-up a prone IOA procedure for intracranial AVM/AVF surgery are proposed: (1) utilize an extended femoral sheath approach, (2) establish a localization landmark with an aneurysm clip and (3) avoid possible image interference from the non-radiolucent component of the head clamp.
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Affiliation(s)
- Chi Wang
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China
| | - Szu-Kai Hsu
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China
- Department of Nursing, Tzu Hui Institute of Technology, Pingtung County, Taiwan, Republic of China
| | - Chih-Ju Chang
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
- Department of Mechanical Engineering, National Central University, Taoyuan County, Taiwan, Republic of China
| | - Ming-Hong Chen
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Chih-Ta Huang
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China
| | - Jing-Shan Huang
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China
| | - I-Chang Su
- Division of Neurosurgery, Department of Surgery, Taipei Cathay General Hospital, Taipei, Taiwan, Republic of China.
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China.
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19
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Suraci N, Garcia P, Mihos C, Rosen G, Santana O. Right Atrial, Right Ventricular, Superior Vena Cava Dissection Caused by Swan-Ganz Catheter Placement. J Invasive Cardiol 2019; 31:E95. [PMID: 31034443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This case involves Swan-Ganz catheter placement in a patient who developed cardiogenic shock, possibly due to the catheter dissecting the intimal lining of the superior vena cava and endocardium.
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Affiliation(s)
| | | | | | | | - Orlando Santana
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Road, Miami Beach, FL 33140 USA.
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20
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Yokoya S, Hino A, Echigo T, Oka H. Place-and-Clip Method for Fixing the Suture Thread in Deep-Brain Vascular Lesions: A Technical Case Report. World Neurosurg 2019; 128:11-13. [PMID: 31009785 DOI: 10.1016/j.wneu.2019.04.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracranial vascular injury incurred during surgery must be repaired as quickly as possible. The standard repair procedure is surgical suturing. However, the narrow and deep working space may obstruct creating a knot with the suture thread. CASE DESCRIPTION Resection of an olfactory groove meningioma was performed in a 73-year-old woman via the right lateral supraorbital approach. Tumor retraction caused an injury to the pericallosal artery. After temporary clipping of the vessel, a 10-0 nylon thread was placed on the vascular lesion and the end of the thread was fixed with an aneurysm clip. CONCLUSIONS Fixing the suture thread with an aneurysm clip can be a rescue technique in suturing procedures on deeply located vascular lesions.
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Affiliation(s)
- Shigeomi Yokoya
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Tadashi Echigo
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
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21
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Tsiafoutis I, Antonakopoulos A, Koutouzis M, Katsanou K, Protogeros D, Zografos T. Dissection Re-entry Technique: How is it Really Looking? J Invasive Cardiol 2019; 31:E58-E59. [PMID: 30927534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dissection re-entry is a widely used technique in many chronic total occlusion centers. This account of a failed re-entry attempt provides in vivo photographic evidence of how the vessel looked after such an attempt. Operators are advised to keep dissection of subintimal space and hematoma limited and use dedicated materials and techniques for controlled re-entry.
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Affiliation(s)
| | | | | | | | | | - Theodoros Zografos
- 3rd Department of Cardiology, Hygeia Hospital Research Associate, Athens Red Cross Hospital, 8 Artemidos Street, 16672, Vari, Athens, Greece.
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22
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Galarraga-Campoverde R, Thenier-Villa JL, Lantier A, Gonzalez-Vargas PM, Calero-Felix L, de la Lama-Zaragoza A, Conde-Alonso C. [Intraoperative intracerebral tension pneumocephalus secondary to hydrogen peroxide as a hemostatic agent]. Rev Neurol 2019; 68:89-90. [PMID: 30638259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | | | - A Lantier
- Hospital Universitario Lucus Augusti, Lugo, Espana
| | | | - L Calero-Felix
- Complejo Hospitalario Universitario de Vigo, Vigo, Espana
| | | | - C Conde-Alonso
- Complejo Hospitalario Universitario de Vigo, Vigo, Espana
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23
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Larney V, Charles R, Brown AS, Leonard IE. Value of Transoesophageal Echocardiography for Diagnosis of Intraoperative Tumour Embolization. Anaesth Intensive Care 2019; 34:797-800. [PMID: 17183901 DOI: 10.1177/0310057x0603400619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant neoplasms such as renal cell carcinoma may invade the inferior vena cava leading to a risk of pulmonary tumour embolization during surgical excision. Although massive pulmonary tumour embolism occurs relatively rarely, it can have catastrophic consequences. We report the case of an acute intraoperative pulmonary tumour embolism during resection of a renal cell carcinoma. The use of transoesophageal echocardiography allowed the immediate diagnosis and appropriate management of the underlying cause of acute haemodynamic instability. The role of transoesophageal echocardiography in the diagnosis of pulmonary embolism is discussed.
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Affiliation(s)
- V Larney
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
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24
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Foppa C, Spinelli A. Ureteric identification with indocyanine green fluorescence in laparoscopic redo pouch surgery. Tech Coloproctol 2018; 22:627-628. [PMID: 30167911 DOI: 10.1007/s10151-018-1838-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
Affiliation(s)
- C Foppa
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
| | - A Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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25
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Mačiulienė A, Gelmanas A, Jaremko I, Tamošiūnas R, Smailys A, Macas A. Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery. Medicina (Kaunas) 2018; 54:E49. [PMID: 30344280 PMCID: PMC6122100 DOI: 10.3390/medicina54030049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/20/2018] [Accepted: 07/09/2018] [Indexed: 12/04/2022]
Abstract
Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.
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Affiliation(s)
- Asta Mačiulienė
- Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
| | - Arūnas Gelmanas
- Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
| | - Inna Jaremko
- Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
| | - Ramūnas Tamošiūnas
- Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
| | - Alfredas Smailys
- Department of Orthopaedics and Traumatology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
| | - Andrius Macas
- Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50009 Kaunas, Lithuania.
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26
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Chuah YY, Lee YY, Chen WC, Kao SS. Sengstaken-Blakemore tube malposition with esophageal rupture. Acta Gastroenterol Belg 2018; 81:447-448. [PMID: 30350541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Yoen Young Chuah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ping Tung Christian Hospital, Ping Tung, Taiwan
| | - Y Y Lee
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - W C Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - S S Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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27
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Otremski H, Dolkart O, Atlan F, Hutt D, Segev E, Pritsch T, Rosenblatt Y. Hairline fractures following volar plating of the distal radius: a recently recognized hardware-related complication. Skeletal Radiol 2018; 47:833-837. [PMID: 29356843 DOI: 10.1007/s00256-018-2877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Intraoperative hairline longitudinal fractures were recently reported in association with distal radius volar plating. Our aim was to further analyze this newly described complication. METHODS A retrospective radiographic and chart review was performed on 225 patients who underwent distal radius plating between June 2013 and June 2015. The Acu-Loc/Acu-Loc2© plating system (Acumed, Hillsboro, OR, USA) was used in 208 cases, and the VariAx© plating system (Stryker, Kalamazoo, MI, USA) was used in 17 cases. Three independent reviewers performed a blind evaluation of all relevant radiographs for the occurrence of longitudinal fractures around the plate, and validity was considered only when there was agreement among all three of them. RESULTS Hairline longitudinal fractures were identified in 57 cases (25%), 55 with the Acu-Loc/Acu-Loc2© system and 2 with the VariAx© system. All fractures occurred with volar plating. Fracture occurrence was associated with age over 59 years, female gender, extra-articular fractures, and the use of Hexalobe screws (Acu-Loc/Acu-Loc2© system). CONCLUSIONS We believe that the source of fracture occurrence lies within the screw design and that better screw design and possibly tapping in patients at risk may reduce the occurrence of intraoperative hairline longitudinal fractures. Further clinical and biomechanical research is needed to better understand this newly reported complication.
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Affiliation(s)
- Hila Otremski
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Hutt
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Segev
- Faculty of Science, Holon Institute of Technology, Holon, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
PURPOSE To study during vitreoretinal surgery the intravitreal posterior empty spaces caused by different posterior relationships between the retina, posterior hyaloid and posterior vitreous. METHODS A total of 151 eyes with different vitreoretinal disorders were considered; 97 eyes with retinal detachment (Group I), 54 eyes without retinal detachment (Group II). Intraoperative anatomy was carefully observed. In Group I, intraoperative observations were made with and without the infusion fluid entering the eyes. RESULTS Different intraoperative posterior empty spaces were found: (i) within the posterior vitreous, (ii) between the detached posterior hyaloid and the retina, (iii) above and below the detached posterior "isolated hyaloid", and (iv) between the more posterior vitreous and the attached posterior hyaloid. The infusion fluid flux may variously change the size and shape of these posterior empty spaces. CONCLUSIONS Many types of posterior empty spaces were observed intraoperatively. Their correct interpretation was important to well-conducted surgery. Dynamic movements of fluids in the vitreous cavity caused many intraoperative artifacts, making it difficult to understand the empty spaces and the vitreoretinal relationships present before surgery.
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Affiliation(s)
- C Azzolini
- Department of Ophthalmology and Visual Sciences, Scientific Institute H.S. Raffaele, University of Milano, Italy
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Bornstein MM, Horner K, Jacobs R. Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research. Periodontol 2000 2018; 73:51-72. [PMID: 28000270 DOI: 10.1111/prd.12161] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.
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Kimura T, Ibayashi K, Kawai K. Intraoperative Resuturing of Occluded Superficial Temporal Artery-Middle Cerebral Artery Anastomoses: Single-Center Retrospective Study. World Neurosurg 2018; 113:e650-e653. [PMID: 29499427 DOI: 10.1016/j.wneu.2018.02.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, there is a certain risk of intraoperative acute occlusion of the bypass that can cause operative complications. OBJECTIVE We sought to assess the efficacy of resuturing at the same site after intraoperative acute occlusion of the bypass. METHODS In total, 129 STA-MCA anastomosis operations were performed on 125 patients at our institution. The electronic medical records of each patient were reviewed to gather information regarding intraoperative occlusion events, and the operative videos and postoperative radiologic images were also reviewed. RESULTS Twelve intraoperative acute occlusions were identified. In each case, resuturing was performed after cutting all knots, flushing the thrombus, and trimming the edges of the STAs. In 11 cases, indocyanine green videoangiography and/or Doppler sonography revealed patency during the operation, which was confirmed by postoperative magnetic resonance angiography. None of the 12 cases exhibited high-signal intensities in the MCA area on diffusion-weighted images. CONCLUSION If intraoperative acute occlusion of STA-MCA anastomosis occurs, reanastomosis at the site should be the first option.
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Affiliation(s)
- Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan.
| | - Kenji Ibayashi
- Department of Neurosurgery, Japanese Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan
| | - Kensuke Kawai
- Department of Neurosurgery, Japanese Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan
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Acosta Martínez J, López-Herrera Rodríguez D, González Rubio D, López Romero JL. Transoesophageal echocardiography during orthotopic liver transplantation. Rev Esp Anestesiol Reanim 2017; 64:522-527. [PMID: 28385292 DOI: 10.1016/j.redar.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 06/07/2023]
Abstract
Despite the importance of haemodynamic management in patients undergoing liver transplantation, there is currently no consensus on the most appropriate type of monitoring to use. In this context, transoesophageal echocardiography can provide useful information to professionals, although their use constraints prevent further spread today.
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Affiliation(s)
- J Acosta Martínez
- Facultativo Especialista de Área, Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital General Virgen del Rocío, Sevilla, España.
| | - D López-Herrera Rodríguez
- Facultativo Especialista de Área, Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital General Virgen del Rocío, Sevilla, España
| | - D González Rubio
- Facultativo Especialista de Área, Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital General Virgen del Rocío, Sevilla, España
| | - J L López Romero
- Facultativo Especialista de Área, Unidad de Gestión Clínica de Anestesiología y Reanimación, Hospital General Virgen del Rocío, Sevilla, España
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Burkhardt JK, Neidert MC, Stienen MN, Schöni D, Fung C, Roethlisberger M, Corniola MV, Bervini D, Maduri R, Valsecchi D, Tok S, Schatlo B, Bijlenga P, Schaller K, Bozinov O, Regli L. Computed tomography angiography spot sign predicts intraprocedural aneurysm rupture in subarachnoid hemorrhage. Acta Neurochir (Wien) 2017; 159:1305-1312. [PMID: 28127657 DOI: 10.1007/s00701-016-3072-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To analyze whether the computed tomography angiography (CTA) spot sign predicts the intraprocedural rupture rate and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS From a prospective nationwide multicenter registry database, 1023 patients with aneurysmal subarachnoid hemorrhage (aSAH) were analyzed retrospectively. Descriptive statistics and logistic regression analysis were used to compare spot sign-positive and -negative patients with aneurysmal intracerebral hemorrhage (aICH) for baseline characteristics, aneurysmal and ICH imaging characteristics, treatment and admission status as well as outcome at discharge and 1-year follow-up (1YFU) using the modified Rankin Scale (mRS). RESULTS A total of 218 out of 1023 aSAH patients (21%) presented with aICH including 23/218 (11%) patients with spot sign. Baseline characteristics were comparable between spot sign-positive and -negative patients. There was a higher clip-to-coil ratio in patients with than without aICH (both spot sign positive and negative). Median aICH volume was significantly higher in the spot sign-positive group (50 ml, 13-223 ml) than in the spot sign-negative group (18 ml, 1-416; p < 0.0001). Patients with a spot sign-positive aICH thus were three times as likely as those with spot sign-negative aICH to show an intraoperative aneurysm rupture [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.04-8.92, p = 0.046]. Spot sign-positive aICH patients showed a significantly worse mRS at discharge (p = 0.039) than patients with spot sign-negative aICH (median mRS 5 vs. 4). Logistic regression analysis showed that the spot sign was an aICH volume-dependent predictor for outcome. Both spot sign-positive and -negative aICH patients showed comparable rates of hospital death, death at 1YFU and mRS at 1YFU. CONCLUSION In this multicenter data analysis, patients with spot sign-positive aICH showed higher aICH volumes and a higher rate of intraprocedural aneurysm rupture, but comparable long-term outcome to spot sign-negative aICH patients.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | | | - David Bervini
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Sina Tok
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Philippe Bijlenga
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hospitaux Universitaires de Geneve (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Benlloch Beitia A, Carpi Femenia I, Ivars Párraga C, González Pérez L. Intraoperative extrinsic left atrial compression due to paraesophageal hiatal hernia. Rev Esp Anestesiol Reanim 2017; 64:299-300. [PMID: 28081873 DOI: 10.1016/j.redar.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/29/2016] [Accepted: 11/17/2016] [Indexed: 06/06/2023]
Affiliation(s)
- A Benlloch Beitia
- Servicio de Anestesiología y Reanimación, Hospital Francisco de Borja, Gandía, Valencia, España.
| | - I Carpi Femenia
- Servicio de Anestesiología y Reanimación, Hospital de Dénia-Marina Salud, DeniaAlicante, España
| | - C Ivars Párraga
- Servicio de Anestesiología y Reanimación, Hospital Francisco de Borja, Gandía, Valencia, España
| | - L González Pérez
- Servicio de Anestesiología y Reanimación, Hospital de Dénia-Marina Salud, DeniaAlicante, España
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Jover JL, Alonso FJ. Neumopericardium in the course of laparoscopic myomectomy. ACTA ACUST UNITED AC 2017; 64:543. [PMID: 28431751 DOI: 10.1016/j.redar.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- J L Jover
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy, Alicante.
| | - F J Alonso
- Servicio de Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoy, Alicante
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35
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Silvestre J, Sánchez-Lauro MDM, Callejón MDM, Burgarolas AM, Cruz F, Marchena J. Pneumoperitoneum after CT colonography in a patient with ulcerative colitis. Rev Esp Enferm Dig 2016; 107:456-7. [PMID: 26140645 DOI: 10.17235/reed.2015.3520/2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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36
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Luigiano C, Iabichino G, Mangiavillano B, Eusebi LH, Arena M, Consolo P, Morace C, Fagoonee S, Barabino M, Opocher E, Pellicano R. Endoscopic management of bile duct injury after hepatobiliary tract surgery: a comprehensive review. MINERVA CHIR 2016; 71:398-406. [PMID: 27589348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bile duct injuries (BDIs) are the most serious complications after hepatobiliary surgery and are associated with high morbidity and mortality. The incidence of iatrogenic injuries of bile ducts has increased after the advent of laparoscopic cholecystectomy. BDIs present with biliary leak or biliary obstruction or a combination of both. Successful treatment of these complications requires a multidisciplinary team that includes biliary endoscopists, interventional radiologists and hepatobiliary surgeons. Endoscopic treatment is the main option for biliary leak. Depending on colangiographic appearance of the biliary damage, several endoscopic techniques (naso-biliary drainage, biliary sphincterotomy, placement of prosthesis) are used, allowing to achieve the leak sealing in most cases. In complex biliary fistulas the use of covered self-expandable metal stents is another therapeutic option with high success rates. The most common endoscopic therapy for biliary strictures involves balloon dilation and placement of multiple plastic stents followed by the periodic exchange of the stents. This is usually performed every three months by placing an increasing number of stents each time, until complete resolution of the stricture. Self-expandable metal stents have a larger diameter compared to plastic stents and therefore, higher patency rate. Covered self-expandable stents are an alternative option with the advantage of providing better permeability, preventing occlusion, and reducing the number of the required procedures. The aim of this paper was to review the endoscopic management of patients with bile duct injuries after hepatobiliary surgery.
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37
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Chauvet D, Imbault M, Capelle L, Demene C, Mossad M, Karachi C, Boch AL, Gennisson JL, Tanter M. In Vivo Measurement of Brain Tumor Elasticity Using Intraoperative Shear Wave Elastography. Ultraschall Med 2016; 37:584-590. [PMID: 25876221 DOI: 10.1055/s-0034-1399152] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Purpose: Objective Shear wave elastography (SWE) enabled living tissue assessment of stiffness. This is routinely used for breast, thyroid and liver diseases, but there is currently no data for the brain. We aim to characterize elasticity of normal brain parenchyma and brain tumors using SWE. Materials and Methods: Patients with scheduled brain tumor removal were included in this study. In addition to standard ultrasonography, intraoperative SWE using an ultrafast ultrasonic device was used to measure the elasticity of each tumor and its surrounding normal brain. Data were collected by an investigator blinded to the diagnosis. Descriptive statistics, box plot analysis as well as intraoperator and interoperator reproducibility analysis were also performed. Results: 63 patients were included and classified into four main types of tumor: meningiomas, low-grade gliomas, high-grade gliomas and metastasis. Young's Modulus measured by SWE has given new insight to differentiate brain tumors: 33.1 ± 5.9 kPa, 23.7 ± 4.9 kPa, 11.4 ± 3.6 kPa and 16.7 ± 2.5 kPa, respectively, for the four subgroups. Normal brain tissue has been characterized by a reproducible mean stiffness of 7.3 ± 2.1 kPa. Moreover, low-grade glioma stiffness is different from high-grade glioma stiffness (p = 0.01) and normal brain stiffness is very different from low-grade gliomas stiffness (p < 0.01). Conclusion: This study demonstrates that there are significant differences in elasticity among the most common types of brain tumors. With intraoperative SWE, neurosurgeons may have innovative information to predict diagnosis and guide their resection.
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Affiliation(s)
- D Chauvet
- Neurosurgery Department, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, Paris, France
| | - M Imbault
- Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
| | - L Capelle
- Neurosurgery Department, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, Paris, France
| | - C Demene
- Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
| | - M Mossad
- Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
| | - C Karachi
- Neurosurgery Department, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, Paris, France
| | - A-L Boch
- Neurosurgery Department, Pitié-Salpêtrière Hospital, 47-83 boulevard de l'Hôpital, Paris, France
| | - J-L Gennisson
- Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
| | - M Tanter
- Langevin Institute, ESPCI ParisTech, PSL Research University, Paris, France
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Weimer JM, Marinov M, Avitsian R. Dural Traction a Possible Cause of Hemodynamic Changes During Single-Level Transforaminal Lumbar Interbody Fusion. World Neurosurg 2016; 97:761.e1-761.e3. [PMID: 27725296 DOI: 10.1016/j.wneu.2016.09.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lumbar spinal surgery may be associated with electrophysiologic and hemodynamic abnormalities during the procedure. CASE DESCRIPTION A 58-year-old man with grade II L4-5 spondylolisthesis and degenerative changes underwent single-level transforaminal lumbar interbody fusion. During decompression of the L4 foramina, distraction of the disc space, and placement of the interbody cage and pedicle screws, episodes of extreme bradycardia with up to 5 seconds of asystole were detected on electrocardiogram and invasive hemodynamic monitoring. The events correlated with and possibly could have been a result of traction on the dura mater. CONCLUSIONS Anesthesia providers should be aware of electrophysiologic and hemodynamic abnormalities during lumbar spinal surgery and the need to respond appropriately with sympathomimetic or vagolytic interventions.
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Affiliation(s)
- Jonathan M Weimer
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Martin Marinov
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.
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Moon YJ, Park JH, Oh J, Lee S, Hwang GS. Harmful effect of epinephrine on postreperfusion syndrome in an elderly liver transplantation recipient with sigmoid ventricular septum: A case report. Medicine (Baltimore) 2016; 95:e4394. [PMID: 27559948 PMCID: PMC5400314 DOI: 10.1097/md.0000000000004394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION As a common morphological change of aging heart, sigmoid ventricular septum is frequently found during routine preoperative evaluation, but often disregarded because of its little clinical importance. However, in this report, we describe a 70-year old patient with sigmoid ventricular septum who developed severe hemodynamic deterioration during liver transplantation because of its unique morphology of heart. METHODS During the course of reperfusion of the graft, patient's hemodynamics were closely monitored using transesophageal echocardiography. RESULTS Immediately after graft reperfusion, epinephrine was given as a treatment of choice for postreperfusion syndrome. Surprisingly, however, hemodynamic derangement persisted and became even worse. Intraoperative transesophageal echocardiography revealed left ventricular outflow tract obstruction resulting from systolic anterior motion of the mitral valve leaflet. Therefore, the patient was treated with phenylephrine and fluid bolus under the guidance of transesophageal echocardiography. CONCLUSION As more elderly recipient present for liver transplantation surgery nowadays, left ventricular outflow tract obstruction should always be considered as a possible cause for hemodynamic instability during reperfusion period. In addition, transesophageal echocardiography is a useful tool for both diagnosis of hemodynamic derangement and guidance for appropriate management during liver transplantation surgery.
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Affiliation(s)
| | | | | | | | - Gyu-Sam Hwang
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence: Gyu-Sam Hwang, Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea (e-mail: )
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Abdelaziz O, Attia H. Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications. World J Gastroenterol 2016; 22:6145-6172. [PMID: 27468207 PMCID: PMC4945976 DOI: 10.3748/wjg.v22.i27.6145] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intra-operative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.
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Maruyama Y, Kasahara Y, Tsukada Y, Arai K, Yoneda K, Murono S, Yoshizaki T. [A Case Treated with Selective Embolization for Hemorrhage during Tonsillectomy]. Nihon Jibiinkoka Gakkai Kaiho 2016; 119:867-873. [PMID: 30010287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Though tonsillectomy is one of the most common surgical procedures in otorhinolaryngology generally for benign diseases and mainly for young people, uncontrollable perioperative bleeding associated with tonsillectomy is a rare but potentially life-threatening event. We report herein on a case of a 19-year-old female with uncontrollable hemorrhage during a tonsillectomy, which was controlled through selective embolization. To the best of our knowledge, this is the first report on endovascular treatment in the management of tonsillectomy-associated intraoperative uncontrollable hemorrhage rather than postoperative bleeding. Selective embolization for perioperative bleeding during a tonsillectomy is considered as an efficient and important therapeutic option in the definitive treatment of this life-threatening occurrence. We also reviewed patients who underwent tonsillectomy in our hospital in the past five years. The ratio of postoperative hemorrhage was 11.8%. All patients with post-tonsillectomy hemorrhage were classified as grade 1 bleeding (spontaneous cessation).
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Abstract
Here, we examined whether intraoperative sonolysis can alter the risk of new ischemic lesions in the insonated brain artery territory during coronary artery bypass grafting (CABG) or valve surgery.Silent brain ischemic lesions could be detected in as many as two-thirds of patients after CABG or valve surgery.Patients indicated for CABG or valve surgery were allocated randomly to sonolysis (60 patients, 37 males; mean age, 65.3 years) of the right middle cerebral artery (MCA) during cardiac surgery and control group (60 patients, 37 males; mean age, 65.3 years). Neurologic examination, cognitive function tests, and brain magnetic resonance imaging (MRI) were conducted before intervention as well as 24 to 72 hours and 30 days after surgery.New ischemic lesions on control diffusion-weighted MRI in the insonated MCA territory ≥0.5 mL were significantly less frequent in the sonolysis group than in the control group (13.3% vs 26.7%, P = 0.109). The sonolysis group exhibited significantly reduced median volume of new brain ischemic lesions (P = 0.026). Stenosis of the internal carotid artery ≥50% and smoking were independent predictors of new brain ischemic lesions ≥0.5 mL (odds ratio = 5.685 [1.272-25.409], P = 0.023 and 4.698 [1.092-20.208], P = 0.038, respectively). Stroke or transient ischemic attack occurred only in 2 control patients (P = 0.496). No significant differences were found in scores for postintervention cognitive tests (P > 0.05).This study provides class-II evidence that sonolysis during CABG or valve surgery reduces the risk of larger, new ischemic lesions in the brain.www.clinicaltrials.gov (NCT01591018).
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Affiliation(s)
- David Školoudík
- From the Department of Neurology, Comprehensive Stroke Center, University Hospital Ostrava, Ostrava (DS, EH); Faculty of Health Sciences, Palacký University, Olomouc (DS); Department of Cardiac Surgery, University Hospital Ostrava, Ostrava (RB), and Department of Neurosurgery and Neurooncology, Comprehensive Stroke Center, Military University Hospital, Prague (RH), Czech Republic
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Defresen AA, Smal N, Belle FC, Renwart HJP, Bonhomme VL. Combined minimally invasive techniques to cure accidental dural tears occurring during spine surgery: epidural blood patch associated with cerebrospinal fluid drainage and ventral bed rest. Acta Anaesthesiol Belg 2016; 67:143-147. [PMID: 29873470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report the case of a 70-year-old man, with increased anesthetic risk, who beneficiated from a lumbar laminarthrectomy from lumbar vertebra 4 (L4) to sacral 1 (S1). A dural tear facing L5-S 1 levels occurred during surgery and was repaired intra-operatively. Postoperatively, back and radicular pain symptoms appeared along with a pseudo-meningocele. Successful treatment was only achieved after performing an epidural blood patch and closed subarachnoid drainage. This well-known but infrequent management was undertaken after a first epidural blood patch attempt, and after two unsuccessful surgical choking procedures. Management is here described, and discussed at the light of existing literature.
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Emperador F, Fita G, Arguís MJ, Gómez I, Tresandi D, Matute P, Roux C, Gomar C, Rovira I. The importance of intraoperative transesophageal echocardiography in the surgical decision in cardiac surgery. Rev Esp Anestesiol Reanim 2015; 62:10-17. [PMID: 25041852 DOI: 10.1016/j.redar.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery. PATIENTS AND METHOD Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anesthesiologist in charge. The data collected were: 1) type of surgery; 2) preoperative echocardiographic diagnosis (baseline ECHO); 3) echocardiographic diagnosis before entering cardiopulmonary bypass (CPB) (pre-CPB IOTEE); 4) any differences between the baseline ECHO and the pre-CPB IOTEE (new pre-CPB finding) and whether these differences modified the planned surgery, and 5) echocardiographic diagnosis after disconnection of CPB (unexpected post-CPB finding) and whether these post-CPB echocardiographic findings led to reinstating it. The software program SPSS(®) was used for data analysis. RESULTS The total number of patients studied was 1,273. Monitoring with IOTEE showed "new pre-CPB" findings in 98 patients (7.7%), and 43.8% of these led to a change in the scheduled surgery. Of these findings, the most frequent were abnormalities of the mitral valve that had not been diagnosed, and which led to a replacement or repair that had not been scheduled. The incidence of "unexpected post-CPB findings" was 6.2% (79 patients), and 46.8% of those required reinstating the CPB and modifying the surgery performed. The failed valve repairs and dysfunctional valve prostheses were the main causes that led to re-entry into CPB. In the remaining 42 patients, with "unexpected post-CPB findings", there were no changes in the surgical procedure as the echocardiographic findings were not considered to be significant enough to re-establish CPB and revise or change the surgical procedure. CONCLUSION Intraoperative monitoring with IOTEE by the anesthesiologist during surgery provides important information before and after the CPB that resulted in modifying surgical management.
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Affiliation(s)
- F Emperador
- Departamento de Anestesiología, Hospital Universitario Quirón Dexeus, Universidad Autónoma de Barcelona, Barcelona, España.
| | - G Fita
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
| | - M J Arguís
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
| | - I Gómez
- Departamento de Anestesiología, Clínica del Pilar, Barcelona, España
| | - D Tresandi
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
| | - P Matute
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
| | - C Roux
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
| | - C Gomar
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
| | - I Rovira
- Departamento de Anestesiología, Hospital Clínico de Barcelona, Universidad de Barcelona, Barcelona, España
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Donadon M, Costa G, Torzilli G. State of the art of intraoperative ultrasound in liver surgery: current use for staging and resection guidance. Ultraschall Med 2014; 35:500-513. [PMID: 25474100 DOI: 10.1055/s-0034-1385515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure. In modern liver surgery the use of intraoperative ultrasound (IOUS) includes staging of the liver disease and more importantly resection guidance. IOUS allows the performance of so-called "radical but conservative surgery", which is pivotal in offering a chance of a cure to an increasing number of patients who until a few years ago were considered only for palliative care. The present article details the rationale of IOUS for staging and for resection guidance in liver surgery.
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Sonny A, Avitsian R, Hussain MS, Elsharkawy H. Angioedema in the neurointerventional suite. J Clin Anesth 2014; 27:170-4. [PMID: 25434502 DOI: 10.1016/j.jclinane.2014.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022]
Abstract
A 68-year-old woman with acute ischemic stroke presented for mechanical thrombectomy, after failed thrombolysis with intravenous recombinant tissue plasminogen activator. The procedure was completed successfully with dexmedetomidine infusion. However, she developed acute angioedema toward the end of the procedure requiring emergent fiberoptic-guided endotracheal intubation. Angioedema has been reported to occur after administering intravenous recombinant tissue plasminogen activator with an incidence of 1.3%-5.1% in patients with acute stroke.
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Affiliation(s)
- Abraham Sonny
- General Anesthesiology and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH.
| | - Rafi Avitsian
- General Anesthesiology, Cleveland Clinic, Cleveland, OH.
| | - M Shazam Hussain
- Vascular Neurology and Endovascular Surgical Neuroradiology, Cleveland Clinic, Cleveland, OH.
| | - Hesham Elsharkawy
- General Anesthesiology and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH.
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López-Aguilera J, Mesa-Rubio D, Ruiz-Ortiz M, Delgado-Ortega M, Villanueva-Fernández E, Romo-Peña E, Pan Álvarez-Ossorio M, Suárez de Lezo J. Mitral regurgitation during transcatheter aortic valve implantation: the same complication with a different mechanism. J Invasive Cardiol 2014; 26:603-608. [PMID: 25364002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS Mitral regurgitation (MR) is a complication that may occur during transcatheter aortic valve implantation (TAVI) in a certain percentage of cases and may require different treatments depending on the mechanism. Our purpose was to describe the occurrence rate of this complication during TAVI with the CoreValve prosthesis, as well as to assess the usefulness of transesophageal echocardiogram (TEE) in the detection of the mechanism of MR. METHODS AND RESULTS We analyzed a total of 129 cases of severe aortic stenosis treated with CoreValve prosthesis from June 2008 to October 2011. We defined a significant MR after TAVI as grade III MR or higher, considering either the new appearance of MR or the worsening of a preexisting MR, as assessed by both TEE and angiography. In our series, there was a total of 11 cases of significant MR after TAVI (8.5%). Angiography detected 100% of the MR cases, but was unable to determine the mechanism of MR in any case. TEE, on the other hand, determined 100% of the MR cases, and determined that 1 case was caused by mechanical asynchrony due to a new left bundle branch block, 3 cases were due to an aortic prosthesis impingement on the anterior mitral leaflet, 2 cases were due to the appearance of a systolic anterior movement of the anterior mitral leaflet with dynamic obstruction of the left ventricular outflow tract, 1 case was caused by a commissural tearing of the valve, and 4 cases were explained by a "functional" mechanism, probably due to transient damage of the subvalvular mitral apparatus by the delivery system. All cases had an MR grade II or less as evidenced by transthoracic echocardiography at discharge. Surgery was not required in any case. Knowledge of the mechanism of MR made it possible to provide the best treatment option in each case. CONCLUSION There is a certain percentage of patients treated with CoreValve prosthesis who develop significant MR during the procedure. TEE, unlike angiography, can define the very diverse mechanisms of MR in 100% of cases, and elucidates the best approach to this complication. Surgery was not required in any case.
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Affiliation(s)
- José López-Aguilera
- Servicio de Cardiología. Hospital Universitario Reina Sofía, Avd. Menéndez Pidal s/n 14005 Córdoba, Spain.
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Jia GL, Xi HL, Wang XK, Feng S, Tian ZL. Selective retention of the great saphenous vein to prevent saphenous nerve injury during varicose vein surgery. Eur Rev Med Pharmacol Sci 2014; 18:3459-3463. [PMID: 25491621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the selective retention of the great saphenous vein trunk below the knee to prevent saphenous nerve injury during varicose vein surgery. PATIENTS AND METHODS This research was a single-center prospective randomized trial. From January 2009 to January 2012, 280 patients of varicose veins in the great saphenous vein were treated and divided into two groups of 140 cases each. In the observation group, the vascular trunk of the great saphenous vein was stripped to below the knee level whilst that in the control group, it was stripped to the ankle level. Patients in both groups were treated with a transilluminated powered phlebectomy (TIPP) and foam sclerotherapy. Primary end points were postoperative pain, saphenous nerve injury, quality of life and recurrence rate. RESULTS After one month follow-up: 5.71% of patients in the observation group had neurological symptoms, while 14.29% of patients had neurological symptoms in the control group. The saphenous nerve injury between the two groups was statistically significant. Postoperative follow-up of one year, 1.47% patients had symptoms of neurological disorders in the observation group, while 7.14% patients had symptoms of neurological disorders in the control group. The saphenous nerve injury between the two groups was statistically significant. Therefore, selective retention of great saphenous vein below-knee can prevent saphenous nerve injury. The main outcome measures were postoperative pain, missing saphenous nerve, improvement of symptoms and the incidence of recurrence. The follow-up after one month showed that the percentage of neurological symptoms in the observation group and the control group was 5.71% and 14.29% respectively, and the saphenous nerve injury showed a statistical difference. The follow-up after one year showed 1.47% of abnormal sensation in the observation group and 7.14% of dysesthesia or paresthesia in the control group in surgical limb according to subjects' claims, and there existed a statistical difference in the saphenous nerve injury. CONCLUSIONS The selective retention of the great saphenous vein trunk below the knee can prevent the saphenous nerve injury.
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Affiliation(s)
- G-L Jia
- Vascular Surgery Department of Xuzhou Central Hospital of Jiangsu Province, Xuzhou, Jiangsu, China.
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Hernandez Pérez IL, Martínez Lorca A, Santos Gómez I, Sánchez Méndez JI, Ramirez Escalante Y, Marin Ferrer MD. [Selective sentinel node biopsy in breast cancer with contralateral axillary drainage]. Rev Esp Med Nucl Imagen Mol 2014; 34:77-8. [PMID: 25112887 DOI: 10.1016/j.remn.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/11/2014] [Accepted: 04/12/2014] [Indexed: 11/18/2022]
Affiliation(s)
- I L Hernandez Pérez
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España.
| | - A Martínez Lorca
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
| | - I Santos Gómez
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
| | - J I Sánchez Méndez
- Servicio de Ginecología y Obstetricia, Hospital Universitario La Paz, Madrid, España
| | | | - M D Marin Ferrer
- Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
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Press CM, O'Connor DP, Elkousy HA, Gartsman GM, Edwards TB. Glenoid perforation does not affect the short-term outcomes of pegged all-polyethylene implants in total shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:1203-7. [PMID: 24560466 DOI: 10.1016/j.jse.2013.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The glenoid vault can be perforated during pegged glenoid preparation in total shoulder arthroplasty. The clinical implications of glenoid vault perforation, however, are unknown. The purpose of this study was to determine the effects of perforation of the glenoid during total shoulder arthroplasty on clinical and radiographic outcomes. MATERIALS AND METHODS Eighteen patients with known intraoperative glenoid perforations were prospectively identified and compared with 34 patients matched by age, gender, diagnosis, and arm dominance during the same period. Patients were evaluated with multiple outcome scores. Radiographs were evaluated for glenoid lucency immediately postoperatively and at final follow-up. RESULTS Average follow-up was 28.1 months for the perforated group and 31.2 months for the matched controls. Both groups had significant improvements in outcome scores postoperatively. American Shoulder and Elbow Surgeons scores increased from 39.8 to 91.0 (P < .001) in the perforated group and from 36.9 to 82.6 (P < .001) in the control group. Constant scores increased from 24.4 to 77.4 (P < .001) in the perforated group and from 36.9 to 75.6 (P < .001) in the control group. Ninety-four percent of the perforated group and 80% of the matched controls were satisfied or very satisfied with their result (P = .896). The presence and number of perforations were not related to the American Shoulder and Elbow Surgeons score (P = .549), Constant score (P = .154), or radiographic lucency grade (P = .584). CONCLUSIONS Glenoid perforation during pegged glenoid preparation in total shoulder arthroplasty does not seem to have an adverse effect on clinical or radiographic outcomes at an average of 2 years of follow-up.
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Affiliation(s)
- Cyrus M Press
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.
| | - Daniel P O'Connor
- Laboratory of Integrated Physiology, University of Houston, Houston, TX, USA
| | - Hussein A Elkousy
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - Gary M Gartsman
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
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