Journal of endourology
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Journal of endourology · Feb 1998
Case ReportsAir travel and thromboembolic complications after percutaneous nephrolithotomy for staghorn stone.
Thromboembolic complications after percutaneous surgery for staghorn stone are rare. We report a case of silent deep vein thrombosis (DVT) after long-distance air travel that was complicated by both recurrent pulmonary emboli and paradoxical arterial embolus despite full-dose systemic heparin anticoagulation. Management options for thromboembolic complications in the context of percutaneous renal surgery are discussed, and risk factors predisposing to silent deep vein thrombosis after long-distance air travel are outlined.
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Journal of endourology · Oct 1996
Randomized Controlled Trial Clinical TrialPatient-controlled sedation and analgesia during SWL.
Sixty unpremedicated outpatients undergoing elective extracorporeal shockwave lithotripsy (SWL) using a Dornier MPL 9000 lithotripter were randomly assigned to receive either propofol-alfentanil (PA group; N = 30) or midazolam-alfentanil (MA group; N = 30) by a patient-controlled analgesia (PCA) device for sedation and analgesia. Although pain intensity scores were lower after 20 minutes and sedation was more pronounced in the MA group, both drug regimens produced satisfactory sedation and analgesia and allowed the maximum number of shockwaves to be given. Alfentanil consumption was less in the MA group (P < 0.05). ⋯ Patient satisfaction was very high with the two sedative-analgesic techniques. Propofol and midazolam, when given in combination with alfentanil using a PCA pump, may provide safe, effective analgesia and sedation during lithotripsy. Patient-controlled sedation and analgesia may provide optimal conditions for SWL of urinary tract stones and is a useful alternative to other forms of anesthesia and analgesia.
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Journal of endourology · Apr 1994
Effects of intra-abdominal pressure on renal tissue perfusion during laparoscopy.
An animal model was established to study the effects of elevated intra-abdominal pressure (IAP) on systemic and renal hemodynamics during laparoscopy. In a pilot study in five dogs, we simultaneously recorded carotid artery blood flow (CABF), carotid artery blood pressure (CABP), inferior vena caval pressure (IVCP), renal parenchymal blood flow, and IAP. The renal parenchymal blood flow was measured by a laser Doppler flowmetry (LDF) needle probe and the renal artery blood flow by an ultrasonic Doppler probe, both placed through laparotomy. ⋯ The CABF decreased in a linear fashion as IAP was increasing (correlation coefficient R = 0.976). Renal cortical blood flow (RCBF) decreased from 50.1 +/- 17.7 mL/min per 100 g at 0 mm Hg to IAP to 21.2 +/- 9.6 mL/min per 100 g of tissue at 15 mm Hg. There was an exponential correlation between IAP and RCBF (R = 0.897).(ABSTRACT TRUNCATED AT 250 WORDS)