European journal of vascular surgery
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Redundant length of the cervical part of the internal carotid artery (ICA) is a clear angiographic entity although the clinical significance is uncertain. Transcranial Doppler sonography (TCD) examinations were performed on 15 patients with 23 elongated ICAs. The recordings were obtained with the use of flat 2 MHz probe from the middle cerebral artery (MCA) and the intracranial part of ICA at rest and in eight possible extreme positions of head and neck rotation. ⋯ The mean blood flow velocity in the MCA was 55.8 +/- 6.7 cm s-1 and did not change significantly after head and neck movements (54.9 +/- 7.6 cm s-1). Analysis of 368 one minute recordings from all possible head positions showed no significant changes of blood flow velocity. Rotation of the head and neck has no significant influence on intracranial blood flow velocity in the presence of carotid artery elongation.
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Comparative Study
The assessment of cerebral oxygenation during carotid endarterectomy utilising near infrared spectroscopy.
Near infrared spectroscopy is a non-invasive method for continuous monitoring of tissue oxygenation. In 11 patients undergoing unilateral carotid endarterectomy, changes in cerebral oxygenation following carotid cross-clamping and declamping detected by a near infrared spectrometer were compared with corresponding changes in ipsilateral middle cerebral artery flow velocity measured by transcranial Doppler ultrasonography. Spectroscopic traces were obtained in all patients but adequate Doppler signals in only eight. ⋯ The near infrared spectrometer was also sensitive to the changes in cerebral haemodynamics due to intraoperative hypo- and hypertensive episodes. No evidence of cerebral intracellular hypoxia was seen and all patients made an uneventful recovery. Near infrared spectroscopy compares well with transcranial Doppler ultrasound as a monitor of cerebral function during carotid endarterectomy and may have a future role in the elucidation of cerebral perfusion and oxygenation changes following surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural anaesthesia prolonged into the postoperative period prevents stress response and platelet hyperaggregability after peripheral vascular surgery.
The occlusion rate of peripheral vascular grafts depends on technical as well as endogenous factors. Platelets play an integral part in graft failure and it has been suggested that anaesthesia may influence platelet function. In order to evaluate the influence of anaesthesia on stress response and platelet function in peripheral vascular surgery, patients (n = 18) were allocated to either general anaesthesia (GA; n = 9) followed by alleviation of postoperative pain with intramuscular analgesics or to lumbar epidural anaesthesia (EPI; n = 9) which was continued for 24 hours postoperatively. ⋯ Platelet aggregability was reduced intraoperatively in both groups but in the postoperative period there was a marked hyperaggregability only in the GA group. P-5HT was increased preoperatively in both groups but was not affected by surgery. It is concluded that epidural anaesthesia, due to its effects on platelet aggregability, may be advantageous for peripheral vascular surgery.
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Comparative Study
Prolonged postoperative myocardial ischaemia and infarction in vascular surgery performed under regional anaesthesia.
The importance of prolonged postoperative myocardial ischaemia in cardiac outcome has recently been emphasised. The present study examines the correlation between perioperative ischaemia and myocardial infarction (MI) in patients undergoing peripheral vascular surgery (PVS) under regional anaesthesia. One-hundred-and-forty consecutive peripheral vascular operations under regional anaesthesia were prospectively analysed, using Holter monitoring for perioperative myocardial ischaemia (defined as down sloping or horizontal ST-segment depression of > or = 1 mm) and postoperative cardiac outcome. ⋯ In 65 cases (46.4%) there were 259 episodes of significant ST-depression. In 75 (53.6%) cases ischaemic episodes were not detected. Patients with postoperative cardiac events had significantly more and longer ischaemic episodes in all three perioperative periods than those without such events.(ABSTRACT TRUNCATED AT 250 WORDS)