Articles: surgery.
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Journal of anesthesia · Jan 2002
Effects of fentanyl on cardiovascular and plasma catecholamine responses in surgical patients.
Whether opioids administered before skin incision, under inhalational anesthesia, improve cardiovascular and plasma catecholamine responses to surgical stimulation compared with those administered after skin incision remains unclear. We compared the effects of fentanyl injected before and after skin incision on these responses. ⋯ Our results indicated that fentanyl depressed cardiovascular and plasma catecholamine responses irrespective of the time of administration, and that the higher dose of fentanyl produced a greater suppression of MAP and HR responses. In addition, the depressant effects on MAP of high-dose fentanyl administered 5 min before skin incision lasted longer than when injected 5 min after incision. At both doses, the opioid attenuated the rise in plasma Epi, but not Nor.
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Journal of anesthesia · Jan 2002
Multiple-deep-breath inhalation induction with 5% sevoflurane and 67% nitrous oxide: comparison with intravenous injection of propofol.
To evaluate the clinical characteristics of multiple-deep-breath inhalation induction with sevoflurane and nitrous oxide followed by the same inhalational anesthetics for maintenance, we compared the technique with intravenous propofol anesthesia. ⋯ Multiple-deep-breath inhalation induction with 5% sevoflurane and 67% nitrous oxide followed by the same inhalational anesthetics for maintenance was safely performed without serious adverse events. However, the induction time was shorter and patient satisfaction was higher in propofol group than in the inhalational group.
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Journal of anesthesia · Jan 2002
Randomized Controlled Trial Clinical TrialComparison of heart rate changes after neostigmine-atropine administration during recovery from propofol-N2O and isoflurane-N2O anesthesia.
Propofol augments the reduction of heart rate (HR) in combination with cholinergic agents and attenuates the HR response to atropine. We examined whether propofol anesthesia was associated with an increased incidence and extent of bradycardia after neostigmine-atropine administration compared with the effects of isoflurane anesthesia. ⋯ We conclude that propofol anesthesia attenuates the initial increases in HR, enhances the subsequent decreases in HR, and increases the incidence of bradycardia after neostigmine-atropine injections compared with the effects of isoflurane anesthesia.
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The effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the internal pallidum (GPi) on the parkinsonian triad and on levodopa-induced dyskinesias are very similar. The antiakinetic effect of STN DBS seems to be slightly better. On the contrary to pallidal DBS, stimulation of the STN allows to reduce dopaminergic treatment by more than 50p.100 on average. ⋯ It is the responsibility of the operating centre to determine the levodopa response, to confirm the diagnosis, to rule out contraindications and to make sure that the medical treatment cannot be further optimised. Severe surgical complications with permanent sequels are relatively rare, about 1p.100 per implanted side. The patient selection, the precision of the surgery and the quality of the postoperative follow-up are the three main determinants of success.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2002
ReviewCurrent status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.
Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. ⋯ Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology.