Articles: postoperative.
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This study was conducted on patients undergoing third molar surgery to evaluate their opinions on surgery and the follow-up period. Two groups were formed, as patients were able to choose between local anaesthesia alone or with additional conscious sedation by means of intravenous Midazolam. ⋯ Following the evaluation of surgery as more "pleasant" by sedated patients, it might be expected that this would contribute to a similar experience of the follow-up period. In this study, however no such connection was found. It is possible that preoperative self-selection of the patients (more sensitive and cautious persons preferred conscious sedation) might be responsible for these results.
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[Development of a screening questionnaire to predict good and poor outcome of lumbar disc surgery.].
The aims were: (1) to investigate the prognostic value of pain history, sociodemographic, psychodiagnostic and medical factors for long-term outcome after lumbar disc surgery and (2) to develop a screening checklist of reliable predictors that distinguish between good and poor outcomes. ⋯ It is possible to determine for each patient a predictor sum that is prognostic for the individual risk of a poor operation outcome.
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Int J Obstet Anesth · Apr 1995
Successful subdural anesthesia for cesarean section and postoperative pain management.
Subdural catheterization is a well described, but uncommon complication of attempted epidural block. Aspiration of blood or cerebrospinal fluid and use of a test dose can help identify venous or subarachnoid catheter placement but do not rule out subdural catheter placement. ⋯ This report describes the early identification of subdural placement of a catheter intended for the epidural space. We present radiologic confirmation of the catheter's location, and describe its use to provide successful anesthesia for cesarean section and postoperative analgesia.
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Journal of anesthesia · Mar 1995
Fibrinolytic shutdown after cardiopulmonary bypass surgery is caused by circulating cytokines during operation, accompanied by endothelial injury.
It has been hypothesized that increased cytokines during cardiopulmonary bypass surgery cause postoperative fibrinolytic shutdown. To investigate the role of cytokines and to elucidate its mechanism, tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), plasminogen activator inhibitor-1 antigen (PAI-1 Ag), PAI-1 activity, and thrombomodulin in 16 patients undergoing elective cardiopulmonary bypass surgery were analyzed after induction of anesthesia, before and after cardiopulmonary bypass, and at the end of the operation. during surgery, TNF-α and LI-1β were detected in 44% and 63% of the cases, respectively. PAI-1 Ag (P<0.01), PAI-1 activity (P<0.001) and thrombomodulin (P<0.01) were significantly increased at the end of the operation. ⋯ In group 1, there was a significant positive correlation between thrombomodulin and PAI-1 Ag (r (2)=0.117,P<0.05) and PAI-1 activity (r (2)=0.124,P<0.05). In conclusion, TFN-α and IL-1β were released into the systemic circulation during cardiopulmonary bypass surgery, and this release may have been caused by vascular endothelial injury. These cytokines increased PAI-1 activity.
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Journal of anesthesia · Mar 1995
Spinal function monitoring by evoked spinal cord potentials in aortic aneurysm surgery.
Evoked spinal cord potentials (ESCPs) were monitored in 12 patients who underwent repair of thoracoabdominal aortic aneurysm with a high risk of spinal ischemia. A pair of bipolar catheter electrodes were introduced into the epidural space, one at the level of the C5-T2 vertebrae and the other at the level of T11-L2. Conductive mixed ESCP in seven patients, conductive sensory ESCP in one patient, and segmental descending ESCP in three patients were observed by applying a rectangular electric current to one of each pair of epidural electrodes and recording through the other. ⋯ The N wave of segmental descending ESCP subsequently flattened in two of the three patients and the N1 wave of segmental ESCP in the one patient. Three of the four patients in whom the ESCPs disappeared during aorta clamping recovered the ESCPs after declamping and showed no neurological disorders postoperatively. Intraoperative ESCP monitoring appears to be useful to detect spinal cord ischemia in the early stage and to alert surgeons and anesthesiologists so that timely resuscitative steps can be taken.