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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three anaesthetic premedication regimens have been compared by double-blind controlled trial in 158 patients undergoing day-case surgery for varicose veins or hernia. Atropine plus droperidol was superior to atropine plus diazepam or atropine alone in lessening nausea and vomiting and in reducing the need for postoperative analgesia.
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PMID:Double-blind clinical trial of anaesthetic premedication for use in major day surgery. 5 98

Bendectin, composed of doxylamine succinate and pyridoxine HCl (1:1), is an antinauseant previously prescribed for nausea and vomiting during pregnancy. The present study examined the maternal and developmental effects of Bendectin (0, 200, 500, or 800 mg/kg/day, po) administered to timed-pregnant CD rats (36-41/group) during organogenesis (gestational days [gd] 6-15). At death (gd 20), all live fetuses were examined for external, visceral, and skeletal abnormalities. At 500 and 800 mg/kg/day, maternal toxicity included reduced food consumption during treatment and for the gestation period, increased water consumption in the posttreatment period, reduced weight gain during treatment, and sedation; water consumption was reduced during treatment and for the gestation period, and maternal mortality (17.1%) was observed only at the high dose. Developmental toxicity included reduced prenatal viability (800 mg/kg/day) and reduced fetal body weight/litter (500 and 800 mg/kg/day). In addition, reduced ossification of metacarpals (800 mg/kg/day), phalanges of the forelimbs (500 and 800 mg/kg/day), and of caudal vertebral centra (all doses) was observed. No increase in percent malformed live fetuses/litter was observed. The proportion of litters with one or more malformed fetuses was higher than vehicle controls only at 800 mg/kg/day, with short 13th rib (to which the test species is predisposed) as the predominant observation. By contrast, a positive control agent (nitrofen, 50 mg/kg/day, po, 14 dams) produced 85% malformed fetuses/litter with the predominant malformation being diaphragmatic hernia. In conclusion, the incidence of litters with one or more malformed fetuses was increased only at a dose of Bendectin which produced maternal mortality (17.1%) and other indices of maternal and developmental toxicity (see Discussion).
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PMID:Developmental toxicity evaluation of Bendectin in CD rats. 340 69

At the University of Minnesota, under the supervision of one staff surgeon, both the jejunoileal bypass (JIB) and gastric bypass (GIB) operations have been done for weight reduction in morbidly obese individuals. Over the past 11 years, end-to-end (40 to 4 cm) JIB performed for 727 patients. In addition, antecolic GIB was performed for 364 patients over the past 6 years. This report is based primarily on a comparison of 205 JIB and 106 GIB patients with surgery between July 1975 and July 1979. Adequate weight loss was seen in 75% of each group. The percentage of excess body weight loss was similar for the first year (65% for JIB and 62% for GIB); however, the JIB patients started at 214% of ideal weight and GIB patients at 197% of ideal weight. The operative mortality rate for either operation was well below 1%, and the immediate operative morbidity rate was low and only rarely delayed discharge from the hospital. The long-term complications for JIB were 37.7% arthralgia or arthritis, 7.1% oxalate urolithiasis, 5.6 incisional hernia, and 1.4% liver failure; complications of GIB were 10.2% nausea and/or vomiting, 1.9% reflux esophagitis, and 2.8% anastomotic problems. At 1 year, plasma cholesterol reductions for JIB patients averaged 42% (P less than 0.001), whereas for the GIB patients it ws only 14% (P less than 0.001). At 1 year after operation, 49% of 88 JIB patients showed progression of liver disease on sequential biopsies, with 31% unchanged and 20% improved. In 43 GIB patients, the biopsies showed improvement in 58%, an unchanged status in 30%, and worsening in 12%. The levels of serum glutamic oxaloacetic transaminase and alkaline phosphatase increased after JIB and eventually returned to normal, while GIB patients had only minor fluctuations of liver function tests. Comparable therapeutic weight results occurred with JIB and GIB; however, the GIB was associated with far fewer serious long-term complications and the JIB with a far greater cholesterol lowering. A percentage of the GIB patients showed progression of liver disease at 1 year after bypass.
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PMID:Comparisons between jejunoileal and gastric bypass operations for morbid obesity. 710 Nov 25

A 57 year old white man, was seen on the 16th, May, 1978, with the chief complaint of severe post-prandial epigastric cramping followed by nausea and vomiting and Dumping. The patient underwent troncular vagotomy and gastrojejunostomy for symptomatic and intractible hiati hernia in May 1960. Two months after discharged, he had recurrent apisodic diarrhea, nausea and vomiting. Physical examination revealed a flat abdomen, incisional hernia, with epigastric tenderness. No mass was palpable. Upper gastrointestinal reontgenographic examination revealed a large mass which was thought to represent a phytobezoar practically filling distal portion of the stomach. Deambulatory treatment was instituted with Tripsin and quimiotripsin; 200000 U. every 6 hrs. and soft diet. A review of his eating habits revealed that he had eaten oranges two weeks prior to the onset of symptoms. Three weeks later, the another upper gastrointestinal examination was normal, without phytobezoar. Recovery was uneventful.
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PMID:[Medical treatment of the gastric phytobezoar. Report of a case]. 746 47

Laparoscopic cholecystectomy is a relatively new surgical procedure which is enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. The efficacy of laparoscopic appendectomy and hemicolectomy has been recently evaluated. However, there have been no prospective randomized studies to date comparing laparoscopic with traditional laparotomy techniques. The physiological effects of prolonged pneumoperitoneum and the longer duration of surgery with the laparoscopic techniques are of concern. The application of laparoscopic inguinal hernia repair may be limited because, unlike traditional surgical hepair, general anesthesia is required and concerns have been expressed about the duration of surgery and the possibility of hernia recurrence. Notwithstanding case reports and series describing successful diaphragmatic and hiatus hernia repair using a laparoscopic surgical technique, the frequently encountered complications of cervical surgical emphysema, pneumothorax, and pneumomediastinum, attributed to passage of insufflating gas through weak points or defects in the diaphragm, must be of major concern. Anesthesiologists must maintain a high index of suspicion for these potential complication and must undertake appropriate monitoring. If there is clinical evidence of a tension pneumothorax, immediate chest tube decompression is indicated. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiological changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for upper abdominal laparoscopic procedures is most frequently limited to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal anti-inflammatory agents has reduced postoperative nausea and vomiting following laparoscopic cholecystectomy. The use of nitrous oxide during laparoscopic procedures remains controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gall-bladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists should thus be prepared to recommend deflation of the pneumoperitoneum and possibly conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties arise during the procedure.
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PMID:Laparoscopic surgery--anesthetic implications. 783 96

A 77-year-old woman had had several 3-day episodes of nausea and vomiting for 3 years. Upper endoscopy led to findings consistent with pyloric outlet obstruction, and barium studies demonstrated an incarcerated peristomal gastric hernia. This is taken to be the third description of this diagnosis. We discuss the pathophysiology of gastric hernias.
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PMID:An incarcerated peristomal gastric hernia causing gastric outlet obstruction. 830 19

The incidence of incisional hernias at 12 mm trocar sites after laparoscopy has been reported as approximately 3%. We report on three cases involving this post-operative complication. The patients underwent a laparoscopically-assisted hysterectomy (LAVH) with fascial closure of 12 mm ports. Each patient presented on postoperative day number two with crampy abdominal pain, nausea and vomiting. Abdominal x-ray findings were consistent with a partial small bowel obstruction. Two patients were re-explored laparoscopically shortly after presentation. One was found to have omental herniation into the pre-peritoneal space which was easily reduced endoscopically with blunt traction. The second patient had a loop of ileum herniating through a small fascial defect. The hernia was repaired by expanding the fascial defect and then digitally replacing the ileum intraperitoneally. The third patient was managed conservatively with nasogastric tube decompression. When symptoms did not resolve completely, the patient was re-explored laparoscopically on postoperative day 21. An adherent loop of small bowel was found in the pre-peritoneal space. Due to trauma in reducing the hernia, a segmental resection of bowel was performed extracorporeally by pulling the damaged bowel through the trocar incision. No patient had complications from the repaired hernias. To avoid this postoperative complication, we now use the Grice suture needle to close both the peritoneum and fascia of all 12-mm trocar incisions. In managing trocar incisional hernias we found that early laparoscopic evaluation allowed both diagnosis and expedient treatment of the patient. Conservative management resulted in a more adherent herniation which was less amenable to easy repair
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PMID:Presentation and Management of Laparoscopic Incisional Hernias 907 85

Congenital diaphragmatic Bochdalek hernia is rarely seen in adults. It may present with jejunal perforation and strangulation. In a 28-year-old man presenting with nausea and vomiting, absence of respiratory murmur at auscultation, loops of small intestine with air-fluid levels were radiographically visualized in the left hemithorax. Surgery revealed 1.5-m of herniated jejunum with three perforations and necrotic areas, 40 cm of which was resected. The patient remains well ten years postoperatively.
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PMID:Bochdalek hernia in an adult. 963 68

Most cases of Morgagni hernia are asymptomatic and diagnosed incidentally on routine chest x-ray film, but they may occasionally become symptomatic. Symptomatic Morgagni hernias may present in many different ways, making the diagnosis challenging. We describe a patient with a Morgagni hernia, resulting in intractable nausea and vomiting, give a brief review of symptoms, note the different types of abdominal contents herniated, and describe the methods used to make the diagnosis.
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PMID:Diaphragmatic hernia of Morgagni. 1021 61

To determine if improved postoperative recovery in surgical inpatients receiving intraoperative therapeutic suggestions are applicable in an outpatient population, 70 consenting, unpremedicated adults undergoing elective outpatient hernia repair under general anaesthesia were allocated randomly to either a therapeutic tape (TT) or a comparison tape (CT) group. A standardized general anaesthetic technique was used with propofol, fentanyl or alfentanil, isoflurane and nitrous oxide in oxygen. Pain, and nausea and vomiting were assessed after operation at 30, 60 and 90 min and at 2, 6 and 24 h. The presence of other side effects, such as headache and muscular discomfort, in addition to recall of tape contents, were also evaluated after operation. Absorption ability was measured before operation. The groups were similar in patient characteristics, preoperative, surgical and anaesthetic characteristics, and level of absorption. There were no differences in pain ratings or need for analgesics administered at any time after operation. Nausea/vomiting was experienced significantly fewer times by patients in group TT compared with group CT over the first 90 min (group CT 15%, group TT 4%; P < 0.02), but not over the last three assessment times (group CT 10%, group TT 14%; P < 0.25). The therapeutic tape group experienced fewer side effects over the entire postoperative assessment period (P = 0.03), in particular less headaches (P = 0.03) and less muscular discomfort (P < 0.02). Use of intraoperative therapeutic suggestions could present mildly significant postoperative benefits in outpatients.
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PMID:Intraoperative therapeutic suggestions in day-case surgery: are there benefits for postoperative outcome? 1069 Jan 56


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