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

Airway obstruction plays an important role in the pathogenesis of apnea in premature infants who have not previously undergone anesthesia. To determine the role of airway obstruction in postoperative apnea, we studied 74 former premature infants by integrated recordings of nasal airflow, pneumocardiography, and pulse oximetry during the initial 2 h of recovery from inhalational anesthesia. Apnea (greater than 6 s) was classified as central, obstructive, or mixed, wherein mixed apnea consisted of central and obstructive apnea within the same apneic episode. Postoperative apnea was observed in 23 infants, ranging in age from 31-48 weeks postconception: 12 had inguinal herniorrhaphy (hernia group) and 11 had other procedures (other group). Of the 268 apneic episodes in the hernia group, 73% were central, 6% obstructive, and 21% mixed. Infants in the other group had 505 apneic episodes, with a distribution nearly identical to that in the hernia group. Central and mixed apnea occurred in all infants experiencing apnea, except in 1 infant, who had only central apnea, whereas obstructive apnea occurred in only one third of the apneic infants. Arterial hemoglobin desaturation was significantly more frequent at the end of mixed and obstructive apnea than after central apnea (P less than 0.01). In both groups, arterial hemoglobin O2 saturation (SpO2) decreased to less than 80% in approximately 35% of mixed and obstructive apneic episodes, compared to approximately 5% of central apneic episodes. SpO2 remained greater than or equal to 90% in over 80% of central apneic episodes, compared to 40% of mixed and obstructive apneic episodes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants. 206 55

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and intraoperative supplementation to general anesthesia for children. To determine the best concentration of bupivacaine for combined general-caudal anesthesia in children, 122 children aged 1-8 yr scheduled for outpatient inguinal herniorrhaphy were randomized to receive, in a double-blind fashion, caudal anesthesia with bupivacaine in one of six concentrations (0.125, 0.15, 0.175, 0.2, 0.225, or 0.25%). After incision, a programmed reduction in inspired halothane resulted, if tolerated by the subject, in an inspired halothane concentration of 0.5% 10 min after incision. End-tidal halothane concentration at hernia sac ligation for subjects receiving 0.175% bupivacaine (0.55 +/- 0.03%) was less than that for subjects receiving 0.15% bupivacaine (0.75 +/- 0.05%; P less than 0.05). Subjects receiving 0.175% bupivacaine also were discharged earlier from the postanesthesia care unit (PACU) (27 +/- 1 min) than were subjects receiving 0.15% bupivacaine (38 +/- 5 min; P = 0.05). Children receiving greater than or equal to 0.2% bupivacaine tended to complain more of leg weakness after surgery; however, the difference did not reach statistical significance (39 of 67 vs. 16 of 47; P = 0.057). The incidence of complaints of leg weakness and paresthesia was positively correlated with bupivacaine concentration (r = 0.706; P = 0.05). Subjects receiving 0.125% bupivacaine had higher pain scores on arrival to the PACU than did those receiving 0.2% bupivacaine (P = 0.05); there were no other differences in pain scores.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Optimum concentration of bupivacaine for combined caudal--general anesthesia in children. 206 61

Twenty-two cases of Cesarean section due to fetal anomaly diagnosed prenatally were reviewed in terms of the anesthetic managements. In 6 cases, diazepam 0.3 mg.kg-1, which provides fetal anesthesia for surgery scheduled immediately after birth, was administered intravenously to the mothers with/without fentanyl (2 general anesthesia and 4 regional anesthesia). The diagnosis of their fetuses was congenital diaphragmatic hernia, congenital cystic adenomatoid malformation of the lung, gastroschisis or omphalocele. No fetal anesthesia was performed in the other 16 cases (15 spinal anesthesia and 1 general anesthesia). Seven of their fetuses were diagnosed as hydrops. Since the general condition of the diseased newborn is known to be deteriorated after receiving various stress and aerophagia, fetal anesthesia in Cesarean delivery has the advantage of stress reduction and prevention of aerophagia. When the newborn is considered to need immediate neonatal resuscitation or intensive care including surgery, fetal anesthesia may be a choice of anesthetic technique.
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PMID:[Anesthesia for cesarean section in patients with fetal anomaly]. 207 16

Haloperidol was administered intravenously at the dose rate of 0.87 mg/kg body weight five minutes prior to thiopental anaesthesia in 5 clinically healthy dogs, aged 10-12 months and weighing 11.5 +/- 0.96 kg. Animals required only 4.36 +/- 0.24 ml of the 5% thiopental sodium to achieve surgical anaesthesia which lasted for 37.5 +/- 4.3 minutes. There was adequate muscle relaxation and loss of pedal and palpebral reflexes during thiopental anaesthesia. Five minutes after administration of haloperidol, there was no appreciable change in the various cardiopulmonary dynamics with the exception of a hypocapnoea and a mild hypotension. During thiopentone anaesthesia, a mild hypotension and arterial hypoxemia was evident. This combination of anaesthesia was also employed in 14 clinical cases varying from fractures of long bones (4), mammary tumours (3), ear haematoma (4), venereal granuloma (2) and abdominal hernia (1). The combination proved extremely useful for orthopaedic surgery as the muscle relaxation was adequate and the reduction of the fractured ends was relatively easy.
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PMID:Haloperidol as a pre-medicant for thiopental anaesthesia in the dog. 211 11

In many children with cholestasis, ultrasonography can rule out the possibility of biliary atresia. In the few cases when a diagnosis cannot be established by ultrasonography, laparoscopy is still justified as an initial procedure, as the amount of trauma involved is still minimal. Of the 36 children with cholestasis on which a laparoscopy was performed, one-third eventually underwent laparotomy because of biliary atresia. The question was whether the primary laparoscopy was really advantageous. In comparison to laparotomy no advantages were found with regard to anesthesia time; morbidity, or complications. The diagnostic accuracy was comparable to that of laparotomy. The only complication was a small scar hernia in a premature baby.
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PMID:Experience with laparoscopy for the evaluation of cholestasis in newborns. 213 62

To reduce leakage of peritoneal dialysis fluid, insertion of a 2-cuff Tenckhoff catheter (TeC) was performed under local anaesthesia by a lateral approach on 30 occasions in 26 patients. Incision was 3 cm laterally of the linea alba. The inner cuff of the TeC was fixed by a purse-string suture of the peritoneal membrane on the abdominal side of the cuff and another purse-string suture, of the inner fascial blade, around the distal end of the cuff. A third purse-string suture was placed around the TeC at the exit through the outer fascial blade. A subcutaneous tunnel completed the insertion. In all patients, dialysis was started immediately after TeC insertion. The median treatment time was 6.5 months (range 3 days-15 months). No leakage developed in any patient and no hernia was created from this approach. Peritonitis was treated on 8 occasions over a period of 163 months. We conclude that the technique is simple, enables immediate start of dialysis with low risk for leakage.
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PMID:Absence of leakage by insertion of peritoneal dialysis catheter through the rectus muscle. 215 Jul 64

Haemodynamic changes and plasma catecholamine concentrations were measured in 12 patients aged 24 to 87 years after performance of a field block for elective repair of inguinal or femoral hernia. The local anaesthetic used comprised a mixture of lignocaine 0.5% with adrenaline 1:200,000; the dose of lignocaine administered varied from 3.8 mg/kg to 4.9 mg/kg. Plasma adrenaline increased by 326% and plasma noradrenaline by 75% at 10 minutes after completion of the block. Mean heart rate increased from 75 to 94 beats/minute after 20 minutes, whilst there were no obvious changes in systolic and diastolic arterial pressures. Potentially serious arrhythmias developed in two patients, thought to be related to the peak plasma concentrations of adrenaline produced. It is recommended that the dose of adrenaline used as described for this block should be reduced.
Anaesthesia 1990 Jan
PMID:Changes in haemodynamics and plasma catecholamine concentrations after field block for inguinal herniorrhaphy using lignocaine with adrenaline. 231 57

This study compared the postoperative pain relief provided by simple instillation of bupivacaine into a hernia wound with that provided by ilioinguinal/iliohypogastric (IG/IH) nerve block. Sixty children undergoing inguinal hernia repair under general anesthesia were randomized to receive 0.25 ml/kg of 0.25% bupivacaine for either IG/IH nerve block or up to 0.5 ml/kg of the same solution for instillation nerve blocks. In the postanesthesia care unit (PACU), a trained blinded observer evaluated the patient's level of postoperative pain using a standardized 10-point objective pain scale. Fentanyl 1-2 micrograms/kg was administered intravenously to any child scoring 6 or more points on the pain scale. The difference in pain scores among the two groups were compared. The two groups were not significantly different in age, duration of surgery, or anesthesia. There was no significant difference between patients who received the two treatment modalities in their pain scores, analgesic requirements in the PACU, recovery times, and discharge times. These results demonstrate that the simple instillation of local anesthetics into a wound provides postoperative pain relief following hernia repair, which is as effective as that provided by intraoperative IG/IH nerve block.
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PMID:A comparison between bupivacaine instillation versus ilioinguinal/iliohypogastric nerve block for postoperative analgesia following inguinal herniorrhaphy in children. 232 81

Because of our recurrence rate of 7.2% after primary operation for inguinal hernia and 10% after operation for recurrent hernia using a modified Bassini procedure, we adopted a transversalis fascia repair under local anesthesia in November 1985. From November 1985 to December 1987 we performed 455 operations on 424 adults. During the introduction phase of this new technique there were especially initially 65 other procedures (modified Bassini or Cooper's ligament operation). 301 patients could be followed by letter 6 months after the operation. Only patients with pain or suspected recurrence were interviewed. We analyzed the group of patients who underwent a transversalis fascia repair (n = 390). 99% were satisfied with the local anesthesia. The average length of stay in the hospital after repair of a primary inguinal hernia could be shortened (2.8 days). The patients returned to work after an average rehabilitation of 3.1 weeks. We have had few early complications (0.7%). It is still impossible to say if this technique is sure in our hands because of the short and incomplete follow-up. Only the long-term results will show the real value of this operative procedure.
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PMID:[Initial results with transversalis-plasty in the treatment of inguinal hernia]. 252 20

From 1983 to 1985, ten men had combined transurethral resection of the prostate (TURP) and inguinal herniorrhaphy; hernia repair immediately preceded transurethral resection. Eight men had unilateral inguinal hernia repair and two had bilateral inguinal herniorrhaphy. Four men had additional procedures done concurrently. Follow-up ranged from 14 to 33 months (mean 22.4 months). There were no recurrent hernias or infections of the hernia incision. These results suggest that combined TURP and inguinal herniorrhaphy can be safely accomplished during a single period of anesthesia.
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PMID:Combined transurethral resection of the prostate and inguinal herniorrhaphy. 266 26


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