Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pharmacokinetics and protein binding of bupivacaine were studied after caudal injection of 2.5 mg/kg in 13 ASA PS 1 infants (1-6 months of age) scheduled for elective hernia repair. Blood was sampled at frequent intervals from 5 min to 600 min in all but one patients. Additional samples were taken at 720 and 840 min in five patients. Bupivacaine concentration was measured using gas chromatography. Protein binding was measured using ultrafiltration. Peak serum concentrations ranged between 0.55 and 1.93 micrograms/ml. The time to reach the peak ranged from 10 to 60 min. Terminal half-life (T1/2 beta) was 7.7 +/- 2.4h (mean +/- SD), the volume of distribution (Vss) was 3.9 +/- 2.01.kg, and the total body clearance (CL) was 7.1 +/- 3.2 ml.min.kg-1. The free fraction was markedly increased (0.16 +/- 0.07) when compared with published adult values, and showed a highly significant negative correlation with age. Alpha 1 acid glycoprotein measured in the same infants correlated significantly with age. In conclusion, pharmacokinetics of caudal bupivacaine in infants are characterized by Cmax of total drug similar to those observed in adults after epidural injection. The free fraction is increased at least until 6 months of life. This suggests caution in the use of bupivacaine in infants until we understand the clinical significance of this increased free fraction.
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PMID:Pharmacokinetics of bupivacaine following caudal anesthesia in infants. 334 93

Xenon is a more potent anesthetic than nitrous oxide, and give more profound analgesia. This investigation was performed to assess the potential of xenon for becoming an anesthetic inspite of its high manufacturing cost. Seven ASA I-II patients undergoing cholecystectomy (n = 4), hernia repair (n = 2), or mammoplasty (n = 1) were studied. Denitrogenation by 15-20 min of oxygen breathing under propofol anesthesia was followed by fentanyl-supplemented xenon anesthesia administered via an automatic minimal flow system which held the oxygen concentration at 30%. Xenon anesthesia lasted 76-228 min and 8-14 l of xenon (ATPD) was used, of which 5.6-8.1 l was expended during the first 15 min. Anesthesia appeared to be satisfactory, and the patients woke up rapidly after xenon was discontinued. The automatic system made minimal flow xenon anesthesia easy to administer, but nitrogen accumulation is still a problem. Assuming a xenon price of 10 US$ per litre, the average cost for xenon was about 65 US$ for the first 15 min and then about 25 US$ for each subsequent hour of anesthesia.
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PMID:Clinical experience with minimal flow xenon anesthesia. 790 41

Wound infection is a frequent complication and is related to various parameters: type of surgery, patient's age, nutritional status, associated diseases, length of surgery and hospital stay, use of prosthesis and drainage and finally surgeon's ability. The frequency of wound infection is reported between 1.5%-5.1% after "clean surgery" and the greatest source of microbial contamination is due to GRAM positive cocci either aerobic or anaerobic. The Authors present their experience of ultra short-term prophylaxis with Teicoplanin in 375 patients undergoing major ambulatory surgery. Median age was 49 years (15-87 ys); patients over 65 years were 22%. Hernias of the abdominal wall and varicose veins represent the diseases most commonly operated on. In 30% of the cases the patients selected for major ambulatory surgery were in II and III classes according to the standards of the American Society of Anaesthesiologists (A.S.A.). The ultra short-term prophylaxis with Teicoplanin was administered as follows: 400 mg, i.v., thirty minutes pre-operatively. The operations were performed under local or loco-regional anaesthesia. The choice of Teicoplanin was based on the strong bactericidal activity on GRAM positive cocci, including the methicillin-resistant Staphylococcus aureus infections, and on the long activity of the drug. The results were considered according to the American College of Surgeons scheme: no wound infection was observed and excellent local and general drug's tolerance were noticed. Ultra short-term prophylaxis in ambulatory surgery was chosen for the following reasons: large use of prosthesis, major risk of sepsis in older patients and at last for a badly accepted infective complications in outpatient surgery.
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PMID:[Teicoplanin in the prevention of wound infections in major ambulatory surgery]. 797 37

The development of surgery in regime of day hospital proceeds swiftly, especially in Anglo-saxon countries, so that at the beginning of the second millennium it can be foreseen that in USA alone, 75% of all surgery will be carried out in this manner. From March 1st to September 1st 1994, 100 patients were submitted to operations in ODS (One Day Surgery). We had 3 reconversions into ordinary hospitalization (3%), 2 for social-economic reasons and one for headache and vomiting due to intolerance to local anesthetics. As has been seen we have encountered no important complications, all patients were satisfied. From the analysis of our experience we have deducted useful indications that oblige us to partially modify our attitude: we want to transform our service into a free standing center where the patient can undergo preoperative exams, anesthesiologic examinations and surgery on the same day; we are just about to verify the possibility, thanks to an accurate anamnesis, to not request preoperative routine exams in patients with ASA 1 and 2 physical status; to look for a possible asymptomatic crural hernia in patients that undergo inguinal hernioplasty; we do not submit patients to ODS if they do not have assistance at home; or if they live too far from our service.
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PMID:One surgical experience in regime of day hospital: considerations on the first one-hundred patients treated. 871 Apr 3

This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N2O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1-12 months were studied. All received inhalation induction with N2O, O2 and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N2O, 30% O2 and halothane. Group II received 70% N2O, 30% O2, halothane and 2 micrograms.kg-1 fentanyl. Group III received 70% N2O, 30% O2 and 10 micrograms.kg-1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (SpO2 > 90% for greater than 30 s). Decreased SpO2 occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO2 (TcCO2) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. SpO2 < 90% and TcCO2 > 9 kPa (70 mmHg) was more common in infants receiving 2 and 10 micrograms.kg-1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants < 3 months old did not have a higher incidence of SpO2 < 90% or significantly higher TcCO2 values when compared to infants > 3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.
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PMID:Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants. 930 63

Late results of TAPP have been assessed in a group of 79 patients operated for inguinal hernia- in the years 1994-1996. Altogether 87 TAPP were performed in this group (8 bilateral herniorrhaphies) all of them classified according to ASA scale from I degree-III degree. Following Schumpelick hernia classification there were: M = 41, L = 35, F = 11, I degree = 31, II degree = 27, III degree = 21. 31 hernias were recurrent and 11 were irreducible. The patients have been followed up for at least 1 year (on average 16 months). TAPP was lasting in this group of patients from 40-120 min (on average 70 min) including bilateral repairs. There was 1 intraoperative bleeding which had been the cause of conversion to the open operation. No wound infection was noticed. Postoperative inguinal hematoma which resolved spontaneously was noticed in 4 cases. The patients left hospital the day after TAPP. 2 recurrences were noticed so far (2.3%), 3 patients complained of transient inguinal neuralgia. Late results of TAPP in the rest of the patients have been very good.
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PMID:[Late results of laparoscopic surgery for inguinal hernia (TAPP)]. 944 94

We present a prospective randomized study of 80 patients with inguinal hernia who underwent either a modified Bassini repair (n = 38) or a Lichtenstein mesh repair (n = 42). Treatment groups were matched for age, side of hernia, type of hernia and ASA grade. There was no difference in the time taken to perform the two operations: the mean time taken to perform Lichtenstein repair was 26.8 min (range 12 to 49), Bassini repair taking a mean of 27.5 min (range 9 to 51), P = 0.76. There was, however, a difference between the operating times with respect to the type of hernia present, direct hernias being the fastest to repair. Pain scores were assessed by a visual analogue scale, and there was significantly less pain in the Lichtenstein group, P = 0.028. Despite this, there was no difference between the analgesic requirements of the two groups, P = 0.073. In order to assess rehabilitation, lengths of time not working and not driving were assessed. There was no difference in either measurement, P = 0.335 and 0.467 respectively. Patients were followed up a mean of 7 weeks post-operatively (range 1 to 13 weeks). There was no significant difference between the two procedures with regard to post-operative urinary complications, wound infection or other complications. All measurements except the time taken to perform the operation were independent of the surgeon involved. The accuracy of the clinical diagnosis was also assessed, and found to be moderate, with 63% of diagnoses being correct.
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PMID:Prospective randomized controlled trial comparing Lichtenstein with modified Bassini repair of inguinal hernia. 962 26

A persistent problem in hernia surgery concerns the repair of bilateral inguinal hernias. A retrospective analysis of 78 patients with bilateral inguinal hernias was performed. Hernia repair was performed either by an open anterior access (modified Shouldice repair) or a laparoscopic posterior approach (TAPP repair). The two patient groups were similar with regard to ASA classification, age, and sex. The intraoperative complication rate was low (2.6% to 7.8%), whereas postoperative complications occurred more frequently (7.7% to 15.4%). The recurrence rate was low in both groups: 5.1% for the open group and 1.3% for the laparoscopic group. The mean hospital stay was 4 days for both groups, and the mean off-work times were 56.4 days and 17.9 days for the open and laparoscopic group, respectively (p < 0.05). Both procedures gave satisfactory results. The main advantages of the laparoscopic approach are the shorter convalescence time and quicker return to work.
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PMID:Simultaneous repair of bilateral groin hernias: open or laparoscopic approach? 970 9

Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.
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PMID:Anesthetic implications of laparoscopic surgery. 1060 86

One hundred and fifty-five patients scheduled for inguinal hernia repair (IHR) were given the choice of either general anesthesia (GA) (n = 53) or spinal anesthesia (SP) (n = 47) or nerve stimulator guided paravertebral blockade (PVB) (n = 55). The incidence of postoperative nausea and vomiting (PONV), duration of hospital stay and need for postoperative analgesia were recorded. Apart from a difference in the age of patients in the GA group who were found to be slightly younger, all groups were found similar with regard to weight, height, duration of surgery, sex, type of hernia and ASA class. The incidence of PONV (0%) v/s 19% and 21% was significantly reduced in patients treated with the PVB compared to patients receiving SA and GA respectively. The length of hospital stay was also found to be shorter in the PVB group (mean 1.2 days) v/s SA (mean 2.4 days) and GA (mean 2.9 days). The need for supplemental postoperative analgesics was also found to be higher in both SA and GA when compared to PVB patients who were managed without any analgesics during the first 24 postoperative hours. The described technique appears to be an attractive alternative method to provide adequate anesthesia for IHR.
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PMID:Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair. 1156 33


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