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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective study of liver function following repeat anaesthesia, patients who received repeat halothane had a higher frequency of abnormal liver enzyme results than a similar group who received repeat enflurane. Obesity and short intervals between administrations increased the likelihood of abnormal liver enzyme activity in the halothane group. Enflurane would seem to be the volatile agent of choice for repeat anaesthesia in such circumstances.
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PMID:Prospective study of liver function following repeat halothane and enflurane. 611 75

In 1978, the Centers for Disease Control initiated a multicenter prospective study to assess the safety of the various female sterilizing operations and the ways in which they could be made safer. During the first 31 months, 3500 women who underwent interval laparoscopic tubal sterilization by electrocoagulation or Silastic banding without other concurrent operations were enrolled in the study. When a standard definition of complications was used, the overall rate of an intraoperative or postoperative complication was 1.7 per 100 women. Several patients factors increased the risk of complications twofold or more: diabetes mellitus, previous abdominal or pelvic surgery, lung disease, a history of pelvic inflammatory disease, and obesity. There was a fivefold difference in complication rates between procedures performed under general anesthesia and those done under local anesthesia.
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PMID:Complications of interval laparoscopic tubal sterilization. 621 31

Experience gained in performing 3615 laparoscopic sterilizations in India over a 10-year period is reported. A simplified technique was developed for performing sterilization under local anesthesia without neuroleptanalgesia, avoiding uterine manipulators, performing direct trocar insertion without prior pneumoperitoneum, and using air for pneumoperitoneum. Beginning in 1973 laparoscopic sterilizations were performed using monopolar electrocoagulation and Hulka clips. The first 100 cases were done under local anesthesia with neuroleptanalgesia (75 mg meperidine, .6 mg atropine intravenously), using uterine manipulators and creating pneumoperitoneum with a Cerres needle and CO2. In 1974, neuroleptanalgesia was no longer used and air was used instead of CO2 for penumoperitoneum (3515 cases). The patients did not fast but were allowed to have liquids and given a glucose drink just prior to survery. The air was insufflated with a sigmoidoscopy bulb or a fish tank minicompressor. Since 1977 the trocar cannula has been inserted directly, without creating a pneumoperitoneum (1035 cases). Since 1980 the semilithotomy position and uterine manipulators are no longer used. A simple supine position with knees bent at right angles and a 30 degree Trendelenburg position was used in the last 435 cases. Of the 3515 cases performed under local anesthesia without neuroleptanalgesia, only 12 (.34%) needed medication during surgery. 20 patients developed vasovagal attacks and required atropine. None needed general anesthesia. Of the 3515 cases in which air was used for pneumoperitoneum, none developed air embolism. When preperitoneal (8 cases), omental (3 cases), and mediastinal (1 case) emphysema developed, it took 3-4 days to subside because the air was absorbed slowly. Postoperative shoulder pain persisted in 1038 cases (29.5%), but it was more of an annoyance than a complication. Of the 1035 cases of direct trocar insertion, there was no injury to the bowel or a blood vessel. In 14 cases (1.3%) the trocar was found to be extraperitoneal and reinserted for correct placement. Pneumoperitoneum with a Verres or spinal needle was created in 21 technically difficult cases (2%), which included obesity, previous scars, and a bulky postpartum uterus. A uterine manipulator wwas used in 9 technically difficult cases (2.07%).
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PMID:Development of a simplified laparoscopic sterilization technique. 623 98

The major premise by which weight reduction is used as a medical therapy is the fact that obesity is a primary risk factor in the onset and severity of many medical diseases. Hypertension, coronary artery disease, adult onset diabetes mellitus, complications of major abdominal and thoracic surgery, cancer of the breast and colon, and degenerative joint disease are prevalent diagnoses. The data to support weight reduction use as a medical therapy derive primarily from studies of cardiovascular disease. These studies show lowering of blood pressure and reduction of risk factors for glucose intolerance, angina, and hyperlipidaemia. The magnitude of weight loss (percent reduction in excess body weight) is important; 10 per cent reduction is a firm threshold in obese patients (greater than 130%- less than 200% ideal body weight). Success at achieving this medical therapy is most frequent using very low calorie diets which average 30-40% reduction of excess body weight. Mild and moderate hypertension will respond in 90% of patients. Type II diabetes mellitus patients can become free of exogenous insulin requirement. Response to general anaesthesia and control of respiratory distress syndrome will improve if preoperative weight loss is achieved. Improved cardiovascular fitness and relief of exertional dyspnoea are other clinically important outcomes of very low calorie diet therapy. A high priority exists to investigate the use of comprehensive professional weight control therapy as medical treatment.
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PMID:Benefits of reducing--revisited. 624 29

The pulmonary complications in a group of more than 20 000 surgical patients between 1971 and 1980 were examined, as well as the pulmonary state of 100 surgical patients who died within 10 days of operation. The factors related to the patient's constitutions, nature of the surgical disease, operation and anaesthesia. Equal and homogeneous groups were considered in respect of each factor which were analyzed retrospectively from 1980 to 1971. The mean frequency of pulmonary complications in the Department of General Surgery was 12%. The main risk factors of pulmonary complications were: the duration beyond 4 h of the operation (59%), age over 70 years (48%), obesity (35%). They were followed in decreasing order by sepsis, hypovolemia and particular sites of operation. Severe pulmonary complications, bronchopneumonia, pneumonia and thromboembolism contribute to mortality.
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PMID:Risk of pulmonary complications in surgical patients. 629 Nov 16

Applied anatomy and physiology of the kidney are briefly reviewed. This includes an account of renal blood flow, glomerular filtration rate, juxtaglomerular apparatus, renal autoregulation and intra-renal blood flow distribution, tubular transport mechanisms, solute handling in proximal tubule, function of loop of Henle and distal tubule system. This section concludes with a summary of changes in tubule fluid along the length of the nephron. Acute effects of anaesthesia are reviewed in detail. Indirect effects include those on circulatory and sympathetic nervous systems, autoregulation, endocrine systems such as those involving anti-diuretic hormone, adrenaline and noradrenaline, renin-angiotensin and aldosterone. Direct effects of anaesthesia on renal function have now been confirmed both in vitro and in vivo. Delayed direct nephrotoxicity of anaesthetics relates predominantly to methoxyflurane (MOF) and its metabolism to inorganic fluoride. Other factors are MOF dose, genetics, age, enzyme induction, obesity, other nephrotoxic drugs. Clinical implications are presented. Enflurane nephrotoxicity is rare but aetiologic factors are similar to the foregoing. Isoflurane and halothane are not nephrotoxic. A consideration of the influence of anaesthetic management on the incidence and severity of postoperative acute renal failure concludes the review.
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PMID:Anaesthesia and the kidney. 635 48

Fifty consecutive patients undergoing cesarean section were evaluated prospectively. A data collection form was developed and 113 variables relating to demographic features, antepartum care, intrapartum events and postpartum course were evaluated. All of the patients were seen and evaluated within 24 hours of delivery and all forms were completed when the patients were discharged from the hospital. Twenty-five of the 50 patients had postpartum febrile morbidity develop. There were 14 instances of endometritis; five, wound infections; two, urinary tract infections; two, upper respiratory tract infections; three pulmonary infections; one patient with phlebitis, and two with febrile morbidity and no apparent source. Factors significantly associated with an increased risk of developing febrile morbidity included antepartum infections, resident staff as primary surgeon, extension of the uterine incision and positive endometrial culture at the time of the operation. Patients undergoing elective repeat cesarean section had less febrile morbidity than others (p less than 0.025). Statistically significant differences between the two groups were not found for the variables obesity, anemia, rupture of membranes, number of pelvic examinations, fetal monitoring, fetal tachycardia, general anesthesia and skin preparation. Operative blood loss was greater in the patients having febrile morbidity develop, but this difference was not statistically significant.
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PMID:Risk factors in the development of cesarean section infection. 636 24

In 271 gynaecological or obstetrical patients a "combined anaesthesia method" was applied, consisting of lumbar catheter epidural analgesia and controlled ventilation with nitrous oxide/oxygen. We aim to show that by mere interaction of the local anaesthetic, with nitrous oxide, and the drugs used for premedication and during induction of anaesthesia a stage of sleep can be achieved, which, on the patient's behalf is identical with his idea of "full anaesthesia", while at the same time the use of centrally acting agents can be kept at a minimum. In incidents of sympatho-adrenergic-stimulation due to insufficient cephalad spread of the blockade and not amenable to additional doses of local anaesthetic, i.v. fentanyl or low concentrations of volatile anaesthetics were added. In the postoperative phase the patients showed a high degree of vigilance. Epidural morphine offered best pain relief with full mobility maintained. In cases with postoperative hypertensive crises, morphine was combined with bupivacaine injections. Even marked obesity or senile degenerative changes in the vertebral column proved not to constitute contraindications for this method.
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PMID:[Experiences with combined catheter-peridural anesthesia and nitrous oxide-oxygen ventilation in patients at risk in gynecology and obstetrics]. 649 87

Our experience with the original suction lipectomy is presented. The fat removal, done with a specially designed suction tube, is performed layerwise, creating a continuous, regular cavity that is transformed into a virtual space by compressive dressings. The main indication being excessive peritrochanteric fat pads, the operation is done under either epidural or general anesthesia. No antibiotics or anticoagulants are administered, and the patients are mobilized as soon as fully awake. Practicing suction-assisted lipectomy for more than seven years, we have never observed an infection, thrombosis, or fat embolism. In experienced hands, good results can be expected in about 80 percent of patients. Complications are almost always of an aesthetic nature as a result of bad indications. The method is not a surgical treatment for severe obesity.
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PMID:Regional fat aspiration for body contouring. 662 66

One hundred and twenty unpremedicated patients, scheduled for minor gynaecological procedures, were randomly allocated to receive Althesin or methohexitone to supplement N2O and O2 anaesthesia. Patients were assessed as thin, medium or fat according to the degree of obesity as measured by skinfold calipers. The range of mean times for the patients to open their eyes was 3.1-4.0 minutes, to be orientated was 4.4-6.7 minutes and to perform a manipulative test was 27.7-32.1 minutes. No statistically significant differences were seen in these indices of recovery whether they received Althesin or methohexitone or whether they were thin, medium or fat. A paper and pencil test was also performed. Induction doses of the intravenous agent were calculated on a body weight basis and increments given only in response to movement. The mean total dose of Althesin was decreased from 1.33 mg total steroid/kg for thin patients to 1.06 mg total steroid/kg for fat patients (p less than 0.01). The mean total dose of methohexitone was decreased from 3.4 mg/kg for thin patients to 2.9 mg/kg for fat patients which was not significant.
Anaesthesia 1983 Oct
PMID:Does obesity affect recovery? A study using intravenous methohexitone and Althesin for short procedures. 663 42


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