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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

New laparoscopic instrumentation coupled with standard surgical techniques allows one to perform procedures previously thought impossible via the laparoscope. This report reviews the natural history, the indications for resection, and the technique of laparoscopic resection of hepatic hemangiomata. Two women, 24 and 62 years of age, were first seen with abdominal pain. A diagnosis of hemangioma was made in each case, and both lesions were removed laparoscopically. Operative blood loss was 200 cc in each case, and neither patient required transfusion. Diets were started on the first postoperative day (POD), and the patients were discharged on the second and fourth PODs without narcotic analgesia. If the size and location of the tumor are favorable, laparoscopic resection of liver hemangiomata can be performed safely. Blood loss comparable to that of open procedures and a quicker recovery support an endosurgical approach to resection of liver hemangiomata in selected cases.
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PMID:Laparoscopic resection of two liver hemangiomata. 755 Dec 79

We report our combined experience on video-assisted thoracoscopic (VAT) anatomic lung resections from two major hospitals in Hong Kong over a 17-month period. From August 1993 to December 1994, 82 cases of major lung resections were attempted using the VATS approach, of which 60 were successfully completed (55 lobectomies, 2 bilobectomies, 2 pneumonectomies, and 1 segmentectomy). Of these 60 cases, there were 43 men and 17 women with a mean age of 66 years (range, 37 to 85 years). The final pathologies were 52 primary lung cancers (37 adenocarcinoma, 11 squamous cell carcinoma, 2 bronchoalveolar carcinoma, 1 adenosquamous carcinoma, and 1 undifferentiated carcinoma); 1 pulmonary metastasis (from nasopharyngeal carcinoma); and 7 benign lesions (3 tuberculosis, 1 bronchiectasis, 1 sclerosing hemangioma, 2 organizing pneumonia). There was one postoperative death (mortality rate, 1.8%). Complications include persistent air leak over 10 days (four), wound infection (two), supraventricular tachycardia (three), and recurrence of tumor over the utility thoracotomy scar (one). All the patients were followed up from 8 weeks to 19 months (mean, 10 months). The mean duration of chest drainage was 5.4 days (range, 2 to 25 days). The mean hospital stay was 7.2 days (range, 4 to 35 days). The average postoperative parenteral narcotic (meperidine hydrochloride [Pethidine]) requirement by patient-controlled analgesia was 275 mg (range, 75 to 800 mg). This compared favorably with an age- and sex-matched historic group of patients who underwent posterolateral thoracotomy and had a hospital stay of 10.4 days (statistically non-significant) and narcotic requirement of 950 mg (statistically significant by paired t test). We conclude that VAT anatomic lung resection is technically feasible. However, there are some specific complications associated with major lung resection through minimal access. Refinement of our present technique and attention to details are important to improve our results.
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PMID:Video-assisted thoracoscopic anatomic lung resections. The initial Hong Kong experience. 854 66

We describe a patient who presented in late pregnancy with deteriorating neurological status due to an intracranial capillary haemangioma causing mass effect and raised intracranial pressure. She became confused and uncooperative leading to practical difficulties in performing adequate radiological imaging. Decision regarding timing of delivery and craniotomy was not straightforward and required discussion between the neurosurgeon, obstetrician and anaesthetist based on assessment of fetal maturity and the need to perform a craniotomy to excise what was initially thought to be a meningioma. Caesarean section was performed under general anaesthesia. The tumour was resected three weeks later. Management of obstetric patients with brain tumours is complex, requiring knowledge of the physiological effects of pregnancy on tumour size and labour on intracranial pressure. Both of these may influence the choice of labour analgesia or anaesthesia for caesarean section. Anaesthetists must be aware of the difficulties of radiological imaging during pregnancy, particularly in confused patients. The conflicting requirements of general anaesthesia for craniotomy and caesarean section should be considered.
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PMID:An unusual intracranial tumour presenting in pregnancy. 1712 3

A 39-year-old woman was diagnosed in infancy as suffering from Klippel-Trenaunay-Weber syndrome, affecting both her lower limbs. She had undergone, for several times, gastroepiploic transplantation at 18 years of age. She was scheduled for lymphaticovenular anastomosis of the right limb. Preoperatively, computed tomography showed no thrombosis in her lower limbs. We gave only general anesthesia, because of her strong anxiety, and concern of hemangioma and blood vessel malformation in epidural space. General anesthesia was induced with thiopental, fentanyl, and vecuronium, and maintained with nitrous oxide, oxygen and sevoflurane. Tourniquet had been used for only 30 minutes considering the risk of occurring deep vein thrombosis. Surgery was successfully finished in eight hours and thirty minutes. Using tourniquet increases the risk of deep vein thrombosis and pulmonary embolism. We should use tourniquet as briefly as possible to avoid the occurrence of pulmonary embolism. We recommend avoidance of epidural analgesia, as the patient may have hemangioma and arteriovenous malformation in epidural space, and we should evaluate them by magnetic resonance imaging before anesthesia.
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PMID:[Anesthetic management for lymphaticovenular anastomosis in a lower leg of a patient with Klippel-Trenaunay-Weber syndrome]. 1936 13

Epidural analgesia during labour is a well-accepted technique. Anaesthetists have to measure the risks of this technique during the first consultation with parturient. Complications, such as temporary or permanent neurological injuries due to this anaesthetic technique, are uncommon. We wonder whether the use of magnetic resonance imaging (MRI) may be relevant for the detection of spinal angiomas in case of cutaneous angiomas. The likelihood of finding a spinal angioma with MRI is low and the modus operandi is infrequently modified. We report here a case of parturient with a cutaneous median angioma in the lumbar region, which was detected by MRI. An epidural analgesia was used for pain management during her labour.
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PMID:[Epidural analgesia and cutaneous angioma: need to perform MRI]. 2008 13

We report two deliveries in a patient with a Parkes-Weber syndrome. This parturient had a complex angiodysplasia including a soft tissue hypertrophy of a lower limb, a cutaneous angioma and arteriovenous malformations. The risk of perimedullar arteriovenous malformations was ruled out by angiographic magnetic resonance imaging of the spinal cord. We also describe other aspects of the management, including prepartum cardiovascular assessment, mode of delivery, the use of epidural analgesia and the prevention of haemorrhagia and thromboembolism.
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PMID:[Parkes-Weber syndrome and pregnancy: anaesthetic implications]. 2360 85

An 8-year-old girl of Type 1 diabetes mellitus on insulin therapy, was surgically treated for brain cavernous hemangioma. Since the hemangioma gradually became larger, the medical team including anesthesiologists, neurosurgeons, and pediatricians discussed and decided to perform craniotomy. Preoperative blood sugar level was around 40 to 300 mg x dl(-1) and appeared poorly controlled. During the surgery, opioid-based anesthesia and 1.3% glucose infusion were given to the patient to avoid surgical stress-induced hyperglycemia and to avoid starvation. Intraoperative blood sugar levels were maintained exactly at 100 to 120 mg x dl(-1) without insulin medication, and cortisol levels were below the limit of detection. Postoperative sugar level was difficult to control at the preoperative level Tumor was completely removed and the patient was discharged without any neurological sequelae. This report suggests that sufficient analgesia with remifen tanil and appropriate glucose infusion may be useful for the metabolic management not only in patients without diabetes but also in those with diabetes.
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PMID:[Craniotomy in a pediatric patient complicated with insufficiently controlled diabetes mellitus: intraoperative management with remifentanil and an electrolyte-containing glucose solution]. 2586 9

Pregnancy can be rarely complicated with cerebral angioma. Such patients can pose a problem to the anesthesiologist and can present for caesarean section (CS). The main anesthetic challenge is prevention of rupture of angioma and subsequent bleed due to intraoperative surge of blood pressure. Both general anesthesia and regional anesthesia have been used in such patients. Spinal anesthesia has the advantage of safety, less hypertensive surge, and better analgesia as well as less blood loss. We hereby present successful anesthetic management of such a case presented for emergency CS done under spinal anesthesia.
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PMID:Anesthetic management of a pregnant patient with cerebral angioma scheduled for caesarean section. 2654 98