0000000000332298
AUTHOR
Irene Tzanova
Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations
Abstract Background . Survival after first-stage palliative Norwood operations for single ventricle with systemic outflow obstruction is mainly dependent on a balanced ratio of pulmonary blood flow to systemic blood flow. Here we report the clinical results using a modified technique that allows a controlled systemic-to-pulmonary shunt flow to prevent pulmonary overcirculation. Methods . From 1995 to 1998, of 26 infants undergoing first-stage palliative Norwood operations, 7 had placement of an adjustable tourniquet around a modified right Blalock-Taussig shunt. Results . Hospital survival was 20 of 26 patients (77%). All 7 patients in whom snaring of the shunt was indicated survived. Two p…
Anästhesie in der Neurochirurgie
Das Wort »Kraniotomie« subsumiert eine ganze Reihe von Interventionen, die von einem kleinen Bohrloch zur Evakuation eines chronischsubduralen Hamatoms oder dem Anbringen einer Drucksonde zur Uberwachung des intrakraniellen Drucks (ICP, »intracranial pressure«) uber eine osteoplastische Kraniotomie zur Entfernung einer Raumforderung (frontal, temporal, okzipital) bis zur Intervention in der hinteren Schadelgrube reichen konnen. Die Mehrzahl der neurochirurgischen Operationen ist mit einer aufwandigen Lagerung und erheblichen Kreislaufreaktionen verbunden. Die mogliche Ausdehnung des Eingriffs sollte vorab mit dem Operateur geklart sein, da Lagerung, Monitoring, Art und Grose der i.v.-Zugang…
Physiologie und Pathophysiologie des respiratorischen Systems
Positive pressure ventilation in children is associated with problems similar to those in the adults: development of atelectasis and barotrauma. During anesthesia atelectasis develop in up to 90% of patients, requiring the use of higher inspiratory pressure to recruit the collapsed lung regions. Especially in the preterm, newborn and younger infants, prolonged ventilation disturbs the anatomical structure of the soft and vulnerable immature airways and their subsequent growth and development, leading to tracheomegaly, tracheal collapse, and bronchopulmonary dysplasia and predisposing to bronchial obstruction. On the basis of pathophysiologic knowledge and studies of ventilation in children,…
Rectal pH in children
In an attempt to establish normal values for rectal pH in children, we have measured pH in 100 paediatric patients. Measurement of rectal pH was performed in 25 infants and 75 children (27 girls and 73 boys) using a monocrystalline antimony electrode. Rectal pH was 9.6 +/- 0.9 (mean +/- SD, range 7.2 to 12.1) and was independent of sex, age and nutrition. This wide range of rectal pH values offers a possible explanation for the widely scattered bioavailability of drugs administered by the rectal route. Mean rectal pH was considerably higher than that reported for adults; this unexpected alkalinity should be taken into account, when drug formulations are considered for rectal administration …
Noninvasive Hemodynamic Measurements During Neurosurgical Procedures in Sitting Position.
Neurosurgical procedures in sitting position need advanced cardiovascular monitoring. Transesophageal echocardiography (TEE) to measure cardiac output (CO)/cardiac index (CI) and stroke volume (SV), and invasive arterial blood pressure measurements for systolic (ABPsys), diastolic (ABPdiast) and mean arterial pressure (MAP) are established monitoring technologies for these kind of procedures. A noninvasive device for continuous monitoring of blood pressure and CO based on a modified Penaz technique (volume-clamp method) was introduced recently. In the present study the noninvasive blood pressure measurements were compared with invasive arterial blood pressure monitoring, and the noninvasive…
Orthotopic liver transplantation in a malignant hyperthermia susceptible patient.
We present a patient with hepatitis C and D and hepatocellular carcinoma who underwent preoperative evaluation for orthotopic liver transplantation. In his past medical history, he reported a life-threatening event during tonsillectomy in 1975. Intubation was impossible due to extreme jaw muscle tension, followed by excessive elevation in body temperature, tachycardia, and coma for a few days. We evaluated him for malignant hyperthermia, according to the European Malignant Hyperthermia Group Protocol, and found him highly positive in both the halothane and caffeine test, respectively. Three months later, we performed an orthotopic liver transplantation. During retransplantation 4 years late…
Extracorporeal circulation and cardiac arrest in an awake patient: a safe approach for single lung pulmonary artery stenting?
We describe the anesthetic concept and approach in a single lung patient scheduled for pulmonary artery stenting due to recurrence of a pulmonary artery sarcoma after left pneumectomy.