Effect of remifentanil on the auditory evoked response and haemodynamic changes after intubation and surgical incision.
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We have observed the effect of intubation and incision, as measured by the auditory evoked response (AER) and haemodynamic variables, in 12 patients undergoing hernia repair or varicose vein surgery who received remifentanil as part of either an inhaled anaesthetic technique using isoflurane or as part of a total i.v. technique using propofol. Anaesthesia was induced with remifentanil 1 microgram kg-1 and propofol, neuromuscular block was achieved with atracurium 0.6 mg kg-1 before intubation, and anaesthesia was maintained with a continuous infusion of remifentanil in combination with either a continuous infusion of propofol or inhaled isoflurane. The AER and haemodynamic variables were measured before and after intubation and incision. The effects of intubation and incision on the AER and haemodynamic variables were not significantly different between the remifentanil-propofol and remifentanil-isoflurane groups. However, the study had a low power for this comparison. When the data for the two anaesthetic combinations were pooled, the only significant effects were increases in diastolic arterial pressure and heart rate immediately after intubation; these were not seen 5 min after intubation. There were no cardiovascular responses to incision. There were no significant changes in the AER after intubation or incision. (+info)
Intraoperative therapeutic suggestions in day-case surgery: are there benefits for postoperative outcome?
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To determine if improved postoperative recovery in surgical inpatients receiving intraoperative therapeutic suggestions are applicable in an outpatient population, 70 consenting, unpremedicated adults undergoing elective outpatient hernia repair under general anaesthesia were allocated randomly to either a therapeutic tape (TT) or a comparison tape (CT) group. A standardized general anaesthetic technique was used with propofol, fentanyl or alfentanil, isoflurane and nitrous oxide in oxygen. Pain, and nausea and vomiting were assessed after operation at 30, 60 and 90 min and at 2, 6 and 24 h. The presence of other side effects, such as headache and muscular discomfort, in addition to recall of tape contents, were also evaluated after operation. Absorption ability was measured before operation. The groups were similar in patient characteristics, preoperative, surgical and anaesthetic characteristics, and level of absorption. There were no differences in pain ratings or need for analgesics administered at any time after operation. Nausea/vomiting was experienced significantly fewer times by patients in group TT compared with group CT over the first 90 min (group CT 15%, group TT 4%; P < 0.02), but not over the last three assessment times (group CT 10%, group TT 14%; P < 0.25). The therapeutic tape group experienced fewer side effects over the entire postoperative assessment period (P = 0.03), in particular less headaches (P = 0.03) and less muscular discomfort (P < 0.02). Use of intraoperative therapeutic suggestions could present mildly significant postoperative benefits in outpatients. (+info)
A cost and profit analysis of hernia surgery.
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The vast majority of surgeons who are in the active practice of their particular field have little time to evaluate their individual practices from a "business perspective." This fact is critical to the future of any entity that is engaged in the delivery of goods and services. Without such an analysis, few businesses will continue to function in such a manner that ensures the financial viability of that enterprise. We have attempted to accumulate the available data to analyze the practice of surgery as it relates to the cost and profit of hernia repairs. Given this information, it is easily extrapolated into other procedures, open or laparoscopic, that are performed by the general surgeon. The herniorraphy analysis indicates that one cannot hope to generate enough income to rely upon a financially successful business. The information presented should be considered a national average and not specific to an individual practice situation. It is meant to serve as a template for which each surgeon can (and must) evaluate his or her own practice profitability. (+info)
Mesh repair of a coccygeal hernia via an abdominal approach.
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We report on the presentation and management of a patient with herniation of the rectum following a coccygectomy. We used an abdominal approach and careful pelvic dissection to define the defect in the pelvic floor at the site where coccyx used to be. Prolene mesh repair resulted in the reduction of the hernia. To our knowledge, this is the first report on the mesh repair of the coccygeal hernia via an abdominal approach. (+info)
S(+)-ketamine for caudal block in paediatric anaesthesia.
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We have evaluated the intra- and postoperative analgesic efficacy of preservative-free S(+)-ketamine compared with bupivacaine for caudal block in paediatric hernia repair. After induction of general anaesthesia, 49 children undergoing hernia repair were given a caudal injection (0.75 ml kg-1) of S(+)-ketamine 0.5 mg kg-1 (group K1), S(+)-ketamine 1.0 mg kg-1 (group K2) or 0.25% bupivacaine with epinephrine 1:200,000 (group B). No additional analgesic drugs were required during operation in any of the groups. Haemodynamic and respiratory variables remained stable during the observation period. Mean duration of analgesia was significantly longer in groups B and K2 compared with group K1 (300 (SD 96) min and 273 (123) min vs 203 (117) min; P < 0.05). Groups B and K2 required less analgesics in the postoperative period compared with group K1 (30% and 33% vs 72%; P < 0.05). Postoperative sedation scores were comparable between the three groups. We conclude that S(+)-ketamine 1.0 mg kg-1 for caudal block in children produced surgical and postoperative analgesia equivalent to that of bupivacaine. (+info)
Small bowel herniation around an anterior gastropexy for a gastric volvulus: a case report.
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Gastric volvulus can be a medical emergency with life-threatening complications. Early surgical intervention is important to avoid potential ischemic complication that may lead to infarction of the stomach. The condition has been reported in children and in the elderly, but the majority of cases are reported in the fifth decade of life. We present a case of a complication arising from corrective laparoscopic surgery for gastric volvulus, whereby most of the small bowel herniated around the anterior laparoscopically performed gastropexy. The herniation was reduced during a laparotomy, and the space through which the herniation occurred was closed. (+info)
Traumatic herniation of the heart into the right hemithorax.
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Pericardial rupture after blunt chest trauma is described in the literature. This case report summarises our experience with a 22-year old male patient who suffered blunt chest trauma during a motor vehicle accident. On admission no serious injuries could be detected, but 3 hours later, displacement of the heart to the right hemithorax combined with sudden cardiac failure appeared. Emergency thoracotomy revealed a right-sided rupture of the pericardium with complete herniation of the heart into the right pleural cavity and consequent strangulation by the margins of the pericardial defect. (+info)
Jejunal obstruction and perforation resulting from herniation through broad ligament.
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Internal herniation of small bowel through broad ligament causing obstruction is rare. A case of jejunal herniation through broad ligament defect with resultant obstruction and perforation is presented. (+info)