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Transitory paraplegia due to a calcificated thoracic disc herniation
Marcelo Wajchenberg,Délio Eulálio Martins Filho,Eduardo Barros Puertas,Hallim Feres Junior
Einstein (S?o Paulo) , 2007,
Abstract: Thoracic disc herniation is rare and its clinical signs differ widely fromthose of cervical and lumbar disc hernias. The anterior approach is theclassical treatment for these cases. We report a case of a 56-year-oldman who presented a T11-T12 calcified thoracic disc herniation thatrapidly progressed to paraplegia. The patient was submitted to spinalcord decompression using the Larson’s lateral extracavitary approachand completely recovered sensation and motor function.
Greater auricular nerve neuropraxia with beach chair positioning during shoulder surgery  [cached]
Ng Albert,Page Richard
International Journal of Shoulder Surgery , 2010,
Abstract: Neuropraxia of the greater auricular nerve is an uncommon complication of shoulder surgery, with the patient in the beach chair position. The greater auricular nerve, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location. In this case series, we present three cases of neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery. We outline the risk of using devices of this nature and discourage the use of similar headrest devices due to the potential complications in headrest devices that exert pressure on the posterior auricular area to maintain head position during surgery.
Paraplegia after Gastrectomy in a Patient with Cervical Disc Herniation: A Case Report and Review of Literature  [PDF]
Qingfu Zhang,Wei Jiang,Quanhong Zhou,Guangyan Wang,Linlin Zhao
Case Reports in Anesthesiology , 2014, DOI: 10.1155/2014/718690
Abstract: Paraplegia is a rare postoperative complication. We present a case of acute paraplegia after elective gastrectomy surgery because of cervical disc herniation. The 73-year-old man has the medical history of cervical spondylitis with only symptom of temporary pain in neck and shoulder. Although the patient’s neck was cautiously preserved by using the Discopo, an acute paraplegia emerged at about 10 hours after the operation. Severe compression of the spinal cord by herniation of the C4-C5 cervical disc was diagnosed and emergency surgical decompression was performed immediately. Unfortunately the patient showed limited improvement in neurologic deficits even after 11 months. 1. Introduction Paraplegia is a rare postoperative complication, and the pathology is various. We present a case of acute paraplegia after elective gastrectomy surgery because of cervical disc herniation. The IRB of Shanghai Sixth People’s Hospital reviewed the case report and gave permission for us to publish the report. 2. Case Description A 73-year-old man with peptic ulcer and bleeding was checked into the Department of Gastroenterology due to brown vomit and drain black stool once. The patient has a past medical history of duodenal ulcer for 18 years and complained from abdominal discomfort for 4 days. He received medical treatment with omepazole for 10 days and then was referred to the Department of General Surgery for selective gastrectomy. He denied any other medical history or other medication during preoperative visit by anesthetist. General anesthesia was induced by intravenous administration of 15?μg/kg fentanyl, 2?mg/kg propofol, and 0.1?mg/kg rocuronium. As the patient had loosened teeth, Discopo was taken for orotracheal intubation. During the whole process, the patient’s neck was placed in a neutral position. The patient was mechanically ventilated with the settings of FiO2 1.0, tidal volume 8?mL/kg, respiratory rate 10/min, and inspiration/expiration 1/2 and one minimum alveolar concentration of sevoflurane was administered during the surgery. In the meantime, propofol (2?mg/kg/h) and fentanyl (3?μg/kg/h) were also infused. Subtotal gastrectomy was performed, and gastrointestinal tract was reconstructed with the method of Billroth II. The operation, which lasted about 2 hours, was uneventful with a total blood loss of 250?mL. There was no hemodynamic instability during surgery. The patient was sent to the postoperative care unit (PACU) and extubated 30 minutes later. The recovery process was smooth, and the patient was transferred to surgery intensive care unit
The Cardiac Function in the Beach Chair Position under General Anesthesia  [PDF]
Kumiko Tanabe, Yuko Yamada, Kiyoshi Nagase, Nobuo Terabayashi, Hiroki Iida
Open Journal of Anesthesiology (OJAnes) , 2018, DOI: 10.4236/ojanes.2017.81003
Background: Shoulder surgery is performed in the beach chair position (BCP). The systemic arterial blood pressure (BP) must be increased to prevent cerebral hypoperfusion. However, it is not clear how the cardiac function is affected when BP increase to maintain cerebral perfusion pressure in anesthetized patients. Methods: An analysis was performed using the data from 13 patients. We prepared a parallel circuit using a FloTrac Sensor transducer and an arterial BP transducer. Following the transfer of the patient to the BCP under general anesthesia, the FloTrac Sensor transducer was placed at the level of the fourth intercostal space, the arterial BP transducer was placed at the external auditory meatus level. We selected two points before surgery (120 s apart), during which the mean arterial BP (mABP) at the level of the brain was stable and at which the values in the supine position and the BCP were within 5 mmHg. Results: While the patients were in the supine position, the mean mABP at the mid-axillary level was 65.7 mmHg. In the BCP, the mean mABP was 66.5 mmHg at the external auditory meatus and 80.7 mmHg at the fourth intercostal space. The cardiac index changed from 2.2 (supine position) to 2.5 l/min/m2 (BCP). The stroke volume index was significantly increased from 35.8 to 42.3 ml/m2 (P = 0.003). The heart rate changed from 63.0 to 58.6 beats/min. The stroke volume variation was significantly decreased from 12.4% to 8.8% (P = 0.024). Conclusion: In order to ensure patient safety, close attention should be paid to the systemic cardiovascular changes that occur when the BP is increased.
The influence of basic ventilation strategies and anesthetic techniques on cerebral oxygenation in the beach chair position: study protocol  [cached]
Picton Paul,Dering Andrew,Miller Bruce,Shanks Amy
BMC Anesthesiology , 2012, DOI: 10.1186/1471-2253-12-23
Abstract: Background Beach chair positioning during general anesthesia is associated with a high incidence of cerebral desaturation; poor neurological outcome is a growing concern. There are no published data pertaining to changes in cerebral oxygenation seen with increases in the inspired oxygen fraction or end-tidal carbon dioxide in patients anesthetized in the beach chair position. Furthermore, the effect anesthetic agents have has not been thoroughly investigated in this context. We plan to test the hypothesis that changes in inspired oxygen fraction or end-tidal carbon dioxide correlate to a significant change in regional cerebral oxygenation in anesthetized patients in beach chair position. We will also compare the effects that inhaled and intravenous anesthetics have on this process. Methods/design This is a prospective within-group study of patients undergoing shoulder arthroscopy in the beach chair position which incorporates a randomized comparison between two anesthetics, approved by the Institutional Review Board of the University of Michigan, Ann Arbor. The primary outcome measure is the change in regional cerebral oxygenation due to sequential changes in oxygenation and ventilation. A sample size of 48 will have greater than 80% power to detect an absolute 4-5% difference in regional cerebral oxygenation caused by changes in ventilation strategy. The secondary outcome is the effect of anesthetic choice on cerebral desaturation in the beach chair position or response to changes in ventilation strategy. Fifty-four patients will be recruited, allowing for drop out, targeting 24 patients in each group randomized to an anesthetic. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor (Covidien, Boulder, CO). Following induction of anesthesia, intubation and positioning, inspired oxygen fraction and minute ventilation will be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded and venous blood gas analysis performed. The overall statistical analysis will use a repeated measures analysis of variance with Tukey’s HSD procedure for post hoc contrasts. Discussion If simple maneuvers of ventilation or anesthetic technique can prevent cerebral hypoxia, patient outcome may be improved. This is the first study to investigate the effects of ventilation strategies on cerebral oxygenation in patients anesthetized in beach chair position. Trial registration NCT01535274
Cost-Effective Traction for Arthroscopic Shoulder Surgery  [PDF]
Ravi Kumar Ray, Helen Aung, Steven Andrew Corbett
Open Journal of Orthopedics (OJO) , 2014, DOI: 10.4236/ojo.2014.45022
Abstract: The application of traction has enhanced views during arthroscopic shoulder surgery, easing visualization and accurate intervention within the shoulder joint and the subacromial space. Many innovative traction techniques are currently employed, including the use of padded traction equipment attached to boom arms and further, pedal-activated, hydraulic traction equipment. Variations in patient positioning and cost-benefit analysis of the use of traction in both beach chair and lateral decubitus positions have been performed in the literature. We demonstrate the use of readily available, simple and inexpensive resources in the beach chair position, allowing the application of traction with minimal set-up time and complexity. Initial equipment outlay requires a drip stand attached to a clamp at the end of the operating trolley, permitting a hook to be applied to the arm that is attached to traction cord and weights. We minimized the cost of ongoing consumable items per case to include a stockinette and benzoic tincture. The theatre team experiences a short learning curve associated with the ease of reliability and reproducibility of this technique.
Muhammad Omar Sawar
The Professional Medical Journal , 1995,
Abstract: The aim in the treatment of Pott's Paraplegia is eradication of the disease producing the paraplegia, recoveryof neurological function, early mobilization and rehabilitation. To achieve this aim we followed the radicalanterior surgical approach. Twelve patients with Pott's paraplegia underwent radical anterior debridementand fusion with autogenous bone grafts. These patients were reviewed as to the effect of this radical approachon return of distal neurological function and time to independent ambulation. Benefits of this radical surgeryare discussed and recommendations made.
Extradural lipomatosis presenting with paraplegia.  [cached]
Deogaonkar M,Goel A,Tingare K,Dahiwadkar H
Journal of Postgraduate Medicine , 1995,
Abstract: An unusual case with spinal extradural lipomatosis in a non-obese and otherwise healthy man is reported. The patient presented with a history of weakness of legs which progressed to paraplegia over a 40 day period.
Acute Paraplegia After General Anesthesia
Siamak Afshinmajd,Alireza Khalaj,Younes Roohani,Mohammadebrahim Yarmohammadi
Acta Medica Iranica , 2011,
Abstract: Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.
Conus medullaris syndrome due to an intradural disc herniation: A case report  [cached]
Chaudhary Kshitij,Bapat Mihir
Indian Journal of Orthopaedics , 2008,
Abstract: A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis.
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