MICROEMBOLISATION DURING SURGICAL SHOCK: EFFECT OF PROSTAGLANDIN E1

1987 ◽  
Author(s):  
K R Poskitt ◽  
J T C Irwin ◽  
C M Backhouse ◽  
C N McCollum
Keyword(s):  
Prostaglandin E1 ◽  
Major Surgery ◽  
Midline Laparotomy ◽  
Venous Shunt ◽  
Platelet Labelling ◽  
Platelet Aggregate ◽  
To Receive ◽  
Surgical Shock ◽  
Autologous Platelet ◽  
Postoperative Pulmonary Dysfunction

Embolisation of microaggregates following major surgery may be a cause of pulmonary arterio-venous shunt and postoperative respiratory failure (1). Prostaglandin E1 may prevent intravascular aggregation and we studied this possibility in a pig model of surgical shock.Following autologous platelet labelling with Indium, 16 pigs (20-30kg) were randomised to receive a perioperative infusion of PGE1 (100ng/kg/min) or placebo. Arterial and Swann Ganz catheters were inserted under anaesthesia prior to surgery consisting of midline laparotomy, exteriorisation of small bowel 1.5 hours of aortic clamping and 1 hour of hypotension. On induction, during shock and at 3 days in survivors platelet and leucocyte count, blood radioactivity, venous aggregates (SFP), lung platelet uptake (LPU), pulmonary vascular resistance (PVR) and alveolar-arterial p02 difference (A-ad02) were measured.All results mean ± sem *p <0.05 Mann Whitney U-testDuring surgical shock, the formation of venous aggregates, the fall in circulating radiolabelled platelets and their accumulation in lungs were reduced by PGE1 (p< 0.05). BP, CVP and PWP were all lower on PGE1 and at 3 days the improvement in A-ad02 in PGE1 pigs failed to reach significance.PGE1 reduced platelet aggregate formation and their subsequent pulmonary microembolisation despite worsening shock due to vasodilation.1. McCollum CN, Campbell IT. The value of measuring intravascular platelet aggregation in the prediction of postoperative pulmonary dysfunction. Br J Surg 1979: 66; 703-707

PULMONARY MICROEMBOLISATION IN SURGICAL SHOCK: THE EFFECT OF CYCLO-OXYGENASE INHIBITION

1987 ◽  
Author(s):  
C M Backhouse ◽  
A C Meek ◽  
K R Poskitt ◽  
C N McCollum
Keyword(s):  
Pulmonary Function ◽  
Aortic Surgery ◽  
High Dose ◽  
Midline Laparotomy ◽  
Arteriovenous Shunts ◽  
Pulmonary Shunting ◽  
Platelet Labelling ◽  
Arterial Po2 ◽  
Surgical Shock ◽  
Autologous Platelet

Thromboxane release from platelet microemboli during major arterial surgery may mediate depression of cardio-pulmonary function. The effect of cyclo-oxygenase inhibition by aspirin has been studied in a porcine model of aortic surgery.Following autologous platelet labelling with 111-lndium, 24 pigs (20-25kg) were randomised to low dose (LD) aspirin (0.5mg/kg), high dose (HD) aspirin (10mg/kg) or placebo.Arterial and Swann Ganz catheters were inserted prior to surgery consisting of midline laparotomy, small bowel extériorisation, 1.5 hours of aortic clamping and 1 hour shock before resuscitation. On induction, during shock and at 3 days, platelet and leucocyte counts, lung platelet uptake (LPU), venous aggregates by screen filtration (SFP), mean arterial pressure (BP), cardiac output (CO), pulmonary shunt (PS) and alveolar-arterial pO2 difference (A-adO2) were measured.During shock following aortic declamping aspirin preserved blood pressure by increasing vascular resistance rather than CO. Venous aggregates by SFP tended to be lower on aspirin with significantly reduced LPU, subsequent pulmonary shunting and A-adO2. The improvement in PS but not A-adO2 remained significant at 3 days (p<0.05).Cyclo-oxygenase inhibition improved pulmonary function during surgical shock either by inhibiting platelet microemboli or by a direct effect on pulmonary arteriovenous shunts.

scholarly journals Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244503
Author(s):  
Rajan Sundaresan Vediappan ◽  
Catherine Bennett ◽  
Clare Cooksley ◽  
John Finnie ◽  
Markus Trochsler ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Abdominal Surgery ◽  
Rat Model ◽  
Adhesion Formation ◽  
Pelvic Surgery ◽  
Albino Rats ◽  
Adhesion Barrier ◽  
Midline Laparotomy ◽  
Safety And Efficacy ◽  
To Receive

Introduction Adhesions are often considered to be an inevitable consequence of abdominal and pelvic surgery, jeopardizing the medium and long-term success of these procedures. Numerous strategies have been tested to reduce adhesion formation, however, to date, no surgical or medical therapeutic approaches have been successful in its prevention. This study demonstrates the safety and efficacy of Chitogel with Deferiprone and/or antibacterial Gallium Protoporphyrin in different concentrations in preventing adhesion formation after abdominal surgery. Materials and methods 112 adult (8–10 week old) male Wistar albino rats were subjected to midline laparotomy and caecal abrasion, with 48 rats having an additional enterotomy and suturing. Kaolin (0.005g/ml) was applied to further accelerate adhesion formation. The abrasion model rats were randomized to receive saline, Chitogel, or Chitogel plus Deferiprone (5, 10 or 20 mM), together with Gallium Protoporphyrin (250μg/mL). The abrasion with enterotomy rats were randomised to receive saline, Chitogel or Chitogel with Deferiprone (1 or 5 mM). At day 21, rats were euthanised, and adhesions graded macroscopically and microscopically; the tensile strength of the repaired caecum was determined by an investigator blinded to the treatment groups. Results Chitogel with Deferiprone 5 mM significantly reduced adhesion formation (p<0.01) when pathologically assessed in a rat abrasion model. Chitogel with Deferiprone 5 mM and 1 mM also significantly reduced adhesions (p<0.05) after abrasion with enterotomy. Def-Chitogel 1mM treatment did not weaken the enterotomy site with treated sites having significantly better tensile strength compared to control saline treated enterotomy rats. Conclusions Chitogel with Deferiprone 1 mM constitutes an effective preventative anti-adhesion barrier after abdominal surgery in a rat model. Moreover, this therapeutic combination of agents is safe and does not weaken the healing of the sutured enterotomy site.

Autologous platelet labelling using “Monovette” vials is not septic

1986 ◽  
Vol 12 (9) ◽  
pp. 471-471
Author(s):  
Helmut Sinzinger ◽  
Eva Strobl-Jäger ◽  
Rudolf Höfer
Keyword(s):  
Platelet Labelling ◽  
Autologous Platelet

Renal Impairment Associated with the Pre-Operative Administration of Recombinant Interleukin-2

1994 ◽  
Vol 87 (5) ◽  
pp. 513-518
Author(s):  
D. J. Deehan ◽  
S. D. Heys ◽  
J. Broom ◽  
O. Eremin ◽  
P. H. Whiting
Keyword(s):  
Renal Impairment ◽  
Renal Dysfunction ◽  
Interleukin 2 ◽  
Fractional Excretion ◽  
Major Surgery ◽  
Colorectal Cancer Surgery ◽  
Routine Monitoring ◽  
Fractional Excretion Of Sodium ◽  
Recombinant Interleukin 2 ◽  
To Receive

1. The T-cell-derived cytokine interleukin-2 may be used to reverse the immune suppression associated with major surgery. However, both major surgical procedures and recombinant interleukin-2 therapy are known to induce renal dysfunction. 2. Eighteen patients were randomized to receive either recombinant interleukin-2 (18 × 106 i.u./day) or placebo, given subcutaneously for 3 days before undergoing curative colorectal cancer surgery. Indices of renal function were determined pre-operatively and for 21 days after surgery. 3. Pre-operative recombinant interleukin-2 was found to significantly increase, compared with placebo controls, N-acetyl-β-D-glucosaminidase [peak levels 28 (SEM 2) versus 11 (SEM 3) i.u./mmol of Cr] and γ-glutamyltransferase [peak levels 5.3 (SEM 0.6) versus 2.4 (SEM 0.2) i.u./mmol/l] and decrease urinary fractional excretion of sodium [peak difference 0.32 (SEM 0.06) versus 0.76 (SEM 0.08)] (all P < 0.05). Significantly increased urinary excretions of creatinine, N-acetyl-β-D-glucosaminidase and γ-glutamyltransferase were also identified after surgery. All variables returned to pretreatment limits by the seventh day post-operatively, except N-acetyl-β-D-glucosaminidase, which was still significantly elevated 21 days after surgery. No differences in the serum concentrations of sodium, creatinine or urea were observed before or after surgery in either group. 4. Recombinant interleukin-2, when given in the preoperative period, was associated with significant renal dysfunction. However, routine monitoring of serum indices (i.e. sodium, urea, creatinine and albumin) failed to detect such renal damage. These results suggest that, with the use of recombinant interleukin-2 to enhance natural cytotoxicity in the peri-operative period, such therapy may potentiate the renal impairment occurring after surgery.

scholarly journals O05 1-YEAR RESULTS OF AN INTERNATIONAL RANDOMIZED CONTROLLED TRIAL (ESTOIH STUDY) COMPARING THE “SHORT STITCH” VERSUS “LONG STITCH” TECHNIQUE USING AN ULTRA-LONG ABSORBABLE ELASTIC SUTURE MATERIAL

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
René Fortelny ◽  
Markus Albertsmeier ◽  
Anna Hofmann ◽  
Stefan Riedl ◽  
Jan Ludolf Kewer ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Controlled Trial ◽  
Cox Proportional Hazards Model ◽  
Published Data ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Short Stitch ◽  
To Receive ◽  
Incisional Hernia Rate

Abstract Aim The aim of this multicenter, randomized, double blinded study was to compare the short stitch technique for elective, primary, median laparotomy closure with the long stitch closure using the ultra-long absorbable, elastic monofilament suture made of poly 4-hydroxybutyrate (MonoMax®). Material and Methods Eligible patients were randomly allocated to receive either the short or the long stitch suture technique in a 1:1 ratio in 9 centers in Austria and Germany after elective midline laparotomy. Results 425 patients were randomized to receive either the short stitch (n = 215) or long stitch technique (n = 210). In a cox proportional hazards model, the risk for burst abdomen was reduced by 7-fold (HR 0.183 (0.0427 - 0.7435), p = 0.0179) for the short stitch group. Complications such as seroma, hematoma and other wound healing disorders occurred without significant differences between groups. After one year, the incisional hernia rate was 3.65% in the short stitch group compared to 8.80% in the long stitch group (p = 0.055). The combination of burst abdomen and incisional hernia rate had a significantly lower rate of 5.38% for the short stitch technique compared to 13.17% for the long stitch technique (p = 0.0142). Conclusions Both in the short-term results, the short-stitch technique showed substantial advantages in burst abdomen rate, as well as in the 1-year follow-up regarding the incidence of incisional hernias. The low incidence of incisional hernia in the short stitch technique with MonoMax® is promising in comparison to previously published data and should be confirmed in the 3-year follow-up.

Hypnotic techniques

2010 ◽  
Author(s):  
Marie-Elisabeth Faymonville ◽  
Christel J Bejenke
Keyword(s):  
Scientific Publication ◽  
Faith Healing ◽  
Major Surgery ◽  
Psychological Reactions ◽  
Anaesthetic Care ◽  
The World ◽  
History Of ◽  
To Receive ◽  
Volatile Agents

Anxiety, fear, tension and apprehension are common emotions in patients undergoing surgery. Clinicians are becoming increasingly aware of the importance of patients’ psychological reactions as well as their physical needs. For instance, surgeons now explain more to their patients than was formerly the case. The anaesthetist is therefore presented with an opportunity to use the pre-operative anaesthesia assessment as a means of fostering greater rapport and providing reassurance. There is, of course, still much reliance upon sedative and analgesic drugs to relieve anxiety and tension prior to major anaesthesia. However, sedatives are not the only answer. Sedation can be accomplished pharmacologically, but drugs cannot re-educate patients in a way that enables them to respond more positively to their medical or surgical treatment. The challenge for anaesthetists seeking to provide optimal anaesthetic care for their patients is not only to become more expert in the latest state-of-the-art technology, but rather to acquire the skills necessary to function effectively in the role of physician healer. Hypnosis is not a ‘therapy’, but a potentially valuable tool in the anaesthetist’s professional armamentarium, and deserves to receive equal consideration with other tools and skills which anaesthetists acquire. Hypnotic techniques can influence communication to such a degree that the patient’s entire medical experience is beneficially affected. Anaesthetists trained in the use of hypnosis can use this approach in ‘formal hypnosis’ or as ‘awake suggestions’. Hypnosis has had a cyclical history of acceptance and rejection. It has been practised in one form or another for thousands of years. However, it was not until 1828 that a scientific publication first reported its effectiveness as an anaesthetic for surgery. However, when volatile agents were introduced, the use of hypnosis as a sole anaesthesia technique died out. Because of its historical association with magic, hypnosis has had to struggle to become disentangled from faith-healing methods and the occult. In a number of hospitals around the world, hypnosis is used as an adjuvant to pharmacological anaesthesia, either before or after general anesthesia. At the same time, the fact that major surgery has been comfortably performed entirely under hypnosis overcomes some of the scepticism associated with its ancillary uses.

scholarly journals Does Rectus Sheath Infusion of Bupivacaine Reduce Postoperative Opioid Requirement?

2007 ◽  
Vol 89 (3) ◽  
pp. 229-232 ◽  
Author(s):  
J Padmanabhan ◽  
A Rohatgi ◽  
A Niaz ◽  
E Chojnowska ◽  
K Baig ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Peak Expiratory Flow ◽  
Flow Rate ◽  
Peak Expiratory Flow Rate ◽  
Rectus Sheath ◽  
Midline Laparotomy ◽  
Postoperative Pain Score ◽  
Expiratory Flow ◽  
To Receive

INTRODUCTION The aim of this work was to assess the effect of intermittent bupivacaine infusion into rectus sheath space on postoperative opioid requirement, postoperative pain score and peak expiratory flow rate. PATIENTS AND METHODS A prospective, randomised study involving patients undergoing midline laparotomy. Patients were randomised to receive either intermittent infusion of bupivacaine 0.25% or normal saline via catheters placed in the rectus sheath for 48 h after operation. All patients received intravenous morphine infusion on demand with a patient-controlled analgesic device (PCAD). RESULTS Forty ASA I–III patients were studied. Nineteen were randomised to receive bupivacaine and 21 patients received normal saline. Patient characteristics and surgical variables were comparable in the two groups. The mean wound lengths were similar. There was no statistically significant difference in postoperative opioid requirement, postoperative pain score and peak expiratory flow rate between the two groups. CONCLUSIONS Intermittent bupivacaine infusion into the rectus sheath space after midline laparotomy does not reduce postoperative opioid requirement nor does it affect postoperative pain score or peak expiratory flow rate.

Postoperative Platelet Accumulation In The Lungs: Can It Be Measured In Surgical Patients And Does It Matter?

1981 ◽  
Author(s):  
C N McCollum ◽  
R J Hawker ◽  
H C Norcott ◽  
C Hail ◽  
Z Drolc ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Aortic Arch ◽  
Femoral Vein ◽  
Surgical Patients ◽  
Major Surgery ◽  
Shock Lung ◽  
Platelet Accumulation ◽  
Kinetics Of ◽  
Arterial Po2 ◽  
Surgical Shock

Pulmonary microembolisation as a result of trauma, sepsis or major surgery may be an aetiology for shock lung. The postoperative kinetics of 111-Indium labeled autologous platelets have been studied to determine whether they accumulate in the lungs, and whether this relates to subsequent pulmonary function.One day prior to major surgery platelets from 10 patients were labelled with 111-Indium-oxine and reinjected. Isotope emissions were counted over the lungs and aortic arch preoperatively, 2.5 hours following surgery and daily for 7 days. Screen filtration pressure (SFP) measurements of aggregates in femoral vein blood was estimated 30 minutes and 3 hours postoperation. Arterial PO2 was measured preoperation and on days 1 and 7 following surgery.The ratio of isotope emissions lung/aortic arch increased following surgery indicating pulmonary accumulation of platelets. The preoperative ratio (mean ± SEM) of 0.38 ± 0.017 rose to 0.47 ± 0.039 (p<0.05) 2.5 hours following surgery and to 0.56 ± 0.052 (p<0.01) the following day. This ratio had returned to preoperative levels by day 4. Immediate postoperative platelet accumulation in the lung (the rise in lung/ aortic arch ratio) correlated closely with SFP measurements (r 0.89, p<0.01) and the fall in arterial PO2 one week following surgery (r 0.69, p<0.05).These results indicate that circulating platelets aggregate during surgical shock and then accumulate in the lungs. This process is associated with postoperative hypoxia.

Epidural and Intravenous Fentanyl Produce Equivalent Effects during Major Surgery 

1995 ◽  
Vol 82 (2) ◽  
pp. 377-382 ◽  
Author(s):  
Jean-Phillipe Guinard ◽  
Randall L. Carpenter ◽  
Pierre-Guy Chassot
Keyword(s):  
Epidural Fentanyl ◽  
Major Surgery ◽  
Epidural Administration ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Urinary Catecholamines ◽  
Intravenous Fentanyl ◽  
Clinical Advantage ◽  
Fentanyl Administration ◽  
To Receive

Background The benefit of epidural versus intravenous fentanyl administration for postoperative analgesia is controversial. In the current study, the intraoperative effects of epidural versus intravenous fentanyl administration were compared during major surgery. Methods Twenty elective patients scheduled for thoracoabdominal esophagectomy under general anesthesia with propofol infusion were randomly allocated to receive either intravenous or epidural boluses of 50-100 micrograms fentanyl in a double-blind fashion to maintain hemodynamic stability. Plasma cortisol and fentanyl, as well as total urinary catecholamines, were obtained at the end of the operations. Results Hemodynamic variations were similar except that patients receiving epidural fentanyl had a lower incidence of heart rate reduction (&gt; 20% reduction from baseline, P &lt; 0.05). There were no differences in mean intraoperative fentanyl (1,115 +/- 430 and 1,010 +/- 377 micrograms, epidural and intravenous, respectively) or propofol (2,281 +/- 645 and 2,452 +/- 1,169 mg) doses, number of boluses of fentanyl (nine in both groups), plasma fentanyl concentration (1.13 +/- 0.4 and 1.02 +/- 0.46 ng/ml), or number of anesthesiologists correctly identifying the site of fentanyl administration. Similarly, there were no differences in plasma glucose (8.9 +/- 1.8 and 9.3 +/- 1.8 mM) and cortisol (696 +/- 446 and 846 +/- 257 mM), or urinary epinephrine (12 +/- 3.7 and 13.1 +/- 9.2, micrograms/sample) and norepinephrine (42.7 +/- 26.7 and 39.1 +/- 27.6, micrograms/sample). Conclusions There appears to be no clinical advantage to epidural administration of fentanyl over intravenous administration during anesthesia for major surgery.

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