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Heart Failure in Adult Congenital Heart Disease
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Andrew Constantine, Ana Barradas-Pires, Isma Rafiq, Justyna Rybicka, Michael A. Gatzoulis, Konstantinos Dimopoulos
Invasive hemodynamic assessment is usually undertaken following non-invasive evaluation and may be performed as a stand-alone diagnostic procedure or as the first part of a percutaneous intervention. Indications include confirmation of non-invasive gradients, including across the outflow tracts, conduits, and pathways (following an atrial switch operation), assessment of coronary anatomy, diastolic function, constrictive pericarditis, and measurement of the transhepatic gradient. Accurate measurement of PVR with assessment of reversibility is performed in patients with PH and those undergoing transplant assessment. General anesthesia may be required, and the risks should be weighed against the benefits.
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
General anaesthesia is a medically controlled state of unconsciousness accompanied by: the inability of the patient to respond purposefully to physical stimulation or verbal command, corresponding to a GCS or CGCS of 3–9andloss of airway protective reflexes, including loss of the patient’s ability to maintain a patent airway independently.
Transcatheter Aortic Valve Implantation (TAVI)
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
The cardiac/vascular surgeon usually isolates and prepares the subclavian artery. The insertion of the sheath is usually done by using standard surgical techniques with local anesthetic agents, in combination with a mild sedative/analgesic. General anesthesia is avoided. Some surgeons prefer performing an arteriotomy or placing a graft conduit, followed by the introduction of a standard 18 Fr sheath, which is then advanced over a stiff guide wire through the subclavian artery into the aortic arch and ascending aorta, stopping just below the origin of the brachiocephalic artery. The rest of the procedure is the same as the standard transfemoral approach. At the end of the procedure, hemostasis is achieved by simply tightening the purse-string sutures, and the skin layers are closed in the usual fashion. A drainage tube is rarely required (Figure 8.3.4).
Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study
Published in Journal of Investigative Surgery, 2022
Hakan Anıl, Nevzat Can Şener, Kaan Karamık, İbrahim Erol, Ediz Vuruşkan, Hakan Erçil, Zafer Gökhan Gürbüz
Inability to insert a DJ stent linked to obstruction in obstructed systems, in other words procedure failure, varies from 0 to 20% [10–13]. In our study, 5 patients (8.1%) among 61 patients, with retrograde ureteral DJ stent insertion planned could not have the stent inserted due to obstruction and PCN was performed. All 49 patients with PCN performed had the procedure completed successfully. When surgery durations are examined, Pearle et al. reported mean operation durations of 32.7 minutes and 49.2 minutes for retrograde ureteral catheterization and PCN insertion, respectively [6]. The same study found the fluoroscopy duration was 7.7 minutes in the PCN group and 5.1 minutes for the DJ stent group. Another study in recent times calculated the operation durations from the moment general anesthesia began [14]. In our data, the median operation durations for the PCN and DJ stent groups were 15 and 7 minutes, respectively. Fluoroscopy durations were 0.44 and 0.13 minutes, respectively. The study by Pearle et al. did not state their criteria for calculating operation durations and reported that some cases were completed under general anesthesia [6]. We link the superior operation and fluoroscopy durations in our cases to all cases being performed under local anesthesia and the popularity of methods with advancing time increasing experience, leading to a reduction in operation duration and fluoroscopy use duration.
Enzymatic debridement: past, present, and future
Published in Acta Chirurgica Belgica, 2022
Ignace De Decker, Liesl De Graeve, Henk Hoeksema, Stan Monstrey, Jozef Verbelen, Petra De Coninck, Els Vanlerberghe, Karel E. Y. Claes
One might argue, that general anesthesia is the most effective technique to guarantee optimized pain management during burn surgery. However, general anesthesia itself means a traumatic and stressful event for patients and often causes nausea, dizziness, and vomiting [96]. Insufficient pain treatment, on the other hand, causes chronic depression and disorders [97]. For this reason, pain management is crucial in traumatized burn patients for not only restoring patients’ mental but also their somatic health [98]. Claes et al. concluded that regional anaesthesia administered at the bedside should be the method of choice for pain management during NexoBrid® procedures because it can be adequately and safely performed in all age groups [40]. The authors presented a flow chart to guide pain management during a NexoBrid® procedure. Galeiras at al. developed a moderate U-type analgosedation strategy to ensure effective pain management during the application, treatment, and removal of NexoBrid® as an alternative to local/regional anesthesia [36].
Diagnostic vocal fold injection as an intervention for secondary muscle tension dysphonia
Published in Hearing, Balance and Communication, 2021
Christopher D. Dwyer, Thomas L. Carroll
Vocal fold injection augmentation, also known as injection laryngoplasty, is a surgical procedure whereby a biocompatible material is injected into the deep vocal fold muscle or paraglottic space to augment the vocal fold mass and medialize the vibratory edge. Duration of augmentation benefit varies across materials. The procedure itself can be performed in the awake setting or under general anaesthesia. Various injection techniques exist, including percutaneous, per-oral and trans-nasal approaches. The cited complication rates are quite low [26,27]. Augmentation of the vocal fold is a tried-and-true approach to addressing glottic insuffiency, most notably in cases of vocal fold paralysis. There is a subset of patients, however, where the outcome of augmentation alone is less predictable or certain, as is the case for many secondary muscle tension dysphonia patients. For these patients, a ‘diagnostic’ vocal fold injection (VFI) is worthwhile.