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Complications of open thoracoabdominal aortic aneurysm repair
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Patient body temperature must be considered throughout the operation. While mild permissive hypothermia is beneficial, care should be taken to avoid a run-away state where rewarming becomes incredibly challenging. This is particularly important during clamp-and-sew or passive shunting cases where the warmer from a mechanical circulatory support circuit is not available. In these cases, warmed blood transfusion with a Belmont device is very useful. An underbody Bair hugger in addition to raising the operative theater's room temperature can also help with a patient's hypothermia, though the Bair hugger must be turned off prior to cross clamping in order to avoid thermal burns if no distal perfusion is maintained. Finally, an eye toward appropriate calcium repletion is crucial as the citrate in stored blood will bind and reduce serum calcium levels, which are necessary for appropriate clotting factor function.
Case 83: Shivering at the Station
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
The patient was warmed to 34°C using a Bair hugger. Intravenous sodium bicarbonate was given until the base excess reached −3. Insulin and dextrose treatment helped to correct the hyperkalaemia. Intravenous co-amoxiclav was commenced for possible sepsis of unknown source. Intravenous pabrinex was started for possible alcohol misuse. She was admitted directly to the high dependency unit.
Single-lung transplantation: Technical aspects
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Christopher Wigfield, Wickii T. Vigneswaran
Once a donor has been verified and a lung has been deemed suitable for transplantation, the recipient is brought into the operating room for transplantation. We prefer to place a thoracic epidural before the transplantation procedure unless cardiopulmonary bypass and full systemic anticoagulation are expected. General anesthesia is provided, and the patient is ventilated with a double-lumen endotracheal tube. The tube’s position is verified by fiberoptic bronchoscopy. Arterial and venous access lines, including a Swan-Ganz catheter, are placed. At this stage we also insert a transesophageal echocardiography (TEE) probe. The patient is placed in a lateral decubitus position for an anterolateral thoracotomy or in a semilateral position if a limited submammary incision is planned. An axillary roll should be placed under the axilla of the dependent arm to prevent injuries to the brachial plexus. A body-warming device (Bair Hugger) is used for the lower part of the body. The chest, abdomen, and groin are exposed, and the field is prepared with antiseptic solution and draped in sterile fashion (in case cardiopulmonary bypass via femoral access is needed). It is helpful to insert a femoral arterial line for a later Seldinger approach in this position if the need for extracorporeal support appears to be likely.
Efficacy of an organophosphorus hydrolase enzyme (OpdA) in human serum and minipig models of organophosphorus insecticide poisoning
Published in Clinical Toxicology, 2020
Michael Eddleston, R. Eddie Clutton, Matthew Taylor, Adrian Thompson, Franz Worek, Harald John, Horst Thiermann, Colin Scott
Inspired and expired carbon dioxide, oxygen and isoflurane concentrations were monitored. Heart rate, oesophageal and peripheral temperature, electrocardiogram, and percentage of saturated haemoglobin were recorded (Datex, Clearwater, FL). The temperature was maintained as close to physiological values as possible by the use of forced warm air blankets (Bair Hugger, Arizant, Wakefield, UK), heat pads and high ambient temperature. Ten millilitre per kilogram per hour Ringer’s lactate solution was administered for the first 30 min after induction of anaesthesia and then at 5 ml/kg/h for the remainder of the study. Fluid administration was increased as necessary to maintain urine output and optimize central venous pressure.
Perioperative effects of desflurane versus propofol on hemostasis guided by thromboelastometry in splenectomy with liver cirrhosis
Published in Egyptian Journal of Anaesthesia, 2019
Hanan F. Khafagy, Yasser M. Samhan, Reeham S. Ebied, Shaimaa S. Abd El-Ghany, Omar M. Sabry, Nadia A. Hussein, Randa I. Badawy, Nashwa N. Talaat, Ahmed H. Helmy, Gehan G. El-Fandy
All patients were premedicated with i.v. midazolam 0.02–0.04 mg/kg. In the operating room, continuous ECG, non-invasive arterial blood pressure, pulse oximetry, PETCO2, end-tidal anesthetic agent, neuromuscular monitoring and core temperature (Infinity Kappa, Dräger, Lübeck, Germany) were monitored throughout the operation. Bispectral index (BIS) for monitoring the anesthetic depth was applied. Patient’s temperature was controlled by a warm air blanket (Bair Hugger) as well as warming of all IV fluids given at a rate of 5–7 ml/kg/h acetated Ringer's solution. A computer generated list randomly allocated the patients to one of two equal groups of 15 patients each according to maintenance of anesthesia:
Acute vesicular eruption postoperatively after use of a forced-air warming device
Published in Baylor University Medical Center Proceedings, 2021
Brett Austin, Brooke Walterscheid, Michelle Tarbox
Intraoperatively, a Bair Hugger warming device had been applied to the full body. Upon examination, the linear pattern and spacing of the vesicles and erythema correlated with manufactured warm air exit perforations in the Bair Hugger device. Intraoperative documentation showed the Bair Hugger air device was used at a high setting (44°C) for approximately the first half hour, after which the patient was found to be warm with a core temperature of 39°C and the device was shut off for the duration of the surgery. No erythema was appreciated by the surgical team at that time.