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Management of vascular complications during nonvascular operations
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kush Sharma, M. Ashraf Mansour
Initial access to the abdomen with a needle (Veress) or trocar is usually blind, as the course of entry cannot be observed with the laparoscope. Safe and effective management of a major vessel injury starts with early recognition. The most likely signs of injury to a major vessel are immediate hemoperitoneum or poor visualization of the peritoneal cavity due to blood that cannot be attributed to bleeding from anterior abdominal wall.26 Hemodynamic changes from bleeding would first be seen in the form of sinus tachycardia. When bleeding is present, any degree of insufflation can result in a possible gas embolism.26 When this is suspected, the anesthesiologist should be alerted. It is possible with a venous injury that the gas used for insufflation gains access to the central circulation causing an “air lock” and preventing blood from circulating to the lungs.28 If this occurs, it can cause sudden severe hypotension. With “Durant's maneuver,” the patient is placed in the left lateral decubitus position in an attempt to displace the air bubble away from the pulmonary circulation.28
Principles of thoracic surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Shaun M. Kunisaki, James D. Geiger
Following the administration of general anesthesia, tracheal intubation can be sufficient for many open and minimally invasive procedures, such as thoracoscopic pulmonary decortication, because of the relatively easy visualization of the pleural space following collapse of the ipsilateral lung with carbon dioxide insufflation. In these situations, having the anesthesiologist ventilate with smaller tidal volumes, lower peak pressures, and high respiratory rates can sometimes further enhance exposure.
Endoscopic Component Separation
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Once the initial plane has been developed with balloon dissection, the balloon is deflated and removed and a 10 mm balloon tip trocar inserted through the same wound as the port for the laparoscope. The insufflation tubing is attached and the working space inflated to 12 mm Hg pressure. Only one 5 mm instrument port is required which is introduced approximately 4 cm lateral to the camera port under vision. It is important that this port enters the working space within the abdominal wall and does not pass posteriorly into the abdomen where it would risk injury to the hepatic flexure, liver and kidney on the right and spleen and splenic flexure on the left.
Diaphragm pacing using the minimally invasive cervical approach
Published in The Journal of Spinal Cord Medicine, 2023
Don B. Headley, Antonio G. Martins, Kevin J. McShane, David A. Grossblat
Most intra-abdominal surgeries are performed with general endotracheal anesthesia and positive pressure ventilation.13 This allows the use of neuromuscular blockade and relaxes the abdominal musculature and diaphragm resulting in more favorable surgical conditions. The use of neuromuscular blockade and subsequent reversal adds to the polypharmacy of the anesthetic and increases the risk of allergic reaction14 and the potential for variable15 and residual weakness.16,17 Insufflation of the abdomen with carbon dioxide has potential hemodynamic and pulmonary consequences.13,18 Most intrathoracic surgeries are also performed with general endotracheal anesthesia.19 An arterial catheter is commonly placed in addition to standard American Society of Anesthesia monitors in order to achieve real time hemodynamic monitoring due to the proximity of the heart and great vessels in the thorax. At times, lung isolation would facilitate a more favorable surgical field and a double lumen endotracheal tube or bronchial blocker is utilized.20 These techniques can be technically challenging and increase the risks of airway trauma as well as pulmonary complications including atelectasis, pneumothorax, hypoxemia, and barotrauma.20,21 Therefore, in a patient without aspiration precautions and normal spontaneous respiratory function, sedation can be utilized in the cervical approach as the surgical stimulation is less intense when the abdomen and thorax are not entered.
Oral, intranasal, and intravenous abuse potential of serdexmethylphenidate, a novel prodrug of d-methylphenidate
Published in Current Medical Research and Opinion, 2022
Megan J. Shram, Beatrice Setnik, Lynn Webster, Sven Guenther, Travis C. Mickle, Rene Braeckman, Jaroslaw Kanski, Andrea Martin, Debra Kelsh, Bradley D. Vince, Andrew C. Barrett
Visual Analog Scale (VAS) assessments recommended for use in human abuse potential studies were scored on a 0–100-point scale30. These assessments included both “at-the-moment” effects (Drug Liking, Feeling High, Good Effects, Bad Effects, Any Effects, and Drowsiness/Alertness) and retrospectively assessed endpoints that measure the overall balance of drug effects (Take Drug Again and Overall Drug Liking), assessed on bipolar or unipolar scales. For the primary efficacy assessment, Drug Liking VAS, subjects responded to the question, “At this moment, my liking for the drug is?,” with 0 = strong disliking, 50 = neither like nor dislike, and 100 = strong liking. The Addiction Research Center Inventory measures (ARCI-Amphetamine [ARCI-A] and ARCI-Benzedrine Group [ARCI-BG]) scales were also assessed32. The ARCI-A questionnaire assesses stimulant effects, and the ARCI-BG questionnaire assesses energy and intellectual efficiency. Subjects answered True or False to a series of 19 questions that assess stimulant-like effects. Scores from several questions were used in both the ARCI-A and ARCI-BG subscales (11 questions for ARCI-A; 13 questions for ARCI-BG). The maximum score is 11 for ARCI-A and 13 for ARCI-BG, with higher scores indicating higher subjective effects. For the study of IN administration (Study 2), subject-reported ease of nasal insufflation was assessed within 5 min after IN drug administration during the Treatment Phase. The question was scored using a 0–100-point unipolar VAS anchored with “Very Easy” (score of 0) to “Very Difficult” (score of 100).
Feasibility of salvage colonoscopy by water exchange for failed air-insufflated patients: a prospective, randomized, controlled trial
Published in Scandinavian Journal of Gastroenterology, 2022
Mo Wang, Hai-Tao Shi, Xin-Xing Tantai, Lei Dong, Shi-Yang Ma
Colonoscopy is the most important examination for screening colon disease. Timely detection of intestinal polyps and premalignant neoplasms greatly improves the survival rate and life quality of patients. However, colonoscopy is an invasive operation, which brings pain, anxiety, and even fear to the patients. The painful experience reduces compliance of patients. Studies have shown that the intolerable pain caused by endoscopy sliding through complex anatomy leads to 16–56% failed cecal intubation [15,16]. Both unwillingness to repeat colonoscopy and incomplete colonoscopy lead to missed lesions and loss of best treatment opportunity. Therefore, safety, comfort and painless colonoscopy becomes important. Sedated colonoscopy causes less or no pain, but is costly and has potential safety issue. Currently in China most cases of colonoscopy have been performed without sedation. Water-assisted colonoscopy was characterized by infusion of water as an adjunct of air insufflation to facilitate insertion to the cecum. Depending on the difference in the timing of water removal, water-aided colonoscopy was categorized as water immersion (WI) and water exchange (WE) [12]. Removal of infused water predominantly during withdrawal is a key feature of WI. WE is modified from WI, whereby infused water is removed predominantly during insertion so that the procedure is carried out in gasless colon with maximized cleanness [17]. Numerous attempts and research by endoscopists all over the world have gradually recognized that WE colonoscopy has huge advantages over traditional air insufflation colonoscopy.