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Management of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Optimising the nasal cavity for an endoscopic approach is an important first step. The patient is catheterised to enable monitoring of fluid balance, broad-spectrum antibiotics are given, and the nose is decongested. The abdomen may be prepared for the harvest of fat and rectus abdominis fascia; in addition, the right thigh can be prepared for fat and fascia lata harvest if the potential defect is larger. The patient should be in reverse Trendelenburg position. Image guidance should be set up.
Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
The patient is placed in the Trendelenburg position. The surgeon and assistant stand at the head of the operating table, and the monitor is placed at the foot of the table. A 3 mm trocar is placed through an umbilical incision and the abdomen is insufflated with CO2 to 5–8 mmHg pressure. Under telescopic vision, two 2 mm ports are placed superior and medial to the anterior superior iliac spine.
Prediction and Management of Ovarian Hyperstimulation Syndrome
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Mohamed A. Youssef, Abdel Maguid Ramzy, Botros Rizk
Surgery is infrequently needed, but if required, there are several aspects important for the anesthesiologist (Table 15.2). Careful positioning of patients during surgery is important because the Trendelenburg position may further compromise the residual pulmonary function capacity. Establishment of access lines may be necessary in patients with contracted vascular volume. Drainage of pleural effusions may assist in improving pulmonary status [89]. Laparotomy, in general, should be avoided in OHSS. If deemed necessary, in cases of hemorrhage or ruptured ovarian cysts or abdominal compartment syndrome (ACS), it should be performed by an experienced gynecologist, and only hemostatic measures should be undertaken to preserve the ovaries [90, 91].
A New Rabbit Model of Chronic Dry Eye Disease Induced by Complete Surgical Dacryoadenectomy
Published in Current Eye Research, 2019
Robert Honkanen, Wei Huang, Liqun Huang, Kevin Kaplowitz, Sarah Weissbart, Basil Rigas
Figure 2 shows the surgical steps. All fur is first removed using shears and Nair® to make more obvious the contours of the LGs. Surgery is performed under general anesthesia with Xylazine/Ketamine induction and maintenance with isoflurane, using an R3 V-gel (Docsinnovent/Jorgensen Laboratories, Loveland CO) to maintain the airway. Respiration, heart rate, respiratory tidal volume, and arterial oxygen saturation are monitored throughout the procedure. Animals are kept on a heating pad to prevent hypothermia. A reverse Trendelenburg position is maintained to lessen the chance for excessive bleeding. Surgical incisions are identified and marked with a pen. The anterior portion of the ILG appears as a protuberance in the skin under the anterior portion of the eye. The OSLG location is identified by gently applying medial pressure to the globe and looking for the area on the skull which bulges, typically in line with the posterior (lateral) canthus and about 1 cm medial to the bony edge of the superior orbital rim. The periorbital area, scalp, and globe are prepped with a 10% povidone-iodine solution diluted to half strength with normal saline and then draped to maintain a sterile field.
The Effects of Positive End-Expiratory Pressure at Different Levels on Postoperative Respiration Parameters in Patients Undergoing Laparoscopic Cholecystectomy
Published in Journal of Investigative Surgery, 2018
Bahadır Ciftci, Mehmet Aksoy, Ilker Ince, Ali Ahıskalıoglu, Elif Yılmazel Ucar
Laparoscopic cholecystectomy provides some advantages compared to open cholecystectomy. Some of the advantages are minimal incision requirements, shortening the length of hospital stay, leading to less pain after the operation, enabling early mobilization and reducing postoperative morbidity [1, 2]. However, gas insufflation into the abdomen, called pneumoperitoneum, leads to the pushed-up diaphragm, decreased lung capacity and impaired gas exchange. Also, trendelenburg position causes an increase in regurgitation risk, a decrease in lung compliance and an increase in airway resistance [3]. Although trendelenburg position is used temporarily in laparoscopic cholecystectomy operations for trocar insertion, hemodynamic, and respiratory changes occur due to the initial trendelenburg position, mechanical and neuroendocrine effects of pneumoperitonium, absorbed carbon dioxide volume and reverse trendelenburg position during surgery [4]. Postoperative atelectasis at 15% ratio was reported in patients underwent laparoscopic cholecystectomy [5].
Controlled hypotensive anesthesia for endoscopic endonasal repair of cerebrospinal fluid rhinorrhea: A comparison between clevidipine and esmolol: Randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2018
Midazolam 0.05mg/kg was given intravenously and patients were placed in the sitting position and lumber puncture was done under complete aseptic precautions at L3-L4 or L4-L5 interspace via a midline approach using g 22 spinal needles.0.25ml of a 10% sterile fluorescein dye was mixed with the aspirated CSF (total 10ml) then reinjected slowly into the subarachnoid space. Patients were turned to Trendelenburg position for 20–30min. Preoxygenation for 3min then general anesthesia was induced with propofol 2mg/kg, fentanyl 2mcg/kg and rocuronium 0.6mg/kg. Oral endotracheal intubation with cuffed endotracheal tube and oropharyngeal pack was inserted then mechanical ventilation was started to keep the ETCO2 30–35mmHg. Anesthesia was maintained using isoflurane 1–2%. All patients were monitored for Invasive arterial blood pressure via radial artery, oxygen saturation, ECG, temperature and Capnography.