Emergency procedures
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The patient is prepared, anaesthetized and positioned with the neck extended and rotated to the contralateral side. Where the neck has already been accessed for another procedure, such as a neck dissection, this approach is used. In non-oncology cases, rapid access is best achieved with a 5-cm incision along the anterior border of sternomastoid. Dissection through the subcutaneous fat and platysma exposes the muscle. The deep cervical fascia investing ster- nomastoid is divided, the muscle retracted posteriorly and the internal jugular vein is exposed. The jugular vein is mobilized by dissecting the carotid sheath and freeing the vein superiorly and inferiorly. The common carotid artery will be seen medially (see Figure 16.11). At this point the anaesthetist should be warned as manipulation of the carotid bulb at the bifurcation may cause cardiac dysrhythmias.
Cardiovascular system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
The thoracic aorta commences at the aortic valve and passes into the abdomen by passing through the diaphragmatic hiatus at the level of the T12 vertebral body. It is divided into the ascending aorta, aortic arch and descending aorta. Major vessels arise from the ascending aorta and arch. The right and left coronary arteries arise from the root of the ascending aorta close to the aortic valve cusps. The aortic arch gives rise to three large vessels that supply the head and neck region and the upper limbs: the brachiocephalic artery (also known as the brachiocephalic trunk or innominate artery), the left common carotid artery and the left subclavian artery. The brachiocephalic artery divides and give rise to the right common carotid and right subclavian arteries. Each common carotid artery divides into the internal and external carotid arteries. The vertebral artery arises as the first branch of the subclavian artery on each side. The subclavian artery passes laterally to continue as the axillary artery at the lateral border of the first rib. The axillary artery continues down the arm and at the inferior margin of the teres major muscle it becomes the brachial artery. At the cubital fossa the brachial artery divides into the radial and ulnar arteries, which continue down the forearm to the hand.
Extracorporeal membrane oxygenation
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
For venoarterial bypass, the arterial cannula is chosen (usually 10 Fr) and marked with a 2/0 silk ligature, left uncut, at a point that will allow the tip of the cannula to lie at the ostium of the brachiocephalic artery (about 2.5 cm). The venous cannula (usually 12−14 Fr) is similarly marked at a point equal to the distance from the venotomy to the right atrium (roughly 6 cm). An obturator is placed into the venous cannula to prevent blood from flowing out through the side holes during introduction into the vessel. The common carotid artery is ligated distally (Figure 14.5). Proximal control is obtained with the use of an angled ductus clamp. A transverse arteriotomy is made near the distal ligature. Full-thickness stay sutures of 6/0 polypropylene are placed on the proximal edge of the artery to prevent subintimal dissection during cannula insertion. Following arterial cannulation, a venotomy is performed in similar fashion. Gentle retraction of the caudal ligature around the vein precludes the need for a ductus clamp during venotomy and venous cannulation. Stay sutures can also aid venous cannulation but can be used selectively.
Diet-induced obesity attenuates the hypothermic response to lipopolysaccharide independently of TNF-α production
Published in Temperature, 2020
Evilin N. Komegae, Monique T. Fonseca, Alexandre A. Steiner
One week before an experiment, the rats were chronically instrumented with an arterial (carotid) catheter and an abdominal telemetry temperature transmitter. The surgery was performed under anesthesia with inhaled isoflurane (2.0–2.5%) and antibiotic prophylaxis with enrofloxacin (5 mg/kg, s.c.). The rats were maintained on a heated pad during surgery. For the catheterization, the left common carotid artery was accessed via the ventral aspect of the neck, and isolated from the adjacent nerve. Using an occlusive technique, a 3-Fr polyurethane catheter was inserted into the artery at this site, and then advanced until its tip reached the descending thoracic aorta. The catheter was then passed under the skin and exteriorized at the nape, after which it was locked with heparinized glycerol (500 U/ml). The telemetry transmitter (model TA-F40; Data Sciences International, St. Paul, MN, USA) was implanted via a midline laparotomy, after which the incision site was sutured in layers. Ketoprofen (5 mg/kg, s.c.) was administered at the end of surgery and on the next day. On the first and fourth days post-surgery, the arterial catheters were flushed with 0.5 ml of saline and re-locked with heparinized glycerol 17.
Utility of the cold pressor test to predict future cardiovascular events
Published in Expert Review of Cardiovascular Therapy, 2019
Sjaak Pouwels, Michel E. Van Genderen, Herman G. Kreeftenberg, Rui Ribeiro, Chetan Parmar, Besir Topal, Alper Celik, Surendra Ugale
An important issue to address is the fact that the physiology of the CPT is not fully understood at this moment. As pointed out multiple mechanisms might be responsible for contributing to either coronary vasodilatation or coronary vasoconstriction [17,138,139]. Regarding the physiological mechanism of the CPT and its effect on the measurements of the carotid artery vasoreactivity [116,117,137] even less is known. It is thought that the carotid artery vasoreactivity test induced change in diameter of the common carotid artery is induced by a direct effect on the vascular smooth muscle (which induces vasoconstriction) and endothelial cells (production of nitric oxide, which induces vasodilatation) [137,140]. The balance of those processes is responsible for the vasoreactivity of the common carotid artery. In the presence of endothelial dysfunction, the common carotid artery will constrict or dilate as a result of a physiological stimulus (hand in cold water) [137,140].
Genistein attenuates brain damage induced by transient cerebral ischemia through up-regulation of Nrf2 expression in ovariectomized rats
Published in Neurological Research, 2018
Zhong-Yan Miao, Xu Xia, Lu Che, Yan-Tao Song
The intraluminal filament model of MCAO was used to induce transient focal cerebral ischemia as described previously (n = 30 per group) [13]. In brief, a heat-blunted 3–0 nylon suture was inserted into the right common carotid artery to obstruct the middle cerebral artery. The right external carotid artery and the common carotid artery were both simultaneously ligated. After 1.5 h of transient occlusion, cerebral blood flow was restored by removing the nylon suture for 72 h. Regional cerebral blood flow was measured via transcranial laser Doppler flowmetry (PeriFlux 5000, Perimed AB, Sweden). Rats with >80% flow reduction during the ischemic period and >70% flow recovery within the first 10 min of reperfusion were included in the study. Physiological variables monitored included rectal temperature, blood pressure, heart rate, blood gas, and glucose levels and were monitored as previously described [14]. Data are shown in Supplementary Table 1. The animals in the sham group were subjected to the same operation; however, no suture was inserted into the right common carotid artery to obstruct the middle cerebral artery. And the rats in Con, OVX, and Genistein group were all received obstruction of the middle cerebral artery.
Related Knowledge Centers
- Aortic Arch
- Brachiocephalic Artery
- Cervical Vertebrae
- External Carotid Artery
- Internal Carotid Artery
- Sternoclavicular Joint
- Thyroid Cartilage
- Blood
- Artery
- Mediastinum