Mediastinal goiters
Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner in Endocrine Surgery, 2017
The results of the surgery for substernal goiters are excellent, with a rare operative mortality. However, the risks to the recurrent laryngeal nerve and permanent hypoparathyroidism are slightly higher than in routine thyroidectomy. The extent of thyroidectomy is generally dictated by the size of the thyroid gland and the histopathology. Total thyroidectomy may be required because of the multiglandular nature of the disease and the absence of essentially normal thyroid tissue. A contralateral subtotal thyroidectomy may be considered to avoid injury to the parathyroids or recurrent laryngeal nerve. The sternoclavicular disarticulation, although described in the literature, is technically quite a difficult procedure and is not generally helpful in surgery for substernal goiter. A median sternotomy is preferred, and the need for this may be predicted by the factors discussed above.
Direct Myocardial Revascularization Sequential Grafting Techniques
Waldemar L. Olszewski in CRC Handbook of Microsurgery, 2019
The median sternotomy is the incision used for all coronary bypass operations. There is need to cannulate each vena cava and to encircle each vein with tourniquet tapes. The superior vena cava is usually cannulated via the right atrial appendage. The inferior vena cava is cannulated at the midportion of the inferior aspect of the right atrium. Arterial return of oxygenated blood is best accomplished by use of the ascending aorta just proximal to the innominate artery. This will leave adequate room for placement of the vein grafts on the aorta. A double purse-string suture and tourniquet is used to control bleeding around the aortotomy.
The Chest
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The surgical approaches in current use include: Anterolateral thoracotomy.Median sternotomy.Bilateral thoracotomy (‘clamshell’ incision).Posterolateral thoracotomy.The ‘trapdoor’ incision.
Combined liver transplantation and off-pump coronary artery bypass grafting: a report of two cases
Published in Acta Chirurgica Belgica, 2022
Tumay Uludag Yanaral, Gokhan Ertugrul, Mustafa Ozer Ulukan, Pelin Karaaslan, Ibrahim Oguz Karaca, Murat Dayangac
Cardiac surgery started with median sternotomy. The pericardium was then opened, and the greater saphenous vein was simultaneously harvested using a traditional long incision. CABG was performed on the beating heart. LAD and the circumflex artery in the first patient, and LAD and the second obtuse marginal artery in the second patient were grafted using saphenous vein graft segments with standard techniques. The reason for using saphenous vein grafts instead of internal mammary artery grafts was the occlusion of the subclavian artery in the first patient and the low-flow internal mammary artery in the second patient. Proximal anastomoses were performed on the appropriate regions of the ascending aorta using a Castaneda clamp. Heparin was neutralized with protamine at the end of OPCAB. The sternotomy incisions were left open in order to prevent shear stress to the sternum and take advantage of a larger surgical field during LT.
Chronic thromboembolic pulmonary hypertension: a review of risk factors, management and current challenges
Published in Expert Review of Cardiovascular Therapy, 2022
John E Cannon, David P Jenkins, Stephen P Hoole
The operative procedure was refined and popularized by the University of California at San Diego, and the principles remain unchanged [30]. It is performed under general anesthesia with a median sternotomy incision as for conventional cardiac surgery. Cardiopulmonary bypass is required to divert blood away from the heart and allow systemic cooling to 20C. The pulmonary arteries are opened with separate right and left arteriotomies within the pericardium and a true endarterectomy plane is developed with the vessel wall. Periods of deep hypothermic circulatory arrest, of up to 20 minutes are required to give a bloodless field for the most distal endarterectomy dissection so that all visible thrombotic material is removed up to subsegmental level. Our own research demonstrated that the circulatory arrest is well tolerated without cognitive dysfunction [31]. Any concomitant procedures can be performed during rewarming although tricuspid regurgitation is usually self-limiting and repair usually unnecessary. After systemic rewarming on bypass, patients are initially managed in intensive care for the initial 2 days after surgery.
Effects of preoperative intravenous glutamine administration on cardiac and renal functions in patients undergoing mitral valve replacement surgeries: A randomized double-blind controlled trial
Published in Egyptian Journal of Anaesthesia, 2023
Mohamed F. Mostafa, Hany Ahmad Ibrahim Elmorabaa, Mohammed Mahmoud Mostafa, Ramy Mostafa Abd El Gawad, Mohamed Ismail Seddik, Ragaa Herdan, Mostafa Hassanien Bakr, Emad Zarief Kamel
Anesthesia was maintained under isoflurane 1–2% in an oxygen-air mixture (1:1 ratio) using Datex-Ohmeda Aespire anesthesia machine (Madison WI 53707–7550 USA), infusion of fentanyl 1–2 μg/kg/h, and cisatracurium 1 μg/kg/h. Monitoring of the patient was continued as before induction and included peripheral O2 saturation (SpO2), end-tidal CO2, electrocardiogram, invasive systemic blood pressure, central venous pressure, nasopharyngeal (core) body temperature, arterial blood gases, and urine output by the Carescape B650 device (GE Healyhcare Finland Oy). Median sternotomy was performed in all patients. Intravenous heparin in a dose of 3–4 mg/kg was given after doing the piercing suture of the aorta to achieve activated clotting time more than 450 s, and protamine sulfate was used for its reversal by the end of the procedure. After confirmation of activated clotting time more than 450 s and placement of aortic and venous cannulae, the patient cardiopulmonary bypass was initiated to keep mean arterial blood pressure appropriate to the degree of hypothermia applied anesthesia was maintained during bypass period using propofol, fentanyl, and cisatracurium infusion. Custodiol HTK was delivered at 3–4°C, 20 ml/kg to a maximum of 2 L.
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