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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC); 20130526-20130529; Düsseldorf; DOCMO.15.05 /20130521/
    Publication Date: 2013-05-22
    Keywords: Perioperative antibiotics ; electronic prescription ; postoperative infection ; ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Anästhesie ; Aortenaneurysma ; Gefäßprothese ; Stent ; Komplikationen ; Key words Anaesthesia ; Aneurysm ; aortic ; Aorta ; Prostheses ; stents ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Surgical treatment of aortic aneurysms carries significant cardiovascular risks. Transvascular insertion of endoluminal prostheses is a new, minimally invasive treatment for aortic aneurysms. The pathophysiology of this novel procedure, risks and benefits of different anaesthetic techniques, and typical complications need to be defined. Methods. With their informed, written consent, 19 male patients aged 48–83 years of ASA physical status III and IV with infrarenal (n=18) or thoracic (n=1) aortic aneurysms underwent 23 stenting procedures under general endotracheal (n=9), epidural (n=8), or local anaesthesia with sedation (n=6). Intra-anaesthetic haemodynamics, indicators of postoperative (p.o.) oxygenation and systemic inflammatory response, and perioperative complications were analysed retrospectively and compared between anaesthetic regimens. Results. Groups were well matched with regard to morphometry and preoperative risk profiles (Table 1). The use of pulmonary artery pressure monitoring, incidence of intraoperative hypotensive episodes, and p.o. intensive care was more frequent with general anaesthesia. Groups did not differ in total duration of anaesthesia care, incidence and duration of intraoperative hypertensive, brady-, or tachycardic periods, incidence of arterial oxygen desaturation, use of vasopressors, colloid volume replacements, or antihypertensives (Table 2). Postoperatively, all groups showed a similar, significant systemic inflammatory response, i.e., rapidly spiking temperature (p.o. evening: mean peak 38.5±1.0° C), leucocytosis, and rise of acute-phase proteins without bacteraemia (Table 3). During this period, despite supplemental oxygen, pulse oximetry revealed temporary arterial desaturation in 13 of 18 patients (70%) (Table 3). In 3 patients, hyperpyrexia was associated with intermittent tachyarrhythmias (n=3) and angina pectoris (n=1). There was no conversion to open aortic surgery, perioperative myocardial infarction, or death. Conclusions. Regional and local anaesthesia with sedation are feasible alternatives to general endotracheal anaesthesia for minimally invasive treatment of aortic aneurysms by endovascular stenting. However, invasive monitoring and close postoperative monitoring are strongly recommended with either method. Specific perioperative risks in patients with limited cardiovascular or pulmonary reserve are introduced by the abacterial systemic inflammatory response to aortic stent implantation. Hyperpyrexia increases myocardial and whole-body oxygen consumption, and can precipitate tachyarrhythmias. Hyperfibrinogenaemia may increase the risk of postoperative arterial and venous thromboses. Close monitoring of vital parameters and prophylactic measures, including oxygen supplementation, low-dose anticoagulation, antipyretics, and fluid replacement are warranted until this syndrome resolves.
    Notes: Zusammenfassung Die transvaskuläre Plazierung endoluminaler Gefäßprothesen mittels interventionell-radiologischer Methoden ist ein neues, minimal invasives Verfahren zur Therapie von Aortenaneurysmen. Wir analysierten retrospektiv die Praktikabilität verschiedener Anästhesieverfahren, die pathophysiologischen Auswirkungen des Eingriffs und typische Risiken. Bei 19 Patienten mit Aneurysmen der infrarenalen (n=18) oder der thorakalen Aorta (n=1) wurden in 23 Eingriffen aortale Stentprothesen implantiert. Die Eingriffe erfolgten in Allgemeinanästhesie (AA: n=9), in Periduralanästhesie (PDA: n=8) oder Lokalanästhesie (LA: n=6) mit Analgosedierung. Trotz erhöhten Überwachungsaufwands in der Gruppe AA ergaben sich keine Unterschiede in folgenden Parametern: Inzidenz und Dauer intraoperativer hypertensiver, brady- oder tachykarder Phasen; Einsatz von Vasopressoren, Antihypertensiva oder Volumenersatz. Hypotensive Episoden waren bei Allgemeinanästhesien häufiger. Postoperativ zeigten alle Patienten Anstiege der Körpertemperatur sowie laborchemischer Entzündungsparameter. Vom Anästhesieverfahren abhängige Unterschiede im Verlauf der Entzündungsreaktion waren nicht erkennbar. 13 von 18 Patienten zeigten passagere arterielle Desaturationen zwischen 83% und 95%. In 3 Fällen gingen Temperaturanstiege mit kardialen Komplikationen (Tachyarrhythmien, Stenokardie) einher. Perioperative Myokardinfarkte oder Todesfälle traten nicht auf. Zur endovaskulären Therapie ausgewählter Aortenaneurysmen sind neben der Allgemeinanästhesie auch die Regional- oder die Lokalanästhesie mit Analgosedierung praktikable, sichere Verfahren, sofern invasives Monitoring und engmaschige postoperative Überwachung gewährleistet sind. Die eingriffstypische abakterielle Entzündungsreaktion stellt für kardiopulmonal vorgeschädigte Patienten ein Risiko dar.
    Type of Medium: Electronic Resource
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