Humans ; Intraoperative Period ; Medicine ; methods ; trends ; Research

PURPOSE: Our experience of laparoscopic radical prostatectomy, for clinically localized prostate cancer, is reported. MATERIALS AND METHODS: Between July 2001 and August 2002, laparoscopic radical prostatectomy was performed on 16 patients with clinically organ confined prostate cancer. Their mean age, preoperative PSA and Gleason score for the biopsy specimens were 63.9 years old, 12.2ng/ml and 5.6, respectively. The "Montsouris" operation technique was followed, and an urethrovesical anastomosis performed with 5 to 10 interrupted sutures. RESULTS: Mean operation time and hospital stay were 347 minutes, ranging from 250 to 500, and 8.3 days, ranging from 3 to 12. Conversion to open surgery was necessary in one case due to difficulty with the urethrovesical anastomosis. Three cases needed a blood transfusion with a mean of 2.3 units. Mean postoperative period of an indwelling Foley catheter was 15.4 days (5-36). The intraoperative complications related to the operation procedures were one epigastric artery injury and two vesicle injuries. There was a positive surgical margin in five cases. The postoperative pathological evaluations comprised of 1 pT0, 5 pT2a, 3 pT2b and 7 pT3a. The PSA value decreased to less than 0.5ng/ml after the laparoscopic radical prostatectomy, with the exception of one case. CONCLUSIONS: Although the mean operation time was still longer than that of conventional open procedures, an intraoperative magnified vision allows for more precise and safer dissections and a meticulous urethrovesical anastomosis. We believe the operative time will decrease further with more experience. The perioperative morbidity with the laparoscopic radical prostatectomy was low. The continence following a laparoscopic radical prostatectomy was comparable to that after an open radical prostatectomy. These results show that a laparoscopic radical prostatectomy can be an acceptable treatment option for localized prostate cancer.
Biopsy ; Blood Transfusion ; Catheters ; Conversion to Open Surgery ; Epigastric Arteries ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Neoplasm Grading ; Operative Time ; Postoperative Period ; Prostate ; Prostatectomy* ; Prostatic Neoplasms ; Sutures

Tracheal intubation is associated with a number of complications. Because most complications are immediately noticeable, once recognized they can be readily treated. However, every once in a while, problems associated with intubation appear at a time distant to the intubation itself. Subcutaneous emphysema can occur as a result of trauma, surgery, and anesthesia. This is a case study conceming a difficult tracheal intubation which led to an extensive subcutaneous emphysema developed during the intraoperative period. However, the emphysema subsided spontaneously without any complications postoperatively. The patient went home in good condition on the 7th postoperative day.
Anesthesia ; Emphysema ; Humans ; Intraoperative Period ; Intubation* ; Subcutaneous Emphysema*

BACKGROUND: The effectiveness of preemptive analgesia is still controversial. This study was designed to compare the effects of nalbuphine used in the pre-anesthesia period and after surgery for pain control when performing adenoidectomy or tonsillectomy in children. METHODS: Two hundreds four patients (aged 3 to 12 years) were randomly allocated into two groups: the preemptive group (group P, n = 98) and the intraoperative group (group I, n = 106). Nalbuphine 0.1 mg/kg was administered into the patients before induction of anesthesia in group P and it was injected at least 10 minutes after the beginning of surgery in group I. The anesthesia was performed in the conventional fashion. The pain score, the sedation score and the agitation score were checked and recorded in the postanesthetic room (PAR) at arrival (0), at 15 minutes and at 30 minutes. RESULTS: The pain scores for PAR 0, 15 and 30 minutes were significantly lower in group I than those in group P. The other sedation scores or agitation scores were similar in both groups. CONCLUSIONS: Nalbuphine used during the pre-anesthetic period was less effective than that used in the intraoperative period for pain control when performing adenoidectomy or tonsillectomy in children.
Adenoidectomy ; Analgesia ; Anesthesia ; Child ; Dihydroergotamine ; Humans ; Intraoperative Period ; Nalbuphine ; Tonsillectomy

Thoracic epidural analgesia is the most effective method of managing post-thoracotomy pain. However, the catheter may be misplaced into the intrapleural, intercostal, subarachnoid, or intravascular space. Intravascular misplacement of a catheter can be detected by aspiration of blood or administration of a test dose of local anesthetic; however, these methods may result in a false-negative response. Moreover, a catheter placed in the epidural space may migrate into a blood vessel during the intraoperative period. Thus, the location of the catheter tip should always be determined before local anesthetic is administered. We report a case of intraoperative intravascular migration of a thoracic epidural catheter in a 32-year-old male who underwent left thoracotomy.
Analgesia, Epidural ; Blood Vessels ; Catheters ; Epidural Space ; Glycosaminoglycans ; Humans ; Intraoperative Complications ; Intraoperative Period ; Male ; Punctures ; Thoracotomy

BACKGROUND: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. METHODS: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. RESULTS: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). CONCLUSION: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.
Catheters ; Chemotherapy, Adjuvant ; Drug Therapy ; Education ; Humans ; Intraoperative Complications ; Intraoperative Period ; Postoperative Complications ; Postoperative Period ; Retrospective Studies* ; Risk Factors

Radiotherapy, surgery and chemotherapy are the main treatments for cancer. Though intraoperative radiotherapy(IORT) for rectal cancer is still at its preliminary stage in China, patients can get more benefits from IORT than pre- or post-operative radiotherapy. IORT improves local control for locally advanced rectal cancer and improves overall survival rate of locally recurrent rectal cancer. In general, IORT is safe and feasible. It will be widely used for patients with rectal cancer in the future.
China ; Combined Modality Therapy ; Humans ; Intraoperative Period ; Postoperative Period ; Rectal Neoplasms ; radiotherapy ; surgery ; Survival Rate

OBJECTIVETo investigate perioperative patterns of melatonin and cortisol secretion rhyme in patients undergoing coronary artery bypass grafting surgery.

METHODSEleven male patients scheduled for elective coronary artery bypass grafting surgery (CABG) under hypothermic cardiopulmonary bypass (CPB) were enrolled in the study. Anesthesia was induced and maintained with propofol (3 mg.kg-1.h-1) and supplemented with fentanyl (15 micrograms/kg). Blood samples were taken during surgery at specific time-points and every 3 h in the immediate postoperative period and postoperative day 2 and day 3. Plasma melatonin and cortisol levels were measured by radioimmunoassay and enzyme-linked immunosorbent assay respectively.

RESULTSDuring surgery, plasma melatonin levels were below the minimum sensitivity level but low levels, without circadian variation, were measured during the immediate postoperative period. During postoperative day 2 and day 3, circadian secretion patterns of melatonin were present in 10 patients and showed an inverse correlation with light intensity exposed (r = -0.480, P = 0.01). Plasma cortisol levels in the immediate postoperative period were significantly higher than those before induction of anesthesia (P < 0.01). During postoperative day 2 and day 3, only 3 patients regained circadian secretion of cortisol.

CONCLUSIONSIt is concluded that melatonin and cortisol secretion are disrupted during cardiac surgery and in the immediate postoperative period.

Cardiopulmonary Bypass ; Circadian Rhythm ; Coronary Artery Bypass ; Coronary Disease ; physiopathology ; surgery ; Humans ; Hydrocortisone ; secretion ; Intraoperative Period ; Male ; Melatonin ; secretion ; Middle Aged ; Monitoring, Intraoperative ; Postoperative Period

Between May, 1994 and December, 1995, 122 adult cardiac surgical procedures requiring cardiopulmonary bypass were performed at Kang Dong Sacred Heart Hospital, including 18 cases(14.8%) that were associated with preoperative(n=9), intraoperative(n=7), postoperative(n=2) use of an IABP(intra-aortic balloon pump). The reasons for IABP were low cardiac output and PTCA(percutaneous transluminal coronary angioplasty) failure in preoperative period, CPB(cardiopulmonary bypass) weaning difficulty in intraoperative period, and intractable arrhythmia in postoperative period. The mean age of the IABP patients was 61.8+/-6.9 years(range, 39 to 75years). The overall hospital mortalities in patients with preoperative and intraoperative IABP insertion were 33.3 and 42.9% respectively. Two patients with postoperative IABP insertion are alive. The rate of IABP weaning is 66.7% for preoperative group, 85.7% for intraoperative group and 100% for postoperative group. In conclusion, if there were no irreversible myocardial damages, IABP could be used safely and emergently at any perioperative period for hemodynamic stability, CPB weaning, and to overcome low cardiac output syndrome.
Adult ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Heart ; Hemodynamics ; Hospital Mortality ; Humans ; Intraoperative Period ; Perioperative Period ; Postoperative Period ; Preoperative Period ; Thoracic Surgery* ; Weaning

BACKGROUND: There is a high incidence of thromboembolism after major orthopedic surgery. However, more perioperative thromboembolic complications are expected after orthopedic surgery in geriatric patients due to the more offensive therapeutic measures and the increasing number of such patients with multimorbidity. Therefore it is important to investigate the perioperative blood coagulation status in detail. METHODS: Forty-five patients who were over 65 years old and scheduled for major orthopedic surgery were enrolled in this study. Patients with preoperative coagulation abnormalities, or receiving anticoagulants or antiplatelet medications were excluded. Preoperative thromboelastography (TEG), intraoperative TEG after blood loss equaling approximately 10% of the estimated blood volume, and postoperative TEG at the recovery room were measured and compared. RESULTS: During the operation, the R time and coagulation time (r + k) showed significant decreases, whereas the alpha angle, maximum amplitude (MA) and TEG index increased significantly (P < 0.05), indicating increased coagulability. The A60, CL30 and CL60 also increased, indicating decreased fibrinolysis (P < 0.05). These hypercoagulable findings were relieved after surgery to levels similar to those observed preoperatively. CONCLUSIONS: The intraoperative coagulability increased compared with the preoperative and postoperative period according to the TEG. This means that the intraoperative period is the period of most susceptibility to thromboembolic complications.
Aged* ; Anticoagulants ; Blood Coagulation ; Blood Volume ; Fibrinolysis ; Humans ; Incidence ; Intraoperative Period ; Orthopedics* ; Postoperative Period ; Recovery Room ; Thrombelastography ; Thromboembolism