Anesthesia Modifiers
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Vantage Total Ankle Replacement
Total Ankle Replacement Find out why the Exactech Ankle may be right for you. UNDERSTANDING ANKLE REPLACEMENT This brochure offers a brief overview of ankle anatomy, arthritis and ankle replacement. This information is for educational purposes only and is not intended to replace the expert guidance of your physician. Please direct any questions or concerns you may have to your doctor. 02 ANKLE ARTHRITIS YOUR ANKLE Your ankle is made up of a variety of bones, ligaments, tendons and cartilage that connect at the junction of your leg and foot. The joint works like a hinge and is responsible for moving your foot up and down. The tibia (shinbone), talus and fibula (smaller bone in the lower leg) are the bones that construct the ankle joint. Your ligaments border these bones on either side, holding them together to provide stability. Meanwhile the tendons connect the muscles to the bone and are responsible for the ankle and toe movements. Covering your bones is a smooth substance called cartilage, which acts as a cushion to reduce the friction between your bones as they move. If your cartilage wears down, arthritis can develop and cause loss of motion and pain. TIBIA FIBULA TALUS CALCANEUS METATARSAL V 03 ARTHRITIC ANKLE HEALTHY ANKLE Nearly half of individuals over the age of 60 have foot or ankle arthritis. 04 ARTHRITIS Nearly half of individuals over the age of 60 have foot or ankle arthritis that may not cause symptoms.1 However, for those suffering from ankle arthritis pain the most reported causes are:2 • Rheumatoid arthritis - It is an autoimmune disease that attacks multiple joints and typically starts in the hands and feet. -
Airway Obstruction After Biopsy by Cervical Mediastinoscopy in a Patient with a Mediastinal Mass -A Case Report
Korean J Anesthesiol 2012 July 63(1): 65-67 Case Report http://dx.doi.org/10.4097/kjae.2012.63.1.65 Airway obstruction after biopsy by cervical mediastinoscopy in a patient with a mediastinal mass -A case report- Yong-Cheol Lee2, Sang-Jin Park1, and In-seong Kim1 Department of Anesthesiology and Pain Medicine, 1College of Medicine, Yeungnam University, 2School of Medicine, Keimyung University, Daegu, Korea Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure, it may cause compression of vital structures such as major airways, the heart, the pulmonary artery, and the superior vena cava after surgery. We observed a case of a 66-year-old man with a mediastinal mass that caused severe airway obstruction during recovery from anesthesia following mediastinoscopic biopsy, probably caused by upper airway edema which seemed to originate from compression of the superior vena cava. Therefore, we suggest that unexpected airway obstruction in a patient with a mediastinal mass can be due to superior vena cava compression. (Korean J Anesthesiol 2012; 63: 65-67) Key Words: Airway obstruction, Mediastinoscopy, Superior vena cava. Biopsies, using mediastinoscopy are commonly utilized Case Report to decide on the treatment of mediastinal masses. However, since the mass is not removed during the biopsy, it may cause A 66-year-old man visited the hospital with a one month compression of vital structures after the procedure [1]. The history of chest discomfort and sporadic swelling in the face superior vena cava has an especially low intravascular pressure and arms in the morning. -
Laparoscopy in Emergency Hernia Repair
Review Article Page 1 of 11 Laparoscopy in emergency hernia repair George P.C. Yang Department of Surgery, Hong Kong Adventist Hospital, Hong Kong, China Correspondence to: George Pei Cheung Yang, FRACS. Department of Surgery, Hong Kong Adventist Hospital, 40 Stubbs Road, Hong Kong, China. Email: [email protected]. Abstract: Minimal access surgery (MAS) or laparoscopic surgery has revolutionized our surgical world since its introduction in the 1980s. Its benefits of faster recovery, lesser wound pain which in turn reduced respiratory complications, allows earlier mobilization, minimize deep vein thrombosis, minimize wound infection rate are well reported and accepted. It also has significant long-term benefits which are often neglected by many, such as reduced risk of incisional hernia and lesser risk of intestinal obstruction from post-operative bowel adhesion. The continuous development and improvement in laparoscopic equipment and instruments, together with the better understanding of laparoscopic anatomy and refinement of laparoscopic surgical techniques, has enable laparoscopic surgery to evolve further. The evolution allows its application to include not only elective conditions, but also emergency surgical conditions. Performing laparoscopy and laparoscopic procedure under surgical emergencies require extra cautions. These procedures should be performed by expert in these fields together with experienced supporting staffs and the availability of appropriate equipment and instruments. Laparoscopic management for emergency groin hernia conditions has been reported by centers expert in laparoscopic hernia surgery. However, laparoscopy in emergency hernia repair includes a wide variety of meanings. Often in the different reports series one will see different meanings for laparoscopic repair and open conversion when reading in details. -
Update in Anaesthesia
Update in Anaesthesia Pulmonary Function Tests and Assessment for Lung Resection David Portch*, Bruce McCormick *Correspondence Email: [email protected] INTRODUCTION Summary respectively. There are 2400 lobectomies and 500 The aim of this article is to describe the tests available This article describes the for the assessment of patients presenting for lung pneumonectomies performed in the UK each year, steps taken to evaluate resection. The individual tests are explained and we with in-hospital mortality 2-4% for lobectomy and patients’ fitness for lung 4 describe how patients may progress through a series of 6-8% for pneumonectomy. resection surgery. Examples tests to identify those amenable to lung resection. Lung resection is most frequently performed to treat are used to demonstrate interpretation of these tests. Pulmonary function testing is a vital part of the non-small cell lung cancer. This major surgery places It is vital to use these tests in assessment process for thoracic surgery. However, large metabolic demands on patients, increasing conjunction with a thorough for other types of surgery there is no evidence postoperative oxygen consumption by up to 50%. history and examination that spirometry is more effective than history and Patients presenting for lung resection are often high in order to achieve an examination in predicting postoperative pulmonary risk due to a combination of their age (median age accurate assessment of each complications in patients with known chronic lung is 70 years)5 and co-morbidities. Since non-surgical patient’s level of function. conditions. Furthermore specific spirometric values mortality approaches 100%, a thorough assessment of Much of this assessment (e.g. -
Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: Lessons Learned from 3,100 Hernia Repairs Over 15 Years
Surg Endosc (2009) 23:482–486 DOI 10.1007/s00464-008-0118-3 Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years Jean-Louis Dulucq Æ Pascal Wintringer Æ Ahmad Mahajna Received: 30 November 2007 / Accepted: 14 July 2008 / Published online: 23 September 2008 Ó Springer Science+Business Media, LLC 2008 Abstract Mean operative time was 17 min in unilateral hernia and Background Two revolutions in inguinal hernia repair 24 min in bilateral hernia. There were 36 hernias (1.2%) surgery have occurred during the last two decades. The first that required conversion: 12 hernias were converted to was the introduction of tension-free hernia repair by open anterior Liechtenstein and 24 to laparoscopic TAPP Liechtenstein in 1989 and the second was the application of technique. The incidence of intraoperative complications laparoscopic surgery to the treatment of inguinal hernia in was low. Most of the patients were discharged at the sec- the early 1990s. The purposes of this study were to assess ond day of the surgery. The overall postoperative morbidity the safety and effectiveness of laparoscopic totally extra- rate was 2.2%. The incidence of recurrence rate was peritoneal (TEP) repair and to discuss the technical changes 0.35%. The recurrence rate for the first 200 repairs was that we faced on the basis of our accumulative experience. 2.5%, but it decreased to 0.47% for the subsequent 1,254 Methods Patients who underwent an elective inguinal hernia repairs hernia repair at the Department of Abdominal Surgery at Conclusion According to our experience, in the hands of the Institute of Laparoscopic Surgery (ILS), Bordeaux, experienced laparoscopic surgeons, laparoscopic hernia between June 1990 and May 2005 were enrolled retro- repair seems to be the favored approach for most types of spectively in this study. -
Ventral Hernia Repair
AMERICAN COLLEGE OF SURGEONS • DIVISION OF EDUCATION Ventral Hernia Repair Benefits and Risks of Your Operation Patient Education B e n e fi t s — An operation is the only This educational information is way to repair a hernia. You can return to help you be better informed to your normal activities and, in most about your operation and cases, will not have further discomfort. empower you with the skills and Risks of not having an operation— knowledge needed to actively The size of your hernia and the pain it participate in your care. causes can increase. If your intestine becomes trapped in the hernia pouch, you will have sudden pain and vomiting Keeping You Common Sites for Ventral Hernia and require an immediate operation. Informed If you decide to have the operation, Information that will help you possible risks include return of the further understand your operation The Condition hernia; infection; injury to the bladder, and your role in healing. A ventral hernia is a bulge through blood vessels, or intestines; and an opening in the muscles on the continued pain at the hernia site. Education is provided on: abdomen. The hernia can occur at a Hernia Repair Overview .................1 past incision site (incisional), above the navel (epigastric), or other weak Condition, Symptoms, Tests .........2 Expectations muscle sites (primary abdominal). Treatment Options….. ....................3 Before your operation—Evaluation may include blood work, urinalysis, Risks and Common Symptoms Possible Complications ..................4 ultrasound, or a CT scan. Your surgeon ● Visible bulge on the abdomen, and anesthesia provider will review Preparation especially with coughing or straining your health history, home medications, and Expectations .............................5 ● Pain or pressure at the hernia site and pain control options. -
Joint Replacement Surgery Table of Contents
Everything You Want to Know About Joint Replacement Surgery Table of Contents Understanding Your Joints: PG.3 How, when and why joint pain occurs Diagnosing Joint Pain: PG.4 The most common conditions and injuries Exploring the Options: PG.5 A look at partial and total joint replacement Seeing What’s New: PG.6 Medical advances in joint replacement surgery Answering Your Questions: PG.7 A discussion with Dr. Donald Hohman, Joint Replacement Program Medical Director Learning More: PG.9 Connecting with Texas Health Center for Diagnostics and Surgery Getting Ready: PG.10 My questions about joint replacement surgery Texas Health Center for Diagnostics & Surgery is a joint venture owned by Texas Health Resources and physicians dedicated to the community and meets the definition under federal law of physician-owned hospital. Physicians on the medical staff practice independently and are not employees or agents of the hospital. PAGE 2 Understanding Your Joints: How, when and why joint pain occurs Healthy joints aren’t just necessary for performing the physical activities we enjoy. They are the mechanical instruments that make virtually every movement possible. When our joints begin to succumb to years of natural wear and tear or degenerative conditions like arthritis, even the most common movements — like walking or climbing stairs — can become painful. Left untreated, joint pain can be potentially debilitating, severely diminishing one’s quality of life. New hope for joint pain Here’s the good news: it is possible to significantly reduce joint pain. Medical advancements in joint surgery have come a long way, particularly partial and total joint replacement. -
Office Brochure-2
COLOPROCTOLOGY ASSOCIATES, PA COLONRECTAL SURGERY HERNIA REPAIR CENTER FOR PRECISION PROCTOLOGY Over the last 20 years, we have striven for one thing above quality service and care.. TRUST... Our patients usually leave our offices with a secure feeling, confident that their problems will be addressed in an Marcus Michael Aquino, honest and cost efficient attempt at successful MD, FACS, FRCS, FASCRS resolution. They realize that Dr. Aquino approaches ColonRectal Surgeon the patient's symptoms and signs as a good detective methodically analyzes a crime scene, looking for a Born and raised in Bangalore, South India, Marcus reason behind every one, and grouping them into a completed his basic surgical training in the United Kingdom unifying diagnosis when possible. before immigrating to the United States of America, where he underwent a 5 year General Surgery residency training in New York City. Following this, he completed a ColonRectal Surgery fellowship training program in Baltimore, Maryland and has subsequently established his practice in Houston since 1988. Dr. Aquino is certified by the American Boards of both (General) Surgery and ColonRectal Surgery. He is a Fellow of the American College of Surgeons, the Royal College of Surgeons (Glasgow, UK) and the American Society of Colon and Rectal Surgeons. Most of his surgery is done in an outpatient setting as this has been shown to be both cost effective and well accepted by patients. Whenever possible, special long acting local anesthetic techniques are used to maximize patient comfort. Dr. Aquino is the only board certified Colon/Rectal surgeon in the entire Galveston Bay area, East of Dr. -
Inguinal Hernia Repair Procedure Guide
INGUINAL HERNIA REPAIR PROCEDURE GUIDE EXAMPLE OPERATING ROOM (OR) CONFIGURATION PATIENT POSITIONING & PREPARATION PORT PLACEMENT SYSTEM DEPLOYMENT & DOCKING SUGGESTED INGUINAL HERNIA PROCEDURE STEPS INSTRUMENT GUIDE IMPORTANT SAFETY INFORMATION Inguinal Hernia Repair – Transabdominal Preperitoneal (TAPP). For use with the da Vinci Xi Surgical System. Developed with, reviewed and approved by Brian Harkins, MD. 1 2 3 4 5 6 7 8 9 PN1039738 REV A 08/2017 INGUINAL HERNIA REPAIR PROCEDURE GUIDE EXAMPLE OPERATING EXAMPLE OPERATING ROOM CONFIGURATION ROOM (OR) CONFIGURATION The following figure shows an overhead view of the recommended OR configuration for a da Vinci PATIENT POSITIONING Inguinal Hernia Repair (Figure 1). & PREPARATION NOTE: Configuration of the operating room suite is dependent on room dimensions as well as the preference and experience of the surgeon. PORT PLACEMENT SYSTEM DEPLOYMENT & DOCKING SUGGESTED INGUINAL HERNIA PROCEDURE STEPS INSTRUMENT GUIDE IMPORTANT SAFETY INFORMATION Inguinal Hernia Repair – Transabdominal Preperitoneal (TAPP). For use with the da Vinci Xi Surgical System. FIGURE 1 Developed with, reviewed and approved by Brian Harkins, MD. 1 2 3 4 5 6 7 8 9 PN1039738 REV A 08/2017 INGUINAL HERNIA REPAIR PROCEDURE GUIDE EXAMPLE OPERATING PATIENT POSITIONING & PREPARATION ROOM (OR) CONFIGURATION > Place the patient in the supine position. PATIENT POSITIONING > Tuck the arms and pad pressure points and bony prominences. & PREPARATION > Secure the patient to the table to avoid any shifting with the Trendelenburg position. > Sterilely prep the abdomen. PORT PLACEMENT > Insufflate the peritoneal cavity up to 12 mmHg. > Before docking, place the patient in approximately 15° Trendelenburg and lower the table as much as possible (Figure 2). -
Consider a Minor Surgery As a Major Surgery and Order Preoperative Tests Accordingly (I.E
ROUTINE PREOPERATIVE LAB TEST GUIDELINES For adult patients (≥ 16 years) undergoing elective surgery TESTS WITHIN 6 MONTHS OF SURGERY CLINICAL JUDGEMENT IS REQUIRED EXCLUSIONS are valid, provided there has been no interim change as additional tests may be appropriate for patients with this guideline does not apply to patients in the patient’s condition. complex or uncommon surgical or medical conditions. undergoing cardiac surgery or cesarean section. MINOR SURGERY MAJOR SURGERY Associated with an expected blood loss of Associated with an expected blood loss of >500mL, significant fluid shifts and typically, at least one night in <500mL, minimal fluid shifts and is typically hospital*. Includes laparoscopic surgery (except cholecystectomy and tubal ligation); open resection of organs; done on an ambulatory basis (day surgery/ large joint replacements; mastectomy with reconstruction; and spine, thoracic, vascular, or intracranial surgery. same day discharge)*. It includes cataract * If the surgery is typically ambulatory but the patient has a medical or social reason for overnight admission (i.e. OSA, no support surgery; breast surgery without reconstruction; at home), still consider the surgery minor in determining which lab tests to order. laparoscopic cholecystectomy and tubal ligation; and most cutaneous, superficial, All Major Age: 16-49 years old Age: 50+ years old endoscopic and arthroscopic procedures. or Order • add ECG for patients with DM, HTN, Renal, • add ECG + + – DO NOT ORDER PREOP TESTS CBC Cardiovascular or severe Respiratory disease. + + – • add Na , K , Cl , TCO2 including: chest x-rays, Na , K , Cl , TCO , + + – 2 Na K Cl TCO & Cr/ eGFR serum glucose, CBC, ECG, INR, urinalysis, • add , , , 2 for patients with • add Cr/ eGFR renal, liver or thyroid function tests in DM; HTN; Malnutrition; BMI > 40; Renal, Liver or asymptomatic** patients. -
EPO Surgeryplus Plan Amendment
AMENDMENT TO THE COLORADO EMPLOYER BENEFIT TRUST EPO MEDICAL BENEFIT PLAN AND SUMMARY PLAN DESCRIPTION, EFFECTIVE JANUARY 1, 2019 The CEBT EPO Medical Benefit Plan and Summary Plan Description, effective January 1, 2019 (the “Plan”), shall be amended effective July 1, 2019 to include SurgeryPlus Benefits as follows: 1. Medical Covered Expenses: SURGERYPLUS BENEFIT Charges for certain surgeries, procedures, and related travel expenses are payable as shown on the Schedule of Benefits. This plan will pay charges for surgeries, procedures, and related travel as approved by SurgeryPlus for one Episode of Care. The SurgeryPlus benefit terminates upon your discharge from the hospital, ambulatory surgical center, or other facility following the Episode of Care. Any services rendered after the termination of the Episode of Care are subject to the applicable rules of this plan. Travel benefits may be payable if you do not have access to SurgeryPlus surgeons. The travel benefits will be determined by SurgeryPlus based upon the procedure, provider, and geographic distance of the provider in relation to your residence. Travel benefits may also be provided for a companion if your procedure requires inpatient or overnight care. Travel arrangements must be made through your SurgeryPlus Care Advocate for benefits to be payable. Some examples of the surgeries and procedures available through SurgeryPlus, include, but are not limited to the following: Knee: Foot & Ankle: General Surgery: Knee Replacement Ankle Replacement Gallbladder Removal Knee Replacement -
Mediastinoscopy: a Clinical Evaluation of 400 Consecutive Cases
Thorax: first published as 10.1136/thx.24.5.585 on 1 September 1969. Downloaded from Thorax (1969), 24, 585. Mediastinoscopy: A clinical evaluation of 400 consecutive cases C. L. SARIN1 AND H. C. NOHL-OSER From the Thoracic Surgical Unit, Harefield Hospital, Harefield, Middlesex Mediastinoscopy was carried out in 400 cases, including 296 of bronchogenic carcinoma. At the time of presentation the new growth had already spread to involve the mediastinal lymph nodes in slightly more than 50% of these. The incidence of involvement was 76% in oat-cell and 35% in squamous-cell carcinoma. Non-resectability at thoracotomy was encountered in seven out of 120 patients. We advocate this procedure in every case of bronchogenic carcinoma which is considered operable on other counts. In patients in whom the mediastinal lymph nodes are invaded by growth we prefer radical radiotherapy to surgery, as the long-term survival of the two methods is comparable. This procedure may be the only source of positive histological proof of diagnosis, not only in carcinoma but in other types of intrathoracic disease. We believe that this procedure reduces the number of unnecessary exploratory thoracotomies. Carlens (1959) introduced diagnostic exploration sible. Biopsy in such cases can be obtained from tissues inside the thoracic inlet. in the of the superior mediastinum. The space explored just Bleeding, copyright. is part of the superior mediastinum which is presence of incipient or developed superior vena caval of the obstruction, or dense fibrosis of the pre-tracheal situated around tihe intrathoracic part fascia, can make the procedure difficult or impossible.