Awake aortic aneurysm repair in patients with severe pulmonary disease.
*Consciousness; Abdominal/*surgery; Administration; Aged; Albuterol/administration & dosage/therapeutic use; Anesthesia; Aortic Aneurysm; Blood Loss; Bronchodilator Agents/administration & dosage/therapeutic use; Critical Care; Epidural; Forced Expiratory Volume/physiology; General; Home Care Services; Hospitalization; Humans; Hypnotics and Sedatives/administration & dosage; Iliac Aneurysm/*surgery; Inhalation; Intravenous; Length of Stay; Lung Diseases/*complications/drug therapy/therapy; Oxygen Inhalation Therapy; Retroperitoneal Space; Retrospective Studies; Risk Factors; Safety; Steroids/administration & dosage/therapeutic use; Surgical; Theophylline/administration & dosage/therapeutic use; Time Factors; Vital Capacity/physiology
BACKGROUND: We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients. METHODS: Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed. RESULTS: All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay. CONCLUSIONS: With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.
McGregor W E; Koler A J; Labat G C; Perni V; Hirko M K; Rubin J R
American journal of surgery
1999
1999-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0002-9610(99)00153-1" target="_blank" rel="noreferrer noopener">10.1016/s0002-9610(99)00153-1</a>
Acute mesenteric vein thrombosis and pancreatitis
Physiology; Endocrinology & Metabolism; pancreatitis; intestinal ischemia; mesenteric vein thrombosis
This article presents a case of acute mesenteric vein thrombosis with small bowel infarction associated with pancreatitis. Although a rare occurrence, the authors suggest this diagnosis should be considered as a possible complication of pancreatic inflammation.
Cornu-Labat G; Kasirajan A; Simon R; Smith D J; Herman M L; Rubin J R
International Journal of Pancreatology
1997
1997-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/bf02821611" target="_blank" rel="noreferrer noopener">10.1007/bf02821611</a>
Systemic consequences of oxidative stress following aortic surgery correlate with the degree of antioxidant defenses
Surgery; oxygen; pulmonary-edema; Cardiovascular System & Cardiology; capacity; ischemia-reperfusion injury; radicals; lung injury; depletion; mediators; xanthine-oxidase
The purpose of this study was to correlate the preoperative level of antioxidant defenses, measured by the plasma total antioxidant capacity (TAC), to the degree of postoperative systemic inflammatory response, measured by the severity of pulmonary injury following elective aortic surgery. Twenty-four patients had TAC measured preoperatively and 24 hr postoperatively. Chest radiography and arterial blood gases were obtained preoperatively and serially during the first 24 hr after surgery. Using objective radiologic criteria and blood gas analysis, the degree of pulmonary edema and pulmonary dysfunction were quantified. All patients showed evidence of pulmonary dysfunction in the first 24 hr following surgery. Fifteen of the 24 patients showed radiographic evidence of noncardiogenic pulmonary edema in the immediate postoperative period. In this group, the TAC was lower than in those without pulmonary edema immediately following surgery (p = 0.03). Preoperative TAC was associated with the degree of pulmonary edema in the postoperative period (r = -0.372, p = 0.067). These results suggest that preoperative antioxidant supplementation may favorably impact the severity of systemic inflammatory response following ischemia and reperfusion injury. DOI: 10.1007/s100169910006.
Cornu-Labat G; Serra M; Smith A; McGregor W E; Kasirajan K; Hirko M K; Turner J J; Rubin J R
Annals of Vascular Surgery
2000
2000-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/s100169910006" target="_blank" rel="noreferrer noopener">10.1007/s100169910006</a>
What Influences Medical Students' Choice Of Surgical Careers
Surgery; Surgery
Erzurum V Z; Obermeyer R; Fecher A; Thyagarajan P; Tan P; Koler A K; Hirko M K; Rubin J R
Surgery
2000
2000-08
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1067/msy.2000.108214" target="_blank" rel="noreferrer noopener">10.1067/msy.2000.108214</a>