Articles: surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2012
Case Reports[Transthoracic echocardiography in anesthesia - case studies].
Transthoracic echocardiography (TTE) is a well established tool in cardiology and cardiosurgery. The rapid availability of TTE, combined with high quality and quantity of diagnostic messages, provides the user an interesting option in the area of anesthesia and intensive care medicine. The presenting case reports describe the importance and possibilities of transthoracic echocardiography for anaesthetists in the non-cardiosurgical area.
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Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s. ⋯ Besides the described effects further savings might be achieved through the effective use of voice control and the benefit of the sterile handle on the navigation camera, since waiting times for an additional nurse are minimized. The time of the procedure of intraoperative imaging is also reduced due to the ceiling-mounted concept, as the C-arm can be moved freely in the operating theater without hindering cables. By these measures and ensuing improved efficiency, the initial high costs for the implementation of the system may be cushioned over time.
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Mobile C-arms with the option of 3D imaging like the Iso-C(3D) allow for intraoperative 3D visualization of anatomical areas with complex three-dimensional structures like articular surfaces. In an 8-year period we performed 1,841 intraoperative control scans following osteosynthesis. Among these patients we registered the number of intraoperative adjustments of fracture reduction and implant position in correlation to the area of surgery. ⋯ Intraoperative need for revision of reduction or implant position is not a rare phenomenon in our experience. Intraoperative 3D imaging is a valid tool to recognize and adjust suboptimal reduction or implant positioning. Intraoperative 3D imaging can improve the quality of osteosynthesis especially in fractures of joints and complex anatomical areas.
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The advantages of flat panel detector technology with X-ray sensitive semiconductor technology has increasingly gained acceptance in the inpatient setting for diagnostic X-ray imaging in recent years and has replaced conventional X-ray films. For intraoperative imaging C-arms, not least for cost reasons, are still based on conventional image intensifier technology. ⋯ Direct digital imaging with improved image quality, with a possible reduction in radiation dose while at the same time enlarging the image field, can affect the procedural quality of surgery. A return on investment can be achieved in part by saving time and avoiding additional postoperative imaging.
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Journal of anesthesia · Feb 2012
Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery.
A relationship between patients with a genetic predisposition to and those who develop postoperative delirium has not been yet determined. The aim of this study was to determine whether there is an association between apolipoprotein E epsilon 4 allele (APOE4) and delirium after major surgery. ⋯ Apolipoprotein e4 carrier status was not associated with an increased risk for early postoperative delirium. Age, congestive heart failure, and emergency surgery were independent risk factors for the development of delirium after major surgery.