Major Surgery In Patients Research Articles

Preoperative hemodynamic evaluation of patients submitted for major surgery.

Prior to major vascular surgery, hemodynamic studies were carried out in 63 patients by means of a flow-directed pulmonary artery balloon catheter. The results were correlated to electrocardiographic and roentgenologic findings, as well as to pertinent clinical information. Of 15 patients with either atrial fibrillation or both left ventricular hypertrophy and an increased cardiace volume, six had pulmonary pressures elevated above normal values; none of 14 patients with only one of the two signs (left ventricular hypertrophy or increased cardiac volume) had elevated pulmonary pressures. Also, the 34 patients with normal roentgenologic and electrocardiographic findings had normal hemodynamics, irrespective of a history of previous AMI, present angina or dyspnea on exertion. It is concluded that hemodynamic studies by means of a balloon-tipped catheter floating in the pulmonary artery are indicated before major surgery in patients with either atrial fibrillation or both electrocardiographic and roentgenologic signs of left ventricular hypertrophy. In such patients pulmonary pressures should be monitored during and after surgical operation.

Major surgery in patients with chronic renal failure

To determine the risks of performing major surgical procedures on patients with chronic renal failure, the charts of twenty-nine hemodialysis patients who underwent thirty-eight elective and nine emergency operations were reviewed. Preoperative preparation included adequate hemodialysis of the patients, 88 per cent of whom were dialyzed within 24 hours of surgery. Azotemia was well controlled prior to administration of anesthesia. The average preoperative hematocrit was 26 per cent, and only one patient was hyperkalemic preoperatively. There were no intraoperative complications attributable to the patients' impaired renal function. Postoperative complications were frequent and are discussed in detail. Hemodialysis was done immediately postoperatively in five patients and on the first postoperative day in twenty-three additional patients with no problems. There were only two deaths (4.3 per cent) in the series. With careful monitoring during the perioperative period, major surgical procedures can safely be performed on patients with chronic renal failure.

Major surgery in patients with acute leukemia

Eleven patients with acute leukemia in whom surgical procedures were performed are reported. Eight patients recovered. Of these eight, six were in a state of hematologic remission and two were in relapse at the time of surgery. Of the three patients who died, two were in relapse and one was in remission.

Surgical risk in cancer patients with abnormal electrocardiograms.

AnaesthesiaVolume 27, Issue 1 p. 41-48 Free Access Surgical risk in cancer patients with abnormal electrocardiograms V. S. Iyer, V. S. Iyer V. S. Iyer, DA, FFARCS; G. B. Shah, MD, FCCP and M. P. Gollerkeri, MRCP: Tata Memorial Hospital, Parel, Bombay, IndiaSearch for more papers by this authorG. B. Shah, G. B. Shah V. S. Iyer, DA, FFARCS; G. B. Shah, MD, FCCP and M. P. Gollerkeri, MRCP: Tata Memorial Hospital, Parel, Bombay, IndiaSearch for more papers by this authorM. P. Gollerkeri, M. P. Gollerkeri V. S. Iyer, DA, FFARCS; G. B. Shah, MD, FCCP and M. P. Gollerkeri, MRCP: Tata Memorial Hospital, Parel, Bombay, IndiaSearch for more papers by this author V. S. Iyer, V. S. Iyer V. S. Iyer, DA, FFARCS; G. B. Shah, MD, FCCP and M. P. Gollerkeri, MRCP: Tata Memorial Hospital, Parel, Bombay, IndiaSearch for more papers by this authorG. B. Shah, G. B. Shah V. S. Iyer, DA, FFARCS; G. B. Shah, MD, FCCP and M. P. Gollerkeri, MRCP: Tata Memorial Hospital, Parel, Bombay, IndiaSearch for more papers by this authorM. P. Gollerkeri, M. P. Gollerkeri V. S. Iyer, DA, FFARCS; G. B. Shah, MD, FCCP and M. P. Gollerkeri, MRCP: Tata Memorial Hospital, Parel, Bombay, IndiaSearch for more papers by this author First published: January 1972 https://doi.org/10.1111/j.1365-2044.1972.tb08159.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 DRY, T. J. (1952). The surgical risk of patients with heart disease. Surgery Gynecology and Obstetrics, 95, 120. 2 HANNIGAN, C. A., WROBLEWSKI, F., LEWIS, W. H. JR. and LADUE, J. S. (1951). Major surgery in patients with healed myocardial infarction. American Journal of the Medical Sciences, 222, 628. 3 ETSTEN, B. and PROGER, S. (1955). Operative risk in patients with coronary heart disease. Journal of the American Medical Association, 159, 845. 4 NACHLAS, M. M., ABRAMS, S. J. and GOLDBERG, M.w. (1961). The influence of arteriosclerotic heart disease on surgical risk. American Journal of Surgery, 101, 447. 5 ARKINS, R., SMESSAERT, A. A. and HICKS, R. G. (1964). Mortality and morbidity in surgical patients with coronary artery disease. Journal of the American Medical Association, 190, 485. 6 CHAMBERLAIN, D. A. and EDMONDS-SEAL, J. (1964). Effects of surgery under general anaesthesia on the electrocardiogram in ischaemic heart disease and hypertension. British Medical Journal, II, 784. 7 FRIEDBERG, C. K. and ZAGER, A. (1961). “Nonspecific” ST and T-wave changes, Circulation, 23, 655. 8 FRASER, J. G., RAMACHANDRAN, P. R. and DAVIS, H. S. (1967). Anesthesia and recent myocardial infarction. Journal of the American Medical Association, 199, 318. 9 TOPKINS, M. J. and ARTUSIO, J. F. (1964). Myocardial infarction and surgery-a five year study. Anesthesia and Analgesia, Current Researches, 43, 716. 10 GERTLER, M. M., FINKLE, A. L., HUDSON, P. B. and NEIDLE, E. G. (1954). Cardiovascular evaluation in surgery. I. Operative risk in cancer patients with bundle branch block. Surgery Gynecology and Obstetrics, 99, 441. 11 FRIEDBERG, C. K. (1966). Diseases of the Heart, 3rd ed, pp. 616– 823. Philadelphia : Saunders. Citing Literature Volume27, Issue1January 1972Pages 41-48 ReferencesRelatedInformation

Surgery in children with congenital disorders of blood coagulation

Major surgery in patients with congenital disorders of blood coagulation such as hemophilia (factor VIII deficiency) and Christmas disease (factor IX deficiency) is becoming increasingly common. 1–3 This is true because of the more general availability of concentrated therapeutic materials and the development and standardization of tests used in diagnosis and control of therapy. A fuller understanding of hemostatic mechanisms, together with increasing experience in the management of surgery in patients with coagulation disorders, has led to a situation in which operations may be performed with a high degree of confidence and success. The Oxford Centre, one of the first designated for the treatment of hemophilia in the United Kingdom, in 1969 had more than a third of the known cases of hemophilia in the country registered under its care (623 patients). In addition, 120 patients with Christmas disease and 183 with von Willebrand's disease were registered. This state of affairs largerly reflects the pioneer work of Biggs and Macfarlane et al., who have made major contributions in this field. 4,5 This report draws on the extensive experience of this large center, with particular reference to the case histories and diagnostic and therapeutic methods used in the management of those children with congenital coagulation disorders who had elective or emergency surgery performed in Oxford between 1959 and 1970.

Major surgery in patients on maintenance hemodialysis

The hospital records of thirty-three patients with chronic renal failure undergoing forty-four major operations and requiring pre- and postoperative hemodialysis were reviewed. The patients were evaluated as to preoperative preparation, intraoperative course, and the development of postoperative complications. Dialysis was performed within twenty-four hours prior to surgery in thirty instances. Most patients were hypertensive. Mean preoperative laboratory values included: blood urea nitrogen of 54 mg. per cent, creatinine of 9.0 mg. per cent, potassium of 4.8 mEq./L., and carbon dioxide of 24 mM/L. Hematocrit averaged 28 per cent. Preoperative anesthetic medications consisted for the most part of a short-acting barbiturate and atropine. Halothane was the general anesthetic most commonly used in conjunction with nitrous oxide. Except for two instances of cardiac arrest (one resulting in death), there were few intraoperative problems. These two cases are described in detail. Postoperative fever was present in twenty-six patients, atelectasis in twenty, wound infection in six, bleeding in four, and pericarditis appeared after surgery in eleven. In six patients thrombosis of the arteriovenous cannulas developed within one week of operation. All postoperative complications were minor and most patients demonstrated excellent wound healing. Twenty-three patients had dialysis within twenty-four hours of surgery. The most common indication for dialysis was a rapidly rising serum potassium level. From our experience, we would recommend that the following conditions prevail in patients on dialysis who are to undergo major surgery: (1) dialytic treatment should be carried out on the day prior to surgery; (2) there should be adequate control of hypertension, either by ultrafiltration or antihypertensive medication; and (3) serum potassium concentration should be below 5.5 mEq./L. on the day of surgery. With careful attention to fluid balance, an awareness of the propensity of these patients to the development of electrolyte-induced cardiac abnormalities, and with the institution of early postsurgical dialysis, the outlook for recovery from operation in the patient on maintenance dialysis would appear to be excellent.

SURGERY OF THE COLON IN A PATIENT WITH ADAMS-STOKES DISEASE: USE OF AN INTRACARDIAC ELECTRODE PACER.

WITH THE lengthening of life expectancy, it is anticipated that an increasing number of patients with severe cardiac disease will be considered for surgical excision of coincidental malignant neoplasia. In patients with serious cardiac arrhythmias who must undergo major cancer surgery, the control of heart rate and the maintenance of an adequate cardiac output are of paramount importance if the hazards of renal, cerebral, and myocardial anoxia are to be avoided. Cardiac output studies 1 in patients with fixed, slow, heart rates associated with complete heart block or disturbances of sino-atrial node activity have shown that the accompanying low cardiac outputs are due, primarily, to the bradycardia. In most patients the cardiac output returned towards normal by artificial pacing at rates of 60 to 70 beats per minute. The use of this technique might thereby lessen the risk of major surgery in patients with these types of arrhythmias. At the

Major surgery in patients 75 years old and older.

From May 1, 1957, to April 30, 1960, 369 patients, whose minimum age was 75 years and whose average age was 81.12 years, had major surgery performed at Evanston Hospital. Seventy per cent were females. There were 46 surgical deaths, a mortality of 12.46% (Table 1). The Evanston Hospital has 425 beds. Under the direction of the Chairman of the Surgical Department are the divisions of neurologic surgery, orthopedics, and urology and the services of thoracic and cardiovascular surgery. Gynecology is a separate department. It is interesting to note that there was no purely gynecologic surgery performed by gynecologists in the age group studied. Ophthalmologic and otolaryngologic procedures have been excluded. The patients have been largely nonindigent. We have made what we think is successful use of our private patients in the training of our house staff. We are an affiliated hospital in the Northwestern University Medical School Residency Training

Major surgery in patients 70 years of age and over; an analysis of 146 operations on 135 patients.

Major surgery in patients 70 years of age and over; an analysis of 146 operations on 135 patients.

The Risk of Major Surgery in Patients with Proven Previous Myocardial Infarction: A Review of the Literature: Report of Twenty-Seven Such Operations

The Risk of Major Surgery in Patients with Proven Previous Myocardial Infarction: A Review of the Literature: Report of Twenty-Seven Such Operations

The risk of major surgery in patients with coronary artery disease.

The risk of major surgery in patients with coronary artery disease.

Major surgery in patients with healed myocardial infarction

Major surgery in patients with healed myocardial infarction

Major surgery in patients with healed myocardial infarction.

Major surgery in patients with healed myocardial infarction.