Depth of intravenous anesthesia: clinical signs against farmacokinetic and neurophysiological parameters

Contains fulltext : mmubn000001_157780643.pdf (publisher's version ) (Open Access)Promotores : J. Crul en S. NotermansVIII, 103 p

Preoperative interscalene block for arthrotomy of the shoulder : comparison of Bupivacaine with Adrenaline versus Prilocaine with Adrenaline

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Venous gas embolism during cryosurgery for bone tumors

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Disposition and renal clearance of propofol and its glucuronide metabolites after a short intravenous infusion of propofol

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Monitoring during cryosurgery of bone tumors

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Influence of controlled hypotension versus normotension on amount of blood loss during breast reduction.

Contains fulltext : 80181.pdf (publisher's version ) (Closed access)SUMMARY: Controlled hypotension employed during surgical procedures results in a beneficial reduction in blood loss during the operation. Breast reduction is a common cosmetic surgical procedure. Yet, in the Netherlands, controlled hypotension is not standard during breast reduction procedures, and in fact is only occasionally employed. Our research aimed to establish a set of guidelines which would outline the application of controlled hypotension during breast reduction surgery. The set up of the study was prospective. The patients were randomised into two groups. In the test group, controlled hypotension with an average of 30% reduction in systolic tension was established during the first operative phase. For the control group, normotension was maintained during the entire procedure. The blood loss in the test group (n=23; mean 318 cc) was reduced by 54.1% compared to control (n=28; mean 598 cc), and this difference was significant. A significant positive correlation was also found between blood loss and total incision time. An overall complication rate of 5.1% was observed; however, there was no significant difference between the two groups. A trend in favour of hypotension does suggest it may also help reduce postoperative complications. Our data indicate that a reduction in blood loss of more than 50% can be achieved by employing controlled hypotension in the first operative phase of breast reduction. A reduction in systolic pressure of 20-25% with the use of nitroprusside is sufficient to achieve this reduced blood loss

Cryosurgery in aggressive, benign, and low-grade malignant bone tumours.

Contains fulltext : 47394.pdf (publisher's version ) (Closed access)Cryosurgery is a method of treatment for various tumours that induces tissue necrosis with ablative intent. It is used in benign, aggressive, and low-grade malignant bone tumours such as chondrosarcoma grade 1. We describe the history of the technique and the issues associated with cryobiology, as well as the indications, technique, complications, and results of cryosurgery. At the University Medical Centre Nijmegen, Netherlands, 302 tumours have been treated by use of cryosurgery with at least 2 years' follow-up. 96-100% of patients were cured-the response depended on tumour type. Comparison of functional results with data from studies shows that these results concur with other studies on cryosurgery, and are at least equal to results of marginal excision and mostly better than those of wide excisions of grade 1 chondrosarcomas. Thus from an oncological point of view, cryosurgery combined with intralesional excision is equal to marginal excision

Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study

Summary Background Long-term postoperative cognitive dysfunction may occur in the elderly. Age may be a risk factor and hypoxaemia and arterial hypotension causative factors. We investigated these hypotheses in an international multicentre study. Methods 1218 patients aged at least 60 years completed neuropsychological tests before and 1 week and 3 months after major non-cardiac surgery. We measured oxygen saturation by continuous pulse oximetry before surgery and throughout the day of and the first 3 nights after surgery. We recorded blood pressure every 3 min by oscillometry during the operation and every 15–30 min for the rest of that day and night. We identified postoperative cognitive dysfunction with neuropsychological tests compared with controls recruited from the UK (n=176) and the same countries as study centres (n=145). Findings Postoperative cognitive dysfunction was present in 266 (25·8% [95% CI 23·1–28·5]) of patients 1 week after surgery and in 94 (9·9% [8·1–12·0]) 3 months after surgery, compared with 3·4% and 2·8%, respectively, of UK controls (