Georgia Kostopanagiotou - Academia.edu (original) (raw)
Papers by Georgia Kostopanagiotou
Regional Anesthesia and Pain Medicine, Nov 1, 2007
Anesthesia & Analgesia, 1999
Interactions Between Immunosuppressive and Anesthetic Drugs Immunosuppressive drugs may modify th... more Interactions Between Immunosuppressive and Anesthetic Drugs Immunosuppressive drugs may modify the pharmacological behavior of many drugs used in anesthesia.
Surgical and Radiologic Anatomy, 2010
The aim of the study was to examine the ultrasound anatomy of the cervical paravertebral space in... more The aim of the study was to examine the ultrasound anatomy of the cervical paravertebral space in order to facilitate the implementation of sonographically guided regional anesthesia techniques for this region. Methods Twenty volunteers were recruited, and the anatomic components of the cervical paravertebral space were sonographically examined. The transducer was positioned in the axial and coronal plane at the posterior cervical triangle. The cervical transverse processes with their respective nerve roots, the deep cervical fascia and the paravertebral muscles were identified. Results There was excellent visualization of the C-3, C-4, C-5, C-6 and C-7 transverse processes in all cases. Excellent visualization of the scalene muscles, vertebral artery and deep cervical fascia was also achieved in all cases. Visualization of the levator of scapula muscle was difficult in 9 and excellent in 11 out of the 20 cases. In all cases, visualization of the C-1, C-2 and C-3 nerve roots was unfeasible. The identification of the C-4 nerve root was excellent in 3, difficult in 6 and unfeasible in 11 out of the 20 cases. The C-5, C-6 and C-7 nerve roots were excellently identified in all cases. The C-8 nerve root was identified only in 8 of the 20 cases. The cervical nerve roots also showed high variation, dividing into more than one branch as they exited the cervical transverse processes. Conclusion Cervical paravertebral anatomy can be depicted with ultrasound imaging techniques. This could be highly clinically significant for the implementation of regional anesthesia techniques.
![Research paper thumbnail of [714] Increased Platelet-Activating Factor (Paf) Degradation Modulates the Pathology of Acetaminophen-Induced Acute Liver Injury in Rats](https://attachments.academia-assets.com/86337322/thumbnails/1.jpg)
](Journal of Hepatology, 2007
cutoff values in viral hepatitis were 14.5 kPa for F =6 (diagnosis accuracy: 0.83) and 7.2lcPa fo... more cutoff values in viral hepatitis were 14.5 kPa for F =6 (diagnosis accuracy: 0.83) and 7.2lcPa for F%o4 (diagnosis accuracy: 0.9); in NASH were 10.5 kPa for F = 4 (cirrhosis, diagnosis accuracy: 0.98). Conclusion: These results confirmed that LSM can distinguish the absence and the presence of fibrosis or cirrhosis with good accuracy, in patients with viral chronic hepatitis and NASH. The liver steatosis may reduce LSM and in patients with NASH a stiffness cutoff of 10.5 kPa may indicate the presence of cirrhosis.
Journal of Cardiothoracic and Vascular Anesthesia, 2011
British Journal of Surgery, 2012
Background Control of bleeding is crucial during liver resection, and several techniques have bee... more Background Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins. Methods All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed. Results From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; ...
HORMONES, 2010
OBJECTIVE: To compare the effects of various anaesthetics on stress response in the presence and ... more OBJECTIVE: To compare the effects of various anaesthetics on stress response in the presence and absence of surgical stimulation. DESIGN: Twenty-nine pigs scheduled to undergo surgical central vein catheter placement were randomly allocated to receive only sedation ...
European …, 2009
Acute liver failure (ALF) can be complicated by lung dysfunction. The aim of this study was to te... more Acute liver failure (ALF) can be complicated by lung dysfunction. The aim of this study was to test the hypothesis that inhibition of oxidative stress through iron chelation with desferrioxamine (DFX) attenuates pulmonary injury caused by ALF. 14 adult female domestic pigs were subjected to surgical devascularisation of the liver and were randomised to a study group (DFX group, n57), which received post-operative intravenous infusion of DFX (14.5 mg?kg-1 ?h-1 for the first 6 h post-operatively and 2.4 mg?kg-1 ?h-1 until completion of 24 h), and a control group (n57). Post-operative lung damage was evaluated by histological and bronchoalveolar lavage fluid (BALF) analysis. DFX resulted in reduced BALF protein levels and tissue phospholipase (PL)A 2 activity. Plasma malondialdehyde and BALF nitrate and nitrite concentrations were lower, while catalase activity in the lung was higher after DFX treatment. PLA 2 , platelet-activating factor acetylhydrolase and total cell counts in BALF did not differ between groups. Histological examination revealed reduced alveolar collapse, pneumonocyte necrosis and total lung injury in the DFX-treated animals. DFX reduced systemic and pulmonary oxidative stress during ALF. The limited activity of PLA 2 and the attenuation of pneumonocyte necrosis could represent beneficial mechanisms by which DFX improves alveolar-capillary membrane permeability and prevents alveolar space collapse.
Journal of Surgical Research, 2017
The adverse effects of myocardial ischemia and reperfusion during cardiopulmonary bypass (CPB) ha... more The adverse effects of myocardial ischemia and reperfusion during cardiopulmonary bypass (CPB) have been thoroughly described. Lazaroid U-74389G, a 21 aminosteroid, has been shown to attenuate ischemia and reperfusion injury and improve recovery in a variety of experimental models. Sixteen male swine were randomly divided in two groups. All animals underwent 45 min of ischemic cardioplegic arrest, with U-74389G addition to the standard cardioplegic solution, whereas controls underwent the same procedure without U-74389G. Creatine kinase-MB isoenzyme (CK-MB) and cardiac troponin T levels were measured immediately before CPB (time point 0), during the ischemic period (time point 1) and 30 (time point 2), 60 (time point 3), and 120 (time point 4) min after reperfusion. Myocardial biopsies were obtained at time points 0 and 4. CK-MB levels (in U/L) at time points 0-4 were 205 (186-235) versus 219 (196-269; P = 0.72), 215 (167-248) versus 253 (193-339; P = 0.23), 234 (198-255) versus 338 (249-441; P = 0.02), 244 (217-272) versus 354 (269-496; P = 0.01), and 285 (230-321) versus 439 (432-530; P < 0.01) in lazaroid-treated animals versus controls, respectively. Cardiac troponin T levels (in ng/L) at time points 0-4 were 58 (26-287) versus 237 (26-395; P = 0.72), 129 (61-405) versus 265 (145-525; P = 0.23), 261 (123-467) versus 474 (427-1604; P = 0.04), 417 (204-750) versus 841 (584-1818; P = 0.11), and 643 (353-1259) versus 1600 (1378-2313; P < 0.01), respectively. Necrosis grades at time point 4 were 0.0 (0.0-1.0) versus 1.5 (1.0-2.0; P < 0.01) in lazaroid-treated animals versus controls, respectively. The present study, in addition to reconfirming the well-described adverse effects of CPB, demonstrates the efficacy of the newer generation lazaroid U-74389G in alleviating these effects.
Archives of Medical Science, 2015
Introduction: Laparoscopic cholecystectomy is associated with a high incidence of postoperative n... more Introduction: Laparoscopic cholecystectomy is associated with a high incidence of postoperative nausea and vomiting. In this study we investigated comparatively the efficacy of combination therapy with ondansetron plus droperidol versus monotherapy with each agent alone in preventing postoperative nausea and vomiting following elective laparoscopic cholecystectomy. Material and methods: One hundred twenty-seven patients who underwent elective laparoscopic cholecystectomy under general anesthesia were included in the study, and assigned to one of the following three groups according to the antiemetic drug given intravenously at the end of the surgery: droperidol 1.25 mg in group D, ondansetron 4 mg in group O, and a combination of droperidol and ondansetron at the doses mentioned above in group D + O. Incidence of postoperative nausea and vomiting, and doses of given rescue antiemetics were recorded during the first postoperative day. The total drug cost per patient spent for postoperative nausea and vomiting management (including prophylactic antiemetics plus rescue postoperative antiemetics) was calculated. Results: Combination therapy significantly reduced postoperative nausea and vomiting at 30 min, 3 h and 6 h after surgery compared with group D (p < 0.01 for all time points) and O (p < 0.01 at 30 min, p < 0.05 at 3 h) and required less rescue antiemetic treatment (p < 0.01). Total antiemetic cost analyses revealed no significant differences among the three groups (p > 0.05). Conclusions: Pretreatment with ondansetron plus droperidol is more effective than monotherapy in preventing postoperative nausea and vomiting following laparoscopic cholecystectomy, without increasing the cost comparatively.
BioMed Research International, 2015
Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the ... more Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly a...
The American Journal of Gastroenterology, 2000
TO THE EDITOR: Liver hemangiomas are the most common primary tumors of the liver (1). Despite the... more TO THE EDITOR: Liver hemangiomas are the most common primary tumors of the liver (1). Despite the presence of a giant hemangioma, surgical treatment is rarely required and most patients remain symptom-free (2). Clinical and laboratory manifestations of the ...
The American Journal of Gastroenterology, 2000
TO THE EDITOR: A 27-yr-old man was admitted to our hospital in December 1996, after an episode of... more TO THE EDITOR: A 27-yr-old man was admitted to our hospital in December 1996, after an episode of massive hematemesis. Esophagogastroduodenoscopy revealed oozing from a small area at the fundus of the stomach; two small clots situated over a serpentine submucous vessel ...
World Journal of Surgery, 2003
A retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior... more A retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior aspect of the right lobe of the liver (segments VI, VII, VIII) is presented. Right thoracotomy was performed in 30 patients, and 50 patients were operated on through bilateral subcostal incisions. The two approaches were compared in terms of radicality and morbidity. The transabdominal approach produced superior results and fewer postoperative complications, resulting in a shorter hospital stay (11 +/- 5 vs. 18 +/- 8 days). Total cystopericystectomy was feasible in 30% of patients operated on transabdominally and in 6% of those approached transthoracically. The rest of the patients were offered partial pericystectomy, except three in the thoracotomy group who underwent simple drainage of the cavity. We recommend that the transabdominal approach be the first choice for treatment of liver hydatid cysts irrespective of their location and size. We abandoned the transthoracic approach for cysts located on the superoposterior aspect of the right liver lobe in 1996. The transabdominal approach enables the surgeon to treat liver hydatidosis in a more radical, safer manner than does the transthoracic approach.
Transplantation Proceedings, 1997
Surgical Infections, 2002
Epidural anesthesia is one of the most common types of regional anesthesia. Although retrospectiv... more Epidural anesthesia is one of the most common types of regional anesthesia. Although retrospective reviews suggest that the incidence of infection from short-term epidural catheter use is exceedingly low in patients undergoing surgery, the correlation between epidural catheter cultures and infection has not been well defined. The purpose of this study was to determine the frequency of bacterial colonization of epidural catheters in adult patients undergoing surgery under epidural anesthesia, as well as the correlation between epidural catheter cultures and infection. A prospective nonrandomized study was conducted over a period of 28 months. The incidence of bacterial contamination after epidural catheterization and the correlation between epidural catheter cultures and infection was investigated for 245 adult ASA I, II patients undergoing surgery under lumbar epidural anesthesia. Catheters were removed when epidural analgesia was no longer required, or if clinical signs of infection or catheter malfunction were present. All epidural catheters were cultured upon withdrawal. Epidural catheters were kept in place for 2.3 +/- 0.2 days (range 0.1-12 days). Bacteriological analysis of the 245 epidural catheters yielded 28% positive cultures. The most prevalent microorganism was Staphylococcus epidermidis (58%). In obstetric operations a frequency of 32% positive cultures was observed. Neither central nervous system nor systemic infections occurred during the study. No correlations were found among the type of surgery, the type of antibiotic administration, the sex or age of the patients, the duration of catheter placement, the maximum body temperature, and the frequency of positive epidural catheter cultures. There was no correlation between epidural catheter colonization and infection. The contamination of epidural catheters was found to be independent of the administered antimicrobial agents prior to surgery, the duration of catheter placement, and the presence of fever. Except for perioperative prophylaxis, therapeutic use of antibiotics for short-term epidural catheters is not recommended.
Regional Anesthesia and Pain Medicine, 2008
Despite advantages of ultrasound-guided peripheral nerve blocks as compared with established tech... more Despite advantages of ultrasound-guided peripheral nerve blocks as compared with established techniques, various limitations may exist. We present 2 trauma patients in whom the usefulness of ultrasound techniques was limited by edema and subcutaneous air. Two male patients were admitted to the Intensive Care Unit due to multiple trauma. In the first patient, tissue edema and obesity (body mass index, calculated as weight [kg]/height [m(2)] = 35), and in the second patient, subcutaneous emphysema, were significant limitations for the application of ultrasound-guided peripheral nerve blocks. These factors made 2-dimensional ultrasound imaging difficult despite the use of tissue harmonic technique and advanced ultrasound equipment. Neurostimulation technique alone, or combined with ultrasound imaging eventually led to successful nerve block. Ultrasound technique limitations do exist. We present 2 conditions, edema and subcutaneous air, which contributed to ultrasound failure to provide a clear image of the targeted nerves.
Pediatric Anesthesia, 2003
The number and success rate of paediatric organ transplantation continue to improve yearly, and t... more The number and success rate of paediatric organ transplantation continue to improve yearly, and the number of transplanted children presenting for either elective or emergency nontransplant surgery is expected to increase accordingly. The general considerations related to any transplant recipient are the physiological and pharmacological problems of allograft denervation, the side effects of immunosuppression, the risk of infection, and the potential for rejection. Preoperative assessment of transplant recipients undergoing nontransplant surgery should focus on graft function, the risk of infection, and function of other organs. Local, regional, or general anaesthesia can be safely delivered to transplant recipients. Specific anaesthetic considerations related to the type of transplantation, have an impact directly on anaesthetic and perioperative management. Since anaesthetists and surgeons in hospitals who are not involved in transplantations, may be required to manage paediatric transplant recipients, the reviews of the existing experience in this field will be valuable tools in their hands.
Liver Transplantation, 2005
Abnormalities of recipient or donor vascular structures are associated with reconstructive diffic... more Abnormalities of recipient or donor vascular structures are associated with reconstructive difficulties in liver transplantation. A patient with thrombosis of the right hepatic vein and associated stricture of the inferior vena cava (IVC), portal vein thrombosis and multiple aberrant arteries underwent orthotopic liver transplantation. The donor&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s suprahepatic IVC was anastomosed to the recipient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s intrathoracic IVC. The portal vein flow was restored by venous graft interposition, while the arterial flow was ensured by interposing an iliac arterial graft anastomosed to the infrarenal aorta. In conclusion, graft function remains excellent more than 5 years postoperatively.
Regional Anesthesia and Pain Medicine, Nov 1, 2007
Anesthesia & Analgesia, 1999
Interactions Between Immunosuppressive and Anesthetic Drugs Immunosuppressive drugs may modify th... more Interactions Between Immunosuppressive and Anesthetic Drugs Immunosuppressive drugs may modify the pharmacological behavior of many drugs used in anesthesia.
Surgical and Radiologic Anatomy, 2010
The aim of the study was to examine the ultrasound anatomy of the cervical paravertebral space in... more The aim of the study was to examine the ultrasound anatomy of the cervical paravertebral space in order to facilitate the implementation of sonographically guided regional anesthesia techniques for this region. Methods Twenty volunteers were recruited, and the anatomic components of the cervical paravertebral space were sonographically examined. The transducer was positioned in the axial and coronal plane at the posterior cervical triangle. The cervical transverse processes with their respective nerve roots, the deep cervical fascia and the paravertebral muscles were identified. Results There was excellent visualization of the C-3, C-4, C-5, C-6 and C-7 transverse processes in all cases. Excellent visualization of the scalene muscles, vertebral artery and deep cervical fascia was also achieved in all cases. Visualization of the levator of scapula muscle was difficult in 9 and excellent in 11 out of the 20 cases. In all cases, visualization of the C-1, C-2 and C-3 nerve roots was unfeasible. The identification of the C-4 nerve root was excellent in 3, difficult in 6 and unfeasible in 11 out of the 20 cases. The C-5, C-6 and C-7 nerve roots were excellently identified in all cases. The C-8 nerve root was identified only in 8 of the 20 cases. The cervical nerve roots also showed high variation, dividing into more than one branch as they exited the cervical transverse processes. Conclusion Cervical paravertebral anatomy can be depicted with ultrasound imaging techniques. This could be highly clinically significant for the implementation of regional anesthesia techniques.
Journal of Hepatology, 2007
cutoff values in viral hepatitis were 14.5 kPa for F =6 (diagnosis accuracy: 0.83) and 7.2lcPa fo... more cutoff values in viral hepatitis were 14.5 kPa for F =6 (diagnosis accuracy: 0.83) and 7.2lcPa for F%o4 (diagnosis accuracy: 0.9); in NASH were 10.5 kPa for F = 4 (cirrhosis, diagnosis accuracy: 0.98). Conclusion: These results confirmed that LSM can distinguish the absence and the presence of fibrosis or cirrhosis with good accuracy, in patients with viral chronic hepatitis and NASH. The liver steatosis may reduce LSM and in patients with NASH a stiffness cutoff of 10.5 kPa may indicate the presence of cirrhosis.
Journal of Cardiothoracic and Vascular Anesthesia, 2011
British Journal of Surgery, 2012
Background Control of bleeding is crucial during liver resection, and several techniques have bee... more Background Control of bleeding is crucial during liver resection, and several techniques have been developed to achieve this. This study compared the safety and efficacy of selective hepatic vascular exclusion (SHVE) and Pringle manoeuvre in partial hepatectomy for liver tumours compressing or involving major hepatic veins. Methods All patients undergoing liver resection between January 2003 and December 2010 for liver tumours compressing or involving one or more major hepatic veins were identified retrospectively from a prospective institutional database. Either SHVE or Pringle manoeuvre was used to minimize blood loss during hepatectomy. Data on demographics and the intraoperative and postoperative course were analysed. Results From the database of 3900 patients, 1420 were identified who underwent liver resection for tumours encroaching on major hepatic veins using either SHVE (550) or the Pringle manoeuvre (870). Intraoperative blood loss (mean(s.d.) 480(210) versus 830(340) ml; ...
HORMONES, 2010
OBJECTIVE: To compare the effects of various anaesthetics on stress response in the presence and ... more OBJECTIVE: To compare the effects of various anaesthetics on stress response in the presence and absence of surgical stimulation. DESIGN: Twenty-nine pigs scheduled to undergo surgical central vein catheter placement were randomly allocated to receive only sedation ...
European …, 2009
Acute liver failure (ALF) can be complicated by lung dysfunction. The aim of this study was to te... more Acute liver failure (ALF) can be complicated by lung dysfunction. The aim of this study was to test the hypothesis that inhibition of oxidative stress through iron chelation with desferrioxamine (DFX) attenuates pulmonary injury caused by ALF. 14 adult female domestic pigs were subjected to surgical devascularisation of the liver and were randomised to a study group (DFX group, n57), which received post-operative intravenous infusion of DFX (14.5 mg?kg-1 ?h-1 for the first 6 h post-operatively and 2.4 mg?kg-1 ?h-1 until completion of 24 h), and a control group (n57). Post-operative lung damage was evaluated by histological and bronchoalveolar lavage fluid (BALF) analysis. DFX resulted in reduced BALF protein levels and tissue phospholipase (PL)A 2 activity. Plasma malondialdehyde and BALF nitrate and nitrite concentrations were lower, while catalase activity in the lung was higher after DFX treatment. PLA 2 , platelet-activating factor acetylhydrolase and total cell counts in BALF did not differ between groups. Histological examination revealed reduced alveolar collapse, pneumonocyte necrosis and total lung injury in the DFX-treated animals. DFX reduced systemic and pulmonary oxidative stress during ALF. The limited activity of PLA 2 and the attenuation of pneumonocyte necrosis could represent beneficial mechanisms by which DFX improves alveolar-capillary membrane permeability and prevents alveolar space collapse.
Journal of Surgical Research, 2017
The adverse effects of myocardial ischemia and reperfusion during cardiopulmonary bypass (CPB) ha... more The adverse effects of myocardial ischemia and reperfusion during cardiopulmonary bypass (CPB) have been thoroughly described. Lazaroid U-74389G, a 21 aminosteroid, has been shown to attenuate ischemia and reperfusion injury and improve recovery in a variety of experimental models. Sixteen male swine were randomly divided in two groups. All animals underwent 45 min of ischemic cardioplegic arrest, with U-74389G addition to the standard cardioplegic solution, whereas controls underwent the same procedure without U-74389G. Creatine kinase-MB isoenzyme (CK-MB) and cardiac troponin T levels were measured immediately before CPB (time point 0), during the ischemic period (time point 1) and 30 (time point 2), 60 (time point 3), and 120 (time point 4) min after reperfusion. Myocardial biopsies were obtained at time points 0 and 4. CK-MB levels (in U/L) at time points 0-4 were 205 (186-235) versus 219 (196-269; P = 0.72), 215 (167-248) versus 253 (193-339; P = 0.23), 234 (198-255) versus 338 (249-441; P = 0.02), 244 (217-272) versus 354 (269-496; P = 0.01), and 285 (230-321) versus 439 (432-530; P &amp;amp;amp;lt; 0.01) in lazaroid-treated animals versus controls, respectively. Cardiac troponin T levels (in ng/L) at time points 0-4 were 58 (26-287) versus 237 (26-395; P = 0.72), 129 (61-405) versus 265 (145-525; P = 0.23), 261 (123-467) versus 474 (427-1604; P = 0.04), 417 (204-750) versus 841 (584-1818; P = 0.11), and 643 (353-1259) versus 1600 (1378-2313; P &amp;amp;amp;lt; 0.01), respectively. Necrosis grades at time point 4 were 0.0 (0.0-1.0) versus 1.5 (1.0-2.0; P &amp;amp;amp;lt; 0.01) in lazaroid-treated animals versus controls, respectively. The present study, in addition to reconfirming the well-described adverse effects of CPB, demonstrates the efficacy of the newer generation lazaroid U-74389G in alleviating these effects.
Archives of Medical Science, 2015
Introduction: Laparoscopic cholecystectomy is associated with a high incidence of postoperative n... more Introduction: Laparoscopic cholecystectomy is associated with a high incidence of postoperative nausea and vomiting. In this study we investigated comparatively the efficacy of combination therapy with ondansetron plus droperidol versus monotherapy with each agent alone in preventing postoperative nausea and vomiting following elective laparoscopic cholecystectomy. Material and methods: One hundred twenty-seven patients who underwent elective laparoscopic cholecystectomy under general anesthesia were included in the study, and assigned to one of the following three groups according to the antiemetic drug given intravenously at the end of the surgery: droperidol 1.25 mg in group D, ondansetron 4 mg in group O, and a combination of droperidol and ondansetron at the doses mentioned above in group D + O. Incidence of postoperative nausea and vomiting, and doses of given rescue antiemetics were recorded during the first postoperative day. The total drug cost per patient spent for postoperative nausea and vomiting management (including prophylactic antiemetics plus rescue postoperative antiemetics) was calculated. Results: Combination therapy significantly reduced postoperative nausea and vomiting at 30 min, 3 h and 6 h after surgery compared with group D (p < 0.01 for all time points) and O (p < 0.01 at 30 min, p < 0.05 at 3 h) and required less rescue antiemetic treatment (p < 0.01). Total antiemetic cost analyses revealed no significant differences among the three groups (p > 0.05). Conclusions: Pretreatment with ondansetron plus droperidol is more effective than monotherapy in preventing postoperative nausea and vomiting following laparoscopic cholecystectomy, without increasing the cost comparatively.
BioMed Research International, 2015
Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the ... more Management of pain and anxiety during oocyte retrieval makes anesthesia an important part of the in vitro fertilization (IVF) procedures. There are many studies investigating the influence of anesthesia on IVF success. This review article provides an overview of published data regarding the potential toxic effects of different anesthetic techniques (Loco-regional, general anesthesia (GA), and monitored anesthesia care (MAC)), different anesthetic agents, and alternative medicine approach (principally acupuncture) on the IVF outcome. From our analysis, evidence of serious toxicity in humans is not well established. Trials regarding different anesthetic techniques ended up without clear conclusions. Studies about GA came up with conflicting results. A few trials relate GA with lower pregnancy rates, although some others failed to prove this conclusion. Furthermore, detectable amounts of some anesthetic agents are measurable in the follicular fluid but these findings are not strongly a...
The American Journal of Gastroenterology, 2000
TO THE EDITOR: Liver hemangiomas are the most common primary tumors of the liver (1). Despite the... more TO THE EDITOR: Liver hemangiomas are the most common primary tumors of the liver (1). Despite the presence of a giant hemangioma, surgical treatment is rarely required and most patients remain symptom-free (2). Clinical and laboratory manifestations of the ...
The American Journal of Gastroenterology, 2000
TO THE EDITOR: A 27-yr-old man was admitted to our hospital in December 1996, after an episode of... more TO THE EDITOR: A 27-yr-old man was admitted to our hospital in December 1996, after an episode of massive hematemesis. Esophagogastroduodenoscopy revealed oozing from a small area at the fundus of the stomach; two small clots situated over a serpentine submucous vessel ...
World Journal of Surgery, 2003
A retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior... more A retrospective study of 80 patients operated on for hydatid cysts located on the superoposterior aspect of the right lobe of the liver (segments VI, VII, VIII) is presented. Right thoracotomy was performed in 30 patients, and 50 patients were operated on through bilateral subcostal incisions. The two approaches were compared in terms of radicality and morbidity. The transabdominal approach produced superior results and fewer postoperative complications, resulting in a shorter hospital stay (11 +/- 5 vs. 18 +/- 8 days). Total cystopericystectomy was feasible in 30% of patients operated on transabdominally and in 6% of those approached transthoracically. The rest of the patients were offered partial pericystectomy, except three in the thoracotomy group who underwent simple drainage of the cavity. We recommend that the transabdominal approach be the first choice for treatment of liver hydatid cysts irrespective of their location and size. We abandoned the transthoracic approach for cysts located on the superoposterior aspect of the right liver lobe in 1996. The transabdominal approach enables the surgeon to treat liver hydatidosis in a more radical, safer manner than does the transthoracic approach.
Transplantation Proceedings, 1997
Surgical Infections, 2002
Epidural anesthesia is one of the most common types of regional anesthesia. Although retrospectiv... more Epidural anesthesia is one of the most common types of regional anesthesia. Although retrospective reviews suggest that the incidence of infection from short-term epidural catheter use is exceedingly low in patients undergoing surgery, the correlation between epidural catheter cultures and infection has not been well defined. The purpose of this study was to determine the frequency of bacterial colonization of epidural catheters in adult patients undergoing surgery under epidural anesthesia, as well as the correlation between epidural catheter cultures and infection. A prospective nonrandomized study was conducted over a period of 28 months. The incidence of bacterial contamination after epidural catheterization and the correlation between epidural catheter cultures and infection was investigated for 245 adult ASA I, II patients undergoing surgery under lumbar epidural anesthesia. Catheters were removed when epidural analgesia was no longer required, or if clinical signs of infection or catheter malfunction were present. All epidural catheters were cultured upon withdrawal. Epidural catheters were kept in place for 2.3 +/- 0.2 days (range 0.1-12 days). Bacteriological analysis of the 245 epidural catheters yielded 28% positive cultures. The most prevalent microorganism was Staphylococcus epidermidis (58%). In obstetric operations a frequency of 32% positive cultures was observed. Neither central nervous system nor systemic infections occurred during the study. No correlations were found among the type of surgery, the type of antibiotic administration, the sex or age of the patients, the duration of catheter placement, the maximum body temperature, and the frequency of positive epidural catheter cultures. There was no correlation between epidural catheter colonization and infection. The contamination of epidural catheters was found to be independent of the administered antimicrobial agents prior to surgery, the duration of catheter placement, and the presence of fever. Except for perioperative prophylaxis, therapeutic use of antibiotics for short-term epidural catheters is not recommended.
Regional Anesthesia and Pain Medicine, 2008
Despite advantages of ultrasound-guided peripheral nerve blocks as compared with established tech... more Despite advantages of ultrasound-guided peripheral nerve blocks as compared with established techniques, various limitations may exist. We present 2 trauma patients in whom the usefulness of ultrasound techniques was limited by edema and subcutaneous air. Two male patients were admitted to the Intensive Care Unit due to multiple trauma. In the first patient, tissue edema and obesity (body mass index, calculated as weight [kg]/height [m(2)] = 35), and in the second patient, subcutaneous emphysema, were significant limitations for the application of ultrasound-guided peripheral nerve blocks. These factors made 2-dimensional ultrasound imaging difficult despite the use of tissue harmonic technique and advanced ultrasound equipment. Neurostimulation technique alone, or combined with ultrasound imaging eventually led to successful nerve block. Ultrasound technique limitations do exist. We present 2 conditions, edema and subcutaneous air, which contributed to ultrasound failure to provide a clear image of the targeted nerves.
Pediatric Anesthesia, 2003
The number and success rate of paediatric organ transplantation continue to improve yearly, and t... more The number and success rate of paediatric organ transplantation continue to improve yearly, and the number of transplanted children presenting for either elective or emergency nontransplant surgery is expected to increase accordingly. The general considerations related to any transplant recipient are the physiological and pharmacological problems of allograft denervation, the side effects of immunosuppression, the risk of infection, and the potential for rejection. Preoperative assessment of transplant recipients undergoing nontransplant surgery should focus on graft function, the risk of infection, and function of other organs. Local, regional, or general anaesthesia can be safely delivered to transplant recipients. Specific anaesthetic considerations related to the type of transplantation, have an impact directly on anaesthetic and perioperative management. Since anaesthetists and surgeons in hospitals who are not involved in transplantations, may be required to manage paediatric transplant recipients, the reviews of the existing experience in this field will be valuable tools in their hands.
Liver Transplantation, 2005
Abnormalities of recipient or donor vascular structures are associated with reconstructive diffic... more Abnormalities of recipient or donor vascular structures are associated with reconstructive difficulties in liver transplantation. A patient with thrombosis of the right hepatic vein and associated stricture of the inferior vena cava (IVC), portal vein thrombosis and multiple aberrant arteries underwent orthotopic liver transplantation. The donor&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s suprahepatic IVC was anastomosed to the recipient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s intrathoracic IVC. The portal vein flow was restored by venous graft interposition, while the arterial flow was ensured by interposing an iliac arterial graft anastomosed to the infrarenal aorta. In conclusion, graft function remains excellent more than 5 years postoperatively.