Interventional Radiology in Cancer

viii.284 hlm.; ill.;27.5 c

Effect of haemodynamic response to laryngoscopy and endotracheal intubation with intravenous lornoxicam-a double blinded control study

Aim: To observe the variations in sympathetic response to laryngoscopy and intubation in patients without measures to attenuate sympathetic response. To study the effectiveness of lornoxicam in attenuating pressor response to laryngoscopy and intubation. Materials and Methods: A clinical comparative study of attenuation of sympathetic response to laryngoscopy and intubation was done posted for elective surgery. 60 cases are divided in to two groups 30 in each group. Group-1 was Control group. In this group placebo i.e (Normal saline-4ml) was administered 30 min before intubation. Group-2 was Lornoxicam group. In this group patients received lornoxicam 16mg ntravenous 30 min before intubation to attenuate pressor response to laryngoscopy and intubation. Results: Sympathoadrenal response to direct laryngoscopy and tracheal intubation invariably results in increases in heart rate and elevation in mean arterial pressure. In some instances arrhythmias can be precipitated. These potentially harmful responses may prove to be detrimental in patient at risk. Many techniques and various drugs have been employed to attenuate these haemodynamic responses. No single drug or technique is totally satisfactory. Thus there is a need to find a simple efficient and reliably consistent method. The present study is a double blinded comparative study conducted in 60 patients belonging to ASA-I and II. One group received placebo(5ml of normal saline )and the other group received Lornoxicam 16mg intravenously half an hour before induction preoperatively. All cases werepremedicated with oral diazepam 10mg the night before surgery. Inj Midazolam 0.05mg/kg IM and was administered 45 minutes before laryngoscoopy. Anaesthesia was induced with Inj thiopetone 5mg/kg IV. Succinylcholine was used for relaxation at a dose of 2mg/kg IV. Laryngoscopy and intubation was limited to 20 seconds in all case. Anaesthesia was maintained with O2 (33%), N2O (67%), sevoflurane and intermittent vecuronium 0.05 mg/kg IV and IPPV using Bain’s circuit. Hemodynamic parameters recorded include heart rate, systolic and diastolic blood pressure before induction, post induction and after 1,3,5 7 and 10 minutes from the onset of laryngoscopy. In the control group heart rate, systolic, diastolic and mean arterial blood pressures showed wide fluctuation, a maximal increase at 1 minute post laryngoscopy and returned gradually to basal values over 10 minutes. In Lornoxicam group significant suppression of heart rate and blood pressure was observed when compared to control group which returned to baseline at the end of 10min. Conclusion: Lornoxicam significantly attenuates the sympathetic response to laryngoscopy and tracheal intubation

Side-to-side sutureless vascular anastomosis with magnets

AbstractObjectiveAbbe and Payr introduced vascular techniques and devices to facilitate vessel anastomosis over a century ago. Obora published the idea of a sutureless vascular anastomosis with use of magnetic rings in 1978. The purpose of this study was to assess the performance of a new magnetic device to perform a side-to-side arteriovenous anastomosis in a dog model.Material and methodsMale fox hounds (25 kg) were treated preoperatively and daily postoperatively with clopidogrel bisulfate (Plavix) and aspirin. The femoral artery and vein were exposed unilaterally in 3 dogs and bilaterally in 4 dogs (n = 11 anastomoses). A 4-mm arteriotomy was performed, and 1 oval magnet 0.5 mm thick was inserted into the lumen of the artery and a second magnet was applied external to the artery, compressing and stabilizing the arterial wall to create a magnetic port. An identical venous magnetic port was created with another pair of oval magnets. When the 2 ports were allowed to approach each other, they self-aligned and magnetically coupled to complete the arteriovenous anastomosis. Patency was assessed for the first hour with direct observation, again after 9 weeks with duplex ultrasound scanning, and at 10 weeks under direct open observation. The anastomoses were explanted after 10 weeks. Hydrodynamic resistance was measured ex vivo on the final 8 anastomoses by measuring the pressure drop across an anastomosis with a known flow rate.ResultsAfter implantation, very high flow created visible turbulence and palpable vibration. All 11 anastomoses were patent under direct observation and palpation. Ten of 11 anastomoses were clearly patent on duplex scans, and patency of 1 anastomosis was questionable. Hydrodynamic resistance averaged 0.73 ± 0.33 mm Hg min/mL (mean ± SEM).ConclusionsVascular anastomoses performed with magnets demonstrated feasibility; exhibited 100% patency after 10 weeks in a dog arteriovenous shunt model; lacked apparent aneurysm or other potentially catastrophic failure; demonstrated remodeling of the vessel wall after several weeks to incorporate the magnets, making the magnetic force unnecessary; and warrants further study in vessels with different sizes, flow rates, and locations.AbstractClinical relevanceWe present a magnet-based device used to perform side-to-side peripheral vascular anastomoses. Its advantages include the ability to anastomose vessels without requiring circumferential surgical exposure. Vascular anastomosis performed with these magnets demonstrated 100% patency in the dog, lacked apparent aneurysm or other potentially catastrophic failure, and demonstrated remodeling of the vessel wall after several weeks, to incorporate the magnets, making indefinite retention of field strength unnecessary. This technique could enable minimally invasive procedures, such as complex reconstructive and revascularizing surgery, and warrants further study in vessels with different sizes, flow rates, and locations