Recurrent superficial thrombophlebitis; or Severe and persistent pain and swelling interfering with activities of daily living and requiring chronic analgesic medication. Surgical ligation including subfascial endoscopic perforator vein surgery SEPS or endovenous ablation procedures are considered medically necessary for the treatment of incompetent perforating veins with vein diameter measured by recent ultrasound of 3. Initially, endovenous ablation therapy of the first vein and of the second and subsequent veins in each affected extremity is considered medically necessary when criteria are met.
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A retrospective study has shown lesser days of hospital stay in patients with increased levels of intra-operative end-tidal carbon dioxide ETCO2. This study was designed to test the hypothesis that higher values of intra-operative ETCO2 decrease the rate of post-operative complications.
In this randomized, double-blind clinical trial, 78 adult patients scheduled for percutaneous nephrolithotomy PCNL were prospectively enrolled and randomly divided into three groups.
ETCO2 was set and maintained throughout the procedure atand mmHg in the hypocapnia, normocapnia and hypercapnia groups, respectively. The rates of post-operative complications were compared among the three groups. Seventy-five patients completed the study 52 male and 23 female.
The nausea score was significantly lower in the hypercapnic group compared with the other groups 3. Mild intra-operative hypercapnia has a protecting effect against the development of post-operative nausea and vomiting and decreases the duration of emergence and recovery from general anesthesia.
Recent studies questioned the value of induced hypocapnia and showed the oxygenation benefits of mild hypercapnia during general anesthesia in laboratory and clinical settings, most of them related to intensive care patients. Other than the proven value of permissive hypercapnia in lung-injured patients,[ 2 ] studies on patients under general anesthesia found higher values of ETCO2 associated with improved cardiac index, tissue perfusion, global hemodynamics and oxygenation.
An initial prospective study showed the protective effects of hypercapnia on the post-operative cognitive dysfunction,[ 9 ] although a subsequent study failed to show any difference regarding psychomotor activity between the hypercapnic and hypocapnic patients.
Mild hypercapnia through improved tissue oxygenation has some beneficial effect on the cardiorespiratory, gastrointestinal and neurologic variables, which directly or indirectly causes improved post-operative condition and lower hospital stay.
Post-operative nausea and vomiting PONV is also an important and common factor that may lead to increased morbidity and hospital stay. Hypocapnia has been shown to be associated with an increased risk of nausea and vomiting in patients with vestibular system disorders,[ 12 ] but its effect on PONV has not been studied in a controlled study.
Hypercapnia may enhance the respiratory drive, which affects the post-operative care of the patients. Hypercapnia, by improving the hemodynamic state, tissue perfusion and oxygenation,[ 34 ] may contribute to a superior quality of post-operative course and lower hospital stay.
The present study was designed in a sample of adult patients undergoing percutaneous nephrolithotomy PCNL under general anesthesia with mechanical ventilation to test the hypothesis that a mild increase in the value of intra-operative ETCO2 reduces the rate of post-operative anesthesia complications compared with normal or lower values.
After obtaining written, informed patient consent, 78 adult aged 18 years old or over otherwise healthy patients scheduled for PCNL were enrolled prospectively in this double-blinded, parallel-group study. The reason for selecting only one type of surgical procedure was to abolish the effects of surgical procedure on the outcome variables of the study and, because the main investigator was working in the urological operating room and nephrolithotomy was one of the most common surgical procedures, we decided to select this type of operation for the study.
Patients with a history of PONV, recent general anesthesia last 6 months with volatile anesthetics, cardio-respiratory diseases, elevated blood urea nitrogen or creatinine more than 30 and 1.
The study was performed at the Al-Zahra Medical Center, a university teaching hospital located in Isfahan, central area of Iran. No premedication was used.
Tracheal intubation was facilitated with atracurium 0. Anesthesia was maintained with isoflurane 0. Patients were placed in a prone position during the procedure.
The patients were allocated to three different groups of ETCO2. After tracheal intubation, morphine was administered at 0.Results. We evaluated 95, electronic anesthesia records at the two hospitals. During the intraoperative period, % of patients had a hypoxemic event, and % of patients had a severely hypoxemic event of two consecutive minutes or longer.
Ultrasound scanners came into different categories according to their performance and price. From the early s, scanners have started to move into clinics and private offices and there is a trend to decentralise ultrasound services all over the world. Forward: Although this depression treatment by magnesium essay was written originally to address the role of magnesium as a depression treatment, the role of magnesium deficiency as cause of vast other morbidity and mortality is also addressed.
Complications that can occur during and following anesthesia in ruminants and swine are discussed., Because many of these complications can be life-threatening, they must be avoided to allow provision of safe general anesthesia. 2 GERIATRIC ANESTHESIA David J.
Cook, MD* This review of research on anesthesia for elderly patients first summarizes the normal physiologic changes that occur with aging, an overview that is essential to frame the sponse to hypoxia also diminishes in the .
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