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11/426. life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block.

    In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.
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keywords = injury, nerve
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12/426. Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia.

    A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.
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ranking = 0.023464322901242
keywords = nerve
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13/426. Traumatic aneurysm of the inferior lateral geniculate artery after total knee replacement.

    A 55-year old man incurred a false aneurysm of the inferior lateral geniculate artery after total knee replacement. The false aneurysm appeared as a pulsatile mass with compressive neuropathy of the posterior tibial nerve. The development of this complication and treatment are discussed.
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ranking = 0.023464322901242
keywords = nerve
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14/426. A complication of intraoperative facial nerve monitoring: facial skin burns.

    OBJECTIVE: To report on three cases of severe facial skin burns resulting from intraoperative facial nerve monitoring in patients undergoing parotidectomies. STUDY DESIGN: This study is a retrospective case review. SETTING: A tertiary referral center. patients: This study includes three patients who underwent parotidectomies with concurrent facial nerve monitoring. RESULTS: Facial skin burns were proven to result from a technical defect of the intraoperative facial nerve monitoring device. burns were sustained at electrode insertion sites and their extent was related to the duration of monitoring. The most probable explanation of these burns is electrolysis. CONCLUSIONS: Successful retracing of technical defaults with biomedical engineers at the device manufacturer have led to the upgrade of the facial nerve monitor apparatus. The benefits of facial nerve monitoring largely outweigh the fortuitous occurrence of skin burns reported in this study. Therefore, this complication should not represent a drawback to the use of facial nerve monitoring.
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ranking = 0.23464322901242
keywords = nerve
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15/426. Complications of retrograde balloon cautery endopyelotomy.

    PURPOSE: adult ureteropelvic junction obstruction is increasingly managed with endoscopic techniques. Retrograde balloon cautery endopyelotomy is quick, requires minimal hospital stay and allows most patients a rapid return to work. The complication rate of retrograde balloon cautery endopyelotomy ranges from 13 to 34%, with vascular injury in 0 to 16% of patients. We report 5 uncommon complications, including 4 vascular injuries, that clinicians should be familiar with when using this technique. MATERIALS AND methods: We reviewed 52 retrograde endoscopic endopyelotomy procedures performed during a 5-year period. There were 5 uncommon complications. RESULTS: Accessory lower pole renal artery injuries occurred in 3 patients, 1 of whom presented 12 days after endopyelotomy. Embolization was successfully performed in all 3 cases and none had subsequent hypertension. In 1 case a right ovarian vein laceration was not evident on preoperative or postoperative angiography. Emergency post-embolization abdominal exploration revealed a 2 mm. injury to the right ovarian vein before entering the right renal vein close to the ureteropelvic junction incision. nephrectomy and ovarian vein ligature were curative. In 1 case the electrocautery wire broke intracorporeally after firing, resulting in a bobby pin-like configuration. Successful removal was accomplished by twisting the catheter and wrapping the wire around the tip, enabling atraumatic removal. CONCLUSIONS: Retrograde balloon cautery endopyelotomy is an emerging technology with potential adverse outcomes. The complications we noted are complex and potentially life threatening. awareness of these complications may help avoid poor outcomes and expedite appropriate treatment.
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ranking = 0.32401757824069
keywords = injury
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16/426. bradycardia and asystole with the use of vagus nerve stimulation for the treatment of epilepsy: a rare complication of intraoperative device testing.

    PURPOSES: A 56-year-old man with mild mental retardation, right congenital hemiparesis, and refractory partial seizures was referred for vagus nerve stimulation (VNS). methods: Routine lead diagnostic testing during the surgical procedure (1.0 mA, 20 Hz, and 500 micros, for approximately 17 s) resulted, during the initial two stimulations, in a bradycardia of approximately 30 beats/min. A third attempt led to transient asystole that required atropine and brief cardiopulmonary resuscitation. RESULTS: The procedure was immediately terminated, the device removed, and the patient recovered completely. A postoperative cardiologic evaluation, including an ECG, 24-h Holter monitor, echocardiogram, and a tilt-table test, was normal. CONCLUSIONS: Possible mechanisms for the bradycardia/asystole include stimulation of cervical cardiac branches of the vagus nerve either by collateral current spread or directly by inadvertent placement of the electrodes on one of these branches; improper plugging of the electrodes into the pulse generator, resulting in erratic varying intensity of stimulation; reverse polarity; and idiosyncratic-type reaction in a hypersusceptible individual. The manufacturer reports the occurrence rate in approximately 3,500 implants for this intraoperative event to be approximately one in 875 cases or 0.1%.
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ranking = 0.14078593740745
keywords = nerve
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17/426. Elicitation of the oculocardiac reflex during endoscopic forehead lift surgery.

    Elicitation of the oculocardiac reflex is a well-documented phenomenon encountered during ophthalmologic surgical procedures. Familiarity with and prompt recognition of this entity has significantly reduced the morbidity associated with it; however, potentially lethal arrhythmias and cardiac arrest still occur. We report elicitation of the reflex during manipulation of the supraorbital nerve during endoscopic forehead lift surgery. To our knowledge this is the first case of elicitation of the oculocardiac reflex reported during endoscopic forehead lift surgery.
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ranking = 0.023464322901242
keywords = nerve
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18/426. Evoked spinal cord potential monitoring reveals peroneal nerve ischemia during thoracoabdominal repair: a case report.

    An 82-year-old man underwent thoracoabdominal aortic replacement under cardiopulmonary bypass with left femoral artery cannulation. Lumber descending evoked spinal cord potentials and segmental evoked spinal cord potentials were monitored simultaneously for detecting spinal cord damage. When the cardiopulmonary bypass was terminated, a peripheral nerve ischemia pattern was evident. Left peroneal nerve paralysis was present at emergence from anesthesia. This monitoring system revealed that peroneal nerve paralysis can occur due to leg ischemia caused by femoral artery cannulation. This is, to our knowledge, the first report that segmental evoked spinal cord potential monitoring reveals peroneal nerve ischemia during thoracoabdominal surgery.
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ranking = 0.18771458320993
keywords = nerve
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19/426. Quantitative assessment of vessel flow integrity for aneurysm surgery. Technical note.

    Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischemic injury and improve patient outcome. The authors report a case of a superior cerebellar artery (SCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in both the SCA and the posterior cerebral artery before and after aneurysm clipping. Following aneurysm clipping, blood flow in the SCA was reduced to less than 25% of its initial baseline value. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip and restore SCA flow to its preclipping value within 5 minutes of initial clip placement. Quantitative vessel-flow measurements were integral to the safe progression of the operation and may have prevented an adverse neurological outcome in this patient. The recommended surgical technique and the principle of operation are described.
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ranking = 0.16200878912034
keywords = injury
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20/426. Iliac vascular injuries during elective laparoscopic surgery.

    Although it is extremely uncommon, iliac vascular injury is a serious complication of laparoscopic surgery. We performed a retrospective review of five patients who sustained injury to the iliac vessels during elective laparoscopic surgery. We reviewed the mechanism and location of injury for each case and examined ways in which such complications can be prevented. There were four women and one man; their mean age was 32 years. Three patients were undergoing laparoscopy at our institution, and two patients were transferred from outlying facilities soon after the injuries occurred. There were a total of seven iliac vascular injuries among our five patients. Three cases involved injury caused by the insufflation needle; the other two were injured by trocar introduction. Postoperative sequelae included decreased lower-extremity pulses in two patients and lower-extremity edema in three patients. The incidence of iliac vascular injury can be significantly reduced by proper insertion technique, the use of an open (Hasson) approach rather than the percutaneous insufflation needle, and a thorough knowledge of the vascular anatomy in the pelvic region.
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ranking = 0.81004394560172
keywords = injury
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