Internal iliac artery occlusion using a stent-graft tunnel during endovascular aneurysm repair: a new alternative to coil embolization.

Purpose: To report a new endovascular technique for internal iliac artery (IIA) occlusion during stent-graft treatment in patients with aortoiliac aneurysm.

Technique: Stent-grafts measuring 20 to 28 mm in diameter and 37.5 mm long were deployed at the iliac bifurcation to occlude the IIA at its origin.

Distal internal iliac artery embolization: a procedure to avoid.

Objectives: Internal iliac artery (IIA) coil embolization as an adjunct to endovascular stent grafting (ESG) is common practice for treating abdominal aortic aneurysm (AAA) in patients with a substantially enlarged common iliac artery requiring extension of the stent-graft limb into the external iliac artery. The literature describing pelvic ischemia in association with IIA coil embolization contains conflicting reports of symptom severity. We studied IIA occlusion outcome as a function of coil placement in the IIA.

Bell-bottom aortoiliac endografts: an alternative that preserves pelvic blood flow.

Objective: Dilated common iliac arteries that complicate aortic aneurysm stent grafting usually have been managed with endograft extension across the iliac artery bifurcation with internal iliac artery (IIA) occlusion. We studied 25 patients with significant common iliac artery (CIA) dilation treated with two methods: endograft extension across the iliac bifurcation or a new approach with a flared cuff within the CIA that preserves the IIA.

Methods: Of 86 patients with abdominal aortic aneurysm (AAA) who underwent bifurcated endovascular stent grafting (ESG), 25 (29.

Transient radicular irritation (TRI) after spinal anaesthesia in day-care surgery.

Background: A high incidence of backache with radiating pains to the lower extremities, termed transient radicular irritation (TRI), has been reported following the use of 5% hyperbaric lidocaine. This has been attributed to a neurotoxic reaction.

Methods: A retrospective audit has been carried out in our hospital on the postoperative anaesthetic records of all patients from the 1st of January 1993 to the 1st of September 1996, who received spinal anaesthesia with either hyperbaric lidocaine or hyperbaric bupivacaine for day-care surgery.

Grading of severity of postdural puncture headache after 27-gauge Quincke and Whitacre needles.

Background: Small-gauge needles are reported to have a low incidence of complications. Pencil-point needles are associated with a lower frequency of postdural puncture headache (PDPH), but a higher failure rate than Quincke needles.

Methods: The incidence of PDPH was investigated in 200 patients under the age of 45, undergoing day-care surgery, after spinal anaesthesia with either 27-gauge Quincke or Whitacre needle.

Classification and severity of postdural puncture headache. Comparison of 26-gauge and 27-gauge Quincke needle for spinal anaesthesia in day-care surgery in patients under 45 years.

Two hundred and five patients, aged 16-45 years, undergoing day care surgery were given a spinal anaesthetic using either a 26- or a 27-gauge Quincke point spinal needle. The occurrence of headache and accompanying symptoms postoperatively was analysed from 186 returned questionnaires. The incidence of classical postdural puncture headache was 4.

Spinal anaesthesia in day-care surgery with a 26-gauge needle.

We studied 106 day-care surgical patients (52 male) aged 18-70 yr (mean 49.6 yr) who received spinal anaesthesia with a 26-gauge spinal needle. The incidence of headache, back pain and patient acceptability were investigated after operation using a questionnaire.

Pharmacokinetics of i.v. and rectal methohexitone in children.

The pharmacokinetics of methohexitone were investigated in 15 healthy children undergoing minor surgery under inhalation anaesthesia. Six received 1% methohexitone 1-2 mg kg-1 i.v.

Rectal induction of anaesthesia in children with methohexitone. Patient acceptability and clinical pharmacokinetics.

Rectal induction of anaesthesia with 10% methohexitone 100 mg ml-1 was used in 50 healthy children, using a standard dose of 25 mg/kg body weight. The absorption of methohexitone was rapid and reliable: the children fell asleep within 10-15 min. The plasma concentration peaked at 10-15 min and then decayed rapidly.

Extradural blood patch--why delay?

Seven patients are described in whom a prophylactic blood patch was instituted within 15 min of accidental dural puncture. Five of the patients received extradural anaesthesia before the blood patch, and one after the blood patch had been performed. In three of these patients further "top-up" doses of local anaesthetic were performed through the extradural catheter.