scholarly journals Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience

2019 ◽  
Vol 35 (12) ◽  
pp. 2307-2312
Author(s):  
Erik J. van Lindert ◽  
K. Djien Liem ◽  
Martin Geerlings ◽  
Hans Delye
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neonatal Intensive Care ◽  
Revision Rate ◽  
Ventricular Dilatation ◽  
Consecutive Series ◽  
Treatment Burden ◽  
Vp Shunt ◽  
Ventricular Access Device ◽  
Shunt Dependency

Abstract Purpose Posthaemorrhagic ventricular dilatation in preterm infants is primarily treated using temporising measures, of which the placement of a ventricular access device (VAD) is one option. Permanent shunt dependency rates are high, though vary widely. In order to improve the treatment burden and lower shunt dependency rates, we implemented several changes over the years. One of these changes involves the setting of the surgery from general anaesthesia in the OR to local anaesthesia in bed at the neonatal intensive care unit (NICU), which may seem counterintuitive to many. In this article, we describe our surgical technique and present the results of this regimen and compare it to our previous techniques. Methods Retrospective study of a consecutive series of 37 neonates with posthaemorrhagic ventricular dilatation (PHVD) treated using a VAD, with a cohort I (n = 13) treated from 2004 to 2008 under general anaesthesia in the OR, cohort II (n = 11) treated from 2009 to 2013 under general anaesthesia in the NICU and cohort III (n = 13) treated from December 2013 to December 2017 under local anaesthesia on the NICU. Results The overall infection rate was 14%; the VAD revision rate was 22% and did not differ significantly between the cohorts. Procedures under local anaesthesia never required conversion to general anaesthesia and were well tolerated. After an average of 33 tapping days, 38% of the neonates received a permanent ventriculoperitoneal (VP) shunt. The permanent VP shunt rate was 9% with VAD placement under local anaesthesia and 52% when performed under general anaesthesia (p = 0.02). Conclusion Bedside placement of VADs for PHVD under local anaesthesia in neonates is a low-risk, well-tolerated procedure that results in at least equal results to surgery performed under general anaesthesia and/or performed in an OR.

Treatment thresholds for intervention in posthaemorrhagic ventricular dilation: a randomised controlled trial

2018 ◽  
Vol 104 (1) ◽  
pp. F70-F75 ◽  
Author(s):  
Linda S de Vries ◽  
Floris Groenendaal ◽  
Kian D Liem ◽  
Axel Heep ◽  
Annemieke J Brouwer ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Ventricular Dilatation ◽  
Shunt Revision ◽  
Neurodevelopmental Outcomes ◽  
Vp Shunt ◽  
Significant Difference ◽  
Randomised Controlled

ObjectiveTo compare a low versus a higher threshold for intervention in preterm infants with posthaemorrhagic ventricular dilatation.DesignMulticentre randomised controlled trial (ISRCTN43171322).Setting14 neonatal intensive care units in six countries.Patients126 preterm infants ≤34 weeks gestation with ventricular dilatation after grade III–IV haemorrhage were randomised to low threshold (LT) (ventricular index (VI) >p97 and anterior horn width (AHW) >6 mm) or higher threshold (HT) (VI>p97+4 mm and AHW >10 mm).InterventionCerebrospinal fluid tapping by lumbar punctures (LPs) (max 3), followed by taps from a ventricular reservoir, to reduce VI, and eventually a ventriculoperitoneal (VP) shunt if stabilisation of the VI below the p97+4 mm did not occur.Composite main outcome measureVP shunt or death.Results19 of 64 (30%) LT infants and 23 of 62 (37%) HT infants were shunted or died (P=0.45). A VP shunt was inserted in 12/64 (19%) in the LT and 14/62 (23%) infants in the HT group. 7/12 (58%) LT infants and 1/14 (7%) HT infants required shunt revision (P<0.01). 62 of 64 (97%) LT infants and 36 of 62 (58%) HT infants had LPs (P<0.001). Reservoirs were inserted in 40 of 64 (62%) LT infants and 27 of 62 (43%) HT infants (P<0.05).ConclusionsThere was no significant difference in the primary composite outcome of VP shunt placement or death in infants with posthaemorrhagic ventricular dilatation who were treated at a lower versus a higher threshold for intervention. Infants treated at the lower threshold received more invasive procedures. Assessment of neurodevelopmental outcomes will provide further important information in assessing the risks and benefits of the two treatment approaches.

High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

2015 ◽  
Vol 41 (3) ◽  
pp. 322-327 ◽  
Author(s):  
J. K. Thillemann ◽  
T. M. Thillemann ◽  
B. Munk ◽  
K. Krøner
Keyword(s):  
Rating Scale ◽  
Revision Rate ◽  
Numerical Rating Scale ◽  
Elevated Serum ◽  
Consecutive Series ◽  
Dash Score ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Thumb Carpometacarpal

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV

STUDY OF THE EFFECT OF GENERALAND REGIONALANESTHESIA ON FOETOMATERNAL OUTCOME IN WOMEN UNDERGOING CAESAREAN SECTION FOR SEVERE PREECLAMPSIA

2021 ◽  
pp. 77-79
Author(s):  
Ashok Das ◽  
Suman Chattopadhyay ◽  
Manas Karmakar
Keyword(s):  
Critical Care ◽  
Caesarean Section ◽  
General Anaesthesia ◽  
Neonatal Intensive Care ◽  
Severe Preeclampsia ◽  
Study Cohort ◽  
Human Right ◽  
Medical College ◽  
Development Goals ◽  
Neonatal Care Unit

INTRODUCTION Motherhood is the ultimate joy in a woman's life. Every woman craves for her own child. However, more than half a million 1 women die each year from pregnancy related causes across the globe. The United Nations Millennium Development Goals has placed maternal health as a basic human right, one that is integral to the core of the ght against poverty and inequality. The high incidence of preeclampsia and its complications makes its prevention and effective management important. AIMS AND OBJECTIVES To study the effect of anaesthetic technique in the foetomaternal outcome in severe preeclamptic patients undergoing caesarean section and determining any difference in the maternal and perinatal morbidity/mortality amongst those receiving either general or regional anaesthesia. MATERIALS AND METHODS Study Area: Eden Hospital, Critical Care Unit (CCU), Special Neonatal Care Unit (SNCU), and Neonatal Intensive Care Unit (NICU) of Medical College & Hospital, Kolkata. Study Population: Mothers and babies of severe preeclamptic patient with 34 or more gestational weeks admitted in Eden Hospital, Medical College & Hospital, Kolkata undergoing caesarean section formed our study cohort. Study Period: 18 months (from February 2012 till June 2013). RESULTS AND OBSERVATIONS The patients of severe preeclampsia were in the age group 18 to 30 years (93 %). Only 1.2 % were aged more than 40years. 5.8 % of patients were between the ages of 30 to 40 years. The age patterns were similar in both the groups receiving either spinal or general anaesthesia. SUMMARY AND CONCLUSION Severe preeclampsia mothers receiving general anaesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was signicantly higher with general anaesthesia. Spinal anaesthesia is safer alternative to general anaesthesia in severe preeclampsia with less post operative morbidity and mortality

scholarly journals Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana

2020 ◽  
Vol 2 (2) ◽  
pp. 01-07
Author(s):  
Anna Konney ◽  
Mawutor Dzogbefia ◽  
Philip Oppong Peprah ◽  
Derrick Gyimah ◽  
Isaac Barnor
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Operating Time ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Tertiary Referral Hospital ◽  
Thyroid Lobectomy ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
The Cost

Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana. Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software. Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period. Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.

Design and clinical application of the ‘styloidectome’ styloid process cutter

2006 ◽  
Vol 120 (9) ◽  
pp. 753-758 ◽  
Author(s):  
W Zhibin ◽  
J Min
Keyword(s):  
Blood Loss ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Styloid Process ◽  
Morphological Data ◽  
Clinical Use ◽  
Deep Tissue ◽  
Tissue Space ◽  
Oral Approach ◽  
The Individual

A styloid process (SP) cutter was developed and put into clinical use. The design of components of the ‘styloidectome’ was based on the principles of mechanics. The measurements of the individual parts were determined on the basis of morphological data of the oropharynx from 40 subjects undergoing tonsillectomy under general anaesthesia. Experiments showed that the instrument could be used to transect the SP and excise the amputated bones from the deep tissue space. We used the instrument for the resection of elongated SPs, via an oral approach, in seven in-patients (involving 10 SPs) under general anaesthesia and in two out-patients (involving three SPs) under local anaesthesia. The length of the resected SP ranged from 0.8 to 2.5 cm and the stump of the SP was smooth. The removal lasted only seconds and blood loss was minimal, without any complications. The styloidectome was reliable, easy to use and could be used for the resection of an elongated SP under general or local anaesthesia.

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

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