Safe method for release of severe post burn neck contracture under tumescent local anaesthesia and ketamine

ABSTRACTSevere post burn neck contracture results in difficult intubation, which can be life threatening and can result in multiple serious complications and sequels. Thirty patients with age ranging from 12 to 50 years were operated under local tumescent anesthesia supplemented with intravenous ketamine for release of post burn neck contracture and split skin grafted. This technique obviates the need for endotracheal intubation. There were no complications attributed to this anesthesia technique. There was no graft loss and blood loss was minimal.

Download Full-text

Suprapubic Catheterization in Neurogenic Bladder by Distending Bladder with Air-A Novel Technique

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i09/1196 ◽

2021 ◽

Vol 6 (09) ◽

pp. 627-629

Author(s):

Xinghui Sun

Keyword(s):

High Risk ◽

Blood Loss ◽

Neurogenic Bladder ◽

Local Anaesthesia ◽

Foley Catheter ◽

Safe Method ◽

Novel Technique ◽

Suprapubic Catheterization ◽

The Mean ◽

General Method

Suprapubic catheterization (SPC) in patients with neurogenic bladder (NGB) is difficult and high risk. Our aim is to provide a novel SPC method in patients with NGB by distending the bladder with air. A total of 26 patients with NGB underwent SPC using this new method. The bladder was first filled with air based on its volume of urine or liquids. Then, a reusable trocar was advanced into the bladder as per the general method. Preoperative demographics of patients and operative details were recorded. SPC was performed under local anaesthesia in 26 patients with NGB, including 18 men and 8 women. The mean age of the patients was 36 years (range, 28-77). An 18F Foley catheter was used for all patients. Blood loss was minimal, and the procedure was performed successfully in all patients without any complication. By distending the bladder with air, the SPC method is presented as an effective and safe method suited for patients with NGB. To our knowledge, this is the first report of this novel procedure.

Download Full-text

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

Journal of Clinical Medicine ◽

10.3390/jcm10204793 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4793

Author(s):

Alison Fecher ◽

Anthony Stimpson ◽

Lisa Ferrigno ◽

Timothy H. Pohlman

Keyword(s):

Blood Loss ◽

Whole Blood ◽

Damage Control ◽

Clinical Information ◽

Fresh Frozen Plasma ◽

Practical Reasons ◽

Freeze Dried ◽

Life Threatening ◽

Sudden Decrease ◽

Polytrauma Patient

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders. Consequently, for every polytrauma victim with a significant mechanism of injury we assume substantial blood loss has occurred and life-threatening hemorrhage is progressing until we can prove the contrary. Second, a decision to begin damage control resuscitation (DCR), a costly, highly complex, and potentially dangerous intervention must often be reached with little time and without sufficient clinical information about the intended recipient. Whether to begin DCR in the prehospital phase remains controversial. Furthermore, DCR executed imperfectly has the potential to worsen serious derangements including acidosis, coagulopathy, and profound homeostatic imbalances that DCR is designed to correct. Additionally, transfusion of large amounts of homologous blood during DCR potentially disrupts immune and inflammatory systems, which may induce severe systemic autoinflammatory disease in the aftermath of DCR. Third, controversy remains over the composition of components that are transfused during DCR. For practical reasons, unmatched liquid plasma or freeze-dried plasma is transfused now more commonly than ABO-matched fresh frozen plasma. Low-titer type O whole blood may prove safer than red cell components, although maintaining an inventory of whole blood for possible massive transfusion during DCR creates significant challenges for blood banks. Lastly, as the primary principle of management of life-threatening hemorrhage is surgical or angiographic control of bleeding, DCR must not eclipse these definitive interventions.

Download Full-text

Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v25i1.1434 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Mukesh Kumar Prasad ◽

Payal Jain ◽

Rohit Kumar Varshney ◽

Aditi Khare ◽

Gurdeep Singh Jheetay

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Blood Loss ◽

General Anesthesia ◽

Local Anesthesia ◽

Skin Graft ◽

Tumescent Local Anesthesia ◽

Graft Harvest ◽

Contracture Release ◽

Split Skin

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique. Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale). Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group. Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia. Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39. DOI: 10.35975/apic.v25i1.1434 Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

Download Full-text

The Safe Evolution of Liposuction into Liposculpture

10.5772/intechopen.97351 ◽

2021 ◽

Author(s):

Ali Juma ◽

Jamil Hayek ◽

Simon Davies

Keyword(s):

Blood Loss ◽

Large Volume ◽

Local Anaesthesia ◽

Body Contouring ◽

Reduce Blood Loss ◽

High Definition ◽

Body Contouring Surgery

Liposuction was described in the 1920s & popularised in 1977 by Illouz. He developed smaller diameter blunt cannulas. To add safety he also developed the wet technique to reduce blood loss. Tumescent anaesthesia described by Klein in 1987 made large volume liposuction safer allowing for more refined body contouring through significantly minimising blood loss. Liposuction journey started as mechanical debulking that evolved over the last 4 decades into a refined high definition body contouring and proportioning surgery, thus making sculpturing a shape of figurine possible. To achieve such high definition body sculpting technology including Laser, and Vaser not only added safety, however, they also achieved outcomes that cannot be matched with the older methods of liposuction, under local anaesthesia. In this chapter we aspire to discuss the journey of how liposuction evolved into body contouring surgery with large volume lipo-aspirates yet more safely.

Download Full-text

Percutaneous embolization of sporadic lumbar nerve root haemangioblastoma under local anaesthesia

BJR|case reports ◽

10.1259/bjrcr.20190037 ◽

2020 ◽

Vol 6 (1) ◽

pp. 20190037

Author(s):

Ho Sang Leung ◽

Ryan Ka Lok Lee ◽

Eric Ka Chai Law ◽

Wai Kit Mak ◽

James Francis Griffith ◽

...

Keyword(s):

Blood Loss ◽

Nerve Root ◽

Local Anaesthesia ◽

Spinal Metastases ◽

Intraoperative Blood Loss ◽

Spinal Tumours ◽

Percutaneous Embolization ◽

Percutaneous Puncture ◽

Lumbar Nerve Root ◽

Spinal Paraganglioma

Pre-operative embolization of spinal tumours are mainly performed using a transarterial approach. Percutaneous embolization of spinal tumours are undertaken much less frequently, though its use has been reported in hypervascular spinal metastases 1,2 and spinal paraganglioma. 3 We present a patient in whom pre-operative percutaneous embolization has been performed to a recurrent lumbar nerve root haemangioblastoma that had previously been embolized using a transarterial approach. Percutaneous embolization, through targeted percutaneous puncture of the extradural component, helped reduce intraoperative blood loss, and minimize risk of spinal ischaemia.

Download Full-text

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002106 ◽

2006 ◽

Vol 120 (9) ◽

pp. 753-758 ◽

Cited By ~ 1

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.

Download Full-text

Study on Maternal and Immediate Fetal outcome of placenta previa

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v11i2.17456 ◽

2017 ◽

Vol 11 (2) ◽

pp. 24-27

Author(s):

Sushma Lama ◽

S Ranjit

Keyword(s):

Blood Loss ◽

Medical Records ◽

Placenta Previa ◽

Fetal Outcome ◽

Intrauterine Fetal Death ◽

Dilatation And Curettage ◽

Life Threatening ◽

Study Population ◽

Risks Factors ◽

Caesarean Hysterectomy

Aims: This study aimed to analyze the demographic profile, maternal and fetal outcome of placenta previa.Methods: This was a retrospective study done at Patan Academy of Health Sciences. The study population comprised of all the patients that had caesarean section for placenta previa from April 2012 to October 2015. All patients diagnosed with placenta previa clinically, ultrasonograph or incidentally during caesarean sections were recruited in this study. The data were obtained from medical records and hospital database system. Individual charts were reviewed and data on various parameters were collected.Results: In Patan hospital, there were total 126 placenta previa cases out of 21,552 deliveries during the two and half year period hence the incidence was 0.58 %. We were able to retrieve patient records of only 108 of 126 cases. The incidence of placenta previa was higher with increasing maternal age ≥30 years (41.67%), more common in multigravida (65.74%). We found that associated risks factors included previous CS, multiparity and dilatation and curettage (40.74%). Eleven patients required blood transfusion, seven of them had blood loss of 1000-1400 ml, one had blood loss of 2000 ml. Also, Caesarean hysterectomy were performed in two patients. In term of fetal outcomes, 37.04% were preterm birth and 29.63% of the babies had low birth weight. There was one incident of congenital anomaly, one intrauterine fetal death and six neonatal deaths.Conclusions: Placenta previa is an obstetrics complication that is potentially life threatening to both the mother and the baby.

Download Full-text