The Impact of Surgical Procedures During Septorhinoplasty on the Intraoperative Pain Response

Abstract Background During septorhinoplasty, many different surgical procedures are used to bring the nose to the desired shape and to solve the breathing complaints. As a matter of course, intraoperative pain response occurs due to these procedures. Objectives This study aims to evaluate the intraoperative pain formed during septorhinoplasty surgery with numerical values, and to determine which stage of surgery is more painful. Methods Between April 2019 and March 2020, a total of 30 female patients who were planned to undergo septorhinoplasty were included in this prospective study. Standard anesthesia and analgesia were applied to all patients. During surgery, State Entropy (SE) measure was used to evaluate the depth of anesthesia, and Surgical Pleth Index (SPI) was used to evaluate the response of the central nervous system to pain "Nociception". Results The age of the patients ranged from 18-42-years-old (average, 25.3 ± 6.1 years). The average value of State Entropy (SE) recorded during the surgery for all patients was found to be 45.43 ± 5.37. The mean beginning SPI value recoded from all of the patients was found to be 23.4 ± 8.84, when compared with the beginning value; the values recorded during periost dissection, lateral osteotomy and lower turbinate lateralization were statistically significantly higher (P <0.005). Conclusions Although sufficient depth of anesthesia and standard protocol of analgesia were applied, pain response was found to be significantly higher at some procedures during septorhinoplasty. We think that increasing the depth of anesthesia during these procedures will increase the comfort of this operation by inhibiting pain response.

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Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients—A Prospective Observational Randomized Monocentric Study

Entropy ◽

10.3390/e22030356 ◽

2020 ◽

Vol 22 (3) ◽

pp. 356 ◽

Cited By ~ 1

Author(s):

Anca Raluca Dinu ◽

Alexandru Florin Rogobete ◽

Sonia Elena Popovici ◽

Ovidiu Horea Bedreag ◽

Marius Papurica ◽

...

Keyword(s):

Study Groups ◽

Depth Of Anesthesia ◽

Hemodynamic Stability ◽

State Entropy ◽

Multimodal Monitoring ◽

Response Entropy ◽

Group A ◽

Group B ◽

The Individual ◽

The Impact

Laparoscopic cholecystectomy is one of the most frequently performed interventions in general surgery departments. Some of the most important aims in achieving perioperative stability in these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact, as monitored through entropy (both state entropy (SE) and response entropy (RE)), that the depth of anesthesia has on the hemodynamic stability, as well as the doses of volatile anesthetic. A prospective, observational, randomized, and monocentric study was carried out between January and December 2019 in the Clinic of Anesthesia and Intensive Care of the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups: patients in Group A (target group) received multimodal monitoring, which included monitoring of standard parameters and of entropy (SE and RE); while the patients in Group B (control group) only received standard monitoring. The anesthetic dose in group A was optimized to achieve a target entropy of 40–60. A total of 68 patients met the inclusion criteria and were allocated to one of the two study groups: group A (N = 43) or group B (N = 25). There were no statistically significant differences identified between the two groups for both demographical and clinical characteristics (p > 0.05). Statistically significant differences were identified for the number of hypotensive episodes (p = 0.011, 95% CI: [0.1851, 0.7042]) and for the number of episodes of bradycardia (p < 0.0001, 95% CI: [0.3296, 0.7923]). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI: [−0.3942, 0.9047]). The implementation of the multimodal monitoring protocol, including the standard parameters and the measurement of entropy for determining the depth of anesthesia (SE and RE) led to a considerable improvement in perioperative hemodynamic stability. Furthermore, optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient led to a considerable decrease in drug consumption, as well as to a lower incidence of hemodynamic side-effects.

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Impact of General Anaesthesia - Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients. A Prospective Observational Randomized Monocentric Study

10.20944/preprints202002.0130.v1 ◽

2020 ◽

Author(s):

Anca Raluca Dinu ◽

Alexandru Florin Rogobete ◽

Sonia Elena Popovici ◽

Ovidiu Horea Bedreag ◽

Marius Papurica ◽

...

Keyword(s):

Study Groups ◽

Depth Of Anesthesia ◽

Hemodynamic Stability ◽

State Entropy ◽

Multimodal Monitoring ◽

Response Entropy ◽

Group A ◽

Group B ◽

The Individual ◽

The Impact

Study background and aims: Laparoscopic cholecystectomy is one of the most frequently performed interventions in departments of general surgery. One of the most important aims in achieving perioperative stability of these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact monitoring the depth of anesthesia through Entropy (state entropy – SE and response entropy -RE) has on the hemodynamic stability and on the doses of volatile anesthetic. Material and Methods: This is a prospective, observational, randomized, monocentric study carried out between January 2019 and December 2019 in the Clinic of Anesthesia and Intensive Care from the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups; patients in Group A (target group) received multimodal monitoring that included monitoring of standard parameters and of Entropy (SE and RE), while patients in Group B (control group) only received standard monitoring. Anesthetic dose in group A were optimized to achieve a target entropy of 40-60. Results: 68 patients met the inclusion criteria and were allocated to one of the two study groups, Group A (N=43) and Group B (N=25). There were no statistically significant differences identified between the two groups for both demographical and clinical data (p>0.05). Statistically significant differences have been identified for the number of hypotensive episodes (p = 0.011, 95% CI 0.1851 to 0.7042) and for the number of episodes of bradycardia (p < 0.0001, 95% CI 0.3296 to 0.7923). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI -0.3942 to 0.9047). Conclusions: The implementation of the multimodal monitoring protocol that includes the standard parameters and the measurement of Entropy for determining the depth of anesthesia (SE and RE) lead to a considerable improvement in perioperative hemodynamic stability. Optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient leads to a considerable decrease in drug consumption as well as to a lower incidence of hemodynamic side-effects.

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Kinematical measurement of hydraulic tortuosity of fluid flow in porous media

International Journal of Modern Physics C ◽

10.1142/s0129183115500175 ◽

2015 ◽

Vol 26 (02) ◽

pp. 1550017 ◽

Cited By ~ 8

Author(s):

Y. Jin ◽

J. B. Dong ◽

X. Li ◽

Y. Wu

Keyword(s):

Porous Media ◽

Flow Direction ◽

Estimation Method ◽

Mean Value ◽

Calculation Model ◽

Flow In Porous Media ◽

Porous Media Flow ◽

Average Value ◽

The Mean ◽

The Impact

It is hard to experimentally or analytically derive the hydraulic tortuosity (τ) of porous media flow because of their complex microstructures. In this work, we propose a kinematical measurement method for τ by introducing the concept of local tortuosity, which is defined as the ratio of fluid particle velocity to its component along the macro flow. And then, the calculation model of τ is analytically deduced in terms of that τ is the mean value of the local tortuosity. To avoid the impact from the singularity of local tortuosity, the velocity is normalized, and τ is then approximated by the ratio of the mean normalized velocity to the average value of its component along the macro-flow direction. The new estimation method is verified by flow through different types of porous media via the lattice Boltzmann method, and the relationships between permeabilities and tortuosities obtained by different methods are examined. The numerical results show that tortuosity by the novel approach is in good agreement with the existing theory, and the kinematic definition of hydraulic tortuosity is also proven.

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IMPACT OF THE COVID-19 PANDEMIC ON SURGICAL PROCEDURES IN BRAZIL: A DESCRIPTIVE STUDY

Iniciação Científica Cesumar ◽

10.17765/2176-9192.2021v23n2e10408 ◽

2021 ◽

Vol 23 (2) ◽

pp. 139-148

Author(s):

Bárbara Okabaiasse Luizeti ◽

Victor Augusto Santos Perli ◽

Gabriel Gonçalves da Costa ◽

Igor da Conceição Eckert ◽

Aluisio Marino Roma ◽

...

Keyword(s):

Surgical Procedures ◽

Surgical Procedure ◽

Maxillofacial Surgery ◽

Descriptive Study ◽

Endocrine Gland ◽

Primary Analysis ◽

Upper Airways ◽

Geographical Regions ◽

The Mean ◽

The Impact

COVID-19 pandemic has deeply affected medical practice, and conducts o minimize the overload of healthcare services were necessary. The objective of this study is to evaluate the impact of the pandemic in the practice of surgical procedures in Brazil. This is a descriptive study with data about hospitalizations for surgical procedures in Brazil from 2016 to 2020, collected from the Department of Informatics of Brazil’s Unified Health System (DATASUS). Primary analysis describes the variations in the number of elective, urgent and other types of surgical procedures performed during this period, by comparing the mean number of hospitalizations from 2016 to 2019 with the absolute number from 2020. Secondary analysis describe the variations in hospitalizations for surgical procedures during this period in each of Brazil’s geographical regions, and variations in different surgical procedure subgroups. There was a decrease of 14.88% [95% CI: 14,82-14,93] in hospitalizations for surgical procedures in 2020, when comparing to the mean between 2016-2019. Decrease rates were 34.82% [95% CI: 34,73-34,90] for elective procedures and 1.11% [95% CI: 1.07-1.13] for urgent procedures. Surgical procedure subgroups with highest decrease rates were endocrine gland surgery, breast surgery, oral-maxillofacial surgery and surgery of upper airways, face, head and neck. The overload of healthcare facilities demanded reductions in non-urgent activities to prevent services’ collapse. Further studies are needed to evaluate the social and clinical impact of such reductions and support the development of precise criteria defining which procedures should be prioritized.

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The Effect of Landscape Trees on Residential Property Values of Six Communities in Cincinnati, Ohio

Arboriculture & Urban Forestry ◽

10.48044/jauf.2013.007 ◽

2013 ◽

Vol 39 (2) ◽

Author(s):

Kelley Dimke ◽

T. Davis Sydnor ◽

David Gardner

Keyword(s):

Urban Forest ◽

Property Values ◽

Urban Forestry ◽

Canopy Cover ◽

Tree Canopy ◽

Tree Cover ◽

Sale Price ◽

Average Value ◽

The Mean ◽

The Impact

The value of the urban forest as a component of the urban environment is significant. Trees provide both environmental and social benefits to urban dwellers. In many cities, financial support for urban forestry is on the decline. The objective of this research was to evaluate the impact trees have on property values of six communities (Bond Hill, Carthage, Clifton, Hyde Park, Kennedy Heights, and North Avondale) of varying socioeconomic levels in Cincinnati, Ohio, U.S. Tax assessor records were obtained for property sales between the years 2000 and 2005. One hundred sites were randomly selected from each of the six communities. Data were collected from each site during the winter as well as the summer months. Dominant genus, caliper of dominant genus, estimate of tree cover, and overall property maintenance were recorded. The hedonic method was used for this analysis. The average (mean) effect of tree canopy across all six communities was an increase of approximately USD $780 per one percent increase in tree cover. The mean sale price across the 600 sites was $188,730; the mean canopy cover was 25.8%. This indicates the average value of tree canopy is $20,226 or 10.7% of the sale price of the home.

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Asteroid and Comet Impact Speeds upon Mars: Significance for Panspermia and the Supply of Organics

International Astronomical Union Colloquium ◽

10.1017/s0252921100014718 ◽

1997 ◽

Vol 161 ◽

pp. 197-201 ◽

Cited By ~ 1

Author(s):

Duncan Steel

Keyword(s):

Probability Distributions ◽

Regions Of Interest ◽

Significant Fraction ◽

Organic Chemicals ◽

Impact Speed ◽

The Mean ◽

The Impact

AbstractWhilst lithopanspermia depends upon massive impacts occurring at a speed above some limit, the intact delivery of organic chemicals or other volatiles to a planet requires the impact speed to be below some other limit such that a significant fraction of that material escapes destruction. Thus the two opposite ends of the impact speed distributions are the regions of interest in the bioastronomical context, whereas much modelling work on impacts delivers, or makes use of, only the mean speed. Here the probability distributions of impact speeds upon Mars are calculated for (i) the orbital distribution of known asteroids; and (ii) the expected distribution of near-parabolic cometary orbits. It is found that cometary impacts are far more likely to eject rocks from Mars (over 99 percent of the cometary impacts are at speeds above 20 km/sec, but at most 5 percent of the asteroidal impacts); paradoxically, the objects impacting at speeds low enough to make organic/volatile survival possible (the asteroids) are those which are depleted in such species.

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Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00110 ◽

2020 ◽

pp. 1-16

Author(s):

Julie L. Wambaugh ◽

Lydia Kallhoff ◽

Christina Nessler

Keyword(s):

Retrospective Analysis ◽

Sound Production ◽

Apraxia Of Speech ◽

Practice Schedule ◽

Practice Schedules ◽

Baseline Performance ◽

The Mean ◽

Number Of Treatment ◽

The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

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Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

The Heart Surgery Forum ◽

10.1532/hsf98.20111185 ◽

2012 ◽

Vol 15 (5) ◽

pp. 251

Author(s):

Changqing Gao ◽

Chonglei Ren ◽

Cangsong Xiao ◽

Yang Wu ◽

Gang Wang ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Surgical Procedures ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Septal Myectomy ◽

The Mean

Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.

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Assessing the Impact of the Inlet Total Pressure Distortion on the Turbofan Thrust

Mechanical Engineering and Computer Science ◽

10.24108/0118.0001360 ◽

2018 ◽

pp. 19-30

Author(s):

Yu. A. Ezrokhi ◽

E. A. Khoreva

Keyword(s):

Total Pressure ◽

External Compression ◽

Average Value ◽

Inlet Distortion ◽

Air Inlet ◽

Engine Thrust ◽

Relative Value ◽

Main Effect ◽

Pressure Recovery Factor ◽

The Impact

The paper considers techniques to develop a mathematical model using a method of «parallel compressors». The model is intended to estimate the impact of the air inlet distortion on the primary parameters of the aero-engine. The paper presents rated estimation results in the context of twin spool turbofan design for two typical cruiser modes of flight of the supersonic passenger jet. In estimation the base values σbase and the average values of the inlet ram recovery σave remained invariable. Thus, parametrical calculations were performed for each chosen relative value of the area of low-pressure region.The paper shows that an impact degree of the inlet distortion on the engine thrust for two modes under consideration is essentially different. In other words, if in the subsonic mode the impact assessment can be confined only to taking into account the influence of decreasing average values of the inlet total pressure, the use of such an assumption in the supersonic cruiser mode may result in considerable errors.With invariable values of the pressure recovery factor at the engine intake, which correspond to the speed of flight for a typical air inlet of external compression σbase, and average value σave, a parameter Δσuneven has the main effect on the engine thrust, and degree of this effect essentially depends on a difference between σave and σbase values.

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Impact of changing rainfall conditions on surface and groundwater resources in an experimental watershed in Greece

Global NEST Journal ◽

10.30955/gnj.000563 ◽

2013 ◽

Vol 12 (2) ◽

pp. 119-125

Keyword(s):

Groundwater Resources ◽

Annual Runoff ◽

Annual Rainfall ◽

Rainfall Regime ◽

Winter Rainfall ◽

Rainfall Depth ◽

Rainfall Volume ◽

The Mean ◽

Groundwater Reserves ◽

The Impact

The present study concerns the impact of a change in the rainfall regime on surface and groundwater resources in an experimental watershed. The research is conducted in a gauged mountainous watershed (15.18 km2) that is located on the eastern side of Penteli Mountain, in the prefecture of Attica, Greece and the study period concerns the years from 2003 to 2008. The decrease in the annual rainfall depth during the last two hydrological years 2006-2007, 2007-2008 is 10% and 35%, respectively, in relation to the average of the previous years. In addition, the monthly distribution of rainfall is characterized by a distinct decrease in winter rainfall volume. The field measurements show that this change in rainfall conditions has a direct impact on the surface runoff of the watershed, as well as on the groundwater reserves. The mean annual runoff in the last two hydrological years has decreased by 56% and 75% in relation to the average of the previous years. Moreover, the groundwater level follows a declining trend and has dropped significantly in the last two years.

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