scholarly journals 1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Khoury ◽  
D Thomson ◽  
M Jones
Keyword(s):  
Local Anaesthetic ◽  
Trauma Surgery ◽  
Anaesthetic Techniques ◽  
Hand Surgery ◽  
Third Wave ◽  
Hand Trauma ◽  
Workplace Injuries ◽  
Exact Test ◽  
Trauma Service ◽  
Reduce Risk

Abstract Introduction Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic. Method Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology. Results 2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia. Conclusions Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.

scholarly journals 535 Private Trauma Lists: A Pragmatic Panacea During This Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Biggs ◽  
E Moore ◽  
M Zbaeda ◽  
K Shah ◽  
A Keightley
Keyword(s):  
Surgical Training ◽  
Service Provision ◽  
Private Hospital ◽  
Trauma Surgery ◽  
Satisfaction Questionnaire ◽  
Operating Capacity ◽  
Trauma Service ◽  
Safe Management ◽  
Reduce Risk ◽  
Mean Time

Abstract Introduction COVID-19 has disrupted the efficiency of hospitals nationwide. Ambulant trauma surgery was minimised to reduce risk of contracting COVID-19. Operating capacity significantly reduced and surgical training dramatically curtailed. Locally, a private hospital has been utilised as a green site with consultant-lead trauma lists. Our aim is to review the safety and efficiency of this service. Method Patients underwent pre-assessment, COVID-19 swabs and 7 days isolation pre and post-op. Staff also underwent swabbing. Prospectively data was gathered for all patients operated on at this site from 12/05/2020 to 20/08/2020. Records reviewed for readmission, complications and COVID status. A satisfaction questionnaire was sent to trainees who operated at this site. Results 79 operations were completed during this period. 50 male and 29 female, average age 49, average ASA 2. No complications or COVID-19 infections were recorded. Mean time to theatre was 18 days. Delays to theatre led to 2 complications. 87% of trainees felt training was maintained. Conclusions Establishing a green site enabled efficient and safe management whilst still facilitating surgical training. This requires clear guidelines for staff and patients. We believe this model can help trauma service provision as the pandemic evolves.

A Comparison of Three Local Anaesthetic Techniques for Skin Biopsy in Dogs

1991 ◽  
Vol 2 (1) ◽  
pp. 21-27 ◽  
Author(s):  
JULIE I. HENFREY ◽  
KEITH L. THODAY ◽  
KENNETH W. HEAD
Keyword(s):  
Skin Biopsy ◽  
Local Anaesthetic ◽  
Anaesthetic Techniques

scholarly journals Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Hand ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 534-541 ◽  
Author(s):  
John C. Dunn ◽  
Kenneth R. Means ◽  
Sameer Desale ◽  
Aviram M. Giladi
Keyword(s):  
Antibiotic Prophylaxis ◽  
Hand Surgery ◽  
Antibiotic Use ◽  
Demographic Variables ◽  
Fisher Exact Test ◽  
Evidence Based ◽  
Supporting Evidence ◽  
Exact Test ◽  
Preoperative Antibiotic Prophylaxis ◽  
Group 1

Background: There are no clearly defined guidelines from hand surgical societies regarding preoperative antibiotic prophylaxis. Many hand surgeons continue to routinely use preoperative prophylaxis with limited supporting evidence. This study aimed to determine for which scenarios surgeons give antibiotics, the reasons for administration, and whether these decisions are evidence-based. Methods: An anonymous 25-question survey was e-mailed to the 921-member American Society for Surgery of the Hand listserv. We collected demographic information; participants were asked whether they would administer antibiotics in a number of surgical scenarios and for what reasons. Respondents were broken into 3 groups based on when they said they would administer antibiotics: Group 1 (40 respondents) would give antibiotics in the case of short cases, healthy patients, without hardware; group 2 (9 respondents) would not give antibiotics in any scenario; and group 3 (129 respondents) would give antibiotics situationally. The Fisher exact test compared demographic variables, frequency of use, and indications of antibiotic prophylaxis. Results: Of the 921 recipients, 178 (19%) responded. Demographic variables did not correlate with the antibiotic use group. Operative case time >60 minutes, medical comorbidity, and pinning each increased antibiotic use. Group 1 respondents were more likely to admit that their practice was not evidence-based (74.4%) and that they gave antibiotics for medical-legal concern (75%). Twenty-two percent of respondents reported seeing a complication from routine prophylaxis, including Clostridium difficile infection. Conclusions: Antibiotics are still given unnecessarily before hand surgery, most often for medical-legal concern. Clear guidelines for preoperative antibiotic use may help reduce excessive and potentially inappropriate treatment and provide medical-legal support.

scholarly journals Impact on the Service Volume of a Single Hand Surgery Center during the COVID-19 Pandemic Period in Daegu

2021 ◽  
Author(s):  
Sang Ho Oh ◽  
Young Woo Kim ◽  
Sang Hyun Woo
Keyword(s):  
Emergency Room ◽  
Hand Surgery ◽  
Significant Negative Correlation ◽  
Protective Equipment ◽  
Hand Trauma ◽  
Early Recovery ◽  
Peak Period ◽  
Wrist Fractures ◽  
Protective Strategy ◽  
Surgery Center

Purpose: We investigated what changes occurred at single hand surgery center during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, Korea using patient data of 4 years (2018–2021).Methods: This is a single-center retrospective study of patients visiting our center during the COVID-19 pandemic for 4 years (January 22 to May 6). Service volumes (SVs) including the number of in/outpatient, emergency room, elective, and emergency surgery were analyzed. During the peak period of the COVID-19 (February 24 to March 9, 2020), patient’s demographics, injury mechanism, and place of injury of hand trauma were analyzed.Results: SVs were significantly reduced in 2020 as compared with other years. The SVs except for the number of emergency surgeries have recovered after 2 months from the first confirmed case of COVID-19 in Daegu, Korea. At the peak period, the effect of COVID-19 was weak on emergency room-related SVs. In addition, a daily number of in/outpatients and elective surgeries had a statistically significant negative correlation with the number of COVID-19 confirmed (p<0.05). During the peak period, superficial laceration increased and finger and wrist fractures decreased. The number of cases occurring in workplace increased, however, occurring outside during daily life decreased.Conclusion: COVID-19 pandemic greatly reduces service volume in our center. Thorough protective strategy from COVID-19 such as personal protective equipment was essential for early recovery of hospital functions during the pandemic. In addition, manpower for the emergency room must be preserved during the pandemic. The results of our study, which reported SVs through the pandemic will help maintain the function of hand surgery centers.

scholarly journals Profile of Hand Surgery Cases at Kirtipur Hospital

2018 ◽  
Vol 14 (2) ◽  
pp. 41-43
Author(s):  
Bikash Karki ◽  
Kiran Nakarmi ◽  
Mangal Gharti Magar ◽  
Krishna Nagarkoti ◽  
Shankar Man Rai
Keyword(s):  
Birth Defects ◽  
Reconstructive Surgery ◽  
Hand Surgery ◽  
Health Concern ◽  
Age Group ◽  
Hand Trauma ◽  
Public Health Concern ◽  
Cross Sectional ◽  
Common Cause ◽  
Male Preponderance

Background: There can be multiple hand problems with which patients can present. Such hand problems can be because of any kind of trauma, birth defects, tumours, infection or other conditions. Hand surgery is a special field of plastic surgery, which deals with these hand problems. The Department of Burns, Plastic & Reconstructive Surgery of Kirtipur Hospital run by Public Health Concern Trust-Nepal has been providing hand surgery service to the patients with these hand problems.Aim of Study: To analyse the various types of surgical hand problems in patients attending Kirtipur Hospital.Material and Methods: It is a cross sectional retrospective  observational study of the patients with different hand problems done at the Department of Burns, Plastic & Reconstructive surgery of Kirtipur Hospital from January to December 2016.Results: There were 124 patients who presented with various hand problems. There was male preponderance and the most common age group affected was between 15-60 years. Hand trauma was the most common cause of hand problems followed by post burn contractures.Conclusion: Hand is a complicated organ which can give rise to various problems. Hand surgery is an essential component of reconstructive surgery to deal with these problems. JNGMC,  Vol. 14 No. 2 December 2016, Page: 41-43

Basic principles of anaesthesia of small mammals: part 2

2020 ◽  
Vol 25 (3) ◽  
pp. 1-8
Author(s):  
Stefania Scarabelli ◽  
Giordano Nardini
Keyword(s):  
Health Status ◽  
General Anaesthesia ◽  
Surgical Procedures ◽  
Small Mammals ◽  
Local Anaesthetic ◽  
Perioperative Management ◽  
Anaesthetic Techniques ◽  
Depth Of Anaesthesia ◽  
Basic Principles ◽  
Volatile Agents

Several anaesthetic protocols are reported in the literature for small mammals; it is however fundamental that drugs used and perioperative management are based on each patient individually, considering several factors such as temperament, health status and the procedure to be performed. Alpha-2 agonists, benzodiazepines and opioids are the drugs most commonly used for sedation and premedication in small mammals. General anaesthesia can be induced with injectable agents, such as propofol and alfaxalone, but inhalant anaesthetics delivered by mask or in an induction chamber are still quite commonly used, particularly in smaller patients. Volatile agents are generally preferred for maintenance of anaesthesia, as easy control of the depth of anaesthesia is achievable. Endotracheal intubation is not always possible in these species, but practice and the use of an endoscope can facilitate the procedure. Analgesia should be provided for surgical procedures, and local anaesthetic techniques are warranted whenever possible.

scholarly journals Monteggia lesion and its equivalents in children

2019 ◽  
Vol 13 (6) ◽  
pp. 560-568 ◽  
Author(s):  
M. Čepelík ◽  
T. Pešl ◽  
J. Hendrych ◽  
P. Havránek
Keyword(s):  
Internal Fixation ◽  
Therapeutic Approach ◽  
Trauma Surgery ◽  
Nonoperative Treatment ◽  
Range Of Movement ◽  
Level Of Evidence ◽  
Exact Test ◽  
Monteggia Lesion ◽  
Significant Difference ◽  
Monteggia Lesions

Purpose The aim of the study is to evaluate our group of paediatric patients with Monteggia lesion and its equivalents and to compare the characteristics of basic types of these lesions concerning therapeutic approach and results of the treatment. Methods Retrospective study of 111 children treated in the Department of Pediatric and Trauma Surgery of the Thomayer Hospital in Prague between 2001 and 2013 (13 years). When evaluating the outcome of the therapy, Bruce’s criteria modified by Letts that assesses range of movement, pain and deformity of the elbow joint were applied. Regarding the therapeutic approach, four groups were compared: nonoperative treatment, reduction and casting, closed reduction and internal fixation (CRIF) and opened reduction and internal fixation (ORIF). Results were compared between three groups of patients (Monteggia lesions, displaced equivalents and non-displaced equivalents) using Fisher´s exact test with α set to 0.05. Results In all, 46 patients were treated for (true) Monteggia lesion, 27 for non-displaced Monteggia equivalent and 38 for displaced equivalent. There is a statistically significant difference in therapeutic approach between all three groups of patients. There is no significant difference in outcome between Monteggia lesions and both types of Monteggia equivalents, but there is a statistically significant difference between displaced and non-displaced equivalents. Conclusion There are only two lesions that meet the criteria of Monteggia – (true) Monteggia lesion and displaced Monteggia equivalent. The non-displaced equivalent does not meet the criteria of Monteggia and, therefore, should not be termed a Monteggia equivalent. Level of Evidence Level III – Retrospective comparative study

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