scholarly journals TP10.2.6Open appendicectomy under spinal anaesthesia – a valuable alternative during COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Stated Preference ◽  
Case Series ◽  
Standard Of Care ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department

Abstract Introduction Concerns relating to COVID-19 and general anaesthesia prompted our department to consider that open appendicectomy under spinal anaesthesia (SA) avoids aerosolisation from intubation and laparoscopy. Whilst common in developing nations, it is unusual in the United Kingdom (UK). We present the first UK case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from 25th March 2020 until the surgical department reverted to laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (4/7) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) post-operative events. Two patients suffered minor post-operative complications. Two experienced intra-operative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days respectively. Although four stated preference in hindsight for general anaesthesia (GA), the majority (5/7) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe, feasible and acceptable in the UK. The technique could be a valuable contingency for COVID suspected cases and patients with high-risk respiratory disease.

scholarly journals Open Appendicectomy under Spinal Anesthesia—A Valuable Alternative during COVID-19

2021 ◽  
Vol 07 (02) ◽  
pp. e69-e72
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Stated Preference ◽  
Case Series ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department ◽  
The United Kingdom

Abstract Introduction Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from March 25th, 2020 until the surgical department reverted to the laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (four-sevenths) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) postoperative events. Two patients suffered minor postoperative complications. Two experienced intraoperative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days, respectively. Although four stated preference in hindsight for GA, the majority (five-sevenths) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe and feasible in the United Kingdom. The technique could be a valuable contingency for COVID-suspected cases and patients with high-risk respiratory disease.

A retrospective, observational study of supine percutaneous nephrolithotomy

2017 ◽  
Vol 11 (4) ◽  
pp. 285-292
Author(s):  
SU Srinivas ◽  
Z Gall ◽  
N Lynch ◽  
A Pollard ◽  
A Counsell ◽  
...  
Keyword(s):  
Observational Study ◽  
Percutaneous Nephrolithotomy ◽  
Perioperative Complications ◽  
Case Series ◽  
District General Hospital ◽  
Renal Calculi ◽  
Retrospective Observational Study ◽  
Complication Rates ◽  
Postoperative Fever ◽  
Stone Clearance

Objective: The objective of this study is to assess stone clearance and perioperative complication rates of supine percutaneous nephrolithotomy (PCNL). Methods: This was a retrospective, observational study of supine PCNL performed in a surgical unit at a district general hospital by two surgeons in the United Kingdom. Data collected included patient demographics, comorbidities, complexity of renal calculi, perioperative complications and stone clearance rates. Results: A total of 112 supine PCNL procedures were observed in this study. The mean (SD) American Society of Anesthesiologists (ASA) grade and Guy’s Stone Score were 2.0 (0.75) and 2.3 (1.06) respectively. The median (interquartile range (IQR)) duration of in-patient admission was four (one) nights. Complete stone clearance was achieved in 74 (67.3%) of the procedures, while more than 90% clearance of the renal stone burden was achieved in a further eight (7.3%). The most common perioperative complications recorded were blood loss requiring blood transfusion (three (2.7%)) and postoperative fever (two (1.8%)). Conclusion: This case series shows that supine PCNL can lead to good stone clearance and low complication rates.

scholarly journals Electrodessication Matricectomy With Modified Hyfrecator Tip: Case Series and Literature Review

2021 ◽  
pp. 120347542110241
Author(s):  
Janet Chan ◽  
Kevin Pehr
Keyword(s):  
Patient Satisfaction ◽  
Case Series ◽  
Healing Time ◽  
Ease Of Use ◽  
Outcome Predictors ◽  
Complication Rates ◽  
Review Of The Literature ◽  
Recurrence Rates ◽  
Satisfaction Rates ◽  
Video Demonstration

Nail matricectomy is indicated in the management of painful onychodystrophies, including recalcitrant onychocryptosis, onychogryphosis, onychauxis, and refractory onychomycosis. Although many matricectomy methods have been described, with phenolization being the best studied, no one method has clearly emerged as superior. We present a series of 14 patients who underwent a total of 18 matricectomies with either phenolization or electrodessication (ED) in a private dermatology office, and describe a simple and effective variation of the ED technique using a modified hyfrecator tip. A video demonstration of this technique is included. We also describe ED matricectomy in the context of a review of the literature, ascertaining recurrence rates, complication rates, healing time, and patient satisfaction. The nuances of technique specifics (such as the use of adjunct methods and antibiotics), as well as outcome predictors and measurements have been highlighted. We found ED to be comparable to other forms of matricectomy, with the advantages of ease of use, minimal complications, and good satisfaction rates.

scholarly journals Propensity-matched analysis of general versus spinal anaesthesia for patients undergoing ankle fracture surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045 ◽  
Author(s):  
David Sing ◽  
Molly Vora ◽  
Paul Tornetta
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Ankle Fracture ◽  
Operating Time ◽  
Knee Surgery ◽  
Complication Rates ◽  
Improvement Program ◽  
Hip And Knee Surgery

Category: Ankle Introduction/Purpose: The choice of anaesthesia is a modifiable risk factor in optimizing post-operative outcomes in hip and knee surgery, with decreased rates of transfusion, thromboembolic events, and infection with the use of spinal anaesthesia versus general anaesthesia. Regional anaesthesia has been evaluated with respect to its effect on early pain in patients undergoing ORIF of the ankle, but there is no data regarding complication rates. The purpose of this study was to compare operating time, length of stay, and rates of post-operative adverse events within 30-days in patients undergoing open reduction and internal fixation (ORIF) of the ankle using spinal vs. general anaesthesia. Methods: Adult patients who underwent ORIF of a closed ankle fracture from 2012 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who were operated on after admission from the ED are not included in the database. Operative time (skin to skin), length of stay, thirty-day adverse events, and unplanned readmissions were compared between patients who received general anaesthesia and those who received spinal anaesthesia. Propensity-adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients using a 1:4 ratio of spinal to general anaesthesia. Adverse events tracked included wound dehiscence, surgical site infection (superficial and deep), sepsis, venous thrombolic events, cardiac events, prolonged intubation, need for unplanned intubation, return to operating room, pneumonia, urinary tract infection, renal insufficiency, and re-admission within 30 days. Comparisons were performed using a propensity based multivariate analysis. Results: Of the 10,795 patients meeting inclusion criteria, 9,862 (91.4%) were treated with only general anaesthesia and 933 (8.6%) were treated with only spinal anaesthesia. Using propensity-scored matching, 822 patients in the spinal cohort were matched to 3,288 patients in the general cohort with similar baseline demographics (61.5% female, mean age 56.4). Procedure performed was similar in both cohorts (47% lateral malleolus ORIF, 34% bimalleolar ORIF, 10% trimalleolar ORIF, 8% medial malleolus ORIF, 1% posterior malleolus ORIF). Spinal anaesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval (CI) 0.20-0.75, p<0.001) and increased mortality (0.6% vs 0.2%, OR: 4.02, 95% CI 1.15-14.1, p=0.03). Rates of overall complications (4.0% vs 4.2%) and readmissions (0.8% vs 0.7%) were similar and available in Table 1. Conclusion: General anaesthesia is predominantly used for fixation of ankle fractures. While spinal anaesthesia is associated with lower complication rates in hip and knee surgery, we found no advantage in patients undergoing ORIF of the ankle.

scholarly journals Laparoscopic Live Donor Nephrectomy: Experience of High-Volume Center with 2,477 Cases

2020 ◽  
pp. 1-8
Author(s):  
Sefa Alperen Ozturk ◽  
Yucel Yuksel ◽  
Halil Erbis ◽  
Ibrahim Aliosmanoglu ◽  
Mehmet Sarier ◽  
...  
Keyword(s):  
Health And Safety ◽  
Case Series ◽  
Standard Of Care ◽  
High Volume ◽  
Warm Ischemia ◽  
Donor Nephrectomy ◽  
Complication Rates ◽  
Live Donor ◽  
Live Donor Nephrectomy ◽  
Laparoscopic Live Donor Nephrectomy

<b><i>Objective:</i></b> Donors’ health and safety are mandatory in the living-donor kidney transplantation procedure. Laparoscopic live donor nephrectomy (LLDN) provides an increase in donor numbers with its benefits and becomes a standard of care. We aimed to explain the results, complication rates, tips, and tricks of the largest number of LLDN case series ever performed in the literature. <b><i>Materials and Methods:</i></b> Between August 2012 and December 2019, 2,477 live donor case files were analyzed retrospectively. Age, gender, hospitalization times, body mass index, warm ischemia times, operation times, numbers of arteries, side of the kidneys, and complications were noted. <b><i>Results:</i></b> 1,421 (57.4%) of 2,477 donors were female (<i>p</i> = 0.007). Operation times and warm ischemia times were found longer in right-sided LLDN and donors with multiple renal arteries (<i>p</i> = 0.046, &#x3c;0.001, and &#x3c;0.001, respectively). Obesity (BMI &#x3e;30 kg/m<sup>2</sup>) did not affect warm ischemia times while prolonging the operation times (<i>p</i> = 0.013). Hospitalization times and numbers of complications were higher in obese donors. <b><i>Conclusions:</i></b> LLDN seems to be a reliable solution with fewer complications and higher satisfaction rates. We hope to illuminate the way with tips and trick points for beginner transplant surgeons based on the experience obtained from 2,477 LLDN cases.

Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series

2021 ◽  
Vol 13 (4) ◽  
pp. 357-362
Author(s):  
Isaac Josh Abecassis ◽  
Vasu Saini ◽  
Timothy John Phillips ◽  
Joshua W Osbun ◽  
Mario Martínez-Galdámez ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Upper Extremity ◽  
Femoral Vein ◽  
Case Series ◽  
Diagnostic Procedures ◽  
Venous Access ◽  
Complication Rates ◽  
Vein Access ◽  
The Right ◽  
International Multicenter

BackgroundRadial artery access for transarterial procedures has gained recent traction in neurointerventional due to decreased patient morbidity, technical feasibility, and improved patient satisfaction. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for the neurointerventionalist, but data are limited. Our objective was to quantify the use of UETV access in neurointerventions and to measure failure and complication rates.MethodsAn international multicenter retrospective review of medical records for patients undergoing UETV neurointerventions or diagnostic procedures was performed. We also present our institutional protocol for obtaining UETV and review the existing literature.ResultsOne hundred and thirteen patients underwent a total of 147 attempted UETV procedures at 13 centers. The most common site of entry was the right basilic vein. There were 21 repeat puncture events into the same vein following the primary diagnostic procedure for secondary interventional procedures without difficulty. There were two minor complications (1.4%) and five failures (ie, conversion to femoral vein access) (3.4%).ConclusionsUETV is safe and technically feasible for diagnostic and neurointerventional procedures. Further studies are needed to determine the benefit over alternative venous access sites and the effect on patient satisfaction.

scholarly journals Comparative study in prolapse lumbar intervertebral disc (PLID) surgery by spinal vs general anaesthesia

2014 ◽  
Vol 23 (2) ◽  
pp. 47-50 ◽  
Author(s):  
Md Shahnewaz Chowdhury ◽  
Sabya Sachi Roy ◽  
Md Matiur Rahman ◽  
Md Mozaffer Hossain ◽  
SMA Alim
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Functional Recovery ◽  
Rating Scale ◽  
Operating Conditions ◽  
Lumbar Spine Surgery ◽  
Single Level ◽  
Spinal Group

Background Lumbar discectomy is most commonly performed under general anaesthesia, which can be associated with several perioperative morbidities including nausea, vomiting, atelectasis, pulmonary aspiration, and prolonged post-anaesthesia recovery. It is possible that fewer complications may occur if the procedure is performed under spinal anesthesia. Objective We have compared patient satisfaction between spinal versus general anaesthesia in patients for single level lumbar surgery. Methods Eighty consecutive patients of ASA grade I-II were recruited and randomized into two equal groups, with half of this patients receiving spinal anaesthesia (n-40) and the remainder general anaesthesia (n-40). A comprehensive postoperative evaluation was carried out documenting any anaesthetic complications, pace of physiological and functional recovery and patient satisfaction. Variables were recorded as pain level using a visual analogue scale (VAS) at 1, 6, 12 and 24 hours; patient level of satisfaction during the stay on the ward using verbal rating scale (VRS) as it was detected by A p-value < 0.05 were considered as significant. Results Spinal anaesthesia patients achieved the milestones of physiological and functional recovery more rapidly and reported less postoperative pain. Perioperative hypotension in 25 % of patients and none was hypertensive in spinal group and in G/A Group 05% of patients was hypotensive and 20% were hypertensive. Postoperative pain intensity more in G/A group than spinal group. Patient satisfaction in spinal group was more comparative to G/A group. Conclusion Spinal anaesthesia ensures better operating conditions, better postoperative pain control and a quicker postoperative recovery when compared to general anaesthesia for single level lumbar spine surgery DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18173 Journal of BSA, 2009; 23(2): 47-50

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