Wide-Awake Brachioplasty: A Safe and Effective Technique for Local Anesthesia

2021 ◽  
pp. 074880682110589
Author(s):  
Alannah L. Phelan ◽  
Phoebe McAuliffe ◽  
Mark G. Albert
Keyword(s):  
Local Anesthesia ◽  
Body Contouring ◽  
The United States ◽  
Massive Weight Loss ◽  
High Patient Satisfaction ◽  
Moderate Sedation ◽  
Successful Technique ◽  
Excellent Safety Profile ◽  
Wide Awake ◽  
Room Time

Brachioplasty is a popular body contouring surgery which treats upper arm deformity related to both aging and massive weight loss. Demand for brachioplasty is growing, as the volume of bariatric surgery performed in the United States has doubled in the last decade.1 Local anesthesia offers multiple benefits for both patients and providers: it avoids anesthetic risks and anesthesia costs, decreases operating room time, and facilitates a more rapid recovery for patients. Brachioplasty is typically performed under general anesthesia or moderate sedation; this study details a successful technique to perform brachioplasty under wide-awake local anesthesia with high patient satisfaction and an excellent safety profile.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Ian Wellington ◽  
Antonio Cusano ◽  
Joel V. Ferreira ◽  
Anthony Parrino
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Postanesthesia Care Unit ◽  
Complication Rates ◽  
Endoscopic Carpal Tunnel Release ◽  
Average Operating ◽  
Wide Awake ◽  
No Tourniquet ◽  
Room Time

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

Wide Awake Hand Surgery Under Local Anesthesia No Tourniquet in South America

Hand Clinics ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Pedro José Pires Neto ◽  
Samuel Ribak ◽  
Trajano Sardenberg
Keyword(s):  
South America ◽  
Local Anesthesia ◽  
Hand Surgery ◽  
Wide Awake ◽  
No Tourniquet

scholarly journals Staffing at Ambulatory Endoscopy Centers in the United States: Practice, Trends, and Rationale

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Deepak Agrawal ◽  
Rajeev Jain
Keyword(s):  
United States ◽  
Patient Care ◽  
Response Rate ◽  
The United States ◽  
Survey Study ◽  
Moderate Sedation ◽  
Endoscopic Procedures ◽  
Staffing Patterns ◽  
And Training

Background. Endoscopy nurse (RN) has a pivotal role in administration and monitoring of moderate sedation during endoscopic procedures. When sedation for the procedure is administered and monitored by an anesthesia specialist, the role of an RN is less clear. The guidelines on this issue by nursing and gastroenterology societies are contradictory. Methods. Survey study of endoscopy lab managers and directors at outpatient endoscopy units in Texas. The questions related to staffing patterns for outpatient endoscopies and responsibilities of different personnel assisting with endoscopies. Results. Responses were received from 65 endoscopy units (response rate 38%). 63/65 (97%) performed at least a few cases with an anesthesia specialist. Of these, 49/63 (78%) involved only an endoscopy technician, without an additional RN in the room. At 12/49 (25%) units, the RN performed tasks of an endoscopy technician. At 14/63 (22%), an additional RN was present during endoscopic procedures and performed tasks not directly related to patient care. Conclusions. Many ambulatory endoscopy units do not have an RN present at all times when sedation is administered by an anesthesia specialist. An RN, when present, did not perform tasks commensurate with the education and training. This has implications about optimal utilization of nurses and cost of performing endoscopies.

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