scholarly journals I gel versus endotracheal intubation for percutaneous tracheostomies: a randomised study to ascertain amicable approach

2021 ◽  
Vol 8 (9) ◽  
pp. 2718
Author(s):  
S. P. Sharma ◽  
Anuj Singh
Keyword(s):  
Guide Wire ◽  
Percutaneous Tracheostomy ◽  
Tracheal Extubation ◽  
Airway Device ◽  
Complication Rates ◽  
Hemodynamic Stability ◽  
Randomised Study ◽  
Accidental Extubation ◽  
Management Procedure ◽  
Group I

Background: Percutaneous tracheostomy or percutaneous dilation tracheostomy (PDT) is an airway management procedure routinely performed in critically ill patients, requiring prolonged ventilation. It is safely performed bedside by anaesthesiologist/intensivist in ICUs. Complications as endotracheal tube (ET) damage, loss of airway due to accidental extubation and piercing of guide wire through ET tube during procedure has led to exploration of safer/effective and viable airway alternatives while performing the procedures.Methods: In this study we randomised 60 patients to group E (ET) and group I (I gel) 30 each and studied ease of carrying out procedure and associated complication rates in both groups.Results: In ET group (group E), 9% of patients suffered with potentially catastrophic complications, e.g. loss of airway, inadequate ventilation of lungs, haemorrhage, airway leak due to ET tube cuff rupture and accidental extubation. In ETT group there was incidence of 18% cuff puncture by guide wire (p=0.025) and 3% accidental tracheal extubation. Group I witnessed lower incidence of haemorrhage (3%) and the incidence of guide wire piercing airway device was nil. Group I also demonstrated better hemodynamic stability attributed to lesser tissue trauma and airway manipulation.Conclusions: This study demonstrates enhanced safety with usage of I gel for PCDT, with less complication, better hemodynamic stability and shorter procedure duration.

scholarly journals A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

2021 ◽  
pp. 014556132110257
Author(s):  
Dongho Shin ◽  
Andrew Ma ◽  
Yvonne Chan
Keyword(s):  
Retrospective Study ◽  
Teaching Hospital ◽  
Intraoperative Complications ◽  
Percutaneous Tracheostomy ◽  
Hospital Setting ◽  
Complication Rates ◽  
Safe Alternative ◽  
Neck Extension ◽  
Intraoperative Complication ◽  
Community Teaching

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

scholarly journals Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial

2019 ◽  
Vol 101 (1) ◽  
pp. 21-29 ◽  
Author(s):  
M Arnous ◽  
H Elgendy ◽  
W Thabet ◽  
SH Emile ◽  
SA Elbaz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Primary Closure ◽  
Randomised Clinical Trial ◽  
Limberg Flap ◽  
Complication Rates ◽  
Cosmetic Results ◽  
Group I ◽  
Group Ii

BackgroundAlthough several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND.MethodsThis was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes.ResultsSixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence.ConclusionsThe Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.

Eighteen-year prospective audit of LASIK outcomes for myopia in 53 731 eyes

2018 ◽  
Vol 103 (9) ◽  
pp. 1228-1234 ◽  
Author(s):  
Daniel Chua ◽  
Hla Myint Htoon ◽  
Li Lim ◽  
Cordelia ML Chan ◽  
Jodhbir S. Mehta ◽  
...  
Keyword(s):  
Complication Rate ◽  
Clinical Audit ◽  
Complication Rates ◽  
Randomised Study ◽  
Ethnic Chinese ◽  
Snellen Visual Acuity ◽  
Retreatment Rate ◽  
Efficacy Index ◽  
Treatment Trends

BackgroundTo assess the outcomes of laser-assisted in situ keratomileusis (LASIK) performed for the treatment of myopia in terms of safety, efficacy and predictability in an 18-year clinical audit.MethodIn this single-centre, prospective, non-randomised study, preoperative and postoperative refractions, uncorrected (UCVA), best-corrected Snellen visual acuity (BCVA) and complications of all eyes undergoing myopic LASIK were recorded. Safety, efficacy, refractive predictability, treatment trends, retreatment rates and complication rates were evaluated.ResultsBetween 1998 and 2015, 53 731 eyes of 27312 patients underwent myopic LASIK. Patients’ median age was 31.6 years (mean, 32.6±7.3 years); there were 9703 males (35.5%). Patients were predominantly ethnic Chinese (87.4%). Mean follow-up time was 78±75.6 days (median, 86 days). Overall efficacy index was 0.91 with >99% of eyes achieving UCVA of ≥20/40 and >70% achieving 20/20 since 2010. 95.43% of eyes had no loss of vision postoperatively and 4.2% and 0.37% lost 1 and ≥2 lines BCVA, respectively. From 2010 the safety index has been >1.05. More than 94.0% of eyes achieved within ±1.0 D of target refraction and at least 70% achieved within ±0.50 D of target from 2010 onwards. Retreatment rate was 2.55% and after retreatment 98.4% of eyes achieved ≥20/40 UCVA and 63.5% achieved ≥20/20 UCVA. The overall complication rate is 0.98%, and since 2010, the annual complication rate has been <0.8%.ConclusionsMyopic LASIK performed in Asian eyes is safe and effective with high refractive predictability in a comprehensive LASIK programme with appropriate clinical audit.

Could spinal anesthesia be a choice for retrograde intrarenal surgery

2018 ◽  
Vol 85 (4) ◽  
pp. 169-173 ◽  
Author(s):  
Ibrahim Karabulut ◽  
Erdem Koc ◽  
Ali Haydar Yilmaz ◽  
Elif Oral Ahiskali ◽  
Ercument Keskin ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Analogue Scale ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
General Anesthesia Group ◽  
Group I ◽  
Anesthesia Group ◽  
Spinal Anesthesia Group

Objective: In this study, we aimed to compare cases of retrograde intrarenal surgery performed under spinal or general anesthesia through investigating relevant parameters for the first time in the literature. Material and method: In total, 86 patients with diagnosis of kidney stone who were treated by retrograde intrarenal surgery were included in this randomized controlled prospective study. In total, 43 of these operations were performed under spinal anesthesia (group I) and 43 were performed under general anesthesia (group II). The groups were compared in terms of demographic features, American Society of Anesthesiologists score, duration of operation, complication rates, postoperative visual analogue scale, postoperative hospitalization period, stone-free rates, and cost value ratios. Results: There were no significant differences between the two groups in terms of demographic findings, preoperative stone loads, postoperative stone-free rates, complication rates and postoperative hospitalization periods (p > 0.05). Postoperative visual analogue scale scores and cost value ratios were found statistically significantly lower in the spinal anesthesia group (group I) when compared with the general anesthesia group (group II; p < 0.001). Conclusion: Performing retrograde intrarenal surgery in the presence of spinal anesthesia is equally effective with general anesthesia. Spinal anesthesia also appears to be a more advantageous method due to statistically significantly lower mean postoperative pain scores and treatment cost value ratios.

scholarly journals Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position

Medicine ◽  
2018 ◽  
Vol 97 (25) ◽  
pp. e11190 ◽  
Author(s):  
Hiroyuki Oshika ◽  
Yukihide Koyama ◽  
Masataka Taguri ◽  
Koichi Maruyama ◽  
Go Hirabayashi ◽  
...  
Keyword(s):  
Prone Position ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Accidental Extubation

scholarly journals Epidural Anaesthesia for Caesarean Section: A Comparison of 0.5% Bupivacaine and 2% Lignocaine Both with Adrenaline

1988 ◽  
Vol 16 (2) ◽  
pp. 187-196 ◽  
Author(s):  
M. J. Paech
Keyword(s):  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Motor Block ◽  
Local Anaesthetics ◽  
Distinct Advantage ◽  
Complication Rates ◽  
Double Blind ◽  
Randomised Study ◽  
Patient Pain

Thirty-eight women having caesarean section under epidural anaesthesia received either lignocaine 2% or bupivacaine 0.5% both with adrenaline 1:200,000 in a double-blind, randomised study. The time to establish satisfactory surgical anaesthesia, the volume required and the quality of analgesia as assessed by the anaesthetist, patient pain and discomfort scales and patient approval, were not significantly different. Motor block assessed by the Bromage and RAM-test was greater in the lignocaine group but surgical opinion of abdominal wall relaxation was not significantly different between groups. The bupivacaine group had significantly longer durations of sensory and motor block while the lignocaine group had a higher incidence of maternal shivering, other complication rates being similar. Neonatal outcomes were uniformly good. Both local anaesthetics provided satisfactory epidural anaesthesia and neither proved to have a distinct advantage in the clinical setting of this study.

Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

2017 ◽  
Vol 83 (7) ◽  
pp. 696-698 ◽  
Author(s):  
Thomas S. Easterday ◽  
Joshuaw Moore ◽  
Meredith H. Redden ◽  
David V. Feliciano ◽  
Vernon J. Henderson ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Percutaneous Tracheostomy ◽  
Trauma Patients ◽  
Complication Rates ◽  
Short Term ◽  
Significant Difference ◽  
Urban Level ◽  
Level I ◽  
Bronchoscopic Guidance

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

scholarly journals The Expansion of Cholangioscopy: Established and Investigational Uses of SpyGlass in Biliary and Pancreatic Disorders

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 132
Author(s):  
Michael Yodice ◽  
Joseph Choma ◽  
Micheal Tadros
Keyword(s):  
Guide Wire ◽  
Prophylactic Antibiotic ◽  
Cost Effective ◽  
Antibiotic Use ◽  
Complication Rates ◽  
Visually Guided ◽  
Endoscopic Retrograde ◽  
Pancreatic Disorders ◽  
Selective Cannulation ◽  
Repeat Procedures

Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques.

scholarly journals Fistulotomy with or without marsupialisation of wound edges in treatment of simple anal fistula: a randomised controlled trial

2019 ◽  
Vol 101 (7) ◽  
pp. 472-478 ◽  
Author(s):  
M Anan ◽  
SH Emile ◽  
H Elgendy ◽  
M Shalaby ◽  
A Elshobaky ◽  
...  
Keyword(s):  
Wound Healing ◽  
Postoperative Pain ◽  
Anal Fistula ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Operation Time ◽  
Complication Rates ◽  
Group I ◽  
Group Ii ◽  
Fistula Track

Background Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula. Methods This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications. Results Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001). Conclusion Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.

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