scholarly journals Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective

2021 ◽  
Vol 8 (12) ◽  
pp. 3673
Author(s):  
Kailash K. Thakuria ◽  
Naveen Kumar M. ◽  
Monmohan Boro
Keyword(s):  
General Anaesthesia ◽  
Aerosol Generation ◽  
Postoperative Intensive Care ◽  
Post Operative Pain ◽  
Related Risk ◽  
Medium Risk ◽  
Risk Patients ◽  
Early Readmission ◽  
The Mean

In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.

scholarly journals 950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hashmi ◽  
R Ahmed ◽  
T Zafar ◽  
M Ahmed ◽  
N Yousaf ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Groin Pain ◽  
Clinical Judgement ◽  
Chronic Groin Pain ◽  
Day Case ◽  
Post Operative Pain ◽  
The Mean ◽  
Mesh Hernioplasty ◽  
Operating Surgeon

Abstract Objective To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case. Method All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters. Results From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up. Conclusions Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.

Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

2013 ◽  
Vol 8 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Francesca Chiaramonti ◽  
Pierandrea Farneti ◽  
Stefano Bevilacqua ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

scholarly journals A PROSPECTIVE RANDOMIZED CONTROLLED STUDY OF COMPARISON OF COMPLICATIONS BETWEEN SLEEVE TECHNIQUE VERSUS CONVENTIONAL DORSAL SLIT TECHNIQUE FOR CIRCUMCISION IN CHILDREN

2020 ◽  
pp. 33-36
Author(s):  
Hamikchandra Patel ◽  
Ronak Kadia
Keyword(s):  
Healing Time ◽  
Controlled Study ◽  
Open Technique ◽  
Postoperative Result ◽  
Randomized Controlled ◽  
Vas Score ◽  
Local Site ◽  
Post Operative Pain ◽  
The Mean

Background: There are several methods of circumcision with its own merits and demerits. Dorsal slit technique is practised all over the world most commonly. The sleeve technique introduced later on which helps in preventing common complications of open technique. Aim: To compare complications of sleeve technique versus conventional dorsal slit technique for circumcision in children. Material and Methods: Total 64 patients were studied by doing comparison of complications between sleeve technique and dorsal slit technique of circumcision allocated randomly. Post-operative pain was evaluated by Visual Analogue Scale (VAS) at 1, 3, 6 and 24 hour. Blood loss, healing time were assessed. Patient was examined on follow up at 1, 2 and 6 week. Results: For Dorsal slit technique, the mean of gauze pieces used was 2.12 pieces and for sleeve technique, the mean of gauze pieces used was 1.71 pieces. For Dorsal slit technique, the mean VAS score was 2.90 and for sleeve technique, the mean VAS score was 2.40. For dorsal slit technique, the mean of healing time was 16 days and for sleeve technique, the mean of healing time was 15.43 days. Post-operatively, 14 and 9 patients of dorsal slit technique and sleeve technique had edema at local site, respectively. Conclusion: Sleeve technique produces a good postoperative result, less bleeding and less postoperative pain as compared to dorsal slit technique. Hence, sleeve technique is recommended for circumcision as compared to dorsal slit technique.

scholarly journals LO06: Development of practice recommendations for ED management of syncope by mixed methods

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S8-S9
Author(s):  
V. Thiruganasambandamoorthy ◽  
M. Taljaard ◽  
N. Hudek ◽  
J. Brehaut ◽  
B. Ghaedi ◽  
...  
Keyword(s):  
High Risk ◽  
Low Risk ◽  
Cardiac Monitoring ◽  
Structured Interviews ◽  
High Risk Patients ◽  
Practice Recommendations ◽  
Medium Risk ◽  
Risk Patients ◽  
Risk Categories

Introduction: Emergency department (ED) syncope management is extremely variable. We developed practice recommendations based on the validated Canadian Syncope Risk Score (CSRS) and outpatient cardiac monitoring strategy with physician input. Methods: We used a 2-step approach. Step-1: We pooled data from the derivation and validation prospective cohort studies (with adequate sample size) conducted at 11 Canadian sites (Sep 2010 to Apr 2018). Adults with syncope were enrolled excluding those with serious outcome identified during index ED evaluation. 30-day adjudicated serious outcomes were arrhythmic (arrhythmias, unknown cause of death) and non-arrhythmic (MI, structural heart disease, pulmonary embolism, hemorrhage)]. We compared the serious outcome proportion among risk categories using Cochran-Armitage test. Step-2: We conducted semi-structured interviews using observed risk to develop and refine the recommendations. We used purposive sampling of physicians involved in syncope care at 8 sites from Jun-Dec 2019 until theme saturation was reached. Two independent raters coded interviews using an inductive approach to identify themes; discrepancies were resolved by consensus. Results: Of the 8176 patients (mean age 54, 55% female), 293 (3.6%; 95%CI 3.2-4.0%) experienced 30-day serious outcomes; 0.4% deaths, 2.5% arrhythmic, 1.1% non-arrhythmic outcomes. The serious outcome proportion significantly increased from low to high-risk categories (p < 0.001; overall 0.6% to 27.7%; arrhythmic 0.2% to 17.3%; non-arrhythmic 0.4% to 5.9% respectively). C-statistic was 0.88 (95%CI0.86–0.90). Non-arrhythmia risk per day for the first 2 days was 0.5% for medium-risk, 2% for high-risk and very low thereafter. We recruited 31 physicians (14 ED, 7 cardiologists, 10 hospitalists/internists). 80% of physicians agreed that low risk patients can be discharged without specific follow-up with inconsistencies around length of ED observation. For cardiac monitoring of medium and high-risk, 64% indicated that they don't have access; 56% currently admit high-risk patients and an additional 20% agreed to this recommendation. A deeper exploration led to following refinement: discharge without specific follow-up for low-risk, a shared decision approach for medium-risk and short course of hospitalization for high-risk patients. Conclusion: The recommendations were developed (with online calculator) based on in-depth feedback from key stakeholders to improve uptake during implementation.

scholarly journals Risk Factors for Peritonitis in a Pediatric Dialysis Program in Guatemala, 2011–2014

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Jeda Chinchilla ◽  
Karla Sebastián ◽  
Renato Meléndez ◽  
Brooke Ramay ◽  
Randall Lou-Meda
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Treatment Time ◽  
Treatment Modalities ◽  
Close Monitoring ◽  
Housing Status ◽  
Related Risk ◽  
Relevant Risk Factor ◽  
Risk Patients

Background. Peritonitis is the most common complication of peritoneal dialysis but there is limited data regarding peritonitis related risk factors in developing countries. Objective. Describe the PD program at Foundation for Children with Kidney Disease (FUNDANIER), in Guatemala, and identify peritonitis related risk factors in these patients. Methods. This retrospective open cohort study included medical records from FUNDANIER during 2011 to 2014. Baseline demographics, treatment modalities, caregivers’ characteristics, and socioeconomic status were recorded. Results. Eighty-nine medical records were included with a treatment time of 1855 months. Median age of patients was 11.3 years (range 6–17). Median duration of PD therapy was 20.8 months (range 1–28). Sixty-eight peritonitis episodes were registered; forty-eight patients (54%) remained peritonitis-free. Median time to first peritonitis episode was 5 months (range 2–16). Peritonitis rate was one episode every 27 months or 0.44 episodes per patient-year. Peritonitis rate in patients with fair housing was 2.5 times higher than in those with good housing (CI = 1.0–5.2, p=0.01). Conclusion. Housing conditions are a relevant risk factor related to peritonitis. Strategies toward preventing peritonitis must consider housing status, establishing adequate follow-up in high-risk patients. Close monitoring of technique serves to overcome understaffing issues in this setting.

scholarly journals Transanal Hemorrhoidal Dearterialization (THD) Anolift-Prospective Assessment of Safety and Efficacy

2021 ◽  
Vol 8 ◽  
Author(s):  
Pasquale Giordano ◽  
Elena Schembari
Keyword(s):  
Hemorrhoidal Disease ◽  
Barbed Suture ◽  
Strongly Correlated ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Skin Tags ◽  
Prospective Assessment ◽  
Advanced Stages ◽  
The Mean

The adjunct of a mucopexy to conventional dearterialization has become a routine part of the transanal hemorrhoidal dearterialization procedure in order to facilitate the management of the prolapsing component and has helped to expand the indications of this technique to more advanced stages of hemorrhoidal disease. A simple technical modification of THD with targeted mucopexy (TM), called Anolift, is described. The aim of the study was to evaluate the safety and effectiveness of this technical variation. The procedure consisted of two parts: one aimed at the dearterialization and the other concentrated on the management of the prolapsing component. Once all the arteries were identified and transfixed an Anolift targeted mucopexy was performed using a continuous barbed suture with a synthetic absorbable monofilament (Polydioxanone) 2/0 Filbloc (Assut Europe) stitch mounted on a 4/8 30 mm needle. Severity of hemorrhoidal symptoms was scored from 0 to 20 using a dedicated questionnaire: the Hemorrhoidal Assessment Severity Score (HASS). From May 2018 to November 2020, 60 patients with hemorrhoidal disease (HD) underwent a THD Anolift procedure. Three patients experienced severe post-operative pain and 10 (23%) suffered with difficulty in evacuation. The median follow-up period was 15.5 months (range 2–32 months). The mean HASS changed from 16.43 pre-operatively to 1.95 post-operatively (p &lt; 0.0001). Pre-operative HASS very strongly correlated with the degree of hemorrhoids (p &lt; 0.001), while there was no correlation between the pre-operative HASS or the degree of hemorrhoids and the post-operative HASS (p = 0.163). There was no significant difference in predicted post-operative HASS according to the pre-operative HD stage. One patient (1.6%) with circumferential IV hemorrhoids had a recurrence and required a further THD. Two patients had excision of skin tags (3%). The Anolift technique is safe and effective for the management of HD even in patients with advanced stages.

scholarly journals Endoscopic Pilonidal Sinus Treatment: A Tertiary Care Academic Center Experience

2021 ◽  
Vol 8 ◽  
Author(s):  
Gaetano Gallo ◽  
Antonio Carpino ◽  
Gilda De Paola ◽  
Serena Fulginiti ◽  
Eugenio Novelli ◽  
...  
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Tertiary Care ◽  
Time To Recurrence ◽  
Academic Center ◽  
Post Operative Pain ◽  
The Mean

Background: Pilonidal disease (PD) represents one of the most common proctological diseases in young adults. Although several approaches to treating PD have been described, there is still a lack of agreement on which is the best. The aim of this study was to evaluate the long-term efficacy of endoscopic pilonidal sinus treatment (EPSiT) at a tertiary care academic center.Methods: Between June 2017 and January 2021, a total of 32 patients [12 women (37.5%) and 20 men (62.5%)] with a mean age of 29.22 ± 12.98 years were treated with EPSiT. Pre- and post-operative symptoms were assessed with a score of 0–5. Success was defined as the absence of any subjective symptoms, as well as by complete post-operative wound healing.Results: Most of the patients had a midline external opening (17/32; 53.1%), with a mean number of external openings of 2.41 (1–4) ± 1.04. The median post-operative pain score was 0, and the mean follow-up period was 22 (4–42) ± 11.49 months. The time to wound healing was reduced in patients with one opening (28.14 ± 4.06 days) compared to patients with two or more openings (33.64 ± 7.3 days) (p = 0.067). The mean operative time was longer in patients who subsequently had a recurrence (41.75 ± 6.24 vs. 34.18 ± 6.24 min; p = 0.031). The overall success rate was 87.5% (28/32), and the mean time to recurrence was 3.25 (2–5) ± 1.26 months.Conclusions: EPSiT represents a viable option for the treatment of PD. More evidence and a longer follow-up period are needed to validate the results.

scholarly journals Endartériectomie carotidienne: histoire médicale préopératoire et devenir à long terme de 82 patients

1983 ◽  
Vol 10 (1) ◽  
pp. 27-31
Author(s):  
L. Trudel ◽  
J. Fabia ◽  
J.P. Bouchard
Keyword(s):  
Medical History ◽  
Risk Group ◽  
Survival Rates ◽  
Low Risk ◽  
Preoperative Risk ◽  
Medium Risk ◽  
Risk Patients ◽  
History Of ◽  
The Difference

SUMMARY:Using medical files, death certificates and an interview at home for the survivors, a long term retrospective follow-up study was done for 82 subjects operated for carotid stenosis. Causes of death, survival rates and medical history of survivors were studied. Subjects were classified in two preoperative risk categories according to their medical history prior to angiography: low risk (36 subjects) and medium risk (46 subjects). None of the subjects were lost during the follow-up period which varies from 81 to 105 months.At seven years, observed survival rate is significantly lower for the medium risk patients than for the low risk patients (43.0 ±8.6 versus 80.6 ± 6.6; X2 M-H, p = 0.006). The difference between the survival rates is markedly noticeable after the fifth year of follow-up. Besides, the percentage of survivors who have developed cerebrovascular problems after the operation is significantly higher in the medium risk group than the low risk group (54.5% versus 25.0%, X2 p ≃ 0,04).Does this mean that the preoperative risk classification separates two different stages or two different forms of atherosclerosis? Can. J. Neurol. Sci. 1983; 10:27–31

P3776Blood pressure variability and incidence of new-onset atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E.-K Choi ◽  
S R Lee ◽  
K D Han ◽  
S Oh
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
High Variability ◽  
Newly Diagnosed ◽  
Risk Patients ◽  
Korean National Health Insurance ◽  
The Mean ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Visit-to-visit blood pressure (BP) variability is a known risk factor for stroke, but the association between BP variability and atrial fibrillation (AF) incidence is uncertain. We sought to evaluate the association between BP variability and incident AF. Methods We identified 8,063,922 subjects (mean age 48 years; 59% men) who had ≥3 health checkups provided by the Korean National Health Insurance Corporation between 2004 and 2010. Systolic and diastolic BP variability was defined as variability independence of the mean (VIM). VIM was divided into four groups and high variability of BP was defined as the highest quartile values. The primary end point was new-onset atrial fibrillation. Results During a mean 7 years of follow-up, 140,086 subjects were newly diagnosed with AF (2.53 per 1000 person-years). High variation in BP was associated with an increase in the risk of AF (SBP: hazard ratio [HR], 1.060; 95% confidence interval [CI], 1.044–1.075, DBP: HR, 1.066; 95% CI, 1.050–1.082) compared with subjects with lowest quartile of BP. Among subjects with high variation both in SBP and DBP, the risk of AF was 7.6% higher than subjects without high variation in SBP and DBP. The risk of high BP variation on new-onset AF was more obvious in high-risk patients. The association of high BP variability with AF was being stronger for high-risk subjects who were older (≥65 years), with diabetes, or with CKD compared with subjects who were younger, without diabetes, or without CKD. Conclusions Fluctuation in SBP and DBP was associated with higher incidence of AF, especially in high-risk subjects, independent of traditional AF risk factors.

Regional Anaesthesia and Subsequent Long-Term Pain

1994 ◽  
Vol 19 (3) ◽  
pp. 342-346 ◽  
Author(s):  
L. WEEKS ◽  
A. BARRY ◽  
T. WOLFF ◽  
J. FIRRELL ◽  
L. SCHEKER
Keyword(s):  
Brachial Plexus ◽  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Significant Proportion ◽  
Regional Block ◽  
Post Operative Pain

The incidence of long-term pain (between 1 and 48 weeks and at 2 year follow-up) unrelated to the surgical site following either regional brachial plexus or general anaesthesia was determined. In 834 patients with regional anaesthesia, the incidence (11.1%) was significantly higher than in the 86 patients with general anaesthesia (3.6%; P =0.03). The incidence of pain was not significantly different among four common techniques of positioning the needle tip in the axillary sheath (9.9 to 11.1%). Parascalene blocks had a slightly but not significantly higher rate (16.3%). A regional re-block was not associated with a higher incidence when compared to those blocked only once. A more distal local re-block was associated with a higher incidence of pain (23%). 2 years post-operatively, 0.5% of patients had pain related to the regional block. A significant proportion of patients developed some long-lasting post-operative pain following regional brachial plexus anaesthesia, although ultimate morbidity was minimal.

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