scholarly journals Clinical Efficacy Evaluation of Full-endoscopic Foraminoplasty and Discectomy Under General Anesthesia in the Treatment of L5-S1 Disc Herniation

2020 ◽  
Author(s):  
Dongfang Meng ◽  
Lihe Wang ◽  
Tao Wang ◽  
Ji Tu ◽  
Chenyang Du ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Neurological Complications ◽  
Spinal Diseases ◽  
Efficacy Evaluation ◽  
Postoperative Mri ◽  
Minimally Invasive Surgical ◽  
Endoscopic Discectomy ◽  
Operation Procedure ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
The Mean

Abstract Background: Percutaneous transforaminal endoscopic discectomy (PTED) is a minimally invasive surgical method for the treatment of spinal diseases. However, the operation procedure relied on the radiative interventional technology, and was conducted under local anesthesia. Method: From June 2016 to December 2019, we performed a newly developed full-endoscopic visualized foraminoplasty and discectomy under general anesthesia in 30 patients with L5/S1 LDH. In this retrospective study, the outcomes and neurological complications of this approach were evaluated. Results: The mean visual analog scale (VAS) and Oswestry Disability Index (ODI) were significantly improved after surgery. The postoperative MRI reexamination revealed that the degree of intervertebral disc degeneration of each subject was improved significantly to different degrees as compared with that before surgery. The learning curve showed operative time rapidly decreased over the earlier cases, and then tapered to a steady state in the latter cases. Conclusions: Full-endoscopic foraminoplasty and discectomy under general anesthesia is efficient and safe for the treatment of the L5-S1 disc herniation.Trial registration: N/A

Feasibility, Safety, and Periprocedural Complications of Pipeline Embolization for Intracranial Aneurysm Treatment Under Conscious Sedation: University at Buffalo Neurosurgery Experience

2015 ◽  
Vol 11 (3) ◽  
pp. 426-430 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Marshall C Cress ◽  
Stephan A Munich ◽  
Ashish Sonig ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
General Anesthesia ◽  
Radiation Exposure ◽  
Intracranial Aneurysms ◽  
Conscious Sedation ◽  
Contrast Material ◽  
Neurological Complications ◽  
Safe Procedure ◽  
Aneurysm Treatment ◽  
The Mean

Abstract BACKGROUND Endovascular Pipeline Embolization Device (PED) placement for intracranial aneurysms is performed under general anesthesia at most centers because of perceived improved image quality and patient safety. OBJECTIVE To report the feasibility, safety, and outcomes associated with the use of the PED for intracranial aneurysms performed in awake patients after the administration of conscious sedation (CS) and a local anesthetic. METHODS Between March 2012 and September 2014, 130 patients with 139 intracranial aneurysms (8 ruptured) were treated with the PED under CS at our institution. Procedure details and time (including duration, radiation exposure, and fluoroscopy) and procedure-related complications were retrospectively reviewed. RESULTS A total of 155 PED deployment procedures were performed under CS. Treatment was successfully completed in all cases. Anesthesia was converted from CS to general anesthesia during 5 procedures. Mean interval from patient entry at the endovascular suite to procedure initiation was 18 minutes (range, 5 minutes-1 hour 10 minutes). Mean procedure length was 1 hour 25 minutes (range, 30 minutes-3 hours 51 minutes). Mean ± SD values for fluoroscopy time and radiation exposure were 36.17 ± 18.4 minutes and 1367 ± 897 mGy, respectively. The mean amount of contrast material administered was 211.37 ± 83.5 mL. Permanent neurological complications were seen in 4 patients (3%). CONCLUSION In our experience, CS for PED placement for intracranial aneurysm treatment is feasible and safe. Procedure and fluoroscopy times and amount of radiation exposure are similar to or less than described in reports of PED placement under general anesthesia. CS allows direct neurological evaluation and earlier detection of and response to intraprocedural complications.

scholarly journals Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

2016 ◽  
Vol 40 (2) ◽  
pp. E3 ◽  
Author(s):  
Pravesh S. Gadjradj ◽  
Maurits W. van Tulder ◽  
Clemens M. F. Dirven ◽  
Wilco C. Peul ◽  
B. Sanjay Harhangi
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Case Series ◽  
Endoscopic Discectomy ◽  
Duration Of Surgery ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
The Mean

OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery (± SD) was 51.0 ± 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 ± 17.3 mm and 60.0 ± 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 ± 24.5 mm and 26.7 ± 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 ± 23.5 mm on the VAS and 20.2 ± 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED.

scholarly journals Effects of sevoflurane anesthesia and abdominal surgery on the systemic metabolome: a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yiyong Wei ◽  
Donghang Zhang ◽  
Jin Liu ◽  
Mengchan Ou ◽  
Peng Liang ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
General Anesthesia ◽  
Tricarboxylic Acid Cycle ◽  
Tricarboxylic Acid ◽  
Metabolic Changes ◽  
Sevoflurane Anesthesia ◽  
Glutamate Metabolism ◽  
Acid Cycle ◽  
Link Type ◽  
The Mean

Abstract Background Metabolic status can be impacted by general anesthesia and surgery. However, the exact effects of general anesthesia and surgery on systemic metabolome remain unclear, which might contribute to postoperative outcomes. Methods Five hundred patients who underwent abdominal surgery were included. General anesthesia was mainly maintained with sevoflurane. The end-tidal sevoflurane concentration (ETsevo) was adjusted to maintain BIS (Bispectral index) value between 40 and 60. The mean ETsevo from 20 min after endotracheal intubation to 2 h after the beginning of surgery was calculated for each patient. The patients were further divided into low ETsevo group (mean − SD) and high ETsevo group (mean + SD) to investigate the possible metabolic changes relevant to the amount of sevoflurane exposure. Results The mean ETsevo of the 500 patients was 1.60% ± 0.34%. Patients with low ETsevo (n = 55) and high ETsevo (n = 59) were selected for metabolomic analysis (1.06% ± 0.13% vs. 2.17% ± 0.16%, P < 0.001). Sevoflurane and abdominal surgery disturbed the tricarboxylic acid cycle as identified by increased citrate and cis-aconitate levels and impacted glycometabolism as identified by increased sucrose and D-glucose levels in these 114 patients. Glutamate metabolism was also impacted by sevoflurane and abdominal surgery in all the patients. In the patients with high ETsevo, levels of L-glutamine, pyroglutamic acid, sphinganine and L-selenocysteine after sevoflurane anesthesia and abdominal surgery were significantly higher than those of the patients with low ETsevo, suggesting that these metabolic changes might be relevant to the amount of sevoflurane exposure. Conclusions Sevoflurane anesthesia and abdominal surgery can impact principal metabolic pathways in clinical patients including tricarboxylic acid cycle, glycometabolism and glutamate metabolism. This study may provide a resource data for future studies about metabolism relevant to general anaesthesia and surgeries. Trial registration www.chictr.org.cn. identifier: ChiCTR1800014327.

scholarly journals First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

2021 ◽  
Author(s):  
Valentina Pennacchietti ◽  
Katharina Stoelzel ◽  
Anna Tietze ◽  
Erwin Lankes ◽  
Andreas Schaumann ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Morphological Variability ◽  
Case Series ◽  
Relevant Information ◽  
Navigation Systems ◽  
Postoperative Mri ◽  
The Mean ◽  
Clinical Conditions

Abstract Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

Comparison of General Anesthesia and Conscious Sedation during Computed Tomography–Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma

2018 ◽  
Vol 69 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Hae Jin Kim ◽  
Byung Kwan Park ◽  
In Sun Chung
Keyword(s):  
Renal Cell Carcinoma ◽  
Radiofrequency Ablation ◽  
General Anesthesia ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Conscious Sedation ◽  
Tumour Progression ◽  
Tumour Size ◽  
General Anesthesia Group ◽  
The Mean

Purpose Percutaneous radiofrequency ablation is so painful that this treatment requires pain control such as conscious sedation or general anesthesia. It is still unclear which type of anesthesia is better for treatment outcomes of renal cell carcinoma. This study aimed to compare general anesthesia and conscious sedation in treating patients with renal cell carcinoma with radiofrequency ablation. Methods Between 2010 and 2015, 51 patients with biopsy-proven renal cell carcinomas (<4 cm) were treated with computed tomography–guided radiofrequency ablation. General anesthesia was performed in 41 and conscious sedation was performed in 10 patients. Tumour size, local tumour progression, metastasis, major complication, effective dose, glomerular filtration rate difference, and recurrence-free survival rate were compared between these groups. Results The mean tumour size was 2.1 cm in both groups ( P = .673). Local tumour progression occurred in 0% (0 of 41) of the general anesthesia group, but in 40% (4 of 10) of the conscious sedation group ( P = .001). Metastases in these groups occurred in 2.4% (1 of 41) of the general anesthesia group and 20% (2 of 10) of the conscious sedation group ( P = .094). No major complications developed in either group after the first radiofrequency ablation session. The mean effective doses in these groups were 21.7 mSv and 21.2 mSv, respectively ( P = .868). The mean glomerular filtration rate differences in the general anesthesia and conscious sedation groups were −13.5 mL/min/1.73 m2 and −19.1 mL/min/1.73 m2, respectively ( P = .575). Three-year recurrence-free survival rates in these groups were 97.6% and 60.0%, respectively ( P = .001). Conclusions General anesthesia may provide better intermediate outcomes than conscious sedation in treating small renal cell carcinomas with radiofrequency ablation.

Application of a Targeted and Quantificational Foraminoplasty Device in Percutaneous  Transforaminal Endoscopic Discectomy for L5-S1 Disc Herniation: Preliminary Clinical Outcomes

2021 ◽  
Author(s):  
Jinlong Liu ◽  
Junlong wu ◽  
Honglei Zhang ◽  
Rui Zuo ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Leg Pain ◽  
Fluoroscopy Time ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Vas Score ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disk herniation(LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5-S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSY at the L5-S1 level.MethodsBetween January to August of 2018, Fifty-six patients with lumbar disk herniation at the single level of L5–S1 and underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the the TESSYS group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time and fluoroscopy time evaluated for the operation efficiency. Clinical outcomes were assessed by visual analog scale(VAS) score and Oswestry Disability Index(ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29±2.05 minutes), foraminoplasty time (12.82±2.52 minutes) and fluoroscopy time (26.29±5.96 seconds) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07±3.13 minutes, p<0.01; foraminoplasty time, 17.18±2.92 minutes, p<0.01; fluoroscopy time, 34.73±6.86 seconds; p<0.01). No significant differences were observed between the 2 groups in the decompression time (p=0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoprative , in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disk herniation at the L5-S1 level.

scholarly journals Letter to the Editor. Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy

2018 ◽  
Vol 29 (4) ◽  
pp. 481-482
Author(s):  
Sanjeev Ariyandath Sreenivasan ◽  
Manoj Phalak ◽  
Sachin Anil Borkar ◽  
Shashank Sharad Kale
Keyword(s):  
Letter To The Editor ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Microendoscopic Discectomy

scholarly journals Varicella complications in children one-site Polish population – a 19- year long survey

2019 ◽  
pp. 459-467
Author(s):  
Beata Smok ◽  
Justyna Franczak ◽  
Krzysztof Domagalski ◽  
Małgorzata Pawłowska
Keyword(s):  
Gastrointestinal Tract ◽  
Survey Methods ◽  
Varicella Vaccine ◽  
Herd Immunity ◽  
Neurological Complications ◽  
National Immunization ◽  
The Mean ◽  
Tract Infections ◽  
Bacterial Skin Infections ◽  
Length Of Hospitalization

OBJECTIVES. The aim of this study was to describe the epidemiology of chickenpox complications in children, based on a 19-year long survey. METHODS. This publication constitutes a review of medical records of 761 patients under the age of 18 who were hospitalized at the T. Browicz Provincial Hospital for Infectious Diseases in Bydgoszcz, Poland from the 1st of January 1999 to the 31st of December 2017. RESULTS. Over the study period, 761 children diagnosed with varicella complications were hospitalized. The mean number of hospitalizations in each year amounted to 40. The median age of admitted patients was 4 years. The median length of hospitalization was 5 days (ranged from 1 to 30 days). The most frequent varicella complications included respiratory tract infections – 229/761 (30.1%), bacterial skin infections – 189/761 (24.8%) and gastrointestinal tract disorders – 142/761 (18.6%). Pneumonia, bronchitis and gastrointestinal tract disturbances, were reported most often in children under 2 years of age, while neurological complications occurred most frequently in children at 3-6 years of age. No significant differences in the number of varicella complications between immunocompromised and immunocompetent children were reported. CONCLUSIONS. Varicella complications mainly affect the youngest immunocompetent children. Population-wide vaccination and herd immunity appears to be the best way to reduce the incidence of chickenpox and the rate of varicella complications. This study gives support for inclusion of universal varicella vaccine in the National Immunization Program in Poland.

scholarly journals Factors affecting general or regional anesthesia preference in patients with elective surgery

2020 ◽  
Vol 7 (7) ◽  
pp. 570-574
Author(s):  
Esra Adıyeke ◽  
Levent Adıyeke
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Significant Positive Correlation ◽  
Elective Surgery ◽  
Education Level ◽  
Foot Surgery ◽  
Factors Affecting ◽  
Positive Correlation ◽  
The Mean ◽  
To Receive

Objective: This study aimed to investigate the factors that affect the preference of the anesthesia method in patients who were indicated for general or regional anesthesia. Material and Methods: A descriptive questionnaire was used to evaluate the opinions of 123 patients who were planned to undergo elective surgery in the orthopedics and traumatology outpatient clinic between January 2018 and June 2019. Results: 73 women (%59) and 50 men (%41) participated in the study. The mean age was 58.62±11 years. General anesthesia was preferred in 58% of the patients. The most common reason for rejection was that the patients who preferred general anesthesia did not want to receive visual and auditory stimuli during the surgical procedure. There was a significant positive correlation between education level and regional anesthesia preference rate. There was a significant positive correlation between the regional anesthesia preference rate of patients receiving hand and foot surgery indications. Conclusion: The preference of the majority of patients was found to be general anesthesia method. Additionally, the type of surgery and education level of the patients was found to be effective in preference of the anesthesia method.

Sign in / Sign up

Export Citation Format

Share Document