scholarly journals APPLICATION OF THE MODIFIED PECS BLOCKADE DURING RECONSTRUCTIVE AND AESTHETIC SURGERY ON THE MAMMARY GLANDS

2021 ◽  
pp. 21-25
Author(s):  
Yu. L. Kuchin ◽  
D. S. Sazhin ◽  
G. I. Patlajan ◽  
E. I. Shorikov
Keyword(s):  
Aesthetic Surgery ◽  
Mammary Glands ◽  
Low Flow ◽  
Inhalation Anesthesia ◽  
Breast Plastic Surgery ◽  
Flow Inhalation ◽  
Anesthetic Solution ◽  
The Difference ◽  
Intercostal Nerves ◽  
Long Term Observation

Existing methods of anesthesia, drugs used in the field of breast plastic surgery have a number of features compared to anesthesia in the practice of general surgery. In particular, techniques of regional blockades, such as interfascial blocks PECS 1 and PECS 2 are taken into account. Their effectiveness in comparison with standard methods of anesthesia for different types of interventions on the breast is subject to further discussion. Thus, the article presents the results of efficiency in the implementation of the author's development - a modified PECS-block during reconstructive and aesthetic surgery on the mammary glands. Material and methods. During 2018-2020, 58 women (average age 36,8 ± 10,8 years) were included in the prospective study, who underwent low-flow inhalation anesthesia with sevoflurane during surgery, and in the postoperative period were divided into two subgroups: 1) subgroup 1, in whom regional anesthesia according to the author's method used; 2) subgroup 2 with nalbuphine analgesia. At the first visit, clinical and laboratory, instrumental ultrasound examination, completed informed consent cards of patients, as well as long-term observation cards were filled in. The method of postoperative analgesia developed by the author's method is, in essence, a combination of PECS 1 and PECS 2 blockades. The anesthetic solution was administered so as to effectively block the intercostal nerves that run along the posterior surface of the chest and extend outward into the parasternal region. For statistical analysis of the obtained results we used a package of general statistic data “Statistica for Windows” version 6.0 (Stat Soft inc., USA). At p<0, 05, the difference was considered statistically significant. Results. It was found that the use of modified PECS-block was characterized by a shortening of the verticalization time by 58,8%, compared with the introduction of nalbuphine and 2,16 times in the absence of postoperative anesthesia. The absolute efficiency (AE,%) of the modified PECS-block relative to the verticalization time was 68,0% higher compared to the use of nalbuphine, with a probable relative efficiency (RR, p<0,05) and the odds ratio (OR, p<0,05). 3 hours after the intervention of AE modified PECS-block relative to the intensity of pain less than 1 point was 89,0%, with a clinical efficiency of 60,0% relative to the use of nalbuphine, probable RR (p<0,05) and OR (p<0,05). The majority of patients who underwent modified PECS-block rated their physical and motor activity by more than 2 points (86,0%), while using nalbuphine the part was only 43.0% (p<0,05). The reversal, moderate regression relationship between pain self-esteem and physical activity (r=-0.46, p<0.05) persisted for 3 hours after the intervention. Against the background of the modified PECS block, there was no cases of postoperative nausea, in contrast to nalbuphine (AE – 18,0%, RR – 0,02 [0,003-0,97], p<0,05; HS – 0,02 [0,004-0,87], p<0,05). Regarding the parameters of cardio hemodynamics, it was found that against the background of nalbuphine there was an increase in heart rate to 29,3% after 1 hour, by 48,6 and 39,7% after 3 and 8 hours, compared with the modified PECS-block. The tendency to high (greater than 140 mm Hg) and high normal (greater than 130 mm Hg) blood pressure on the background of nalbuphine, in contrast to the modified PECS-block, where the CAT values during the 1st day stayed in the range of optimal pressure (110-130 mm Hg).

scholarly journals COMPARISON OF ANESTHESIA AND PERIOPERATIVE ANALGESIA OPTIONS IN ENDOSCOPIC SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY

2018 ◽  
Vol 12 (2) ◽  
pp. 98-106
Author(s):  
M. I Neimark ◽  
Roman V. Kiselev
Keyword(s):  
Morbid Obesity ◽  
Postoperative Analgesia ◽  
Perioperative Period ◽  
Low Flow ◽  
Inhalation Anesthesia ◽  
Perioperative Analgesia ◽  
Flow Inhalation ◽  
Combined Anesthesia ◽  
Group 2 ◽  
The Impact

Patients with morbid obesity have an increased sensitivity of the respiratory center to opioids, which leads to an increased incidence of respiratory diseases, which dictates the need to limit the use of opioids in the structure of anesthesia. Purpose of the trial. Comparison of the impact of anesthesia options with minimal use of opioids during the perioperative period. Materials and methods. A randomized trial of 59 patients with a body mass index > 35 kg/m2, which was performed endoscopic sleeve gastectomy. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (n-30), the operation was performed under conditions of combined anesthesia based on low-flow inhalation of desflurane in combination with prolonged epidural analgesia (PEA) with of ropivacaine in group 2 (n-29), the operation was performed under conditions of combined anesthesia based on low flow inhalation of desflurane in combination with a combination with an infusion of the analgesic-sympatholytic solution. The indicators of the adequacy of anesthesia, central and peripheral hemodynamics, monitoring of neuromuscular conduction, the efficiency of postanesthesia recovery and the quality of postoperative analgesia were studied. Results and Conclusion. It was revealed that surgical intervention in conditions of low-flow inhalation anesthesia on the basis of desflurane in combination with PEA ropivacaine promotes faster postnanaesthesia recovery and effective postoperative analgesia.

scholarly journals Comparison of the effects of combined neuraxial anesthesia and multicomponent low-flow inhalation anesthesia in the structure of perioperative anesthesia management in arthroscopic knee surgeries

2021 ◽  
Vol 17 (4) ◽  
pp. 80-85
Author(s):  
V.V. Yevsieieva ◽  
Ye.O. Skobenko ◽  
L.M. Zenkina ◽  
M.O. Malimonenko ◽  
S.O. Savchenko
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Postoperative Nausea And Vomiting ◽  
Knee Surgery ◽  
Low Flow ◽  
Inhalation Anesthesia ◽  
Arthroscopic Knee Surgery ◽  
Anesthesia Management ◽  
Flow Inhalation ◽  
Arthroscopic Knee

Background. Arthroscopic knee surgery is one of the most common types of surgeries in the world. But the optimal anesthesia management for this type of orthopedic surgery is still debatable. The purpose of the study was to improve the quality of anesthesia management for arthroscopic interventions on the knee joint by introducing a personalized perioperative anesthesia management. Materials and methods. One hundred and forty-two patients aged 18–78 years, who underwent arthroscopic knee surgery, took part in the study. They were randomized into 2 groups according to the type of anesthesia chosen by the patient. In the first group (n1 = 82), individuals underwent neuraxial anesthesia in combination with intravenous administration of dexmedetomidine, in the second group (n2 = 60) — multicomponent low-flow inhalation anesthesia with sevoflurane combined with multimodal analgesia. Before the operation, the level of preoperative stress was assessed. During the first 24 hours after surgery, we have evaluated the level of postoperative pain by the visual analogue scale, the incidence of postoperative nausea and vomiting, and overall patient’s satisfaction with the surgery. Results. The level of pain according to the visual analogue scale, the incidence of postoperative nausea and vomiting, the level of satisfaction in the study groups did not differ significantly. The level of preoperative stress had a significant impact on the patient’s choice regarding the type of anesthesia. Conclusions. Neuraxial and general anesthesia for arthroscopic knee surgery has advantages and disadvantages. Decision-making on the method of anesthesia should be based on the patient’s wishes and possible previous surgical experience.

scholarly journals COMPARISON OF THE EFFECTS OF COMBINED NEURAXIAL ANESTHESIA AND MULTICOMPONENT LOW-FLOW INHALATION ANESTHESIA IN THE STRUCTURE OF PERIOPERATIVE ANESTHETIC MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC INTERVENTIONS ON THE KNEE JOINT

2021 ◽  
pp. 51-55
Author(s):  
V. Yevsieieva ◽  
Y. Skobenko ◽  
L. Zenkina ◽  
M. Malimonenko ◽  
S. Savchenko
Keyword(s):  
Knee Joint ◽  
Anesthetic Management ◽  
Neuraxial Anesthesia ◽  
Knee Surgery ◽  
Low Flow ◽  
Inhalation Anesthesia ◽  
Arthroscopic Knee Surgery ◽  
Advantages And Disadvantages ◽  
Flow Inhalation ◽  
Arthroscopic Knee

Abstract. Arthroscopic knee surgery (AKS) is one of the most common types of surgery in the world. But there is still a debate about the optimal type of anesthetic management for this type of orthopedic surgery. The purpose of the study was to improve the quality of anesthetic management of arthroscopic interventions on the knee joint by introducing personalized perioperative anesthesia management. Materials and methods: 142 patients, aged 18-78 years, who were planned for AKS, took part in the study. The patients were randomized into 2 groups according to the type of anesthesia chosen by the patient. In the first group (n1 = 82) patients underwent neuraxial anesthesia in combination with intravenous administration of dexmedetomidine, in the second group (n2 = 60) – multicomponent low-flow inhalation anesthesia with sevoflurane in combination with multimodal analgesia. Before the operation, the level of preoperative stress was assessed. During the first 24 hours after surgery, the level of postoperative pain was assessed by the VAS, the incidence of PONV, and overall patient satisfaction with the surgery. Results: the level of pain according to the VAS, the incidence of PONV, the level of satisfaction in the study groups did not differ significantly. Conclusions: Neuraxial and general anesthesia for arthroscopic knee surgery has advantages and disadvantages. The patient’s choice of one or another type of anesthetic aid was significantly influenced by the level of preoperative stress. Decision-making on the method of anesthesia should be based on the patient’s wishes and possible previous surgical experience.

scholarly journals The European 2015 drought from a hydrological perspective

2017 ◽  
Vol 21 (6) ◽  
pp. 3001-3024 ◽  
Author(s):  
Gregor Laaha ◽  
Tobias Gauster ◽  
Lena M. Tallaksen ◽  
Jean-Philippe Vidal ◽  
Kerstin Stahl ◽  
...  
Keyword(s):  
Water Cycle ◽  
Hydrological Drought ◽  
Low Flow ◽  
Drought Indices ◽  
Climate Indices ◽  
Climate Data ◽  
Spatial And Temporal Scales ◽  
Space And Time ◽  
Dynamic Development ◽  
The Difference

Abstract. In 2015 large parts of Europe were affected by drought. In this paper, we analyze the hydrological footprint (dynamic development over space and time) of the drought of 2015 in terms of both severity (magnitude) and spatial extent and compare it to the extreme drought of 2003. Analyses are based on a range of low flow and hydrological drought indices derived for about 800 streamflow records across Europe, collected in a community effort based on a common protocol. We compare the hydrological footprints of both events with the meteorological footprints, in order to learn from similarities and differences of both perspectives and to draw conclusions for drought management. The region affected by hydrological drought in 2015 differed somewhat from the drought of 2003, with its center located more towards eastern Europe. In terms of low flow magnitude, a region surrounding the Czech Republic was the most affected, with summer low flows that exhibited return intervals of 100 years and more. In terms of deficit volumes, the geographical center of the event was in southern Germany, where the drought lasted a particularly long time. A detailed spatial and temporal assessment of the 2015 event showed that the particular behavior in these regions was partly a result of diverging wetness preconditions in the studied catchments. Extreme droughts emerged where preconditions were particularly dry. In regions with wet preconditions, low flow events developed later and tended to be less severe. For both the 2003 and 2015 events, the onset of the hydrological drought was well correlated with the lowest flow recorded during the event (low flow magnitude), pointing towards a potential for early warning of the severity of streamflow drought. Time series of monthly drought indices (both streamflow- and climate-based indices) showed that meteorological and hydrological events developed differently in space and time, both in terms of extent and severity (magnitude). These results emphasize that drought is a hazard which leaves different footprints on the various components of the water cycle at different spatial and temporal scales. The difference in the dynamic development of meteorological and hydrological drought also implies that impacts on various water-use sectors and river ecology cannot be informed by climate indices alone. Thus, an assessment of drought impacts on water resources requires hydrological data in addition to drought indices based solely on climate data. The transboundary scale of the event also suggests that additional efforts need to be undertaken to make timely pan-European hydrological assessments more operational in the future.

scholarly journals Manajemen Low Flow Anesthesia pada Pasien Kraniosinostosis dengan Hipertelorisme yang menjalani Four Box Wall Osteotomy, dan Eksisi Redundant Skin Fronto Nasal

2021 ◽  
Vol 10 (3) ◽  
pp. 172-181
Author(s):  
Syarif Afif ◽  
◽  
Dewi Yulianti Bisri ◽  
M. Sofyan Harahap ◽  
Syafruddin Gaus ◽  
...  
Keyword(s):  
Fluid Management ◽  
Coagulation Factor ◽  
Massive Bleeding ◽  
Low Flow ◽  
First Year ◽  
Inhalation Anesthesia ◽  
Good Communication ◽  
Post Operative Pain ◽  
Low Flow Anesthesia ◽  
First Year Of Life

Craniosynostosis is a case that diagnosed in the first year of life and can need surgical in young age. Craniosynostosis is a part of hypertelorism with incidence rate around 20%. Boy, 13 years old with hypertelorism had undergone multiple surgery for correction of hypertelorism before. Patient was planned to advance surgical correction of four box wall osteotomy which consist frontal part correction and part of it is release craniosynostosis in coronal suture. Risk of massive bleeding because patient already in teen age and length of surgery can be prolonged. Difficult airway management due to fascial deformity, use of low flow anesthesia to preserve temperature and reduce inhalation anesthesia usage, intraoperative fluid management in consideration maintenance and replacement blood loss and post operative pain management has become another consideration. Covid-19 as part of problems post operatively being known before extubation made the process is delayed. Massive bleeding needs massive transfusion protocol to speed up blood availability. Blood product such as PRC, FFP and TC should be available because coagulation factor is part of consideration. Anesthesia management in hypertelorism with four box wall osteotomy need good communication between anesthesiologist, neurosurgeon, plastic surgeon and pediatric intensivist to reduce perioperative risk including covid-19 in pandemic era.

Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions

1990 ◽  
Vol 73 (6) ◽  
pp. 859-863 ◽  
Author(s):  
Robert D. Brown ◽  
David O. Wiebers ◽  
Glenn S. Forbes
Keyword(s):  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Low Flow ◽  
Content Type ◽  
Unruptured Intracranial Aneurysms ◽  
The Difference ◽  
Arterial Feeder ◽  
Relationship Of ◽  
The Relationship ◽  
Feeding Systems

✓ Among 91 patients with unruptured intracranial arteriovenous malformations (AVM's), 16 patients had 26 unruptured intracranial saccular aneurysms. An actuarial analysis showed the risk of intracranial hemorrhage among patients with coexisting aneurysm and AVM to be 7% per year at 5 years following diagnosis compared to 1.7% for patients with AVM alone. The difference in length of survival free of hemorrhage was significant (log-rank, p < 0.0007). Several angiographic and clinical parameters were investigated to better understand the relationship of these lesions. The aneurysms occurred in similar percentages in patients with small, medium, and large AVM's. Twenty-five aneurysms were on arteries feeding the malformation system, almost equally distributed proximally and distally. Eleven aneurysms were atypical in location, and all arose from primary or secondary branch feeders to the malformation; 24 were on enlarged feeding arteries. Eleven (16%) of the 67 patients with high-flow AVM's had associated aneurysms, compared with five (21%) of the 24 patients with low-flow AVM's. Four (16%) of 25 low-shunt malformations and 12 (18%) of 65 high-shunt malformations had associated aneurysms. All five aneurysms associated with low-shunt malformations were on a direct arterial feeder of the malformation. These data suggest that the intracranial AVM's predispose to aneurysm formation within AVM feeding systems and that the mechanism is not simply based upon the high blood flow or high arteriovenous shunt in these systems.

scholarly journals Estimating the Relative Uncertainties Sourced from GCMs and Hydrological Models in Modeling Climate Change Impact on Runoff

2012 ◽  
Vol 13 (1) ◽  
pp. 122-139 ◽  
Author(s):  
Jin Teng ◽  
Jai Vaze ◽  
Francis H. S. Chiew ◽  
Biao Wang ◽  
Jean-Michel Perraud
Keyword(s):  
Climate Change ◽  
Climate Change Impact ◽  
Daily Rainfall ◽  
Low Flow ◽  
Hydrological Models ◽  
Rainfall Runoff ◽  
Runoff Modeling ◽  
Change Impact ◽  
The Difference ◽  
Climate Series

Abstract This paper assesses the relative uncertainties from GCMs and from hydrological models in modeling climate change impact on runoff across southeast Australia. Five lumped conceptual daily rainfall–runoff models are used to model runoff using historical daily climate series and using future climate series obtained by empirically scaling the historical climate series informed by simulations from 15 GCMs. The majority of the GCMs project a drier future for this region, particularly in the southern parts, and this is amplified as a bigger reduction in the runoff. The results indicate that the uncertainty sourced from the GCMs is much larger than the uncertainty in the rainfall–runoff models. The variability in the climate change impact on runoff results for one rainfall–runoff model informed by 15 GCMs (an about 28%–35% difference between the minimum and maximum results for mean annual, mean seasonal, and high runoff) is considerably larger than the variability in the results between the five rainfall–runoff models informed by 1 GCM (a less than 7% difference between the minimum and maximum results). The difference between the rainfall–runoff modeling results is larger in the drier regions for scenarios of big declines in future rainfall and in the low-flow characteristics. The rainfall–runoff modeling here considers only the runoff sensitivity to changes in the input climate data (primarily daily rainfall), and the difference between the hydrological modeling results is likely to be greater if potential changes in the climate–runoff relationship in a warmer and higher CO2 environment are modeled.

scholarly journals Randomized Double-Blind Trial of the Effects of Humidified Compared with Nonhumidified Low Flow Oxygen Therapy on the Symptoms of Patients

1997 ◽  
Vol 4 (2) ◽  
pp. 76-80 ◽  
Author(s):  
Darcy Andres ◽  
Norma Thurston ◽  
Rollin Brant ◽  
Ward Flemons ◽  
Doreen Fofonoff ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Tertiary Care ◽  
University Teaching ◽  
Low Flow ◽  
Subjective Symptoms ◽  
Double Blind ◽  
Significant Group ◽  
Oxygen Administration ◽  
Symptom Scores ◽  
The Difference

OBJECTIVE: To determine the effects of humidified versus nonhumidified low flow oxygen therapy on the subjective symptoms of patients.METHODS: Randomized double-blind clinical trial conducted in a tertiary care university teaching hospital. The sample included medical and surgical in-patients receiving oxygen therapy who met criteria including medical stability, no overt cognitive impairment, English comprehension, voluntary participation and attending physician agreement. Humidified subjects numbered 96 and nonhumidified subjects were 95. The intervention was humidified or nonhumidified oxygen administration using two flowmeters covered by an opaque bag. Patients receiving oxygen therapy longer than three days (first period) were crossed to the alternate treatment (second period) and followed for three more days.RESULTS: Mean symptom scores for nasal dryness were low (mild) for both groups; however, humidification group scores were significantly lower (P=0.018) in the first period than the nonhumidification scores. A corresponding increase in the incidence of nosebleeds was not statistically significant between groups nor were there statistically significant differences between groups for other symptoms/problems. The prevailing trend was decreased incidence of dry mouth, dry throat, headache and chest discomfort during the study.CONCLUSIONS: Although this sample was large enough to expose statistically significant group differences in nasal dryness, the difference was not judged to be clinically significant. The predominant trend was a decrease in symptom scores over time with either treatment. In this group of patients, humidified oxygen does not appear to alleviate subjective symptoms.

Investigation of Drilling of CFRP-Aluminum Stacks Under Different Cooling Modes

2016 ◽  
Author(s):  
M. Meshreki ◽  
A. Damir ◽  
A. Sadek ◽  
M. H. Attia
Keyword(s):  
Tool Wear ◽  
Flow Rate ◽  
Tool Material ◽  
Minimum Quantity Lubrication ◽  
Infrared Camera ◽  
Low Flow ◽  
Hole Quality ◽  
Reinforced Plastics ◽  
Lubrication Mode ◽  
The Difference

Drilling of stacks poses great challenges due the heterogeneity and abrasiveness of the composites, the chip evacuation through the stack, in addition to the difference in properties between the metallic and the composite materials. The objective of this paper is to investigate the effect of drilling conditions such as tool material and geometry and lubrication mode on the hole quality as well as the tool wear in drilling of composite stacks (Carbon Fiber Reinforced Plastics CFRP-Aluminum). The thickness of each material was 19 mm. A 2-flute uncoated drill was used. Four different cooling modes were applied namely dry, minimum quantity lubrication (MQL) with low pressure (<1.5 bar) and high flow rate (400 ml/hr), MQL with high pressure (4.25 bars) and low flow rate (10 ml/hr), and finally flood cooling. The process control parameters, namely the forces and temperatures were measured using a special fixture design using a Kistler dynamometer and a reflective system with an infrared camera. The quality of the holes was compared in terms of delamination, surface roughness, circularity, concentricity, and diameter errors. The resultant cutting forces were found to be much lower than the thrust forces. The mean forces in the Aluminum were more than double those in the CFRP. Negligible tool wear was observed (less than 60 μm). No indication of thermal damage was found on the circumference of the holes in all the tested conditions. Due to the fact that the CFRP was supported by the Aluminum stack, the exit of the holes was mostly free from delamination. The dry and flood conditions produced holes free from entry delamination, while the holes drilled with MQL had delamination within 24% of the hole diameter. Both MQL cooling modes resulted in comparable temperatures, forces and hole quality.

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