The effectiveness of flat angle on patient comfort after removing the sheet after femoral angiography

Introduction: Noninvasive frameless modalities have become increasingly utilized for stereotactic radiosurgery (SRS) for benign and malignant pathologies. There is minimal comparison in the literature of frame-based (FB) and mask-based (MB) SRS. With the dual capabilities of the Elekta Gamma Knife® Icon™, we sought to compare patient perceptions of FB and MB SRS with respect to comfort and pain and to examine effects of lesion type on the patient experience of SRS. Methods: Over a 1-year period, patients who underwent single fraction, fractionated or hypofractionated FB or MB Gamma Knife SRS at our institution were given an 8-question survey about their experience with the procedure immediately after treatment was completed. Descriptive statistics were applied. Results: A total of 117 patients completed the survey with 65 FB and 52 MB SRS treatments. Mean pain for FB SRS (5.64 ± 2.55) was significantly greater than mean pain for MB SRS (0.92 ± 2.24; t114 = 10.46, p < 0.001). Patient comfort during the procedure was also higher for those having MB SRS (p < 0.001). Mixed results were obtained when investigating if benign versus malignant diagnosis affected patient experience of SRS. For the purposes of this study, malignant diagnoses were almost entirely metastatic lesions. Diagnosis played no role on pain levels when all patients were analyzed together. The treatment technique had no effect on patient comfort in patients with benign diagnoses, while patients with malignant diagnoses treated with MB SRS were more likely to be comfortable (p < 0.001). Among patient’s receiving FB treatments, diagnosis played no role on patient comfort. When only MB treatments were analyzed, patients were more likely to be comfortable if they had a malignant lesion (p < 0.01). Conclusions: Patients treated with MB SRS experience the procedure as more comfortable and less painful compared to those treated using a FB modality. Overall, this difference was not affected by a benign versus a malignant diagnosis and the treatment type is more indicative of the patient experience during SRS. A more homogenous sample between modalities and diagnoses and further follow-up with the patient’s input on their experience would be beneficial.

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Treatment of an external iliac artery chronic total occlusion using alternate access sites

CVIR Endovascular ◽

10.1186/s42155-019-0089-6 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Justin Ratcliffe ◽

Mike Gorenchtein ◽

Pankaj Khullar ◽

Abel Casso Dominguez ◽

Mohan Satish ◽

...

Keyword(s):

Iliac Artery ◽

Chronic Total Occlusion ◽

External Iliac Artery ◽

Arterial Disease ◽

Patient Comfort ◽

Vascular Lesions ◽

Symptom Improvement ◽

Total Occlusion ◽

Maximal Medical Therapy ◽

Peripheral Arterial

Abstract Background With the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can now be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort. However, a paucity of literature exists on the availability of support devices that can be utilized during challenging cases. Case presentation A 70 year-old female patient presented for evaluation of severe lifestyle-limiting left-sided claudication refractory to maximal medical therapy. Angiography revealed a chronic total occlusion of the left external iliac artery, which was treated successfully by percutaneous intervention via a primary transpedal approach and with the assistance of the Outback® Elite re-entry device. The patient was discharged 2 h after the procedure and reported significant symptom improvement at follow-up. Conclusion This case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lower-extremity vascular lesions.

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Continuous, transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0448 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Weinmann ◽

A Lenz ◽

R Heudorfer ◽

D Aktolga ◽

M Rattka ◽

...

Keyword(s):

Carbon Dioxide ◽

Conscious Sedation ◽

Venous Blood ◽

Patient Comfort ◽

Carbon Dioxide Partial Pressure ◽

Close Monitoring ◽

Blood Gas ◽

Transcutaneous Carbon Dioxide ◽

The Difference ◽

Venous Blood Gas

Abstract Background Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring. Purpose We investigated the feasibility and accuracy of an additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO2) measurement during conscious sedation in complex electrophysiological catheter ablation procedures. Methods We evaluated the accuracy and additional value of tpCO2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses. Results We included 110 patients in this prospective observational study. Arterial pCO2 (paCO2) and tpCO2 showed good correlation throughout the procedures (r=0.60–0.87, p<0.005). Venous pCO2 (pvCO2) were also well correlated to transcutaneous values (r=0.65–0.85, p<0.0001). Analyses of the difference of pvCO2 and tpCO2 measurements showed a tolerance within <10mmHg in up to 96–98% of patients. Hypercapnia (pCO2<70mmHg) was detected more likely and earlier by continuous tpCO2 monitoring compared to half-hourly pvCO2 measurements. Conclusion Continuous tpCO2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety. Funding Acknowledgement Type of funding source: None

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“I’m Going to Scope You”—The Balance between Examiner Visualization and Patient Comfort

Journal of Investigative Surgery ◽

10.1080/08941939.2020.1782544 ◽

2020 ◽

pp. 1-2

Author(s):

Christina M. Parducci ◽

Jason E. Cohn

Keyword(s):

Patient Comfort

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Improvements in Muller’s Muscle Resection Through the Use of Tenotomy Scissors and Dissolvable Suture

The American Journal of Cosmetic Surgery ◽

10.1177/0748806819885252 ◽

2019 ◽

Vol 37 (2) ◽

pp. 61-64

Author(s):

Michael K. Paap ◽

Rona Z. Silkiss

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Chart Review ◽

Adult Patients ◽

Patient Comfort ◽

Modified Technique ◽

Corneal Abrasion ◽

Müller’S Muscle

Muller’s muscle resection is a straightforward and effective surgical treatment for acquired blepharoptosis. The authors describe a novel modification of this procedure that reduces risk of corneal complications using dissolvable suture and tenotomy scissors in place of scalpel excision. In all, 122 consecutive adult patients with mild to moderate acquired eyelid ptosis treated with this modified technique were identified through chart review. In this cohort, all patients were satisfied with the result, none required reoperation, and none sustained postoperative complications. This technique modification maintains procedural efficacy and efficiency while improving patient comfort and decreasing the risk of inadvertently cutting a suture and inducing a corneal abrasion or incision dehiscence.

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