scholarly journals Comparison of the Different Treatment Strategies for Patients with Rectus Sheath Haematoma

Medicina ◽  
2018 ◽  
Vol 54 (3) ◽  
pp. 38 ◽  
Author(s):  
Audrius Gradauskas ◽  
Linas Venclauskas ◽  
Matas Pažusis ◽  
Andrius Karpavičius ◽  
Almantas Maleckas
Keyword(s):  
Hospital Stay ◽  
Hypovolemic Shock ◽  
Vital Signs ◽  
Treatment Strategies ◽  
Rectus Sheath ◽  
Treated Group ◽  
Packed Red Blood Cells ◽  
Type Iii ◽  
Physical Status Classification ◽  
American Society

Background and objective: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Materials and methods: A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient’s age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. Results: The patients’ mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1–4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. Conclusions: Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

scholarly journals Clinical Mortality Review of COVID-19 Patients at Sukraraj Tropical and Infectious Disease Hospital, Nepal; A Retrospective Study

2021 ◽  
Vol 6 (3) ◽  
pp. 137
Author(s):  
Anup Bastola ◽  
Sanjay Shrestha ◽  
Richa Nepal ◽  
Kijan Maharjan ◽  
Bikesh Shrestha ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Hospital Stay ◽  
Secondary Infection ◽  
Treatment Strategies ◽  
Chronic Obstructive ◽  
Female Ratio ◽  
Infectious Disease Hospital ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Disease Hospital

Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17:1. Most were above 65 years of age (72%) and had two or more comorbidities (64%). The most common comorbidities among the patients who had died during hospital stay were hypertension (58%) followed by diabetes mellitus (50%) and chronic obstructive airway disease (24%). The median duration from the symptom onset to death was 18 days, ranged from the minimum of 2 days till maximum of 39 days. D-dimer was found to be >1 mg/L in 58% cases and ferritin was >500 ng/ml in 42% patients at presentation. A total of 42% patients had thrombocytopenia, 80% patients had lymphocytopenia and 60% had Neutrophil to Lymphocyte ratio >11.75 with the mean NLR of 18.38. Of total mortalities, 16% patients also showed microbiological evidence of secondary infection; Male gender, age more than 65 years, multiple comorbidities with lymphocytopenia, elevated Neutrophil lymphocyte ratio and elevated inflammatory markers were risk factors found in majority of mortalities in our study. These findings could be utilized for early triage and risk assessment in COVID-19 patients so that aggressive treatment strategies could be employed at the earliest to reduce mortalities due to COVID-19 in future.

scholarly journals Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Cyrus Motamed ◽  
Migena Demiri ◽  
Nora Colegrave
Keyword(s):  
Neuromuscular Blockade ◽  
Lower Limit ◽  
Elective Surgery ◽  
Orotracheal Intubation ◽  
Neuromuscular Blocking ◽  
Physical Status Classification ◽  
Train Of Four ◽  
Surgery First ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

scholarly journals PREWARMING FOR PREVENTION OF PERIOPERATIVE HYPOTHERMIA IN PATIENTS WITH COMBINED EPIDURAL AND GENERAL ANESTHESIA: A RANDOMIZED CONTROLLED TRIAL

2021 ◽  
Author(s):  
Dang Tinh Pham ◽  
Thi Ngoc Le ◽  
Ton Ngoc Vu Phan ◽  
Parshal Bhandari ◽  
Sairah Zia ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
General Anesthesia ◽  
Outcome Measures ◽  
Medical Center ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Perioperative Hypothermia ◽  
Randomized Controlled ◽  
Physical Status Classification ◽  
American Society

OBJECTIVE The aim of this study was to access the influence of active warming after epidural anesthesia (EDA) and before general anesthesia in prevention of perioperative hypothermia. METHOD This randomized controlled trial was conducted in the department of anesthesiology in university medical center of Ho Chi Minh city, Vietnam from December 2019 until April 2020. This trial included 60 adult patients who were scheduled for major abdominal surgery with a duration of at least 120 minutes and under combined general anesthesia and EDA. Patients were excluded if age was below 18 years, American Society Anesthesiologists’ physical status classification of IV or higher, or refusal of EDA. Written informed consent was obtained for all patients. Patients were divided randomly into two groups. The first group received 10 minutes of active air-forced warming after EDA before the induction of general anesthesia. The second group was covered with a blanket 10 minutes after EDA and before general anesthesia. Core temperatures were recorded throughout the study. The primary outcome measures were the incidence of perioperative hypothermia and the degree of hypothermia. The secondary outcome measures were rate and time for body temperature to return to normal and incidence of postoperative body shivering. RESULTS Without active warming (n = 21), 70% of patients became hypothermic (<36°C) postoperatively. Active air-forced warming for 10 minutes after EDA and before induction of general anesthesia decreased the incidence of postoperative hypothermia to 26.7% (n = 8). CONCLUSION Active air-forced warming for 10 minutes after EDA and before induction of general anesthesia is efficient in reducing the incidence of perioperative hypothermia.

scholarly journals Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

2020 ◽  
Vol 8 (9) ◽  
pp. 3309
Author(s):  
Aman Choudhary ◽  
Sakshi Maheshwari ◽  
Naveen Paliwal ◽  
Shobha Ujwal ◽  
Geeta Singariya
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
International Association ◽  
Labour Analgesia ◽  
Arterial Blood ◽  
Physical Status Classification ◽  
Significant Difference ◽  
Ethical Committee Approval ◽  
American Society ◽  
Double Blinded

Background: Toxonomy committee of International Association defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. The present study was conducted to evaluate the effect of a combination of low dose ropivacaine with fentanyl and tramadol in epidural labour analgesia.Methods: This prospective randomized double blinded clinical study was conducted in 100 patients in labour after ethical committee approval. Inclusion criteria was patients who had ASA I and ASA II (American society of anesthesiologists physical status classification system), age above 18 years, height more than 150 cm, weight less than 110 kg, either primigravidae or gravid 2. Patients were allocated into two groups Group F (ropivacaine with fentanyl) and group T (ropivacaine with tramadol) by computer generated randomisation technique.Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 22.54±2.5, mean age in group T (ropivacaine with tramadol) was 22.86±2.17, and weight in group F was 56.68±2.75 and group T was 56.58±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (P>0.05). More side effects were seen in group F.Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

scholarly journals Short Review On Varicose Vein And Its Management

2021 ◽  
Vol 12 (1) ◽  
pp. 832-836
Author(s):  
Pranav N ◽  
Anila K N ◽  
Riju.R.Menon
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Inflammatory Responses ◽  
Early Stage ◽  
Treatment Strategies ◽  
Short Review ◽  
Disease Diagnosis ◽  
Treated Group ◽  
Severe Condition

A varicose vein is a condition which affects a large number of people in Western countries and India especially, the northern areas. For curing this proper disease diagnosis, sufficient care for patient and treatment strategies are required, to control the symptoms and signs of varicose vein, the flavonoid group of drugs have been widely used for many years. Under this group, Daflon is the most potent and efficient drug which can be used. This enhances the bioavailability and absorption from the gastrointestinal area. Improved quality of patient's life and efficacy makes this drug therapy more potent and significant. Some of the clinical studies have shown its better action for increased venous tone, lymphatic drainage, decreases cosmetic disfigurement, inflammatory responses occur in microcirculation, protection from free radicals and improved quality of life and efficacy. When compared with other available drugs like Polidocanol, Sotradecol, Asclera, Varithena, Sodium tetradecyl sulfate etc. .clinical benefits of Daflon is more. This drug is useful in the early stage and can be used in severe condition along with sclerotherapy, compression treatment and surgery. Increased patient’s quality of life and increased efficacy were observed in Daflon treated group. Thus it is efficacious as a standard therapy alone and also in combination with other conservative treatment.

Validation of the Tokyo guideline 2018 treatment proposal for acute cholecystitis from a single-center retrospective analysis

2019 ◽  
Author(s):  
Tomoaki Bekki ◽  
Tomoyuki Abe ◽  
Hironobu Amano ◽  
Keiji Hanada ◽  
Tsuyoshi Kobayashi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Acute Cholecystitis ◽  
Treatment Strategy ◽  
Early Laparoscopic Cholecystectomy ◽  
Physical Status Classification ◽  
Severity Grading ◽  
Hospital Stays ◽  
Comorbidity Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Based on the revised Tokyo guideline 2018 (TG18), early laparoscopic cholecystectomy (LC) is recommended in patients who satisfy the Charlson Comorbidity Index (CCI) criteria and the American Society of Anesthesiologists Physical Status Classification (ASA-PS). Our study aims to determine the efficacy of TG18 treatment strategy. Methods We enrolled 324 patients with acute cholecystitis (AC) diagnosed by TG18 who underwent cholecystectomy between 2010 and 2018. Perioperative variables and surgical outcomes were analyzed according to the TG18 treatment strategy and severity grading. Results ASA-PS scores and CCI were significantly higher in patients with Grade II (GII) and GIII AC. Higher severity grading resulted in failed LC, requiring blood transfusion and bailout surgery. The TG18 within group showed a higher proportion of GI and GII AC and their ASA-PS scores were also significantly lower. TG18 within group demonstrated significant differences in the achievement of LC, bailout surgery, postoperative hospital stays, and 90-day mortality rates. Intraoperative blood loss and blood transfusion were significantly higher in the TG18 outside group than that in the TG18 within group. Conclusions Our study shows that the TG18 treatment strategy is well-designed and efficacious. Novel findings Our study established the feasibility and efficacy of TG18. The usefulness of performing aggressive surgery beyond the TG18 strategy requires further study.

scholarly journals A Clinical Audit of An Office-Based Anaesthesia Service for Dental Procedures in Victoria

2018 ◽  
Vol 46 (4) ◽  
pp. 404-413 ◽  
Author(s):  
A. Silvers ◽  
A. Licina ◽  
L. Jolevska
Keyword(s):  
Adverse Event ◽  
General Anaesthesia ◽  
Demographic Data ◽  
Day Surgery ◽  
Adverse Event Rate ◽  
Policy Documents ◽  
Patient Demographics ◽  
Physical Status Classification ◽  
Dental Procedures ◽  
American Society

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.

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