Thyroidectomy under Local Anaesthesia: A Viable Option in a Resource Limited Community

Abstract Background Gasless laparoscopy emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource-limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and laparotomy.Methods Following PRISMA guidelines, Medline, Embase, Web of Science and Cochrane were searched. Variables of interest were determined a priori and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.Results Of 1080 screened studies a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomized studies. In these, the mean set-up time for gasless and conventional laparoscopy was 13.14 (95% CI: -0.16–26.44) and 12.8 (95% CI: -10.86–36.47) minutes respectively; The mean duration of surgery for gasless and conventional laparoscopy was 89.39 (95% CI: 77.44-101.34) and 72.59 (95% CI: 63.44–81.74) minutes respectively and the mean length of stay was 4.25 (95% CI: 2.02–6.48) and 4.04 (95% CI: 1.72–6.36) days respectively. Most reported complications were hemorrhage and infection with no assessable statistical difference.Conclusions Although gasless laparoscopy seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency don’t suffice to recommend gasless laparoscopy as an alternative to conventional laparoscopy or laparotomy. Larger randomized trials with a low risk of bias are warranted.

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Efficacy and tolerability of Day 2 manipulation and local anaesthesia after collagenase injection in patients with Dupuytren’s contracture

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413490899 ◽

2013 ◽

Vol 39 (5) ◽

pp. 466-471 ◽

Cited By ~ 17

Author(s):

C. J. Manning ◽

R. Delaney ◽

M. J. Hayton

Keyword(s):

Clinical Trials ◽

Local Anaesthesia ◽

Hand Function ◽

Dupuytren’S Contracture ◽

Patient Evaluation ◽

Viable Option ◽

Dupuytren's Contracture ◽

Collagenase Injection ◽

Evaluation Measure

In clinical trials, treating Dupuytren’s contracture with collagenase injection involves manipulation the day after injection, without local anaesthesia. We evaluated the efficacy and tolerability of manipulation 2 days after injection with local anaesthesia. Forty-five patients received 50 injections into cords contracting metacarpophalangeal and proximal interphalangeal joints; follow-up visits were at 3 and 14 weeks. For the metacarpophalangeal joints there were >90% reduction in contracture at both visits. The proximal interphalangeal joints that improved spontaneously after metacarpophalangeal injection or received direct injections showed 51–55% reduction in contracture. Changes in scores on the Patient Evaluation Measure suggest that patients perceived improvements in their hand function was good and they were satisfied with the procedure. Collagenase and local anaesthesia injections were well tolerated; adverse events were localized to the injection site and were mild and transient in nature. These findings provide another viable option for practising surgeons and may help with the logistics of patient care.

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532: Empirical Antibiotic Therapy in the Management of Elevated Serum PSA- A Viable Option?

The Journal of Urology ◽

10.1016/s0022-5347(18)32778-2 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 172-172

Author(s):

Chee Kwan Ng ◽

Gerald Y. Tan ◽

Khai Lee Toh ◽

Sing Joo Chia ◽

James K. Tan

Keyword(s):

Antibiotic Therapy ◽

Elevated Serum ◽

Empirical Antibiotic Therapy ◽

Viable Option

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Abstract #288 Dyslipidemia in Childhood Type 1 Diabetes in India: Prevalence Correlates and Management Challenges in a Resource Limited Setting

Endocrine Practice ◽

10.1016/s1530-891x(20)46632-7 ◽

2019 ◽

Vol 25 ◽

pp. 117

Author(s):

S Chandraprabha ◽

T Jayalakshmi ◽

Reshma Vijay ◽

Kavitha Muniraj ◽

Muralidhara Krishna ◽

...

Keyword(s):

Type 1 Diabetes ◽

Resource Limited Setting ◽

Resource Limited ◽

Childhood Type 1 Diabetes ◽

Childhood Type ◽

Limited Setting

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Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile

VASA ◽

10.1024/0301-1526.38.3.225 ◽

2009 ◽

Vol 38 (3) ◽

pp. 225-233 ◽

Cited By ~ 2

Author(s):

Aleksic ◽

Luebke ◽

Brunkwall

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Carotid Endarterectomy ◽

Complication Rate ◽

Local Anaesthesia ◽

High Risk Group ◽

High Risk Patients ◽

Hostile Neck ◽

Risk Patients ◽

Angioplasty And Stenting

Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA). Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, “hostile neck”, recurrent ICA stenosis, contralateral ICA occlusion, age ≥ 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups. Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0,011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0,001) and shunt necessity (33% vs. 14%, p < 0,001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2,9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2,85, 95% CI 1,38-5,91) and intraoperative shunting (OR 5,57, 95% CI 2,69-11,55) were identified as independent risk factors for an increased combined complication rate. Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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