Evaluation of the effect of preoperative anxiety on intraoperative hemodynamic stability and drug consumption in patients who underwent BIS-guided total intravenous anesthesia (TIVA) for neurophysiological monitoring in spine surgery

In our study, the aim was to evaluate the effects of preoperative anxiety measured by Spielberger’s State-Trait Anxiety Inventory-State (STAI-S) and State-Trait Inventory-Trait (STAI-T) scores on intraoperative hemodynamic stability, drug consumption and recovery in patients who underwent spinal surgery with neurophysiological monitoring and total intravenous anesthesia with bispectral index (BIS) monitoring, without the use of muscle relaxants. Eighty patients with planned spinal surgery and neurophysiological monitoring were included in this prospective observational study. Anxiety scores were recorded by applying Spielberger’s STAI-T and STAI-S scoring questionnaires to all patients included in the study 1 hour before the operation. Age, gender and American Society of Anesthesiologists (ASA) scores of the patients who were taken to the operating table without premedication were recorded. Before anesthesia induction, standard monitoring including electrocardiography (ECG), noninvasive blood pressure, peripheral oxygen saturation (SpO2), BIS was applied. The correlation between STAI-T and STAI-S scores with demographic characteristics of patients, preoperative, post-induction, 5th minute, 10th minute, 30th minute, 50th minute, 70th minute, 90th minute heart rate (HR), mean arterial pressure (MAP), SpO2, operation time, recovery time, and total amount of propofol and remifentanil used during the operation were evaluated statistically. A significant negative correlation was observed between STAI-S anxiety scoring and age (p < 0.05). A significant positive correlation was found between the total amount of remifentanil and propofol used with the STAI-S score (p < 0.05). Significant positive correlations were observed between the STAI-S score and the HR value preoperatively, and in the 5th, 30th, 50th, 70th, and 90th minutes (p < 0.05). Our study showed that preoperative anxiety increases intraoperative drug consumption and heart rate. It is of great importance to keep the amount of intraoperative medication at optimal levels, to measure preoperative anxiety, and to eliminate it with multimodal treatments, especially for the accurate detection of neurological damage in patients with neurophysiological monitoring.

Robotic thymectomy: A surgical point of view

Robotic thymectomy is the most innovative surgical approach for treating disease of the anterior mediastinum. Robotic surgery offers low postoperative morbidity, faster recovery, shorter hospital stay, and better cosmetic results, without compromising surgical radicality. During the operation, the patient is placed in a supine position at the left edge of the operating table with the left hemithorax upward; the position is maintained with sandbags. The target area for the autodocking should be toward the jugulum. The first surgical step is to isolate the inferior thymic horns via the dissection that starts from the inferior portion of the mediastinal tissue and proceeds toward the right side, following the contralateral pleural reflection. Afterward, it is necessary to move toward the superior horns, following the phrenic nerve, the first landmark, to the innominate vein, our second landmark. Finally, we dissect the superior horns while searching for the thymic veins, which could appear atrophic, and clip the vessels to safely isolate the innominate vein. During this step, it is useful to use a retraction movement to progressively dissect the horns from the jugulum. The thymus gland is removed en bloc with the perithymus fat using an endoscopic bag inserted through the right port incision.

Anterior intrapelvic approach and suprapectineal quadrilateral surface plate for acetabular fractures with anterior involvement: a retrospective study of 34 patients

Background The purpose of the study is to evaluate the use of the suprapectineal quadrilateral surface (QLS) plates associated with the anterior intrapelvic approach (AIP) to the acetabulum in the surgical treatment of acetabular fractures with anterior involvement. Methods We did a retrospective study of patients surgically treated with QLS plates and AIP for acetabular fractures with the involvement of the anterior column, between February 2018 and February 2020, in our Hospital. The following data were recorded: mechanism of injury, the pattern of fracture, presence of other associated injuries, the time before performing the surgery, surgical approach, position on operating table, time of surgery, intraoperative bleeding, hospitalization time, intraoperative and postoperative complications. Follow-ups were performed at 1, 3, 6, 12 months, then annually. The clinical-functional outcome was assessed with the Merle d’Aubigne Postel score (MAP) modified by Matta; while the radiological outcome with the Matta Radiological Scoring System (MRSS). A Chi-square test was utilized to examine associations between parametric variables. Results We included 34 patients, mean age 62.1, with an average follow-up of 20.7 months. The most frequent traumatic mechanism was road trauma. There were 15 isolated anterior columns and 19 associated patterns. There were 5 cases of associated visceral injuries, and 10 cases of other associated skeletal fractures. All patients were in the supine position. The surgical approach used was the AIP in all cases, with the addition of the first window of the ilioinguinal approach in 16 cases and of the Kocher-Langenbeck approach in 2 cases. The average time before performing the surgery was 8.5 days. The mean time of the surgery and the mean length of stay after surgery were 227.9 min and 8.2 days, respectively. There weren’t cases of intra-operative complications, while there were postoperative complications in 5 patients. The MRSS was judged anatomical in 26 cases, imperfect in 7 cases and poor in 1 case. The average MAP value was 15.2. We observed a significant relationship between the radiological outcome and the clinical outcome (p < 0.05). Conclusions The QLS plates in association with the AIP approach represent an effective treatment strategy for the treatment of acetabular fractures with anterior involvement.

Application of Biological Glue in Orthopedics and Traumatology

The purpose of the study was to investigate the method of osteosynthesis using glues. Materials and methods. The simplest and most effective method in the treatment of traumatological patients is a plaster fixing bandage of different variations. This is a conservative type of treatment. Also, a very common method in the treatment of orthopedic and traumatological patients is the surgical method. Modern high-tech methods of osteosynthesis require a thorough preoperative examination of the patient, conducting a 3D tomographic examination for intra-articular fractures, clear planning of the course of surgical intervention, electro optical probing techniques during the operation, the availability of tool kits for installing retainers, the ability to choose a retainer intraoperative in the size range. An orthopedic-traumatologist and the entire operating team need appropriate training. All operational fixation methods must provide adequate stability to maintain axis length and rotation. Results and discussion. In the world practice, biological glues are used in such areas as abdominal surgery, neuro- and cardiac surgery, plastic and pediatric surgery, orthopedics and traumatology. Cyanocrylate glues have undergone extensive experimental clinical testing. Positive characteristics of cyanoacrylate glues are the ability to glue living tissues in a humid environment, polymerization rate, autosterility, bactericidal, absence of histotoxicity, hemostatic effect. Another glue in the review is sulfacrylate. It can be used in patients of any age, starting from newborns, regardless of the pathogenesis of the disease. Venaseal glue, used by many authors to treat fistulas of the gastrointestinal tract. Widely used fibrin glues, such as Evicel, are used to achieve hemostasis and sealing in surgery, for example, in vascular operations, kidney resection and neurosurgical interventions, in the surgical treatment of distal hypospadias in children. BioGlue glue is designed to seal surgical sutures, thereby preventing fluids (exudate, lymph, urine, gastric juice) and / or air from leaking through them. It is also used in liver surgery. At the moment, the use of bone cement is the most common auxiliary method for surgical interventions. But its side effects are very clear. Bone cement can cause the patient to die on the operating table or, in the postoperative period, in intensive care. This is due to an immediate or rapid allergic reaction. This situation is dangerous for humans. Biological glues are not so toxic and do not cause such allergic reactions Conclusion. The search for new materials and techniques for consolidating bone fragments is one of the most important problems of modern medical science, namely orthopedics and traumatology. Substances that are included in the biological glue must be bioinert, contain elements of strength (for holding fragments), looseness of the structure (for germination of capillaries between fragments), natural antibiotic (for antibiotic prevention), activators of hematopoiesis processes (for the fastest callus), organic and inorganic substances (for the building material of bone tissue). Therefore, the desire to improve treatment and improve its results, in particular in orthopedics and traumatology, is the key to the development of modern medicine

Luxmeter Design with Proximity Sensor to Efficiently Test Light Intensity and Distance on Lamp Operation in Hospitals

The lighting of the operating/surgical site depends on the quality of the lighting from the overhead light source and the reflection from the curtain. Light measurement on the operating table is very necessary because it generates light that is irradiated into the cutting wound without dazzling the cutting surface so that pathological conditions can be recognized and must provide depth contrast and anatomical relationships, to ensure this proper calibration method is needed. Long-term use of medical devices can cause changes in accuracy. Therefore, the author makes a tool to measure the intensity of light which is equipped with a distance meter. The purpose of this study was to develop a measuring instrument for measuring the intensity of light in operating lamps, namely a luxmeter by making Luxmeter equipped with a TFT Display Distance Sensor. This tool uses an ultrasonic sensor HC-SR04 to measure the distance between the light source and the sensor module and the MAX44009 sensor to measure the light intensity of the operating lamp displayed on the TFT screen. Based on the module distance setting to the roll meter, the distance error value for the measurement of the Surabaya electromedical engineering workshop lamp at the 75 cm roll meter distance setting is 0.0127% for the 100 cm roll meter distance setting is 0.0045%. The error rate of the light intensity module on the results of the measurement of light intensity on the luxmeter by setting the roll meter distance of 75 cm between the tool and the lamp of the electromedical engineering workshop is getting an error value of 0.082% lux and for the light intensity on the results of the measurement of light intensity on the luxmeter with a roll meter distance setting of 100 cm between the tool and the lamp in the electromedical engineering workshop, that is, the error value of lux is 0.055%. The design of a luxmeter equipped with a proximity sensor can measure the intensity of light and the distance between the tool and the light source and can assist in the learning process with a more effective Luxmeter design that will assist electromedics in testing operating lamps in hospitals to be more efficient.

A case of pregnancy in the free abdomen

Cases of ectopic pregnancy in the free abdominal cavity are extremely rare (according to A.D. Alovsky - 0.4%). The diagnosis of pregnancy in the free abdominal cavity is very difficult. The diagnosis is more often made at the operating table. In the light of these facts, the case of abdominal pregnancy observed by us is of interest.

TP7.2.4 Skin-to-gel is a safe and effective method to prevent patients sliding during minimally invasive colorectal surgery

Aims Minimally invasive colorectal surgery often requires manipulating the patient position to facilitate exposure of the surgical field, such as a steep Trendelenburg position. However, this exposes patients to risks of sliding on the operating table. Preventive interventions are available, such as bean bags; we explore our experiences of gel pads within a district general hospital. Methods A retrospective analysis was performed of all colorectal patients undergoing laparoscopic resections over the last ten years, identifying complications associated with the use of intra-operative gel pads (skin-to-gel) with no shoulder support. Results Over 500 patients have undergone laparoscopic colorectal resections during this time, all utilising pressure-relieving gel pads. Patients are placed skin-to-gel, lying on a single torso-length gel pad laid directly on the operating table mattress. Dependent upon the operative approach, the legs can be placed in stirrups or maintained supine on table extensions. There have been no DATIX recorded skin-tears, pressure or position-related injuries. The pads have also proven to prevent patient movement on the operating table, negating the use of shoulder supports when adopting the Trendelenburg position. On discussions with theatre staff, the Consultant body and interrogation of the DATIX database, there has only been one reported incidence of slipping when a patient was left on the slide sheet on top of the gel pad. They are relatively inexpensive, durable and easily maintained, proving a highly cost-effective piece of equipment. Conclusion Gel pads have proven to be highly effective in preventing both pressure-related injuries and patient movement during laparoscopic surgery.

To the casuistry of spleen blood cysts

Cases of blood cysts of the spleen are extremely rare on the operating table (Finkelstein could collect only 28 such cases from the literature), even more rare on the sectional table (only 3 cases in Finkelstein) and exquisite-rare, in the order of correct preliminary recognition.

Anesthetic challenges involved in successful resuscitation of a child from cardiac arrest secondary to massive hemorrhage and possible venous air embolism while undergoing fronto-orbital advancement surgery for metopic craniosynostosis

A one year 3 month old child undergoing fronto-orbital advancement surgery for metopic craniosynostosis had severe bleeding when the surgeon attempted to remove bone flap. Head-end elevation was given at the surgeon’s request to reduce bleeding. Immediately there was a drastic fall in end tidal carbon dioxide (ETCO) and arterial saturation (SpO). Considering air embolism, fraction of inspired oxygen (FiO) was increased to 100% and the surgeon filled the field with saline and covered the area with wet gauze. The operating table was leveled. The child continued to deteriorate with the cardiac rhythm changing to pulseless electrical activity and asystole. Incremental bolus doses of adrenaline, blood products transfusion, fluid bolus and infusion of inotropes were given. Chest compression was not done as the endotracheal tube was fixed to the chest of the patient. Tube dislodgement without access to the head-end of the patient would have been a disaster. The child became hemodynamically stable, the surgery continued and the child was extubated the next day. Other than focal seizures which responded to levetiracetam, the child had no neurological deficits.