Mythbusters! The Truth about Common Misconceptions in Cochlear Implantation

Cochlear implantation (CI) is the preferred method of hearing rehabilitation when patients cannot perform well with traditional amplification. Unfortunately, there are still significant misconceptions around this life-changing intervention. The goal of this article is to address some of the most common myths around CI surgery. After reading this article, the learner will be able to explain the utility of CI in patients with residual hearing and recognize that insurance coverage is widespread. The reader will be able to list common risks associated with this well-tolerated procedure including anesthetic risk and the risk of vestibular dysfunction. Additionally, the reader will be able to identify the significant positive impact of CI on patients' quality of life. Finally, the reader will identify that many patients can safely have an MRI scan after implantation, including nearly all contemporary recipients.

Biochemical markers of surgical stress in endoscopic rhinosinus surgery under combined anesthesia in children

BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children. MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 617 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygenair mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an airoxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.70.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an airoxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia. RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group. DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values. CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.

Robotic-assisted laparoscopic partial nephrectomy. Retrospective descriptive study over a 10-year period. Anesthetic experience

Introduction: Robot-assisted laparoscopic surgery is currently the surgical treatment of choice for small renal masses. Objective: Reviewing the anesthetic management and perioperative morbidity of patients undergoing robotic-assisted laparoscopic partial nephrectomy (RALPN) from 2009 to 2019 at Hospital Universitario Donostia. Material and methods: Retrospective, descriptive, observational study involving 343 patients. Results: 95 % of the patients were ASA II-III. Transient renal artery clamping was performed in 91 %, with a mean ischemia time of 17.79 minutes. The mean duration of the procedure under balanced general anesthesia was 184 min. Standard monitoring was performed along with invasive arterial pressure monitoring (IAP), central venous catheter (CVC) and EV1000 platform (Edwards®) for complex patients. Complications were recorded in 40 patients (11.67 %). Patients under anti-aggregation therapy experienced more bleeding than non-anti-aggregation patients (p 0.04) but did not require more transfusions. Patients with a higher anesthetic risk did not experience more complications. No statistically significant association was found between worsening renal function and the occurrence of intraoperative complications. 21 patients (6 %) were readmitted due to complications; the most frequent complication was renal artery pseudoaneurysm that required endovascular embolization. Conclusions: It should be highlighted that after ten years of experience with this technique, the patients with a higher anesthetic risk have not experienced serious perioperative complications. RALPN is a safe technique that demands a careful anesthetic support. A robot-assisted approach alone is not a guarantee for success without strong teamwork.

Real-time ultrasound-guided epidural anesthesia for cesarean section in a parturient with achondroplasia

Achondroplasia is a type of disproportionate dwarfism with short limbs and a normal-sized torso. This condition results in a potential spinal abnormality and a difficult airway may increase the anesthetic risk, not only in neuraxial anesthesia, but also in general anesthesia. We report a 25-year-old primigravida with achondroplasia who underwent cesarean section under epidural anesthesia with the assistance of real-time ultrasound guidance. A total dose of 17 mL 2% lidocaine with 7.5 μg sufentanil was administered via epidural catheter intermittently. The level of anesthesia reached T4. No other anesthetic was administered during the operation and the procedure was uneventful. The mother and her newborn were routinely discharged without any adverse events. During the follow-up at 10 months postoperatively, the patient did not have any discomfort. We suggest that titrated epidural anesthesia at the time of real-time ultrasound-guidance is a safe and effective epidural anesthesia for patients with achondroplasia.

Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.

APPLICATION OF MODERN METHODS OF ENDOSCOPIC HАEMOSTASIS IN THE TREATMENT OF GASTRODUODENAL ULCER BLEEDING

Summary. The aim of the study is to improve the results of treatment of patients with ulcerative gastroduodenal bleeding by using the methods of endoscopic hаemostasis. Materials and research methods. The results of endoscopic hаemostasis of 153 patients who were treated in the surgical department of the “Regional Clinical Hospital” were analyzed. Patients were examined clinically, laboratory and instrumental. Results and its discussion. For Forrest 1a, b bleeding, endoscopic clipping was used in 16 (10.4 %) patients with a visualized vessel in the bottom of the ulcer. In the studied patients of this group, there were no relapses of bleeding. Diathermy coagulation was used in 42 (27.5 %) patients. Recurrent bleeding was observed in 6 patients. Submucosal infiltration was performed in 37 (24.2 %) patients with ulcerative bleeding. Repeated bleeding was recorded in 9 patients within the next 3 hours after the intervention and in 7 patients during the first days after endoscopic hаemostasis. Combinations of endoscopic methods of hаemostasis were used in 58 (37.9 %) patients. Conclusions. The use of modern methods of endoscopic hаemostasis followed by adequate pharmacotherapy in most cases allows achieving a final stop of bleeding. Patients with a high risk of recurrent bleeding and a low surgical and anesthetic risk after successful endoscopic hаemostasis are shown surgical intervention before the development of recurrent bleeding.

Anesthetic management of a pregnant broodmare with gastrointestinal colic

Gastrointestinal colic in mares during early pregnancy may require general anesthesia for surgical correction. There is a scarcity of literature identifying anesthetic risk factors associated with negative outcome in the pregnant mare. In this case report, a seven-year-old Thoroughbred broodmare, presenting for the investigation and treatment of colic in the fifth month of pregnancy, underwent surgery for the correction of right dorsal displacement of the large colon. Intraoperatively, interventions for maternal hypoxemia and hypotension were necessary. The mare recovered well from general anesthesia and was discharged from the hospital eleven days postoperatively. In this case report, the successful anesthetic management of a pregnant broodmare is described, and all aspects that may improve the outcome for both mare and fetus are considered, with emphasis on the prevention of cardiovascular and respiratory disturbances.

ПОТЕНЦИРОВАНИЕ МУЛЬТИМОДАЛЬНОЙ АНЕСТЕЗИИ КВАНТОВЫМ ИЗЛУЧЕНИЕМ ПРИ ПОМОЩИ ОПТОЭЛЕКТРОННЫХ УСТРОЙСТВ

The purpose of the work: to develop method of potentiation of multimodal anesthesia with led radiation in 650±20 nm and blue 470±10nm range using Autonomous optoelectronic devices. Abstract . Material and methods. Conducting contact led exposure was carried out portable semiconductor led device AFS K-630/670 in the red range with a wavelength of 470±10 nm. Multimodal anesthesia was perfomed on the patients abdominal profile (n=124) (78 women and 46 men) with concomitant diseases aged 52 to 93 years/ The weight of patients ranged from 64 to 131 kg/ All patients had 3 degree of anesthetic risk according to the classification of MEAR. The patients were divided into 2 groups: the main group and the control group. In the main group (n=68) 42 patients underwent planned laparoscopic cholecystectomy, 26 patients herniation with alloplasty by laparoscopic method. In the control group (n=56) 39 patients underwent laparoscopic cholecystectomy and laparoscopic alloplasty in 17 patiemts. Results. It is established that the potential multimodal anesthesia portable semiconductor led apparatus ASFto -630/670 in the red range with a wavelength of 650±20 nm and in the blue range ( the control group patients consumption of fentanil made up 4,92±0,34 mg/kg/h in the main 1,23±012 mg/kg/h. The indicator of Central hemodynamics si in main group increased at the end of surgery from 2,28±0,43 l/min/m2 to 3,29 l/min/m2. (OPSS) DIN C. sm-5 with the initial values from 1604,2±367,3 to 1196,7±385,1 DIN. C. sm-5. In the control group si increased at the end of surgery from 2,28±0,43 to 3,29±0,51 l/min/m2. (OPSS) DIN C. sm-5 increased at 1598,7,±426,5 tо 1610,7±429,1 DIN C. sm-5. Conclusion. The potentiation of multimodal anesthesia by contact light emitting diodes during abdominal surgeries in the main group allowed, on average, to reduce the dosage of narcotic drugs by 4 times fentanyl analgesics, stabilize hemodynamic parameters, increase the heart index and reduce the total peripheral vascular resistance more than in the control group during the anesthetic treatment.