Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty

Objective We aimed to compare the effect of dexmedetomidine with remifentanil on hemodynamic stability, surgical field quality, and surgeon satisfaction during rhinoplasty. Methods and materials In this double-blind randomized controlled-trial, 60 participants scheduled for rhinoplasty at the Mother and Child Hospital, Shiraz, Iran, was randomely divided into the dexmedetomidine group (IV infusion of 1 μg/kg dexmedetomidine over 20 min before induction of anesthesia then 0.6 μg/kg/hr. dexmedetomidine from the time of induction until the end of the operation) or in the the remifentanil group (an infusion rate of 0.25 μg/kg/min from the time of anesthesia induction until the end of the operation). Bleeding volume, surgeon satisfaction, postoperative pain (visual analog scale (VAS)), Level of sedation (Richmond Agitation Sedation Scale (RASS)), Patient satisfaction, Vital signs & recovery, and the Aldrete Score (used to discharge the patients from recovery) were measured for all participants. Results The patients in the dexmedetomidine group had less bleeding (p = 0.047) and shorter time to return of respiration, extubation, and the postoperative recovery time (p < 0.001). The surgeon satisfaction was higher in the dexmedetomidine group (p < 0.001). Patient satisfaction was significantly different between the two groups (p < 0.001). VAS scores, intaking paracetamol, and RASS score were significantly lower in the remifentanil group (p < 0.001). SBP, DBP, MAP, and heart rate were lower in dexmedetomidine group. Conclusion Dexmedetomidine was associated with relatively stable hemodynamics, leading to decreased intraoperative bleeding, recovery time, and greater surgeon satisfaction and the level of consciousness in the recovery ward. However, painlessness and patient satisfaction were greater with the use of remifentanil. Trial registration IRCT20141009019470N112.

Comparison of patient and surgeon satisfaction in patients undergoing knee arthroscopy with peripheral nerve block versus spinal anesthesia

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p <0.01) and surgeon (p = 0.022; p <0.05) satisfaction rates, these being lower in the group with SFNB comparable to patients with spinal anesthesia. There was a statistically significant difference between the first analgesic requirements of the patients according to the groups (p = 0.001; p <0.01). The first analgesic requirement of the patients who received SFNB was later than in the case of patients who received spinal anesthesia. Conclusions. Patient and surgeon satisfaction with SA was significantly higher than SFNB. The peripheral nerve blocks are inadequate for patient and surgeon satisfaction for knee arthroscopy compared to SA.

Use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy: new strategy to reduce complications

Background: Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. Methods: A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017–2018: enrollment; 2018–2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. Results: A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications ( p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade ( p < 0.0001). Conclusions: Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.

Assessing intravenous midazolam for conscious sedation during cataract surgery

Background: A large number of geriatric populations above the age of 50 worldwide suffer from cataract. Cataract starts with short-sightedness and gradually worsens resulting in blurring of vision and inability to visualize and distinguish fine details. Surgery is the only available treatment for cataract. Anaesthesia is essential during cataract surgery to minimize pain caused during surgical procedure and to achieve favourable surgical outcome. The current investigation was aimed towards assessing the performance of intravenous midazolam used for conscious sedation during cataract surgery along with retrobulbar block.Methods: Current study is a randomized double blinded study performed for duration of 6 months on 60 patients undergoing cataract surgery at Terna medical college and hospital. Patients were divided in two groups; group M received 0.02 mg/kg midazolam diluted to 5 ml, group N received 5 ml normal saline before cataract surgery. All vital hemodynamic parameters were observed after 5 minutes of sedation, immediately after block administration and after every 15 minutes till the end of the surgery to assess the effect of sedation. Patients and surgeons satisfaction levels were also documented post-surgery.Results: Patients who were sedated with midazolam prior to cataract surgery along with block exhibited a significant decrease in hemodynamic parameters like SAP, DAP and heart rate which indicated effective sedation. Anxiety level also significantly decreased in the patients who received midazolam. No major adverse or intra-operative events were observed in the patients who received midazolam.Conclusions: Sedation with midazolam provides haemodynamic conditions favourable for cataract surgery along with high level of patient and surgeon satisfaction.

Is Saddle block superior to spinal anaesthesia for patients undergoing transurethral resection of prostate- a comparative evaluation

Background: TURP is the most common surgical intervention for patients with benign prostatic hyperplasia. Aims and Objectives: This prospective randomized study was planned to evaluate spinal anaesthesia (SA) versus saddle block with regard to haemodynamic parameters, ephedrine consumption, patient and surgeon satisfaction, perioperative complications in patients undergoing TURP. Materials and Methods: Eighty patients between the ages of 50-80 years with BPH, belonging to ASA grade I- III, prostatic volume between 50 - 80 cc were included in our study. Patients were randomly divided into two groups of 40 patients each. Patients in group SA (n=40) received spinal anaesthesia and the patients in group SBBI (n=40) were given saddle block with bladder instillation of local anaesthetic jelly for undergoing TURP. Results: There was more statistically significant fall in MAP in Group SA as compared to Group SBBI (p<0.05). Complications like hypotension, bradycardia and vasopressor requirement was less but requirement (p=0.021) of supplemental analgesia was more in patients who were administered saddle block. There was significantly lower patient satisfaction in saddle block (p=0.044) but comparable surgical satisfaction in both groups. Conclusion: Both Spinal anaesthesia and saddle block are safe and effective techniques of anaesthesia for patients undergoing TURP. SA has advantages like less requirement of supplemental analgesia, longer duration of post-operative analgesia and more patient satisfaction. However, saddle block is superior to spinal anaesthesia with regard to haemodynamic stability; with less chances of hypotension, bradycardia and less vasopressor requirement. It is similar to SA in terms of providing adequate surgical conditions.

Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery – A Comparative Study from Hyderabad Karnataka Region

BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia

A Ruler for Abdominoplasty Preoperative Markings: The Potential of Best Scar Symmetry

Background. Scar appearance is an important outcome in abdominoplasty surgery, and its asymmetry can have a significant impact on patient and surgeon satisfaction. Here, we compared the scar symmetry reached with a ruler specially designed for the preoperative marking in abdominoplasty to the classic preoperative incision marking. Methods. In this randomized, uni-blind study, 42 patients were allocated to 2 different groups. Group 1 patients had their preoperative marking made by a group of surgeons that used the classic technique as described by Baroudi (n = 21), and Group 2 patients received their preoperative marking by another group of surgeons, using a ruler specially designed to fit the abdominal contour (n = 21). Patients were evaluated using a standard questionnaire that collected information about general patient’s characteristics. On the follow-up period, we evaluated the presence of late surgical complications, need for revision surgery, patient’s satisfaction concerning the postoperative scar, and 4 distances were measured in both groups to assess symmetry. Statistical analysis was made. Results. A total of 42 patients underwent abdominoplasty and were evaluated on the follow-up period (mean time: 4 months). The mean difference of corresponding measures on each side (A-B vs. A-B’ and A-C vs. A-C’) was higher in Group 1 comparing to Group 2. The level of correlation between corresponding measurements was higher in Group 2. Better satisfaction regarding the scar symmetry was achieved in Group 2, being this result statistically significant ( P = .004). Conclusions. The use of the specialized ruler may help surgeons achieve a better scar symmetry with higher patient satisfaction.