A Fictitious Replicated Display about the Effect of Physiotherapy and Health Education Programs on the Surgical Repair of Vesico-Vaginal Fistula

Objectives: Surgery is the only effective therapy for the majority of Vesico-Vaginal (V-V) fistulae. The current research assessed the effect of a planned program of pre- and postoperative physiotherapy and health education on the outcome of V-V fistula surgery. Methods: We examined the postoperative outcomes of two groups of women with V-V fistulae recruited and followed up on by two local nonprofit organizations at a hospital in Saudi Arabia on April-October 2021. The first group of women (n = 99) underwent fistula repair using conventional procedures. The second group (n = 112) had a standardized surgical technique as well as a systematic pre- and postoperative health education and physiotherapy regimen. Results: The training had a strong favorable influence on overall recovery and urine incontinence in particular. The chances of recovery after physiotherapy were 2.7 times higher for women in the physiotherapy group than for control patients, and the likelihood of postoperative stress incontinence was significantly higher for patients in the control group than for those in the physiotherapy group (P value 0.001). Conclusion: A planned program of health education and physiotherapy provided by skilled nurses and physiotherapists increases the chance of a satisfactory result after V-V fistula repair surgery.

New surgical realities: implementation of an enhanced recovery after surgery protocol for gynecological laparoscopy—a prospective study

Background Multimodal rehabilitation allows optimization of functional recovery in surgery patients by reducing the postoperative stress and hospital stay duration, without increasing the morbidity and mortality. It is reportedly successful in other surgical disciplines, and guidelines for its application to gynecological surgery are available; however, most evidence for these guidelines is derived from observational and/or retrospective studies. Therefore, this study aimed to investigate the applicability of an enhanced recovery after surgery (ERAS) protocol in laparoscopic gynecological surgery and its influence on the postoperative stay, morbidity, mortality, and readmission, through a prospective approach. Methods This prospective cohort study was performed on 90 patients who underwent laparoscopic hysterectomy for benign causes from October 2017 to October 2019. Patients in whom the ERAS (ERAS group, n = 30) and traditional (control group, n = 60) protocols were implemented were compared. All patients were followed for 6 months. Results The groups were homogeneous and did not differ significantly with respect to the demographic characteristics (age, ASA score, body mass index), surgical indications, and surgery types. Adherence to the ERAS protocol was over 99%. The postoperative hospital-stay durations were 1.73 days (r = 1–3) and 2.97 days (r = 2–6) in the ERAS and control groups, respectively (p = 0.000). No significant intergroup differences were observed in the rates of complications and readmissions. Conclusions The ERAS protocol is applicable in laparoscopic gynecological surgery and can be implemented with good adherence. This can allow optimization of patient recovery by reducing the hospital stay duration, without increasing the rates of morbidity, mortality, or readmission.

Evaluation the preventive effect of Selenium on acute kidney injury following on-pump cardiac surgery

Introduction: patients who undergo on-pump cardiac surgery are at risk of acute kidney injury following the operation. This is mainly due to some ischemic events and also pre- and postoperative stress responses which can result in postoperative organ dysfunction. Selenium as an antioxidant may help to reduce the inflammation and subsequent related complications. In this study we tested that if administration of oral Se compliment before and following the on-pump cardiac surgery can reduce the incidence or severity of kidney injury following the operation. Methods: In a randomized double-blind trial we divided the randomly selected patients who were candidate for on-pupm cardiac surgery into two groups of those who received selenium and control group. In selenium group we administrated 500 µg of selenium orally 14 and 2 hours before surgery and every 12 hours postoperatively for 2 days (overall 3000 µg) while the control group received only the routine and standard care. Subsequently patients were closely observed for serum creatinine rise and incidence of post-operative AKI during their hospitalization period in both groups using both Rifle and AKIN criteria separately. Besides, some additional data including: ICU-stay, duration of the operation and need for Blood products during the operation were recorded. At the end, the statistical analysis was carried out using SPSS 11.5 software in order to determine any significant difference in case and control group. Results: The study population included 120 patients divided in two equal groups of 60, consisting of 46 (38.3%) males and 74 (61.7%) females with the mean age of 52.8±16.7 years. Both groups were similar regarding the demographics and comorbidities. Also statistics showed no significant difference regarding Cardiac Operative Risk Evaluation (EuroSCORE) in both groups. Considering the RIFLR criteria, AKI occurred in 11 (17.9%) patients in selenium group and 13 (21.4%) patients in control group while based on AKIN criteria figures were 17 (28.6%) and 21 (35.7%) in selenium and the control group , respectively. The most frequent stage of AKI among patients was the first stage in both group and the highest rate of AKI occurred in 3-4 days after surgery in both groups. Conclusion: According to our research Administrating oral Selenium was not beneficial in order to prevent AKI after on-pump cardiac surgery.

Anesthesia Analepsia Management Improves Postoperative Stress Reaction and Oxygenation in Elderly Patients Undergoing Lumbar Spine Surgery

Background: Developing a scientific and effective anesthesia analepsia management strategy is of great significance to reduce the risk of complications in elderly patients. This study aims to explore the effect of analepsia management on the postoperative stress reaction and oxygenation in elderly patients with lumbar spine surgery.Methods: In this randomized controlled study, 60 elderly patients who underwent lumbar spine surgery with general anesthesia in Traditional Chinese Medicine Hospital of Shapingba District, Chongqing City were included. According to the random number table method, patients were randomly divided into test group (n=30) and control group (n=30). During the analepsia period, patients in the control group received routine management, while the test group received a new analepsia management strategy based on the control group. The analepsia quality, postoperative stress reaction, oxygenation function, and complication rates of the two groups were compared.Results: Compared with the control group, the extubation time, fully awake time, and resuscitation chamber residence time in test group were significantly shortened (P<0.05). At different times postoperatively, the test group had significantly lower epinephrine, cortisol, and blood sugar levels than the control group (P<0.001), and significantly higher or lower PaO2, oxygenation index (OI), and PaCO2 values ​​(P<0.01). Compared with the control group, the postoperative visual analogue scale (VAS) score in the test group was lower (P＜0.05), while the Quality of Recovery-40 (QoR-40) score was higher (P＜0.05), and the test group had a lower incidence of restlessness, hypothermia and respiratory complications during the analepsia period (P<0.05).Conclusions: This study showed that the analepsia management strategy could improve the postoperative stress reaction and oxygenation function of elderly patients with lumbar spine surgery, which could promote the postoperative recovery of patients.

Effects of Three Different Doses of Dexmedetomidine and Ropivacaine on Analgesia and the Stress Response in Hypospadias Surgery: A Randomized Trial

Objective: This study was designed to investigate the effects of three different doses of dexmedetomidine in caudal blocks on postoperative stress and pain after pediatric urethroplasty.Methods: A total of 160 children who underwent elective urethroplasty were enrolled in this study. They were randomly divided into four groups: groups D1, D2, and D3, in which the patients were injected respectively with a mixed solution of 1, 1.5, or 2 μg kg−1 of dexmedetomidine and 0.25% ropivacaine into the sacral canal; and group R, in which the patients were injected with 0.25% ropivacaine into the sacral canal. Cortisol and interleukin-6 (IL-6) levels within 24 h, the incidence of adverse events in the circulatory system during surgery, onset time of the caudal block, duration of postoperative analgesia, the incidence of agitation during recovery, and other anesthetic adverse reactions were observed and recorded.Results: Compared with group R, cortisol and IL-6 levels in groups D1, D2, and D3 decreased within 24 h after the operation (T2–T6). The incidence of intraoperative hypertension, tachycardia, and shivering during the recovery period decreased, the onset time of the caudal block decreased, and the duration of postoperative analgesia increased (p &lt; 0.01). Compared with group D1, the duration of postoperative analgesia increased in groups D2 and D3 (p &lt; 0.01). Compared with groups D1 and D2, the incidence of excessive sedation and bradycardia in group D3 increased (p &lt; 0.05).Conclusion: The administration of 1.5 μg kg−1 of dexmedetomidine appears to be most feasible in accelerating the onset of the caudal block, reducing stress and inflammation, stabilizing the circulation, increasing the duration of postoperative analgesia, and reducing anesthesia- and operation-associated adverse events.

Fellows and Observers Are Not a Problem for Infection in the Operating Rooms of Teaching Centers

Purpose: The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the risk of infection but also the risk of intraoperative complications due to distractions during the surgery. Materials and Methods: This retrospective study included all patients who had surgery between January 2017 and January 2018 in an OR with the usual surgical team and three or more observers. Patient demographic data, surgical details (duration of the surgery, the surgery being open or arthroscopic, and whether a graft was used), and intraoperative and postoperative complications were recorded. Results: A total of 165 surgeries were recorded, with a mean operating time of 70 min (40% open surgeries, 37% arthroscopic surgeries, and 23% combined open and arthroscopic procedures). The main intraoperative complications were vessel damage, nerve damage, premature cement setting, and leg-length discrepancy, with 1 case each. The main postoperative complications were rigidity (8 cases), unexplained pain (11 cases), failed meniscal suturing (3 cases), a postoperative stress fracture (1 case), correction loss in osteotomy (1 case), and wound problems not related to infection (1 case). There were no cases of infection. Discussion: The present study shows that the complication rate when having observers in the OR is comparable to the reported data. The key to avoiding complications is for everyone to comply with basic OR behavior.