Subcutaneous nerve stimulation in canine model of persistent atrial fibrillation v1

This animal protocol was approved by the Institutional Animal Care and Use Committee of the Indiana University School of Medicine and the Methodist Research Institute, Indianapolis, IN, and conformed to the Guide for Care and Use of Laboratory Animals. The surgical procedure is performed under anesthesia and should incorporate all local requirements for standards of animal experimentation, including methods of anesthesia, surgical environment, and post-operative monitoring and care.

Use of cholera toxin subunit B to label neural projections to lower urinary tract organs v1

This protocol is used to visualise sensory and autonomic neurons innervating organs of the lower urinary tract in an experimental adult male or female rat. The protocol is performed under anesthesia and should incorporate all local requirements for standards of animal experimentation, including methods of anesthesia, surgical environment, and post-operative monitoring and care.

Corneal neurotisation for neurotrophic keratopathy with a sural nerve autograft: a case report

Neurotrophic keratopathy is a corneal disease characterised by reduced corneal sensation. Corneal neurotization is the transfer of healthy donor nerve tissue to the cornea to restore sensation. An 11-year-old male presented with reduced Mackie Stage 1 neurotrophic keratopathy from de-bulking of a cerebellopontine angle arachnoid cyst. He underwent minimally invasive indirect corneal neurotization with a sural nerve autograft to ipsilateral supratrochlear nerve and cornea. Close and objective post-operative monitoring of donor sites, the cornea, visual acuity, and tear production clearly demonstrate the efficacy of this technique, and the timeline of clinical improvement.

Tubectomy of Pregnant and Non-pregnant Female Balinese Macaques (Macaca Fascicularis) With Post-operative Monitoring

Worldwide, primates, and humans increasingly share habitats and often enter in conflict when primates thrive in human-dominated environments, calling for special management measures. Reproductive control is increasingly used to manage population growth but very few monitoring data are available. Therefore, the efficiency and implications of such programs require a careful examination. In the context of a contraception program in wild female long-tailed macaques in Ubud, Bali, conducted over four successive campaigns between 2017 and 2019, including 140 females (i.e., 41.9% of the reproductive females of the population in 2019), modifications of an endoscopic tubectomy procedure, a permanent sterilization method, clinical evaluation of this method, and the post-operative monitoring results of the neutered females after release are described. This surgical approach was applicable for pregnant females: 28.6% of the treated females were pregnant at the time of the surgery. The procedure used a single lateral port to reach and cauterize both oviducts in non-pregnant as well as in early to mid-term pregnant females. Pregnant females nearer to term required a second lateral port to access both oviducts masked by the size of the gravid uterus. Moreover, bipolar thermocauterization was utilized successfully without resection to realize the tubectomy. The average duration of the laparoscopic surgery was 14 min for non-pregnant females and 22 min for pregnant females. Animals were released 3 h 22 min in average following their capture. This short holding time, recommended for free-ranging primates, was made possible by the minimal invasiveness of the sterilization approach. A laparoscopic post-operative evaluation conducted on two patients during the following campaign confirmed that the oviducts were definitely disrupted and no longer patent. Moreover, no new pregnancies in sterilized females were recorded during the 3-year observation period. The survival rate of the treated females 6 months after sterilization was high (96.3%) with no major post-operative complications clinically recorded. Among females that were pregnant during surgery, 81.1% were confirmed to experience term delivery. This study demonstrates the safety and efficiency of endoscopic tubectomy, even for pregnant females, as a mean of wild macaques' population control.

836 DIEP Flap Monitoring Adherence

Aim The popularity of Deep Epigastric Perforator (DIEP) free flaps for breast reconstruction after mastectomies have increased due to their natural aesthetic results and reliability. Free flaps require strict post-operative monitoring by nursing staff during the early post-operative period where they should notify the surgeons to anticipate vascular compromise in order to salvage the flap. To ensure success the DIEP guidelines were introduced to Morriston Hospital, Swansea. This was a first cycle closed loop re-audit. Method Interventions from initial audit were implemented in 2018. Retrospective analysis of patient notes over an 8-month period (August 2019- March 2020) and compared with DIEP checklist. Clinical notes, nursing cartex and flap observations and medication charts were reviewed. Results 100% had bear huggers, antiemetics (87% in 2018), correct thromboprophylaxis (75% in 2018) and laxatives (37% in 2018). 100% had senior reviews daily post op (75% in 2018). 100% had flap observations performed as guidelines immediately post op. Conclusions This was a successful re-audit showing significant improvements in adherence rates amongst the surgical and nursing staff in the plastic surgery department. Implementation of the DIEP operation note template may help maintain such adherence amongst staff.

829 Perioperative Surgical Patients and The Availability and Utilisation Of ECGs Machines Pre- And Post-Pandemic

Introduction ECGs are a NICE recommended pre-operative investigation and an integral part of post-operative monitoring. Delay in recognition of cardiac pathology can be catastrophic. Therefore, ECG machines should be readily available. Here, we report the results of an audit assessing the availability of ECG machines in surgical wards. Method In 2018 and then 2020, a bespoke, nine-item audit proforma was disseminated to all foundation doctors. Results In 2018, 17/32 wards had a ward based, readily available machine, 6/32 shared with another ward and 15/32 did not have a ward-based machine. The same was noted in 2020. In 2018 and 2020, the average time to obtain an ECG machine was 27 and 23 respectively. When no ECG was available, a doctor would obtain the machine 24% in 2018 compare to 52% in 2020. The diagnoses of the patients who had ECGs in 2018 were: normal sinus rhythm, atrial fibrillation, bradycardia, supraventricular tachycardia, sinus tachycardia and STEMI. In 2020 were: normal sinus rhythm, atrial fibrillation, supraventricular tachycardia, sinus tachycardia, atrial flutter, bradycardia, prolonged QTc, hyperkalaemia, STEMI and NSTEMI. The average time for NSTEMI patients to have an ECG was 35mins while for STEMI patients was 11.6mins. Conclusions Whilst our audit has highlighted the importance of ECG machine availability, the time to obtain one remained static between the two cycles. A study investigating the impact on patient outcomes may highlight the necessity for available ECG machines further.

Peri-Operative Cerebral Regional Oxygen Saturation Variability and Short-Term Outcomes Following Cardiac Surgery in Neonates

Decreased post-operative cerebral region oxygenation saturation (crSO2) variability, a surrogate for cerebral autoregulation, correlates with poor neurodevelopmental outcomes in neonates who undergo cardiac surgery. The goal of this study is to investigate the relationship between pre- and post-operative crSO2 variability in neonates requiring neonatal cardiac surgery for congenital heart disease (CHD). The variability of averaged 1-min crSO2 values was calculated for a minimum of 12h before and for the first 48h following cardiac surgery with cardiopulmonary by-pass in neonates between November 2019 and May 2021. The crSO2 variability increased by 9% with each additional postnatal day in the pre-operative monitoring period (p=0.009). There was a 40% decrease in crSO2 variability between the pre-and post-operative monitoring periods (p<0.001). There were no associations between the degree of decrease in crSO2 variability and CHD classification (aortic arch obstruction or single ventricle physiology). The crSO2 variability improves with each additional postnatal day but then decreases by almost half following cardiac surgery in neonates. We did not observe any association between pre-operative crSO2 variability and post-operative ventilator-free days, post-operative ICU days, or mortality.The long-term effects or significance of reduced crSO2 require further exploration.

Post-Operative Monitoring of Intestinal Tissue Oxygenation Using an Implantable Microfabricated Oxygen Sensor

Anastomotic leakage (AL) is a common and dangerous post-operative complication following intestinal resection, causing substantial morbidity and mortality. Ischaemia in the tissue surrounding the anastomosis is a major risk-factor for AL development. Continuous tissue oxygenation monitoring during the post-operative recovery period would provide early and accurate early identification of AL risk. We describe the construction and testing of a miniature implantable electrochemical oxygen sensor that addresses this need. It consisted of an array of platinum microelectrodes, microfabricated on a silicon substrate, with a poly(2-hydroxyethyl methacrylate) hydrogel membrane to protect the sensor surface. The sensor was encapsulated in a biocompatible package with a wired connection to external instrumentation. It gave a sensitive and highly linear response to variations in oxygen partial pressure in vitro, although over time its sensitivity was partially decreased by protein biofouling. Using a pre-clinical in vivo pig model, acute intestinal ischaemia was robustly and accurately detected by the sensor. Graded changes in tissue oxygenation were also measurable, with relative differences detected more accurately than absolute differences. Finally, we demonstrated its suitability for continuous monitoring of tissue oxygenation at a colorectal anastomosis over a period of at least 45 h. This study provides evidence to support the development and use of implantable electrochemical oxygen sensors for post-operative monitoring of anastomosis oxygenation.