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Anaesthetic Management of Early-Onset Scoliosis
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
Damarla Haritha, Souvik Maitra
The anaesthesia technique as a whole revolves around spinal cord monitoring used in the intraoperative period to assess the integrity of the dorsal and ventral columns of the spinal cord. Previously, subjective tests such as the wake-up test and clonus test were used, but now, when available at the facility, they have been replaced by more objective ways of measurement such as somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP).
Combined Endoscopic-Laparoscopic Surgery (CELS) for Colorectal Polypectomy
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Miguel E Gomez, Parul J Shukla
To start off, the procedure allows for the underlying colon to be invaginated, assisting in the snaring of a difficult flat polyp. By manipulating the colon to allow the polyp to protrude, colorectal surgeons can facilitate its placement into the snare for removal, therefore preventing the need for resection [11]. In addition, laparoscopic mobilization and angulation of the colon provide better access to, and exposure of, the polyp in question. This again facilitates manipulation of the polyp, while also providing better visualization of the lesion [12]. The laparoscopic component of CELS also allows for easy detection and repair of full-thickness injury to the colon [4]. Therefore, surgeons can treat this possible injury, while also ensuring that patient postoperative complications are minimal. Having laparoscopic equipment readily available also facilitates conversion of the surgery to laparoscopic resection, in case the polyp cannot be removed endoscopically, or is deemed to be suspicious of malignancy during the intraoperative period [13]. The possibility of potentially switching procedures during surgery provides surgeons with flexibility and less stress, as they are better able to tailor their surgical approach to the unique conditions of the patient. Moreover, visualization of both the external and internal wall of the colon provides simple verification of the complete excision of the polyp and of any unexpected bleeding or perforation that can be immediately addressed [11].
Lung volume reduction − old and new approaches
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Nathaniel Marchetti, Gerard Criner
Of the 511 subjects who underwent LVRS in NETT, there was 5.5% 90-day mortality, and the only predictor of operative mortality was the presence of non-upper lobe predominant disease on high-resolution CT (HRCT) imaging with a relative odds (RO) of 2.99 (p = 0.009) (19). The intraoperative period was relatively safe with 91% of the subjects having no complications while only 2.2% had transient hypoxaemia and 1.2% developed an arrhythmia. However, during the 30-day postoperative period, 58.7% of LVRS subjects had a complication, with the most common being cardiac arrhythmia (23.5%). Other 30-day postoperative complications included reintubation (21.8%), pneumonia (18.2%), ICU readmission (11.7%) and requirement of tracheostomy (8.2%). Only 5.1% of subjects were not extubated within 3 days of undergoing LVRS (19). Major pulmonary and cardiovascular events occurred in 29.8% and 20% of subjects, respectively. Multivariate logistic regression demonstrated that pulmonary morbidity was greater in older patients (RO = 1.05, p = 0.02), lower FEV1 (RO = 0.97, p = 0.05) and lower DLCO (RO = 0.97, p = 0.01). Cardiovascular morbidity was higher with age (RO = 1.07, p = 0.004), preoperative steroid use (RO = 1.72, p = 0.04) and the presence of non-upper lobe-predominant emphysema (RO = 2.67, p < 0.001) (19).
Parental active participation during induction of general anesthesia to decrease children anxiety and pain
Published in Egyptian Journal of Anaesthesia, 2022
Tarek I Ismail, Rabab S. S. Mahrous
The child’s anxiety during induction was assessed by blind assessor using mYPAS. As soon as general anesthesia was induced, mothers were escorted to the waiting area and asked again to rate their own anxiety using VFAS. During intraoperative period, i.v. fentanyl was given according to the discretion of the anesthesiologist. At the end of the surgery, initial doses of i.v diclofenac 1 mg kg and Paracetamol 20 mg kg −1 were given, and i.v. morphine 0.1 mg kg−1 was also given if needed. After extubation, children were brought to the recovery area. After the end of surgery, children were awakened and transferred to the recovery room. Rescue analgesia, extra morphine, could be given by the recovery nurse according to perceived clinical need. Mother was allowed with the child in the recovery room.
Can Applying a Risk Stratification System, Preoperatively, Reduce Intraoperative Complications during Phacoemulsification?
Published in Current Eye Research, 2021
Pakinee Pooprasert, James Hansell, Tafadzwa Young-Zvandasara, Mohammed Muhtaseb
Amongst the principles of providing healthcare is the need for safe surgery. Guidance from the Royal College of Ophthalmologists states the aims of modern cataract surgery is not only the restoration of vision and to achieve the desired refractive outcome but also improvement in quality of life and ensuring patient safety and satisfaction. 1 Similar guidance is reiterated by other Colleges, Academies and Societies such as the American Academy of Ophthalmology. Achieving these aims is likely to require an uneventful preoperative, intraoperative and postoperative period. Although all are important for a successful recovery, the intraoperative period is crucial, as a turbulent time during surgery could have an immediate effect in the post-operative period – be it the need for further treatment, a delay in recovery or not reaching the full postoperative visual potential. Cataract surgery is thought to be arguably the most cost-effective procedure in medicine and remains the leading surgical procedure in modern Health Services.2 A good outcome is highly desirable and cataract surgeons are reminded of this by various studies.
Evaluation of single stage adjustable strabismus surgery (SSASS) under topical anesthesia in patients with symptomatic diplopia
Published in Strabismus, 2020
Sandra Chandramouli Ganesh, Shilpa G. Rao, Kalpana Narendran
Single-stage adjustable surgery can be performed under topical anesthesia. In addition to circumventing the risks associated with general or local anesthesia, it affords additional advantage of lesser chances of infection and quicker rehabilitation. Adjustment under topical anesthesia is cost effective, as patients need not undergo an additional surgery, or bear additional costs related to anesthesia. However, this form of anesthesia is better reserved for adult patients who are motivated for the same, who are not overly anxious or apprehensive about the procedure and who are likely to cooperate on table, during the intraoperative period.