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Seeman K, Caso J. Clinical Issues - July 2024. AORN J 2024; 120:50-55. [PMID: 38924563 DOI: 10.1002/aorn.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 06/28/2024]
Abstract
Cleaning surgical instruments after use in a procedure involving chemotherapeutic medications Key words: deactivation, decontamination, cleaning, disinfection, chemotherapeutic medication. Paper count sheets sterilized inside instrument sets Key words: count sheets, instrument sets, printer ink, toner, toxicity. Off-label use of dental devices during direct laryngoscopy Key words: mouth guard, dental injury, direct laryngoscopy, anesthesia, intubation. Using intermittent pneumatic compression devices on patients in lithotomy position Key words: mechanical compression devices, compartment syndrome, lithotomy, venous thromboembolism, thromboprophylaxis.
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Wu D, Gu H, Tang Y, Peng L, Liu H, Jiang Y, Xu Z, Wei Q, Wang Y. Predictive factors on postoperative venous thromboembolism after minimally invasive colorectal cancer surgery: a retrospective observational study. BMC Surg 2023; 23:85. [PMID: 37041489 PMCID: PMC10091640 DOI: 10.1186/s12893-023-01992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/06/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious and preventable postoperative complication. However, the predictive significance of perioperative biochemical parameters for VTE after minimally invasive colorectal cancer surgery remains unclear. METHODS A total of 149 patients undergoing minimally invasive colorectal cancer surgery were collected between October 2021 and October 2022. Biochemical parameters related to preoperative and postoperative day 1, day 3, and day 5 were collected, including D-Dimer, mean platelet volume (MPV), and maximum amplitude (MA) of thromboelastography (TEG). Receiver operating characteristic (ROC) curves were used to explore the predictive powers of meaningful biochemical parameters for postoperative VTE, and calibration curves were used to assess predictive accuracy. RESULTS The overall cumulative incidence of VTE was 8.1% (12/149). The preoperative and postoperative day 3 D-Dimer, postoperative day 3, and day 5 MPV, and postoperative day 1, day 3, and day 5 TEG-MA was significantly higher in the VTE group than in the non-VTE group (P < 0.05). The results of both the ROC curve and the calibration curve indicated that these meaningful D-Dimer, MPV, and TEG-MA had moderate discrimination and consistency for postoperative VTE. CONCLUSIONS D-Dimer, MPV, and TEG-MA may predict postoperative VTE in patients undergoing minimally invasive surgery for colorectal cancer at specific times in the perioperative period.
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Affiliation(s)
- Dabin Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Haitao Gu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yunhao Tang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Linglong Peng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Hang Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yahui Jiang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Zhiquan Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Qi Wei
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yaxu Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Kajitani R, Minami M, Kubo Y, Iwaihara H, Takishita Y, Isayama M, Ohno R, Hayashi T, Sasaki T, Matsumoto Y, Nagano H, Komono A, Aisu N, Yoshimatsu G, Yoshida Y, Hasegawa S. Intraoperative pressure monitoring of the lower leg for preventing compression-related complications associated with the lithotomy position. Surg Endosc 2021; 36:5873-5881. [PMID: 34851475 DOI: 10.1007/s00464-021-08921-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several serious complications are associated with the lithotomy position, including well-leg compartment syndrome and peroneal nerve paralysis. The aims of this study were to identify risk factors for the intraoperative elevation of lower leg pressure and to evaluate the effectiveness of monitoring external pressure during surgery for preventing these complications. METHODS The study included 106 patients with a diagnosis of sigmoid colon or rectal cancer who underwent elective laparoscopic surgery between June 2019 and December 2020. We divided the posterior side of the lower leg into four parts (upper outside, upper inside, lower outside, lower inside) and recorded the peak pressure applied to each area at hourly intervals during surgery (called "regular points") and when the operating position was changed (e.g., by head-tilt or leg elevation; called "points after change in position"). When the pressure was observed to be higher than 50 mmHg, we adjusted the position of the leg and re-recorded the data. Data on postoperative leg-associated complications were also collected. RESULTS The pressure was measured at a total of 1125 points (regular, n = 620; after change of position, n = 505). The external pressure on the upper outer side of the right leg (median, 36 mmHg) was higher than that on any other area of the lower leg. The pressure increase to more than 50 mmHg was observed not only during the change of position (27.5%) but also during regular points (22.4%). Bodyweight, strong leg elevation, and low head position were identified as factors associated with increased external pressure. There have been no compression-related complications in 534 cases at our institution since the introduction of intraoperative pressure monitoring. CONCLUSIONS Several risk factors associated with increased external pressure on the lower leg were identified. Intraoperative pressure monitoring might help reduction of pressure-related complications, needing further and larger prospective data collections.
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Affiliation(s)
- Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Maiko Minami
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Yuka Kubo
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Haruka Iwaihara
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Yurie Takishita
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Mie Isayama
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Ryo Ohno
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Takaomi Hayashi
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Takahide Sasaki
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Akira Komono
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan.
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Furnas HJ, Canales FL, Pedreira RA, Comer C, Lin SJ, Banwell PE. The Safe Practice of Female Genital Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3660. [PMID: 34249585 PMCID: PMC8263325 DOI: 10.1097/gox.0000000000003660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 01/11/2023]
Abstract
The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to look for in the patient's motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.
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Affiliation(s)
- Heather J. Furnas
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
- Plastic Surgery Associates, Santa Rosa, Calif
| | | | - Rachel A. Pedreira
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
| | - Carly Comer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Samuel J. Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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Abstract
LEARNING OBJECTIVES After studying this article, participants should be able to: (1) Identify the most appropriate type of anesthesia for the female genital plastic surgical patient and minimize risks of nerve injury and thromboembolic event through proper preoperative evaluation and knowledge of positioning. (2) Define the vulvovaginal anatomy, including common variants, and assess vulvovaginal tissues after childbirth and menopause. (3) Apply surgical techniques to minimize complications in female genital plastic surgery. (4) Classify the types of female genital mutilation/cutting and design methods of reconstruction after female genital mutilation/cutting. SUMMARY Female genital plastic surgery is growing in popularity and in numbers performed. This CME article covers several aspects of safety in the performance of these procedures. In choosing the best candidates, the impact of patient motivation, body mass index, parity, menopause and estrogen therapy is discussed. Under anesthesia, consideration for the risks associated with the dorsal lithotomy position and avoidance of compartment syndrome, nerve injury, deep venous thromboses, and pulmonary embolus are covered. Anatomical variations are discussed, as is the impact of childbirth on tissues and muscles. Surgical safety, avoidance of complications, and postoperative care of a variety of vulvovaginal procedures are discussed. Videos showing anatomical variations and surgical techniques of the most common female genital procedures with recommendations to reduce the complication rate are included in the article. Finally, female genital mutilation/cutting is defined, and treatment, avoidance of complications, and postoperative care are discussed.
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