Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group

Effect of refined management in operating room nursing on surgical efficiency and nursing satisfaction during laparoscopic radical resection of colon cancer

AIM

To assess the effect of refined management in the operating room nursing on surgical efficiency and nursing satisfaction during laparoscopic radical resection of colon cancer.

METHODS

In this retrospective study, 100 patients with laparoscopic radical resection of colon cancer were enrolled into this study. There were 51 patients who received refined management (the observation group) and 49 patients who received routine nursing intervention (the control group). The effect of refined management in the operating room nursing was evaluated by comparing the surgical efficiency, quality of care ratings, pain scores, and the nursing satisfaction between the two groups.

RESULTS

The preoperative preparation time, surgical time, intraoperative bleeding volume, and time to first postoperative defecation in the observation group were all less than those in the control group after nursing intervention (all P<0.05). The observation group had higher scores than the control group in five categories: operating room environment and safety, drug and instrument management, hygiene and sterilization, nursing records, and nursing professionalism (all P<0.05). The numerical rating scale (NRS) pain scores of the patients in the observation group were lower than those of the control group at 12, 24, and 48 hours postoperatively (all P<0.05). The rate of satisfaction in the observation group was 96.1%. This was higher than the 91.8% in the control group (P<0.05). The multivariate regression analysis demonstrated that refined management intervention is an independent factor for patients' prognosis.

CONCLUSION

The implementation of a refined management model in the operating room is effective in improving the quality of surgical care and surgical efficiency, and increasing patient satisfaction with nursing staff.

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery: Four case reports

BACKGROUND

During skull base surgery, intraoperative internal carotid artery (ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia. Appropriate management of ICA injury plays a crucial role in the prognosis of patients. Neurosurgeons have reported multiple techniques and management strategies; however, the literature on managing this complication from the anesthesiologist’s perspective is limited, especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.

CASE SUMMARY

We describe 4 cases of ICA injury during neurosurgery; there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma. After the onset of ICA injury, all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation. Three patients were transferred to the hybrid operating room, and one patient was transferred to the catheter operating room. Three patients underwent covered stent implantation, and one patient underwent embolization. All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation. After the neurosurgery, one patient was extubated and returned to the ward, and the other three were delayed tracheal extubation and returned to the intensive care unit. One patient died from serious neurological complications after 62 d in the hospital, but the other three showed good clinical outcomes.

CONCLUSION

ICA injury imposes a high risk of massive hemorrhage and subsequent infarction. Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons, anesthesiologists, and interventional neuroradiologists. Effective hemostatic methods, stable hemodynamics sufficient to ensure perfusion of vital organs, airway safety during transit, rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Internal Carotid Injury during Skull Base Surgery-Case Report and a Review of the Literature

Iatrogenic injury of the internal carotid artery (ICA) is a rare, and probably underreported, complication of transnasal endoscopic skull base surgery. Although treatment algorithms have been suggested, there is no definite consensus or guideline for the management of this severe complication. We describe a case of ICA injury that occurred during a transsphenoidal biopsy of a tumor in the cavernous sinus and we present a treatment algorithm for managing this complication. We reviewed the articles published from 1998 to 2021, reporting on major vascular injury during transnasal endoscopic skull base surgery and endonasal endoscopic surgery, and we compare the methods and results of ICA injury management reported in the literature with the presented case. The most promising treatment for ICA injury might be packing with a muscle graft initially, then performing an endovascular intervention.