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Binda F, Gambazza S, Marelli F, Rossi V, Lusignani M, Grasselli G. Upper limb peripheral nerve injuries in patients with ARDS requiring prone positioning: A systematic review with proportion meta-analysis. Intensive Crit Care Nurs 2024; 85:103766. [PMID: 39126976 DOI: 10.1016/j.iccn.2024.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/06/2024] [Accepted: 07/06/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning. METHODS This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning. RESULTS A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I2 = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies. CONCLUSION During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations. IMPLICATIONS FOR CLINICAL PRACTICE Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.
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Affiliation(s)
- Filippo Binda
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Simone Gambazza
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Laboratory of Medical Statistics, Biometry and Epidemiology 'G. A. Maccacaro', Department of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023-2027, University of Milan, Milano, Italy.
| | - Federica Marelli
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Veronica Rossi
- Department of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Yang X, Zhang X, Liu C, Zhang L, Wu F, Shen Q, Yu Y. Treatment of Distal Third Tibial Fractures with Anterior Soft Tissue Compromise through the Posterolateral Approach: Distal Third Tibial Fractures via the Posterolateral Approach. J Foot Ankle Surg 2024:S1067-2516(24)00215-1. [PMID: 39245431 DOI: 10.1053/j.jfas.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 09/10/2024]
Abstract
Distal third tibial fractures associated with anterior soft tissue compromise are a predictor of more complications and poor prognosis. The study aimed to introduce the treatment of such fractures through the posterolateral approach. From March 2020 and January 2022, 32 patients with distal third tibial fractures were plated through the posterolateral approach due to concurrent closed anterior soft tissue compromise. There were 30 male and 2 female patients with the mean age of 33 years (range, 20-53 years). The reduction quality of diaphyseal fractures was good (n=30) and acceptable (n=2). The reduction quality of articular fragments was anatomic (n=21), good (n=6), and fair (n=1). All anterior soft tissue injuries healed without surgical intervention. Follow-ups lasted 28 months (range, 25-34 months). The mean dorsiflexion of the injured and uninjured ankles were 17.8°±5.4° and 24.5°±6.6°, respectively (P<0.05). The mean plantar flexion of the ankles were 42°±8.8° and 46°±12.9°, respectively (P>0.05). The mean inversion of the injured and uninjured ankles were 15°±13.3° and 19°±12.4°, respectively (P<0.05). The mean eversion of the injured and uninjured ankles were 27.8°±16.9° and 32.9°±14.3°, respectively (P>0.05). The mean American Orthopaedic Foot and Ankle score was 90 (range, 68-100). Distal third tibial fractures with anterior soft tissue compromise can be plated through the posterolateral approach, resulting in good functional outcomes and minimum complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV.
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Affiliation(s)
- Xiaoliang Yang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xu Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Caixia Liu
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Liming Zhang
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Fan Wu
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Qiang Shen
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Yadong Yu
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Li X, Liu T, Hou Q, Zeng X, Xiong Y, Yang Y, Li Z, Li Y, Lin Y, He L. Comparison of Prone With Lithotomy Position in Removal of Posterior Myoma in Transvaginal Natural Orifice Endoscopic Surgery: A Prospective Cohort Study. J Minim Invasive Gynecol 2024; 31:795-802. [PMID: 38692483 DOI: 10.1016/j.jmig.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is considered to have the advantages of completely scarless, less postoperative pain, earlier flatus, and faster postoperative recovery. However, posterior myoma are relatively difficult to operate through vNOTES in the conventional lithotomy position. Thus, we innovated the application of prone position in the removal of posterior myoma in vNOTES. The aim of this study is the comparison of myomectomy outcomes of patient for single posterior myoma in prone and lithotomy position. DESIGN A single-center, prospective study. SETTING A university teaching hospital. PATIENTS A total of 81 patients with posterior myoma who underwent myomectomy in vNOTES from January 2021 to December 2022. INTERVENTIONS The patients underwent myomectomy in vNOTES in prone or lithotomy position. MEASUREMENTS AND MAIN RESULTS Among the patients who underwent vNOTES myomectomy, 29 (35.8%) were in the lithotomy position group, and 52 (64.2%) in the prone position group. Of note, 4 (4.9%) patients underwent a conversion to LESS during the operation-3 in the lithotomy and 1 in the prone position group. And a patient in the lithotomy position group underwent resurgery for hemostasis due to postoperative pelvic bleeding. Compared with the lithotomy position, prone position significantly shortens the operation time (12.3, 95% CI: 6.811, 17.761. p = .009) without increasing the complications and postoperative discomfort of patients. CONCLUSION Compared to the lithotomy position, the prone position provides greater convenience for operation and exhibits a lower rate of surgical conversion during the removal of single posterior myomas via vNOTES. Further, for patients selecting vNOTES, surgeons need to conduct sufficient preoperative evaluation, timely hemostasis during surgery, and timely surgical conversion if necessary to ensure patient safety.
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Affiliation(s)
- Xin Li
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Tianjiao Liu
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Qiannan Hou
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoyan Zeng
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Xiong
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Yang Yang
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Zhongzhi Li
- Department of Gynaecology and Obstetrics (Z. Li), Chongqing University Fuling Hospital, Chongqing, China
| | - Yalan Li
- Psychosomatic Medical Center (Y. Li), The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Yonghong Lin
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China
| | - Li He
- Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China.
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Sharma V, Soundararajan DCR, Shetty AP, Kanna RM, Shanmuganathan R. Variation in thoracic inlet measurements and its correlation with pulmonary dysfunction in kyphoscoliotic deformities: a prospective case-control study. Spine Deform 2024; 12:1299-1309. [PMID: 38722533 DOI: 10.1007/s43390-024-00881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/09/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Pulmonary dysfunction in thoracic kyphoscoliosis has been correlated with chest wall distortion, uneven trunk growth and restrictive pattern. The study aims to analyse the variation in thoracic inlet measurements on pulmonary dysfunction with varying curve magnitude and thoracic cage parameters. METHODS In a non-randomised, prospective case-control study, 80 consecutive patients with thoracic kyphoscoliosis were divided into 3 groups based on Cobb angle: Group 1 (31-50), Group 2 (51-80) and Group 3 (> 80). Thoracic inlet measurement was calculated by thoracic inlet index (TI) on MRI at the sternal level. Pulmonary function and thoracic cage parameters [hemi thorax height, rib-apex distance, AP chest diameter at sternal level and transverse thoracic diameter] were documented. TI values were compared with 20 age-matched asymptomatic controls. Multivariate correlation and regression analysis were performed to investigate the correlations. RESULTS The mean age of the study cohort was 14.1 ± 4.4 years, including Group 1 (6 patients), Group 2 (55 patients) and Group 3 (19 patients) versus 12.9 ± 2.2 years in controls. The mean TI was 2.8 ± 0.56 in Group 1, 3.7 ± 0.9 in Group 2 and 4.0 ± 1.12 in Group 3 versus 2.6 ± 0.43 in controls. Pulmonary dysfunction was severe with TI > 7.1 (p < 0.001) in Group 3 patients with thoracic hypokyphosis. Multivariate regression for thoracic parameters and TI > 5.6 showed significant correlation of pulmonary dysfunction in Group 2 and 3 curves with apex between T1 and T4, whereas transverse thoracic diameter, rib-apex distance and hemi thorax height were weakly associated. CONCLUSION Thoracic inlet index (TI), a neglected pre-operative variable associated with pulmonary dysfunction in thoracic kyphoscoliosis, can be evaluated on MRI without an additional cost and radiation. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Vyom Sharma
- Department of Orthopaedics, Military Hospital Khadki and Armed Forces Medical College, Pune, India
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt., Ltd., Mettupalayam Road, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt., Ltd., Mettupalayam Road, Coimbatore, India
| | - Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt., Ltd., Mettupalayam Road, Coimbatore, India.
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Cho A, Lippolis MA, Herta J, Dogan M, Hedrich C, Azizi AA, Peyrl A, Gojo J, Czech T, Dorfer C. The telovelar approach for fourth ventricular tumors in children: is removal of the posterior arch of C1 necessary? Childs Nerv Syst 2024; 40:2707-2711. [PMID: 38703239 PMCID: PMC11322403 DOI: 10.1007/s00381-024-06443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Various surgical nuances of the telovelar approach have been suggested. The necessity of removing the posterior arch of C1 to accomplish optimal tumor exposure is still debated. Therefore, we report on our experience and technical details of the fourth ventricular tumor resection in a modified prone position without systematic removal of the posterior arch of C1. METHODS A retrospective analysis of all pediatric patients, who underwent a fourth ventricular tumor resection in the modified prone position between 2012 and 2021, was performed. RESULTS We identified 40 patients with a median age of 6 years and a M:F ratio of 25:15. A telovelar approach was performed in all cases. In 39/40 patients, the posterior arch of C1 was not removed. In the remaining patient, the reason for removing C1 was tumor extension below the level of C2 with ventral extension. Gross or near total resection could be achieved in 34/39 patients, and subtotal resection in 5/39 patients. In none of the patients, a limited exposure, sight of view, or range of motion caused by the posterior arch of C1 was encountered, necessitating an unplanned removal of the posterior arch of C1. Importantly, in none of the cases, the surgeon had the impression of a limited sight of view to the most rostral parts of the fourth ventricle, which necessitated a vermian incision. CONCLUSION A telovelar approach without the removal of the posterior arch of C1 allows for an optimal exposure of the fourth ventricle provided that critical nuances in patient positioning are considered.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maria Aliotti Lippolis
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Muhammet Dogan
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Cora Hedrich
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Amedeo A Azizi
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Min JY, Jeon JP, Chung MY, Kim CJ. Use of the cardiac power index to predict fluid responsiveness in the prone position: a proof-of-concept study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844545. [PMID: 39117065 DOI: 10.1016/j.bjane.2024.844545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The primary aim of this proof-of-concept study was to investigate whether the Cardiac Power Index (CPI) could be a novel alternative method to assess fluid responsiveness in the prone position. METHODS Patients undergoing scheduled elective lumbar spine surgery in the prone position under general anesthesia were enrolled in the criteria of patients aged 19-75 years with American Society of Anesthesiologists (ASA) physical status I-II. The hemodynamic variables were evaluated before and after changes in posture after administering a colloid bolus (5 mL.kg-1) in the prone position. Fluid responsiveness was defined as an increase in the Stroke Volume Index (SVI) ≥ 10%. RESULTS A total of 28 patients were enrolled. In responders, the CPI (median [1/4Q-3/4Q]) decreased to 0.34 [0.28-0.39] W.m-2 (p = 0.035) after the prone position. After following fluid loading, CPI increased to 0.48 [0.37-0.52] W.m-2 (p < 0.008), and decreased SVI (median [1/4Q-3/4Q]) after prone increased from 26.0 [24.5-28.0] mL.m-2 to 33.0 [31.0-37.5] mL.m-2 (p = 0.014). Among non-responders, CPI decreased to 0.43 [0.28-0.53] W.m-2 (p = 0.011), and SVI decreased to 29.0 [23.5-34.8] mL.m-2 (p < 0.009). CPI exhibited predictive capabilities for fluid responsiveness as a receiver operating characteristic curve of 0.78 [95% Confidence Interval, 0.60-0.95; p = 0.025]. CONCLUSION This study suggests the potential of CPI as an alternative method to existing preload indices in assessing fluid responsiveness in clinical scenarios, offering potential benefits for responders and non-responders.
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Affiliation(s)
- Ji Young Min
- The Catholic University of Korea, College of Medicine, Eunpyeong St. Mary's Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Republic of Korea
| | - Joon Pyo Jeon
- The Catholic University of Korea, College of Medicine, Eunpyeong St. Mary's Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Republic of Korea
| | - Mee Young Chung
- The Catholic University of Korea, College of Medicine, Eunpyeong St. Mary's Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Republic of Korea
| | - Chang Jae Kim
- The Catholic University of Korea, College of Medicine, Eunpyeong St. Mary's Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Republic of Korea.
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Tanaka M, Al Askar AEK, Kumawat C, Ekade SJ, Uotani K. A New Minimally Invasive Technique for Thoracolumbar/Lumbar Focal Kyphosis Due to Osteoporotic Vertebral Fracture: A Case Report. Cureus 2024; 16:e66069. [PMID: 39229420 PMCID: PMC11368576 DOI: 10.7759/cureus.66069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/05/2024] Open
Abstract
Osteoporotic vertebral fractures are common fractures in the elderly population and are often associated with low back pain and disruption in daily living activities. Reconstruction surgeries, such as corpectomy, are among the treatment options for these conditions. However, a corpectomy requires a longer surgical procedure and involves a significant amount of blood loss. We present the case of an 80-year-old woman with severe low back pain due to an L2 fracture and focal kyphosis treated with a novel minimally invasive technique. The patient underwent anterior and posterior surgery in the right decubitus position using a C-arm-free technique. Hyperlordotic cages were inserted in the upper and lower disc space via a lateral approach, while percutaneous pedicle screws were inserted from a posterior approach. These procedures were performed simultaneously under navigation guidance only.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, JPN
| | | | - Chetan Kumawat
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN
| | - Shashank J Ekade
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN
| | - Koji Uotani
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, JPN
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Park H, Son H, Kim JH, Kim S, Kim YR, Lee CH, Chung CK, Kim CH. Single-position oblique lumbar interbody fusion with navigation: improved efficiency and screw accuracy compared to dual-position with fluoroscopy. Sci Rep 2024; 14:16907. [PMID: 39043758 PMCID: PMC11266416 DOI: 10.1038/s41598-024-67007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/08/2024] [Indexed: 07/25/2024] Open
Abstract
Dual-position oblique lumbar interbody fusion with fluoroscopy (D-OLIF) requires repositioning the patient to a prone position for pedicle screw insertion. Recently, single-position surgery with navigation has been introduced. However, there are concerns regarding pedicle screw accuracy and achieving appropriate sagittal balance in single-position OLIF with navigation (S-OLIF). The purpose of this study is to evaluate the clinical and radiological outcomes of S-OLIF compared to D-OLIF. A retrospective analysis was conducted on 102 patients who underwent single-level OLIF at a single institution. The patients were divided into two groups: 55 in the S-OLIF group and 47 in the D-OLIF group. The numeric rating scale for back and leg, Oswestry disability index, and walking distance improvements showed no significant difference. However, the EuroQol 5-dimension 5-level index showed higher improvement in the S-OLIF (P = 0.029). The segmental lordosis, lumbar lordosis, and C7 sagittal vertical axis showed no significant difference. S-OLIF had significantly fewer cases of pedicle screw malposition (P = 0.045). Additionally, the surgery time was shorter in the S-OLIF (P = 0.002). In conclusion, S-OLIF exhibited clinical and radiological outcomes comparable to D-OLIF, with the added advantages of reduced surgery time and enhanced accuracy in pedicle screw placement.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hui Son
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sum Kim
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Rak Kim
- Department of Neurosurgery, Armed Forces Yangju Hospital, Yangju, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Dow R, Gronowicz S, Aceto M, Daniels A, Diebo B, Chiappetta G, Haque M. Single-Position Synchronal Management of Metastatic Prostate Cancer of the Spine and Femur Using Prone Nailing: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00010. [PMID: 38991096 DOI: 10.2106/jbjs.cc.24.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
CASE A 71-year-old man with castration-resistant Stage IVB prostate cancer developed symptomatic oligometastatic disease in the lumbar spine and bilateral proximal femurs. He was treated with a single-position L2-L4 kyphoplasty with concomitant prone left-sided femoral prophylactic cephalomedullary nailing. Six months later when he again lost the ability to ambulate, he was treated with a single-position L4-L5 laminectomy for an epidural tumor with prone right-sided femoral prophylactic cephalomedullary nailing. CONCLUSION Single-position prone surgery of the spine and prone femoral nailing is feasible and improves on traditional multiposition approaches, eliminating the need to reposition or change tables during management.
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Affiliation(s)
- Robert Dow
- Rutgers Robert Wood Johnson Medical School, Department of Orthopaedics, New Brunswick, New Jersey
| | - Scott Gronowicz
- University of Central Florida, College of Medicine, Orlando, Florida
| | - Matthew Aceto
- University of Central Florida, College of Medicine, Orlando, Florida
| | - Alan Daniels
- Brown University, Department of Orthopaedics, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Bassel Diebo
- Brown University, Department of Orthopaedics, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Gino Chiappetta
- Rutgers Robert Wood Johnson Medical School, Department of Orthopaedics, New Brunswick, New Jersey
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Sadeghzadeh S, Yoo KH, Lopez I, Johnstone T, Schonfeld E, Haider G, Marianayagam NJ, Stienen MN, Veeravagu A. Impact of Supine versus Prone Positioning on Segmental Lumbar Lordosis in Patients Undergoing ALIF Followed by PSF: A Comparative Study. J Clin Med 2024; 13:3555. [PMID: 38930084 PMCID: PMC11204788 DOI: 10.3390/jcm13123555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Anterior lumbar interbody fusion (ALIF) and posterior spinal fusion (PSF) play pivotal roles in restoring lumbar lordosis in spinal surgery. There is an ongoing debate between combined single-position surgery and traditional prone-position PSF for optimizing segmental lumbar lordosis. Methods: This retrospective study analyzed 59 patients who underwent ALIF in the supine position followed by PSF in the prone position at a single institution. Cobb angles were measured preoperatively, post-ALIF, and post-PSF using X-ray imaging. One-way repeated measures ANOVA and post-hoc analyses with Bonferroni adjustment were employed to compare mean Cobb angles at different time points. Cohen's d effect sizes were calculated to assess the magnitude of changes. Sample size calculations were performed to ensure statistical power. Results: The mean segmental Cobb angle significantly increased from preoperative (32.2 ± 13.8 degrees) to post-ALIF (42.2 ± 14.3 degrees, Cohen's d: -0.71, p < 0.0001) and post-PSF (43.6 ± 14.6 degrees, Cohen's d: -0.80, p < 0.0001). There was no significant difference between Cobb angles after ALIF and after PSF (Cohen's d: -0.10, p = 0.14). The findings remained consistent when Cobb angles were analyzed separately for single-screw and double-screw ALIF constructs. Conclusions: Both supine ALIF and prone PSF significantly increased segmental lumbar lordosis compared to preoperative measurements. The negligible difference between post-ALIF and post-PSF lordosis suggests that supine ALIF followed by prone PSF can be an effective approach, providing flexibility in surgical positioning without compromising lordosis improvement.
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Affiliation(s)
- Sina Sadeghzadeh
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Kelly H. Yoo
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Ivan Lopez
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Thomas Johnstone
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Ethan Schonfeld
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Ghani Haider
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Neelan J. Marianayagam
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
| | - Martin N. Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Cantonal Hospital St. Gallen, Rorschacher Str. 95, CH-9007 St. Gallen, Switzerland;
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University, 453 Quarry Road, Stanford, CA 94305, USA; (S.S.); (I.L.); (T.J.); (E.S.); (G.H.); (N.J.M.)
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11
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Dhoon TQ, Tiwari A, Villaluz E, Morrison DE. Understanding the Physiological Connection: Cardiac Arrest Following Prone Positioning. Cureus 2024; 16:e63050. [PMID: 39050332 PMCID: PMC11268726 DOI: 10.7759/cureus.63050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Prone positioning of patients is a routine occurrence in procedural suites and operating rooms (ORs). However, the physiological changes that occur with prone positioning are frequently underappreciated by proceduralists, surgeons, and anesthesiologists. This may be related to a sense of the routine or a lack of familiarity with physiological changes that accompany the prone position. The prone position, while aiding visualization and cannulation of the ampulla of Vater during endoscopic retrograde cholangiopancreatography (ERCP), can induce physiological changes such as reduced preload, inferior vena cava filling, and cardiac output; it can also increase intrathoracic pressure and mediastinal compression. Anesthetic agents can further impact cardiopulmonary physiology, decreasing systemic vascular resistance and reducing cardiac contractility. In addition, the transition from negative to positive pressure ventilation following endotracheal intubation can increase pulmonary artery pressures and right ventricular (RV) strain. Therefore, caution is needed with patients who have RV dysfunction, pulmonary hypertension, or preload dependency, as they may not tolerate prone positioning. We describe a case in which a 73-year-old male patient scheduled for an ERCP suffered cardiac arrest after being transitioned to the prone position. The patient was repositioned in the supine position and resuscitated. The case was completed in the supine position.
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Affiliation(s)
- Taizoon Q Dhoon
- Anesthesiology, University of California, Irvine (UCI) Health, Orange, USA
| | - Anil Tiwari
- Anesthesiology and Perioperative Medicine, University of California, Irvine (UCI) Health, Orange, USA
| | - Evan Villaluz
- Anesthesiology and Perioperative Medicine, University of California, Irvine (UCI) Health, Orange, USA
| | - Debra E Morrison
- Anesthesiology and Perioperative Medicine, University of California, Irvine (UCI) Health, Orange, USA
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12
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Lippi G, Mattiuzzi C, Favaloro EJ. Prone Position and the Risk of Venous Thrombosis in COVID-19 Patients with Respiratory Failure. Semin Thromb Hemost 2024. [PMID: 38733979 DOI: 10.1055/s-0044-1786735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Camilla Mattiuzzi
- Provincial Agency for Social and Sanitary Services (APSS), Rovereto Hospital, Trento, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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13
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Koh JRD, Kon CKK, Chandrakumara SD. Endoscopic Calcaneoplasty With Bony Debridement and Radiofrequency. Arthrosc Tech 2024; 13:102912. [PMID: 38690328 PMCID: PMC11056730 DOI: 10.1016/j.eats.2024.102912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/05/2023] [Indexed: 05/02/2024] Open
Abstract
Haglund's deformity refers to the enlargement of the posterosuperior tuberosity of the calcaneus, which can cause debilitating posterior heel pain and swelling. Calcaneoplasty is indicated for the treatment of Haglund's deformity following a failure of conservative treatment. Endoscopic calcaneoplasty confers a few advantages over open surgery and has been growing in popularity as the preferred technique. This Technical Note presents an endoscopic calcaneoplasty technique with bone debridement followed by treatment with a Topaz radiofrequency device, with the patient in a supine position.
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14
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Priya V, Sen J, Ninave S. A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions. Cureus 2024; 16:e57247. [PMID: 38686225 PMCID: PMC11056907 DOI: 10.7759/cureus.57247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in implementation, psychosocial impacts, technological innovations, economic considerations, barriers to adoption, and implications for clinical practice. The physiological benefits of prone positioning, including improved oxygenation and lung compliance, are discussed alongside the challenges of patient selection and technical complexities. The psychosocial impact on patients and caregivers, as well as the economic implications for healthcare systems, adds a crucial dimension to the analysis. The review also delves into innovative technologies, such as advanced monitoring and automation, shaping the landscape of prone ventilation. Moreover, it addresses the barriers to widespread adoption and outlines strategies to overcome resistance, emphasizing the need for a comprehensive and collaborative approach. The implications for clinical practice underscore the importance of evidence-based guidelines, ongoing education, and a holistic patient-centered care approach. The conclusion highlights the call to action for further research to refine protocols and technology, ultimately optimizing the application of prone ventilation in critical care settings.
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Affiliation(s)
- Vishnu Priya
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jayashree Sen
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sanjot Ninave
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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15
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Ndege MR, Clanton A, Lacy T, Doan A. Effects of Anesthetic Choice on the Incidence of Transcranial-Motor Potential-Induced Oral Trauma. Neurodiagn J 2024; 64:11-23. [PMID: 38437032 DOI: 10.1080/21646821.2024.2319508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/12/2024] [Indexed: 03/06/2024]
Abstract
Transcranial motor-evoked potentials (TcMEPs) play an integral role in assessing motor tract function in surgical procedures where motor function is at risk. However, transcranial stimulation creates a risk for oral trauma. Several studies have reported on distinct factors that can influence the rate of TcMEP-induced oral trauma, but little is known about how an anesthetic regimen can influence this rate. In this retrospective review, we investigated the incidence of oral injury under total intravenous anesthesia (TIVA) and balanced anesthesia in 66,166 cases from 2019 to 2021. There were 295 oral injuries in our sample, yielding an incidence of 0.45%, which is in line with ranges reported in the literature. A total of 222 of the injured patients were sedated with balanced anesthesia, while the remaining 73 were under TIVA anesthetics. This difference in distribution was statistically significant (p < 0.0002). Our findings suggest TIVA is associated with lower risk of oral trauma when TcMEPs are monitored, thereby improving patient safety.
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Affiliation(s)
| | | | - Tammy Lacy
- NuVasive Clinical Services, Columbia, Maryland
| | - Adam Doan
- NuVasive Clinical Services, Columbia, Maryland
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16
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Carabini LM, Koski TR, Bebawy JF. Perioperative Management for Complex Spine Fusion Surgery. Anesthesiology 2024; 140:293-303. [PMID: 38048486 DOI: 10.1097/aln.0000000000004744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Complex spine surgeries performed worldwide continue to increase in number, as do the age and comorbidity of patients undergoing these operations. Perioperative care protocols related to blood management, postoperative pain control, and intraoperative measures to mitigate morbidity may improve clinical workflows and patient outcomes.
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Affiliation(s)
- Louanne M Carabini
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tyler R Koski
- Departments of Neurological Surgery and Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John F Bebawy
- Departments of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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17
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Hisatomi O, Fujiyoshi T, Shinotsuka S, Saiwai H, Higashi M, Yamaura K. Delayed Emergence from Total Intravenous Anesthesia Following Posterior Spinal Correction and Fusion for Scoliosis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e941563. [PMID: 38192096 PMCID: PMC10788232 DOI: 10.12659/ajcr.941563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/07/2023] [Accepted: 11/09/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Postoperative acute liver failure, a complication following spine surgery, can cause delayed emergence from total intravenous anesthesia. Here, we report a case of acute severe postoperative liver failure following posterior spinal correction and fusion in a patient with congenital scoliosis. CASE REPORT A girl's congenital scoliosis worsened, and posterior spinal correction and fusion was scheduled. General anesthesia was induced with sevoflurane, fentanyl, target-controlled-infusion with propofol, and rocuronium. General anesthesia was maintained using target-controlled-infusion with propofol and remifentanil. The operation was completed with no remarkable complications. The operative time was 516 min and the anesthesia time was 641 min in the prone position. Emergence from anesthesia was poor, and it took 68 min to remove the tracheal tube after discontinuation of the anesthetic agents. The patient was drowsy and was transferred to her room in a general ward without reporting any pain, nausea, or dyspnea. On postoperative day 1, the results of laboratory investigations were suggestive of acute liver failure; contrast-enhanced computed tomography revealed a poorly enhanced area in the umbilical portion of the left liver lobe portal vein, indicating ischemic liver damage. Although no additional treatment was administered for acute liver failure, the patient recovered over time, and laboratory values normalized. No other postoperative complications were observed, and the patient was discharged on postoperative day 1. CONCLUSIONS Delayed emergence from general anesthesia may be due to acute liver failure following posterior spinal correction and fusion. There are several possible causes of postoperative liver failure, including anesthetics, prone position, and spinal surgery.
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Affiliation(s)
- Osamu Hisatomi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | | | - Sho Shinotsuka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hirokazu Saiwai
- Department of Orthopaedic Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
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18
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Hsiao KY, Wong TY, Zhao DH, Chen KC, Huang JS, Chen MY. Enhancing surgical outcomes of posterior iliac bone harvesting through a pivotal modification. J Dent Sci 2024; 19:648-651. [PMID: 38303838 PMCID: PMC10829661 DOI: 10.1016/j.jds.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/27/2023] [Indexed: 02/03/2024] Open
Abstract
Traditionally, patients are positioned in the prone position to access the donor site during the posterior iliac bone graft harvesting procedure. However, this well-established method is associated with complications such as pressure injuries, displacement of the endotracheal tube and intravenous catheter, and blindness. Moreover, the process of turning patients 180° between the supine and prone positions is both laborious and time consuming. However, no updates have been made in the approaches published in the literature to counteract these problems. Therefore, to overcome these challenges and improve patient outcomes, we proposed a pivotal modification: change prone position to the lateral decubitus position. This approach allowed us to effectively avoid the aforementioned complications. In addition, this modification offered significant advantages, including ease of implementation and timesaving benefits. The article presented results of the modification and a comprehensive evaluation of clinical and anesthetic considerations comparing the two methods.
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Affiliation(s)
- Kai-Yuan Hsiao
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tung-Yiu Wong
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Dentistry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - De-Hui Zhao
- Department of Anesthesia, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ken-Chung Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Dentistry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jehn-Shyun Huang
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Dentistry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Yen Chen
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Dentistry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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19
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Chumnanvej S, Lekcharoensombat N. Comparison of standard and modified prone positioning for lateral lumbar spine fusion: a feasibility study to reduce lumbar plexus injury. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:463-471. [PMID: 38196723 PMCID: PMC10772666 DOI: 10.21037/jss-23-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
Single-prone-lateral (PL) positioning is a new technique that allows for simultaneous anterior and posterior lumbar spine surgery. However, there is a concern regarding the risk of lumbar plexus injury in PL positioning. This study compared the risk of lumbar plexus damage and the overall safety profile of a modified PL (mPL) position to the standard PL (sPL) position for lateral lumbar spine fusion surgery. A crossover soft cadaveric study was conducted with two raters examining the comparative outcomes of position A: sPL and position B: mPL. The mPL position differs from the sPL position in that the ipsilateral arm is placed at the side of the body rather than above the head. To assess positive results (no lumbar plexus injury) between positions A and B, a mixed effects logistic regression model was utilized. The odds ratio of a good result between positions B and A was also determined. The odds ratio of the favorable outcome between position B and A was 1.77, indicating significantly higher odds of a favorable outcome in the modified position B than in the control or position A. The mPL positioning outperformed the sPL positioning in terms of safety and efficacy for lateral lumbar spine fusion. The mPL positioning may reduce the risk of lumbar plexus injury by allowing for a more direct approach to the lumbar spine and by avoiding excessive stretching of the lumbar plexus.
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Affiliation(s)
| | - Nopporn Lekcharoensombat
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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20
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Yankov D, Bussarsky A, Karakostov V, Sirakov A, Ferdinandov D. Evaluation of multidetector CT Hounsfield unit measurements as a predictor of efficacy and complications in percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Front Med (Lausanne) 2023; 10:1333679. [PMID: 38098844 PMCID: PMC10720980 DOI: 10.3389/fmed.2023.1333679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction More than 30 years after the initial experience of Galibert and Deramond with percutaneous vertebroplasty, the procedure has gone through countless refinements and clinical evaluations. Predictors for the success and failure of the procedure in the literature vary and are focused on the duration of complaints, type of fracture, presence of edema on MRI scans, etc. We propose using a quantitative method based on a standard CT examination of the thoracic or lumbar spine to assess the risks and potential success of performing vertebroplasty. Materials and methods This is a single-center prospective observational study on 139 patients treated with percutaneous vertebroplasty (pVPL) for a single symptomatic osteoporotic vertebral compression fracture (OVCF). We measured the levels of disability and pain preoperatively and again at the 3-, 6- and 12-month marks using the standardized VAS and ODI questionnaires. Every patient in the study was evaluated with postoperative multidetector CT (MDCT) to determine the presence, extent, and localization of vertebral cement leakage and to measure the adjacent vertebrae's minimal and mean density in Hounsfield units (HUmin and HUmean, respectively). Results We determined that a slight (r = -0.201) but statistically significant (p = 0.018) correlation existed between HU measurements taken from radiologically intact adjacent vertebrae and the procedure's effect concerning the pain levels at the 3-month follow-up. This correlation failed to reach statistical significance at 12 months (p = 0.072). We found no statistically significant relationship between low vertebral cancellous bone density and cement leakage on postoperative scans (p = 0.6 for HUmin and p = 0.74 for HUmean). Conclusion We have moderately strong data that show a negative correlation between the mean values of vertebral cancellous bone density in patients with OVCF and the effect of pVPL in reducing pain. Lower bone densities, measured this way, showed no increased risk of cement leakage.
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Affiliation(s)
- Dimo Yankov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Assen Bussarsky
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Vasil Karakostov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Alexander Sirakov
- Department of Radiology, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Dilyan Ferdinandov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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21
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Ohba T, Oda K, Tanaka N, Haro H. The Utility and Appropriateness of Single-Position Circumferential Lumbar Interbody Fusion Using O-Arm-Based Navigation in the Novel Oblique Position. J Clin Med 2023; 12:7114. [PMID: 38002728 PMCID: PMC10672567 DOI: 10.3390/jcm12227114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Single-position surgery with patients in a lateral position, which involves inserting percutaneous pedicular screws (PPS) and lateral interbody fusion (LIF) to avoid changing the position, has been reported. The purpose of the present study was to evaluate the utility and appropriateness of single-position LIF-PPS using O-arm-based navigation in the innovative oblique position. METHODS This study involved a retrospective analysis of 92 consecutive patients with lumbar spondylolisthesis who underwent LIF-PPS using O-arm-based navigation. Thirty-five subjects demonstrated surgery with repositioning, as well as 24 in the lateral decubitus position, and 33 in the oblique during PPS, where the position was changed to the lateral decubitus position using bed rotation without resetting. We compared these three groups in terms of the surgery time, blood loss, and the accuracy of the screw placement. RESULTS The operative time was significantly shorter in the single-position surgery, both in the lateral and oblique positions, compared to surgery in a dual position. The blood loss was significantly increased in the lateral position compared to the dual and oblique positions. The screw trajectory angle on the downside was significantly smaller in the lateral position, and the accuracy of the screw placement on the downside was significantly lower in the lateral position compared to the dual and oblique positions. CONCLUSION Single-position surgery could reduce the average surgery time by about 60 min. The present study indicated the oblique position during PPS insertion might make single-position surgery more useful to improve the accuracy of PPS on the downside, with less blood loss.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan; (K.O.); (N.T.); (H.H.)
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22
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Ko E, Kwak JS, Park H, Lim CH. Limited effect of sugammadex on postoperative pulmonary complications in patients undergoing spine surgery in prone position intraoperatively: A retrospective analysis of matched cohort data. Medicine (Baltimore) 2023; 102:e35858. [PMID: 37933001 PMCID: PMC10627630 DOI: 10.1097/md.0000000000035858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
Postoperative pulmonary complications (PPCs) increase postoperative mortality, hospital stays, and healthcare costs. Whether the use of sugammadex could reduce PPCs remains controversial. This study aimed to determine if sugammadex could more effectively reduce PPCs than acetylcholinesterase inhibitor (AChEi) in patients who had undergone spine surgery, in prone position intraoperatively. From March 2019 to February 2021, adult patients who underwent elective spine surgery were eligible. Primary outcomes were PPCs (including atelectasis on chest radiograph, pneumonia, acute respiratory distress syndrome, and aspiration pneumonitis) and respiratory failure that occurred within 28 days after surgery. Secondary outcomes were length of hospital stay, in-hospital death, and readmission rate within 30 days. Patients were divided into 2 groups (Sugammadex group and AChEi group) and compared by 1:1 propensity score matching. Of a total of 823 patients who underwent spinal surgery, 627 were included. After 1:1 propensity matching, 142 patients were extracted for each group. PPCs occurred in 9 (6.3%) patients in both groups (P = 1.000). Respiratory failure occurred in 7 (4.9%) patients in the Sugammadex group and 5 (3.5%) patients in the AChEi group (P = .77). There was no significant difference in secondary outcomes between the 2 groups. Although there have been some evidences showing that the use of sugammadex can attenuate the development of PPCs, this study did not show positive effects of sugammadex on patients who underwent spine surgery in the prone position.
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Affiliation(s)
- Eunji Ko
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Ji Soo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Heechan Park
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, South Korea
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23
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Hammon DE, Chidambaran V, Templeton TW, Pestieau SR. Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery. Paediatr Anaesth 2023; 33:894-904. [PMID: 37528658 DOI: 10.1111/pan.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
Anesthesia for posterior spinal fusion for adolescent idiopathic scoliosis remains one of the most common surgeries performed in adolescents. These procedures have the potential for significant intraprocedural and postoperative complications. The potential for pressure injuries related to prone positioning must be understood and addressed. Additionally, neuromonitoring remains a mainstay for patient care in order to adequately assess patient neurologic integrity and alert the providers to a reversible action. As such, causes of neuromonitoring signal loss must be well understood, and the provider should have a systematic approach to signal loss. Further, anesthetic design must facilitate intraoperative wake-up to allow for a definitive assessment of neurologic function. Perioperative bleeding risk is high in posterior spinal fusion due to the extensive surgical exposure and potentially lengthy operative time, so the provider should undertake strategies to reduce blood loss and avoid coagulopathy. Pain management for adolescents undergoing spinal fusion is also challenging, and inadequate analgesia can delay recovery, impede patient/family satisfaction, increase the risk of chronic postsurgical pain/disability, and lead to prolonged opioid use. Many of the significant complications associated with this procedure, however, can be avoided with intentional and evidence-based approaches covered in this review.
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Affiliation(s)
- Dudley E Hammon
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vidya Chidambaran
- Department of Anesthesiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Thomas W Templeton
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sophie R Pestieau
- Department of Anesthesiology, Washington National, Washington, DC, USA
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24
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Martins Lima P, Pinto SG, Dias J. The Challenges of Spinal Surgery Requiring Ventral Decubitus in the Critical Trauma Patient on Extracorporeal Membrane Oxygenation: A Case Report. Cureus 2023; 15:e45904. [PMID: 37885529 PMCID: PMC10599098 DOI: 10.7759/cureus.45904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) provides a bypass of the lungs, ensuring blood oxygenation and carbon dioxide removal in cases of respiratory failure. The nature of the device itself creates many perioperative challenges, including fluid management and the management of anticoagulation. Surgery via the posterior approach for an unstable spinal fracture requiring the ventral decubitus position comes with its own set of difficulties, among which are the need for stability and craniocaudal alignment when rotating the patient, the risk of increased abdominal pressure, and the damage to vulnerable soft tissues like the eyes, nose, and others. The combination of these two situations creates a synergistic effect, which adds to the difficulty of the management of the situation and requires a personalized, multidisciplinary approach. We present a case of a critical trauma patient who was on venovenous ECMO as a consequence of refractory respiratory hypoxemia with an unstable mid-thoracic spinal fracture requiring surgical intervention via the posterior approach (demanding intra-operative ventral decubitus).
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Affiliation(s)
| | - Sérgio G Pinto
- Anesthesiology, Centro Hospitalar Universitário São João, Porto, PRT
| | - José Dias
- Anesthesiology, Centro Hospitalar Universitário São João, Porto, PRT
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Aljohani AK, Khalid Bin Yunus M, Fallatah AA, Kheder OM, Almolki KS, Alawad H, Talal Halawani R, Abdelaziz AA, Sherif A. Inferior Mesenteric Artery Injury in Post-lumbar Microdiscectomy: A Case Report. Cureus 2023; 15:e42998. [PMID: 37671208 PMCID: PMC10476926 DOI: 10.7759/cureus.42998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Iatrogenic vascular injury during lumbar microdiscectomy is a rather rare complication, but it can have fatal consequences. Here, we report a patient who underwent an L5-S1 microdiscectomy, which was complicated by inferior mesenteric artery injury. The patient presented in the recovery room with symptoms of hypotension and tachycardia after the operation which was successfully managed by endovascular embolization. The patient was positioned in a prone position, which may have contributed to the development of vascular injury. To prevent potential complications, we advised using the Jackson table rather than a standard surgical table and thoroughly inspecting the abdomen and pelvis prior to the operation.
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Affiliation(s)
| | | | | | | | | | - Hani Alawad
- Neurosurgery, King Fahad Hospital, Medina, SAU
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Turlip R, Ahmad HS, Ghenbot YG, Wathen C, Chauhan D, McCloskey K, Yoon JW. Characterizing and Improving Nomenclature for Reporting Lumbar Interbody Fusion Techniques. World Neurosurg 2023; 175:e134-e140. [PMID: 36921714 DOI: 10.1016/j.wneu.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. This study systematically analyzes LIF nomenclature in contemporary literature and proposes a standardized classification system for reporting LIF terminology. METHODS A search query was conducted through the PubMed database using "lumbar fusion OR lumbar interbody fusion." A total of 1455 articles were identified, and 605 references to LIF were recorded. Following a systematic review of the terminology, we developed a LIF reporting guidelines that capture the existing LIF nomenclature while avoiding redundant or ambiguous terminology. RESULTS The most referenced anatomical approaches were transforaminal (43.0%), followed by posterior (25.0%), lateral (19.7%), and anterior (10.9%). Overall, there were 72 unique ways to describe LIF. Unique prefixes were recorded by approach (posterior: 26; lateral: 13; anterior: 3). Forty unique prefixes/suffixes overlapped in their usage. "MI" (14.4%), "MIS" (38.1%), and "MISS" (0.6%) all referenced a minimally invasive approach. "O" (12.5%), "CO" (1.3%), and "TO" (1.3%) all described open techniques. "Endo" (0.6%), "Endoscopic-assisted" (1.3%), and "PE" (1.9%) all referenced endoscopic-assisted procedures. CONCLUSIONS The current LIF nomenclature contains many unique LIF terms that were found to be inconsistently defined, redundant, or ambiguous. We propose the standardization of a 4-part naming system which highlights the crucial parts of LIF: (1) intraoperative repositioning, (2) patient position, (3) anatomical approach, and (4) orientation of the surgical corridor to the psoas muscles.
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Affiliation(s)
- Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yohannes G Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Kandasamy P, Pujari VS, Channaiah SRD. Effect of spine frame on the changes in respiratory dynamics in prone patients under general anaesthesia- a prospective, observational study. Indian J Anaesth 2023; 67:609-613. [PMID: 37601933 PMCID: PMC10436715 DOI: 10.4103/ija.ija_108_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/08/2023] [Accepted: 04/08/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aims The prone position is one of the common surgical positions used in clinical practice. Manoeuvring patients from supine to a prone position can impact respiratory dynamics and result in haemodynamic variations. Methods This study included 64 patients and was conducted after obtaining approval from the ethics committee and registration of the trial. The primary objective was to evaluate the changes in peak inspiratory pressure (PIP), plateau pressure (Pplat) and mean airway pressure (MAP) in patients undergoing surgery under general anaesthesia in the prone position with (Group S) and without (Group P) spine frame. The secondary objective was to evaluate and compare the variations in heart rate and blood pressure. Results On turning the patient prone, there was statistically significant increase in median PIP (Group S 4 cmH2O vs. Group P 0.5 cmH2O, P < 0.001), Pplat (Group S 3.5 cmH2O vs. Group P 1 cmH2O, P = 0.004) and dynamic compliance (Group S -5.513 vs. Group P -2.78, P < 0.004). Conclusions Our study found that prone positioning with a spine frame led to a significantly greater increase in airway pressures and a decrease in dynamic compliance when compared to patients positioned prone without the spine frame.
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Affiliation(s)
- Preeti Kandasamy
- Department of Anaesthesiology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Vinayak S. Pujari
- Department of Anaesthesiology, Manipal Hospitals, Bengaluru, Karnataka, India
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Doan H, Holy T, Richter DL, Campos T, Held M, Del Castillo J, Schenck RC. Supine Lobenhoffer Approach Optimizes PCL Reconstruction with Tibial Inlay in Knee Dislocations: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00068. [PMID: 37616422 DOI: 10.2106/jbjs.cc.23.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
CASE A 47-year-old man suffered a knee dislocation while skiing with associated damage to the anterior cruciate, posterior cruciate, medial collateral, and medial patellofemoral ligaments. The patient underwent a multiple-ligament knee reconstruction using the supine Lobenhoffer approach, which resulted in remarkable outcomes that persisted throughout the 56-month follow-up period. CONCLUSION The utilization of this approach can prevent inappropriate graft tension and iatrogenic damage, reduce surgical time, and minimize airway complications by eliminating the need for the prone position. Optimizing these factors enhances the patient's chances for long-term outcomes; thus, surgeons should consider this approach in managing multiple-ligament knee injuries.
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Affiliation(s)
- Hoi Doan
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Tomas Holy
- Department of Orthopaedics, University of New Mexico School of Medicine, MSC 10 5600, Albuquerque, NM
| | - Dustin L Richter
- Department of Orthopaedics, University of New Mexico School of Medicine, MSC 10 5600, Albuquerque, NM
| | - Tulio Campos
- Departamento de Aparelho Locomotor Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Michael Held
- Department of Orthopaedics,University of Cape Town
| | - Juan Del Castillo
- Clínica de Traumatología y Ortopedia, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Robert C Schenck
- Department of Orthopaedics, University of New Mexico School of Medicine, MSC 10 5600, Albuquerque, NM
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Dhas MM, Gayathri B, Kuppusamy A, Mani K, Pattu H. Assessment of haemodynamic response to tracheal intubation and prone positioning following clonidine and enalaprilat in lumbar spine surgeries: A double blind randomised controlled trial. Indian J Anaesth 2023; 67:633-637. [PMID: 37601931 PMCID: PMC10436731 DOI: 10.4103/ija.ija_731_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aim This study evaluates the effectiveness of long-acting antihypertensive drugs (clonidine and enalaprilat) in blunting the intubation response. Also, the study seeks to determine how effectively clonidine and enalaprilat can maintain stable haemodynamics during a change in position. Methods After ethical committee approval and trial registration, a double-blinded, randomised controlled trial was conducted with 71 consenting patients scheduled for elective spine surgery in a prone position under general anaesthesia. Group C received clonidine 2 μg/kg, and Group E received enalaprilat 1.25 mg diluted in normal saline as an intravenous infusion given over 10 min before induction of anaesthesia. The changes in heart rate (HR) and blood pressure (BP) in response to the infusion of the study drugs, induction, tracheal intubation and change in position were recorded. P value <0.05 was considered significant. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Results Clonidine infusion caused a significant fall in heart rate post-infusion and post-induction with propofol (p value <0.05). Both clonidine and enalaprilat caused a significant fall in mean arterial pressure (MAP) post-infusion and post-induction (p value <0.05). Clonidine effectively blunted the intubation response with no increase in HR and MAP following intubation. Enalaprilat caused a significant rise in HR in response to intubation. On proning, there was a significant fall in MAP in both groups. Conclusion Clonidine is effective in blunting the intubation response. Preoperative infusion of clonidine and enalaprilat causes hypotension during a change of position.
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Affiliation(s)
- Meshach M. Dhas
- Department of Anaesthesiology, SRM MCH RC, Chengalpattu, Tamil Nadu, India
| | | | - Anand Kuppusamy
- Department of Anaesthesiology, SRM MCH RC, Chengalpattu, Tamil Nadu, India
| | - Karthik Mani
- Department of Anaesthesiology, SRM MCH RC, Chengalpattu, Tamil Nadu, India
| | - Harish Pattu
- Department of Anaesthesiology, SRM MCH RC, Chengalpattu, Tamil Nadu, India
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Vrettos T, Martinez BB, Tsaturyan A, Liourdi D, Al-Aown A, Lattarulo M, Liatsikos E, Kallidonis P. Effect of patient positioning on anesthesiologic risk in endourological procedures. Urol Ann 2023; 15:261-265. [PMID: 37664107 PMCID: PMC10471805 DOI: 10.4103/ua.ua_113_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/08/2022] [Indexed: 09/05/2023] Open
Abstract
Objective The objective is to compare supine and prone positions in terms of arterial blood gas during lithotripsy endourology procedures in different stages. Material and Methods Cases of during lithotripsy endourology procedures in our department from March to September 2020 were included prospectively. The variables registered were body mass index, age, the American Society of Anesthesiologists (ASA) score, diabetes mellitus, positive end-expiratory pressure (PEEP), FiO2, stone size, stone location, procedural type, position, procedure duration, PaO2, SaO2, PaCO2, pH, and dynamic compliance. PaO2, SaO2, PaCO2, pH, and dynamic compliance were recorded at the beginning of the procedure, 5 min later, 15 min later, and at the end of the procedure. Results Thirty patients in prone position and 30 in lithotomy position were included in this study. Patients in prone position underwent percutaneous nephrolithotomy, and patients in supine/lithotomy underwent retrograde intrarenal surgery or ureteroscopy. Statistically significant differences were found in PEEP, duration, PaO2 at the beginning, SaO2 at the beginning and at the end of the procedure, PaCO2 at the beginning and at minute 5 and pH at the beginning of the surgery. The saturation PaO2 increased significantly on prone position and was statistically significantly better at the end of the surgery. Conclusions Both prone and supine positions were safe regarding anesthesiologic risk and had no clinically relevant differences in terms of individual comparisons in arterial blood gas parameters in static moments of the procedure. Prone position was related to an increase in PaO2 and a drop in PaCO2 gradually from the beginning to the end of the surgery.
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Affiliation(s)
- Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | | | - Despoina Liourdi
- Department of Internal Medicine, General Hospital of Patras Ag. Andreas, Patras, Greece
| | - Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Medical University of Vienna, Austria
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Yucepur S, Kepekci AB, Erbin A, Ozenc E. Effects of lithotomy and prone positions on hemodynamic parameters, respiratory mechanics, and arterial oxygenation in percutaneous nephrolithotomy performed under general anesthesia. Folia Med (Plovdiv) 2023; 65:427-433. [PMID: 38351819 DOI: 10.3897/folmed.65.e81068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/10/2022] [Indexed: 02/16/2024] Open
Abstract
AIM The position of the body during surgery may affect the patient's body functions, especially the hemodynamic parameters. We aimed to comparatively analyze the effects of lithotomy and prone position on respiratory mechanics, arterial oxygenation, and hemodynamic parameters in patients who underwent percutaneous nephrolithotomy (PNL).
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Affiliation(s)
- Serkan Yucepur
- Bilecik Training and Research Hospital, Bilecik, Turkiye
| | | | - Akif Erbin
- Haseki Training and Research Hospital, Istanbul, Turkiye
| | - Ecder Ozenc
- Haseki Training and Research Hospital, Istanbul, Turkiye
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McCloskey K, Singh S, Ahmad HS, Turlip R, Ghenbot Y, Yoon JW. Standardizing Lumbar Interbody Fusion Nomenclature. Clin Spine Surg 2023; 36:217-219. [PMID: 36728215 DOI: 10.1097/bsd.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This article is a research methodology study. OBJECTIVE We summarize current ambiguities and inaccuracies regarding lumbar interbody fusion nomenclature and propose a standardized reporting method to improve the clarity of future research and communication among spine surgeons and researchers. SUMMARY OF BACKGROUND DATA Lumbar interbody fusion techniques have seen an impressive degree of refinement over recent years. This innovation has ushered in a plethora of naming conventions for these new surgical approaches. Many of the current trends in naming lumbar fusion techniques are, however, redundant and contradictory, creating unnecessary confusion in the field. METHODS Following an extensive literature review, we developed a 4-part naming convention that highlights the crucial features of lumbar fusion surgical procedures. RESULTS Current literature regarding lumbar fusions is rife with inconsistent usage and privatization of terminology that can inadvertently result in ambiguous operative vocabulary, potentially compromising the accuracy of future research. We propose a 4-part naming system that highlights crucial features of lumbar interbody fusions, including (1) intra-operative repositioning, (2) patient position, (3) surgical technique, and (4) orientation of the surgical corridor to the psoas muscle. CONCLUSIONS This study raises awareness of current inconsistencies in naming conventions and proposes a standardized system for improving the clarity of lumber interbody fusion terminology for the broader spine community. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine
| | - Shikha Singh
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Hudec J, Prokopová T, Kosinová M, Gál R. Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review. J Clin Med 2023; 12:jcm12113651. [PMID: 37297846 DOI: 10.3390/jcm12113651] [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: 05/05/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Scoliosis is the most frequent spinal deformity in children. It is defined as a spine deviation of more than 10° in the frontal plane. Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic scoliosis. However, patients and their relatives report improved quality of life after the surgery. The challenges for the anesthetic team result from the specifics of the anesthesia, the scoliosis surgery itself, or factors associated with neuromuscular disorders. This article includes details of preanesthetic evaluation, intraoperative management, and postoperative care in the intensive care unit from an anesthetic view. In summary, adequate care for patients who have neuromuscular scoliosis requires interdisciplinary cooperation. This comprehensive review covers information about the perioperative management of neuromuscular scoliosis for all healthcare providers who take care of these patients during the perioperative period, with an emphasis on anesthesia management.
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Affiliation(s)
- Jan Hudec
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Tereza Prokopová
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Martina Kosinová
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Roman Gál
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University, University Hospital Brno, 601 77 Brno, Czech Republic
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Henao Romero S, Berbeo M, Diaz R, Villamizar Torres D. Minimally invasive lateral single-position surgery for multilevel degenerative lumbar spine disease: feasibility and perioperative results in a single Latin-American spine center. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1688-1694. [PMID: 36961569 DOI: 10.1007/s00586-023-07591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Within advances in minimally invasive spine surgery, the implementation of lateral single position (LSP) increases efficiency while limiting complications, avoiding intraoperative repositioning and diminishing surgical time. Most literature describes one-level instrumentation of the lumbar spine; this study includes the use of LSP for multilevel degenerative disease. OBJECTIVE The objective of the article is to analyze initial clinical results and complications in the use of LSP for multiple level instrumentation in adults with lumbar degenerative disease. METHODS A retrospective early clinical series was performed for patients who had multiple level instrumentation in LSP between August 2019 and September 2022 at the Hospital Universitario San Ignacio in Bogota, Colombia. Inclusion criteria were patients older than 18 years with symptomatic lumbar degenerative disease, undergoing any combination of multilevel anterior lumbar interbody fusion, lateral lumbar interbody fusion (LLIF) and pedicle screw fixation. RESULTS Forty patients with an average age of 61.3 years were included, with diagnosis of multilevel degenerative spondylotic changes. Four-, three- and two-level interventions were performed in 52.5, 35 and 12.5%, respectively. Average time per level was 68.9 min, and length of hospital stay had an average of 2.4 days, with all patients starting ambulation within the first postoperative day. CONCLUSION Procedural time and blood loss were similar to those reported in literature. No severe lesions, postoperative infections or reinterventions took place. Although it was a small number of patients and further clinical trials are needed, LSP for multiple levels is apparently safe with adequate outcomes which may improve efficiency in the operating room.
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Affiliation(s)
- Sara Henao Romero
- Department of Neurosurgery, Hospital Universitario San Ignacio, Ak. 7 # 40 - 62, Bogota, Colombia.
| | - Miguel Berbeo
- Department of Neurosurgery, Hospital Universitario San Ignacio, Ak. 7 # 40 - 62, Bogota, Colombia
| | - Roberto Diaz
- Department of Neurosurgery, Hospital Universitario San Ignacio, Ak. 7 # 40 - 62, Bogota, Colombia
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Al Ghamdi A, Parramón MM, Cavallé-Garrido T. Unexplained Cardiovascular Collapse After Scoliosis Surgery in a Patient With Loeys-Dietz Syndrome. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:82-85. [PMID: 37970529 PMCID: PMC10642104 DOI: 10.1016/j.cjcpc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/18/2022] [Indexed: 11/17/2023]
Affiliation(s)
- Abdulrahman Al Ghamdi
- Division of General Pediatrics, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Marina Mir Parramón
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Tíscar Cavallé-Garrido
- Division of Cardiology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
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Metikala S, Anibas JJ, Price R, Cheppalli N. A Novel Positioning Technique for Olecranon Fracture Fixation. Cureus 2023; 15:e38338. [PMID: 37266056 PMCID: PMC10230847 DOI: 10.7759/cureus.38338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/03/2023] Open
Abstract
Various positioning techniques have been described for the osteosynthesis of olecranon fractures, each with their own pros and cons. The supine position is time-efficient and better suited in a polytrauma setting but frequently requires an assistant to maintain optimal limb positioning. Also, adequate fluoroscopic imaging is not possible without moving the operative extremity outside the sterile field. We describe a simple and reproducible method addressing these limitations while providing excellent surgical access and intraoperative imaging.
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Affiliation(s)
| | - Jakob J Anibas
- Biological Sciences, University of Minnesota Twin Cities, Minneapolis, USA
| | - Ryan Price
- Orthopaedic Surgery and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, USA
| | - Naga Cheppalli
- Orthopaedics, Veterans Affairs (VA) Hospital Albuquerque, Albuquerque, USA
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Singha D, Kattimani MM, Kanwar M, Bhandari S, Singh J. Evaluation of changes in Mallampati class in patients undergoing lumbar spine surgeries in the prone position: A prospective observational study. Saudi J Anaesth 2023; 17:163-167. [PMID: 37260643 PMCID: PMC10228842 DOI: 10.4103/sja.sja_438_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/28/2022] [Indexed: 03/11/2023] Open
Abstract
Background Positioning of patients during surgery, whether prone or head down, can lead to airway edema which, in turn, may lead to a difficult airway, and enhanced chances for reintubation. We aimed to assess and evaluate modified Mallampati class (MMC) change in patients scheduled for lumbar spine surgery in the prone position. Materials and Methods This prospective observational study included 80 patients scheduled for lumbar spine surgery. The MMC was assessed up to 48 h postoperatively. The time taken by the patients in the postoperative period for MMC class to revert to preoperative value and airway complications, if any, was noted. Other parameters observed were surgical duration, intraoperative fluids used, and blood loss to look for any significant correlation with changes in MMC. Results MMC increase by one grade was observed in 73 patients (91%). MMC in 54 patients (74%) returned to baseline within 18 h, in 12 patients (16%) it took 24 h, and in the remaining 7 patients (10%) the time taken was 36 h. Conclusion It was concluded and established by this study that the MMC declined by one grade and reverted to baseline value within 36 h. This change in MMC necessitates extra caution to be adopted during the postoperative period as surgery in a prone position may predispose to an increased risk of encountering difficult reintubation. The change in MMC was not significantly correlated to intraoperative variables like duration of surgery, amount of intraoperative fluid given, and blood loss.
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Affiliation(s)
- Dheeraj Singha
- Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
| | | | - Manjeet Kanwar
- Department of Anaesthesia, Dr. RKGMC, Hamirpur, Himachal Pradesh, India
| | - Shyam Bhandari
- Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
| | - Jai Singh
- Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India
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Oh SK, Lim BG, Kim H, Lee JH, Lee JE. Performance of a new auxiliary device based on wrist brace to improve accuracy and feasibility in neuromuscular monitoring with acceleromyography in prone-positioned patients undergoing lumbar spine surgery: a prospective randomized clinical trial. J Clin Monit Comput 2023:10.1007/s10877-023-01000-w. [PMID: 37004664 DOI: 10.1007/s10877-023-01000-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
Accuracy of acceleromyography (AMG) is not be comparable to that of mechanomyography or electromyography (EMG). In particular, the prone position may reduce the accuracy and feasibility of AMG. We developed a new device based on wrist brace to allow free thumb movement and fix the other parts of the hand and wrist. We aimed to test whether the brace applied to the AMG would increase precision of AMG and agreement with the EMG in the prone position. Fifty-seven patients, undergoing lumbar surgery under general anesthesia, were randomly assigned to groups to which AMG was applied with or without (no) brace (29 in group B vs. 28 in group NB). EMG was performed in the contralateral arm. Repeatability coefficients of the first twitch height (T1) and train-of-four (TOF) ratio were assessed from nine consecutive measurements during spontaneous recovery from rocuronium-induced neuromuscular block and the AMGs of the two groups were compared in prone position. The agreement between AMG and EMG in each group was assessed using the Bland-Altman method. In group B, the repeatability coefficient of T1 was significantly lower during the recovery to T1 of 25% and TOF ratio of 0.9 (P = 0.017 and 0.033, respectively), indicating higher precision. The mean differences of bias (95% limits of agreement) between AMG and EMG in TOF ratio of 0.9 were 6.839 (- 26.54 to 40.22) in group NB and 3.922 (- 21.83 to 29.67) in group B. The wide limits of agreement in group NB was slightly narrowed in group B but without significance. Trial registration: registered on the UMIN Clinical Trials Registry in August 2020 (UMIN000041310).
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Affiliation(s)
- Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hak Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Eun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Schwendner M, Liang R, Butenschön VM, Meyer B, Ille S, Krieg SM. The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position. Front Surg 2023; 10:1152316. [PMID: 37009623 PMCID: PMC10060549 DOI: 10.3389/fsurg.2023.1152316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveTreatment strategies of patients suffering from pyogenic spondylodiscitis are a controverse topic. Percutaneous dorsal instrumentation followed by surgical debridement and fusion of the infectious vertebral disc spaces is a common approach for surgical treatment. Technical advances enable spinal navigation for dorsal and lateral instrumentation. This report investigates combined navigated dorsal and lateral instrumentation in a single surgery and positioning for lumbar spondylodiscitis in a pilot series.MethodsPatients diagnosed with 1- or 2-level discitis were prospectively enrolled. To enable posterior navigated pedicle screw placement and lateral interbody fusion (LLIF) patients were positioned semi-prone in 45-degree fashion. For spinal referencing, a registration array was attached to the pelvic or spinal process. 3D scans were acquired intraoperatively for registration and implant control.Results27 patients suffering from 1- or 2-level spondylodiscitis with a median ASA of 3 (1–4) and a mean BMI of 27.9 ± 4.9 kg/m2 were included. Mean duration of surgery was 146 ± 49 min. Mean blood loss was 367 ± 307 ml. A median of 4 (4–8) pedicle screws were placed for dorsal percutaneous instrumentation with an intraoperative revision rate of 4.0%. LLIF was performed on 31 levels with an intraoperative cage revision rate of 9.7%.ConclusionsNavigated lumbar dorsal and lateral instrumentation in a single operation and positioning is feasible and safe. It enables rapid 360-degree instrumentation in these critically ill patients and potentially reduces overall intraoperative radiation exposure for patient and staff. Compared to purely dorsal approaches it allows for optimal discectomy and fusion while overall incisions and wound size are minimized. Compared to prone LLIF procedures, semi-prone in 45-degree positioning allows for a steep learning curve due to minor changes of familiar anatomy.
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Affiliation(s)
- Maximilian Schwendner
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Raimunde Liang
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Vicki M. Butenschön
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Correspondence: Sandro M. Krieg
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Arabzadeh Bahri R, Maleki S, Shafiee A, Shobeiri P. Ultrasound versus fluoroscopy as imaging guidance for percutaneous nephrolithotomy: A systematic review and meta-analysis. PLoS One 2023; 18:e0276708. [PMID: 36862676 PMCID: PMC9980746 DOI: 10.1371/journal.pone.0276708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES To determine whether the outcomes of ultrasound-guided percutaneous nephrolithotomy (UG-PCNL), an alternative to traditional fluoroscopy-guided percutaneous nephrolithotomy (FG-PCNL), are comparable. METHODS A systematic search of PubMed, Embase, and the Cochrane Library was carried out to discover investigations comparing UG-PCNL to FG-PCNL, and accordingly, a meta-analysis of those studies was performed. The primary outcomes included the stone-free rate (SFR), overall complications based on Clavien-Dindo classification, duration of surgery, duration of patients' hospitalization, and hemoglobin (Hb) drop during the surgery. All statistical analyses and visualizations were implemented utilizing R software. RESULTS Nineteen studies, including eight randomized clinical trials (RCTs) and eleven observational cohorts, comprising 3016 patients (1521 UG-PCNL patients) and comparing UG-PCNL with FG-PCNL met the inclusion criteria of the current study. Considering SFR, overall complications, duration of surgery, duration of hospitalization, and Hb drop, our meta-analysis revealed no statistically significant difference between UG-PCNL and FG-PCNL patients, with p-values of 0.29, 0.47, 0.98, 0.28, and 0.42, respectively. Significant differences were discovered between UG-PCNL and FG-PCNL patients in terms of the length of time they were exposed to radiation (p-value< 0.0001). Moreover, FG-PCNL had shorter access time than UG-PCNL (p-value = 0.04). CONCLUSION UG-PCNL provides the advantage of requiring less radiation exposure while being just as efficient as FG-PCNL; thus, this study suggests prioritizing the use of UG-PCNL.
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Affiliation(s)
- Razman Arabzadeh Bahri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Saba Maleki
- School of Medicine, Guilan University of Medical Sciences (GUMS), Rasht, Guilan Province, Iran
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Cunha PD, Barbosa TP, Correia G, Silva R, Cruz Oliveira N, Varanda P, Direito-Santos B. The ideal patient positioning in spine surgery: a preventive strategy. EFORT Open Rev 2023; 8:63-72. [PMID: 36805330 PMCID: PMC9968999 DOI: 10.1530/eor-22-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Patient positioning on the surgical table is a critical step in every spine surgery. The most common surgical positions in spine surgery are supine, prone and lateral decubitus. There are countless lesions that can occur during spine surgery due to patient mispositioning. Ulnar nerve and brachial plexus injuries are the most common nerve lesions seen in malpositioned patients. Devastating complications due to increased intraocular pressure or excessive abdominal pressure can also occur in prone decubitus and are real concerns that the surgical team must be aware of. All members of the surgical team (including surgeons, anesthesiologists and nurses) should know how to correctly position the patient, identify possible positioning errors and know how to avoid them in order to prevent postoperative morbidity. This work pretends to do a review of the most common positions during spine surgery, alert to errors that can happen during the procedure and how to avoid them.
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Affiliation(s)
- Paulo Diogo Cunha
- Orthopedic Surgery Department, Hospital de Braga, Portugal,Correspondence should be addressed to P D Cunha;
| | | | | | - Rafaela Silva
- Anesthesiology Department, Hospital de Braga, Portugal
| | | | - Pedro Varanda
- Orthopedic Surgery Department, Hospital de Braga, Portugal,Life and Health Science Research Institute, University of Minho, Portugal
| | - Bruno Direito-Santos
- Orthopedic Surgery Department, Hospital de Braga, Portugal,Life and Health Science Research Institute, University of Minho, Portugal
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Romero J, Garcia M, Diaz JC, Gabr M, Rodriguez-Taveras J, Braunstein ED, Purkayastha S, Gamero MT, Alviz I, Marín J, Aristizábal J, Reynbakh O, Peralta AO, Duque M, Dave KP, Rodriguez D, Nino C, Briceno D, Velasco A, Ferrick K, Slipczuk L, Natale A, Di Biase L. Anatomical considerations and clinical interpretation of the 12-lead ECG in the prone position: a prospective multicentre study. Europace 2023; 25:175-184. [PMID: 36196043 PMCID: PMC10103558 DOI: 10.1093/europace/euac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study is to provide guidance for the clinical interpretation of electrocardiograms (ECGs) in prone position and to establish the electroanatomic explanations for the possible differences to supine position ECGs that may be observed. Additionally, to determine if prone back ECG can be used as an alternative to standard ECG in patients who may benefit from prone position. METHODS AND RESULTS The ECG in supine (standard ECG), prone back (precordial leads placed on the patient's back), and prone anterior position (precordial leads placed in the standard position with the subjects in prone position) were prospectively examined on 85 subjects. Comparisons of ECG parameters between these positions were performed. Computed tomography (CT) scans were performed in both positions to determine possible electroanatomic aetiologies for prone-associated ECG changes. There were significant differences in QRS amplitude in Leads V1-V5 between supine and prone positions. Q waves were more frequently observed in prone back position vs. supine position (V1: 74.1 vs. 10.6%, P < 0.0001; V2: 23.5 vs. 0%, P < 0.0001, respectively). Flat and inverted T waves were more common in prone back leads (V1: 98 vs. 66%, P < 0.0001; V2: 96 vs. 8%, P < 0.0001; V3: 45 vs. 7%, P < 0.0001). The 3D-CT reconstructions measurements corroborated the significant inverse correlation between QRS amplitude and the distance from the centre of the heart to the estimated lead positions. CONCLUSION In prone back position ECG, low QRS amplitude should not be misinterpreted as low voltage conditions, neither should Q waves and abnormal T waves are considered anteroseptal myocardial infarction. These changes can be explained by an increased impedance (due to interposing lung tissue) and by the increased distance between the electrodes to the centre of the heart.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Mario Garcia
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | | | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Joan Rodriguez-Taveras
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Eric D Braunstein
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Sutopa Purkayastha
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Maria T Gamero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Jorge Marín
- Cardiology Department, Clínica Las Americas, Medellín, Colombia
| | | | - Olga Reynbakh
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Adelqui O Peralta
- VA Boston Healthcare System, Division of Cardiology, Harvard Medical School, Boston, MA, USA
| | - Mauricio Duque
- Cardiology Department, Universidad CES, Medellín, Colombia
| | - Kartikeya P Dave
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Daniel Rodriguez
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Cesar Nino
- Cardiology Department, Clínica Las Americas, Medellín, Colombia
| | - David Briceno
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Kevin Ferrick
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Leandro Slipczuk
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, 111 E 210th street, Bronx, NY 10467, USA
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Ghenbot Y, Ahmad HS, Chauhan D, McCloskey K, Turlip R, Yoon JW. Simultaneous Anterior Posterior Approach for Single-Position Lateral Lumbar Interbody Fusion with Robotic Assistance: Technical Guidelines and Early Outcomes. World Neurosurg 2023; 170:e425-e430. [PMID: 36396051 DOI: 10.1016/j.wneu.2022.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lumbar lateral interbody fusion (LLIF) is traditionally performed in 2 stages: placing the interbody cage in the lateral decubitus position, then placing the percutaneous pedicle screw in the prone position. Performing interbody fusion and posterior fixation simultaneously could improve operative efficiency and clinical outcomes associated with longer operative times. We describe the operative steps and report clinical and radiographic outcomes associated with a simultaneous anterior and posterior approach (SAPA) for LLIF. METHODS Patients who underwent SAPA LLIF performed by a single surgeon over 1 year were retrospectively reviewed. Demographic, clinical, and radiographic data were analyzed, an operative guideline was created, and a learning curve was constructed using operative times. RESULTS SAPA LLIF was performed in 11 patients. Three patients experienced transient postoperative femoral nerve plexopathy with symptoms of ipsilateral hip flexion weakness and/or anterior thigh numbness; there were no other complications in the cohort. Radiographically, patients achieved significant increases in disc height (8.3 mm vs. 13.5 mm, P = 0.002) and foraminal height (20.2 mm vs. 25.3 mm, P = 0.0001). Patients showed significant improvements in Oswestry Disability Index (52 vs. 27.8, P = 0.002) and Patient-Reported Outcome Measurement Information System Physical Function (32.6 vs. 39, P = 0.048) and Pain Interference (64.9 vs. 59.6, P = 0.001) at 3 months. A downward trend in operative time was observed for 1-level SAPA LLIF. CONCLUSIONS SAPA LLIF is a safe approach for LLIF that results in favorable clinical outcomes. This technique can potentially improve operative efficiency further along the course of a surgeon's learning curve.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle McCloskey
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Elmer N, REIßHAUER A, Brehm K, Vockeroth C, Liebl ME. Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature. Eur J Phys Rehabil Med 2023; 59:111-121. [PMID: 36441010 PMCID: PMC10035441 DOI: 10.23736/s1973-9087.22.07529-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation. EVIDENCE ACQUISITION PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions (i.e. possible effects on the course of rehabilitation and therapy strategies). EVIDENCE SYNTHESIS A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn. CONCLUSIONS Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.
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Affiliation(s)
- Nancy Elmer
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany -
- Humboldt University of Berlin, Berlin, Germany -
| | - Anett REIßHAUER
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
| | - Katharina Brehm
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
| | - Clarissa Vockeroth
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
| | - Max E Liebl
- Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany
- Humboldt University of Berlin, Berlin, Germany
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Baskaran V, Banerjee JK, Ghosh SR, Kumar SS, Dey SK, Kulkarni SV, Bharathi RS. Minimal access surgery of corrosive and thermal strictures of the foregut. J Minim Access Surg 2023; 19:1-19. [PMID: 36722526 PMCID: PMC10034818 DOI: 10.4103/jmas.jmas_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/22/2022] [Accepted: 08/28/2022] [Indexed: 01/21/2023] Open
Abstract
Background and Aim : Conventional surgery for caustic/thermal strictures (CS/TS) entails considerable trauma, which may be mitigated by minimal access surgery (MAS). Experience with its use in CS/TS is both heterogeneous and limited, hence, warrants a comprehensive review. Methods : Medical literature/indexing databases were systematically searched for pertinent articles published in English, from 1990 to 2021, and analysed. Results : Fifty relevant articles, pertaining to over 200 patients, were found. They showed that MAS is feasible in CS/TS management. It reduces the access damage in chest and abdomen whilst facilitating resection or bypass of the affected gut segment through different combination of operations, sequence of steps, conduits and routes. The procedures range from completely minimal access to hybrid ones, with reduced complications and faster recovery. Hybrid procedures prove as expeditious as open ones. Conclusions : MAS proves efficacious in restoring alimentary continuity in corrosive/thermal strictures of the foregut.
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Affiliation(s)
- Vasudevan Baskaran
- Department of Gastro-Intestinal Surgery, MIOT Hospital, Chennai, Tamil Nadu, India
| | - Jayant Kumar Banerjee
- Department of Gastro-Intestinal Surgery, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
| | - Sita Ram Ghosh
- Department of Gastro-Intestinal Surgery, IQ City Medical College, Durgapur, West Bengal, India
| | - Sukumar Santosh Kumar
- Department of Gastro-Intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Santosh Kumar Dey
- Department of Pediatric Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Shrirang Vasant Kulkarni
- Department of Gastro-Intestinal Surgery, Army Hospital (Research and Referral), New Delhi, India
| | - Ramanathan Saranga Bharathi
- Department of Gastro-Intestinal Surgery, Command Hospital (Northern Command), Udhampur, Jammu and Kashmir, India
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Prone vs lateral positioning for posterior acetabular fracture surgery. J Orthop Trauma 2023; 37:e54. [PMID: 36518070 DOI: 10.1097/bot.0000000000002502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Tsaturyan A, Vrettos T, Ballesta Martinez B, Liourdi D, Lattarulo M, Liatsikos E, Kallidonis P. Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Minerva Urol Nephrol 2022; 74:695-702. [PMID: 35622348 DOI: 10.23736/s2724-6051.22.04787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aim of the current study was to perform a critical review of existing literature and report the potential morbidity of patient positioning during urological surgeries as well as evaluate the surgical outcomes and anesthesiologic benefits and risks of prone percutaneous nephrolithotomy (PCNL). A narrative review of the current literature has been performed. Articles related to position-related injuries and complications under general anesthesia in prone positions were selected, studied, and considered for the current review. We found that under general anesthesia, the prone position improved the oxygenation of patients and increased the elimination of carbon dioxide. A potential risk for position-related anesthesiologic side effects was reported for longer spine surgeries in a prone position. The injuries and position-related side effects were extremely rare following prone PCNL since the mean duration of the procedure was significantly shorter than that of spine surgery. In conclusion, the prone PCNL remains the most often utilized and preferred approach globally with well-established success and complication rates. Clinical outcomes of prone PCNL do not demonstrate an increased rate of anesthesiologic complications compared to the supine approach. Standardization of turnover of the position, and reduction of the operative time warrant a faster and complication-free recovery.
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Affiliation(s)
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Despoina Liourdi
- Department of Urology, University of Patras, Patras, Greece.,Department of Internal Medicine, Ag. Andreas General Hospital of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece - .,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Salmons HI, Baird MD, Dearden ME, Wagner SC, Sebastian AS. Prone Versus Lateral Decubitus Positioning for Direct Lateral Interbody Fusion. Clin Spine Surg 2022; 35:351-353. [PMID: 34966037 DOI: 10.1097/bsd.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/01/2021] [Indexed: 01/25/2023]
Affiliation(s)
| | - Michael D Baird
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Marissa E Dearden
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott C Wagner
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Muacevic A, Adler JR, Rudrappa S. Massive Congestive Facial and Submandibular Oedema Due to Extreme Neck Flexion Following Suboccipital Craniectomy: A Case Report. Cureus 2022; 14:e31759. [PMID: 36569736 PMCID: PMC9775002 DOI: 10.7759/cureus.31759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
A variety of factors could contribute to facial oedema during a prone neurosurgical procedure. For optimal surgical exposure, suboccipital cranial surgeries frequently necessitate extreme neck flexion. Extreme neck flexion in the prone position can impair venous drainage of the facial and oropharyngeal structures, leading to life-threatening oedema, so a two-fingerbreadth space between the chin and the sternum is critical. We present a case of massive facial oedema with submandibular swelling in a patient who underwent foramen magnum decompression in the prone position for Arnold Chiari malformation.
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Ocular injuries during prone ventilation. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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