1
|
Sandhofer M, Hofer V, Sandhofer M, Sonani M, Moosbauer W, Barsch M. High Volume Liposuction in Tumescence Anesthesia in Lipedema Patients: A Retrospective Analysis. J Drugs Dermatol 2021; 20:326-334. [PMID: 33683073 DOI: 10.36849/jdd.5828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lipedema is a chronic, progressive disease that occurs almost exclusively in women and leads to pathological, painful fat growths at the extremities. Only symptomatic therapy can be offered since the etiology of the disease has not yet been clarified. Liposuction in tumescent anesthesia has established itself as a surgical treatment method of choice. The complication rate associated with the procedure and the pharmacological course and safety of treatment in patients with lipedema has not yet been sufficiently studied. The aim of the study was to broaden the evidence on the safety of ambulatory high-volume liposuction in tumescent anesthesia in lipedema patients. Influencing factors of patients (weight, fat content, comorbidities) or the process technique (drug administration, volume of aspirates) should be investigated on the safety and risks of tumescent anesthesia. This was a retrospective data analysis in which data from 27 patients (40 liposuction procedures) treated at the Sandhofer and Barsch lipedema center between 2016 and 2018 were evaluated. The liposuctions were carried out in tumescent anesthesia and using a Power-Assisted Liposuction system. Clinical examinations and regular blood samples were carried out before the procedure, intra- and postoperatively. The procedures lasted an average of 118 minutes and an average of 6111 ml of aspirate was removed. For tumescent anesthesia, patients were given an average lidocaine dose of 34.23 mg/kg body weight and an epinephrine dose of 0.11 mg/kg body weight. No relevant complications associated with drug side effects, hypovolemia or hypervolemia or blood loss were detected. Liposuction under high volume tumescent anesthesia for the treatment of lipedema patients is, even for major intervention, a safe procedure. J Drugs Dermatol. 2021;20(3):326-334. doi:10.36849/JDD.5828.
Collapse
|
2
|
Abstract
OBJECTIVES With tympanostomy tube insertion remaining the most common procedure performed in children to date, growing interests in minimizing both procedural costs and anesthetic exposure in the pediatric population have inspired innovation with respect to tympanostomy tubes. As such, we aim to discuss the current state of tympanostomy tube innovation including insertion devices, tube material, and design. METHODS Computerized literature review. RESULTS (1) Numerous single-use devices consisting of a myringotomy knife and preloaded tympanostomy tube offer potential advantages of decreasing or eliminating operating room time and may be performed under moderate instead of a general anesthetic. (2) Innovation with respect to tympanostomy tube material and design may offer enhanced ototopical drug delivery, decreased rates of tube occlusion, and/or the ability to dissolve "on-command" with application of a novel ototopical material. (3) These technologies currently remain in various phases of preclinical and clinical testing. CONCLUSIONS While clinical testing for a number of new technologies is preliminary and ongoing, tympanostomy tube-related innovations hold exciting promise to supplement or potentially replace the present-day armamentarium of tympanostomy tube design and insertion moving forward.
Collapse
Affiliation(s)
- Rachel L Whelan
- Department of Otolaryngology, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raymond C Maguire
- Department of Otolaryngology, 12317University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
3
|
Jacob JS, Hsu S. When the Gloves Come Off: Are Non-Sterile Gloves Safe in Outpatient Procedures? Skinmed 2020; 18:165-166. [PMID: 32790613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine
| |
Collapse
|
4
|
Lwin AA, Zeng J, Evans P, Phung MC, Hynes KA, Price ET, Twiss CO, Tzou DT, Funk JT. Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery. Urology 2020; 138:119-124. [PMID: 31962119 DOI: 10.1016/j.urology.2020.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the safety, feasibility and treatment outcomes of holmium laser enucleation of the prostate (HoLEP) as a same day surgery (SDS). METHODS HoLEPs performed from November 2013 to December 2018 at our institution were reviewed retrospectively. Inclusion criteria for same day surgery (SDS) included living in the local metropolitan area with access to local hospital and Eastern Cooperative Oncology Group (ECOG) 0-2, regardless of prostate size and anticoagulation status. Those patients who were discharged directly from the postoperative care unit were identified as SDS cases. Patients admitted overnight after HoLEP during the same period were used as a matched cohort. Patient demographics, disease characteristics and treatment outcomes were compared. RESULTS A total of 377 patients were identified, including 199 SDS and 178 non-SDS patients. No statistical difference was present between the 2 groups regarding the post-op complication and readmission rates. The non-SDS group had a significantly higher percentage of patients with history of urinary retention, lower pre-op Qmax, and larger prostate volume. The SDS group had shorter operative time, length of stay (LOS), and catherization time (all P <.05). At 1-year follow-up, no statistically different change in Qmax, PVR, or IPSS score was noted between the 2 groups. CONCLUSION Same day outpatient surgery for HoLEP is safe in patients who live in close proximity and have ECOG status 0-2. Our readmission rate and complication rate are comparable to those reported in the literature with markedly decreased LOS. Long-term functional outcome is not compromised by SDS.
Collapse
Affiliation(s)
- Aye A Lwin
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
| | - Patrick Evans
- Department of Urology, University of Arizona, Tucson, AZ
| | | | - Kieran A Hynes
- Division of Urology, University of Mississippi Medical Center, Jackson, MS
| | | | | | - David T Tzou
- Department of Urology, University of Arizona, Tucson, AZ
| | - Joel T Funk
- Department of Urology, University of Arizona, Tucson, AZ.
| |
Collapse
|
5
|
Huynh E, Klouche S, Martinet C, Le Mercier F, Bauer T, Lecoeur A. Can the number of surgery delays and postponements due to unavailable instrumentation be reduced? Evaluating the benefits of enhanced collaboration between the sterilization and orthopedic surgery units. Orthop Traumatol Surg Res 2019; 105:563-568. [PMID: 30862491 DOI: 10.1016/j.otsr.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/10/2019] [Accepted: 01/25/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The development of outpatient surgery, cost-reduction pressures and instrumentation storage limitations have led to their use "just-in-time". A recent study showed that stoppage of surgical procedures immediately before the incision (No-Go) was often due to the management of supplies and implantable medical devices. To our knowledge, since the development of outpatient surgery and the shortening of hospital stays, managing the flow of instrumentation has not been optimized. At our hospital, we used a two-prong approach consisting of a tool to manage instrumentation and working group from the sterilization and orthopedic surgery units. The aims of this study were to: 1) evaluate whether this approach led to better notification of the risk of supply shortage for instrumentation and 2) determine whether it could reduce by at least half operating room disruptions such as delays or cancellation of surgical procedures. HYPOTHESIS This approach results in better notification of the risk of supply shortage for instrumentation and reduces by at least half operating room disruptions such as delays or cancellation of surgical procedures. MATERIAL AND METHODS A tool was developed to manage instrumentation flow based on a retrospective analysis of data from 2015. This tool consisted of: (1) a list of instrumentation needed for each surgical procedure from an analysis of the surgical schedule and verification of traceability labels of the instrumentation actually used, (2) a list of reasons for supply shortage identified from an analysis of non-conformities occurring in the sterilization process of instrumentation kits. These analyses resulted in the development of checklists for instrument sets for each procedure, while identifying those with a high risk of shortage. In 2017, a working group focused on instrumentation was set up with personnel from the sterilization unit and the orthopedic surgery unit. Based on the check-lists and the schedule 24hours before the surgery, the sterilization unit alerted the surgery unit by email of the risk of material shortage; the surgery ward replied with potential changes to the material or the surgery planning. This approach (instrumentation management tool and working group) was named just-in-time (JIT). The main outcome was the number of notifications of potential supply shortage with and without JIT over a 10-week period. The secondary outcomes were the number of notifications resolved in time and the occurrence of operating room disruptions (delay>30min or postponement of surgery) related to unavailable instrumentation. RESULTS Nine reasons for potential supply shortage were identified such as instrumentation kits used for several types of procedures, those with fast rotation and low stock, or in double pathways (on loan and on deposit). The working group reported 163 potential shortages with JIT versus 41 without (p<10-5), of which 150 (92.5%) were resolved. Thirteen operating room disruptions occurred; only one was not detected by the JIT approach. CONCLUSION Our JIT approach (instrumentation management tool and working group) is effective at preventing instrumentation supply shortages. LEVEL OF EVIDENCE III, prospective comparative study.
Collapse
Affiliation(s)
- E Huynh
- Stérilisation centrale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - S Klouche
- Orthopaedic surgery, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - C Martinet
- Orthopaedic surgery, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - F Le Mercier
- Stérilisation centrale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - T Bauer
- Orthopaedic surgery, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - A Lecoeur
- Stérilisation centrale, hôpital Ambroise-Paré, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| |
Collapse
|
6
|
Emery RW, Korj O, Agarwal R. A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars. J Oral Maxillofac Surg 2017; 75:1591-1600. [PMID: 28419843 DOI: 10.1016/j.joms.2017.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE We performed a retrospective review of in-office removal of complex mandibular third molars with a dynamic image navigation system (DINS). MATERIALS AND METHODS A retrospective review was conducted of cases completed from 2010 to 2014 by a single oral and maxillofacial surgeon. The average age of the patients was 47 years (range, 27 to 72 years). Extraction complexity was classified with Juodzbalys and Daugela's classification system. The included study cases had complexity scores of 9 or greater. Each patient received custom intraoral splints to secure the tracking array and underwent cone beam computed tomography image acquisition. All surgical procedures were performed with a precalibrated tracking straight handpiece under dynamic navigation. RESULTS All 25 cases were treated successfully with the use of the DINS. Twelve of these cases were associated with pathologic lesions. Three patients were noted to have inferior alveolar nerve paresthesia. One patient sustained a pathologic fracture at week 2. Postoperative infections were noted in 7 cases, 2 of which had a pre-existing infection. One patient reported temporary limitation of mouth opening. A coronectomy was performed in 1 case. CONCLUSIONS We present results using a new technology, the DINS, for removal of complex mandibular third molars. Potential advantages are 1) improved visualization and localization of anatomic structures such as the inferior alveolar nerve, lingual cortical plate, and adjacent roots; 2) improved control during osteotomy; 3) decreased surgical access requirements and reduction in overall bone removal; 4) ability to perform complex procedures successfully in an in-office setting; 5) decreased surgical time resulting from improved visualization; and 6) potential use as a teaching tool. Possible limitations of the use of an in-office DINS include increased cost, increased time attributed to presurgical planning, initial learning curve, and optical array interference by the surgeon or assistants during surgery.
Collapse
Affiliation(s)
- Robert W Emery
- Senior Attending Surgeon, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC
| | - Oxana Korj
- Chief Resident, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC.
| | - Ravi Agarwal
- Program Director, Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC
| |
Collapse
|
7
|
Liang W, Huang S, Chen S, Tan KK. Force estimation and failure detection based on disturbance observer for an ear surgical device. ISA Trans 2017; 66:476-484. [PMID: 27743604 DOI: 10.1016/j.isatra.2016.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 06/01/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
The disturbance observer is one of the useful tools for estimating the contact force between the subject body and the environment in robotic and mechatronic systems. This paper introduced a novel automatic office-based ear surgical device for the treatment of Otitis Media with Effusion (OME) under the guidance of force sensing information. Since the force sensing information must be reliable so as to ensure the safety of the device, a contact force estimation method based on the disturbance observer is proposed. The system model is built and a control strategy is proposed and developed. In the control strategy, a composite motion controller for an ultrasonic motor (USM) stage is presented, and then the design and the stability analysis of an advanced disturbance observer is given. Furthermore, a contact estimator and a failure detector, aiming to enhance the safety and reliability enhancement, are designed. Finally, the proposed control strategy is studied with both simulation and experiment. The experimental results show that the advanced disturbance observer can estimate the actual contact force correctly and precisely, and the disturbance observer based force estimation and failure detection method is feasible which can be used in force sensing, contact detection and fault diagnosis.
Collapse
Affiliation(s)
- Wenyu Liang
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore.
| | - Sunan Huang
- Temasek Laboratories, National University of Singapore, Singapore
| | - Silu Chen
- Singapore Institute of Manufacturing Technology, A(⁎)STAR, Singapore
| | - Kok Kiong Tan
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| |
Collapse
|
8
|
Brown SR, Tiernan JP, Watson AJM, Biggs K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 2016; 388:356-364. [PMID: 27236344 PMCID: PMC4956910 DOI: 10.1016/s0140-6736(16)30584-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used outpatient treatment. We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. METHODS This multicentre, open-label, parallel group, randomised controlled trial included patients from 17 acute UK NHS trusts. We screened patients aged 18 years or older presenting with grade II-III haemorrhoids. We excluded patients who had previously received any haemorrhoid surgery, more than one injection treatment for haemorrhoids, or more than one RBL procedure within 3 years before recruitment. Eligible patients were randomly assigned (in a 1:1 ratio) to either RBL or HAL with Doppler. Randomisation was computer-generated and stratified by centre with blocks of random sizes. Allocation concealment was achieved using a web-based system. The study was open-label with no masking of participants, clinicians, or research staff. The primary outcome was recurrence at 1 year, derived from the patient's self-reported assessment in combination with resource use from their general practitioner and hospital records. Recurrence was analysed in patients who had undergone one of the interventions and been followed up for at least 1 year. This study is registered with the ISRCTN registry, ISRCTN41394716. FINDINGS From Sept 9, 2012, to May 6, 2014, of 969 patients screened, 185 were randomly assigned to the HAL group and 187 to the RBL group. Of these participants, 337 had primary outcome data (176 in the RBL group and 161 in the HAL group). At 1 year post-procedure, 87 (49%) of 176 patients in the RBL group and 48 (30%) of 161 patients in the HAL group had haemorrhoid recurrence (adjusted odds ratio [aOR] 2·23, 95% CI 1·42-3·51; p=0·0005). The main reason for this difference was the number of extra procedures required to achieve improvement (57 [32%] participants in the RBL group and 23 [14%] participants in the HAL group had a subsequent procedure for haemorrhoids). The mean pain 1 day after procedure was 3·4 (SD 2·8) in the RBL group and 4·6 (2·8) in the HAL group (difference -1·2, 95% CI -1·8 to -0·5; p=0·0002); at day 7 the scores were 1·6 (2·3) in the RBL group and 3·1 (2·4) in the HAL group (difference -1·5, -2·0 to -1·0; p<0·0001). Pain scores did not differ between groups at 21 days and 6 weeks. 15 individuals reported serious adverse events requiring hospital admission. One patient in the RBL group had a pre-existing rectal tumour. Of the remaining 14 serious adverse events, 12 (7%) were among participants treated with HAL and two (1%) were in those treated with RBL. Six patients had pain (one treated with RBL, five treated with HAL), three had bleeding not requiring transfusion (one treated with RBL, two treated with HAL), two in the HAL group had urinary retention, two in the HAL group had vasovagal upset, and one in the HAL group had possible sepsis (treated with antibiotics). INTERPRETATION Although recurrence after HAL was lower than a single RBL, HAL was more painful than RBL. The difference in recurrence was due to the need for repeat bandings in the RBL group. Patients (and health commissioners) might prefer such a course of RBL to the more invasive HAL. FUNDING NIHR Health Technology Assessment programme.
Collapse
Affiliation(s)
| | | | | | - Katie Biggs
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Neil Shephard
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Allan J Wailoo
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Abualbishr Alshreef
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
9
|
Mouadeb DA, Belafsky PC. In-Office Laryngeal Surgery with the 585nm Pulsed Dye Laser (PDL). Otolaryngol Head Neck Surg 2016; 137:477-81. [PMID: 17765779 DOI: 10.1016/j.otohns.2007.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Revised: 01/08/2007] [Accepted: 02/05/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES: The 585nm pulsed dye laser (PDL) is a promising tool for in-office laryngeal surgery. Data with respect to the safety and efficacy of the PDL for office laryngeal use is sparse. The purpose of this study is to review our experience with unsedated office PDL surgery. METHODS: Records of individuals undergoing in-office PDL between September 1, 2004, and September 1, 2006 were abstracted from a clinical database. RESULTS: Forty-seven patients underwent 117 treatments. The most common indications were recurrent respiratory papillomatosis (RRP), Reinke's edema, and vocal fold polyps. One hundred and four of 117 procedures were felt to be a success ablating all disease. Thirteen treatments requred early termination. The most common factor responsible for termination was an inability to achieve a comfortable level of anesthesia. One patient with Reinke's edema developed postprocedure stridor that required a 3-day hospital admission for observation and corticosteroids. There was no incidence of any vocal fold scarring, web formation, or other complications. CONCLUSIONS: The 585nm PDL is a promising tool for in-office treatment of various laryngeal disorders. Complications are rare.
Collapse
Affiliation(s)
- Debbie Aviva Mouadeb
- The Center for Voice and Swallowing, University of California at Davis Medical Center, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA.
| | | |
Collapse
|
10
|
Calabrese S, DE Alberti D, Garuti G. The use of bipolar technology in hysteroscopy. Minerva Ginecol 2016; 68:133-142. [PMID: 26928415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Bipolar technology was introduced in the hysteroscopic clinical use in 1999, by the design of both loop electrodes addressed to resectoscopic surgery and miniaturized electrodes adaptable to small-size hysteroscopes. The need of an electrolytic solution as distension medium and the spatial relationships between the active and return bipolar electrode avoid, by definition, the risks of severe electrolyte imbalance syndromes and unpredictable electrical burns, sometimes complicating monopolar surgery. The true revolution in the hysteroscopy care has achieved through the availability of mini-hysteroscopes not requiring cervical dilatation, thus limiting uterine wall damages and allowing surgeons to manage several endometrial pathologies by mini-invasive procedures using an effective electrosurgical bipolar instrumentation. Many surgical interventions, traditionally accomplished by the resectoscope in a surgical room theatre, can be now carried out in an outpatient setting without any support from anesthesia. The patients' avoidance of surgical room access and the quick return to daily activities lead to an obvious - but not fully demonstrated - improvement in the medical and social costs associated to outpatient operative hysteroscopy. In the field of resectoscopy, bipolar electrodes are clinically as effective as monopolar devices. Randomized trials showed that bipolar resectoscopic technology prevents the electrolyte imbalance observed after monopolar surgery. However, in daily clinical practice the assumedly safer profile of bipolar with respect to monopolar resectoscopy has not been demonstrated yet.
Collapse
Affiliation(s)
- Stefania Calabrese
- Department of Obstetrics and Gynecology, Public Hospital of Lodi, Lodi, Italy -
| | | | | |
Collapse
|
11
|
Ge N, Guan M, Li X, Li S, Wang EB. [Application of flexible laryngeal mask airway in oral & maxillofacial day surgery]. Beijing Da Xue Xue Bao Yi Xue Ban 2015; 47:1010-1014. [PMID: 26679667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To access the feasibility and safety of application of flexible laryngeal mask airway (FLMA) in oral & maxillofacial day surgery. METHODS Retrospective study was conducted of 40 oral & maxillofacial day surgery patients (3 to 61 years of age) using FLMA under general anaesthesia in Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology. All the patients were with American Society of Anesthesiologists(ASA) physical status I-II,including 19 males and 21 females. The patients'vital signs were recorded at five different time points: baseline before anesthesia (T0), time right after the FLMA insertion (T1), time at incision (T2), 15 min after incision (T3) and time at the end of the operation (T4). The first attempted FLMA insertion successful rate and the number of timed of changing to endotracheal intubation were recorded. During operation, frequencies of movement, hypoxia and obstruction of airway were noted and the operation time, anesthesia time, time from the end of the operation to extubation, movement and coughing following extubation and sore throat within 24 h were taken down. Operation-related complications of bleeding, hematoma and injury of local nerves were recorded within 24 h as well. RESULTS The operations of all the 40 patients were successfully done under general anaesthesia. The 36(90%, 36/40)patients using FLMA successfully were under steady process, including 16 males and 20 females. The first attempted successful rate of FLMA insertion was 80% (32/40), and the second 50% (4/8). Three out of the 4 failed FLMA patients were changed to endotracheal intubation after the second attempt failed. The other patient was changed to endotracheal intubation before operation because of leak. The average operation time was (46.58 ± 22.57) min, the anesthesia time was (77.97 ± 26.82) min and the time from the end of operation to extubation was (8.31 ± 3.33) min. All the patients were recorded without obvious body movement during the operation procedure. There were 4 patients (11.11%, 4/36) with slight body movement during extubation. The incidence of sore throat was 13.89% (5/36) within 24 h postoperatively. There were no complications of bleeding, hematoma and injury of local nerves. The vital signs of baseline T0 were significantly different from those at other time points T1, T2, T3, and T4 (P<0.01). As to the hearts rate after anesthesia, the values at T1, T2, T3 and T4 for two-two comparison, there was no statistical difference (P>0.05). As to the values of systolic blood pressure and diastolic blood pressure after anesthesia at T1 and T4, T2 and T3, for two-two comparison, there was no statistical difference (P>0.05). As to the respiratory rate from the start of the surgery, the values at T2, T3 and T4 showed no statistical difference (P>0.05). CONCLUSION Flexible laryngeal mask airway is a supraglottic airway management method. It is suitable and safe for securing the airway in oral & maxillofacial day surgery. The advantages of fewer haemodynamic changes and postoperative complications are confirmed.
Collapse
Affiliation(s)
- Na Ge
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Ming Guan
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xi Li
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Shuai Li
- Department of Implantology, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - En-bo Wang
- Department of Oral & Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| |
Collapse
|
12
|
Bityukov YV, Dereza SV, Kuznetsov IV, Kurochkin VN, Myasnikova VV, Potyadina OV, Fedorenka SS. [THE EXPERIENCE OF ANAESTHESIA MANAGEMENT FOR SENSING OF NASOLACRIMAL DUCT IN CHILDREN]. Anesteziol Reanimatol 2015; 60:26-29. [PMID: 26415292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite low invasiveness, lacrimal passages, intubation in children requires general anaesthesia to prevent traumatic and neurological complications. General anaesthesia with sevoflurane is optimal for technical simplicity, safety and controllability. Methods of face mask inhalation anesthesia with halothan and sevoflurane were compared in 996 patients. The authors have developed their own standart of performing the face mask inhalation anesthesia with sevoflurane in children during lacrimal passages intubation. This allowed to minimize the number of intra- and postoperative complications in children, to reduce period of postanesthetic observation, to advance the peroral compensation of fluid deficit.
Collapse
|
13
|
Jaoua H, Djaziri L, Bousselmi J, Belhouane H, Skander R, Ben Maamer A, Cherif A, Ben Fadhel K. Evaluation of a new supraglottic airway device in ambulatory surgery: the I-gel. Tunis Med 2014; 92:239-244. [PMID: 25224417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Its tube is profiled to facilitate and stabilize its insertion. aim : The aim of our study is to state the efficiency and the place of I-gel® in airway management in adult anaesthetic practice. methods: One hundred patients, ASA I-II, scheduled for shortduration elective surgery under general anaesthesia were included in this prospective study. Patients with neck pathology, previous or anticipated airway problems, increased risk of regurgitation or aspiration, ASA III and above and undergoing emergency surgery were not included in the study. We collected the following data: adequacy of the size recommended to the patient, ease in inserting the I-gel®, leak fraction, gastric leak, complications during insertion and removal, ease in inserting the gastric tube, haemodynamic and ventilatory parameters, stability during patient movement and satisfaction of the anaesthetists. results: The success rate of insertion and the use of the I-gel was respectively 99% and 96%. The device was inserted at the first attempt in 92% of cases. The introduction of the I-gel® was rated easy in 99% of cases taking a median of 13 seconds. Complications of insertion were restricted to coughing in 5 patients and hiccups in 7 patients. There were no significant increase in heart rate and mean arterial blood pressure compared to pre-insertion values. An audible leak was recorded in 14.6% of cases. The need for additional manoeuvres was less than or equal to 2 in 96.9 % of patients. The mean of the recorded peak airway pressure values was 18 cmH2O. After a fibreoptic exam via the airway tube, the glottis was completely seen in 74% of cases and partially seen in 14.6%. Two cases of gastric inflation were recorded. There was no case of regurgitation or hypoxemic episode during this trial. Post-operatively sore-throat was reported by one patient in recovery. After I-gel withdrawal, trace of blood was observed in 5 devices. One case of dental trauma was noted. 95% of the anaesthetists were satisfied with the use of the I-gel in their pratice. CONCLUSION This study showed that I-gel® can be used safely and effectively in patients undergoing short-duration elective surgery because the I-gel® has a very good insertion success rate and few complications. The fibreoptic position of the device was correct and the ventilation was highly effective. These elements must be corroborated in larger series.
Collapse
|
14
|
[The organization and rendering of ambulatory surgical medical care to the population of the Russian Federation]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2012;:31-5. [PMID: 23033575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article deals with the results of analysis of official statistic data concerning the rendering of ambulatory surgical care to the population of the Russian Federation. The main volumes of surgical care rendered to the population (including children) in ambulatory polyclinic institutions, day-time in-patient establishment of ambulatory polyclinic institutions are demonstrated. The structure of ambulatory surgical operations according the localization and applied medical equipment is analyzed. The research data testify the necessity of further development of organization and rendering of ambulatory surgical care including enhancement of its significance, availability and effectiveness at the expense of reallocation of surgical care volumes to the ambulatory stage.
Collapse
|
15
|
Allen J, Belafsky PC. Seldinger technique for in-office tracheoesophageal puncture. Ear Nose Throat J 2010; 89:355-356. [PMID: 20737372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- Jacqui Allen
- Center for Voice and Swallowing, Department of Otolaryngology, University of California Davis Medical Center, Sacramento, CA, USA
| | | |
Collapse
|
16
|
Vestermark V, Fall O. [Outpatient treatment of menorrhagia]. Ugeskr Laeger 2010; 172:1443-1446. [PMID: 20470654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Abnormal menstrual bleeding, menorrhagia, is a common problem in premenopausal women. Thermal balloon ablation can be done with Thermablate. It is simple to use and can be done quickly in an outpatient setting. MATERIAL AND METHODS We have performed 116 treatments with Thermablate and followed the patients during a six month period. The treatment was primarily performed in paracervical block to outpatients. RESULTS Few problems were observed. The general satisfaction was good, 76% was very or fairly satisfied. More than 80% reported reduced bleeding, but only 7% became amenorrheic. CONCLUSION Thermablate is suitable in treatment of menorrhagia and can be done in paracervical block to outpatients. It is a simple treatment with few complications. Few became amenorrheic, the majority of patients experienced reduced bleeding and were satisfied.
Collapse
Affiliation(s)
- Vibeke Vestermark
- Gynologisk-obstetrisk Afdeling, Slagelse Sygehus, 4200 Slagelse, Denmark.
| | | |
Collapse
|
17
|
Ho P, Poon JTC, Cho SY, Cheung G, Tam YF, Yuen WK, Cheng SWK. Day surgery varicose vein treatment using endovenous laser. Hong Kong Med J 2009; 15:39-43. [PMID: 19197095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To examine the safety and efficacy of endovenous laser obliteration to treat varicose vein in a day surgery setting, using sedation and local anaesthesia. DESIGN Prospective study. SETTING Day surgery centre in a regional hospital in Hong Kong. PATIENTS A total of 24 patients with duplex-confirmed long saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment from July to November 2007 in a single day surgery centre. Adjuvant phlebectomy and injection sclerotherapy were performed in the same session if indicated. All patients had postprocedural venous duplex scan and clinic assessment on day 7 and day 10 respectively. MAIN OUTCOME MEASURES Procedure success rate, unplanned hospital admissions and re-admissions, major complications, and long saphenous vein obliteration rate. RESULTS A total of 31 limbs of the 24 patients were treated with endovenous laser varicose vein treatment under local anaesthesia and sedation. The procedural success rate was 100%. All but two patients were admitted on the day of treatment and none were re-admitted. The patients' mean visual analogue pain score for the whole procedure was 2.3 (standard deviation, 1.5; range, 0-5). Post-procedural duplex scans showed 100% thrombosis of the treated long saphenous veins with no deep vein thrombosis. There were no skin burns or instances of thrombophlebitis. Induration of the treated long saphenous vein was relatively common (54%). The majority of the patients (54%) experienced mild discomfort in the early postoperative period. CONCLUSION Endovenous laser varicose vein treatment performed under local anaesthesia and sedation in a day surgery setting is safe, and yields satisfactory clinical and duplex outcomes.
Collapse
Affiliation(s)
- P Ho
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
18
|
Gips M, Melki Y, Salem L, Weil R, Sulkes J. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 2008; 51:1656-62; discussion 1662-3. [PMID: 18516645 DOI: 10.1007/s10350-008-9329-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 01/02/2008] [Accepted: 01/21/2008] [Indexed: 12/23/2022]
Abstract
PURPOSE This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease. METHODS From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts. RESULTS One thousand three hundred fifty-eight symptomatic patients participated in the study and were mostly male (84.3 percent) and the mean age 20.9 +/- 3.6 years. Rates of postoperative infection, secondary bleeding, and early failure were 1.5, 0.2, and 4.4 percent, respectively. In patients with full postoperative clinical attendance, complete healing was observed within 3.4 +/- 1.9 weeks. Phone interview included 1,165 patients (85.8 percent) with a mean follow-up interval of 6.9 +/- 1.8 years. Recurrence rates after 1 year was 6.5 percent, 5 years was 13.2 percent, and 10 years was 16.2 percent. Mean time to recurrence was 2.7 +/- 2.6 years postoperatively. The disease-free probability estimate was 93.5 percent at one year and 86.5 percent at 5 years. CONCLUSIONS Compared with frequently used pilonidal operations, the trephine technique is associated with a lower recurrence rate and a low postoperative morbidity rate.
Collapse
Affiliation(s)
- Moshe Gips
- Pilonidal Sinus Clinic, Surgical Unit, Military Medical Facility, Zerifin, Israel.
| | | | | | | | | |
Collapse
|
19
|
De Placido G, Clarizia R, Cadente C, Castaldo G, Romano C, Mollo A, Alviggi C, Conforti S. Compliance and diagnostic efficacy of mini-hysteroscopy versus traditional hysteroscopy in infertility investigation. Eur J Obstet Gynecol Reprod Biol 2007; 135:83-7. [PMID: 17481803 DOI: 10.1016/j.ejogrb.2007.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 11/23/2006] [Accepted: 02/19/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare traditional hysteroscopy with mini-hysteroscopy in terms of compliance, side effects and diagnostic efficacy. STUDY DESIGN We prospectively considered 950 female candidates for an IVF programme. All women underwent outpatient hysteroscopy; in 602 cases (Group A) a mini-hysteroscope was employed; in 348 women (Group B) a 5-mm hysteroscope was adopted. RESULTS Cavity findings were similar in both groups. Endometrial polyps and uterine septum seem to be more frequent in our infertile patients than in the general population. No significant differences in terms of side effects were found between the groups. Mean visual analogue pain scale score was significantly lower in the patients of Group A than in those of Group B (p<0.001). CONCLUSIONS Office mini-hysteroscopy is a very effective diagnostic tool in an infertility work-up and is more widely accepted than traditional hysteroscopy. Routine use of the technique should be considered.
Collapse
Affiliation(s)
- Giuseppe De Placido
- University of Naples Federico II, Obstetric and Gynaecological Sciences, Urologic and Reproductive Medicine, Via Pansini 5, 80131 Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW Malignant pleural effusion is a common complication in advanced malignancy that causes debilitating symptoms which result in impaired quality of life. The primary therapeutic goal in malignant pleural effusion management is effective palliation of the associated respiratory symptoms. Pleurodesis by chest tube or thoracoscopy is widely accepted as the gold standard treatment, although these treatments are not without problems. Tunneled pleural catheters represent a new safe and effective outpatient treatment option for these patients, with no reported mortality and minimal morbidity. RECENT FINDINGS Chest tube insertion with talc slurry and thoracoscopy with talc insufflation are effective methods for achieving spontaneous pleurodesis, although associated with significant morbidity and mortality. A growing body of evidence is confirming that long-term palliation of malignant pleural effusion can be achieved by using tunneled pleural catheters in a large proportion of relatively unselected patients on an outpatient basis. SUMMARY The optimal method for palliative management of malignant pleural effusion remains controversial. The high success rates, low complication rates and efficacy in patients with a wide range of performance status support the use of tunneled pleural catheters as a first-line treatment for symptomatic malignant pleural effusion.
Collapse
|
21
|
Abstract
OBJECTIVE To compare tubal anastomosis by robotic system compared with outpatient minilaparotomy. METHODS In this retrospective case-control study, women were identified by current procedural terminology code for tubal anastomosis. We included all cases of tubal anastomosis for reversal of a prior tubal ligation by either outpatient minilaparotomy or robotic system technique. Cases performed by laparoscopy without aid of the robot were excluded. Comparisons were based on Fisher's exact, chi(2), and Wilcoxon rank sum tests. RESULTS There were 26 cases of tubal anastomosis performed with the robot and 41 cases performed by outpatient minilaparotomy. The two groups were comparable in age, body mass index, and parity. Anesthesia time for the robotic technique (median with interquartile range) was 283 (267-290) minutes compared with 205 (170-230) minutes with outpatient minilaparotomy (P<.001). Surgical times for the robot and minilaparotomy were 229 (205-252) minutes and 181 (154-202) minutes respectively (P=.001). Hospitalization times, pregnancy, and ectopic pregnancy rates were not significantly different. The robotic technique was more costly. The median difference in costs of the procedures was $1,446 (95% confidence interval $1,112-1,812) (P<.001). The time to return to work was significantly shorter in the robotic system group by approximately 1 week (P=.013). CONCLUSION Robotic surgery for tubal anastomosis was successfully accomplished without conversion to laparotomy. The robotic technique for tubal anastomosis required significantly prolonged surgical and anesthesia times over outpatient minilaparotomy (P<or=.001). Costs were higher with the robotic technique. Return to normal activity was shorter with the robotic technique.
Collapse
Affiliation(s)
- Allison K Rodgers
- Departments of Obstetrics and Gynecology, the Cleveland Clinic, Cleveland, Ohio 44159, USA
| | | | | | | |
Collapse
|
22
|
Abstract
INTRODUCTION The aim of this study was to investigate the feasibility of out-patient flexible cystoscopy. PATIENTS AND METHODS Twenty-seven patients awaiting diagnostic or check cystoscopy in Leeds, UK were invited to undergo out-patient flexible cystoscopy using a CST-2000 Flexible Cystoscope (Vision Sciences; Natick, MA, USA) using the sterile single-use slide-on(trade mark) disposable endosheath endoscope system (EndoSheath); Vision Sciences). The performance of the cystoscope was evaluated, and the patients' experiences were documented using a questionnaire. RESULTS The out-patient setting proved to be ideal for flexible cystoscopy. The cystoscope was rated highly for image quality, ease of use and handling. All patients complimented us on the service and preferred out-patients to a day-ward or theatre attendance. CONCLUSIONS This study demonstrates that it is possible to perform out-patient flexible cystoscopy safely, economically and efficiently with the aid of a disposable endoscope system.
Collapse
Affiliation(s)
- Michael Kimuli
- Pyrah Department of Urology, St James's University Hospital, Leeds, UK
| | | |
Collapse
|
23
|
Telling a story with supply cost data. OR Manager 2007; 23:27-8. [PMID: 17612344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
|
24
|
|
25
|
|
26
|
Affiliation(s)
- Abtin Tabaee
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, 772 Park Avenue, New York, NY 10021, USA
| | | | | |
Collapse
|
27
|
|
28
|
Manchester A. Surgical bus serves communities and enhances the skills of rural nurses. Nurs N Z 2006; 12:20-1. [PMID: 16610610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
|
29
|
Manchester A. What are the attractions of surgical nursing? Nurs N Z 2006; 12:22-3. [PMID: 16610611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
|
30
|
Abstract
In the last decade, advancements have been made in hysteroscopic techniques, instrumentation and indications. Vaginoscopic hysteroscopy is performed without medication, cervical dilation and use of vaginal speculum or cervical tenaculum. To prevent complications during uterine access, both misoprostol and laminaria are equally effective for cervical priming. The use of normal saline to distend the uterus prevents hyponatraemia, but hypervolaemia may still be a major problem. Irrigant fluid deficit is best monitored by automated devices. Bipolar electrosurgical systems do not require dispersive return electrodes and do not generate stray currents, thus minimizing the risk of electrical burns. Tissue debulking and extraction are facilitated by vaporizing electrodes or morcellators. Hysteroscopic indications have expanded to include diagnosis and treatment of missed abortion, and cervical and interstitial pregnancies. The most important advancement of hysteroscopy has been proximal tubal access for sterilization.
Collapse
Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, The University of Western Ontario, St Joseph's Health Care, Room L111, 268 Grosvenor Street, London, Ont., Canada N6A 4V2.
| | | |
Collapse
|
31
|
Affiliation(s)
- Fatih Atug
- Department of Urology, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-42, New Orleans, LA, USA
| | | | | |
Collapse
|
32
|
Wang D, Wang XR, Sun JJ, Yu F, Fu XDD, Sun ZT, Hao YP, Wang P. [Analysis of tonsillectomy for outpatients using high frequency electro-guillotine]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2005; 40:68-9. [PMID: 15906529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
|
33
|
Affiliation(s)
- Marcy S Tucker
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | |
Collapse
|
34
|
Minkowitz B, Finkelstein BI, Bleicher M. Percutaneous tendo-Achilles lengthening with a large-gauge needle: a modification of the Ponseti technique for correction of idiopathic clubfoot. J Foot Ankle Surg 2004; 43:263-5. [PMID: 15284817 DOI: 10.1053/j.jfas.2004.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Ponseti technique has become standard for the treatment of congenital idiopathic clubfoot. Treatment includes serial manipulations and casting, accompanied by percutaneous tenotomy of the Achilles tendon. In this article, the authors describe a modification in the Achilles tenotomy technique by using a large-gauge hypodermic needle in the outpatient setting.
Collapse
Affiliation(s)
- Barbara Minkowitz
- Department of Orthopaedic Surgery, Columbia University Hospital of Physicians and Surgeons, New York, NY, USA
| | | | | |
Collapse
|
35
|
Postma GN, Goins MR, Koufman JA. Office-based laser procedures for the upper aerodigestive tract: emerging technology. Ear Nose Throat J 2004; 83:22-4. [PMID: 15366418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
|
36
|
Simpson CB, Amin MR. Office-based procedures for the voice. Ear Nose Throat J 2004; 83:6-9. [PMID: 15366414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
|
37
|
Kentucky Board of Medical Licensure. J Ky Med Assoc 2004; 102:107-21. [PMID: 15067796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
|
38
|
Goh KBC. Inexpensive, compact fluid warmer. Plast Reconstr Surg 2003; 112:1734. [PMID: 14578813 DOI: 10.1097/01.prs.0000084563.27829.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Iwai H, Yukawa H, Yamamoto T, Miyamoto S, Adachi M, Horiguchi A, Tomoda K, Yamashita T. Secondary shunt procedure for alaryngeal patients in an outpatient clinic. Acta Otolaryngol 2002; 122:661-4. [PMID: 12403131 DOI: 10.1080/000164802320396367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The shunt procedure used for laryngectomized patients undergoing secondary tracheo-esophageal (T-E) puncture is inconvenient and causes stress to the patient. In order to overcome these problems we developed a novel surgical T-E shunt technique using the Groningen voice prosthesis that does not require esophagoscopy or general anesthesia and can be performed in an outpatient clinic. In this procedure, a shunt is created using a pair of nasal forceps with the patient seated. An endoscope with biopsy forceps is used to insert the Groningen voice prosthesis. The procedure is usually completed within 20 min after inducing local anesthesia. Neither the technique itself nor the time taken to complete the procedure differed for T-E and tracheo-neoesophageal (reconstructed with flap) shunting. We believe that this procedure is suitable for patients who are afraid of esophagoscopy and/or are not considered suitable candidates for esophagoscopy and repeated general anesthesia. The procedure is also beneficial for both patients and surgeons with regard to its duration and the cost-effectiveness of treatment.
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to remind gynecologists of the indications for office hysteroscopy as well as to provide an update on equipment, techniques, and reimbursements. RECENT FINDINGS Office hysteroscopy is a technique that has been available for over three decades. Whereas nearly 100% of urologists utilize office cystoscopy to evaluate bladder pathology, it is estimated that less than 20% of gynecologists utilize office hysteroscopy to evaluate intrauterine pathology. Although no one knows for sure, I speculate that the reasons for its under-utilization include a perceived lack of patients who would benefit from the procedure, expensive capital equipment with poor reimbursement, and a lack of expertise in performing the procedure. SUMMARY As a result of not routinely using office hysteroscopy, many women who could greatly benefit from the use of the office hysteroscope are being denied a technique that is likely to keep them from more invasive and less useful procedures, such as diagnostic hysteroscopy and dilatation and curettage performed in the operating room under general anesthesia. This paper addresses these misconceptions in an effort to encourage more gynecologists to employ this technology.
Collapse
Affiliation(s)
- Keith Isaacson
- Minimally Invasive Gynecological Surgery Unit, Newton Wellesley Hospital, Newton, Massachusetts 02462, USA.
| |
Collapse
|
41
|
Brownlow H, Grice A. Survey of airway management equipment in day surgery centres. Anaesthesia 2002; 57:407. [PMID: 11949651 DOI: 10.1046/j.1365-2044.2002.2575_6.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
42
|
Abstract
The boundaries of endoscopy will continue to expand. Imaging modalities, such as high-resolution and high magnification endoscopy, tissue spectroscopy, optical coherence tomography, and wireless endoscopy, will continue to evolve. New therapeutic modalities, such as endoscopic antireflux procedures, are making endoscopic surgery a reality. In the increasingly restrictive reimbursement environment, however, it is critical to establish the cost-effectiveness of these new technologies to integrate them into daily practice.
Collapse
Affiliation(s)
- Douglas B Nelson
- Division of Gastroenterology, Minneapolis Veterans Affairs Medical Center (111D), Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
43
|
Abstract
BACKGROUND Prominent periocular veins, primarily of the lower eyelid, are a relatively frequent cosmetic problem. Reported treatment techniques have included electrosurgical, sclerotherapy, and longer-wavelength lasers. OBJECTIVE Ambulatory phlebectomy can be performed on reticular veins of the leg. This technique has been applied over the past few years to periocular reticular veins in order to observe the results and side effects. METHODS Using a hook specifically designed for reticular veins, we treated 10 patients who had larger reticular periocular eyelid veins. One or several punctures with an 18-gauge needle were made in the center of the targeted length of vein. The reticular vein was then gently dissected by undermining with the stem of the Ramelet phlebectomy hook. RESULTS All 10 patients tolerated the procedure well. In 8 of 10 patients there was complete elimination with a single procedure. Surprisingly, no significant hematoma was seen in any patient, although two patients had a small hematoma lasting less than 1 week. Two patients had only partial success, as a small segment of vein was difficult to extract. This was eliminated with a second phlebectomy performed 2 months later in both cases. Edema that is usually seen after sclerotherapy was not noted in any of these patients. CONCLUSIONS Ambulatory phlebectomy appears to be a safe and effective means of permanently eradicating periocular veins.
Collapse
Affiliation(s)
- Robert A Weiss
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | |
Collapse
|
44
|
Todd DW. A comparison of endotracheal intubation and use of the laryngeal mask airway for ambulatory oral surgery patients. J Oral Maxillofac Surg 2002; 60:2-4; discussion 4-5. [PMID: 11756995 DOI: 10.1053/joms.2002.29047] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study compared current experience with the laryngeal mask airway (LMA) to previous experience with endotracheal intubation for ambulatory patients receiving general anesthesia. PATIENTS AND METHODS A retrospective comparison of 157 patients (50 endotracheal intubation [ET] and 107 LMA cases) was conducted. The subjects were American Association of Anesthesiologist (ASA) Class I and II patients who underwent outpatient general anesthesia for dentoalveolar surgery. Procedure time, recovery time, and cost of techniques were compared. RESULTS The patients undergoing a variety of outpatient dentoalveolar surgical procedures under general anesthesia in the LMA group had a shorter procedure time than the ET group (40 vs 44 minutes) and had a significantly shorter recovery time (54 vs 67 minutes). In addition, compared with the cost of delivering care with ET, the LMA provided slightly lower cost per case ($20 to $30 per case compared with $35 to $80 per case), depending on the anesthetic technique used. Comparing the 2 techniques for removal of 4 impacted third molars (25 patients ET and 68 patients LMA) revealed a similar procedure time of 39 minutes for both groups, but a shorter recovery time for the LMA group (54 vs 68 minutes). CONCLUSIONS Use of the LMA has advantages over endotracheal intubation for outpatients receiving general anesthesia for dentoalveolar surgery.
Collapse
|
45
|
Kühnel T, Hosemann W, Rothammer R. Evaluation of powered instrumentation in out-patient revisional sinus surgery. Rhinology 2001; 39:215-9. [PMID: 11826692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A feasibility study was carried out to prove the benefits of powered instrumentation, i.e. microdebrider in revisional surgery under local anaesthesia of chronic sinusitis in out-patients. Acceptance by the patients was investigated by questionnaire. Out-patient surgery is well tolerated by the majority (79.2%) of patients. Ninety-four percent would undergo the treatment again if necessary. An operation under general anaesthesia could be avoided in the cases we submitted to investigation. The cost-effectiveness of the method is thus an important consideration, despite calculating high prime costs and rather expensive, expendable instrumentation. Special consideration is attributed to a new feature added to the debrider device. To improve out-patient care, we developed an integrated electrocoagulation unit which supplements the microdebrider. It proved to be effective and easy to use. Bleeding was reduced to a minimum. Hence, nasal packing could be avoided in all out-patient cases. The possibility of causing severe complications using the microdebrider-technique is not eliminated as was shown in the anatomical specimens. Based on our experience, reduction of strong bony structures is subject to limitations at present. We therefore recommend the use of microdebriders for soft tissue manipulations, especially in revisional surgery. The microdebrider proved to be a significant advantage in out-patient surgery for recurrent sinusitis.
Collapse
Affiliation(s)
- T Kühnel
- ORL-Department, University of Regensburg, Regensburg, Germany
| | | | | |
Collapse
|
46
|
Abstract
The continued success of the ambulatory surgery environment of care has been achieved through patient, physician, and nursing staff satisfaction. The growth in this industry has been greatly influenced by advances in technology, as well as the development and administration of newer anesthetic agents. The implications delineated in this article provide an overview of what is in store for the specialty of perianesthesia nursing. Issues of competency, professional excellence, patient expectations, continuous quality improvement, research, and ethics have become part of the daily lexicon. Never before has the professional nurse been counted on for so much, and future expectations of the nurse continue to grow. To survive, the nurse needs to expand the boundaries of nursing practice as they have been defined. Nurses are the backbone of the delivery of patient care, nurses are on the front line guiding the patient through every care decision, and nurses are positioned to influence the continued evolution of ambulatory surgery and perianesthesia nursing care.
Collapse
Affiliation(s)
- S Barnes
- Ambulatory Surgery and the PACU at Greenwich Hospital, Greenwich, CT, USA.
| |
Collapse
|
47
|
Abstract
Dermatologic surgery can be enjoyable and rewarding, particularly if one constantly seeks ways to improve service and efficiency. Although new technology provides opportunities to expand and improve one's skills, the importance of courtesy, common sense, and creativity should not be overlooked as tools to perfect one's practice.
Collapse
Affiliation(s)
- M L Ramsey
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| |
Collapse
|
48
|
Nzoghe Nguema P, Ogowet Igumu N, Pither S, Ngaka Nsafu D. [ Ambulatory laparoscopic gynecological surgery in Africa: feasibility]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30:462-6. [PMID: 11598560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
We report a prospective survey conduced between March 1998 and February 1999 among 100 women classes ASA I and II who underwent laparoscopic surgery for gynecological disorders under general anesthesia. Among these laparoscopies 85 (85%) were performed for operative purposes and 12 (10.7%) for diagnostic purposes. Minimal monitoring was used (no capnography) so prophylacti fluid loading with 0.9% saline was used before insufflation to reduce hemodynamic changes induced by abdominal overpressure and to avoid potential massive air embolism. Insufflation pressure was limited to 14 mmHg. The main agent used for all procedures was propofol. Mean duration of the procedures was 55 minutes. There were no cases of complications or delayed recovery. Complete exsufflation by abdominal compression at the end of the procedures induced minimal abdominal pain and scapulalgia. Ketoprofen as effective postoperatively. Twenty-five patients (25%) complained of nausea and vomiting in the recovery room and were treated effectively with metoclopramide. All patients were discharged and accompanied to their home six hours later after a well-tolerated light meal. The postoperative course was uneventful.
Collapse
|
49
|
Abstract
OBJECTIVES/HYPOTHESIS To study the efficacy and safety of topical tetracaine anesthesia for office myringotomy and myringotomy with a tube. STUDY DESIGN Retrospective review of patients undergoing office myringotomy, with or without tube insertion, performed over a 4-year period. METHODS A topical solution of 8% tetracaine base in 70% isopropyl alcohol was used in 381 ears. Five to 10 drops of the solution were applied to the tympanic membrane for 10 to 15 minutes and aspirated. Myringotomy was performed either with a myringotomy knife or with a CO(2) laser (OtoLAM). RESULTS Topical tetracaine was used in all 231 ears (100%) undergoing myringotomy without a tube and 150 of 212 ears (71%) undergoing myringotomy with a tube. Tetracaine alone was effective in providing tympanic membrane anesthesia in 95% of myringotomy without a tube (220 ears) and in 93% of myringotomy with a tube (139 ears). There were six complications, including five cases of severe vertigo and one unusual prolonged, transient facial nerve weakness. CONCLUSION Topical tetracaine is efficacious and safe for use in office myringotomy.
Collapse
Affiliation(s)
- R A Hoffman
- Department of Otolaryngology/Head and Neck Surgery, Beth Israel Medical Center, New York, NY 10003, USA
| | | |
Collapse
|
50
|
Affiliation(s)
- S Argov
- Elisha and Horev Medical Centers, POB 8744, 31087, Haifa, Israel.
| | | |
Collapse
|