Clinical outcomes of triclosan-coated barbed suture in open hernia repair: a retrospective cohort study

PURPOSE

We assessed clinical outcomes of patients undergoing open hernia repair using STRATAFIX™ Symmetric, a barbed triclosan-coated suture (TCS; Ethicon), versus conventional polydioxanone suture (PDS) for abdominal wall closure.

METHODS

This single-center retrospective cohort study identified patients undergoing hernia repair. The site used PDS from 2013 to 2016 and switched exclusively to barbed TCS in 2017. Outcomes were assessed at 30, 60, and 90 days. Multivariate regression analyses and Cox proportional hazards models were used.

RESULTS

Of 821 hernia repairs, 446 used barbed TCS and 375 used conventional PDS. Surgical site infections (SSIs) were significantly less frequent with barbed TCS (60 days, 5.9% vs. 11.4%; P = 0.0083; 90 days, 5.9% vs. 11.7%; P = 0.006) and this remained consistent after multivariate adjustment (60 days, OR [95% CI]: 0.5 [0.3-0.9]; 90 days, 0.5 [0.3-0.9]). Among patients with SSI, deep SSIs were less frequent with barbed TCS (60 days, 9.1% vs. 35.7%; P = 0.022; 90 days, 9.1% vs. 34.9%; P = 0.0252). Barbed TCS significantly reduced the risk of perioperative complications (HR [95% CI]: 0.5[0.3-0.8]; P = 0.0058). Hospital length of stay was 2.5 days shorter with barbed TCS (mean [95% CI]: 5.7[4.9-6.6] vs. 8.2[7.3-9.1] days; P < 0.0001). No differences in reoperation rate over time were observed by type of suture (HR[95% CI]:1.3 [0.5-3.4]; P = 0.4793).

CONCLUSIONS

This study showed that patients who underwent open hernia repair appeared to recover equally well regardless of the suture type. In addition, the use of barbed TCS was associated with significantly reduced risk of perioperative complications and hospital length of stay.

Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review

Numerous advantages, including a quick start and consistent anesthesia, are provided by spinal anesthesia, a method often utilized in contemporary medicine for various surgical operations. However, it has some hazards, just like any medical procedure. With an emphasis on identifying and assessing the risk factors associated with administering spinal anesthesia, the review analyzes published literature and clinical investigations carried out in the field of anesthesia. Various key factors, including technique-related procedural and patient-related aspects, can influence the effectiveness of spinal anesthesia. Among these factors are age, sex, body mass index, concurrent conditions (such as cardiovascular disease, diabetes, and respiratory problems), pre-existing neurological issues, allergies, and a history of adverse responses to anesthesia drugs. Additionally, the chance of problems might be increased by physical abnormalities or malformations in the spinal canal and vertebral column. The safety and effectiveness of spinal anesthesia depend significantly on procedural factors, such as the type and dosage of anesthesia agents administered and the patient's position and alignment maintained during the entire surgical procedure and the injection rate. Increased risks can also be caused by inadequate monitoring and a slow response to unfavorable circumstances. Risk factors related to the technique include the expertise and competency of the anesthesiologist or medical professional carrying out the procedure. Inadequate post-procedure monitoring, inadvertent dural puncture, and improper needle placement might lead to complications during or after the spinal anesthesia administration. This review emphasizes the need for a complete preoperative assessment, suitable patient selection, and rigorous procedural planning to reduce the likelihood of problems during the administration of spinal anesthesia. It also emphasizes the significance of ongoing monitoring and timely management of adverse events to guarantee patient safety and the best results. Healthcare professionals may put preventative measures in place and follow best practices to limit possible consequences efficiently by recognizing the risk factors associated with spinal anesthesia. This review helps encourage safer anesthesia practices and improve patient care as medical knowledge and technology advance. However, further study and evidence-based recommendations are required to enhance patient outcomes and risk assessment.

Anesthetic Challenges in an Infant With Tetralogy of Fallot Posted for Non-cardiac Surgery: A Case Report and Literature Review

The goal of this article is to provide an up-to-date and comprehensive review of the current perioperative anesthetic management of pediatric patients with congenital heart disease (CHD) undergoing non-cardiac surgery. This report discusses a case of a nine-month-old female with Tetralogy of Fallot who was scheduled for non-cardiac surgery for anorectal malformation stage 1 and stage 2 repair. This case study discusses how to adjust perioperative anesthesia care in cases of left-to-right shunt, right-to-left shunt, and complex cardiac disease. In addition, the author discusses special considerations such as pulmonary hypertension, newborns with CHD undergoing extracardiac surgery, and the importance of regional anesthesia in children with CHD undergoing non-cardiac surgery.

McKusick-Kaufman Syndrome: A Case Report With an Emphasis on Perinatal Diagnosis and Genetic Counseling

McKusick-Kaufman syndrome is a rare genetic disorder that affects limb development, genital formation, and heart function. It is caused by mutations in the MKKS gene on chromosome 20. Individuals with this condition may have extra fingers or toes, fused labia or undescended testes, and, less commonly, severe heart defects. Diagnosis involves a physical examination and genetic testing, while treatment focuses on symptom management, including surgical intervention if necessary. The prognosis varies depending on the severity of associated complications. In a recent case, a 27-year-old woman with fetal hydrometrocolpos gave birth to a female neonate with extra digits on both hands and feet, fused labia, and a small vaginal opening. The neonate also had a large abdominal cystic mass, and echocardiography revealed a patent foramen ovale. Genetic testing confirmed an MKKS gene mutation, and the hydrometrocolpos required surgical management. Early diagnosis and intervention can improve outcomes for individuals with this syndrome.

Anaesthetic Challenges in a Case of Oral Carcinoma With Anticipated Difficult Airway Posted for Tumour Excision and Reconstruction Surgery

Mandibular surgery, edentulous jaw, denture wear, and ageing are all risk factors for persistent mandibular ridge resorption and weakening. The tongue occludes the upper airway due to the mandible's edentulous condition. All of these factors contribute to the difficulties in regulating the airway. An adequate preoperative review assisted in classifying this index patient as having a high risk of difficult airway management, and appropriate actions were made to facilitate effective airway care. A 60-year-old male presented to casualty with a complaint of squamous cell carcinoma of the right buccal mucosa and was posted for wide local excision of the tumour, segmental mandibulectomy, bilateral modified radical neck dissection, and reconstruction with a fibular free flap. He had a restricted mouth opening and a heavy jaw, with Mallampati grade 4 and had an anticipated difficult airway. Hence, awake endotracheal intubation was done by flexible fibreoptic bronchoscope following airway blocks and an 8.0 mm cuffed flexometallic armoured tube was secured at 28 cm at the angle of the nose. Bilateral modified radical neck dissection and wide local excision of the tumour were done followed by mandibulectomy and its reconstruction by fibular free flap and anastomosis was performed. Tracheostomy was performed and the patient was shifted to the intensive care unit and kept knocked out with injection vecuronium and injection midazolam infusion. The patient was gradually weaned off the ventilator the following day and discharged on postoperative day 12 with minimal postoperative complications. A thorough pre-anaesthetic plan, simple and skilled anaesthetic management strategy, and well-organized teamwork aided in the effective anaesthetic care of this challenging airway patient.

Challenges in Anaesthetic Management in a Case of Facial Plexiform Neurofibromatosis Posted for Debulking Surgery

A patient diagnosed with facial plexiform neurofibromatosis type 1 who is 18 years old and is scheduled for tumour resection and debulking surgery of his face is the subject of this study. The purpose of this paper is to describe the anaesthetic treatment that was administered to this patient. In addition, we analyze the relevant literature, with a particular emphasis on the implications of modifying neurofibromatosis to achieve anaesthesia. Our patient was found to have multiple huge tumours all over his face. When he first arrived, he experienced cervical instability as a result of the enormous mass on the back of his head and in the region of his scalp. He also expected to have difficulty maintaining an airway and breathing through a bag and mask. To protect the patient's airway, a video laryngoscopy was performed, and a difficult airway cart was maintained on standby in the event it was required. In conclusion, the purpose of this case study was to demonstrate the relevance of comprehending the one-of-a-kind anaesthetic requirements of persons diagnosed with neurofibromatosis type 1 who are about to undergo surgical procedures. Neurofibromatosis is an extremely uncommon kind of disease that requires the anesthesiologist's undivided attention in surgical settings. Careful pre-operative planning and competent intra-operative treatment are required when dealing with patients who are expected to have difficult airway management.

P-142 CLINICAL AND ECONOMIC OUTCOMES OF ABSORBABLE KNOTLESS BARBED SUTURE VERSUS OTHER CONVENTIONAL SUTURES FOR ABDOMINAL MIDLINE CLOSURE IN PATIENTS UNDERGOING OPEN HERNIA REPAIRS

Aim

We assessed clinical and economic outcomes of patients undergoing open hernia repair using absorbable knotless barbed suture versus conventional absorbable suture for abdominal wall closure.

Methods

This retrospective cohort study identified patients undergoing hernia repair at a single center between 2013 and 2020. Fixed follow-up of 30, 60, and 90 days were used to assess outcomes (peri-operative complications, and resource utilization). Multivariate analyses for outcomes and Cox Proportional Hazards models for time to readmission and complications were conducted.

Results

Of 821 hernia repairs, 446 used absorbable knotless barbed suture and 375 used conventional absorbable suture. Baseline characteristics were largely similar between the groups. Surgical site infections (SSI) were significantly less frequent with absorbable knotless barbed suture (60-day, 5.9% vs. 11.4%; P=0.0083; 90-day, 5.9% vs. 11.7%; P=0.006) and remained consistent after multivariate adjustment (60-day, OR [95% CI]: 0.52 [0.29–0.92]; 90-day, 0.51 [0.28–0.90]). Among patients with SSI, deep SSI were less frequent with absorbable knotless barbed suture (60-day, 9.1% vs. 35.7%; P=0.022; 90-day, 9.1% vs. 34.9%; P=0.0252). Absorbable knotless barbed suture significantly reduced the risk of peri-operative complications over time (HR 0.57 [95% CI 0.36–0.92]; P=0.0203). Hospital length of stay was, on average, 2.74 days longer in conventional absorbable suture patients (mean [95% CI] 8.75 [7.83–9.78] vs. 6.01 [5.16–6.99] days; P&lt;.0001).

Conclusions

Significant differences between sutures were seen with peri-operative infections, which occurred less frequently with absorbable knotless barbed suture and less severe. Peri-operative complications and length of stay were significantly reduced with absorbable knotless barbed suture.

Covid-19 Affected Workers of Micro, Small, and Medium Enterprises

Purpose: India announced the first lockdown starting from March 25, 2020, due to the outbreak of the COVID-19 pandemic. The Micro, Small and Medium Enterprises (MSMEs) have limited finances, workforce, and operations regarding products or services and do not have the resources to deal with such unexpected lockdowns. This study is to understand the impact of COVID-19 on the workers of MSMEs. Method: An e-questionnaire in the local language was circulated to 444 workers, out of which 426 participated in the study. Result: 98.6% of females earned Rs 5000 to 10000 per month. 95.6% females and 72.1% males saved less than Rs 2000 per month. 25.8% of micro 8.4% of small and 17.2% of the medium-scale workers were not aware of the updates on COVID-19. 70.55% of medium and micro-scale workers stayed at home compared to 45.1% of small-scale workers. 99.7% of micro and small and 93.8% of medium-scale workers regularly sanitized hands at the workplace. 41.9% micro, 84.2% small, and 69% of medium-scale workers said that the COVID-19 outbreak impacted their social life. The pandemic impacted 64.5% micro, 92.9% small, and 97.4% of medium-scale workers’ earnings. 80.6% micro, 97.3% small & 90.5% of medium-scale workers were provided financial assistance by their companies. 80% of medium and micro-scale workers & 94.9% of small-scale workers said they were satisfied with the response/action taken by local municipal authorities. Conclusion: The COVID-19 pandemic has impacted the socio-economic lives of MSME workers. There is an impact of information about the COVID19 outbreak shared by the Govt. of India and social media.

Duration of Postoperative Analgesia with Intravenous Nalbuphine versus Intravenous Butorphanol in Patients Undergoing Short Surgical Procedures under TIVA

Aims and Objectives: To compare the duration of post operative analgesia of nalbuphine 0.3 mg/kg IV and butorphanol 0.04 mg/kg IV in patients posted for short surgical procedures under TIVA. Also to observe the sedation score as well as the side effects like nausea, emesis, pruritis, hypotension, respiratory depression. Materials and Methods: By closed envelope technique, sixty female patients of ASA Class I and II aged 20-60 years, who were posted for short gynaecological surgeries under TIVA were randomly allocated into two groups: Group N (nalbuphine) and Group B (butorphanol). Just prior to surgery, Group N patients got IV Nalbuphine 0.3 mg/kg, while Group B patients received IV Butorphanol 0.04 mg/kg. Patients were asked to rate their pain intensity on a VAS scale in the course of the postoperative period, and the duration of postoperative analgesia was compared between the two groups. The Modified Ramsay sedation scale was exercised to assess sedation at the time of pain complaint, and patients were additionally monitored for 24 hours post the surgery for any adverse or side effects. Results: In group N, 63.33% of patients had duration of pain relief ranging 31-50 minutes, with mean duration of analgesia being 46.333 ± 2.061. In group B, 60% of patients had duration of pain relief ranging from 11-30 minutes, with mean duration being 19.167± 1.68 minutes. In group N, 63.33% of patients had score for sedation as 3 and rest (36.67%) had a  score for sedation as 2.       In group B, 80% of patients had a score for  sedation as  2 and rest (20%) had a score for sedation as 1. Conclusion: When compared to IV Butorphanol, intravenous Nalbuphine delivers a more effective post-operative analgesia with better sedation. IV Nalbuphine is recommended for post operative analgesia in patients undergoing short surgical procedures.  Both the drugs did not cause any side effects.

Anaesthetic Management of a Peripartum Cardiomyopathy Patient Undergoing Caesarean Section

Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the last month of pregnancy or upto five months after delivery. In this condition, the heart chamber enlarges and the muscle weakens. This case report is about a 30- year-old primigravida,with oligohydramnios, at 32.3 weeks of gestation. She visited for a caesarean section, and was diagnosed with PPCM on the basis of clinical findings of growing fatigability, troubled breathing and severe dyspnoea and on echocardiography ejection fraction of 64% with mild mitral regurgitation, moderate dilated left ventricle, tricuspid regurgitation was found. These patients require vigilantanaesthetic intervention for management of painless labour and/or either vaginal or operative delivery. The basic haemodynamic goals should always be kept in mind for favorable maternal as well as foetal outcomewhile selecting the drug dose and mode of anaesthesia. Various studies showed thatboth general and regional anaesthesia can be used with comparable outcomes in PPCM patients undergoing caesarean section. The index patient, who needed a cesarean section, was managed with Combined Spinal-Epidural (CSE) anaesthesia, weighing the risk of increase mortality due to general anaesthesia.

Comparative Evaluation of the Effect of Clonidine and Dexmedetomidine as Adjuncts to Lignocaine in Intravenous Regional Anaesthesia in Forearm and Hand SurgeriesA Randomised Clinical Study

Introduction: Intravenous regional anaesthesia for forearm and hand surgeries, which is one of the safe, cost-effective and rapid onset anaesthesia is less popular nowadays, because of its lesser postoperative analgaesia and tourniquet pain. Aim: To compare dexmedetomidine and clonidine as an adjuvant to 0.5% lignocaine to study block characteristics, tourniquet pain and postoperative analgaesia in forearm and hand surgeries. Materials and Methods: This randomised clinical trial was conducted in Acharya Vinoba Bhave Rural Hospital (Tertiary Care Hospital), Wardha, Maharashtra, India, from September 2019 to September 2021 on 70 patients posted for forearm and hand surgeries. The patients were divided into two groups of 35 each. Group C received clonidine 1 mcg /kg with 40 mL of 0.5% lignocaine preservative free. Group D received dexmedetomidine 1 mcg /kg with 40 mL of 0.5% lignocaine preservative free. Independent samples t-test was used for evaluation of demographic data, haemodynamic data, block characteristics, duration of surgery and tourniquet, onset of tourniquet pain, duration of analgaesia and intraoperative and postoperative analgesic requirement. Results: Onset of sensory and motor block was faster with dexmedetomidine group (1.60±0.60 min and 2.77±0.81 min) when compared to clonidine group (3.57±0.74 min and 6.40±1.26 min). Duration of analgaesia was significantly longer in group D (345.23±44.52 min) compared to group C (205.14±37.76 min), sensory and motor regression was delayed with group D (7.69±0.72 min) as compared to group C (6.40±0.85 min). There was no significant adverse effect noted in both the groups. Conclusion: Dexmedetomidine is an excellent adjuvant when added to lignocaine for Intravenous Regional Anaesthesia (IVRA) in terms of block quality, postoperative analgaesia, and adverse effects.

Effect of Intrathecal Dexmedetomidine as an Adjuvant for Labour Analgesia

Opioids analgesics have been used commonly among several patients in labour in various studies but side effects associated with use of opioids during painless delivery are the main factors that affect rapid postpartum recovery. Opioid use can result in risk of respiratory depression in the patient and can also disrupt the baby’s breathing and heart rate. So, the non opioid analgesic dexmedetomidine, a new alpha-2-adrenergic agonist came into existence, was evaluated and used intrathecally among parturients as an alternative adjuvant. The aim of the present review article was to establish the effect of non opioid analgesic dexmedetomidine, to assess the potency and the safety of dexmedetomidine when given intrathecally as an adjuvant to neuraxial block among patients in labour. Studies report that addition of dexmedetomidine improves the quality of the block, causes an early onset and better length of the sensory block, enhances the onset and duration of the motor block, as well as the onset of analgesia. Additionally, this lengthens the time needed to restore analgesia. Use of dexmedetomidine in combination with bupivacaine significantly prolonges the sensory block time in pregnant women.

Effectiveness of Intrathecal Dexmedetomidine and Fentanyl as Adjuvant to Bupivacaine for Labour Analgesia: A Study Protocol

Background: The most commonly used labour analgesia is epidural. Another alternative method is intrathecal low dose analgesic, given for providing labour analgesia in the areas where the epidural kit, multiparameter monitors, staff members scarcity is present. Fentanyl has been used widely to decrease motor block effect of local anaesthetics during labour, presence of these opioids along with local anaesthetics can cause pruritus and respiratory depression. Selective α2- agonist Dexmedetomidine (DMT) helps in providing stable haemodynamic parameters, and an effective intraoperative and postoperative analgesia. This study aims to compare the effectiveness of an intrathecal analgesia during labor, using bupivacaine in combination with dexmedetomidine and fentanyl in terms of quality and duration of analgesia. Materials and Methods: This will be a prospective comparative observational study. Total 80 patients will be included in the study and assigned to two groups by computerized randomization method. GROUP BD (n=40) will receive an intrathecal 0.5% hyperbaric bupivacaine dose 2.5 mg along with dexmedetomidine dose 2.5 μg .GROUP BF (n=40) will receive an intrathecal 0.5% hyperbaric bupivacaine 2.5mg with fentanyl 25mcg. Data will be analysed and Quality and duration of analgesia will be compared for both groups. Expected Results: Significant difference is expected in labor analgesia and safety profile with the combination of intrathecal bupivacaine and dexmedetomidine compared to combination of bupivacaine and fentanyl.

A Case Report on Cesarean Section under Spinal Anesthesia in a Patient of Takayasu’s Arteritis

Takayasu's arteritis (TA) is a chronic inflammatory illness of the major arteries that is extremely rare. It mainly affects women of reproductive age which increases the risk of cardiovascular problems such hypertension and congestive heart failure. In this study, we discuss the case of a pregnant woman with TA who was diagnosed and managed successfully at a tertiary care facility with a good outcome. As a result, comprehensive care for TA patients has been shown to be critical in achieving optimal maternal and fetal/neonatal outcomes.

A Comparative Perspective Study between Intrathecal Midazolam & Nalbuphine as an adjuvant with Hyperbaric Bupivacaine for Post-Operative Analgesia in Total Abdominal Hysterectomy

Background: Subarachnoid block is the preferred form of regional anesthesia for obstetric surgeries. Local anesthetic agents alone are insufficient in providing adequate postoperative analgesia, which is an essential factor for the patients & is the sole essence of anesthesia. Adding adjuvant will result in better quality, the efficacy of SAB & will prolong analgesia postoperatively. Due to minimal hemodynamic & respiratory complications, Nalbuphine, an opioid, can be favored as an adjuvant to subarachnoid block. The addition of Nalbuphine in limiting doses to Hyperbaric Bupivacaine offers improved block quality & adequate pre & post-operative analgesia. Midazolam, an imidazobenzodiazepine given intrathecally, raises the threshold of pain; it also has hypnotic, anticonvulsant, muscle relaxant & amnesic effects of other benzodiazepines. Objectives: Primarily to compare the duration of pain relief in the postoperative period between administration of Intrathecal Nalbuphine (1mg) & Midazolam(2.5mg) ( Timing of 1st rescue analgesia). Secondarily to compare the onset of action & duration of motor & sensory block (Modified Bromage Scale), Effect on Hemodynamic Parameters, 24 hours requirement of analgesic (No. of Injection Paracetamol 15-20mg/kg ), Degree of sedation(Modified Ramsay Sedation Scale) &  After-effects(PONV, Pruritis, Shivering & Retention of urine). Methodology: The study type will be a Comparative Prospective Study on 60 ASA 1 & 2 females in the age group 35-75 years, planned for total abdominal hysterectomy will be separated in two equivalent Group M (n=30) & Group N (n=30). Group M will receive combination Midazolam preservative-free 0.5 ml (2.5 mg) with 0.5% Hyperbaric Bupivacaine 2.5 ml(12.5 mg), & Group N will receive combination Nalbuphine 1 ml (1 mg) with Hyperbaric Bupivacaine (0.5%) 2.5 ml (12.5mg) by Intrathecal Route. Analgesia duration in the postoperative period, the onset of action & duration of motor & sensory block, effect on hemodynamic parameters, 24 hours analgesics requirement, degree of sedation, after-effects, if any, will be studied & compared. Conclusion: Expected to prove the hypothesis that adding which of the following adjuvant 1mg Nalbuphine or 2.5mg Midazolam with 0.5% Hyperbaric Bupivacaine intrathecally given in SAB prolongs the postoperative analgesia duration more as compared to other.

Formative evaluation of a teledentistry training programme for oral health professionals

INTRODUCTION

The objective of this study was to conduct a formative evaluation of a teledentistry (TD) programme that was developed for a predominantly rural state in the Midwestern United States.

MATERIALS AND METHODS

Formative evaluation data were collected on programme activities from the TD programme records. In addition, the effectiveness of the TD training programme was evaluated using a self-administered paper-based survey administered to the participants, immediately following completion of the training activity. Ninety-three dental students, oral health and other health professionals participated in the TD training programme.

RESULTS

Overall, the trainees rated the TD training programme highly, with regard to the content, format and skills improvement. The evaluation also demonstrated a positive change in all trainees' attitudes following the training sessions, with most trainees acknowledging a positive impact of the training on their knowledge and competency.

DISCUSSION AND CONCLUSIONS

We identified challenges in the development of the TD programme and in expanding access to oral health care for rural communities. Challenges included reimbursement and a limited interest amongst established dental offices. Dental schools can play an important role in preparing both dental health professionals and other health professionals in the use of TD by providing training and oral health expertise. The use of TD by non-dental providers for consultation, referral and disease management has the potential to improve oral health outcomes, particularly for rural and underserved populations. Evaluation data provide critical feedback to programme planners and administrators.

The use of solar energy for powering a portable autoclave

Climate change and the depletion of fossil fuels have forced the developed world to look for clean energy alternatives. Solar cooking is developing in Asian and African countries blessed with ample sun, but is still at an early stage. A portable autoclave was developed in India using this technology. The Prince-40 Concentrator provided adequate capacity to autoclave culture media and treat biomedical waste in a small laboratory set-up, and could save electricity worth Rs. 15,000 (188.10 GBP)/year or LPG worth Rs. 37,500 (470.25 GBP)/year. This technology would be of immense use in health centres in rural areas with frequent power cuts or no power supply.