Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study

BACKGROUND

Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance.

METHODS

Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT).

RESULTS

Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance.

CONCLUSIONS

Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema.

REGISTRATION

ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic.

CLINICALTRIALS

gov/ct2/show/NCT04269382.

Reducing patient's perception of postoperative vaginal bleeding after laparoscopic hysterectomy via independent closure of the vaginal cuff angles (RCT)

STUDY OBJECTIVE

Determine if independently suturing the vaginal cuff angles in addition to running barbed suture has an effect on patients' perception of postoperative bleeding after laparoscopic hysterectomy.

DESIGN

Randomized controlled trial.

SETTING

University-based medical center.

PATIENTS

Females ages 18-60 undergoing laparoscopic hysterectomy.

INTERVENTIONS

Patients were randomly assigned to either cuff closure via single layer of barbed suture (control) vs adding figure-of-eight stitches at each angle (intervention). A survey was given between 10 and 25 days after surgery inquiring about bleeding and dyspareunia. A second survey was given between postoperative days 90-114. Chart review was performed to record emergency room visits, complications, infections, and reoperations during the first 90 postoperative days.

RESULTS

n = 117 patients were analyzed. 62 (control) and 55 (intervention). Groups were similar in terms of age (42.92 v 44.29p =.35), BMI (33.79 v 34.06p =.85), diabetes (5.26 % (3/55) v 15.09 % (8/53) p =.08) p =.97). Bleeding was decreased in intervention arm (24.19 % (15/62) v 9.09 % (5/55) p =.03). Median (IQR) pelvic pain score was similar (2.0 (0-5.0) v 2.0 (0-4.0) p =.26). Median total operative time (IQR) (129 min (102, 166) v 139 min (120, 163) p =.39) and median EBL (IQR) (50 mL (30-75) vs 50 mL (20-75) p =.43) were similar. Cuff closure in seconds (IQR) was higher in intervention group (373 sec (323, 518) v 571 sec (520, 715) p <.01). 8/60 control patients visited the ED (13.33 %) v 7/54 (12.96 %) p =.95. Readmissions (1.67 % (1/60) v 1.85 % (1/55) p = 1), re-operations (0 % (0/60) v 1.85 % (1/55) p =.47) and postoperative infections (5.0 % (3/60) v 1.85 % (1/54) p =.62) were similar. Secondary survey showed no significant difference in bleeding (15.38 % (4/26) v 4.35 % (1/23) p =.35) and SF-36 results were similar.

CONCLUSION

Independently suturing the vaginal cuff angles reduces patients' perception of vaginal bleeding in the early postoperative period. Incidence of complications, reoperations, and long-term quality of life are similar.

Differences in residual volume above different tracheostomy tube cuffs depending on tube structure, tube tilt angle, and liquid viscosity

INTRODUCTION

Proper management of aspirated material above the tracheostomy tube cuff is crucial to prevent complications, such as aspiration pneumonia. This study aimed to thoroughly examine the effects of aspirated liquid viscosity, suction port positioning, and tube tilt angle on residual volume above the cuff (RVAC).

METHODS

Five types of tracheostomy tubes (approximately 9 mm outer diameter) were placed through a transparent cylinder with an inner diameter of 18 mm. The cuff was inflated to completely seal the interior of the cylinder. Four liquids with different viscosities were poured onto the cuff, and the liquid above the cuff was suctioned from the side port. The cylinder was angled at 90° and 20°, and each test was performed thrice to determine the average RVAC.

RESULTS

After side-port suctioning, some liquid residue was observed on the cuff of all tracheostomy tubes. The RVAC increased with higher liquid viscosity. The tubes with a longer distance from the suction port opening to the cuff top exhibited more RVAC. Moreover, the RVAC was almost the same regardless of the cylinder angle for tubes with a suction port on the lateral side. However, tubes with backside ports showed a decreased RVAC with cylinder tilt.

CONCLUSIONS

This study underscores the persistence of residual material on cuffed tracheostomy tubes even with regular subglottic secretion drainage. This emphasizes the need for specialized tracheostomy tube development aimed at reducing post-suction RVAC. Improved designs can potentially minimize complications associated with residue accumulation.

Application of Electrical Stimulation to Enhance Axon Regeneration Following Peripheral Nerve Injury

Enhancing axon regeneration is a major focus of peripheral nerve injury research. Although peripheral axons possess a limited ability to regenerate, their functional recovery is very poor. Various activity-based therapies like exercise, optical stimulation, and electrical stimulation as well as pharmacologic treatments can enhance spontaneous axon regeneration. In this protocol, we use a custom-built cuff to electrically stimulate the whole sciatic nerve for an hour prior to transection and repair. We used a Thy-1-YFP-H mouse to visualize regenerating axon profiles. We compared the regeneration of axons from nerves that were electrically stimulated to nerves that were not stimulated (untreated). Electrically stimulated nerves had longer axon growth than the untreated nerves. We detail how variations of this method can be used to measure acute axon growth.

Role of Bladder Functional Testing Prior to Surgeries for Benign Prostatic Obstruction

PURPOSE OF REVIEW

There is no consensus on preoperative functional testing prior to surgeries for benign prostatic obstruction causing lower urinary tract symptoms (LUTS).

RECENT FINDINGS

Surgical management offers definite benefits, but the results are not always satisfactory. The urodynamic study (UDS) is the gold standard for assessing bladder outlet obstruction (BOO) which is the best predictor of surgical success. Yet, it is not recommended by our urologic societies as standard testing prior to surgery. In this narrative review of the literature, we report recent findings and controversies regarding the benefits and downside of UDS, and the use of other less-invasive approaches to achieve this goal. The lack of strong evidence for or against performing UDS was surprising. Prospective UDS data may not predict surgical outcomes if there is no consensus on criteria that directs surgical intervention. However, confirming the presence of BOO and characterizing the bladder function to identify detrusor over- and underactivity may help counselling and setting patient's post-operative expectations. Urocuff, a non-invasive testing offers promising results to address this problem with a less-invasive assessment of BOO. We emphasize better pre-operative characterization of patients to confirm BOO and better define subgroups to improve surgical decision-making.

The role of estrogen and progesterone receptors in the rotator cuff disease: a retrospective cohort study

Background

Rotator cuff (RC) tears represent a common cause of shoulder pain and dysfunction in adults. The disease affects primarily women and occurs mainly in the postmenopausal period.

This study aimed to investigate immunohistochemically the presence of estrogen receptor-alpha (ER-⍺), estrogen receptor-beta (ER-β) and progesterone receptor (PR) in the supraspinatus tendon of patients with RC tendinopathy, searching for gender differences of expression. A secondary aim was to evaluate potential links between their expression and the typical histopathological findings of the ailment.

Methods

Biopsies of the supraspinatus tendon were collected intraoperatively from 15 postmenopausal women and 9 men undergoing RC surgery. Specimens were stained with Haematoxylin/Eosin, Masson-Goldner Trichrome, Alcian Blu and immunohistochemical stainings for ER-⍺, ER-β and PR were performed. Tendon alterations were evaluated with the Bonar histopathological scale. Statistical tests used in this study were the Spearman correlation coefficient and the Mann-Whitney U test.

Results

In the supraspinatus tendon, cells expressed ER-⍺ (p = 0.043), ER-β (p = 0.048) and PR (p = 0.004) with statistically significant differences related to age and sex of patients. Immunoreactivity was seen in the nuclei of tenocytes and vascular cells. Postmenopausal women’s samples showed a markedly higher expression of these receptors compared to their male counterpart. There was a positive correlation between the expression of ER-⍺ and ER-β (r = 0.59; p = 0.02) and between ER-β and PR (r = 0.72; p = 0.002) in women’s samples. Furthermore, in postmenopausal women the PR expression decreased with age (r = − 0.56; p = 0.027). Only in women, the ER-β expression positively correlated with the total Bonar histopathological score (p = 0.019) and the ER-β vascular expression positively correlated with ground substance alterations (p = 0.029).

Conclusions

These results reveal that ERs and PR are present in the supraspinatus tendon of patients with RC tears, suggesting a role of sex hormones in the pathogenesis of the disease.

The Relevance of Open Rotator Cuff Repair in 2021

BACKGROUND

The last decade has seen a large increase in rotator cuff surgery and arthroscopic surgery. We were asked to define the relevance of open rotator cuff repair in 2021.

PURPOSE

To define whether there are proven advantages to arthroscopic or open rotator cuff repair surgery.

METHOD

We reviewed the recent literature regarding recent trends, anaesthetic time, rehabilitation, post-operative pain, complications, economic considerations, the learning curve and outcomes. We outlined the senior authors' technique preferences, rationale and patient reported outcomes.

RESULTS

There is no clear evidence of proven advantage in arthroscopic rotator cuff repair compared to open rotator cuff repairs, with regard to outcomes or the other aspects reviewed. There were no differences in the outcomes of arthroscopic and open repairs in the senior authors practice with his procedure indications.

CONCLUSIONS

Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited. We believe surgeons should learn both techniques and the principles of good patient selection, tissue handling, and fixation techniques are of paramount importance in both arthroscopic and open rotator cuff surgery.

Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model

PURPOSE

Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success.

METHODS

A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size "repair box" using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box.

RESULTS

Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage.

CONCLUSION

Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.

Endotracheal tube inflation tubing defect: an unusual cause of intraoperative volume leak

Loss of endotracheal cuff pressure can lead to airway compromise and loss of volume delivery in mechanical ventilation requiring immediate intervention. A 40 years old male posted for bilateral interpositional arthroplasty was intubated nasally with 7.5 mm flexometallic endotracheal tube. In the intraoperative period airway leak was detected due to loss of cuff pressure even after repeated attempt of cuff inflation. After changing endotracheal tube, leak was detected from the inflation tubing distal to the cuff, which was apparent only when cuff pressure was increased above 30 cm of H₂O.

Neonatal Blood Pressure Standards: What Is "Normal"?

Blood pressure (BP) is routinely measured in newborn infants. Published BP nomograms demonstrate a rise in BP following delivery in healthy infants at all gestational ages (GA) and evidence that BP values are higher with increasing birth weight and GA. However, the complex physiology that occurs in newborn infants and range of BP values observed at all GA make it difficult to identify "normal" BP for a specific infant at a specific time under specific conditions. As such, complete hemodynamic assessment should include the physical examination, perinatal history, other vital signs, and laboratory values in addition to BP values.

Pelvic myoma arising from vaginal cuff after hysterectomy: A case report and literature review

Leiomyomas are the most common benign gynecologic tumors and the most common surgical indication for hysterectomy or myomectomy. Recurrent pelvic leiomyomas or vaginal leiomyomas are rare. We report the case of a 60-year-old woman with a history of a cesarean total hysterectomy 25 years before presenting to us, who developed a pelvic leiomyoma arising from the vaginal cuff. The patient underwent single-port laparoscopic tumor excision and recovered uneventfully.

An endotracheal tube providing "pressurized sealing" prevents fluid leakage in mechanically ventilated critically ill patients: a pilot study

Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. We conducted a 24 h study to investigate the sealing effect of this ETT in 12 critically ill mechanically ventilated patients. Methylene blue, instilled through a bronchoscope on top of the proximal cuff, was used as leakage tracer. Fiberoptic visualisation of the trachea was performed 1 h and 24 h thereafter. Leakage was confirmed if blue dye was detected on the tracheal mucosa beyond the tip of the ETT. In no patient, dye passed by the cuffs during the study period. Presence of the ETT did not interfere with ventilator settings, patient mobilization, physiotherapy, and technical acts. Overall, pressures in the intercuff space remained between 10 and 15 cmH₂O. Excessive pressure swings were swiftly corrected by the CPAP system. A double-cuffed ETT, offering “pressurized sealing” of the trachea, safely and effectively prevented leakage during 24 h mechanical ventilation.

Epidemiology of rotator cuff surgery in Italy: regional variation in access to health care. Results from a 14-year nationwide registry

PURPOSE

Rotator cuff (RC) disease is frequent and represents a common source of shoulder pain. The aim of this study is to analyse geographical differences in RC surgeries from 2001 to 2014 in Italy, a country with universal and free health care for its population.

METHODS

An analysis of the Italian National Hospital Discharge records from 2001 to 2014 was performed. These data are anonymous and include patient's age, sex, domicile, region of hospitalization, length of the hospitalization and type of reimbursement (public or private). National and regional population data were obtained from the National Institute for Statistics (ISTAT) for each year.

RESULTS

During the 14-year study period, 390,001 RC repairs were performed in Italy, which represented a mean incidence of 62.1 RC procedures for every 100,000 Italian inhabitants. Nevertheless, the incidence was very different if every single regional population is considered individually. Lombardy resulted to have the highest number of surgeries during the 14-year study period, with 27.95% (108,954) of the total national procedures performed in the 2001-2014 time span. More than half the surgeries (52.00%) were performed in only 3 regions of the northern part of Italy.

CONCLUSIONS

This study shows the existence of geographical disparities in access to RC surgery and patients' necessity to migrate among regions in order to obtain it. Southern regions of Italy are characterized by a lower number of surgeries compared to the northern part of Italy.

Acute effects of whole body vibration combined with blood restriction on electromyography amplitude and hormonal responses

The purpose of this study was to investigate the effects of whole body vibration (WBV) exercise with and without blood flow restriction (BFR) on electromyography (EMG) amplitude and hormonal responses. Eight healthy male adults who lacked physical activity participated in this study and completed 10 sets of WBV and WBV + BFR sessions in a repeated measures crossover design. In the WBV + BFR session, the participants wore a BFR device inflated to 140 mmHg around the proximal region of the thigh muscles. The results indicated that the EMG values from the rectus femoris and vastus lateralis during the WBV + BFR session were significantly higher than those during the WBV session (p < 0.05). Two-way analysis of variance with repeated measures showed that the WBV + BFR and WBV exercise sessions induced a significant (simple main effect for time) increase in lactate (LA) (0.61–4.68 vs. 0.46–3.44 mmol/L) and growth hormone (GH) (0.48–3.85 vs. 0.47–0.82 ng/mL) responses after some of the post-exercise time points (p < 0.05). WBV + BFR elicited significantly higher LA and GH (simple main effect for trial) responses than did WBV after exercise (p < 0.05). Although no significant time × trial interactions were observed for testosterone (T) (604.5–677.75 vs. 545.75–593.88 ng/dL), main effects for trial (p < 0.05) and for time (p < 0.05) were observed. In conclusion, WBV + BFR produced an additive effect of exercise on EMG amplitude and LA and GH responses, but it did not further induce T responses compared to those with WBV alone.

Efficacy and safety of a new elastic tourniquet cuff in total knee arthroplasty: a prospective randomized controlled study

Background

The effects of cuff shape, timing of tourniquet application, and automated systems using limb occlusion pressure (LOP) have been reported to minimize the appropriate tourniquet pressure. However, studies on the raw material of the cuff itself to reduce the complications related to the tourniquet have been very rarely reported. The purpose of this study is to report the efficacy and safety of a tourniquet system with a new elastic cuff in which pressure is set with LOP in total knee arthroplasty (TKA).

Methods

A total of 63 patients who underwent primary TKA for osteoarthritis were enrolled from July to December 2015. Thirty-one patients were allocated to the new elastic cuff group and 32 in the conventional cuff group. Bloodless surgical field, pain visual analog scale (VAS) on the thigh, thigh circumference, range of motion, incidence of deep vein thrombosis, and muscle enzyme level after surgery were checked and compared between the 2 groups.

Results

Only 1 of the 31 patients in the elastic cuff group required more pressure for obtaining a bloodless surgical field, whereas 4 of the 32 patients in the conventional cuff group required more pressure to complete surgery without being disturbed by sustained bleeding. Two patients in the conventional cuff group needed treatment for blisters and bullae at the tourniquet application site. There was no difference in pain VAS score, thigh circumference, range of motion, incidence of deep vein thrombosis, and level of muscle enzyme.

Conclusions

A new elastic tourniquet cuff provided a more proper bloodless surgical field with less adjustment of tourniquet pressure despite a similar level of tourniquet pressure compared to the conventional cuff and had a low incidence of skin complications on the site of tourniquet application in TKA. These benefits make it an effective and safe medical device for orthopedic surgery requiring a tourniquet, such as TKA.

Perivascular medical devices and drug delivery systems: Making the right choices

Perivascular medical devices and perivascular drug delivery systems are conceived for local application around a blood vessel during open vascular surgery. These systems provide mechanical support and/or pharmacological activity for the prevention of intimal hyperplasia following vessel injury. Despite abundant reports in the literature and numerous clinical trials, no efficient perivascular treatment is available. In this review, the existing perivascular medical devices and perivascular drug delivery systems, such as polymeric gels, meshes, sheaths, wraps, matrices, and metal meshes, are jointly evaluated. The key criteria for the design of an ideal perivascular system are identified. Perivascular treatments should have mechanical specifications that ensure system localization, prolonged retention and adequate vascular constriction. From the data gathered, it appears that a drug is necessary to increase the efficacy of these systems. As such, the release kinetics of pharmacological agents should match the development of the pathology. A successful perivascular system must combine these optimized pharmacological and mechanical properties to be efficient.

The burden of rotator cuff surgery in Italy: a nationwide registry study

PURPOSE

This study aimed to estimate the yearly number of RC surgeries in Italy, a country with universal access to healthcare for its population, from 2001 to 2014, based on official information source as hospitalization records. A secondary aim was to explore geographical variation in equity in access to RC surgery between three macroregions of Italy (North, Center and South). A tertiary aim was to perform statistical projections of the number of RC procedure volumes and rates on the basis of data from 2001 to 2014. Finally, we aimed to perform a prediction of charges by 2025 to examine the economic impact of RC surgery.

METHODS

The analysis of the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health, concerning the 14 years of our survey (2001 through 2014) was performed. These data are anonymous and include the patient's age (in aggregate for class of age), sex, domicile, region of hospitalization, length of the hospitalization, and type of reimbursement (public or private).

RESULTS

During the 14-year study period, 390,001 RC repairs were performed in Italy, which represented an incidence of 62.1 RC procedures for every 100,000 Italian inhabitants over 25 years old. Approximately 65% of RC repair were performed annually in patients ages <65 years, thus affecting the working population. 246,810 patients (63.3%) from the North underwent RC repairs from 2001 through 2014, 78,540 patients (20.2%) from the Center, and 64,407 patients (16.5%) from the South. The projection model predicted substantial increases in the numbers of RC repairs.

CONCLUSIONS

This study confirms that the socioeconomic burden of RC surgery is growing and heavily affecting the working population. According to the prediction model, hospital costs sustained by the national health care system for RC procedures are expected to be over 1 billion euros by 2025.

LEVEL OF EVIDENCE

II.

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.

The Effect of the Silicone Ring Tourniquet and Standard Pneumatic Tourniquet on the Motor Nerve Conduction, Pain and Grip Strength in Healthy Volunteers

BACKGROUND

The pneumatic tourniquet (PT) is routinely used in upper and lower limb operations by most orthopaedic surgeons. The silicone ring tourniquet (SRT) was introduced in clinical practice over the last decade. Clinical as well as comparative studies have been published in volunteers concerning its safety and efficacy. The aim of this study was to investigate the postoperative effect of the silicone ring tourniquet (SRT), primarily on the motor nerve conduction, and secondarily on the pain and grip strength, in comparison to the effect of the pneumatic tourniquet (PT) in healthy volunteers.

METHODS

Both tourniquets were applied in the forearm of the dominant arm in 20 healthy volunteers and were kept on for 10 minutes. Pain was measured using the visual analogue scale and grip strength was measured with a hand dynamometer. We evaluated the following parameters of median nerve conduction: motor conduction velocity (MCV), latency (LAT) and amplitude (AMP).

RESULTS

Pain score at the time of tourniquet application was higher in SRT group but the alteration in pain scores in PT group was higher, with statistical significance (P<0.05). The grip strength was reduced by the application of both tourniquets; however there was a significantly higher reduction in the SRT group (P<0.05). The conduction impairment of the median nerve was worse in the PT group than in the SRT one, according to the changes in MCV (P<0.05).

CONCLUSION

Median nerve conduction was affected more after PT application as compared to the SRT. Nevertheless, the reduction of grip strength was higher after the SRT application.

Pneumatic tourniquet use in foot and ankle surgery--is padding necessary?

BACKGROUND

The majority of foot and ankle surgery is carried out in a bloodless field achieved by the use of a pneumatic tourniquet. The risks of tourniquet use may be divided into those resulting from direct mechanical pressure from the cuff and those secondary to prolonged limb ischaemia. Current peri-operative guidelines advise the use of padding beneath the cuff, in particular to reduce skin complication.

OBJECTIVES

To assess the complication rate of tourniquet use when the cuff is applied directly to the skin.

METHOD

Patients undergoing foot and ankle surgery under tourniquet control without use of padding were assessed pre and post operatively for soft tissue complication, neurological deficit and post-tourniquet syndrome.

RESULTS

We recorded findings for 97 patients, 47 thigh and 50 ankle tourniquets. We found a complication rate of 0%. There were no cases of skin blistering, abrasion, bruising, laceration or burn.

CONCLUSIONS

These findings are contrary to published RCTs supporting the use of padding. Our study demonstrates the safe use of pneumatic tourniquets without padding in foot and ankle surgery.

In vitro evaluation of diffusion of lidocaine and alkalinized lidocaine through the polyurethane membrane of the endotracheal tube

OBJECTIVES

Endotracheal tube (ETT) and its inflated cuff are likely to induce specific reactivity at the emergence time. In ICU, the tolerance of the ETT cuff could be a part of patient agitation and increased of sedation.

MATERIALS AND METHODS

Using specific ICU ETT cuff (thin polyurethane cuff), we perform an in vitro evaluation of diffusion of lidocaine and alkalinized lidocaine (L-B) across the PU cuff for a long duration. We evaluate the safety of this procedure by a daily injection into the cuff.

RESULTS

With lidocaine alone, we observed a low rate of diffusion through the cuff (<8% over 24h), whereas the L-B solution had a high diffusion (>90% over 24h). The released profiles were similar from day 0 to day 8, and no cuff rupture was reported over the 8-day study.

CONCLUSION

The safety, controlled release, and lack of deleterious effects on cuff membrane were confirmed. In case of unexpected cuff rupture, an adequate determination of the mixture allows to obtain a safe solution with the achievement of a physiological pH (7.4) and the small dose of lidocaine (40 mg).

Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

We discuss a case of difficult extubation, due to inadequate deflation of the tracheal tube cuff, despite collapse of the pilot balloon, on its aspiration. This was caused by inadvertent kinking of the pilot balloon tubing due to inappropriate tape fixation of the endotracheal tube.

Radial nerve injury due to automatic blood pressure monitoring: A case report

We experienced an unusual complication of acute radial nerve palsy presenting as wrist drop after application of automated cycled blood pressure monitoring for 3 hours. A 19-year-old ASA physical status 1 female was scheduled to undergo nail removal, had been operated internal transport over the nail lengthening for fibular hemimelia. Blood pressure cuff was affixed to her right upper arm and worked automatically every 5 minute during surgery. One day after operation she complained of pain over the lower lateral aspect of the right upper arm and examination revealed zero power of the wrist and finger extensor muscles. Electromyelography (EMG) and nerve conduction velocity (NCV) revealed right radial neuropathy. She was discharged 20 days after operation with improvement of the right upper arm pain. After three months of physical therapy, the muscle power of wrist extensors reverted to completely normal and the muscle power of the finger extensors improved to fair.