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Low resource anesthesia

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https://www.readbyqxmd.com/read/30098047/fluorescent-reporter-mice-for-nerve-guidance-conduit-assessment-a-high-throughput-in-vivo-model
#1
Suresh Mohan, Iván Coto Hernández, Wenjin Wang, Kaiyang Yin, Cathryn A Sundback, Ulrike G K Wegst, Nate Jowett
OBJECTIVE: Use of cell culture and conventional in vivo mammalian models to assess nerve regeneration across guidance conduits is resource-intensive. Herein we describe a high-throughput platform utilizing transgenic mice for stain-free axon visualization paired with rapid cryosection techniques for low-cost screening of novel bioengineered nerve guidance conduit performance. METHODS: Interposition repair of sciatic nerve transection in mice expressing yellow fluorescent protein in peripheral neurons (Thy1...
August 10, 2018: Laryngoscope
https://www.readbyqxmd.com/read/30045182/a-sustainable-and-scalable-approach-to-the-provision-of-cleft-care-a-focus-on-safety-and-quality
#2
Tara L Braun, Matthew R Louis, Ryan M Dickey, Edward P Buchanan
BACKGROUND: A global health model based on partnering with local hospitals and surgical teams, providing education and training for local providers, and mandating adherence to safety and quality standards to ensure safe surgery and anesthesia care can build local surgical capacity and strengthen existing health care systems in low- and middle-income countries. Smile Train uses this sustainable partnership model to provide responsible humanitarian aid while maintaining a bidirectional exchange with its international partners...
August 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/30007249/an-alternate-surgical-approach-to-reduce-hemorrhage-and-complications-during-cesarean-hysterectomy-for-adherent-placenta
#3
Pradip Kumar Saha, Rashmi Bagga, Jasvinder Kaur Kalra, Aashima Arora, Rimpi Singla, Vanita Suri, Kajal Jain, Praveen Kumar, Nalini Gupta, Ashish Jain, Tulika Singh, Ravimohan S Mavuduru
BACKGROUND: Cesarean hysterectomy for adherent placenta is associated with increased maternal morbidity due to massive hemorrhage requiring large volume blood transfusion, bladder or ureteric injury, intensive care unit (ICU) admission and prolonged hospital stay. There is an ongoing effort to improve the outcome of these women and measures to reduce blood loss. OBJECTIVE: The purpose of the present study was to develop an alternate surgical approach for performing a Cesarean hysterectomy in women with adherent placenta in order to reduce hemorrhage and urinary tract injuries, and thereby improve the maternal outcome...
July 4, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29985841/postoperative-airway-obstruction-in-a-low-resource-setting-a-case-report
#4
Gregory C Sund, Samuel Nizigiyimana
A 2-month-old girl with abnormal facial features and malnutrition presented for placement of a gastrostomy tube. The surgery was performed under general anesthesia using a laryngeal mask airway (LMA); however, after removal of the LMA, the patient had recurrent airway collapse, requiring repeated insertion of the LMA. The authors describe the management of this problem with the use of a tongue suture and anterior traction in the postoperative period in a resource-limited setting.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4...
July 5, 2018: A&A practice
https://www.readbyqxmd.com/read/29961144/design-and-evaluation-of-a-real-time-physiological-signals-acquisition-system-implemented-in-multi-operating-rooms-for-anesthesia
#5
Quan Liu, Li Ma, Shou-Zen Fan, Maysam F Abbod, Cheng-Wei Lu, Tzu-Yu Lin, Kuo-Kuang Jen, Shang-Ju Wu, Jiann-Shing Shieh
With critical importance of medical healthcare, there exist urgent needs for in-depth medical studies that can access and analyze specific physiological signals to provide theoretical support for practical clinical care. As a consequence, obtaining the valuable medical data with minimal cost and impacts on hospital work comes as the first concern of researchers. Anesthesia plays a widely recognized role in surgeries, which attracts people to undertake relevant research. In this paper, a real-time physiological medical signal data acquisition system (PMSDA) for the multi-operating room applications is proposed with high universality of the hospital practical settings and research requirements...
June 30, 2018: Journal of Medical Systems
https://www.readbyqxmd.com/read/29925253/using-clinical-indicators-to-reduce-perianesthesia-recovery-time-following-outpatient-tonsillectomy
#6
Habib G Zalzal, Chadi A Makary, Raquel Evans, Stacy Giardina, Tracy Underwood, Aletha Rowlands, Hassan H Ramadan
OBJECTIVE: To determine whether we could reduce the time that patients undergoing tonsillectomy are observed postoperatively without decreasing the quality of care, which would eliminate the unnecessary use of resources to monitor those patients. STUDY DESIGN: Prospective cohort. METHODS: Patients undergoing tonsillectomy were recruited for the study prior to their operation. Each patient was then monitored in perianesthesia recovery until clinical indicators for discharge readiness were met (baseline respiratory function, afebrile, ambulation per age, adequate consciousness, absence of nausea/vomiting, adequate pain control, no active bleeding, fluid toleration)...
June 1, 2018: Annals of Otology, Rhinology, and Laryngology
https://www.readbyqxmd.com/read/29912008/processed-electroencephalogram-monitoring-and-postoperative-delirium-a-systematic-review-and-meta-analysis
#7
Kristen K MacKenzie, Angelitta M Britt-Spells, Laura P Sands, Jacqueline M Leung
BACKGROUND: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction...
June 15, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29889708/a-prospective-observational-study-of-anesthesia-related-adverse-events-and-postoperative-complications-occurring-during-a-surgical-mission-in-madagascar
#8
Michelle C White, Brian J Barki, Stephen A Lerma, Sarah Kate Couch, Dennis Alcorn, Richard G Gillerman
BACKGROUND: Two-thirds of the world's population lack access to safe anesthesia and surgical care. Nongovernmental organizations (NGOs) play an important role in bridging the gap, but surgical outcomes vary. After complex surgeries, up to 20-fold higher postoperative complication rates are reported and the reasons for poor outcomes are undefined. Little is known concerning the incidence of anesthesia complications. Mercy Ships uses fully trained staff, and infrastructure and equipment resources similar to that of high-income countries, allowing the influence of these factors to be disentangled from patient factors when evaluating anesthesia and surgical outcomes after NGO sponsored surgery...
August 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29870136/guidelines-and-checklists-for-short-term-missions-in-global-pediatric-surgery-recommendations-from-the-american-academy-of-pediatrics-delivery-of-surgical-care-global-health-subcommittee-american-pediatric-surgical-association-global-pediatric-surgery-committee
#9
Marilyn Butler, Elizabeth Drum, Faye M Evans, Tamara Fitzgerald, Jason Fraser, Ai-Xuan Holterman, Howard Jen, Matthew Kynes, Jenny Kreiss, Craig D McClain, Mark Newton, Benedict Nwomeh, James O'Neill, Doruk Ozgediz, George Politis, Henry Rice, David Rothstein, Julie Sanchez, Mark Singleton, Francine S Yudkowitz
Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries are increasingly engaged in resource-limited areas, with short-term missions as the most common form of involvement. However, consensus recommendations currently do not exist for short-term missions in pediatric general surgery and associated perioperative care. The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc...
May 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29859626/short-term-surgical-missions-in-resource-limited-environments-five-years-of-early-surgical-outcomes
#10
Peter F Johnston, Anastasia Kunac, Mawuli Gyakobo, Samba Jalloh, David H Livingston, Ziad C Sifri
Outcomes of short-term surgical missions (STSMs) hosted in developing countries are underreported, raising quality concerns. This study aims to analyze early outcomes of one humanitarian surgical organization to show that safe essential general surgery can be provided in the context of STSMs. Records from 6 STSMs to Sierra Leone and Ghana were reviewed for early complications and analysis performed to identify associated factors. Missions performed elective, general surgery on low risk patients, with adherence to patient safety protocols...
May 18, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29847377/efficacy-of-malignant-hyperthermia-association-of-the-united-states-recommended-methods-of-preparation-for-malignant-hyperthermia-susceptible-patients-using-dr%C3%A3-ger-zeus-anesthesia-workstations-and-associated-costs
#11
Victor Manuel Neira, Waleed Al Madhoun, Kamyar Ghaffari, Nicholas Barrowman, Patrick Berrigan, William Splinter
BACKGROUND: The objective of this study was to assess the efficacy and cost of Malignant Hyperthermia Association of the United States-recommended methods for preparing Dräger Zeus anesthesia workstations (AWSs) for the malignant hyperthermia-susceptible patient. METHODS: We studied washout profiles of sevoflurane, isoflurane, and desflurane in 3 Zeus AWS following 3 preparation methods. AWS was primed with 1.2 minimum alveolar concentration anesthetic for 2 hours using 2 L/min fresh gas flow, 500 mL tidal volume, and 12/min respiratory rate...
May 25, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29781859/nonoperating-room-anesthesia-for-gastrointestinal-endoscopic-procedures
#12
Otto S Lin, Wade Weigel
PURPOSE OF REVIEW: To assess the trends in nonoperating room anesthesia (NORA) for gastrointestinal endoscopy over the past few years, and to describe alternative methods of delivering propofol sedation in selected low-risk patients. RECENT FINDINGS: The use of NORA for routine gastrointestinal endoscopic procedures has been rising steadily over the past decade in the United States, considerably increasing healthcare costs. Because of this, there have been attempts to develop nonanesthesiologist-administered propofol sedation methods in low-risk patients...
August 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29682064/awake-craniotomy-with-noninvasive-brain-mapping-by-3-tesla-functional-magnetic-resonance-imaging-for-excision-of-low-grade-glioma-a-case-of-a-young-patient-from-pakistan
#13
Atta Ul Aleem Bhatti, Nasir Khan Jakhrani, Maria Adnan Parekh
The past few years have seen increasing support for gross total resection in the management of low-grade gliomas (LGGs), with a greater extent of resection correlated with better overall survival, progression-free survival, and time to malignant transformation. There is consistent evidence in literature supporting extent of safe resection as a good prognostic indicator as well as positively affecting seizure control, symptomatic relief in pressure symptoms, and longer progression-free and total survival. The operative goal in most LGG cases is to maximize the extent of resection for these benefits while avoiding postoperative neurologic deficits...
April 2018: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29664956/you-pray-to-your-god-a-qualitative-analysis-of-challenges-in-the-provision-of-safe-timely-and-affordable-surgical-care-in-uganda
#14
Katherine Albutt, Rachel R Yorlets, Maria Punchak, Peter Kayima, Didacus B Namanya, Geoffrey A Anderson, Mark G Shrime
BACKGROUND: Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. METHODS: From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care...
2018: PloS One
https://www.readbyqxmd.com/read/29655617/novel-treatment-of-papillomatous-conjunctival-lesions-using-pattern-scanning-laser-photocoagulation-1-year-results
#15
R N Belfort, J Isenberg, A G Castillejos, R Sant'ana, A O Romano
PURPOSE: To evaluate the safety and 1-year effect of pattern scanning laser photocoagulation treatment for pedunculated papillomatous and sessile conjunctival lesions in a low-resource setting with extremely limited operating room access. METHODS: Adult patients with clinical diagnosis of conjunctival papilloma underwent complete ophthalmologic exam including anterior segment photography. After topical anesthesia and toluidine blue 1% instillation, the lesion was treated by pattern scanning photocoagulation using a duration time that varied from 20 to 100 ms and power from 600 to 1800 mW, treating the entire lesion surface with a 2 mm margin...
July 2018: Ocular Surface
https://www.readbyqxmd.com/read/29619512/a-nationwide-assessment-of-pediatric-surgical-capacity-in-mongolia
#16
Laura F Goodman, Erdenetsetseg Chuluun, Burmaa Sanjaa, Sanchin Urjin, Sarnai Erdene, Narantuya Khad, Adiyasuren Jamiyanjav, Jacob Stephenson, Diana L Farmer
BACKGROUND: Mongolia is a country characterized by its vast distances and extreme climate. An underdeveloped medical transport infrastructure makes patient transfer from outlying regions dangerous. Providing pediatric surgical care locally is crucial to improve the lives of children in the countryside. This is the first structured assessment of nationwide pediatric surgical capacity. METHODS: Operation rates were calculated using data from the Mongolian Center for Health Development and population data from the Mongolian Statistical Information Service...
April 4, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29580444/medical-simulation-as-a-vital-adjunct-to-identifying-clinical-life-threatening-gaps-in-austere-environments
#17
Adaora M Chima, Rahul Koka, Benjamin Lee, Tina Tran, Onyebuchi U Ogbuagu, Howard Nelson-Williams, Michael Rosen, Michael Koroma, John B Sampson
BACKGROUND: Maternal mortality and morbidity are major causes of death in low-resource countries, especially those in Sub-Saharan Africa. Healthcare workforce scarcities present in these locations result in poor perioperative care access and quality. These scarcities also limit the capacity for progressive development and enhancement of workforce training, and skills through continuing medical education. Newly available low-cost, in-situ simulation systems make it possible for a small cadre of trainers to use simulation to identify areas needing improvement and to rehearse best practice approaches, relevant to the context of target environments...
April 2018: Journal of the National Medical Association
https://www.readbyqxmd.com/read/29547426/improving-anesthesia-safety-in-low-resource-settings
#18
Fauzia A Khan, Alan F Merry
The safety of anesthesia characteristic of high-income countries today is not matched in low-resource settings with poor infrastructure, shortages of anesthesia providers, essential drugs, equipment, and supplies. Health care is delivered through complex systems. Achieving sustainable widespread improvement globally will require an understanding of how to influence such systems. Health outcomes depend not only on a country's income, but also on how resources are allocated, and both vary substantially, between and within countries...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29547424/education-the-heart-of-the-matter
#19
Wayne W Morriss, Miodrag S Milenovic, Faye M Evans
There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29547423/strengthening-the-anesthesia-workforce-in-low-and-middle-income-countries
#20
Søren Kudsk-Iversen, Naomi Shamambo, M Dylan Bould
The majority of the world's population lacks access to safe, timely, and affordable surgical care. Although there is a health workforce crisis across the board in the poorest countries in the world, anesthesia is disproportionally affected. This article explores some of the key issues that must be tackled to strengthen the anesthesia workforce in low- and lower-middle-income countries. First, we need to increase the overall number of safe anesthesia providers to match a huge burden of disease, particularly in the poorest countries in the world and in remote and rural areas...
April 2018: Anesthesia and Analgesia
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