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Anesthesia And Safety(Regional)

Benjamin J Levy, Brandon M Tauberg, Ari J Holtzman, Konrad I Gruson
INTRODUCTION: To report on the effectiveness of a standardized patient positioning and padding protocol in reducing lateral femoral cutaneous nerve (LFCN) palsy in obese patients who have undergone shoulder surgery in the beach chair position. METHODS: We retrospectively reviewed the medical records of 400 consecutive patients with a body mass index (BMI) of ≥30 kg/m who underwent either open or arthroscopic shoulder surgery in the beach chair position by a single surgeon...
October 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jarna Shah, Effrossyni Gina Votta-Velis, Alain Borgeat
Local anesthetics are used for performing various regional anesthesia techniques to provide intraoperative anesthesia and analgesia, as well as for the treatment of acute and chronic pain. Older medications such as lidocaine and bupivacaine as well as newer ones such as mepivacaine and ropivacaine are being used successfully for decades. Routes of administration include neuraxial, perineural, intravenous, various infiltrative approaches, topical, and transdermal. There are new innovations with the use of older local anesthetics in a novel manner, in addition to the development and use of new formulations...
June 2018: Best Practice & Research. Clinical Anaesthesiology
Egils Vjaters, David Nitsan, Michael Mullerad, Dov Engelstein, Ilan Leibovitch, Yair Feld
BACKGROUND: Although effective for benign prostatic hyperplasia (BPH), transurethral resection of the prostate (TURP) can be associated with side effects including prolonged recovery, storage and voiding symptoms, and a risk of acute urinary retention. OBJECTIVE: To test a new minimally invasive device for the treatment of lower urinary tract symptoms (LUTS) due to BPH, involving implantation of a C-shaped nitinol ring (ClearRing) in a circular incision in the prostatic tissue using an electrocuting blade over a dilatation balloon...
October 4, 2018: European Urology Focus
Amos Neheman, Andrew C Strine, Charles W Concodora, Marion E Schulte, Paul H Noh
PURPOSE: Robotic extravesical ureteral reimplantation has been established as a viable option for surgical management of vesicoureteral reflux. Typically, this procedure is associated with a hospital stay for routine postoperative care. The aim of the study was to assess the short-term safety of robotic unilateral extravesical ureteral reimplantation as a scheduled outpatient procedure in a pediatric population. MATERIAL AND METHODS: A retrospective cohort study was performed for patients who underwent robotic extravesical ureteral reimplantation between June 2012 and January 2018...
September 12, 2018: Journal of Urology
Chrystelle Sola, Cecilia Menacé, Sophie Bringuier, Anne-Charlotte Saour, Olivier Raux, Olivier Mathieu, Xavier Capdevila, Christophe Dadure
BACKGROUND: The transversus abdominis plane (TAP) block has become a common regional anesthesia technique for pain management in a wide variety of abdominal procedures. Evidence to support any particular local anesthetic regimen as well as pharmacokinetic and systemic toxicity risks of TAP block remain insufficiently studied in children. The aim of this study was to compare the analgesic effects and investigate pharmacokinetic profile of levobupivacaine after ultrasound-guided TAP block using a low volume/high concentration (LVHC) or a high volume/low concentration (HVLC) solution in children...
September 5, 2018: Anesthesia and Analgesia
Guan-Nan Wu, Shi-Min Zhang, Yu-Zhang Liu, Ming Ma, Jiao Jin, Zuo-Xu Li, Zhao-Jie Zhang
OBJECTIVE: To evaluate the operative characteristic, safety, clinical effect of percutaneous endoscopic interlaminar discectomy (PEID) in treating displacement-type lumbar intervertebral disc protrusion on L₂-L₅. METHODS: Form November 2015 to October 2016, 15 patients with displacement-type lumbar intervertebral disc protrusion were treated with percutaneous endoscopic interlaminar discectomy. There were 9 males and 6 females, aged from 19 to 63 years old with an average of 42 years...
August 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
David N Bernstein, Hao-Hua Wu, Harry E Jergesen
Background: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it is not known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor and underserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at various institutions may help guide future interventions and policy aimed at improving underserved patients' outcomes. Methods: In this cross-sectional study, safety net hospitals were asked to complete a survey over the phone, via email or in person regarding existence and elements of perioperative management protocols for total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
July 2018: Archives of Bone and Joint Surgery
Meresa Gebremedhin Weldu, Haileselasie Berhane, Negassie Berhe, Kebede Haile, Yosef Sibhatu, Tsehaynesh Gidey, Kahsay Amare, Hiwot Zelalem, Rahel Mezemir, Tsegay Hadgu, Kesete Birhane
BACKGROUND: Surgical site infections (SSIs) are the most common hospital-acquired infection among surgical patients and remains a major clinical issue. In Ethiopia, despite many studies, the magnitude and associated factors of SSIs are not well documented and differ among regions. The aim of this study was to identify the magnitude and associated factors of SSIs in Suhul Hospital, Northern Ethiopia. METHODS: An institution-based cross-sectional study was conducted from February 2-March 31, 2016, in Shire Suhul Hospital...
August 20, 2018: Surgical Infections
Michael C Grant, Melinda M Gibbons, Clifford Y Ko, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Matthew D McEvoy, Adam B King, Christopher L Wu
Enhanced recovery after surgery protocols for bariatric surgery are increasingly being implemented, and reports suggest that they may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. We have conducted an evidence review to select anesthetic interventions that positively influence outcomes and facilitate recovery after bariatric surgery...
August 14, 2018: Anesthesia and Analgesia
Ian R Slade, Ron E Samet
Regional anesthesia for the acute trauma patient is increasing due to the growing appreciation of its benefits, development of newer techniques and equipment, and more robust training. Block procedures are expanding beyond perioperative interventions performed exclusively by anesthesiologists to paramedics on scene, emergency medicine physicians, and nurse-led services using these techniques early in trauma pain management. Special considerations and indications apply to trauma victims compared with the elective patient and must be appreciated to optimize safety and clinical outcomes...
September 2018: Anesthesiology Clinics
Christopher A J Webb, T Edward Kim
Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics...
September 2018: Anesthesiology Clinics
Benjamin J Walker, Justin B Long, Madhankumar Sathyamoorthy, Jennifer Birstler, Christine Wolf, Adrian T Bosenberg, Sean H Flack, Elliot J Krane, Navil F Sethna, Santhanam Suresh, Andreas H Taenzer, David M Polaner, Lynn Martin, Corrie Anderson, Rani Sunder, Trevor Adams, Lizabeth Martin, Martha Pankovich, Amod Sawardekar, Patrick Birmingham, Ryan Marcelino, R J Ramarmurthi, Peter Szmuk, Galit Kastner Ungar, Sara Lozano, Karen Boretsky, Ranu Jain, Maria Matuszczak, Timothy R Petersen, Jennifer Dillow, Robert Power, Kim Nguyen, Benjamin H Lee, Lisa Chan, Jorge Pineda, Jacob Hutchins, Kimberly Mendoza, Kristen Spisak, Aali Shah, Kathryn DelPizzo, Naomi Dong, Vidya Yalamanchili, Claudia Venable, Cassandra Armstead Williams, Reena Chaudahari, Susumu Ohkawa, Helga Usljebrka, Tarun Bhalla, Pedro Paulo Vanzillotta, Seza Apiliogullari, Andrew D Franklin, Akiko Ando, Sophie R Pestieau, Caroline Wright, Julia Rosenbloom, Tony Anderson
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children. METHODS: This is a prospective, observational study of routine clinical practice...
October 2018: Anesthesiology
Yanzi Zhang, Bo Cui, Chunyu Gong, Yidan Tang, Jianxiong Zhou, Yi He, Jin Liu, Jing Yang
It is important to develop a feasible animal model of regional anesthesia other than sciatic nerve blockade for pharmacokinetic investigations of new local anesthetics or analgesia in upper extremity surgery. Herein, we explored a nerve stimulator (NS)-guided brachial plexus block (BPB) in a rat model. The anatomy of the brachial plexus in rats was delineated in cadavers, and various BPBs were examined. The puncture point was located 0.5-1.0 cm below the lateral one-third of the clavicle. The efficacy and safety of the NS-guided BPB were evaluated using an injection of 2% lidocaine or 0...
July 26, 2018: Laboratory Animals
Ellen M Soffin, Melinda M Gibbons, Clifford Y Ko, Stephen L Kates, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Christopher L Wu
Successes using enhanced recovery after surgery (ERAS) protocols for total hip arthroplasty (THA) are increasingly being reported. As in other surgical subspecialties, ERAS for THA has been associated with superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost savings. Nonetheless, the adoption of ERAS to THA has not been universal. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery...
July 21, 2018: Anesthesia and Analgesia
Alexander Kulikov, Federico Bilotta, Beatrice Borsellino, Denis Sel'kov, Grigory Kobyakov, Andrey Lubnin
BACKGROUND: The asleep-awake-asleep (AAA) craniotomy is a technique that offers the opportunity of having a patient fully cooperative during the awake phase, and minimizes the possible discomfort, due to the asleep phase. The aim of this prospective observational case series, is to test the use of Xenon in the first asleep phase of an AAA craniotomy, in patients undergoing craniotomy for brain tumor resection. METHODS: The data have been collected from 40 awake craniotomy procedures, performed in patients with cerebral tumor, treated with the AAA technique...
July 20, 2018: Minerva Anestesiologica
Xiaocheng Liu, Guiming Huang, Ruipeng Zhong, Shifu Hu, Ruiming Deng
The aim of the present meta-analysis was to systematically examine the literature and to identify of the results of randomized controlled trials (RCTs) comparing the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for percutaneous nephrolithotomy (PCNL). An exhaustive electronic literature search of PubMed, Embase, and Web of science was performed until March 2018. Nine prospective RCTs concluding 858 patients comparing the use of RA to GA for PCNL were included. Combined results demonstrated that PCNL under RA could reduce operative time (mean difference [MD] -6...
2018: Urologia Internationalis
Mohammed S ElSheemy, Waleed Ghoneima, Akram A Elmarakbi, Ahmed M Al-Kandari, Hamdy Ibrahim, Sunil Shrestha, Sanjay Khadgi
OBJECTIVE: To compare safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) vs staged-Mini-PNL. PATIENTS AND METHODS: Adult patients with bilateral renal stones indicated for PNL were managed with BSS-Mini-PNL (45 patients and 90 renal units) and prospectively compared vs staged-Mini-PNL (55 patients and 110 renal units) between July 2014 and December 2017. Mini-PNL was done through 18-Fr tract in prone position under regional anesthesia and fluoroscopy using pneumatic lithotripsy...
July 20, 2018: Urology
Evgeny Goloborodko, Ann Christina Foldenauer, Nassim Ayoub, Matthias Knobe, Stephan Christian Möhlhenrich, Kristian Kniha, Frank Hölzle, Ali Modabber
Patients with sleeping disorders, such as obstructive sleep apnea, (OSA) have a higher risk for postoperative complications after maxillofacial surgery under general anesthesia. The aim of this study was to detect specific complications after oral and maxillofacial surgery. Sixty-nine cases of patients with middle or severe sleep apnea who underwent an operation under general anesthesia in the oral and maxillofacial region were retrospectively analyzed. This group was compared with an age and diagnosis matched group without sleep apnea receiving the same operative treatment...
September 2018: Journal of Cranio-maxillo-facial Surgery
Michael J Barrington, Yoshiaki Uda
PURPOSE OF REVIEW: Ultrasound guidance has become the accepted standard of practice for peripheral regional anesthesia. Despite evidence supporting the efficacy of ultrasound-guided regional anesthesia, its impact on patient safety has been less clear. RECENT FINDINGS: Evidence has been consistent that ultrasound guidance reduces the incidence of vascular injury, local anesthetic systemic toxicity, pneumothorax and phrenic nerve block. Within the limited global scope of the epidemiology and etiologic complexity of perioperative (including block-related) peripheral nerve injury, there has not been consistent evidence that ultrasound guidance is associated with a reduced incidence of nerve injury...
October 2018: Current Opinion in Anaesthesiology
Kang Zhou, Zhuoli Zhang, Matteo Figini, Junjie Shangguan, Yining Wang, Haifeng Shi, Yumei Li, Zhengyu Jin, Jie Pan
The efficacy and safety of combining open-configuration magnetic resonance imaging (MRI) and an optical surgical navigation system (OSNS) for guidance of percutaneous liver cryoablation were evaluated in a pig model. This approach was successfully executed in eight test pigs under general anesthesia. Another two pigs spared from ablation served as controls. MRI studies, blood testing, and pathologic examinations were performed at various time points. MRI-determined minimal and maximal cryolesion diameters were 19...
2018: American Journal of Translational Research
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