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Regional anesthesia

Obaid S Malik, Ethan Y Brovman, Richard D Urman
OBJECTIVE: Over 150,000 carotid endarterectomy (CEA) procedures are performed each year. Perioperative anesthetic management may be complex due to multiple patient and procedure-related risk factors. The authorsaimed to determine whether the use of general anesthesia (GA), when compared with regional anesthesia (RA), would be associated with reduced perioperative morbidity and mortality in patients undergoing a CEA. DESIGN: Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database...
August 23, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Shu-Jun Chen, Yu-Xuan Chen, Jian-Rui Xiao, Xiao-Zong Wei, Shuang-Min Chen, Wang-Zhan Jiang
PURPOSE: Necrotizing fasciitis is a severe soft tissue infection that is uncommon in the head and neck region. Despite the advancement of care over the past few decades, the mortality rate remains high. Negative pressure wound therapy (NPWT), an advanced wound-healing technique, has become increasingly popular for a wide variety of complicated wounds. Since December 2015, we have used this technique in the management of necrotizing fasciitis of the head and neck. We report a consecutive case series treated with NPWT as the initial surgical procedure...
August 28, 2018: Journal of Oral and Maxillofacial Surgery
R Douglas Wilson, Aaron B Caughey, Stephen L Wood, George A Macones, Ian J Wrench, Jeffrey Huang, Mikael Norman, Karin Pettersson, William J Fawcett, Medhat M Shalabi, Amy Metcalfe, Leah Gramlich, Gregg Nelson
OBJECTIVE: This ERAS Guideline for perioperative care in Cesarean Delivery (CD) will provide best practice, evidenced-based, recommendations for pre-operative, intra-operative, and post-operative phases with primarily, a maternal focus. The 'focused' pathway process for scheduled and unscheduled CD, for this ERAS CD guideline will consider, from 'decision to operate (starting with the 30 - 60 minutes prior to skin incision) to hospital discharge'. METHODS: The literature search (1966-2017) used Embase and PubMed to search medical subject headings including "Cesarean Section", "Cesarean Section", "Cesarean Section Delivery" and all pre- and intra-operative ERAS® items...
September 18, 2018: American Journal of Obstetrics and Gynecology
Edward Ram, Aviad Hoffman, Yuri Goldes, Danny Rosin, Nir Horesh, Mordechai Gutman, Yair Edden
BACKGROUND: Full-thickness rectal prolapse has a significant negative impact on quality of life. The therapeutic options, specifically in elderly patients, are imperfect. Perineal stapled rectal prolapse resection is a novel operation for treating external rectal prolapse. Long-term follow-up following this procedure is lacking. In our study, we report a long-term follow-up of 30 patients, analyzing the long-term recurrence rate, morbidity, and functional outcome. OBJECTIVE: This study aimed to examine the long-term results of perineal stapled rectal resection in a population unfit for prolonged general anesthesia...
September 19, 2018: Diseases of the Colon and Rectum
Ilhan Nahit Mutlu, Burak Kocak, Melis Baykara Ulusan, Kivilcim Ulusan, Mehmet Semih Cakir, Ozgur Kilickesmez
INTRODUCTION: Pericatheter bleeding (PB) following tunneled hemodialysis catheter (THC) placement is a common phenomenon. In addition to complicating securement of the THC, the PB may loosen the adhesive catheter dressing and delay wound healing. The primary aim of this study was to determine whether epinephrine-containing local anesthetics rather than plain ones reduce superficial PB after THC placement. METHODS: The study was based on the retrospective analysis of the prospectively gathered data...
September 21, 2018: Hemodialysis International
Sachiyuki Tsukada, Kenji Kurosaka, Tetsuyuki Maeda, Akihiro Iida, Masahiro Nishino, Naoyuki Hirasawa
PURPOSE: This study was performed to determine whether periarticular injection performed in the early stage of total knee arthroplasty (TKA) could provide a better postoperative pain relief than periarticular injection performed in the late stage of TKA. The hypothesis was based on the concept that analgesic intervention before the onset of noxious stimuli would be associated with less postoperative pain. METHODS: A total of 105 participants were randomly assigned to receive superficial injection just prior to arthrotomy (early stage periarticular injection group) or superficial injection after implanting the prosthesis (late-stage periarticular injection group) in patients undergoing unilateral TKA with 1:1 treatment allocation...
September 20, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
T Warnecke, J Schmitz, S Kerkhoff, J Hinkelbein
BACKGROUND: Neurodegeneration with brain iron accumulation (NBIA) forms a group of rare hereditary diseases with rapid neurodegenerative progression due to an abnormal accumulation of iron in the basal ganglia. This causes extrapyramidal symptoms as well as dystonia and mental retardation. The most common form of NBIA is pantothenate kinase-associated neurodegeneration (PKAN, formerly Hallervorden-Spatz syndrome). There are multiple anesthesiological challenges with great implications for the clinical routine, particularly regarding the preparation for general anesthesia and the premedication visits...
September 20, 2018: Der Anaesthesist
Soon Eu Chong, Rhendra Hardy Mohamad Zaini, Wan Fadzlina, Al Jadidi Sulaiman, Vivekananda Gunasekaran
Postlaparotomy management for elderly patients with underlying comorbidities is always a challenge because of poor cardiorespiratory reserves and prolonged effect of anesthetic drugs. For these reasons, such patients usually require intensive care unit (ICU) admission in the postoperative period. We report a case of an 85-year-old chronic smoker with controlled diabetes mellitus who needed an emergency laparotomy for a perforated gastric ulcer. Unfortunately, there was a shortage of ICU backup. With the successful conduct of an early surgery using combined general and regional anesthesia, the use of sugammadex (Bridion, Merck Sharp & Dohme Corp, Oss, the Netherlands) as a reversal agent, a skilled surgeon, and good postanesthesia care, the patient did not require ICU admission...
October 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Liangyuan Lu, Zhanmin Yang, Guyue Zhang, Bin An, Yanjun Lin, Xiangli Zheng
INTRODUCTION: Paragangliomas (PGs) or extra-adrenal pheochromocytomas are rare neuroendocrine neoplasms of ubiquitous distribution. Those that produce excess catecholamine are categorized as functional, and those that do not are categorized as nonfunctional. Although modern medical technology is becoming more widespread, there are still substantial risks of misdiagnosis or missed diagnosis of PGs. CASE PRESENTATION: A 38-year-old woman who lived in an autonomous region of inner Mongolia presented complaining of having experienced coughing for approximately the past month...
September 2018: Medicine (Baltimore)
Robert B Lewis, Omar Hariri, Marilyn E Elliott, Chan-Hee Jo, Brandon A Ramo
BACKGROUND: Health care in America continues to place more importance on providing value-based medicine. Medicare reimbursements are increasingly being tied to this and future policy changes are expected to reinforce these trends. Recent literature has shown pediatric femur fractures in preschool-age children have equivalent clinical and radiographic outcomes when treated with spica casting or flexible intramedullary nails (IMN). We compared hospital care statistics including charges for nonoperative versus operative treatment for closed femur fractures in 3- to 6-year-olds...
September 18, 2018: Journal of Pediatric Orthopedics
Rodney A Gabriel, John J Finneran, Andrea M Trescot, Brian M Ilfeld
Pain after limb amputation is frequently challenging to adequately treat with local anesthetic-based regional anesthesia techniques due to its relatively long duration. Furthermore, uncontrolled pain in the immediate postoperative period is associated with persistent postsurgical pain, and frequently phantom limb pain. Cryoneurolysis is an alternative regional analgesic method to local anesthesia-based techniques. We report 3 cases in which ultrasound-guided percutaneous cryoneurolysis was performed in the perioperative period of limb amputation...
September 18, 2018: A&A practice
Gregory S Berns, Mark Spivak, Sarah Nemanic, Nicole Northrup
Training dogs for awake-MRI began in 2012 for the study of canine cognition. Although originally envisioned as a research technique to understand the neural mechanisms of canine cognitive function, its potential as a new diagnostic clinical tool has become apparent. A high-quality structural scan of the brain can be acquired without sedation or anesthesia in as little as 30 s in a well-trained dog. This has opened the possibility of longitudinal imaging of CNS disease with MRI both as a means of monitoring treatment and potentially as a surveillance tool for inflammatory and neoplastic brain diseases in high-risk breeds...
2018: Frontiers in Veterinary Science
M Catherine Sargent
Use of a single-leg spica cast for femoral fractures in ambulatory children 1 to 5 years of age facilitates care and mobilization of the patient. It may allow a shorter duration of cast treatment than is possible with a traditional one and one-half-leg spica cast, particularly in patients 1 to 3 years of age. The single-leg spica is indicated for children who are small enough to be lifted safely in the cast and who have an isolated, closed, low-energy femoral shaft fracture. The procedure consists of the following steps:Step 1: Obtain adequate sedation...
September 28, 2017: JBJS Essential Surgical Techniques
Marc A Miller, Jalaj Garg, Benjamin Salter, Thomas F Brouwer, Alex J Mittnacht, Morgan L Montgomery, Rafael Honikman, Derya E Arkonac, Subbarao Choudry, Srinivas R Dukkipati, Vivek Y Reddy, Menachem M Weiner
INTRODUCTION: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is most commonly implanted under general anesthesia (GA), due to the intra-operative discomfort associated with tunneling and dissection. Post-operative pain can be substantial, and is often managed with opioids. There is a growing interest in transitioning away from the routine use of GA during S-ICD implantation, while also controlling peri-operative discomfort without the use of narcotics. As such, we assessed the feasibility of a multimodal analgesia regimen that included regional anesthesia techniques in patients undergoing S-ICD implantation...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Alexandra V Ulyanova, Paul F Koch, Carlo Cottone, Michael R Grovola, Christopher D Adam, Kevin D Browne, Maura T Weber, Robin J Russo, Kimberly G Gagnon, Douglas H Smith, H Isaac Chen, Victoria E Johnson, D Kacy Cullen, John A Wolf
The hippocampus is integral to working and episodic memory and is a central region of interest in diseases affecting these processes. Pig models are widely used in translational research and may provide an excellent bridge between rodents and nonhuman primates for CNS disease models because of their gyrencephalic neuroanatomy and significant white matter composition. However, the laminar structure of the pig hippocampus has not been well characterized. Therefore, we histologically characterized the dorsal hippocampus of Yucatan miniature pigs and quantified the cytoarchitecture of the hippocampal layers...
September 2018: ENeuro
Yasemin Gündoğdu, Hamdi Şükür Kiliç
BACKGROUND: Femtosecond laser mass spectrometry (FLMS) has become an important tool for investigation of chemical and biological materials in many areas from medical to industrial. OBJECTIVE: In medicine, the morphological examination of tissues is determined by performing pathological investigations under microscope. However, some novel improvements or developments must be performed for much faster diagnosis of the tissue during the operation when patient is under anesthesia...
September 18, 2018: Photomedicine and Laser Surgery
Nagarajan Swathi, K Srikanth, S Venipriya
Purpose: To determine the necessity of hyaluronidase as an anesthetic adjuvant for peribulbar anesthesia during cataract surgery and to assess differences in anesthetic outcomes in the absence of hyaluronidase. Methods: In this double blinded randomized study, 202 patients reporting for surgery for senile cataract in their first eye under regional ocular anesthesia without pre-existing extra ocular movement restriction were randomly divided into 2 groups: Group 1 - anesthesia without hyaluronidase, Group 2 - anesthesia with 50 IU/ml Hyaluronidase...
July 2018: Saudi Journal of Ophthalmology: Official Journal of the Saudi Ophthalmological Society
David J Barton, Ryan T Marino, Anthony F Pizon
Snakebite envenomations occur throughout the United States, with most envenomations resulting from Crotalid bites. These envenomations can result in severe pain despite aggressive analgesia due to effects of venom toxins. We report a case in which we treated a 44- year-old man who sustained a Copperhead (Agkistrodon contortrix) bite to his left hallux with progressive local toxicity, including severe pain radiating into his upper leg, without evidence of compartment syndrome or coagulopathy. His pain was unresponsive to multiple doses of opioids...
September 14, 2018: American Journal of Emergency Medicine
M T Fisher, C K Zigler, A J Houtrow
PURPOSE: To evaluate variables that modulate pain during intramuscular botulinum toxin A injections in children. METHODS: As part of a Quality Improvement project, this retrospective analysis compared reported pain during and five minutes post injections with patient and procedural variables using subgroup and regression analyses (N= 593 procedures with 249 unique patients). RESULTS: Mean procedural pain for all procedures (n= 563) was 3.8 ± 3...
August 31, 2018: Journal of Pediatric Rehabilitation Medicine
Zemin Li, Houqing Long, Fengyu Huang, Yaodong Zhang, Jinghui Xu, Xiaobo Wang
STUDY DESIGN: This was a retrospective comparative study. OBJECTIVE: The main objective of this study was to investigate the effects of epidural anesthesia (EA) versus general anesthesia (GA) in elderly patients undergoing lower lumbar spine fusion surgeries. SUMMARY OF BACKGROUND DATA: Lumbar spine surgery can be performed under GA or regional anesthesia. GA is more commonly used in lumbar spine surgery, which renders the patient motionless throughout the procedure and provides a secure airway...
September 15, 2018: Clinical Spine Surgery
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