Hand Suction Research Articles

A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era.

PurposeTo provide a novel solution to reduce aerosol exposure in the operating room during endoscopic sinus and skull base procedures in the COVID-19 era.MethodsWe have designed a 3D printable midfacial mask that partially seals the nose, while allowing instrumentation during endoscopic transnasal surgery. The mask when connected to a vacuum system creates a constant negative pressure inside it, sucking out aerosols and gases generated during surgical procedures. Its effectiveness was tested using vapour exhalations by a human volunteer and drilling bone in a head model. The physical barrier effect was measured using fluorescein atomization in a head model.ResultsThe pressure and airflow measured remained negative inside it in all the different situations tested. The mask was capable of completely evacuating human adult exhalation, and was more effective than the hand suction instrument. However, it was as effective as hand suction instrument at preventing aerosol spread from bone drilling. The physical barrier effect achieved a 72% reduction in the splatter created from the fluorescein atomization.ConclusionsThe mask effectively prevented the spread of aerosols and reduced droplet spread during simulated transnasal endoscopic skull base surgery in laboratory conditions. This device has potential benefits in protecting surgical personnel against airborne transmission of COVID-19 and could be useful in reducing chronic exposure to the hazard of surgical smoke.Electronic supplementary materialThe online version of this article (10.1007/s00405-020-06462-1) contains supplementary material, which is available to authorized users.

New procedure of bronchoalveolar lavage using a balloon catheter in diffuse lung diseases

Various procedures for bronchoalveolar lavage (BAL) have been developed. BAL needs a wedge between the bronchoscope and the inner surface of the bronchus. The feasibility of performing BAL at the targeted position cannot be determined until immediately before the procedure. We examined BAL performed using a balloon catheter to evaluate the stability of the procedure itself and quality of the specimen obtained. The main inclusion criteria were diffuse lung disease with a shadow in the B5a area. The tip of a disposable balloon catheter was passed through the orifice of the B5a bronchus, and the balloon was expanded at the B5a bronchus. A 50-mL syringe containing saline was instilled, and gentle hand suction was performed. This procedure was repeated two more times (total: 150mL). In all the 13 patients, the balloon of the catheter was inflated at the B5a bronchus. The median recovery rate was 34.92%±13.22%. These values were comparable to previously obtained BAL data (control group, N=56) from our facility. The BAL fluid findings and final diagnosis, with the exception of one undiagnosed case, were consistent. Overall, four patients suffered an adverse event during BAL (hypoxemia). All cases were managed by increasing the oxygen flow rate, and the adverse event did not affect the subsequent examinations. Using a balloon catheter enabled us to perform BAL at the intended bronchus. The quality of the obtained specimen was also acceptable.

Comparative study between different methods of aliquots suction during bronchoalveolar lavage

Bronchoalveolar lavage (BAL) is a widely performed diagnostic and research procedure. The aim of the present study was to standardize the method of retrieving BAL in our institution through comparing three methods of BAL retrieval regarding efficacy and safety. A total of 60 adult patients were randomly divided according to the method for retrieving BAL infusate into three groups, of 20 patients each. These are by using gentle hand suction into sterile syringe (Group I), using gentle syringe suction into a fluid trap (Group II), or using gentle suction by aspirator, collecting the lavage specimen into a collection trap (Group III). No statistical difference was noted between groups regarding age, sex, presenting symptoms, anesthesia, patient position, introduction site, postprocedural complications, and total cell count in the retrieved fluid. The volume of the recovered fluid using the method in group III was significantly higher than that of the method used in group II (P=0.001). Although the volume of the recovered fluid by the method in group III was apparently higher than that of the method in group I, and that for the method in group I was apparently higher than that in group II, both lacked significance (P=0.188 and 0.066, respectively). All studied methods of retrieving BAL infusate are safe. Using an aspirator into a fluid trap is superior to using syringe suction into a fluid trap in retrieving more voluminous BAL infusate.

Investigação de um sistema de alimentação em recém-nascidos prematuros a partir de estimulação gustativa

Objetivo investigar a existência do sistema de alimentação em recém-nascidos prematuros a partir da estimulação gustativa. Métodos estudo experimental, analítico, duplo-cego. Participaram 90 recém-nascidos prematuros, de uma maternidade pública de Sergipe. O teste foi filmado, constituindo-se por três momentos de cinco minutos. O primeiro e último momento sem realizar estímulo, o segundo momento com estimulação gustativa, sendo que os recém-nascidos foram divididos em dois grupos (água ou sacarose). Foram estudados os comportamentos específicos sucção de mão direita e esquerda, protrusão de língua e movimentos de sucção nos estados comportamentais sono profundo, sono leve, sonolento, agitado/irritado e choro. Para caracterizar a população foram utilizadas média, desvio-padrão e prevalências. Foi utilizado o teste não paramétrico Mann-Whitney para comparação de médias. O teste de Spearman verificou correlação entre estados comportamentais e comportamentos específicos em cada momento do teste. O valor de p foi significante quando menor que 0,05. Resultados independente do estímulo administrado, a correlação aumentou em todos os comportamentos específicos. Comparando os grupos separadamente, após a estimulação, observou-se aumento de correlação em sucção de mão direita e protrusão de língua para ambos os grupos. O mesmo aconteceu em sucção, com exceção do estado agitado/irritado. Após a estimulação, houve maior correlação para o comportamento de sucção de mão esquerda no grupo sacarose quando comparado ao grupo água. Os resultados evidenciam que estímulos gustativos podem contribuir na prontidão para alimentação nesta população. Conclusões evidenciou-se nos recém-nascidos prematuros aumento de correlação para os comportamentos específicos relacionados ao sistema de alimentação, após estimulação oral, o que vislumbra a possibilidade da estimulação gustativa ser utilizada para ativação de um sistema de alimentação em recém-nascidos prematuros.

Integrated sensory motor system in prematurely born children

To investigate about an integrated sensory motor system existence in premature newborns, submitted to gustatory stimulation. Analytical and experimental study of contents, double-blind. Being participants 90 premature newborns, divided into two groups (water or sucrose analysis 12%). Recorded by 15 minutes (first and last moments, without stimulation; and second time with gustatory stimulation). Three independent judges analyzed the behaviors in the right hand and left hand in the mouth and suction in the left and right and hand during the various behavioral states, those being inserted in the database of Statistical Package for Social Science, being then considered that the events observed by at least two of them. It was made use of Spearman' s rank correlation test on a significance level by p<0.05. Considering the groups both separately and together, right and left had initially moderate correlation, being right hand in the mouth remained strong at the end and left hand in the mouth finished on moderate and strong correlation, according to each behavioral state. Right hand suction in its total and sucrose showed a strong correlation initially in drowsy state, becoming moderate at the end. In alertness state there was initially a weak correlation in both stimuli ending in moderate correlation in sucrose and strong in water. Left hand suction presented initially moderate correlation on the alert state, ending in weak correlation in sucrose stimuli, which did not occur in the water that started and finished strong. The oral stimulation influenced the hand-mouth coordination, showing early motor sensory integration. However, there was no discrimination about the gustatory capacity on the newborns.

A new BAL fluid instillation and aspiration technique: A multicenter randomized study

Bronchoalveolar lavage (BAL) is a widely used clinical and research tool even though certain steps in the procedure have not been standarized. One step that is subject to variation is the technique used to instill and recover BAL fluid. Our aim was to assess whether attaching a plastic tube between the syringe and the working channel of the flexible bronchoscope allowed recovery of more fluid in comparison with recovery using only a syringe, and whether tubing had a favorable impact on diagnostic yield and complications. A randomized multicenter study was performed in eleven public hospitals in Catalonia (Spain). Patients scheduled for BAL were randomly assigned to tubing (n=140) or no-tubing groups (n=155). Flexible bronchoscopy and a 150 mL BAL in three 50 mL aliquots with or without tubing attached to the syringe. In the group with tubing, 8% more fluid was recovered. The difference was both statistically significant and clinically relevant given that 17.4% more diagnoses, 6.9% fewer complications, and 8.8% fewer technical failures were recorded. Based on these results, we recommend performing BAL using plastic tubing between the 50 mL syringe and the working channel of the flexible bronchoscope when carrying out manual instillation and suction.

The Comparison of Characteristics of Recoverd Fluid between two Aspiration Techniques of Bronchoalveolar Lavage Procedures (Hand Suction Versus Controlled Wall Suction

The Comparison of Characteristics of Recoverd Fluid between two Aspiration Techniques of Bronchoalveolar Lavage Procedures (Hand Suction Versus Controlled Wall Suction

The Intra Ocular Cutter.

Inappropriate infusion, either suprachoroidal or subretinal massive intraocular haemorrhage and inadvertent tearing or nibbling of the retina, are problems which may be induced iatrogenically during vitrectomy. Familiarity with the mechanical principles of each type of vitrectomy instrument will serve to minimise such hazards. This paper presents the special features of our newest generation intra Ocular Cutter (I.O.C.) in its two modes: (1) the fully integrated, electronically controlled, automatic unit with surgical stand and tray; (2) the Standby I.O.C., which is battery operated with simple hand suction. Particular stress is laid on the economy of ocular perfusion which may be achieved with informed use of these instruments.

Studies of Gastric Hydrochloric Acid Secretion in Pernicious Anemia: The Value of Near-maximal Stimulation Techniques.

s1 May 1965Studies of Gastric Hydrochloric Acid Secretion in Pernicious Anemia: The Value of Near-maximal Stimulation Techniques.Julius Wenger, M.D. (Associate), Ivan A. Backerman, M.D., Joel S. Steinberg, M.D., Benjamin R. Gendel, M.D., F.A.C.P.Julius Wenger, M.D. (Associate)Search for more papers by this author, Ivan A. Backerman, M.D.Search for more papers by this author, Joel S. Steinberg, M.D.Search for more papers by this author, Benjamin R. Gendel, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-62-5-1082_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Excerpt"A chlorhydria" in pernicious anemia requires more specific definition. Accurate gastric juice collection and pH determination and the choice of proper gastric stimuli are essential.Fifty-four adult patients with known pernicious anemia were retested for the ability to secrete gastric hydrochloric acid with the newer stimulating techniques. Gastric aspiration by hand suction was performed at 15-minute intervals for 1 hour after a stimulus that wasgreaterthan the "standard dose" of histamine. The pH of each specimen was determined with a glass electrode. A fall in pH below 6.0 or a fall in pH of more than 1.0 pH unit... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Atlanta, Georgia PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1965Volume 62, Issue 5Page: 1082-1082KeywordsFallsHistamineHydrochloric acidPernicious anemia Issue Published: 1 May 1965 PDF DownloadLoading ...