Intraoperative Use Research Articles

Twelfth thoracic vertebra erector spinae plane block for postoperative analgesia and early recovery after lumbar spine surgery in elderly patients: a single-blind randomized controlled trial

BackgroundSevere pain after lumbar spine surgery can delay recovery in elderly patients. We explored the efficacy of T12 erector spinal plane block (ESPB) in elderly patients who underwent lumbar spine surgery.MethodsA total of 230 patients undergoing lumbar spine surgery were divided and randomly allocated to ultrasound-guided ESPB (n = 115) and control (n = 115) groups. The ESPB group received 20 mL of 0.4% ropivacaine bilaterally at the T12 level after intubation, whereas the control group did not receive a block. The primary outcome was the numeric rating scale (NRS) score at 12 h after surgery. Secondary outcomes included the NRS score and tramadol use within 72 h postoperatively, intraoperative remifentanil use, incidence of postoperative delirium (POD), complications of ESPB, ambulation time, and length of hospitalization after surgery.ResultsThe12-hour NRS (median (IQR)) score was remarkably lower in the ESPB group than in the control group (2 (1–3) vs. 3 (2–4), p = 0.004), as well as NRS score within 48 h (P < 0.01). The ESPB group had less intraoperative remifentanil use (P < 0.001), and less tramadol use within 72 h postoperatively (P < 0.001). Seven patients (6.7%) developed POD in the ESPB group and ten patients (9.3%) in the control group, without any statistically significant difference (P > 0.05). The ambulation time and length of hospitalization after surgery were shorter in the ESPB group than in the control group (P < 0.05). No ESPB-related complications were observed.ConclusionsBilateral T12 ESPB lowered the NRS score within 48 h after lumbar spine surgery, decreased perioperative opioid use and resulted in faster recovery in elderly patients but did not significantly reduce the incidence of POD.Trial registrationThe study was retrospectively registered at www.chictr.org.cn (ChiCTR2100042037) on January 12, 2021.

Cerebral Hydatid Disease Patients Admitted to Duhok City Hospitals: Management and Outcome

Background and objectives: The human systemic infestation with Echinococcus granulosus affects the brain in 2% of cases, cerebral hydatid cyst, which presents clinically as slowly growing intracranial mass lesion leading to variable symptomatology of raised intracranial pressure, neurological deficit, and epilepsy. The condition, when occurs, needs prompt surgical removal in order to avoid fatal consequences. The aim of this article is to report clinical data and our experience concerning cerebral hydatid cyst presentation, surgical management, complications, and outcome. Methods: A retrospective case-series study encompassing 8 patients, four females and four males, whose ages ranged between 3.5-35 years, harboring cerebral hydatid cysts, including one cerebral hydatid abscess. The current study was conducted at Duhok Teaching Hospitals, during January 2005-May 2021. The diagnosis was established on clinical and radiological, computed tomography and magnetic resonance imaging backgrounds, and confirmed by operative findings, and histopathology (abscess cyst). Via appropriate craniotomies, all cerebral hydatid cysts, and abscess, were successfully removed, except, the recurrent hydatid cysts which needed an additional posterior fossa craniectomy to achieve total removal. There was no need for the use of advanced statistical system. Results: Compared to their original neurological deficit at presentation, seven cases could achieve complete recovery, except, the patient with recurrence, whose recovery was delayed and suboptimal due to repeated surgeries; there was no mortality. Conclusion: The operating surgeon should practice meticulous care avoiding the possible risk of an accidental rupture during cyst delivery. Various opinions address the pre-operative, intra-operative and post-operative use of Albendazloe, however, we are not sure whether the use of this medication could have prevented the recurrence of CHC which followed the accidental rupture.

Opioid-free versus opioid-sparing anaesthesia in ambulatory total hip arthroplasty: a randomised controlled trial

BackgroundEnhanced recovery after surgery pathways are essential for ambulatory surgery. They usually recommend lower intraoperative opioid use to avoid opioid-related adverse effects. This has led to opioid-sparing anaesthesia (OSA) techniques, with the extreme approach of opioid-free anaesthesia (OFA) mostly with dexmedetomidine. As evidence is lacking in day-case primary total hip arthroplasty, this study was performed to assess the potential benefits in postoperative analgesia of OFA over OSA. MethodsIn this single-centre, prospective, triple blind study, we randomly allocated 80 patients undergoing day-case primary THA under general anaesthesia. Patients received a total intravenous anaesthesia with a laryngeal mask and multimodal analgesic regimen with non-opioid analgesics. The OSA group received low dose of sufentanil, and the OFA group received dexmedetomidine The primary outcome was the opioid consumption in the first 24 h in oral morphine equivalents (OME). ResultsThere was no difference in median cumulative OME consumption at 24 h between the OSA and OFA groups (12 [0–25] mg vs 16 [0–30] mg, respectively; P=0.7). Pain scores were similar and low in both groups with comparable walking recovery time. Adverse events were sparse and equivalent in both groups except for dizziness, which was more frequent in the OSA group (P<0.05). ConclusionsIn day-case total hip arthoplasty under general anaesthesia, opioid-free anaesthesia and opioid-sparing anaesthesia both provide early recovery and effective postoperative pain relief. When compared with opioid-sparing anaesthesia, opioid-free anaesthesia does not decrease opioid consumption in the first 24 h. These findings do not suggest any significant benefit from complete intraoperative avoidance of opioids. Clinical trial registrationNCT0507270.

Quantification of skin wound tension using a newly designed wound tensiometer.

To (i) quantitatively measure wound tension in experimental skin wounds using a newly developed wound tensiometer and (ii) establish reference values for primary skin wound closure in medium- and large-breed dogs. Experimental cadaveric study. Nineteen dogs of medium to large breeds (BW 20 to 40 kg). Elliptical skin wounds of different sizes were created on the chest and abdomen. The wounds were gradually enlarged. Experienced surgeons (ECVS diplomates or professors of small animal surgery) and inexperienced surgeons (1st year after graduation) independently assessed wound tension through manual manipulation and determined whether the wound could be closed without tension-relieving measures. In addition, wound tension was objectively quantified using a newly developed wound tensiometer. The upper threshold for wound tension at which direct appositional wound closure was recommended by the experienced surgeons was 5.4 N, and the median minimal tension without recommendations for closure was 6.0 N. The data also demonstrate that wound tension and wound size do not necessarily correlate, and inexperienced surgeons need to develop a feel for wound tension. The intraoperative use of the wound tensiometer, in combination with established cut-off values, might facilitate decision-making regarding primary wound closure. The findings of this study provide evidence for the applicability of a wound tensiometer in guiding inexperienced surgeons in their choice of the skin wound closure method.

Intraoperative Computed Tomography Use in Orbital Fracture Repair: A Systematic Review and Meta-Analysis.

Background: Intraoperative computed tomography (CT) allows surgeons to make adjustments during orbital fracture repair that may impact postoperative outcomes. Learning/Study Objectives: To determine the impact of intraoperative CT use on intraoperative revision and surgical outcomes for orbital fracture repair. Methods: A systematic review was performed in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines: the population was patients undergoing orbital fracture repair; intervention was use of intraoperative CT; comparison was patients not undergoing intraoperative CT; and outcomes were intraoperative revision rate, postoperative complications, and secondary revision surgeries. Meta-analysis was performed on the rate of intraoperative revision. Results: The search criteria yielded 790 articles, 377 were eligible for review, and 20 articles met criteria for analysis. In 19, intraoperative imaging led to immediate surgical corrections, with a random pooled effect size of 0.27 (0.20-0.35). Six studies reported secondary revision surgery rates (range 0-10.5%), and six studies reported postoperative complication rates (range 10-30%). Conclusions: Intraoperative imaging helps surgeons make precise, real-time adjustments in 27% of orbital fracture repair cases, which may improve surgical outcomes; however, more research is needed to investigate its impact on health care costs, operating time, and radiation exposure.

Dual Microscope Indocyanine Green Video Angiography and Endoscopic Review to Treat Intracranial Aneurysm: A Review of the Literature Regarding a Case.

The use of the indocyanine green video angiography (ICG-VA) both endoscope and microscope has become popular in recent decades thanks to the safety, efficacy, and added value that they have provided for cerebrovascular surgery. The dual use of these technologies is considered complementary and has helped cerebrovascular surgeons in decision-making, especially for aneurysm clipping surgery; however, its use has been described for both aneurysm surgery, resection of arteriovenous malformations, or even for bypass surgeries. We conducted a review of the literature with the MeSH terms "microscope indocyanine green video angiography (mICG-VA)," "endoscopic review," AND/OR "intracranial aneurysm." A total of 97 articles that included these terms were selected after a primary review to select a total of 26 articles for the final review. We also present a case to exemplify its use, in which we use both technological tools for the description of the aneurysm, as well as for decision-making at the time of clipping and for reclipping. Both tools, both the use of the endoscope and the mICG-VA, have helped decision-making in neurovascular surgery. A considerable clip replacement rate has been described with the use of these technologies, which has helped to reduce the complications associated with poor clipping. One of the main advantages of their usefulness is that they are tools for intraoperative use, which is why they have shown superiority compared to digital subtraction angiography, which takes longer to use and has a higher risk of complications associated with the contrast medium. On the other hand, a very low rate of complications has been described with the use of the endoscope and mICG-VA, which is why they are considered safe tools to use. In some cases, mention has been made of the use of one or the other technology; however, we consider that its dual use provides more information about the status of the clip, its anatomy, its relationship with other vascular structures, and the complete occlusion of the aneurysm. We consider that the use of both technologies is complementary, so in case of having them both should be used, since both the endoscope and the mICG-VA provide additional and useful information.

Perioperative Hypotension in Patients Undergoing Orthopedic Upper Extremity Surgery with Dexmedetomidine Sedation: A Retrospective Study.

(1) Background: limited data exist regarding the occurrence of hypotension associated with dexmedetomidine use and its risk factors in the context of intraoperative sedation for patients receiving peripheral nerve blocks. (2) Method: This single-center retrospective study assessed the incidence of hypotension in patients undergoing orthopedic upper extremity surgery with brachial plexus blockade. Patients were classified into three groups: group N (non-sedated), group M (midazolam), and group D (dexmedetomidine), based on their primary intraoperative sedative use. The primary outcome was the incidence of perioperative hypotension, defined as systolic blood pressure (SBP) < 90 mmHg or mean blood pressure (MBP) < 60 mmHg, at a minimum of two recorded time points during the intraoperative period and post-anesthesia care unit stay. Multivariable logistic models for the occurrence of hypotension were constructed for the entire cohort and group D. (3) Results: A total of 2152 cases (group N = 445, group M = 678, group D = 1029) were included in the analysis. The odds ratio for the occurrence of hypotension in group D was 5.68 (95% CI, 2.86 to 11.28) compared with group N. Concurrent use of a beta blocker, longer duration of surgery, and lower preoperative SBP and higher preoperative heart rate were identified as significant risk factors. (4) Conclusions: the increased risk of hypotension and the associated factors should be taken into account before using dexmedetomidine in these cases.

Lugol's Solution Reduces Positive Margins and Residual Disease After the Large Loop Excision of Transformation Zone.

This study aimed to examine whether the intraoperative use of Lugol's solution reduces the proportion of positive resection margins (RMs) using the data of women who underwent large loop excision of the transformation zone (LLETZ). A total of 1,751 consecutive women with cervical intraepithelial neoplasia (CIN) who underwent LLETZ with or without Lugol's solution were retrospectively retrieved from each database of 3 university hospitals in South Korea. Outcomes included positive RMs and residual disease pathologically confirmed within 6 months after LLETZ. Positive RMs were noted in 345 cases (19.7%). Among 1,507 women followed up, residual disease was diagnosed in 100 cases (6.6%) (69/308 cases with positive RMs; 31/1,199 cases with negative RMs). The Lugol's solution group was less likely to have positive RMs (11.8% vs 25.5%, p < .01), to require additional surgical intervention (5.4% vs 10.2%, p < .01), and to have residual disease (4.9% vs 8.0%, p = .02). On multiple logistic regression analysis, Lugol's solution reduced the proportion of positive RMs (adjusted odds ratio [aOR], 0.31). Age (50 years or older; aOR, 1.64), preconization cervical cytology (aOR, 1.53), high-risk human papillomavirus (aOR, 1.75), and CIN 2 or 3 (aOR, 2.65) were independent risk factors for margin positivity ( p < .01 for all except high-risk human papillomavirus of p = .05). Lugol's solution optimizes CIN treatment by reducing the proportion of positive RMs and residual disease after LLETZ.

Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients

Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass surgery: a double-blinded randomized controlled trial

PurposeMinimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with significant postoperative pain. We aimed to investigate the efficacy of ultrasound-guided erector spinae plane block (ESPB) for analgesia after MIDCAB.MethodsWe conducted randomized controlled trial in 60 patients undergoing MIDCAB who received either a single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group, n = 30) or normal saline 0.9% (control group, n = 30). The primary outcome was numerical rating scale (NRS) pain scores at rest within 48 hr postoperatively. The secondary outcomes included postoperative NRS pain scores on deep inspiration within 48 hr, hydromorphone consumption, and quality of recovery-15 (QoR-15) score at 24 and 48 hr.ResultsCompared with the control group, the ESPB group had lower NRS pain scores at rest at 6 hr (estimated mean difference, –2.1; 99% confidence interval [CI], –2.7 to –1.5; P < 0.001), 12 hr (–1.9; 99% CI, –2.6 to –1.2; P < 0.001), and 18 hr (–1.2; 99% CI, –1.8 to –0.6; P < 0.001) after surgery. The ESPB group also showed lower pain scores on deep inspiration at 6 hr (–2.9; 99% CI, –3.6 to –2.1; P < 0.001), 12 hr (–2.3; 99% CI, –3.1 to –1.5; P < 0.001), and 18 hr (–1.0; 99% CI, –1.8 to –0.2; P = 0.01) postoperatively. Patients in the ESPB group had lower total intraoperative fentanyl use, lower 24-hr hydromorphone consumption, a shorter time to extubation, and a shorter time to intensive care unit (ICU) discharge.ConclusionErector spinae plane block provided early effective postoperative analgesia and reduced opioid consumption, time to extubation, and ICU discharge in patients undergoing MIDCAB.Trial registrationwww.chictr.org.cn (ChiCTR2100052810); registered 5 November 2021.

A novel approach to microsurgical teaching in head and neck surgery leveraging modern 3D technologies

The anatomically complex and often spatially restricted conditions of anastomosis in the head and neck region cannot be adequately reproduced by training exercises on current ex vivo or small animal models. With the development of a Realistic Anatomical Condition Experience (RACE) model, complex spatial-anatomical surgical areas and the associated intraoperative complexities could be transferred into a realistic training situation in head and neck surgery. The RACE model is based on a stereolithography file generated by intraoperative use of a three-dimensional surface scanner after neck dissection and before microvascular anastomosis. Modelling of the acquired STL file using three-dimensional processing software led to the model’s final design. As a result, we have successfully created an economical, sustainable and realistic model for microsurgical education and provide a step-by-step workflow that can be used in surgical and general medical education to replicate and establish comparable models. We provide an open source stereolithography file of the head-and-neck RACE model for printing for educational purposes. Once implemented in other fields of surgery and general medicine, RACE models could mark a shift in medical education as a whole, away from traditional teaching principles and towards the use of realistic and individualised simulators.

3D Printing Applications for Craniomaxillofacial Reconstruction: A Sweeping Review.

The field of craniomaxillofacial (CMF) surgery is rich in pathological diversity and broad in the ages that it treats. Moreover, the CMF skeleton is a complex confluence of sensory organs and hard and soft tissue with load-bearing demands that can change within millimeters. Computer-aided design (CAD) and additive manufacturing (AM) create extraordinary opportunities to repair the infinite array of craniomaxillofacial defects that exist because of the aforementioned circumstances. 3D printed scaffolds have the potential to serve as a comparable if not superior alternative to the "gold standard" autologous graft. In vitro and in vivo studies continue to investigate the optimal 3D printed scaffold design and composition to foster bone regeneration that is suited to the unique biological and mechanical environment of each CMF defect. Furthermore, 3D printed fixation devices serve as a patient-specific alternative to those that are available off-the-shelf with an opportunity to reduce operative time and optimize fit. Similar benefits have been found to apply to 3D printed anatomical models and surgical guides for preoperative or intraoperative use. Creation and implementation of these devices requires extensive preclinical and clinical research, novel manufacturing capabilities, and strict regulatory oversight. Researchers, manufacturers, CMF surgeons, and the United States Food and Drug Administration (FDA) are working in tandem to further the development of such technology within their respective domains, all with a mutual goal to deliver safe, effective, cost-efficient, and patient-specific CMF care. This manuscript reviews FDA regulatory status, 3D printing techniques, biomaterials, and sterilization procedures suitable for 3D printed devices of the craniomaxillofacial skeleton. It also seeks to discuss recent clinical applications, economic feasibility, and future directions of this novel technology. By reviewing the current state of 3D printing in CMF surgery, we hope to gain a better understanding of its impact and in turn identify opportunities to further the development of patient-specific surgical care.

Postoperative clinical outcomes with and without short-term intravenous tranexamic acid after posterior lumbar interbody fusion: A prospective cohort study.

The use of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) surgery is believed to be beneficial for reducing intraoperative blood loss, postoperative drainage volume (PDV), and length of hospital stay (LOS). However, whether continued administration of intravenous TXA within 24 hours after surgery is more beneficial to patients has not yet been studied. This study prospectively analyzed the perioperative outcomes of patients who received and did not receive intravenous TXA within 24 hours after PLIF (≥2 segments) surgery from January 2018 to December 2021. A total of 78 and 69 patients were included in the TXA (receive intravenous TXA intraoperatively and within 24 hours postoperatively) and non-TXA (only receive intravenous TXA intraoperatively) groups, respectively. No significant differences were observed in the intraoperative blood loss and operative time between the 2 groups. The postoperative drainage volume, postoperative drainage time, and length of hospital stay in the TXA group were significantly lower than those in the non-TXA group. The rates and volumes of postoperative blood and albumin transfusions were significantly lower in the TXA group than those in the non-TXA group. No significant differences were observed in the perioperative complication rates between the 2 groups. No increase in thrombosis-related complications was observed with postoperative TXA administration. Short-term TXA use after PLIF (≥2 segments) surgery is safe. In addition to intraoperative use of TXA, additionally administration of intravenous TXA within 24 hours postoperatively can improve the perioperative clinical outcomes of patients without increasing the risk of thrombotic events.

Preclinical safety evaluation of continuous UV-A lighting in an operative setting.

Germicidal ultraviolet (UV-C) light has been shown as an effective modality for disinfection in laboratory settings and in the operative room. Traditionally, short-wavelength UV-C devices, which have previously been shown to cause DNA damage, are utilized only for disinfection in pre- and post-operative settings and are not continuously active during operations. Continuous use of intraoperative UV light has potential to decrease pathogens and subsequent surgical site infections (SSIs), which arise in approximately 5-15% of operative cases. SSIs are a significant determinant of patient morbidity, readmission rates, and overall cost. Therefore, a method of UV light disinfection with a low risk of DNA damage is needed so that greater antimicrobial protection can be afforded to patients during the entirety of their surgical procedures. A new disinfection device that harnesses longer-wavelength UV-A light to disinfect the surgical field throughout the entirety of the procedure, including pre- and post-operation has been developed. This study aimed to determine if UV-A light administered intraoperatively was safe, as defined by the minimal presence of DNA damage and safe amounts of reflection upon medical personnel. Using in vitro models, we examined the differential impacts of UV-C and UV-A light on DNA damage and repair pathways. In a murine model, we looked at the production of DNA damage photoproduction in relation to UV-A versus UV-C exposure. Our results show UV-A light does not induce a significant amount of DNA damage at the cellular or tissue level. Furthermore, a preclinical porcine study showed that surgical personnel were exposed to safe levels of UV-A irradiance from an overhead UV-A light used during an operation. The amount of UV-A transmitted through surgical personal protective equipment (PPE) also remained within safe levels. In conclusion, we found that UV-A may be safe for intraoperative use.

An Investigation Into Whether the Facial Nerve and Auditory Nerve can be Protected by Removal of the Posterior Wall of the Internal Auditory Canal Under 30° Neuroendoscopy During Vestibular Schwannoma Surgery.

The aim of this study was to evaluate the surgical technique of microresection of vestibular schwannoma by removing the posterior wall of the internal auditory canal (IAC) under neuroelectrophysiological monitoring and 30° neuroendoscopy, with respect to the protection of facial and auditory nerve function. Forty-five cases of microscopic resection of auditory neuromas were performed through a posterior approach to the inferior occipital sigmoid sinus using a 30° neuroendoscope to assist in the removal of the posterior wall of the IAC during surgery. Patients underwent cranial enhancement magnetic resonance imaging examination and functional assessment of the facial and auditory nerves before and after surgery, and clinical data were collected for retrospective analysis. All tumors were removed in 41 patients, and most of the tumors were removed in 4 patients. The facial nerve was anatomically preserved in 43 patients (95.6%), and the percentage of facial nerve function preservation (House-Brackmann grade I-II) was 84.4%. Forty patients (88.9%) had anatomical preservation of the auditory nerve, with a 66.7% functional preservation rate. At 3 to 39 months of follow-up, 45 patients were reviewed with 3.0T-enhanced magnetic resonance imaging, and no tumor recurrence was observed in any of the patients. Microscopic resection of auditory neuroma through the posterior approach of the inferior occipital sigmoid sinus with intraoperative use of 30° neuroendoscopic assistance to abrade the posterior wall of the IAC can eliminate dead space in certain anatomical areas during surgery and minimize surgical damage to the facial and auditory nerves, which is the basis for preservation of facial and auditory nerve function.

Use of 3D Fluoroscopy to Assist in the Reduction and Fixation of Pelvic and Acetabular Fractures: A Safety and Quality Case Series.

Multidimensional fluoroscopy has been increasingly used in orthopaedic trauma to improve the intraoperative assessment of articular reductions and implant placement. Owing to the complex osteology of the pelvis, cross-sectional imaging is imperative for accurate evaluation of pelvic ring and acetabular injuries both preoperatively and intraoperatively. The continued development of fluoroscopic technology over the past decade has resulted in improved ease of intraoperative multidimensional fluoroscopy use in pelvic and acetabular surgery. This has provided orthopaedic trauma surgeons with a valuable tool to better evaluate reduction and fixation at different stages during operative treatment of these injuries. Specifically, intraoperative 3D fluoroscopy during treatment of acetabulum and pelvis injuries assists with guiding intraoperative decisions, assessing reductions, ensuring implant safety, and confirming appropriate fixation. We outline the useful aspects of this technology during pelvic and acetabular surgery and report its utility with a consecutive case series at a single institution. The added benefits of this technology have improved the ability to effectively manage patients with pelvis and acetabulum injuries.

A secure blood-saving protocol for Jehovah's Witnesses in primary total hip replacement.

The study aimed to analyze the efficacy of the blood management protocol developed by our team for patients who are Jehovah's Witnesses (JW) presenting for primary total hip replacement (THR). Thirty JW patients (6 males, 24 females; mean age: 70.1±9.8 years; range, 65 to 81 years) and 30 age- and sex-matched controls (6 males, 24 females; mean age: 68.7±9.1 years; range, 62 to 79 years) who underwent primary THR at our institution between January 2018 and June 2020 were retrospectively evaluated. While the surgical technique of THR was not different among the groups, blood loss management differed between the groups. Patients in the control group were given 1 g of intravenous tranexamic acid (TXA) 15 min before the surgical incision. In addition to the same TXA protocol, intraoperative cell salvage with a continuous autologous transfusion system was used for JW patients. The estimated blood loss (EBL) was determined using Meunier's formula. Hemoglobin (Hgb) decline, EBL on the first and third postoperative days, allogenic blood transfusion (ABT) requirement, and complications were analyzed between groups. There were no significant differences between groups regarding demographic and clinical characteristics (p>0.05), ABT requirement (p>0.999), and Hgb decline in the first and third postoperative days (p=0.540 and p=0.836, respectively). Furthermore, both groups did not significantly differ between EBL in the first and third postoperative days (p=0.396 and p=0.616, respectively) and the length of hospital stay (p=0.547). Similar complication rates were noted for both groups. Hemoglobin level assessments revealed that values on the first and third postoperative days were significantly lower than the baseline Hgb value in both cohorts (p<0.001). A combination of intravenous administration of 1 g of TXA, meticulous hemostasis, and intraoperative use of cell saver constitutes a reasonable strategy for achieving the goal of transfusion-free primary THR with predictable levels of blood loss that are similar to non-JW patients.

PAEDIATRIC-02 ROLE OF INTRAOPERATIVE INTRATUMORAL HYDROGEN PEROXIDE IN RESECTION OF SOLID BRAIN TUMORS: CASE SERIES AND BRIEF REVIEW OF LITERATURE

Abstract INTRODUCTION The use of Hydrogen peroxide (H2O2) has been reported in surgical literature as one of the best agents for irrigation during neurosurgical procedures for many years due to its purported effects on mechanical debridement and its antiseptic and haemostatic properties although its use has been similarly surrounded by persistent controversy. METHODS We report the intraoperative use of hydrogen peroxide injection in tumour resection among four paediatric patients with different solid brain tumours which included tuberculoma, diffuse B cell lymphoma, pilocytic astrocytoma and medulloblastoma. Following open craniotomy, 3mls of diluted 6% hydrogen peroxide were injected into the exposed solid tumour. The tumour became firmer and evidently more devascularized and this was followed with meticulous bipolar cauterization-resection of the tumour with the aim to achieve total resection. RESULTS Total tumour resection was achieved and the patients recovered uneventfully without any complications. None of the patients in our series developed gas embolism, dysrhythmias nor pneumocephalus. DISCUSSION Hydrogen peroxide irrigation is commonly utilised in neurosurgical procedures for its bactericidal and haemostatic effects. Although several authors have reported adverse complications in literature, we report the judicious safe use of H202 in tumour resection without adverse effects. CONCLUSION The authors report the safe use of intratumoral hydrogen peroxide in resection of solid tumours with aiding control of blood loss and improving resectability. Close observation by the anaesthesiology team is paramount for early detection of gas embolism to avoid adverse outcomes

Is PONV still a problem in pediatric surgery: a prospective study of what children tell us.

Postoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies. A prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey. On the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8-19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9-11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1-1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5-4.4) and diclofenac (OR 2.0, 95% CI: 1. 3-3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9-4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7-11.6). The main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.

Prediction model for postoperative pneumonia in abdominal surgery: results of an observational multicenter study

INTRODUCTION: Taking into account the prevalence of postoperative pneumonia and the increase in the number of surgical procedures, forecasting its development is an urgent task that allows taking measures to reduce the frequency of its occurrence by optimizing the perioperative period. Despite their value, the existing scales for predicting postoperative pneumonia do not provide domestic specialists with a reliable and consistent method by which to stratify the risk of developing postoperative pneumonia in our population. OBJECTIVE: To develop a model for predicting postoperative pneumonia based on the identification of risk factors for its development. MATERIALS AND METHODS: A multicenter prospective study of 6844 patients over 18 years of age undergoing elective abdominal surgery. 30-day mortality and postoperative pneumonia were assessed. In the first phase of the study, a comparison was made between the pneumonia and non-pneumonia group of baseline patient data, as well as factors associated with surgery and anesthesia. At the second stage of the study, a logistic regression analysis was performed to assess the contribution of factors to the development of postoperative pneumonia. At the third stage of the study, a model for predicting postoperative pneumonia was built according to the data of multivariate logistic regression analysis. At the final stage, the obtained model was compared with the forecasting models of other authors found in the world literature. RESULTS: Pneumonia was detected in 53 patients (0.77 %). A lethal outcome was observed in 39 patients: in patients with pneumonia in 15 cases (28.3 %), and without pneumonia in 24 cases (0.4 %). Retrospectively, taking into account the obtained model, 933 patients were assigned to the high-risk group for developing pneumonia, the incidence of pneumonia was 4.5 %. In the low-risk group for developing pneumonia — 5911 patients, the incidence of pneumonia was 0.19 %. CONCLUSIONS: Eight independent variables associated with postoperative pneumonia were identified: duration of surgery, smoking, complete functional dependence, perioperative anemia requiring iron supplementation, intraoperative use of vasopressors, American Society of Anesthesiologists classification 3 functional class, use of bronchodilators for chronic obstructive pulmonary disease, and high operative risk. The postoperative pneumonia prediction model has excellent predictive value (AUROC = 0.904).