Number Of Maneuvers Research Articles

Number of maneuvers need to get a negative Dix-Hallpike test

SummaryBenign Paroxysmal Positional Vertigo is one of the most common causes of dizziness. Its characteristic clinical profile is dizziness at head movements. The main diagnostic maneuver of posterior canal Benign Paroxysmal Positional Vertigo is the Dix-Hallpike test. If the maneuver is positive (vertigo and/or nystagmus), the physician can perform the Epley maneuver on the injured side.AimThis paper aims at checking the number of maneuvers necessary for patients with posterior canal Benign Paroxysmal Positional Vertigo to have a negative Dix-Hallpike test.Materials and methodswe carried out a retrospective analysis of 71 charts of patients with posterior canal Benign Paroxysmal Positional Vertigo, who were treated with the modified Epley maneuver.Study DesignCross-Sectional Retrospective.ResultsWe found that 76.00% of the patients analyzed had the symptoms completely resolved and negative Dix-Hallpike test with a single maneuver.ConclusionBased on our results it is possible to conclude that the number of modified Epley maneuvers is variable depending on the etiology, being that the Benign Paroxysmal Positional Vertigo secondary to the traumatic brain injury needed a greater number of maneuvers for Dix-Hallpike test to become negative.

Clinical results and combined medication of epiduroscopy

AbstractIn chronic radiculopathic pain and back pain associated with epidural fibrosis, spinal endoscopy is potentially a powerful weapon. Its usefulness in diagnosis has not been realised but its therapeutic role is effective. The generation of radiculopathic pain is complex and there are a number of manoeuvres within this technique that are potentially beneficial. Recent evidence has shown that the most important component is safe and effective adhesiolysis. Recent outcomes of three prospective case series, two retrospective evaluations and a randomized, double-blind controlled trial have been positive for improvements in pain and physical function in patients who had previously obtained inadequate pain relief with traditionally placed caudal or lumbar epidural steroids. Saline is used in spinal endoscopy in order for direct vision to be achieved but also to aid with an adhesiolytic distension effect. Inflammatory chemicals leaking from degenerate intervertebral discs or zygapophysial joints may be wash...

The Transversus Abdominis Plane Block

In Response: Dr. Reid (1) makes two points. The first concerns the anatomy of the triangle of Petit. Dr. Rafi (2), an early collaborator with the first author (JMcD) in developing this block, was incorrect in stating that the floor of the triangle is formed by the internal oblique muscle. As stated in our original paper, the floor of the triangle of Petit is made up of fascial extensions of the external and internal oblique muscles (3). The needle does not traverse the external oblique muscle, but rather the fascial extensions of this muscle and the internal oblique. It is these fascial layers which produce the “pop” sensation described when performing the block. The needle then lies just lateral to the transversus abdominis, which is the correct position for the performance of the block. We are currently further characterizing the anatomy of the transversus abdominis plane block in cadaveric studies. The second point concerns the performance of the block in obese patients. We acknowledge that the triangle of Petit can be more difficult to locate in these patients. However, we have a high success rate with the block even in this group. However, we do recommend initially performing this block in patients with a normal body habitus, in order to gain experience with the block prior to moving onto patients that one might find more challenging. A number of maneuvers may aid palpation of the triangle in these patients. There is usually tenting of the adipose tissue at the pelvic rim, so that this adipose fold can be “displaced” superiorly. Palpation can be further aided by having the patient lift their head off the bed which tenses the abdominal wall and makes the triangle easier to palpate. It is also worth remembering that palpation of the triangle of Petit can cause some discomfort, which can be used to confirm the location of the triangle. We are currently characterizing the utility of ultrasound, which may aid the location of the triangle, particularly in obese patients. We agree with Dr. Tornero-Campello (4) that the clinical utility of the transversus abdominis plane block can usefully be compared to epidural analgesia. We wish to clarify that there is currently no reason to contend that the transversus abdominis plane block would provide superior analgesia to epidural blockade, and have not made this claim. As discussed in our paper, there are many patients undergoing abdominal surgery for epidural blockade is not available, due to contraindications such as sepsis or coagulopathy or to logistical issues such the lack of availability of the required postoperative monitoring. Therefore epidural analgesia cannot be considered “standard care,” but rather is the ‘gold standard’ for provision of postoperative analgesia. Furthermore, the transversus abdominis plane block can provide unilateral analgesia, an advantage in patients undergoing non-midline abdominal incisions. In our study, we demonstrated that the transversus abdominis plane block substantially improves patient comfort when compared to patients who receive opioid-based postoperative analgesia. Therefore, at present we would recommend the transversus abdominis plane block for patients in whom epidural analgesia is not feasible for the reasons discussed earlier. John G. McDonnell John G. Laffey Department of Anaesthesia Clinical Sciences Institute Galway University Hospitals Galway, Ireland [email protected]

Maternal morbidity associated with obstetrical maneuvers in shoulder dystocia

Objectives To determine whether shoulder dystocia and obstetrical maneuvers used for its relief have detrimental effects on perineum or immediate postpartum outcome. Design Case–control study. Setting Tertiary maternity ward in Marseille, France. Population A total 140 cases with shoulder dystocia and 280 controls without shoulder dystocia were enrolled by reviewing charts for the period between January 1999 and December 2004. Methods Demographic data including obstetrical history, age, height, weight before pregnancy and at the time of delivery, and respective body mass index (BMI) and obstetrical data including analgesic technique, duration of first and second stage of labor were compared in function of outcome and of the type and number of maneuvers used to relieve shoulder dystocia. Results Resolving shoulder dystocia required one obstetrical maneuver in 41 cases (29.3%) and two obstetrical maneuvers in 48 cases (34.3%). Third-degree tears occurred in one patient in the case group versus five in the control group. No correlation was found between the number of obstetrical maneuvers needed to relieve shoulder dystocia and risk for third-degree tear (OR: 0.8; 95% CI: 0.1–7.6). Mean hemoglobin values were 96.1 g/l in the case group and 96.0 g/l in the control group ( p = 0.95). There was no difference between the two groups regarding duration of postpartum hospitalization. The incidence of urinary incontinence was similar in the group that underwent obstetrical maneuvers: 4.7% (6/127) and in the control group: 3.7% (13/352). Only two patients reported de novo anal symptoms, both in the control group. Conclusion Shoulder dystocia and obstetrical techniques used for its relief did not result in adverse maternal outcome.

Assessment of surgeon competency to remove mandibular third molar teeth

Abstract.There is an increasing demand for methods to objectively assess a surgeon's competence. The purpose of this study is to test two evaluation methods that assess a surgeon's skills in the removal of mandibular third molar teeth. One method uses an objective checklist scale by which twenty components of the operation are judged as correct or incorrect. The second method is a global rating scale, that scores different aspects of performance, such as respect for tissue, number of manoeuvres, knowledge of procedure and instrument handling. Using these two methods, assessors judged the removal of 22 mandibular third molar teeth by 17 different surgeons.Good inter-rater reliability was achieved using both scales. A greater preference was expressed for the global rating scale for assessment and for the objective checklist scale for guiding feedback in training. Scales such as these need to be developed for, and tested on, different surgical procedures in order that credible assessment of surgical skills can be obtained.

Feedback information from flow volume curves to the practice.

To investigate whether the use of feedback information provided by viewing flow volume (F/V) curves during spirometry performed by practice assistants improves spirometry test quality. Randomised controlled single session crossover study. Eight practice assistants performed spirometry in healthy subjects (n=47). Two measurement conditions were applied, one allowing viewing of F/V curves during the tests ('unblinded') the other not ('blinded'). Outcomes were differences in FEV1, FVC, FEV1/FVC ratio, PEF, FEV1 repeatability and number of manoeuvres per test. Two lung function technicians indicated their preference for either the blinded or unblinded F/V curve. Higher PEF values were observed for the unblinded condition (0.43 L/s, 95% CI 0.08, 0.77). The other outcomes showed no differences. One lung function technician judged that in 62% (p=0.012) of the pairs the F/V curve from the unblinded condition was better, the other technician judged so in 51% (p=0.349). This study in healthy subjects showed that the use of information from F/V curves leads to a modest quality improvement of spirometric tests performed by practice assistants and can therefore be recommended for use in general practice.

Perinatal Outcome and the Type and Number of Maneuvers in Shoulder Dystocia

Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Int J Gynecol Obstet 1996;55:219-224.

Perinatal outcome and the type and number of maneuvers in shoulder dystocia

Objectives: To ascertain the type and order of maneuvers that should be used for the treatment of shoulder dystocia; and to attempt to quantify the severity of shoulder dystocia, and to determine its correlation with perinatal outcome. Methods: We reviewed all consecutive cases of shoulder dystocia from January 1986 to August 1994 in our institution to obtain the type, order and number of maneuvers used for delivery. Patients were stratified by the number of maneuvers required for delivery. Outcome parameters included cord pH, Apgar score, neonatal trauma (Erb's palsy and fracture), and maternal trauma. Results: The incidence of shoulder dystocia was 0.7% (39 280 total vaginal deliveries). Use of only two maneuvers, McRoberts and suprapubic pressure, resulted in resolution in 58% of cases. The addition of the Woods screw maneuver and/or delivery of the posterior arm was sufficient in all remaining cases. The rates of neonatal palsy and fracture, and maternal fourth-degree laceration, increased with the number of maneuvers. Conclusions: The McRoberts maneuver and suprapubic pressure should be first-line treatment for shoulder dystocia. More difficult and damaging maneuvers such as Woods screw and delivery of the posterior arm may be reserved for refractory cases. Additional maneuvers are rarely necessary for delivery. The number of maneuvers may serve as a measure of the severity of the shoulder dystocia.

The significance of persistent myocardial perfusion during aortic cross-clamping in myocardial protection

Persistent residual myocardial blood flow during aortic cross-clamping can wash out the cardioplegic solution and metabolic end products, continue to deliver substrates, and rewarm the heart. Since microsphere tracers previously used to study “noncoronary” flow could be trapped in the lung before the bronchial circulation reaches the heart, we used xenon 133 washout from the myocardium to determine the residual flow during normothermic cardiopulmonary bypass and aortic cross-clamping. In 16 dogs, with either normal or hypertrophic left ventricles, the persistent myocardial flows during aortic cross-clamping were found to be significant and variable, ranging between 10% and 50% of pre-cross-clamp flows, and were consistently higher in nonvented hearts. The normal hearts with left ventricular venting had residual flow of 13.3 ± 4.0 ml/100 gm/min; those without venting had 37.4 ± 13.0 ml/100 gm/min. The hypertrophic hearts had 9.7 ± 0.7 ml/100 gm/min with venting and 14.1 ± 2.0 ml/100 gm/min without venting. Myocardial biopsy specimens were obtained before and at the end of a 30 minute aortic cross-clamp period, and the myocardial tissue lactate levels were determined. There was an inverse relationship between the magnitude of myocardial residual flow and the tissue lactate accumulation, indicating the metabolic significance of such residual flow. Certain controversies on myocardial protection, which arose due to discrepancies in results obtained from isolated in vitro preparations as compared with those from the in vivo hearts (e.g., the roles of glucose and calcium), may be explained by considering the effects of such residual myocardial flow. Furthermore, the magnitude of myocardial perfusion during aortic cross-clamping can be modulated by a number of maneuvers in order to achieve better myocardial protection during cardiac operations.

Dissociated reabsorption of phosphate and bicarbonate in the post-obstructed dog kidney.

A parallel relationship exists between the absorption of phosphate and bicarbonate in the normal kidney (Table I). A number of maneuvers which inhibit phosphate absorption also inhibit absorption of bicarbonate such as volume expansion (1–3), parathyroid extract (2), parathyroid hormone (1), cAMP (4) and hypocalcemia (5). On the other hand, those maneuvers which enhance phosphate absorption also enhance bicarbonate absorption such as renal hypoperfusion (6), aortic constriction (7), parathyroidectomy (2), hypercalcemia (2) and vitamin D (8). The nature of the parallelism between phosphate and bicarbonate absorption is not known but it may be the result of a relation between the absorption of each of these anions to the absorption of sodium and water in the proximal tubule, since many of the maneuvers discussed above alter sodium absorption in a parallel fashion.KeywordsNormal KidneyAortic ConstrictionUnilateral Ureteral ObstructionBicarbonate AbsorptionUreteral ObstructionThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.