Perioperative Side Effects Research Articles

Comparison of anesthetic efficacy of intrathecal 1% isobaric 2-chloroprocaine with 0.5% isobaric ropivacaine for inguinal hernia surgeries

Background: Inguinal hernia repair is one of the most common surgical conditions. In the absence of other comorbidities, it can be performed as a day-care procedure. Spinal anesthesia is most preferred technique this surgery. Local anesthetics having rapid and smooth onset of action, good intraoperative analgesia, short recovery period, and least side effects are preferred. Aims and Objectives: The objective of the study was to compare the anesthetic efficacy of intrathecal 1% isobaric 2-chloroprocaine (CP) and 0.5% isobaric ropivacaine for inguinal hernia surgeries. Materials and Methods: Sixty patients with ASA grade I/II scheduled for elective inguinal hernia surgeries were randomly allocated into group C (n=30), received 3 mL of 1% isobaric 2- CP and group R (n=30), received 3 mL of 0.5% isobaric ropivacaine intrathecally. Results: Demographic profile, mean time for onset of sensory blockade at T10, highest level of sensory blockade, and maximum motor blockade were comparable among the groups (P>0.05). The highest level of sensory blockade in group C is T7 and group R is T8. The mean time to two segment regression, complete sensory regression, complete motor recovery, recovery of parameters for achieving discharge criteria such as time to unassisted ambulation, drink water, micturition, and first rescue analgesia were significantly shorter in group C (P<0.0001). Visual analog scale score at the time of first rescue analgesia was significantly higher in group C (P<0.0001). Intraoperative hemodynamic changes and perioperative side effects were comparable (P>0.05). Conclusion: CP provides faster block resolution, earlier hospital discharge, and early ambulation with minimal side effects, making it a better alternative to ropivacaine for inguinal hernia surgeries.

Safety profile of robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate.

Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate is a novel and highly accurate procedure. The aim of this study was to evaluate the MonaLisa prostate biopsy system in terms of safety, tolerability, and patient-related outcomes. This prospective study included 228 patients, who had undergone Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate at the University Hospital Basel between January 2020 and June 2022. Peri-operative side effects, functional outcomes and patient satisfaction were assessed. Mean pain score on the day of biopsy was 1.3 points on VAS, which remained constant on the day after biopsy. Overall, 32 of 228 patients (14%) developed grade I complications according to Clavien-Dindo classification. No higher-grade complications occurred. Gross haematuria, hematospermia and acute urinary retention occurred in 145/228 (63.6%), 98/228 (43%) and 32/228 (14%) patients, respectively. One patient (0.4%) developed urinary tract infection. Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate performed under general anesthesia is a safe and well tolerated procedure. This technique allows to omit perioperative prophylaxis and at the same time minimizes the risk of infectious complications. We attribute the favorable risk profile and tolerability to the minimal invasive approach via two entry points.

Intravesical aminophylline instillation as an alternative for balloon dilatation prior to semi-rigid ureteroscopic management of distal ureteral stones

PurposeIn a randomized controlled trial, we evaluated the effect of intravesical aminophylline instillation (IVAI) on intraureteral pressure of lower ureter and its use as an alternative to balloon dilatation after failure of advancing semi-rigid ureteroscope through the ureteric orifice without endodilatation.MethodsOur study included 83 patients with juxta-vesical distal ureteral calculi requiring endodilatation after unsuccessfully introducing the semi-rigid ureteroscope through the ureteric orifice. Patients were randomized into two groups: group A (study group) included 41 patients, where IVAI was used to dilate the ureter and facilitate ureteroscopy (the intraureteral pressure was measured using a pressure transducer connected to an invasive pressure monitor before and 5 min after IVAI), whereas group B (control group) included 42 patients, where balloon dilatation was used prior to ureteroscopy. Perioperative surgical outcomes of ureteroscopy were evaluated in both groups.ResultsA statistically significant decrease in mean intraureteral pressure of intravesical ureter was found after IVAI from 12.34 mmHg ± 1.94 before injection to 8.46 mmHg ± 1.94 after injection (P < 0.001). Ureteral injuries, postoperative pain and hematuria were statistically significantly less among the study group compared to the control group (P < 0.05). We did not find statistically significant differences in operative time, need for DJ ureteral stenting or stone-free rate between both groups and no perioperative side effects were associated with IVAI.ConclusionIn ureteroscopic management of distal ureteral stones, intravesical aminophylline instillation is safe, inexpensive and effective in reducing intraureteral pressure and achieves comparable outcomes to balloon dilatation with less ureteral injuries, postoperative pain and hematuria.

MP09-07 SAFETY PROFILE OF ROBOTIC-ASSISTED TRANSPERINEAL MRI-US-FUSION GUIDED BIOPSY OF THE PROSTATE

You have accessJournal of UrologyCME1 May 2022MP09-07 SAFETY PROFILE OF ROBOTIC-ASSISTED TRANSPERINEAL MRI-US-FUSION GUIDED BIOPSY OF THE PROSTATE Christian Wetterauer, Walter Manuel, Pawel Trotsenko, Matthias Marc, Winkel David Jean, Breit Christian, Meyer Anja, and Seifert Hans Helge Christian WetterauerChristian Wetterauer More articles by this author , Walter ManuelWalter Manuel More articles by this author , Pawel TrotsenkoPawel Trotsenko More articles by this author , Matthias MarcMatthias Marc More articles by this author , Winkel David JeanWinkel David Jean More articles by this author , Breit ChristianBreit Christian More articles by this author , Meyer AnjaMeyer Anja More articles by this author , and Seifert Hans HelgeSeifert Hans Helge More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002531.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted transperineal MRI-US-fusion guided biopsy of the prostate (RA-TP-PBx) is a novel and highly accurate procedure. The aim of this study was to evaluate the MonaLisa prostate biopsy system in terms of safety, tolerability, and patient-related outcomes. METHODS: This prospective study included 135 patients, who had undergone RA-TP-PBx at the University Hospital Basel between January 2020 and August 2021. Peri-operative side effects, functional outcomes and patient satisfaction were assessed. RESULTS: Overall, 18 of 135 patients (13.3%) developed grade I complications according to Clavien-Dindo classification. No higher-grade complications occurred. Mean pain score on the day of biopsy was 1.1 points on VAS, which remained constant on the day after biopsy. Gross haematuria, hematospermia and acute urinary retention occurred in 91/135 (68.9%), 66/135 (26.5%) and 17/135 (12.6%) patients, respectively. One patient (0.7%) developed urinary tract infection. CONCLUSIONS: RA-TP-PBx performed under general anesthesia is a safe and well tolerated procedure. This technique allows to omit perioperative prophylaxis and at the same time minimizes the risk of infectious complications. We attribute the favorable risk profile and tolerability to the minimal invasive approach via two entry points. Source of Funding: Uromed © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e137 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Wetterauer More articles by this author Walter Manuel More articles by this author Pawel Trotsenko More articles by this author Matthias Marc More articles by this author Winkel David Jean More articles by this author Breit Christian More articles by this author Meyer Anja More articles by this author Seifert Hans Helge More articles by this author Expand All Advertisement PDF DownloadLoading ...

The effect of two groups of intrathecal fentanyl doses on analgesic outcomes and adverse effects in parturients undergoing cesarean delivery: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

BackgroundVariable doses of intrathecal fentanyl (ITF) have been used for peri-operative analgesia during cesarean delivery (CD). We conducted a systematic review and meta-analysis to compare lower doses (LD; ≤12.5 µg) and higher doses (HD; >12.5 µg) of ITF in parturients undergoing CD. MethodsDatabases were searched from inception to December 2020 for randomized controlled trials (RCTs) administering ITF as an additive to local anesthetic. The primary outcome was the use of intra-operative analgesic supplementation. Time to first rescue analgesia, the incidence of peri-operative side effects and neonatal outcomes were secondary outcomes. Additional analysis was performed after stratifying trials using ≤15 µg and >15 µg of ITF. Mean difference (MD) and risk difference (RD) with 95% confidence interval (CI) were calculated. ResultsEleven RCTs met inclusion criteria. Study groups were 601 patients (LD) and 749 patients (HD). A HD of ITF reduced the risk for supplementation by 6% (95% CI 0 to 13%; P=0.05; I2=80%) compared with LD, and increased the time to first rescue analgesia (MD 55.2 min, 95% CI 20.3 to 90.1, P=0.002; I2=100%). The risk of pruritus increased by 13% (95% CI 5 to 21%; P=0.001; I2=81%). Pooled data suggest that the incidence of nausea and vomiting, and neonatal outcomes did not significantly differ. ConclusionsIn women undergoing CD, doses of ITF >12.5 µg reduced the requirement for intra-operative analgesic supplementation and prolonged the time to first rescue analgesia compared with smaller doses, but increased pruritus. On revising the cut-off to 15 µg, no significant difference was found.

Utility and safety of low-concentration nitrous oxide anesthesia in ptosis surgery.

To evaluate the utility of low-concentration nitrous oxide (N2O) anesthesia in ptosis surgeryThis study was a retrospective consecutive case series that included 54 successive patients with blepharoptosis who underwent bilateral levator aponeurosis advancement and on whom skin resection performed by the same surgeon between August 2016 and July 2017. Among these patients, 27 were operated with a local anesthesia injection (air group) and 27 with a local anesthesia injection and low-concentration N2O anesthesia (N2O group). All N2O cases used a total of 6 L of gas comprising 70% oxygen and 30% N2O. Preoperative and postoperative blood pressure (BP) and heart rate (HR) and intraoperative pain, anxiety, nausea, and memory were measured immediately after surgery using visual analog scale score (VASS). Additionally, perioperative side effects were examined.There was no significant difference in age, sex, and preoperative and postoperative margin reflex distance (MRD) between the 2 groups (all P > .05). The intraoperative mean peripheral oxygen saturation was significantly higher (97.5% ± 1.6% vs 99.5% ± .6%, P < .001), intraoperative HR was significantly lower (78.2 ± 12.8 vs 70.7 ± 11.6 bpm, P = .02), and operation time was significantly shorter (33.1 ± 8.1 vs 29.4 ± 10.3 minutes, P = .03) in the N2O group than in the air group.Difference between intraoperative and preoperative systolic BP (BPs) (+15.8 ± 18.0 vs + 3.1 ± 21.7 mm Hg, P = .02), diastolic BP (BPd) (+7.0 ± 17.4 vs −2.3 ± 13.6 mm Hg, P = .04), and HR (3.2 ± 8.5 vs −3.9 ± 9.4 bpm, P = .01) was significantly lower in the N2O group than in the air group.VASS of intraoperative pain was significantly lower in the N2O group than in the air group (49.5 ± 24.7 vs 22.6 ± 14.9, P < .001), whereas intraoperative anxiety and memory did not present significant differences between the groups (P = .09 and P = .45, respectively). Intraoperative nausea score was 0 for all cases in both groups. There was no other side effect.Ptosis surgery with anesthesia using 30% N2O may effectively suppress intraoperative BP and HR along with pain and shorten the operation time without side effects such as nausea.

Growth Promoting Effect of Vacuum Sealing Drainage in the Healing Processes of Diabetic Foot Ulcers.

AimTo explore the growth-promoting effect of vacuum sealing drainage (VSD) during the healing processes of diabetic foot ulcers (DFUs).MethodsFrom November 2018 to December 2019, 38 patients with unilateral DFUs were enrolled in this retrospective study. All patients were divided into two groups according to the use of VSD or not: the VSD group (n=20) and the control group (n=18). The following parameters were used to evaluate the healing process: changes in the mean areas of the ulcers; healing rate (HR); epithelial hyperplasia and angiogenesis as determined by hematoxylin-eosin staining (HE staining); and expression of CD34, CD68 and VEGF as assessed through immunohistochemistry. Perioperative side effects and complications were also recorded.ResultsAll patients received follow-up and eventually healed. The mean area of wounds was reduced in the VSD group compared to the control group (1.75±0.64 cm2 vs 0.88±0.54 cm2, P=0.031). The mean HR of the ulcers in the VSD group was significantly higher than that in the control group (35.23±2.87% vs 28.78±1.09%, P=0.017). HE staining showed that the amount of epithelial hyperplasia and angiogenesis increased significantly after VSD, and the immunohistochemistry results showed that the expression of CD34, CD68 and VEGF increased significantly in the VSD group.ConclusionVSD could significantly accelerate the wound healing process, probably by enhancing the inflammatory response and promoting granulation and angiogenesis in DFUs.

Comparison of Various Techniques of Anesthesia for Surgical Management of Diabetic Foot

Background: Diabetes mellitus is a multisystem disease caused by an absolute or relative deficiency of insulin secretion or resistance or a combination of both. Anesthesia in them is of special concern because of complex polypharmacy, an inappropriate dose of oral hypoglycemic agents or insulin and errors in converting IV insulin to usual medication. The objective is to compare the various techniques of anesthesia for surgical management of diabetic foot in terms of intraoperative hemodynamic stability, perioperative problems related to anesthesia techniques, postoperative analgesia. Subjects and Methods: Sixty adult diabetic patients of both gender of ASA grade II-III, aged 35years undergoing surgical management of diabetic foot were elected and separated into three groups, Group A: general anesthesia with tracheal intubation, Group B: unilateral spinal anesthesia with injection 0.5% bupivacaine heavy 1.5ml (7.5mg), Group C: popliteal nerve block via lateral approach by injecting 30 ml 0.5% bupivacaine. Parameters like pulse rate, mean arterial blood pressure, respiratory rate and SpO2 were recorded at regular intervals. Postoperative pain, perioperative side effects, complications and problems related to anesthetic techniques were noted. The analysis is done by unpaired t-test and chi-square test. Results: Group C patients were hemodynamic stable than Group A and B. Post-op analgesia was prolonged in Group C. Perioperative side effects were more found in Group A. Conclusion: Popliteal nerve block and unilateral spinal anesthesia provide better hemodynamic stability and postoperative analgesia with negligible side effects as compared to general anesthesia for surgical management of diabetic foot.

Ablation of soft tissue tumours by long needle variable electrode-geometry electrochemotherapy: final report from a single-arm, single-centre phase-2 study

Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treatment of small superficial lesions. Variable electrode-geometry ECT (VEG-ECT) may overcome these limitations by using long freely-placeable electrodes. Patients with bulky or deep-seated soft-tissue malignancies not amenable to resection participated in a single-arm phase-2 study (ISRCTN.11667954) and received a single course of VEG-ECT with intravenous bleomycin (15,000 IU/m2) and concomitant electric pulses applied through an adjustable electrode array. The primary outcome was radiologic complete response rate (CRR) per RECIST; secondary endpoints included feasibility, metabolic response, toxicity (CTCAE), local progression-free survival (LPFS) and patient perception (EQ-5D). During 2009–2014, we enrolled 30 patients with trunk/limb sarcomas, melanoma, Merkel-cell carcinoma, and colorectal/lung cancer. Median tumour size was 4.7 cm. Electrode probes were placed under US/TC guidance (28 and 2 patients, respectively). Median procedure duration was 80 minutes. Tumour coverage rate was 97% (29 of 30 patients). Perioperative side-effects were negligible; one patient experienced grade-3 ulceration and infection. One-month 18F-FDG-SUV decreased by 86%; CRR was 63% (95% CI 44–79%). Local control was durable in 24 of 30 patients (two-year LPFS, 62%). Patients reported an improvement in “usual activities”, “anxiety/depression”, and “overall health” scores. VEG-ECT demonstrated encouraging antitumour activity in soft-tissue malignancies; a single course of treatment produced high and durable responses, with low complications.

Comparision of Dexmedetomidine and Propofol in Patients Undergoing Laparoscopic Cholecystectomy Under Spinal Anesthesia.

Background:Spinal anesthesia (SA) with sedation is considered to be an alternative to general anesthesia for laparoscopic cholecystectomy (LC) in high-risk patients. Ketamine in analgesic dose with propofol or dexmedetomidine infusion provides titratable sedation, hemodynamic stability, and minimum respiratory depression without psychomimetic effects.Aim:To compare the efficacy of ketamine–dexmedetomidine and ketamine-propofol combination in relation to sedation, analgesia, hemodynamic effects, and perioperative side effects.Settings and Design:This was a prospective, randomized single-blind comparative study comprising 100 American Society of Anesthesiologists I, II, and III patients posted for LC.Materials and Methods:Patients were randomized into two groups of 50 patients each. Group KP (ketamine + propofol) received intravenous (i.v.) bolus of injection ketamine 0.5 mg.kg −1 and propofol infusion at 3 mg.kg −1.h −1. Group KD (ketamine + dexmedetomidine) received i.v. bolus of injection ketamine 0.5 mg.kg −1 and dexmedetomidine infusion at 0.4 μg.kg −1.h −1. Parameters observed were vitals, perioperative side effects, time to first rescue analgesia, and return of consciousness.Statistical Analysis:Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables.Results:Duration of analgesia was longer in KD Group (191.2 vs. 173.5 min), and time to regain consciousness was faster in KP Group (14.9 vs. 20.4 min).Conclusion:Both the techniques of sedation are feasible, safe, and comparable, except the duration of analgesia and time to regain consciousness which was longer in KD Group.

Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups; 35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p 2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe; produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

Flexible video endoscope versus Macintosh laryngoscope for orotracheal tracheal intubation in the lateral position: a study protocol for a randomized controlled trial

BackgroundTracheal intubation with the patient in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. Flexible video endoscopes may facilitate intubation even when laryngeal views are poor on direct laryngoscopy because the patients are positioned laterally. Thus, this trial aims to compare the efficacy of flexible video endoscopes to Macintosh laryngoscopes for orotracheal intubation in the lateral position and to investigate their feasibility, i.e., whether the use of the two devices in combination can secure the airway when endotracheal intubation in the lateral position has failed using one device.MethodsThis will be a prospective, randomized, single-center, clinical trial. One hundred and seventy-four patients aged 18–65 years, who have been scheduled to undergo tracheal intubation under uniform general anesthetic techniques for elective kidney surgery in the lateral decubitus position will be randomly divided into the flexible video endoscope and the Macintosh laryngoscope groups. Primary outcomes include intubation time and intubation success rate. Secondary outcomes include overall user satisfaction (graded from 1 to 10 (1 = very poor, 10 = excellent)) and perioperative side effects and complications, such as frequency of esophageal intubation, lip or dental injury, sore throat, and hoarseness.DiscussionThe trial will clarify the efficacy of intubation with a Macintosh laryngoscope and a flexible video endoscope in the lateral position, and whether the two devices could be used in combination to secure the airway in cases where endotracheal intubation in the lateral position has failed with one device.Trial registrationChinese Clinical Trial Register, ChiCTR- IOR-15007175. Registered on 6 October 2015.

Neuraxial Anesthesia in the Geriatric Patient

Neuraxial anesthesia is recommended as a well-accepted option to minimize the perioperative side effects in the geriatric patients. The available data from the current researches have shifted the focus from the conventional approach to spinal anesthesia to the concept of low dose local anesthetic combined with opioids. What remains clear from all these studies is that hemodynamic stability is much better in patients who received low-doses of intrathecal bupivacaine in combination with opioids, which is possibly result of a potent synergistic nociceptive analgesic effect and their minimal potential effects on sympathetic pathways thus minimizing spinal hypotension. Spinal anesthesia with 5–10 mg of 0.5% heavy bupivacaine, fentanyl 20 mcg and 100 mcg of long-acting morphine added to the perioperative plan decreased the incidence of spinal hypotension and improved perioperative outcomes in the geriatric patients undergoing (low segment) surgical procedures. These findings may be of interest in the gynecologic geriatric surgery also in which area there are very few studies concerning the use of low-dose concept.

A randomized clinical trial of intrathecal magnesium sulfate versus midazolam with epidural administration of 0.75% ropivacaine for patients with preeclampsia scheduled for elective cesarean section.

Background and Aims:Magnesium sulfate and midazolam have been used as adjuvants to local anesthetics via intrathecal and epidural routes to augment the quality of block and prolong postoperative analgesia. This study compares addition of intrathecal magnesium sulfate versus intrathecal midazolam to epidurally administered isobaric ropivacaine as a part of combined spinal epidural technique in pre-eclamptic parturients undergoing elective cesarean section.Material and Methods:After institutional ethics committee approval and written informed consent, 50 pre-eclamptic parturients were randomly allocated to one of the two groups of 25 each to either receive intrathecal magnesium sulfate (50 mg) or intrathecal midazolam (1 mg) in combination with epidural ropivacaine (0.75%; 14–16 ml). The onset and duration of sensory and motor blockade, duration of postoperative analgesia, postoperative visual analogue scores for pain, and perioperative side effects were noted. Data were analyzed statistically using Graphpad.com software.Results:Onset times to sensory and motor blockade were faster in midazolam than in magnesium group (P < 0.01). Duration of sensory and motor blockade, and time to first request of analgesia were significantly longer in the magnesium group compared to the midazolam group (P < 0.01). The fetal outcomes according to APGAR scores were comparable in both the groups, the median APGAR score at 1 minute was 8 and at 5 minutes was 10 in both the groups.Conclusion:Intrathecal magnesium with epidural ropivacaine significantly prolonged postoperative analgesia compared to intrathecal midazolam without any complications. Perioperative hemodynamics were comparable in both groups.

Implantation of a biodegradable rectum balloon implant: tips, Tricks and Pitfalls.

ABSTRACTIntroduction:A rectum balloon implant (RBI) is a new device to spare rectal structures during prostate cancer radiotherapy. The theoretical advantages of a RBI are to reduce the high radiation dose to the anterior rectum wall, the possibility of a post-implant correction, and their predetermined shape with consequent predictable position.Objective:To describe, step-by-step, our mini-invasive technique for hands-free transperineal implantation of a RBI before start of radiotherapy treatment.Materials and Methods:We provide step-by-step instructions for optimization of the transperineal implantation procedure performed by urologists and/or radiation oncologists experienced with prostate brachytherapy and the use of the real-time bi-plane transrectal ultrasonography (TRUS) probe. A RBI was performed in 15 patients with localised prostate cancer. Perioperative side-effects were reported.Results:We provide ‘tips and tricks’ for optimizing the procedure and proper positioning of the RBI. Please watch the animation, see video in https://vimeo.com/205852376/789df4fae4.The side-effects included mild discomfort to slight pain at the perineal region in 8 out of 15 patients. Seven patients (47%) had no complaints at all. Two patients developed redness of the skin, where prompt antibiotic regimen was started with no further sequelae. One patient revealed a temporary urine retention, which resolved in a few hours following conservative treatment. Further no perioperative complications occurred.Conclusion:This paper describes in detail the implantation procedure for an RBI. It is a feasible, safe and very well-tolerated procedure.

Three-Year Outcomes of the Prospective, Randomized Controlled Rezūm System Study: Convective Radiofrequency Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

To report 3-year outcomes of a prospective, multicenter, randomized, blinded control trial after treatment with convective radiofrequency (RF) water vapor thermal therapy for moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Fifteen centers enrolled and randomized 197 men ≥50 years old with International Prostate Symptom Score (IPSS) ≥13, maximum flow rate (Qmax) ≤15 mL/s, and prostate volume 30 to 80 cc to thermal therapy with Rezūm System or control (2:1). Rigid cystoscopy with simulated active treatment sound effects served as the control procedure. Convective RF thermal energy was delivered into obstructive prostate tissue including the median lobe as needed. After randomized comparison at 3 months, thermal therapy subjects were followed annually for 3 years. Convective RF thermal therapy yielded IPSS improvement of 160% compared with control subjects at 3 months (P <.0001). Maximal symptom relief of at least 50% improvement in IPSS, quality of life, Qmax, and BPH Impact Index remained durable throughout 3 years (P <.0001). Subjects with a treated median lobe had similar responses. No late-related adverse events occurred, and no de novo erectile dysfunction was reported. The surgical retreatment rate was 4.4% over 3 years. The minimally invasive convective RF thermal therapy is an office or ambulatory outpatient procedure with minimal transient perioperative side effects. It provides early effective and durable relief of BPH symptoms with preservation of sexual function in subjects followed up for 3 years and is applicable to treatment of the median lobe and hyperplastic central zone tissue.

Sedation with intrathecal clonidine versus fentanyl with bupivacaine in elective cesarean section in a sample of Egyptian parturients

Background and objectiveRegional analgesia has become the preferred technique in obstetrics. Spinal analgesia has many advantages, including being a single injection, being easier to administer, and being faster to take effect.Patients and methodsThis study was carried out on 40 parturients scheduled for cesarean sections with spinal analgesia who were categorized as follows: the fentanyl group − 20 parturients received 2 ml of 0.5% hyperbaric bupivacaine and 25 μg fentanyl; and the clonidine group − 20 parturients received 2 ml of 0.5% hyperbaric bupivacaine and 75 μg clonidine. Hemodynamic measurements, sensory blockade, pain intensity using visual analog scale (VAS) and time to first request for analgesia, motor blockade, perioperative side effects or complications, fetal well-being using Apgar score, and both parturient and surgeon satisfaction were recorded and statistically analyzed.ResultsThe parturients who received intrathecal clonidine had a higher level and faster onset of sensory blockade and delayed regression of sensory level compared with those who received intrathecal fentanyl. Regarding the changes in pain intensity measured by VAS, the clonidine group revealed low VAS compared with the fentanyl group immediately after spinal anesthesia and up to 3 h postoperatively with earlier and multiple requests for analgesics in the fentanyl group. On comparing both groups regarding onset of motor block and its regression using the modified Bromage score, we noticed slower onset and regression of motor block in the fentanyl group with longer duration of motor block compared with the clonidine group. Sedation was significantly higher in the clonidine group (25%) than in the fentanyl group. The incidence of nausea and vomiting was significantly higher in parturients who received intrathecal fentanyl (30%) than in those who received intrathecal clonidine (5%) (P<0.05).ConclusionUse of intrathecal clonidine for cesarean section results in better sensory blockade and early recovery of motor blockade as compared with the use of intrathecal fentanyl. Intraoperative sedation is significantly better in the clonidine group.

Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial

A double blind randomized clinical trial of sufentanil as an adjunct in spinal anesthesia for cesarean section and, thereby, be able to reduce the dose of bupivacaine, a local anesthetic, with the same result of an anesthetic block with higher doses but with fewer perioperative side effects, such as hypotension.

The effects of pressure controlled ventilation for tracheobronchial foreign body removal in children

Objective:To evaluate the effects of pressure controlled ventilation for tracheobronchial foreign body removal in children.Method: Ninety ASAⅡor Ⅲ children,aged 10 months to 3 yr,weighing 8-16 kg undergoing removal of airway foreign body were randomly divided into 3 groups(n=30 each):groupⅠpressure controlled ventilation(P)，group Ⅱ high-frequency jet ventilation(H),and group Ⅲ, reserve spontaneously breathings.Arterial blood gas analysis of Pre-operation and the end of operation,the occurrence of hypoxia during operation,the duration of operation,anesthesia emergence time and perioperative side effects were recorded. Result:The arterial blood gas analysis(PaO₂,PaCO₂,SaO₂)and SPO₂of Pre-operation in group P and H had no significant difference. The PaO₂ of the end of operations was significantly higher,and PaCO₂ was lower in group H. The occurrence of hypoxia during operation, the duration of operation,anesthesia emergence time and perioperative side effects in two group had no significant difference.Conclusion:The effects of pressure controlled ventilation and high-frequency jet ventilation for tracheobronchial foreign body removal in children were nearly the same,and pressure controlled ventilation can be commonly used in clinic.

Comparison of analgesic efficacy between oxycodone and sufentanil in painless induced abortion

Objective To assess the efficacy and safety of oxycodone injection in combination with propofol administered in painless induced abortion. Methods Based on random number tables, sixty patients were randomly divided into three groups(n=20): propofol and oxycodone group (group A), propofol and sufentanil group(group B), and propofol and placebo group (group C). MAP, HR, and SpO2 were recorded before anesthesia induction(T1), upon cervical dilatation(T2), and upon recovery time(T3). They also participated in the comparisons of perioperative side effects, VAS T3, thirty minutes after recovery(T4) and three and half hours after recover(T5), administered times of atropine and metaraminol, as well as the discharge time. Results Disparities in medical records and operative procedure time of the three groups had no statistical significance(P>0.05). In group A and B, the dose of propofol, (130±22) mg and (141±27) mg respectively, and recovery time, (1.2±0.8) min and (1.3±1.1) min respectively, showed marked decrease compared with group C, whose measurement of the two aspects stood at (164±40) mg and (2.6.±1.6) min(P 0.05). Group C patients stayed longer in hospital than that of group A and B(P<0.05). Conclusions Among the three pain management methods, propofol combined with oxycodone, propofol in conjunction with sufentanil and independent dosing of propofol, the first regimen achieved the best efficacy along with fewer side effects, making it a safe and effective option for painless induced abortion. Key words: Oxycodone; Sufentanil; Painless induced abortion