Recovery Area Research Articles

Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study

BackgroundThe COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children’s and community hospitals.MethodsWe purposefully sampled participants from both community and children’s hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2–3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes.ResultsWe interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians’ mental health, and they stressed the importance of mental health resources and wellness activities/spaces.ConclusionsWe identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians’ expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians’ mental health and well-being, re-evaluating trainees’ skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.

Peak shaving benefit assessment considering the joint operation of nuclear and battery energy storage power stations: Hainan case study

The rapid development of battery energy storage technology provides a potential way to solve the grid stability problem caused by the large-scale construction of nuclear power. Based on the case of Hainan, this study analyses the economic feasibility for the joint operation of battery energy storage and nuclear power for peak shaving, and provides an effective solution framework for construction scale and battery type determination. Under the proposed framework, a novel cost model for the large-scale battery energy storage power station is proposed. Then, economic analysis is conducted to get the most economical battery type and construction scale by considering the comprehensive economic benefit of the joint operation under the limit of the load factor. On this basis, sensitivity analysis of economic indicators to control parameters and economic parameters is performed to further demonstrate the economic feasibility of the joint operation. Comparative analysis shows that 270 MW lithium iron phosphate battery energy storage power station has the best and stable comprehensive performance in terms of the IRR, PBP and LCOE, which are 16.27%, 6.27 year and 0.464¥/kWh, respectively. In comparison with the pumped storage, the battery energy storage has lower initial investment, faster capital recovery and smaller floor area under the joint operation mode. Moreover, sensitivity analysis illustrates that the large-scale application of battery energy storage still depends on the trade-off between the cost performance of battery and the real-time electricity price.

Risk of Collapse in Water Quality in the Guandu River (Rio de Janeiro, Brazil).

The Guandu River, one of the main rivers in the state of Rio de Janeiro, provides water for more than nine million people in the metropolitan region. However, the Guandu has suffered from massive domestic and industrial pollution for more than two decades, leading to high levels of dissolved total phosphorus, cyanobacteria, and enteric bacteria observed during the summers of 2020 and 2021. The use of Phoslock, a palliative compound, was not effective in mitigating the levels of phosphorus in the Guandu River. Furthermore, potable water driven from the river had levels of 2-MIB/geosmin and a mud smell/taste. With all these problems, several solutions are proposed for improving the Guandu River water quality, including establishment of (i) sewage treatment plants (STPs), (ii) strict water quality monitoring, (iii) environmental recovery (e.g., reforestation), and (iv) permanent protected areas. The objective of this paper is to verify the poor water quality in the Guandu and the ineffectiveness and undesired effects of Phoslock.

Menakar Kelayakan Pinjaman Pemulihan Ekonomi Nasional (PEN) Daerah pada Kabupaten Bone Bolango

This study aims to assess the feasibility of regional national economic recovery loans (PEN) in Bone Bolango Regency, by analyzing 4 (four) indicators of eligibility requirements for granting Regional PEN Loans, namely (1) the area is affected by Covid 19; (2) have a Regional Economic Recovery program or activity that supports the National Economic Recovery program; (3) The remaining amount of the loan plus the amount of the loan to be withdrawn does not exceed 75 percent of the general revenue of the previous year's Regional Government Budget; (4) meet the ratio of regional financial capacity to repay regional loans of at least 2.5 percent.The first and second indicators were tested using desk study analysis. then the third and fourth indicators are tested by analyzing the financial statements of the Bone Bolango Regency in 2020 and calculating the Debt Service Coverage Ratio (DSCR) to assess the ability of the region to repay loans. The results showed that Bone Bolango Regency deserved a regional loan from the Central Government. This is because Bone Bolango fulfills 4 (four) loan requirements for the national economic recovery area.

Correlation of LET With MRI Changes in Brain and Potential Implications for Normal Tissue Complication Probability for Patients With Meningioma Treated With Pencil Beam Scanning Proton Therapy

This study aimed to investigate the correlation between imaging changes in brain normal tissue and the spatial distribution of linear energy transfer (LET) for a cohort of patients with meningioma treated with scanned proton beams. Then, assuming imaging changes are induced by cell lethality, we studied the correlation between normal tissue complication probability and LET. Magnetic resonance imaging T2/fluid attenuated inversion recovery acquired at different intervals after proton radiation were coregistered with the planning computed tomography (CT) images from 26 patients with meningioma with abnormalities after proton radiation therapy. For this purpose, the T2/fluid attenuated inversion recovery areas not on the original magnetic resonance images were contoured, and the LET values for each voxel in the patient geometry were calculated to investigate the correlation between the position of imaging changes and the LET at those positions. To separate the effect of the dose as the inductor of these changes, we compared the LET in these areas with a sample of voxels matching the dose distributions across the image change areas. Patients with a higher LET in image change areas were grouped to verify whether they shared common characteristics. Eleven of the patients showed higher dose-averaged LET (LETd) in imaging change regions than in the group of voxels with the same dose. This group of patients had significantly shallower targets for their treatment than the other 15 and used fewer beams and angles. This study points toward the possibility that areas with imaging change are more likely to occur in regions with high dose or in areas with lower dose but increased LETd. The effect of LETd on imaging changes seems to be more relevant when treating superficial lesions with few nonopposed beams. However, most patients did not show a spatial correlation between their image changes and the LETd values, limiting the cases for the possible role of high LET as a toxicity inductor.

Sensitivity simulation on isotopic fissile measurement using neutron resonances

Uranium and plutonium are required to be accounted in spent fuel head-end and major recovery area in pyro-process for safeguards purpose. The possibility of neutron resonance technique, as a non-destructive analysis, was simulated on isotopic fissile analysis for large scale process. Neutron resonance technique has advantage to distinguish uranium from plutonium directly in mixture. Simulation was performed on U235 and Pu239 assay in spent fuel and for scoping examination of assembly type. The resonance energies were determined for U235 and Pu239. The linearity in the neutron transmission was examined for the selected resonance energies. In addition, the limit for detection was examined by changing sample density, thickness and content for actual application. Several factors were proposed for neutron production and the moderated neutron source was simulated for effective and efficient transmission measurement. From the simulation results, neutron resonance technique is promising to analyze U235 and Pu239 for spent fuel assembly. An accurate fissile assay will contribute to an increased safeguards for the pyro-processing system and international credibility on the reuse of fissile materials in the fuel cycle.

Recovery 2.0

<h3>Background Information</h3> In our large, academic health system one of the most significant perioperative challenges is safely recovering patients once the primary recovery area is fully occupied. In 2019 we had over 21,000 minutes of Operating Room/Procedural Area (ORPA) holds where patients were recovered in the procedural areas. Recovering patients in the Operating Room (OR) has financial implications, since there is loss of revenue when the room is not being utilized for a scheduled procedure. In addition to the financial cost of delayed OR start times, dissatisfaction of the patients, surgery staff, and surgeons was also evident. The goal was to streamline, coordinate, and optimize patient recovery in a value focused environment while also assigning post procedural/surgical patients to the appropriate level of recovery. <h3>Objectives of Project</h3> Our goal was a 40% decrease in the time delays associated with ORPA holds over the course of 6 months. <h3>Process of Implementation</h3> We identified a multitude of causes and developed a process where Anesthesia recovers patients in the recovery room as opposed to the procedural areas, which we call the Anesthesia Recovery Program (ARP). Our ARP plan is triggered whenever an ORPA hold will exceed 10 minutes. The anesthesia team is directed to move the patient to a recovery room slot that is not staffed by RNs. The anesthesia provider monitors the patient in the recovery area until an RN-staffed slot becomes available. Additionally, a decision tree was created with guidelines in place in order to stratify recovery area assignments by optimizing the recovery workflow. <h3>Statement of Successful Practice</h3> The initial results showed an 85% decrease in ORPA holds. Having patients recovered by anesthesia providers improved turnover times and increased elective cases during business hours. Further work on this projected was interrupted by the COVID-19 pandemic. <h3>Implications for Advancing the Practice of Peri anesthesia Nursing</h3> The interprofessional team developed a model for dealing with potentially costly delays. Through cross disciplinary efforts significant cost benefits can be appreciated while maintaining optimal patient safety.

Nursing Best Practice: Promoting Medication Safety on Commonly Used Medications in the Ambulatory Surgery PACU

<h3>Background Information</h3> In the perioperative setting at a comprehensive and complex cancer center, multiple medications are utilized to provide high quality and safe patient care. Nursing staff are cross trained to work in various specialty areas within the unit. This required a need for awareness and understanding of the various medications available in each area for safe nursing practice. <h3>Objectives of Project</h3> To provide a quick reference guide for nurses on commonly used unit-based medications in each specialty area to serve as a resource tool to help promote medication safety and minimize medication errors. <h3>Process of Implementation</h3> Nurses were educated on commonly used unit-based medications utilizing a PowerPoint presentation. A printed quick reference guide was created and made available in the ASC PACU, Extended Recovery, IR PACU, Brachytherapy PACU, and Pre-Op areas. This provides an easy and quick access to unit-based available medications, medication doses, indications, and common side effects. <h3>Statement of Successful Practice</h3> The commonly used unit-based medication reference guide was successful in promoting medication safety, improved patient care, and nurse satisfaction. Feedback was obtained via a post-implementation survey of 41 nurses. The results show that 93% found the tool beneficial to their patient care, and 95% agreed it will promote medication safety during cross-training in another specialty area. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> A reference guide of commonly used unit-based medications is a great resource tool for nurses. It fosters medication safety and is useful for peri-anesthesia nurses in their daily nursing practice. Since implementation, the team has collaborated with leadership to incorporate the guide in the New Employee and cross-training orientation packet.

Microbial Fuel Cell for Energy Production, Nutrient Removal and Recovery from Wastewater: A Review

The world is facing serious threats from the depletion of non-renewable energy resources, freshwater shortages and food scarcity. As the world population grows, the demand for fresh water, energy, and food will increase, and the need for treating and recycling wastewater will rise. In the past decade, wastewater has been recognized as a resource as it primarily consists of water, energy-latent organics and nutrients. Microbial fuel cells (MFC) have attracted considerable attention due to their versatility in their applications in wastewater treatment, power generation, toxic pollutant removal, environmental monitoring sensors, and more. This article provides a review of MFC technologies applied to the removal and/or recovery of nutrients (such as P and N), organics (COD), and bioenergy (as electricity) from various wastewaters. This review aims to provide the current perspective on MFCs, focusing on the recent advancements in the areas of nutrient removal and/or recovery with simultaneous power generation.

Experimental and Numerical Simulation Study of Pressure Pulsations during Hose Pump Operation

An adventitious flow field has a great impact on the operational reliability of pumps; therefore, it is important to study pump flow characteristics to reduce the noise, vibration, and cavitation performance of pumps. To study the pressure fluctuation characteristics of the hose pump, a three-dimensional two-way fluid structure coupling model of the hose pump was established. The transient structural module, fluid flow (fluent) module, and system coupling module of ANSYS Workbench 19.0 were used to simulate the unsteady multiple working conditions of the hose pump. The accuracy and reliability of the calculation results from the fluid solid coupling simulation were verified via experimentation. The results show that the roller pass frequency is the main frequency of the pressure fluctuation at the outlet of the hose pump. When the plane of the deformation recovery area is small, the pressure pulsation amplitude is large, and the outlet pressure and speed are large. Due to the irregular backflow of the fluid, stall zones of different sizes form, the outlet pressure is closer to a sinusoid when there is no pressure. The higher the rotating speed is, the faster the pressure roller leaving the hose, the higher the pressure pulsation, and the larger the stall zone. Therefore, the best way to reduce the pressure pulsation in the pump is to optimize the geometry of the pressure roller and change the outlet angle of the hose.

Broadening the toolset for stakeholder engagement to explore consensus over wolf management

Facilitating coexistence between people and large carnivores is critical for large carnivore conservation in human-dominated landscapes, when their presence impacts negatively on human interests. Such situations will often require novel ways of mediating between different values, worldviews and opinions about how carnivores should be managed. We report on such a process in an agricultural area of recent wolf recovery in central Italy where unsolved social tensions over wolf presence have radicalized opinions on either side of the wolf debate, resulting in a stalemate. Where previous mitigation policies based on top-down damage compensation have failed, we tested the potential for applying a participatory approach to engage different stakeholder groups in a dialogue aimed at sharing a deep understanding of the problem and co-creating potential solutions. We based our approach on the theory of meta-consensus, using a decision support tool known as Multi Criteria Decision Analysis (MCDA). Over the course of three months, we carried out five workshops with stakeholder representatives from farming, hunting and environmental associations, and one biologist. Stakeholders shared several objectives and agreed over many management interventions, including the management of free-ranging dogs, the implementation of damage prevention measures, and a damage compensation system suitable for farmers. The process facilitated agreement over actions aimed at improving relations between stakeholders and enhancing the state of knowledge on the issues at stake. Most importantly, we recorded positive social and relationship outcomes from the workshops, and observed a willingness from participants to engage in further discussions over disputed management preferences. Overall, we found MCDA to be a useful tool for laying the groundwork for further participatory and deliberative processes on wolf management. However, challenges ahead included the involvement of a larger number of representatives of different social sectors, and a simplification of the methodology which some participants found too complicated and time consuming.

The resilience of the developing reading system: multi-modal evidence of incident and recovery after a pediatric stroke

ABSTRACT Decades of neuroscientific findings have elucidated the highly specialized brain areas involved in reading, especially along the ventral occipitotemporal stream where the critical step of recognizing words occurs. We report on a 14-year-old female with temporary dyslexia after a left ventral occipitotemporal ischemic stroke. Our longitudinal multimodal findings show that the resolution of the reading impairment was associated with heightened activity in the left posterior superior and inferior temporal gyri. Our findings highlight the role of the left inferior temporal gyrus in reading and the importance of perilesional and ipsilateral cortical areas for functional recovery after childhood stroke.

Quantitative Assessment of Nitrous Oxide Levels in Room Air of Operation Theaters and Recovery Area: An Observational Study.

Background:Nitrous oxide has been used during surgical anesthesia for many years. However, information about occupational exposure and related risks due to N2O exposure to the health care personnel in India are still poorly understood. Here, we measured the residual N2O levels during the working time of operation theatre room air in our tertiary care hospital.Material and Methods:The air samples were collected from different anesthesia exposure zones on different days for quantitative analysis of available N2O in the room air in respective areas. Nitrous oxide concentrations in the ambient air were also measured to compare outdoor and indoor levels.Observations and Results:Nitrous oxide mixing ratios were found to be 65.61 ± 0.05 ppm, 281.63 ± 0.43 ppm, and 165.42 ± 0.42 ppm in elective surgical theatres of the hospital on three different days whereas in emergency operation theatres of the same hospital levels of N2O were 166.75 ± 0.07 ppm, 510.19 ± 0.30 ppm and 2443.92 ± 0.64 ppm during same period. In elective pediatric surgical theatres levels of N2O were found to be 1132.55 ± 0.70 ppm and 362.21 ± 0.13 ppm on two days of reading respectively. Outdoor levels of N2O in contrast found 0.32 ± 0.01 ppm and was lower by a factor of 1000.Conclusion:We observed the very high ambient concentration of N2O in the surgical theatre's environment (up to 2443 ppm) and recovery areas (up to 50 ppm). It was 5 to 50 times higher ambient concentration of N2O than REL in OT area and 200-7000 times higher ambient concentration of N2O than outdoor ambient air in all surgical theaters other than CTVS OTs.

The Efficacy of Prophylactic Intravenous Granisetron in Preventing Post Anaesthesia Shivering in Gynaecological Patients Undergoing Surgery Under General Anaesthesia

Post-anaesthetic shivering is one of the commonest complications during emergence from general anaesthesia with the rate of occurrence between 5 to 65%. It increases oxygen consumption and carbon dioxide production resulting in delayed recovery from anaesthesia and other adverse events. Granisetron is one of the drugs used to prevent post-anaesthetic shivering. This prospective, double-blind and randomised control study compared the efficacy of prophylaxis IV granisetron at 2 mg and 3 mg doses in preventing post-anaesthetic shivering. There were 104 patients, ASA I and II scheduled for elective open gynaecological surgery recruited and randomised into 2 groups: Group A and B, receiving 2 and 3 mg of IV granisetron, resepectively. Intravenous anaesthetic drugs were administered and tracheal intubation was facilitated by muscle paralysis. Patients’ baseline and periodic tympanic core temperatures were measured perioperatively. The incidence and severity of shivering were assessed postoperatively using Wrench Scoring Classification whereby Group A and B had 8.3% and 16.7% of incidence, respectively, in which they were not statistically significant (p = 0.199). All patients from both groups who shivered experienced Grade 1 shivering except for one patient who registered a Grade 2 in Group B. None of our patients had Grade 3 or 4 shivering postoperatively. No one experienced nausea or vomiting in the recovery area. Prophylactic IV granisetron of 2 mg and 3 mg were equally effective in reducing the incidence and severity of post-anaesthetic shivering in gynaecological patients undergoing surgery under general anaesthesia with no unpleasant side effects.

Corneal Abrasions During Endoscopic Procedures in the COVID-19 Era Are a Preventable Phenomenon: A Quality Improvement Project

Corneal abrasion (CA) is the most common ocular adverse event from non-ocular surgery under sedation. CA is a known but rare complication after gastrointestinal endoscopy described in the left eye due to left lateral decubitus positioning for the procedure. Patients undergoing endoscopy after the onset of the COVID-19 pandemic were required to wear surgical masks during all endoscopic procedures (unless per-orum endoscopy) and post-procedurally in the recovery area. The aim of this quality improvement (QI) project was to chronicle the rate of CA in the COVID-19 era and determine the efficacy of a simple intervention for its prevention.

Oil and gas in Kurgan region

This article analyzes the prospects of petroleum potential in Kurgan region. The relevance of the work is due to the high degree of development of the traditional oil and gas recovery areas of Western Siberia, which leads to the need to organize search activities in areas with a low density of hydrocarbon resources. We have analyzed the results of exploratory drilling in the area of the Alabuga river in Kurgan region, and have studied the history of detections of onshore oil occurrences there. Based on the results of the retrospective analysis, the research area was determined, field work was performed to determine the state of search wells in the area, and a collection of geochemical soil and liquid samples was selected. The analysis of the samples revealed that all of them contain methane and its homologues up to and including pentane. The genesis of light methane homologs is related to the processes of catagenesis; their detection on the surface indicates active processes of generation and migration of petroleum hydrocarbons. Based on the analysis of archival materials and estimated ground-based geochemical studies, a conclusion is made about petroleum potential in Kurgan region.

Developing person-centred goal setting resources with and for people with aphasia: a multi-phase qualitative study

ABSTRACT Introduction: Stroke patients with aphasia are often excluded from person-centred goal setting as part of their clinical care, despite a recommendation for person-centred goal setting in national clinical guidelines. Aim: To develop and field test an aphasia supplement to a person-centred goal setting package for stroke to better meet the needs of patients with aphasia. Methods: A multi-phase, qualitative study design was employed building on prior work in a non-aphasia stroke population. Initial materials, including clinician training, were developed into an aphasia goal setting supplement with input from an expert working group. In phase one, feedback was sought from consumers with aphasia (n=5) on the layout and format of the patient-facing components. In phase two, six clinicians from one Australian healthcare network (occupational therapy: n=2, physiotherapy: n=1 and speech pathology: n=3) were observed using the goal setting package with eight inpatients with aphasia (2 mild, 3 moderate, 3 severe). In phase three, post field testing feedback was sought from clinicians (n=5) and patients with aphasia (n=3). Content analysis of interview data was carried out. Results: The consumer feedback session in phase one indicated that the supplement layout was helpful for including people with aphasia to participate actively in person-centred goal setting. Adaptations were made for the aphasia supplement including language, graphic, and format changes based on the feedback. During the field testing in phase two, 18 person-centred goals were set with eight patients with aphasia (median two goals) and included: secondary prevention (8%), functional recovery (31%), community participation (28%), everyday activities (28%), and environment (6%). Based on observations by members of the research team during field testing, clinicians across the multidisciplinary team were able to facilitate goal setting effectively. In phase three, clinicians and patients reported the supplement was useful to facilitate person-centred goal setting for people with aphasia.Conclusion: The aphasia supplement for the goal setting package was appropriate in meeting the needs of patients with aphasia after stroke and encouraged person-centred goal setting across multiple recovery areas. Conclusion: The aphasia supplement for the goal setting package was appropriate in meeting the needs of patients with aphasia after stroke and encouraged person-centred goal setting across multiple recovery areas..

Short-Term Effect in Soil Microbial Community of Two Strategies of Recovering Degraded Area in Brazilian Savanna: A Pilot Case Study.

The Brazilian Cerrado is a highland tropical savanna considered a biodiversity hotspot with many endemic species of plants and animals. Over the years, most of the native areas of this biome became arable areas, and with inadequate management, some are nowadays at varying levels of degradation stage. Crop-livestock integrated systems (CLIS) are one option for the recovery of areas in degradation, improving the physicochemical and biological characteristics of the soil while increasing income and mitigating risks due to product diversification. Little is known about the effect of CLIS on the soil microbial community. Therefore, we perform this pilot case study to support further research on recovering degraded areas. The bacterial and fungal soil communities in the area with CLIS were compared to an area under moderate recovery (low-input recovering - LI) and native savanna (NS) area. Bacterial and fungal communities were investigated by 16S and ITS rRNA gene sequencing (deep rRNA sequencing). Ktedonobacteraceae and AD3 families were found predominantly in LI, confirming the relationship of the members of the Chloroflexi phylum in challenging environmental conditions, which can be evidenced in LI. The CLIS soil presented 63 exclusive bacterial families that were not found in LI or NS and presented a higher bacterial richness, which can be related to good land management. The NS area shared 21 and 6 families with CLIS and LI, respectively, suggesting that the intervention method used in the analyzed period brings microbial diversity closer to the conditions of the native area, demonstrating a trend of approximation between NS and CLIS even in the short term. The most abundant fungal phylum in NS treatment was Basidiomycota and Mucoromycota, whereas Ascomycota predominated in CLIS and LI. The fungal community needs more time to recover and to approximate from the native area than the bacterial community. However, according to the analysis of bacteria, the CLIS area behaved differently from the LI area, showing that this treatment induces a faster response to the increase in species richness, tending to more accelerated recovery. Results obtained herein encourage CLIS as a sustainable alternative for recovery and production in degraded areas.

Effect of total intravenous anesthesia or inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy: A randomized controlled trial

Study objectiveTo investigate the effect of propofol-based total intravenous anesthesia (TIVA) or sevoflurane-based inhalation anesthesia on postoperative quality of recovery in patients undergoing total laparoscopic hysterectomy. DesignA prospective randomized controlled trial. SettingAn operating room, a postoperative recovery area, and a hospital ward. PatientsA total of 102 female patients scheduled for elective total laparoscopic hysterectomy were randomly divided into two groups: the propofol group (group P) or sevoflurane group (group S). InterventionsAnesthesia in group P was induced by propofol, fentanyl and rocuronium, and maintained by intravenous infusion of propofol and remifentanil. Anesthesia in group S was induced by a tidal volume inhalation technique with sevoflurane and rocuronium and maintained with sevoflurane and remifentanil. Patients in group P did not receive any volatile drugs. MeasurementsQuality of Recovery-40 (QoR-40), Pittsburgh Sleep Quality Index (PSQI) and Numerical Rating Scale (NRS) scores were assessed at 8, 24, 48, 72 h, 7 days and 30 days after surgery. Intraoperative hemodynamics, postoperative inflammatory indicators and adverse reactions were also recorded. Main resultsThe QoR-40 score and its 5 dimensions were similar in the two groups at each point in time (P > 0.05). Group S had less consumption of remifentanil (P < 0.001) but increased use of phenylephrine (P = 0.001) intraoperatively. PSQI scores were also comparable between groups at each point in time (P > 0.05). NRS scores at 72 h (P = 0.023) and 7 days (P = 0.017) after surgery, postoperative NLR (P = 0.024) and hs-CRP (P = 0.042), and the incidence of abdominal distension (P = 0.017) were significantly lower in group P than in group S. Multiple linear regression analyses demonstrated that duration of pneumoperitoneum and sleep quality were associated with postoperative recovery. ConclusionsThe choice of intravenous or inhalation maintenance anesthesia did not affect overall postoperative recovery as measured by the QoR-40 in patients undergoing total laparoscopic hysterectomy. Reducing the duration of pneumoperitoneum and improving sleep quality were conducive to postoperative recovery.

Comparison of analgesic efficacy of shoulder block versus interscalene block for postoperative analgesia in arthroscopic shoulder surgeries: A randomised trial.

Background and Aims:Arthroscopic orthopaedic surgery may lead to significant postoperative pain. Interscalene block (ISB) is associated with undesirable effects like phrenic nerve palsy. Shoulder block (ShB) is a relatively recent diaphragm sparing alternative for analgesia in these cases.Methods:This prospective randomised trial was conducted in 70 adult patients posted for arthroscopic Bankart repair surgery. Patients were randomly assigned into two groups: interscalene block [Group ISB (n = 35): 0.5% bupivacaine 10 ml] or shoulder block [Group ShB (n = 35): 0.5% bupivacaine (suprascapular block 10 ml and axillary block 10 ml)] using ultrasound and nerve stimulator. The primary aim of our study was to compare the ISB with ShB for visual analogue score (VAS) in recovery area (zero hour). Time for block performance, VAS, time to first rescue analgesia, total analgesic requirement, patient satisfaction and complications were recorded.Results:VAS was significantly higher in ShB group at 2 and 4 h (P = 0.001 and 0.000) while it was significantly higher in ISB group at 12 h (P = 0.013). The time to first analgesic request was significantly prolonged in ISB group as compared to ShB group (8.22 h vs. 4.69 h; P = 0.002) but total analgesic requirement and patient satisfaction at 24 h were similar. Complications like dyspnoea, ptosis and motor weakness were seen only with ISB group.Conclusion:Both ShB and ISB blocks have similar efficacy in terms of postoperative pain scores, cumulative analgesic requirements and patient satisfaction. However, considering the various undesirable effects associated with ISB, like phrenic nerve blockade, prolonged upper limb weakness and the occurrence of rebound pain, shoulder block may be preferred for arthroscopic shoulder surgeries.