Rescue Technique Research Articles

One-stage conversion of laparoscopic adjustable gastric banding to laparoscopic 1-anastomosis gastric bypass: a single-center experience on 1,000 patients at 5 years of follow-up.

Data regarding the use of 1-anastomosis gastric bypass (OAGB) as a conversion technique after laparoscopic adjustable gastric banding (LAGB) failure is scarce in the literature. The aim of this study was to assess our experience with OAGB as a rescue procedure after failed LAGB. This study involved patients treated at a private hospital in France. This single-center retrospective study included all consecutive patients receiving OAGB from January 2005 to January 2016. Of the 3,224 patients, 63.5% received primary OAGB (pOAGB) and 36.5% received OAGB as a conversion procedure after LAGB (cOAGB). During the period considered, 2,046 patients with obesity received pOAGB, whereas 1,000 patients underwent conversion of LAGB to OAGB in 1 step. The rate of patients lost to follow-up at 5 years was 31% in the pOAGB group and 32.5% in the cOAGB group (P = .4). Five years after the surgery, the mean body mass index was 30.8 ± 10.2 kg/m2, the mean percentage total weight loss was 34.6% ± 9.6%, and the mean percentage excess weight loss was 76.1% ± 24.6% in the pOAGB group, and the mean was 29.7 ± 10.4 kg/m2 (P = .58), the mean percentage total weight loss was 33.8% ± 10.2% (P = .82) and the mean percentage excess weight loss was 73.5% ± 22.2% (P = .78) in the cOAGB group. There was no difference in terms of early complications between the 2 groups (3.2% pOAGB versus 3.6% cOAGB, P = .59), while there was a statistically significant difference in terms of late complications (11% pOAGB versus 18% cOAGB, P < .00001). In particular, there was a significantly higher incidence of symptomatic postoperative biliary reflux in the cOAGB group (12% in cOAGB versus 5% in pOAGB, P < .00001). In this study, OAGB was effective and safe as a rescue technique after LAGB failure. Conversion in one step did not appear to increase the risk of early complications, whereas a history of gastric banding seems to increase the risk of bile reflux in the long term.

Analysis of Novel Assistive Robotic Multi‐Stage Underwater Lift Design for Swimmer Safety

Unintentional deaths particularly near swimming pools are alarmingly increasing in recent times. The rate of increase in deaths was reported in the world health organization and other national health magazines. There were very few inventions and research work done on autonomous rescue designs. The paper introduced new methods and techniques to address the issues. The paper introduces very novel architecture; novel multilayer approaches especially worked on fail-proof autonomous rescue techniques by using natural buoyancy as a main source of mechanical power in lifting drowning persons from the water. The trials conducted by the paper were accurate and reliable and the proposed autonomous drown-rescue system design is suitable for most the situations. The placement of sensors, elevator, semiautomatic arrangements such as panic switches, and buoyancy helped elevator are the total innovative approaches in addressing the situation (cause). There is no big limitation in the proposed methods except 20–30% of the total cost of the construction of the swimming pool which is not a problem when addressing alarmingly increasing deaths due to drowning in all age groups people. The methods discussed in the paper are all possible and feasible cost-effective methods and add more confidence in maintaining a pool in-house without any health risks. The governments and communities must frame rules to implement the proposed system as mandatory to maintain a pool that is 100% safe for all age groups. The methods addressed in the paper are completely novel and new. The paper contributes major design contributions for the detection of drowning accidents using underwater and buoyancy-dependent lifts, proximity sensors, and laser tripwires.

Ultrasound-guided posterior tibial artery cannulation as a rescue for intraoperative accidental arterial line displacement in the prone position: A case report

Arterial cannulation for patients in prone position poses a great challenge for the anaesthesiologists because of restricted anatomical access and technical difficulty in needle advancement. In such a problematic scenario, ultrasound might be hugely helpful. We report a case of a 42-year-old male who underwent Atlanto-occipital fusion in prone position. Intraoperatively the left radial arterial cannula got dislodged accidentally. The right posterior tibial artery was cannulated under ultrasound guidance by long-axis in-plane approach as a rescue technique for continued management without disturbing the procedure and inconvenience to the team. The procedure was successful on the first attempt.

Relighting the Charitable Deduction: A Proposed Public Benefit Exception

"Let no man’s ghost say his training ever let him down."Throughout the country, firefighters risk their lives on a daily basis to keep the public safe. It is, therefore, imperative they receive the best possible training. One invaluable training method is live burn training, in which a structure is set on fire providing firefighters with “a level of realism that is unsurpassed.” Fire departments, both career and volunteer, as well as numerous municipal departments conduct various training exercises, including roof ventilation, domestic violence exercises, simulated meth lab explosions, room-to-room fire practice, firefighter survival techniques, arson investigation training, rescue techniques, and/or firefighter down techniques, through the donation of homes that are finally burned to the ground as part of live burn training.For over thirty-five years, relying on a United States Tax Court case, many believed a taxpayer could claim a charitable deduction for the donation of the taxpayer’s home to the local municipality for live burn training, while still retaining ownership of the underlying land (live burn donation). In 2004, however, the Internal Revenue Service (the Service) established a task force, charged with the sole purpose of extinguishing live burn donations, and requested that local municipalities not cooperate with taxpayers in executing the requisite paperwork in claiming a charitable deduction for a live burn donation. In 2009, the deductibility of a live burn donation was thrust into the public spotlight as the media publicized the Service’s attack on the charitable deduction claimed by Kirk Herbstreit, an ESPN commentator and former Ohio State quarterback, for the donation of his home to the local fire department. Soon after, in 2010, the live burn donation was back in the headlines as it was exposed that Oregon gubernatorial candidate, Chris Dudley, claimed a deduction on his 2004 federal income tax return for a live burn donation so he could build a new residence on the land. Consequently, in recent years, there has been much confusion and debate on whether live burn donations qualify for charitable deductions.

Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review

ObjectivesDespite the success of mechanical thrombectomy in large vessel acute ischemic stroke, recanalization may fail due to difficult anatomic access or peripheral arterial occlusive disease. In these cases, transcarotid access may be used as an alternative, but it has not gained prominence due to safety concerns. Our objective was to assess the efficacy and safety of transcarotid access for mechanical thrombectomy. Materials and MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform a systematic review with articles published from 2010 to 2020 summarizing pre-intervention characteristics, techniques utilized, and outcomes of patients undergoing mechanical thrombectomy via trans-carotid puncture. We performed a meta-analysis of clinical outcomes, reperfusion times and overall complications rates of trans-carotid approach. ResultsSix studies describing 80 total attempts at carotid access, 72 of which were successful (90% success rate), were included. Direct carotid puncture was most often used as a rescue technique (87% of patients) secondary to failed femoral access. Successful recanalization was achieved in 76% of patients. 90 day modified Rankin Scale ≤ 2 was achieved in 28% of patients. Carotid puncture-reperfusion time was 32 min (CI = 24–40, p < 0.001). Cervical complications occurred at a rate of 26.5% (95% CI = 17%–38%). Only 1.3% (1/80 patients) had a fatal outcome and 96% of complications required no intervention. ConclusionsOur results on the safety and efficacy of transcarotid access suggests that this approach is a viable alternative to failed thrombectomy when transfemoral or trans-radial access may be impractical.

Adjustable Gastric Banding Conversion to One Anastomosis Gastric Bypass: Data Analysis of a Multicenter Database

IntroductionOne anastomosis gastric bypass (OAGB) has been proposed as a rescue technique for laparoscopic adjustable gastric banding (LAGB) poor responders. AimWe sought to analyze, complications, mortality, and medium-term weight loss results after LAGB conversion to OAGB. MethodsData analysis of an international multicenter database. ResultsOne hundred eighty-nine LAGB-to-OAGB operations were retrospectively analyzed. Eighty-seven (46.0%) were converted in one stage. Patients operated on in two stages had a higher preoperative body mass index (BMI) (37.9 vs. 41.3 kg/m2, p = 0.0007) and were more likely to have encountered technical complications, such as slippage or erosions (36% vs. 78%, p < 0.0001). Postoperative complications occurred in 4.8% of the patients (4.6% and 4.9% in the one-stage and the two-stage group, respectively). Leak rate, bleeding episodes, and mortality were 2.6%, 0.5%, and 0.5%, respectively. The final BMI was 30.2 at a mean follow-up of 31.4 months. Follow-up at 1, 3, and 5 years was 100%, 88%, and 70%, respectively. ConclusionConversion from LAGB to OAGB is safe and effective. The one-stage approach appears to be the preferred option in non-complicate cases, while the two-step approach is mostly done for more complicated cases.

Right hemihepatectomy for ischemic liver necrosis after cholecystectomy

Injury of the extrahepatic bile duct system during cholecystectomy is a complex problem in biliary surgery. Combined injuries of the bile ducts and vessels in the hepatoduodenal ligament significantly complicate treatment and increase mortality. Efficient revascularization is possible in a specialized clinic during the initial hours following the injury. Anatomical liver resection is a rescue technique for the surgical elimination of such complications. Herein, we present a case of a patient who underwent right hemihepatectomy.

Animal models of impaired long bone healing and tissue engineering- and cell-based in vivo interventions.

Bone healing after injury typically follows a systematic process and occurs spontaneously under appropriate physiological conditions. However, impaired long bone healing is still quite common and may require surgical intervention. Various complications can result in different forms of impaired bone healing including nonunion, critical-size defects, or stress fractures. While a nonunion may occur due to impaired biological signaling and/or mechanical instability, a critical-size defect exhibits extensive bone loss that will not spontaneously heal. Comparatively, a stress fracture occurs from repetitive forces and results in a non-healing crack or break in the bone. Clinical standards of treatment vary between these bone defects due to their pathological differences. The use of appropriate animal models for modeling healing defects is critical to improve current treatment methods and develop novel rescue therapies. This review provides an overview of these clinical bone healing impairments and current animal models available to study the defects in vivo. The techniques used to create these models are compared, along with the outcomes, to clarify limitations and future objectives. Finally, rescue techniques focused on tissue engineering and cell-based therapies currently applied in animal models are specifically discussed to analyze their ability to initiate healing at the defect site, providing information regarding potential future therapies. In summary, this review focuses on the current animal models of nonunion, critical-size defects, and stress fractures, as well as interventions that have been tested in vivo to provide an overview of the clinical potential and future directions for improving bone healing.

Punch and rescue technique for scleral fixation of dislocated single-piece intraocular lenses.

In-the-bag intraocular lens (IOL) dislocation is a well-known complication after cataract surgery. As the number of cataract surgeries performed annually continues to increase, so will the incidence of IOL dislocations requiring surgical correction. Described is a new technique for rescue and refixation of a single-piece acrylic IOL. In this method, a new instrument called the IOL punch is used to create a hole at the optic-haptic junction or along the border of the optic, which acts as an anchor point for centration and subsequent scleral fixation of a dislocated IOL. The IOL punch allows for precise intraocular manipulation of the IOL and is less invasive compared with popular scleral fixation methods. This innovative technique may decrease the risk for postoperative complications and allows patients to maintain or recover previous uncorrected visual acuity by circumventing the need for IOL explantation or exchange.

Optimization of an In Vitro Embryo Rescue Protocol for Breeding Seedless Table Grapes (Vitis vinifera L.) in Italy

Conventional crossing of stenospermocarpic grapes for the obtainment of seedless cultivars presents some technical constraints causing embryo abortion in the early berry developmental stages. Embryo rescue technique partially overcomes these limitations, but the obtainment of viable plantlets relies on the optimization of several genetic and methodological issues. This work aimed to regenerate viable plants from immature ovules of stenospermocarpic table grape hybrids by applying a three-step in vitro culture protocol consisting of embryo development, embryo germination-rooting, and plantlet formation. The influence of parental genotypes (six “seedless × seedless” crosses), ovule sampling time (30, 40, 50 days after pollination (DAP)), and extent of embryo germination induction (4, 6, 8 weeks) was assessed on ovule fertilization, embryo development and germination, rooting, and plantlet formation to establish the best rescue time for each combination hybrid. Our optimized protocol included immature ovule isolation for 40 DAP and embryo germination induction for 8 weeks. As for genotypes, the most efficient embryo germination was recovered from hybrids of Thompson, Superior, and Regal cultivars, whereas the highest percentage of viable plants was derived from 50-DAP ovules of Luisa × Thompson progeny. Such an optimized protocol could be useful to maximize the efficiency of future breeding programs for grape seedlessness.

Adverse events of emergency surgical front of neck airway access: an observational descriptive study.

AimEmergency front of neck access (eFONA), such as scalpel cricothyroidotomy, is a rescue technique used to open the airway during “cannot intubate, cannot oxygenate” situations. However, little is known about the adverse events associated with the procedure. This study aimed to describe the adverse events that occur in patients who undergo eFONA and their management.MethodsThis retrospective observational cohort study included emergency patients who underwent eFONA between April 2012 and August 2020. We described the patients’ characteristics and the adverse events during or immediately after the procedure.ResultsAmong 75,529 emergency patients during the study period, 31 (0.04%) underwent an eFONA. The median (interquartile range) age was 53 (39–67) years, and 23 patients (74.2%) were men. Of all cases, 13 (41.9%) experienced adverse events. Of these, three cases (23.2%) were cephalad misplacement of the intubation tube, one case (7.7%) was cuff injury, one case (7.7%) was tube obstruction due to vomiting, and one case (7.7%) was tube kink. In cases with these adverse events, the initial attempt of eFONA failed, and alternative immediate action was necessary to secure the airway.ConclusionThis single‐center retrospective observational study described several adverse events of eFONA. In particular, it is important to understand the possible life‐threatening adverse events that lead to failure of securing airways such as cephalad displacement, tube obstruction, and tube kink and respond promptly to ensure a secure definitive airway for patients’ safety.

Development of operational and demand-oriented firefighting equipment

Due to the increasing demands and the constantly changing tasks, it is significant that the rescue tools of rescue and emergency organizations are optimally adapted to the situation. At the same time, rescue tools should be usable by as many members of the organizations as possible. That means that people should not be excluded from using the tool, for example, because they are too heavy or complicated to handle. At the same time, rescue techniques must be adapted to new challenges such as new materials or power sources in vehicles. The research aims to produce a guide to counteract this problem.

Vegetative rescue and in vitro propagation of Persea willdenovii

Persea willdenovii is a native species popularly known for its high potential for medicinal use. Due to problems in low seed production and germination, vegetative propagation appears promising. Thus, we seek with this work to evaluate techniques of vegetative rescue and the potential use of shoots obtained in tissue culture. Adult trees of the species were used to apply total and partial girdling treatments and obtain pruned branches as vegetative rescue techniques. Shoot production was monitored over time (90 to 240 days). Sprouts were used for in vitro propagation, and disinfestation treatments were carried out using biocides such as NaClO and Plant Preservative Mixture PPMTM (PPMTM), changing the time and concentrations of the products. Multiplication was also tested using doses of 6-benzylaminopurine (BAP) and media and the potential for callogenesis under combinations of BAP and Naphthalene Acetic Acid (ANA). The vegetative rescue by complete or semi-girdling has the potential to produce shoots, though pruned branches proved to be one of the best techniques for rescue. In the micropropagation, the use of biocides such NaOCl for a long period of time (2 % for 20 min) with PPMTM added to the culture medium shows a potential for disinfestation in the in vitro establishment. For in vitro multiplication, the usage of WPM and BAP (2 a 4 g L-1) promotes higher shoot length, shoot number and leaf number. For indirect organogenesis by leaf segments, the cultivation with BAP and ANA was not responsive to the induction of callogenesis.

The use of CRISPR to generate a whole-gene humanized MAPT and the examination of P301L and G272V clinical variants, along with the creation of deletion null alleles of ptl-1, pgrn-1 and alfa-1 loci.

To study important genes involved in Frontotemporal Dementia ( MAPT , GRN and C9orf72 ), we created deletion alleles in the three orthologous genes ( ptl-1 , pgrn-1 , and alfa-1 ). Simultaneously, we replaced the C. elegans ptl-1 gene with the predicted orthologous human MAPT gene, often called whole-gene humanization, which allows direct assessment of conserved gene function, as well as the opportunity to examine consequences of clinical disease-associated patient variations. Each gene was manipulated using a different selection strategy, including a novel strategy using an unc-18 mutation rescue technique. Clinical MAPT ALS/FTD missense variants G272V and P301L were successfully inserted in hMAPT . Neither ptl-1 loss or clinical variants caused neuronal defects in young adult or aged C. elegans , based on examination of glutamatergic phasmid neurons. Yet, we noted decreased survival to day 9 in the P301L hMAPT strain, compared to control strains. Based on these results, we comment on strategies for humanization, including the importance of confirming C. elegans gene predictions and identifying loss of function defects for each gene before embarking on humanization, and we report the creation of strains and a new gene-editing selection strategy that will be useful for future studies.

Anesthesia for tracheal and carinal resection and reconstruction.

The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction. In addition to the traditional anesthetic approach using conventional tracheal intubation after induction of general anesthesia and cross-field intubation or jet-ventilation once the airway has been surgically opened, there is a trend toward less invasive anesthetic procedures. Regional anesthetic techniques and approaches focusing on the maintenance of spontaneous respiration have emerged. Especially for cervical tracheal stenosis, laryngeal mask airways appear to be an advantageous alternative to tracheal intubation.Extracorporeal support can ensure adequate gas exchange and/or perfusion during complex resections and reconstructions without interference of airway devices with the operative field. It also serves as an effective rescue technique in case other approaches fail. The spectrum of available anesthetic techniques for major airway surgery is immense. To find the safest approach for the individual patient, comprehensive interdisciplinary planning is essential. The location and anatomic consistency of the stenosis, comorbidities, the functional status of respiratory system, as well as the planned reconstructive technique need to be considered. Until more data is available, however, a reliable evidence-based comparison of different approaches is not possible.

Safety analysis and complications of condylar screws in a single-surgeon series of 250 occipitocervical fusions

ObjectiveCondylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous surgical bone removal along the supraocciput has occurred which makes anchoring of a traditional barplate technically difficult or impossible. However, the challenging dissection of C0-1 necessary for condylar screw fixation and the concerns about possible complications have, thus far, prevented the acquisition of large surgical series utilizing occipital condylar screws. In the largest case series to date, this paper aims to evaluate the safety profile and complications of condylar screw fixation for occipitocervical fusion.MethodsA retrospective safety and complication-based analysis of occipitocervical fusion via condylar screws fixation was performed.ResultsA total of 250 patients underwent occipitocervical fusions using 500 condylar screws between September 2012 and September 2018. No condylar screw pullouts, or vertebral artery impingements were observed in this series. The sacrifice of condylar veins during the dissection at C0-1 did not cause any venous stroke. Hypotrophic condyles were found in 36.4% (91 of the 250) cases and did not prevent the insertion of condylar screws. Two transient hypoglossal deficits occurred at the beginning of this surgical series and were followed by recovery a few months later. Corrective strategies were effective in preventing further hypoglossal injuries.ConclusionsThis surgical series suggests that the use of condylar screws fixation is a relatively safe and reliable option for OC fusion in both adult and pediatric patients. Methodical dissection of anatomical landmarks, intraoperative imaging, and neurophysiologic monitoring allowed the safe execution of the largest series of condylar screws reported to date. Separate contributions will follow in the future to provide details about the long-term clinical outcome of this series.

Assessment of Chainsaw Operators Training in Andalusia (Spain)

The chainsaw, as a work equipment, is considered one of the most dangerous in the field of occupational health and safety. The chainsaw is especially used in the forestry sector, although it is also used in other different sectors such as agriculture, construction or gardening. This study was carried out using an ad-hoc questionnaire as a research tool in order to assess the weaknesses in the training received by workers who use chainsaws in Andalusia, Spain, since it has never been addressed before. To achieve the objective set, the questionnaire was completed by 378 operators working with chainsaw and their responses were analysed. The results of this study show that there are obvious shortcomings related to work with chainsaws in very significant aspects for the occupational health and safety. Of special importance is the lack of training detected on rescue techniques and work at height, since these are aspects of special risk for workers’ health that could cause accidents with severe injuries. Also, a common denominator in all aspects studied was the lack of safety inspections and the state of the equipment to be used. These results evidence that there is a need to regulate chainsaw operator training.

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Abstract 1122‐000059: Considering Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta‐Analysis and Systematic Review

Introduction : Despite the success of mechanical thrombectomy in large vessel acute ischemic stroke, there remain cases where recanalization fails due to difficult anatomic access or peripheral arterial occlusive disease. In these cases, transbrachial or transcarotid access may be considered as alternatives to the transfemoral or increasingly popular transradial route. Of these approaches, the transcarotid route has not gained prominence due to safety concerns despite its prior routine use in angiography. In this study, we conducted a systematic review and meta‐analysis of the literature in order to better summate the data on transcarotid access. Methods : Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were used in order to perform a systematic review of articles published from 2010–2020 summarizing pre‐intervention characteristics of patients undergoing mechanical thrombectomy via transcarotid puncture. We performed a meta‐analysis focused on clinical outcomes, reperfusion times (in minutes), and overall complication rates of transcarotid access for mechanical thrombectomy. Pooled analyses were performed to examine predictors of complications and outcomes. Results : Six studies describing 72 patients, out of 80 attempts at carotid access (90% success rate), were included. Age ranged from the 5th to 9th decade (median 7.5). Initial National Institutes of Health Stroke Scale (NIHSS) score ranged from 4 to 28 (median 17). Direct carotid puncture was most often used as a rescue technique (86% of patients) secondary to failed femoral access. Successful recanalization was achieved in 85% of patients. Good 90‐day outcome (modified Rankin Scale ≤2) was achieved in 27% of patients. Median carotid puncture‐to‐reperfusion time was 32 minutes (CI = 24–40, p &lt; 0.001). Cervical complications occurred at a rate of 23% (CI = 14– 35%, p &lt; 0.001). Only one complication resulted in a fatal outcome and only one required an intervention (each 1.4%). Use of IV thrombolysis did not significantly predict better mTICI outcome. Complications were not predicted by use of IV thrombolysis or closure method. Carotid puncture as the primary access route was associated with significantly shorter procedure times and carotid puncture as a rescue route was associated with comparable procedure times to the classic femoral access route. Conclusions : Our results suggest that, despite current concerns about the use of transcarotid access, this technique can be considered a viable backup route in cases of failed transfemoral or transradial access. Though this method requires further research to better understand the variables that might play into clinical decision‐making for its use in acute stroke management, it is a promising area of study that could allow for thrombectomy in patients where it would otherwise be aborted.

Anesthetic considerations in lung transplantation: past, present and future

Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs. Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient’s hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.