Routine Postoperative Management Research Articles

Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care

BackgroundMany early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries.Material and methodsThis pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians.ResultsThe general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians’ dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users’ satisfaction and willingness to use the system.ConclusionImplementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.

The Effect of Naldemedine Tosylate on the Postoperative Course of Robot-Assisted Radical Cystectomy

Radical cystectomy is an invasive procedure frequently followed by postoperative complications. Although the protocol of enhanced recovery after surgery (ERAS) is used in the postoperative course, several components of the ERAS protocol may increase the workload of medical workers. In this study, we added naldemedine tosylate only to routine postoperative management instead of using the ERAS protocol and evaluated the effect on the postoperative course of robot-assisted radical cystectomy (RARC). We retrospectively investigated 58 patients who underwent RARC from May 2015 to February 2022 at our hospital and evaluated the postoperative complications, such as ileus and urinary tract infections, and, length of hospital stay (LOS). We used naldemedine tosylate for the patients who underwent RARC after November 2019. As a result, naldemedine tosylate reduced 26.8% of postoperative complications within 30 days after the operation (p＝0.041) and shortened LOS 8 days (p＝0.018). Naldemesine tosylate improved the postoperative course of RARC.

Postoperative awake prone position in geriatric patients with hip fractures: a protocol for a randomized controlled trial on the efficacy of postoperative prone position in reducing pulmonary complications and improving oxygenation

IntroductionPostoperative pulmonary complications (PPCs) are prevalent in geriatric patients with hip fractures. Low oxygen level is one of the most important risk factors for PPCs. Prone position has been proven efficacy in improving oxygenation and delaying the progress of pulmonary diseases, especially in patients with acute respiratory distress syndrome induced by multiple etiologies. The application of awake prone position (APP) has also attracted widespread attention in recent years. A randomized controlled trial (RCT) will be carried out to measure the effect of postoperative APP in a population of geriatric patients undergoing hip fracture surgery.MethodsThis is an RCT. Patients older than 65 years old admitted through the emergency department and diagnosed with an intertrochanteric or femoral neck fracture will be eligible for enrollment and assigned randomly to the control group with routine postoperative management of orthopedics or APP group with an additional prone position for the first three consecutive postoperative days (PODs). Patients receiving conservative treatment will not be eligible for enrollment. We will record the difference in the patient’s room-air-breathing arterial partial pressure of oxygen (PaO2) values between the 4th POD (POD 4) and emergency visits, the morbidity of PPCs and other postoperative complications, and length of stay. The incidence of PPCs, readmission rates, and mortality rates will be followed up for 90 PODs.DiscussionWe describe the protocol for a single-center RCT that will evaluate the efficacy of postoperative APP treatment in reducing pulmonary complications and improving oxygenation in geriatric patients with hip fractures.Ethics and disseminationThis protocol was approved by the independent ethics committee (IEC) for Clinical Research of Zhongda Hospital, Affiliated to Southeast University, and is registered on the Chinese Clinical Trial Registry. The findings of the trial will be disseminated through peer-reviewed journals.Ethics approval number2021ZDSYLL203-P01Trial registrationChiCTR ChiCTR2100049311. Registered on 29 July 2021.Trial statusRecruiting. Recruitment is expected to be completed in December 2024.

SERRATUS ANTERIOR PLANE BLOCK FOR TOTALLY ENDOSCOPIC AORTIC VALVE REPLACEMENT SURGERY: A RANDOMIZED CONTROLLED TRIAL

<h3>Objective</h3> Totally endoscopic aortic valve replacement (AVR) has several benefits compared to the classic approach via sternotomy. However, pain after this thoracoscopic intervention is still a problem. The current pain treatment after AVR consists of opioids. Unfortunately, opioids have various side effects, such as nausea, constipation and respiratory depression. These side effects prevent a fast recovery after surgery. Therefore, it is essential to keep postoperative opioid consumption to a minimum. This study aims to investigate the efficacy of the serratus anterior plane (SAP) block in reducing acute postoperative pain after totally endoscopic AVR surgery. During a SAP block, local anaesthetics are injected in the plane beneath the anterior serratus muscle and in the plane between latissimus dorsi and serratus anterior in an ultrasound guided manner. This induces analgesia in dermatomes T2 to T9, which includes the place where surgical incision is realized. In this study, postoperative pain was compared between a treatment with the postoperative SAP block and a treatment without the SAP block. <h3>Design and method</h3> This double-blinded, mono-center, prospective, randomized controlled superiority trial took place in the Jessa Hospital in Hasselt, Belgium. Patients undergoing totally endoscopic AVR were included and randomly allocated to the experimental group, receiving the standard of care plus SAP block, or the control group, receiving normal standard of care. The primary outcome was total opioid (piritramide) consumption during the first 24h after surgery. Secondary outcome measures were physical and mental health measured by the SF-36 questionnaire on postoperative day 2 and length of stay in the ICU and hospital. <h3>Results</h3> Between December 3, 2020 and May 11, 2022, 67 patients were included, of which 62 were analysed. The need for opioid consumption was lower in the experimental group compared to the control group (12 mg [8-26] vs. 19 mg [13.5-30.5], p=0.06). Physical (p=0.70) and mental health (p=0.93) on postoperative day 2 and length of stay in the ICU (p=0.79) and hospital (p=0.84) were similar in both groups. <h3>Conclusions</h3> These preliminary data show a tendency towards reduced opioid consumption when postoperative single-shot serratus anterior plane block is added to routine postoperative care management after thoracoscopic AVR.

Pre-emptive intraoperative administration of PCC4 in cardiac surgery patients at high risk of bleeding: Apilot study.

Four-factor prothrombin complex (PCC4), a concentrate of factors II, VII, IX, and X and proteins C and S, has been used selectively for reversal of oral anticoagulation before surgery. There is data to support PCC4 as opposed to supplemental fresh frozen plasma (FFP) to manage postoperative bleeding following cardiac surgery. The preemptive, intraoperative use of PCC4 in cardiothoracic surgery has not been studied though it may prevent postoperative bleeding, the need for blood transfusion and the risk of transfusion-related acute lung injury, volume overload, and right ventricular (RV) heart failure. The purpose of this study is to evaluate the intraoperative administration of PCC4 to decrease bleeding and lower the rate of blood transfusion. A single institution retrospective chart review was conducted from May 2020 to November 2021 of patients who received PCC4 intraoperatively during cardiothoracic surgery of high-risk variety. Patients were evaluated for the type of surgery, demographics, baseline anticoagulation, PCC4 dose, type and quantity of blood transfusion within 72 hours (h) postoperatively, chest tube output, the incidence of RV failure, hypersensitivity reactions, acute kidney injury (AKI), thrombosis, acute lung injury, and mortality within 45 days of the operative dose of PCC4. Thirty-five patients received PCC4 at a mean dose of 2920 units (U). Sixty-fivepercent of cases were left ventricular assist devices(LVADs) or heart transplants. The protocol is to use PCC4 30 units (U)/kg immediately after the completion of protamine administration. Inclusion criteria are cardiothoracic surgery with increased risk of postoperative right heart failure commonly secondary to blood product transfusion, or cardiothoracic surgery associated with increased risk of bleeding, including heart transplant, LVAD implant, aortic dissection, and redo sternotomy (e.g., coronary artery bypass). Total chest tube output was recorded as a mean of 757 ml for 24 h after surgery (32 ml/h). Overall median event rates of FFPand red blood cell (RBC) transfusions were 0 (interquartile range [IQR]: 0-3 U) and 4 (IQR: 2-5 U). Overall, 43%and 89%of cases received FFP and RBC, respectively. There was one occurrence of RV failure, one occurrence of AKI requiring renal replacement therapy, one occurrence of venoarterial extracorporeal membrane oxygenation, one occurrence of venous thromboembolism related to a central venous access line, and one death unrelated to surgery or PCC4 that was attributed to advanced heart failure not amenable to advanced therapies. Overall patients received a low rate of blood transfusion, had minimal chest tube output, and there was a small incidence of right heart failure. Patients did not have an increased risk of adverse effects such as AKI or venous thromboembolism. A randomized controlled clinical trial comparing the observed dose and timing of PCC4 versus routine postoperative bleeding management with blood product transfusion is recommended.

Implementation of the “No ICU – Unless” approach in postoperative neurosurgical management in times of COVID-19

Following elective craniotomy, patients routinely receive 24-h monitoring in an intensive care unit (ICU). However, the benefit of intensive care monitoring and treatment in these patients is discussed controversially. This study aimed to evaluate the complication profile of a “No ICU – Unless” strategy and to compare this strategy with the standardized management of post-craniotomy patients in the ICU. Two postoperative management strategies were compared in a matched-pair analysis: The first cohort included patients who were managed in the normal ward postoperatively (“No ICU – Unless” group). The second cohort contained patients routinely admitted to the ICU (control group). Outcome parameters contained detailed complication profile, length of hospital and ICU stay, duration to first postoperative mobilization, number of unplanned imaging before scheduled postoperative imaging, number and type of intensive care interventions, as well as pre- and postoperative modified Rankin scale (mRS). Patient characteristics and clinical course were analyzed using electronic medical records. The No ICU – Unless (NIU) group consisted of 96 patients, and the control group consisted of 75 patients. Complication rates were comparable in both cohorts (16% in the NIU group vs. 17% in the control group; p = 0.123). Groups did not differ significantly in any of the outcome parameters examined. The length of hospital stay was shorter in the NIU group but did not reach statistical significance (average 5.8 vs. 6.8 days; p = 0.481). There was no significant change in the distribution of preoperative (p = 0.960) and postoperative (p = 0.425) mRS scores in the NIU and control groups. Routine postoperative ICU management does not reduce postoperative complications and does not affect the surgical outcome of patients after elective craniotomies. Most postoperative complications are detected after a 24-h observation period. This approach may represent a potential strategy to prevent the overutilization of ICU capacities while maintaining sufficient postoperative care for neurosurgical patients.

Less is more: clinical utility of postoperative laboratory testing following minimally invasive hysterectomy for endometrial cancer

With the increasing rates of same-day discharge following minimally invasive surgery for endometrial cancer, the need for and value of routine postoperative testing is unclear. This study aimed to determine whether routine postoperative laboratory testing following minimally invasive hysterectomy for endometrial cancer leads to clinically significant changes in postoperative care. This was a single-institution retrospective cohort study of patients undergoing minimally invasive hysterectomy for endometrial cancer by a gynecologic oncologist between June 2014 and June 2017. Patient demographics, preoperative comorbidities, operative and postoperative data, and pathologic findings were manually extracted from the patients' medical records. The financial burden of laboratory testing was computed using hospital-level cost data. Of the 649 women included in the analysis, most (91.4%) were White, with a mean age of 61 years, and mean body mass index of 38.0 kg/m2. The most common comorbidities were diabetes mellitus (31.9%, n=207), chronic pulmonary disease (7.9%, n=51), and congestive heart failure (3.2%, n=21). Median operative time was 151 minutes (range, 61-278), and median estimated blood loss was 100 mL (range, 10-1500). Most patients (68.6%, n=445) underwent lymphadenectomy. All patients had postoperative laboratory tests ordered: 100% complete blood count, 99.7% chemistry, 62.9% magnesium, 46.8% phosphate, 37.4% calcium, and 1.2% liver function tests. Twenty-six patients (4.0%) had a change in management owing to postoperative laboratory test results. Of these 26 women, 88% experienced a change in clinical status that would have otherwise prompted testing. Only 3 (0.5% of entire cohort) were asymptomatic: 1 received a blood transfusion for asymptomatic anemia, and the other 2, who did not carry a diagnosis of diabetes mellitus, had interventions for hyperglycemia. On univariable analysis, peripheral and cerebrovascular disease, diabetes mellitus with end-organ damage, and a Charlson Comorbidity Index of ≥3 were associated with increased odds of change in management; these were not significant on multivariable analysis. Routine postoperative laboratory evaluation in this cohort increased hospital costs by $292,000. Routine postoperative laboratory tests are unlikely to lead to significant changes in management for women undergoing minimally invasive hysterectomy for endometrial cancer, and may increase cost without providing a discernible clinical benefit. In the setting of strict postoperative guidelines, laboratory tests should be ordered when clinically indicated rather than as part of routine postoperative management for women undergoing minimally invasive hysterectomy for endometrial cancer.

Application of FOCUS-PDCA in Management of Patients after Induced Abortion

Objective To explore the effect of FOCUS-PDCA applied in the management of patients after induced abortion. Methods A total of 2930 patients undergoing induced abortion in Shaanxi Provincial People's Hospital from January 2019 to December 2020 were enrolled in the study, who were divided into control group and observation group in chronological order. The control group was given routine preoperative education and postoperative management, while the observation group introduced the FOCUS-PDCA program on the basis of the conventional process. The contraceptive knowledge level, PAC related knowledge (including the precautions of nursing after induced abortion and the harm of induced abortion to female reproductive health), recovery rate of sexual life and repeated abortion rate were observed and compared between two groups. Results The familiarities of contraceptive knowledge and PAC related knowledge in observation group were significantly improved compared with that before intervention (P < 0.05), the recovery rate of sexual life within 1 month after surgery decreased (P<0.05), and repeated abortion within 1 year of follow-up also decreased (P<0.05). Conclusion FOCUS-PDCA can significantly improve the quality of long-term management of induced abortion patients, which is worthy of promotion in clinic.

The effectiveness of a parent participation in postoperative pain management programs for children in a urology ward: A randomized controlled trial.

Postoperative pain has adverse effects on children after urology treatment, including sleep disturbance, incision dehiscence, bleeding, and delayed recovery. Parents, as the most direct caregivers of children, can make accurate assessments of children´s personal behaviors and responses, which is very important for the management of postoperative pain in children. The purpose of the current study was to develop a Parent Participation in Postoperative Pain Management Program for children in a urology ward and to evaluate its effects on children's postoperative pain scores and other outcome indicators. This research comprised two phases. The first phase was the development of a Parent Participation in Postoperative Pain Management Program. The second phase was a randomized controlled trial between two groups, and was carried out in a 45-bed inpatient urology ward of a tertiary children's hospital in China. In the trial, 211 children and their parents were randomly selected as a control group between July 1 and August 15, 2019, and 202 children and their parents were randomly selected as an intervention group between August 16 and September 15, 2019. Following the framework and methods of the Evidence-based Continuous Quality Improvement Model developed at Fudan University Evidence-Based Nursing Center, we systematically gathered evidence regarding parental involvement in postoperative pain management in children to construct the program. To evaluate the program's effectiveness, the control group performed routine postoperative pain management, while the intervention group underwent the Parent Participation in Postoperative Pain Management Program. The management period was during hospitalization, and generally ranged 3-7days. The Statistical Table of Pain Assessment for Children after Urology was employed by researchers. The results revealed no significant differences in demographic characteristics between the two groups of children and their parents. Children's pain scores during dressing removal (Z=-3.108, p=0.002), at discharge (Z=-2.185, p=0.029) and during catheter removal (Z=-6.553, p=0.000) were significantly lower in the intervention group compared with the control group. The Parent Participation in Postoperative Pain Management Program was found to be effective for alleviating postoperative pain scores among children, and provided useful information regarding postoperative pain management in children involving four aspects of parental involvement: cognition, guidance, documentation and support.

Assessment of post-operative analgesia in modified radical mastectomy patients using surgical wound irrigation with 0.25% bupivacaine

Modified Radical Mastectomy is the widely followed treatment for operable breast cancers. Among the methods used to alleviate pain, irrigation of wound with 0.25% Bupivacaine is one of the under-utilized methods with good efficiency compared to other drugs.To evaluate the role of local irrigation of 0.25% bupivacaine in alleviating the post-operative pain. This observational study was conducted among 60 female patients who underwent Modified Radical Mastectomy in a tertiary care teaching hospital between January 2017 and July 2018. Thirty (30) patients were randomly allotted to control group, where the routine post-operative pain management was followed. Another 30 were randomly allotted to study group where, before closure of the wound, a 20G scalp vein set was used along the length of the incision with multiple punctures in it for continuous irrigation with 0.25% Bupivacaine. Post operatively Visual analogue scale was used to measure the pain sensation at every six hours for 24 hours. The adverse effects like pain, hematoma, wound dehiscence, infection was noted on all the post-operative days.Both the groups were similar with respect to basic parameters measured. There was a significant reduction in need for rescue analgesia in the study group. There was a significant difference in mean VAS score between both groups from 6 hour of surgery. Post-operative nausea and vomiting was significantly less in the study group. Irrigation of wound with 0.25% Bupivacaine is found to reduce the pain sensation with minimal side effects without systemic compromise.

Less is more: clinical utility of postoperative labs following minimally invasive hysterectomy for endometrial cancer

<h3>Objectives:</h3> With the Increasing rates of same day discharge following minimally invasive endometrial cancer (EC) surgery, the need for and value of routine postoperative testing is unclear. We determined whether routine postoperative labs following minimally invasive hysterectomy for EC led to clinically significant changes in postoperative care. <h3>Methods:</h3> This was a single-institution retrospective cohort study of patients undergoing minimally invasive hysterectomy for EC by a gynecologic oncologist. A random sample was selected from an existing database of patients who underwent surgery for EC between June 2014-2017. Patient demographics, preoperative comorbidities, operative and postoperative data, and pathologic findings were manually extracted from the patients' medical records. The financial burden of laboratory evaluation was computed using hospital-level cost data. <h3>Results:</h3> Of the 266 women included in the analysis, the majority (91.4%) were White, with a mean age of 61.5 years, and mean BMI of 38.0±10.1kg/m². The most common comorbidities were diabetes (29.3%, n=78), chronic pulmonary disease (7.9%, n=21), and renal disease (3.8%, n=10). The mean operative time was 152.1±37.8 minutes and mean EBL was 105±91.7mL. Most patients (66.5%, n=177) underwent LAD, of which 77.4% had sentinel (n=78) and/or complete pelvic LAD (n=128), and an additional 42.4% (n=75) underwent paraaortic lymph node assessment. All patients had post-operative labs ordered: 100% complete blood count, 99.2% chemistry, 55.3% magnesium, 44.7% phosphate, 39.8% calcium, 3.4% PT/PTT/INR, 1.9% liver function tests, and 15% other. The mean pre- and post-operative hemoglobin was 13.5±1.4g/dL and 11.5±1.3g/dL, respectively. Mean pre- and post-operative creatinine were 0.83±0.21mg/dL and 0.78±0.20mg/dL. Thirteen patients (4.9%) had a change in management due to postoperative lab results (Table 1). Of these, only two patients (0.8% of entire cohort) had no symptoms or change in clinical status that would have otherwise prompted labs to be performed: one received a blood transfusion for asymptomatic anemia and the other electrolyte repletion for asymptomatic hypomagnesemia of 1.2mg/dL. There were no preoperative or operative factors significantly associated with a postoperative change in management due to labs, postoperative creatinine or postoperative hemoglobin. Routine postoperative laboratory evaluation in this cohort increased hospital costs by $118,455 or approximately $445 per patient. <h3>Conclusions:</h3> Routine postoperative labs are unlikely to lead to significant changes in management for women undergoing minimally invasive hysterectomy for EC, and may increase cost without providing a discernable clinical benefit. In the setting of strict post-operative guidelines, laboratory tests should be ordered when clinically indicated rather than as part of routine postoperative management for women undergoing minimally invasive hysterectomy for EC.

Routine Postoperative Management of Blepharoplasty: A Review of Current Evidence-Based Practice.

Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion "bleph*" was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4-5 evidence). Few randomized controlled trials were performed (level 2). Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.

DIAPHRAGMATIC HEMIPARALYSIS AS A RARE CONSEQUENCE OF HIGH THORACIC EPIDURAL ANESTHESIA IN LUNG TRANSPLANTATION: A CASE REPORT

SESSION TITLE: Fellows Transplantation Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Thoracic epidural anesthesia is routinely placed intraoperatively for postoperative pain management in lung transplant recipients [1]. Herein, we sought to detail a rare consequence of thoracic epidural anesthesia if placed too high. CASE PRESENTATION: A 56-year-old male underwent bilateral lung transplant in April 2020 for treatment of end-stage idiopathic pulmonary fibrosis. There were no major intraoperative complications, and no phrenic nerve injury noted. Thoracic epidural anesthesia was placed in the operating room for routine postoperative pain management. The immediate postoperative period was uncomplicated, as the patient had no primary graft dysfunction at time 0 or 24 hours after transplant. The allograft was functioning well with minimal secretions and no positive cultures detected. After rapid ventilator weaning, the patient was extubated on post-transplant day one. However, the patient required two unsuspected re-intubations, and the right hemidiaphragm was found notably elevated on chest radiograph. The epidural block was weaned within six hours, and the patient was successfully extubated, without need for further re-intubation. The initial and follow-up chest radiographs after recovery are depicted in Figure 1. DISCUSSION: Upon review, it was noted that the epidural catheter was inserted high at the T2-3 intervertebral space. Although thoracic epidural block extending up to the T2 level does not normally alter ventilation significantly in healthy persons, our patient recovering from lung transplant was dyspneic and had difficulty generating adequate tidal volume, necessitating re-intubation. Importantly, large volumes of anesthetics may be necessary after a highly invasive thoracic surgery such as lung transplant. A high thoracic epidural block with significant anesthetic volume may affect the roots of the brachial plexus, some of which are responsible for the phrenic nerve and diaphragmatic contraction. CONCLUSIONS: Anesthesiologists and transplant clinicians should be aware that intraoperative high thoracic epidural anesthesia in a lung transplant recipient may have post-transplant motor repercussions of diaphragmatic hemiparalysis, resulting in changes to respiratory dynamics and pulmonary symptoms. Reference #1: Von Dossow V, Welte M, Zaune U, et al. Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesth Analg. 2001;92(4):848-854. doi:10.1097/00000539-200104000-00010 DISCLOSURES: No relevant relationships by Hesham Abdelrazek, source=Web Response No relevant relationships by ASHWINI ARJUNA, source=Web Response No relevant relationships by Hesham Mohamed, source=Web Response No relevant relationships by Michael Olson, source=Web Response No relevant relationships by Josna Padiyar, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Rajat Walia, source=Admin input, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 by Rajat Walia, source=Admin input, value=Honoraria Speaker/Speaker's Bureau relationship with Grifols Please note: $5001 - $20000 by Rajat Walia, source=Admin input, value=Honoraria Speaker/Speaker's Bureau relationship with Shire Please note: $1001 - $5000 by Rajat Walia, source=Admin input, value=Honoraria Speaker/Speaker's Bureau relationship with Astellas Please note: $5001 - $20000 by Rajat Walia, source=Admin input, value=Honoraria

Variations in Postoperative Management of Pediatric Open-Vault Craniosynostosis.

Craniosynostosis is the premature fusion of 1 or more of the calvarial sutures causing a secondary distortion of the skull shape due to lack of growth perpendicular to the fused suture and compensatory overgrowth parallel to the suture. Open vault craniosynostosis repair requires extensive dissection and reshaping of the skull and can be associated with significant pain, commonly undervalued, and underreported in the pediatric cohort. Although there is an extensive body of literature focusing on the operative treatment of craniosynostosis, there is little consensus about optimal postoperative management protocols, including pain control regimens. The purpose of this study was to assess variation in immediate postoperative management protocols within the United States. A Qualtrics-based survey was submitted to all 112 American Cleft Palate-Craniofacial Association-approved craniofacial teams regarding their routine postoperative management protocol. Nineteen responses were obtained. All surgeons reported routine post-op intensive care unit stay. Mean overall length of stay was 3.5 days. Pain control agents included acetaminophen (100%), intravenous opioids (95%), oral opioids (79%), and ketorolac (53%). Eighty-eight percent of surgeons reported utilizing vital signs and observational parameters for pain assessment with 47% reporting the use of a formal pain scale. Sixty-three percent of those surveyed used a drain, 88% used a foley catheter, 75% used postoperative prophylactic antibiotics, and 75% routinely used arterial line monitoring postoperatively. The results of this survey will be the basis for future direction in understanding the efficacy of differing management protocols and further study of pain management in the pediatric craniosynostosis population.

Distal paravertebral nerve block in sheep undergoing laparohysterotomy: Comparing the use of 1% and 2% lignocaine hydrochloride

Abstract The study was designed as a blinded, randomized, prospective, clinical trial to compare the use of 1% and 2% lignocaine hydrochloride for distal paravertebral nerve block in sheep undergoing Caesarian section. Full-term ewes (n = 18) with dystocia requiring laparohysterotomy were randomly and equally allotted to two groups (I and II). They were administered ceftriaxone (10 mg kg−1) and meloxicam (0.3 mg kg−1, IM) 30 min and diazepam (0.2 mg kg−1, IV) 15 min before injecting 15.0 mL (5.0 mL per spinal nerve) of either 1% (Group I) or 2% (Group II) lignocaine hydrochloride for achieving distal paravertebral anesthesia. Nociceptive stimuli during pre- and postoperative periods comprised of superficial and deep pinpricks. The reaction of the animals to the surgical intervention, manipulations and application of the sutures were recorded intraoperatively. Routine postoperative management included regular wound dressing, administration of the antibiotic and analgesic. The onset time (mean ± standard deviation) of the regional anesthesia in group I and II ewes was 4.6 ± 1.5 min and 5.4 ± 2.8 min respectively. One sheep per group showed temporary, mild muscle twitching near ventral flank but required no rescue analgesia. The duration of surgery was 52 ± 11 min and 60 ± 11 min and the anesthesia lasted for 87 ± 15 min and 98 ± 17 min respectively. Significant difference between the groups was not detected in any of these variables. From this clinical study it is concluded that satisfactory flank anesthesia is achieved using 2% or 1% lignocaine hydrochloride for distal paravertebral nerve block. The recommendation to use 1% instead of 2% local anesthetic preparation for safety in small ruminants is thus validated.

Glioblastoma survival is better analyzed on preradiotherapy MRI than on postoperative MRI residual volumes: A retrospective observational study

ObjectivesEstablishing an overall survival prognosis for resected glioblastoma during routine postoperative management remains a challenge. The aim of our single-center study was to assess the usefulness of basing survival analyses on preradiotherapy MRI (PRMR) rather than on postoperative MRI (POMR). Patients and methodsA retrospective review was undertaken of 75 patients with glioblastoma treated at our institute. We collected overall survival and MRI volumetric data. We analyzed two types of volumetric data: residual tumor volume and extent of resection. Overall survival rates were compared according to these two types of volumetric data, calculated on either POMR or PRMR and according to the presence or absence of residual enhancement. ResultsAnalysis of volumetric data revealed progression of some residual tumors between POMR and PRMR. Kaplan-Meier analysis of the correlations between extent of resection, residual tumor volume, and overall survival revealed significant differences between POMR and PRMR data. Both MRI scans indicated a difference between the complete resection subgroup and the incomplete resection subgroup, as median overall survival was longer in patients with complete resection. However, differences were significant for PRMR (25.3 vs. 15.5, p = 0.012), but not for POMR (21.3 vs. 15.8 months, p = 0.145). With a residual tumor volume cut-off value of 3 cm3, Kaplan-Meier survival analysis revealed non-significant differences on POMR (p = 0.323) compared with PRMR (p = 0.007). ConclusionSurvival in patients with resected glioblastoma was more accurately predicted by volumetric data acquired with PRMR. Differences in predicted survival between the POMR and PRMR groups can be attributed to changes in tumor behavior before adjuvant therapy.

Chewing Aid in Routine Postoperative Orders - Does it reduce Postoperative Ileus after Cesarean Section? A Randomized Control Trial

OBJECTIVE: To assess effectiveness of chewing gum in women undergoing cesarean section(C-Section) on return of bowel movements.METHODOLOGY: Randomized clinical trial was conducted at a tertiary care hospital, Karachi fromJanuary 2013 to January 2016. Total 218 participants, who were planned for Cesarean section, wererandomly allocated into two groups, 109 participants in each group. In Group-I, patient’s receivedchewing gum as routine and group II was control group. Data of all subjects were analyzed using SPSSversion 20.RESULTS: The mean age of participants was 22.68±6.31 years. There was no significant differencebetween both groups in terms of age, Body Mass index, duration of surgery, parity, number ofmiscarriages and type of cesarean section whether elective or emergency. Significant reduction wasfound in terms of onset of defecation (P<0.001), onset of first flatus passed (P<0.001) and feeling ofhunger (P<0.003) between two groups.CONCLUSION: The current study identified that routine use of chewing gum as postoperative orderimpacts positively on time of passing flatus, defecation, and feeling of hunger. Eventually, it will reducesuffering resulting from ileus fostering early feeding. Since it is non-expensive and easy to use methodtherefore, it can be included as a routine post-operative management for women undergoing cesareansection. However, it is recommended to investigate impact of using chewing gum in other abdominalsurgeries.

Rigid dressings versus soft dressings for transtibial amputations.

Rigid dressings versus soft dressings for transtibial amputations.

The cervicofacial flap

Surgical and traumatic defects of the face present a reconstructive challenge to restore facial symmetry. The cervicofacial flap is a rotational and advancement flap with random blood supply utilized to close moderate- to large-sized defects of the cheek. Subcutaneous dissection of the cervical region allows for a large amount of tissue mobilization. Depending on the location of the cheek defect, the flap can be pedicled either anteriorly or posteriorly. This article presents the authors’ preferred surgical technique as well as reported surgical variations. Routine postoperative care and management of potential complications are discussed.

Efficacy of perioperative management in elderly hemorrhoids patients undergoing procedure for prolapse and hemorrhoids

Objective To investigate the efficacy of perioperative management in elderly hemorrhoids patients undergoing procedure for prolapse and hemorrhoids(PPH). Methods A total of 128 elderly patients treated with PPH in the Second Affiliated Hospital of Jiaxing University from February 2018 to January 2019 were enrolled and randomly divided into the routine group(n=64)and the intervention group(n=64). The routine group underwent routine postoperative management, and the intervention group received intervention postoperative management as add-on to routine postoperative management.Clinical efficacy was compared between the two groups. Results The frequency of constipation and hematochezia was less and the hospitalization days were shorter in the intervention group than in the routine group(0.8±0.6 times/d vs.1.2±0.4 times/d, 1.3±0.8 times/d vs.2.0±1.0 times/d, 4.9±1.1 days vs.7.4±1.3 days, t=4.438, 4.372 and 11.744 respectively, all P=0.000). The scores of visual analog scale(VAS)and geriatric depression scale(GDS)had no significant difference between the intervention and routine groups(5.0±1.6 scores vs.5.2±1.3 scores for VAS; 22.2±2.9 scores vs.22.5±2.6 scores for GDS, t=0.776 and 0.616, P=0.220 and 0.269)before intervention, and had significant difference between the intervention and routine groups[2.7±0.7 scores vs.3.2±1.1 scores for VAS; 17.2±1.8 scores vs.19.0±2.2 scores for GDS(t=3.068 and 5.066, P=0.001 and 0.000)]after intervention.The scores of quality of life, including physiological function, emotional function, social function, mental health and health status, were higher in the intervention group than in the routine group(all P<0.05). Conclusions Intervention perioperative management is effective in elderly hemorrhoids patients undergoing procedure for prolapse and hemorrhoids.It can not only effectively improve clinical symptoms and shorten treatment time, but also alleviate pain and improve prognosis and quality of life. Key words: Procedure for prolapse and hemorrhoids; Hemorrhoids