Routine Preoperative Preparation Research Articles

Auricular point acupressure for managing postoperative pain and reducing anxiety in patients with perianal abscesses

ObjectiveThe objective of this study is to assess the efficacy of auricular point acupressure in relieving postoperative pain and reducing anxiety among patients with perianal abscesses. MethodsWe included 61 patients with perianal abscesses who were admitted to the Nantong First People's Hospital between July 2019 and June 2020 and were scheduled to undergo one-stage radical surgery. We divided them into the treatment group (n = 31), where patients were administered preoperative auricular acupressure targeting the bilateral Shenmen, subcortical, and other points. They were instructed to apply pressure five to six times per day, each time for about 3–5 min. Patients in the control group (n = 30) received routine preoperative preparation. The treatment duration for both groups was one week. We compared the two groups using the pain visual analog scale (VAS) scores, the use of additional postoperative analgesics, and scores on the Hamilton anxiety and depression scales pre- and post-surgery at 6 h, 24 h, 48 h, 72 h, and 1 week after surgery, as well as at the time of the first bowel movement. ResultsPatients in the treatment group reported lower VAS scores than those of the control group at 48 h, 72 h, 1 week, and at the first defecation post-surgery, and the differences were statistically significant (all P < 0.05). Additional postoperative analgesics were used in seven patients in the treatment group (22.58 %) and in 10 patients in the control group (33.33 %). The difference between the two groups was not statistically significant (χ2 = 0.88, P = 0.35). Postoperative scores for the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) in the treatment group were significantly lower than those in the control group (P < 0.05). ConclusionThe results of this study demonstrated that auricular point acupressure was effective in alleviating postoperative pain in patients with perianal abscesses and simultaneously reduced their postoperative psychological stress reactions. This dual effect provided both pain relief and a reduction of anxiety with fewer adverse reactions, making it a safe and effective treatment option.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

The Effect of Intraoperative Body Temperature on Postoperative Nausea and Vomiting in Pediatric Patients

PurposePediatric patients are at greater risk for both perioperative hypothermia and postoperative nausea and vomiting (PONV). The primary aim of this study was to investigate whether there is a relationship between intraoperative body temperature and PONV in children undergoing anesthesia. The secondary aim was to investigate the relationship between PONV and intraoperative fentanyl use, age and duration of operation. DesignA prospective cohort study MethodsThe study included 80 children who were undergoing lower abdominal surgery. Body temperature was monitored after routine preoperative preparation and standard induction. Analgesic and antiemetic requirements and the presence of nausea and vomiting were assessed postoperatively on the 30th minute and the 6th, 12th and 24th hour. FindingsThe children with or without PONV were compared. At the postoperative 6th hour, the incidence of nausea was statistically significant in the children with a mean body temperature below 36°C (P = 0.044; P < 0.05). The mean duration of the surgery was statistically significant longer in the children with PONV (P = 0.001; P = 0.004; P <0.05). Mean body temperature was not statistically significant when comparing children with and without vomiting(P > 0.05). ConclusionWhile a body temperature below 36°C increases the incidence of postoperative nausea, it does not cause an increase in the incidence of vomiting. A long operation time in pediatric patients causes an increase in the incidence of PONV. Although not statistically significant, PONV is encountered more than twice as much in patients receiving intraoperative fentanyl administration.

Optimising working space for laparoscopic pyeloplasty in infants: Preliminary observations with the SGPGI Protocol.

Aims:This study aimed to test the efficacy of SGPGI protocol to minimise bowel distension and optimise working space for laparoscopic pyeloplasty in infants.Methodology:All infants who underwent laparoscopic pyeloplasty for unilateral pelvi-ureteric junction obstruction (PUJO) between January 2017 and March 2020 were included in the study. The patient cohort was divided into two groups: Group A and B. Group A included patients who underwent routine pre-operative preparation. Group B included patients wherein the SGPGI protocol was used. The key features of the protocol were fasting for 8 h, enemas, inserting a nasogastric tube in the pre-operative period and decompressing the colon on the operation table. Demographic features, pre-operative, intraoperative and post-operative parameters were compared between the two groups.Results:A total of 26 infants with unilateral PUJO underwent laparoscopic pyeloplasty during the study period. Group A included 12 patients and Group B included 14 patients. Both the groups were similar in age, weight and sex distribution. The median surgeon's rating score for suturing conditions was 2 for Group A and 5 for Group B patients (P > 0.05). The operating time was significantly longer in Group A (196 ± 21 min) as compared to Group B (114 ± 18 min) (P < 0.05). In Group A, intra-abdominal pressure (IAP) varied between 9 and 14 mmHg (median 12 mmHg), while in Group B, IAP varied between 6 and 9 mmHg (median 8 mmHg) (P < 0.05). In Group A, in 2/12 cases (16.7%), conversion to an open procedure was necessary because of inadequate working space owing to gross intestinal distension. Two patients in Group A also had intraoperative injuries to adjacent structures due to poor working space.Conclusions:Optimal working space is critical to the performance of advanced laparoscopic surgery like pyeloplasty in infants. SGPGI protocol significantly improves working space, which permits a faster and safer surgery with a lower intra-abdominal working pressure. This protocol is simple, safe and easy to replicate at most centres in our country.

Impact of standardized computed tomographic angiography for minimally invasive mitral and tricuspid valve surgery

BackgroundFemoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department.MethodsBetween July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups.ResultsIn patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications.ConclusionsCT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.

Does prophylactic ureteral catheter placement offer any advantage for laparoscopic gynecological surgery? A urologist' perspective from a systematic review and meta-analysis.

Our aim is to assess the efficacy of prophylactic ureteral catheter placement on patients undergoing laparoscopic gynecological surgery. We searched the electronic database including PubMed, Cochrane Library, Embase, Web of Science, WANFANG and CNKI in January 2020 to identify possible studies without languages limitations. A manual search was also conducted. The trials that compared catheterized group (CG) to non-catheterized group (NCG) were included. This meta-analysis was accomplished by RevMan5 (version 5.3). Initial search yield 997 studies and 5 randomized control trials were included in the final meta-analysis. Pooling data of five studies showed that patients in the CG had a lower risk of ureteral injury than those in NCG (RR: 0.44, 95% CI: 0.20–0.97, P=0.04) without significant between-study heterogeneity (P=0.23, I2=29%). The pooled data analysis showed a statistically significant difference in favor of prophylactic ureter catheter placement (MD: −40.51, 95% CI: −58.65 to −22.36, P<0.0001). Random-effects model meta-analysis found that patients in the CG experienced higher EBL compared to NCG (SMD: −5.78, 95% CI: −10.51 to −1.04, P=0.02). There was no statistically significant difference between CG group and NCG group (P=0.23) with regard to LOS. Current evidence indicates that prophylactic ureteral catheter placement has the advantages of reducing ureteral injury, shortening the operative time, and reducing the amount of bleeding. It might serve as a routine preoperative preparation choice for laparoscopic gynecological surgery, especially with pelvic adhesion. Further large volume, multicenter well-designed trials are warranted before making the final clinical guidelines.

Effectiveness of a Group Game Intervention in Reducing Preoperative Anxiety Levels of Children and Parents: A Randomized Controlled Trial.

Surgical experiences are often stressful for children and their parents. This study aimed to determine the effect of a group game intervention on the preoperative anxiety levels of 94 parent-child dyads who were awaiting elective minor surgery at a pediatric surgery clinic. The experimental group intervention included routine preoperative preparation and a group (ie, child, parent, and researcher) game. After the parent dressed the child for surgery, a research team member assessed the child's and parent's anxiety levels using the Facial Affective Scale and Visual Facial Anxiety Scale, respectively. Before the child was transferred to the OR, the research team member reassessed both anxiety levels. When compared to the control group, the results showed that children and parents involved in facilitated group play experienced significantly decreased anxiety levels (P < .001).

Ebštejnova anomalija u perioperativnom periodu kod pacijenta tokom nekardiohirurške operacije

Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.

Impact of one-week preoperative physical training on clinical outcomes of surgical lung cancer patients with limited lung function: a randomized trial.

To investigate the influence of preoperative physical training combining aerobic and breathing exercises on surgical lung cancer patients with impaired lung function. A total of 68 patients with predicted postoperative FEV1% <60% were equally and randomly assigned into one-week physical training combining aerobic and breathing exercises (intervened group: IG) or routine preoperative preparation (control group: CG). Then, 6-min walking distance (6-MWD), in-hospital length of stay (LOS), and other clinical variables were included and recorded. An increase of 22.6±27.0 m of 6-MWD was observed in IG, compared to 2.7±27.6 m in CG (between-group difference: 19.9 m, 95% CI: 6.7 to 33.2, P=0.004), but no difference was found in lung function. The emotional function of EORTC-QLQ-30 was significantly improved in IG after the training regimen, compared to CG. Meanwhile, the intervened patients (IG) had significantly lower postoperative pulmonary complication (PPC) rate (11.8%, 4/34 vs. 35.3%, 12/34, P=0.022), shorter postoperative LOS [median: 5.0 interquartile (4.0-7.0) vs. 8.0 (7.0-10.0) days, P<0.001] and lower costs, including total cost [48,588.7 (44,999.1-52,693.3) vs. 52,445.3 (49,002.9-61,994.0) ¥, P=0.016], material cost [23,350.8 (18,300.6-26,421.9) vs. 25,730.0 (21,328.7-29,250.2) ¥, P=0.048] and drug cost [7,230.0 (6,661.9-8,347.4) vs. 11,388.6 (7,963.0-16,314.3) ¥, P<0.001]. The preoperative physical training combining aerobic and breathing exercises can improve exercise capacity, decrease the occurrence of PPCs, and shorten LOS with lower in-hospital cost; it thus shows potential to be an effective preparation strategy for surgical lung cancer patients with limited lung function.

Efficacy of MAGPI procedure in the management of hypospadias

Background: Hypospadias is a relatively common congenital defect of male external genitalia. It is present in approximately 1 in 300 males new born. The meatus may be located anywhere along the shaft of the penis from glans to scrotum or even perineum. The objective is to study the efficacy of MAGPI procedure in the management of hypospadias.Methods: Detailed case study was done as per the proforma, in majority of cases patient’s mother were informants, thorough clinical examination was done in all cases and looked for any congenital anomalies and family history was also taken, and any drugs intake was also taken. All the cases routine investigation was done like (Hb, BT, Ct, Wt). USG was done in required cases. Routine pre-operative preparation was done like keeping nil orally, preparing parts was done. The type of surgery for each patient was assessed after clinical examination of location of meatus: Anterior, Middle, and Posterior. On discharge, the patients and mothers were advised to bring their children for regular check up to hospital.Results: Most common position of hypospadias was glanular and coronal. The most common surgery performed was Snodgrass technique and for distal and mid penile hypospadias and MAGPI for glanular type of hypospadias. MAGPI procedure was most commonly performed for glanular and coronal type of hypospadias. Other minor Complication was wound infection and penile torsion of mild degree and was managed conservatively.Conclusions: There is significant difference in outcome of hypospadias surgery done by pediatric urologist and other surgeons.

The Effect of Education on the Anxiety Level of Patients Before Thyroidectomy

The present study aims to evaluate the effect of preoperative education on the level of anxiety provided to patients scheduled for thyroidectomy using education brochures on the level of anxiety. The study design was quasi-experimental. The study data were collected using the Patient Information Form and the Turkish version of the Anxiety Specific to Surgery Questionnaire (ASSQ). Study group patients were informed by brochure before 24hours. Control group patients were informed verbally during routine preoperative preparation or 1day before surgery. Test and control group patients were resubjected to the ASSQ before being transported from their unit beds to the operating room. There was no significant difference in the mean scores of the pretest and final test ASSQ scores for the test and control groups (P > .05). Our study results showed that education provided to the patients scheduled for thyroid surgery using written materials did not affect anxiety.

Comparison of haemodynamic responses to tracheal intubation using Macintosh and Airtraq® laryngoscope in patients with simulated cervical spine injury

Background: Mechanical stimulation of airway structures occurs during laryngoscopy. The magnitude of cardiovascular response is related to the force and duration of laryngoscopy. Video laryngoscopes like Airtraq® will help us to intubate patients with restricted neck movements without much manipulation but are bulkier than conventional Macintosh laryngoscope. We compared Airtraq® and Macintosh laryngoscopes in patients with simulated cervical spine injury with respect to haemodynamic fluctuations. Methodology: A prospective, randomized study involving patients who are undergoing elective surgical procedures under GA. After routine preoperative preparation and monitoring, patients were administered conventional general anaesthesia. Preloaded Airtraq® or Macintosh laryngoscope was used for intubation. The outcome variables of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at regular intervals. Duration for intubation, manoeuvers required to optimize laryngeal view, glottic view, number of attempts taken and complications if any, were noted down as secondary objectives. Results: We observed that there is no significant difference in the average of variation in HR (p=0.078), SBP (p=0.515) and MAP (p=0.057) from the baseline between the two groups. We performed independent sample t test to know whether there is any significant difference for average duration of intubation, glottic view, ease of intubation and complications and we observed that there is significant difference in average duration of intubation (p=0.002) between two groups. Conclusion: Haemodynamic response caused by intubation with Airtraq® and Macintosh laryngoscopes in simulated cervical spine injury were comparable.

Effects of individualized preoperative bowel preparation regimen on intestinal cleansing in patients with cervical cancer

Objective To investigate the effects of individualized preoperative bowel preparation regimen on intestinal cleansing in patients with cervical cancer. Methods Totally 140 patients who were admitted and diagnosed with cervical cancer in the Department of Oncology of Wuxi Maternal and Child Care Hospital from January 2016 to May 2017 were selected by convenient sampling and randomly divided into a control group and an experimental group by drawing method. Finally, totally 67 patients in each group completed the experiment. Routine preoperative bowel preparation was adopted for patients in the control group, while individualized bowel preparation regimen was adopted for patients in the experimental group, including evaluation before medication, activity guidance for patients with different ages, control of medication speed and response to untoward effects. The intestinal cleansing, untoward effects, time of first defecation and total time of defecation were compared between the patients in the two groups. The rank-sum test, χ2 test and t test were used to analyze the data for the patients in the two groups. Results There was statistically significant difference in the degree of intestinal cleansing between the patients in the two groups (Z=-2.732, P<0.05) ; there was statistically significant difference in the degree of nausea and vomiting between the patients in the two groups (Z=-2.065, P<0.05) ; there was statistically significant difference in the degree of abdominal distension between the patients in the two groups (Z=-2.526, P<0.05) ; and there was statistically significant difference in the incidence of stomachache between the patients in the two groups (χ2=5.835, P<0.05) . The time of first defecation and the total time of defecation of the patients in the experimental group was shorter than that of the patients in the control group (t=-3.901, -6.689; P<0.01) . Conclusions The individualized preoperative bowel preparation for patients with cervical cancer can improve the intestinal cleansing, shorten the time of defecation and reduce untoward effects such as abdominal distension and stomachache in these patients. Key words: Cervical neoplasms; Polyethylene glycol electrolytes powder; Intestinal cleansing

Operative Learning Needs and Preparation for the Gynecologic Operating Room: A Comparison Between Junior and Senior Residents

BACKGROUND: Differences in operative learning needs and preoperative educational resources utilized by OBGYN residents across postgraduate year (PGY) levels in preparation for gynecologic operative cases are unknown. Understanding these learning needs and preparatory patterns can inform surgical curricula development and address gaps in preparation. METHODS: A cross-sectional survey developed with validity evidence was administered to a registry of 19 OBGYN residency programs. Residents were surveyed on 12 operative learning needs that persisted following routine preoperative preparation and resources utilized to prepare for gynecologic surgical cases and the frequency of use. RESULTS: Participants included 214 residents distributed similarly across PGY levels. The frequency of unmet operative learning needs was consistent across PGY levels with no differences in 8 of 12 topic areas. Junior and senior residents reported a similar ranking of their most frequently unmet operative learning needs in topics of anatomy, patient outcomes, suture selection, and follow-up procedures. No significant differences between junior and senior residents were noted in their regular/frequent use of preparatory educational resources, and more than 90% of both groups reported YouTube as the most commonly accessed web-based resource. DISCUSSION: Despite differences in years of training and surgical case experience, junior and senior residents reported similar unmet operative learning needs and preparatory resource utilization. These findings call for improved alignment in training and identify considerations for future surgical curricula development.

Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial.

The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT). A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients. Patient groups received one of three treatment regimens: (I) high-intensity pulmonary rehabilitation (PR) that combined IMT with conventional resistance training (CRT) (combined PR group); (II) conventional PR (single IMT group); or (III) routine preoperative preparation (control group). The primary endpoint was a change in the occurrence of post-operative pulmonary complications (PPCs) that occurred within 30 days after surgery, while secondary endpoints included changes in length of hospital stay, quality of life (QoL) scores, 6-min walk distance (6-MWD) and peak expiratory flow (PEF). A total of 90 enrolled patients were randomized into three groups with a computer-based 1:1:1 ratio. The intention-to-treat analysis of the study revealed that, compared with the Control Group, the Combined PR Group had a significant increase in ∆6-MWD (by 32.67 m, P=0.002), ∆PEF (by 14.3 L/min, P=0.001), ∆global scores (by 3.7, P=0.035); and a reduced ∆average total hospital stay (by 3.2 d, P=0.001) and ∆postoperative stay (by 3.6 d, P=0.001). With regard to PPC rate, the Combined PR Group had a somewhat lower PPC severity (grade II-V) compared to the Control Group. This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program, indicating that this approach would be a feasible strategy for treating LC patients, especially those waiting operations with surgery-related risk factors.

Surfactant Protein-D: A sensitive predictor for efficiency of preoperative pulmonary rehabilitation

BackgroundSurfactant Protein D (SP-D) as a lung-derived biomarker for inflammatory lung disease is being studied in depth. Meanwhile, the Pre-operative Rehabilitation Program (PRP) has been proposed as an effective treatment to reduce the incidence of Post-operative Pulmonary Complications (PPCs) and further improve quality of life. However, the relationship between serum SP-D levels and PRP remains unclear. This study aimed to explore the correlation between these two phenomena and validate the feasibility of using preoperative serum SP-D levels to predict or assess the effectiveness of PRP. MethodsA prospective study with a total of 80 lung cancer patients with risk factors for PPCs was conducted; subjects were randomly divided into an Intervention Group (IG, n = 36) and a Control Group (CG, n = 44). The IG was treated with one week of PRP, and the CG was treated for the same duration with routine preoperative preparation before the lobectomy. Peripheral venous blood samples were collected at five time points and serum SP-D levels were measured by enzyme-linked immunosorbent assay (ELISA). We analysed the serum level changes of SP-D as well as the PPCs occurred between the two groups. ResultsBoth groups were comparable at baseline. The average levels of SP-D in both groups showed a decline trend with time, and levels before the day of surgery revealed a significant decline range in the IG compared with the CG (6.56 ± 5.30 vs. 1.05 ± 2.79 ng/ml, P < 0.001). The incidence of PPCs in the IG was significantly lower than in the CG (2/36 vs. 10/44, p = 0.032), as were the PPC person-times occurring from postoperative days 1–4 (POD 1–4) (5/36 vs. 15/44, p = 0.038) and the total person-times (5/36 vs. 19/44, p = 0.004). The overall SP-D levels on the day before surgery in patients with PPCs were significantly higher than those without PPCs (34.07 ± 4.32 vs. 30.30 ± 6.52 ng/ml, p = 0.005); furthermore, the overall SP-D levels on admission day in CG patients with PPCs were also significantly higher than those without PPCs (34.93 ± 4.15 vs. 29.81 ± 7.47 ng/ml, p = 0.045). ConclusionsThe Preoperative Intensity Rehabilitation Program could positively decrease the serum SP-D levels in lung cancer patients with PPC risk factors, and higher preoperative serum SP-D levels may related to a higher incidence of PPCs. Serum SP-D may be a potential predictor for evaluating the efficiency of PRPs and the risk of PPC occurrence.

Comparative study on digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures

Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures. Methods A retrospectivecase-control analysis was made on 19 cases undergone percutaneous screw fixation of acetabular anterior column fractures under image-based computer navigation from January 2015 to 2016 March. There were 12 males and 7 females, aged from 21 to 66 years (mean, 39.3 years). AO fracture classification was A3 type in 17 cases and B1 type in 2. Based on the application of three-dimensional digital programming, the cases were assigned to two groups: group A (n=9), virtual three-dimensional model was reconstructed and the virtual screw were inserted to uninjured side by software Mimics and group B (n=10), patients were only prepared for routine preoperative preparation. Time of anterior column screw insertion, intraoperative bleeding, intraoperative fluoroscopy frequency, fracture reduction and Majeed score were compared between the two groups. Results All cases were followed up for mean 8.4 months (range, 3-12 months). There were no significant differences between groups A and group B in intraoperative bleeding [(14.1±3.0)ml, (15.1±2.2)ml], good to excellent rate of reduction (89%, 80%), good to excellent rate of Majeed score (89%, 80%)(P>0.05). Time of anterior column screw insertion [(22.4±3.4)min] and intraoperative fluoroscopy frequency [(24.9±3.8)times] in group A were significantly less than those[(29.4±4.5)min, (30.5±5.8)times] in group B (P<0.05). Conclusion Digital orthopedic three-dimensional visualization technology is associated with shortened time of anterior column screw insertion and reduced intraoperative fluoroscopy frequency, indicating an effective adjuvant technique for percutaneous screw fixation of acetabulum anterior column under navigation. Key words: Acetabulum; Imaging, three-dimensional; Surgery, computer-assisted

Cloudy Urine after Propofol Anesthesia; A Rare Occurrence after a Routine Anesthetic

A 27 year old man with a history of achalasia presented for an elective laparoscopic pylorotomy under general anesthesia. He was well with no significant comorbidities nor risk factors for hyperuricemia. The patient underwent routine preoperative screening and preparation. He was intubated and a urinary catheter was inserted prior to the start of surgery. A total intravenous anesthesia technique with neuromuscular blockade was used. Propofol and remifentanil were infused to maintain anesthesia. After completion of the surgical procedure, anesthesia was stopped with cessation of the respective infusions and reversal of neuromuscular blockade. It was then observed that there was cloudy urine in the urinary bag. A sample of the urine was sent for further analysis and uric acid crystals were visualized under microscopy, causing the urine to take on a cloudy white appearance. The patient continued to be monitored in the post-operative care unit where the urine returned to being clear after an hour. The patient was followed up to the point of discharge. He was able to micturate normally and produced clear urine. Subsequent postoperative urinalysis did not show the presence of uric acid crystals.

APPLICATION OF HIGH QUALITY NURSING SERVICE TO PCI PATIENTS IN CARDIOVASCULAR DIVISION

ObjectivesThe aim of this study was to evaluate the effect of high quality nursing service to PCI patients in Cardiovascular Division life satisfaction and the nursing job satisfaction.MethodsPCI patients in...

Optimizing pancreatectomy outcomes: Follow the evidence

A PubMed search of “pancreatectomy” reveals 10,376 articles, and a fraction of these represent randomized controlled trials (n = 81) [ [1] Available at: http://www.ncbi.nlm.nih.gov/pubmed. Accessed Feb 8, 2012. Google Scholar ]. The number of randomized trials performed to date by surgeons to optimize outcomes in pancreatic resection is remarkable. Some of the recent major trials are shown in Table 1. These trials form the basis for many discussions on teaching rounds and include some of the most debatable topics in surgical Morbidity and Mortality conference, such as the routine use of intraperitoneal drains and when to remove them, preoperative biliary drainage, the use of pancreatic stents, intraoperative fluid restriction, preoperative biliary stent versus no drainage, or how to close the pancreatic stump. Table 1Recent randomized controlled trials in pancreatectomy outcomes. Variable Study, year Randomization Outcome PBD van der Gaag et al., 2010 [8] van der Gaag N.A. Rauws E.A. van Eijck C.H. et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010; 362: 129 Crossref PubMed Scopus (758) Google Scholar PBD versus surgery alone 46% complication rate from PBD procedures performed preoperativelyNo difference in operative complications Anastomotic technique Berger et al., 2009 [9] Berger A.C. Howard T.J. Kennedy E.P. et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg. 2009; 208 (discussion 47): 738 Abstract Full Text Full Text PDF PubMed Scopus (277) Google Scholar Invagination versus duct to mucosa anastomosis for pancreaticojejunostomy Statistically significant decrease in fistula rate in invagination group Pancreatic stump closure Diener et al., 2011 [10] Diener M.K. Seiler C.M. Rossion I. et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): A randomised, controlled multicentre trial. Lancet. 2011; 377: 1514 Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar Hand sewn versus stapler after distal pancreatectomy No difference in pancreatic fistula or operative mortality Duration of intraperitoneal drainage Bassi et al., 2010 [11] Bassi C. Molinari E. Malleo G. et al. Early versus late drain removal after standard pancreatic resections: Results of a prospective randomized trial. Ann Surg. 2010; 252: 207 Crossref PubMed Scopus (353) Google Scholar Early drain removal (POD 3) versus late drain removal (POD ≥ 5) Significant reduction in pancreatic fistulae, overall complications, and hospital stay and associated costs in early drain removal group Pancreatic stent Pessaux et al., 2011 [12] Pessaux P. Sauvanet A. Mariette C. et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: Prospective multicenter randomized trial. Ann Surg. 2011; 253: 879 Crossref PubMed Scopus (194) Google Scholar External pancreatic stent versus no stent Significant decrease in pancreatic fistulae, wound infections, and delayed gastric emptying in stented group Intraoperative fluid management Fischer et al., 2010 [13] Fischer M. Matsuo K. Gonen M. et al. Relationship between intraoperative fluid administration and perioperative outcome after pancreaticoduodenectomy: Results of a prospective randomized trial of acute normovolemic hemodilution compared with standard intraoperative management. Ann Surg. 2010; 252: 952 Crossref PubMed Scopus (87) Google Scholar Acute normovolemic hemodilution versus standard fluid management No difference in transfusions between groupsHemodilution group had a significant increase in pancreatic anastomotic complications likely because of increased fluid administration PBD = Preoperative biliary drainage; POD = Post-operative day. Open table in a new tab PBD = Preoperative biliary drainage; POD = Post-operative day. Perioperative Surgical Care Bundle Reduces Pancreaticoduodenectomy Wound InfectionsJournal of Surgical ResearchVol. 174Issue 2PreviewPancreaticoduodenectomy (PD) is a complex surgical procedure with a historically high morbidity rate. The goal of this study was to determine if the implementation of a 12-measure perioperative surgical care bundle (SCB) was successful in reducing infectious and other complications in patients undergoing PD compared with a routine preoperative preparation group (RPP). Full-Text PDF