Significant Difference In Recovery Time Research Articles

Incisional negative pressure wound therapy (PrevenaTM) vs. conventional post-operative dressing after immediate breast reconstruction: a randomized controlled clinical trial

BackgroundSurgical complications following breast reconstruction remain a significant concern. This study aimed to investigate if incisional negative pressure wound therapy (iNPWT) using Prevena™ provides superior wound treatment for patients undergoing immediate breast reconstruction (IBR) compared to conventional postoperative dressing. Additionally, we investigated whether intraoperative indocyanine green angiography (ICG-A) could predict and prevent postoperative complications.MethodsA randomized controlled study (RCT) comprising 39 patients was conducted. The primary outcome was time until surgical drain removal. ICG-A was applied to evaluate tissue perfusion and compared to rate of postoperative complications. Patients were followed for one year, including postoperative complications, quality of life (QoL), scar evaluation, incidence of lymphedema and timely administration of adjuvant therapy.ResultsNo significant differences were observed in time to surgical drain removal, hospitalization or incidence of postoperative complications between the two groups. Analysis revealed no significant association between ICG-A results and postoperative complications. After one year, both groups exhibited similar QoL and satisfaction with scars. One patient developed lymphedema during follow-up, and adjuvant treatment was timely administered in 82%.ConclusionsThis RCT investigated iNPWT by Prevena™ compared to conventional postoperative dressing in IBR using implants or tissue expanders. ICG-A was applied to assess tissue perfusion and compared to postoperative complications. We did not find any significant differences in recovery time, hospitalization duration, postoperative complication rates, QoL, or scar satisfaction between the two groups within a one-year follow-up. Additionally, there were no significant association between ICG-A and postoperative complications. Larger randomized studies incorporating intraoperative ICG-A are needed to obtain higher quality data.Level of Evidence: Level I, Risk/Prognostic

Technical Sprinting in the Early Phase of Hamstring Injury Rehabilitation to Accelerate Return to Full Participation in Track and Field Athletes: A Comparative Study of Two Rehabilitation Strategies.

Hamstring injuries are common in track and field athletes with a higher incidence in males than females. It causes a significant loss in training time and a decline in performance. This study evaluated rehabilitation strategies to accelerate return to full participation following hamstring injury. Thirty-three athletes (22 males; 11 females) were screened from November 2021 to October 2023 until their final major competition. Out of these, 17 athletes with hamstring injuries were included in this study which were further divided into two groups, A (n=8) and B (n=9), using stratified random sampling with single blinding. Group A received technical sprints using mini hurdles as part of their training from the early stages of rehabilitation, while Group B underwent high-volume low-intensity rehabilitation before progressing to sprints. The progress of each group was monitored on a weekly basis. The average time loss was calculated using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Google Forms (Google, Inc., Mountain View, CA) with built-in validation. The two groups demonstrated a significant difference in recovery times. In group A, the length of hamstring tenderness (LHT) improved from 9 ± 2.7 (95% CI 2.27) to 0.15 ± 0.3 (95% CI 0.62), active total knee extension (ATKE) from 161.8 ± 7.1 (95% CI 5.95) to 175.4 ± 2 (95% CI 2.3), and Numeric Pain Rating Scale (NPRS) in the isometric test from 5.6 ± 1.09 (95% CI 0.88) to 0.6 ± 0.5 (95% CI 0.63) with p<0.05, and in Group B, LHT improved from 6.8 ± 2.1 (95% CI 1.62) to 0.6 ± 0.7 (95% CI 0.55), ATKE improved from 168.7 ± 8.2 (95% CI 6.3) to 178.7 ± 2.7 (95% CI 2.06) and NPRS with resisted isometric test improved from 6 ± 1.4 (95% CI 1.08) to 0.8 ± 0.7 (95% CI 0.51) with p<0.05. However, Group A took an average of 3.55 weeks (1.22 SD 95% CI 1.08) and Group B took an average of 4.53 weeks (1.98 SD, 95% CI 1.52) to resume full participation. Three athletes from Group A and six athletes from Group B experienced hamstring tightness during the competition, two athletes from Group B were forced to withdraw from the competition due to hamstring reinjury. The findings indicate that an early technical sprint program can facilitate an early return to full participation. This research can be a guide towardaccelerated and integrated hamstring injury rehabilitation among track and fieldathletes.

Postoperative Outcomes Between Positive and Negative Electrodiagnosis in Patients With Tarsal Tunnel Syndrome: A Retrospective Comparative Study.

The sensitivity of diagnosing tarsal tunnel syndrome with an electrodiagnostic study is just over 50%. Given this low reliability, many surgeons prefer to make a diagnosis solely from a physical examination, despite reported electrodiagnostic findings. Thus, to understand the clinical ramifications between these 2 methods of diagnosis, this investigation compared the postoperative outcomes following a tarsal tunnel release between patients with positive and negative preoperative electrodiagnosis (EDx). This study retrospectively reviewed 53 consecutive patients who underwent tarsal tunnel release by a single surgeon between 2015 and 2022. The primary outcome was pain level using visual analog scale (VAS) whereas the secondary outcomes were 36-Item Short Form Health Survey questionnaire, Foot and Ankle Ability Measure, recovery times (time to return to activities of daily living, work, and sports), and complications. Pre- and postoperative functional outcomes were compared within each EDx group using a paired sample t test. Postoperative outcomes between groups were compared using a generalized linear model adjusted for potential confounders. Both EDx groups (positive studies = 31 patients and negative studies = 22 patients) demonstrated significant improvement of all functional outcomes (P < .001). We found no significant difference in recovery time or postoperative outcomes between the 2 groups (P > .05). Multivariable analysis showed diabetes (risk ratio [RR] = 1.79, 95% CI 1.11-2.90) and longer duration of symptoms before surgery (RR = 1.02, 95% CI 1.00-1.04) as prognostic factors for residual pain following tarsal tunnel release. In our series, we found that preoperative electrodiagnostic results did not prognosticate postoperative functional outcomes or recovery times after tarsal tunnel release. Level III, retrospective cohort study.

Evaluation of propofol and remifentanil combination for controlled hypotension during anesthesia in pediatric nasal endoscopic surgery

Purpose: To investigate the safety and efficacy of propofol in combination with remifentanil for controlled hypotension during pediatric nasal endoscopic surgery. &#x0D; Methods: The study involved 30 patients who underwent controlled hypotension measures with remifentanil during the operation (study group), and 30 patients who did not receive controlled hypotension measures (control group). Various parameters including vital signs, operation time, intraoperative bleeding, surgical field quality, anesthesia quality, postoperative recovery time, adverse reaction rate, pain scores, and serum C-reactive protein levels were compared between the two groups. &#x0D; Results: The results revealed a significant decrease in mean arterial pressure and heart rate in the study group during the operation compared to control group. Moreover, study group exhibited improved operation time, reduced intraoperative bleeding, and better surgical field quality compared to control group. Pain scores and serum C-reactive protein levels were also lower in the study group. However, there were no significant differences in recovery time, anesthesia quality, postoperative adverse reaction rate, or cognitive function between the two groups. &#x0D; Conclusion: Propofol in combination with remifentanil for controlled hypotension is a safe and effective anesthesia approach for pediatric nasal endoscopic surgery. Future studies will require larger sample size from different study centers to improve the robustness of the findings of this study.

TIME TO RECOVERY FROM COVID-19 AMONG PATIENTS IN SIDOARJO REGENCY, EAST JAVA PROVINCE, INDONESIA IN 2022

Background: The SARS-CoV-2 mutation in the bodies of COVID-19 patients is a critical factor for health. Notably, in October 2022, the disease recovery rate in Sidoarjo (96.05%) was lower than the national rate (97.30%). Purpose: This study aims to identify the recovery time and its influencing factors in COVID-19 patients in Sidoarjo. Methods: The life-table method was used to conduct a survival analysis on data from the NAR COVID-19 dashboard in Sidoarjo from January 3 to August 4, 2022, which involved 20,662 respondents. Age group, sex, treatment status, and testing purpose were analyzed. Results: The majority of COVID-19 patients were females (50.30%) aged 26-&lt;46 years (46.24%). Most patients (64.74%) chose to self-isolate, and 63.34% were screened as COVID-19 positive. On average, patients recovered within seven days of diagnosis. The Wilcoxon (Gehan) statistical test yielded a p-value of less than 0.001 for all factors at a significance level of 0.05, indicating a significant difference in the survival time distribution. The age group with the shortest median recovery time was 6-&lt;12 years at 7.03 days, while males had a median recovery time of at 7.66 days. Patients who self-isolated had a median recovery time of 7.16 days, and those who were tested for close contact purposes had a median recovery time of 7.65 days. Conclusion: The median recovery time for COVID-19 patients post-diagnosis was seven days. There was a significant difference in recovery time among the COVID-19 patients based on age group, sex, treatment status, and testing purpose.

Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP: a randomized controlled trial

Background and objectsPatients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the anesthetic effect of different doses of alfentanil combined with ciprofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).MethodsIn this clinical trial, 137 patients, who were candidates for ERCP were randomly divided into three groups. Group A were given 0.15 μg/kg/min of alfentanil in maintenance stage, Group B were given 0.25 μg/kg/min and Group C were given 0.35 μg/kg/min. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) of the patients at each time point including the entry into the operation room (T0), at the beginning of surgery(T1), 10 min after surgery(T2), 20 min after surgery(T3), 30 min after surgery(T4),endoscopy withdrawal (T5) were recorded. Adverse events(including respiratory depression, body movement and hypoxemia),the dosage of ciprofol, the time of operation time and awakening were recorded.ResultsCompared with Group A, MAP and HR in Group B and Group C was decreased during T1-T5 (P < 0.05). Compared with group B, MAP and HR in group C was decreased during T1-T5 (P < 0.05). Compared with Group A and Group C,the number of adverse reactions of Group B was decreased(P < 0.05). There was no statistical difference in surgical time among the three groups(P > 0.05),but a statistically significant difference in recovery time (P < 0.05).ConclusionThe adverse events of alfentanil 0.25μg/kg/min combined with ciprofol were low, and the anesthetic effect was the best.

Conventional reversal of rocuronium-induced neuromuscular blockade by sugammadex in Korean children: pharmacokinetics, efficacy, and safety analyses.

Background: Sugammadex is known to reverse neuromuscular blockade induced by non-depolarizing agents. In children, the recommended dose for reversal of moderate neuromuscular blockade is 2mg/kg. We investigated the pharmacokinetics and pharmacodynamics of sugammadex in Korean children. Methods: Children (2-17years of age) undergoing brain or spine surgery were enrolled and randomly assigned to control (neostigmine) and 2, 4, or 8mg/kg sugammadex groups. Following induction of anesthesia and monitoring of the response to train-of-four stimulation, 1mg/kg rocuronium was intravenously administered. Upon reappearance of the second twitch to train-of-four stimulation, the study drug was administered according to group allocation. The plasma concentrations of rocuronium and sugammadex were serially measured at nine predefined time points following study drug administration. To determine efficacy, we measured the time elapsed from drug administration to recovery of T4/T1 ≥ 0.9. For pharmacokinetics, non-compartmental analysis was performed and we monitored adverse event occurrence from the time of study drug administration until 24h post-surgery. Results: Among the 29 enrolled participants, the sugammadex (2mg/kg) and control groups showed recovery times [median (interquartile range)] of 1.3 (1.0-1.9) and 7.7 (5.3-21.0) min, respectively (p = 0.002). There were no significant differences in recovery time among the participants in sugammadex groups. The pharmacokinetics of sugammadex were comparable to those of literature findings. Although two hypotensive events related to sugammadex were observed, no intervention was necessary. Conclusion: The findings of this pharmacokinetic analysis and efficacy study of sugammadex in Korean children indicated that sugammadex (2mg/kg) may be safely administered for reversing moderate neuromuscular blockade. Some differences in pharmacokinetics of sugammadex were observed according to age. Clinical Trial Registration: http://clinicaltrials.gov (NCT04347486).

‘If in Doubt, Sit Them Out’: How Long to Return to Elite Cycling Competition following a Sports-Related Concussion (SRC)?

A concussion or sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. After a SRC diagnosis is made, a concussed individual must undergo a period away from competition while they return to their baseline level of functioning. The Union Cycliste Internationale (UCI) currently recommend a minimum of 6 days restriction from competitive cycling following a SRC but there is a growing feeling amongst those involved in brain injury research that this period is too short. Therefore, how much time should cyclists be removed from competitive sporting action following a SRC? To review the time out of competition following the diagnosis of a SRC for elite cyclists within British Cycling (BC). All medical records for elite cyclists within BC were audited for diagnoses of "concussion" or "sports-related concussions" from January 2017 until September 2022. The days out of competition following the concussion until ready to compete again (that is, returned to full training) was then calculated. All diagnoses and management of SRC were undertaken by the medical team at BC and in-keeping with current international guidelines. Between January 2017 and September 2022, there were 88 concussions diagnosed, 54 being males and 8 in para-athletes. The median duration for time out of competition for all concussions was 16 days. There was no statistical difference between males (median 15.5 days) and females (median 17.5 days) for time out of competition (p-value 0.25). The median duration out of competition following a concussion for able-bodied athletes was 16 (80 athletes) compared to 51 days (8 athletes) in para-cyclists, which was not statistically different (p-value 0.39). This is the first study to report SRC concussion recovery times in elite cycling, including para-athletes. Between January 2017 and September 2022, there were 88 concussions diagnosed at BC and the median duration for time out of competition for all concussions was 16 days. There was no statistically significant difference in recovery times between male and females and para- and able-bodied athletes. This data should be used to help establish minimum withdrawal times post-SRC for elite cycling participation and we call on the UCI to review this data when establishing SRC protocols for cycling, with further research required in para-cyclists.

An exploratory study into the relationship between playing at home or away and concussion

ABSTRACT Primary Objective To investigate the effect of home and away game travel on risk of concussion across different levels of rugby union. Research Design Exploration study across school, university, and professional rugby teams. Methods and Procedures Retrospective analysis of concussion incidence and symptomology of surveillance data and prospective data collection for potential concussions via surveys. Data was collected from school rugby teams (n = 344 matches, over 2 years), a university rugby (n = 6 matches), and a professional rugby team (n = 64 matches, over two seasons). Main Outcomes and Results School level rugby had an increased prevalence of concussions in away matches (p = 0.02). Likewise, there was a significant increase (p < 0.05) in concussions at away matches in university rugby. In addition, the professional rug by team had significant differences in recovery times and symptoms with away fixtures, including longer recovery times (p < 0.01), more initial symptoms (p < 0.01), as well as greater and more severe symptoms at 48 hours (p < 0.05). Conclusions This research highlights an increased prevalence of concussion in school and university-aged rugby players away from home, as well as increased symptoms, symptom severity, and recovery times in professional rugby players.

The effectiveness of esketamine and propofol versus dezocine and propofol sedation during gastroscopy: A randomized controlled study.

Propofol is widely used in painless gastroscopy. However, sedation with propofol alone might increase the risk of respiratory and circulatory complications. This randomized clinical study compares the efficacy and safety of esketamine or dezocine combined with intravenous (IV) propofol in patients undergoing gastroscopy. A total of 102 patients were enrolled in this study and randomized into two groups. All patients were adults aged 18-64 years who underwent upper gastrointestinal gastroscopy. Patients were randomly assigned to two groups to receive esketamine (0.3mg/kg) combined with propofol (group E) or dezocine (0.05 mg/kg) combined with propofol (group D). In both groups, the drugs were administered intravenously. The primary outcome was the dose of propofol which provided a satisfactory sedative effect, both to the endoscopist and the patients. Secondary outcomes included recovery time, side effects (such as hypotension, nausea and vomiting and agitation), and the number of adverse circulatory and respiratory events. Data of 83 patients were analysed in the present study. Dosage of propofol required in group E (1.44 mg/kg ± 0.67 mg/kg) was significantly lower compared with that in group D (2.12 mg/kg ± 0.37 mg/kg) (p < 0.0001). There was no statistically significant difference in recovery time, side effects, and the frequency of sedation-related adverse events between the two groups. The study indicates that intravenous injection of propofol and esmketamine is more effective for gastroscopy. Use of esketamine reduces the total amount of propofol required in ASA I-II patients undergoing gastroscopy compared with single use of dezocine. It also provides more stable hemodynamics, without affecting the recovery time and side effects such as respiratory and circulatory adverse events. The study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn; registration number: ChiCTR2100051814) on 05/10/2021.

Single bolus dexmedetomidine versus propofol for treatment of pediatric emergence delirium following general anesthesia.

Pediatric emergence delirium is a psychomotor disorder occurring in the early postanesthetic stage. There is no clear consensus regarding its treatment; however, dexmedetomidine and propofol have both been shown to be effective. In this single-center, randomized, double-blind prospective study, we compared the efficacy of dexmedetomidine against that of propofol in the treatment of established emergence delirium in pediatric patients undergoing general anesthesia. Patients aged 1-14years, with ASA I or II and severe emergence delirium (Pediatric Anesthesia Emergence Delirium score of ≥15) during the postoperative period following general anesthesia, were randomized to receive intravenous bolus injection of 0.5μg.kg-1 dexmedetomidine or 1mg.kg-1 propofol. The primary outcome was the pediatric anesthesia emergence delirium (PAED) score after treatment, and the secondary outcome was the recovery time in the postanesthetic care unit. Of the 53 patients who participated in the study, 26 (49%) were treated with dexmedetomidine and 27 (51%) with propofol. In the dexmedetomidine group, a single-dose intervention was effective for all patients (100%); whereas in the propofol group, 19 patients (70.4%) had PAED score of <12 after the first dose (p=.004; relative risk [95% confidence interval]=0.1422 [0.113-1.815]). No significant difference in recovery time (median [IQR (range)]) was observed between the dexmedetomidine (20[14-30(10-45)]) and propofol groups (25 [20-40 (10-50)]; p=.056; 95% confidence interval=0.113-1.815). A single bolus of 0.5μg.kg-1 of dexmedetomidine was more effective than a single bolus of 1mg.kg-1 of propofol in treating emergence delirium during the early postanesthetic stage.

Comparison of The Effectiveness of Remifentanyl versus Fentanyl in Pediatric Undergoing Methotrexate Therapy

Background: Anesthesia procedure is routinely performed for some painful pediatric oncologic procedures such as lumbar puncture (LP) and bone marrow examination (BME). Several studies mentioned that fentanyl and remifentanyl are often used as anesthetic agent of this procedure, but none of them compare the recovery time of both agent. This study aims to compare the recovery time of fentanyl and remifentanyl in pediatric patients undergoing methoterexate therapy. Subjects and Method : This was a double-blind randomized controlled trial on 36 patients who underwent intratechal methotrexate chemoterapy under general anesthesia anesthesia in pediatric intervention room of Moewardi General Hospital Surakarta that met inclusion criteria. The dependent variable was recovery time and the independent variable were fentanyl and remifentanyl. The samples were divided into 2, Fentanyl (F) and Remifentanyl (R) group. Recovery time was recorded after the procedure until the subject reached Pediatric Glasgow Comma Scale (PGCS) of 15. Statistical analysis was Mann Whitney U Test using SPSS 25 for Windows. Results : The mean recovery time of F group was 373.39 ± 29.48 seconds, while R group was 124.67±11.55 seconds. There was a significant difference in recovery time between patients in the Fentanyl group and the Remifentanyl group (p= 0.000). Conclusion: Remifentanyl recovery time was significantly faster than with fentanyl in pediatric patients undergoing intrathecal methotrexate chemotherapy. Keywords: Fentanyl, Methotrexate, Outpatient anesthesia, Recovery time, Remifentanyl Correspondence: Ferdy Pamungkas. Anesthesiology Department, Moewardi General Hospital, Surakarta. Jalan Kolonel Sutarto 132 Jebres, Kecamatan Jebres, Surakarta City 57126. Central Java, Indonesia. dr.ferdypamungkas@gmail.com. +6281230269501. Indonesian Journal of Medicine (2022), 07(01): 115-121 https://doi.org/10.26911/theijmed.2022.07.01.12

Effects of remifentanil on the recovery quality among pediatric candidates for dental procedures under general anesthesia.

Background:Remifentanil is a short-acting synthetic opioid, seems to facilitate hospital discharge, induce less agitation and better recovery quality. The aim of this study was to investigate the effects of remifentanil on the quality of recovery among healthy children who were candidate for dental procedures under general anesthesia.Materials and Methods:This study was a double blind randomized controlled clinical trial on healthy children who referred to the Department of Pediatric dentistry, School of Dentistry, Isfahan University of Medical Sciences. Both groups were anaesthetized using 5 mg/kg thiopental sodium, 1 μg/kg fentanyl and 0.6 μg/kg atracurium. The first group received propofol to maintain anesthesia and the second group was given remifentanil along with propofol. Then, the time span to regain consciousness, level of agitation during recovery and time of discharge were monitored and compared between the two groups. Data were analyzed using the Mann-Whitney U-test, and the Kruskal–Wallis test at P < 0.05 level of significance.Results:Findings showed that the propofol + remifentanil group recovered faster than the propofol group. Chi-square test showed a significant difference in recovery time between the two groups (P < 0.05). About 45 min after regaining consciousness, the mean pediatric anesthesia emergence delirium score in the propofol group was 4.02 ± 2.19 and was significantly higher than the propofol + remifentanil group (3.02 ± 2.83) (P < 0.05). In addition, the mean Postanesthetic Discharge Scoring System score in the propofol group was 6.04 ± 1.74 and was significantly higher than the propofol + remifentanil group (7.58 ± 2.14) (P < 0.05).Conclusion:Combination of propofol and remifentanil significantly reduced the time taken for recovery, discharge and agitation level compared to propofol.

Comparison of Motor Seizure Duration of Ketofol and Propofol for Electroconvulsive Therapy

Objectives: Propofol and ketamine have become progressively popular in electroconvulsive therapy (ECT) anesthesia. Ketofol is a combination of ketamine and Propofol, and the current study was designed to evaluate the effect of Ketofol and Propofol on motor seizure duration, hemodynamic profile and recovery times in patients undergoing ECT. Methods: Fifty-four ECT sessions were randomized into Ketofol and Propofol group. Motor seizure duration, hemodynamic profile and recovery times were recorded. Results: Motor seizure duration in Ketofol group (28.55 + 6.54 seconds) was longer than Propofol group (22.22 + 7.94 seconds) which was statistically significant (p =0.002). Both drugs had motor seizure duration within the therapeutic range. At 1 min after the end of seizure heart rate in Propofol group (97.40 + 18.18 bpm) was lower compared to Ketofol group (109.37 + 17.69 bpm) which was statistically significant (p= 0.017). Similarly at 5 min after the end of seizure the heart rate in Propofol group (95.25 + 10.38 bpm) was lower compared to Ketofol group (102.51 ± 13.65) which was statistically significant (p= 0.032). There was no statistically significant difference in recovery times between Ketofol and Propofol group. Conclusion: Although Ketofol 1:1 mixture is associated with a longer motor seizure duration than Propofol in ECT anesthesia, both drugs are equally effective in producing motor seizure duration within the therapeutic range.

Early Management of Cervical Impairments and the Incidence of Delayed Recovery in Adolescents With Acute Concussion

To determine if concussed adolescents with positive cervical findings on examination provided with early cervical treatment demonstrate recovery time and incidence of persistent post-concussive symptoms (PPCS, recovery = 30 days) comparable to those without cervical findings. Cervical impairments resulting from concussive injury are historically associated with longer recovery times. Concomitant cervical injuries may result in symptoms that overlap with concussion, including headache, dizziness, tinnitus, sleep disturbances, and blurred vision. Current recommendations include assessment of the cervical spine; however, there is limited evidence for the effect of immediate cervical intervention on recovery. Retrospective case-controlled study. Patients included adolescents with acute concussion presenting with (n = 132, 14.99 ± 1.9 years, 58% male, 5.70 ± 3.3 days since injury) and without (n = 138, 14.85 ± 1.8 years, 65% male, 6.13 ± 3.4 days since injury) cervical findings on physical exam. Patients were assessed with the Buffalo Concussion Physical Examination (BCPE), Neck Disability Index (NDI) and Post-Concussion Symptom Scale (PCSS) instruments. Groups were separated based on positive or negative cervical findings on the BCPE. Cervical impairments were addressed by physicians specializing in concussion management using a clinical algorithm. Mild impairments were managed conservatively (over-the-counter analgesics, warm/cold compresses, and/or neck stretching exercises). Patients with moderate or greater impairments were assessed by a physical therapist at the initial clinic encounter and given specific cervical interventions. Physician-observed cervical findings had moderate agreement with self-reported function on the NDI (? = 0.414, p < 0.001). Patients with cervical findings reported greater symptom severity on the PCSS (37.9 ± 22.1 vs 30.8 ± 20.2, p = 0.011); however, there was no significant difference in recovery time (34.44 ± 33.2 vs 34.81 ± 39.0 days, p = 0.933) or incidence of persistent symptoms (39% vs 35%, p = 0.511). In this group of adolescents, cervical impairment managed early after concussion was not associated with prolonged recovery. Early management of cervical impairments may reduce the development of PPCS. Prospective evaluation is warranted.

Comparison of recovery time with target controlled infusion of propofol with sevoflurane anesthesia using bispectral index monitoring in vitrectomy surgery

Background: Rapid recovery after anesthesia is critical and is associated with the anesthetic agents used. The bispectral index (BIS) monitoring to guide anesthetic agents' doses may play a significant role in the recovery time. This study compared recovery time after Target Controlled Infusion (TCI) of propofol with sevoflurane anesthesia by using BIS monitoring during vitrectomy surgery. &#x0D; Methodology: This was a prospective observational, randomized study on 40 patients aged 18–65 y, physical status ASA I–II, body mass index (BMI) 18–30 kg/m2, who underwent vitrectomy surgery. Subjects were randomly assigned into two groups, Group P – the TCI propofol group, and Group S – the sevoflurane group. Subjects in the Group P received TCI propofol (Schnider), and subjects in the Group S received sevoflurane for anesthesia maintenance, with a targeted BIS score of 40–60. Inj. fentanyl 1 µg/kg was administered if there was an increase in blood pressure, heart rate and/or BIS that could not be overcome by increasing the dose of TCI propofol or sevoflurane. Recovery time was calculated from when the maintenance regimen was stopped until the patient was able to obey simple commands. Recovery time, fentanyl consumption, postoperative agitation, nausea and vomiting incidence were noted and analyzed with SPSS v21.0 for Windows. T–Test or Mann–Whitney U test was performed to analyze the data. &#x0D; Result: Recovery time in the Group P [11.5 (5–25) min)] was not significantly different from the Group S [9 (4–18) min, p = 0.139]. Total fentanyl consumption was higher in the Group P than in the Group S (1.765 vs. 1.428 µg/kg). The frequency of agitation during recovery was higher in the Group S than in the Group P (30% vs. 20%)&#x0D; Conclusion: There was no significant difference in recovery time between target controlled infusion of propofol and BIS controlled sevoflurane anesthesia in vitrectomy. Total fentanyl consumption was higher in the Group P than in the sevoflurane group. The impact of these anesthetic regimens on postoperative agitation needs further investigation.&#x0D; Key words: Intravenous anesthesia; Bispectral index monitoring; BIS; Propofol; Sevoflurane; Target Controlled Infusion; TCI; Vitrectomy&#x0D; Citation: Tantri AR, Sukmono RB, Atmadja LS. Comparison of recovery time with target controlled infusion of propofol with sevoflurane anesthesia using bispectral index monitoring in vitrectomy surgery. Anaesth. pain intensive care 2021;25(6):707–712:&#x0D; DOI: 10.35975/apic.v25i6.1689

Heparin-Induced Thrombocytopenia with Very High Antibody Titer Is Associated with Slower Platelet Recovery

Introduction: HIT is a relatively common and potentially catastrophic prothrombotic disorder caused by platelet activating antibodies targeting complexes of platelet factor 4 (PF4) and heparin. Diagnosis rests on clinical features coupled with serologic assays, most commonly an ELISA for heparin-PF4 antibodies. The ELISA optical density (OD) is a surrogate for antibody titer, an OD < 1 conveying a likelihood for pathogenic platelet-activating antibodies of < 1%, while OD > 2.0 confirms clinically suspected platelet activating antibodies in about 90%. The treatment for HIT is alternative anticoagulation, effecting platelet recovery >100,000 usually within 3 days and in the great majority within 7 days. We and others have observed very delayed platelet recovery (sometimes for weeks; “persisting HIT”) and this appeared more common with high titer antibodies. We did a retrospective analysis of 116 patients with HIT from single institution to investigate whether high titres of antibodies in HIT is associated with prolong time to platelet recovery and its potential impact on overall survival.Method: We retrospectively reviewed 116 patients diagnosed with HIT in our institution from 2009 to 2017 using our hospital database. Charts were reviewed for clinical comorbidities, association of surgery, thromboembolic events, type of alternative anticoagulation used on HIT diagnosis, platelet nadir count and time to recovery, and the relationship to ELISA OD. For statistical analysis, patients with HIT were categorized into 3 cohorts based on OD 1 to OD equal or less than 2.5, OD 2.5 to OD equal or less than 3 and OD more than 3 (Table 1). Patients with OD less than or equal to 2.5 was chosen as the reference group. A competing risk analysis based on the Fine & Gray method investigated differences in cumulative incidence of platelet recovery among the cohorts. Death before recovery was treated as a competing risk. Pooled t- test analysis was used to study correlation between OD and survival.Results: Median age of 116 patients was 65 years (63-68 ; 95% CI). 60.3% of the patients were male. Median value of initial platelet count during admission was 212k. Median value of nadir platelet count after diagnosis of HIT was 47k. 90% had surgery prior to diagnosis of HITT. 57% of patients with HIT had thromboembolic disease. 53%; 15% and 9% of patients were transitioned to Coumadin, NOACs and Arixtra respectively after initially getting treated with alternative anticoagulation Bivalirudin for HIT. Out of 116 patients, 101 patients (87%) of patients had platelet recovery in median of 6 days. The heparin OD value is significantly different between the two cohorts (p=0.0485) based on a pooled t-test. We further categorized all the patients into 3 cohorts based on their PF4 OD to study its impact on time to platelet recovery as shown in Table 1.There was no significant difference in recovery time between patients with OD between 2.5 and 3.0 and those less than 2.5 (p = 0.7207). The estimated hazard ratio of 0.921 [95% CI: (0.588, 1.444)], implying that patients with a higher OD value were likely to take slightly longer to recover their platelet count. However there was a statistically significant difference in platelet recovery time for patients OD greater than 3.0 (p = 0.0260) with hazard ratio 0.598 [95% CI: (0.380, 0.940)] compared to the reference group (see Figure 1). In-hospital mortality was 24.14% (28 patients) but was not significantly different by ELISA OD (p=0.7432). There is ongoing analysis of relationship of ELISA OD to thrombotic complications.Conclusion: Time to platelet recovery was significantly increased in HIT patients with heparin-PF4 OD value > 3. The lack of impact on overall survival probably relates to the fact that most deaths with HIT are related to underlying disorders (multiorgan failure, severe cardiac disease, cancer) rather than complications of HIT per se. A larger prospective study might further clarify the impact of PF4 OD on HIT treatment and outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A meta-analysis of functional outcomes in rat sciatic nerve injury models.

Rat sciatic nerve injury (PNR) is the most utilized model in studies on peripheral nerve regeneration. However, large animal models are increasingly favored based on the assumption that nerve regeneration in rodents achieves more favorable outcomes than in humans. The purpose of this meta-analysis was to investigate which rat PNR models are more stringent and should be used before utilizing large animal experimentation. A PRISMA-guided meta-analysis of the English literature regarding functional outcomes in rat peripheral nerve injury models was conducted. Outcomes of five basic scenarios: (1) transected nerve/negative control, (2) transection with primary microsurgical repair, (3) isogenic/autologous grafts, (4) acellular-allogenic grafts, and (5) limb transplantation were compared to sciatic nerves without any intervention/positive control. Outcomes were compared using Sciatic Functional Index (SFI). Log-based projections were generated and evaluated using mean squared error (MSE), one-way-ANOVA, and Tukey-HSD post-hoc analysis. In total, 167 articles met the inclusion criteria. The earliest manifestations of motor recovery were encountered in the transection and primary repair group (p <.0005). There was a significant difference in recovery time and degree of recovery between all surgical models (p <.0005). At 24 weeks, the SFI in hindlimb transplantation group was significantly worse than all other groups (-74.07 ± 2.74, p <.0005). Autografts smaller than 10 mm recovered sooner than autografts longer than 10 mm (p = .021) and autografts recovered faster than allografts. This meta-analysis does not support the belief that neuro-regeneration is exceptional in transection models. These models remain adequate to provide translatable information and should initially be used in investigational studies.

Feasibility of Day Surgery for Cochlear Implantation under Conscious Sedation with Same-Day Fitting.

To evaluate the feasibility of performing cochlear implantation under conscious sedation (CS) as day surgery with same-day fitting. All patients underwent cochlear implantation under CS between November 2017 and April 2018. The data collected included demographic information, preoperative clinical characteristics, surgical details, postoperative fitting information, and side effects, if any. Nine patients had 11 cochlear implants (CIs) placed under CS (2 patients received bilateral CIs). One patient's data were excluded from the audiological results because conversion to general anesthesia (GA) was necessary. One patient (11%) vomited just before the end of the procedure. Seven patients had uneventful procedures. Eight (88%) patients were discharged home the same day. There was a statistically significant difference in recovery time between the CS group and the GA group (t=-2.26, df=12, p<0.05). In the CS group, there was no statistically significant change in the maximum comfortable loudness level for all electrodes from the day of the surgery to the following day. However, there was a statistically significant difference in the threshold levels of all electrodes from the day of the surgery to the following day (Z=-2.04, N=120, p<0.05). Further analysis revealed a statistically significant difference in the four most apical electrodes (Z=-3.496, N=40, p<0.0001), but not in the middle or basal electrodes. Cochlear implantation can be performed under CS with careful patient selection. This approach facilitates same-day fitting and day surgery by minimizing comorbidity.

The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most complex gastrointestinal endoscopic procedures. Currently, it is still unclear which sedation regimen best facilitates an ERCP. The N-methyl-D-aspartate receptor antagonist esketamine has anaesthetic, analgesic and sympathomimetic properties and is known to cause less cardiorespiratory depression than other sedatives. It could therefore be an ideal adjunct to propofol for deep sedation. To assess the effectiveness of esketamine versus alfentanil as an adjunct to propofol target-controlled infusion (TCI) for deep sedation during ambulant ERCP. A randomised controlled multicentre study. Endoscopic intervention suite at an academic and general hospital in the Netherlands. Adult, American Society of Anesthesiologists Physical Status I to III patients scheduled to undergo ERCP. Consecutive patients were randomly assigned to receive sedation for an ERCP with propofol TCI and alfentanil (group A) or with propofol TCI and esketamine (group E). The primary outcome was effectiveness of the sedation regimen expressed as the total dose of propofol - as a surrogate parameter - necessary to perform ERCP in a satisfactory manner for endoscopist and patients. Secondary outcomes were recovery time, patients' and endoscopists' satisfaction with sedation, side effects (e.g. psychotomimetic effects, nausea and vomiting) and the number of respiratory and cardiovascular adverse events. Data from 162 patients were analysed. The total dose of propofol required was significantly lower in group E (n=83) (8.3 mg kg h) than in group A (n=79) (10.5 mg kg h) (P < 0.001). There were no significant differences in recovery time, patients' and endoscopists' satisfaction, side effects, psychotomimetic effects and the number of sedation-related adverse events. Low-dose esketamine reduces the total amount of propofol necessary for sedation during ERCP in American Society of Anesthesiologists I and II patients without affecting recovery time, satisfaction of patients and endoscopists, side effects and respiratory or cardiovascular adverse events, when compared with alfentanil. The Netherlands Trial Register (NTR5486).