Suction Catheter Research Articles

Development and Safety Trial of the OstreaVent2™ Prototype for Mechanically Ventilated Adult Patients.

With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines. To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital. The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient's vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A post-study chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its third-party certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause. The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator's performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.

Suctioning in intubated and tracheotomized patients : Anarrative review

Endotracheal suctioning in intubated or tracheotomized critically ill patients is adaily task of various professional groups in intensive and emergency medicine; however, aGerman language summary of current evidence is lacking. The aim is to develop anarrative overview of current evidence on endotracheal suctioning of intubated or tracheotomized patients in the clinical setting. Aliterature search was conducted in the databases Cinahl, Cochrane Library, Livivo, and Medline via PubMed by nurses with an academic degree. In addition, ahand search and applying the snowball principle were performed. Following asuccessful critical appraisal, all English and German language publications addressing endotracheal suctioning in the context of hospital care were included. Atotal of 23 full texts were included. After developing 6 main topics on endotracheal suction 19articles were considered in the reporting. The results showed, among others, that routine deep suctioning once per shift is contraindicated and that the catheter should be advanced no more than 0.5-1 cm beyond the distal end of the tube or tracheal cannula. Closed suction catheters offer advantages, especially for staff protection, although studies are heterogeneous. Further training of staff is obligatory. Few conclusive studies on endotracheal suction could be found; however, with the available evidence initial conclusions can be drawn which should be considered in, for example, internal standard operating procedures. Further research is needed.

The Effects of Inspiratory Flows, Inspiratory Pause, and Suction Catheter on Aerosol Drug Delivery with Vibrating Mesh Nebulizers During Mechanical Ventilation.

Background: Some experts recommend specific ventilator settings during nebulization for mechanically ventilated patients, such as inspiratory pause, high inspiratory to expiratory ratio, and so on. However, it is unclear whether those settings improve aerosol delivery. Thus, we aimed to evaluate the impact of ventilator settings on aerosol delivery during mechanical ventilation (MV). Methods: Salbutamol (5.0 mg/2.5 mL) was nebulized by a vibrating mesh nebulizer (VMN) in an adult MV model. VMN was placed at the inlet of humidifier and 15 cm away from the Y-piece of the inspiratory limb. Eight scenarios with different ventilator settings were compared with endotracheal tube (ETT) connecting 15 cm from the Y-piece, including tidal volumes of 6-8 mL/kg, respiratory rates of 12-20 breaths/min, inspiratory time of 1.0-2.5 seconds, inspiratory pause of 0-0.3 seconds, and bias flow of 3.5 L/min. In-line suction catheter was utilized in two scenarios. Delivered drug distal to the ETT was collected by a filter, and drug was assayed by an ultraviolet spectrophotometry (276 nm). Results: Compared to the use of inspiratory pause, the inhaled dose without inspiratory pause was either higher or similar across all ventilation settings. Inhaled dose was negatively correlated with inspiratory flow with VMN placed at 15 cm away from the Y-piece (rs = -0.68, p < 0.001) and at the inlet of humidifier (rs = -0.83, p < 0.001). The utilization of in-line suction catheter reduced inhaled dose, regardless of the ventilator settings and nebulizer placements. Conclusions: When VMN was placed at the inlet of humidifier, directly connecting the Y-piece to ETT without a suction catheter improved aerosol delivery. In this configuration, the inhaled dose increased as the inspiratory flow decreased, inspiratory pause had either no or a negative impact on aerosol delivery. The inhaled dose was greater with VMN placed at the inlet of humidifier than 15 cm away the Y-piece.

Detecting contamination events during robotic total joint arthroplasty

Robot-assisted total joint arthroplasty (robotic-TJA) has become more widespread over the last 20 years due to higher patient satisfaction and reduced complications. However, robotic TJA may have longer operative times and increased operating room traffic, which are known risk factors for contamination events. Contamination of surgical instruments may be contact- or airborne-related with documented scalpel blade contamination rates up to 9%. The robot arm is a novel instrument that comes in and out of the surgical field, so our objective was to assess whether the robot arm is a source of contamination when used in robotic TJA compared to other surgical instruments. This was a prospective, single-institution, single-surgeon pilot study involving 103 robotic TJAs. The robot arm was swabbed prior to incision and after closure. Pre- and postoperative control swabs were also collected from the suction tip and scalpel blade. Swabs were incubated for 24hours on tryptic soy agar followed by inspection for growth of any contaminating bacteria. A contamination event was detected in 10 cases (10%). The scalpel blade was the most common site of contamination (8%) followed by the robot arm (2%) and suction tip (0%). Robotic TJA is contaminated with bacteria at a rate around 10%. Although the robot arm is an additional source of potential contamination, the robot arm accrues bacterial contamination infrequently compared to the scalpel blade. Contamination of the robot arm during robotic TJA is minimal when compared to contamination of the scalpel blade.

Design and application of a new type of switchable semi-closed sputum suction device for transfer

Sputum suction is a necessary measure to remove respiratory secretions and collect sputum specimens, and the traditional sputum suction device includes open and closed methods. However, the open sputum suction device can easily cause sputum splashing during operation, polluting the operator and the surrounding environment. The closed sputum suction device is more expensive than the open sputum suction device. Although it can be used repeatedly, the friction between the protective sleeve and the wall of the suction tube increases after repeated uses, which in turn affects the operation. In addition, the two sputum suction methods need to be connected to a sputum collector when the sputum specimen is collected. This process can easily lead to leakage and contamination of specimens, and at the same time increase the infection risk for patients. In order to overcome the above problems, the medical staff from the department of critical care medicine of the First Affiliated Hospital of Dalian Medical University invented a new type of switchable semi-closed sputum suction device, and obtained the National Utility Model Patent of China (ZL 2020 2 1564712.3). The device is composed of a suction device connection port, a sliding negative pressure switch, an adapter interface, a pipe body, a transparent film protective sleeve, a clip-on connection joint, and a sputum collector. The sliding negative pressure switch at the connection port of the suction device can realize one-person one-handed operation. The sputum collector is connected with the sputum suction device to ensure that the specimen is not exposed. The transparent film protective sleeve covers the sputum suction tube body to ensure that the whole process of sputum suction operation is pollution-free. The clip-on connection joint is connected with the artificial airway interface to avoid sputum splashing during sputum suction, and it is clamped immediately after operation to reduce environmental pollution. Compared with the existing sputum suction device, the new switchable semi-closed sputum suction device has a more reasonable design and lower cost, which is worthy of clinical promotion.

In-line Mechanical Insufflation-Exsufflation as an Alternative to Invasive Suction for Secretion Management in Ventilated Patients, A Randomized Controlled Trial

Background Catheter suction (CS), the standard method for airway secretion management in tracheostomized or intubated patients, is invasive and has significant hemodynamic and traumatic side effects. In-line mechanical insufflation-exsufflation (IL-MIE) is a new, non-invasive technology that clears secretions by simulating coughs without interrupting ongoing mechanical ventilation. It is not known whether IL-MIE can be safely and effectively used as an alternative to CS in these ventilated patients. Methods A randomized controlled study was conducted comparing a standard protocol of CS with automatic IL-MIE (CoughSync, Ruxin Medical Systems, Beijing) performed every 30 minutes, with CS added only if needed, in post-operative mechanically ventilated patients. Results Over 8 hours, the IL-MIE cohort required significantly fewer CS treatments per patient than the control cohort (mean 0.4 vs. 2.6, p &lt; 0.001, n = 60 for both cohorts). Seventy-three percent of the IL-MIE subjects required no CS at all, compared to 2% in the control group (p &lt; 0.001). At 8 hours, IL-MIE subjects had a significantly lower heart rate than control subjects (mean 90 vs. 96, p = 0.047), implying a hemodynamic advantage to IL-MIE. No significant adverse events were associated with IL-MIE. Conclusions IL-MIE minimizes the need for invasive CS without detriment to ventilatory management in mechanically ventilated patients.

Suctioning with a bulb syringe or suction catheter after delivery?

Suctioning with a bulb syringe or suction catheter after delivery?

Differences in time-intensity sensory profiles of sweet taste intensity of glucose between older and young adults.

To understand age-related changes in sweet taste perception in daily life, it is important to understand taste intensity at the suprathreshold level. Previous studies have attempted to characterize the temporal aspects of human taste perception in terms of time-intensity evaluations. The perception of dynamic taste intensity in older adults increases slowly for salty taste; however, there have been no previous studies on time-intensity sensory evaluation of sweet taste in older adults. We hypothesized that older adults perceive sweet taste intensity more slowly than young adults. Fifty young and 40 older adults participated in the study and glucose solutions of 0.6 M and 1.5 M were used as stimuli. The study comprised two experiments: (1) a cup tasting test (static taste perception in the mouth), and (2) a time-intensity sensory evaluation, in which the solutions were presented using a custom-made delivery system. The intra-oral device was made to fit each participant's dentition. Further, the level of gag reflex was taken into consideration for each participant in the design of the intra-oral device. A suction tube was placed across the posterior tongue near the throat to remove solution and saliva. The solution delivery system was controlled by an original computer program. Older adults presented significantly different maximum intensity timing and slope for both concentrations compared with young adults (slope for 1.5 M, p < 0.01; others, p < 0.05). No significant differences were found between the older and young adults for reaction timing and maximum intensity. We conclude that older adults perceived sweetness more slowly than young adults, and ultimately perceived almost the same intensity as young adults. This is the first reported characterization of the time-intensity profile of sweet taste intensity of glucose in older adults. Using a standardized system enabled us to assess and compare feedback on taste intensities among different age groups in real-time. Based on this, we recommend older adults "savor" to perceive sweet tastes at the same level experienced by young adults.

Checking the Cleanliness of Surgical Instruments Using the Adenosine Triphosphate-Bioluminescence Assay

Purpose: Cleaning is crucial for reprocessing reusable surgical instruments (RSIs). In this study, we used the adenosine triphosphate (ATP) bioluminescence method to assess the cleanliness of RSIs according to the cleaning method used.Methods: From April 3 to June 2, 2023, surgical sets, including hemostatic forceps, needle holders, operating scissors, dressing forceps, and suction tubes, that arrived at the decontamination room in the central sterile supply department of one general hospital were selected through convenience sampling. For each of the three cleaning processes, 30 cleaned RSIs were sampled with test swabs for inspection, and the relative light unit value was measured using ATP test equipment.Results: Suction tubes, hemostatic forceps, and needle holders ranked low in cleanliness (&lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=11.69, &lt;i&gt;p&lt;/i&gt;=.020), and the contamination rate after mechanical cleaning was significantly lower than that after manual cleaning (&lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=31.34, &lt;i&gt;p&lt;/i&gt;&lt;.001).Conclusion: Surgical instruments treated by manual processing and those containing tubes were associated with the low cleanliness. Therefore, it is necessary to check whether surgical instruments, including tubes, are manually washed at an appropriate level, and regular monitoring will be required.

Evaluating surgical expertise with AI-based automated instrument recognition for robotic distal gastrectomy.

Complexities of robotic distal gastrectomy (RDG) give reason to assess physician's surgical skill. Varying levels in surgical skill affect patient outcomes. We aim to investigate how a novel artificial intelligence (AI) model can be used to evaluate surgical skill in RDG by recognizing surgical instruments. Fifty-five consecutive robotic surgical videos of RDG for gastric cancer were analyzed. We used Deeplab, a multi-stage temporal convolutional network, and it trained on 1234 manually annotated images. The model was then tested on 149 annotated images for accuracy. Deep learning metrics such as Intersection over Union (IoU) and accuracy were assessed, and the comparison between experienced and non-experienced surgeons based on usage of instruments during infrapyloric lymph node dissection was performed. We annotated 540 Cadiere forceps, 898 Fenestrated bipolars, 359 Suction tubes, 307 Maryland bipolars, 688 Harmonic scalpels, 400 Staplers, and 59 Large clips. The average IoU and accuracy were 0.82 ± 0.12 and 87.2 ± 11.9% respectively. Moreover, the percentage of each instrument's usage to overall infrapyloric lymphadenectomy duration predicted by AI were compared. The use of Stapler and Large clip were significantly shorter in the experienced group compared to the non-experienced group. This study is the first to report that surgical skill can be successfully and accurately determined by an AI model for RDG. Our AI gives us a way to recognize and automatically generate instance segmentation of the surgical instruments present in this procedure. Use of this technology allows unbiased, more accessible RDG surgical skill.

Postoperative Upper Airway Blood Clot After Tonsillectomy Requiring a Suction Catheter Without Side Holes for Removal: A Case Report.

We present a case of acute dyspnea due to postoperative oral bleeding after tonsillectomy, wherein a blood clot obscured the laryngeal structures to such an extent that no recognizable structures could be identified. A larger-bore suction catheter without side holes proved necessary to solve the problem. The case illustrates how a gradually forming blood clot can remain asymptomatic until reaching a size where it poses an airway threat and highlights the necessity for readily available larger-bore suction devices without side holes. We consider this as an important reminder of the unpredictable nature of blood clot formation and its management.

(194) Midline Reservoir Placement of Infrapubic Inflatable Penile Prosthesis: A Step-by-Step Surgical Technique

Abstract Introduction Various alternative placements of inflatable penile prosthesis (IPP) reservoirs have been previously documented, differing from the traditional retroperitoneal placement in the Space of Retzius. Pelvic trauma, history of surgery in the pelvic region, and atypical anatomy can necessitate an alternative location for implantation of the IPP reservoir. The midline placement of the IPP reservoir provides numerous advantages in outcomes, patient experience, and versatility of implantation. This video demonstrates the surgical procedure for midline placement of the IPP reservoir. Objective We outline a surgical technique to place the IPP reservoir in an alternative midline location. Methods The patient was instructed to void his bladder prior to the procedure to circumvent Foley catheter insertion. A 2.5 cm-wide horizontal incision was made 2 finger widths cranially to the dorsal aspect of the base of the penis. The surgeon’s index finger was used for blunt dissection along the linea alba above the pubic tubercles. A tonsil clamp is used to pierce the rectus fascia at the midline, below the arcuate line, to leave a defect just wide enough to accommodate a 70 mm nasal speculum. The surgeon’s finger is used to assess the space to determine if a 9/10 mm Hegar dilator is necessary to expand the avascular space by sweeping it parallel to the fascia. The speculum is inserted and positioned with the blades pointed cranially parallel to the facial axis and the handles pointed superiorly. The reservoir is prepared and delivered into this space using a metal pediatric Yankauer suction tip through the open blades of the nasal speculum. A syringe filled with saline solution is connected to the reservoir tubing, and the fluid is transferred completely to the reservoir and the tubing is clamped. The tubes originating from the reservoir and implant cylinders are both clamped, trimmed to length, and connected to each other in a watertight fashion to permit the bidirectional flow of saline solution. Proper IPP cylinder inflation is tested prior to closing the incision. Results The reservoir is thus safely deployed cranially to the pubic bone and avoids interfering with the urinary bladder. No complications were observed in this patient, and he was discharged on the same day. Conclusions The midline surgical placement of the reservoir during the infrapubic implantation of an inflatable penile prosthesis is a safe and effective alternative placement for patients with prior pelvic surgery, injuries, or atypical pelvic anatomy. Patients with compromised pelvic, abdominal, or inguinal regions due to hernia repair, patulous inguinal rings, or dense lateral pelvic scarring stand to benefit the most from this reservoir placement. This procedure outlines the surgical steps of midline reservoir placement for new IPP implantation or relocation during a revision procedure. Disclosure No.

Prehospital difficult airway management using a Yankauer suction catheter as guidewire

Prehospital difficult airway management using a Yankauer suction catheter as guidewire

An in vitro study of the effects of respiratory circuit setup and parameters on aerosol delivery during mechanical ventilation.

Aerosol therapy is often prescribed concurrently during invasive mechanical ventilation (IMV). This study determines the effects of nebuliser position, circuit humidification source, and most importantly, lung health on the delivery of aerosol in simulated adult and paediatric IMV patients. Furthermore, the influence of closed suction catheters on aerosol delivery is also addressed. A vibrating mesh nebuliser was used to deliver Albuterol to simulated adult and paediatric IMV patients with differing states of lung health. Four different nebuliser positions and two types of humidification were analysed. Closed suction catheter mounts, a mainstay in IMV therapy, were incorporated into the circuits. The mean ± SD dose of aerosol (%) was assayed from a filter at the distal end of the endotracheal tube. Nebuliser placement and circuit humidification source had no effect on the delivered dose (%) in adults, yet both significantly did in the simulated paediatric patients. The use of closed suction catheter mounts significantly reduced the delivered dose (%) in adults but not in paediatric patients. A simulated healthy lung state generated the largest delivered dose (%), irrespective of nebuliser position in the adult. However, different lung health and nebuliser positions yielded higher delivered doses (%) in paediatrics. Lung health and respiratory circuit composition significantly affect aerosol delivery in both adult and paediatric IMV patients. Nebuliser placement and respiratory circuit humidification source do not affect the delivered dose in adult but do in paediatric IMV patients.

The Third Hand of Neurosurgeons - a novel intraoperative malleable adjustable continuous suction tube.

We designed a novel intraoperative malleable adjustable continuous suction tube to obtain clear surgical fields, reduce intracranial pressure, and lower the temperature of the surgical area. This device consists of six parts: continuous suction tube head and cotton patty, suction tube, fixed wire position, fixed clip, spiral plastic pressure regulating valve, and tail. It can continuously extract blood, cerebrospinal fluid, and rinsing solution from surgical fields, with minimal contact and trauma to tissues, nerves, and blood vessels, while also having a negligible impact on the surgeon's focus and procedure. The excellent and safe performance (simple, malleable, adjustable, space-saving, inexpensive, safe, and effective) of this device in clearing the operating field has been proven in more than 2000 neurosurgical operative procedures. We encountered no complications associated with this device, such as cerebral hematoma, postoperative low intracranial pressure, or vascular and nerve injuries. The newly innovated intraoperative malleable adjustable continuous suction tube is effective and safe for microneurosurgery.

Siphon-type hydroelectric plants: application for power generation in a low head dam in southern Brazil

Hydroelectric energy continues to be the most representative renewable resource in the world, accounting today for 40% of installed capacity. The availability of water, combined with the technologies for generating electricity at a reasonable cost, have sustained the success of this type of generation over the years. Continuing to leverage the hydroelectric sector is even more challenging today, because there is a growing world demand for energy, at the same time that the most attractive places from an economic point of view have already been benefited. The current context refers to approaches to water exploitation aimed at exploiting smaller-scale potentials and existing water structures that operate in a multifunctional way. Solidified in this conjecture, the purpose of this study is to contribute, in the sense of attributing alternatives, for the generation of energy in existing low head dams through the pre-dimensioning of a siphon plant. This type of plant is part of a specific and still evolving niche for decentralized power generation. The reduced structural requirements (generator, turbine, and suction tube), as well as the minimal intervention in the existing structure of the dam, the cessation of new socio-environmental and economic impacts related to the construction of a new plant are the main favorable characteristics of these facilities. The case study of an inoperative plant and the tools available in the Homer Software for data simulation were used as methodological resources. Two base configurations were considered: one with 100% renewable matrices and another one including a diesel generator. From them, different hybrid systems, to determine an optimal configuration in terms of net present cost, were simulated. Among the simulations performed, the most promising optimal solution was hybrid, considering among its components a set of siphon turbines totaling 271 kW, plus 50 kW in photovoltaic modules and 140 kW in a diesel support system. A battery bank with 32 200 Ah batteries complemented this system. The energy cost for this system is $0.164 per kWh. For a system without diesel and with 0% service failures, viable results appear only up to 2600 kWh load.

Microbiome Profiling Demonstrates Concordance of Endotracheal Tube Aspirates With Direct Lower Airway Sampling in Intubated Patients

BackgroundEndotracheal aspirates (ETAs) are widely used for microbiological studies of the respiratory tract in intubated patients but involve sampling through an established endotracheal tube using suction catheters, both of which can acquire biofilms that may confound results. Research questionDoes standard clinical ETA in intubated patients accurately reflect the authentic lower airway bacterial microbiome? Study design and methodsWe applied comprehensive quantitative bacterial profiling using 16S rRNA V1V2 gene sequencing to compare bacterial populations captured by standard clinical ETA with contemporaneous “gold standard” samples acquired directly from the lower airways through a freshly-placed sterile tracheostomy tube in 13 patients undergoing percutaneous tracheostomy following prolonged (median 15 days) intubation. Metrics of bacterial composition, diversity and relative quantification were applied to samples. ResultsPre-tracheostomy ETAs closely resembled the gold-standard immediate post-tracheostomy airway microbiomes in bacterial composition and community features of diversity and quantification. Endotracheal tube and suction catheter biofilms also resembled cognate ETA and fresh tracheostomy communities. Interpretation.Unbiased molecular profiling demonstrates that standard clinical endotracheal aspirate sampling has good concordance with the authentic lower airway microbiome in intubated patients.

Beyond Endoscopes: Pilot Study of Surgical Instrument Lumen Inspection.

Objective: Borescope examinations of endoscope channels are commonly described in literature, but no studies on surgical instrument lumen inspection have been published recently. Inadequately processed surgical instruments have been implicated in patient infections. This study assessed the utility of borescopes for inspecting surgical instruments. Methods: The study team inspected and photographed sterilized, patient-ready arthroscopic shaver handpieces and suction tips using a tablet camera and borescopes to characterize internal anatomy, defects found in lumens, and the impact of recleaning on debris or residues. Results: Ten suctions and eight shavers were inspected. All suctions had internal ridges and suction holes that were perpendicular to the lumen. All shavers had visible ridges, elbows, and lever mechanisms inside lumens. Of the 18 instruments, 16 (88%) had internal features that appeared rough or jagged and 17 (94%) had visible debris or discoloration in the lumens. Recleaning efforts generally were effective for suctions, but multiple rounds of recleaning with enhanced steps were less effective for shavers, which were replaced. Researchers documented retained soil and brush bristles in several new shavers despite following manufacturer instructions for cleaning and found visible damage and discoloration within five uses. Discussion: This study demonstrated the value of borescope examinations for surgical instrument lumens. Visual inspections identified anatomical features that could influence cleaning effectiveness and detected residual soil, discoloration, and debris in most instruments. The findings suggested that manufacturer cleaning instructions were insufficient and additional cleaning was not always effective. In response, the site's multidisciplinary team strengthened risk assessment protocols and enhanced their cleaning practices.

Effect of the extent of posterior septectomy on surgical access during the endoscopic endonasal approach to the sella: A technical note

BackgroundUsing the bi-nostril 4-hand technique during the endoscopic endonasal approach (EEA) facilitates bimanual microsurgical techniques yet requires resection of the posterior nasal septum. The surgical exposure and degree of maneuverability gained proportionate to the extent of posterior septectomy in the sagittal plane was previously quantified. Research questionWe aim to describe our technique of posterior septectomy, and the effect of its extent in the axial plane on surgical access, and instrument maneuverability. Material and methodsAfter fracturing the posterosuperior nasal septum, we disarticulate the vomer from the sphenoid rostrum and remove its upper part. The sphenoid rostrum is excised next exposing the clival recess where a suction tip without a side channel is anchored, allowing the assisting surgeon to use an additional instrument in their dominant hand. The vomer is removed down to the level of the floor of the sphenoid sinus. ResultsA wide exposure is achieved in the coronal plane bilaterally at the level of the sphenoid rostrum allowing unobstructed instrument manipulation in the craniocaudal and cross-court trajectories. Furthermore, the floor of the sella is reached through a straight rather than angled trajectory facilitating surgical access, manipulation, and instrument maneuverability. For lateral lesions requiring contralateral access, the assisting surgeon can assist in dissection from the contralateral nostril without changing the position of the endoscope. Discussion and conclusionRemoving the upper vomer improves surgical access, and instrument maneuverability. Simultaneous dissection from both nostrils might be attempted. Caudally extending the posterior septectomy during the EEA allows better exposure and improves surgical access in all planes.

A step towards sustainability in current dental practice: a cross sectional study

Background: Preservation of planet should be of utmost importance. All practicing dentists collectively produce an amount of waste which can turn out to be extremely harmful to the environment. Biomedical waste management and eco-friendly approach in dental practice should be leveraged for a better future. Aim was to assess the changing trends regarding biomedical waste management and eco-friendly approach in regular practice among dentists of Ahmedabad. Methods: A questionnaire-based study consisting of 17 questions was conducted among practicing dentists of Ahmedabad city. A total of 301 dentists voluntarily participated in the study. Results: Most of the practicing dentists (98.7%) were aware about the biomedical waste management categories and 90.4% were known to the colour coding system used for waste segregation and disposal. A standard method of mercury waste management and sharps disposal was practiced by 53.7% and 88.4% of total participants respectively. Most of the participants were using disposable suction tips (91.6%) and disposable syringes (98.9%). However, 71.6% and 28.4% participants were using autoclavable patient drape, head cap and mask. Conclusions: Comparison based on experience revealed that dentists with lesser experience are more prone to having eco-friendly choices. Comparison based on qualification revealed that paediatric dentists were having the least eco-friendly approach in regular practice compared to other groups. Concept of eco-friendly dentistry was familiar to majority of the dentists but, use of various eco-friendly alternatives were not preferred equally by all dentists.