Surgeon Satisfaction Scores Research Articles

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

BackgroundSeveral studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery.MethodsWe prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3–5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively.ResultsOf the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation.ConclusionOncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction.Trial registrationICTRP, KCT0003886; retrospectively registered May 3, 2019, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0003886

A prospective randomized double-blinded study of dexmedetomidine versus propofol infusion for orbital surgeries.

PURPOSE:Orbital surgeries are traditionally taken up under general anesthesia. Local anesthesia combined with moderate sedation can also be considered as an alternative option. This study was performed to compare the safety and efficacy of dexmedetomidine and propofol infusion for orbital surgeries under local anesthesia.METHODS:Twenty patients undergoing orbital surgery by a single surgeon were enrolled in this prospective randomized study. Selected patients were randomly administered dexmedetomidine (Group D) or propofol (Group P). Hemodynamic and respiratory effects, sedation levels, recovery profile, analgesic properties, and satisfaction levels of the patients and the surgeon were assessed.RESULTS:There was a significant decrease in mean arterial pressures following drug administration compared to initial measurements in both the groups. However, a statistically significant decrease in heart rate was observed only in Group P. The sedation score at the end of loading dose was 3.3 ± 0.82 in Group D and 2.5 ± 0.52 in Group P and this difference was also statistically significant (P value-0.027). The surgeon's satisfaction score was 6.5 ± 0.71 in Group D and 5.6 ± 1.07 in Group P (P value – 0.045). There were no statistically significant differences observed in patients' satisfaction, pain, and anxiety scores in either group. No major hemodynamic changes or complications were noted in either of the groups.CONCLUSION:Dexmedetomidine, in comparison to propofol, provides better sedation levels with good hemodynamic stability. It also offers better surgeon satisfaction, thus providing a useful alternative for general anesthesia in selective patients undergoing orbital surgery.

Acceptability and Feasibility of an Innovative Anesthesia Technique in a Low-Resource Setting at a Rural Community Ophthalmic Center: A Prospective Journey.

Background:Ocular blindness and ocular morbidities are very much prevalent in pediatric age group in India. Mostly, these are all surgically amenable, provided they have access to safe anesthesia. Suboptimal facilities for conventional general anesthesia (GA) led to a different thought process. The combination of anesthetic and analgesic property of ketamine was utilized in a low-resource setting at a tertiary ophthalmic center for pediatric ophthalmic surgeries.Aims:The aim of this study was to decipher whether this technique is acceptable and feasible.Settings and Design:It was a prospective consecutive series at a rural eye center done over a period of 5 years.Materials and Methods:Inclusion criterion was children undergoing eye surgeries between the ages of 7 and 18 years, who could be adequately counseled about the concept of painless intravenous cannulation and subsequent painless block. Intravenous anesthesia comprised of ketamine, in conjunction with peribulbar block. Complications of the technique, time to discharge, mean pain score, and patient and surgeon satisfaction score were documented.Statistical Analysis Used:Data were analyzed on Microsoft Excel.Results:A total of 905 cases were conducted uneventfully without conversion to GA. No emergency resuscitation was required. The surgeon and the patient had a satisfying experience, with the technique being totally acceptable to them.Conclusions:Intravenous ketamine is an inexpensive and safe anesthetic technique when used in conjunction with regional block and is certainly a boon for minimal resource ophthalmic setup in rural India.

Male Gynecomastia Correction by Superior Dynamic Flap Method: A Consistent and Versatile Technique.

BACKGROUNDGynecomastia is a common cosmetic issue in India. Many combinations of liposuction and excision of the gland have been advocated. Complete removal of the breast leaves behind a contour deformity and hence a sliver of it needs to be left behind. This study used a consistent and versatile technique for correction of gynecomastia by a superior dynamic flap method. METHODSA retrospective study was conducted in 1159 gynecomastia surgeries done from March 2013 to February 2019. All these patients were treated by a single surgeon using the superior dynamic flap method in a single center and the results were assessed with patient and surgeon satisfaction scores. The technique involved leaving behind a thin sliver of the gland in order to avoid contour deformity and achieve a smoother shape overall.RESULTSMinor complications were seen in 27 patients and the satisfaction scores were 8.9 and 8.79 in patients and surgeon, respectively. There was no incidence of contour deformity after the procedure.CONCLUSIONSuperior dynamic flap method was a versatile technique and allowed the surgeon not only to avoid contour deformities, but also to correct asymmetries.

A Comparative Study between Nitroglycerin and Magnesium Sulfate during Shoulder Arthroscopic Surgery in the Beach Chair Position

AbstractBackground: This study was designed to compare the efficacy of intravenous infusion of nitroglycerin versus mag-nesium sulfate for controlled hypotensive anesthesia during arthroscopic shoulder surgery in Beach Chair Position (BCP).Aim of Study: To compare the efficacy of nitroglycerin versus magnesium sulfate in inducing deliberate hypotension and satisfactory surgical field in patients undergoing arthro-scopic shoulder surgery.Material and Methods: Fourty patients scheduled for arthroscopic shoulder surgery under general anesthesia in BCP, randomly assigned into two equal groups, nitroglycerin group (NTG group, n=20) received infusion of 0.5-5μg/kg/min and magnesium group (Mg group, n=20) received 40mg/kg, as slow bolus before induction in 100mL saline solution over 10min then 15mg/kg/h by infusion during the operation to achieve a mean arterial blood pressure (MAP) of about 50 to 65mmHg.Results: Controlled hypotension was achieved in both groups. There was no significant difference in MAP between two groups in first 30mins after infusion then magniseum group produced significantly lower MAP values till stopping of infusion. Heart Rate (HR) was significantly lower in mg group compared with the NTG group. More patients required fentanyl consumption intraoperative (p<0.0001) and frequent administration of rocuronium (p=0.001) in NTG group. How-ever, there was longer extubation time and recovery time in Mg group compared with the NTG group. Bleeding score was insignificantly lower in Mg group and surgeon's satisfaction score was significantly better (p=0.035) in the Mg group.Conclusions: Nitroglycerin and magnesium sulfate can effective in achieving hypotensive anesthesia during arthro-scopic shoulder surgery. However, MgSO4 provide a favorable surgical field condition and better surgeon's satisfaction.

Endoscopic evaluation of completeness of conventional curettage adenoidectomy: a single-blinded observational study

BackgroundConventional curettage adenoidectomy is a blind procedure, which performed in a confined postnasal space produces surgical challenges. The aim was to examine the completeness of conventional adenoidectomy and compare it with surgeon satisfaction and to identify the need to objectively assess the residual tissue at the end of procedure.AimThe primary aim was to objectively assess the residual adenoid mass after curettage adenoidectomy and compare it with surgeon satisfaction using digital palpation.Settings and designA prospective single-blinded observational study was conducted at a tertiary care hospital between February 2015 and September 2015.Patients and methodsA total of 45 cases that underwent conventional curettage adenoidectomy were included in the study. Intraoperative images of the postnasal space were recorded and compared with surgeon satisfaction score by a single-blinded observer.Statistical analysisStatistical analysis of interobserver correlation was performed using Cohen’s κ statistics using Graphpad Prism, version-6.07 (trial).ResultsThe 45 cases had a mean±SD age of 8.45±2.47 years, and female to male ratio was 1.4 : 1. The kappa analysis of surgeon satisfaction in relation to the presence of residual adenoid tissue showed that the strength of agreement was worse than that expected by chance (κ=−0.383, SE=0.129).ConclusionThe study showed that surgeon satisfaction via digital palpation alone fails to assess residual adenoid tissue, and we recommend endoscopic visualization of the nasopharynx to assess completeness of adenoidectomy.

Coverage of radial forearm flap donor site with full thickness skin graft and Matriderm®: An alternative reliable solution?

After harvesting a radial forearm flap (RFF) an optimal aesthetic and functional restitution of the donor site is required. In order to cover the secondary defect of the donor site, several solutions are currently available, but there is still no real evidence of the most reliable option. A retrospective study was conducted in order to evaluate a new technique of forearm coverage with artificial dermis: the association of full thickness skin graft (FTSG) with Matriderm®. Our study included all RFF performed during a 34-month period. Forty-three forearm secondary defects after harvesting a RFF (16 men, 27 female) were included. Forearm donor site was covered using three techniques: a simple FTSG, split thickness skin graft (STSG) with Matriderm® or FTSG with Matriderm®. Clinical evaluations based on residual functionality, skin quality and aesthetic result were assessed using respectively the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Vancouver Scar Scale (VSS) score and a blind panel questionnaire. FTSG with Matriderm® showed an improved DASH (10.6/100) and VSS score (5.5/13) if compared to the other techniques, mean surgeon satisfaction score was 3/5, mean patient satisfaction score was 3/5 in the FTSG with Matriderm® group. The results of this study revealed that the new association of FTSG with Matriderm® improves the DASH score and the aesthetic outcomes resulting to be a reliable solution in treating full thickness forearm skin defects after RFF harvesting.

Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients: A prospective randomized controlled trial.

Background:Percutaneous tracheostomy, almost associated with cough reflex and hemodynamic fluctuations, is a common procedure for traumatic brain injury (TBI) patients, especially those in neurosurgery intensive care units (NICUs). However, there are currently a lack of effective preventive measures to reduce the risk of secondary brain injury. The aim of this study was to compare the effect of dexmedetomidine (DEX) vs sufentanil during percutaneous tracheostomy in TBI patients.Methods:The 196 TBI patients who underwent percutaneous tracheostomy were randomized divided into 3 groups: group D1 (n = 62, DEX infusion at 0.5 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), group D2 (n = 68, DEX infusion at 1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), and group S (n = 66, sufentanil infusion 0.3 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.4 μg·kg–1·hour–1). The bispectral index (BIS) of all patients was maintained at 50 to 70 during surgery. Anesthesia onset time, hemodynamic variables, total cumulative dose of DEX/sufentanil, total doses of rescue propofol and fentanyl, time to first dose of rescue propofol and fentanyl, number of intraoperative patient movements and cough reflexes, adverse events, and surgeon satisfaction score were recorded.Results:Anesthesia onset time was significantly lower in group D2 than in both other groups (14.35 ± 3.23 vs 12.42 ± 2.12 vs 13.88 ± 3.51 minutes in groups D1, D2, and S, respectively; P < .001). Both heart rate and mean arterial pressure during percutaneous tracheostomy were more stable in group D2. Total doses of rescue propofol and fentanyl were significantly lower in group D2 than in group D1 (P < .001). The time to first dose of rescue propofol and fentanyl were significantly longer in group D2 than in both other groups (P < .001). The number of patient movements and cough reflexes during percutaneous tracheostomy were lower in group D2 than in both other groups (P < .001). The overall incidences of tachycardia and hypertension (which required higher doses of esmolol and urapidil, respectively) were also lower in group D2 than in both other groups (P < .05). Three patients in group S had respiratory depression compared to X in the D1 group and X in the D2 group. The surgeon satisfaction score was significantly higher in group D2 than in both other groups (P < .05).Conclusions:During percutaneous tracheostomy, compared with sufentanil, DEX (1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1) can provide the desired attenuation of the hemodynamic response without increased adverse events. Consequently, DEX could be used safely and effectively during percutaneous tracheostomy in TBI patients.

Comparison of two different dosages of the tranexamic acid on reducing of bleeding during spinal fusion surgery

Background: One of the problems that influenced surgeon and anesthesiologist in strumental spinal fusion surgery (CD surgery) is the excessive bleeding during surgery. There are different ways for reducing bleeding during surgery such as the intravenous administration of tranexamic. In this study the effect of two doses of tranexamic acid for reducing of bleeding in spinal fusion surgery was evaluated. Methods: This clinical trial study was performed on 75 patients with class I and II ASA patients scheduled for strumental spinal fusion surgery under the same general anesthesia. The patient’s randomly divided into 3 groups. One group received single dose of tranexamic acid and another group received single dose of tranexamic acid plus maintenance dose of tranexamic acid that continued during surgery and the control group received normal saline as a placebo. The blood loss during surgery and until 24 hours later was documented. Bleeding score and surgeon satisfaction scores were recorded. Results: The amount of blood loss was reduced in both groups receiving the tranexamic acid (934 cc in control group, 664cc in single dose group and 758 cc in single dose plus maintenance dose group). But the difference was not statistically significant. (P value>0.05). Conclusion: The quality of surgery field, surgeon satisfaction scores and blood transfusion to patients in 3 groups was not significantly different.

Procedural Sedation Using a Propofol-Ketamine Combination (Ketofol) vs. Propofol Alone in the Loop Electrosurgical Excision Procedure (LEEP): A Randomized Controlled Trial.

Background: Although the loop electrosurgical excision procedure (LEEP) is a brief procedure, it can cause severe pain and discomfort to patients in the absence of adequate sedation. An admixture of ketamine with propofol (ketofol), may reduce patient movement due to insufficient sedation while providing hemodynamic and respiratory stability. This study evaluated the ability of two ratios of a propofol–ketamine combination, compared with propofol alone, to reduce patient movement during procedural sedation for LEEPs. Methods: One hundred and twenty women scheduled for a LEEP were randomly assigned to three groups. Anesthesia was induced with 1 mg/kg propofol (group P), 1 mg/kg propofol and 0.33 mg/kg ketamine (group K1), or 1 mg/kg propofol and 0.66 mg/kg ketamine (group K2). The primary outcome was the incidence of adduction motion in the lower extremities during the procedure. The requirements for respiratory interventions, changes in vital signs, sedation score, additional anesthetic usage, and surgeon and patient satisfaction were also evaluated. Results: The incidence of adduction motion was significantly lower in groups K1 and K2 than in group P (overall p-value <0.001) but did not differ significantly in groups K1 and K2. Group K2 needed more jaw thrust maneuvers than group K1. Additional propofol usage was lower and surgeon satisfaction scores higher in groups K1 and K2 than in group P. Conclusion: A propofol–ketamine combination is more effective than propofol alone in reducing procedural interference during LEEPs. However, increasing the dose of ketamine showed no additional benefit.

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial.

BackgroundRapid emergence from general anesthesia during endovascular interventional therapies (EITs) is important. However, the solution that improved quality of both analepsia and postoperative recovery after EITs has not been specifically addressed. We conducted this prospective, randomized, controlled trial to evaluate the intraoperative infusion of dexmedetomidine on quality of analepsia and postoperative recovery in patients undergoing EITs.MethodsEighty‐six patients undergoing EITs were divided into three groups: RD1 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.2 μg kg−1 hr−1 throughout EIT), RD2 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.4 μg kg−1 hr−1 throughout EIT), and RD3 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs, prevalence of complications and symptomatic cerebral vasospasm, duration of postanesthesia care unit (PACU) stay, Glasgow Outcome Score (GOS) at 3 months, and prevalence of cerebral infarction 30 days after surgery.ResultsDexmedetomidine application in the regimen RD3 reduced the consumption of the total dose of nimodipine and sufentanil 48 hr after surgery, prevalence of symptomatic cerebral vasospasm, consumption of narcotic drugs and nimodipine during surgery, pain intensity during the first 8 hr after surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days.ConclusionsDexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT) could reduce the total consumption of nimodipine and opioid during the first 48 hr after surgery, the concerning adverse effects, and improve pain scores. The optimal dosage of dexmedetomidine during EITs merits further investigation.

The effects of music on anxiety and pain in patients during carotid endarterectomy under regional anesthesia: A randomized controlled trial

ObjectiveMusic can be used as an alternative method to decrease anxiety in awake patients during surgical procedures. The aim of this study was to test the hypothesis that listening to music during carotid endarterectomy (CEA) under regional anesthesia decreases the patient’s anxiety and pain. DesignA multicenter, prospective, randomized controlled trial. SettingPatients undergoing carotid endarterectomy under cervical plexus block. InterventionsPatients scheduled for carotid endarterectomy under cervical plexus block were randomized into two groups: Music Group and Control Group. Main Outcome MeasuresThe primary endpoint of this study was the difference in intraoperative anxiety in patients with or without music during CEA under regional anesthesia, and the secondary endpoints were intraoperative and postoperative pain, use of additional local anesthetics, use of intravenous analgesics, patient and surgeon satisfaction and complications. Anxiety was assessed using State Trait Anxiety Inventory (STAI) and numeric rating scale (NRS). Visual analog scale (VAS) was used for pain assessment. ResultsThe postoperative STAI scores were similar in both groups (p = 0.839). The NRS scores measured immediately after the end of the surgery were statistically higher in Music Group (p = 0.001). The intraoperative anxiety statistically increased in Music Group, when the scores of the intraoperative responses to the questions of “are you relaxed?” and "are you calm?" were compared. (p = 0.0001 and p = 0.0001, respectively). There were no statistical differences in terms of the amount of intraoperative and postoperative analgesic used (p = 0.801, p = 0.773, respectively). The intraoperative VAS scores, postoperative VAS scores, patient and surgeon satisfaction scores were similar in both groups (p = 0.586, p = 0.185, p = 0.302 and p = 0.599, respectively). Systolic, diastolic and mean arterial blood pressure and heart rate were no different between Music Group and Control Group at any of all time points during the intraoperative period. Surgical side and contralateral side cerebral rSO2 values are similar in both groups (p = 0.438, p = 0.397, respectively). ConclusionsMusic use in CEA under regional anesthesia increased intraoperative patient anxiety, and had no effect on intraoperative and postoperative pain or patient satisfaction.

A randomized, controlled trial of comparison of a continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) using 0.2% ropivacaine for postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA)

Background and Aims:Postoperative pain relief following total knee arthroplasty (TKA) is a major concern as it will help to achieve an effective functional outcome. The present study was conducted to compare continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) techniques using ropivacaine.Material and Methods:Forty patients were randomly allocated into group F and group E to receive 0.2% ropivacaine through femoral catheter or epidural catheter respectively. An infusion was started @6 ml/h post-operatively when VAS was ≥4. The dose was titrated to keep VAS <4 (with minimum rate 2 ml/h and maximum rate 10 ml/h). If VAS ≥4 occurred despite maximum rate of infusion, a rescue analgesic was given. Primary objectives were to compare visual analogue score (VAS), rehabilitation indices, and rescue analgesic requirement. Secondary objectives were to assess patient and surgeon's satisfaction score, motor blockade, and complications if any.Results:The mean VAS score, rehabilitation goals, rescue analgesic requirement, and patient's and surgeon's mean satisfaction scores were comparable in both the groups. Motor blockade was not seen and though the number of side effects were more in group E, they did not achieve statistical or clinical significance.Conclusion:CFNB can be used as an alternative, effective postoperative analgesic technique for TKA.

Pre-induction fentanyl dose-finding study for controlled hypotension during functional endoscopic sinus surgery.

Background and Aims:Fentanyl can facilitate controlled intraoperative hypotension by its sympatholytic effect in patients undergoing functional endoscopic sinus surgery (FESS). We investigated the effects of different doses of pre-induction fentanyl on controlled hypotension profile during FESS.Methods:This prospective, randomised study included 120 patients randomly allocated to three groups (40 each) based on administration of pre-induction fentanyl; 2 μg/kg group, 3 μg/kg group and 4 μg/kg group. The primary objective was to assess effect on intraoperative heart rate and mean arterial pressure. Use of additional hypotensive agents, surgical field condition and surgeon satisfaction were also analysed.Results:Controlled hypotension was achieved adequately in all participants. Patients belonging to fentanyl 4 μg/kg group had significantly lower heart rate for the duration of controlled hypotension intraoperatively versus fentanyl 2 μg/kg group (P < 0.05). Trinitroglycerin [TNG] and metoprolol were administered to 3 [7.5%] and 9 [22.5%] patients respectively in the fentanyl 3 μg/kg group, and to 3 [7.5%] and 5 [12.5%] patients respectively in the 4 μg/kg group, compared to 14 [35%] and 20 [50%] in the fentanyl 2 μg/kg group, respectively (TNG, P < 0.001). Surgical field conditions and surgeon satisfaction scores were significantly superior in fentanyl 3 μg/kg and 4 μg/kg groups than in fentanyl 2 μg/kg group.Conclusion:Pre-induction fentanyl 3 μg/kg and 4 μg/kg group showed superior controlled hypotension facilitation than 2 μg/kg fentanyl during FESS in terms of measurable haemodynamic endpoints and favourable operative conditions, surgeon's satisfaction and sparing of additional hypotensive agents.

Microtia Reconstruction in Hemifacial Microsomia Patients: Three Framework Coverage Techniques

Microtia with hemifacial microsomia is difficult to treat because of skin volume deficiency. To provide further information for coverage techniques in microtia reconstruction, the authors have reviewed and analyzed patients who underwent surgery at their center. A total 52 patients with microtia with hemifacial microsomia who underwent reconstruction between 2006 and 2016 were involved. Patients were reviewed retrospectively by examining medical records and photographic data. All reconstructed cases were followed for 6 months to 10 years (median, 33 months). The average (median) surgeon's satisfaction score was 8.2 (median, 9) for the embedded and elevation technique (n = 23); 7.89 (median, 8) for the temporoparietal fascia flap technique (n = 10); and 6.30 (median, 7) for the subfascial expansion technique (n = 19). The median score difference between the embedding and subfascial expansion techniques was statistically significant (p = 0.03). Major factors that deteriorated aesthetic outcomes were large reconstructed ears (11 cases), cartilage framework resorption (11 cases), mismatched skin color (eight cases), different axis (seven cases), and different shapes (five cases). Mismatched skin color was significant in cases treated with the fascia flap technique (p < 0.0001), whereas cartilage framework resorption was significant in cases treated with the tissue expansion technique (p = 0.004). To obtain better aesthetic outcomes, the embedding technique should be used when the patient shows a mild to moderate degree of low hairline and usable remnant vestiges. In cases showing severe degrees of associated anomalies, the temporoparietal fascia flap technique should be used. Therapeutic, III.

Tumescent Local Infiltration Anesthesia for Mini Abdominoplasty with Liposuction.

AIM:To evaluate the feasibility and safety of mini abdominoplasty with liposuction under local tumescent anaesthesia (LA) as the sole anaesthetic modality.METHODS:The study included 60 female patients with a mean age of 33.3 ± 5.6 years. Local infiltration using a mixture of 1:1000 epinephrine (1 ml), 2% lidocaine (100 ml) and 0.5% Levobupivacaine (50 ml) in 2500 ml saline was started with Local infiltration started with the abdomen, outer thigh, hips, back, inner thighs and knees. After Mini Abdominoplasty with supplemental liposuction was conducted and application of suction drains wound closure was performed, and the tight bandage was applied. Pain during injection, incision and surgical manipulations was determined. Duration of postoperative analgesia, till oral intake and return home, patients and surgeon satisfaction scores were determined.RESULTS:All surgeries were conducted completely without conversion to general anaesthesia. Injection pain was mild in 46 patients, moderate in 10 and hardly tolerated in 4 patients. Incision pain was mild in 16 patients, while 44 patients reported no sensation. During the surgical procedure, 6 patients required an additional dose of LA. Meantime till resumption of oral intake was 1.6 ± 0.9 hours. Meantime till home return was 5.6 ± 2.4 hours. Twelve patients were highly satisfied, 18 patients were satisfied, and these 42 patients were willing to repeat the trial if required. Eight patients found the trial is good and only one patient refused to repeat the trial and was dissatisfied, for a mean total satisfaction score of 3.1 ± 0.9.CONCLUSION:Mini Abdominoplasty with liposuction could be conducted safely under tumescent LA with mostly pain-free intraoperative and PO courses and allowed such surgical procedure to be managed as an office procedure. The applied anaesthetic procedure provided patients’ satisfaction with varying degrees in about 97% of studied patients.

Comparison of Epidural and Spinal Anesthesia Techniques for Transurethral Resections

Purpose: Transurethral resections (TUR) are commonly performed for elderly population who have multiple comorbidities which can cause intraoperative and postoperative complications. The type of anesthesia has an impact on patient outcome. The aim of the study is to compare the effectiveness of epidural and spinal anesthesia techniques for TUR. Methods: A total of 158 elective TUR cases were evaluated. The patients were randomized into 2 groups: Epidural anesthesia was applied to Group I (n=82) and spinal anesthesia was applied to Group II (n=76). Both groups were compared for intraoperative hemodynamic parameters (mean arterial pressure, heart rate, peripheral oxygen saturations), total duration of hospital stay, perioperative complications, and satisfaction of the patients and surgeons. Results: The patients in the spinal anesthesia group experienced more frequent intraoperative hypotensive episodes during TUR (n=2 vs. n=10; p=0.026) and had lower mean arterial pressure values for the first 30 minutes of anesthesia compared to epidural anesthesia group. The postoperative duration of bed stay was longer in the spinal anesthesia group (402.96±49.61 min) than the epidural anesthesia group (205.91±28.27 min) (p&lt;0.001). The patient satisfaction score was significantly higher in the epidural anesthesia group (2.54±0.63) than the spinal anesthesia group (2.23±1.22) (p=0.04) where as the surgeon satisfaction score were similar in both groups. Conclusion: Epidural anesthesia can be considered as an effective and safe technique for ambulatory interventions especially for elderly patients providing perioperative hemodynamic stability and postoperative early mobilization.

Development and Application of a No-Clog Surgical Suction Tip Using 3D Printing Technology.

BackgroundClogging of the suction tip frequently occurs during orthopedic surgery. We developed a novel anti-clog suction tip using 3D printing technology to improve orthopedic surgery efficiency.Material/MethodsWe studied the root causes of obstructions in suction tips currently employed in orthopedic surgery during actual surgical cases. CAD software and 3D printer was used to design, modify, and print the novel suction tip. The frequency of clogging, the frequency of replacement of the suction tip, the time lost in replacing suction tips or connecting tubes, surgical duration, intraoperative surgical blood loss, and the satisfaction scores for the suction tips as rated by the surgeons were compared between the novel suction tip and the conventional suction tip. Comparisons were made first in laboratory experiments using a simulant liquid and then during total hip replacement surgeries.ResultsIn the simulant liquid experiments, the novel suction tips showed significantly reduced frequency of complete clogging and decreased time spent removing all fluid in comparison to the conventional suction tips (p<0.05). In the clinical trials, the novel suction tips exhibited significantly reduced frequency of complete clogging, shorter surgical duration, and reduced intraoperative surgical blood loss compared to the conventional suction tips (p<0.05). Surgeon satisfaction scores were higher for the novel tips than for the conventional tips (p<0.05).ConclusionsOur surgeon-designed and -produced surgical suction tip utilizing 3D desktop printing technology was highly effective in resolving the problem of clogged suction tips during orthopedic surgery and yielded high surgeon satisfaction.

Lumbar Laminectomy: TIVA with Propofol Versus Inhalation Anesthesia with Isoflurane

Background: Surgical treatment of lumbar intervertebral disc herniation is a critical procedure due to the proximity of the operation field to neural structures. Providing a bloodless field and optimizing surgeon vision is of high value in this regard. Total intravenous anesthesia with propofol and inhalation anesthesia with isoflurane are both used in spine surgeries. Both of these agents have vasodilator properties that could be benefited in inducing controlled hypotension as a blood sparing technique. We sought to compare propofol and isoflurane anesthesia in terms of intraoperative bleeding and hemodynamic changes. Methods: After obtaining ethics approval and informed consent, 88 Iranian patients with American society of anesthesiology score 1 and 2 were randomly divided into two groups. The ISO group received isoflurane and the PRO group received propofol as the main anesthetic agent. Hemodynamic changes, intraoperative bleeding, urinary output, and surgeon satisfaction score were recorded. Results: The two groups were similar in demographic characteristics (for age P = 0.072; for gender P = 0.286). The ISO group had significantly lower blood pressure after 30 minutes of anesthesia (P = 0.01). Intraoperative bleeding in terms of qualitative and quantitative measures was lower in the ISO group (P = 0.001). Isoflurane anesthesia was also associated with a higher surgeon satisfaction score (P = 0.01). Conclusions: Our findings showed that isoflurane as a volatile agent provides a bloodless field better than does propofol through TIVA. Keywords: Isoflurane; Propofol; Laminectomy; Anesthesia; Inhalation

Impedance cardiography as tool for continuous hemodynamic monitoring during cesarean section: randomized, prospective double blind study

BackgroundImpedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia.MethodsSixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups. Mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate (HR), stroke volume index (SVI) were recorded from Tbaseline to 31 min after CSE by ICG. Sensory and motor blocks, patients and surgeons satisfaction, neonatal data were also recorded.ResultsFifteen of 32 patients in GL6 and 15 of 30 patients in GL8 experienced hypotension at T2 vs Tbaseline (P < .001) and SVRI reduction (P = .035 and P < .001 respectively). MAP, CI and SVRI were always slightly higher in GL6 vs GL8. HR and SVI remained stable until the end of surgery in all patients. Total ephedrine requirements was higher in GL8 (P = .010). The onset and offset time of sensory and motor block were similar in both groups, but the number of patients with motor block was lower in GL6 vs GL8 (P = .001). Patients and surgeon satisfaction scores, the number of patients needed systemic rescue doses, neonatal data were similar in both groups.ConclusionsICG is a useful noninvasive tool to monitor continuously hemodynamics during cesarean section. The hemodynamic stability, the satisfying sensory block and rapid mobilization provided by low levobupivacaine dose may be particularly advantageous in obstetric patients.Trial registrationClinicalTrials.gov: NCT03170427. Retrospectively Registered (Date of registration: May 2017).