Surgeon Satisfaction Research Articles

A Universal C-arm Language Improves OR Morale

Background: Miscommunication while using intraoperative fluoroscopy C-arm can increase frustration, time, and radiation exposure. There have been no studies to date that have examined a standardized C-arm language during live cases, nor its durability over time. We aimed to design a directive language for use at a single institution and compare pre- and post-implementation surgeon and radiology technologist satisfaction and sense of operative efficiency.Methods: All surgeons regularly using intraoperative fluoroscopy and all radiology technicians were surveyed regarding their experience and satisfaction regarding C-arm usage. Respondents provided their preferred terminology for each C-arm motion; the most frequent responses for each movement were used to create a universal language. Users were educated on the language via email and OR/C-arm signage for 1 month. Participants' recall of the terminology and satisfaction with use of the C-arm was evaluated at 1-month and 3-months post-intervention.Results: 57 people responded to the initial survey—30 radiology technicians and 27 surgical attendings. Initially, surgeons indicated a significantly greater need to correct C-arm movement and repeat fluoroscopy and more case delays due to miscommunication than radiology technicians. At 3 months, surgeons reported significant improvements in how often the C-arm movement had to be corrected due to miscommunication (p=0.007), frustration due to C-arm miscommunication (p=0.002), and frequency of operative delays due to C-arm miscommunication (p=0.03). At 1 month, participants were able to recall the standardized language terms 76.9% of the time (surgical attendings: 74.4%, radiology technicians: 79.2%). This decreased slightly to 72.2% at 3 months (surgical attendings: 66.7%, radiology technicians: 77.6%).Conclusions: Training in a universal C-arm language significantly improved surgeon but not radiology technician experience using C-arm intraoperatively, with decreased frustration and perceived improvements in efficiency. There was good retention of the language terms at 3 months.Level of Evidence: IV, case series Key Concepts•No universal intraoperative fluoroscopy movement vocabulary exists.•The lack of agreed-upon terms for C-arm movements leads to frustration.•A universal C-arm language can be taught and retained for at least 3 months.•A universal C-arm language improves surgeon experience with intraoperative fluoroscopy.

The surgical outcome of buried penis surgery

Buried penis is a condition where the penis retracts. It has a significant impact on quality of life of the patient and can present with a variety of symptom. Whilst there are several causes, obesity is the most common in adults. A retrospective study on patients with buried penis operated on between 2010 and 2020. Data retrieved included presenting complaints, previous surgery, co-morbidities, surgical details and patient and surgeon satisfaction rates. A total of 141 patients were recruited with buried penis (median age 54). The presenting complaints were inability to void standing n=30, erectile dysfunction n=18, and small penis n=94. 96 patients had had previous surgery, 49 were circumcisions. The operations performed on the 141 patients were circumcision (n=40), scrotoplasty (n=35), V-Y plasty(n=11), skin grafting (n=34), suprapubic fat pad excision(n=77), abdominoplasty (n=25), penile prosthesis (n=14), and division of suspensory ligament (n=24). The post-operative length of stay was 0-52 days. There were 27 complications; infections (n=15), dehiscence (n=5), haematomas (n=2)The mean follow up was 506 days (range 0-4313 days) with a surgical satisfaction rate of 87% and patient satisfaction of 79% (p=0.021). Of note the highest dissatisfaction occurred in patients having circumcision and/or suprapubic fat pad removal. Buried penis is a complex condition with patients likely requiring a combination of surgical techniques. Circumcision alone usually does not treat the problem and may make things worse. A prolonged hospital stay with significant wound complications may occur but the majority of patients are happy with the final outcome. No conflict of interest to declare.

Fat Grafting in Facial Palsy: A Secondary Revision Technique to Improve the Facial Aesthetics.

Summary:We report our experience of using autologous fat grafting (AFG) as an adjunct to dynamic and static facial reanimation surgical techniques in patients with facial palsy. A consecutive series of patients with facial palsy (congenital or acquired) treated by AFG between September 2007 and October 2017 were reviewed. Multiple strategies for initial dynamic facial reanimation have been utilized. Indications for AFG included asymmetry, volume deficiency, and visible muscle tethering. Standard AFG technique was used with fat harvested from the lower abdomen or thigh and injected into multiple affected areas. Fat grafting was repeated as necessary. Two-dimensional analysis was performed using standardized pre- and postoperative photographs to assess facial symmetry. Patient, surgeon, and independent evaluator satisfaction was recorded using a five-point Likert scale (0–4). Thirty-two patients with a mean age of 43 ± 15.5 years were treated with AFG following facial reanimation. A mean of 1.7 ± 1.4 secondary procedures were performed following initial dynamic reanimation before fat grafting. The average number of AFG episodes was 2.2 ± 1.4 with a mean volume of 12.9 ± 6.0 ml. Minimal complications were seen in either the donor or the recipient sites. There was significant improvement (P ≤ 0.001) of postoperative quantitative facial symmetry following fat grafting. At one-year follow-up, surgeon, patient, and independent evaluator were mostly satisfied (3.06 ± 0.62, 3.31 ± 0.59, and 3.16 ± 0.57, respectively). We report a positive experience of correction of facial asymmetry, contour abnormality and visible muscle pull with fat transplantation following dynamic facial reanimation. The procedure has been shown to be quick and simple, with few complications.

Realidad mixta en Hololens 2 como sistema de asistencia intraoperatoria en cirugía de escoliosis idiopática del adolescente: un caso clínico.

Virtual reality has been one of the main technological revolutions in trauma in the last decade. This allows us to perform intraoperative assistance in a simple way, without the use of physical anchors and with a quick and accessible image preparation process. We present the use of this technology in surgical assistance for the correction of the deformity in adolescent idiopathic scoliosis. Material and methods: using C++ code and the Unity platform, a virtual planning tool was generated and the optimal positioning and size of the implants were designed at the apex of the deformity. Subsequently, the image was fixed in the ptaient and the holographic image was used for surgical assistance. Results: the positioning and size of the implants were identical to those planned using this technology. The planning time was low and the surgeon's satisfaction was high regarding the practicality of its use and the result obtained. Conclusions: virtual reality is a simple technology that allows improving intraoperative assistance in spinal surgery, this being one of the first cases described for its intraoperative use.

The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace

BackgroundAs more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. MethodsAn anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. ResultsOf the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. ConclusionsWorkplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.

Tek Doz İntraartiküler Lokal Anestezik ile İnterskalen Brakiyal Pleksus Bloğunun Postoperatif Ağrı Üzerine Etkisi

Aim: Postoperative pain management is important because shoulder surgery causes severe pain. In this present study our aim was to analyse the comparison of the influences of ultrasonography-guided interscalene block and perioperative intra-articular local anesthetic injection on postoperative pain in cases who will undergo arthroscopic shoulder procedure.
 Material and Method: It was planned as a prospective randomized controlled trial. After the confirmation of the local ethical committee, our cases were randomly divided into two groups and one group (Group ISBPB) was administered general anesthesia after ultrasonography guided interscalene block. In the other group (Group LA), surgical procedure was carried out under general anesthesia and a single dose of intra-articular local anesthetic was administered peroperatively. Postoperative analgesia requirement, time, VAS scores, patient and surgeon satisfaction were registered.
 Results: We could not obtain a statistically significance between group LA and group ISBPB groups according to gender, side, comorbidity, additional procedure and age variables in the participants included in the study (p>0.05). A numerically significance was observed between Group LA and Group ISBPB groups in terms of first analgesia requirement and patient satisfaction variables in the participants included in the study (p

Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery: a prospective, randomized, double-blind controlled clinical trial

BackgroundOpioids analgesics commonly used in abortion procedures are associated with respiratory and circulatory depression. Esketamine is a N-methyl-D-aspartate receptor (NMDA) antagonist and a common analgesic. The drug has several advantages including rapid onset and offset and it causes minimal cardiorespiratory depression. However, studies have not explored the effects of esketamine in patients undergoing painless abortion surgery. Therefore, the present study sought to evaluate the effect of different doses of esketamine compared with the effect of fentanyl on incidence of perioperative hypotension in patients undergoing painless abortion surgery and to explore the optimal esketamine dose for this population.MethodsA total of 178 female patients undergoing painless abortion surgery were enrolled to the current study. The patients were aged 18–45 years, had a body mass index (BMI) of 18–28 kg m− 2 and a class I or II physical status as determined using the American Society of Anesthesiologists (ASA) system. Patients were randomly assigned to four groups as follows: group F (n = 45) in which patients underwent intravenous (IV) administration of 1 μg kg− 1 fentanyl followed by IV administration of 2 mg kg− 1 propofol, and group EL, group EM and group EH (n = 45, 44, 44) with patients receiving IV administration of 0.2 mg kg− 1, 0.25 mg kg− 1, 0.3 mg kg− 1 esketamine, respectively, followed by IV administration of 2 mg kg− 1 propofol. The primary outcome of the study was the incidence of hypotension whereas secondary outcomes included incidence of adverse events, perioperative changes of vital signs, anesthesia induction time, recovery time and dischargeable time, propofol addition, as well as patient, surgeon and anesthesiologist satisfaction levels.ResultsThe findings showed that the incidence of hypotension was significantly lower in subjects in group EL, group EM and group EH (0, 0, 0%) relative to the incidence in patients in group F (20%) (χ2 = 19.648; P = 0.000). In this study, the incidence of hypoxia of subjects in group EL, group EM and group EH (0, 2.3, 2.3%) was significantly lower compared with that of patients in group F (11.1%) (χ2 = 8.622; P = 0.035). The findings indicated that the incidence of somatic motor reactions was significantly lower in participants in group EM and group EH (9.1, 4.5%) relative to that of patients in group F and group EL (26.7, 15.6%) (χ2 = 10.254; P = 0.016). The results showed that the incidence of nausea and vomiting and potential psychiatric symptoms were significantly higher in patients in group EH (15.9, 11.4%) compared with that of participants in group F (2.2, 0%), group EL (4.4, 0%) and group EM (2.3, 2.3%) (χ2 = 7.493; P = 0.038 and χ2 = 8.248; P = 0.003). In this study, the mean arterial pressure (MAP) and heart rate (HR) of subjects in group EL, group EM and group EH were more stable compared with that of patients in group F. Frequency of the additional propofol dose was markedly less in group EM and EH (26.7%, 17,8%) compared with that in group F and EL (9.1, 4.5%) (χ2 = 10.254; P = 0.016). The findings indicated that the dischargeable time was significantly shorter for patients in group EM compared with that of subjects in group F, group EL and group EH.ConclusionsThe findings of the present study showed that single-dose esketamine (0.25 mg kg− 1) effectively decreased incidence of hypotension and total adverse events and reduced the frequency of additional propofol dose required for patients undergoing painless abortion with preservation of physician-patient satisfaction.

In-silico patient-specific and patient-appropriate engineering method to judiciously select an ameliorative implant design in a single-patient using finite element-n-of-1 (fe-n-of-1) empirical test analysis to reconstruct mid-sagittal osteochondrotomy of the sternum following cardiac surgery

Introduction: No two patients have similar normal anatomy and physiology because of genetics, physical development, and age that the same type of surgery and reconstruction implant will perform equally well. Such a notion demands the need for individualization of treatment and a method to select an ameliorative implant prospectively. One such empirically testing method is the finite element-n-of-1 (fe-n-of-1), where a treatment plan is executed specifically and systematically for a single patient as part of pre-operative planning. Objective: It is to evaluate and discuss the method of finite element analysis to carry out the fe-n-of-1 empirical test in a fact-driven manner connecting various scientific domains. It presents a preliminary protocol how to select an ameliorative implant to mitigate sternal instability due to suboptimal standard stainless-steel cerclage wiring to reconstruct the sternum following open-heart surgery. Methodology: The instability following the reconstruction of the sternum is a mechanical problem therefore it is appropriate to apply harmless structural engineering methods to choose a suitable implant design to fix it. This exploratory descriptive research describes finite element n-of-1 empirical testing using in-silico engineering principles applied to patient-specific and patient-appropriate mechanical loading conditions. Conclusion: Single-patient fe-n-of-1 empirical testing is a benign engineering method based on finite element modeling and finite element analysis. It is a safe mathematical evaluation free from subjective bias to select in advance the most ameliorative implant design to opt out of the suboptimal stainless steel cerclage wire as ‘standard of care’ and improve patient-based outcome and surgeon satisfaction.

Effect of Dexmedetomidine Added to Lidocaine Cartridge on the Level of Patient Sedation, Cooperation, and Patient and Surgeon Satisfaction during Mandibular Third-Molar Extraction Surgery: A Randomized Double-Blind Controlled Trial.

Background Various methods have been introduced for anxiety control during third-molar extraction surgery. Dexmedetomidine (DEX) is known to have analgesic, anxiolytic, and sympatholytic properties with minimal adverse effects. This study aimed to evaluate the impact of the local injection of the combination of DEX and Lidocaine on patients' anxiety and the surgeon's satisfaction during third-molar extraction surgery. Methods A total number of 26 healthy volunteers with symmetrical bilateral impacted mandibular third-molar teeth indicated for surgical removal were included in this double-blind randomized controlled trial. A single experienced surgeon performed two surgical extraction procedures within at least four-week time intervals using anesthetic cartridges containing “DEX + LIDO” or “LIDO alone” used randomly on each side for each patient. The Visual Analog Scale and the SDFQ index were used to evaluate patients' anxiety and surgeon satisfaction during the procedure. Results SDFQ reports showed that patients in the “DEX” group were 1.5 times more relaxed than those in the “LIDO alone” group. As a result, the level of sedation was considered statistically significant between the two groups (Wilcoxon test, P value <0.019). Wilcoxon test results also showed significant differences between the two groups regarding patients' overall cooperation in terms of interfering movement and verbal presentation of discomfort (P value <0.05); however, this difference was not considered significant regarding nonverbal signs of discomfort (P value >0.05). Moreover, both the surgeon and the patients reported a significantly higher satisfaction rate in the DEX group (paired T-test, df = 25, P value <0.05). Conclusions It was inferred from the outcomes of the present study that the application of DEX added to the LIDO local anesthesia cartridge could significantly benefit anxious patients with previous unpleasant dental treatment experiences. Trial Registration. This trial is registered with the clinical trial registration number: IRCT20200406046966N.

Comparative study of the effect of two different doses of remifentanil on bleeding control in lumbar fusion surgery: A randomized clinical trial.

ObjectivesSpinal fusion surgery completely prevents movement or friction between the two vertebrae. Remifentanil, a selective drug agonist, suppresses and decreases the vasomotor system upon release of histamine. In this study, the efficacy of remifentanil infusion at doses of 0.1 and 0.3 μg/kg/min in the control of low blood pressure was compared.MethodsIn this randomized clinical trial, 110 candidates for selective spinal fusion surgery were entered and randomized into 2 groups. The first group received 0.1 μg/kg/min and in the second group 0.3 μg/kg/min remifentanil. The systolic and diastolic blood pressure, pulse rate, SPO2, and surgeon's satisfaction were measured and compared between groups.Resultsthe systolic blood pressure was significantly lower in patients receiving 0.3 μg of remifentanil by the time 30, 45, 60, and 90 min during the surgeries (P < 0.05). No significant difference was observed in terms of PR (P = 0.19) and SPO2 (P = 0.41) between the two groups. We also observed significantly higher duration of surgeries (P = 0.002), duration of anesthesia (P = 0.009), significantly higher bleeding volume (P < 0.001), higher fluid intake (P = 0.01) and higher transfused blood (P = 0.01) in patients that received 0.1 μg remifentanil compared to other patients.ConclusionHere we showed that administration of 0.3 μg/kg/min remifentanil was associated with significantly lower systolic blood pressure during the surgeries. On the other hand, patients that received 0.1 μg/kg/min remifentanil had significantly higher duration of surgeries, duration of anesthesia, significantly higher bleeding volume, higher fluid intake, and also higher transfused blood.

Robust Multi-Objective Supply Chain Optimization of Surgical Supplies Considering Costs and Satisfaction of Surgeon, and ranking Suppliers Using ARAS Method

Robust Multi-Objective Supply Chain Optimization of Surgical Supplies Considering Costs and Satisfaction of Surgeon, and ranking Suppliers Using ARAS Method

Evaluation of continuous intravenous lidocaine on brain relaxation, intraoperative opioid consumption, and surgeon's satisfaction in adult patients undergoing craniotomy tumor surgery: A randomized controlled trial.

In craniotomy tumor removal, brain relaxation after dura opening is essential. Lidocaine is known to have analgesic and antiinflammatory effects. It is excellent in decreasing cerebral metabolic rate of oxygen, cerebral blood flow, and cerebral blood volume; and can potentially reduce intracranial pressure, resulting in exceptional brain relaxation after dura opening. However, no study has examined continuous intravenous lidocaine infusion on brain relaxation, intraoperative opioid consumption and surgeon's satisfaction in adult patients undergoing craniotomy tumor removal. A total of 60 subjects scheduled for craniotomy tumor removal were enrolled in a double-blind, randomized controlled trial with consecutive sampling. Patients received either an intravenous bolus of lidocaine (2%) 1.5 mg/kg before induction followed by 2 mg/kg/h continuous infusion up to skin closure (lidocaine group) or placebo with similar volume (NaCl 0.9%). Neurosurgeons evaluated brain relaxation and surgeon's satisfaction with a 4-point scale, total intraoperative opioid consumption was recorded in μg and μg/kg/min. All sixty subjects were included in the study. Lidocaine group showed better brain relaxation after dura opening (96.7% vs 70%; lidocaine vs placebo, P < .006), less intraoperative fentanyl consumption (369.2 μg vs 773.0 μg; P < .001, .0107 vs .0241 μg/kg/min; lidocaine vs placebo, P < .001). Higher surgeon's satisfaction was found in lidocaine group (96.7% vs 70%, P = .006). No side effects were observed during this study. Continuous lidocaine intravenous infusion improves brain relaxation after dura opening, and decreases intraoperative opioid consumption, with good surgeon satisfaction in adult patients undergoing craniotomy tumor removal.

Evaluation of the Effects of Using Buccal Fat Pad on Dorsum Changes: A Randomized Clinical Trial

Background: Irregularity of the dorsum is one of the common complications in rhinoplasty. Today, various methods are used to correct the irregularity of dorsum. This study was conducted to determine the effects of using Buccal Fat pad on dorsum changes. Methods: In a randomized clinical trial, 20 patients undergoing primary rhinoplasty with open technique were randomly assigned to the intervention and control groups. In intervention groups, after the end of the osteotomy and before the skin is sutured, A layer of buccal fat was placed on the dorsum and fixed. In the control group dorsum region without the use of buccal fat was sutured. Both groups followed for six months and were assessed regarding, dorsum changes and satisfaction of dorsum aesthetic. Results: In the intervention and control groups, the mean age of patients was 26.60 ±3.92 and 25.90 ±4.38 years, respectively (P = 0.711). In terms of gender, 70% of patients in the intervention group and 80% in the control group were women. The frequency of nasal asymmetry, nasal depression, dorsum narrowing, step and nasal width in the intervention and control groups were 20% and 50% (P = 0.350). The mean score of patient satisfaction and surgeon satisfaction with the beauty of the bridge of the nose in the intervention group was significantly higher than the control group (P &lt;0.05). Conclusion: Using Buccal Fat pad on dorsum during primary rhinoplasty, in addition to reducing changes in dorsum, increases the satisfaction of dorsum beauty.

Intraoral Approach to Fat Grafting Based on the Mimetic Muscle Unit.

Recently, the concepts of anatomic-based fat grafting and mid-facial anatomy have been studied. However, there is no clear consensus on the optimal fat grafting technique. We aimed to introduce a novel intraoral approach to fat grafting based on mid-facial mimetic muscles, wherein a substantial amount of fat was injected into appropriate locations to increase patient satisfaction and decrease the need for additional surgical techniques. Sixty-four Asian women (mean age, 41.2 y) who had undergone fat grafting through the intraoral approach between 2014 and 2019 were enrolled. We sequentially performed the following steps: fat harvesting, centrifugation, and fat injection. All patients were followed at an outpatient clinic for 6 to 12 months. We obtained photographs of their face before and at 3 and 6 months postoperatively and conducted a 5-point scale questionnaire survey at the 2 time points postoperatively to evaluate the satisfaction of patients and surgeons. We divided the mid-facial areas into malar eminence, infraorbital, and nasolabial fold areas and evaluated the following items: volume consistency, softness, irregularity, and overall satisfaction. Patients reported "satisfactory" for the postoperative results. There were only 2 cases of complication among the 64 cases which resolved spontaneously. The highest and lowest satisfaction were reported for the malar eminence and nasolabial fold areas, respectively. Fat grafting through the intraoral approach based on the mimetic muscle unit is an effective and safe method for mid-facial rejuvenation.

Effects of a fixed nurse team in the orthopaedic surgery operating room on work efficiency and patient outcomes: a propensity score-matched historically controlled study

BackgroundThe work value of operating room (OR) nurses is directly reflected in nursing quality. However, evaluating the work value of these nurses has not been sufficiently investigated. This study evaluated the effects of a fixed nurse team (FNT) in an orthopaedic surgery OR on work efficiency and patient outcomes.MethodsA propensity score-matched historically controlled study conducted from 1 July 2015 to 30 June 2018 was used to investigate the difference in nursing quality between an FNT period and a non-FNT period in the orthopaedic surgery OR at a tertiary care hospital in China. The primary outcome was surgical site infections (SSIs) during in-hospital visits, and as a secondary outcome, other nursing-sensitive quality indicators were assessed with historically controlled data. A multifactor logistic regression model was constructed to examine the primary outcome differences between the FNT and non-FNT periods before and after propensity score matching.ResultsIn total, 5365 patients and 33 nurses were included in the final analysis. The overall SSI rate was 2.1% (110/5365; the non-FNT period 2.6% [64/2474], the FNT period 1.6% [46/2891]). A lower incidence of SSIs in patients (odds ratio 0.57, 95% CI 0.36 to 0.88, P=0.013), a lower turnover time of the surgical procedure (odds ratio 0.653, 95% CI 0.505 to 0.844, P<0.001), and improvement in surgeon satisfaction (odds ratio 1.543, 95% CI 1.039 to 2.292, P=0.031), were associated with the FNT period compared with the non-FNT period. However, we did not find significant differences between the FNT period and the non-FNT period in terms of the other indicators.ConclusionsThe presence of an FNT in an OR reduces the incidence of SSIs in surgical patients and the turnover time of surgical procedures and improves surgeon satisfaction. Further implementation of an advanced-practice nurse model with nurse specialists is encouraged.

A Prospective, Randomized, Controlled Comparison of Adhesive Wound Closure Devices in an Orthopaedic Patient.

Introduction:The objective of this study was to compare Zip and Clozex with a typical closure using a running 3-0 Prolene suture.Methods:A prospective, randomized, controlled trial was conducted in patients aged 18 years and older undergoing elective orthopaedic surgical procedures between 2019 and 2021. Patients were randomized to undergo skin closure using a running 3-0 Prolene suture, Zip, or Clozex. The length and location of incision, time to close, surgeon satisfaction, and complications were recorded. The Stony Brook Scar Evaluation Scale (SBSES) was used to assess cosmesis at 2 weeks and 3 months postoperatively. Patient satisfaction and adverse events were also recorded.Results:Thirty-two patients were included in the analysis. Suture closure time was longer than Zip (266 vs 123 seconds; P = 0.02) and Clozex (266 vs 91 seconds; P = 0.005). SBSES scores were greater for Clozex at 2 weeks compared with suture (4.09 vs 2.8; P = 0.005). At 3 months, Clozex maintained greater scores compared with suture (3.82 vs 2.85; P = 0.023) and Zip (3.82 vs 3.0; P = 0.046).No differences were observed in patient satisfaction at any time points.Discussion:Although patient satisfaction was similar across groups, wound closure times, SBSES scores, and total cost favor Clozex compared with Prolene suture or Zip.ClinicalTrials.gov Registration Number:NCT05251064

COBLATION TONSILLECTOMY VERSUS DISSECTION TONSILLECTOMY IN MANAGEMENT OF PATIENTS WITH CHRONIC TONSILLITIS

BACKGROUND: Tonsillectomy is the most routinely performed surgical operation in the recent years. There have been lots of controversies about tonsillectomy techniques to provide better conditions with more benefits and less complications. Coblation tonsillectomy is an advanced surgical technique and demands further research to be proven as a suitable and standard method of tonsillectomy. For more than a century, traditional dissection tonsillectomy has remained the gold standard for tonsil removal. &#x0D; OBJECTIVE: The objective of this study is to compare mean operation time and blood loss after radiofrequency coblation tonsillectomy versus dissection tonsillectomy in management of patients with chronic tonsillitis&#x0D; RESULTS: The mean age of cases in this study was 33.78±16.21 years with 56(46.67%) male and 64(53.335) female cases in this study. In dissection group mean blood loos was 143.63±34 mL and in Coblation group the mean blood loos was 113.45±24.61 mL, p-value &lt; 0.001. The mean surgery time in dissection group was 40.08±6.64 minutes and in Coblation group was 32.62±4.21 minutes with significantly less in Coblation method when compared with dissection group, p-value &lt;&#x0D; 0.001. &#x0D; Conclusion: Through the findings of this study we found that radiofrequency Coblation yields less mean operation time and mean blood loss when compared with dissection tonsillectomy in management of patients with chronic tonsillitis. Using radiofrequency Coblation better outcome can be achieved along with patient’s and surgeons satisfaction.

Comparison of nalbuphine and propofol verses pentazocine and promethazine in tympanoplasty surgeries under monitored anesthesia care

Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P&lt;0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field.

A randomised comparative study of desflurane and sevoflurane with esmolol to evaluate hemodynamic parameters and recovery characteristics in middle ear surgery

To produce a blood less field for middle ear surgery performed with operating microscope, controlled hypotention is essential which achieve by means of Inhalational agents and Esmolol.The goal of the study was to assess the effects of Desflurane and Sevoflurane vs esmolol in terms of creating controlled hypotension, intraoperative blood loss, surgeon satisfaction with the surgical field, and complications. From December 2019 to July 2021, a prospective, randomised, double-blind trial was undertaken. A total of 100 patients, ranging in age from 18 to 60 years, were recruited and had elective middle ear procedures in the Department of Oto-rhino-laryngology operating theatre. Simple randomization (computer-generated) was used to divide the patients into two groups: Group S and Group D. Inj. Esmolol 0.5 mg/kg was administered as a loading dose, followed by a continuous infusion, and Propofol 2 mg/kg was used to produce anaesthesia. Inj. Vecuronium (0.1mg/kg) was administered to help with laryngoscopy and intubation. Oxygen, Nitrous oxide, Sevoflurane 1-3 percent (Group S) or Desflurane 3-6 percent (Group D) and intermittent InjVecuronium (0.05 mg/kg) were used to maintain anaesthesia. Intraoperative haemodynamics, six-point bleeding score, surgeon satisfaction, and postoperative Aldrete recovery score were all observed. Microsoft Excel was used to input and evaluate the data.When comparing Group S to Group D, haemodynamic measures were significantly different (p value 0.05). When comparing Group S to Group D, the six-point bleeding score and surgeon satisfaction score were considerably higher in Group S (p value 0.05). Within 5 minutes of surgery, 100% of patients in Group D and 76% of patients in Group S had achieved an aldrete score of 9,10.In middle ear surgery, sevoflurane produces more controlled hypotension. When compared to the Desflurane group, the sevoflurane group had superior surgical field vision and a higher surgeon satisfaction score. When compared to the Sevoflurane group, the Desflurane group had a superior post-operative Aldrete recovery score.

Comparison of the Effect of Injectable Tranexamic Acid and Inhaled Desmopressin in Controlling Bleeding and Ecchymosis in Open Rhinoplasty.

Bleeding during rhinoplasty surgery has a negative effect on the quality of surgery; so, it is important to reduce bleeding during rhinoplasty. We aimed to evaluate the effect of injectable tranexamic acid (TXA) and nasal spray of desmopressin (DDAVP) on reduction in intraoperative bleeding and ecchymosis after open rhinoplasty. In a Randomized Clinical Trial ( RCT) prepared since 2020 to 2021 in Razi Hospital and Imam Khomeini Hospital, Tehran, Iran on 42 patients who underwent open rhinoplasty were divided into three groups. In the first group, TXA was injected one hour before surgery at a dose of 10 mg / kg with a placebo inhalation spray. In the second group, DDAVP was administered as a nasal spray at a dose of 40 mcg with a placebo injection. The third group received a placebo spray and placebo injection. All required data were gathered and analyzed. In TXA group and DDAVP groups, the volume of bleeding during surgery significantly (P=0.022) decreased compared to placebo group, also, the quality of the surgical field and the surgeon's satisfaction significantly (P=0.007) improved compared to the placebo group but not with each other. Unlike placebo group, there were no reports of postoperative bleeding in the TXA and DDAVP groups. Duration of surgery, ecchymosis on the day after surgery and coagulation tests before and after surgery were not significantly different in three groups. Use of DDAVP and TXA can both reduce the amount of bleeding during surgery and postoperative bleeding in rhinoplasty and improve the quality of the surgical field and the surgeon 's satisfaction during surgery.