Ambulation Time Research Articles

Preliminary application results of laparoscopic assisted proximal gastrectomy λ-shaped double tract anastomosis

Objective: To share the results of laparoscopic assisted proximal gastrectomy λ- shaped modified double tract reconstruction. Method: This study retrospectively included 3 patients during January 2024 from the Department of Gastric Surgery at the First Affiliated Hospital of Nanjing Medical University using the λ-shaped modified double tract reconstruction. The procedure of the λ-shaped modified double tract reconstruction is as follows. After completing proximal gastrectomy, the jejunum is transected 15 cm from the Treitz ligament. A suture is made 18-20 cm from the distal jejunum to mark the esophagojejunal anastomosis site. A circular stapler anvil is inserted through the distal jejunum, and the remaining end of the jejunum is turned to the right. The circular stapler is pierced through the marked site for an esophagojejunal end-to-end anastomosis, which is reinforced with a barbed suture continuously. A 60mm linear stapler is used to close the remaining end of the jejunum. We then mark the gastric side of the gastrojejunal anastomosis with suture in the middle of the anterior wall of the residual stomach, and mark the jejunal side of the gastrojejunal anastomosis at a distance of about 2 cm and 8 cm from the residual end of the distal jejunum. We make an opening of about 0.5 cm and use a 60 mm linear stapler to perform anastomosis on the jejunal side of the anterior wall of the residual stomach according to the markings, so that the distance between the esophagojejunal anastomosis and the gastrojejunal anastomosis is 10-12 cm. The common opening is closed with barbed wire. About 50 cm below the esophagojejunal anastomosis, the small intestine opening is anastomosed side to side using a circular stapler and the common opening is closed. Return the jejunum into the abdominal cavity to complete the reconstruction of the λ-shaped double tract reconstruction. We analyzed the surgery and postoperative conditions, including surgery time, anastomosis time, intraoperative bleeding, tumor size and pathology, postoperative mobilization, passage of gas and water intake time, discharge time, postoperative complications, and postoperative gastrointestinal imaging to observe the passage of food through the gastric and intestinal loops. Results: Three patients successfully received laparoscopic assisted proximal gastrectomy with λ-shaped modified double tract reconstruction. The surgical time was 155 minutes, 240 minutes, and 160 minutes, respectively; The postoperative time for first ambulation was 20 hours, 18 hours, and 26 hours, respectively. The time for passage of gas was 59 hours, 83 hours, and 75 hours, respectively. The drinking time was 66 hours, 87 hours, and 90 hours, respectively. The postoperative discharge days were all 7 days. No surgical related complications occurred. On the 6th day and 3 months after surgery, gastrointestinal angiography was performed. The contrast agent passed smoothly through the jejunal loop and residual stomach jejunal loop, and both sides were unobstructed. No contrast agent was found to retrograde to the esophagojejunal anastomosis. Conclusion: Laparoscopic assisted proximal gastrectomy with λ-shaped modified double tract reconstruction is safe and feasible, as it improves the diversion of food through the residual stomach while ensuring anti-reflux effects.

Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.

The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge. All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h. With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005). Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.

Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery

Objective: To evaluate the clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Method: This was a retrospective study. A total of 120 patients with cervical cancer undergoing radical surgery at Tangshan People’s Hospital from June 2021 to June 2023 were randomly divided into two groups (n=60 cases each group). The control group received routine nursing intervention, while the study group was provided with comprehensive nursing intervention. Comparative analysis was conducted on clinical indicators, postoperative complications, bladder and pelvic floor function recovery, and patient satisfaction before and after intervention in both groups. Result: In the study group, ambulation time, gastrointestinal function recovery, duration of postoperative drainage tube placement, oral diet resumption time, duration of postoperative vaginal bleeding, and length of hospital stay were significantly shorter than in the control group (all p&lt; 0.05). Bladder function recovery in the study group was superior to that in the control group (p&lt; 0.05). The study group showed lower scores for anorectal disorders, urogenital disorders, and pelvic organ prolapse than the control group (p&lt; 0.05, respectively). Patient satisfaction was 100% in the study group and 85% in the control group, suggesting a statistically significant difference between the two groups (p&lt; 0.05). Conclusion: Comprehensive nursing intervention deserve to be promoted as it can accelerate postoperative clinical recovery, reduce the incidence of surgical complications, improve pelvic floor and bladder function post-cervical cancer surgery, and enhance patient satisfaction with care. doi: https://doi.org/10.12669/pjms.40.10.9271 How to cite this: Zhao Q. Application and clinical efficacy of comprehensive nursing intervention in pelvic floor and bladder function recovery post-cervical cancer surgery. Pak J Med Sci. 2024;40(10):2287-2292. doi: https://doi.org/10.12669/pjms.40.10.9271 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture.

Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures. The data of 31 patients with odontoid fractures who underwent PRTF through intermuscular approach were retrospectively reviewed. Operation time, intraoperative blood loss, the time of ambulation and surgery-related complications were recorded. After fracture healing, the instrumentation was removed. The Japanese Orthopedic Association score, Visual Analog Scale score for neck pain, and patient satisfaction were recorded. The range of motion in rotation of C1-C2 was calculated 1 month after removing the instrumentation. Fracture healing was observed in all patients, and the instrumentation was removed. After removing the instrumentation, the range of motion of C1-C2 in rotation was returned to 35.6° ± 4.8°. Patient satisfaction was improved (P < .05). There was no significant difference in Japanese Orthopedic Association scores and Visual Analog Scale score for neck pain between 2 values before and after removing the instrumentation (P > .05). No osteoarthritis was observed at the C1-C2 lateral mass joints. There were no perioperative complications. PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.

Ultrasound-guided Genicular Nerve Block in Patients Undergoing Knee Arthroscopy: A Randomized Controlled Trial

This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into two groups: 1. nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral and inferomedial genicular nerve, 2-ml 0.5% ropivacaine each nerve.) prior to the general anesthesia, 2. control group: no intervention prior to the general anesthesia. The measurements were pain severity at 3,6, 12, 24, 48, and 72 hours after surgery at rest and at activity(Pain severity was primary outcome at 3 hours after surgery at rest); the time for first ambulation; straight leg raise; mechanical pain threshold of the block areas; time of the surgery, anesthesia and extubation; the use of analgesics in the perioperative period and 72 hours after the surgery; the number of patients awakening from pain on the first two nights after the surgery; the length of hospital stay; postoperative adverse effects. The pain severity was performed by VAS (A 10-point visual analogue scale, 0 points painless, 10 points severe pain) and median (interquartile range; IQR). A total of 70 patients (median age: 53 y, 32 men; 35 per group) were included. Compared to the control group, the nerve block group had a lower pain VAS score at rest (2[2-2] vs. 3[2-4], P&lt;0.01) at 3 hours, and lower pain VAS score at rest persisted for 24 hours and activity persisted for 12 hours after the surgery, also had lower intraoperative dosage of sufentanil (20±4.8 vs. 28.5±5.1 mg; P&lt;0.001), lower requirement for analgesics for pain and lower PONV (postoperative nausea and vomiting) throughout the 72-hour observation period. There were no significant difference for the incidence of postoperative adverse effects and straight leg raise. In conclusion, ultrasound-guided genicular nerve block could reduce the pain severity after knee arthroscopy and decrease the use of intraoperative sufentanil without affecting motor function.

Association of depression in multiple sclerosis with fatigue, sleep disturbances, disability, and health-related quality of life: Outcomes of a cross-sectional study.

IntroductionDepression affect individuals with multiple sclerosis (MS) more frequently compared with the general population. It can worsen the symptoms of MS, influence disability progression, and significantly reduce the quality of life (QoL). MethodWe investigated the prevalence of depressive symptoms in a cohort of 200 patients with MS (76% women) and their association with sleep patterns, fatigue, QoL, demographics, and other clinical characteristics in real-world settings. The study was conducted through clinical evaluations and questionnaires related to depression: Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS); fatigue: Modified Fatigue Impact Scale (MFIS); sleep quality: Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS); and QoL: Multiple Sclerosis Quality of Life-54 (MSQOL-54). ResultsAccording to the BDI and HDRS, the prevalence of depressive symptoms was 40.5 and 28.27%, respectively. Patients with depressive symptoms exhibited higher disability scores, longer ambulation times, worse cognitive function in the SDMT and poorer sleep quality. They also had significantly higher fatigue and daytime somnolence scores, as well as lower scores on the MSQOL-54: physical (40.55 vs. 62.3; p < 0.001) and mental (44.49 vs. 71.89; p < 0.001) health composites. We demonstrated the correlation between depression and fatigue, as well as their negative impact on QoL in patients with MS. ConclusionThis study underscores the prevalence and impact of depression in MS, emphasizing the importance of routine screening and active management of psychiatric comorbidities in individuals with MS. These findings contribute valuable insights into the complex interplay between mental health, disease variables, and QoL in MS.

Comparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease

BackgroundThis study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches.MethodsFrom January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion.ResultsThere were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups.ConclusionThere was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient’s financial situation, their ability to tolerate surgery, and the surgeon’s expertise.

ESR Essentials: arterial vascular access and closure devices-practice recommendations by the Cardiovascular and Interventional Radiological Society of Europe.

Vascular access is the initial, very important, step of endovascular procedures. Various access sites include the common femoral artery, brachial artery, radial artery, popliteal artery, and distal tibial vessels (pedal arteries). Successful arterial access requires advanced knowledge of anatomy, as well as proper training and experience. Today, vascular access should be obtained using real-time, ultrasound guidance to reduce access time, patient discomfort, and puncture-related complications including dissection, arteriovenous communication, and bleeding. Nevertheless, high-level evidence to support this recommendation in peripheral procedures is limited and level A data are mainly derived from randomized cardiac trials investigating only radial and femoral access. Vascular closure devices (VCDs) for femoral access can be broadly categorized as active closure devices, compression assist devices, and external/topical hemostasis devices. There is high-level evidence demonstrating that their use is related to less time for ambulation and increased patient satisfaction. However, available data failed to clearly demonstrate a benefit in complications compared to standard manual compression in peripheral endovascular arterial procedures, and thrombotic and infectious complications reported following VCD use remain an issue. Heterogeneity noted in the literature, caused by the vast variety of devices, access sites, sheath sizes, clinical scenarios, and procedures, poses difficulties in data analysis and future study design. As a result, an individualized VCD use is currently suggested for ≥ 5 Fr femoral artery access not only to reduce time to hemostasis and ambulation and to improve patient comfort, but also to reduce bleeding complications in cases of femoral access with increased bleeding risk, deranged coagulation, and large-bore access, though a high level of evidence to support this later recommendation is limited. KEY POINTS: US guidance is strongly recommended for femoral access and is mandatory to obtain more challenging access. The use of VCDs for femoral hemostasis is generally safe, effective, and currently supported by level I evidence. Proper training and correct VCD choice, based on the patient's individual characteristics, are imperative to optimize outcomes.

Clinical application of a modified wiltse approach in middle and lower thoracic vertebrae: a case-control study of thoracic fracture patients

BackgroundThe Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage.MethodsFrom May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb’s angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI).ResultsCompared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb’s angle, or postoperative PAVBH.ConclusionWe propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae.

The application of ERAS in the perioperative period management of patients for lung transplantation

ObjectiveTo explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation. MethodsWe retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores. ResultsComparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05). ConclusionThe ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.

Risk Factors for Postoperative Delirium in Thoracic Surgery Patients – A Prospective Cross-sectional Study

Background: Postoperative delirium (POD) is a common complication that affects the prognosis and outcome. The risk factors of different surgical types have significance in preventing POD. Still, there are few studies on the risk factors for this complication of thoracic surgery, and further research and exploration are necessary. Method: This study intends to conduct a prospective cross-sectional study, including patients undergoing elective thoracic surgery. The primary outcome is the incidence of POD 1-7 days after surgery or before discharge. The essential information on patients, surgery, anesthesia, and postoperative details are gathered for statistical analysis. We are exploring the potential relationship between anesthesia-related factors and POD. Result: One hundred seventy-five patients were included in this study, and 17 (9.7%) patients developed POD. Univariate analysis showed that age-adjusted Charlson Comorbidity Index (aCCI), educational attainment, blood transfusion, artificial blood vessel replacement, and indwelling urinary catheter were statistically different. Logistic regression results showed that the aCCI index (OR 1.811, 95% CI 1.058-3.103; P=0.030), the ambulation time (OR 12.303, 95% CI 2.670-56.686; P=0.001) increased POD risk. In patients undergoing thoracotomy, blood transfusion (RR 16.875, 95% CI 2.149-132.508; P=0.012) was statistically different between POD and non-POD groups. Conclusion: The results of this study showed that the higher the aCCI index, the later the ambulation time is the risk factor for POD in thoracic surgery patients. The risk of POD may be heightened in thoracic surgery patients who require a blood transfusion. However, additional research is warranted to confirm these findings.

Orthopedic robot-assisted endoscopic transforaminal lumbar interbody fusion for lumbar disc herniation with lumbar instability

To explore the safety and effectiveness of the robot-assisted system for transforaminal percutaneous endoscopic in the treatment of lumbar disc herniation with lumbar instability. From October 2021 to March 2023, 26 patients with single-segment lumbar disc herniation and lumbar spinal instability were treated with robot-assisted system for transforaminal percutaneous endoscopic. The operation time, intraoperative blood loss, incision length, postoperative drainage volume, postoperative ambulation activity time, postoperative hospitalization time were record. The intervertebral space height and the lumbar lordosis angle before and after surgery were observed and compared. Pain level was evaluated using the visual analogue scale(VAS). The clinical efficacy was evaluated by Oswestry disability index(ODI). The interbody fusion was evaluated by Brantigan Steffee criteria. All patients successfully completed the operation, the operation time ranged form 105 to 109 min with an average of (150.8±24.1) min. Intraoperative blood loss ranged form 35 to 88 ml with an average of (55.5±16.4) ml. Incision length ranged form 1.4 to 3.5 cm with an average of (2.3±0.8) cm. Postoperative drainage volume ranged form 15 to 40 ml with an average of (28.5±7.8) ml. Postoperative ambulation time ranged form 15 to 30 h with an average of (22.8±4.5) h. Postoperative hospitalization time was 3 to 7 d with an average of (4.2±1.3) d. Total of 26 patients were followed up, the duration ranged from 12 to 16 months with an average of (14.0±1.3) months. The VAS and ODI at 1 week [(2.96±0.72) points, (41.63±4.79)%] and 12 months[(1.27±0.60) points, (13.11±2.45)%] were significantly different from those before surgery[(6.69±0.93) points, (59.12±5.92)%], P<0.01. The height of the intervertebral space (11.95±1.47) mm and lumbar lordosis (57.46±7.59)° at 12 months were significantly different from those before surgery [(6.67±1.20) mm, (44.08±7.79)°], P<0.01. At 12 months after surgery, all patients had no pedicle screw rupture or dislocation of the fusion cage, and the intervertebral fusion was successful. According to Brantigan-Steffee classification, 17 cases were grade D and 9 cases were grade E. Robot-assisted system for transforaminal percutaneous endoscopic for the treatment of single-segment lumbar disc herniation with lumbar instability improved the accuracy and safety of the operation, and the clinical effect of early follow-up is accurate.

Neuraxial Analgesia for Scoliosis Correction: A Case Series in a Specialised Children's Centre.

Surgical correction of spinal deformities in children presents a challenge to the anaesthetist due to the extensive nature of the surgery, the co-morbidities of the patients and the constraints on aesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Patients undergoing scoliosis surgery are considered to suffer severe pain, which may lead to a negative impact on patient psychology and physical well-being. By using effective postoperative pain regimens to enhance recovery after surgery, pain can be significantly reduced, leading to patient satisfaction, facilitating early mobilisation, promoting oral intake, lowering postoperative pain and shortening the length of hospital stay. Thus, the primary objectives of this study were to assess the postoperative pain management andfirst rescue analgesic medications, by using preservative-free morphine 50 mcg/kg and dexmedetomidine 4 mcg along with normal saline 0.5 ml kg caudally, as well as to look for thesecondary objectivesside effects, including respiratory depression, nausea, vomiting and pruritis, timing of postoperative ambulation and length of hospital stay. Methods: In this study, we retrospectively included children under 14 years of age and above three years who underwent scoliosis surgery under a caudal epidural-general anaesthesia using caudal morphine and the dexmedetomidine technique in the period from January to May 2023 at the National Guard Health Affairs Hospital (NGHA), Riyadh. We collected the data of seven cases using the electronic chart system of the Best Care database to extract the specific cases that meet the inclusion criteria for the study, which are idiopathic scoliosis patients, aged 3-14 years, and primary correction procedures. Results: The pain-free duration was between seven hours and 48 hours (about two days). There were four female cases (57.14%), and three cases were male (42.85%). The patients' American Society of Anesthesiologists (ASA) status were II to III. In all the cases, there was no documentation of any episodes of postoperative nausea and vomiting (PONV), respiratory distress or pruritus, except for one case where the patient had an episode of PONV. Conclusion: In this study, our aim was to present our experience with dexmedetomidine as an efficient medication when coadministered with morphine to be used in the operating room. We found a high level of reliability in prolonging analgesia time and delaying the usage of rescue medication. We encourage more studies on caudal dexmedetomidine for patients undergoing scoliosis surgery.

Feasibility, safety, and efficacy of a novel external compression vascular closure device: The LockeT® study.

Hemostasis following large-bore femoral vein access remains a challenge. Manual compression has been the standard of care but requires bedside staff, prolonged bed rest, and longer length of stay. The LockeT is an external compression device that attempts to address these issues while achieving venous hemostasis. We evaluate postprocedural hemostasis and vascular closure outcomes after using LockeT following cardiac electrophysiologic procedures. We performed a single-center, observational study of patients who underwent vascular closure for electrophysiology procedures using LockeT. Postprocedural outcomes were subsequently analyzed. We studied 102 patients (N) for whom LockeT was used to close 182 separate vascular access sites (n). Common procedures were atrial fibrillation ablation (56.9%, N = 58) and left atrial appendage occlusion (28.4%, N = 29). Most often, 8-Fr [48.3% (n = 126)], 11-Fr [27.2% (n = 71)], and 8.5-Fr [16.9% (n = 44)] sheaths were used, with an average procedure time of 82.1 ± 29.4 min. Hemostasis was achieved in 97.8% (n = 187) of all LockeT cases. Time to ambulation and discharge were 3.93 ± 1.10 hand 8.1 ± 4.4 h, respectively. No major complications were noted. Postprocedurally, 52% (N = 53) of patients were discharged on the same day. There were no differences in hemostasis (p = .859) or ambulation times (p = .202) between procedure types. The LockeT can effectively close venous access sites with no major complications.

Suture closure AFtEr large bore vein access (SAFE-VEIN): A randomized, prospective study of the efficacy and safety of venous closure device.

Perclose ProGlide (PPG) Suture-Mediated Closure System™ is safe and can reduce time to hemostasis following procedures requiring arterial access. We aimed to compare PPG to figure of 8 suture in patients who underwent interventional catheter procedures requiring large bore venous access (LBVA) (≥13 French). In this physician-initiated, randomized, single-center study [clinicaltrials.gov ID: NCT04632641], single-stick venous access was obtained under ultrasound guidance. Eligible patients were randomized 1:1, and 100 subjects received allocated treatment to either PPG (n = 47) or figure of 8 suture (n = 53). No femoral arterial access was used in any patient. Primary outcomes were time to achieve hemostasis (TTH) and time to ambulation (TTA). Secondary outcomes were time to discharge (TTD) and vascular-related complications and mortality. Wilcoxon rank-sum test was used to compare TTH, TTA, and TTD. TTH (minutes) was significantly lower in PPG versus figure of 8 suture [median, (Q1, Q3)] [7 (2,10) vs. 11 (10,15) respectively, p < 0.001]. TTA (minutes) was significantly lower in PPG compared to figure of 8 suture [322 (246,452) vs. 403 (353, 633) respectively, p = 0.005]. TTD (minutes) was not significantly different between the PPG and figure of 8 suture arms [1257 (1081, 1544) vs. 1338 (1171,1435), p = 0.650]. There was no difference in minor bleeding or access site hematomas between both arms. No other vascular complications or mortality were reported. PPG use had lower TTH and TTA than figure of 8 suture in a population of patients receiving LBVA procedures. This may encourage same-day discharge in these patients.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia.

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

Early ambulation after total knee arthroplasty: a retrospective single-center study

PurposeEarly ambulation is an important step in accelerating post-joint replacement surgery recovery. However, there is limited research on populations who are unable to walk immediately after the operation. The purpose of this study was to determine the factors influencing postoperative ambulation in total knee arthroplasty (TKA) patients.MethodsPrimary TKA patients were included in this retrospective study. All patients were divided into two groups. Patients who began walking within 24 h were categorized as the early ambulation group, while patients who began walking after 24 h were classified as the late ambulation group. Recorded demographic data included age, gender, body mass index (BMI), clinical diagnosis, and comorbidities. Hematological parameters potentially affecting patients’ preoperative physical condition were also documented. Additionally, intraoperative metrics such as surgical time, surgical side, tourniquet time, intraoperative blood loss, the placement of drains, and prosthetic model were recorded.ResultsA total of 453 patients (79.0% female, 21.0% male) were included in this study. The average age of all patients was 68.5±7.9 years, ranging from 36 to 87 years, with an average BMI of 27.2±9.9 kg/m2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\mathrm {m^{2}}$$\\end{document}. The mean postoperative ambulation time was 1.6 days, with a range of 0–4 days. In univariate group comparisons, an increase in postoperative time to ambulation was significantly associated with a history of heart disease (P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}), stroke history (P=0.003\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.003$$\\end{document}), and prior surgeries (P=0.003\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.003$$\\end{document}). Patients who delayed ambulation also exhibited significantly higher coagulation-related parameters including PT (P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}), APTT (P=0.002\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.002$$\\end{document}), TT (P=0.039\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.039$$\\end{document}) before surgery compared to those who mobilized early. Furthermore, prolonged surgical time (P=0.030\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P= 0.030$$\\end{document}), increased intraoperative blood loss (P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}), and the placement of intraoperative drains (P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}) also significantly extended the time to postoperative ambulation. However, after multivariate logistic regression analysis, only PT (OR 1.86, 95% CI 1.32-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}2.61, P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}), TT (OR 1.30, 95% CI 1.09-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}1.55, P=0.004\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.004$$\\end{document}) intraoperative blood loss (OR 1.01, 95% CI 1.00-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}1.01, P=0.008\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.008$$\\end{document}) and the placement of intraoperative drains (OR 11.39, 95% CI 6.59-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-$$\\end{document}19.69, P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}) were identified as predictive factors for late ambulation in patients after TKA.ConclusionIn this study, preoperative coagulation function, intraoperative blood loss and the placement of intraoperative drains were factors contributing to delay ambulation time. Therefore, it is believed that properly improving preoperative coagulation function, effective intraoperative hemostasis, and reducing the placement of drains have a positive impact on early postoperative ambulation in patients undergoing TKA.

Comparing Obtura Vascular Closure Device to Manual Compression for Achieving Hemostasis After Percutaneous Transfemoral Procedures: A Randomized Study.

This trial was designed and aimed to compare safety and efficacy of Obtura™ vascular closure device (VCD) to manual compression (MC) among patients undergoing transfemoral catheterization. This prospective, randomized, controlled, multicenter trial of Obtura VCD against MC randomized patients in 1:1 (n=268; 134:134) ratio. Safety and efficacy were measured by primary endpoints (time to hemostasis [TTH] and deployment success) and secondary endpoints which included technical success, device-related adverse events, and time to ambulation (TTA). The procedural access using right femoral artery was performed in 95.52% of patients in Obtura VCD versus 96.27% in standard MC method, whereas 2.99% of patients in each group underwent left femoral access. Bilateral access was performed in 1.49% (n=2) versus 0.75% (n=1) in Obtura VCD versus MC, respectively. Both the technical success and deployment success were 100%. Patients in Obtura VCD group had shorter TTH (3.26±3.39 vs 23.95±8.24 minutes; p<0.0001) and TTA (155.44±125.32 vs 723.84±197.98 minutes; p<0.0001) than MC group. No access site complications (re-bleeding, infection, arteriovenous fistula, and transient access site nerve injury) were noted at 2-week, 1-month, and 3-month follow-ups. There were 4 (3%) and 6 (4.5%) cases of hematoma, respectively, in Obtura VCD versus MC and 1 case (0.7%) of post-procedural arterial pseudoaneurysm each in both the groups which were successfully resolved and patients were discharged with no further complications. Further follow-up was without any adverse events. The study demonstrated favorable safety and efficacy of Obtura™ VCD with a significantly short TTH and TTA compared to MC. In patients undergoing cardiac catheterization, vascular closure devices (VCDs) can achieve hemostasis faster after successful implantation of the device with fewer complications such as bleeding and ambulation can be achieved faster. In terms of effectiveness, Obtura VCD was found to be better than manual compression in achieving early hemostasis and higher technical and deployment success was accomplished. Obtura VCD does not require enlargement of the route through the tissues, uses the same existing arterial sheath as its conduit, and does not cause patients' access sites to feel uncomfortable while it is being deployed.

Does Routine Post-Operative Use of Drainage in Minimally Invasive Lumbar Spine Surgery Offer Better Results?

Objective: The advantages of minimally invasive spine surgery (MISS) in lumbar degenerative diseases have been well described (less tissue damage, shorter hospital stay, better results in pain assessment). One aspect that has not yet been studied enough is the usage of a post-operative drain in MISS. The aim of this study was to determine whether drainage in MISS is necessary or not and what advantages or disadvantages its use offers. Materials - Methods: We conducted a systematic review of the published literature, searching articles published on Pubmed and Embasse until December 1st 2022, regarding MISS in the lumbar region and post-operative drain usage. Our inclusion criteria were original articles written in English and articles using minimally invasive techniques (usage of tubular retractors along with an endoscope or microscope, paramedian incision, percutaneous screw placement). 42 articles were assessed, and after careful examination and duplication exclusion, 26 research papers were included. Usage, type and duration of postoperative drainage, length of hospital stay, ambulation time and complications were extracted, and relevant results were pooled. Results: The majority of the included articles (80.7 %) reported using a negative-pressure post-operative drain tube. Drains were removed either 48 hours after surgery or when the drainage volume was less than 50ml/24h. Hospital stays and time to ambulation were shorter in cases where drainage was not used. There was no difference in complications between cases where drainage was used and those that it was not. Conclusion: The rationale behind post-operative drainage in MISS is to protect from surgical site infections and hematoma creation. Based on our study there is no evidence to support this hypothesis. On the contrary, our results suggest that the drawbacks of using a drain (pain, discomfort, anxiety, inconvenience of mobilisation, prolongation of hospitalisation) outweigh the advantages, thus making the routine use of postoperative drainage in MISS unnecessary.

Effects of hydromorphone-based patient-controlled intravenous analgesia on postoperative hypoxaemia: a randomised controlled non-inferiority clinical trial

ObjectiveThis study aimed to compare the effects of patient-controlled intravenous analgesia (PCIA) with and without low-basal infusion on postoperative hypoxaemia.DesignA randomised parallel-group non-inferiority trial.SettingThe trial was conducted at a grade-A...