Topical Spray Research Articles

Endoscopic devices and techniques for the management of gastric varices (with videos).

Gastric variceal bleeding occurs less commonly than bleeding from esophageal varices (EVs), although it is associated with higher morbidity and mortality. Bleeding from gastroesophageal varices type 1 (GOV1) is treated like EVs. In contrast, other forms of gastric variceal bleeding, including gastroesophageal varices type 2 (GOV2) and isolated gastric varices types 1 (IGV1) and 2 (IGV2), are treated with varying endoscopic approaches. Nonendoscopic methods include transjugular intrahepatic portosystemic shunt (TIPS) or balloon-occluded retrograde transvenous obliteration (BRTO). This technology report focuses on endoscopic management of gastric varices (GVs). The MEDLINE database was searched through August 2022 for relevant articles by using key words such as gastric varices, glue, cyanoacrylate, thrombin, sclerosing agents, band ligation, topical hemostatic spray, coils, EUS, TIPS, and BRTO. The article was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee and approved by the Governing Board of the ASGE. Endoscopic injection with cyanoacrylate (CYA) glue has been the primary endoscopic method to treat GVs. EUS-guided angiotherapy with CYA glue and coil embolization has emerged as an alternative method enabling improved detection of GVs with a high technical success for targeting and obliterating GVs. Combining CYA glue with coil therapy allows the coil to act as a scaffold for the glue, reducing the risk of glue embolization and improving outcomes. Alternative injectates or topical treatments have been described but remain poorly studied. The mainstay paradigm for the endoscopic management of gastric variceal bleeding is the injection of CYA glue. The published success of EUS-guided angiotherapy using CYA glue with or without embolization coils has increased our treatment armamentarium.

Efficacy of combined hyperbaric oxygen therapy and topical haemoglobin spray in treating hard-to-heal sloughy wounds.

This study examined the effectiveness of a combination of hyperbaric oxygen therapy (HBOT) and topical haemoglobin spray in treating hard-to-heal, sloughy diabetic foot ulcers (DFUs). Patients with hard-to-heal DFUs at least 25% sloughy or necrotic were included in the study. We compared the results of patients who received standard of care and HBOT with topical haemoglobin spray (oxygen group) to an equal number of patients who only received standard personalised wound care (control group). The initial values of haemoglobin A1C and C-reactive protein, wound culture results and SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) scores were documented. Wounds were considered healed when completely closed within 16 weeks. The oxygen group (n=21) had a mean SINBAD score of 5.00±0.89, while the control group (n=21) had a mean score of 4.62±0.80 (p=0.155). After 16 weeks, 85.7% of wounds in the oxygen group showed complete recovery, compared with 52.4% in the control group (p=0.02). In this study, a greater number of wounds in the oxygen group healed. Combining HBOT with topical haemoglobin spray provides oxygenation to the wound for longer, primarily because patients can receive 90 minutes of HBOT daily. This ensures that patients benefit from both systemic and local oxygen. This combination therapy may effectively address the problem of hypoxia and promote healing in hard-to-heal wounds.

Effect of phosphorus and micronutrients on growth and yield of groundnut (Arachis hypogaea L.)

An experiment was conducted at the Crop Research Farm (CRF), Department of Agronomy, SHUATS, Prayagraj, U.P, India, during the Kharif season of 2023. The experiment was replicated three times according to a Randomized Block Design (RBD) with ten treatments. Three different concentrations of phosphorus (40, 50, and 60 kg/ha) and micronutrients (0.5% FeSO4, 0.5% ZnSO4, and 0.2% Borax) were administered as a topical spray to the leaves. A control group was treated with a mixture of 20:60:40 kg N:P:K/ha. Phosphorus application at a rate of 60 kg/ha and foliar spray of ZnSO₄ at 0.5% (treatment 8) resulted in the highest plant dry weight of 35.54 g, crop growth rate of 25.14 g/m²/day, number of pods per plant of 21.50, number of kernels per pod of 2.13, highest test weight of 365.33 g, seed yield of 3552.10 kg/ha, and B:C ratio of 2.43. The effect of applying a higher quantity of phosphorus, specifically 60 kg/ha, together with a foliar spray of ZnSO₄ at 0.5%, on the growth and yield of groundnut was found to be superior compared to the control treatment.

Topical larynx lidocaine Spraying reduces cardiovascular stress response caused by suspension laryngoscopic surgery

ObjectiveThis study aimed to investigate the potential reduction of cardiovascular stress response caused by suspension laryngoscopic surgery through the application of lidocaine spray on the larynx and trachea. MethodsA total of 68 patients scheduled for elective suspension laryngoscopic surgery were randomly assigned to either the lidocaine group (Group L, n = 34) or the control group (Group C, n = 33). In Group L, patients received a sprayed lidocaine dose of 2 mg/kg on the larynx and trachea after anesthesia induction, prior to intubation. In Group C, equal volumes of saline solution were administered. MAP and HR were recorded at various time points: before anesthesia (T0), 1-minute after intubation (T1), 1 and 3 min after suspension laryngoscopy (T2 and T3), at the end of the operation (T4), and at 1, 5, and 30 min after extubation (T5, T6, and T7). Arterial blood glucose, epinephrine, and norepinephrine levels were measured at T0, T2, T5, and T7. The occurrence of severe cough and sore throat at T6 and T7 after extubation was compared between the two groups. ResultsAt T0 and T1, there were no statistically significant differences in mean arterial pressures, heart rate, and blood catecholamine levels between the two groups. However, from T2 to T7, the blood pressure and heart rate in Group L were lower compared to Group C, with significant differences observed at T2‒T6 (p < 0.05). Group L also showed less elevation in blood glucose at T2, T5, and T7 (p < 0.05). The changes in epinephrine and norepinephrine levels between the two groups were statistically significant at T2 and T5 (p < 0.05). ConclusionsAdministering lidocaine spray on the larynx and trachea during intubation for suspension laryngoscopic surgery can effectively alleviate the stress response. Level 1 evidencePatients in this study are randomly assigned to the treatment or control group and are followed prospectively.

Regression course of ostium granulomas under topical intranasal steroids coverage after endoscopic dacryocystorhinostomy

This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided.

173-OR: A Clinical Study of Novel Antimicrobial Peptide PL-5 Topical Spray for Mild to Moderate Infectious Wounds of Diabetic Foot

173-OR: A Clinical Study of Novel Antimicrobial Peptide PL-5 Topical Spray for Mild to Moderate Infectious Wounds of Diabetic Foot

Comparison of Efficacy of Autologous Platelet Rich Plasma Therapy With 5% Topical Minoxidil Spray in Treating Alopecia Areata: A Head-to-Head Assessment of Novel Approaches.

Alopecia areata (AA) remains one of the most challenging afflictions encountered in dermatology clinics. It is characterized by an autoimmune-mediated inflammatory process of and around hair follicles, causing reversible, non-scarring hair loss. With the ongoing search for optimal treatment strategies, the potentially positive role of autologous platelet-rich plasma (PRP) therapy as well as minoxidil has been reported in various studies; however, the comparison of the two treatment modalities is largely underexplored. This research aims to compare and assess the effectiveness of intralesional PRP with topical minoxidil therapy in AA to identify efficacious management options amongst the newly described treatment modalities. The research work was conducted over four months and included 40 (31 males and 9 females) patients suffering from alopecia areata. They were divided into Group A, which was administered monthly autologous PRP injections, while Group B was given daily topical 5% minoxidil therapy. In group A, four treatments of PRP were given, each one month apart. While in group B, daily topical minoxidil spray was administered for the same duration. The alopecia areata severity grade was recorded by employing the "Severity of Alopecia Tool" (SALT) scoring system. The pre- and post-treatment SALT scores were noted and compared at each monthly visit. The study comprised nine (22.5%) female and 31 (77.5%) male patients. At the beginning of the study and after one month of treatment, the difference in the SALT score was not statistically significant between the two groups, suggesting that both interventions had similar effects during the early stages of the treatment. At two months, a statistically significant difference emerged (p-value 0.037), indicating that a more significant fall in the SALT score was observed with autologous PRP treatment compared to topical minoxidil. After four months, a highly significant difference was noted between the two groups (p-value <0.0001), implying that intralesional PRP therapy led to a far more significant decrease in the SALT score compared to topical minoxidil therapy. Monthly intralesional autologous PRP therapy for four months manifests better outcomes in alopecia areata than daily 5% topical minoxidil therapy.

Clinical observation of topical antipruritic spray acting on epidermal growth factor receptor tyrosine kinase inhibitor in the treatment of dermatitis.

To observe the efficacy of topical antipruritic spray (TAS) in the treatment of epidermal growth factor receptor (EGFR) tyrosine kinase-related rashes, and to evaluate its efficacy and safety. 120 malignant tumor patients with confirmed pathological diagnosis and rash after EGFR application were selected and randomly divided into an experimental group of 60 cases and a control group of 60 cases. The 2 groups were intervened with self-made antipruritic spray and erythromycin ointment for 14 consecutive days. To observe the changes in rash, itching degree, and quality of life index of skin diseases in both groups of patients before and after treatment. The decrease in the number of itching cases in the experimental group reached 53.84%, and after 7 weeks of intervention, the total effective rate of rash treatment in this group of patients (91.67%) was significantly better than that in the control group (36.67%); The symptoms of the dermatology life quality index (DLQI) scale in the experimental group patient table after intervention showed significant changes compared to before intervention. After statistical testing, there was a significant difference between the groups and outside the group (R < 0.05). And the comprehensive effect of the experimental patients with external spray after 14 weeks of intervention reached 93.16%. The self-made antipruritic spray has significant effect on improving EGFR rash and itching, and there is no obvious adverse reaction.

Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta-analysis.

Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re-examination of the current literature. Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo-controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio). Ten trials (N=751) were included for meta-analysis, with a mean age of 47.5 years (range: 18-80 years; 95% confidence interval [CI]: 43.9-51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI: 0.3-0.6; p<0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI: 0.1-0.7; p=0.01), but not with topical spray (Δ0.04; 95% CI: -0.9 to 1.0; p=0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR]: 3.4; 95% CI: 1.9-6.0; p<0.0001; OR: 12.4; 95% CI: 1.8-83.8; p<0.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9-4.0; p=0.12). Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.

Comparison of Mucosal Vibration and Topical Anesthetic Spray for Pain Reduction during Local Anesthesia in Young Adults: A Randomized Controlled Clinical Trial

Comparison of Mucosal Vibration and Topical Anesthetic Spray for Pain Reduction during Local Anesthesia in Young Adults: A Randomized Controlled Clinical Trial

Propellant Free Pressurized Spray System of Etodolac to Manage Acute Pain Conditions: In Vitro and In Vivo Evaluation.

This study aimed to develop a propellant-free topical spray formulation of Etodolac (BCS-II), a potent NSAID, which could be beneficial in the medical field for the effective treatment of pain and inflammation conditions. The developed novel propellant-free spray formulation is user-friendly, cost-effective, propellant-free, eco-friendly, enhances the penetration of Etodolac through the skin, and has a quick onset of action.Various formulations were developed by adjusting the concentrations of different components, including lecithin, buffering agents, film-forming agents, plasticizers, and permeation enhancers. The prepared propellant-free spray formulations were then extensively characterized and evaluated through various in vitro, ex vivo, and in vivo parameters. The optimized formulation exhibits an average shot weight of 0.24 ± 0.30ml and an average drug content or content uniformity of 87.3 ± 1.01% per spray. Additionally, the optimized formulation exhibits an evaporation time of 3 ± 0.24min. The skin permeation study demonstrated that the permeability coefficients of the optimized spray formulation were 21.42cm/h for rat skin, 13.64cm/h for mice skin, and 18.97cm/h for the Strat-M membrane. When assessing its potential for drug deposition using rat skin, mice skin, and the Strat-M membrane, the enhancement ratios for the optimized formulation were 1.88, 2.46, and 1.92, respectively against pure drug solution. The findings from our study suggest that the propellant-free Etodolac spray is a reliable and safe topical formulation. It demonstrates enhanced skin deposition, and improved effectiveness, and is free from any skin irritation concerns.

Numerical study of the distribution of sprayed particle deposition in different human nasal cavity

This article numerically investigates the propagation of nasal sprayer particles to improve drug delivery through the nasal cavity. Topical nasal sprays are among the generally dictated therapeutic agents for sinus disorders in humans. However, the inconsistency of instructions indicates a lack of definitive knowledge of the best methods for nebulizing drugs. This study suggested nasal spray angles that could improve local drug delivery to the affected area compared to common spray methods. In this study, various particle diameters and aerosol flow angles are examined to evaluate the optimal efficiency of drug supply into the nasal cavity. Computational simulation of a particle-laden flow is performed in the nasal cavity of a healthy patient and a patient with rhinitis. The numerical results of this work open up new possibilities for proposing an alternative user-friendly plan that can essentially improve local drug delivery to the human nasal cavity.

Comparative Study on the Efficacy of Lignocaine Nebulisation Vs Topical Lignocaine Spray in Attenuation of Haemodynamic Surge in Patients Undergoing Surgery Under General Anaesthesia - A Single Blinded Randomized Controlled Study

Introduction: Laryngoscopy and tracheal intubation are powerful noxious stimuli that should be attenuated. The present study is to compare the efficacy of lignocaine nebulisation vs topical lignocaine spray in attenuation of haemodynamic surge in patients undergoing surgery under general anaesthesia. Methodology: After ethical committee clearance, a single blind randomized control study was done on sixty patients of either sex aged between 18-55 years of ASA status I undergoing elective surgery under general anaesthesia with endotracheal intubation. Patients were randomly allocated into 2 groups: GROUP A:received nebulised Lignocaine Hydrochloride 4% at 2 mg/kg. GROUP B: received Topical Lignocaine spray 10% at 2mg/kg. Heart rate, Systolic, diastolic and mean blood pressure was documented before administering premedication (T0), at the time of intubation (TI) and at 1min (T-1), 2min (T-2) &amp; 5min (T-5) after intubation. Attenuation in HR, SBP, DBP and MBP were found statistically significant (p&lt;0.05) in group A in comparison to group B. Thus in conclusion Lignocaine nebulisation is far more effective in comparison to topical lignocaine spray in attenuation of the laryngoscopic surge. Results: After conducting the study on a total of sixty patients it was found that there was statistically significant reduction in SBP, DBP, MBP and HR in GROUP A receiving lignocaine nebulisation compared to GROUP B receiving topical lignocaine spray. Conclusion: Lignocaine nebulisation is more effective than topical lignocaine spray in attenuation of haemodynamic surge following laryngoscopy and intubation in patients undergoing surgery under general anaesthesia. Keywords: Laryngoscopy, Tracheal Intubation, Lignocaine Nebulisation, Lignocaine Spray, Heamodynamic Surge

Evaluation of different doses of dexmedetomidine for awake fibreoptic nasotracheal intubation in patients undergoing oromaxillofacial and oral malignancy surgeries: A randomised, double-blind study.

In patients undergoing cancer surgeries with anticipated difficult airway, awake fibreoptic nasotracheal intubation (AFONI) is critical for securing the airway. However, different doses of dexmedetomidine (DEX) are yet to be evaluated in these patients. Thus, we compared three doses of DEX for AFONI in patients undergoing oromaxillofacial and oral malignancy surgeries. In this randomised, double-blind study, 90 patients aged 18-60 years of either gender, with American Society of Anesthesiologists physical status I/II, and undergoing elective oromaxillofacial and oral malignancy surgeries were randomised to three groups: Group D1 (0.5 µg/kg DEX), Group D2 (1 µg/kg DEX), and Group D3 (1.5 µg/kg DEX). The primary outcome measure was the airway obstruction score. Secondary outcome measures were intubation scores (including vocal movement, coughing, and limb movements) and a 5-point fibreoptic intubation comfort score. Sedation was assessed using the Ramsay sedation score (RSS). One-way ANOVA and Chi-square test were used to assess the association between quantitative and qualitative variables, respectively. A P value of <0.05 was considered statistically significant. The airway obstruction score was comparable between the groups (P = 0.78). Similarly, vocal movement (P = 0.15), coughing (P = 0.31), limb movement (P = 0.51), and 5-point fibreoptic intubation comfort score (P = 0.49) did not differ between the groups. The mean RSS was significantly greater in Group D3 than in Groups D1 and D2 (P = 0.001). In combination with topical spray and airway block, all three doses of DEX resulted in comparable airway obstruction scores and thus provided favourable conditions for AFONI.

Microbial Safety Assessment of Gebauer’s Pain Ease® Spray on Invasive Procedural Sites

Abstract Aim: This study aimed to investigate the impact of Gebauer’s Pain Ease® (Gebauer Company, Cleveland, OH) topical refrigerant spray on the disinfection of skin sites, focusing on the volar wrist and lower back. The primary objective was to determine whether the application of Pain Ease would compromise the disinfection of these sites, potentially making it a suitable alternative to injectable lidocaine for invasive medical procedures. Methods: This prospective, blinded, controlled study was conducted at Henry Ford Hospital in Detroit, MI. Healthy adult hospital employees were recruited, and written consent was obtained. Swabs were taken from the volar wrist and lower back sites before and after treatment with ChloraPrep™ (BD, Franklin Lakes, NJ) and Pain Ease. Microbial cultures were performed, and microbial growth levels were assessed and categorized. Data analysis included comparisons of microbial growth between untreated samples, ChloraPrep-treated samples, and ChloraPrep + Pain Ease-treated samples. Results: Data were collected from 72 participants, with 6 samples per participant (2 locations, 3 treatments each). For wrist samples, there were no statistically significant differences in microbial growth between ChloraPrep and ChloraPrep + Pain Ease. Similarly, for lower-back samples, microbial growth did not significantly differ between these 2 treatment groups. Conclusions: This study demonstrates that the application of Gebauer’s Pain Ease to ChloraPrep disinfected skin areas does not negatively affect the reduction of the bacterial load, supporting its potential as an alternative to injectable lidocaine and other superficial anesthetics for vascular access or invasive medical procedures. However, further research is warranted to explore the application of Pain Ease in various clinical scenarios and optimize patient comfort during longer and more invasive procedures.

Fabrication and in vitro characterization of curcumin film-forming topical spray: An integrated approach for enhanced patient comfortandefficacy.

Curcumin, known for its anti-inflammatory properties, was selected for the developing consumer friendly film forming spray that offers precise delivery of curcumin and and improves patient adherence. An optimized film-forming solution was prepared by dissolving curcumin (1%), Eudragit RLPO (5%), propylene glycol (1%), and camphor (0.5%) in ethanol: acetone (20:80) as the solvent. The solution was filled in a spray container which contained 70% solutions and 30% petroleum gas. In-vitro characterization was performed. Potential anti-inflammatory phytoconstituents were extracted from the PubChem database and prepared as ligands, along with receptor molecules (nsp10-nsp16), for molecular docking using Autodock Vina. The docking study showed the lowest binding energy of -8.2 kcal/mol indicates better binding affinities. The optimized formulation consisted of ethanol:acetone (20:80) as the solvent, Eudragit RLPO (5%) as the polymer, propylene glycol (1%) as the plasticizer, and camphor oil (0.5%) as the penetration enhancer. The optimized formulation exhibited pH of 5.8 ± 0.01, low viscosity, low film formation time (19.54 ± 0.78 sec), high drug content (8.243 ± 0.43 mg/mL), and extended ex vivo drug permeation (85.08 ± 0.09%) for nine hours. Consequently, the formulation was incorporated into a container using 30% liquefied petroleum gas, delivering 0.293 ± 0.08 mL per actuation, containing 1.53 ± 0.07 mg of the drug. The film-forming spray exhibited higher cumulative drug permeation (83.94 ± 0.34%) than the marketed cream formulation and pure drug solution after 9 h, with an enhancement ratio of 14. Notably, the film-forming spray exhibited no skin irritation and remained stable for over three months. The developed curcumin film-forming system is promising as a carrier for wound management because of its convenient administration and transport attributes. Further in vivo studies are required to validate its efficacy in wound management.

Nasal preparation prior to nasal endoscopy: a comparison of cotton pledget packing versus topical spray

Nasal endoscopy (NE) is an office procedure done to look at the nasal and sinus passages using an endoscope which could be either rigid or flexible. It allows the clinician to characterize the intranasal anatomy better compared to the conventional techniques of headlight, speculum and mirror thus aiding the diagnosis. Therefore its popularity has increased recently and is one of the most frequently performed diagnostic procedures in Otorhinolaryngology and Head and Neck Surgery OPD. A unanimous consensus has not been reached regarding the best method for preparing the patients for NE. This study compares two methods of nasal preparation; cotton pledget packing and topical spray. A total of 100 patients were randomised into two groups of 50 each (A and B). In Group A, the nasal cavity was packed with a cotton pledget soaked in 4% lignocaine and xylometazoline nasal drops. Whereas in Group B, xylometazoline nasal drops were instilled and nasal cavity was sprayed with 10% lignocaine spray. After performing rigid nasal endoscopy, a proforma based on the patients’ and consultant’s response was filled. Patients in the cotton pledget group experienced more discomfort during packing (p=0.04), during the waiting time (p=0.001) and also during the endoscopic procedure. From the clinician’s perspective, the duration for the overall endoscopic procedure was significantly less in the spray group (p&lt;0.001). Visualisation of structures was comparable in both groups. Less bleeding was experienced in the spray group. We concluded that nasal spray is a better alternative to nasal packing for preparation of nose prior to nasal endoscopy.

Comparative Evaluation of Topical and Local infiltration of Lignocaine Hydrochloride in Kano Brown Does

The aim of this study was to compare the effectiveness of pain elimination and onset of anaesthetic activity by topical lignocaine spray with subcutaneous infiltration of lignocaine hydrochloride (LH) through assessment of the effects on vital parameters and pain responses in Kano Brown does. Fourteen does aged 1-3 years were randomly divided into two equal groups (A and B). The does were shaved at the left flank, group A does were infiltrated with 5 mL of LH while does of group B were administered with LH topically. A needle prick test was then carried out post administration in both groups, clinical and behavioral pain responses were assessed over a 2 hours period. Group A recorded a higher pulse rate (85.14± 6.02 bpm) as compared to group B (82.29 ± 4.68 bpm), respiratory rate was significantly (p&lt;0.05) lower in group A (20.00±1.23cpm) as compared to group B (25.71± 1.47 cpm) and a lower rectal temperature was recorded in group A (38.63± 0.35ºc) in comparison to Does of group B (39.11 ± 0.07ºC). The locally infiltrated group recorded no sign of pain throughout the needle prick test while variations in pain responses were recorded in topical LH administered group. 71% of the topical spray (TS) does exhibited signs of pain immediately post spray, 57% exhibited pain response at 60 and 180 seconds, and 43% at 300 seconds. When the needle prick was carried out at 600 seconds, 14% of the TS does showed signs of pain at first prick while 29% recorded pain signs on second needle prick. No signs of pain was recorded at 1200 (20 minutes) and 1800 (30 minutes) seconds in the TS does. It was concluded, that subcutaneous infiltration of LH had a faster onset of action, last longer and provides better analgesia/anesthesia than topical lignocaine spray.

Postoperative sore throat: prophylaxis and treatment

Postoperative sore throat (POST) is one of the most reported complications after general anesthesia with an incidence of as high as 60% which may impact patient satisfaction and increase the cost of treatment. The aim of this review is to summarize the currently accepted approaches and new trends intended to reduce the risk and increase the treatment efficacy of POST. Difficult intubation, traumatic intubation, and several other factors contribute to the development of POST. Endotracheal intubation using a stylet-loaded tube exerts excessive pressure on the anterior tracheal wall predisposing to mucosal trauma and contributing to development of POST. Pharmacological interventions are aimed at prevention, amelioration of symptoms, and treatment of POST. Medications suggested for this purpose include corticosteroids, topical sprays and creams, non-steroidal anti-inflammatory drugs (NSAID), and N-methyl-D-aspartate (NMDA) receptor antagonists. The use of video-laryngoscopes (VL) for endotracheal intubation improves the glottic view and increases the success rates with less force required to ensure adequate laryngoscopic view. Nevertheless, despite advances in laryngoscopic devices, the incidence of POST remains high. A novel intubation technique with endotracheal tube (ETT) rotation 180 degrees (ETT 180°) has been suggested to overcome stylet related injury and, possibly, decrease the POST. To date, no clinical trials have been conducted to test the efficacy of ETT 180° in reducing the incidence of POST. Undoubtedly, the suggested method deserves further investigation to determine its role in patient care.

Hysteroscopic Lysis of Complex Uterine Adhesions After Interventional Radiology-Guided Access

To demonstrate a novel surgical technique using hysteroscopic lysis of adhesions after interventional radiology (IR)-guided access in patients with severe intrauterine adhesions and challenging uterine access. This video illustrates the technique of the safe division of intrauterine adhesions after IR-guided access. Conventional hysteroscopic adhesiolysis might be inadequate or risky in cases of severely narrowed or obstructed uterine flow tract, possibly resulting in incomplete adhesiolysis, false passages, or uterine perforation. This video presents 2 cases from a tertiary center involving a multidisciplinary team of a reproductive surgeon and an interventional radiologist. The first case involves a 38-year-old with severe Asherman syndrome, who experienced unsuccessful attempt to treat adhesions that was complicated by a false passage. The second case involves a 39-year-old with recurrent severe Asherman syndrome and a history of unsuccessful attempts at hysterosalpingogram and conventional hysteroscopic lysis of adhesions. In the IR suite, the patient was put in a lithotomy position on the fluoroscopy table. A vaginal speculum was inserted exposing the cervix. The procedure was performed using intravenous sedation and topical anesthetic spray applied to the cervix. Using fluoroscopy, a balloon cannula was inserted through the cervix, followed by contrast injection to assess uterine access. If there is no route, transvaginal ultrasound-guided needle cannulation of the main portion of the uterine cavity would be performed, approximating as closely as possible to the expected route of the cervical canal. A guidewire followed by a locked loop catheter was advanced through adhesions into the uterine cavity. The catheter was left protruding from the cervix to guide the hysteroscope. The patient was then transferred to the operating room for the hysteroscopic procedure. Under the guidance of the intrauterine catheter, the adhesions were carefully lysed using cold scissors. The endometrial cavity and tubal openings were inspected to ensure complete adhesiolysis and exclusion of any other copathologies. IR guidance can provide a safe and effective approach to hysteroscopic lysis of adhesions in patients with challenging intrauterine adhesions and difficult uterine access, such as patients with severe Asherman syndrome, intractable cervical stenosis, uterine wall agglutination, previous adhesiolysis failure, marked fixed retroverted retroflexed uteri, and previous false passage or uterine perforation.