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Low resource anesthesia

Jennifer M Singleton, Leslie A Bilello, Louisa S Canham, Robin B Levenson, Gregory J Lopez, Sarah P Tadiri, Nathan I Shapiro, Carlo L Rosen
BACKGROUND: Previous studies demonstrate an association between rib fractures and morbidity and mortality in trauma. This relationship in low-mechanism injuries such as ground-level fall is less clearly defined. Furthermore, computed tomography (CT) has increased sensitivity for rib fractures compared with chest x-ray (CXR); its utility in elderly fall patients is unknown. We sought to determine whether CT-diagnosed rib fractures in elderly fall patients with a normal CXR were associated with increased in-hospital resource utilization or mortality...
January 23, 2019: Journal of Trauma and Acute Care Surgery
Emmanuel A Ameh, Marilyn W Butler
Children's surgical care is cost-effective and can avert mortality and long-term disability in children, with ramifications throughout life not only for the patient, but for the extended family and community as well. Considering the current gaps and limited capacity for children's surgery in low- and middle-income countries (LMICs), it is clear that without expanding and scaling up the infrastructure, World Health Assembly (WHA) resolution 68/15 targets and child-related targets of Sustainable Development Goals and Universal Health Care are unlikely to be met by 2030...
January 3, 2019: World Journal of Surgery
Graeme W Morgan, Kirsty Foster, Brendan Healy, Craig Opie, Vu Huynh
The United Nations Sustainable Development Goals 2015 to 2030 includes a specific goal for health (Sustainable Development Goal [SDG] 3) with 13 targets, including SDG3.4 for the control and treatment of noncommunicable diseases (NCDs), namely, cardiovascular diseases, cancer, diabetes, and chronic lung disease. There is considerable concern that SDG3.4 may not be achieved. The WHO Best Buys for NCDs has emphasized prevention, and although crucial, it alone will not achieve the 30% reduction in NCDs by 2030...
December 2018: Journal of Global Oncology
Tharusan Thevathasan, Curtis C Copeland, Dustin R Long, Maria D Patrocínio, Sabine Friedrich, Stephanie D Grabitz, George Kasotakis, John Benjamin, Karim Ladha, Todd Sarge, Matthias Eikermann
BACKGROUND: In this prespecified cohort study, we investigated the influence of postoperative admission to the intensive care unit versus surgical ward on health care utilization among patients undergoing intermediate-risk surgery. METHODS: Of adult surgical patients who underwent general anesthesia without an absolute indication for postoperative intensive care unit admission, 3530 patients admitted postoperatively to an intensive care unit were matched to 3530 patients admitted postoperatively to a surgical ward using a propensity score based on 23 important preoperative and intraoperative predictor variables...
November 21, 2018: Anesthesia and Analgesia
Maziar M Nourian, Patrick Kolbay, Soeren Hoehne, Ahrash E Poursaid, Ann E Rowley, Mark J Harris, Kai Kuck
BACKGROUND: Access to basic anesthetic monitoring in the developing world is lacking, which contributes to the 100 times greater anesthesia-related mortality in low- and middle-income countries. We hypothesize that an environmental sensor with a lower sampling rate could provide some clinical utility by providing CO2 levels, respiratory rate, and support in detection of clinical abnormalities. MATERIALS AND METHODS: A bench-top lung simulation was created to replicate CO2 waveforms, and an environmental sensor was compared with industry-available technology...
November 25, 2018: Surgical Innovation
Anahita R Chauhan
Fibroids in pregnancy are increasingly common, due to advanced maternal age, better diagnostic tools and use of assisted reproductive techniques. Cesarean section (CS) is the commonest mode of delivery in these patients. Cesarean myomectomy (CM) is the term used to describe the removal of fibroids at CS; it has always been a controversial topic, with two schools of thought. Some obstetricians advise against it due to the traditional fear of massive obstetric hemorrhage and its attendant complications. However, recent literature advocates elective or opportunistic myomectomy in well-selected cases during CS...
December 2018: Journal of Obstetrics and Gynaecology of India
Robert F Grace
Over a 6-month period, eight neonates weighing less than 3 kg were operated on at Hospital Nacional Guido Valadares, Dili, Timor-Leste. Each was operated on for an abdominal condition. There is no postoperative neonatal ventilation, neonatal inotropes, fluid warmers, or parenteral nutrition available at Hospital Nacional Guido Valadares. Medical air and nitrous oxide are unavailable. Oxygen from cylinders is the only gas available in theaters and on the wards. Generally equipment is problematic and not designed for neonates...
November 1, 2018: Paediatric Anaesthesia
Ann Monahan, Joanne Guay, John Hajduk, Santhanam Suresh
BACKGROUND: The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac surgery. METHODS: A search was done in May 2018 in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing RA techniques with systemic analgesia...
January 2019: Anesthesia and Analgesia
Virginia T Gauger, Deborah Rooney, Kevin J Kovatch, Lauren Richey, Allison Powell, Hailesllassie Berhe, David A Zopf
BACKGROUND: Similar to other sub-Saharan countries, Ethiopia suffers from a severe shortage of adequately trained health professionals. Academic partnerships can support sustainable training programs and build capacity for low-resource settings. 3D modeling and simulation-based training provide necessary tools, especially for rarely-encountered clinical situations, such as needle cricothyroidotomy. METHODS: Departments of Anesthesiology, Otolaryngology, and Learning Health Sciences collaborated to develop a low-cost, high-fidelity simulator and Cricothryoidotomy Skills Maintenance Program (CSMP)...
November 2018: International Journal of Pediatric Otorhinolaryngology
M Catherine Sargent
Use of a single-leg spica cast for femoral fractures in ambulatory children 1 to 5 years of age facilitates care and mobilization of the patient. It may allow a shorter duration of cast treatment than is possible with a traditional one and one-half-leg spica cast, particularly in patients 1 to 3 years of age. The single-leg spica is indicated for children who are small enough to be lifted safely in the cast and who have an isolated, closed, low-energy femoral shaft fracture. The procedure consists of the following steps:Step 1: Obtain adequate sedation...
September 28, 2017: JBJS Essential Surgical Techniques
Suresh Mohan, Iván Coto Hernández, Wenjin Wang, Kaiyang Yin, Cathryn A Sundback, Ulrike G K Wegst, Nate Jowett
OBJECTIVE: Use of cell culture and conventional in vivo mammalian models to assess nerve regeneration across guidance conduits is resource-intensive. Herein we describe a high-throughput platform utilizing transgenic mice for stain-free axon visualization paired with rapid cryosection techniques for low-cost screening of novel bioengineered nerve guidance conduit performance. METHODS: Interposition repair of sciatic nerve transection in mice expressing yellow fluorescent protein in peripheral neurons (Thy1...
August 10, 2018: Laryngoscope
Tara L Braun, Matthew R Louis, Ryan M Dickey, Edward P Buchanan
BACKGROUND: A global health model based on partnering with local hospitals and surgical teams, providing education and training for local providers, and mandating adherence to safety and quality standards to ensure safe surgery and anesthesia care can build local surgical capacity and strengthen existing health care systems in low- and middle-income countries. Smile Train uses this sustainable partnership model to provide responsible humanitarian aid while maintaining a bidirectional exchange with its international partners...
August 2018: Plastic and Reconstructive Surgery
Pradip Kumar Saha, Rashmi Bagga, Jasvinder Kaur Kalra, Aashima Arora, Rimpi Singla, Vanita Suri, Kajal Jain, Praveen Kumar, Nalini Gupta, Ashish Jain, Tulika Singh, Ravimohan S Mavuduru
BACKGROUND: Cesarean hysterectomy for adherent placenta is associated with increased maternal morbidity due to massive hemorrhage requiring large volume blood transfusion, bladder or ureteric injury, intensive care unit (ICU) admission and prolonged hospital stay. There is an ongoing effort to improve the outcome of these women and measures to reduce blood loss. OBJECTIVE: The purpose of the present study was to develop an alternate surgical approach for performing a Cesarean hysterectomy in women with adherent placenta in order to reduce hemorrhage and urinary tract injuries, and thereby improve the maternal outcome...
September 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Gregory C Sund, Samuel Nizigiyimana
A 2-month-old girl with abnormal facial features and malnutrition presented for placement of a gastrostomy tube. The surgery was performed under general anesthesia using a laryngeal mask airway (LMA); however, after removal of the LMA, the patient had recurrent airway collapse, requiring repeated insertion of the LMA. The authors describe the management of this problem with the use of a tongue suture and anterior traction in the postoperative period in a resource-limited setting.
August 15, 2018: A&A practice
Quan Liu, Li Ma, Shou-Zen Fan, Maysam F Abbod, Cheng-Wei Lu, Tzu-Yu Lin, Kuo-Kuang Jen, Shang-Ju Wu, Jiann-Shing Shieh
With critical importance of medical healthcare, there exist urgent needs for in-depth medical studies that can access and analyze specific physiological signals to provide theoretical support for practical clinical care. As a consequence, obtaining the valuable medical data with minimal cost and impacts on hospital work comes as the first concern of researchers. Anesthesia plays a widely recognized role in surgeries, which attracts people to undertake relevant research. In this paper, a real-time physiological medical signal data acquisition system (PMSDA) for the multi-operating room applications is proposed with high universality of the hospital practical settings and research requirements...
June 30, 2018: Journal of Medical Systems
Habib G Zalzal, Chadi A Makary, Raquel Evans, Stacy Giardina, Tracy Underwood, Aletha Rowlands, Hassan H Ramadan
OBJECTIVE: To determine whether we could reduce the time that patients undergoing tonsillectomy are observed postoperatively without decreasing the quality of care, which would eliminate the unnecessary use of resources to monitor those patients. STUDY DESIGN: Prospective cohort. METHODS: Patients undergoing tonsillectomy were recruited for the study prior to their operation. Each patient was then monitored in perianesthesia recovery until clinical indicators for discharge readiness were met (baseline respiratory function, afebrile, ambulation per age, adequate consciousness, absence of nausea/vomiting, adequate pain control, no active bleeding, fluid toleration)...
September 2018: Annals of Otology, Rhinology, and Laryngology
Kristen K MacKenzie, Angelitta M Britt-Spells, Laura P Sands, Jacqueline M Leung
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia...
September 2018: Anesthesiology
Michelle C White, Brian J Barki, Stephen A Lerma, Sarah Kate Couch, Dennis Alcorn, Richard G Gillerman
BACKGROUND: Two-thirds of the world's population lack access to safe anesthesia and surgical care. Nongovernmental organizations (NGOs) play an important role in bridging the gap, but surgical outcomes vary. After complex surgeries, up to 20-fold higher postoperative complication rates are reported and the reasons for poor outcomes are undefined. Little is known concerning the incidence of anesthesia complications. Mercy Ships uses fully trained staff, and infrastructure and equipment resources similar to that of high-income countries, allowing the influence of these factors to be disentangled from patient factors when evaluating anesthesia and surgical outcomes after NGO sponsored surgery...
August 2018: Anesthesia and Analgesia
Marilyn Butler, Elizabeth Drum, Faye M Evans, Tamara Fitzgerald, Jason Fraser, Ai-Xuan Holterman, Howard Jen, Matthew Kynes, Jenny Kreiss, Craig D McClain, Mark Newton, Benedict Nwomeh, James O'Neill, Doruk Ozgediz, George Politis, Henry Rice, David Rothstein, Julie Sanchez, Mark Singleton, Francine S Yudkowitz
Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries are increasingly engaged in resource-limited areas, with short-term missions as the most common form of involvement. However, consensus recommendations currently do not exist for short-term missions in pediatric general surgery and associated perioperative care. The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc...
May 2018: Paediatric Anaesthesia
Peter F Johnston, Anastasia Kunac, Mawuli Gyakobo, Samba Jalloh, David H Livingston, Ziad C Sifri
Outcomes of short-term surgical missions (STSMs) hosted in developing countries are underreported, raising quality concerns. This study aims to analyze early outcomes of one humanitarian surgical organization to show that safe essential general surgery can be provided in the context of STSMs. Records from 6 STSMs to Sierra Leone and Ghana were reviewed for early complications and analysis performed to identify associated factors. Missions performed elective, general surgery on low risk patients, with adherence to patient safety protocols...
May 18, 2018: American Journal of Surgery
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