Anesthesia

BACKGROUND: In the monitored anesthesia care setting for awake craniotomy (AC), maintaining airway patency in sedated patients remains challenging. This randomized controlled trial aimed to compare the validity of the below-epiglottis transnasal tube insertion (the tip of the tube placed between the epiglottis and vocal cords) and the nasopharyngeal airway (simulated by the above-epiglottis transnasal tube with the tip of the tube placed between the epiglottis and the free edge of the soft palate) with respect to maintaining upper airway patency for moderately sedated patients undergoing AC...

BACKGROUND: Postoperative hypoxemia is prevalent in hospitalized patients and may adversely affect recovery. However, little data exists on the post-discharge phase or details on duration, severity and potential risk factors. Thus, we investigated the incidence and risk factors for severe desaturation during the first postoperative week after THA/TKA by continuous nocturnal oxygen saturation monitoring. METHODS: The study was a secondary analysis of a prospective cohort study of 112 patients undergoing fast-track THA/TKA...

OBJECTIVE: Parturients in second delivery undergoing vaginal birth after cesarean (VBAC) are divided to those who had their cesarean delivery (CD) while in labor as opposed to those who had an elective CD. We aimed to study if the stage of labor that was present during the primary CD is associated with the duration of subsequent spontaneous VBAC. METHODS: A retrospective study (2006-2014). Multiparas in second delivery with a history of a CD (P2-VBAC) were sub-grouped based on stage of labor at which the CD was performed in the first delivery; elective, latent, first or second stage of labor, Duration of labor was compared between P2-VBAC (as one group and further as the sub-groups) to primiparas (P1), multiparas in second (P2) and third (P3) vaginal delivery (VD)...

IMPORTANCE: Infected vallecular cysts should first be treated conservatively and if airway is compromised surgical treatment is considered. OBJECTIVE: The aim of this study was to determine the feasibility and safety of transcervical aspiration of an infected vallecular cyst. DESIGN: A retrospective review of a novel technique that has been used for drainage of vallecular cyst abscesses for 5 years (2012 to 2017). SETTING: Galilee Medical Center affiliated to Azrieli Faculty of Medicine...

OBJECTIVE: There is limited data on access type when treating ruptured abdominal aortic aneurysms (AAA) with EVAR. Our study's objective was to evaluate if the type of access in ruptured abdominal aortic aneurysm affected outcomes. METHODS: The Vascular Quality Initiative was queried from 2009 to 2018 for all ruptured AAA treated with an index EVAR. Procedures were grouped by access type: percutaneous, open, and failed percutaneous that converted to open access...

Dietary supplement use is high among United States adults, with the intention by users to promote overall health and wellness. Kidney donors, who are selected based on their overall good health and wellness, can have high utilization rates of dietary supplements. We provide a framework for evaluation of living kidney donors and use of dietary supplements. In this review, dietary supplements will include any orally administered dietary or complementary nutritional products, but excluding micronutrients (vitamins and minerals), food, and cannabis...

There are many established factors that influence glioma progression, including patient age, grade of tumor, genetic mutations, extent of surgical resection, and chemoradiotherapy. Although the exposure time to anesthetics during glioma resection surgery is relatively brief, the hemodynamic changes involved and medications used, as well as the stress response throughout the perioperative period, may also influence postoperative outcomes in glioma patients. There are numerous studies that have demonstrated that choice of anesthesia influences non-brain cancer outcomes; of particular interest are those describing that the use of total intravenous anesthesia may yield superior outcomes compared with volatile agents in in vitro and human studies...

Due to high potency and low toxicity, desflurane has been widely used during surgery. Recent evidence that the use of desflurane was associated with colorectal cancer (CRC) tumor metastasis and poor prognosis raising concerns about the safety of desflurane. However, the mechanism was uncovered. CRC cells were exposed to desflurane, the changes in morphology and epithelial-mesenchymal transition (EMT)-related genes were evaluated. Transwell assay was used to study the migration and invasion effect. Xenograft was performed to study the tumor formation ability of desflurane-treated cells in vivo...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The evaluation of pleural diseases has been well established. If pleurocentensis is non-diagnostic, the second investigation depending upon availability could be either closed pleural biopsy or image guided pleural biopsy or thoracoscopic pleural biopsy (medical or surgical). Pleural disease presenting as thickness/mass/nodule in the mediastinum is difficult to access through ultrasound or computed tomography and will need thoracoscopy. Thoracoscopy is an invasive procedure which can be difficult to perform in localized mediastinal pleural disease without effusion or poor health condition not suitable for general anesthesia...

Recently published case reports relating to anesthesia in patients with coronavirus disease (COVID-19) were reviewed. The diagnosis of COVID-19 was confirmed by positive results of reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous reports handled emergency cesarean delivery. Primary symptoms and laboratory data of pregnant women with COVID-19 were similar to those of non-pregnant patients. Although the mortality rate is reported to be high after surgery in patients with COVID-19, cesarean delivery was successfully performed under regional anesthesia in most cases and postoperative course was favorable both in the parents and newborns...

Sugammadex is an innovative reversal agent for neuromuscular blockade (NMB) induced by rocuronium. Although there is a case that re-paralysis is necessary after sugammadex administration, limited reports can be found on the sugammadex dosage for reversal from profound paralysis after induction and immediate re-paralysis following such reversal in detail. We experienced a case in which NMB reversal was required in a short period after paralysis for induction due to the discovery of anisocoria. We successfully re-induced general anesthesia with tracheal intubation soon after...

Closed reduction and percutaneous pinning (CRPP) for supracondylar humeral fractures (SCHF) comprised considerable surgical volume in pediatric orthopaedics. Limited reports are available on how standardization of the surgical care affects the cost and trainee's learning experience. Methods: Cost analysis was performed by chart review with the billing department in a university teaching hospital. The association of cost with perioperative variables was determined by univariate and multivariable analyses...

Background: In recent years, full-endoscopic debridement and drainage (FEDD) is gaining popularity treating spondylodiscitis. Comparing to tradition open surgery, FEDD possess many advantages including lower anesthesia risk and minimally invasiveness. In this study, we report our surgical technique of FEDD and preliminary clinical outcome in 34 consecutive patients with minimum 12 months follow-up. Methods: In our institute, "early intervention and minimally invasive surgery" is our primary strategy to treat spine infection...

Background: Symptomatic thoracic disc herniation (TDH) is a rare clinical entity and surgical intervention for it is even more uncommon. Despite several surgical techniques being described for thoracic discectomy, considering the unique surgical challenges, none of them have been accepted universally. Minimally invasive techniques have brought in a paradigm shift in the management of cervical/lumbar spinal disorders and similar techniques have been extrapolated to the thoracic region too...

Objective: Lactate is often used as a surrogate marker of inappropriate oxygen delivery. It has been shown that hyperlactatemia is associated with worse clinical outcome in children after cardiac surgery. The purpose of this study is to evaluate the association of hyperlactatemia, low systemic oxygen delivery, and hyperglycemia, in children admitted to the pediatric critical care unit after cardiopulmonary bypass. Design: Secondary analysis of an observational cohort study. Setting: Tertiary pediatric critical care unit (PICU)...

The most preferred treatment for organized chronic subdural hematoma (OSDH) remains controversial. Although a large craniotomy has been reported to be necessary and effective for the treatment of an OSDH, a craniotomy is associated with postoperative hemorrhagic complications and recurrence. Although middle meningeal artery (MMA) embolization has been reported to be effective for a refractory chronic subdural hematoma (CSDH), its efficacy for an OSDH remains unclear. We report two cases of OSDH treated with MMA embolization followed by hematoma removal via a small craniotomy under local anesthesia with good progress...

In the last few decades, several formulations have evolved to realize better efficacy of administered anesthesia. These innovative formulations have facilitated surgeons to perform operations under purely local anesthesia, which provides extra protection and comfort to patients. Ease of delivery of local anesthesia is the need of the current generation, because some of the standard procedures are performed without the use of any sedative agent. Therefore, we are presenting here the various approaches of administration of local anesthetics by the surgeons...

Pancreatic neuroendocrine tumors (PNET) are a heterogeneous group of neoplasms that vary in their clinical presentation, behavior and prognosis. The most common site of metastasis is the liver. Surgical resection of neuroendocrine liver metastases (NELM) is thought to afford the best long-term outcomes when feasible. Initial preoperative workup should include surveillance for carcinoid syndrome, screening for evidence of liver insufficiency, and performance of imaging specific to neuroendocrine tumors such as a somatostatin receptor positron emission tomography scan...