Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 6 Articles
Background: Intravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting\ncough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough\nduring the tracheal extubation period after thyroid surgery.\nMethods: One hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group\n(received lidocaine 1.5mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 microg/kg\nloading, 0.4 microg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes\nof cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage,\nthe postoperative visual analogue scale and adverse effects were recorded.\nResults: The incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than\nthat in the CON group (66.7%) (P = 0.000). Additionally, both moderate and severe cough were significantly lower in\nthe LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) (P < 0.05). Compared with the\ntwo treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group\nduring tracheal extubation (P < 0.05). Compared with the CON group, the volume of drainage was significantly reduced\nin the two treatment groups within 48 h after surgery (P < 0.05). compared with the CON group, the postoperative\nvisual analogue scale was significantly lower in groups LIDO and DEX after surgery(P < 0.05). Compared with the LIDO\ngroup and the CON group, the time to awareness was longer in the DEX group (P<0.05). In the DEX group, bradycardia\nwas noted in 35 patients, while no bradycardia was noted in LIDO group and CON group.\nConclusion: Compared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal\neffectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid\nsurgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better\nanalgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed the time\nto awareness when compared with lidocaine and normal saline....
Far lateral disc prolapse accounts for 6.5% to 12% of all lumbar disc prolapses.\nSurgical options include open laminectomy with discectomy, microscopic\nand endoscopic excision of the prolapsed disc. Some of these options\nmay not be available in limited resources centers. We will highlight the effectiveness\nof various surgical options. Twenty patients with foraminal and\nextraforaminal lumbar disc prolapse were operated upon from January, 2015\nto June, 2016 in the neurosurgical departments of Cairo and Fayoum Universities\nin Egypt by different modalities (open laminectomy with discectomy,\nmicroscopic and endoscopic discectomy). Seventeen patients had foraminal\ndisc prolapse and only three patients had extraforaminal disc prolapse.\nTwelve patients were operated by conventional laminectomy approach. Microscope\nwas used in four patients and four patients were operated endoscopically.\nExcellent radicular pain improvement was achieved in 15 cases\n(75%) including all of the laminectomy groups. Conventional laminectomy\nand discectomy in far lateral disc prolapse remains an excellent option especially\nin limited resources centers. Although building up experience with other\nsurgical modalities is mandatory....
Background: Anemia in cardiac surgery patients has been associated with poor outcomes. Transfusion of red\nblood cells during surgery is common practice for perioperative anemia, but may come with risks. Little is known\nabout the association between intra-operative transfusion and mortality in patients undergoing cardiac surgery.\nMethods: Single centre historical cohort study in 2933 adult patients undergoing coronary surgery with or without\naortic valve replacement from June 2011 until September 2014. To estimate the odds ratio for mortality in patients\nreceiving intra-operative transfusion, a propensity score based logistic regression analysis was performed.\nResults: Intra-operative transfusion was associated with a more than three-fold increased risk of 30-day mortality.\nPatients in the highest quartile of probability of transfusion were older (age 75 vs 66; P < 0.001), had a higher\nEuroSCORE (6 vs 3; P < 0.001), had lower preoperative hemoglobin levels (7.6 vs 8.9 mmol/l; P < 0.001), had\ncombined surgery more often (CABG + AVR in 33.4% of cases vs 6.6% (P < 0.001) and a longer duration of surgery\n(224 vs 188 min; P < 0.001). The association between intra-operative transfusion and mortality persisted after\nadjustment for these risk factors (adjusted OR 2.6; P = 0.007).\nConclusions: Intra-operative transfusion of red blood cells was found to be associated with increased mortality in\nadults undergoing coronary surgery. Preoperative patient optimization may improve perioperative outcomes by\nreducing the likelihood of requiring transfusion and thus its associated risk....
Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for\nreconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue\nin cleft care due to traditional teaching concerning the potential impairment of nasal growth. This\nstudy assessed long-term nasal growth in patients with bilateral cleft lip and palate who\nunderwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal\nmaturity..........................
Background: Late solidified hematoma is a rare complication of breast reconstruction with latissimus dorsi (LD)\nflap. The majority of hematomas occur in the immediate postoperative period; however, some cases can occur at a\ndistant point in time after surgery and do not have a definitive mechanism of injury or develop symptoms\nimmediately after the triggering event. Moreover, treatment of hematoma has not yet been established.\nCase presentation: Breast reconstruction with LD flap has been performed between January 2014 and June 2018\nin more than 275 cases. We report 3 cases of late solidified hematoma at the back-donor site that have developed\nyears after breast reconstruction with LD flap, in which a surgical approach was performed because the solidified\nhematomas could not be treated with percutaneous aspiration.\nConclusions: We report successful surgical treatment and histological findings of late-onset solidified hematoma as\na rare complication of Breast reconstruction with LD flap....
Patients with metastatic epidural spinal cord compression (MESCC) often need surgical intervention due to pain, neurological\ndeficits, and spinal instability. Spinal disease is commonly treated via the minimally invasive mini-open approach. However,\nfew studies have evaluated MESCC treatment via mini-open approach. The present study compared the traditional open\napproach versus the mini-open approach for thoracolumbar MESCC. A cohort of 209 consecutive patients who were diagnosed\nwith thoracolumbar metastases and underwent corpectomy and polymethylmethacrylate reconstruction from 2010 to 2016 was\nretrospectively identified. Traditional open surgery was performed in 113 patients (open group; mean age 57.7 years), while 96\npatients underwent mini-open surgery (mini-open group; mean age 54.3 years). Patients were followed up for 24 months or until\ndeath.Thebaseline characteristics of both groups were similar.Themost common origin of the primary lesion was the lung (37.3%),\nhematological system (22.0%), and kidney (15.8%). Surgery effectively achieved pain relief, restored neurological function, and\nimproved quality of life in both groups. The mini-open group was superior to the open group regarding estimated blood loss, blood\ntransfusion, hospital stay, complications, and pain score. While the mini-open group had a longer operation time than the open\ngroup, the two groups had similar improvements in the Frankel grade and Karnofsky functional score. The 30-day mortality rate\ntended to be higher in the open group (5.3%) than the mini-open group (2.1%) without significance.The 24-month survival rate\nwas similar in both groups (26.5% versus 26.0%). In conclusion, surgery improved pain, function, and quality of life in patients\nwith MESCC. The mini-open approach resulted in less estimated blood loos, less blood transfusion, and shorter hospitalization\nthan the traditional open approach, while both methods had similar mortality and morbidity rates.Thus, the mini-open approach\nmay be more beneficial than the traditional approach for MESCC....
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