Pub Date : 2020-09-03DOI: 10.33552/ASOAJ.2020.02.000531
Wafaa Abdel Wahab Abdel Halim
The goal of this study is comparison between silver containing dressings (Aquacel or Acticoat) and Silver Sulfadiazine cream in management of superficial partial thickness burns according to time for complete wound healing, number of dressing changes, level of pain during dressing change, incidence of infection, and total cost effectiveness. The study found that silver containing dressings are superior to the conventional treatment with Sulfadiazine cream in superficial partial thickness burns.
{"title":"A Comparative Study Between Silver Containing Dressings (Aquacel, Acticoat) and Sulfadiazine in Management of Superficial Partial Thickness Burns in Trunk and Extremities","authors":"Wafaa Abdel Wahab Abdel Halim","doi":"10.33552/ASOAJ.2020.02.000531","DOIUrl":"https://doi.org/10.33552/ASOAJ.2020.02.000531","url":null,"abstract":"The goal of this study is comparison between silver containing dressings (Aquacel or Acticoat) and Silver Sulfadiazine cream in management of superficial partial thickness burns according to time for complete wound healing, number of dressing changes, level of pain during dressing change, incidence of infection, and total cost effectiveness. The study found that silver containing dressings are superior to the conventional treatment with Sulfadiazine cream in superficial partial thickness burns.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76831041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-14DOI: 10.33552/asoaj.2020.02.000530
Jaskaran Bains
To construct an economic model to estimate the potential length-of-stay cost savings for hospitals which replace conventional antibiotic susceptibility testing (AST) with rapid AST for the sepsis patient population. We used a wide range of academic studies from the medical and economics literature. Relevant studies were identified and weighted based on study methodological rigor, year of publication and geographic proximity of study population. Each flagged study was read in its entirety and screened for relevant data on inputs to the economic model. Studies which included relevant estimates were read again by two authors to confirm the correct estimate. Each component of the model was compiled from a comprehensive literature search identifying key studies in the field and then combining individual estimates from these studies into a weighted average. Implementation of rapid AST in the sepsis patient population can lead to over $1,600 of savings per sepsis case, or 7.3% of total average admission costs, solely in savings from improved length-of-stay (LOS). When scaled to the hospital level, this represents $5.65 million saved per 100,000 total hospital admissions. The magnitude of potential savings suggests that replacing conventional AST with rapid AST could provide a high return on investment for hospital systems.
{"title":"The Economic Value of Rapid AST in Reducing Length of Stay of Septic Patients","authors":"Jaskaran Bains","doi":"10.33552/asoaj.2020.02.000530","DOIUrl":"https://doi.org/10.33552/asoaj.2020.02.000530","url":null,"abstract":"To construct an economic model to estimate the potential length-of-stay cost savings for hospitals which replace conventional antibiotic susceptibility testing (AST) with rapid AST for the sepsis patient population. We used a wide range of academic studies from the medical and economics literature. Relevant studies were identified and weighted based on study methodological rigor, year of publication and geographic proximity of study population. Each flagged study was read in its entirety and screened for relevant data on inputs to the economic model. Studies which included relevant estimates were read again by two authors to confirm the correct estimate. Each component of the model was compiled from a comprehensive literature search identifying key studies in the field and then combining individual estimates from these studies into a weighted average. Implementation of rapid AST in the sepsis patient population can lead to over $1,600 of savings per sepsis case, or 7.3% of total average admission costs, solely in savings from improved length-of-stay (LOS). When scaled to the hospital level, this represents $5.65 million saved per 100,000 total hospital admissions. The magnitude of potential savings suggests that replacing conventional AST with rapid AST could provide a high return on investment for hospital systems.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78520309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-08DOI: 10.33552/asoaj.2020.02.000529
Carlos de la Paz Estrada
Obese patients represent a real challenge for the anesthesiologist both technically and intellectually. This group of people has been found to be closely associated with increased perioperative morbidity and mortality. As a result, the anesthesiologist must be prepared to treat obese patients in the operating room and intensive care unit, so they must understand their pathophysiology and specific complications associated with their condition to make our treatment more effective in this group of patients. Undoubtedly, patients who suffer from this disease due to its complications become ill and die more frequently [1].
{"title":"ERAS Protocol in Bariatric Surgery","authors":"Carlos de la Paz Estrada","doi":"10.33552/asoaj.2020.02.000529","DOIUrl":"https://doi.org/10.33552/asoaj.2020.02.000529","url":null,"abstract":"Obese patients represent a real challenge for the anesthesiologist both technically and intellectually. This group of people has been found to be closely associated with increased perioperative morbidity and mortality. As a result, the anesthesiologist must be prepared to treat obese patients in the operating room and intensive care unit, so they must understand their pathophysiology and specific complications associated with their condition to make our treatment more effective in this group of patients. Undoubtedly, patients who suffer from this disease due to its complications become ill and die more frequently [1].","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75016306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-02DOI: 10.33552/asoaj.2020.02.000528
D. Laury
{"title":"Locum Lifestyle","authors":"D. Laury","doi":"10.33552/asoaj.2020.02.000528","DOIUrl":"https://doi.org/10.33552/asoaj.2020.02.000528","url":null,"abstract":"","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"29 58","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72560130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cindy B Yeoh, Kathleen J Lee, Shalini Mathias, Luis E Tollinche
The environmental debate continues to expand in the realm of healthcare, resulting in increased scrutiny of the impact of material waste and gas emissions in the operating room (OR). In a single day, ORs can contribute up to 2000 tons of medical waste, mostly in the form of disposable medical supplies. We review the major challenges associated with "going green" in the OR.
{"title":"Challenges of Going Green in the Operating Room.","authors":"Cindy B Yeoh, Kathleen J Lee, Shalini Mathias, Luis E Tollinche","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The environmental debate continues to expand in the realm of healthcare, resulting in increased scrutiny of the impact of material waste and gas emissions in the operating room (OR). In a single day, ORs can contribute up to 2000 tons of medical waste, mostly in the form of disposable medical supplies. We review the major challenges associated with \"going green\" in the OR.</p>","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351340/pdf/nihms-1601349.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38152586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.33552/ASOAJ.2020.02.000527
Cindy B. Yeoh, Kathleen J Lee, S. Mathias, L. Tollinche
The environmental debate continues to expand in the realm of healthcare, resulting in increased scrutiny of the impact of material waste and gas emissions in the operating room (OR). In a single day, ORs can contribute up to 2000 tons of medical waste, mostly in the form of disposable medical supplies. We review the major challenges associated with "going green" in the OR.
{"title":"Challenges of Going Green in the Operating Room.","authors":"Cindy B. Yeoh, Kathleen J Lee, S. Mathias, L. Tollinche","doi":"10.33552/ASOAJ.2020.02.000527","DOIUrl":"https://doi.org/10.33552/ASOAJ.2020.02.000527","url":null,"abstract":"The environmental debate continues to expand in the realm of healthcare, resulting in increased scrutiny of the impact of material waste and gas emissions in the operating room (OR). In a single day, ORs can contribute up to 2000 tons of medical waste, mostly in the form of disposable medical supplies. We review the major challenges associated with \"going green\" in the OR.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78912803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-27DOI: 10.33552/asoaj.2020.01.000526
N. Mageed
Sternum is the main source of pain after cardiac surgery. The use of high doses of opioid are associated with prolonged mechanical ventilation. Regional anesthetic techniques facilitate early recovery. Transversus thoracis plane (TTP) block is a newly developed analgesic technique that can provide adequate analgesia for surgeries associated with sternotomy. In pediatric cardiac surgery, the dose of local anesthetics for TTP block is not described in any of literature. In our hospital (Mansoura University Children Hospital), we perform bilateral TTP block for most of children submitted for cardiac surgery via median sternotomy in a dose of 0.2-0.3mL/kg 0.2 to 0.25 % bupivacaine on each side of sternum. We found that, the above dose provides effective perioperative analgesia without any signs of local anesthetic toxicity. The aim of this work is to highlight the analgesic efficacy of TTP block and the dose of local anesthetic in children undergoing open heart surgery via median sternotomy.
胸骨是心脏手术后疼痛的主要来源。使用高剂量阿片类药物与延长机械通气时间有关。区域麻醉技术有助于早期恢复。横胸平面阻滞是一种新发展的镇痛技术，可以为胸骨切开术相关手术提供充分的镇痛。在小儿心脏手术中，TTP阻滞的局麻药剂量在任何文献中都没有描述。在我们医院(曼苏拉大学儿童医院)，我们通过胸骨正中切开术对大多数接受心脏手术的儿童进行双侧TTP阻滞，胸骨两侧剂量为0.2-0.3 ml /kg 0.2- 0.25%布比卡因。我们发现，上述剂量提供了有效的围手术期镇痛，没有任何局部麻醉毒性的迹象。这项工作的目的是强调TTP阻滞和局麻药剂量在儿童经胸骨正中切开心内直视手术中的镇痛效果。
{"title":"Transversus Thoracis Muscle Plane Block in Children Undergoing Open Heart Surgery via Median Sternotomy","authors":"N. Mageed","doi":"10.33552/asoaj.2020.01.000526","DOIUrl":"https://doi.org/10.33552/asoaj.2020.01.000526","url":null,"abstract":"Sternum is the main source of pain after cardiac surgery. The use of high doses of opioid are associated with prolonged mechanical ventilation. Regional anesthetic techniques facilitate early recovery. Transversus thoracis plane (TTP) block is a newly developed analgesic technique that can provide adequate analgesia for surgeries associated with sternotomy. In pediatric cardiac surgery, the dose of local anesthetics for TTP block is not described in any of literature. In our hospital (Mansoura University Children Hospital), we perform bilateral TTP block for most of children submitted for cardiac surgery via median sternotomy in a dose of 0.2-0.3mL/kg 0.2 to 0.25 % bupivacaine on each side of sternum. We found that, the above dose provides effective perioperative analgesia without any signs of local anesthetic toxicity. The aim of this work is to highlight the analgesic efficacy of TTP block and the dose of local anesthetic in children undergoing open heart surgery via median sternotomy.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88544455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.33552/asoaj.2020.01.000525
W. Ferjaoui
We present the case of a 49-year-old female patient with no past medical history. She presented with dysphagia and regurgitation for 8 months before admission. Physical examination was unremarkable. Blood tests were normal. Eso-gastro-duodenal fibroscopy was made and showed a huge diverticulum 31 cm from the dental arches. In order to better exploit this diverticulum, we completed with a transit which showed a large diverticulum at the level of 1/3 of the middle of the esophagus (Figure 1). The patient was operated bay right thoracoscopy and a diverticulectomy was done. The post-operative period was uneventful.
{"title":"Image in Surgery Diverticula of The Thoracic Esophagus Discover on a Gastroduodenal Transit","authors":"W. Ferjaoui","doi":"10.33552/asoaj.2020.01.000525","DOIUrl":"https://doi.org/10.33552/asoaj.2020.01.000525","url":null,"abstract":"We present the case of a 49-year-old female patient with no past medical history. She presented with dysphagia and regurgitation for 8 months before admission. Physical examination was unremarkable. Blood tests were normal. Eso-gastro-duodenal fibroscopy was made and showed a huge diverticulum 31 cm from the dental arches. In order to better exploit this diverticulum, we completed with a transit which showed a large diverticulum at the level of 1/3 of the middle of the esophagus (Figure 1). The patient was operated bay right thoracoscopy and a diverticulectomy was done. The post-operative period was uneventful.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73127760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-27DOI: 10.33552/asoaj.2020.01.000524
N. Mageed
Neonates born to mothers with COVID-2019 are at high risk of SARS-CoV-2 infection, although the direct vertical transmission from mother to fetus have not been documented but the baby may be infected during breast feeding by airborne or droplet infection. The baby should be isolated from infected mother and from other neonates born to healthy mothers. Neonates born with critical and severe cardiac anomalies usually require lifesaving cardiac surgical intervention. The patient’s hemodynamics should be stabilized before surgery. The patient should be considered as a source of SARS-CoV-2 transmission of infection even in the absence of any clinical, laboratory or radiologic evidence of COVID-2019. Medical personnel’s should use personal protective equipment (PPE) especially during intubation, extubation and handling patient secretions. The circuits of cardiopulmonary bypass should be small as possible to decrease the priming volume. This review is focused on anesthetic hemodynamic goals of different congenital heart disease and methods of protection of medical team in operating room and neonatal intensive care unit from transmission of SARS-CoV-2 infection.
{"title":"Perioperative Management of Neonates Born to Mothers with COVID-19 Undergoing Urgent Cardiac Surgery","authors":"N. Mageed","doi":"10.33552/asoaj.2020.01.000524","DOIUrl":"https://doi.org/10.33552/asoaj.2020.01.000524","url":null,"abstract":"Neonates born to mothers with COVID-2019 are at high risk of SARS-CoV-2 infection, although the direct vertical transmission from mother to fetus have not been documented but the baby may be infected during breast feeding by airborne or droplet infection. The baby should be isolated from infected mother and from other neonates born to healthy mothers. Neonates born with critical and severe cardiac anomalies usually require lifesaving cardiac surgical intervention. The patient’s hemodynamics should be stabilized before surgery. The patient should be considered as a source of SARS-CoV-2 transmission of infection even in the absence of any clinical, laboratory or radiologic evidence of COVID-2019. Medical personnel’s should use personal protective equipment (PPE) especially during intubation, extubation and handling patient secretions. The circuits of cardiopulmonary bypass should be small as possible to decrease the priming volume. This review is focused on anesthetic hemodynamic goals of different congenital heart disease and methods of protection of medical team in operating room and neonatal intensive care unit from transmission of SARS-CoV-2 infection.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85929148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-21DOI: 10.33552/asoaj.2020.01.000523
N. Mageed
Coarctation of aorta (CoA) is a localized narrowing of descending thoracic aorta most commonly between left subclavian artery and ductus arteriosus causing proximal hypertension and distal hypoperfusion. The clinical presentation of CoA in neonates and infants varies from acute hemodynamic collapse to weak or absent arterial femoral pulsation. Keeping the patency of ductus arteriosus with prostaglandin E1 infusion is lifesaving, once the diagnosis of severe CoA is established. Transthoracic echocardiography is the cornerstone for the diagnosis and follow-up of CoA. Inotropic drugs such as dobutamine, dopamine and epinephrine are indicated to maintain and stabilize the hemodynamics in neonates and infants with acute heart failure. Resection of the constricted segment with end to end anastomosis is the standard surgical approach. Preductal invasive arterial pressure monitoring via an arterial catheter placed in the right arm is essential. During surgery, passive cooling of the patients to a temperature of 35°C is recommended in to reduce the risk of neurological injury. Clamping the aorta aggravates the proximal hypertension and cause distal body hypoperfusion with increased risk of spinal cord injury. The aim of this review is to declare the anesthetic management of neonates and infants undergoing surgical correction of CoA and how to reduce the risk of aortic cross clamping.
{"title":"Anesthetic Management of Surgical Repair of Coarctation of Aorta in Neonates and Infants","authors":"N. Mageed","doi":"10.33552/asoaj.2020.01.000523","DOIUrl":"https://doi.org/10.33552/asoaj.2020.01.000523","url":null,"abstract":"Coarctation of aorta (CoA) is a localized narrowing of descending thoracic aorta most commonly between left subclavian artery and ductus arteriosus causing proximal hypertension and distal hypoperfusion. The clinical presentation of CoA in neonates and infants varies from acute hemodynamic collapse to weak or absent arterial femoral pulsation. Keeping the patency of ductus arteriosus with prostaglandin E1 infusion is lifesaving, once the diagnosis of severe CoA is established. Transthoracic echocardiography is the cornerstone for the diagnosis and follow-up of CoA. Inotropic drugs such as dobutamine, dopamine and epinephrine are indicated to maintain and stabilize the hemodynamics in neonates and infants with acute heart failure. Resection of the constricted segment with end to end anastomosis is the standard surgical approach. Preductal invasive arterial pressure monitoring via an arterial catheter placed in the right arm is essential. During surgery, passive cooling of the patients to a temperature of 35°C is recommended in to reduce the risk of neurological injury. Clamping the aorta aggravates the proximal hypertension and cause distal body hypoperfusion with increased risk of spinal cord injury. The aim of this review is to declare the anesthetic management of neonates and infants undergoing surgical correction of CoA and how to reduce the risk of aortic cross clamping.","PeriodicalId":92982,"journal":{"name":"Anaesthesia & surgery open access journal","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89269222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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