Articles: operative.
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Paediatric anaesthesia · Dec 2022
Comparison of General Endotracheal Anesthesia vs. Sedation without Endotracheal Intubation during Initial PEG Insertion for Infants: A Retrospective Cohort Study.
Critical airway incidents are a major cause of morbidity and mortality during anesthesia. Delayed management of airway obstruction quickly leads to severe complications due to the reduced apnea tolerance in infants and neonates. The decision of whether to intubate the trachea during anesthesia is therefore of great importance, particularly as an increasing number of procedures are performed outside of the operating room. ⋯ Study results suggest that providers selected general anesthesia over monitored anesthesia care for infants and neonates with low body weights, cardiac comorbidities, and neurologic comorbidities. Increased rates of airway intervention, and increased length of stay may be at least partially related to more severe patient comorbidity, as indicated by higher American Society of Anesthesiologists classifications. However, due to the exploratory nature of these analyses, further confirmatory studies are needed to evaluate the impact of airway selection during PEG on postoperative patient outcomes.
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Non-union occurs when a fracture fails to adequately heal, and requires additional intervention to achieve union. The purpose of this scoping review is to provide a high-level overview of the existing non-union management literature. This review aims to highlight the current literature on non-union management, as well as identify key areas that require future research to provide a better understanding of potential non-union management strategies. ⋯ A large body of evidence exists on non-union management, which is largely comprised of case series and reports. The most commonly assessed non-unions include the tibia, wrist, and femur. Bone grafting, plating, and nailing are the most investigated treatment options. BGS are a non-operative treatment options for non-union that provide similar healing rates to surgical options in certain indications within initial observational data. BGS are a potential option for non-operative management of non-unions to reduce socioeconomic burdens of surgical intervention, with a need for further high-quality investigation in this therapeutic area.
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Case Reports
Acute Intraoperative Hyperkalemia During Robot-Assisted Radical Cystectomy: A Case Report.
A 50-year-old man with muscle-invasive bladder cancer was scheduled for a robotic radical cystectomy. Four hours into the surgery, his electrocardiogram showed rhythm disturbances. Arterial blood gas analysis showed a serum potassium concentration of 6.6 mEq/L. ⋯ The procedure was completed after conversion to an open surgery. The postoperative serum potassium concentration was reduced to 4.6 mEq/L, and the patient was extubated. The remainder of his hospital stay was uneventful.
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Randomized Controlled Trial
Effect of Combined Epidural Morphine and Midazolam on Postoperative Pain in Patients Undergoing Major Abdominal Cancer Surgery.
The objective was to compare analgesic effect of combined epidural morphine-midazolam with either drug alone on postoperative pain in patients undergoing major abdominal cancer surgery. ⋯ Addition of midazolam to epidural morphine prolonged time of first analgesic request and decreased total analgesic consumption.