A clinical study of effect of peri-tonsillar infiltration of ropivacaine on tonsillectomy haemorrhage

<p><strong>Background:</strong> The aim of this study to determine the relationship between the peritonsillar infiltration of ropivacaine hydrochloride and haemorrhage in patients undergoing tonsillectomy.</p><p><strong>Methods </strong>This prospective study was conducted in the department of otorhinolaryngology and head and neck surgery, Adichunchanagiri institute of medical sciences, B. G. Nagara, Mandya district. A sample size of 30 patients which satisfied the inclusion criteria were included in the study. <strong></strong></p><p>Ropivacaine (0.75%)<strong> </strong>was locally infiltrated on the right side (R-side) in the peri-tonsillar region before the surgery. The left side was considered as the control side. Intra-operative blood loss was estimated separately for both the sides. The data from the study will be analysed using chi square test and Student t test technique.</p><p><strong>Results:</strong> The 17 (56.7%) females and 13 (43.3%) males participated in the study. Majority of the cases belonged to &lt;10 years of age group. By analysing the data, blood loss was found to be higher on the left side (control side) compared to the right side on which peri-tonsillar infiltration of ropivacaine was given. The association between the blood loss on the right side and the left side (control side) was found to be significant (p&lt;0.0001).<strong></strong></p><p><strong>Conclusions: </strong>Based on the result of our study it can be derived that the peri-tonsillar infiltration of Ropivacaine (0.75%) is very effective in reducing intra-operative bleeding and at the same time providing a better bloodless field during surgery. Hence, we recommend the use of peri-tonsillar infiltration of Ropivacaine (0.75%) in view of better management of intra-operative blood lossissn.2454-5929.ijohns20220041</p>

Transapical cannulation for surgical repair of chronic type B aortic dissection

Open surgery for chronic type B aortic dissection has been shown to have considerable risks of cerebrovascular complications. Because retrograde perfusion is a potential cause of intraoperative cerebrovascular events, we report our transapical cannulation strategy for descending aorta replacement in chronic type B aortic dissection repair with circulatory arrest. This technique provides an easy and quick establishment of cardiopulmonary bypass by way of a left thoracotomy, and prevention of cerebrovascular event. Transapical cannula can be also used as a vent to ensure a bloodless field during proximal anastomosis and to prevent extension of left ventricle during rewarming. Transapical cannulation is a useful option in open repair of the descending aorta for chronic type B aortic dissection by way of left thoracotomy.

Common haemostatic techniques used in surgical practice

Intraoperative bleeding can be difficult to manage and is associated with worse patient outcomes. Good intraoperative haemostasis by the surgeon is a key factor in ensuring a bloodless field and reducing intraoperative blood loss. There is a myriad of mechanical, thermal and energy-based techniques available to use, each of which has their own benefits and drawbacks. The decision of which to use will depend on patient and procedural factors as well as the surgeon's preference. This article reviews techniques commonly used in surgical practice to maintain intraoperative haemostasis.

Experience of Tympanoplsty Done Under Local Anesthesia without Sedation

Tympanoplsty is the common operation for chronic otitis media that is performed under local Anesthesia (LA) or general anesthesia (GA). LA is more popular than GA in the underdeveloped and developing countries in almost all ear surgeries. The authors have been using LA without sedation for more than 20 years. LA without sedation is relatively safer, less expensive and perform more surgeries in a shorter period of time. This study aimed to share the experience of LA without sedation in tympanoplsty. Patients and Method: 7050 patents underwent tympanoplsty under LA without sedation from 1999 to 2019 in the different hospital of Bangladesh. Patients were thoroughly evaluated preoperatively, explained the advantages of LA without sedation in details LA was used with different Adrenaline concentrations (1: 1000 to 1: 200,000) either by injection or topically. Patients’ compliance, pain, discomfort, drowsiness, and other parameters ware recorded. Results: Amongst 7050 patients, 3877 were male and 3173 were female. The youngest patient was 14 year boy and oldest patient was of 58 year male. Operative time was short with a bloodless field. Mean operative time was 45 minutes. The overall safety was good and needed shortest hospital stay (Hour/day); and of course very less expensive. Conclusion: Tympanoplsty under local anesthesia without sedation is safer, relatively cost effective, can be performed as a day/hour care case. Suitable patient selection and adequate preoperative counseling is essential to achieve a great success

Tympanoplasty under Local Anesthesia (LA) Without Sedation

Background & Objectives: Local Anesthesia (LA) is getting popularity in comparison to general anesthesia (GA) in underdeveloped and developing countries in many otolaryngological operations. The rationale for LA is the lack of trained anesthesia staff, lack of adequate anesthesia machines and monitoring equipment. LA is safe; and ability to perform more cases in a shorter period of time. This study aimed to find out patients compliance in the operative procedures under LA without sedation. Methods: 7905 patents underwent tympanoplsty under LA without sedation from 1999 to 2019 in the different hospital of Bangladesh. Preoperative thorough counselling with psychological motivation, advantages of LA, intraoperative surgeon patient conversation and watching surgical steps on monitor, tests of facial nerve function were explained to the patient. LA with different Adrenaline concentrations (1: 1000 to 1: 200,000) was used either by injection or topically. Patients’ satisfaction, vertigo, drowsiness, hangover, orientation and other parameters ware recorded. Results: Amongst 7905 patients; male 56.2% and 43.8% was female. Maximum numbers (26.3) were found between 26 year to 35 year of age. Patients’ intraoperative compliance showed excellent without sedation. Operative time was short with a bloodless field. The overall safety was good and needed shortest hospital stay (Hour/day); and of course very less expensive. Conclusion: Patient’s safety is the primary objective considered in all patients. The advantages recorded as day/hour care hospital stay, patients comfort, less bleeding, ability to assess patient’s hearing during surgery and cost effectiveness

Total trapeziometacarpal joint arthroplasty using wide awake local anaesthetic no tourniquet

We conducted a descriptive study of 50 consecutive cases of total trapeziometacarpal joint arthroplasty by one surgeon using wide awake local anaesthetic no tourniquet to assess the usefulness and reliability of the anaesthesia, any adverse effects and patient acceptance. No difference was found when comparing the duration of surgery with 50 cases of total trapeziometacarpal joint arthroplasty inserted in a bloodless field under general or regional anaesthesia by the same surgeon. Wide awake local anaesthetic no tourniquet was found to be useful in providing adequate anaesthesia and haemostasis, and to be reliable and safe with no adverse effects. Patient satisfaction was high with 100% willing to repeat. Overall, wide awake local anaesthetic no tourniquet was a satisfactory method of anaesthesia for trapeziometacarpal joint arthroplasty with the potential for significant benefits to both patient and surgeon compared with traditional general anaesthesia and regional block. Level of evidence: II

A surgical technique for ascending aorta, aortic arch and descending aorta replacement without cross-clamp, circulatory arrest or hypothermia

Treatment of the aneurysms comprising the aortic arch is challenging. Surgical reconstruction usually requires aortic cross-clamping, cardiac arrest, and even deep hypothermia for a bloodless field. In this report, we present our surgical technique providing normothermic ascending aorta, aortic arch, and proximal descending aorta replacement with selective cannulation and perfusion of the whole body.

Myocardial protection: a forgotten modality

SummaryThe goals of a cardiac surgical procedure are both technical excellence and complete protection of cardiac function. Cardioplegia is used almost universally to protect the heart and provide a quiet bloodless field for surgical accuracy. Yet, despite the importance of myocardial protection in cardiac surgery, manuscripts or dedicated sessions at major meetings on this subject have become relatively rare, as though contemporary techniques now make them unnecessary. Nevertheless, septal dysfunction and haemodynamic support (inotropes, intra-aortic balloon pump, assist devices) are common in postoperative patients, indicating that myocardial damage following cardiac surgery is still prevalent with current cardioplegic techniques and solutions. This article first describes why cardiac enzymes and septal function are the ideal markers for determining the adequacy of myocardial protection. It also describes the underappreciated consequences of postoperative cardiac enzyme release or septal dysfunction (which currently occurs in 40–80% of patients) from inadequate protection, and how they directly correlate with early and especially late mortality. Finally, it reviews the various myocardial protection techniques available to provide a detailed understanding of the cardioplegic methods that can be utilized to protect the heart. This will allow surgeons to critically assess their current method of protection and, if needed, make necessary changes to provide their patients with optimal protection.