AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into gener...AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into general anesthesia group(group A,70 eyes)and local anesthesia group(group B,71 eyes).Patients received optical PKP(group A1,30 eyes;group B1,30eyes)or therapeutic PKP(group A2,40 eyes;group B2,41 eyes).Measurement of anterior chamber treatment time(T)for PKP patients and the ratio(R)of the area of the pupils to that of recipient graft region.T and R values,as well as perioperative and postoperative complications,were compared between groups A and B using t-test orχ2test.RESULTS:Patients were followed for 2wk after PKP.T was(13.45±8.64)min for group A and(7.36±5.24)min for group B,a statistically significant difference(P【0.001).The R value for group A was stable during the operation,while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing.In group B,extrusion of intraocular contents occurred in 5 eyes,and iridal prolapse occured in 11cases;no perioperative complications occurred in group A.Relapse rate for fungal keratitis was 13.04%in group B and 0%in group A.CONCLUSION:Under general anesthesia,pupils remaine stable during PKP and perioperative complications are averted.General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.展开更多
BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Sys...BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry,many studies have compared its efficacy and safety to conventional anesthesia.However,very few studies have compared single tooth anesthesia(STA)and traditional local anesthesia.AIM To compare pain rating,changes in blood pressure,and heart rate during the local anesthetic injection.The secondary objectives were to measure the patients’level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.METHODS A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study.The patients were evaluated for their general physical status and oral clinical findings before enrollment.Information regarding perceived pain,changes in heart rate and blood pressure,and patients’satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.RESULTS No significant difference was noted in perceived pain(P=0.59)and systolic blood pressure(P=0.09)during anesthetic injection using both traditional and STA techniques.STA patients had a significantly higher heart rate during anesthesia,although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia.During the restorative procedure,less pain was perceived by STA patients on the Wong-Baker FACES pain scale,which was statistically significant(P<0.001).Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future(P=0.04).CONCLUSION STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.展开更多
BACKGROUND Fibrobronchoscopy is a common adjunct tool that requires anesthesia and is widely used in the diagnosis and treatment of various respiratory diseases.However,current anesthesia methods,such as spray,nebuliz...BACKGROUND Fibrobronchoscopy is a common adjunct tool that requires anesthesia and is widely used in the diagnosis and treatment of various respiratory diseases.However,current anesthesia methods,such as spray,nebulized inhalation,and cricothyroid membrane puncture,have their own advantages and disadvantages.Recently,studies have shown that bronchoscopic direct-view glottis anesthesia is a simple and inexpensive method that shortens the examination time and provides excellent anesthetic results.AIM To evaluate the effectiveness of bronchoscopic direct vision glottis anesthesia for bronchoscopy.METHODS The study included 100 patients who underwent bronchoscopy during thoracic surgery.A random number table method was used to divide the patients into control and observation groups(50 patients each).The control and observation groups were anesthetized using the nebulized inhalation and bronchoscopic direct vision glottis method,respectively.Hemodynamic indices[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and oxygen saturation(SpO_(2))before(T1),5 min after anesthesia(T2),and at the end of the operation(T3)]serum stress hormone indices[norepinephrine(NE),epinephrine(E),adrenocorticotropic hormone(ACTH),and cortisol(Cor)before and after treatment]were compared between the 2 groups.Adverse effects were also RESULTS At T2 and T3,SBP,DBP,and HR were lower in the observation group than the control group,whereas SpO_(2) was higher than the control group[(119.05±8.01)mmHg vs(127.05±7.83)mmHg,(119.35±6.66)mmHg vs(128.39±6.56)mmHg,(84.68±6.04)mmHg vs(92.42±5.57)mmHg,(84.53±4.97)mmHg compared to(92.57±6.02)mmHg,(74.25±5.18)beats/min compared to(88.32±5.72)beats/min,(74.38±5.31)beats/min compared to(88.42±5.69)beats/min,(97.36±2.21)%vs(94.35±2.16)%,(97.42±2.36)%vs(94.38±2.69%],with statistically significant differences(all P<0.05).After treatment,NE,E,ACTH,and Cor were significantly higher in both groups than before treatment,but were lower in the observation group than in the control group[(68.25±8.87)ng/mL vs(93.35±14.00)ng/mL,(53.59±5.89)ng/mL vs(82.32±10.70)ng/mL,(14.32±1.58)pg/mL vs(20.35±3.05)pg/mL,(227.35±25.01)nmol/L vs(322.28±45.12)nmol/L],with statistically significant differences(all P<0.05).The incidence of adverse reactions was higher in the control group than in the observation group[12.00%(12/50)vs 6.00%(3/50)](P<0.05).CONCLUSION The use of bronchoscopic direct vision glottis anesthesia method for bronchoscopy patients is beneficial for stabilizing hemodynamic indices during bronchoscopy and reducing the level of patient stress,with good safety and practicality.展开更多
Objective: To observe the influence of local infiltration anesthesia at the scalp point on acupuncture stimulation induced changes of cerebral blood perfusion in the brain. Methods: Experiments were conducted in 10 he...Objective: To observe the influence of local infiltration anesthesia at the scalp point on acupuncture stimulation induced changes of cerebral blood perfusion in the brain. Methods: Experiments were conducted in 10 healthy volunteer subjects (8 males and 2 females) who were ordered to take a lying position on a specific bed with their heads keeping in a fixed position. Scalp point used was Motor Area (MS 6). The first syringe needle (gauge 5) was inserted into the scalp from the upper 1/5 of MS 6 and the second syringe needle inserted into the scalp from the middle 2/5 of MS 6 and advanced downward, with the two needles connected to a HAN’s Therapeutic Apparatus. Images of the brain were then taken before and after electroacupuncture (EA) stimulation, and after local injection of 1% lidocaine [mixed with epinephrine (1∶200,000, 3 mL)] plus EA by using Siemens ECAM/ICON Single Photo Emission Computed Tomography (SPECT). Intravenous injection of Ethyl cysteinate dimmer 555 MBq was performed before displaying cerebral images. Data of blood functional changing rat (BFCR%) were analyzed quantitatively using a mathematic model. Results: Before EA stimulation, the blood perfusion and function of cerebral cortex, thalamus, basal ganglion and cerebellum on both sides of the brain were basically symmetry. Following EA of MS 6, BFCR% of the contralateral thalamus, parietal lobe and the frontal lobe increased significantly. Following local infiltration anesthesia, BFCR% of the contralatral thalamus declined markedly (P<0.05). The results of quantitative analysis were in agreement with those of visual observation. Conclusion: Local infiltration anesthesia of the scalp point can significantly weaken or block EA stimulation induced changes of BFCR%.展开更多
Tubal ligation is a surgical sterilization procedure that provides permanent and reliable contraception to women.?Tubal obstruction is a method of permanent birth control that can be performed after mini-laparotomy un...Tubal ligation is a surgical sterilization procedure that provides permanent and reliable contraception to women.?Tubal obstruction is a method of permanent birth control that can be performed after mini-laparotomy under local anesthesia. Objective:?To determine the outcome of tubal sterilizations by mini-laparotomy under local anesthesia performed in clients who underwent the surgical operation in the Maternity Ward of Ignace Deen National Hospital. Patients and Methods:?The Gynecology and Obstetrics Department of Ignace Deen National Hospital was used as the place for the study. The study involved all the women seeking voluntary surgical contraception. This was a retrospective study of a descriptive type carried out from January 1, 2017 to December 31, 2018. A consent form was filled out and signed by spouses after an interview and a systematically carried out pre-operative clinical and para-clinical assessment. Results:?During the study period, 56 tubal ligations were performed i.e. 4.72 percent of all family planning methods. The recruiting for the surgical contraception involved clients whose typical profile is that of women with an average age of 35, mostly housewives (35.71%), major multiparous (69.63%) with 6 living children on average. Married women made up the bulk of the recruiting i.e. 96.44%. Unmarried women made much more use of other methods. Indications of personal convenience were the most frequently encountered common reason. Among medical causes, high blood?pressure concerned the majority of cases: 38% of the indications. Surgical contraception in between was more practiced than the post-partum one. The recorded complication was the parietal hematoma due to a lack of hemostasis and it accounted for 1.79% of cases. The progress was uncomplicated in?98.68% of cases. Forty couples (71.42%) expressed their feelings of satisfaction against only 6 cases of regret (10.71%). Conclusion:?The surgical contraception has become a requirement for modern couples. Tubal ligation by?mini-laparotomy is a simple operation and a harmless method of contraception that allows clients to use permanent contraception. Carried out on an outpatient basis, incidents and accidents are rare and may have psychological repercussions that are difficult to assess. The technical mastery of the gesture helps to minimize these incidents.展开更多
Lidocaine hydrochloride(LIDH) as an anesthetic is widely used in local anesthesia. Dissolving microneedles(MNs) have great application value in the field of skin anesthesia. However, the limited drug-loading of dissol...Lidocaine hydrochloride(LIDH) as an anesthetic is widely used in local anesthesia. Dissolving microneedles(MNs) have great application value in the field of skin anesthesia. However, the limited drug-loading of dissolving MNs is an existing challenge that affects clinical use. In this study, we have screened isomaltulose(ISO) as the proper matrix material for the MNs by using molecular dynamics(MD) simulation. Our findings indicate that ISO has good compatibility with LIDH, and the LIDH-loaded ISO MNs(LI-MNs) have high drug-loading capacity. The drug-loading capacity of LI-MNs could reach 80%, and it could effectively puncture the skin. In addition, the preparation method of customized LI-MNs was established based on three-dimensional(3D) printing technology. It was shown that the administration time of LI-MNs could be controlled within 3 min. Also, the LI-MNs were able to provide the local anesthetic efficacy within2 min and sustained for more than 2 h. Significantly, LI-MNs had more efficient drug efficacy compared to the topical creams and the majority of existing LIDH-loaded dissolving MNs. They even provided a longer duration of action than the injections. Overall, the LI-MNs with high drug-loading have a promising application prospect.展开更多
Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like sho...Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like short-term admission or for those not indicated for general anesthesia due to complications. This report presents the outcomes of breast conserving surgery and sentinel lymph node biopsy under local anesthesia. Patients and Methods: The study included 61 patients with breast cancer that were all definitely diagnosed before surgery. The indications were preoperatively diagnosed localized DCIS, invasive carcinoma measuring less than 3 cm in tumor diameter on ultrasound, and tumors with negative axillary lymph nodes. The surgical procedures included breast conserving surgery associated with sentinel lymph node navigation biopsy. Results: The surgery could be performed under local anesthesia in all 61 patients, and no patient was converted to general anesthesia. Four patients had sentinel lymph node metastasis. Surgical stumps were positive in 18 patients (29.5%). Ten Gy of boost irradiation of the tumor bed was added to the conventional breast irradiation for these patients. There were no serious complications associated with surgery. Conclusion: Breast conserving surgery and sentinel lymph node biopsy for early breast cancer can be performed safely under local anesthesia. This procedure contributes to shortening the length of hospitalization and thereby saving medical resources without deceasing the quality of treatment.展开更多
<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Surgical treatment of r...<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Surgical treatment of rectocele and cystocele is usually performed in a hospital setting under regional (spinal or epidural) or general anesthesia, and patients commonly have to stay in the hospital for at least one or two days. The possibility of performing the surgery under local anesthesia, as an outpatient procedure with minimal bleeding and pain, no surgical assistants, with immediate discharge and, most importantly, without compromising postoperative results, is appealing. To our knowledge, no studies ha</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ve</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> evaluated whether performing rectocele and/or cystocele rectocele repair under local infiltration anesthesia and without separation of the vaginal mucosa from the underlying fascia achieves these goals.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The aim of this study is to describe a new surgical technique for outpatient treatment of cystocele and rectocele under local anesthesia, and our initial results. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Forty women underwent outpatient surgical repair of rectocele and/or cystocele between April and September 2020 at the ambulatory procedure room of the authors’ clinics. The technique consists of a triangular-shaped CO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> laser vaporization</span><span style="color:red;"> </span><span style="font-family:Verdana;">or electrocauterization of the posterior and/or anterior vaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactin suture. A perineorrhaphy was always performed concomitantly with rectocele repair, and a transobturator sling was performed in women presenting with concomitant stress urinary incontinence. Postoperative evaluation included POP-Q measurement for each patient six months after the procedure, and resolution of prolapse was considered when anterior and/or posterior vaginal wall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzed using Wilcoxon signed-rank test.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The mean operating time was 21 minutes (range: 14</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">38 minutes). All patients tolerated the procedure well and were discharged immediately afterwards. There were no intraoperative or postoperative complications, and all patients had satisfactory healing of the vaginal mucosa. Bleeding from the rectocele and/or cystocele repair was minimal, and nobody required extra-anesthesia or transfer to a hospital surgical theater. At six month follow-up, pre and postoperative POP-Q measurement</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of points Ap, Bp, Aa and Ba were all statistical</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">l</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y significant (Ap 1.6 ± 1.2 × -2.4 ± 0.9, Bp 2.6 ± 1.6 × -2.7 ± 1.4, Aa 1.4 ± 1.1 × -2.3 ± 0.8, and Ba 2.4 ± 1.5 × -2.5 ± 1.2) respectively, revealing satisfactory resolution of both rectocele and cystocele.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Our initial results suggest that rectocele and cystocele may be safely and effectively treated under local anesthesia in an outpatient setting using this new technique.</span></span></span>展开更多
<strong>Introduction:</strong> Epiphora is a common ophthalmologic complaint and referrals to oculoplastics and, in the presence of lower complete lacrimonasal duct obstruction, may lead to mild to severe ...<strong>Introduction:</strong> Epiphora is a common ophthalmologic complaint and referrals to oculoplastics and, in the presence of lower complete lacrimonasal duct obstruction, may lead to mild to severe complications, thus requiring surgery to create a new drainage path. The external dacryocystorhinostomy with silicon intubation is the surgical technique with better long-term outcomes and performed in the institutions where this study was conducted. Can be performed under either general or loco-regional anesthesia, or a combination of both. <strong>Methods:</strong> This article presents a revision of 218 consecutive cases from December 2016 to June 2021 in two specialized centers with the same standardized surgical and anesthetic technique. <strong>Results:</strong> 242 surgical prontuaries were selected, with 218 filling the inclusion criteria. 13% of the patients required additional anesthetic infusion before the beginning of the surgery;2.7% of the patients required field anesthetic infusion during the surgery and 6.4% required supplementary sedation, thus meaning a positive outcome, as the number of patients with intraoperative complaints was low, and the overall comfort was high. During the follow up, no patient required pain medication after 24 hours. <strong>Discussion:</strong> This study points towards the feasibility of the described technique in an outpatient fashion, with low, mild and tolerable side effects associated.展开更多
Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our cont...Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our context of exercise, we sometimes have a different attitude dictated by various constraints. Observation: 55-year-old patient with no notable history, seen in consultation for a very large ulcerative-budding lesion on the right 2/3 of the lower lip with mucocutaneous involvement without lymph node findings found on examination. Faced with this suspicious lesion and the patient’s financial difficulties, we decided to operate under local anesthesia to remove this tumor. The oncological excision was followed by immediate plasty using a Camille-Bernard flap with a good immediate aesthetic and functional result and postoperative day 7. The patient was unable to take his surgical specimen to anatomy-pathology and was lost to follow-up due to lack of financial resources. On anatomo-pathological analysis of the surgical specimen, the margins were healthy with confirmation of squamous cell carcinoma (anapathological reading made for scientific interest). Discussion: The particular mentality of certain patients and their difficult financial conditions push us to have an unconventional therapeutic attitude in oncology, but which nevertheless makes it possible to resolve certain problems that we often face. Local anesthesia is possible and realistic in cases like ours and the results can be acceptable and life-saving.展开更多
Background Rapid right ventricular pacing is one of the methods for counteracting the ＂wind sock＂ effect in the thoracic endovascular aortic repair （TEVAR）. Most of the doctors are to complete this operation under...Background Rapid right ventricular pacing is one of the methods for counteracting the ＂wind sock＂ effect in the thoracic endovascular aortic repair （TEVAR）. Most of the doctors are to complete this operation under general anesthesia. Now, our operation has been performed under local anesthesia. No related reports were found as to whether can the patient tolerate rapid fight ventficular pacing under local anesthesia. Methods From 2009 January to 2010 January, in our hospital all the DeBakey llI aortic dissection patients who underwent TEVAR were randomly divided into general anesthesia group （n = 50） and local anesthesia group （n = 51）. All the data were compared between two groups including the hemodynamic indexes, the graft positioning accuracy, rapid pacing duration, operation time, intraoperative discomfort and postoperative neurological understanding function changes and the complications. Results The success rate were 100% in the two groups. The duration of rapid pacing, operation time, the accuracy of graft localization and the intraoperative discomfort scores of Numerical Pain Rating Scale showed no significant difference between the two groups （P 〉 0.05）. There were no rapid fight ventricular pacing-related complications in the two groups. Conclusion During thoracic endovascular aortic repair procedure, rapid fight ventricular pacing under local anesthesia is safe and feasible. Thus it is worthy to be popularized in clinical practice.展开更多
Introduction: This paper presents the design, development, and usability evaluation of a custom haptic syringe aimed to improve the realism of a virtual reality local anesthesia simulation (VRLA), specifically for the...Introduction: This paper presents the design, development, and usability evaluation of a custom haptic syringe aimed to improve the realism of a virtual reality local anesthesia simulation (VRLA), specifically for the inferior alveolar nerve block (IANB), that formally used a head mounted device (HMD) and vibration feedback via hand controllers. The custom haptic syringe interface provides a more realistic tactile sensation of plunging a real syringe in a human patient. This pilot study investigated the usability of the custom haptic syringe to replace one of the hand controllers to provide a more realistic and better training experience. Method: A one group pre-post survey investigated student perceptions regarding the effectiveness and usability of a haptic syringe to provide a more realistic experience to train dental students to learn the procedural steps to inject local anesthesia into a virtual patient. Twenty-two third year dental students participated. The pre-post survey examined changes in students’ perceived emotions, preparedness, and effectiveness of the VRLA as a foundational learning strategy prior to entering clinical group practice. Results: While quantitative results on comparable survey questions did not yield statistically significant differences, qualitative open-ended responses revealed a much greater satisfaction using the custom haptic syringe compared to the out of the box controllers. Conclusions: Feedback regarding the haptic syringe showed a substantial step closer to providing a more real experience for students in an effort to create a better bridge between classroom learning and clinical practice in order to prepare students to more confidently and competently work with real clients. Further refinement of the syringe is forthcoming along with a more formal comparative experimental study.展开更多
Introduction: Varicocele is one of the most frequent causes of infertility. There are several therapeutic modalities, namely surgery (open and laparoscopic) and conventional radiology. The aim of our study was to eval...Introduction: Varicocele is one of the most frequent causes of infertility. There are several therapeutic modalities, namely surgery (open and laparoscopic) and conventional radiology. The aim of our study was to evaluate the impact of a varicocele cure under local anaesthesia on spermogram quality. Material and Methods: We conducted a retrospective descriptive study from 1 January 2022 to 31 December 2023 in the urology department of the Hôpital Militaire de Ouakam (HMO). The parameters studied were age, reasons for consultation, time to urology consultation, grade of varicocele, Doppler ultrasound and spermogram data before treatment and 3 months after treatment. Treatment consisted of bilateral subinguinal varicocelectomy under local anaesthetic. Data were entered and analysed using Excel software version 2021. Results: We studied 41 patients. The mean age of the patients was 35.3 ± 6.9 years, with extremes of 22 and 50 years. Thirty-eight of our patients (88.37%) were married. The most frequent reason for consultation was primary infertility (72.09%). 28 patients (68.3%) had a bilateral varicocele on ultrasound. Varicocele was associated with bilateral testicular hypotrophy in 13 patients (31.7%) and unilateral left testicular hypotrophy in 11 patients (26.8%). All patients underwent subinguinal varicocelectomy under local anaesthetic. Mean follow-up was 4.5 months. A clear statistically significant improvement was noted in sperm motility and concentration in postoperative spermograms, with normalisation of the spermogram in 15 (36.5%) of patients. Conclusion: The impact of varicocele on sperm parameters has been clearly established. There are various therapeutic methods for curing varicocele, including varicocelectomy under local anaesthetic, which, in addition to its undeniable economic advantages, can significantly improve sperm parameters in patients with varicocele and prevent their deterioration over time.展开更多
This paper reviews a local anesthesia for resection of back mass, and the rescue of patients with sudden apnea during the operation. It also summarizes the nursing experience and shortcomings of the visiting nurses du...This paper reviews a local anesthesia for resection of back mass, and the rescue of patients with sudden apnea during the operation. It also summarizes the nursing experience and shortcomings of the visiting nurses during the operation, which provides relevant experience for the future local anesthesia operation for patients with cardiovascular complications. The patient underwent left back mass resection under local anesthesia. Blood pressure, heart rate and blood oxygen saturation were monitored. The right lateral position was adopted during the operation. During the 5-minute operation to separate the tumor, the visiting nurse noticed that the patient was pale and weak in answering the questions, and immediately she cried out. The ECG monitor showed that the heart rate was 45 beats/min and the SpO2 was 85%, with continuous decrease. Immediately call the surgeon to stop the operation. Change the patient from lateral position to supine position. Due to the timely rescue and proper measures, the patients heart rate rose to 70 beats/min, BP120/70mmHg, R22 beats/min, SpO2 was 98% after about 10 minutes. The patient regained consciousness and was able to correctly answer the questions. After 15 minutes of observation, the patients condition was stable and there was no discomfort. The right lateral decubitus position was placed again and the operation was completed after the drape was disinfected again. Conclusion: local anesthesia operation has certain risks. Attention should be paid to local anesthesia operation for patients with cardiovascular and other complications. Preoperative preparation should be adequate, peripheral veins should be opened regularly, and ECG and blood pressure should be monitored. During the operation, the patients complexion, consciousness and breathing were closely observed. If there is any abnormal situation, the surgeon should be reported in time and the emergency plan should be started to ensure the safety of the patients during the operation and to improve the quality of nursing cooperation during the operation.展开更多
Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients und...Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and March 2014. Of the total number of hernias surgically treated in this period, 755 were operated on the right, 394 on the left and 37 bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m2), patient’s refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. Results: All operations were completed successfully. In no case there was a need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64%. There was no need for hospital admissions greater than 24 hours. Conclusion: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.展开更多
Objective To discuss the feasibility of pereutaneous nephrolithotomy ( PCNL) for treating upper urinary calculi under local anesthesia. Methods One thousand three hundred and sixty - three patients who suffered
AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment...AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied en- ergy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION: These results suggest that EI-RFA, un- der general anesthesia, may be effective for the treat- ment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain- free condition for the patients.展开更多
AIM:To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification.· METHODS:This was a randomized,double-blind clinical trial which was conducted at Nikookar...AIM:To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification.· METHODS:This was a randomized,double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months.Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with(LH),or without(L) addition of hyaluronidase(150IU/mL).Akinesia was assessed 15 minutes after sub-Tenon's injection.Patients and surgeon's satisfaction,as well as the postoperative pain(the visual analogue scale,VAS) were investigated after operation.The contingency tables(including the Chi-square or Fisher's exact tests,when appropriate) and parametric analysis(the independent samples t test) were used for statistical analysis.· RESULTS:Complete akinesia(33.3% vs 4.8%,P =0.04),as well as the patients(85.7% vs 57.1%,P =0.04)and surgeon's satisfaction(87.5% vs 52.4%,P =0.02) were significantly more frequent in LH than in L group.The mean VAS was significantly lower in the same group(1.90±1.45 vs 3.00±1.55,P =0.04).· CONCLUSION:Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia,enhances the intra-operative patients and surgeons' satisfaction,and attenuates the postoperative pain.·展开更多
OBJECTIVE: To evaluate the effect on acne vulgaris of pricking-bloodletting cupping at Dazhui(GV 14) under acupuncture anesthesia, and establish whether providing anesthesia to the treatment area by manipulating Hegu(...OBJECTIVE: To evaluate the effect on acne vulgaris of pricking-bloodletting cupping at Dazhui(GV 14) under acupuncture anesthesia, and establish whether providing anesthesia to the treatment area by manipulating Hegu(LI 4) and Quchi(LI 11) might have an additional therapeutic benefit. METHODS: Thirty-eight patients were recruited and randomized into a control group and an intervention group with a single-blind(observer-blind) method. The control group was treated by pricking-bloodletting cupping at Dazhui(GV 14) and the studied group by pricking-bloodletting cupping at Dazhui(GV 14) under acupuncture anesthesia at Hegu(LI 4) and Quchi(LI 11). Both groups were treated twice weekly for 6 weeks. The analgesic and therapeutic effects of acupuncture were evaluated on a visual analog scale(VAS) and global acne grading system(GAGS), respectively.RESULTS: There were differences in the VAS scores of pain on pricking and in the pricked area, and the duration of pain between the groups. After 12 treatments, there was a significant reduction in GAGS scores from baseline in both groups, but there was no significant difference between the groups. CONCLUSION: Acupuncture anesthesia at Hegu(LI 4) and Quchi(LI 11) is an effective means of alleviating the pain of pricking-bloodletting cupping and reducing the duration of pain in the treatment area. Pricking-bloodletting cupping at Dazhui(GV 14) improves the skin lesions of patients with moderate acne vulgaris, but acupuncture anesthesia does not appear to have an additional therapeutic effect.展开更多
AIM To investigate the effect of clonidine on the cutaneous silent period(CSP)during spinal anesthesia.METHODS A total of 67 adult patients were included in this randomized,prospective,single-center,double-blind trial...AIM To investigate the effect of clonidine on the cutaneous silent period(CSP)during spinal anesthesia.METHODS A total of 67 adult patients were included in this randomized,prospective,single-center,double-blind trial.They did not have neurological disorders and were scheduled for inguinal hernia repair surgery.This trial was registered on ClinicalTrials.gov(NTC03121261).The patients were randomized into two groups with regards to the intrathecally administered solution:(1)15 mg of 0.5%levobupivacaine with 50μg of 0.015%clonidine,or(2)15 mg of 0.5%levobupivacaine alone.There were 34 patients in the levobupivacaine-clonidine(LC)group and 33 patients in the levobupivacaine(L)group.CSP and its latency were measured four times:prior to the subarachnoid block(SAB),after motor block regression to the 0 level of the Bromage scale,with ongoing sensory blockade,and both 6 and 24 h after SAB.RESULTS Only data from 30 patients in each group were analyzed.There were no significant differences between the groups investigated preoperatively and after 24 h.The CSP of the L group at the time point when the Bromage scale was 0 was 44.8±8.1 ms,while in the LC group it measured 40.2±3.8 ms(P=0.007).The latency in the L group at the time point when the Bromage scale was 0 was 130.3±10.2 ms,and in the LC group it was 144.7±8.3 ms(P<0.001).The CSP of the L group after 6 h was 59.6±9.8 ms,while in the LC group it was 44.5±5.0 ms(P<0.001).The latency in the L group after 6 h was 110.4±10.6 ms,while in LC group it was 132.3±9.7 ms(P<0.001).CONCLUSION Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone resultsin a diminished inhibitory tonus and shortened CSP.展开更多
文摘AIM:To examine which anesthesia general or local is more effective for penetrating keratoplasty(PKP).METHODS:Patients with indications for PKP(n=141)were enrolled in a prospective study and randomly divided into general anesthesia group(group A,70 eyes)and local anesthesia group(group B,71 eyes).Patients received optical PKP(group A1,30 eyes;group B1,30eyes)or therapeutic PKP(group A2,40 eyes;group B2,41 eyes).Measurement of anterior chamber treatment time(T)for PKP patients and the ratio(R)of the area of the pupils to that of recipient graft region.T and R values,as well as perioperative and postoperative complications,were compared between groups A and B using t-test orχ2test.RESULTS:Patients were followed for 2wk after PKP.T was(13.45±8.64)min for group A and(7.36±5.24)min for group B,a statistically significant difference(P【0.001).The R value for group A was stable during the operation,while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing.In group B,extrusion of intraocular contents occurred in 5 eyes,and iridal prolapse occured in 11cases;no perioperative complications occurred in group A.Relapse rate for fungal keratitis was 13.04%in group B and 0%in group A.CONCLUSION:Under general anesthesia,pupils remaine stable during PKP and perioperative complications are averted.General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.
文摘BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry,many studies have compared its efficacy and safety to conventional anesthesia.However,very few studies have compared single tooth anesthesia(STA)and traditional local anesthesia.AIM To compare pain rating,changes in blood pressure,and heart rate during the local anesthetic injection.The secondary objectives were to measure the patients’level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.METHODS A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study.The patients were evaluated for their general physical status and oral clinical findings before enrollment.Information regarding perceived pain,changes in heart rate and blood pressure,and patients’satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.RESULTS No significant difference was noted in perceived pain(P=0.59)and systolic blood pressure(P=0.09)during anesthetic injection using both traditional and STA techniques.STA patients had a significantly higher heart rate during anesthesia,although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia.During the restorative procedure,less pain was perceived by STA patients on the Wong-Baker FACES pain scale,which was statistically significant(P<0.001).Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future(P=0.04).CONCLUSION STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.
基金Hebei Science and Technology Program,No.162777232(to Xing SS).
文摘BACKGROUND Fibrobronchoscopy is a common adjunct tool that requires anesthesia and is widely used in the diagnosis and treatment of various respiratory diseases.However,current anesthesia methods,such as spray,nebulized inhalation,and cricothyroid membrane puncture,have their own advantages and disadvantages.Recently,studies have shown that bronchoscopic direct-view glottis anesthesia is a simple and inexpensive method that shortens the examination time and provides excellent anesthetic results.AIM To evaluate the effectiveness of bronchoscopic direct vision glottis anesthesia for bronchoscopy.METHODS The study included 100 patients who underwent bronchoscopy during thoracic surgery.A random number table method was used to divide the patients into control and observation groups(50 patients each).The control and observation groups were anesthetized using the nebulized inhalation and bronchoscopic direct vision glottis method,respectively.Hemodynamic indices[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and oxygen saturation(SpO_(2))before(T1),5 min after anesthesia(T2),and at the end of the operation(T3)]serum stress hormone indices[norepinephrine(NE),epinephrine(E),adrenocorticotropic hormone(ACTH),and cortisol(Cor)before and after treatment]were compared between the 2 groups.Adverse effects were also RESULTS At T2 and T3,SBP,DBP,and HR were lower in the observation group than the control group,whereas SpO_(2) was higher than the control group[(119.05±8.01)mmHg vs(127.05±7.83)mmHg,(119.35±6.66)mmHg vs(128.39±6.56)mmHg,(84.68±6.04)mmHg vs(92.42±5.57)mmHg,(84.53±4.97)mmHg compared to(92.57±6.02)mmHg,(74.25±5.18)beats/min compared to(88.32±5.72)beats/min,(74.38±5.31)beats/min compared to(88.42±5.69)beats/min,(97.36±2.21)%vs(94.35±2.16)%,(97.42±2.36)%vs(94.38±2.69%],with statistically significant differences(all P<0.05).After treatment,NE,E,ACTH,and Cor were significantly higher in both groups than before treatment,but were lower in the observation group than in the control group[(68.25±8.87)ng/mL vs(93.35±14.00)ng/mL,(53.59±5.89)ng/mL vs(82.32±10.70)ng/mL,(14.32±1.58)pg/mL vs(20.35±3.05)pg/mL,(227.35±25.01)nmol/L vs(322.28±45.12)nmol/L],with statistically significant differences(all P<0.05).The incidence of adverse reactions was higher in the control group than in the observation group[12.00%(12/50)vs 6.00%(3/50)](P<0.05).CONCLUSION The use of bronchoscopic direct vision glottis anesthesia method for bronchoscopy patients is beneficial for stabilizing hemodynamic indices during bronchoscopy and reducing the level of patient stress,with good safety and practicality.
文摘Objective: To observe the influence of local infiltration anesthesia at the scalp point on acupuncture stimulation induced changes of cerebral blood perfusion in the brain. Methods: Experiments were conducted in 10 healthy volunteer subjects (8 males and 2 females) who were ordered to take a lying position on a specific bed with their heads keeping in a fixed position. Scalp point used was Motor Area (MS 6). The first syringe needle (gauge 5) was inserted into the scalp from the upper 1/5 of MS 6 and the second syringe needle inserted into the scalp from the middle 2/5 of MS 6 and advanced downward, with the two needles connected to a HAN’s Therapeutic Apparatus. Images of the brain were then taken before and after electroacupuncture (EA) stimulation, and after local injection of 1% lidocaine [mixed with epinephrine (1∶200,000, 3 mL)] plus EA by using Siemens ECAM/ICON Single Photo Emission Computed Tomography (SPECT). Intravenous injection of Ethyl cysteinate dimmer 555 MBq was performed before displaying cerebral images. Data of blood functional changing rat (BFCR%) were analyzed quantitatively using a mathematic model. Results: Before EA stimulation, the blood perfusion and function of cerebral cortex, thalamus, basal ganglion and cerebellum on both sides of the brain were basically symmetry. Following EA of MS 6, BFCR% of the contralateral thalamus, parietal lobe and the frontal lobe increased significantly. Following local infiltration anesthesia, BFCR% of the contralatral thalamus declined markedly (P<0.05). The results of quantitative analysis were in agreement with those of visual observation. Conclusion: Local infiltration anesthesia of the scalp point can significantly weaken or block EA stimulation induced changes of BFCR%.
文摘Tubal ligation is a surgical sterilization procedure that provides permanent and reliable contraception to women.?Tubal obstruction is a method of permanent birth control that can be performed after mini-laparotomy under local anesthesia. Objective:?To determine the outcome of tubal sterilizations by mini-laparotomy under local anesthesia performed in clients who underwent the surgical operation in the Maternity Ward of Ignace Deen National Hospital. Patients and Methods:?The Gynecology and Obstetrics Department of Ignace Deen National Hospital was used as the place for the study. The study involved all the women seeking voluntary surgical contraception. This was a retrospective study of a descriptive type carried out from January 1, 2017 to December 31, 2018. A consent form was filled out and signed by spouses after an interview and a systematically carried out pre-operative clinical and para-clinical assessment. Results:?During the study period, 56 tubal ligations were performed i.e. 4.72 percent of all family planning methods. The recruiting for the surgical contraception involved clients whose typical profile is that of women with an average age of 35, mostly housewives (35.71%), major multiparous (69.63%) with 6 living children on average. Married women made up the bulk of the recruiting i.e. 96.44%. Unmarried women made much more use of other methods. Indications of personal convenience were the most frequently encountered common reason. Among medical causes, high blood?pressure concerned the majority of cases: 38% of the indications. Surgical contraception in between was more practiced than the post-partum one. The recorded complication was the parietal hematoma due to a lack of hemostasis and it accounted for 1.79% of cases. The progress was uncomplicated in?98.68% of cases. Forty couples (71.42%) expressed their feelings of satisfaction against only 6 cases of regret (10.71%). Conclusion:?The surgical contraception has become a requirement for modern couples. Tubal ligation by?mini-laparotomy is a simple operation and a harmless method of contraception that allows clients to use permanent contraception. Carried out on an outpatient basis, incidents and accidents are rare and may have psychological repercussions that are difficult to assess. The technical mastery of the gesture helps to minimize these incidents.
基金supported by the National Key Research and Development Program of China (No.2021YFF1200800)the Sichuan Science and Technology Program (Nos.2021JDTD0001,2022YFQ0004)the Natural Science Foundation of Sichuan Province (No.2023NSFSC1629)。
文摘Lidocaine hydrochloride(LIDH) as an anesthetic is widely used in local anesthesia. Dissolving microneedles(MNs) have great application value in the field of skin anesthesia. However, the limited drug-loading of dissolving MNs is an existing challenge that affects clinical use. In this study, we have screened isomaltulose(ISO) as the proper matrix material for the MNs by using molecular dynamics(MD) simulation. Our findings indicate that ISO has good compatibility with LIDH, and the LIDH-loaded ISO MNs(LI-MNs) have high drug-loading capacity. The drug-loading capacity of LI-MNs could reach 80%, and it could effectively puncture the skin. In addition, the preparation method of customized LI-MNs was established based on three-dimensional(3D) printing technology. It was shown that the administration time of LI-MNs could be controlled within 3 min. Also, the LI-MNs were able to provide the local anesthetic efficacy within2 min and sustained for more than 2 h. Significantly, LI-MNs had more efficient drug efficacy compared to the topical creams and the majority of existing LIDH-loaded dissolving MNs. They even provided a longer duration of action than the injections. Overall, the LI-MNs with high drug-loading have a promising application prospect.
文摘Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like short-term admission or for those not indicated for general anesthesia due to complications. This report presents the outcomes of breast conserving surgery and sentinel lymph node biopsy under local anesthesia. Patients and Methods: The study included 61 patients with breast cancer that were all definitely diagnosed before surgery. The indications were preoperatively diagnosed localized DCIS, invasive carcinoma measuring less than 3 cm in tumor diameter on ultrasound, and tumors with negative axillary lymph nodes. The surgical procedures included breast conserving surgery associated with sentinel lymph node navigation biopsy. Results: The surgery could be performed under local anesthesia in all 61 patients, and no patient was converted to general anesthesia. Four patients had sentinel lymph node metastasis. Surgical stumps were positive in 18 patients (29.5%). Ten Gy of boost irradiation of the tumor bed was added to the conventional breast irradiation for these patients. There were no serious complications associated with surgery. Conclusion: Breast conserving surgery and sentinel lymph node biopsy for early breast cancer can be performed safely under local anesthesia. This procedure contributes to shortening the length of hospitalization and thereby saving medical resources without deceasing the quality of treatment.
文摘<strong>Background:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Surgical treatment of rectocele and cystocele is usually performed in a hospital setting under regional (spinal or epidural) or general anesthesia, and patients commonly have to stay in the hospital for at least one or two days. The possibility of performing the surgery under local anesthesia, as an outpatient procedure with minimal bleeding and pain, no surgical assistants, with immediate discharge and, most importantly, without compromising postoperative results, is appealing. To our knowledge, no studies ha</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ve</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> evaluated whether performing rectocele and/or cystocele rectocele repair under local infiltration anesthesia and without separation of the vaginal mucosa from the underlying fascia achieves these goals.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> The aim of this study is to describe a new surgical technique for outpatient treatment of cystocele and rectocele under local anesthesia, and our initial results. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> Forty women underwent outpatient surgical repair of rectocele and/or cystocele between April and September 2020 at the ambulatory procedure room of the authors’ clinics. The technique consists of a triangular-shaped CO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> laser vaporization</span><span style="color:red;"> </span><span style="font-family:Verdana;">or electrocauterization of the posterior and/or anterior vaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactin suture. A perineorrhaphy was always performed concomitantly with rectocele repair, and a transobturator sling was performed in women presenting with concomitant stress urinary incontinence. Postoperative evaluation included POP-Q measurement for each patient six months after the procedure, and resolution of prolapse was considered when anterior and/or posterior vaginal wall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzed using Wilcoxon signed-rank test.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The mean operating time was 21 minutes (range: 14</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">38 minutes). All patients tolerated the procedure well and were discharged immediately afterwards. There were no intraoperative or postoperative complications, and all patients had satisfactory healing of the vaginal mucosa. Bleeding from the rectocele and/or cystocele repair was minimal, and nobody required extra-anesthesia or transfer to a hospital surgical theater. At six month follow-up, pre and postoperative POP-Q measurement</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of points Ap, Bp, Aa and Ba were all statistical</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">l</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">y significant (Ap 1.6 ± 1.2 × -2.4 ± 0.9, Bp 2.6 ± 1.6 × -2.7 ± 1.4, Aa 1.4 ± 1.1 × -2.3 ± 0.8, and Ba 2.4 ± 1.5 × -2.5 ± 1.2) respectively, revealing satisfactory resolution of both rectocele and cystocele.</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">: Our initial results suggest that rectocele and cystocele may be safely and effectively treated under local anesthesia in an outpatient setting using this new technique.</span></span></span>
文摘<strong>Introduction:</strong> Epiphora is a common ophthalmologic complaint and referrals to oculoplastics and, in the presence of lower complete lacrimonasal duct obstruction, may lead to mild to severe complications, thus requiring surgery to create a new drainage path. The external dacryocystorhinostomy with silicon intubation is the surgical technique with better long-term outcomes and performed in the institutions where this study was conducted. Can be performed under either general or loco-regional anesthesia, or a combination of both. <strong>Methods:</strong> This article presents a revision of 218 consecutive cases from December 2016 to June 2021 in two specialized centers with the same standardized surgical and anesthetic technique. <strong>Results:</strong> 242 surgical prontuaries were selected, with 218 filling the inclusion criteria. 13% of the patients required additional anesthetic infusion before the beginning of the surgery;2.7% of the patients required field anesthetic infusion during the surgery and 6.4% required supplementary sedation, thus meaning a positive outcome, as the number of patients with intraoperative complaints was low, and the overall comfort was high. During the follow up, no patient required pain medication after 24 hours. <strong>Discussion:</strong> This study points towards the feasibility of the described technique in an outpatient fashion, with low, mild and tolerable side effects associated.
文摘Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our context of exercise, we sometimes have a different attitude dictated by various constraints. Observation: 55-year-old patient with no notable history, seen in consultation for a very large ulcerative-budding lesion on the right 2/3 of the lower lip with mucocutaneous involvement without lymph node findings found on examination. Faced with this suspicious lesion and the patient’s financial difficulties, we decided to operate under local anesthesia to remove this tumor. The oncological excision was followed by immediate plasty using a Camille-Bernard flap with a good immediate aesthetic and functional result and postoperative day 7. The patient was unable to take his surgical specimen to anatomy-pathology and was lost to follow-up due to lack of financial resources. On anatomo-pathological analysis of the surgical specimen, the margins were healthy with confirmation of squamous cell carcinoma (anapathological reading made for scientific interest). Discussion: The particular mentality of certain patients and their difficult financial conditions push us to have an unconventional therapeutic attitude in oncology, but which nevertheless makes it possible to resolve certain problems that we often face. Local anesthesia is possible and realistic in cases like ours and the results can be acceptable and life-saving.
基金supported by the grants from Technology Planning Project of Guangdong Province(No.2012B31800318)The object of Guangdong Province Medical Research Foundation Research(No.A2011007)
文摘Background Rapid right ventricular pacing is one of the methods for counteracting the ＂wind sock＂ effect in the thoracic endovascular aortic repair （TEVAR）. Most of the doctors are to complete this operation under general anesthesia. Now, our operation has been performed under local anesthesia. No related reports were found as to whether can the patient tolerate rapid fight ventficular pacing under local anesthesia. Methods From 2009 January to 2010 January, in our hospital all the DeBakey llI aortic dissection patients who underwent TEVAR were randomly divided into general anesthesia group （n = 50） and local anesthesia group （n = 51）. All the data were compared between two groups including the hemodynamic indexes, the graft positioning accuracy, rapid pacing duration, operation time, intraoperative discomfort and postoperative neurological understanding function changes and the complications. Results The success rate were 100% in the two groups. The duration of rapid pacing, operation time, the accuracy of graft localization and the intraoperative discomfort scores of Numerical Pain Rating Scale showed no significant difference between the two groups （P 〉 0.05）. There were no rapid fight ventricular pacing-related complications in the two groups. Conclusion During thoracic endovascular aortic repair procedure, rapid fight ventricular pacing under local anesthesia is safe and feasible. Thus it is worthy to be popularized in clinical practice.
文摘Introduction: This paper presents the design, development, and usability evaluation of a custom haptic syringe aimed to improve the realism of a virtual reality local anesthesia simulation (VRLA), specifically for the inferior alveolar nerve block (IANB), that formally used a head mounted device (HMD) and vibration feedback via hand controllers. The custom haptic syringe interface provides a more realistic tactile sensation of plunging a real syringe in a human patient. This pilot study investigated the usability of the custom haptic syringe to replace one of the hand controllers to provide a more realistic and better training experience. Method: A one group pre-post survey investigated student perceptions regarding the effectiveness and usability of a haptic syringe to provide a more realistic experience to train dental students to learn the procedural steps to inject local anesthesia into a virtual patient. Twenty-two third year dental students participated. The pre-post survey examined changes in students’ perceived emotions, preparedness, and effectiveness of the VRLA as a foundational learning strategy prior to entering clinical group practice. Results: While quantitative results on comparable survey questions did not yield statistically significant differences, qualitative open-ended responses revealed a much greater satisfaction using the custom haptic syringe compared to the out of the box controllers. Conclusions: Feedback regarding the haptic syringe showed a substantial step closer to providing a more real experience for students in an effort to create a better bridge between classroom learning and clinical practice in order to prepare students to more confidently and competently work with real clients. Further refinement of the syringe is forthcoming along with a more formal comparative experimental study.
文摘Introduction: Varicocele is one of the most frequent causes of infertility. There are several therapeutic modalities, namely surgery (open and laparoscopic) and conventional radiology. The aim of our study was to evaluate the impact of a varicocele cure under local anaesthesia on spermogram quality. Material and Methods: We conducted a retrospective descriptive study from 1 January 2022 to 31 December 2023 in the urology department of the Hôpital Militaire de Ouakam (HMO). The parameters studied were age, reasons for consultation, time to urology consultation, grade of varicocele, Doppler ultrasound and spermogram data before treatment and 3 months after treatment. Treatment consisted of bilateral subinguinal varicocelectomy under local anaesthetic. Data were entered and analysed using Excel software version 2021. Results: We studied 41 patients. The mean age of the patients was 35.3 ± 6.9 years, with extremes of 22 and 50 years. Thirty-eight of our patients (88.37%) were married. The most frequent reason for consultation was primary infertility (72.09%). 28 patients (68.3%) had a bilateral varicocele on ultrasound. Varicocele was associated with bilateral testicular hypotrophy in 13 patients (31.7%) and unilateral left testicular hypotrophy in 11 patients (26.8%). All patients underwent subinguinal varicocelectomy under local anaesthetic. Mean follow-up was 4.5 months. A clear statistically significant improvement was noted in sperm motility and concentration in postoperative spermograms, with normalisation of the spermogram in 15 (36.5%) of patients. Conclusion: The impact of varicocele on sperm parameters has been clearly established. There are various therapeutic methods for curing varicocele, including varicocelectomy under local anaesthetic, which, in addition to its undeniable economic advantages, can significantly improve sperm parameters in patients with varicocele and prevent their deterioration over time.
文摘This paper reviews a local anesthesia for resection of back mass, and the rescue of patients with sudden apnea during the operation. It also summarizes the nursing experience and shortcomings of the visiting nurses during the operation, which provides relevant experience for the future local anesthesia operation for patients with cardiovascular complications. The patient underwent left back mass resection under local anesthesia. Blood pressure, heart rate and blood oxygen saturation were monitored. The right lateral position was adopted during the operation. During the 5-minute operation to separate the tumor, the visiting nurse noticed that the patient was pale and weak in answering the questions, and immediately she cried out. The ECG monitor showed that the heart rate was 45 beats/min and the SpO2 was 85%, with continuous decrease. Immediately call the surgeon to stop the operation. Change the patient from lateral position to supine position. Due to the timely rescue and proper measures, the patients heart rate rose to 70 beats/min, BP120/70mmHg, R22 beats/min, SpO2 was 98% after about 10 minutes. The patient regained consciousness and was able to correctly answer the questions. After 15 minutes of observation, the patients condition was stable and there was no discomfort. The right lateral decubitus position was placed again and the operation was completed after the drape was disinfected again. Conclusion: local anesthesia operation has certain risks. Attention should be paid to local anesthesia operation for patients with cardiovascular and other complications. Preoperative preparation should be adequate, peripheral veins should be opened regularly, and ECG and blood pressure should be monitored. During the operation, the patients complexion, consciousness and breathing were closely observed. If there is any abnormal situation, the surgeon should be reported in time and the emergency plan should be started to ensure the safety of the patients during the operation and to improve the quality of nursing cooperation during the operation.
文摘Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and March 2014. Of the total number of hernias surgically treated in this period, 755 were operated on the right, 394 on the left and 37 bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m2), patient’s refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. Results: All operations were completed successfully. In no case there was a need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64%. There was no need for hospital admissions greater than 24 hours. Conclusion: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.
文摘Objective To discuss the feasibility of pereutaneous nephrolithotomy ( PCNL) for treating upper urinary calculi under local anesthesia. Methods One thousand three hundred and sixty - three patients who suffered
文摘AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied en- ergy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION: These results suggest that EI-RFA, un- der general anesthesia, may be effective for the treat- ment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain- free condition for the patients.
文摘AIM:To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification.· METHODS:This was a randomized,double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months.Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with(LH),or without(L) addition of hyaluronidase(150IU/mL).Akinesia was assessed 15 minutes after sub-Tenon's injection.Patients and surgeon's satisfaction,as well as the postoperative pain(the visual analogue scale,VAS) were investigated after operation.The contingency tables(including the Chi-square or Fisher's exact tests,when appropriate) and parametric analysis(the independent samples t test) were used for statistical analysis.· RESULTS:Complete akinesia(33.3% vs 4.8%,P =0.04),as well as the patients(85.7% vs 57.1%,P =0.04)and surgeon's satisfaction(87.5% vs 52.4%,P =0.02) were significantly more frequent in LH than in L group.The mean VAS was significantly lower in the same group(1.90±1.45 vs 3.00±1.55,P =0.04).· CONCLUSION:Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia,enhances the intra-operative patients and surgeons' satisfaction,and attenuates the postoperative pain.·
基金Supported by the New Technique and Occupation Project of General Hospital of Ningxia Medical University(No.2011-2-20)
文摘OBJECTIVE: To evaluate the effect on acne vulgaris of pricking-bloodletting cupping at Dazhui(GV 14) under acupuncture anesthesia, and establish whether providing anesthesia to the treatment area by manipulating Hegu(LI 4) and Quchi(LI 11) might have an additional therapeutic benefit. METHODS: Thirty-eight patients were recruited and randomized into a control group and an intervention group with a single-blind(observer-blind) method. The control group was treated by pricking-bloodletting cupping at Dazhui(GV 14) and the studied group by pricking-bloodletting cupping at Dazhui(GV 14) under acupuncture anesthesia at Hegu(LI 4) and Quchi(LI 11). Both groups were treated twice weekly for 6 weeks. The analgesic and therapeutic effects of acupuncture were evaluated on a visual analog scale(VAS) and global acne grading system(GAGS), respectively.RESULTS: There were differences in the VAS scores of pain on pricking and in the pricked area, and the duration of pain between the groups. After 12 treatments, there was a significant reduction in GAGS scores from baseline in both groups, but there was no significant difference between the groups. CONCLUSION: Acupuncture anesthesia at Hegu(LI 4) and Quchi(LI 11) is an effective means of alleviating the pain of pricking-bloodletting cupping and reducing the duration of pain in the treatment area. Pricking-bloodletting cupping at Dazhui(GV 14) improves the skin lesions of patients with moderate acne vulgaris, but acupuncture anesthesia does not appear to have an additional therapeutic effect.
文摘AIM To investigate the effect of clonidine on the cutaneous silent period(CSP)during spinal anesthesia.METHODS A total of 67 adult patients were included in this randomized,prospective,single-center,double-blind trial.They did not have neurological disorders and were scheduled for inguinal hernia repair surgery.This trial was registered on ClinicalTrials.gov(NTC03121261).The patients were randomized into two groups with regards to the intrathecally administered solution:(1)15 mg of 0.5%levobupivacaine with 50μg of 0.015%clonidine,or(2)15 mg of 0.5%levobupivacaine alone.There were 34 patients in the levobupivacaine-clonidine(LC)group and 33 patients in the levobupivacaine(L)group.CSP and its latency were measured four times:prior to the subarachnoid block(SAB),after motor block regression to the 0 level of the Bromage scale,with ongoing sensory blockade,and both 6 and 24 h after SAB.RESULTS Only data from 30 patients in each group were analyzed.There were no significant differences between the groups investigated preoperatively and after 24 h.The CSP of the L group at the time point when the Bromage scale was 0 was 44.8±8.1 ms,while in the LC group it measured 40.2±3.8 ms(P=0.007).The latency in the L group at the time point when the Bromage scale was 0 was 130.3±10.2 ms,and in the LC group it was 144.7±8.3 ms(P<0.001).The CSP of the L group after 6 h was 59.6±9.8 ms,while in the LC group it was 44.5±5.0 ms(P<0.001).The latency in the L group after 6 h was 110.4±10.6 ms,while in LC group it was 132.3±9.7 ms(P<0.001).CONCLUSION Intrathecal addition of clonidine to levobupivacaine for SAB in comparison with levobupivacaine alone resultsin a diminished inhibitory tonus and shortened CSP.
