BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation...BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.展开更多
Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy s...Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.展开更多
Background: Metabolic syndrome (MS) is a constellation of factors associated with increased risk of developing cardiovascular diseases and Diabetes Mellitus. Despite of the many studies related to MS, little is known ...Background: Metabolic syndrome (MS) is a constellation of factors associated with increased risk of developing cardiovascular diseases and Diabetes Mellitus. Despite of the many studies related to MS, little is known about its impact on scenarios such as surgical anesthesia. Objective: To examine the correlation between demographic and metabolic variables with the occurrence of perioperative complications in patients with MS undergoing scheduled surgeries using a spinal anesthesia technique in the surgery department at the University Clinic San Juan de Dios in Cartagena de Indias, Colombia. Methods: Observational, analytical, cross-sectional, single-center study of 150 subjects with MS and 150 control subjects. Perioperative complications, socio-demographic, hemodynamic and respiratory variables were registered. Groups were compared using t test, Fisher’s exact test or Chi-square, as appropriate. We applied a logistic multiple regression model, adjusted by backward stepwise at 0.25 and forward at 0.05, to find possible incompatible associations. p value < 0.05 was considered significant. Results: There were significant differences between groups in age, American Society of Anesthesiologists physical status classification, frequency of diseases associated to MS and perioperative complications. There were no cases of mortality among patients. There was statistically significant difference between the two groups for intraoperative hypotension and hypertension with p values of <0.0001 and 0.034. Among postoperative complications there was statistically significant difference in pain (13.3% vs 5.3% in patients without MS) and nausea and/or postoperative vomiting (8% vs 2% in patients without MS) with a p value of 0.027 and 0.015 (by Fisher) respectively. Conclusions: Metabolic abnormalities in MS are a risk factor for developing complications in the perioperative period of patients scheduled for surgeries using the subarachnoid anesthesia technique. Accordingly, it is appropriate to implement health intervention strategies by the surgical team, aiming at their prevention and management.展开更多
Background: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive action in healthcare settings. Objectives: The aim of this study was to determine...Background: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive action in healthcare settings. Objectives: The aim of this study was to determine the profile of pathogens isolated among patients admitted to an intensive care unit of a major urban Moroccan city that presented nosocomial infection during their hospitalisation. Results: During the study period, 34 patients developed a nosocomial infection during hospitalisation in ICU. The mean age of patients was 42.3 ± 18.3 years (range: 18.0 - 86.0 years) and 68% were males. The main diagnoses were multiple trauma injuries (47%) and thermal burns (18%). In terms of morbidities, 9% of the patients presented diabetes. The most common sites were central line-associated bloodstream infection (38%), bloodstream infection (35%), ventilator-associated pneumonia (32%), urinary catheter-related infection (29%), and soft tissue infection (21%). Most frequently isolated pathogens were: Acinetobacter baumani (25%), followed by Klebsiella spp. (12%), Pseudomonas aeruginosa (8%), coagulase negative Staphylococcus aureus (6%), E. coli (6%), Providencia spp. (6%), Enterococcus faecalis (6%), Raoultella terrigena (4%). Conclusion: The bloodstream was the most common site and Gram-negatives were the most commonly reported causes of ICU infections. The incidence found was high, the mortality was strong, corresponding with that of developing countries. These results will allow to set up a targeted program of prevention and to estimate the efficiency of interventions.展开更多
<b>Introduction and Purpose:</b> The problem of obesity has started to increase in children and adolescents, similar to adults, due to irregular and unhealthy diet, the limitation of physical activity and ...<b>Introduction and Purpose:</b> The problem of obesity has started to increase in children and adolescents, similar to adults, due to irregular and unhealthy diet, the limitation of physical activity and genetic factors. Various difficulties and complications may be encountered in the anesthesia management of obese patients. Difficult airway, difficulty in intravenous and intra-arterial intervention, difficulty in positioning the patient, difficulty in finding suitable equipment for the patient, intraoperative and postoperative pulmonary complications, prolonged recovery and difficulty in patient transport are the points to be considered in perioperative management. In our presentation, we wanted to discuss perioperative anesthesia management in adolescent bariatric surgery, which is not performed frequently, with a case study. <b>Case Presentation:</b> A 16-year-old girl with BMI of 44.4 was evaluated for bariatric surgery due to obesity. She had a history of hypertension, sleep apnea and insulin resistance. In her physical examination, her mouth opening was normal, her Mallampati score was 3, and her neck circumference was 43 cm. After the preoperative difficult intubation preparations were completed, the patient was monitored. The patient was preoxygenated with 100% oxygen for 3 minutes. The patient with comfortable mask ventilation was intubated with an appropriately sized endotracheal tube. Hemodynamics and oxygen saturation remained stable throughout the surgery. At the end of the surgery, she was extubated without any problem and transferred to the pediatric surgical intensive care unit. The patient was taken to the ward on the 2nd postoperative day and discharged on the 6th day. <b>Discussion and Conclusion:</b> The problem of obesity in adolescents is increasing today, and it is possible to struggle with obesity by making lifestyle changes, teaching children and parents about healthy nutrition, encouraging more physical activity and creating weight control programs. At this point, metabolic and bariatric surgery emerges as a preferred method in overweight, obese adolescents. The anesthesia risks of these surgeries are significantly higher. Postoperative pain management and respiratory physiotherapy should be performed in obese patients. Although prevention of obesity is the mainstay of obesity treatment, bariatric surgery is also a safe and effective treatment method in adolescents.展开更多
Noise pollution is in an increasing trend in the operating rooms, as has been the case in various other domains in life. It has been shown in studies that the main cause of this noise pollution consist of the behavior...Noise pollution is in an increasing trend in the operating rooms, as has been the case in various other domains in life. It has been shown in studies that the main cause of this noise pollution consist of the behavior related to the operating room personel and the surgical equipment. These higher than normal noise levels may increase stress and decrease communication and performance, apart from the negative health effects on the operating team. In this study, we aimed to explore the sources of noise pollution and the place of music on these effects on anesthesiology and surgical doctors. Questions formulated through a questionnaire have been asked to the anesthesiology and surgical department physicians on a voluntary basis, and their approach to the concept of noise has been assessed. The study was planned as a descriptive study. In total, highest impact from noise pollution was found to be the aspirator (74.3%), chatting (55.4%), noises from the monitors (54.8%), alarms (48.6%), surgical material (25.9%) and music (23.8%). Noise had the most impact on the concentration of the doctors with a rate of 61.9%. Anesthesiologists, when compared to other surgical department physicians, were found to be impacted most by music with 37.2%. It is not realistic to eliminate all the noise and distraction. On the other hand, it can be minimalized through sufficient measures. Yet, general measures to keep the silence isn’t too likely to keep the noise down during long operations. Whereas music stays as a matter of personal choice. Controlled studies on whether to keep or not the music in the operating rooms aren’t yet sufficient, due to which, general recommendations do not apply. As a result of this study, we have found that while music might have performance increasing effects, it still has a potential as a distraction and interfere with the communication in the operating room.展开更多
Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation pl...Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus;it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.展开更多
Neurotic angioedema may be secondary to ACE (Angiotensin-converting enzyme) inhibitor. From a case of neurotic angioedema in a hypertensive man under ACE (Angiotensin-converting enzyme) inhibitor, we expose the clinic...Neurotic angioedema may be secondary to ACE (Angiotensin-converting enzyme) inhibitor. From a case of neurotic angioedema in a hypertensive man under ACE (Angiotensin-converting enzyme) inhibitor, we expose the clinical characteristics typical of the edema and its evolution. A 73-year-old man has consulted for edema of the face and redness of the palmar surface of the hand not pruriginous for 2 days. He has already had conventional anti-edematous treatments but no changes. In the absence of a technical platform, no paraclinical examination was carried out. The cessation of ACE inhibitor and the administration of tranexamic acid were made immediately. Signs regressed within 24 hours. Neurotic angioedema is a diagnostic problem in countries where biological examination is still limited and if practitioners are unaware of the possibility of its occurrence during IEC treatment. While the patient’s prognosis depends on the precocity of management.展开更多
The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 year...The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.展开更多
Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at d...Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at different stages of the surgical processes are not clear. The aim of this study was to evaluate any existing association between preoperative parental anxiety and emergence agitation in a pediatric surgery population. Materials and Methods: A total of 60 children ASA class I or II, aged 3 - 12 years old, undergoing adenotonsillectomy with sevoflurane, were included in the study. Before surgery, we used State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. Emergence agitation of the children was assessed with Watcha scale and recorded every 10 min of first 30 min of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate their satisfaction, post operative pain and any side effect observed in the children. Results: Preoperatively, the mean STAI-S scores of mothers were significantly higher than those of fathers (p 0.05). The children had the highest agitation scores at 10th postoperative minutes with an incidence of 73.9%. There was no correlation between parental anxiety and emergence agitation. Logistic regression analysis showed that low educational level of the parent was the only independent factor for state anxiety (OR: 8.96, 95% CI: 1.50 - 40.35, p = 0.030). Discussion: In this study, we observed that education level of the parents might affect their preoperative anxiety. The factors influential in parental anxiety were not correlated with pediatric emergence agitation in this study.展开更多
文摘BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.
文摘Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.
文摘Background: Metabolic syndrome (MS) is a constellation of factors associated with increased risk of developing cardiovascular diseases and Diabetes Mellitus. Despite of the many studies related to MS, little is known about its impact on scenarios such as surgical anesthesia. Objective: To examine the correlation between demographic and metabolic variables with the occurrence of perioperative complications in patients with MS undergoing scheduled surgeries using a spinal anesthesia technique in the surgery department at the University Clinic San Juan de Dios in Cartagena de Indias, Colombia. Methods: Observational, analytical, cross-sectional, single-center study of 150 subjects with MS and 150 control subjects. Perioperative complications, socio-demographic, hemodynamic and respiratory variables were registered. Groups were compared using t test, Fisher’s exact test or Chi-square, as appropriate. We applied a logistic multiple regression model, adjusted by backward stepwise at 0.25 and forward at 0.05, to find possible incompatible associations. p value < 0.05 was considered significant. Results: There were significant differences between groups in age, American Society of Anesthesiologists physical status classification, frequency of diseases associated to MS and perioperative complications. There were no cases of mortality among patients. There was statistically significant difference between the two groups for intraoperative hypotension and hypertension with p values of <0.0001 and 0.034. Among postoperative complications there was statistically significant difference in pain (13.3% vs 5.3% in patients without MS) and nausea and/or postoperative vomiting (8% vs 2% in patients without MS) with a p value of 0.027 and 0.015 (by Fisher) respectively. Conclusions: Metabolic abnormalities in MS are a risk factor for developing complications in the perioperative period of patients scheduled for surgeries using the subarachnoid anesthesia technique. Accordingly, it is appropriate to implement health intervention strategies by the surgical team, aiming at their prevention and management.
文摘Background: Pathogens surveillance and antimicrobial resistance are essential for the prompt organization of therapeutic and preventive action in healthcare settings. Objectives: The aim of this study was to determine the profile of pathogens isolated among patients admitted to an intensive care unit of a major urban Moroccan city that presented nosocomial infection during their hospitalisation. Results: During the study period, 34 patients developed a nosocomial infection during hospitalisation in ICU. The mean age of patients was 42.3 ± 18.3 years (range: 18.0 - 86.0 years) and 68% were males. The main diagnoses were multiple trauma injuries (47%) and thermal burns (18%). In terms of morbidities, 9% of the patients presented diabetes. The most common sites were central line-associated bloodstream infection (38%), bloodstream infection (35%), ventilator-associated pneumonia (32%), urinary catheter-related infection (29%), and soft tissue infection (21%). Most frequently isolated pathogens were: Acinetobacter baumani (25%), followed by Klebsiella spp. (12%), Pseudomonas aeruginosa (8%), coagulase negative Staphylococcus aureus (6%), E. coli (6%), Providencia spp. (6%), Enterococcus faecalis (6%), Raoultella terrigena (4%). Conclusion: The bloodstream was the most common site and Gram-negatives were the most commonly reported causes of ICU infections. The incidence found was high, the mortality was strong, corresponding with that of developing countries. These results will allow to set up a targeted program of prevention and to estimate the efficiency of interventions.
文摘<b>Introduction and Purpose:</b> The problem of obesity has started to increase in children and adolescents, similar to adults, due to irregular and unhealthy diet, the limitation of physical activity and genetic factors. Various difficulties and complications may be encountered in the anesthesia management of obese patients. Difficult airway, difficulty in intravenous and intra-arterial intervention, difficulty in positioning the patient, difficulty in finding suitable equipment for the patient, intraoperative and postoperative pulmonary complications, prolonged recovery and difficulty in patient transport are the points to be considered in perioperative management. In our presentation, we wanted to discuss perioperative anesthesia management in adolescent bariatric surgery, which is not performed frequently, with a case study. <b>Case Presentation:</b> A 16-year-old girl with BMI of 44.4 was evaluated for bariatric surgery due to obesity. She had a history of hypertension, sleep apnea and insulin resistance. In her physical examination, her mouth opening was normal, her Mallampati score was 3, and her neck circumference was 43 cm. After the preoperative difficult intubation preparations were completed, the patient was monitored. The patient was preoxygenated with 100% oxygen for 3 minutes. The patient with comfortable mask ventilation was intubated with an appropriately sized endotracheal tube. Hemodynamics and oxygen saturation remained stable throughout the surgery. At the end of the surgery, she was extubated without any problem and transferred to the pediatric surgical intensive care unit. The patient was taken to the ward on the 2nd postoperative day and discharged on the 6th day. <b>Discussion and Conclusion:</b> The problem of obesity in adolescents is increasing today, and it is possible to struggle with obesity by making lifestyle changes, teaching children and parents about healthy nutrition, encouraging more physical activity and creating weight control programs. At this point, metabolic and bariatric surgery emerges as a preferred method in overweight, obese adolescents. The anesthesia risks of these surgeries are significantly higher. Postoperative pain management and respiratory physiotherapy should be performed in obese patients. Although prevention of obesity is the mainstay of obesity treatment, bariatric surgery is also a safe and effective treatment method in adolescents.
文摘Noise pollution is in an increasing trend in the operating rooms, as has been the case in various other domains in life. It has been shown in studies that the main cause of this noise pollution consist of the behavior related to the operating room personel and the surgical equipment. These higher than normal noise levels may increase stress and decrease communication and performance, apart from the negative health effects on the operating team. In this study, we aimed to explore the sources of noise pollution and the place of music on these effects on anesthesiology and surgical doctors. Questions formulated through a questionnaire have been asked to the anesthesiology and surgical department physicians on a voluntary basis, and their approach to the concept of noise has been assessed. The study was planned as a descriptive study. In total, highest impact from noise pollution was found to be the aspirator (74.3%), chatting (55.4%), noises from the monitors (54.8%), alarms (48.6%), surgical material (25.9%) and music (23.8%). Noise had the most impact on the concentration of the doctors with a rate of 61.9%. Anesthesiologists, when compared to other surgical department physicians, were found to be impacted most by music with 37.2%. It is not realistic to eliminate all the noise and distraction. On the other hand, it can be minimalized through sufficient measures. Yet, general measures to keep the silence isn’t too likely to keep the noise down during long operations. Whereas music stays as a matter of personal choice. Controlled studies on whether to keep or not the music in the operating rooms aren’t yet sufficient, due to which, general recommendations do not apply. As a result of this study, we have found that while music might have performance increasing effects, it still has a potential as a distraction and interfere with the communication in the operating room.
文摘Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus;it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.
文摘Neurotic angioedema may be secondary to ACE (Angiotensin-converting enzyme) inhibitor. From a case of neurotic angioedema in a hypertensive man under ACE (Angiotensin-converting enzyme) inhibitor, we expose the clinical characteristics typical of the edema and its evolution. A 73-year-old man has consulted for edema of the face and redness of the palmar surface of the hand not pruriginous for 2 days. He has already had conventional anti-edematous treatments but no changes. In the absence of a technical platform, no paraclinical examination was carried out. The cessation of ACE inhibitor and the administration of tranexamic acid were made immediately. Signs regressed within 24 hours. Neurotic angioedema is a diagnostic problem in countries where biological examination is still limited and if practitioners are unaware of the possibility of its occurrence during IEC treatment. While the patient’s prognosis depends on the precocity of management.
文摘The hypoglycaemia paraneoplastic is uncommon in diabetic patients. Our aim was to report a case of paraneoplastic hypoglycaemia discovered after the diagnosis of gastric adenocarcinoma in a diabetic patient. A 65 years old man, was hospitalized for the management of acute digestive haemorrhage. In his medical history, he had diabetes since 20 years. He was alcoholic weaned for 3 years and had an unexplored repetitive epigastralgia. During his hospitalization, the exploration of acute digestive haemorrhage found a gastric adenocarcinoma with hepatic metastasis. At the 4th day of his hospitalization, he presented a hypoglycaemic coma with capillary blood glucose at 0.36 g/L. The patient was conscious after the infusion of Hypertonic Glucose Solution (HGS) 10%. After 3 days, the recurrent hypoglycaemia occurred and we intermittently treated by infusion of glucose solution 10%. The measurements of insulin level and C-peptide weren’t performed because they didn’t exist in the city. So, the notion of cancer and the recurrent hypoglycaemia even if we stopped the oral antidiabetic therapy make us think of a paraneoplastic syndrome. The chemotherapy associated with corticosteroid therapy is the standard treatment of the hypoglycaemia paraneoplastic but the patient refused the chemotherapy and we couldn’t use the corticosteroid therapy because of digestive haemorrhage. At the end of his hospitalization, he still had hypoglycaemia treated by infusion of glucose solution 10%. In the absence of means of diagnosis, we should think of paraneoplastic syndrome in front of recurrent hypoglycaemia and cancer in the diabetic patient.
文摘Introduction: The preoperative distress and anxiety experienced by preschoolers are associated with an increased incidence of troubled recovery from anesthesia. However, influences of parental anxiety on children at different stages of the surgical processes are not clear. The aim of this study was to evaluate any existing association between preoperative parental anxiety and emergence agitation in a pediatric surgery population. Materials and Methods: A total of 60 children ASA class I or II, aged 3 - 12 years old, undergoing adenotonsillectomy with sevoflurane, were included in the study. Before surgery, we used State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. Emergence agitation of the children was assessed with Watcha scale and recorded every 10 min of first 30 min of the postoperative period. Parents were contacted 24 hours after the surgery to evaluate their satisfaction, post operative pain and any side effect observed in the children. Results: Preoperatively, the mean STAI-S scores of mothers were significantly higher than those of fathers (p 0.05). The children had the highest agitation scores at 10th postoperative minutes with an incidence of 73.9%. There was no correlation between parental anxiety and emergence agitation. Logistic regression analysis showed that low educational level of the parent was the only independent factor for state anxiety (OR: 8.96, 95% CI: 1.50 - 40.35, p = 0.030). Discussion: In this study, we observed that education level of the parents might affect their preoperative anxiety. The factors influential in parental anxiety were not correlated with pediatric emergence agitation in this study.
