scholarly journals Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series

JMIRx Med ◽  
10.2196/25204 ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. e25204
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinnor Parveen ◽  
Alak Nandy ◽  
Md Samiul Hasan
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Hospital Costs ◽  
Case Series ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Standard Of Care ◽  
Patient Comfort ◽  
Hospital Discharges ◽  
Significant Difference

Background Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatric patients is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness, and success. Objective The objective of this study is to compare postoperative patient comfort, length of hospital stay, and cost-effectiveness of pediatric laparoscopic appendectomies performed under spinal and general anesthesia with the usual standard-of-care procedures employed in the hospital. Methods This is a case series of 77 consecutive pediatric laparoscopic appendectomies (involving 5-8–year-old children) that took place in a hospital in Chittagong, Bangladesh, in 2019. A total of 40 patients underwent spinal anesthesia and 37 patients underwent general anesthesia. Variables such as surgery and operation theater times, pain score, incidence of postsurgery vomiting, analgesic usage, discharge times, and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of anesthesia type. Results The probability of vomiting when using spinal compared to general anesthesia was lower within the first 5 hours (P<.001) and 6 hours (P=.008) postoperation. A significant difference (P<.001) was observed between the total costs of the two procedures, with spinal anesthesia being less expensive. Patients were more likely to be discharged the same day of the procedure when spinal anesthesia was used (P=.008). Conclusions Spinal anesthesia has many advantages compared to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved due to a significant decrease in vomiting. This allows for more rapid hospital discharges and substantial cost savings, without compromising the outcome of the procedure.

scholarly journals Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study (Preprint)

2020 ◽  
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinnor Parveen ◽  
Alak Nandy ◽  
Md Samiul Hasan
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Hospital Costs ◽  
Cost Effective ◽  
Patient Comfort ◽  
Hospital Discharges ◽  
Operation Theatre ◽  
Post Surgery ◽  
Significant Difference ◽  
Control Study

BACKGROUND to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success. OBJECTIVE The objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia. METHODS This was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia. RESULTS The probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008). CONCLUSIONS Spinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.

scholarly journals Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

2020 ◽  
Author(s):  
Md Jafrul Hannan ◽  
Mosammat Kohinoor Parveenl ◽  
Alak Nandy ◽  
Md Samiul Hasan
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Hospital Costs ◽  
Cost Effective ◽  
Patient Comfort ◽  
Controlled Study ◽  
Hospital Discharges ◽  
Retrospective Case ◽  
Post Surgery ◽  
Significant Difference

STRUCTURED ABSTRACTBackgroundOwing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success.ObjectiveThe objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia.MethodsThis was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia.ResultsThe probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008).ConclusionsSpinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.MINI-ABSTRACTSpinal anesthesia is seldom used for laparoscopy in children. This retrospective case-controlled study compared spinal anesthesia with general anesthesia in children between 5 and 8 years of age. Spinal anesthesia proved to be safer and cost-effective for laparoscopy in children.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

scholarly journals Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies

2020 ◽  
pp. 145749692093860
Author(s):  
T. Mönttinen ◽  
H. Kangaspunta ◽  
J. Laukkarinen ◽  
M. Ukkonen
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Time Of Day ◽  
University Hospital ◽  
Patient Comfort ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Clinically Significant

Introduction: Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis. Materials and Methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations. Results: A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes. Discussion: We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.

scholarly journals Cost Savings Analysis of Individualized Exercise Oncology Programs

2019 ◽  
Vol 18 ◽  
pp. 153473541983946 ◽  
Author(s):  
Karen Y. Wonders ◽  
Rob Wise ◽  
Danielle Ondreka ◽  
Josh Gratsch
Keyword(s):  
Cancer Care ◽  
Cost Savings ◽  
Length Of Hospital Stay ◽  
Standard Of Care ◽  
National Standard ◽  
Cost Burden ◽  
Post Intervention ◽  
Before And After ◽  
The Impact ◽  
Exercise Oncology

Background: The physical and economic toll of cancer make it a high health priority. The rising cost of cancer care is now a primary focus for patients, payers, and providers. Escalating costs of clinical trials and national drug regulations have led the median monthly costs of cancer drugs to rise from less than $100 in 1965 to 1969, to more than $5000 in 2005 to 2009, stressing the importance of finding innovative ways to reduce cost burden. In the present study, we report the economic evaluation of an individualized exercise oncology program beginning early after diagnosis. Methods: An independent research group, ASCEND Innovations, retrospectively analyzed patient records to statistically demonstrate the impact of exercise oncology during cancer treatment. All patients completed 12 weeks of prescribed, individualized exercise that included cardiovascular, strength training, and flexibility components. The 3 primary hospital measures leveraged for statistical comparison before and after supportive care enrollment were number of encounters, number of readmissions, and average total charges, as well as emergency room visits and length of hospital stay ( P < .05). Results: The resulting dataset consisted of 1493 total hospital encounters for 147 unique patients. The results statistically demonstrate a positive effect of exercise oncology during cancer care, in terms of reductions in overall cost per patient pre- to post-intervention. Conclusions: Individualized exercise oncology programs should be employed as part of the national standard of care for individuals battling cancer, in order to improve patient outcome and reduce cost burden.

155 Topical Vancomycin Reduces Surgical-site Infections After Craniotomy: A Prospective, Controlled Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 238-238
Author(s):  
Kalil G Abdullah ◽  
Arka Mallela ◽  
Andrew Richardson ◽  
Timothy H Lucas
Keyword(s):  
Cohort Study ◽  
Hospital Costs ◽  
Secondary Analysis ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Standard Of Care ◽  
Potential Method ◽  
Outcome Variable ◽  
Controlled Study ◽  
Neurosurgical Patients

Abstract INTRODUCTION Surgical site infections are an important cause of morbidity and mortality in neurosurgical patients. Topical antibiotics are one potential method to reduce the incidence of these infections. This study examined the efficacy of topical vancomycin applied within the wound during craniotomy in a large prospective cohort study at a major academic center. METHODS 355 patients were studied prospectively in this cohort study. 205 patients received 1 g of topical vancomycin powder in the subgaleal space while 150 matched control patients did not. Patients otherwise received identical care. The primary outcome variable was surgical-site infection rate factored by cohort. Secondary analysis examined cost-savings from vancomycin usage estimated from hospital costs associated with SSI in craniotomy patients. RESULTS >The addition of topical vancomycin was associated with a significantly lower rate of surgical site infections than standard of care alone (0.49% (1/205) vs. 6% (9/150), P = 0.002). Based on the costs of revision surgery for infections, topical vancomycin usage was estimated to save $1367,446 per 1000 craniotomy patients. No adverse reactions occurred. CONCLUSION Topical vancomycin is a safe, effective, and cost-saving measure to prevent surgical-site infections following craniotomy. These results have broad implications for standard of care in craniotomy.

scholarly journals EMERGENCY LAPAROTOMIES UNDER SPINAL ANESTHESIA: A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY, IN KABUL, AFGHANISTAN

2021 ◽  
Vol 9 (06) ◽  
pp. 751-756
Author(s):  
Wais Farda ◽  
◽  
Ahmad Bashir Nawazish ◽  
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Average Length ◽  
Emergency Laparotomy ◽  
Complication Rates ◽  
Abdominal Incision ◽  
Significant Difference ◽  
The Mean

Background: Laparotomy is most commonly performed under general anesthesia, but spinal anesthesia (SA) is considered an alternative to in the context of limited resources. The safety and efficacy of using SA as substitute for general anesthesia(GA) has not been explored in Afghanistan. Methodology: We conductedan observational study in the general surgery department of Isteqlal hospital in Kabul, Afghanistan on 196 adult patients undergoing emergency laparotomy under spinal anesthesia betweenApril 2018-April 2020. Results: The mean age of patients was 41.5 years (SD=19.4), the ratio of males to females was 1.9:1 and almost half (44.4%) had comorbidities. 21% were classified as ASA grade III and IV with a similar pattern among males and females. A total of 11 (5.6%) cases were converted to GA. Conversion pattern to GA was similar amongmales and females(P=0.71), ASA grade (P=0.432) and age group (P=0.642). The mean length of stay after operation was 6.5 days (SD=4.1). 32 (16.3%) patients suffered SA complications with no significant difference in terms of sex (P=0.134). Hypotension and headache accounted for 97% of complications. Complication rates were similar in terms of intervertebral level (P=0.349), type of abdominal incision (P>0.1) and average length of stay (P=0.156). 18 patients (9.2%) died due to MOF, sepsis, respiratory failure, thromboembolism and cardiogenic shock. Conclusion: Spinal anesthesia is considered a safe and effective anesthesia for emergency laparotomies, even for those with comorbidities. Based on our findings we would recommend spinal anesthesia as an alternative to general anesthesiain emergency laparotomy in Afghanistan.

scholarly journals Comparison of General versus Spinal Anesthesia in Patients undergoing Percutaneous Nephrolithotomy: A Prospective Randomized Study

2016 ◽  
Vol 5 (1) ◽  
pp. 37-42
Author(s):  
Rupak Bhattarai ◽  
Chittarranjan Das ◽  
Bandana Paudel ◽  
Sailoj Jung Dangi
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Percutaneous Nephrolithotomy ◽  
P Value ◽  
Recovery Duration ◽  
Significant Difference ◽  
Hospital Stays ◽  
Surgical Duration

Background Percutaneous Nephrolithotomy, widely used procedure by urologists for removing renal stones nowadays. Generally, it is preferred in general anesthesia but here in our study we have compared it with spinal anesthesia to know its safety and efficacy.Material and Methods Sixty patients of either sex, aged between 20-60 years, ASA – Grade I and II, with stones size larger than 15 mm posted for Percutaneous Nephrolithotomy were randomly selected. Patient was divided in two groups 30 each, Spinal Anesthesia (S) and General Anesthesia (G). Patient’s stones sizes, numbers & location, Anesthesia duration, Surgical duration, Recovery duration, Blood loss and Blood transfusion, Analgesic demand, post-operative Nausea & Vomiting, Patient satisfaction, Hospital stays and Heart Rate and Mean arterial pressure between two groups were compared.Results There was no significant difference in terms of mean age, weight, stones sizes, and numbers and its location. The p value for Anesthesia duration and surgical duration were 0.144 and 0.22 which was insignificant. Recovery duration (p-value 0.007), Blood loss (p-value 0.004) were significantly lesser in spinal anesthesia group. There was no significant difference in nausea and vomiting, patient satisfaction when compared between two groups. But Analgesic demand, Blood Transfusion and Hospital stays significantly found to be decreased in spinal anesthesia groups (p<0.05). The mean of MAP showed no significant difference except in 10 and 20 minutes.Conclusion Spinal anesthesia tends to be as effective as general anesthesia for PCNL and beneficial in terms of recovery duration, blood loss, analgesic demands, hospital stays, hence decrease the cost of patient. Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, Page: 37-42

scholarly journals PERBANDINGAN NYERI YANG TERJADI 24 JAM PASCA OPERASI PADA PENDERITA YANG DIBERIKAN ANESTESIA UMUM DAN ANESTESIA SPINAL

e-CliniC ◽  
2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Fiska M. Muhammad ◽  
Lucky Kumaat ◽  
Iddo Posangi
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Emotional Experience ◽  
P Value ◽  
Inhalation Anesthesia ◽  
Vas Score ◽  
Post Operative Pain ◽  
Wide Range ◽  
Significant Difference ◽  
Anesthesia Spinal

Abstract: Pain can be described as an unpleasant sensory and emotional experience associated with tissue damage which has already occured or potentially will be occurred. General anesthesia is oftenly perfomed on a wide range of surgical procedures. There are two techniques of general anesthesia: inhalation anesthesia and intravenous anesthesia. Spinal anesthesia is one of the simplest and most reliable of regional anesthesia technique. This study aimed to compare the pain between general anesthesia and spinal anesthesia 24 hours post operative. This was an analytical prospective study. Samples were 24 patients consisting of 12 patients with general anesthesia and 12 patients with spinal anesthesia. The inclusion criteria were patients aged 20-60 years old, duration of operation 1-4 hours, and the operations were caesarean section and hysterectomy. The pain assessment used VAS score as well as blood pressure, pulse, and respiration. Data were statistically analyzed by using the Mann-Whitney test and showed a p-value 0.876. Conclusion: There was no significant difference in 24-hour-post-operative pain using VAS score among patients with general anesthesia and with spinal anesthesia.Keywords: VAS scores, general anesthesia, spinal anesthesia.Abstrak: Nyeri dapat digambarkan sebagai suatu pengalaman sensorik dan emosional yang tidak menyenangkan yang berkaitan dengan kerusakan jaringan yang sudah atau berpotensi terjadi. Anestesia umum sering dilalukan pada berbagai macam prosedur pembedahan dan terbagi atas anestesia inhalasi dan anestesia intravena. Anestesia spinal merupakan salah satu anestesia yang paling sederhana dan paling dapat diandalkan dari tehnik anestesia regional. Penelitian ini bertujuan untuk mengetahui perbandingan nyeri pada pemberian anestesia umum dan anestesia spinal 24 jam pasca operasi. Penelitian ini menggunakan metode analitik prospektif. Terdapat 24 sampel yang terbagi atas 12 penggunaan anestesia umum dan 12 penggunaan anestesia spinal, dengan kriteria rentang umur pasien 20-60 tahun, lama operasi 1-4 jam serta jenis pembedahan seksio sesarea dan histerektomi. Penilaian nyeri menggunakan skor VAS serta tekanan darah, nadi dan respirasi. Data diolah dengan menggunakan program SPSS versi 20. Hasil uji statistik Mann-Whitney mendapatkan nilai p= 0,876 yang menunjukkan tidak terdapat perbedaan bermakna dari skor VAS. 24 jam pasca operasi dengan anestesia umum dan anestesia spinal. Simpulan: Tidak terdapat perbedaan bermakna nyeri 24 jam pasca operaasi dinilai dengan skor VAS pada pemberian anestesia umum dan anestesia spinal.Kata kunci: Skor VAS, anestesia general, anestesia spinal

scholarly journals Diffuse Dermal Angiomatosis of the Breasts: A Case Series of 8 Patients

2021 ◽  
Vol 5 (3) ◽  
pp. 301-306
Author(s):  
Landon Kaleb Hobbs ◽  
Darren Guffy ◽  
R. Hal Flowers
Keyword(s):  
Weight Loss ◽  
Smoking Cessation ◽  
Reduction Mammaplasty ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Smoking History ◽  
Potential Association ◽  
Significant Difference ◽  
History Of

Background: Diffuse dermal angiomatosis (DDA) is a rare, reactive vascular disorder of the skin. Association with vascular disease, smoking, and large pendulous breasts has been reported. No standard of care exists but benefit with medication and reduction mammaplasty has been reported. Methods: We report a case of a 49-year-old obese female with a history of smoking who presented with DDA that improved with smoking cessation and pentoxifylline prior to reduction mammaplasty. We also performed a retrospective chart review of all patients with DDA seen at our institution between 2010 and 2020. Results: Eight female patients with DDA affecting the breasts were evaluated at our institution. The mean age was 49.5 years. Five of the patients noted symptoms at presentation. Obesity was seen in 7 (87.5%) patients and 5 (63%) had a smoking history. There was no significant difference between symptomatic and asymptomatic groups in regard to age, t4=-0.63, p=0.56, but BMI trended higher in the symptomatic group, t6=2.27, p=0.06. Three patients (38%) were noted to have fibromyalgia. All symptomatic patients saw improvement in their symptoms with treatments including reduction mammaplasty (1 patient), aspirin (1 patient), pentoxifylline (3 patients), smoking cessation (2 patients), and/or weight loss (1 patient). Conclusions: Our series is the second largest series of DDA of the breasts and confirms many reported associations including obesity, smoking, and large pendulous breasts. We report the first known case of improvement with weight loss as a sole intervention, as well as identify a novel potential association between DDA and fibromyalgia.

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