ABSTRACT
Sub?macular hemorrhage poses a potential threat to vision if left untreated. The preferred surgical technique to clear sub?macular hemorrhage includes vitrectomy followed by retinotomy using a 41G needle with subsequent injection of recombinant tissue plasminogen activator (r?tPA) followed by air/SF6 injection into the sub?retinal space. A malleable nature, increased resistance, and the cost of the 41G needle limit its use. We evaluated the safety and efficacy of a 26G needle for retinotomy as a supplement for the 41G needle in a series of six subjects with sub?macular hemorrhage. A slight modification in the procedure was done by injecting air into the sub?retinal space prior to the r?tPA injection. We found that our technique of using the 26G needle for retinotomy is safe and effective due to its stable nature and self?sealing properties. An air injection prior to r?tPA allows for increased bioavailability of the drug by preventing efflux due to its tamponading effect.
ABSTRACT
The entire operating team shares the responsibility of patient positioning before a surgical procedure. It is of prime importance to maintain a balance between optimal surgical positioning and the safety of the patient as many of these positions can induce adverse physiological consequences which can affect the haemodynamics of the patient. This study was conducted with the primary objective of determining the incidence of position related injuries and incidents and to analyse the risk factors associated in patients undergoing urological procedures under anaesthesia. The secondary objective was to study the time taken for the injury to resolve and their management.METHODSThis is a prospective observational study carried out in adult subjects undergoing urological procedures over a period of 6 months. A thorough preoperative evaluation was carried out which included history taking, examination, preoperative neurological and vascular examination, and pertinent investigations. After the patient was anaesthetized and operative position decided, the nature of position, time taken to position, number of people involved, and the positioning aids used were noted. Any adverse hemodynamic changes occurring during or after the positioning were noted. At the end of the surgery the patient was re-examined for any injuries or incidents related to positioning. Factors contributing to positional injury were categorized and the management of these injuries and the progress was followed up. An analysis sheet was attached. Statistical analysis was done with the help of SPSS Software ver. 10.RESULTSOnly one patient sustained nerve injury. The incidence of position related injuries was about 2.1 % with more injuries in patients with general anaesthesia, longer duration of surgery, in those with low BMI. The incidence of position related incidents was seen to be 3.4% with most common event being hypotension requiring vasopressors and was more prevalent in those undergoing surgery under general anaesthesia.CONCLUSIONSIn conclusion, it must be stressed that utmost care must be taken to avoid the occurrence but also to counsel patients undergoing surgeries about the rare possibility of positioning related injuries and incidents under anaesthesia. Every effort should be taken to analyse the underlying precipitating factors and correct them. Symptomatic incidents leading to unstable haemodynamic condition should be treated promptly.