ABSTRACT
Background: Central venous cannulation is a commonly performed procedure in neurosurgical patients to maintain the hemodynamic stability in the intraoperative period. It is used for infusion of intravenous fluids, vasopressors central venous pressure monitoring and detection of air embolism. Subclavian vein is commonly performed as there are minimal effects of positioning on it. Supraclavicular approach to subclavian vein cannulation is not as frequently employed as the infraclavicular approach. The purpose of this study was to compare the supraclavicular approach versus the infraclavicular approach in terms of number of attempts, success rate of catheterization and complications associated with the procedure.Methods: About 150 patients undergoing various neurosurgical procedures were enrolled in the study. They were divided into two groups. 75 patients underwent right supraclavicular catheterization of subclavian vein while as 75 patients underwent right infraclavicular catheterisation of the subclavian vein. The number of attempts for cannulation, success or failure of catheterization and any complications associated with the procedure or in the postoperative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent Samples T-test.Results: The right supraclavicular vein was successfully cannulated in 90.66% while as the right infraclaviclar vein was successfully cannulated in 96% of the patients (p >0.05). Malpositioning of catheter (threaded in contralateral subclavian) was noted in 4 patients in Group S and ipsilateral internal jugular vein in 2 patients. Pneumothorax was encountered in 1 patient in the group S undergoing supraclavicular subclavian vein cannulations while as subclavian arterial puncture was seen in 4 patients who underwent infraclavicular arterial puncture.Conclusions: There was no difference in successive cannulations between right the supraclavicular and right infraclaviclar veins. The rate of complications between the two approaches was comparable.
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OBJECTIVE: This report describes the clinical study of the surgical method of lateral third infraclavicular implantation of vagal nerve stimulation (VNS) generator through the axillary wrinkle incision. METHODS: In a retrospective study, the data for 20 patients with medically intractable epilepsy treated by this approach were examined. The mean age was 31.4 years (range : 14-50), and the mean follow-up period was 12.15 months (range : 4-21 months). The male to female ratio was 2.3 : 1. The subcutaneous pocket for the generator was located in the lateral third infraclavicular area through the axillary wrinkle. Our method was a modification of the standard VNS generator implantation in the mid-infraclavicular pocket through anterior axillary incision. RESULTS: There were the excellent or good cosmetic satisfaction in 95% of the cases and fair in 5%. The generator was located outside the lung field in 15%, periphery of the lung field in 45%, and crossed over the lung field in 40%. Discomfort from shoulder motion occurred transiently in 35% of cases. Other complications were minimal. CONCLUSION: These results demonstrate that the lateral third infraclavicular apporach will offers cosmetic benefits and reduction of obscuration of the lung field without serious complications. Thus, this technique provides an attractive alternative among the surgical techniques for the vagal nerve stimulation.
Subject(s)
Female , Humans , Male , Epilepsy , Follow-Up Studies , Lung , Retrospective Studies , Shoulder , Vagus Nerve StimulationABSTRACT
Objective To evaluate the feasibility and advantages of gasless endoscopic thyroidectomy via the infraclavicular approach.Methods A single 2-to 4-cm infraclavicular incision was made at the ipsilateral side under local anesthesia.The subplastysmal plane was dissected up to the anterior neck to build a gasless space by mechanical method.Afterwards,by using ultrasonic scalpel,thyroidectomy was performed.Results The procedure was completed in 34 cases with a mean operation time of(120?30) min and mean blood loss of(20?12) ml.After the surgery,3 patients developed subcutaneous fluid and 1 patient had incisional infection,all of the 4 patients were cured by conservative therapy.The 34 cases were followed up for 1 to 30 months with a mean of 18.5 months,during the period,none of them had recurrence.Conclusions Gasless endoscopic thyroidectomy via the infraclavicular approach is a simple and safe method with good cosmetic outcomes.
ABSTRACT
BACKGROUND: The continuous infraclavicular brachial plexus block (BPB) has many merits compared to other approaches. However, due to complications and the discomfort felt by patients during the procedure, it has not gained much in popularity. We assumed that the neurovascular sheath is one compartment and placed the catheter deeply into the sheath, as used in the infraclavicular approach, through the axilla. METHODS: Patients scheduled for surgery were paired according to their diagnoses and sites of surgery. Thirty-two patients were randomly chosen and divided into two groups. Selander's continuous axillary BPB was performed in the axillary group. In the infraclavicular group, we inserted an epidural catheter with a stylet deeper into the site just medial to the coracoid process using a C-arm and nerve stimulator. RESULTS: In the infraclavicular group, sensory and motor block of the musculocutaneous nerve and the quality of BPB was superior to those of the axillary group (P < 0.05). The average depth of the catheter from the skin was 14 +/-1.5 cm. CONCLUSIONS: Continuous infraclavicular BPB can cause no more discomfort as Selander's continuous axillary approach. Furthermore, it may improve the quality of block and reduce the amount of local anesthetic used.