Endovascular Intervention with a Mobile C-Arm in the Operating Room

Mobile C-arm fluoroscopic X-ray systems are used for various diagnostic imaging and minimally invasive endovascular procedures. One of the greatest advantages of a mobile C-arm is its ability to move around the patient. The purpose of this study was to address the optimal setting of the mobile C-arm and the operating table, as well as the proper position of the operator and assistants for each procedure. In addition, methods to minimize radiation exposure to the operator and medical staff are described. Both the optimal setting and the proper position were classified by 5 types. These include the setting for aortic and inferior vena caval procedures (type I); left lower extremity (LE) intervention with an up-and-over technique (type II); right LE intervention with up-and-over technique, or bilateral LE vascular intervention with antegrade access (type III); arteriovenous fistula/graft intervention (type IV); and central vein catheterization (type V).

Comparison of the Outcomes after Primary Total Hip Arthroplasty Using a Short Stem between the Modified Anterolateral Approach and Direct Anterior Approach with a Standard Operation Table / 대한정형외과학회잡지

PURPOSE: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. MATERIALS AND METHODS: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. RESULTS: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). CONCLUSION: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.

Control inalámbrico de mesa quirúrgica desde dispositivo móvil / Wireless control of operating tables from a mobile device

Para la mayoría de las mesas quirúrgicas del hospital, el proveedor ya no comercializa controles remotos compatibles, lo cual implicaría un gasto importante para su actualización o renovación. Para evitar dicho gasto, se diseñó un control inalámbrico para manejar los movimientos de las mesas quirúrgicas a través de un dispositivo móvil.

The provider no longer provides compatible remote controls for most of operating tables at the hospital, which would imply an important expense for their upgrading or renewal. In order to avoid that expenditure, a wireless control was designed to improve operating table movements from a mobile device.

Early Experiences with Ultra-Fast-Track Extubation after Surgery for Congenital Heart Disease at a Single Center

BACKGROUND: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1–2 hours after surgery, in patients with congenital cardiac disease. METHODS: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016. To evaluate the feasibility and effectiveness of our recently introduced UFT extubation strategy, we retrospectively reviewed 195 patients who underwent similar operations for similar diseases from September 2015 to September 2017, including the 1-year periods immediately before and after the introduction of the UFT extubation protocol. Propensity scores were used to assess the effects of UFT extubation on length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and medical costs. RESULTS: After propensity-score matching using logistic regression analysis, 47 patients were matched in each group. The mean ICU LOS (16.3±28.6 [UFT] vs. 28.0±16.8 [non-UFT] hours, p=0.018) was significantly shorter in the UFT group. The total medical costs (182.6±3.5 [UFT] vs. 187.1±55.6 [non-UFT] ×100,000 Korean won [KRW], p=0.639) and hospital stay expenses (48.3±13.6 [UFT] vs. 54.8±29.0 [non-UFT] ×100,000 KRW, p=0.164) did not significantly differ between the groups. CONCLUSION: UFT extubation decreased the ICU LOS and mechanical ventilation time, but was not associated with postoperative hospital LOS or medical expenses in patients with simple congenital cardiac disease.

Influence of support surfaces on the distribution of body interface pressure in surgical positioning / Influência das superfícies de apoio na distribuição da pressão de interface corporal durante o posicionamento cirúrgico / Influencia de las superficies de apoyo en la distribución de presión de la interfaz corporal durante el posicionamiento quirúrgico *

Abstract Objective: to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences. Method: a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data. Results: the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg). Conclusion: IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS.

RESUMO Objetivo: valiar a pressão de interface (PI) das superfícies de apoio (SAs) em proeminências ósseas. Método: um estudo quase experimental com medidas repetidas em diferentes SAs. Vinte voluntários adultos saudáveis participaram do estudo. Os participantes foram colocados em decúbito dorsal em uma mesa cirúrgica para avaliação da PI nas proeminências ósseas das regiões occipital, subescapular, sacral e calcânea utilizando sensores. Sete avaliações foram realizadas para cada proeminência óssea: uma avaliação em uma mesa de operação padrão e as outras avaliações em mesas contendo SAs à base de polímero viscoelástico, espuma macia, ou espuma selada. Estatística descritiva e análise de variância foram utilizadas para analisar os dados. Resultados: a PI média foi maior na SA feita de polímero viscoelástico em comparação com as outras SAs (p<0,001). A PI média foi relativamente menor na espuma selada de densidade 33 e na espuma macia de densidade 18. Além disso, essa variável foi comparativamente maior na região sacral (42,90 mmHg) e na região calcânea (15,35 mmHg). Conclusão: a PI foi menor em SAs à base de espuma, especialmente espuma macia de densidade 18 e espuma selada de densidade 33. No entanto, a PI não foi reduzida na SA à base de polímero viscoelástico comparado com a SA controle.

RESUMEN Objetivo: evaluar la presión de interfaz (PI) de las superficies de apoyo (SAs) en prominencias óseas. Método: un estudio casi experimental con medidas repetidas en diferentes SAs. Veinte voluntarios adultos saludables participaron del estudio. Los participantes fueron colocados en decúbito dorsal en una mesa quirúrgica para evaluación de la PI en las prominencias óseas de las regiones occipital, subescapular, sacra y calcánea utilizando sensores. Siete evaluaciones fueron realizadas para cada prominencia ósea: una evaluación en una mesa de operación estándar y otras evaluaciones en mesas que contenían SAs a base de polímero viscoelástico, espuma blanda, o espuma sellada. Fueron utilizadas la estadística descriptiva y el análisis de la varianza para analizar los datos. Resultados: la PI media fue mayor en la SA hecha de polímero viscoelástico en comparación con las otras SAs (p<0,001). La PI media fue relativamente menor en la espuma sellada de densidad 33 y en la espuma blanda de densidad 18. Además, esa variable fue comparativamente mayor en la región sacra (42,90 mmHg) y en la región calcánea (15,35 mmHg). Conclusión: la PI fue menor en SAs a base de espuma, especialmente espuma blanda de densidad 18 y espuma sellada de densidad 33. Sin embargo, la PI no fue reducida en la SA a base de polímero viscoelástico comparado con la SA control.

Retroauricular Thyroidectomy Using a New Flexible, Single-Port Robotic Surgical System / 대한이비인후과학회지

This study aimed to assess a new flexible, single-arm robotic surgical system to retroauricular thyroidectomy. Three fresh cadavers were used. Technical elements of the system and the whole surgical procedures were described in detail. This single-port flexible system could be used to successfully perform retroauricular thyroidectomy. The ideal angle to dock the patient-side cart was at a 90-degree angle to the operating table. When the cannula tip was placed 10–15 cm away from the skin incision, positioning and full movement of all four instruments without collisions were possible. Flexible three instruments and a stereoscope made the robotic dissection more efficient, safe and time-saving. We report the first preclinical evaluation of an innovative, flexible, single-arm robotic surgical system for retroauricular thyroidectomy.

Análise microbiológica da ocorrência da contaminação bacteriana da mesa cirúrgica comparando o TNT gramatura 20 e gramatura 40 / Microbiological analysis of occurrence of bacterial contamination of surgical table comparing 20 thickness and 40 thicknes

A limpeza e desinfecção das superfícies operatórias fixas e partes expostas do equipo odontológico reduzem, significativamente, a contaminação. Este estudo teve como objetivo avaliar se há contaminação da mesa cirúrgica, ao se utilizar o TNT esterilizado nas gramaturas 20 g/m² e 40 g/m². Materiais e Métodos: O trabalho constituiu-se de 2 grupos, compostos por 30 amostras (campos cirúrgicos) para cada grupo. Após a desinfecção prévia das mesas cirúrgicas, foram colocados campos de TNT. No grupo 1, foi utilizado TNT gramatura 20, e no grupo 2, gramatura 40. A coleta das amostras dos dois grupos foi realizada logo após a colocação dos campos cirúrgicos (tempo 1) e 1 hora após (tempo 2). Resultados: Em relação à ocorrência de contaminação bacteriana, não houve diferença estatisticamente significativas entre tempo de coletas. Mesmo com os cuidados de desinfecção da mesa e paramentação adequada, esses campos não foram totalmente eficazes. Conclusão: A amostra do TNT gramatura 40, tanto no início da cirurgia quanto 1 hora após, obteve melhores resultados, comparando-se com o TNT gramatura 20 sem diferenças estatísticas... (AU)

The cleaning and disinfecting fixed operative surfaces and exposed parts of the dental unit significantly reduces contamination. This study aimed to assess whether there is contamination of the surgical table to use the TNT sterilized in the weights 20 g/m² and 40 g/m². Materials and Methods: The study consisted of two groups, composed of 30 samples (drapes) for each group. After prior disinfection of surgical tables were placed TNT fields. Group 1 was used TNT weight and 20 in group 2 weight 40. The sample collection from both groups was held soon after the placement of surgical fields (time 1) and 1 hour after (time 2). Results: Regarding the occurrence of bacterial contamination, there was no statistically significant difference between time of collection. Even with the disinfecting care of the table and adequate scrub, these fields have not been fully effective. Conclusion: Thus, the sample weight of the TNT 40, both at the beginning of surgery, as 1 hour, better results compared to the TNT weight 20 without statistical differences... (AU)

Infección del sitio quirúrgico poscesárea / Infection of the postcesarean section surgical site

Se realizó un estudio descriptivo y transversal de 21 puérperas cesareadas, con infección del sitio quirúrgico, ingresadas en el Hospital Ginecoobstétrico Dra. "Nelia Irma Delfín Ripoll" de Palma Soriano, provincia de Santiago de Cuba, desde octubre de 2014 hasta igual mes de 2015, a fin de caracterizarles según variables seleccionadas. En la serie predominaron el grupo etario de 20-29 años, la anemia (66,6 %) y la obesidad (42,8 %) como principales factores de riesgo, la cirugía urgente limpia contaminada (76,1 %), así como el Staphylococcus aureus y la Escherichia coli como los gérmenes más aislados; asimismo, se utilizaron combinaciones de antibióticos de primera línea con resultados favorables en todas las pacientes. Se concluye que la presencia de factores de riesgo y la identificación de bacterias como agentes causales importantes, exige mantener una vigilancia epidemiológica permanente para disminuir la infección en estas pacientes.

A descriptive and cross-sectional study of 21 newly-delivered woman undergoing cesarean section, with infection of the surgical place, admitted to Dr. "Nelia Irma Delfín Ripoll" Ginecoobstetric Hospital in Palma Soriano, Santiago de Cuba, was carried out from October, 2014 to the same month in 2015, in order to characterize them according to selected variables. In the series the 20-29 age group, anemia (66.6%) and obesity (42.8%) prevailed as main risk factors, the polluted clean urgent surgery (76.1%), as well as the Staphylococcus aureus and the Escherichia coli as the isolated germs; also, combinations of first line antibiotics were used with favorable results in all the patients. It was concluded that the presence of risk factors and the identification of bacterias as important causal agents, demands maintaining a permanent epidemiologic surveillance to diminish the infection in these patients.

Posicionamento Cirúrgico: cuidados de enfermagem no transoperatório / Posicionamiento quirúrgico: cuidados de la enfermería en el período transoperatorio / Surgical positioning: nursing care in the transoperative period

Durante a atuação em centro cirúrgico observou-se que a enfermagem não atuava no posicionamento do paciente na mesa cirúrgica, o que nos incentivou a investigar sobre o tema. Objetivo: Identificar os cuidados de enfermagem no posicionamento, relatando as complicações. Método: Trata-se de revisão integrativa da literatura, com busca nos bancos de dados LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e SciELO (Scientific Electronic Library Online), no período de agosto de 2004 a setembro de 2014. Resultados: Foram encontrados 20 artigos e selecionados 10 conforme critérios. Discussão: O posicionamento pode ocasionar complicações, sendo a úlcera por pressão a mais frequentemente apontada. As intervenções eficazes são aquelas que aliviam as pressões durante a permanência na mesa. Conclusão: O enfermeiro é o responsável pelos cuidados de enfermagem e juntamente com a equipe deve promover ações que garantam a segurança do paciente, considerando as particularidades e os recursos disponíveis.

Durante la actuación en el centro quirúrgico, se observó que la enfermería no trabajaba en el posicionamiento del paciente en la mesa quirúrgica, lo que alentó a investigar la cuestión. Objetivo: Identificar los cuidados de enfermería en el posicionamiento, haciendo un informe sobre las complicaciones. Método: Se trata de una revisión integradora de la literatura, utilizándose la búsqueda en las bases de datos LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) y SciELO (Scientific Electronic Library Online), en el período comprendido entre agosto de 2004 hasta septiembre de 2014. Resultados: Se encontraron 20 artículos y se seleccionaron 10 de ellos, basándose en criterios. Discusión: El posicionamiento puede causar complicaciones, y las ulceras por presión son las más frecuentes reportadas. Las intervenciones eficaces se relacionan con el alivio de las presiones en la mesa quirúrgica. Conclusión: El enfermero es responsable por los cuidados de enfermería y debe promover acciones juntamente con su equipo que garanticen la seguridad del paciente, teniendo en cuenta las particularidades y los recursos disponibles.

During the operation room activities, it was observed that the nursing team did not actively perform patient positioning on the operating table, which encouraged us to investigate the issue. Objective: To identify the nursing care routine in patient positioning, reporting complications. Methods: This is an integrative literature review, with search in LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) and SciELO (Scientific Electronic Library Online) databases, from August to September 2014. Results: We found 20 articles and selected 10 according to the criteria. Discussion: The positioning can cause complications, with pressure ulcers being the most frequent. Effective interventions are those that relief the pressure during the patient?s stay at the table. Conclusion: The nurse is responsible for nursing care and, together with the team, for actively promoting actions that ensure patient safety, considering the circumstances and available resources.

Comparison of the rate of successful endotracheal intubation between the "sniffing" and "ramped" positions in patients with an expected difficult intubation: a prospective randomized study / 대한마취과학회지

BACKGROUND: Optimal head and neck positioning and clinical experience are important factors for successful endotracheal intubation in patients with a difficult airway. This study aimed to investigate the rate of successful endotracheal intubation between the sniffing and ramped positions in patients with an expected difficult intubation. METHODS: The study included 204 patients with an expected difficult intubation (airway difficulty score > or = 8) based on the preoperative airway assessment. The patients were randomized into the following groups: group S was placed in the sniffing position, and group R was placed in the ramped position during direct laryngoscopy. The primary outcome was successful endotracheal intubation and the secondary measure was laryngeal view in the ramped or sniffing position when the operating table was placed at two different heights. RESULTS: Group R showed a higher rate of successful endotracheal intubation and better laryngeal view than group S (P < 0.05). The rate of successful endotracheal intubation was higher in group R than in group S at both heights of the operating table; but, it was not different within each group. Laryngeal view was not different between the two groups and within each group when the two heights of the operating table were used. Fully trained and experienced attending anesthesiologists achieved a higher rate of successful endotracheal intubation than less experienced residents in group R (P < 0.05) but not in group S. CONCLUSIONS: Ramped position and clinical experience can be important factors for laryngeal view and success rate of endotracheal intubation in patients with an expected difficult intubation.

Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus

OBJECTIVES: To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography. METHODS: Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months. RESULTS: Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided. CONCLUSION: Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.

Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis

Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.

Intraoperative electrical burn caused by stainless tube tree with noncontact electrosurgical ground: A case report

Noncontact electrosurgical ground is recently developed to provide adequate electrical return to electric surgical unit without direct contact to the patient. It provides full and safe electrical return without direct contact of patient due to oscillating, high frequency nature of the current flow and large surface of pad. It is useful in burn surgery and effective to prevent burn by improper placements of the grounding pad. But it can induce current to conducting object with direct contact. Current induced in conductive materials can produce heat to make burns. We present a patient with full-thickness burn in left third finger which was resulted from current through stainless steel tube tree on the operating table during surgery. The stainless tube tree was placed on noncontact electrosurgical ground which was covered with plastic sheet and linen sheet. Staff in operating room should be educated and remain vigilant for electrical burns caused by metallic object on noncontact grounding pad.

Canine model of ischemic stroke with autologous thrombus in three dogs; Magnetic resonance imaging features and histopathological findings / 동물의과학연구지

Ischemic stroke is the most common type of stroke in humans. The purpose of this study was to evaluate the diagnostic value of magnetic resonance imaging (MRI) in a canine model of stroke. Ischemic stroke was induced by using prepared autologous thrombus. The dogs were placed in lateral recumbency on the operation table and the cervical area of each dog was sterilized by using alcohol. After making a cervical incision, the common carotid artery and internal carotid artery (a branch of the common carotid artery that supplies an anterior part of the brain) were exposed. A 200 microL injection of the autologous thrombus prepared 24 hr prior to surgery was delivered with a 20 gauge venous catheter through an internal carotid artery. After successful delivery of the autologous thrombus, the venous catheter was removed, and the cervical incision was sutured. Neurologic signs including generalized seizures, tetraparesis, and altered mental status, were observed in all 3 dogs after induction of ischemic stroke and the signs manifested immediately after awakening from anesthesia. T1- and T2-weighted images and fluid-attenuated inversion recovery (FLAIR) images of the brain were acquired 1 day before and 1 day after surgery. On the day following ischemic stroke induction, MRI revealed multifocal lesions in the cerebral cortex and subcortex such as T1 hypointensity, T2 hyperintensity, FLAIR hyperintensity, and diffusion-weighted hyperintensity in all 3 dogs. Upon postmortem examination, ischemic lesions were found to be consistent with the MRI findings and they were unstained with 2% triphenyltetrazolium chloride. Histologic features of the earliest neuronal changes such as cytoplasmic eosinophilia with pyknotic nuclei were identified. Neuropil spongiosis and perivascular cuffing were also prominently observed at the infarcted area. The present study demonstrated the features of MRI and histopathologic findings in canine ischemic stroke models.

The correlation between the Trendelenburg position and the stroke volume variation / 대한마취과학회지

BACKGROUND: The stroke volume variation (SVV), based on lung-heart interaction during mechanical ventilation, is a useful dynamic parameter for fluid responsiveness. However, it is affected by many factors. The aim of this study was to evaluate the effects of SVV on Trendelenburg (T) and reverse Trendelenburg (RT) position and to further elaborate on the patterns of the SVV with position. METHODS: Forty-two patients undergoing elective surgery were enrolled in this study. Fifteen minutes after standardized induction of anesthesia with propofol, fentanyl, and rocuronium with volume controlled ventilation (tidal volume of 8 ml/kg of ideal body weight, inspiration : expiration ratio of 1 : 2, and respiratory rate of 10-13 breaths/min), the patients underwent posture changes as follows: supine, T position at slopes of operating table of -5degrees, -10degrees, and -15degrees, and RT position at slopes of operating table of 5degrees, 10degrees, and 15degrees. At each point, SVV, cardiac output (CO), peak airway pressure (PAP), mean blood pressure, and heart rate (HR) were recorded. RESULTS: The SVV was significant decreased with decreased slopes of operating table in T position, and increased with increased slopes of operating table in RT position (P = 0.000). Schematically, it was increased by 1% when the slope of operating table was increased by 5degrees. But, the CO and PAP were significant increased with decreased slopes of operating table in T position, and decreased with increased slopes of operating table in RT position (P = 0.045, 0.027). CONCLUSIONS: SVV is subjected to the posture, and we should take these findings into account on reading SVV for fluid therapy.

A Randomized Controlled Trial about the Levels of Radiation Exposure Depends on the Use of Collimation C-arm Fluoroscopic-guided Medial Branch Block

BACKGROUND: C-arm fluoroscope has been widely used to promote more effective pain management; however, unwanted radiation exposure for operators is inevitable. We prospectively investigated the differences in radiation exposure related to collimation in Medial Branch Block (MBB). METHODS: This study was a randomized controlled trial of 62 MBBs at L3, 4 and 5. After the patient was laid in the prone position on the operating table, MBB was conducted and only AP projections of the fluoroscope were used. Based on a concealed random number table, MBB was performed with (collimation group) and without (control group) collimation. The data on the patient's age, height, gender, laterality (right/left), radiation absorbed dose (RAD), exposure time, distance from the center of the field to the operator, and effective dose (ED) at the side of the table and at the operator's chest were collected. The brightness of the fluoroscopic image was evaluated with histogram in Photoshop. RESULTS: There were no significant differences in age, height, weight, male to female ratio, laterality, time, distance and brightness of fluoroscopic image. The area of the fluoroscopic image with collimation was 67% of the conventional image. The RAD (29.9 +/- 13.0, P = 0.001) and the ED at the left chest of the operators (0.53 +/- 0.71, P = 0.042) and beside the table (5.69 +/- 4.6, P = 0.025) in collimation group were lower than that of the control group (44.6 +/- 19.0, 0.97 +/- 0.92, and 9.53 +/- 8.16), resepectively. CONCLUSIONS: Collimation reduced radiation exposure and maintained the image quality. Therefore, the proper use of collimation will be beneficial to both patients and operators.

Discrepancies in Soft Tissue Profile of Patients for Orthognathic Surgery between Preoperative Lateral Facial Photograph, Lateral Cephalogram and Supine Position on Operation Table

Development of complex regional pain syndrome at independent arm associated with lateral decubitus position: A case report

A 27-year-old man underwent excision of a mediastinal mass using video-assisted thoracoscopic surgery (VATS) performed in the right lateral position. Postoperatively, he complained of pain in the left upper arm and chest wall, limitation of the left shoulder joint, allodynia, hyperalgesia, spontaneous pain in left finger, edema, hypohidrosis, and change of skin color of the left hand. We diagnosed the patient with complex regional pain syndrome (CRPS) by using the proposed modified International Association of the Study of Pain (IASP) research diagnostic criteria, and initiated treatment through medication and interventional management. After 3 months of treatment, the pain intensity reduced to below 2 cm on the VAS. In this study, we describe a case of postoperative CRPS, which is believed to have been caused by excessive stretching of the brachial plexus. Careful positioning of patients on the operating table with proper padding will reduce injuries to the peripheral nerves.