Evaluation of remote OMFS assessments in the era of pandemic COVID-19 control measures.

Pandemic COVID-19 has put unprecedented pressure on NHS providers to offer non face-to-face consultation. This study aims to assess acceptability of patients and clinicians towards teleconsultation in oral and maxillofacial surgery compared with an expected face-to-face assessment. 340 telephone clinic patient episodes were surveyed over the initial 7-week period of pandemic-related service restriction. Appointment outcomes from a further 420 telephone consultations were additionally scrutinised. A total of 59.1% of patients expressed a strong preference for teleconsultation with only 13.1% stating a moderate or strong preference for face-to-face assessment. Diagnostic accuracy was highlighted as a concern for both clinicians and patients due to inherent inability to conduct a traditional clinical examination, notable in 43.5% of qualitative comments. Logistical concerns, communications needs and other individual circumstances formed the other emerging themes. The majority of remote consultations (59.5%) were outcomed as requiring further review. A total of 29.3% of patients were discharged. These findings suggest that the increasing use of remote follow-up in carefully selected subgroups can facilitate efficient and acceptable healthcare delivery. Although 'in-person' clinical appointments will continue to be regarded as the default safe and gold standard management modality, OMFS departments should consider significant upscaling of teleconsultation services.

Effects of sedation with acepromazine maleate and buprenorphine hydrochloride on femoral artery blood flow in healthy dogs.

The purpose of this study was to qualify and quantify the femoral artery blood flow by duplex Doppler ultrasonography (DDU) in healthy dogs, before and after the administration of a combination of acepromazine maleate and buprenorphine hydrochloride (ACP-BPN). Seven healthy adult mongrel dogs and three adult beagles were used. Heart rate, arterial blood pressure and measurement of femoral artery blood flow by DDU were also recorded. The DDU measurements were: femoral artery diameter (FAD), peak systolic velocity (PSV), early retrograde (EDV) and end diastolic velocities (EnDV), mean velocity (BMV), pulsatility index (PI), flow velocity integral (FVI) and femoral blood flow (FBF). After 30 min, combination ACP-BPN was administered intramuscularly, and all the measurements were recorded again. The ACP-BPN protocol induced a significant decrease in systolic, mean, and diastolic arterial blood pressure, and heart rate. A significant increase in peak systolic velocity and integral flow velocity integral of the femoral blood were obtained. The Doppler spectra of the blood flow in the femoral artery revealed a spectral dispersion pattern after ACP-BPN administration in all the dogs. These results demonstrate that despite quantitative and qualitative changes, the overall femoral blood flow (FBF) is not significantly modified.

Anaesthesia for liver transplantation. The Groote Schuur Hospital experience.

In October 1988 the orthotopic liver transplantation programme recommenced at Groote Schuur Hospital. The experience gained from our first 10 patients is described here. Anaesthesia for this type of surgery is demanding given the long duration of the operation and the severe haemodynamic and physiological alterations that can occur. A rapid sequence induction is usually performed and anaesthesia maintained with fentanyl and isoflurane. Dopamine and mannitol are used for renal protection. Extensive monitoring of haemodynamics, biochemistry, coagulation and temperature is essential. A rapid infusion device is mandatory as massive blood loss may occur. All patients were electively ventilated in the surgical intensive care unit postoperatively. One patient died 11 days postoperatively. The remainder are well at the time of writing.