Effect of preoperative gabapentin and acetaminophen on opioid consumption in video-assisted thoracoscopic surgery: a retrospective study.

BACKGROUND: Patients undergoing video-assisted thoracoscopic surgery (VATS) are particularly vulnerable to opioid-induced sedation and hypoventilation. Accordingly, reducing opioid consumption in these patients is a primary goal of multimodal analgesic regimens. Although administration of preoperative gabapentin and acetaminophen has been shown to decrease postoperative opioid consumption in other surgeries, this approach has not been studied in VATS lobectomy. Our objective was to examine the impact of the addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic plan on postoperative opioid consumption, nausea/vomiting, and sedation. METHODS: With IRB approval, we performed a retrospective chart review of patients who underwent VATS lobectomy at a single center between 2015 and 2016 to identify those that received preoperative gabapentin and acetaminophen and those that received neither. Opioid consumption in the first 24 hours postoperatively was converted to oral morphine equivalents (OMEQs). Postoperative sedation was evaluated using Aldrete scores and the percentage of patients requiring antiemetics in the first 24 hours was also examined. RESULTS: There were 133 patients who were opioid naive: 31 received preoperative gabapentin and acetaminophen and 102 received neither. Median 24 hour postoperative opioid consumption was lower but not statistically significant in the gabapentin and acetaminophen group vs. neither (36 mg vs. 45 mg, p = 0.08). Notably, there was a change in the distribution of opioid consumption, with no patients in the gabapentin and acetaminophen group requiring more than 200 mg OMEQ in the first 24 hours postoperatively. No significant difference in postoperative nausea/vomiting or sedation was observed. CONCLUSIONS: The addition of preoperative gabapentin and acetaminophen to a VATS lobectomy multimodal analgesic regimen reduces the incidence of high dose postoperative opioid consumption without observed negative side effects.

Construction of fetal inferior facial angle and hemi-mandible length reference ranges at 18-21 weeks' gestation in an Australian population.

OBJECTIVE: The aim of this pilot study was to provide modern reference intervals for both inferior facial angle and hemi-mandible length in fetuses of 18-21 weeks' gestation. METHODS: Prospectively, 296 apparently normal fetuses were sonographically assessed at 18-21 weeks' gestation. Inferior facial angle and hemi-mandible length were measured and parametrically analysed with respect to gestational age. Regression models were derived for each parameter and compared with models of previous studies. RESULTS: The mean inferior facial angle remained constant over the studied gestational age range at 63.9°, with 5th and 95th percentiles of 56.6° and 73.4°, respectively. Hemi-mandible length was found to be positively correlated with gestational age over the studied range, and the mean value is described by the equation 40.89 mm - (6327.495 × GA-2) with a standard deviation of 1.231 mm. CONCLUSION: Modern reference intervals for inferior facial angle and hemi-mandible length were defined within this pilot study. These reference intervals will aid in improving accuracy diagnosing micrognathia and our ability to differentiate true micrognathia from retrognathia.

Early Identification of Traumatic Durotomy Associated with Atlantooccipital Dislocation May Prevent Retropharyngeal Pseudomeningocele Development.

Atlantooccipital dislocation can be complicated by a traumatic durotomy that may lead to the rare development of a retropharyngeal pseudomeningocele. To our knowledge this has been reported only five times previously. We present the case of a 60-year-old man involved in a motor vehicle accident who suffered an atlantooccipital dislocation and C5-C6 three-column injury. A unique MRI image of a defect in the ventral dura posterior to C2 was appreciated. He underwent occiput to T2 internal fixation and arthrodesis. During surgery, CSF egress was seen caudal to the right C2 nerve root. A DuraMatrix onlay patch reinforced with DuraSeal was placed to stop the CSF leak. A lumbar subarachnoid drain was also placed. The patient made a satisfactory recovery with residual mild weakness of his right upper extremity. In this report, we demonstrate that careful MRI review can reveal a ventral durotomy in a traumatic atlantooccipital dislocation and, if discovered, effective treatment including a lumbar subarachnoid drain for CSF diversion may prevent progression to a retropharyngeal pseudomeningocele. The literature on this rare presentation and associated durotomy is provided.

Surgeons' perspectives on optimal patient positioning during simultaneous cranial procedures and exploratory laparotomy.

OBJECTIVES: Patients presenting with traumatic intracranial and intraabdominal injuries often require emergent care. Triage of injuries is based on severity of the individual injuries, but treatment occasionally must proceed simultaneously. Determining an optimal patient position at the time of surgery often produces unnecessary delays and this delay may negatively affect patient outcome. This study aimed to determine an operative patient position that simultaneously optimizes access to neurosurgical and general surgical teams without compromising sterility or severely affecting surgeon and anesthesia comfort. METHODS: Photographs of traditional exploratory laparotomy patient positioning (position A), traditional supine craniotomy patient positioning (position B), and a hybrid patient position (position C) were presented to 29 general surgeons and 12 neurosurgeons at a single institution. Surgeons were asked to rate the positions on acceptability and to rank the three positions according to preference when simultaneous exploratory laparotomy and craniotomy were necessary. RESULTS: Position C was rated as an acceptable option by 82.8% of general surgeons and 100% of neurosurgeons. In addition, 51.9% of general surgeons and 81.8% of neurosurgeons preferred position C to their respective specialty's traditional patient positioning in situations that required simultaneous exploratory laparotomy and craniotomy. CONCLUSIONS: We present a novel hybrid operative patient position for use during simultaneous exploratory laparotomy and craniotomy. In doing so, we emphasize the importance of constructive dialogue among trauma surgeons and neurosurgeons in optimizing the care of acutely ill trauma patients with multisystem injuries.

A Unified Multi-Functional Dynamic Spectrum Access Framework: Tutorial, Theory and Multi-GHz Wideband Testbed.

Dynamic spectrum access is a must-have ingredient for future sensors that are ideally cognitive. The goal of this paper is a tutorial treatment of wideband cognitive radio and radar-a convergence of (1) algorithms survey, (2) hardware platforms survey, (3) challenges for multi-function (radar/communications) multi-GHz front end, (4) compressed sensing for multi-GHz waveforms-revolutionary A/D, (5) machine learning for cognitive radio/radar, (6) quickest detection, and (7) overlay/underlay cognitive radio waveforms. One focus of this paper is to address the multi-GHz front end, which is the challenge for the next-generation cognitive sensors. The unifying theme of this paper is to spell out the convergence for cognitive radio, radar, and anti-jamming. Moore's law drives the system functions into digital parts. From a system viewpoint, this paper gives the first comprehensive treatment for the functions and the challenges of this multi-function (wideband) system. This paper brings together the inter-disciplinary knowledge.