Preoperative Dyeing Technique for Decreasing Radiation Exposure in Unilateral Biportal Endoscopic Spine Surgery.

BACKGROUND: Minimally invasive surgery has many advantages, including early recovery and cosmetic preservation. However, the higher radiation exposure to physicians and patients has drawbacks. Preoperative tissue dyeing techniques are feasible options for reducing radiation exposure and procedure time, but their efficacy has not yet been evaluated. Therefore, this study aimed to evaluate surgical outcomes and reduce radiation exposure during unilateral biportal endoscopy surgery. METHODS: This was a prospective, case-controlled analysis in a tertiary hospital. Patients receiving experimental tissue dye and controls in the nondye group were compared from May 2020 to September 2021. The ipsilateral posterolateral approach (IPA) and the far lateral approach (FLA) were analyzed separately among all single-level spinal procedures without instrumentation. Operative details (operation time, improvement of back and leg pain, and length of hospital stay) and radiation exposure (dose and duration) were compared. RESULTS: A total of 88 cases were included, consisting of 64 interlaminar approaches (experimental: 33, control: 31) and 24 FLAs (experimental: 13 and control: 11). In the IPA approach, the patient and physician radiation exposure doses and duration decreased significantly. Conversely, for the FLA, only the duration of the physician exposure decreased significantly. CONCLUSIONS: Preoperative tissue dyeing techniques using IPA can reduce radiation exposure for physicians and patients. However, a decrease in the duration of radiation was observed only in physicians using the FLA. The dyeing technique is effective in IPA, but the efficacy of FLA is doubtful.

Experience of the United Arab Emirates in the use of monoclonal antibody drug sotrovimab in high-risk vaccinated and unvaccinated patients with COVID-19: an observational cohort study.

OBJECTIVES: Monoclonal antibodies can slow COVID-19 progression. This study describes the experience of using sotrovimab in patients with COVID-19 at high risk for disease progression and hospitalisation within the United Arab Emirates (UAE). DESIGN: Observational cohort study. SETTING: A tertiary hospital in the Emirate of Sharjah, UAE. PARTICIPANTS: Patients with mild or moderate COVID-19 at high risk for disease progression. INTERVENTIONS: Infusion with a single 500 mg dose of the monoclonal antibody drug sotrovimab. PRIMARY AND SECONDARY OUTCOME MEASURES: Any adverse effect within 24 hours, disease progression within 5 days, emergency department visit within 10 days, hospital admission within 10 days or mortality within 28 days of infusion. RESULTS: 3227 high-risk COVID-19 patients were infused with sotrovimab during the mild (n=3107, 96.3%) or moderate (n=120, 3.7%) disease stages. The incidence of at least one outcome was recorded in 196 (6.1%) of the patients (60.7 per 1000 patients). The most common outcome was disease progression within 5 days of infusion in 129 patients (4.0%), followed by emergency department visits by 90 patients (2.8%) within 10 days. Twenty-nine (0.9%) patients were hospitalised within 10 days of infusion with only two deaths (0.1%). Patients infused with sotrovimab during the moderate disease stage had 11 times greater odds of developing at least one outcome compared with patients infused during the mild stage (adjusted OR, aOR 10.86, 95% CI 7.14 to 16.54). SARS-CoV-2 vaccinated (aOR 12.8, 95% CI 7.3 to 20.5) and unvaccinated (aOR 7.2, 95% CI 3.4 to 15.3) patients infused with sotrovimab during the moderate disease stage had similar odds of at least one outcome compared with patients infused during the mild stage. CONCLUSIONS: Among high-risk sotrovimab-infused COVID-19 patients, there were relatively low incidences of disease progression and hospitalisation. Regardless of vaccination history, monoclonal antibody intervention during the early stages of COVID-19 results in better outcomes.

Intra Operative Use of Anti Emetic Drugs for Children Undergoing Full Dental Rehabilitation under General Anesthesia. A Double Blind Randomized Clinical Trial.

BACKGROUND: Postoperative Nausea and Vomiting (PONV) is a common complication following dental treatment under general anesthesia (DGA) that may lead to unplanned hospitalization, increased costs and dissatisfaction of parents. AIM: To investigate the incidence of Postoperative Vomiting (POV) on children who underwent dental rehabilitation under general anesthesia and to compare possible preventive effect of Dexamethasone and Ondansetron on occurrences of POV. STUDY DESIGN: A double blind randomized parallel clinical trial was carried out on 352 ASA I children who underwent DGA in a private Saudi hospital in Jeddah. Children were allocated randomly to four groups. Group D of 91 children, received Dexamethasone PONV prophylaxis, group O of 87 children received Ondansetron, group DO of 93 children received combination of the two drugs and group C the control group of 81 children. The three groups were investigated by blinded dental staff for POV episodes, number of times analgesia was needed and post anesthesia care unit time (PACUT). RESULTS: There was a no significant difference between the two drugs on POV. There was a significant difference in POV between control group and groups D, O, and DO. There was significant reduction in need for analgesia in the Dexamethasone groups. The three groups, which had PONV prophylaxis, showed significant reduction in PACUT compared to control group. CONCLUSIONS: Antiemetic drugs are useful adjuncts in DGA. Some dental procedures may have higher emetic potential than others. The type of dental procedures done is to be considered when deciding the drug profile in children undergoing DGA.

Surgical analysis of pediatric and adolescent sporadic pheochromocytoma: single center experience.

INTRODUCTION: The aim of this study is to review our experience with sporadic pheochromocytoma in pediatrics and adolescents focusing upon surgical approach, incidence of malignancy, and recurrence rate. MATERIALS AND METHODS: Between 1990 and 2007, 8 pediatric patients were diagnosed with sporadic pheochromocytoma. Demographic data, clinical and radiological findings, laboratory profile, preoperative preparation, surgical approach, operative findings, postoperative course as well as pathologic diagnosis of the removed specimen were reviewed. RESULTS: Mean age of presentation was 13.1 ± 4.7 years. Five patients had right-sided masses, 1 harbored left-sided mass, and bilaterality was observed in 2 with mean size of 5.7 ± 1.3 cm. Computed tomography showed no evidence of local infiltration, regional lymphadenopathy or distant metastasis in all patients but two. Six masses were excised through thoraco-abdominal approach, 3 were removed laparoscopically, while percutaneous alcohol ablation was adopted for the last. We had one postoperative death (12.5%:1/8), and the remaining 7 patients were followed for a mean of 8.6 ± 3 years. Five patients never had recurrence. Bilateral recurrence developed in 2 patients, where they were safely excised in one patient and was a part of disseminated disease in the other. Malignant nature of the disease was proved in 2 patients and showed poor survival. CONCLUSION: Under adequate anesthetic control, pediatric pheochromocytoma could be safely managed through both the open and laparoscopic approaches. Advanced radiological stage would suggest the malignant nature of the disease with dismal outcome. Long-term follow-up is warranted for possibility of delayed curable recurrence.

Multidrug intravenous anesthesia for children undergoing MRI: a comparison with general anesthesia.

BACKGROUND: We used a multidrug intravenous anesthesia regimen with midazolam, ketamine, and propofol to provide anesthesia for children during magnetic resonance imaging (MRI). This regimen was compared with general anesthesia in a randomized comparative study. Outcome measures were safety, side effects and recovery variables in addition to adverse events in relation to age strata. METHODS: The children received either general anesthesia with propofol, vecuronium and isoflurane [general endotracheal anesthesia (GET) group; n=313] or intravenous anesthesia with midazolam, ketamine, and propofol [intravenous anesthesia (MKP) group; n=342]. Treatment assignment was randomized based on the date of the MRI. Physiological parameters were monitored during anesthesia and recovery. Desaturation (SpO2<93%), airway problems, and the need to repeat the scan were recorded. The discharge criteria were stable vital signs, return to baseline consciousness, absence of any side effects, and ability to ambulate. RESULTS: With the exception of two children (0.6%) in the MKP group, all enrolled children completed the scan. A significantly greater number (2.3%) required a repeat scan in the MKP group (P<0.05) and were sedated with a bolus dose of propofol. The total incidence of side effects was comparable between the MKP (7.7%) and GET groups (7.0%). Infants below the age of 1 year showed a significantly higher incidence of adverse events compared with the other age strata within each group. Within the MKP group, risk ratio was 0.40 and 0.26 when comparing infants aged below 1 year with the two older age strata, respectively. Recovery characteristics were comparable between both groups. CONCLUSIONS: Intravenous midazolam, ketamine and propofol provides safe and adequate anesthesia, comparable with that obtained from general endotracheal anesthesia, for most children during MRI.

Prevention of hypothermia in children under combined epidural and general anesthesia: a comparison between upper- and lower-body warming.

BACKGROUND: Children receiving combined epidural and general anesthesia may be at greater risk of hypothermia. Active warming should be undertaken to combat heat loss. With combined epidural and general anesthesia heat loss from the lower body may be greater than from the upper body because of shift of blood towards the vasodilated lower body. We assumed that application of the warming blanket to the lower body might provide better protection against hypothermia. To test this hypothesis, lower-body warming (LBW) was compared with upper-body warming (UBW) in a randomized comparative study. METHODS: Children subjected to open urologic surgery under combined epidural and general anesthesia were randomly allocated to either UBW n = 38 or LBW n = 35 using a forced-air warming blanket. Core and peripheral skin temperatures were monitored. Temperature gradients between forearm and fingertip during LBW and between leg and toe during UBW were calculated. The warmer was set at 32 degrees C, room temperature was around 22 degrees C and fluids were infused at ambient room temperature. RESULTS: The changes in core temperature were comparable and parallel in both groups. Core temperature decreased significantly in each group at 1 h after induction compared with basal values. Temperature gradients at forearm-fingertip and at leg-toe were also comparable in both groups. Recovery was uneventful and no patient shivered in the recovery room. CONCLUSIONS: Lower body warming is as effective as UBW in prevention of hypothermia in children subjected to combined epidural and general anesthesia.

Complete primary repair of bladder exstrophy in children presenting late and those with failed initial closure: single center experience.

PURPOSE: Complete primary repair (CPR) of bladder exstrophy using Mitchell's technique gained wide popularity. We present a single center experience with CPR in 30 children with bladder exstrophy presenting late or after failed initial closure. MATERIALS AND METHODS: Between November 1998 and November 2003, 45 patients underwent CPR of bladder exstrophy using Mitchell's technique. All 22 boys and 8 girls presenting beyond the age of 1 year were evaluated. Of the 30 patients 19 (63%) had a history of failed exstrophy closure. Mean patient age at surgery was 3.2 years (range 1 to 8). Bilateral anterior iliac osteotomies were performed in all children. Ultrasound was performed before surgery and 3 months thereafter in all patients. Voiding cystourethrography was obtained at 3 months and then annually. Continence was defined as dry intervals of 3 hours or more. RESULTS: Mean followup is 40 months (range 5 to 64). Concomitant intestinal bladder augmentation was performed in 5 children (17%). The repair resulted in hypospadias in 17 of 22 boys (77%). Following catheter removal 7 patients (23%) had suprapubic urine leakage that ceased spontaneously in all. Early postoperative hydronephrosis was present in 19 of the 30 children (63%) and resolved spontaneously in all. Six patients (20%) had febrile urinary tract infection that was treated conservatively. Vesicoureteral reflux was present in 23 children (68%). Of the 5 patients treated with concomitant bladder augmentation 2 are continent, 2 underwent bladder neck closure and 1 underwent bladder neck reconstruction (BNR). All 5 patients are currently dry. The remaining 25 patients had a mean bladder capacity of 90 ml (range 30 to 200) with continence in 6 children (24%). Continence was achieved in 3 of 6 girls (50%) versus 3 of 19 boys (16%). Five patients underwent BNR with ileocystoplasty in 4. The remaining 14 patients are awaiting BNR with or without bladder augmentation. CONCLUSIONS: CPR of bladder exstrophy is feasible in children presenting late or after failed initial closure. Concomitant intestinal bladder augmentation was required in 17% of our patients. The procedure resulted in hypospadias in 77% of the boys. Continence was achievable in 50% of the girls without subsequent bladder neck surgery. On the other hand, most boys (84%) will require BNR with or without augmentation.

Hypobaric bupivacaine spinal anesthesia for cystoscopic intervention: the impact of adding fentanyl.

BACKGROUND AND OBJECTIVE: Addition of fentanyl to hyperbaric bupivacaine spinal anesthesia prolonged the duration of sensory block. This study seeks to test the hypothesis that adding fentanyl to small dose hypobaric spinal anesthesia will improve intraoperative patients and surgeon satisfaction without delay in recovery. METHODS: Patients (n = 80) subjected to minor cystoscopic surgery were randomly assigned to have spinal anesthesia with either 5 mg bupivacaine 0.1% or 5 mg bupivacaine 0.1% mixed with 20 micrograms fentanyl. The main outcome measures included intraoperative patient and endoscopist satisfaction, sedative/analgesic supplementation, postoperative side effects and time to ambulation. RESULTS: Patients in the bupivacaine group needed more analgesic supplementation. Analgesia was more adequate in the bupivacaine-fentanyl group. Pruritus was the main side effect in the bupivacaine fentanyl group. Ambulation and discharge of patients were nearly the same in both groups. CONCLUSIONS: Spinal anesthesia with small dose (5 mg) hypobaric (0.1%) bupivacaine mixed with fentanyl (20 micrograms) produced adequate anesthesia for short cystoscopic procedures with minimal side effects and without delay in ambulation.