2016

Incidence of postoperative nausea and vomiting following gynecological laparoscopy: A comparison of standard anesthetic technique and propofol infusion (2016)

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Type of publication:
Journal article

Author(s):
Bhakta P., Ghosh B.R., Singh U., Govind P.S., Gupta A., Kapoor K.S., *Jain R.K., Nag T., Mitra D., Ray M., Singh V., Mukherjee G.

Citation:
Acta Anaesthesiologica Taiwanica, March 2016(no pagination)

Abstract:
Objective: To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane. Design: Randomized single-blind (for anesthesia techniques used) and double-blind (for postoperative assessment) controlled trial. Setting: Operation theater, postanesthesia recovery room, teaching hospital. Patients: Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20-60 years) scheduled for gynecological laparoscopy were included in the study. Interventions: Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane-fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting. Measurements: Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours. Main Results: Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (p . <. 0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (p . <. 0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications. Conclusion: Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.

Link to full-text: http://www.sciencedirect.com/science/article/pii/S1875459716300145/pdfft?md5=23ae5cc15830c8a727672ad3ea135958&pid=1-s2.0-S1875459716300145-main.pdf

Endoscopic Ear Surgery and its impact on the operating theatre team (2016)

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Type of publication:
Conference abstract

Author(s):
Paramita Baruah and *Duncan Bowyer

Citation:
The Journal of Laryngology and Otology, Volume 130, Issue S3 (Abstracts for the 10th International Conference on Cholesteatoma). May 2016, pp. S154-S155

Link to more details or full-text: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitleendoscopic-ear-surgery-and-its-impact-on-the-operating-theatre-teamdiv/9BC11266B24CA333FE8F8C24DB660A32#

A Comparison of Operative Time Outcomes in Endoscopic and Open Tympanomastoid Surgery (2016)

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Type of publication:
Conference abstract

Author(s):
*Mohamed Rizny Sakkaff and *Duncan Bowyer

Citation:
The Journal of Laryngology and Otology, Volume 130, Issue S3 (Abstracts for the 10th International Conference on Cholesteatoma). May 2016, pp. S207-S208

Link to more details or full-text: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/div-classtitlea-comparison-of-operative-time-outcomes-in-endoscopic-and-open-tympanomastoid-surgerydiv/260FA9CCDD529CE5E41661ECB229FE81

An auditon paediatric syncope: Do paediatricians identify the red flags for cardiac syncope? (2016)

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Type of publication:
Conference abstract

Author(s):
*Mikrou P.; *Kannivelu A.

Citation:
European Journal of Pediatrics; 2016; vol. 175 (no. 11); p. 1480-1481

Abstract:
Background and aims Syncope is a common presentation in Paediatrics. Although cardiac syncope is rare, identifying the red flags that could signify an underlying cardiac cause (see chart 1) is an essential skill for all Paediatricians. Methods We conducted a retrospective audit of children with presentation of syncope/presyncope in our local District General Hospital. We based our standards on the Department of Health and Arrhythmia Alliance Primary Care pathway, NICE and European Society of Cardiology guidance on Transient Loss of Consciousness in young people and adults. Results A total of 33 patients were analysed, in two different subgroups: Paediatric Assessment Unit (PAU) group (n=23) and Outpatient group (n=10). In the PAU subgroup, only 70% of patients had a 12-lead ECG (44% had a manual QTC calculated). Family history of sudden death was not documented in 48% of cases. In the outpatient subgroup a significantly higher number of investigations were performed (100% had 12-lead ECGs, 70% Holter monitors and 30% echocardiograms). There was felt to be a selection bias (clinic being run by a Paediatrician with Cardiology expertise). Conclusions A standard operating procedure pathway was formulated to guide clinicians in the Emergency Department and PAU for the management of children presenting with syncope. Key points are that all children presenting with syncope should have a 12-lead ECG and 'red flags' explored in history (e.g. family history of sudden unexplained death, exercise induced symptoms, palpitations). We hope that the pathway implementation will lead to improved patient care outcomes.

The effect of fetal gender on the delivery outcome in primigravidae women with induced labours for all indications (2016)

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Type of publication:
Journal article

Author(s):
Antonakou A.; *Papoutsis D.

Citation:
Journal of Clinical and Diagnostic Research; Dec 2016; vol. 10 (no. 12)

Abstract:
Introduction: There is increasing evidence of a gender-related phenomenon where the presence of a male fetus may have an adverse effect on the outcome of pregnancy. Aim: The aim of this study was to investigate the effect of fetal gender on the delivery outcome in primigravidae women with induced labours. Materials and Methods: This was an observational cohort study of primigravidae women who had Induction Of Labour (IOL) for all indications during a two-year period. Women with breech vaginal deliveries, stillbirths, multiple pregnancies and elective Caesarean Section (CS) were excluded. Results: Of the 936 eligible patients identified, 493(52.6%) gave birth to male neonates and 443(47.4%) to female neonates. Age, ethnicity, Body Mass Index (BMI) and smoking were similar between women that delivered male and female neonates. More than half of all women were induced for post-date pregnancies. In women who gave birth to male neonates, the CS delivery rate was higher than in those with female neonates (23.7% vs 17.8%; p=0.029). Though emergency admission rates to the neonatal Intensive Care Unit (ICU) and arterial/venous pH from umbilical cord sampling immediately after birth were similar between male and female neonates, nevertheless male neonates had lower Apgar scores of <7 at 1 minute after birth (p=0.02). Conclusions: This study has shown that, male gender fetuses have a higher CS delivery rate in primigravidae women undergoing IOL and may be more vulnerable to fetal compromise when in labour.

Link to more details or full-text: http://www.jcdr.net/articles/PDF/9104/22099_CE[Ra1]_F(GH)_PF1(PI_RK)_PFA(AK)_PF2(PAG).pdf

Are Temporary Tracheostomies a necessity for free flap surgery? (2016)

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Type of publication:
Conference abstract

Author(s):
*Sandhu B.; *Mihalache G.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2016; vol. 54 (no. 10)

Abstract:
Controversy still surrounds the use of tracheosteomies in maxillofacial oncology surgery with free flaps. Many surgeons place tracheostomies in patients for airway protection post-operatively due to suspected swelling, removing the tube at approximately 10 days. However, patients undergoing this extensive surgery may not require routine tracheostomy and few maxillofacial units across the UK employ this principle. The aim of this study was to determine tracheostomy need within maxillofacial free flap surgery, and the associated complications, including extended recovery.A retrospective study was carried out of 40 patients whom underwent excision of tumours with free flap reconstruction from January 2013 to December 2015, with comparison to 2010-2012 where tracheostomies were routinely used. Analysis was made of hospital stay duration and post-operative complications.From the results of this study we can see that only 5% of cases underwent tracheostomies compared to 75% of the previous three years. All tracheostomy cases of 2013-2015 experienced chest or tracheostomy wound infections, compared to 31% of the 2010-2012 cases. The average hospital stay for those with temporary tracheostomies was 15-16 days and those without was 10 days for across the six years. There have been no reported cases of airway obstruction post-operatively in those cases where tracheostomies have not been placed following free flap surgery, including fibula free flaps. As a unit it has been concluded to avoid placing a temporary tracheostomy in all cases where possible. This is to avoid postoperative complications, reduce hospital stay and improve the quality of recovery from the patient's perspective.

A Case Report of the Management of a Severe Scalp Wound with Combination Treatment including Negative Pressure Therapy with Skin Cell Spray (2016)

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Type of publication:
Conference abstract

Author(s):
*Sandhu B.; *Messahel A.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2016; vol. 54 (no. 10)

Abstract:
Facial injuries can lead to extensive scarring, causing physical discomfort, anxiety and social isolation for patients. The optimum method of wound healing would be primary closure, however in cases where this is not possible other options must be explored. This case report involves a 40 year old female who sustained a severe scalp wound following a road traffic accident, causing partial ejection from the vehicle. The patient was transferred to our care seven days after receiving treatment to the affected area by an emergency department. Examination revealed an 8 cm right frontal scalp region wound present, which was clearly acutely infected with areas of full thickness skin necrosis and generalised overlying slough across the defect. The lower region of the wound involved an area of 2.5 cm exposed bone. There was also weakness noted of the temporal branch of the right facial nerve with reduced brow movement. Following thorough debridement and lavage, combination treatment consisting of negative pressure vacuum therapy and allogenic skin spray application was instigated. Negative pressure allowed for contraction of the wound edges for granulation, and reduced dehiscence risk. It also increased vascularisation of the exposed bone region inferiorly and significant reduction in wound size. Fresh allogenic human keratinocyte suspension allowed for complete healing of the defect. This involved epithelisation of the superficial layer of the wound, with no remaining exudate and complete bone coverage.This successful result is exemplary of a non-surgical therapy for extensive wounds in aesthetically challenging areas.