Mckinleygarza5570
Some evidences have reported that intravenous (IV) lidocaine and dexmedetomidine alone can improve the quality of recovery after surgery. The main purpose of our study to explore whether co-administration of lidocaine and dexmedetomidine infusion could further improve the quality of recovery after laparoscopic hysterectomy compared to either lidocaine or dexmedetomidine administration.
A total of 160 subjects were randomly allocated to four groups the control group (group C) received an equal volume of normal saline, the lidocaine group (group L) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion), the dexmedetomidine group (group D) received dexmedetomidine (0.5 μg/kg for bolus over 10 min before induction of anesthesia, 0.4 μg/kg/h for continuous infusion), the lidocaine plus dexmedetomidine group (group LD) received lidocaine (1.5 mg/kg for bolus over 10 min before induction of anesthesia, 1.5 mg/kg/h for continuous infusion) and dexm of intraoperative bradycardia and hypoxemia in the PACU, and prolonged the length of PACU stay.
Co-administration of lidocaine plus dexmedetomidine infusion improved to some extent the quality of recovery on POD1 compared to lidocaine and dexmedetomidine alone, but it significantly increased the incidence of intraoperative bradycardia and hypoxemia in the PACU, and prolonged the length of PACU stay.
Chronic postsurgical pain (CPSP) is a common and disabling postoperative complication. Several risk factors for CPSP have been established, but it is unclear whether they are significant for any type of surgery. This systematic review aimed to assess the risk of CPSP related to three known preoperative risk factors "age, sex and preoperative pain" in the adult population after any type of elective non-obstetrical surgery.
We conducted a systematic literature search using PubMed and EMBASE databases retrieving 1458 abstracts; 320 publications were screened and 71 papers were included. Odds ratios were combined across studies and quality of evidence graded using GRADE. Sub-groups comparisons were conducted for type of surgery, time point for CPSP and definition of CPSP.
The pooled unadjusted ORs were 1.34 for female sex, 2.43 for preoperative pain at surgical site, 1.75 for preoperative pain elsewhere and 3.95 for preoperative pain at an unspecified site. The pooled unadjusted OR for age was 2.04 in the younger (age midpoint <40 years) compared with the older population of patients (age midpoint >62.5 years). In the subgroup analysis, preoperative pain was a more important risk factor for orthopedic surgery and age for breast surgery.
This systematic review confirms that younger age, female sex, and preoperative pain are associated with higher risk of developing CPSP in any type of elective non-obstetrical surgery. However, effect sizes are small and quality of evidence low-moderate only, limiting comparisons of different types of surgery.
This systematic review confirms that younger age, female sex, and preoperative pain are associated with higher risk of developing CPSP in any type of elective non-obstetrical surgery. However, effect sizes are small and quality of evidence low-moderate only, limiting comparisons of different types of surgery.
It is crucial to reduce bleeding during functional endoscopic sinus surgery (FESS). Our primary goal was to evaluate the effect of intravenous lidocaine infusion (ILI) as an adjunct to the enhanced recovery after surgery (ERAS) protocols on intraoperative bleeding during FESS. We hypothesized that ILI could improve the surgical field.
Forty-three adult patients ASA I-II, 20-50 years old, undergoing FESS under general anesthesia were randomly assigned to receive immediately after induction of anesthesia either ILI 1.5 mg/kg as a bolus followed by 1.5 mg/kg/ h until the end of surgery (Group L) or normal saline (Group NL). Intraoperative blood loss, bleeding and surgeon satisfaction scores, mean arterial pressure (MAP), heart rate (HR), extubation and eye-opening times, and time to first analgesic request were recorded.
Intraoperative bleeding and bleeding scores in the first 45 min after ILI were decreased, with better surgeon satisfaction in Group L (P<0.05). MAP and HR values were lower after ILI in Group L during surgery (P<0.05). Extubation and eye-opening times were shorter (P=0.001) and the time to first analgesic request was prolonged (P=0.001) in Group L than in Group NL.
ILI decreased intraoperative blood loss and improved the surgical field visibility in the first 45 min during FESS.
ILI decreased intraoperative blood loss and improved the surgical field visibility in the first 45 min during FESS.Mesenteric panniculitis is encountered frequently during abdominopelvic CT scanning, often as an incidental finding. The observation is problematic because an association with malignancy has been raised in the literature. This review will describe the CT appearances and examine the available evidence regarding the significance of this finding.Ultimately, the literature remains unclear regarding how these patients should be managed, if at all.Microorganisms such as bacteria, microalgae and fungi, are natural and rich sources of several valuable bioactive antioxidant's compounds, including carotenoids. Among the carotenoids with antioxidant properties, astaxanthin can be highlighted due to its pharmaceutical, feed, food, cosmetic and biotechnological applications. The best-known producers of astaxanthin are yeast and microalgae cells that biosynthesize this pigment intracellularly, requiring efficient and sustainable downstream procedures for its recovery. Conventional multi-step procedures usually involve the consumption of large amounts of volatile organic compounds (VOCs), which are regarded as toxic and hazardous chemicals. learn more Considering these environmental issues, this review is focused on revealing the potential of unconventional extraction procedures [viz., Supercritical Fluid Extraction (SFE), Ultrasound-Assisted Extraction (UAE), Microwave-Assisted Extraction (MAE), High-Pressure Homogenization (HPH)] combined with alternative green solvents (biosolvents, eutectic solvents and ionic liquids) for the recovery of microbial-based astaxanthin from microalgae (such as Haematococcus pluvialis) and yeast (such as Phaffia rhodozyma) cells. The principal advances in the area, process bottlenecks, solvent selection and strategies to improve the recovery of microbial astaxanthin are emphasized. The promising recovery yields using these environmentally friendly procedures in lab-scale are good indications and directions for their effective use in biotechnological processes for the production of commercial feed and food ingredients like astaxanthin.
Cone beam computed tomography (CBCT) images are being increasingly used to acquire three-dimensional (3D) models of the skull for additive manufacturing purposes. However, the accuracy of such models remains a challenge, especially in the orbital area. The aim of this study is to assess the impact of four different CBCT imaging positions on the accuracy of the resulting 3D models in the orbital area.
An anthropomorphic head phantom was manufactured by submerging a dry human skull in silicon to mimic the soft tissue attenuation and scattering properties of the human head. The phantom was scanned on a ProMax 3D MAX CBCT scanner using 90 and 120 kV for four different field of view positions standard; elevated; backwards tilted; and forward tilted. All CBCT images were subsequently converted into 3D models and geometrically compared with a "gold-standard" optical scan of the dry skull.
Mean absolute deviations of the 3D models ranged between 0.15 ± 0.11 mm and 0.56 ± 0.28 mm. The elevated imaging position in combination with 120 kV tube voltage resulted in an improved representation of the orbital walls in the resulting 3D model without compromising the accuracy.
Head positioning during CBCT imaging can influence the accuracy of the resulting 3D model. The accuracy of such models may be improved by positioning the region of interest (
the orbital area) in the focal plane (Figure 2a) of the CBCT X-ray beam.
Head positioning during CBCT imaging can influence the accuracy of the resulting 3D model. The accuracy of such models may be improved by positioning the region of interest (e.g. the orbital area) in the focal plane (Figure 2a) of the CBCT X-ray beam.An attempt is made to evaluate the nonstatistical effects in the thermal decomposition of hydrogen peroxide (H2O2). Previous experimental studies on this reaction reported an unusual pressure dependence of the rate constant indicating broader falloff behavior than expected from conventional theory. In this work, the possibility that the rate constant is affected by nonstatistical effects is investigated based on classical trajectory calculations on the global potential energy surfaces of H2O2 and H2O2 + Ar. The emphasis is on the intramolecular energy redistribution from the K-rotor, that is, the external rotor for rotation around the principal axis of least moment of inertia. The calculations for the H2O2 molecules excited above the dissociation threshold suggest that the energy redistribution from the torsion and K-rotor to vibrations can be competitive with dissociation. In particular, the slow redistribution of the energy associated with the K-rotor significantly affects the dissociation rate. The successive trajectory calculations for collisions of H2O2 with Ar show that the energy associated with the K-rotor can be collisionally transferred more efficiently than the vibrational energy. On the basis of these results and several assumptions, a simple model is proposed to account for the nonstatistical effects on the pressure-dependent thermal rate constants. The model predicts significant broadening of the falloff curve of the rate constants but still cannot fully explain the experimental data.This study aimed at investigating nurse practitioners' self-efficacy and behavior in supporting self-management of patients with a progressive, life-threatening illness and their relatives. We adapted an existing validated instrument for this purpose, amongst other things by adding a seventh subscale "attention for relatives," and administered it in a nationwide, cross-sectional online survey among Dutch nurse practitioners. We analyzed associations between self-reported self-efficacy and behavior using Pearson correlations and paired sample t tests. Associations between self-efficacy and behavior with nurse practitioners' characteristics were examined using linear regression models. Most nurse practitioners (n = 327; 26% complete responses) were women (93%). Subscale and total scores for nurse practitioners' self-efficacy were moderately positively correlated with those for their behavior in self-management support. Subscale and total scores were statistically significantly higher for their self-efficacy than for their behavior. Increased work experience with patients with a progressive, life-threatening illness was associated with higher scores on self-efficacy and behavior in self-management support. We conclude that nurse practitioners are confident in their ability to support self-management; yet, they do not always use these competencies in practice.
