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Denke NJ. Local Anesthetic Systemic Toxicity (LAST): More Common Than You Think. J Emerg Nurs 2024; 50:336-341. [PMID: 38705705 DOI: 10.1016/j.jen.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 05/07/2024]
Abstract
The number of anesthetic body procedures in the United States is rapidly increasing, with many being performed on an outpatient basis. These procedures are advertised as being safe, and many times the serious complications may not be discussed. Although local anesthetic systemic toxicity is a rare complication, it is associated with an increase in morbidity. The emergency department staff should be aware of the possibility of this rare complication, as well as the variety of resulting symptoms (from minor to severe), potential sequelae, and appropriate management for patients who have undergone an outpatient anesthetic body procedure. Multiple factors contribute to the development of local anesthetic systemic toxicity, resulting in life-threatening effects on the neurologic and cardiovascular systems. Also, the site of administration, along with the local anesthetic agent used, can impact the risk of the development of local anesthetic systemic toxicity. To minimize the risk and ensure the best possible outcome for these patients, emergency department staff must be highly aware of the mechanisms, risk factors, prevention, and management/treatment of local anesthetic systemic toxicity.
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Atiyeh BS, Emsieh SE, Ibrahim AE, Fadul RR, Hakim CR, Gnaedinger AG, Oneisi AK, Chalhoub RS, Beaineh PT. Determination of Appropriate Umbilicus Position during Abdominoplasty in Male Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5342. [PMID: 37850205 PMCID: PMC10578692 DOI: 10.1097/gox.0000000000005342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023]
Abstract
Background Abdominoplasty techniques are well documented. The ideal position of the umbilicus has, however, received limited attention. Unfortunately, umbilicus position is not universally agreed upon in male cosmetic abdominoplasty. This study was conducted to determine the ideal umbilicus anthropometric measurements in young men, and the relationships between umbilical position and anterior trunk and torso reference points that may be applicable to intraoperative positioning. It is aimed also at investigating whether umbilicus position would be more accurately determined by considering nipple position instead of the abdominal crease, as recently proposed. Methods Several anthropometric measurements of various anterior abdominal and thoracic landmarks were conducted on 60 young and middle-aged male volunteers and 30 cadavers at São Paulo city. All statistical analysis was completed using Stata software. Results Of all the measured reference points, a much stronger correlation (0.513) was demonstrated between umbilicus-anterior axillary fold (U-AX) and inter-nipple (N-N) distances with a constant golden number ratio relationship (N-N = U-AX × 0.618) compared with the weak correlation of 0.034 between umbilicus-xiphisternum and umbilicus-abdominal crease. In 75% of volunteers, the calculated U-AX was within ±3 cm of actual measurement, and in 33.33% within ±1 cm. Conclusions U-AX = 1.618 × N-N equation is more predictive of adequate umbilicus repositioning during abdominoplasty in male patients. Chest and abdomen of men are a single aesthetic unit. Proper positioning of the nipples and umbilicus, as well as harmonious abdominal and torso proportions are critical for an optimal final aesthetic outcome.
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Affiliation(s)
- Bishara S. Atiyeh
- From the American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif E. Emsieh
- From the American University of Beirut Medical Center, Beirut, Lebanon
| | - Amir E. Ibrahim
- From the American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | | | | | - Paul T. Beaineh
- From the American University of Beirut Medical Center, Beirut, Lebanon
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Albertin G, Astolfi L, Fede C, Simoni E, Contran M, Petrelli L, Tiengo C, Guidolin D, De Caro R, Stecco C. Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen. Life (Basel) 2023; 13:life13030836. [PMID: 36983991 PMCID: PMC10058564 DOI: 10.3390/life13030836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Recently, the superficial fascia has been recognized as a specific anatomical structure between the two adipose layers-the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). The evaluation of specific characteristics of cells, fibers, blood circulation, and innervation has shown that the superficial fascia has a clear and distinct anatomical identity, but knowledge about lymphatic vessels in relation to the superficial fascia has not been described. The aim of this study was to evaluate the presence of lymphatic vessels in the hypodermis, with a specific focus on the superficial fascia and in relation to the layered subdivision of the subcutaneous tissue into SAT and DAT. Tissue specimens were harvested from three adult volunteer patients during abdominoplasty and stained with D2-40 antibody for the lymphatic endothelium. In the papillary dermis, a huge presence of lymphatic vessels was highlighted, parallel to the skin surface and embedded in the loose connective tissue. In the superficial adipose tissue, thin lymphatic vessels (mean diameter of 11.6 ± 7.71 µm) were found, close to the fibrous septa connecting the dermis to the deeper layers. The deep adipose tissue showed a comparable overall content of lymphatic vessels with respect to the superficial layer; they followed the blood vessel and had a larger diameter. In the superficial fascia, the lymphatic vessels showed higher density and a larger diameter, in both the longitudinal and transverse directions along the fibers, as well as vessels that intertwined with one another, forming a rich network of vessels. This study demonstrated a different distribution of the lymphatic vessels in the various subcutaneous layers, especially in the superficial fascia, and the demonstration of the variable gauge of the vessels leads us to believe that they play different functional roles in the collection and transport of interstitial fluid-important factors in various surgical and rehabilitation fields.
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Affiliation(s)
- Giovanna Albertin
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Laura Astolfi
- Bioacoustics Research Laboratory, Department of Neuroscience (DNS), University of Padova, 35129 Padova, Italy
- Interdepartmental Research Center of International Auditory Processing Project in Venice (I-APPROVE), Department of Neurosciences, University of Padova, Santi Giovanni e Paolo Hospital, ULSS3 Serenissima, 30122 Venezia, Italy
| | - Caterina Fede
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Edi Simoni
- Bioacoustics Research Laboratory, Department of Neuroscience (DNS), University of Padova, 35129 Padova, Italy
- Interdepartmental Research Center of International Auditory Processing Project in Venice (I-APPROVE), Department of Neurosciences, University of Padova, Santi Giovanni e Paolo Hospital, ULSS3 Serenissima, 30122 Venezia, Italy
| | - Martina Contran
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Lucia Petrelli
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Cesare Tiengo
- Clinic of Plastic Surgery, Padova University Hospital, 35128 Padova, Italy
| | - Diego Guidolin
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Raffaele De Caro
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Carla Stecco
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
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Global Prevalence and Preferences of Progressive Tension Suture Usage in Abdominoplasties. Aesthetic Plast Surg 2022; 47:1076-1086. [DOI: 10.1007/s00266-022-03146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/09/2022] [Indexed: 11/01/2022]
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