1
|
Kayali H, Moghamis I, Radi M, Baroudi O, Hantouly A, Toubasi A, Foodoul MA, Alkhayarin M, Ahmed G. The role of patient positioning in surgical fixation of the calcaneus fractures using the lateral extensile approach. Eur J Orthop Surg Traumatol 2024; 34:1529-1534. [PMID: 38265742 PMCID: PMC10980634 DOI: 10.1007/s00590-023-03829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Calcaneus is the most commonly fractured tarsal bone. Open reduction and internal fixation of the displaced intra-articular fractures is considered the gold standard treatment. The lateral extensile approach is the most commonly used approach, and usually, the patients are kept in lateral decubitus position. Recent study has descried calcaneus fracture fixation utilizing the lateral extensile approach with the patient in prone position. The aim of this study was to compare the postoperative radiological outcome, reoperation rate, operative and anesthesia time, infection and the wound complications rate between the two groups. METHODS The data of 49 adult patients with unilateral closed calcaneus fracture underwent open reduction and internal fixation using lateral extensile approach were collected. Postoperative Bohler's, Gissane angles and complications rate were compared between the two groups. RESULTS A total of 49 patients were included. Lateral position was utilized in 26 patients (53.1%), while 23 patients (46.9%) were operated in prone position. Majority of the patients were males 87.8% (43 patients), and the mean age of the patients was 31.12 ± 7.50. The most commonly mechanism of injury was fall from height in (91.8%) of the patients. The mean preoperative Bohler's angle was 9.33 ± 13.07 and increased to 22.69 ± 9.15 postoperatively. The mean preoperative angle of Gissane was 130.45 ± 26.98 whereas it was 124.76 ± 17.20 postoperatively. The mean postoperative Bohler's angle and angle of Gissane were significantly higher among patient who underwent fixation in lateral position (25.88 ± 6.62, 137.15 ± 11.17) when compared to the prone one (19.09 ± 10.35, 110.74 ± 10.81). There was no significant difference between the two groups regarding the reoperation rate (p 0.947), infection (p 0.659, operative time (p 0.688), anesthesia time (p 0.522) and wound complications (p 0.773). CONCLUSION Surgical restoration of the Bohler's and Gissane's angles with the patient placed in the lateral decubitus position remains superior to the prone position with no difference in the complication rate between the two groups.
Collapse
Affiliation(s)
- Hammam Kayali
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Isam Moghamis
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Radi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Omar Baroudi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Toubasi
- School of Medicine, University of Jordan, Amman, Jordan
| | - Mazen A Foodoul
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alkhayarin
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| |
Collapse
|
2
|
Yang T, Feng R, Li L, Guo X. The CORN assessment scale in preventing intraoperatively acquired pressure injury in thoracic surgery. Asian J Surg 2024:S1015-9584(24)00288-4. [PMID: 38395712 DOI: 10.1016/j.asjsur.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Affiliation(s)
- Tianyu Yang
- Inner Mongolia Medical University, Huhehot Xinhua Street, Inner Mongolia, 010059, China
| | - Rui Feng
- The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Nursing Department, Baotou Hudemulin Street, Inner Mongolia, 014010, China
| | - Linlin Li
- China-Japan Union Hospital of Jilin University, Operation Room, Changchun Xiantai Street, Jilin Province, 130033, China.
| | - Xiuzhen Guo
- Inner Mongolia Medical University, Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Huhehot North Street, Inner Mongolia, 010050, China.
| |
Collapse
|
3
|
Tao D, Zhang G, Zheng X, Wang X, Gao G, Yang Z, Lin Y, Lu L. Feasibility study of intubation in lateral position using Viva-sight double-lumen tube combined with video laryngoscope in patients undergoing pulmonary lobectomy. Asian J Surg 2024; 47:373-379. [PMID: 37696694 DOI: 10.1016/j.asjsur.2023.08.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Double-lumen tube (DLT) intubation in lateral decubitus position is rarely reported. We designed this study to evaluate the feasibility of VivaSight double-lumen tube (VDLT) intubation assisted by video laryngoscope in lateral decubitus patients. METHODS Patients undergoing elective video-assisted thoracoscopic surgery (VATS) for lung lobectomy were assessed for eligibility between January 2022 and December, 2022. Eligible patients were randomly allocated into supine intubation group (group S) and lateral intubation group (group L) by a computer-generated table of random numbers. The prime objective was to observe whether the success rate of VDLT intubation in lateral position with the aid of video laryngoscope was not inferior to that in supine position. RESULTS A total of 116 patients were assessed, and 88 eligible patients were randomly divided into group L (n = 44) and group S (n = 44). The success rate of the first attempt intubation in the L group was 90.5%, lower than that of S group (97.7%), but there was no statistical difference (p > 0.05). Patients in both groups were intubated with VDLT for no more than 2 attempts. The mean intubation time was 91.98 ± 26.70 s in L group, and 81.39 ± 34.35 s in S group (p > 0.05). The incidence of the capsular malposition in the group L was 4.8%, less than 36.4% of group S (p < 0.001). After 24 h of follow-up, it showed a higher incidence of sore throat in group S, compared to that in group L (p = 0.009). CONCLUSION Our study shows the comprehensive success rate of intubation in lateral decubitus position with VDLT assisted by video laryngoscope is not inferior to that in supine position, with less risk of intraoperative tube malposition and postoperative sore throat. TRIAL REGISTRATION Chinese Clinical Trail Register (ChiCTR2200062989).
Collapse
Affiliation(s)
- Deqiang Tao
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Guyue Zhang
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xiangli Zheng
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xiaofan Wang
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Guangya Gao
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Zhanmin Yang
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yanjun Lin
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
| | - Liangyuan Lu
- Department of Anesthesiology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
| |
Collapse
|
4
|
Zhang X, Wang D, Zhang Z, Tang Y, Zhang Q, Tong F, Hu Y, Lu X, Liu H, Hu S. Effect of intubation in lateral position on placement of a double-lumen tube in patients undergoing unilateral video-assisted thoracic surgery: a randomied clinical trial. EClinicalMedicine 2024; 67:102402. [PMID: 38261940 PMCID: PMC10796973 DOI: 10.1016/j.eclinm.2023.102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Approximately one-third of patients who undergo double-lumen tube (DLT) intubation in the conventional supine position experience DLT malposition. No randomized study investigates the effect of DLT intubation in the lateral position. We therefore aimed to evaluate the effect of intubation in lateral position on placement of a DLT compared to supine intubation, and to test primary hypothesis that lateral DLT intubation could reduce the incidence of DLT malposition. Methods We randomly allocated 108 patients undergoing video-assisted thoracic surgery to receive DLT intubation in the comfortable and surgically required lateral position (lateral group) or in the supine position (supine group) from October to December 2022. The primary outcome was the incidence of DLT malposition defined as movement >1.0 cm to correct the DLT position. The secondary outcomes included intubation time, the frequency and duration of fibreoptic bronchoscopy, the need for re-intubation, intra-operative vital signs, and post-operative recovery. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2200060794). Findings The incidence of DLT malposition was significantly lower in the lateral group (1/53 [2%]) than that in the supine group (16/53 [30%]; RR [95% confidence interval] of 0.06 [0.01-0.46]; P < 0.001). Lateral DLT intubation decreased the intubation time, the frequency and duration of fibreoptic bronchoscopy. The incidence of hypotension, post-operative sore throat, and upper-arm discomfort was lower in the lateral group. Other secondary outcomes were similar between groups. Interpretation Lateral DLT intubation reduced the incidence of DLT malposition for patients undergoing video-assisted thoracic surgery. These results support that lateral DLT intubation offers more benefits and may be a superior option compared to conventional supine intubation. Funding National Natural Science Foundation of China and of Zhejiang Province.
Collapse
Affiliation(s)
- Xi Zhang
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
- Department of Anaesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongxu Wang
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Zhenduo Zhang
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Yawen Tang
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Qin Zhang
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Fei Tong
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Yonghe Hu
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Xian Lu
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - He Liu
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| | - Siping Hu
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University, Huzhou, China
| |
Collapse
|
5
|
Zhou X, Luo X, Li Q, Chen G, Tong J, Deng W. Prone versus lateral position in acute hypoxemic respiratory failure patients with HFNO therapy: study protocol for a multicentre randomised controlled open-label trial. Trials 2023; 24:762. [PMID: 38012708 PMCID: PMC10683165 DOI: 10.1186/s13063-023-07761-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND High-flow nasal oxygen (HFNO) therapy is a leading treatment technique for acute hypoxemic respiratory failure (AHRF), but its treatment failure rate remains high. The awake prone position (APP) has been proven to increase oxygenation and reduce the endotracheal intubation rate in patients with COVID-19-induced AHRF. However, the APP is poorly tolerated in patients, and its performance in improving prognoses is controversial. The lateral position has a similar mechanism and effect to the prone position, but it is more tolerable than the prone position. Therefore, it is worth exploring whether the lateral position is better for awake patients with AHRF. METHODS This is a protocol for a three-arm parallel-group multicentre randomised controlled open-label exploratory trial. A total of 583 patients from two hospitals in Chongqing, China, will be randomised to take the semi-recumbent position, lateral position, or prone position at a ratio of 1:1:1. Patients are all diagnosed with AHRF secondary to non-COVID-19 pneumonia or lung infection and receiving HFNO therapy. The primary outcome is ventilator-free days in 28 days. The secondary outcomes are the 28-day intubation rate, 28-day all-cause mortality, total position change time, the incidence of adverse events, number of hours using HFNO therapy, length of hospital and intensive care unit (ICU) stay, and others. We will conduct subgroup analyses on the arterial partial pressure of oxygen to the fraction of inspiration oxygen (PaO2/FiO2) ratio (> 200 mmHg or ≤ 200 mmHg), time from admission to intervention implementation (< 24 h or ≥ 24 h), position changing time, and different diagnoses. DISCUSSION This trial will explore the prognostic effects of the APP with that of the lateral position in awake patients with non-COVID-19AHRF and compare the differences between them. To provide evidence for clinical decision-making and further research on position management. TRIAL REGISTRATION This trial was registered in the Chinese Clinical Trial Registry. The registration number is ChiCTR2200055822 . Registered on January 20, 2022.
Collapse
Affiliation(s)
- Xixin Zhou
- The Second Clinical College, Chongqing Medical University, Chongqing, China
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqing Luo
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Li
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guihua Chen
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Jin Tong
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wang Deng
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
6
|
Garg B, Bansal T, Mehta N, Sharan AD. Patient Positioning in Spine Surgery: What Spine Surgeons Should Know? Asian Spine J 2023; 17:770-781. [PMID: 37226380 PMCID: PMC10460667 DOI: 10.31616/asj.2022.0320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 05/26/2023] Open
Abstract
Spine surgery has advanced tremendously over the last decade. The number of spine surgeries performed each year has also been increasing constantly. Unfortunately, the reporting of position-related complications in spine surgery has also been steadily increasing. These complications not only result in significant morbidity for the patient but also raises the risk of litigation for the surgical and anesthetic teams. Fortunately, most position-related complications are avoidable with basic positioning knowledge. Hence, it is critical to be cautious and take all necessary precautions to avoid position-related complications. We discuss the various position-related complications associated with the prone position, which is the most commonly used position in spine surgery, in this narrative review. We also discuss the various methods for avoiding complications. Furthermore, we briefly discuss less commonly used positions in spine surgery, like the lateral and sitting positions.
Collapse
Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi,
India
| | - Tungish Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi,
India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi,
India
| | - Alok D. Sharan
- Spine and Orthopedics, NJ Spine and Wellness, Matawan, NJ,
USA
| |
Collapse
|
7
|
Johnsen P, Satpathy J, Patel NK, Hansen E, Mounasamy V. Antegrade femoral nailing in the lateral decubitus position: a case series, technical tips and review of literature. Eur J Orthop Surg Traumatol 2023; 33:381-384. [PMID: 35024951 DOI: 10.1007/s00590-021-03200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Femoral intramedullary nailing is traditionally performed with the patient supine on a fracture table. We aimed to describe a case series of femoral intramedullary nailing for fracture in the lateral position, with discussion of the operative technique. METHODS A retrospective analysis identified 52 patients who underwent femoral intramedullary nailing performed in a lateral position without traction over a 5-year period at a single level 1 trauma center. Medical records were reviewed for demographics, blood loss including need for transfusion, operative duration, complications, length of stay, fracture union, re-operation and death. RESULTS There were 24 subtrochanteric, 16 peri-trochanteric and 12 diaphyseal femoral fractures. Mean operative time was 136.2 ± 101.4 min with a mean estimated blood loss of 372.5 ± 349.6 ml. Seventeen patients required blood transfusion. Mean length of stay was 10.3 ± 8.1 days. There were 3 (5.8%) surgical (compartment syndrome, infection and retained drain) and 12 (23.1%) medical complications, with a 30-day mortality rate of 3.8% (2). Mean follow-up was 9.9 ± 8.7 months. The union rate was 94.2% (49) and 3.8% (2) patients required revision fixation (hardware exchange for irritation and exchange nailing for non-union). Discharge destination was home, rehabilitation center and specialized nursing facility in 21 (40.4%), 16 (30.8%) and 15 (28.8%) patients, respectively. DISCUSSION AND CONCLUSION Femoral intramedullary nailing in the lateral decubitus position is a useful technique of managing peri-trochanteric, subtrochanteric and diaphyseal femoral fractures. We describe a known technique with technical tips, which has distinct advantages over traditional supine positioning especially in certain patient and fracture types. In addition, operative times, blood loss, length of stay, revision and outcomes were comparable to the literature.
Collapse
Affiliation(s)
- P Johnsen
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - J Satpathy
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - N K Patel
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - E Hansen
- Medical College of Virginia, Richmond, VA, USA.,Virginia Commonwealth University, Richmond, VA, USA
| | - V Mounasamy
- Virginia Commonwealth University, Richmond, VA, USA.
| |
Collapse
|
8
|
Zhang X, Wang DX, Zhang Q, Shen QB, Tong F, Hu YH, Zhang ZD, Liu FF, Tang YW, Chen JL, Liu H, Zhou F, Hu SP. Effect of intubation in the lateral position under general anesthesia induction on the position of double-lumen tube placement in patients undergoing unilateral video-assisted thoracic surgery: study protocol for a prospective, single-center, parallel group, randomized, controlled trial. Trials 2023; 24:67. [PMID: 36710355 DOI: 10.1186/s13063-023-07075-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/05/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The double-lumen tube (DLT) is an essential equipment for thoracic anesthesia and the precise position of DLT placement is particularly important for anesthesia and surgery. However, the incidence of DLT malposition remains high and it leads to lung isolation failure and hypoxemia during one-lung ventilation. This trial aims to explore the clinical application and efficacy of intubation in the lateral position under general anesthesia induction to reduce the incidence of DLT malposition in patients undergoing unilateral video-assisted thoracic surgery (VATS). METHODS In this prospective, single-center, parallel group, randomized, controlled trial, we will recruit 108 patients, aged 18-80 years, scheduled for elective unilateral VATS with DLT intubation under general anesthesia, and they will be randomly assigned to two groups: a lateral DLT intubation group (group L) and a conventional supine DLT intubation group (group C). The left-sided DLT will be used to intubate in patients of both groups. The position of DLT will be confirmed and adjusted by using the fiberoptic bronchoscopy (FOB). The primary outcome is the incidence of DLT malposition observed via the FOB, and the secondary outcomes include the time of intubation, the frequency and duration of re-adjustments of DLT placement under FOB, whether to re-intubate, intraoperative vital signs, and postoperative recovery. DISCUSSION Accurate DLT positioning is crucially important for thoracic surgery, but the incidence of DLT malposition is still high in the present clinical practice of thoracic anesthesia. This trial aims to investigate whether lateral DLT intubation can reduce the incidence of DLT malposition, with more stable intraoperative vital signs and less postoperative complications. TRIAL REGISTRATION The study protocol was registered at Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) with registration number: ChiCTR2200060794 on June 11, 2022.
Collapse
|
9
|
Papalia GF, Zampogna B, Albo E, Torre G, Villari E, Papalia R, Denaro V. The role of patient surgical positioning on hip arthroplasty component placement and clinical outcomes: a systematic re-view and meta-analysis. Orthop Rev (Pavia) 2023; 15:74116. [PMID: 37064045 PMCID: PMC10097590 DOI: 10.52965/001c.74116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Total Hip Arthroplasty (THA) may be performed through various approaches; however, depending on the surgical position of the patient, the superiority of lateral or supine position is still debated. The aim of this systematic review and meta-analysis was to compare the supine versus lateral position in THA in terms of intraoperative and postoperative outcomes and component placement. The systematic literature search was performed by the use of Cochrane Central, Pub-Med-Medline, and Google Scholar in order to select studies that evaluated clinical outcomes and the outliers of cup alignment for inclination and anteversion between supine and lateral position for hip arthroplasty. Finally, 9 articles were included in this review. The meta-analysis showed no significant differences between the two groups for clinical outcomes, unless for blood loss and VAS (respectively p = 0.05 and p = 0.004 in favour of lateral decubitus). Regarding the number of outliers, the supine decubitus showed significant differences only for the cup anteversion (p = 0.01). However, more prospective studies with a longer follow-up that analyze both clinical and radiological parameters are needed to assess the superiority of supine or lateral patient position for total hip arthroplasty.
Collapse
Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Erika Albo
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Eleonora Villari
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| |
Collapse
|
10
|
Aoki Y, Suzuki M, Takahashi H, Nakajima A, Sonobe M, Kotani T, Nakajima T, Sato Y, Inoue M, Saito J, Norimoto M, Eguchi Y, Orita S, Ohtori S, Nakagawa K. Comparison of pain and discomfort in supine and lateral positions after surgery for lumbar degenerative disease: A prospective randomized controlled study. Int J Orthop Trauma Nurs 2022; 47:100959. [PMID: 36055074 DOI: 10.1016/j.ijotn.2022.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To compare postoperative pain and discomfort between supine and lateral positions after lumbar surgery, a prospective randomized controlled study was performed. METHODS Forty-three patients with lumbar degenerative disease, treated by decompression (n = 23) or fusion surgery (n = 20), were randomly assigned to be placed in either the supine (supine group: n = 21) or lateral (lateral group: n = 22) position postoperatively, and asked to maintain their position until a day after the surgery. Postoperative back pain and discomfort (visual analog scale [VAS], 0-100 mm) and the number of patients who could maintain their position were examined. RESULTS The VAS scores for back pain (supine: 64.9 ± 22.0, lateral: 55.7 ± 21.4) showed no significant difference between the positions. However, the supine group showed significantly more severe discomfort (75.6 ± 15.7) than the lateral group (64.9 ± 15.7, p = 0.039). Significantly fewer patients maintained their position in the supine group (28.2%) than in the lateral group (68.2%; p = 0.022). Among patients who underwent fusion surgery, significantly fewer patients maintained their position in the supine group (10.0%) than those in the lateral group (60.0%, p = 0.029). CONCLUSION Postoperative discomfort was significantly reduced in the lateral position than in the supine position; thus, the lateral position is more suitable after lumbar surgery in terms of postoperative discomfort.
Collapse
Affiliation(s)
- Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.
| | - Makoto Suzuki
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| |
Collapse
|
11
|
Sun Y, Wang J, Wang W, Fan G, Wu S, Zhao F, Lu Y, Liu D, Li Y, Hu J, Yang L, Bai Y, Zhao T, Zhao Y. Effect of different surgical positions on intraocular pressure: a cross-sectional study. BMC Ophthalmol 2022; 22:318. [PMID: 35883052 PMCID: PMC9317174 DOI: 10.1186/s12886-022-02547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intraoperative intraocular pressure (IOP) elevation is a risk factor for postoperative blindness. Surgical position is associated with intraoperative IOP elevation. In China, there are few studies on the effect of various surgical positions on intraoperative IOP. This study was conducted to explore IOP change and its related factors in four common surgical positions in China. Methods This was a cross-sectional observational study. A total of 325 surgical patients who had non-ocular surgery from January 2019 to December 2019 in the hospital, were enrolled in this study. During their surgeries for general anesthesia, these participants were placed in lithotomy position/lateral position/prone position/supine position according to their surgery requirement. IOP was measured by icareTA03 handheld portable tonometer at 9 different time points from admission to exiting the operation room. And general information, postural position, and surgery information were collected through a uniform questionnaire. Multivariate analysis was performed to explore the related factors of IOP change. Results IOP of both eyes on lithotomy position, lateral position, and supine position showed statistical differences by ANOVA test at each time point (p < 0.05). IOP of both eyes in the prone position before exit from the operating room was significantly higher than IOP 10-min after anesthesia (p < 0.01). IOP under different postural angles showed statistical differences (F value = 4.85, P < 0.05), and the larger the head-down angle, the higher the IOP. IOP on the compressed side in the lateral position was higher than that on the non-compressed side (p < 0.01). In the multivariate linear regression analysis adjusted by other factors, postural position and baseline IOP were associated with IOP difference between before and after surgery (p < 0.01). Conclusion IOP in the four surgical positions showed different change patterns with the surgical process and position change. Nurses should assist the surgeon to reduce the head-down angle without interfering with the surgical operation and strengthen the inspection of IOP on patients with long-time surgery, to avoid intraoperative rapid IOP changes.
Collapse
Affiliation(s)
- Yuhong Sun
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
| | - Juan Wang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Wei Wang
- Beijng Tongren Hospital, Beijing, 100730, People's Republic of China
| | - Guohui Fan
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Sinan Wu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Fei Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology,, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yi Lu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Di Liu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Jin Hu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Lin Yang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Yu Bai
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Tong Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Ying Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| |
Collapse
|
12
|
Li C, Ren Q, Li X, Han H, Peng M, Xie K, Wang Z, Wang G. Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial. BMC Anesthesiol 2022; 22:215. [PMID: 35820814 PMCID: PMC9275275 DOI: 10.1186/s12871-022-01748-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS). Methods We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO2) and fraction of inspired oxygen (FiO2) ratio (PaO2/FiO2), and other explanatory variables were acquired from each patient before and after recruitment. Results Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO2/FiO2 between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO2/FiO2 and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered. Conclusions Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it’s long-term effects on pulmonary complications and hospital length of stay. Trial registration ChiCTR1900024379. Registered 8 July 2019, Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01748-9.
Collapse
Affiliation(s)
- Caifeng Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China
| | - Qian Ren
- Advertising Center, Tianjin Daily, Tianjin, China
| | - Xin Li
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongqiu Han
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Peng
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China.
| | - Zhiqiang Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China.
| | - Guolin Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China.
| |
Collapse
|
13
|
Yokogawa F, Oe K, Hosokawa M, Masui K. Lateral position for difficult intubation in a patient with history of hemiglossectomy and flap reconstruction: a case report. JA Clin Rep 2022; 8:16. [PMID: 35239042 PMCID: PMC8894536 DOI: 10.1186/s40981-022-00509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Reconstructive head and neck surgery can alter upper airway anatomy. We report a difficult intubation in a patient with a history of hemiglossectomy and reconstruction. Case presentation A 65-year-old female patient, who had undergone hemiglossectomy with the flap reconstruction, underwent video-assisted thoracoscopic esophagectomy for esophageal cancer. After the loss of consciousness during anesthesia induction, we failed to perform direct and oral fiberoptic intubation using a video laryngoscope and nasal fiberoptic intubation without or with video laryngoscope assistance in the supine position. Finally, shifting the patient to the left-lateral position allowed successful nasal fiberoptic intubation. Postoperatively, we were informed that she was unable to sleep in the supine position because of airway obstruction and therefore always slept on her side. Conclusion Preanesthetic evaluation of the influence of body position on the airway patency during sleep or sedation may aid in airway management.
Collapse
Affiliation(s)
- Fumiko Yokogawa
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Oe
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Maiko Hosokawa
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Kenichi Masui
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan. .,Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan.
| |
Collapse
|
14
|
Peng L, Zheng Z, Xu J, Zhong W. Retrograde intrarenal surgery in lateral position for lower pole stone: an initial experience from Single Academic Hospital. Urolithiasis 2022. [PMID: 35048132 DOI: 10.1007/s00240-021-01297-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Retrograde intrarenal surgery (RIRS) was generally challenging in management of lower pole stone (LPS) since the unfavorable anatomy. Theoretically, LPS was prone to fall out and down to renal pelvis when patients turned to lateral position, thus to facilitate lithotripsy. The aim of the present study was to report our initial experience of RIRS in lateral position for LPS. From January 2020 to February 2021, 21 patients with LPS received RIRS in lateral position. The intraoperative finding, operation time, complications and stone-free rate (SFR) were recorded and analyzed. The mean stone size was 16.7 ± 2.4 mm, multiple stones in lower pole were noted in 38.1% (8/21) cases. The mean infundibular-pelvic angle (IPA) was 35.2 ± 6.9°, IPA less than 30° was noted in six cases (28.6%, 6/21). Mean operation time was 43.5 ± 6.3 min. Obvious stone fragments dropping from the lower calyx to renal pelvis during the lithotripsy were noted in 17 cases (81.0%). Only one case (4.8%) suffered postoperative fever (Clavien I), no severe complication (> Clavien II) was noted. Hospital stay was 1.1 ± 0.3 days, the SFR in postoperative 1 month was 85.7%. LPS was prone to fall out and down to renal pelvis when patients in lateral position, thus to facilitate the lithotripsy. RIRS in lateral position was feasible for the management of LPS; however, RCT with large sample was required to certify our initial finding.
Collapse
|
15
|
Takada R, Jinno T, Miyatake K, Hirao M, Yoshii T, Kawabata S, Okawa A. Does surgical body position influence the risk for neurovascular injury in total hip arthroplasty? A magnetic resonance imaging study. Orthop Traumatol Surg Res 2021; 107:102817. [PMID: 33484902 DOI: 10.1016/j.otsr.2021.102817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neurovascular injury is a critical complication in total hip arthroplasty (THA). However, neurovascular geographic variations around the hip joint in different body positions have not been examined. This study investigated the differences in hip neurovascular geography in the supine and lateral positions using magnetic resonance imaging (MRI). HYPOTHESIS The neurovascular geography of the hip is influenced by differences in surgical body position. PATIENTS AND METHODS This was a single-center prospective study of 15 healthy volunteers enrolled between January 2018 and March 2019. Each subject's bilateral hips were scanned with a 3-T MRI scanner in both the supine and lateral positions. In T1-weighted axial images at the level of the hip center, the anterior and posterior acetabular edges were defined as reference points at which retractors are commonly placed during surgery. We measured the distance between the anterior acetabular edge and the femoral nerve (dFN), femoral artery (dFA), and femoral vein (dFV), as well as that between the posterior acetabular edge and the sciatic nerve (dSN). The primary outcome measures were the distances in both the supine and lateral positions. RESULTS dFN, dFA, and dFV in the supine and lateral positions (mm, mean±standard deviation) were 25.8±5.6 and 32.4±6.4 (p<0.0001), 25.7±4.5 and 32.2±5.0 (p<0.0001), and 26.5±4.8 and 32.3±5.1 (p<0.0001), respectively. Most of these elements moved anteromedially in the lateral position compared to the supine position. There was no significant difference in dSN between the supine and lateral positions (23.7±4.9 and 24.5±6.5 (p=0.46). DISCUSSION THA in the supine position may be accompanied by a higher risk of femoral neurovascular injury than that in the lateral position. The application of our findings could reduce the risk of femoral neurovascular injury during THA. LEVEL OF EVIDENCE III; prospective diagnostic case control study.
Collapse
Affiliation(s)
- Ryohei Takada
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan
| | - Masanobu Hirao
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan
| | - Shigenori Kawabata
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, 113-8519 Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
16
|
Yamamoto N, Ikuma H, Noda T, Inoue T, Kawasaki K, Ozaki T. Spinopelvic fixation with retention of external fixation in a lateral position for unstable pelvic fracture. Orthop Traumatol Surg Res 2021; 107:103008. [PMID: 34217863 DOI: 10.1016/j.otsr.2021.103008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 02/03/2023]
Abstract
Anterior external fixation (EF), as the primary treatment for unstable pelvic fractures, is performed with patients in the supine position. In most cases, however, definitive surgery for posterior fixation is performed first in the prone position without EF. We report the case of a patient with unilateral and vertically unstable pelvic fracture whom we had treated with minimally invasive spinopelvic fixation, with retention of the anterior EF in a lateral position. Reduction of the residual displacement was performed with percutaneous spinal instrumentation, and acceptable reduction was achieved. At the 13-month follow-up, the functional outcome, calculated using the Majeed Score, was 87 points. The plain radiograph showed good bone union, except for the right superior pubic ramus. The radiological outcome, measured using the Matta rating, was excellent. Thus, retaining the EF facilitates safe and accurate reduction without major surgical complications and may offer surgeons an additional management option for such fractures.
Collapse
Affiliation(s)
- Norio Yamamoto
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, 760-8557 Takamatsu, Kagawa, Japan.
| | - Hisanori Ikuma
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, 760-8557 Takamatsu, Kagawa, Japan
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoo Inoue
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, 760-8557 Takamatsu, Kagawa, Japan
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, 760-8557 Takamatsu, Kagawa, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| |
Collapse
|
17
|
Song G, Liu D, Wu X, Wang X, Zhou Y, Li M, Lin Q, Guo H, Tang J, Xiao X, Chen G, Bao Y, Liang J. Outcomes after semisitting and lateral positioning in large vestibular schwannoma surgery: A single-center comparison. Clin Neurol Neurosurg 2021; 207:106768. [PMID: 34175644 DOI: 10.1016/j.clineuro.2021.106768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The semisitting position (SSP) and lateral position (LP) in vestibular schwannoma (VS) surgery each have advantages and disadvantages, and which position is superior overall is debatable. Our objective was to determine the optimal position for surgical treatment of VSs with a diameter ≥3 cm. METHODS We retrospectively evaluated consecutive patients with a large VS treated between January 2010 and July 2020. Patients were grouped by surgical position and analyzed. RESULTS We enrolled 259 patients (LP group, n = 156; SSP group, n = 103). The resection extent was not significantly different between the SSP (gross-total resection [GTR], n = 89 [88.1%], near-total resection [NTR], n = 10 [9.9%], subtotal resection [STR], n = 2 [2.0%]) and LP (GTR, n = 125 [80.1%]; NTR, n = 24 [15.4%]; STR, n = 7 [4.5%]) groups. The rate of GTR with facial nerve (FN) functional preservation was higher in the SSP group than in the LP group (P = 0.014) at eight days after the operation. However, during follow-up (SSP group median, 31.5 months; LP group median, 19.5 months), there was no significant between-group difference in FN functional preservation. Two patients in the SSP group required conversion to the LP due to severe intraoperative venous air embolism (VAE). CONCLUSION Compared with the LP, the SSP did not produce significantly better FN outcomes in patients with a large VS. The duration of surgery was significantly longer in SSP cases than in LP cases. Given the risk of VAE associated with the SSP, the selection of the optimal surgical position should be made with caution on an individual basis.
Collapse
Affiliation(s)
- Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Dong Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Yiqiang Zhou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Qingtang Lin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China.
| |
Collapse
|
18
|
Takada R, Jinno T, Miyatake K, Watanabe N, Koga H, Yoshii T, Okawa A. Difference in tapered wedge stem alignment between supine and lateral position in cementless total hip arthroplasty via modified Watson-Jones anterolateral approach. Eur J Orthop Surg Traumatol 2021; 32:497-503. [PMID: 34021789 DOI: 10.1007/s00590-021-03001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether different body positions during surgery affect postoperative stem alignment in total hip arthroplasty (THA) remains unclear. The purpose of this study was to clarify differences in tapered wedge stem alignment between supine and lateral positions in THA under the modified Watson-Jones anterolateral approach. METHODS We reviewed 242 consecutive, primary cementless THAs performed with ceramic-on-cross-linked polyethylene via the modified Watson-Jones approach in either supine or lateral positions between 2009 and 2015 (supine group: 113 cases; lateral group: 129 cases). No specific reasons to select supine or lateral positions for the surgery were given during the study period. Computed tomography was performed pre- and postoperatively to measure preoperative femoral anteversion and postoperative stem anteversion, respectively. Stem alignment in coronal and sagittal planes was also evaluated. RESULTS Mean difference in stem anteversion and femoral anteversion was 8.6 ± 9.4 in the supine position and 13.0 ± 11.4 in the lateral position (p = 0.0013). Although no significant difference was seen between groups for stem alignment in the coronal plane, flexed implantation was more likely in the supine group (46/113, 40.7%) than in the lateral group (20/129, 15.5%). A significant correlation was found between femoral anteversion and stem anteversion in both the supine and lateral groups (r = 0.68, p < 0.0001 and r = 0.52, p < 0.0001, respectively). CONCLUSION Although stem anteversion was more strongly correlated with femoral anteversion in the supine position than in the lateral position, neutral position in the sagittal plane was more likely to be found with the lateral position than with the supine position. Surgeons can achieve ideal stem positioning by considering these results in the modified Watson-Jones approach in both the supine and lateral positions.
Collapse
Affiliation(s)
- Ryohei Takada
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Naoto Watanabe
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| |
Collapse
|
19
|
Zhao J, Qu L, Li P, Tan C, Tao C. Lateral position: a friendly surgical position for intramedullary nailing of tibial shaft fractures via infrapatellar approach. BMC Musculoskelet Disord 2021; 22:25. [PMID: 33407332 PMCID: PMC7786492 DOI: 10.1186/s12891-020-03883-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. However, this has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. Accordingly, the present study investigated the utility of the lateral position in the infrapatellar approach to intramedullary nailing of tibial shaft fractures. METHODS The present study was a retrospective analysis of 112 patients who sustained closed tibial shaft fractures and treated with intramedullary nailing via the infrapatellar approach. Patients were divided into two groups according to surgical position: lateral or supine. The demographic and clinical data were collected and analyzed. RESULTS There were 54 patients in the lateral and 58 in the supine position groups. The duration of surgery and fluoroscopy was shorter in the lateral group than the supine group (p < 0.05). Blood loss during surgery was lower in the lateral compared with supine position group (p < 0.05). The malunion rate was lower in the lateral position group as compared with the supine position group (p < 0.05); moreover, fewer surgical assistants were needed than in the supine group (p < 0.05). There were no significant differences in fracture healing time, other complications between the two groups (p > 0.05). CONCLUSIONS The lateral position was a more convenient choice for intramedullary nailing of tibial shaft fractures via infrapatellar approach.
Collapse
Affiliation(s)
- Jinzhu Zhao
- Department of Orthopedics, No.971 Hospital of the PLA Navy, 22 Ming-Jiang Road, 266071, Qingdao city, PR China
| | - Liang Qu
- Department of Orthopedics, No.971 Hospital of the PLA Navy, 22 Ming-Jiang Road, 266071, Qingdao city, PR China
| | - Peng Li
- Department of Orthopedics, No.971 Hospital of the PLA Navy, 22 Ming-Jiang Road, 266071, Qingdao city, PR China
| | - Changlong Tan
- Department of Orthopedics, No.971 Hospital of the PLA Navy, 22 Ming-Jiang Road, 266071, Qingdao city, PR China
| | - Chunsheng Tao
- Department of Orthopedics, No.971 Hospital of the PLA Navy, 22 Ming-Jiang Road, 266071, Qingdao city, PR China.
| |
Collapse
|
20
|
Takami M, Taiji R, Okada M, Minamide A, Hashizume H, Yamada H. Lateral lumbar interbody fusion after reduction using the percutaneous pedicle screw system in the lateral position for Meyerding grade II spondylolisthesis: a preliminary report of a new lumbar reconstruction strategy. BMC Musculoskelet Disord 2021; 22:17. [PMID: 33402131 PMCID: PMC7786473 DOI: 10.1186/s12891-020-03935-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of a cage with a large footprint in lateral lumbar interbody fusion (LLIF) for the treatment of spondylolisthesis leads to a high fusion rate and neurological improvement owing to the indirect decompression effect and excellent alignment correction. However, if an interbody space is too narrow for insertion of an LLIF cage for cases of spondylolisthesis of Meyerding grade II or higher, LLIF cannot be used. Therefore, we developed a novel strategy, LLIF after reduction by the percutaneous pedicle screw (PPS) insertion system in the lateral position (LIFARL), for surgeons to perform accurate and safe LLIF with PPS in patients with such pathology. This study aimed to introduce the new surgical strategy and to present preliminary clinical and radiological results of patients with spondylolisthesis of Meyerding grade II. METHODS Six consecutive patients (four men and two women; mean age, 72.7 years-old; mean follow-up period, 15.3 months) with L4 spondylolisthesis of Meyerding grade II were included. Regarding the surgical procedure, first, PPSs were inserted into the L4 and L5 vertebrae fluoroscopically, and both rods were placed in the lateral position. The L5 set screws were fixed tightly, and the L4 side of the rod was floated. Second, the L4 vertebra was reduced by fastening the L4 set screws so that they expanded the anteroposterior width of the interbody space. At that time, the L4 set screws were not fully tightened to the rods to prevent the endplate injury. Finally, the LLIF procedure was started. After inserting the cage, a compression force was added to the PPSs, and the L4 set screws were completely fastened. RESULTS The mean operative time was 183 min, and the mean blood loss was 90.8 mL. All cages were positioned properly. Visual analog scale score and Oswestry disability index improved postoperatively. Bone union was observed using computed tomography 12 months after surgery. CONCLUSION For cases with difficulty in LLIF cage insertion for Meyerding grade II spondylolisthesis due to the narrow anteroposterior width of interbody space, LIFARL is an option to achieve LLIF combined with posterior PPS accurately and safely. TRIAL REGISTRATION UMIN-Clinical Trials Registry, UMIN000040268, Registered 29 April 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045938.
Collapse
Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| |
Collapse
|
21
|
Vaidya R, Patel I, Simmons K, Nasr K, Washington A. Antegrade anterior column screw placement in the lateral decubitus position utilizing an axial view: a technical trick. SICOT J 2020; 6:43. [PMID: 33166248 PMCID: PMC7735812 DOI: 10.1051/sicotj/2020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
The placement of anterior column screws is a useful procedure and has standard views when placing this screw in the supine position. Feng et al. described an acetabular anterior column axial view for patients in the supine position for a placement of a retrograde anterior column screw [J Orthop Surg (Hong Kong) 25, 2309499016685012]. However, many acetabular fracture surgeries are performed in the lateral decubitus position due to a variety of reasons. Placing an antegrade anterior column screw in this position is difficult due to an unfamiliarity of the optimal fluoroscopic images. The purpose of this article is to describe a novel technique to obtain appropriate imaging to safely place an anterior column screw while the patient is in the lateral decubitus position.
Collapse
Affiliation(s)
- Rahul Vaidya
- Detroit Medical Center, Detroit, 48201 MI, USA - Wayne State University School of Medicine, Detroit, 48201 MI, USA
| | - Ishan Patel
- Detroit Medical Center, Detroit, 48201 MI, USA - Wayne State University School of Medicine, Detroit, 48201 MI, USA
| | | | | | | |
Collapse
|
22
|
Al-Maghlouth AK, Bin Ajjaj A. Post operative visual loss after nephrectomy performed in lateral position in female patient with congenitally left blindness. Urol Case Rep 2020; 33:101356. [PMID: 33102055 PMCID: PMC7573957 DOI: 10.1016/j.eucr.2020.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022] Open
Abstract
Postoperative visual loss (POVL) after non-ocular surgery is relatively uncommon. Patients undergoing spinal and cardiac surgery seems to be at the highest risk and ischemic optic Neuropathy was the most commonly diagnosed cause1 POVL following urological procedures are rare, only a few cases were reported mainly in prone position. Here, we present the first case of a patient with congenital left blindness having many risk factors of POVL who experienced this complication following a nephrectomy performed in the lateral position. The aim of this case presentation is to know this complication in order to prevent or minimize its occurrence.
Collapse
Affiliation(s)
| | - Abdulbari Bin Ajjaj
- Department Urology-Surgery, King Abdullah International Medical Research Center, King Saud Bin AbdulAziz University for Health Sciences, King Abdulaziz National Guard Hospital, Saudi Arabia
| |
Collapse
|
23
|
Msika R, Fourquet A, Laki F, Porte B, Servois V, Kirova Y. Institut Curie guidelines on breast target volume delineation for patients treated in lateral position. Cancer Radiother 2020; 24:795-798. [PMID: 32981844 DOI: 10.1016/j.canrad.2020.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/28/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To develop guidelines for and describe the delineation of breast for patients treated in lateral position and to transform this three-dimensional technique based on the virtual simulation to volume-based modern intensity-modulated irradiation technique. MATERIAL AND METHODS In our department, during the daily delineation, radiation oncologists specialized in breast cancer treatment sought consensus on the delineation of clinical treatment volume of the breast through dialogue based on cases. A radiation oncologist delineated clinical treatment volumes on CT scans of five to 20 patients, followed by a discussion and adaptation of the delineation between all radiation oncologists of the team. The consensus established between clinicians was discussed, corrected and improved. All patients were delineated in treatment position; skin markers were used to visualize the breast tissue after careful palpation. RESULTS Breast clinical treatment volume was situated and delineated between pectoral muscle and 5mm below the skin (dosimetric considerations), within the space outlined by skin markers, that showed the limits of the palpable breast tissue. In lateral position some vessels were very useful to define the limits as rami mammarii (from thoracica interna) for the internal one and thoracica lateralis for the external. This is the first atlas proposed for the delineation of the breast clinical treatment volumes for breast cancer using alternative technique of breast irradiation (lateral). CONCLUSION This atlas will be helpful for the volume definition in our daily practice of breast irradiation in lateral position and can open perspectives to develop also atlases for other alternative techniques as treatment in prone position.
Collapse
Affiliation(s)
- R Msika
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Laki
- Department of surgical oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - B Porte
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - V Servois
- Department of radiology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of radiation oncology, Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
24
|
Chen C, Xu L, He J, Wang Y, Wang B, Li W, He X. Contralateral Dependent Position During Percutaneous CT-Guided Core Needle Biopsy for Small (≤ 20 mm) Lung Lesions Adjacent to the Pericardium: Effect on Procedures and Complications. Cardiovasc Intervent Radiol 2020; 43:1652-1660. [PMID: 32803284 DOI: 10.1007/s00270-020-02608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the effect of contralateral dependent position on procedures and complications of percutaneous computed tomography (CT)-guided core needle biopsy (PCT-CNB) for small (≤ 20 mm) lung lesions adjacent to the pericardium. MATERIALS AND METHODS Retrospective view was performed to identify patients with small (≤ 20 mm) lung lesions located within 10 mm of the pericardium and who underwent PCT-CNB in the standard supine or prone position (n = 66) or in contralateral dependent position ( n = 35) between March 2010 and January 2020. In 35 patients, CT images in the contralateral dependent position were compared with images in the supine position to assess the mean distance of the lesion from the pericardium and the mean length of interface between these two positions. Complications including rates of pneumothorax, chest tube insertion, and pulmonary hemorrhage were assessed. RESULTS In comparison with axial images in supine position, the pericardium were located farther from the lesion in the contralateral dependent position; the mean distance of lesions from the pericardium became farther (P < 0.001), and the mean length of interface with the pericardium became shorter (P = 0.008). There was no difference in the complication rates between supine or prone position and contralateral dependent position (pneumothorax, P = 0.098; pulmonary hemorrhage, P = 0.791). CONCLUSION Placing patients in contralateral dependent position may confer some advantages, including maximizing distance and minimizing length of interface of the lesion to the pericardium during PCT-CNB for small (≤ 20 mm) lung lesions adjacent to the pericardium.
Collapse
Affiliation(s)
- Chao Chen
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Lichao Xu
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Jia He
- Blood Purification Room, Queshan County People's Hospital, Zhumadian, Henan Province, 463200, China
| | - Ying Wang
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Biao Wang
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| | - Wentao Li
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China.
| | - Xinhong He
- Deparment of Interventional Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui, Shanghai, 200032, China
| |
Collapse
|
25
|
Carr M, Phillips D. Sleep endoscopy findings in children in supine versus left lateral position. Int J Pediatr Otorhinolaryngol 2020; 134:110056. [PMID: 32361256 DOI: 10.1016/j.ijporl.2020.110056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe how drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea (OSA) change with lateral positioning. METHODS Children undergoing DISE for OSA in 2018-19 at a tertiary care children's hospital were positioned first supine and then in left lateral (LL) and findings were compared. RESULTS 63 children were included, 30 (47.6%) female and 33 (52.4%) male, mean age 4.64 years, and a mean Z-score 0.70. Mean pre-op Apnea Hypopnea Index (AHI) was 6.41 and REM AHI was 15.04. In supine position, 20 had obstruction at the palate (31.7%), 39 (61.9%) had obstruction at each of the base of tongue and the larynx, 17 (27.0%) had obstruction at the tonsils. In LL position, 11 (17.5%) were obstructed at the palate, 21 (33.3%) at the tonsils, 8 (12.7%) at the base of tongue and 7 (11.1%) at the larynx. Larynx and base of tongue were most likely to improve in LL position, as 54% of patients obstructed in supine position were open in LL position. Overall 38 (60.3%) patients improved on LL, 18 (28.6%) had no change, and 7 (11.1%) worsened. 30 (47.6%) patients improved in 1 site while 12 (19.0%) improved in more than 1 site. 16 (25.4%) patients worsened in 1 site and 9 (56.3%) of these had improvement in another site. CONCLUSION A significant number of patients improved airway patency, particularly at the base of tongue/larynx, during DISE when placed in LL position as compared to standard supine positioning.
Collapse
|
26
|
Šribar A, Merc V, Peršec Z, Peršec J, Milas I, Husedžinović S. Influence of different PEEP levels on electrical impedance tomography findings in patients under general anesthesia ventilated in the lateral decubitus position. J Clin Monit Comput 2020; 34:311-8. [PMID: 31062131 DOI: 10.1007/s10877-019-00318-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/30/2019] [Indexed: 12/12/2022]
Abstract
To determine the effect of various PEEP levels on electrical impedance tomography (EIT) measured differences in regional ventilation, hemodynamics, lung mechanics and parameters of alveolar gas exchange. Thirty three patients scheduled for elective urologic surgery in general anesthesia in lateral decubitus position were randomized into three groups-PEEP 0, 5 and 10 mbar. EIT recording, arterial blood gas analysis and hemodynamic parameters were captured at three timepoints-before induction (T0), 5 min after lateral positioning (T1) and 90 min after positioning (T2). Dynamic compliance (Cdyn) was measured at T1 and T2. Offline EIT data analysis was performed to calculate EIT derived parameters of ventilation distribution. Patients ventilated with PEEP of 10 mbar had a significantly lower A-a (alveolo arterial) gradient over measurements and symmetrical distribution of ventilation measured by EIT. There was no significant difference in Cdyn, center of ventilation indices and inhomogeneity index between groups. There was no difference of mean arterial pressure, cardiac index and heart rate between groups. Patients with 5 mbar of PEEP had higher stroke volume index compared to 0 and 10 mbar at baseline and over measurements. Nondependent/dependent TV ratio as well as global inhomogeneity index were correlated with A-a gradient. Dynamic compliance showed no correlation to A-a gradient. In our study, a PEEP level of 10 mbar improved alveolar gas exchange without compromising hemodynamic stability in patients mechanically ventilated in the lateral decubitus position. EIT measured parameters may be used to determine optimal ventilation parameters in these patients with inhomogeneous lung mechanics. Further studies are needed in patients with various lung pathologies.
Collapse
|
27
|
Wu H, Cheng WD, Jing J. Total hip arthroplasty by direct anterior approach in the lateral position for the treatment of ankylosed hips. Eur J Orthop Surg Traumatol 2020; 30:993-1001. [PMID: 32185574 DOI: 10.1007/s00590-020-02655-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of total hip arthroplasty (THA) via the direct anterior approach (DAA) for the treatment of hip ankylosis in the lateral position. METHODS A retrospective analysis was performed on the clinical data of 24 patients (39 hips) who underwent THA via the DAA in the lateral position for the treatment of hip ankylosis between January 2016 and December 2018. We performed bilateral THA for fifteen patients and unilateral THA for nine patients. Operation time, intraoperative blood loss, length of incisions, straight leg-raising time, length of postoperative hospital stay, operation-related complication, prosthesis position, radiological outcomes, postoperative pain relief (evaluated by VAS) and functional rehabilitation [evaluated by Harris hip score and range of motion (ROM)] were analyzed to determine clinical efficacy. These clinical data were compared and statistically analyzed with the clinical data of another 23 patients (28 hips) who underwent THA via the posterolateral approach (PLA) for the treatment of hip ankylosis in the lateral position. RESULTS Follow-up was performed at 12-15 months. The incision length in the DAA group and the PLA group was (11.12 ± 1.69 vs. 14.36 ± 3.42) cm, the intraoperative blood loss was (371.25 ± 120.55 vs. 396.80 ± 101.21) ml, the operation time was (122.47 ± 25.40 vs. 138.47 ± 24.45) min, the postoperative hospital stay was (9.59 ± 4.62 vs. 12.08 ± 3.58) days, and the straight leg elevation time was (9.20 ± 2.12 vs. 12.34 ± 3.25) days, respectively. The prosthesis of the two groups was in a good position: The average angle of cup anteversion in the DAA group and the PLA group was (10.76 ± 2.84 vs. 15.36 ± 3.42)°, and the average angle of cup abduction in the DAA group and the PLA group was (40.00 ± 3.45 vs. 41.21 ± 2.85)° (P > 0.05). The VAS score, ROM and Harris score at different follow-up time points were significantly improved in the two groups compared with those before surgery. In the first 3 months after surgery, the VAS score, ROM and Harris score of the DAA group were significantly better than those of the PLA group (P < 0.05), but with the extension of the follow-up time, there was no significant difference in the above indicators between the two groups (P > 0.05). One case of greater trochanteric fracture occurred in the DAA group. Two cases of hip posterior dislocations occurred in the PLA group, and no dislocations occurred after manual closed reduction and hip fixation in bed for 1 month to the last follow-up. No complications such as infection, deep vein thrombosis, fat embolism, prosthesis loosening, limb length inequality or joint dislocation were reported. CONCLUSION THA via the DAA for the treatment of hip ankylosis in the lateral position was safe and effective and had the advantage of reduced trauma, quicker recovery of hip function, lower incidence of postoperative dislocation and ability to expose the acetabulum fully and fit the prosthesis properly, providing satisfactory clinical efficacy.
Collapse
|
28
|
Tao Y, Huang C, Li F, Chen Q. Magnetic Resonance Imaging Study of Oblique Corridor and Trajectory to L1-L5 Intervertebral Disks in Lateral Position. World Neurosurg 2020; 134:e616-23. [PMID: 31678316 DOI: 10.1016/j.wneu.2019.10.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study investigated the retroperitoneal oblique corridor and trajectory of L1-L5 as the lateral surgical access to the intervertebral disks in the Chinese population and detected the potential relationship between the corridor or trajectory and vertebral parameters, including disk axis, psoas muscle, and retroperitoneal vessel. METHODS Seventy magnetic resonance imaging studies performed from January 2017 to January 2019 were investigated. The oblique corridor was defined as the distance between the left lateral border of the retroperitoneal vessel and the anterior border of psoas. The trajectory was defined as the distance between the retroperitoneal vessel and lumbar plexus. RESULTS The oblique corridor analysis to L1-L5 disks have the following mean distances: L1-2 13.36 mm, L2-3 13.36 mm, L3-4 12.37 mm, and L4-5 10.36 mm. There was no difference in the L1-L5 corridor between genders. And the position of retroperitoneal vessel was negatively correlated with the corridor width. The trajectory measurements to L1-L5 disks have the following mean distances: L1-2 27.44 mm, L2-3 30.86 mm, L3-4 30.73 mm, and L4-5 24.36 mm. Moreover, the vertebral parameters, including the disk axis and psoas muscle, were positively correlated with the trajectory width. Otherwise, the position of retroperitoneal vessel was negatively correlated with the trajectory width. CONCLUSIONS Compared with previous studies, the safe surgical area of the Chinese is generally smaller than that of Caucasian. The position of the retroperitoneal vessel is the vital potential to limit the corridor and trajectory. Preoperative assessment of vertebral parameters, especially vascular structure, is essential for planning surgical process.
Collapse
|
29
|
Oksenberg A, Gadoth N, Töyräs J, Leppänen T. Prevalence and characteristics of positional obstructive sleep apnea (POSA) in patients with severe OSA. Sleep Breath 2019; 24:551-559. [PMID: 31325020 DOI: 10.1007/s11325-019-01897-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We assessed the prevalence of positional patients (PPs) and the main predictors of positional dependency in severe obstructive sleep apnea (OSA). A simulated effect of positional therapy (PT) vs. continuous positive airway pressure (CPAP) was also assessed. METHODS Polysomnographic recordings of 292 consecutive patients with severe OSA (Apnea-Hypopnea Index (AHI) ≥ 30) who slept > 4 h and had ≥ 30 min sleep in both supine and lateral positions were assessed. PPs were defined to have a supine AHI/lateral AHI ratio ≥ two and non-positional patients (NPPs) a supine AHI/lateral AHI ratio < two. RESULTS A total of 35.3% of the severe OSA patients were PPs. They were less obese and had less severe OSA (p < 0.001) compared with NPPs. The percentage of total apnea-hypopnea time from total sleep time (AHT%) was the most significant predictor for positional dependency. By sleeping in the lateral posture (i.e. after simulated PT), 78 (75.7%) PPs obtained significant improvement of their OSA severity and 9 (8.7%) of them became "non-OSA". Moreover, if CPAP was used only for 50% of total sleep time, 53 patients (18.2%) gained more benefit from avoiding the supine posture than from CPAP therapy. CONCLUSIONS More than a third of the studied severe OSA patients were PPs. These patients could achieve a significant decrease in the number and severity of apneas and hypopneas by adopting the lateral posture, suggesting that PT may be a valuable therapy for a significant portion of these severe OSA patients who for whatever reason are not being treated by CPAP. TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT03232658.
Collapse
Affiliation(s)
- Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel.
| | - Natan Gadoth
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
30
|
Xu HP, Bronsart E, Costa É, Krhili S, Logerot C, Bazire L, Fournier-Bidoz N, Belshi A, Fourquet A, Kirova YM. Patterns of locoregional failure in women with early-stage breast cancer treated by whole breast irradiation in the lateral isocentric decubitus position: Large-scale single-centre experience. Cancer Radiother 2019; 23:116-124. [PMID: 30935887 DOI: 10.1016/j.canrad.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/01/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate locoregional control and describe the patterns of failure in patients with breast cancer receiving whole breast radiotherapy in the isocentric lateral decubitus position technique. PATIENTS AND METHODS In a series of 832 consecutive female patients with early-stage breast cancer including invasive and in situ tumours treated by breast-conserving surgery followed by three-dimensional conformal whole breast irradiation in the isocentric lateral decubitus position between 2005 and 2010, all patients who experienced locoregional recurrence were studied. Five-year recurrence-free and overall survival rates were calculated. Regional recurrence mapping patterns were also determined. RESULTS The median age of this series of 832 women was 61.5 years (range: 29-90 years). Various types of fractionation were used: 50Gy in 25 fractions (17.9%), 66Gy in 33 fractions (50Gy in 25 fractions to breast followed by sequential boost to tumour bed to a total dose 66Gy in 33 fractions.) (46.5%), 40Gy in 15 fractions or 41.6Gy in 13 fractions (26.1%) and 30Gy in 5 fractions (9.5%). With a median follow-up of 6.4 years, only 36 patients experienced locoregional recurrence and no association with the fractionation regimen was identified (P=0.2). In this population of 36 patients, 28 (3.3%) had "in-breast" local recurrences (77.8%), two had local recurrences and regional lymph node recurrence (5.6%), and six had regional lymph node recurrence only (in non-irradiated areas; 16.6%). The median time to recurrence was 50 months. Complete mapping of patterns of recurrences was performed and, in most cases, local recurrences were situated adjacent to the primary tumour bed. Cases of local recurrences presented a significantly lower distant metastasis rate (P<0.001) and had a significantly longer overall survival compared to patients with regional lymph node recurrence (P<0.001). However, multivariate Cox regression analysis showed that the site of recurrence had no significant impact on overall survival (P=0.14). CONCLUSION The results of this study indicate a low local recurrence rate. Further careful follow-up and recording of recurrences is needed to improve the understanding of patterns of recurrence.
Collapse
Affiliation(s)
- H-P Xu
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - E Bronsart
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - É Costa
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - S Krhili
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - C Logerot
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - L Bazire
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - N Fournier-Bidoz
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Belshi
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Y-M Kirova
- Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| |
Collapse
|
31
|
Ubukata Y, Suga H, Morita Y, Ida M, Mera H. Curvature of the left main bronchus caused by postural change from supine to left lateral position. J Anesth 2018; 32:649-651. [PMID: 29926174 DOI: 10.1007/s00540-018-2521-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
This study was designed to examine deviation of the bronchus by postural change from supine to lateral position during spontaneous respiration. Fifteen healthy volunteers [13 men and 2 women, mean age: 34 years (range 26-42)] participated. Chest radiograms (anterior-posterior) were acquired in the order of supine, left lateral, and right lateral position. The bilateral bronchus angles and secondary carina angles were measured in the acquired images, and the angles were compared between the supine and lateral positions to evaluate deviation of the bronchus in the lateral position. The left secondary carina angle in the supine position was 61.3° ± 4.0° and it significantly increased to 65.5° ± 6.0° in the left lateral position (P = 0.001), but no significant difference was noted in the left bronchus angle between the supine and left lateral positions (P = 0.158). The curvature of left main bronchus, which we defined more than 5° increase in secondary carina angle, was observed in a half of the male participants during left lateral position. We should be aware of these anatomical changes due to the surgical posture as a possible cause for ventilation failure during one-lung ventilation.
Collapse
Affiliation(s)
- Yusuke Ubukata
- Department of Anesthesiology, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo, Japan.
| | - Hiroki Suga
- Department of Anesthesiology, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo, Japan
| | - Yasuhiro Morita
- Department of Anesthesiology, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo, Japan
| | - Masahiro Ida
- Department of Radiology, Ebara Hospital, Tokyo, Japan
| | - Hitoshi Mera
- Department of Anesthesiology, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo, Japan
| |
Collapse
|
32
|
Eli IM, Kim RB, Kilburg C, Pecha TJ, Couldwell WT, Menacho ST. Postoperative Posterior Ischemic Optic Neuropathy After Left Far-Lateral Craniectomy for Resection of Craniocervical Meningioma. World Neurosurg 2018; 114:339-343. [PMID: 29627627 DOI: 10.1016/j.wneu.2018.03.204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative posterior ischemic optic neuropathy (PION) is a rare cause of postoperative vision loss, most often seen when surgical patients are placed in the prone position for a prolonged period of time. We report a case of bilateral PION after far-lateral craniectomy in the lateral position. CASE DESCRIPTION A 36-year-old man presented with a history of right extremity numbness, weakness, and muscle atrophy, and a craniocervical meningioma was diagnosed. Surgery in the lateral position lasted 9 hours, 52 minutes; the patient had 2 L of blood loss. On postoperative day 1, the patient had bilateral vision loss, which prompted further work-up. Diffusion-weighted imaging of the orbits demonstrated restricted diffusion within the bilateral optic nerves. The clinical presentation of painless vision loss after surgery with these imaging findings led to a diagnosis of PION. At the time of discharge, he had not recovered any visual function. CONCLUSIONS This case suggests that PION can occur in the lateral position where there is no direct pressure on the orbits. PION is often not discussed as a potential complication during the preoperative consent process. This case suggests it may be prudent to discuss PION in similar neurosurgical cases. Intraoperative blood transfusion should be considered in prolonged surgeries in the lateral position, where slow blood loss over a long period could be a contributing factor to development of PION.
Collapse
Affiliation(s)
- Ilyas M Eli
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert B Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Craig Kilburg
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Travis J Pecha
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
| |
Collapse
|
33
|
Luo HL, Cui MJ, Li YL. Influence of different pneumoperitoneum pressures on pulmonary shunt and pulmonary compliance in patients undergoing retroperitoneal laparoscopic surgery. Shijie Huaren Xiaohua Zazhi 2018; 26:276-281. [DOI: 10.11569/wcjd.v26.i4.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the influence of different pneumoperitoneum pressures on the pulmonary shunt and pulmonary compliance in patients undergoing laparoscopic surgical procedures in a lateral position.
METHODS One hundred and two patients who underwent retroperitoneal laparoscopic surgery at the Second People's Hospital of Linghai were randomly divided into either group A or group B. Group A underwent the surgery at a pneumoperitoneum pressure of 10 mmHg, and group B underwent the surgery at a pneumoperitoneum pressure of 15 mmHg. The amount of drugs and liquids used, blood pressure, heart rate, pulmonary shunt, and lung compliance were observed.
RESULTS There was no significant difference in the amount of drugs and liquids used between the two groups (P > 0.05). Systolic blood pressure at T2 (35 min after pneumoperitoneum was established) was significantly higher in group A than in group B (128.02 mmHg ± 7.98 mmHg vs 149.94 mmHg ± 8.31 mmHg, P < 0.05). Dynamic pulmonary compliance at T2 stage was significantly higher in group A than in group B (65.22 mL/cm H2O ± 5.37 mL/cm H2O vs 53.98 mL/cm H2O ± 5.33 mL/cm H2O), and dynamic pulmonary compliance at T2 stage was significantly higher than that at T1 (15 min after pneumoperitoneum was established) and T3 (10 min after drug withdrawl) stages in group A (P < 0.05). PaCO2 at T2 stage was significantly lower in group A than in group B (4.54 kPa ± 0.51 kPa vs 5.89 kPa ± 0.55 kPa), and PaCO2 at T2 stage was significantly higher than that at T1 and T3 stages in group A (P < 0.05). Time to eye opening, time to recovery of spontaneous breathing, time to extubation, and time to orientation recovery were significantly shorter in group A than in group B (P < 0.05). The rate of adverse reactions was significantly lower in group A than in group B (P < 0.05).
CONCLUSION A pneumoperitoneum pressure of 10 mmHg in retroperitoneal laparoscopic surgery can significantly improve pulmonary compliance and postoperative recovery and has higher safety than a pneumoperitoneum pressure of 15 mmHg.
Collapse
|
34
|
Barasinski C, Debost-Legrand A, Lémery D, Vendittelli F. Positions during the first stage and the passive second stage of labor: A survey of French midwives. Midwifery 2018; 56:79-85. [PMID: 29096283 DOI: 10.1016/j.midw.2017.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/11/2017] [Accepted: 10/15/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE the objective of our study was to describe the practices reported by French midwives during labor (first stage and passive phase of the second stage). DESIGN this cross-sectional internet questionnaire surveyed French midwives who attended at least one delivery in 2013. SETTING this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS 1496 midwives from 377 maternity units participated in the study. Nearly 93% of the midwives worked in an obstetric unit, 5.9% had a mixed practice, and 1.3% worked in private practice. MEASUREMENTS AND FINDINGS during the first stage of labor, midwives reported suggesting that women without epidural analgesia use a birthing ball (98.1%) and that they walk around (97.4%). For women with epidural analgesia, most suggested motion in horizontal positions. Epidural analgesia was proposed more often by midwives from level II (75.7%) and level III (73.5%) maternity wards than by those at level 1 units (57.7%) (p<0.0001). The midwives preferred a lateral position during the first stage for women with epidural analgesia and during the second stage for women both with and without it. Midwives in practice for 5 years or less suggested a kneeling position for women with epidural analgesia more often than more experienced midwives. KEY CONCLUSION the practices of French midwives vary with their place of practice and their experience. IMPLICATIONS FOR PRACTICE to promote normal labor, French midwives must reappropriate vertical positions and analgesic alternatives to epidurals.
Collapse
|
35
|
Abstract
OBJECTIVE A higher incidence in women (approximately 7:3) and a predominant involvement of the right ear (approximately 7:5) are interesting features of BPPV (benign paroxysmal positional vertigo). It is speculated that these features are related to sleep position. The first aim of this study was to compare the frequency of position shifts during sleep between men and women. The second aim was to elucidate any differences in sleep position between men and women. The third aim was to clarify the laterality of sleep position. METHODS We retrospectively selected the data of 30 males (mean, 53.1 years) and 22 females (mean, 50.6 years) diagnosed as mild or moderate obstructive sleep apnea. A position sensor was attached to the patient's anterior chest. Supine position was defined as less than 45° tilt, and lateral position was defined as more than 45° tilt. A single overnight laboratory polysomnography provided the number of position shifts, total sleep time, sleep time spent in the supine position (S), sleep time spent in the right-side-down lateral position (R), and sleep time spent in the left-side-down lateral position (L). RESULTS The mean value and standard deviation of the number of position shifts per hour was 2.4±1.3 in males, and 2.3±1.1 in females. There was no significant difference between males and females. Twelve cases (40%) were lateral type (S<R+L), and 18 (60%) were supine type (S>R+L) in males. Ten cases (45%) were lateral type, and 12 (55%) were supine type in females. There was no significant difference between males and females. Seventeen cases (56.6%) were right-dominant type (R-L>0), and 13 (43.3%) were left-dominant type (R-L<0) in males. Thirteen cases (59%) were right-dominant type, and 9 (41%) were left-dominant type in females. CONCLUSION Body position and the number of position shifts during sleep differ substantially between individuals. There is no gender difference in the frequency of position shifts. Although the supine type is more common than the lateral type, there is no gender difference in sleep position. Therefore, the reason of higher incidence in women is not related to sleep. The right-dominant type occurs more than the left-dominant type in both genders. It is possible that this behavior is the reason for the predominant involvement of the right ear in BPPV.
Collapse
Affiliation(s)
- Hiroaki Ichijo
- Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki 036-8002, Japan.
| | - Miwaoki Akita
- Yoshida Ear, Nose and Throat Clinic, 2-1-15, Nakano, Hirosaki 036-8155, Japan.
| |
Collapse
|
36
|
Mecheri S, Rosey F, Lobjois R. The effects of lane width, shoulder width, and road cross-sectional reallocation on drivers' behavioral adaptations. Accid Anal Prev 2017; 104:65-73. [PMID: 28486150 DOI: 10.1016/j.aap.2017.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/21/2017] [Accepted: 04/25/2017] [Indexed: 06/07/2023]
Abstract
Previous research has shown that lane-width reduction makes drivers operate vehicles closer to the center of the road whereas hard-shoulder widening induces a position farther away from the road's center. The goal of the present driving-simulator study was twofold. First, it was aimed at further investigating the respective effects of lane and shoulder width on in-lane positioning strategies, by examining vehicle distance from the center of the lane. The second aim was to assess the impact on safety of three possible cross-sectional reallocations of the width of the road (i.e., three lane-width reductions with concomitant shoulder widening at a fixed cross-sectional width) as compared to a control road. The results confirmed that lane-width reduction made participants drive closer to the road's center. However, in-lane position was affected differently by lane narrowing, depending on the traffic situation. In the absence of oncoming traffic, lane narrowing gave rise to significant shifts in the car's distance from the lane's center toward the edge line, whereas this distance remained similar across lane widths during traffic periods. When the shoulders were at least 0.50m wide, participants drove farther away from both the road center and the lane center. Road reallocation operations resulted in vehicles positioned farther away from the edge of the road and less swerving behavior, without generating higher driving speeds. Finally, it is argued that road-space reallocation may serve as a good low-cost tool for providing a recovery area for steering errors, without impairing drivers' behavior.
Collapse
Affiliation(s)
- Sami Mecheri
- Laboratory for Road Operations, Perception, Simulators and Simulation, IFSTTAR, Paris-Est University, France.
| | | | - Régis Lobjois
- Laboratory for Road Operations, Perception, Simulators and Simulation, IFSTTAR, Paris-Est University, France.
| |
Collapse
|
37
|
Hyldmo PK, Horodyski M, Conrad BP, Aslaksen S, Røislien J, Prasarn M, Rechtine GR, Søreide E. Does the novel lateral trauma position cause more motion in an unstable cervical spine injury than the logroll maneuver? Am J Emerg Med 2017; 35:1630-1635. [PMID: 28511807 DOI: 10.1016/j.ajem.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/08/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Prehospital personnel who lack advanced airway management training must rely on basic techniques when transporting unconscious trauma patients. The supine position is associated with a loss of airway patency when compared to lateral recumbent positions. Thus, an inherent conflict exists between securing an open airway using the recovery position and maintaining spinal immobilization in the supine position. The lateral trauma position is a novel technique that aims to combine airway management with spinal precautions. The objective of this study was to compare the spinal motion allowed by the novel lateral trauma position and the well-established log-roll maneuver. METHODS Using a full-body cadaver model with an induced globally unstable cervical spine (C5-C6) lesion, we investigated the mean range of motion (ROM) produced at the site of the injury in six dimensions by performing the two maneuvers using an electromagnetic tracking device. RESULTS Compared to the log-roll maneuver, the lateral trauma position caused similar mean ROM in five of the six dimensions. Only medial/lateral linear motion was significantly greater in the lateral trauma position (1.4mm (95% confidence interval [CI] 0.4, 2.4mm)). CONCLUSIONS In this cadaver study, the novel lateral trauma position and the well-established log-roll maneuver resulted in comparable amounts of motion in an unstable cervical spine injury model. We suggest that the lateral trauma position may be considered for unconscious non-intubated trauma patients.
Collapse
Affiliation(s)
- Per Kristian Hyldmo
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway; Trauma Unit, Sørlandet Hospital, Kristiansand, Norway.
| | - MaryBeth Horodyski
- Department of Orthopedics & Rehabilitation, University of Florida, Gainesville, Florida, USA.
| | - Bryan P Conrad
- Department of Orthopedics & Rehabilitation, University of Florida, Gainesville, Florida, USA; Nike Inc., Portland, Oregon, USA
| | - Sindre Aslaksen
- Division of EMS, Sørlandet Hospital, Kristiansand, Norway; Norwegian Air Ambulance, Drøbak, Norway.
| | - Jo Røislien
- Department of Health Studies, University of Stavanger, Stavanger, Norway.
| | - Mark Prasarn
- Department of Orthopedics, University of Texas, Huston, Texas, USA.
| | - Glenn R Rechtine
- Bay Pines VAHCS, Bay Pines, Florida, USA; University of South Florida, Tampa, Florida, USA
| | - Eldar Søreide
- Stavanger University Hospital, Stavanger, Norway; Network for Medical Sciences, University of Stavanger, Stavanger, Norway.
| |
Collapse
|
38
|
Rustagi P, Patkar GA, Ourasang AK, Tendolkar BA. Effect of Pneumoperitoneum and Lateral Position on Oropharyngeal Seal Pressures of Proseal LMA in Laparoscopic Urological Procedures. J Clin Diagn Res 2017; 11:UC05-UC09. [PMID: 28384963 DOI: 10.7860/jcdr/2017/22168.9422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A sustained and effective oropharyngeal sealing with supraglottic airway is required to maintain the ventilation during laparoscopic surgery. Previous studies have observed the Oropharyngeal Seal Pressure (OSP) for Proseal Laryngeal Mask Airway (PLMA) after pneumoperitoneum in supine and trendelenburg position, where PLMA was found to be an effective airway device. This study was conducted with ProSeal LMA, for laparoscopic Urologic procedures done in lateral position. AIM To measure OSP in supine and lateral position and to observe the effect of pneumoperitoneum in lateral position on OSP. Secondary objectives were to assess adequacy of ventilation and incidence of adverse events. MATERIALS AND METHODS A total number of 25 patients of American Society of Anaesthesiologists (ASA) physical status II and I were enrolled. After induction of anaesthesia using a standardized protocol, PLMA was inserted. Ryle's tube was inserted through drain tube. The position of PLMA was confirmed with ease of insertion of Ryle's tube and fibreoptic grading of vocal cords. Patients were then put in lateral position. The OSP was measured in supine position. This value was baseline comparison for OSP in lateral position and that after pneumoperitoneum. We assessed the efficacy of PLMA for ventilation, after carboperitoneum in lateral position (peak airway pressure, End Tidal Carbon dioxide (EtCO2), SPO2). Incidence of adverse effects (displacement of device, gastric insufflation, regurgitation, coughing, sore throat, blood on device, trauma) was also noted. RESULTS The OSP was above Peak Airway Pressure (PAP) in supine (22.1±5.4 and 15.4±4.49cm of H2O) and lateral position (22.6±5.3 and 16.1±4.6). After pneumoperitoneum, which was in lateral position, there was statistically significant (p-value <0.05) increase in both PAP (19.96±4.015) and OSP (24.32±4.98, p-value 0.03). There was no intraoperative displacement of PLMA. There was no event of suboptimal oxygenation. EtCO2 was always within normal limits. Gastric insufflation was present in one patient. One patient had coughing and blood was detected on device. Three patients had throat discomfort post-operatively. CONCLUSION In this study, Oropharyngeal seal pressures with PLMA were found to increase after pneumoperitoneum in lateral position. PLMA forms an effective seal around airway and is an efficient and safe alternative for airway management in urological laparoscopic surgeries done in lateral position.
Collapse
Affiliation(s)
- Preeti Rustagi
- Assistant Professor, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital , Sion, Mumbai, Maharashtra, India
| | - Geeta A Patkar
- Professor, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital , Sion, Mumbai, Maharashtra, India
| | - Anil Kumar Ourasang
- Registrar, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital , Sion, Mumbai, Maharashtra, India
| | - Bharati A Tendolkar
- Professor and Head, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital , Sion, Mumbai, Maharashtra, India
| |
Collapse
|
39
|
Abstract
BACKGROUND Atrial fibrilation (AF) is the most common complication following heart surgeries; it often occurs in patients after coronary artery bypass graft (CABG). The purpose of this review is to categorize prophylaxes or treatment by administration of Amiodaron in patients with CABG. DATA RESOURCES We searched google scholar, pubmed, and Cochrane Library databases (the period 1970-2010) for articles on Amiodaron in CABG and cardiac surgery. A total of 1 561 articles were identified, and 30 articles met the criteria and were enrolled in this review. RESULTS Most studies supported Amiodarone for prophylaxi purpose in patients who were performed with CABG; few papers supported Amiodaron as a drug for treating CABG. The prophylaxis can decrease the incidence rate of AF in CABG, but if it uses as a treatment, the side effect of Amiodaron will decrease because all of the patients will not get Amiodarone. In the other hand use of Amiodarone as a treatment does not influence the length of hospital stay significantly but these kinds of study are so few. CONCLUSION No appropriate therapeutic method has been defined for AF. At present, the common way of treating AF following cardiac surgery is mainly based on prophylaxis in medical books and references.
Collapse
Affiliation(s)
- Paria Habibollahi
- Pharmacology and Toxicology Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Shahrzad Hashemi Jam
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Samad Shams Vahdati
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Hamidreza Morteza Baghi
- Emergency Medicine Research Team, Emergency Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Hassan Amiri
- Emergency Department, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
40
|
Yunoki K, Sasaki R, Taguchi A, Maekawa S, Ueta H, Yamazaki K. Successful recovery without any neurological complication after intraoperative cardiopulmonary resuscitation for an extended period of time in the lateral position: a case report. JA Clin Rep 2016; 2:7. [PMID: 29497662 PMCID: PMC5818729 DOI: 10.1186/s40981-016-0036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022] Open
Abstract
No successful resuscitation has ever been reported about intraoperative cardiopulmonary resuscitation (CPR) for an extended period of time in the lateral position. Here we report a case of successful resuscitation without any neurological complication after cardiac arrest due to massive hemorrhage and 25 min of CPR in the lateral position. The patient was a 65-year-old man. During open hemostasis for the postoperative hemorrhage, the patient's rhythm changed sinus to ventricular fibrillation (VF), followed by asystole. We started CPR immediately with the patient in the left lateral position. Chest compression was performed by two practitioners, one pressing patient's sternum and the other pressing simultaneously patient's mid-thoracic spine from his back. During CPR, though the value of end-tidal CO2 (EtCO2) was significantly low (around 5-20 mmHg), the value of systolic arterial pressure was kept about 35-50 mmHg, and diastolic pressure about 20-30 mmHg. After the 25 min of lateral CPR, he achieved the return of spontaneous circulation (ROSC). He was hemodynamically stable after ROSC. He regained his consciousness at the next postoperative day. He was discharged from our hospital on the 60th day of operation without any cardiac and neurological complication. Successful neurological outcome suggests that we may expect satisfactory neurological outcome even in the case of lateral position and prolonged CPR if we perform effective CPR with the feedback of arterial blood pressure and EtCO2 and with the immediate intervention to culprit injuries.
Collapse
Affiliation(s)
- Kazuma Yunoki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo 650-0047 Japan
| | - Ryo Sasaki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo 650-0047 Japan
| | - Akihisa Taguchi
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo 650-0047 Japan
| | - Shun Maekawa
- Department of Anesthesiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwacho, Amagasaki-city, Hyogo 660-8550 Japan
| | - Hiroshi Ueta
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo 650-0047 Japan
| | - Kazuo Yamazaki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo 650-0047 Japan
| |
Collapse
|
41
|
Takenaka I, Aoyama K. Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions. World J Emerg Med 2016; 7:285-289. [PMID: 27942346 DOI: 10.5847/wjem.j.1920-8642.2016.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pulmonary aspiration of gastric contents during tracheal intubation is a life-threatening complication in emergency patients. Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications. Although it has been considered that aspiration can be prevented in the lateral position, few studies have evaluated the ability to prevent aspiration. Moreover, this position is not always a favorable position for tracheal intubation. If aspiration can be prevented in a clinically relevant semi-lateral position, it may be advantageous. We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model. METHODS A manikin's head was placed in the neutral, simple extension, or sniffing position. The amount of aspirated saline into the bronchi during simulated vomiting was measured at semi-lateral position angles of 0º to 90º in 10º increments. The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semi-lateral position in the three head-neck positions. RESULTS Pulmonary aspiration was prevented at the ≥70º, ≥80º, and 90º semi-lateral positions in the neutral, simple extension, and sniffing positions, respectively. The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented. CONCLUSION The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation. Prevention of aspiration was difficult within clinically relevant semi-lateral positions.
Collapse
Affiliation(s)
- Ichiro Takenaka
- Department of Anesthesia, Kyushu Rosai Hospital, 1-1 Sonekita, Kokuraminami, Kitakyushu 800-0296, Japan
| | - Kazuyoshi Aoyama
- Department of Anesthesia, Kitakyushu General Hospital, 5-10-10 Yugawa, Kokuraminami, Kitakyushu 800-0295, Japan
| |
Collapse
|
42
|
Roessler K, Krawagna M, Bischoff B, Rampp S, Ganslandt O, Iro H, Schmitt H, Buchfelder M. Improved Postoperative Facial Nerve and Hearing Function in Retrosigmoid Vestibular Schwannoma Surgery Significantly Associated with Semisitting Position. World Neurosurg 2016; 87:290-7. [PMID: 26732954 DOI: 10.1016/j.wneu.2015.11.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The pros and cons of semisitting positioning (SSP) versus lateral, horizontal positioning (LP) during retrosigmoid vestibular schwannoma (VS) surgery, especially concerning postoperative cranial nerve and brain stem preservation, are under continuous discussion. METHODS In a single-center retrospective cohort study, 30 VSs operated on in SSP compared with 30 operated on in LP with comparable demography were analyzed. During SSP surgery, transesophageal echocardiographic monitoring for venous air embolism was used continuously. Electrophysiologic cranial nerve monitoring was used in both groups. RESULTS Length of surgery was significantly different between both groups: 183 minutes mean in SSP surgery versus 365 minutes mean in LP surgery (P = 0.0001). Postoperative rates of facial palsy and hearing loss were also significantly different. Six months postoperatively, 63% had normal facial nerve function after SSP surgery, whereas in LP surgery, 40% had no facial palsy (P = 0.02). Hearing preservation rate was also significantly different: 44% in SSP surgery compared with 14% in LP surgery who had preserved hearing (P = 0.006). Because of cerebrospinal fluid leaks, there were 3 operative revisions in the LP group (10%) and 1 (3.3%) in the SSP group. A clinically insignificant venous air embolism rate was found in 3.3% of patients (1/30) during SSP surgery. The neurologic outcome after 6 months was 1.2 on the Rankin Scale in the LP group and 1.0 in the SSP group, with zero mortality. CONCLUSIONS SSP compared with LP surgery was associated with significantly shorter operation time and better facial and cochlear nerve function in VS surgery postoperatively, without differences in complication rates.
Collapse
|
43
|
Rizvi MM, Singh RB, Sarkar A, Choubey S. Anaesthesia for a "Scalped" Patient. J Clin Diagn Res 2015; 9:UD03-4. [PMID: 26266193 DOI: 10.7860/jcdr/2015/12863.6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/21/2015] [Indexed: 11/24/2022]
Abstract
Trichilemmal carcinoma of scalp is a rare malignant tumour of scalp. A 52-year-old female presented with an extensive ulcerative lesion of the scalp. As the location of the tumour was in the occipital region and there was loss of bony skull in the region, this case became challenging. This patient was managed in the left lateral which was a difficult situation for even the experienced Anaesthesiologist. Intravenous access was acquired, central venous catheter (CVC) was placed in the right internal jugular vein under ultrasonography (USG) guidance and intubation was carried out in the lateral position. After the procedure, patient was again returned to the left lateral position. The trachea was extubated in the lateral position once the patient was awake, after thorough reversal of neuromuscular blockade. Patient had an uneventful postoperative period. This case report highlights the management of an unusual case of Trichilemmal carcinoma of the scalp.
Collapse
Affiliation(s)
- M M Rizvi
- Assistant Professor, Department of Anaesthesiology and Critical Care, Era's Lucknow Medical College and Hospital , Lucknow, India
| | - Raj Bahadur Singh
- Assistant Professor, Department of Anaesthesiology and Critical Care, Era's Lucknow Medical College and Hospital , Lucknow, India
| | - Arindam Sarkar
- Assistant Professor, Department of Anaesthesiology and Critical Care, Era's Lucknow Medical College and Hospital , Lucknow, India
| | - Sanjay Choubey
- Professor, Department of Anaesthesiology and Critical Care, Era's Lucknow Medical College and Hospital , Lucknow, India
| |
Collapse
|
44
|
Spektor S, Fraifeld S, Margolin E, Saseedharan S, Eimerl D, Umansky F. Comparison of outcomes following complex posterior fossa surgery performed in the sitting versus lateral position. J Clin Neurosci 2015; 22:705-12. [PMID: 25752232 DOI: 10.1016/j.jocn.2014.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/21/2014] [Accepted: 12/26/2014] [Indexed: 01/05/2023]
Abstract
The sitting position during surgery is thought to provide important advantages, yet it remains controversial. We compared surgical and neurological outcomes for patients operated on in the sitting versus lateral position. Technically difficult procedures performed from the years 2001-2008 for complex lesions in the posterior fossa (vestibular schwannomas, other cerebellopontine angle tumors, foramen magnum meningiomas, brainstem cavernomas, pineal region tumors) were included. Outcomes in the two surgical positions were compared for all 243 patients (93 sitting, 38.3%; 150 lateral, 61.7%) and for 130/243 patients with vestibular schwannomas (50 sitting, 38.5%; 80 lateral, 61.5%). Sitting and lateral patient subgroups were clinically comparable. There were no surgical mortalities. The extent of removal and surgical and neurological outcomes were comparable. We found no advantage in surgical or neurological outcomes for use of the sitting or lateral surgical positions in technically difficult posterior fossa procedures. In vestibular schwannoma surgeries facial nerve preservation (House-Brackmann score 1-2) was related to extent of resection but not to surgical position. The choice of operative position should be based on lesion characteristics and the patient's preoperative medical status as well as the experience and preferences of the surgeons performing the procedure.
Collapse
Affiliation(s)
- Sergey Spektor
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
| | - Shifra Fraifeld
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel
| | - Emil Margolin
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel
| | - Sanjith Saseedharan
- Department of Anesthesiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Critical Care Medicine, S.L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Daniel Eimerl
- Department of Anesthesiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Felix Umansky
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel
| |
Collapse
|
45
|
de Waard D, Westerhuis F, Lewis-Evans B. More screen operation than calling: the results of observing cyclists' behaviour while using mobile phones. Accid Anal Prev 2015; 76:42-48. [PMID: 25590920 DOI: 10.1016/j.aap.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 01/02/2015] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
Operating a mobile telephone while riding a bicycle is fairly common practice in the Netherlands, yet it is unknown if this use is stable or increasing. As such, whether the prevalence of mobile phone use while cycling has changed over the past five years was studied via on-road observation. In addition the impact of mobile phone use on lateral position, i.e. distance from the front wheel to the curb, was also examined to see if it compared to the results seen in previous experimental studies. Bicyclists were observed at six different locations and their behaviour was scored. It was found that compared to five years ago the use of mobile phones while cycling has changed, not in frequency, but in how cyclists were operating their phones. As found in 2008, three percent of the bicyclists were observed to be operating a phone, but a shift from calling (0.7% of cyclists observed) to operating (typing, texting, 2.3% of cyclists) was found. In 2008 nearly the complete opposite usage was observed: 2.2% of the cyclists were calling and 0.6% was texting. Another finding was that effects on lateral position were similar to those seen in experimental studies in that cyclists using a phone maintained a cycling position which was further away from the curb. It was also found that when at an intersection, cyclist's operating their phone made less head movements to the right than cyclists who were just cycling. This shift from calling to screen operation, when combined with the finding related to reduced head movements at intersections, is worrying and potentially dangerous.
Collapse
Affiliation(s)
- Dick de Waard
- University of Groningen, Department of Psychology, Faculty of Behavioural and Social Sciences, Neuropsychology, Traffic and Environmental Psychology Group, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
| | - Frank Westerhuis
- University of Groningen, Department of Psychology, Faculty of Behavioural and Social Sciences, Neuropsychology, Traffic and Environmental Psychology Group, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Ben Lewis-Evans
- University of Groningen, Department of Psychology, Faculty of Behavioural and Social Sciences, Neuropsychology, Traffic and Environmental Psychology Group, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| |
Collapse
|
46
|
Abstract
Transcription factors establish the tremendous diversity of cell types in the nervous system by regulating the expression of genes that give a cell its morphological and functional properties. Although many studies have identified requirements for specific transcription factors during the different steps of neural circuit assembly, few have identified the downstream effectors by which they control neuronal morphology. In this Review, we highlight recent work that has elucidated the functional relationships between transcription factors and the downstream effectors through which they regulate neural connectivity in multiple model systems, with a focus on axon guidance and dendrite morphogenesis.
Collapse
Affiliation(s)
- Celine Santiago
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Greg J Bashaw
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
47
|
Neidert MC, Losa M, Regli L, Sarnthein J. Elevated serum creatine kinase after neurosurgeries in lateral position with intraoperative neurophysiological monitoring is associated with OP duration, BMI and age. Clin Neurophysiol 2015; 126:2026-32. [PMID: 25631613 DOI: 10.1016/j.clinph.2014.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/23/2014] [Accepted: 12/27/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Elevated serum levels of creatine kinase (CK) reflect skeletal muscle injury, which may lead to renal dysfunction following surgery. High CK levels are known to occur after neurosurgical interventions, especially following lateral positioning, but a consensus on possible risk factors is still lacking. Here we investigate risk factors for postoperative CK excess in a patient population at high risk (lateral position) with a special focus on the influence of intraoperative neurophysiological monitoring (IONM), particularly Motor Evoked Potentials (MEPs). METHODS We analyzed patient charts from elective surgeries in lateral position between 2010 and 2012 and where IONM was performed and where postoperative CK-levels were available. In these patients, the anesthesia regimen excluded muscle relaxants. Patient charts were reviewed retrospectively for patient characteristics, CK levels and indicators of renal dysfunction. The MEP response intensity was measured. These patients were compared to a matched (age, BMI, surgery duration) control group of patients operated with IONM, but operated in prone or supine position. RESULTS We included 96 patients (55 female, mean age 50years). The maximal CK level (CKmax) occurred on postoperative days 2 or 3 (mean 1763U/L). In a multivariate linear regression model, log(CKmax) correlated positively with duration of surgery (p<0.001) and BMI (p=0.007), and negatively with age (p=0.007), but not with MEP response intensity (p=0.481). We did not observe impaired renal function. CONCLUSIONS CK excess following neurosurgical procedures in lateral position correlated positively with duration of surgery and BMI and negatively with age. MEP stimulations of the muscles at risk did not cause further CK elevation. SIGNIFICANCE In patients undergoing long neurosurgeries without muscle relaxants, we recommend special care regarding positioning and perioperative management.
Collapse
Affiliation(s)
- Marian C Neidert
- Neurosurgery Department, University Hospital Zurich, Switzerland
| | - Marco Losa
- Neurosurgery Department, University Hospital Zurich, Switzerland
| | - Luca Regli
- Neurosurgery Department, University Hospital Zurich, Switzerland
| | - Johannes Sarnthein
- Neurosurgery Department, University Hospital Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland.
| |
Collapse
|
48
|
Pahlavanhosseini H, Valizadeh S, Banadaky SHS, Karbasi MHA, Abrisham SMJ, Fallahzadeh H. Management of Hip Fractures in Lateral Position without a Fracture Table. Arch Bone Jt Surg 2014; 2:168-173. [PMID: 25386577 PMCID: PMC4225021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/27/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. METHODS 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). RESULTS The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). CONCLUSIONS It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe.
Collapse
Affiliation(s)
- Hamid Pahlavanhosseini
- Hamid Pahlavanhosseini MD, Sima Valizadeh MD, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sima Valizadeh
- Hamid Pahlavanhosseini MD, Sima Valizadeh MD, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyyed Hossein Saeed Banadaky
- Hamid Pahlavanhosseini MD, Sima Valizadeh MD, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad H Akhavan Karbasi
- Hamid Pahlavanhosseini MD, Sima Valizadeh MD, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Mohammad J Abrisham
- Hamid Pahlavanhosseini MD, Sima Valizadeh MD, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Hamid Pahlavanhosseini MD, Sima Valizadeh MD, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
49
|
Nozoe M, Mase K, Takashima S, Matsushita K, Kouyama Y, Hashizume H, Kawasaki Y, Uchiyama Y, Yamamoto N, Fukuda Y, Domen K. Measurements of chest wall volume variation during tidal breathing in the supine and lateral positions in healthy subjects. Respir Physiol Neurobiol 2014; 193:38-42. [PMID: 24418356 DOI: 10.1016/j.resp.2013.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/24/2013] [Accepted: 12/29/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To study the feasibility and the laterality of measurements of chest wall volume variation during tidal breathing in the lateral position in healthy subjects. METHODS Eighteen normal subjects were studied. Chest wall volume changes were measured by optoelectronic plethysmography in the supine and right and left lateral positions during quiet breathing. The accuracy of measuring lung volume was also examined using hot wire spirometry in 10 of the subjects. RESULTS The measurement errors between lung volume changes and chest wall volume changes were not significantly different in all positions. There was no significant difference between right and left compartmental volume changes in the supine position. However, chest wall volume changes were lower on the dependent side in the lateral position than on the non-dependent side because of the decrease in abdominal rib cage and abdomen volume changes. CONCLUSION Chest wall volume measurements during quiet breathing in the lateral position have high measuring accuracy and show laterality.
Collapse
|