Retained needle after cement injection during vertebral augmentation and its management strategy.

A middle aged patient with multiple myeloma resulting in numerous pathological fractures underwent an L2, L3, and L5 vertebral cement augmentation for pain relief. After injection, the trocar at L2, the final level, could not be withdrawn despite several attempts of needle rotation, a second needle inserted to distract on, and rocking the needle on the pedicle. After a neurosurgical consultation, the patient was transferred to the operating room for open removal. As the needle protruded approximately 3 inches from the patient's back, the patient could not be positioned supine, and was anesthetized and intubated in the right semi-prone position prior to being placed prone on the operating room table. The needle was surgically exposed, cut off at the pedicular bone edge, and its free component was removed.

Retained needle after cement injection during vertebral augmentation and its management strategy.

A middle aged patient with multiple myeloma resulting in numerous pathological fractures underwent an L2, L3, and L5 vertebral cement augmentation for pain relief. After injection, the trocar at L2, the final level, could not be withdrawn despite several attempts of needle rotation, a second needle inserted to distract on, and rocking the needle on the pedicle. After a neurosurgical consultation, the patient was transferred to the operating room for open removal. As the needle protruded approximately 3 inches from the patient's back, the patient could not be positioned supine, and was anesthetized and intubated in the right semi-prone position prior to being placed prone on the operating room table. The needle was surgically exposed, cut off at the pedicular bone edge, and its free component was removed.

Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial--the PINOCCHIO trial.

BACKGROUND: Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient.We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. METHODS/DESIGN: After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl.The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale) preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation.Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight) and to the preoperative score index for delirium. DISCUSSION: The results of this comparative anaesthesiological trial should whether each the three hypnotics tested is related to a significantly different postoperative delirium rate. This information could ultimately allow us to select the most appropriate hypnotic to maintain anaesthesia for specific subgroups of patients and especially for those at high risk of postoperative delirium. REGISTERED AT TRIAL.GOV NUMBER: ClinicalTrials.gov: NCT00507195.