Penthrox® (Methoxyflurane) as an Analgesic for Removal of Circular External Fixators and Minor Procedures during the COVID-19 Pandemic.

Introduction: Methoxyflurane has excellent analgesic properties and is approved for use in the United Kingdom and Ireland since 2015. It is currently used in emergency departments for analgesia during fracture reductions. During the COVID-19 pandemic, with theatre access severely restricted, Penthrox® had the potential to provide adequate pain relief to aid frame and wire removal in the clinic setting. Materials and methods: Patients presenting to the limb reconstruction service elective clinic and requiring frame removal or minor procedures were included in the study. Patients with renal, cardiac or hepatic disease, a history of sensitivity to fluorinated anaesthetic agents and those on any nephrotoxic or enzyme-inducing drugs were excluded. All procedures were performed in an appropriate isolated room in the clinic. Patient demographics, procedure details, visual analogue score, Richmond Agitation Scale and patient satisfaction were recorded. Results: A total of 39 patients were included in the study of which 17 had Ilizarov frames removed, 10 had hexapod removals, nine had heel rings removed and three had an external fixator removed. Eleven patients received additional pain relief in the form of oral analgesia. All patients were satisfied or very satisfied with the experience. One patient required a general anaesthetic for the removal of a wire that could not be removed in the clinic due to bony overgrowth. Conclusion: Patient satisfaction was very high (>95%), and it was possible to perform frame removals and minor procedures in the clinic environment during the COVID-19 pandemic. We see potential for regular use of Penthrox® in the future for the removal of external fixation outside of the operating theatre. Clinical significance: Penthrox as an analgesic for frame adjustments and removals is safe and has the potential for significant financial savings for the National Health Service (NHS). How to cite this article: Debuka E, Birkenhead P, Shah S, et al. Penthrox® (Methoxyflurane) as an Analgesic for Removal of Circular External Fixators and Minor Procedures during the COVID-19 Pandemic. Strategies Trauma Limb Reconstr 2023;18(2):82-86.

Displaced distal tibial Salter-Harris II fractures.

Salter-Harris II fractures of the distal tibia affect children frequently, and when they are displaced present a treatment dilemma. Treatment primarily aims to restore alignment and prevent premature physeal closure, as this can lead to angular deformity, limb length difference, or both. Current literature is of poor methodological quality and is contradictory as to whether conservative or surgical management is superior in avoiding complications and adverse outcomes. A state of clinical equipoise exists regarding whether displaced distal tibial Salter-Harris II fractures in children should be treated with surgery to achieve anatomical reduction, or whether cast treatment alone will lead to a satisfactory outcome. Systematic review and meta-analysis has concluded that high-quality prospective multicentre research is needed to answer this question. The Outcomes of Displaced Distal tibial fractures: Surgery Or Casts in KidS (ODD SOCKS) trial, funded by the National Institute for Health and Care Research, aims to provide this high-quality research in order to answer this question, which has been identified as a top-five research priority by the British Society for Children's Orthopaedic Surgery.

Draft Genome Sequencing of Three Glutaraldehyde-Tolerant Bacteria from Produced Water from Hydraulic Fracturing.

Here, we report the draft genome sequence of three glutaraldehyde-resistant isolates from produced water from hydraulic fracturing operations. The three strains were identified as Marinobacter sp. strain G11, Halomonas sp. strain G15, and Bacillus sp. strain G16. The genome sequences of these isolates will provide insights into biocide resistance in hydraulic fracturing operations.

Local functional overconnectivity in posterior brain regions is associated with symptom severity in autism spectrum disorders.

Although growing evidence indicates atypical long-distance connectivity in autism spectrum disorder (ASD), much less is known about local connectivity, despite conjectures that local overconnectivity may be causally involved in the disorder. Using functional connectivity MRI and graph theory, we found that local functional connectivity was atypically increased in adolescents with ASD in temporo-occipital regions bilaterally. Posterior overconnectivity was found to be associated with higher ASD symptom severity, whereas an ASD subsample with low severity showed frontal underconnectivity. The findings suggest links between symptomatology and local connectivity, which vary within the autism spectrum.

Connecting multiple low-flow intravenous infusions in the newborn: problems and possible solutions.

OBJECTIVE: To compare the efficiency of a stopcock system and a newly designed device to titrate low-flow infusions to critically ill infants. DESIGN: In vitro study comparing fluid delivery through readily available and custom-built equipment. SETTING: Engineering laboratory of a university-affiliated hospital. PATIENTS/SUBJECTS: None. INTERVENTIONS: Two infusion pumps were used to deliver five 0.1-mL/hr infusions and an 8-mL/hr carrier through a conventional stopcock system. A diluted dye was used to quantize the amount of any given infusion reaching the patient. Samples were collected over a 90-min period and analyzed by spectophotometry. Thirty minutes into each trial, the red dye infusion rate was doubled. A multiple infusion connector was manufactured and tested in place of the stopcock system. Without a stopcock system or multiple infusion connector, both an infusion and a syringe pump were tested for accuracy of delivery of 0.1 mL/hr and 0.2 mL/hr of dye infusions. MEASUREMENTS AND MAIN RESULTS: The infusion pump was more accurate than a 60-mL syringe pump in generating infusion rates of both 0.1 mL/hr and 0.2 mL/hr. When delivering a 0.1-mL/hr dye infusion through the distal port of an array of six stopcocks, the actual delivery of a diluted red dye infusion took approximately 32 mins to double after being increased from 0.1 mL/hr to 0.2 mL/hr. When using the multiple infusion connector to connect the low-volume drips together, the same change in flow rate caused the actual delivery of dye to double in <8 mins (a result comparable to the data from the proximal port of a stopcock). This result was independent of which port was used for dye delivery. Streaming of the red dye within the stopcock system was observed. CONCLUSIONS: When using the conventional stopcock array to titrate low-rate infusions, significant delays were observed. A device designed specifically for infusions in infants may substantially improve this system.