Preoperative point-of-care neck ultrasound: beyond the airway.

PURPOSE: A preoperative point-of-care neck ultrasound, carried out during preoperative airway evaluation by extending the scans to the regions close to the larynx and trachea, can allow for the rapid identification of unknown pathologies or abnormalities in a cost-effective and non-invasive manner. This prospective, observational study examines a series of ultrasound findings in structures close to the airway, made through preoperative point-of-care neck ultrasound in a cohort of 230 patients. METHODS: We conducted a prospective observational study, enrolling 230 adult patients selected for elective abdominal surgery. The primary goal was to verify the predictive role of airway ultrasound in identifying difficult airways, while the secondary goal was to evaluate structures close to the airway such as jugular veins, carotid arteries, thyroid gland and soft tissues. RESULTS: Overall, preoperative point-of-care neck ultrasound proved to be an effective and reliable method of obtaining details about local or systemic pathologies, which could affect perioperative care. For example, the exam consistently revealed the presence of carotid plaques or venous congestion, which could be used to best determine the patient's cardiovascular risk or to instigate further investigations. It also allowed for more accurate central venous catheter placement planning and better airway management and it warned about possible thyroid or neoplastic pathologies that would have otherwise remained unknown. In some cases, information from preoperative point-of-care neck ultrasound has even led to modifications in perioperative therapy. CONCLUSION: Preoperative point-of-care neck ultrasound is fast, inexpensive, and non-invasive, and it can be easily performed by a properly trained professional during the preoperative airway ultrasound evaluation. It can be considered as a new preoperative assessment tool.

Clinical use of parnaparin in major and minor orthopedic surgery: a review.

Patients undergoing arthroplasty or other orthopedic surgery show a high risk of venous thromboembolism (VTE), involving mortality, morbidity, and social costs; however, the risk for VTE in minor orthopedic surgery should not be underestimated and antithrombotic prophylaxis may be required. According to the literature, low-molecular-weight heparins (LMWHs) are more effective in preventing VTE than unfractionated heparins (UFHs) or vitamin K antagonists, and have a lower hemorrhagic risk. By comparing different prophylactic regimens, it has been shown that starting the prophylaxis near the time of the operation is the most critical point for efficacy, whether or not the first dose is administered pre- or post-operatively. Moreover, most thromboembolic complications are observed after discharge and, therefore, many clinicians advocate continuing prophylaxis for longer times (6-8 weeks) in order to further reduce the rate for VTE. The literature on parnaparin, a new LMWH, in VTE prophylaxis was reviewed. Parnaparin is equally effective as UFH, but it offers the advantages of a once-daily administration and improved tolerability, thus allowing the home management of patients with no need for laboratory coagulation tests.

Prophylaxis of venous thromboembolism in minor orthopedic surgery with parnaparin.

This study analyzed the efficacy of venous thromboembolism prophylaxis in knee arthroscopy in 509 patients who received Parnaparin (Alfa Wassermann, Bologna, Italy), 3200 IU to 4250 IU daily, after minor arthroscopic knee surgery. No proximal deep venous thrombosis or other thromboembolic events occurred. Adverse events related to the treatment with Parnaparin were observed in 2 of 172 patients treated with 3200 IU/d and in 6 of 337 patients treated with 4250 IU/d, without any evidence of dose-proportionality in the incidence. Prophylaxis with a low-molecular-weight heparin such as Parnaparin should be considered in all patients who will be undergoing a procedure in which a tourniquet is used. If Parnaparin is used, it should be started immediately after knee arthroscopy at doses of 3200 to 4250 IU/d, according to the characteristics of the patients. Depending on the patient's risk factors, postoperative prophylaxis for 10 days may be appropriate.