Bilateral Spigelian Hernias Robotic Repair: A Novel Approach to a Rare Surgical Entity.

Spigelian hernias are an uncommon protrusion defect noted between the rectus abdominis and the transversus abdominis muscles, at the semilunar line, with a low incidence of approximately 0.12% to 2% of all ventral hernias. Furthermore, the incidence of bilateral cases is noted to be even lower in the general population. They are associated with bowel incarceration and strangulation; hence surgical repair is indicated. Therapeutic alternatives for Spigelian hernias include open repair, however laparoscopic repair stands as the standard of care in these cases. Feasible and successful robotic repair has been reported, with associated advantages in terms of visualization and surgical instrument dexterity. We present the first ever reported cases of bilateral Spigelian hernias repaired using robotic approach. Two female Puerto Rican patients referred to our institution complaining of abdominal pain, where imaging studies found bilateral Spigelian hernias. In both cases, a transabdominal preperitoneal repair was performed using the Da Vinci Surgical System. Both patients were discharged home tolerating oral intake with adequate wound healing. On follow up visits, patients denied abdominal discomfort and had adequate wound healing. Robotic surgery for Spigelian hernias poses an advantage over laparoscopic repair as improved visualization, mobility, and precision in movements allow for more gentle tissue manipulation. Furthermore, this is the first evidence of safe and effective repair in the uncommon entity of bilateral cases, providing a newer alternative in the setting of such presentation.

Antioxidant Responses and Phytochemical Accumulation in Raphanus Species Sprouts through Elicitors and Predictive Models under High Temperature Stress.

Crop production is being impacted by higher temperatures, which can decrease food yield and pose a threat to human nutrition. In the current study, edible and wild radish sprouts were exposed to elevated growth temperatures along with the exogenous application of various elicitors to activate defense mechanisms. Developmental traits, oxidative damage, glucosinolate and anthocyanin content, and antioxidant capacity were evaluated alongside the development of a predictive model. A combination of four elicitors (citric acid, methyl jasmonate-MeJa, chitosan, and K2SO4) and high temperatures were applied. The accumulation of bioactives was significantly enhanced through the application of two elicitors, K2SO4 and methyl jasmonate (MeJa). The combination of high temperature with MeJa prominently activated oxidative mechanisms. Consequently, an artificial neural network was developed to predict the behavior of MeJa and temperature, providing a valuable projection of plant growth responses. This study demonstrates that the use of elicitors and predictive analytics serves as an effective tool to investigate responses and enhance the nutritional value of Raphanus species sprouts under future conditions of increased temperature.

Promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions are associated with tumor differentiation, nodal involvement and survival.

Differentially methylated regions (DMRs) can be used as head and neck squamous cell carcinoma (HNSCC) diagnostic, prognostic and therapeutic targets in precision medicine workflows. DNA from 21 HNSCC and 10 healthy oral tissue samples was hybridized to a genome-wide tiling array to identify DMRs in a discovery cohort. Downstream analyses identified differences in promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions associated with tumor differentiation, nodal involvement and survival. Genome-wide DMR analysis showed 2,565 DMRs common to the three subsites. A total of 738 DMRs were unique to laryngeal cancer (n=7), 889 DMRs were unique to oral cavity cancer (n=10) and 363 DMRs were unique to pharyngeal cancer (n=6). Based on the genome-wide analysis and a Gene Ontology analysis, 10 candidate genes were selected to test for prognostic value and association with clinicopathological features. TIMP3 was associated with tumor differentiation in oral cavity cancer (P=0.039), DAPK1 was associated with nodal involvement in pharyngeal cancer (P=0.017) and PAX1 was associated with tumor differentiation in laryngeal cancer (P=0.040). A total of five candidate genes were selected, DAPK1, CDH1, PAX1, CALCA and TIMP3, for a prevalence study in a larger validation cohort: Oral cavity cancer samples (n=42), pharyngeal cancer tissues (n=25) and laryngeal cancer samples (n=52). PAX1 hypermethylation differed across HNSCC anatomic subsites (P=0.029), and was predominantly detected in laryngeal cancer. Kaplan-Meier survival analysis (P=0.043) and Cox regression analysis of overall survival (P=0.001) showed that DAPK1 methylation is associated with better prognosis in HNSCC. The findings of the present study showed that the HNSCC subsites oral cavity, pharynx and larynx display substantial differences in aberrant DNA methylation patterns, which may serve as prognostic biomarkers and therapeutic targets.

The pathway to the natural gas industry: Financial development, coal consumption, and carbon dioxide emissions in P.R. China.

This paper revisits the causal links between financial development, coal consumption, and CO2 emissions in P.R. China over the 1977-2017 period to validate the development of its natural gas industry. It uses a Bootstrap ARDL bound test with structural breaks to establish stationarity, short- and long-run dynamics, and causality of the series. The results show there are no long-run relationships among these three variables, but a Granger causality test does indicate the presence of both a two-way Granger causality between coal consumption and CO2 emissions, and a one-way Granger causality running from financial development to both coal consumption and CO2 emissions. These results have important policy implications for the Chinese government's efforts to meet its commitment at the 75th UN General Assembly to achieve carbon neutrality. In that context, the promotion of its natural gas industry, including carbon pricing mechanisms and taxation schemes while enacting environmentally friendly energy abatement policies become a must.

The Diverse Biological Activity of Recently Synthesized Nitro Compounds.

The search for new and efficient pharmaceuticals is a constant struggle for medicinal chemists. New substances are needed in order to treat different pathologies affecting the health of humans and animals, and these new compounds should be safe, effective and have the fewest side effects possible. Some functional groups are known for having biological activity; in this matter, the nitro group (NO2) is an efficient scaffold when synthesizing new bioactive molecules. Nitro compounds display a wide spectrum of activities that include antineoplastic, antibiotic, antihypertensive, antiparasitic, tranquilizers and even herbicides, among many others. Most nitro molecules exhibit antimicrobial activity, and several of the compounds mentioned in this review may be further studied as lead compounds for the treatment of H. pylori, P. aeruginosa, M. tuberculosis and S. mutans infections, among others. The NO2 moiety triggers redox reactions within cells causing toxicity and the posterior death of microorganisms, not only bacteria but also multicellular organisms such as parasites. The same effect may be present in humans as well, so the nitro groups can be considered both a pharmacophore and a toxicophore at the same time. The role of the nitro group itself also has a deep effect on the polarity and electronic properties of the resulting molecules, and hence favors interactions with some amino acids in proteins. For these reasons, it is fundamental to analyze the recently synthesized nitro molecules that show any potential activity in order to develop new pharmacological treatments that enhance human health.

Bedside Intraperitoneal Chemotherapy for Recurrent Pseudomyxoma Peritonei, an Alternative to Current Methods in a Low-Resource Tertiary Center.

Pseudomyxoma peritonei (PMP) is a condition presenting with tumors of the abdominal cavity presenting which could lead abdominal distention and ascites secondary to mucus production. Tumors of this type are potentially fatal due to their obstructing of abdominal structures. The current management of the condition includes surgical debulking with intraoperative or postoperative chemotherapy with protocols such as hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy (EPIC), respectively. We describe herein a case in which a tumor debulking surgery was performed. Afterwards, we placed intraperitoneal catheters so that a 4-day regimen of bedside intraperitoneal 5-fluorouracil chemotherapy could be administered on her bedside. Chemotherapy was infused and removed with the use of Hemovac and Jackson-Pratt drainage catheter systems attached to suction, for the intrahospital management of recurrent PMP in a young Hispanic female patient. Though it requires further study, we propose this method as a safe and effective alternative to current strategies at low income or resources centers.

Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients.

PURPOSE: To compare clinical, surgical, and cost outcomes in patients undergoing head and neck free-flap reconstructive surgery in the setting of postoperative intensive care unit (ICU) against general floor management. METHODS: Retrospective analysis of head and neck free-flap reconstructive surgery patients at a single tertiary academic medical center. Clinical data was obtained from medical records. Cost data was obtained via the Mayo Clinic Rochester Cost Data Warehouse, which assigns Medicare reimbursement rates to all professional billed services. RESULTS: A total of 502 patients were included, with 82 managed postoperatively in the ICU and 420 on the general floor. Major postoperative outcomes did not differ significantly between groups (Odds Ratio[OR] 1.54; p = 0.41). After covariate adjustments, patients managed in the ICU had a 3.29 day increased average length of hospital stay (Standard Error 0.71; p < 0.0001) and increased need for take-back surgery (OR 2.35; p = 0.02) when compared to the general floor. No significant differences were noted between groups in terms of early free-flap complications (OR 1.38;p = 0.35) or late free-flap complications (Hazard Ratio 0.81; p = 0.61). Short-term cost was $8772 higher in the ICU (range = $5640-$11,903; p < 0.01). Long-term cost did not differ significantly. CONCLUSION: Postoperative management of head and neck oncologic free-flap patients in the ICU does not significantly improve major postoperative outcomes or free-flap complications when compared to general floor care, but does increase short-term costs. General floor management may be appropriate when cardiopulmonary compromise is not present.

A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space.

Medullary thyroid cancer (MTC) represents less than 1% of all thyroid cancers. Complete surgical resection remains the mainstay of treatment for locoregional disease. Unfortunately, patients with recurrence may present with metastasis to challenging anatomic locations. We describe the first case of a recurrent MTC metastatic to the parapharyngeal space (PPS) that was managed using a combined transoral robotic surgery (TORS) and transcervical (TC) approach. We review the presentation, natural history, diagnosis and management of recurrent MTC, and describe a novel combined TORS-TC surgical approach for the treatment of PPS metastasis. A 66-year-old male with history of MTC treated with total thyroidectomy in 2000 and a liver resection in 2011 for metastatic MTC was referred to our Head and Neck Surgery Clinic in October 2016 due to increased calcitonin and CEA levels. Exam was significant for mild right tonsillar/pharyngeal bulging and induration. Imaging with PET-CT and MRI showed an enlarging ovoid mass centered within the right PPS without the presence of another systemic metastasis. FNA was consistent with MTC. The patient was taken to the operating room for a combined TORS-TC approach. Final pathology was consistent with metastatic MTC. Until recently, PPS tumors have been managed using highly morbid and cosmetically disfiguring open surgical approach. TORS provides a safe and effective alternative.

Atrición dental severa y sus factores asociados: un estudio de casos y controles / Severe dental attrition and its associated factors: a case-control study

BACKGROUND: Severe attrition is a type of dental wear caused by friction of tooth surfaces with each other. Although it is a frequent condition, it is not known what are the factors associated with its appearance. Objective: To relate factors such as: age, sex, origin, number of residual teeth, salivary pH and bruxism, with severe dental attrition. Design: cases and controls Patients: a total of 237 patients, 79 cases, with dental attrition grades 2, 3 and 4 according to the Smith and Knight index and 158 controls, with attrition grades 0 and 1. A clinical and photographic analysis was performed to determine the relationship between Dental attrition and factors such as age, sex, origin, number of residual teeth, salivary pH and bruxism. RESULTS: After a bivariate analysis, it was observed that patients older than 25 years (OR = 2.47 CI = 1.41 - 4.35 X2 = 10.21 p = 0.001), with less than 20 residual teeth in the mouth (OR = 4.95 CI = 1.47 - 16.62 X2 = 7.97 p = 0.004) and with bruxism (OR = 2.64 CI = 1.45 - 4.81 X2 = 10.49 p = 0.001), Are more likely to have severe dental attrition. After a binary logistic regression, the statistically significant relationship of these factors with severe dental attrition was confirmed. Conclusions: Severe dental attrition has a statistically significant relationship with age, number of residual teeth in the mouth and bruxism.

Antecedentes: la atrición severa es un tipo de desgaste dental causado por fricción de superficies dentarias entre sí. A pesar de ser una condición frecuente, no se conoce cuáles son los factores asociados con su aparición. Objetivo: Relacionar factores como: edad, sexo, procedencia, número de dientes residuales, pH salival y bruxismo, con la atrición dental severa. Diseño: casos y controles Pacientes: un total de 237 pacientes, 79 casos, con atrición dental grados 2, 3 y 4 según el índice de Smith y Knight y 158 controles, con atrición grados 0 y 1. Se realizó un análisis clínico y fotográfico para determinar la relación entre la atrición dental y factores como edad, sexo, procedencia, número de dientes residuales, pH salival y bruxismo. Resultados: Luego de realizar un análisis bivariado se evidenció que los pacientes con 25 años y más (OR= 2,47 IC= 1,41 ­ 4,35 X2= 10,21 p=0,001), con menos de 20 dientes residuales en boca (OR= 4,95 IC= 1,47 ­ 16,62 X2= 7,97 p=0,004) y con bruxismo (OR= 2,64 IC= 1,45 ­ 4,81 X2= 10,49 p=0,001), tienen más probabilidades de presentar atrición dental severa. Luego de una regresión logística binaria se confirmó la relación estadísticamente significativa de dichos factores con la atrición dental severa. Conclusiones: la atrición dental severa tiene una relación estadísticamente significativa con la edad, el número de dientes residuales en boca y el bruxismo.

Estado de conservación de prótesis totales de pacientes de una clínica dental universitaria en Ecuador / State of conservation of total prosthetics of patients of a university dental clinic in Ecuador

Objetivos: Analizar el estado de las prótesis totales removibles en una muestra de pacientes edéntulos bimaxilares, atendidos en la Facultad de Odontología de la Universidad de Cuenca en el periodo 2012-2015. Material y Métodos: estudio descriptivo de corte transversal, que se realizó en 70 pacientes que consultaron y recibieron tratamiento. Se realizó un análisis de los siguientes aspectos: oclusión balanceada bilateral, dimensión vertical oclusal, pérdida de dientes, fracturas, desgaste y año de realización de la prótesis, por medio de un cuestionario y un examen clínico elaborados para el estudio. Resultados: El 97,1% de pacientes presentan alguna condición afectada en su prótesis, el desgaste fue la alteración de mayor frecuencia, con 57,1%, sin embargo la oclusión balanceada bilateral correcta fue, 86%; dimensión vertical correcta, 76%; no hubo pérdida de dientes protésicos en, 90%; y ausencia de fracturas, 84%. Conclusiones: el estado protésico de los pacientes estudiados fue malo, al presentar al menos una alteración en una de sus características, de los cuales, la mayor frecuencia fueron pacientes mujeres, mayores a 45 años y con dos años de haberse realizado sus prótesis. (AU)

Objectives: To analyze the status of total removable prostheses in a sample of bimaxillary edentulous patients, attended at the Faculty of Dentistry of the University of Cuenca in the period 2012-2015. Materials and Methods: a descriptive cross-sectional study was carried out in 70 patients who consulted and received treatment. An analysis of the following aspects was performed: bilateral balanced occlusion, vertical occlusal dimension, tooth loss, fractures, wear and year of the prosthesis, by means of a questionnaire and a clinical examination prepared for the study. Results: 97.1% of patients presented some condition affected in their prosthesis, wear was the most frequent alteration, with 57.1%; however the correct bilateral balanced occlusion was 86%; correct vertical dimension, 76%; there was no loss of prosthetic teeth in, 90%; and absence of fractures, 84%. Conclusions: the prosthetic status of the patients studied was poor, showing at least one alteration in one of its characteristics, of which, the most frequent were female patients, older than 45 years and two years after having had their prosthesis. (AU)

Effect of the composition of extra virgin olive oils on the differentiation and antioxidant capacities of twelve monovarietals.

The effect of the composition of twelve varieties of extra virgin olive oils (EVOOs) on their differentiation based in agronomic criteria and on the antioxidant capacity was studied. Principal component analysis permitted an overview of the samples and their compositions, showing evidence of grouping and correlation between antioxidant capacity, oleuropein and ligstroside derivatives (OLD) and specific extinction at 270. Oleic and linoleic acids, 3,4-DHPEA-EA and p-HPEA-EDA (OLD), unsaturated/saturated ratio and induction time (IT) allowed the correct classification of samples according to year of harvest, ripening stage and variety. The antioxidant capacity of EVOOs was satisfactory predicted through a partial least square model based on ΔK, hydroxytyrosol, pinoresinol, oleuropein derivate and IT. Validation of the model gave a correlation R>0.83 and an error of 7% for independent samples. This model could be a useful tool for the olive industry to highlight the nutritional quality of EVOOs and improve their marketing.

Anesthetic management of a large mediastinal mass for tracheal stent placement / Manejo anestésico de grande massa mediastinal para a colocação de stent traqueal

ABSTRACT The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

RESUMO O manejo anestésico de pacientes com grandes massas situadas no mediastino pode ser complicado por causa dos efeitos da pressão da massa sobre as vias aéreas ou grandes vasos. Relatamos o manejo anestésico bem-sucedido de uma paciente de 64 anos com uma grande massa mediastinal que invadiu os grandes vasos e comprimiu a traqueia. Um stent traqueal foi colocado para aliviar a compressão da traqueia, sob anestesia geral. A ventilação espontânea foi mantida durante o período perioperatório com o uso de uma máscara laríngea clássica. Discutimos a utilidade da máscara laríngea para o manejo da colocação de stent traqueal em pacientes com massas situadas no mediastino.

Anesthetic management of a large mediastinal mass for tracheal stent placement.

The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

Management of abdominal compartment syndrome after transurethral resection of the prostate / Manejo da síndrome do compartimento abdominal pós-ressecção transuretral de próstata

Acute abdominal compartment syndrome is most commonly associated with blunt abdominal trauma, although it has been seen after ruptured abdominal aortic aneurysm, liver transplantation, pancreatitis, and massive volume resuscitation. Acute abdominal compartment syndrome develops once the intra-abdominal pressure increases to 20-25 mm Hg and is characterized by an increase in airway pressures, inadequate ventilation and oxygenation, altered renal function, and hemodynamic instability. This case report details the development of acute abdominal compartment syndrome during transurethral resection of the prostate with extra- and intraperitoneal bladder rupture under general anesthesia. The first signs of acute abdominal compartment syndrome in this patient were high peak airway pressures and difficulty delivering tidal volumes. Management of the compartment syndrome included re-intubation, emergent exploratory laparotomy, and drainage of irrigation fluid. Difficulty with ventilation should alert the anesthesiologist to consider abdominal compartment syndrome high in the list of differential diagnoses during any endoscopic bladder or bowel case.

A síndrome compartimental abdominal aguda é mais comumente associada a trauma abdominal fechado, embora tenha sido observada após ruptura de aneurisma da aorta abdominal, transplante de fígado, pancreatite e reanimação com volume maciço. A síndrome compartimental abdominal aguda surge quando a pressão intra-abdominal aumenta para 20-25 mm Hg e é caracterizada pelo aumento das pressões das vias aéreas, ventilação e oxigenação inadequadas, função renal alterada e instabilidade hemodinâmica. Este relato de caso descreve o desenvolvimento da síndrome compartimental abdominal aguda durante a ressecção transuretral de próstata com ruptura da bexiga extra e intraperitoneal sob anestesia geral. Os primeiros sinais da síndrome compartimental abdominal aguda nesse paciente eram pressões de pico elevadas das vias aéreas e dificuldade para fornecer volumes correntes. O manejo da síndrome de compartimento inclui reintubação, laparotomia exploratória de emergência e drenagem de líquidos de irrigação. A dificuldade na ventilação deve alertar o anestesiologista para que considere a síndrome compartimental abdominal em primeiro lugar na lista de diagnósticos diferenciais durante qualquer caso de endoscopia de bexiga ou intestino.

Preoperative patient education: can we improve satisfaction and reduce anxiety? / Informação pré-operatória ao paciente: podemos melhorar a satisfação e reduzir a ansiedade? / Información preoperatoria al paciente: ¿podemos mejorar la satisfacción y reducir la ansiedad?

BACKGROUND AND OBJECTIVES: Patients' knowledge deficits concerning anesthesia and the anesthesiologist's role in their care may contribute to anxiety. The objective of this study was to develop anesthesia patient education materials that would help improve patient's satisfaction regarding their knowledge of the perioperative process and decrease anxiety in a community hospital with a large Spanish-speaking population. METHODS: A survey (Survey A) in English and Spanish was administered to all adult anesthesiology preoperative clinic patients during a 4-week period. The data were analyzed and then a patient education handout was developed in both English and Spanish to assist with our patients' major concerns. A second survey (Survey B) was administered that was completed after the education handout had been put into use at the clinic. The survey asked for basic demographic information and included questions on satisfaction with regard to understanding of anesthesia as well as worries regarding surgery and pain. RESULTS: In the patients who received the handout, statistically significant improvement was found in the questions that asked about satisfaction with regard to understanding of type of anesthesia, options for pain control, what patients are supposed to do on the day of surgery, and the amount of information given with regard to anesthetic plan. There was no difference in anxiety related to surgery in patients who received the educational handout compared to those patients who did not. CONCLUSIONS: Patient education handouts improved patient's satisfaction regarding their knowledge of the perioperative process but did not reduce anxiety related to surgery. .

JUSTIFICATIVA E OBJETIVOS: A falta de conhecimento dos pacientes em relação à anestesia e ao papel do anestesiologista em sua assistência pode contribuir para a ansiedade. O objetivo deste estudo foi desenvolver materiais explicativos para o paciente sobre a anestesia que poderiam ajudar a melhorar a satisfação do paciente em relação ao seu conhecimento do processo perioperatório e a diminuir a ansiedade em hospital comunitário com uma grande população de língua espanhola. MÉTODOS: Durante quatro semanas, uma pesquisa (Pesquisa A) em inglês e espanhol foi feita no período pré-operatório com todos os pacientes adultos que seriam submetidos à anestesia. Os dados foram analisados e, posteriormente, um folheto explicativo foi desenvolvido em inglês e espanhol para esclarecer as principais preocupações dos pacientes. Uma segunda pesquisa (Pesquisa B) foi feita após a colocação do folheto explicativo em uso na clínica. A pesquisa investigou as informações demográficas básicas e incluiu perguntas sobre a satisfação relacionada à compreensão da anestesia, bem como as preocupações com a cirurgia e a dor. RESULTADOS: Nos pacientes que receberam o folheto houve melhoria estatisticamente significativa em relação às perguntas sobre a satisfação com a compreensão do tipo de anestesia, as opções para o controle da dor, o que os pacientes deveriam fazer no dia da cirurgia, bem como a quantidade de informações prestadas sobre o plano anestésico. Não houve diferença na ansiedade relacionada à cirurgia entre os pacientes que receberam e os que não receberam o folheto educativo. CONCLUSÕES: Os folhetos explicativos melhoraram a satisfação do paciente em relação ao conhecimento do processo perioperatório, mas não reduziram a ansiedade relacionada à cirurgia. .

JUSTIFICACIÓN Y OBJETIVOS: La falta de conocimiento de los pacientes con relación a la anestesia y al papel del anestesista en su asistencia puede contribuir a la ansiedad. El objetivo de este estudio fue desarrollar materiales explicativos para el paciente sobre la anestesia que podrían ayudar a mejorar la satisfacción del paciente respecto a su conocimiento del proceso perioperatorio y a disminuir la ansiedad en un hospital comunitario con una gran población de hablantes de lengua española. MÉTODOS: Durante un período de 4 semanas, se llevó a cabo una investigación (investigación A) en inglés y en español en el período preoperatorio con todos los pacientes adultos que se iban a someter a la anestesia. Se analizaron los datos analizaron y posteriormente se confeccionó un folleto explicativo en inglés y en español para aclarar las principales preocupaciones de los pacientes. Una segunda investigación (investigación B) fue realizada después de que se completó el folleto explicativo que se estaba usando en la clínica. La encuesta solicitó información demográfica básica e incluyó preguntas sobre la satisfacción relacionada con la comprensión de la anestesia y también sobre las preocupaciones relacionadas con la cirugía y el dolor. RESULTADOS: En los pacientes que recibieron el folleto hubo una mejoría estadísticamente significativa con relación a las preguntas sobre la satisfacción con la comprensión del tipo de anestesia, las opciones para el control del dolor, lo que los pacientes deberían hacer el día de la cirugía, como también la cantidad de informaciones prestadas sobre el plan de anestesia. No hubo diferencia en la ansiedad relacionada con la cirugía entre los pacientes que recibieron y los que no recibieron el folleto educativo. CONCLUSIONES: Los folletos explicativos mejoraron la satisfacción del paciente respecto al conocimiento del proceso perioperatorio, pero no redujeron la ansiedad relacionada con la cirugía. .

[Preoperative patient education: can we improve satisfaction and reduce anxiety?]. / Informação pré-operatória ao paciente: podemos melhorar a satisfação e reduzir a ansiedade?

BACKGROUND AND OBJECTIVES: Patients' knowledge deficits concerning anesthesia and the anesthesiologist's role in their care may contribute to anxiety. The objective of this study was to develop anesthesia patient education materials that would help improve patient's satisfaction regarding their knowledge of the perioperative process and decrease anxiety in a community hospital with a large Spanish-speaking population. METHODS: A survey (Survey A) in English and Spanish was administered to all adult anesthesiology preoperative clinic patients during a 4-week period. The data were analyzed and then a patient education handout was developed in both English and Spanish to assist with our patients' major concerns. A second survey (Survey B) was administered that was completed after the education handout had been put into use at the clinic. The survey asked for basic demographic information and included questions on satisfaction with regard to understanding of anesthesia as well as worries regarding surgery and pain. RESULTS: In the patients who received the handout, statistically significant improvement was found in the questions that asked about satisfaction with regard to understanding of type of anesthesia, options for pain control, what patients are supposed to do on the day of surgery, and the amount of information given with regard to anesthetic plan. There was no difference in anxiety related to surgery in patients who received the educational handout compared to those patients who did not. CONCLUSIONS: Patient education handouts improved patient's satisfaction regarding their knowledge of the perioperative process but did not reduce anxiety related to surgery.

Randomized, controlled trial comparing the effects of anesthesia with propofol, isoflurane, desflurane and sevoflurane on pain after laparoscopic cholecystectomy.

BACKGROUND: Pain is the primary complaint and the main reason for prolonged recovery after laparoscopic cholecystectomy. The authors hypothesized that patients undergoing laparoscopic cholecystectomy will have less pain four hours after surgery when receiving maintenance of anesthesia with propofol when compared to isoflurane, desflurane, or sevoflurane. METHODS: In this prospective, randomized trial, 80 patients scheduled for laparoscopic cholecystectomy were assigned to propofol, isoflurane, desflurane, or sevoflurane for the maintenance of anesthesia. Our primary outcome was pain measured on the numeric analog scale four hours after surgery. We also recorded intraoperative use of opioids as well as analgesic consumption during the first 24h after surgery. RESULTS: There was no statistically significant difference in pain scores four hours after surgery (p=0.72). There were also no statistically significant differences in pain scores between treatment groups during the 24h after surgery (p=0.45). Intraoperative use of fentanyl and morphine did not vary significantly among the groups (p=0.21 and 0.24, respectively). There were no differences in total morphine and hydrocodone/APAP use during the first 24h (p=0.61 and 0.53, respectively). CONCLUSION: Patients receiving maintenance of general anesthesia with propofol do not have less pain after laparoscopic cholecystectomy when compared to isoflurane, desflurane, or sevoflurane.