The delaying of elective surgeries after COVID-19 infection decreases postoperative complications.

BACKGROUND: Huge controversy surrounds delaying elective surgeries after COVID-19 infection. Although two studies evaluated the issue, several gaps still exist. METHODS: A propensity score matched retrospective single center cohort design was used to evaluate the optimum time of delaying elective surgeries after COVID-19 infection and the validity of the current ASA guidelines in this regard. The exposure of interest was a previous COVID-19 infection. The primary composite included the incidence of death, unplanned Intensive Care Unit admission or postoperative mechanical ventilation. The secondary composite included the occurrence of pneumonia, acute respiratory distress, or venous thromboembolic. RESULTS: The total number of patients was 774, half of them had a history of COVID-19 infection. The analysis revealed that delaying surgeries for 4 weeks was associated with significant reduction in primary composite (AOR = 0.02; 95%CI: 0.00-0.33) and the length of hospital stay (B = 3.05; 95%CI: 0.41-5.70). Furthermore, before implementing the ASA guidelines in our hospital, a significant higher risk for the primary composite (AOR = 15.15; 95%CI: 1.84-124.44; P-value = 0.011) was observed compared to after applying it. CONCLUSION: Our study showed that the optimum period of delaying elective surgery after COVID-19 infection is four weeks, with no further benefits from waiting for longer times. This finding provide further support to the current ASA guidelines about delaying elective surgeries. Further large-scale prospective studies are needed to give more evidence-based support to the appropriateness of the 4-week waiting time for elective surgeries after COVID-19 infection and to investigate the effect of type of surgery on the required delay.

Combining Stellate ganglion block and intravenous regional anesthesia to treat complex regional pain syndrome: A 19-years' experience in a tertiary center.

OBJECTIVES: To study reduction in pain score after treatment with intravenous regional anesthesia (IVRA) and Stellate ganglion block (SGB) combination on complex regional pain syndrome (CPRS) patients and to quantify patients' satisfaction with treatment and occurrence of complications. METHODS: This is a record-based retrospective review carried out in 2020, targeting patients treated in the University of Jordan Hospital, Amman, Jordan, over the years 2002-2020. RESULTS: Among 99 patients, a significant drop in pain scores occurred in 88% of the patients' sample. Gender, age, type of CRPS, and duration of symptoms didn't affect statistical results. An average of 8.6 sessions needed to achieve 50% drop in pain score, and 2-3 sessions for first clinical improvement. Patients with previous application of plaster of Paris had increased success rates. CONCLUSION: We find it practical, inexpensive, safe, and straightforward to combine SGB with IVRA for CRPS patients.

The combinatorial use of propofol-fentanyl-ketamine for sedoanalgesia in patients undergoing urological procedures.

OBJECTIVES: To compare sedoanalgesia achieved using propofol-fentanyl-ketamine (PFK) combination with general anesthesia (GA) in terms of safety, hemodynamic stability, and perioperative complications. METHODS: Patients in the GA group were anesthetized using fentanyl (2 µg kg-1) and propofol (2 mg kg-1). The PFK group was anesthetized using a mixture of which each one ml contains 0.005 mg of fentanyl, 5 mg of propofol, 5 mg of ketamine, and 2 mg of lidocaine. Patients received an initial dose of 0.05 ml kg-1, followed by 0.05 mg kg-1 60 seconds later. Maintenance boluses of 0.025 ml kg-1 were administered every 3-5 minutes. Respiration occurred spontaneously through a simple face mask with 3 L min-1 O2. RESULTS: The GA group had 37 (37%) patients develop hypotensive episodes, compared to one (1%) episode in the PFK group (p<0.001). Five (5%) patients in the PFK group had an episode of transient O2 desaturation, compared to one (1%) patient in the GA group (p=0.212). The duration of induction and termination of anesthesia were significantly shorter in the PFK group (p<0.001). CONCLUSION: The PFK combination herein described is safe, effective, and provides intraoperative hemodynamic stability in patients with multiple comorbidities undergoing urological procedures.

Corrosion behavior, in vitro and in vivo biocompatibility of a newly developed Ti-16Nb-3Mo-1Sn superelastic alloy.

The biocompatibility of a recently developed Ni-free Ti-16Nb-3Mo-1Sn (at.%) superelastic alloy was investigated both in vitro and in vivo. In addition, static water contact angle (WCA) and electrochemical tests were carried out. Commercial purity Ti (cp-Ti), which is already being used as a clinical material, was used as the control material. The alloy showed a stable corrosion behavior similar to that of the cp-Ti. The WCA measurements showed that the alloy exhibited hydrophilic properties that contributed to cell attachment to implants, as evident by the cytocompatibility tests. According to the in vivo implantation tests conducted on 30 adult BALB/c rats for periods up to 12 weeks, the tissue reaction around the implants was similar for both the cp-Ti and the alloy, and no significant difference was found in almost all parameters analyzed. Due to its stable superelastic properties accompanied with excellent biocompatibility and high corrosion resistance, we believe that this alloy is considered as a promising substitute for the biomedical materials containing Ni or other toxic elements.

Effect of dexmedetomidine added to spinal bupivacaine for urological procedures.

OBJECTIVES: To determine the effect of adding dexmedetomidine to bupivacaine for neuraxial anesthesia. METHODS: Sixty-six patients were studied between April and May 2008 in the University of Jordan, Amman Jordan. They were randomly assigned into 3 groups, each receiving spinal bupivacaine 12.5mg combined with normal saline (group N) Dexmedetomidine 5 microg (group D5), or dexmedetomidine 10 microg (group D10). The onset times to reach T10 sensory and Bromage 3 motor block, and the regression times to reach S1 sensory level and Bromage 0 motor scale, were recorded. RESULTS: The mean time of sensory block to reach the T10 dermatome was 4.7 +/- 2.0 minutes in D10 group, 6.3 +/- 2.7 minutes in D5, and 9.5 +/- 3.0 minutes in group N. The mean time to reach Bromage 3 scale was 10.4 +/- 3.4 minutes in group D10, 13.0+/-3.4 minutes in D5, and 18.0 +/- 3.3 minutes in group N. The regression time to reach S1 dermatome was 338.9 +/- 44.8 minutes in group D10, 277.1 +/- 23.2 minutes in D5, and 165.5 +/- 32.9 minutes in group N. The regression to Bromage 0 was 302.9 +/- 36.7 minutes in D10, 246.4 +/- 25.7 minutes in D5, and 140.1 +/- 32.3 minutes in group N. Onset and regression of sensory and motor block were highly significant (N vesus D5, N versus D10, and D5 versus D10, p<0.001). CONCLUSION: Dexmedetomidine has a dose dependant effect on the onset and regression of sensory and motor block when used as an adjuvant to bupivacaine in spinal anesthesia.