Assessments of perioperative respiratory pattern with non-contact vital sign monitor in children undergoing minor surgery: a prospective observational study.

PURPOSE: Nurses routinely assess respiration of hospitalized children; however, respiratory rate measurements are technically difficult due to rapid and small chest wall movements. The aim of this study is to reveal the respiratory status of small children undergoing minor surgery with load cells placed under the bed legs, and to test the hypothesis that respiratory rate (primary variable) is slower immediately after arrival to the ward and recovers in 2 h. METHODS: Continuous recordings of the load cell signals were performed and stable respiratory waves within the 10 discriminative perioperative timepoints were used for respiratory rate measurements. Apnea frequencies were calculated at pre and postoperative nights and 2 h immediately after returning to the ward after surgery. RESULTS: Continuous recordings of the load cell signals were successfully performed in 18 children (13 to 119 months). Respiratory waves were appraisable for more than 70% of nighttime period and 40% of immediate postoperative period. There were no statistically significant differences of respiratory rate in any timepoint comparisons (p = 0.448), thereby not supporting the study hypothesis. Respiratory rates changed more than 5 breaths per minute postoperatively in 5 out of 18 children (28%) while doses of fentanyl alone did not explain the changes. Apnea frequencies significantly decreased 2 h immediately after returning to the ward and during the operative night compared to the preoperative night. CONCLUSION: Respiratory signal extracted from load cell sensors under the bed legs successfully revealed various postoperative respiratory pattern change in small children undergoing minor surgery. CLINICAL TRAIL REGISTRATION: UMIN (University Hospital Information Network) Clinical Registry: UMIN000045579 ( https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052039 ).

An evidence-based review of optimal perioperative practices in minor hand surgery.

BACKGROUND: Like many surgical subspecialties, there have been frequent advancements and discoveries in the field of hand and upper extremity surgery. With a rapidly growing literature base, it can be difficult to remain updated on the latest recommendations. METHODS: A comprehensive literature search was completed on PubMed using MeSH terms. Topics included nutrition management, anticoagulation, immunosuppressive medication management, antibiotic use, skin preparation, splinting, tourniquet use, and suture choice. Data from articles with a level of evidence 1A-3 C were included. RESULTS: A total of 42 articles were identified and reviewed to provide evidence for recommendations regarding various aspects of pre-, intra-, and post-operative care. CONCLUSIONS: The objective of this manuscript is to serve as a resource for evidence-based recommendations by the findings of recent evidence related to perioperative care in elective hand surgery. Additional studies are required in certain areas of the literature in order to provide stronger recommendations.

Eficacia del óxido nitroso como sedoanalgesia en pacientes pediátricos para procedimientos menores en áreas de hospitalización y urgencias / Efficacy of nitrous oxide as sedoanalgesia in pediatric patients for minor procedures in hospitalization and emergency areas. Bibliographic review

Objetivo: Conocer la utilización del óxido nitroso en procedimientos menores invasivos en pacientes pediátricos hospitaliza-dos y/o atendidos en servicios de urgencias. Método: Revisión bibliográfica. Se consultaron las bases Pub-Med, Scielo y Cochrane. Como criterios de inclusión se consideró idioma castellano e inglés y, últimos 10 años de publicación. Resultados: Se incluyeron 11 artículos: ensayos clínicos aleatoriza-dos, revisiones sistemáticas y estudios observaciones de cohortes. El intervalo de edad de utilización es de 3-6 años. La concentración recomendada del medicamento es 50-50. La eficacia del fármaco se describe para procedimientos dolorosos breves, accesos venosos, curas de heridas, sondajes vesicales, extracción de cuerpos extraños, drenajes de abscesos, punciones lumbares y reducción de fracturas, entre otros. Los efectos adversos son leves y se describen en menos del 10% de los estudios estando relacionados con mareos, cefalea, náuseas y vómitos. Se precisa administrar analgésico tópico previo. Profesionales de la salud, padres y pacientes refieren recomendar su uso. Discusión: Algunos estudios se realizan en muestras de edades amplias entre 1-18 años. Pocos estudios especifican el tipo de procedimiento que se llevó a cabo, y los que lo hacen coinciden en los tipos de procedimientos realizados. Todos los artículos recomiendan la administración de un analgésico previo. No todos los estudios hacen referencia a la satisfacción con la utilización del fármaco en los procedimientos. Se debe utilizar en procedimientos que no duren más de 15 minutos y los profesionales deben poseer competencias en el manejo de la vía aérea. Conclusiones: El óxido nitroso es un fármaco eficaz para la sedación en pacientes pediátricos. (AU)

Objective: To know the efficacy of nitrous oxide in minor invasive proce-dures in hospitalized pediatric patients or in emergency services. Methods and design: Bibliographic review. PubMed, Scielo and Cochrane databases were consulted. Spanish and English language and the last 10 years of publication were considered as inclusion criteria. Results: Eleven articles were included: randomized clinical trials, systematic reviews, and observational cohort studies. The age range was 3-6 years. The recommended concentration is 50-50. The efficacy of the drug is recom-mended for painful procedures, brief venous access, wound care, bladder catheters, extraction of foreign bodies, abscess drainage, lumbar punctures, reduction of fractures, among others. Adverse effects are mild and are de-scribed in less than 10% of the studies as being related to dizziness, head-ache, nausea, and vomiting. It is necessary to administer a previous topical analgesic. Health professionals, parents and patients report recommending its use. Discussion: Some studies are carried out in ages between 1-18 years. Few studies name the type of procedure that was carried out, those that do agree on the types of procedures performed. All the articles name the administration of a previous analgesic. Not all studies refer to satisfaction with the use of the drug in procedures. It should be used in procedures that last no more than 15 minutes and professionals should have skills in airway management.Conclusions: Nitrous oxide is an effective drug for sedation in pediatric patients. (AU)

Comparison of Ambu AuraGain and BlockBuster laryngeal mask for controlled ventilation in children undergoing minor surgical procedures under general anesthesia: A prospective randomized controlled study.

BACKGROUND: Ambu AuraGain has proven to be better compared with other supraglottic airway devices in terms of higher first-attempt insertion success rate, time and ease of insertion, high oropharyngeal leak pressure, and fewer complications in children. The performance of the BlockBuster laryngeal mask has not been evaluated in children. AIMS: The primary objective of this study was to compare the oropharyngeal leak pressure of the BlockBuster laryngeal mask with those of the Ambu AuraGain during controlled ventilation in children. METHODS: Fifty children aged 6 months to 12 years with normal airways were randomized into group A (Ambu AuraGain) and group B (BlockBuster laryngeal mask). After administration of general anesthesia, an appropriate size supraglottic airway (size 1.5/2.0/2.5) was inserted according to the groups. Oropharyngeal leak pressure, success and ease of supraglottic airway insertion, gastric tube insertion, and ventilatory parameters were noted. The glottic view was graded by fiberoptic bronchoscopy. RESULTS: Demographic parameters were comparable. The mean oropharyngeal leak pressure in the BlockBuster group (24.72 ± 6.81 cm H2 O) was significantly higher than Ambu AuraGain group (17.20 ± 4.28 cm H2 O) by 7.52 cm H2 O (95% CI 4.27 to 10.76; p = 0.001). The mean time for supraglottic airway insertion in the BlockBuster and Ambu AuraGain group was 12.04 ± 2.55 s and 13.64 ± 2.76 s, respectively (mean difference- 1.6 s, 95% CI 0.09-3.12; p = 0.04). Ventilatory parameters, first-attempt supraglottic airway insertion success rate, and ease of gastric tube insertion were comparable between the groups. The BlockBuster group showed easy supraglottic airway insertion compared with the Ambu AuraGain group. The BlockBuster group had better glottic views with only the larynx seen in 23 out of 25 children compared to the Ambu AuraGain with only the larynx seen in 19 out of 25 children. No complication was noted in either group. CONCLUSIONS: We found that the BlockBuster laryngeal mask has higher oropharyngeal leak pressure compared with Ambu AuraGain in a pediatric population.

Office-Based Minor Surgery: An Ever-Increasing Challenge Not Only for the Dutch General Practitioner.

BACKGROUND AND OBJECTIVES: Office-based minor surgery (OBMS) refers to all surgical procedures performed under local anesthetic in the office setting. It is cost effective for the health economy, safe, and appreciated by patients. It is not yet fully understood why some general practitioners (GPs) perform OBMS and others do not, while there is a growing demand for OBMS. Therefore, we explored factors that influence the performance of OBMS by GPs. The aim of this study is to explore the facilitators and barriers that influence GPs in deciding whether to perform OBMS. METHODS: We performed a qualitative study using focus groups consisting of GPs and GP trainers. Two researchers analyzed the data independently. RESULTS: The analysis resulted in a comprehensive list of facilitators and barriers. Besides already known factors such as financial consequences and geographic location, the most important factors influencing the decision to perform OBMS were training and the role of the GP trainer; fear of having to work alone and having to solve unexpected complications; and the influence of collaboration, organization, and facilities in the GP's own practice. CONCLUSIONS: The increasing demand for OBMS in primary care centers requires more attention to training aspects, the existing fear, adequate reimbursement for special accreditation, and collaboration and organization. We expect that addressing these factors will result in the strengthening of primary care, improving patient safety, lower referral rates, and a reduction in health care costs.

Minor surgery in primary care has reduced minor surgery waiting lists: a 12-month review.

BACKGROUND: To investigate minor procedures performed in general practice, to alleviate the burden on the economy, patients and secondary care physicians. AIMS: To determine the range of minor surgical procedures performed in a single group general practice, subsequent referrals made to secondary care, follow-up surgical procedures required and post-operative complications within a patient group. METHODS: Retrospective data collection from the electronic records of a single group general practice consisting of 5101 active patients within the previous 12 months. Through use of Socrates software program and statistical analysis, patients were stratified into demographics, including, age, gender, the cost of the procedure, the type of procedure being carried out, the post-operative referral rate to secondary care and any subsequent procedures required. The patients were excluded if their minor procedure was classified as a joint injection. RESULTS: 133 procedures were carried out over the 12-month period. Of these patients, the majority were male, and the mean age was 44 years old. The most common procedures included the removal of ingrown toenails, lesion excisions and punch biopsies. Histological analysis was done on biopsies, with a low rate of misdiagnosis pre-operatively. Additionally, there were minimal referrals and no complications recorded. CONCLUSIONS: This study has demonstrated the ability for minor surgery to be safely carried out in primary care. The integration of general practice, general surgery and plastic surgery could provide a higher level of patient care and exchange of skills to help reduce waiting lists and alleviate the burden secondary care.

Técnica modificada Mölndal/Jubilee frente a tratamiento tradicional en heridas quirúrgicas tras cirugía menor en atención primaria / The modified Mölndal/Jubilee technique versus traditional treatment for minor surgical wounds in primary care

Objetivos: General: Comparar la técnica de cura en ambiente húmedo Mölndal/Jubilee modificada para las suturas en cirugía menor ambulatoria, en relación con la cura seca. Específicos: a) medir el tiempo de cicatrización en días entre la técnica Mölndal/Jubilee modificada y la cura seca; b) número de curas realizadas en cada técnica y tiempo en minutos invertido en cada técnica; c) valorar el dolor en cada técnica, y d) comparar las complicaciones aparecidas en cada técnica. Metodología: Ensayo de intervención longitudinal prospectivo multicéntrico y aleatorizado, con grupo control, para evaluar la eficacia de una metodología de cura aplicada tras cirugía menor en atención primaria. La muestra se compone de los pacientes cuyo procedimiento quirúrgico finaliza con sutura. Resultados: Los días hasta la retirada de la sutura invertidos en el grupo intervención fueron de media 9,2 días, con una desviación típica de 2,1, mientras que en el grupo control se emplearon 10,5 días, con una desviación de 2,3. El número de curas que se realizaron en el grupo intervención hasta la retirada de la sutura resultaron de 2 en 45 pacientes (46,9%), 45 pacientes 3 visitas (46,9%) y 6 (6,2%) 4 visitas. En el grupo control no hubo ningún paciente que necesitara menos de 3 visitas; con 3 visitas 18 pacientes (18,8%) del grupo, 4 visitas 41 (42,7%), 5 visitas 30 pacientes (31,2%) y con 7 visitas 7 pacientes (7,3%). El tiempo medio invertido en cada visita para el grupo intervención fue de 2,7 min con una desviación de 0,6 y para el grupo control de 3,1 min con desviación de 0,6. El dolor medio, escala visual analógica, en el grupo intervención se posicionó en 0,5, con desviación típica de 1,0, y de 2,1 para el grupo control con desviación de 1,2. Las complicaciones supusieron el 6,2% en el grupo intervención, 6 complicaciones, en el grupo control se apreciaron 27, el 28,1% (AU)

Objectives: General: Compare the healing technique in a wet environment (Mölndal/Jubilee modified by Grupo Heridas Axarquia) for surgical wounds in minor outpatient surgery, in relation to a dry healing. Specific:a) measure the healing time between the modified technique Mölndal/Jubilee and the dry healing; b) number of cures in each technique and the time spent in both techniques; c) assess the pain in each technique; and d)compare the complications that appear in each technique. Methodology:Multicenter, randomized, control-group, prospective longitudinal intervention trial to evaluate the efficacy of a cure methodology applied after minor surgery in primary care. The sample includes patients whose surgical procedure ends up with suture. Results: The days up to the removal of the inverted suture in the intervention group were on average 9.2 days with a standard deviation of 2.1, while in the control group 10.5 days were used with a deviation of 2.3. The number of cures that were performed in the intervention group until the suture was removed was 2 in 45 patients (46.9%), 3 visits in 45 patients (46.9%) and 4 visits (6.2%) in 6 patients. In the control group there were no patients who needed less than 3 visits; with 3 visits, 18 patients (18.8%) of the group, 4 visits, 41 patients (42.7%), 5 visits 30 patients (31.2%) and with 7 visits 7 patients (7.3%). The average time spent on each visit for the intervention group was 2.7 minutes with a deviation of 0.6 and for the control group 3.1 with a deviation of 0.6. Average pain, analog visual scale, in the intervention group was positioned at 0.5 with standard deviation of 1.0 and 2.1 for control with deviation of 1.2. Complications accounted for 6.2% in the intervention group, 6 complications, and in the control, 27 and 28.1% (AU)

How can competencies in minor surgery in general practice be increased? Assessing the effect of a compact intervention in postgraduate training: a mixed-methods study.

OBJECTIVES: We aimed to assess general practice (GP) trainees' self-perception of surgical competencies and to explore longitudinal effects of a compact intervention. DESIGN: We performed a mixed-methods study including a before and after comparison in the intervention group (IG), a comparison of attendees and non-attendees (control group (CG)) and a qualitative evaluation of the intervention. Competencies were self-assessed through surveys. Semi-structured interviews were performed after 9 months. SETTING: In 2019, a 2-day voluntary seminar focussing on minor surgery/injuries was offered on 13 occasions by educators from KWBW Verbundweiterbildungplus (Competence Centre for Postgraduate Medical Education Baden-Württemberg). PARTICIPANTS: All enrolled GP trainees were offered participation. GP trainees who did not attend a seminar (non-attendees) were recruited for CG after the 13th intervention. INTERVENTION: Attendees took part in an interactive, GP-oriented short course incorporating 270 min of focused minor surgery/injuries training (compact intervention) on the second day of the 2-day seminar. RESULTS: 326 GP trainees (IG: n=257; CG: n=69) participated in the study. 17 attendees were interviewed. CG had more often experienced a surgical rotation (p=0.03) and reported higher interest in performing minor surgery in future practice (p=0.03). GP trainees self-rated their all-round competency in minor surgery as average (IG: 3.0±1.0, CG: 3.2±0.9, IG:CG p=0.06). After the intervention, attendees felt that surgical skills should be a core component of GP vocational training (p=0.05). After 9 months, attendees remembered a variety of content and valued the interactive, case-oriented, peer-to-peer approach in a mixed learning group. Some attendees reported they had started to overcome competency gaps in minor surgery. CONCLUSIONS: A compact intervention in minor surgery provides an 'intense' stimulus which could foster positive attitudes towards minor surgery and promote longitudinal personal development of related competencies in GP trainees, including those with little interest in surgery. Such measures appear crucial to support individual progress of GP trainees to provide comprehensive primary care.

Low Infection Rate for Hand Fractures Managed with Surgical Fixation under Wide-Awake Local Anesthesia with No Tourniquet in Minor Surgery.

BACKGROUND: The purpose of this study was to review the rate and type of infectious complications after surgical fixation of hand fractures managed under wide-awake local anesthesia with no tourniquet (WALANT) in minor procedure rooms outside the main operating room. METHODS: A two-surgeon retrospective chart review was performed of patients who received surgical fixation of hand fractures under WALANT in minor surgery from March of 2014 to March of 2019. RESULTS A TOTAL OF: patients, with distal phalanx ( n = 16), middle phalanx ( n = 7), proximal phalanx ( n = 11), or metacarpal ( n = 26) fractures, were included in the study. The average patient age was 37 years, with a higher proportion of male patients (51:7). Two patients had two fractures each. Thirty of the 58 cases were already open fractures. Fixation was performed using either plates and screws (25 of 58) or nonburied Kirschner wires (31 of 58). Thirty-six percent of patients (21 of 58) were treated with prophylactic antibiotics. One patient developed postoperative cellulitis. The only case of osteomyelitis occurred in a patient with risk factors known to increase rates of infectious complications (open fracture, smoking history, and >24 hours from injury to treatment). No infectious complications occurred in those who sustained closed fractures. CONCLUSIONS: Although the minor surgery environment varies significantly from that of the main operating room, infection rates after surgical fixation of hand fractures using WALANT in this setting remain low (3.4 percent), with no documented infections in fractures that were referred closed and opened surgically for operative fixation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Adaptation of Parental Self-Efficacy Scale for Child Autonomy Toward Minor Surgery to Turkish.

PURPOSE: The purpose of the study was to conduct validity and reliability testing of the Turkish version of the Parent Self-Efficacy Scale for Child Autonomy toward Minor Surgery (PSESCAMS). DESIGN: The research is a methodological study. METHODS: Data were collected using an Introductory Form and the PSESCAMS. Factor analysis, Cronbach's alpha, and item-total score analysis were used for the data analysis. FINDINGS: The scale consisted of 18 items and four subscales. The Cronbach's alpha coefficient for the overall scale was 0.95, and the Cronbach's alpha values for the subscales were 0.64-0.92. The total factor loading was > 0.45 for both exploratory and confirmatory factor analyses. GFI, AGFI, and CFI were > 0.90, RMSEA was 0.06. CONCLUSION: PSESCAMS was found to be a valid and reliable measurement tool for Turkish culture.

Continuing versus withholding angiotensin receptor blocker (ARB)/calcium channel blocker (CCB) combination tablets during perioperative periods in patients undergoing minor surgery: a single-blinded randomized controlled trial.

PURPOSE: This trial was conducted to compare effects of continuing versus withholding single-pill combination tablets consisting of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) on perioperative hemodynamics and clinical outcomes. METHODS: Patients undergoing minor abdominal or urological surgery (n = 106) were randomly assigned to Group C, in which ARB/CCB combination tablets were continued until surgery, or Group W, in which they were withheld within 24 h of surgery. Perioperative hemodynamics and clinical outcomes were compared between the Groups. RESULTS: The incidence of hypotension during anesthesia requiring repeated treatment with vasoconstrictors was higher in Group C than Group W (p = 0.0052). Blood pressure during anesthesia was generally lower in Group C than Group W (p < 0.05) despite significantly more doses of ephedrine and phenylephrine administrated in Group C (p = 0.0246 and p = 0.0327, respectively). The incidence of postoperative hypertension did not differ between Groups (p = 0.3793). Estimated glomerular filtration rate (eGFR) on the preoperative day did not differ between Groups (p = 0.7045), while eGFR was slightly lower in Group C than Group W on the first and third postoperative days (p = 0.0400 and p = 0.0088, respectively), although clinically relevant acute kidney injury did not develop. CONCLUSIONS: Continuing ARB/CCB combination tablets preoperatively in patients undergoing minor surgery increased the incidence of hypotension during anesthesia, increased requirements of vasoconstrictors to treat hypotension, and might deteriorate postoperative renal function, albeit slightly. These results suggest that withholding ARB/CCB tablets preoperatively is preferable to continuing them. CLINICAL TRIAL REGISTRATION: This trial is registered with the Japan Registry of Clinical Trials (jRCT) at Japanese Ministry of Health, Labour, and Welfare (Trial ID: jRCT1031190027).

Development and Implementation of a Neonatal Pain Management Guideline for Minor Surgeries.

BACKGROUND: Although opioids are effective for neonatal postoperative pain management, cumulative opioid exposure may be detrimental. Pain management practices vary among providers, but practice guidelines may promote consistency and decrease opioid use. PURPOSE: To develop a pain management guideline (PMG) for neonates undergoing minor surgical procedures with the overarching goal of reducing opioid use without compromising the pain experience. The specific aim was for neonatal intensive care unit providers to adhere to the PMG at least 50% of the time. METHODS: An interdisciplinary pain and sedation work group in a large level IV neonatal intensive care unit developed an evidence-based PMG for minor surgical procedures. Nurses and providers were educated on the new guideline, and rapid cycle quality improvement methodology provided an opportunity to adjust interventions over 3 months. RESULTS: The PMG was used for 32 neonates following minor surgical procedures: 18 (56%) of the neonates received only acetaminophen and no opioids, 32% required 0.15 mg/kg dose equivalent of morphine or less, and only 9% required more than 0.15 mg/kg dose equivalent of morphine. Overall, opioid use decreased by 88% compared with rates before implementation of the PMG. Providers adhered to the PMG approximately 83.3% of time. IMPLICATIONS FOR PRACTICE: A PMG is a systematic approach to direct nurses and providers to appropriately assess, prevent, and treat neonatal pain following minor surgery while alleviating opioid overuse. IMPLICATIONS FOR RESEARCH: Future research should focus on determining and mitigating barriers to nurse/provider use of the PMG and developing and implementing a PMG for major surgical procedures.

Usefulness of Routine Coagulation Tests in Healthy Children Undergoing Elective Minor Surgery: a 12-Year Retrospective Study.

BACKGROUND: Although routine coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) are performed before surgery to identify the risk of perioperative bleeding, bleeding complications are rare in minor surgeries, and false-positive results are often observed. Therefore, this study aimed to analyze the common causes of abnormal results of preoperative coagulation tests in previously healthy children undergoing elective minor surgery and determine the usefulness of performing these tests. Additionally, it aimed to identify the distribution of factor XII activity in children with prolonged aPTT. METHODS: The medical records of 363 pediatric patients aged 0 - 18 years, who were referred to the pediatric hematology-oncology department due to abnormal preoperative coagulation tests prior to undergoing minor surgery at the Kyung Hee University Medical Center between March 2008 and October 2020, were retrospectively review-ed. RESULTS: The majority of patients (n = 348, 96%) had prolonged aPTT, few (n = 29, 8%) had a prolonged PT international normalized ratio, and a small number (n = 14, 4%) had both prolonged PT and aPTT. On repeating the coagulation tests, 194 children showed persistent abnormal results. Of these, 184 patients underwent mixing tests, and 176 showed correction for factor deficiency (n = 26) and lupus anticoagulant positive (n = 14). Factor deficiencies included factor XII (n = 16), possibility of von Willebrand disease (vWD; n = 4), factor XI (n = 2), factor VIII (n = 1), factors IX and XII (n = 1), factor VII (n = 1), and factor V (n = 1). The severity of factor deficiency was mild (25 - 38%). One patient with factor VII deficiency received preoperative clotting factors but had postoperative bleeding requiring clotting factor replacement. Another patient with possible vWD received fresh frozen plasma after surgery and had mild symptoms. Linear regression showed no significant correlation between factor XII activity and aPTT in patients with prolonged aPTT (R2 = 0.0002, p = 0.84) or factor XII activity according to aPTT results in those with factor XII deficiency (R2 = 0.04749, p = 0.40). CONCLUSIONS: These results suggest that coagulation tests may be selectively performed in previously healthy children undergoing minor surgery with positive bleeding and/or family history. The distribution of factor XII should be investigated further.

Single centre, real-world experience of perioperative rFIXFc use in adult patients with haemophilia B undergoing major and minor surgery.

INTRODUCTION: Recombinant factor IX fusion protein concentrate (rFIXFc) is increasingly used for prophylaxis in people with haemophilia B (PWHB), but experience in the perioperative setting is limited. AIMS: To evaluate real-world perioperative factor usage, bleeding and complications in PWHB (≥18 years) who received rFIXFc for surgical haemostasis and to describe the treatment regimens used. METHODS: Single centre, retrospective review of all PWHB who underwent a major or minor surgical procedure between June 2017 and July 2020 and received rFIXFc perioperatively for maintenance of surgical haemostasis. RESULTS: A total of 56 PWHB (45 male and 11 female), including people with mild (n = 32), moderate (n = 4) and severe (n = 20) haemophilia B, underwent 11 major and 131 minor procedures with rFIXFc for surgical haemostasis. Haemostasis was rated as excellent (9/11) or good (2/11) in all major procedures. Median total rFIXFc consumption for orthopaedic surgeries was 972 IU/kg (range 812-1031 IU/kg) and for other major (non-orthopaedic) surgeries was 323 IU/kg (range 167-760 IU/kg). The median number of perioperative rFIXFc infusions was 19 (range 17-26) for orthopaedic surgery and 7 (range 5-17) for other major surgeries. The number of infusions in the postoperative period was determined by procedure and patient factors. Complications included bowel ileus and wound infection. Most minor procedures were managed with single infusion of rFIXFc, with no bleeding complications in 95% of minor procedures. There were no thromboembolic events or inhibitor formation. CONCLUSION: This unique data provides real-world evidence that rFIXFc is safe and effective in achieving haemostasis in PWHB undergoing surgery.

Ataque isquémico transitorio por embolia aérea iatrogénica secundaria a inyecciones intracavernosas en procedimiento urológico / Transient ischemic attack due to iatrogenic air embolism secondary to intracavernous injections during an urologic procedure

RESUMEN Se presenta un caso de ataque isquémico transitorio con sintomatología compatible con lesión de la circulación cerebral posterior, secundario a embolia aérea iatrogénica. Se describe la evolución clínica y las consideraciones más relevantes de la atención y el diagnóstico del ataque cerebrovascular de la circulación posterior. En cuanto a la embolia gaseosa, se describen los métodos diagnósticos, las intervenciones clínicas y las opciones de tratamiento disponibles.

SUMMARY Here ia a case of transient ischemic attack with symptoms compatible with injury to the posterior cerebral circulation, secondary to iatrogenic air embolism. Clinical evolution and the most relevant aspects for the care and diagnosis of cerebrovascular stroke of the posterior circulation are described. Regarding air embolism, the diagnostic methods, clinical interventions, and available treatment options are described.

Risk Factors for Infection After Minor Dermatologic Procedures: A Case-Control Study.

BACKGROUND: There are limited published data regarding the incidence and risk factors for infection after minor dermatologic procedures, such as skin biopsy, shave, and curettage. Prior studies of infection risk after dermatologic procedures have often not specified the method of preparation of local anesthetic. OBJECTIVE: To assess the incidence and risk factors for infection after minor procedures performed in a general dermatology clinic using buffered lidocaine prepared in office. MATERIALS AND METHODS: In this retrospective case-control study, the medical record was searched for cases of infection after skin biopsies, shaves, conventional excisions, and destructions performed in a general dermatology clinic over a 4-year period. Patient and procedure characteristics were compared with uninfected controls. RESULTS: Of 9,031 procedures performed during the study period, there were 34 infections (0.4%). The odds of infection for procedures on the arm and leg were 5.29 and 9.28 times higher, respectively, than those on the head/neck. There was no significant effect of age, sex, smoking, immunosuppression, diabetes, or anticoagulation. CONCLUSION: The incidence of infection is low after minor dermatologic procedures performed with local anesthesia using buffered lidocaine prepared in office. There is a higher risk of infection on the arm and leg compared with the head and neck.

Small surgeries, big smiles: using virtual reality to reduce the need for sedation or general anesthesia during minor surgical procedures.

PURPOSE: Children often require anesthesia for simple diagnostic and therapeutic procedures. The aim of this study was to evaluate the feasibility of using virtual reality (VR) to reduce sedation in children undergoing minor surgical procedures. METHOD: In this prospective, non-randomized clinical trial, pediatric patients at a free-standing children's hospital undergoing hormone implant placement, removal, or exchange were recruited to use VR and local anesthesia instead of procedural sedation or general anesthesia (GA). Patients were enrolled between November 2017 and March 2020, and were compared to historic controls who underwent similar procedures without VR between April 2016 and February 2020. Primary outcome measure was successful procedure completion without sedation or GA. Secondary measures included assessments of pain, fear and anxiety, patient compliance, procedural and recovery times. RESULTS: Twenty-eight patients underwent 29 procedures with VR. Hormone implants (72%), removals (7%), or exchanges (21%) were completed without GA, sedation or IV placement. Procedure lengths and pain scores were similar between VR patients and historic controls, but recovery times were significantly shorter in VR patients (18 vs 65 min, p < 0.001). Participant satisfaction scores were high, with 95% recommending VR to others. CONCLUSIONS: VR is a feasible alternative to sedation or GA for select pediatric patients undergoing minor surgical procedures.

The Resident-Run Minor Surgery Clinic: A Four-Year Analysis of Patient Outcomes, Satisfaction, and Resident Education.

OBJECTIVE: A resident-run minor surgery clinic was developed to increase resident procedural autonomy. We evaluated whether 1) there was a significant difference between complications and patient satisfaction when procedures were independently performed by surgical residents vs. a surgical attending and 2) if participation was associated with an increase in resident procedural confidence. DESIGN: Third year general surgery residents participated in a weekly procedure clinic from 2014-2018. Post-procedure complications and patient satisfaction were compared between patients operated on by residents vs. the staff surgeon. Residents were surveyed regarding their confidence in independently performing a variety of clinic-based patient care tasks. SETTING: Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. PARTICIPANTS: Post-graduate year three general surgery residents that ran the clinic as part of a general surgery rotation. RESULTS: 1230 patients underwent 1592 procedures (612 in resident clinic, 980 in attending clinic). There was no significant difference in the 30-day complication rate between patients operated on by the resident vs. attending (2.5% vs. 1.9%, p = 0.49). 459 patient satisfaction surveys were administered with a 79.1% response rate. There was no significant difference in the overall quality of care rating between residents and the attending surgeon (87.5% top-box rating vs. 93.1%, p = 0.15). Twenty-one residents completed both a pre- and post-rotation survey (77.8% response rate). The proportion of residents indicating that they could independently perform a variety of patient care tasks significantly increased across the rotation (all p < 0.05). CONCLUSION: Mid-level general surgery residents can independently perform office-based procedures without detriment to safety or patient satisfaction. The resident-run procedure clinic serves as an environment for residents to grow in confidence in both technical and non-technical skills. Given the high rate at which patients provide resident feedback, future work may investigate how to best incorporate patient derived evaluations into resident assessment.