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Purpose: Prediction of postoperative outcome following major surgery in elderly patients requires a decision-making process based on data on cognitive function, functional status and frailty. In this study, we aimed to evaluate the predictive value of these parameters for minor surgeries. Materials and Methods: Patients aged ≥65 years with American society of Anesthesiologists (ASA) score 1-3 scheduled for elective minor surgery were included in the study. Mini Mental Test (MMSE), Barthel Index (BI) and Clinical Frailty Scale (CSHA-CFS) were used to assess cognitive function, functional status and frailty at hospitalization. The associations of these parameters with postoperative hospitalization status were evaluated. Results: Ninety-nine patients were included in the study. MMSE scores, Barthel Indices and CSHA-CFS scores were similar in all groups. The number of inpatients was higher in patients with MMSE2 (n=19 (82.6%)). The number of inpatients was higher in patients with a frailty score of CSHA-CFS≥4 (n=33 (75%)) (p=0.025) or ASA >2 (n=20 (83.3%)) (p=0.023). Patients with ASA>2 were more likely to have >1 day length of stay (LOS) (p=0.036) and intensive care unit (PACU) stay (p=0.042), independent of the frailty score. Readmission within 30 days was not correlated with the parameters. Conclusion: ASA>2 and MMSE

Copyright of Ahi Evran Medical Journal is the property of Ahi Evran University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Skin cancer is one of the most common types of cancer in the world, and it is estimated that the risk of developing it increases from 1 to 5 throughout life. Its incidence has increased considerably in recent decades. Objective: To characterize the patients operated with skin cancer in the minor outpatient surgery clinic. Methods: A cross-sectional descriptive observational study was conducted in the population attended in the outpatient minor surgery consultation belonging to the Lawton Teaching Polyclinic, located in Diez de Octubre municipality of the province of Havana between the years 2018 and 2022. The following variables were used: sex, age, skin complexion, lesion location and histological type. Frequency analysis was performed. Results: A predominance of females was observed with 57.22%, predominating between the ages of 65 - 76 years of age, mostly of white complexion. There was an increase in the incidence during the year 2021 with 29%. The most frequent location was on the face with 27.84% of the total. The definitive diagnosis according to the biopsy results was solid basal carcinoma with 36.69%. Conclusions: In the series of cases studied, the female sex, the elderly, white skin predominate, and solid basal carcinoma is more frequently present.

Background: In this study, we wanted to compare the safety and efficacy of clear fluids until 3 hours as compared to 6 hours of starvation before and after minor surgical procedures. Materials And Methods: This was a hospital based prospective randomized comparative interventional study conducted among patients age group of 18 to 60 years of either sex who presented with minor surgeries to the Department of Surgery, ENT, Obstetrics & Gynaecology and Ophthalmology after obtaining clearance from institutional ethics committee and written informed consent from the study participants. Results: The sense of wellbeing parameters in the starvation group that were not statistically significant were dizziness, anxiety, nausea or loss of appetite, headache and weakness than the clear fluid group at 3 and 6 hours of starvation post operatively. The difference was statistically significant with regard to thirst and dryness of mouth. Conclusion: Wellbeing parameters were significantly improved in patients who were given clear liquids before surgery and after surgery and significance reduced as fluids replaced over time. [ABSTRACT FROM AUTHOR]

Background/Aim. The incidence of nodular thyroid dis-ease increases significantly with age as well as the incidence and aggressiveness of thyroid cancers. The aim of the study was to determine whether thyroid surgery for geriatric patients is safe in a short hospital stay surgery set-ting. Methods. In this retrospective study, medical histories of all operated geriatric patients (65 years and older), in whom a total thyroidectomy (TT) or hemithyroidectomy (HT) was performed from January 2012 to December 2018, were analyzed. A total of 976 patients were operated on for thyroid diseases in the mentioned period, out of which 247 geriatric patients fulfilled the inclusion criteria. Patients with thyroid reoperations and simultaneous neck lymph node dissections were excluded from the study. The geriatric patients were divided into two groups: the HT group (33 patients) and the TT group (214 patients). Each of these two geriatric groups, HT and TT, had two additional paired control groups. Control group I consisted of younger subjects from 20–44 years, and control group II included middle-aged subjects from 45–64 years. Results. All three TT groups – geriatric, control I, and control II, had 214 patients each, and all three HT groups had 33 patients each. In all three HT groups, the average hospital stay was 24 hrs, while in the TT geriatric group, 150 (70.1%) of 214 patients spent 24 hrs at the hospital. In the geriatric population, the incidence of neck swelling and in-creased drainage output were higher compared to both control groups, and thus the need for longer hospitalizations. When the age was compared, it was shown that sub-jects with each subsequent year of intervention had a 22% lower chance of developing complications, and regarding the pathohistological finding, benign thyroid hyperplasia was less likely to develop complications compared to malignant hyperplasia. Conclusion. According to the study, TT can be safely performed within the concept of a short hospital stay in patients under 65 years, while in the elder-ly, hospitalization days may be extended due to more frequent surgical and nonsurgical complications. Speaking of HT, the short hospital stay is safe for all age groups.

This study assessed, for the first time, the expression of the genes hOGG1, TP53, and IL‐6 in leukocytes by real‐time quantitative polymerase chain reaction in surgical patients before (baseline), during (2 h of anesthesia) and 1 day after sevoflurane anesthesia. Additionally, DNA damage was detected by the comet assay, serum interleukin (IL)‐6 was detected by flow cytometry, and differential leukocyte counting was also performed. TP53 and hOGG1 expression was downregulated on the day after anesthesia compared to before anesthesia. However, IL‐6 expression did not change, and no DNA damage induction was observed during or after anesthesia. At the systemic level, mild neutrophilia and an increase in IL‐6 levels occurred after anesthesia. Our findings suggest that sevoflurane anesthesia downregulates gene expression (hOGG1 and TP53) and contributes to an inflammatory status (increased systemic IL‐6 and mild neutrophilia) but is not associated with DNA damage in patients without comorbidities who undergo minor elective surgery. [ABSTRACT FROM AUTHOR]

Viral fever with thrombocytopenia is an insidious cause of postoperative hemorrhage. Timely diagnosis and prompt treatment of this disorder will ensure minimal morbidity and mortality. The present study reported the case of a 19-year-old male with postoperative viral pyrexia with thrombocytopenia following a periodontal flap procedure and its management. The present case study demonstrates the significance of a rigid follow-up routine even after minor surgery. Clinicians must be aware of the optimal diagnosis and treatment for pyrexia with thrombocytopenia.

Resumen: Objetivo: comparar diferentes técnicas de abordaje de fibromas blandos (FB), añadiendo una nueva técnica, para conocer cuál produce menos complicaciones, menor coste y una epitelización más temprana. Diseño: ensayo clínico aleatorizado sin ciego con muestreo consecutivo. Lugar: Área Básica de Salud Balaguer. Participantes: N = 240 FB. Intervenciones: se realizó la técnica aleatoria correspondiente y su consiguiente seguimiento hasta epitelización. Variables: sexo, edad, antecedentes familiares de FB, localización del FB, diabetes, coste, tiempo de curación, complicaciones y técnica utilizada: cura seca (CS) (crioterapia, electrocirugía, escisión con aplicación de nitrato de plata [ENP]) y escisión con tratamiento de cura en ambiente húmedo (CAH). Resultados: según las técnicas, el tiempo de curación es menor en CAH (3,3[±1,0] días) versus CS (crioterapia 4,5[±2,3] días, electrocirugía 8,2[±4,2] días y ENP 10,7[±4,8] días), p

To assess the risk of new persistent opioid use in opioid-naïve men who underwent male fertility procedures. Retrospective cohort study using a claims database. A database linking electronic medical record data and claims—assessing men who underwent fertility procedures between 2010 and 2021. Opioid-naïve men who underwent fertility procedures (open or laparoscopic varicocelectomy, spermatocele excision, and testicular excisional or incisional biopsy) without further surgical intervention requiring anesthesia in the 2 years after the index procedure. Those with and without perioperative opioid prescriptions were propensity score matched on age, race/ethnicity, smoking status, mental health diagnoses, and preoperative pain diagnoses. Perioperative opioid prescription. The primary outcome was the incidence of new persistent opioid use (opioid prescription 3–9 months after the index fertility procedure). The secondary outcome was prolonged opioid use (opioid prescription 9–24 months after the index fertility procedure). A total of 387,565 men who underwent fertility procedures were identified, of whom 25.1% received an opioid prescription. After propensity score matching, 97,215 men were included; 4.7% of men who received a perioperative opioid prescription developed new persistent opioid use compared with 2.2% of those without a perioperative opioid prescription (risk ratio, 2.16; 95% confidence interval, 2.05–2.27; number needed to harm, 39). When assessing each unique fertility procedure independently, men who received perioperative opioids had statistically higher odds of developing new persistent opioid use for all procedure types. Men with new persistent opioid use were much more likely to go on and develop prolonged opioid use than men without new persistent opioid use. Opioid prescription after male fertility procedures is associated with a significant risk of new persistent opioid use, emphasizing the importance of judicious opioid prescribing for male fertility procedures. [ABSTRACT FROM AUTHOR]

Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or “roots” that may be missed if an excised tumor is serially cross-sectioned in a “bread-loaf” fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs’s initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.

Background : Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure. Purpose : The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation. Methods : In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions. Results : A total of 133 patients, 79% male, with a mean age of 70 +/- 10 years, were included. Patients adjusted to the device over time (P <.001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P <.001. Patients' recovery improved over time (P <.001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P <.001) and wound healing (9% vs 2%, P <.05) improved. Conclusions: Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact. [ABSTRACT FROM AUTHOR]

Abstract Background The provision of minor surgical services is an established part of the task profile of general practitioners (GPs) in many countries in Europe and elsewhere. This study aimed to collect data on the clinical process and outcomes for specified minor surgical procedures undertaken in Irish general practice by GPs experienced in minor surgery in order to document the scope and safety of minor surgery being undertaken. Methods Over a six-month period, 24 GPs in 20 practices recorded data on a pre-determined list of procedures undertaken in adults (aged 18 and older); procedures for ingrown toenails were also recorded for those aged 12–18 years. Clinical data were rendered fully anonymous by the participating GPs, entered onto the Excel database template and returned to the project team monthly. Results On average, each practice undertook 212 procedures in a six-month period. The four most frequent procedures include two relatively non-invasive procedures (cryosurgical ablation of skin lesions and aspiration and/or injection of joints) and two more invasive procedures (full thickness excision of skin lesion and shave, punch or incisional biopsy). Overall, 83.8% of relevant specimens were submitted for histology. Combining benign and malignant cases, there was an overall 87% clinical and histological concordance; 85% of malignancies were suspected clinically. A complication was recorded in 0.9% after 1 month. Conclusions Irish GPs with experience in minor surgery can provide a range of surgical services in the community safely.

Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Introduction: Minor oral surgical procedures are practiced in dental teaching. Interns are required to be competent, wellprepared and acknowledge its basics before their practice. Lack of training and knowledge could lead to serious consequences during clinical practice. Aim: To assess the knowledge and confidence level between male and female dental interns in private and governmental Riyadh dental schools in performing simple dento-alveolar procedures. Materials and Methods: A cross-sectional observational study was conducted at Princess Nourah bint Abdulrahman University in Riyadh, Saudi Arabia in January 2020 among dental interns from all Riyadh dental schools. A cross-sectional survey containing 23 items was used. The first part included the informed consent and demographic data (item 1-3). The second part consisted of 10 case scenarios to assess the knowledge level (item 4-13), and the third part was developed to self-rate their confidence level (item 14-23). Around 300 participants belonging to five Riyadh dental schools comprised the study population. All interns were included in the study after obtaining informed consent. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 21.0 and Microsoft Excel 16.16. Groups were compared using Pearson chi-square and unpaired sample t-test. The p-value of

Introduction: Minor oral surgical procedures are practiced in dental teaching. Interns are required to be competent, well prepared and acknowledge its basics before their practice. Lack of training and knowledge could lead to serious consequences during clinical practice. Aim: To assess the knowledge and confidence level between male and female dental interns in private and governmental Riyadh dental schools in performing simple dento-alveolar procedures. Materials and Methods: A cross-sectional observational study was conducted at Princess Nourah bint Abdulrahman University in Riyadh, Saudi Arabia in January 2020 among dental interns from all Riyadh dental schools. A cross-sectional survey containing 23 items was used. The first part included the informed consent and demographic data (item 1-3). The second part consisted of 10 case scenarios to assess the knowledge level (item 4-13), and the third part was developed to self-rate their confidence level (item 14-23). Around 300 participants belonging to 5 Riyadh dental schools comprised the study population. All interns were included in the study after obtaining informed consent. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 21.0 and Microsoft Excel 16.16. Groups were compared using Pearson chi-square and unpaired sample t-test. The p-value of <0.05 was considered statistically significant. Results: Out of 300 interns invited to participate, 210 submitted the electronic survey (70%). The final study population included 117 (56%) females and 93 (44%) males. A total of 111 (53%) belonged to a governmental college, and 99 (47%) belonged to a private college. There was no statistically significant difference between females and males in total knowledge (p<0.272) and confidence score (p<0.850) respectively. However, a statistically significant difference in knowledge and confidence between government and private colleges was found (p<0.001). A weakly positive significant correlation (r=0.217, p=0.002) was found between the total score of knowledge and the total score of confidence in performing surgical procedures. Conclusion: The study provides baseline data on the knowledge and perceived confidence of dental interns in Saudi Arabia about certain clinical procedures in oral surgery, where respondents were most knowledgeable in prescribing an appropriate medication. They were confident in giving effective local anaesthesia. All in all, interns had a superficial knowledge about the classification of impacted teeth and they were least confident in managing cases of an intraoral abscess. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Dental Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objective: This study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects., Materials and Methods: The authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023., Results: 463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications., Conclusion: Bedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

ABSTRACT Mucocele is a benign lesion, originating from disorders of minor salivary glands containing mucus. These lesions are found in children and young adults and usually occur due to local trauma. Clinically, it presents as a circumscribed, asymptomatic, soft and bluish or normocromic blister. The treatment of choice is surgical removal, when the lesion does not rupture naturally. This study aims to report a clinical case of mucocele in a pediatric patient removed through total surgical excision. A 7-year-old patient accompanied by mother sought care at the Dentistry Clinic of the “Tiradentes” University Center (UNIT / AL), with a main complaint of asymptomatic blister in the lower lip for about 15 days. In the anamnesis, the habit of biting in the region was reported. At clinical examination, a blister with clear limits of approximately 10 mm in diameter was observed in the lower lip mucosa, with slightly firm/fibrous consistency, which gave rise to doubts about the possible diagnosis, since it presented characteristics similar to that of a mucocele, although consistency at palpation indicates possible fibroma. Surgical excision of the lesion was performed; the material collected was fixed in 10% formalin and sent to histopathological examination that confirmed the diagnosis of mucocele. The patient was kept on follow-up, and there was no recurrence of the lesion. Surgical excision demonstrated an effective and prognostic therapeutic course, allowing accurate diagnosis through the histopathological evaluation of the lesion.

INTRODUCTION: Nymphoplasty or labioplasty is the most common genital plastic surgery. The objective of labioplasty is to correct hypertrophy of the labia minora and clitoral prepuce, removing excess tissue without affecting their function of protecting the vagina and aiding in genital lubrication. Several types of classifications have been proposed to facilitate the understanding of the degree of hypertrophy of the labia minora and assist in selecting the most suitable procedure in labioplasty. After analyzing several classifications, the author proposes a new classification to facilitate the understanding of hypertrophy of the labia minora, clitoral hood, and vaginal prepuce and help select the best labioplasty procedure. METHODS: A literature search was conducted in PubMed/Medline using the following terms: hipertrofia lábios vaginais, labioplastia, labiaplasty, labioplasty, labia minora hypertrophy, and labial protrusion. All the classifications described in the identified studies were analyzed. RESULTS: A new classification has been proposed. Hypertrophy of the labia minora was classified in four grades: grade 0 (< 1 cm), grade 1 (> 1 cm and < 3 cm), grade 2 (> 3 cm and > 5 cm), and grade 3 (> 5 cm). CONCLUSIONS: The new classification improves the understanding of the size and extent of hypertrophy of the labia minora and helps select the best procedure in labioplasty.

Background: In Japan, even if physicians have not experienced surgical training, they face many instances in which they must provide initial surgical treatment, especially during off‐hours. This study aimed to identify the frequency and fields of commonly encountered problems in a Japanese emergency department. Methods: A retrospective review was performed to identify walk‐in outpatients with exogenous problems visiting during off‐hours in the Japanese educational hospital providing primary to tertiary emergency care between January 1 and December 31, 2014. Diseases were aggregated according to International Classification of Primary Care (Second Edition; ICPC‐2). Results: During the study period, 33 424 patients visited and 7476 were classified into the "exogenous" group. We analyzed the data of 7421 patients after excluding 55 who were deemed undiagnosable based on reviews of the charts. The median age of patients who visited the ED during off‐hours was 29 years (range: 0‐101 years, IQR: 8‐60 years). Altogether, 226 types of problems included in ICPC‐2 were identified during the study period. The majority fields of exogenous problems were 'skin,' 'Musculoskeletal,' and 'eye.' The 15 problems with the highest frequencies accounted for 50.2% of the total problems. Conclusions: We identified surgical problems with high treatment frequencies among patients visiting the ED during off‐hours. Providing education focusing on these frequent surgical problems can help to improve the initial treatment quality and reduce the anxiety for those doctors who provide initial surgical treatment. [ABSTRACT FROM AUTHOR]

Background: It is reported that medical students do not receive adequate opportunities to learn surgical skill and are at risk of being unable to perform simple surgical procedures safely. The usefulness of peer-assisted learning (PAL) as a tool to assist in delivering surgical skills training is worth exploring. Methods: This is a randomised single blinded controlled trial. Fourth-year students from the university's Surgical Society were asked to volunteer as peer tutors and those in 3rd-year were asked to undertake surgical skills training. A cohort of 35 students were selected and randomised to receive basic surgical skills training conducted either by faculty members or peers. The students' performance of basic suturing skills was assessed using a checklist, through directly observed procedural skills (DOPS) technique. The assessment was conducted by faculty blinded to the training. Students' perception to surgical skills training was assessed using a questionnaire survey. Results: The suturing and knotting skills of students learned from their peers was comparable to that acquired from faculty. The students' perceived that their peers could conduct surgical skills training similar to their faculty. Conclusion: PAL approach for basic surgical skills training is as effective as faculty-led training. PAL has the potential to optimise the delivery of surgical skills training in undergraduate medical education. [ABSTRACT FROM AUTHOR]

Copyright of CES Medicina is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objectives. In this retrospective report the aim was to present the experience about bleeding characteristics and management of minor surgeries in rare bleeding disorders (RBDs). Methods. Twenty-six patients were included; with Factor (F) V, FV+VIII, VII, FXI deficiency and afibrinogenemia. Six of the patients were asymptomatic. Results. Fifty-three percent of the patients suffered from mucosal bleeding. Life-threatening bleedings were observed only in the patients with afibrinogenemia and good hemostatic control could only be provided with plasma-derived (pd)-fibrinogen concentrate. Twelve of the patients had undergone 17 minor surgeries. In the patients with FVII and FXI deficiencies with plasma F:C activity between 20-47%, there was a history of uneventful tooth extractions, circumcisions and a pilonidal sinus operation performed without any replacement treatment, whereas one patient with plasma F:C activity of FVII 47% had a history of poor hemostatic control during an adeno-tonsillectomy operation. Although some of these patients were asymptomatic to be on the safe side, minor operations were performed with preoperative administration of one dose of (pd)-fibrinogen concentrate to one afibrinogenemia patient, recombinant active FVII (rFVIIa) to 2 FVII deficient patients and fresh frozen plasma (FFP) to 3 FXI deficient and 1 FVII deficient patients plus postoperatively tranexamic acid (TXA) for 5-7 days. Only with one dose of the replacement therapy just before surgeries good hemostatic control was achieved and none of them had bleeding neither during nor after the surgeries. Conclusion. We suggest that minor operations must be performed with preoperative replacement therapies plus 5-7 days of antifibrinolytics under close observation of the hematologist and the surgeon. [ABSTRACT FROM AUTHOR]

Background: The provision of minor surgical services is an established part of the task profile of general practitioners (GPs) in many countries in Europe and elsewhere. This study aimed to collect data on the clinical process and outcomes for specified minor surgical procedures undertaken in Irish general practice by GPs experienced in minor surgery in order to document the scope and safety of minor surgery being undertaken. Methods: Over a six-month period, 24 GPs in 20 practices recorded data on a pre-determined list of procedures undertaken in adults (aged 18 and older); procedures for ingrown toenails were also recorded for those aged 12–18 years. Clinical data were rendered fully anonymous by the participating GPs, entered onto the Excel database template and returned to the project team monthly. Results: On average, each practice undertook 212 procedures in a six-month period. The four most frequent procedures include two relatively non-invasive procedures (cryosurgical ablation of skin lesions and aspiration and/or injection of joints) and two more invasive procedures (full thickness excision of skin lesion and shave, punch or incisional biopsy). Overall, 83.8% of relevant specimens were submitted for histology. Combining benign and malignant cases, there was an overall 87% clinical and histological concordance; 85% of malignancies were suspected clinically. A complication was recorded in 0.9% after 1 month. Conclusions: Irish GPs with experience in minor surgery can provide a range of surgical services in the community safely. [ABSTRACT FROM AUTHOR]

Several studies have shown the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery. This study aims to investigate the effectiveness of a specific non-pharmacological technique, the relaxation-guided imagery, in reducing both preoperative anxiety and postoperative pain in a sample of 60 children (6-12 years old) undergoing minor surgery who were randomly assigned to the experimental group (N = 30) or the control group (N = 30). The first group received the relaxation-guided imagery, before the induction of general anesthesia; the second group received standard care. The levels of preoperative anxiety and postoperative pain were assessed using, respectively, the modified Yale Preoperative Anxiety Scale and the Face, Legs, Activity, Cry, and Consolability Scale. The results showed a statistically significant difference between groups, with less anxiety and less pain for children included in the experimental group (p < .001; p < .001).Conclusion: Results suggest that relaxation-guided imagery reduces preoperative anxiety and postoperative pain in children. Future studies should focus on developing protocols and studying the eventual reduction of administered drugs for anesthesia and pain. What is Known: • Literature suggests the usefulness of relaxation-guided imagery in reducing anxiety and pain in the perioperative period. • Stronger evidences are needed to support the application of relaxation-guided imagery as routine care in pediatric surgery. What is New: • To our knowledge, this is the first randomized study to investigate the efficacy of relaxation-guided imagery in reducing preoperative anxiety and postoperative pain within a single pediatric sample. • The present study provides stronger evidence in an area that is lacking in research. [ABSTRACT FROM AUTHOR]

Objective: Minor surgical procedures under general anaesthesia require a patent airway without the use of muscle relaxant. Supraglottic airway devices have been widely used for airway management. A study was undertaken to compare first-time insertion success rate, insertion time, sealing pressure and complications between the Baska® mask and I-gel. Methods: After approval from the institutional ethical committee, a randomised single-blinded study was conducted on 50 American Society of Anesthesiologists' physical status I and II female patients aged 18-40 years who underwent minor surgical procedures under general anaesthesia. Patients were randomly categorized into two groups of 25 each; group Baska® mask and group I-gel, and the first-time success rate, mean insertion time and sealing pressure were measured. The results were analysed using unpaired t-test, Mann-Whitney U test, Chi-square test and ANOVA. A p value <0.05 was considered to be statistically significant. Results: The first-time insertion success rate of the Baska® mask was 21/24 (88%) when compared with the I-gel, which was 23/25 (92%) (p=0.585). The insertion time of the Baska® mask was 14.9±6.2 s, whereas that of the I-gel was 14.7±4.4 s (p=0.877). The mean sealing pressure of the Baska® mask was significantly higher when compared with the I-gel (28.9±3.5 vs. 25.9±2.5 cmH2O) (p=0.001). Conclusion: The Baska® mask had a similar first-time insertion success rate and insertion time as the I-gel. The sealing pressure of the Baska® mask was significantly greater than that of the I-gel. Both devices had complications that were comparable. [ABSTRACT FROM AUTHOR]

Little is known regarding the factors associated with surgical antibiotic prophylaxis (SAP) compliance in elective minor surgery. The purposes of this cross-sectional study were to identify the frequency of inappropriate SAP administration and to understand the characteristics associated with such inappropriateness in a sample of elective minor surgical procedures. The study was performed between May and July 2019 among a random sample of patients aged 18 years and older in seven public hospitals randomly selected in the Campania and Calabria Regions of Italy. Globally, only 45% of SAP approaches were deemed completely in accordance with the evidence-based guidelines. Patients with an ordinary admission, those who underwent local anesthesia, those receiving plastic and reconstructive and ophthalmology surgery, and those who had not received a prosthetic implant were more likely to receive an appropriate SAP approach; those receiving obstetrics, gynecological, and urological surgical procedures were less likely than those who underwent abdominal, vascular, and breast surgery. The course of antibiotic prophylaxis was not consistent with the guidelines in 48.5% procedures with one or more reasons for inappropriateness. Appropriate time of the SAP administration was more frequently observed in patients who were older, those with a Charlson comorbidity index of 0, those who did not receive a prosthetic implant, and those receiving plastic and reconstructive surgery; it was less likely in patients receiving obstetrics, gynecological, and urological surgeries compared with those who underwent abdominal, vascular, and breast surgery. Aspects of SAP that need to be improved are molecule choice, time of administration, and specific surgical procedures. Hospital managers should involve surgeons and anesthesiologists in initiatives tailored to optimize SAP prescribing.

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&#95;e/ctr&#95;view.cgi?recptno=R000052039 )., (© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Methoxyflurane delivered via a hand-held inhaler is a proven analgesic which has been used in Australasia for emergency relief of trauma associated pain since the 1970s. The agent is self-administered by the patient under the supervision of trained personnel. More than 5 million patients have received inhaled methoxyflurane without significant side effects. Methoxyflurane is also licensed in Australasia for the relief of pain in monitored conscious patients requiring analgesia for minor surgical procedures. Recent clinical studies undertaken in a variety of outpatient settings, including colonoscopy, prostate biopsy, dental procedures, bone marrow biopsy, and the management of burns dressings, indicate that inhaled methoxyflurane has significant analgesic activity, without producing deep sedation or respiratory depression. Return to full psychomotor activity is rapid. Thus, methoxyflurane may be a suitable and well-tolerated alternative to traditional i.v. sedative agents for outpatient medical and surgical procedures. There are direct advantages to the patient in terms of rapid recovery and an early return to normal activities, and significant benefits for outpatient departments in terms of cost saving and rate of throughput. Further randomised controlled trials comparing the efficacy, safety, and cost-effectiveness of inhaled methoxyflurane against traditional i.v. sedative techniques are currently in progress. [ABSTRACT FROM AUTHOR]

Purpose: Routine preoperative pulmonary function tests (PFTs) are not recommended prior to low-risk surgery because their prognostic value is limited. However, only a few studies have assessed the utilization of healthcare resources regarding preoperative PFTs in a real-world setting. Here, we aimed to assess the prevalence and determinant factors of preoperative PFTs before low-risk surgery in Japan.Methods: In this retrospective cohort study, we used the nationwide insurance claims databases. Patients who underwent low-risk surgeries under general anesthesia between April 1, 2012, and March 31, 2016, were included. The primary outcome was the receipt of PFTs within 60 days before an index surgery. We performed descriptive analyses to estimate the rates of preoperative PFTs annually starting in 2012, and examined the associations between patient- and institutional-level factors and preoperative PFTs using multilevel logistic regression analyses.Results: The cohort included 9495 procedures (8866 patients) at 1487 institutions. Preoperative PFTs were conducted before 71.8% of the procedures. The temporal trend of preoperative PFTs remained constant from 72.4% in 2012 to 72.2% in 2015. Multilevel regression analysis revealed that preoperative PFTs were associated with older age, number of beds at a medical facility, and inpatient procedures. The median institutional-specific proportion of PFTs was 75.0% (interquartile range, 14.3–100%) with wide inter-institutional variation.Conclusions: Our analysis found that preoperative PFTs were performed before 72% of low-risk surgeries under general anesthesia. Apart from age, preoperative PFTs were determined primarily by non-medical factors. Additionally, we observed substantial institutional variation in the use of preoperative PFTs. [ABSTRACT FROM AUTHOR]

BackgroundWe compared the postoperative analgesic efficacy of caudal levobupivacaine with bupivacaine in pediatric subumbilical surgery.MethodsSixty American Society of Anesthesiologists I-II patients scheduled for elective minor surgery (1.5-7 years old) were randomly divided into three groups to receive caudal injections of study drugs at 0.5 ml/kg. All patients received 0.1 mg/kg oral midazolam 30 min before surgery. Group B received 0.125% bupivacaine, group L received 0.125% levobupivacaine, and group LF received 0.125% levobupivacaine + 0.5 µg/kg fentanyl. Blood pressure, heart rate and sedation (using a four-scale sedation score) were monitored perioperatively. During the postoperative period, an anesthesiologist blinded to the study groups used the Children's and Infants' Postoperative Pain Scale to monitor patients' pain and degree of sedation. The time before the first rescue analgesic was recorded as well as any side effects over the next 24 h.ResultsThe four-scale sedation and postoperative pain scale scores in all groups were identical. Blood pressure and heart rate measured at 15 min postoperatively were lower, and time to first rescue analgesic was longer, in Group LF compared to the others.ConclusionsCaudal 0.5 ml/kg of 0.125% bupivacaine and levobupivacaine are equally effective for postoperative analgesia after subumbilical surgeries in pediatric patients. Addition of fentanyl may lower the required amount of local anesthetics.

Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.

Background: Oxygen supplementation through Hudson type face mask is frequently used in perioperative settings. Hudson mask is a variable rate performance device with the risk of rebreathing. Studies using capnography to find out an actual fraction of rebreathing in spontaneously breathing patients are not available. Aims: In this study, we analyzed the effects of different flow rates through Hudson mask with capnography on fractional inspired carbon dioxide (FiCO2). Setting and Designs: Forty patients posted for minor surgeries under monitored anesthesia care were divided into four groups. They received oxygen flow rate of 3 L/min, 4 L/min, 5 L/min, and 6 L/min as per group division, through Hudson mask. Materials and Methods: Parameters such as pulse rate, noninvasive blood pressure, oxygen saturation, respiratory rate (RR), end-tidal carbon dioxide (EtCO2), and FiCO2 were noted at baseline. After starting oxygen supplementation, these parameters were monitored every minute for ten minutes. Statistical analysis was done using analysis of variance and Kruskal-Wallis test. Pearson correlation was used to establish a relation between RR and FiCO2. Results and Conclusions: EtCO2 and FiCO2 were comparable in all four groups with no statistical significance. There was strong positive correlation seen between RR and FiCO2 at a flow rate of 3 L/min while negative correlation in other groups. We conclude that FiCO2 is similar at all flow rates while breathing through Hudson mask. Increase in RR can cause increase in FiCO2 at lower flow rate, which is within physiological tolerance limits. [ABSTRACT FROM AUTHOR]

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., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: An increasing interest in intravenous anesthetic agent has resulted from the availability of more effective intravenous agents. Objectives: Comparison of intravenous Ketamine with combination of intravenous Propofol and Fentanyl in ASA Gr. 1 patients of middle age in minor surgical procedures, To compare the haemodynamic fluctuation of intravenous Ketamine with intravenous propofol – fentanyl combination in short surgical procedure and to compare recovery and side-effective in postoperative period of intravenous Ketamine with intravenous propofol- Fentanyl combination in short surgical procedures. Methodology: This observational study includes 20 patients of ASA Grade I of either sex, especially those who were coming for minor surgery. Patients divided in group A: Patients were preoxygenated with 100% oxygen. Induction was done with injection Ketamine 2 mg/kg intravenous. O2 was given throughout surgery and group B: Patients were preoxygenated with 100% oxygen. Induction was done with inj. Fentanyl citrate I mg/kg over 1 minute followed after 3 minute by propofol 2.5 mg/kg O2 was given throughout surgery. Results: Highest patients belong to 21-30 years age group. Female were higher in both the group that male. Most of (18) patients belongs to 51 to 40 kg group. Falling in blood pressure and pulse was more in Group B than Group A patients. Post-operative side effects more seen Group A than Group B patients. Conclusion: Inspite of more side effects and more change in hemodynamics parameters in Propofol-fentanyl group than Ketamine group, Both Ketamine and Propofol–fentanyl combinations produce rapid, pleasant and safe anesthesia with only a few untoward side effects and only minor hemodynamic effects.