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Original Research ARTICLE\nElamipretide (SS-31) Ameliorates Isoflurane-Induced Long-Term Impairments of Mitochondrial Morphogenesis and Cognition in Developing Rats\n- 1Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China\n- 2Medical School of Henan Polytechnic University, Jiaozuo, China\n- 3Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China\nMitochondria are supposed to be involved in the early pathogenesis of general anesthesia (GA)-induced neurotoxicity and long-term cognitive deficits in developing brains. However, effective pharmacologic agents targeted on mitochondria during GA exposure are lacking. This study explores the protective effects of mitochondrion-targeted antioxidant elamipretide (SS-31) on mitochondrial morphogenesis and cognition in developing rats exposed to isoflurane. Rat pups at postnatal day (PND) 7 were exposed to 1.5% isoflurane for 6 h following intraperitoneal administration of elamipretide or vehicle with 30 min interval. The hippocampus was immediately removed for biochemical assays. Histopathological studies were conducted at PND 21, and behavioral tests were performed at PND 40 or 60. We found that early exposure to isoflurane caused remarkable reactive oxygen species (ROS) accumulation, mitochondrial deformation and neuronal apoptosis in hippocampus. The injury occurrence ultimately gave rise to long-term cognitive deficits in developing rats. Interestingly, pretreatment with elamipretide not only provided protective effect against oxidative stress and mitochondrial damages, but also attenuated isoflurane-induced cognitive deficits. Our data support the notion that mitochondrial damage is an early and long lasting event of GA-induced injury and suggest that elamipretide might have clinically therapeutic benefits for pediatric patients undertaking GA.\nThousands of infants and children require prolonged periods of anesthesia when complicated surgery is needed each year. A large number of preclinical studies have raised concern about the potential of neurotoxicity and long-term cognitive impairments caused by general anesthetics in developing brains (Ing et al., 2014a; Lin et al., 2014; Rappaport et al., 2015; Walters and Paule, 2017). Due to the increasing demand for pediatric patients to have anesthesia during surgery, recent research efforts are focusing on deciphering the earliest cellular targets and mechanistic pathways of general anesthesia (GA)-induced developmental neurotoxicity so that strategies for effective ameliorating or preventing the adverse effects can be devised (Boscolo et al., 2012, 2013a; Jevtovic-Todorovic et al., 2012; Noguchi et al., 2016).\nImpaired mitochondrial function and morphology are centrally involved in the neurotoxicity and play key pathogenic roles in GA-induced cognitive deficits (Sanchez et al., 2011; Boscolo et al., 2012, 2013a,b). The mitochondrial abnormalities exist in vulnerable brain regions evidenced by increased reactive oxygen species (ROS) generation and lipid peroxidation, mitochondrial enlargement, and impaired structural integrity (Sanchez et al., 2011; Boscolo et al., 2012, 2013a,b). However, efforts to directly target mitochondria to limit ROS and oxidative stress and modify mitochondrial function during GA exposure are still in progress because of the absence of effective pharmacological agents. Elamipretide (SS-31, D-Arg-dimethylTyr-Lys-Phe-NH2) is a novel mitochondrion-targeted antioxidant. It has an alternating aromatic-cationic structure that allows it to freely cross the blood-brain barrier and cell membrane, then concentrate >1000 fold in the mitochondrial inner membrane independently of mitochondrial membrane potential. It has been demonstrated that elamipretide inhibits ROS generation and lipid peroxidation in many processes both in vitro and in vivo (Zhao et al., 2005; Szeto, 2008; Min et al., 2011; Hao et al., 2015; Yin et al., 2016). Our previous studies provided evidences that elamipretide protected mitochondrial function by reducing ROS generation, maintaining adenosine triphosphate (ATP) production and mitochondrial membrane potential, and inhibiting opening of mitochondrial permeability transition pore in aged mice receiving isoflurane anesthesia (Wu et al., 2015a, 2016). However, the efficacy of elamipretide has yet to be studied in the developing rats.\nIn the present study, we sought to examine the antioxidative and mitochondrial protective effects of elamipretide in rats during the critical stage of brain development. We administered elamipretide and isoflurane anesthesia to rat pups at postnatal day (PND) 7 and discovered that elamipretide treatment ameliorated isoflurane-induced oxidative stress and long-term impairments of mitochondrial morphogenesis and cognition in developing rats.\nMaterials and Methods\nSprague-Dawley rat pups at PND 7 were used in the present study. All experimental procedures and protocols were reviewed and approved by the Animal Investigation Ethics Committee of Nanjing University and were performed in accordance with the Guidelines for the Care and Use of Laboratory Animals from the National Institutes of Health, USA. The pups were housed in a room maintained under standard environmental condition (temperature 22–24°C, a 12 h light/dark cycle, and 50 ± 10% humidity) with their mothers till PND 20. At PND 21, the pups were weaned and housed 4–5 per cage in standard condition.\nNinety-six rat pups at PND 7 of both sexes were randomly assigned to one of the following four treatment protocols (n = 24/group): control, control + elamipretide, isoflurane and isoflurane + elamipretide. Elamipretide (5 mg/kg, synthesized in China Peptides Co., Ltd., Shanghai, China) or phosphate-buffered saline (PBS) was intraperitoneally administered to the pups with a volume of 0.4 ml/kg 30 min before gas inhalation. The dose of elamipretide was chosen according to our previous studies (Wu et al., 2015a,b, 2016). Anesthesia was performed based on previous optimization, in which 6 h isoflurane anesthesia can induce developmental neurotoxicity (Boscolo et al., 2012, 2013a; Wang et al., 2014; Xu et al., 2015). Anesthesia was induced by placing the pups in an anesthetizing chamber prefilled with 1.8% isoflurane plus 30% oxygen (O2) for 10 min and then changed to 1.5% isoflurane plus 30% O2 for 350 min. For control experiments, 30% O2 was delivered for 6 h at the same flow rate. The composition of the chamber gas was continuously monitored using a DatexTM infrared analyzer (Capnomac, Helsinki, Finland). Rats were kept normothermic throughout the experiment.\nAfter the administration of anesthesia, rats were randomly divided into three subgroups. Six rats in subgroup 1 were sacrificed immediately postanesthesia (at PND 7), and the hippocampi were rapidly removed for biochemical studies. Six rats in subgroup 2 were sacrificed at PND 21 and the brain of each rat was cut into two halves for histopathological studies, and 12 rats in subgroup 3 were used for behavioral studies at PND 40 or 60. Efforts were made to minimize the number of animals used in this study.\nROS Level, Superoxide Dismutase (SOD) Activity and Malondialdehyde (MDA) Content Assays\nRats (n = 6 for each group) were sacrificed immediately postanesthesia (at PND 7), and the hippocampi were removed quickly. Intracellular ROS were detected using a ROS assay kit (Genmed Scientifics Inc., Shanghai, China) containing an oxidation-sensitive fluorescent probe (DCFH-DA) with a spectrofluorometer (excitation 490 nm, emission 520 nm). Malondialdehyde (MDA) is an end-product of ROS-induced peroxidation. Superoxide Dismutase (SOD) is an important enzyme that participates in the removal of ROS from the cellular environment. The extent of lipid peroxidation was estimated by MDA levels, which were measured by using the spectrophotometric diagnostic kits (Jiancheng Biological Technology Co., Ltd., Nanjing, China) according to the manufacturer’s instructions. The SOD activity was determined using a SOD assay kit (Jiangsu KeyGEN BioTECH Co., Ltd., Nanjing, China) according to manufacturer’s instructions. Enzyme activity was converted to units per milligram of protein. One unit of SOD activity was defined as the amount that reduced the absorbance at 550 nm by 50%.\nWestern Blotting Analysis\nHippocampal homogenate was prepared for the determination of SOD2 expression by standard western blotting. Total protein (35 μg/lane) was electrophoretically separated and blotted onto nitrocellulose membrane. Protein levels were determined via incubation with antibodies against SOD2 (1:1000; Abcam, Cambridge, MA, USA) and tubulin (1:1000; Sigma, St. Louis, MO, USA). Bands were visualized by enhanced chemiluminescence and quantified with the Image Quant Software (Syngene).\nDetermination of Mitochondrial Swelling\nHippocampal tissue was removed immediately post-anesthesia and cut into small pieces for mitochondria isolation. The tissue was homogenized in 1.5 ml lysis buffer supplemented with protease inhibitor solution (QIAGEN China Co., Ltd., Shanghai, China) and centrifuged at 1000 g for 10 min at 4°C. The cell pellet was resuspended and homogenized in 1.5 ml ice-cold disruption buffer and centrifuged at 1000 g for 10 min. The supernatant was carefully transferred to a clean 1.5 ml tube and centrifuged at 6000 g for 10 min. The mitochondrion-enriched pellet was resuspended in 1 ml mitochondrial storage buffer and centrifuged at 6000 g for 20 min at 4°C.\nThe hippocampal mitochondrial swelling assay was performed by measuring the changes of the absorbance following addition of the mitochondrial suspension at 540 nm for 10 min using a colorimetric assay kit (Genmed Scientifics Inc., Wilmington, DE, USA). A decrease in absorbance represents the degree of mitochondrial swelling.\nAt PND 21, rats (n = 6 for each group) were perfused with normal saline, followed by 4% paraformaldehyde. Brains were then immersed in 4% paraformaldehyde for later embedding. Ultrastructural changes in hippocampal mitochondria were assessed by transmission electron microscopy. Briefly, the brain was fixed with 4% buffered glutaraldehyde and postfixed with 1% osmium tetroxide. The preparation was dehydrated through an ethanol gradient, processed for Epon 812 embedding, and sectioned at a thickness of 80 nm on a rotary microtome. The ultrathin sections were stained with 4% uranyl acetate-lead citrate and examined with a Tecnai G2 Transmission Electron Microscopy (FEI Company, Hillsboro, OR, USA). Electron microscope photographs were analyzed using Image-Pro Plus 6.1 software (Media Cybernetics, Silver Spring, MD, USA). We analyzed four neurons from each rat (n = 6 rats/group) for a total of 24 neurons in each group. Morphometric analyses were conducted as previously described by an investigator blinded to the experimental conditions (Sanchez et al., 2011; Boscolo et al., 2012, 2013a).\nParaffin sections were deparaffinized and hydrated using the following incubation steps: 10 min in xylene twice; 5 min in 100%, 10 min in 95%, 10 min in 85%, and 10 min in 70% ethanol; and 5 min three times in PBS at room temperature. Antigen retrieval was achieved by boiling the sections in 10 mM sodium citrate for 10 min in a microwave oven. The sections were washed with PBS three times, and treated with 3% H2O2-methanol for 15 min. Immunostaining was performed by incubation with antibody against cleaved caspase 3 (1:200; Cell Signaling Technology, Beverly, MA, USA) for 2 h. Sections were then washed three times and incubated with secondary antibodies labeled with horseradish peroxidase for 30 min at room temperature. Immunohistochemical (IHC) imaging was performed using ZEISS HB050 (Zeiss, Jena, Germany) inverted microscope system and handled by Image-Pro Plus 6.1 software (Media Cybernetics, Rockville, MD, USA). Cells with brownish-yellow cytoplasm were counted as positive cells. The numbers of caspase 3 immunoreactive cells in the hippocampal CA1 and dentate gyrus (DG) regions were counted and analyzed in four microscopic fields (at ×200 magnification) by an investigator blinded to the treatment conditions.\nTUNEL Fluorescent Assays\nThe TUNEL assay was carried out with the in situ Cell Death Detection Kit (Roche Inc., Indianapolis, IN, USA) following the protocols as previously described (Wu et al., 2015a). Sections were counterstained by 4′,6-diamidino-2-phenylindole (DAPI, Beyotime Institute of Biotechnology, Shanghai, China) for 3 min, washed with PBS three times, and covered by microscopic glass with antifade mounting medium (Beyotime) for further analyses. Fluorescence microscopy imaging was performed using ZEISS HB050 (Zeiss, Jena, Germany) inverted microscope system and handled by Image-Pro Plus 6.1 software (Media Cybernetics, Rockville, MD, USA). The positive cells were identified, counted and analyzed by an investigator blinded to the grouping. The apoptotic index was defined as the average percentage of TUNEL-positive cells in each section counted in four hippocampal CA1 microscopic fields (at ×400 magnification).\nOpen Field Tests\nTo evaluate the anxiety behavior and general locomotor activity, we subjected rats (n = 12 for each group) to the open field test at PND 40. Each rat was gently placed in the center of a black plastic chamber (100 cm × 100 cm × 40 cm) for 10 min, while exploratory behavior was automatically recorded by a video tracking system (XR-XZ301, Shanghai Soft Maze Information Technology Co., Ltd., Shanghai, China). The total distance and the amount of time traveled in the center area (50 cm × 50 cm) of the maze were measured. After each test, the arena was cleaned with 75% alcohol to avoid the presence of olfactory cues.\nMorris Water Maze (MWM) Tests\nTo investigate spatial learning and memory function, we subjected rats (n = 12 for each group) to the Morris water maze (MWM) test (XR-XM101; Shanghai Xinruan Information Technology Co., Ltd., Shanghai, China) at PND 60. The MWM was a black metal tank (120 cm in diameter, 60 cm in depth) equipped with a platform (10 cm in diameter) 1–2 cm below the surface of the water. The MWM task was performed according to our previous study (Zhang et al., 2016). Briefly, it consisted of two phases, training phase for five consecutive days and probe trial phase on day 6. In the training phase, the rat was allowed to face to the pool wall in four random places (N, S, E, W) in the pool to find the fixed platform. Release positions were randomly predetermined. The trial was terminated once the rat reached the platform. If the rat failed to reach the platform within 60 s, it would be guided to the platform and allowed to stay for 15 s, then the latency was recorded for 60 s. In the probe test, single-probe trial was conducted with the original platform removed 24 h after the last training session. The rat was released at a random start position and allowed to swim for 60 s in the pool.\nData are presented as the mean ± SEM and analyzed by the Statistical Product for Social Sciences (SPSS; version 17.0, Chicago, IL, USA). The difference between the groups was determined by one-way analysis of variance followed by the Tukey’s tests. Comparisons for the spatial training sessions of MWM and mitochondrial size classification were performed by repeated two-way analysis of variance (ANOVA) followed by LSD test. A p value < 0.05 was regarded as statistical significance.\nElamipretide Inhibits ROS Accumulation and Oxidative Stress in the Hippocampus of Developing Rats Exposed to Isoflurane\nSince early exposure to isoflurane would induce excessive ROS accumulation inside the mitochondria, leading to the subsequent oxidative stress (Zhang et al., 2010; Boscolo et al., 2012, 2013a; Sun et al., 2014), we initially examined whether mitochondrion-targeted antioxidant elamipretide could timely inhibit hippocampal ROS accumulation and oxidative stress induced by isoflurane exposure. Our results showed that the levels of ROS (Figure 1A) and MDA (Figure 1B) were increased, while the expression and activity of SOD were reduced (Figures 1C,D) in the isoflurane group. However, the consequence was curtailed by elamipretide pretreatment (Figure 1), indicating that elamipretide provided rapidly antioxidative effects by inhibiting ROS accumulation and oxidative stress in the hippocampus of developing rat brain exposed to isoflurane.\nFigure 1. Effects of elamipretide pretreatment on isoflurane-induced oxidative stress in the hippocampus of developing rats. Elamipretide (5 mg/kg) or phosphate-buffered saline (PBS) was intraperitoneally administered to the pups with a volume of 0.4 ml/kg 30 min before gas inhalation. Anesthesia was induced by placing the pups in an anesthetizing chamber prefilled with 1.8% isoflurane plus 30% oxygen (O2) for 10 min and then changed to 1.5% isoflurane plus 30% O2 for 350 min. For control experiments, 30% O2 was delivered for 6 h at the same flow rate. Con: rats treated with PBS and 30% O2; Con + Ela: rats treated with elamipretide and 30% O2; Iso: rats treated with PBS and isoflurane; Iso + Ela: rats treated with elamipretide and isoflurane. The definition of Con/Con + Ela/Iso/Iso + Ela is the same as in the following figures. Reactive oxygen species (ROS) levels (A), Malondialdehyde (MDA) levels (B), Superoxide Dismutase (SOD) protein levels (C) and SOD activities (D) were determined with the fresh homogenates of hippocampal tissues obtained from postnatal day (PND) 7 rats (See “Materials and Methods” Section) immediately after 6 h of gas inhalation. Values are presented as mean ± SEM (n = 6 rats/group). *p < 0.05 vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nElamipretide Reverses Mitochondrial Ultrastructural Damages in the Hippocampus of Developing Rats Exposed to Isoflurane\nEarly exposure to GA may cause oxidative damages and long-term disturbances of mitochondrial morphology in developing rat brain (Sanchez et al., 2011; Boscolo et al., 2012). Here, we assessed whether timely diminishing substantial ROS and attenuating oxidative stress would ameliorate the damages of mitochondrial ultrastructure in developing rats exposed to isoflurane. We noted that isoflurane exposure caused early mitochondrial swelling (Figure 2A) at PND 7, and subsequently ultrastructural abnormalities (Figures 2B,C) at PND 21. In the isoflurane group, many mitochondria presented disorganized and vacuolated cristae (white arrows, Figures 2B, 3A) which made the mitochondria appear over-swelling and larger than normal ones. Other mitochondria were dark and condensed, indicating severe degenerative changes (black arrows, Figures 2B, 3A). In contrast, mitochondrial ultrastructure in the elamipretide-treated isoflurane group appeared similar to the control group with normal morphology of mitochondria without swelling or injury (Figures 2B,C). These results demonstrated that treatment with elamipretide before isoflurane exposure offered complete and lasting protection against isoflurane-induced ultrastructural damages of mitochondria in the hippocampus of developing rats.\nFigure 2. Ultrastructural changes in mitochondria of the hippocampal neurons after elamipretide pretreatment and isoflurane anesthesia. (A) Mitochondrial swelling was measured from fresh homogenates of the hippocampal tissues obtained from PND 7 rats. (B) Representative images of mitochondrial ultrastructure in hippocampal neuron of the developing rats at PND 21. White arrows: swollen mitochondria with disintegrated and disorganized mitochondrial inner membrane. Black arrows: degenerative mitochondria with dark and condensed presence. Scale bar = 0.5 μm for all the photographs. (C) Quantification analysis of abnormal-looking mitochondria in hippocampus of each group. Values are presented as mean ± SEM (n = 6 rats/group, four neurons from each rat). *p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nFigure 3. Mitochondrial density and size classification in the hippocampal neurons after elamipretide pretreatment and isoflurane anesthesia. (A) Mitochondrial overview in hippocampal neuron of the developing rats at PND 21. Scale bar = 1 μm for all the photographs except for the last one (scale bar = 0.5 μm). (B) Mitochondrial density was assessed by counting the number of mitochondria per unit area (μm2) of cytoplasmic area in each neuron. (C) Mitochondrial area was presented as a percentage of the cytoplasmic area of hippocampal neuron. (D) Size classification was assessed by mitochondrial size and counting the number of mitochondria in each group. Values are presented as mean ± SEM (n = 6 rats/group, four neurons from each rat). *p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nElamipretide Rescues Changes of Mitochondrial Density and Size in the Hippocampus of Developing Rats Exposed to Isoflurane\nSince GA appears to cause mitochondrial enlargement and disturb the regional distribution of developing neuronal mitochondria (Sanchez et al., 2011; Boscolo et al., 2012, 2013a), we performed detailed morphometric analysis of each mitochondrion and determined mitochondrial density in the soma of hippocampal neurons. We calculated mitochondrial density by counting the number of mitochondria per unit area (μm2) of cytoplasmic soma and measured mitochondrial areas as a percentage of the cytoplasmic area in each neuron (Figures 3A–C). The results showed that mitochondrial density in isoflurane group is less than that in control group (Figures 3A,B), but the mitochondria occupied more area of the cytoplasmic soma area in the isoflurane group than in the control group (Figures 3A,C). When classing mitochondria by their sizes and counting the number of mitochondria in each cell, we found more mitochondria larger than 0.5 μm in the isoflurane group than in the control group (Figure 3D). Interestingly, all the changes were completely reversed by elamipretide pretreatment (Figure 3). These results suggest that elamipretide offers mitochondrial protective effects associated with maintenance of mitochondrial density and size in spite of isoflurane exposure.\nElamipretide Suppresses Neuroapoptosis in the Hippocampus of Developing Rats Exposed to Isoflurane\nBecause isoflurane not only caused severe ROS generation and oxidative stress, but also disturbed mitochondrial morphogenesis, we examined whether these effects had long-lasting consequence with regard to developmental neuroapoptosis and whether elamipretide pretreatment would attenuate this neurotoxicity. Our results showed that prolonged (6 h) isoflurane exposure induced significant increase of caspase 3 (Figure 4) and the number of TUNEL-positive cells (Figure 5) in hippocampus, which was attenuated by elamipretide pretreatment, supporting that mitochondrion-targeted peptide elamipretide presented a long-lasting protection of hippocampal neurons from apoptosis.\nFigure 4. Isoflurane-induced activation of caspase 3 was attenuated by elamipretide pretreatment in the hippocampal CA1 and dentate gyrus (DG) regions. Representative images of cleaved caspase 3 in the hippocampal CA1 and DG regions are shown, revealed by immunohistochemical (IHC) staining at PND 21. Cells with brownish-yellow cytoplasm are positive for cleaved caspase 3. Scale bar = 100 μm for all the photographs except for the last two (scale bar = 50 μm). Lower panel presents statistical data from the four experimental groups. Values are presented as mean ± SEM (n = 6 rats/group). *p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nFigure 5. The number of TUNEL-positive cells was diminished by elamipretide pretreatment in the hippocampal CA1. Representative images of TUNEL in the hippocampal CA1 region at PND 21 are shown. Green color indicates TUNEL-positive cells; blue, 4′,6-diamidino-2-phenylindole (DAPI) stained nucleus. Scale bar = 25 μm. The lower panel shows statistical numbers of TUNEL-positive cells. Values are presented as mean ± SEM (n = 6 rats/group). *p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nElamipretide Ameliorates Isoflurane-induced Long-term Cognitive Deficits in Adolescent Rats\nTo further verify the beneficial effects of elamipretide on cognitive development, open field and MWM tests were performed at PND 40 or 60, respectively. Open field test showed no difference among the four groups in the spontaneous locomotor activity as reflected by the total distance (Figure 6A) and the time spent in the center (Figure 6B), excluding the possibility that locomotor activity per se affected the results in MWM tests. Elamipretide pretreatment successfully shortened the escape latency in training test (Figure 6C) and increased the crossing-platform times (Figures 6D,E) and target quadrant time (Figures 6D,F) in probe trial in the developing rats exposed to isoflurane. These results suggest that elamipretide has a potential therapeutic effect on long-term cognitive deficits in adolescent rats after early exposure to isoflurane.\nFigure 6. Elamipretide pretreatment prevented isoflurane-induced cognitive deficits in adolescent rats, tested at PND 40 or 60. (A) Total distance traveled and (B) time spent in the center in open field test. (C) Escape latency in every day during the spatial training of MWM. (D) Representative swimming trajectory of the rats, (E) crossing-platform times and (F) time spent in the target quadrant in the probe trial of MWM. Values are presented as mean ± SEM (n = 12 rats/group). *p < 0.05 vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance. The procedures of the water maze test are in “Materials and Methods” Section. MWM, Morris water maze.\nIn the present study, we showed that early exposure to isoflurane for the developing rats caused increased oxidative stress, mitochondrial deformation and neuronal apoptotic toxicity in the hippocampus. Pretreatment with mitochondrion-targeted antioxidant elamipretide resulted in significant improvement of mitochondrial integrity in the early and later period and, most importantly, prevented the young rats from development of anesthesia-induced cognitive deficits.\nA growing body of preclinical as well as some retrospective clinical evidences suggests that exposure to GA during the critical periods of development has been associated with neurotoxicity and long-term behavioral impairments (Flick et al., 2011; Ing et al., 2014b; Lin et al., 2014; Rappaport et al., 2015; Pinyavat et al., 2016; Walters and Paule, 2017). Consistently, we found that isoflurane administration induced long lasting neuronal apoptosis and cognitive deficits in developing rats. Mitochondria are supposed to be the most vulnerable initial target of these disorders (Sanchez et al., 2011; Boscolo et al., 2012, 2013a,b). Available evidences accompanying with our results suggest that rats exposed to isoflurane at PND 7 present substantial alterations in mitochondrial morphogenesis and regional distribution, manifested as a decrease of mitochondrial size as acute effects (at PND 8; Boscolo et al., 2013a) and an enlargement of mitochondria as long-term effects (at PND 21; Sanchez et al., 2011; Boscolo et al., 2012). Our findings are in agreement with previous studies (Sanchez et al., 2011; Boscolo et al., 2012) demonstrating that prolonged (6 h) isoflurane exposure causes swollen mitochondria with lower density and more cytoplasmic area occupation in the soma of hippocampal neurons at PND 21, suggesting long-term ultrastructural damages of mitochondria. It is likely that the swelling enlargement leads to “leakage” and results in neurotoxicity via activating the intrinsic mitochondria-dependent apoptotic pathway (Zhang et al., 2010; Wu et al., 2015a).\nAgents and strategies have been proposed to be potential to ameliorate the mitochondrial morphologic abnormality induced by neonatal GA (Boscolo et al., 2012, 2013a; Xu et al., 2016). These findings suggest that mitochondrial ROS as well as lipid peroxidation are important in the development and progression of impaired mitochondrial morphogenesis. In agreement with these, molecules that are capable of targeting and treating the dysfunctional mitochondria to suppress oxidative stress are needed. Elamipretide is a novel mitochondrion-targeted peptide to meet the need (Zhao et al., 2005; Szeto, 2008; Min et al., 2011; Hao et al., 2015; Yin et al., 2016). Previously, we found that elamipretide prevented isoflurane-induced mitochondrial ROS generation to improve mitochondrial function in aged mice (Wu et al., 2015a, 2016). Here, we show that elamipretide attenuates acute ROS accumulation induced by isoflurane exposure and, more importantly, protects mitochondrial morphology from enlargement in neonatal rats lasting to early adulthood. As a result, elamipretide ameliorated isoflurane-induced long-term cognitive deficits. Thus, we provide the evidences that elamipretide not only improves biochemical and pathological processes, but also the preclinical symptoms. Consistence with that, elamipretide was reported to reduce impaired mitochondrial dynamics and enhance mitochondrial biogenesis in Huntington’s disease neurons (Yin et al., 2016). Due to the superpower properties of elamipretide, more than 20 clinical trials (registered as elamipretide or Bendavia) have been being conducted as phase 1 or 2 drug1 covering a number of mitochondrial disorders. So far the safety and tolerability were well confirmed (Gibson et al., 2016), which might potentially raise a new therapeutic strategy for elamipretide as a drug to protect pediatric patients undertaking GA.\nIn conclusion, this is the first study to our knowledge that directly targeting mitochondrial ROS ameliorated isoflurane-induced long-term impairments of mitochondrial morphogenesis and cognition in developing rats. This work suggests a new strategy to reverse developing- and/or mitochondrion-related impairments in GA-induced neurotoxicity and cognitive deficits.\nJW, KL and J-JY conceived and designed experiments. JW and SH performed experiments and data acquisition. JW, SH, KL and J-JY analyzed and interpreted data. JW and KL wrote the manuscript. X-RS, HZ, HL, HtZ and M-HJ contributed to acquiring and analyzing data. All authors read and approved the final manuscript.\nConflict of Interest Statement\nThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\nThis work was supported by the National Basic Research Program of China (Grant No. 2015CB856300), the National Nature Science Foundation of China (Grant Nos. 31371060, 81271216, 81471105) and the Program B for Outstanding PhD Candidate of Nanjing University (Grant No. 201602B070).\nBoscolo, A., Milanovic, D., Starr, J. A., Sanchez, V., Oklopcic, A., Moy, L., et al. (2013a). Early exposure to general anesthesia disturbs mitochondrial fission and fusion in the developing rat brain. Anesthesiology 118, 1086–1097. doi: 10.1097/ALN.0b013e318289bc9b\nBoscolo, A., Ori, C., Bennett, J., Wiltgen, B., and Jevtovic-Todorovic, V. (2013b). 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Neurodevelopmental outcomes after initial childhood anesthetic exposure between ages 3 and 10 years. J. Neurosurg. Anesthesiol. 26, 377–386. doi: 10.1097/ANA.0000000000000121\nJevtovic-Todorovic, V., Boscolo, A., Sanchez, V., and Lunardi, N. (2012). Anesthesia-induced developmental neurodegeneration: the role of neuronal organelles. Front. Neurol. 3:141. doi: 10.3389/fneur.2012.00141\nMin, K., Smuder, A. J., Kwon, O. S., Kavazis, A. N., Szeto, H. H., and Powers, S. K. (2011). Mitochondrial-targeted antioxidants protect skeletal muscle against immobilization-induced muscle atrophy. J. Appl. Physiol. 111, 1459–1466. doi: 10.1152/japplphysiol.00591.2011\nNoguchi, K. K., Johnson, S. A., Kristich, L. E., Martin, L. D., Dissen, G. A., Olsen, E. A., et al. (2016). Lithium protects against anaesthesia neurotoxicity in the infant primate brain. Sci. Rep. 6:22427. doi: 10.1038/srep22427\nPinyavat, T., Warner, D. O., Flick, R. P., McCann, M. E., Andropoulos, D. B., Hu, D., et al. (2016). Summary of the update session on clinical neurotoxicity studies. J. Neurosurg. Anesthesiol. 28, 356–360. doi: 10.1097/ANA.0000000000000347\nRappaport, B. A., Suresh, S., Hertz, S., Evers, A. S., and Orser, B. A. (2015). Anesthetic neurotoxicity—clinical implications of animal models. N. Engl. J. Med. 372, 796–797. doi: 10.1056/NEJMp1414786\nSanchez, V., Feinstein, S. D., Lunardi, N., Joksovic, P. M., Boscolo, A., Todorovic, S. M., et al. (2011). General anesthesia causes long-term impairment of mitochondrial morphogenesis and synaptic transmission in developing rat brain. Anesthesiology 115, 992–1002. doi: 10.1097/ALN.0b013e3182303a63\nSun, Y., Cheng, B., Dong, Y., Li, T., Xie, Z., and Zhang, Y. (2014). Time-dependent effects of anesthetic isoflurane on reactive oxygen species levels in HEK-293 cells. Brain Sci. 4, 311–320. doi: 10.3390/brainsci4020311\nWalters, J. L., and Paule, M. G. (2017). Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity. Neurotoxicol. Teratol. 60, 2–23. doi: 10.1016/j.ntt.2016.11.005\nWang, W. Y., Luo, Y., Jia, L. J., Hu, S. F., Lou, X. K., Shen, S. L., et al. (2014). Inhibition of aberrant cyclin-dependent kinase 5 activity attenuates isoflurane neurotoxicity in the developing brain. Neuropharmacology 77, 90–99. doi: 10.1016/j.neuropharm.2013.09.006\nWu, J., Li, H., Sun, X., Zhang, H., Hao, S., Ji, M., et al. (2015a). A mitochondrion-targeted antioxidant ameliorates isoflurane-induced cognitive deficits in aging mice. PLoS One 10:e0138256. doi: 10.1371/journal.pone.0138256\nWu, J., Zhang, M., Hao, S., Jia, M., Ji, M., Qiu, L., et al. (2015b). Mitochondria-targeted peptide reverses mitochondrial dysfunction and cognitive deficits in sepsis-associated encephalopathy. Mol. Neurobiol. 52, 783–791. doi: 10.1007/s12035-014-8918-z\nWu, J., Zhang, M., Li, H., Sun, X., Hao, S., Ji, M., et al. (2016). BDNF pathway is involved in the protective effects of SS-31 on isoflurane-induced cognitive deficits in aging mice. Behav. Brain Res. 305, 115–121. doi: 10.1016/j.bbr.2016.02.036\nXu, F., Armstrong, R., Urrego, D., Qazzaz, M., Pehar, M., Armstrong, J. N., et al. (2016). The mitochondrial division inhibitor Mdivi-1 rescues mammalian neurons from anesthetic-induced cytotoxicity. Mol. Brain 9:35. doi: 10.1186/s13041-016-0210-x\nXu, K. X., Tao, J., Zhang, N., and Wang, J. Z. (2015). Neuroprotective properties of vitamin C on equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in high fat diet fed neonatal mice. Int. J. Clin. Exp. Med. 8, 10444–10458.\nYin, X., Manczak, M., and Reddy, P. H. (2016). Mitochondria-targeted molecules MitoQ and SS31 reduce mutant huntingtin-induced mitochondrial toxicity and synaptic damage in Huntington’s disease. Hum. Mol. Genet. 25, 1739–1753. doi: 10.1093/hmg/ddw045\nZhang, H., Sun, X. R., Wang, J., Zhang, Z. Z., Zhao, H. T., Li, H. H., et al. (2016). Reactive oxygen species-mediated loss of phenotype of parvalbumin interneurons contributes to long-term cognitive impairments after repeated neonatal ketamine exposures. Neurotox. Res. 30, 593–605. doi: 10.1007/s12640-016-9653-1\nZhang, Y., Dong, Y., Wu, X., Lu, Y., Xu, Z., Knapp, A., et al. (2010). The mitochondrial pathway of anesthetic isoflurane-induced apoptosis. J. Biol. Chem. 285, 4025–4037. doi: 10.1074/jbc.M109.065664\nZhao, K., Luo, G., Giannelli, S., and Szeto, H. H. (2005). Mitochondria-targeted peptide prevents mitochondrial depolarization and apoptosis induced by tert-butyl hydroperoxide in neuronal cell lines. Biochem. Pharmacol. 70, 1796–1806. doi: 10.1016/j.bcp.2005.08.022\nKeywords: elamipretide, general anesthesia, antioxidant, mitochondrial morphology, cognition\nCitation: Wu J, Hao S, Sun X-R, Zhang H, Li H, Zhao H, Ji M-H, Yang J-J and Li K (2017) Elamipretide (SS-31) Ameliorates Isoflurane-Induced Long-Term Impairments of Mitochondrial Morphogenesis and Cognition in Developing Rats. Front. Cell. Neurosci. 11:119. doi: 10.3389/fncel.2017.00119\nReceived: 16 February 2017; Accepted: 10 April 2017;\nPublished: 25 April 2017.\nEdited by:Chao Deng, University of Wollongong, Australia\nReviewed by:Cláudia Fragão Pereira, University of Coimbra, Portugal\nHari Prasad Osuru, University of Colorado Hospital, USA\nCopyright © 2017 Wu, Hao, Sun, Zhang, Li, Zhao, Ji, Yang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.\n† These authors have contributed equally to this work. |
Septoplasty is a surgery to straighten a\n. The septum is the wall dividing the left and right nasal cavities. It is made of cartilage and bone and is lined with a thin mucus membrane.\nA normal septum is straight and in the center of the nose. A deviated septum is bent or off-center. Septal deviation may occur during development in the womb, during birth, as your nose grows, or after a traumatic injury. Septoplasty may be done at the same time as other nasal surgery, like\nSeptoplasty is considered if a deviated septum obstructs your nasal passages. The obstruction can cause impaired nasal breathing,\nobstructive sleep apnea\n, or a runny nose. A deviated septum may also need to be corrected with septoplasty if it causes chronic headaches.\nDeviated Nasal Septum\nCopyright © Nucleus Medical Media, Inc.\nProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: Numbness in the tip of the nose or upper front teethBleedingInfectionSeptal perforation—a hole in the septumNo improvement in symptomsPoor cosmetic outcome\nBefore your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinkingChronic diseases, such as diabetes or obesity\nTo prepare for surgery, follow any instructions provided by your doctor.\nTalk to your doctor about your medications, including vitamins, herbs, or dietary supplements. You may be asked to stop taking some medications up to one week before the procedure, like:\nBlood thinnersAntiplateletsIf you are having local anesthesia for the procedure, it is likely that no other special preparation is needed. If you will be having general anesthesia, your doctor will give you additional instructions.\nSeptoplasty can be done using local or\nanesthesia. Local anesthesia will numb the area. General anesthesia will put you to sleep.\nAn incision will be made inside the nose. The lining of the septum will be lifted up and out of the way.\nThe bent bone or cartilage will be straightened by moving it or cutting off the bent piece. After the repair is done, the lining will be replaced over the top of the septum. Gauze may be placed in the nose to soak up any blood. A plastic splint may also be inserted to keep the septum in place while it heals.\nAnesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.\nMost people leave the care center after 3-4 hours.\nDuring your stay, the care center staff will take steps to reduce your chance of infection, such as: Washing their handsWearing gloves or masksKeeping your incisions covered\nThere are also steps you can take to reduce your chance of infection, such as: Washing your hands often and reminding your healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incision\nIf nasal packing is used, it is removed 1-2 days after the surgery. The splint remains in the nose for up to a week. After the surgery, do the following to ensure a smooth recovery: Try to breathe through your mouth for the first few days.Do not blow your nose.Keep your head elevated when lying down for the first 1-2 days.Apply ice packs to your nose to reduce pain and swelling.Do not take aspirin products for pain.Your doctor may want to see you for a follow-up visit to monitor healing or to remove the gauze packing or splint.\nCall your doctor if any of the these occur: Signs of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteHeavy bleedingPacking from your nose falls into the back of your throat, causing discomfortPersistent nausea and/or vomitingVomit that is bloody or the color of coffee groundsPain that you cannot control with the medications you have been givenCough, shortness of breath, or chest pain\nIf you think you have an emergency, call for medical help right away.\nDeviated septum. Cedars-Sinai website. Available at:\nhttp://www.cedars-sinai.edu/Patients/Health-Conditions/Deviated-Septum.aspx. Accessed July 23, 2013.\nDeviated septum. Children's Hospital of Pittsburgh website. Available at:\nhttp://www.chp.edu/CHP/P02062. Accessed July 23, 2013.\nFact sheet: deviated septum. American Academy of Otolaryngology website. Available at\nhttp://www.entnet.org/HealthInformation/deviatedSeptum.cfm. Accessed July 23, 2013.\n6/3/2011 DynaMed's Systematic Literature Surveillance\nhttp://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis.\nAm J Med.\nLast reviewed July 2013 by Marcin Chwistek, MD; Michael Woods, MD\nPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.\nCopyright © EBSCO Publishing. All rights reserved. |
Bone augmentation in upper jaw – in other words: Sinus lift.\nThe “sinus floor augmentation”, aka “sinus lift” is a procedure to level out the too little bone substance in the upper jaw. The problem of limited bone supply may occur because the maxillary sinuses get larger and continuously extend in the upper jaw bone as we get older.\nDentists also use this solution when the jaw ridge is too narrow.\nIn this article you will get answers to the following:\n- When is a sinus lift necessary?\n- Materials for bone augmentation – What options are available?\n- What is the procedure of a sinus lift operation?\n- Is there any pain?\n- Where can the jawbone augmentation be carried out?\nWhen is a sinus lift necessary?\nIn a successful implantation, the quality of the bone plays the most important role. The bone must have a very good substance, as the artificial tooth root is embedded in the bone. The implant has to join with the surrounding bone. Therefore it is important that the jaw ridge has enough substance, so that the implant can grow together with the bone.\nMaterials for bone augmentation – What options are available?\nAutologous bone can be recovered sufficiently from different parts of the body. There is no risk of infection for the patient and therefore the body’s own bone is superior to all other materials.\nNatural bone substitute materials are obtained from animals (bone and connective tissues). Natural bone replacement materials are suitable for the filling of smaller jaw defects, or as addition to the patient’s own bone.\nSynthetic bone substitute materials consist of ceramics based on calcium. They are produced as granules. Due to their moderate stability, dentists only use them to correct smaller jaw defects.\nYour dentist will determine the right material for your case in base of the results of the necessary clinical and radiological examinations.\nWhat is the procedure of a sinus lift operation?\nIn most cases, the dentist performs the sinus lift surgery under local anesthesia. The dentist lifts the sinus floor, carefully detaches the mucous membrane and pushes it upwards. This results in a deepening between the mucous membrane and alveolar ridge. The dentist fills this void with bone graft material or with the patient’s own bone.\nIn some cases the dentist can carry out the sinus lift and the placement of implants in the same session, but oftentimes there is a healing period of 3 to 6 months between the two procedures.\nIs there any pain?\nYou may experience some pain after the effect of the anesthesia wears off. Your dentist will recommend you suitable painkillers (mostly: Ibuprofen 400) for any eventual discomfort and pain. You must avoid medications containing ASA (acetylsalicylic acid), as aspirin, as they cause or enhance bleeding. If your doctor has prescribed you antibiotics, take the medication as prescribed, even if you have no complaints whatsoever.\nWhere can the jawbone augmentation be carried out?\nIn principle, there are only a few places in Europe where dental surgeons perform the surgery for the jaw bone grafting. Hungary is one of the most famous places of internationally renowned dental treatments. A dental treatment in Hungary is exceptionally reliable because of our excellent and well-trained doctors. Furthermore, it is important to know that the dental tourism in Hungary is well developed and organised, so that patients can travel back home with the greatest satisfaction about their teeth.\nThe cost of a sinus lift in Hungary is around 510 usd. |
Your pet is an important part of your family, and when he or she is ill, you want the best medical care available.\nSpay & Neuter\nSurgery includes routine as well as unexpected procedures. Spaying and Neutering your pet can prevent unwanted litters and avoid multiple illnesses related to reproductive systems such as pyometra (infection of the uterus), mammary cancer, dystocia, perineal hernia, urethral prolapse, testicular cancer – all of which can be deadly.\nOur experienced team of doctors and staff make it their number one priority to focus on pain management, patient safety, and we use the most current surgical practices to ensure your pet receives the best veterinary care. Our team will be working with you before, during, and after surgery to address any questions or concerns you may have about the surgical procedure, anesthesia, or postoperative care.\nIt is recommended to examine your pet’s feces annually to ensure no new parasitic infections have been acquired.\nEven if dewormer was administered a fecal examination is recommended to ensure the appropriate medication was used, there are numerous infectious organisms that can be identified in the feces that require different medications to be cleared. Not all parasites are visible by eye and not all parasitic infestations necessarily cause diarrhea.\nWest Russell Animal Hospital requires a negative fecal examination within the past year to permit boarding.\nFlea and tick prevention\n|Weight (lbs)||Cat Neuter||Cat Spay|\n|Dog Neuter||Cat Spay|\nPricing includes Pre-anesthetic exam, IV cath, anesthesia monitoring, pre and post-operative pain meds, e-collar and nail trim. Not valid with any other specials or coupons.\nPlease note there are various options when spaying or neutering your pet. Call to speak to a member of our veterinary team to discuss your pet’s individualized needs. Additional costs may apply to pets in heat, pregnant, or with other health concerns |
Analgesia for day-case shoulder surgery\nSingle-shot nerve blocks provide excellent postoperative analgesia for a limited period and are increasingly used in day-case units. They allow early patient discharge following painful operative procedures that would otherwise require overnight hospitalization. We investigated the adequacy of analgesia at home after the block had worn off.Methods\nA prospective audit by telephone 1 week after surgery of 50 consecutive patients who had had a single-shot interscalene block for day-case shoulder arthroscopic surgery.Results\nThe mean length of adequate sensory block was 22.5 h (9–48 h) after which 20% of patients had a maximum visual analogue scale (VAS) score of 5/5. Most patients did not take analgesics as prescribed and two patients (5.4%) required additional analgesia from their family doctor or accident and emergency department.Conclusions\nWe conclude that analgesia at home is often inadequate after painful day-case surgical procedures if single-shot local anaesthetic blockade is used. |
Learn About Your Surgery Experience\nBefore your procedure we work with you to gather paper work, review financial information, and ensure you’re completely prepared and comfortable.\nAfter getting checked in, you’ll be assisted by one of our friendly nurses to review your health history and get you all prepped. Then your physician and anesthesiologist will discuss the entire procedure with you, making everyone is on the same page. When everything is set, you will be taken back for your procedure. |
Case Reports in Anesthesiology\nVolume 2012 (2012), Article ID 592198, 3 pages\nImpossible Airway Requiring Venovenous Bypass for Tracheostomy\nDepartment of Anesthesiology, Montefiore Medical Center, Bronx, New York City, NY 10467, USA\nReceived 26 June 2012; Accepted 29 July 2012\nAcademic Editors: J. J. Derose, M. Kodaka, and M. Marandola\nCopyright © 2012 Johnathan Gardes and Tracey Straker. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.\nThe elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient’s life.\nProper management of the difficult airway presents one of the most important skill sets for the anesthesiologist to master. However, certain situations necessitate one look beyond traditional algorithms. In this case, a multidisciplinary team of otorhinolaryngologists, cardiac surgeons, perfusionists, and anesthesiologists decided to use venovenous bypass as a means to oxygenate a patient whose airway could not be secured because of severe tracheal stenosis.\n2. Case Report\nA 45-year-old woman with a long history of tracheal stenosis and upper airway obstruction presented for elective tracheostomy placement in the setting of supra- and infraglottic stenosis after failed awake tracheostomy by an otorhinolaryngologist (ORL) (Figures 1 and 2). It was felt by the attending ORL surgeon that the airway could not be secured from above after serial diagnostic scopes. Due to the failed awake tracheostomy, it was felt that surgical airway under bypass was the only option.\nEight years previously, the patient presented for an elective bilateral tubal ligation. At the time, she was otherwise healthy. The intraoperative course was unremarkable and the patient’s trachea was extubated on the operating table. However, after moving to the stretcher for transport, she developed acute respiratory distress. She was quickly returned to the operating room (OR) table and her trachea reintubated after several attempts at direct laryngoscopy. At the time, her airway was noted to be acutely swollen and edematous. She remained intubated in the intensive care unit for two weeks during which time several attempts at extubation failed. Finally, she was weaned off support and discharged home. The presumptive diagnosis was an acute allergic reaction to the antibiotic cephazolamine, which she had received intraoperatively.\nTwo days after discharge the patient returned to the emergency room in acute respiratory distress and could not be intubated. An emergency tracheostomy was performed to secure her airway. The patient remained with the tracheostomy for the next 7 months before she was successfully decannulated. Since that time, the patient has returned to the operating room several times with tracheal stenosis requiring dilation. Her past medical history was also significant for hypothyroidism, morbid obesity, obstructive sleep apnea requiring continuous positive airway pressure (CPAP), and hypertension. Medications included levothyroxine sodium, furoate monohydrate by nasal inhalation and esomeprazole. Allergies to latex and cephalosporins were reported. Review of symptoms was significant for chronic shortness of breath and three pillow orthopnea. The patient had fasted for more than 8 hours. On physical examination, the patient was mildly hypertensive, with a class III airway, mild stridor, and oozing from the site of the prior tracheostomy. All laboratory values and the cardiogram were within normal limits.\nBecause of the inability to secure the airway, even by tracheostomy, and repeated incidents of desaturation during prior attempts, the team felt that adequate oxygenation could best be managed by venovenous bypass. Venovenous bypass was suggested after consultation with the cardiac anesthesiology team because oxygenation would be maintained and the cardiac function of the patient was normal. The ORL surgeon requested that we do not cannulate any structures in the neck as they would be working in that area. With this request from the ORL service and the fact that arterial venous bypass provides greater control over hemodynamics, femoral bypass was the chosen area for cannulation.\nThe anesthetic plan for spinal without sedation was discussed with the patient. The patient was brought into the OR where standard ASA monitors were placed including arterial cannulation and cerebral oximetry. Spinal anesthesia was placed at L4-5 using 24G Gertie Marx spinal needle and 1.2 mL of hyperbaric 7.5% bupivacaine. The patient had a T10 level at 5 minutes with vital signs stable throughout. Of note, the patient started to receive an infusion of vancomycin prior to incision and immediately experienced pruritus and scratchy throat. The antibiotic infusion was promptly discontinued and the patient was given steroids and subcutaneous epinephrine. The symptoms resolved and surgery continued. The patient was heparinized. Just prior to going on femoral venovenous bypass, general anesthesia was induced using midazolam, fentanyl, and etomidate. Once on bypass, vecuronium was given. As the patient was to have a tracheostomy on bypass, general anesthesia was instituted to assure no issues of recall.\nShortly bypass was initiated, cerebral oximetry and pulse oximetry values as well as blood pressure all dropped rapidly, likely from poor brain and upper extremity perfusion caused by the bypass. During cutdown on the patient’s vasculature, it was discovered that he had severe tortuosity of the vessels. The cut-down time was extensive and the spinal anesthetic began to wear off. It was thought that one of the differentials for failure of bypass was the creation of a false lumen from the cannulation.\nAt this point, the otorhinolaryngologist rapidly secured the airway using rigid laryngoscopy and placed an oral endotracheal tube. With proper ventilation, the vital signs all returned to normal and she was taken off bypass and the heparin was reversed. The tracheostomy was then performed by the surgeon under general anesthesia. The remainder of the intraoperative course was unremarkable and the patient was extubated at the end of the case. The patient did well postoperatively and was discharged home.\nThe difficult airway algorithm from the American Society of Anesthesiologists details a complex decision tree of basic and advanced airway management choices in both the awake and anesthetized patient who has suspected or known difficult ventilation and/or intubation . The final steps in this algorithm end with invasive or surgical airway access. In this case, the patient had already failed awake surgical airway and was believed to have additional upper airway obstruction and anatomy that would prevent safe intubation either awake or asleep. With the failure of what is usually the final step in the algorithm, the anesthesia team in consultation with other surgical specialists opted for venovenous bypass as a means to oxygenate and anesthetize a patient whose airway could not be secured. While extracorporeal membrane oxygenation (ECMO) has been utilized and reported in the pediatric population fairly extensively, venovenous bypass has only rarely been reported in the literature as a means of oxygenation in the setting of the impossible airway in an adult, often in the setting of a large thyroid or mediastinal tumor or severe tracheal trauma [2, 3]. Rosa and colleagues and Jeon and colleagues both presented cases of cardiopulmonary bypass being safely utilized in this manner for cases of a cervical and thyroid tumor, respectively [4, 5]. Shiraishi and colleagues presented a series of 18 cases of tracheal resection and reconstruction, one of which required percutaneous cardiopulmonary support under minimal sedation . Cardiopulmonary bypass is not without risk and complications as demonstrated by the fall in cerebral oximetry and pulse oximetry in our patient. .\nThe ORL surgeon admitted that this case was transferred to him from a colleague, and he had actually never instrumented the patient’s airway in the operating room for a direct laryngoscopy. Perhaps had the otorhinolaryngologist actually instrumented the airway previously, better objective data would have been available to avoid the case outcome.\nThe otorhinolaryngologist was present throughout the procedure and was able to provide a rapid and safe emergency airway intervention that allowed the patient to be adequately oxygenated. While our patient had an uncomplicated postoperative course, the risk of hemorrhage in this population is significant.\nEven though the patient was unable to tolerate bypass for the length of the tracheostomy procedure and required alternative means of securing the airway, the presence of the multidisciplinary team provided safe and effective backup. We believe that rare and complex airway situations such as this case should always be approached with a multidisciplinary team of surgeons and anesthesiologists as the alternatives to traditional airway management such as venovenous bypass can be extremely challenging and unpredictable.\n- American Society of Anesthesiologists Task Force on Management of the Difficult Airway, “Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the difficult airway,” Anesthesiology, vol. 98, no. 5, pp. 1269–1277, 2003.\n- J. Raake, B. Johnson, B. Seger, et al., “Extracorporeal membrane oxygenation, extubation, and lung-recruitment maneuvers as rescue therapy in a patient with tracheal dehiscence following slide tracheoplasty,” Respiratory care, vol. 56, no. 8, pp. 1198–1202, 2011.\n- C. SenDasgupta, G. Sengupta, K. Ghosh, A. Munshi, and A. Goswami, “Femoro-femoral cardiopulmonary bypass for the resection of an anterior mediastinal mass,” Indian Journal of Anaesthesia, vol. 54, no. 6, pp. 565–568, 2010.\n- P. Rosa, E. A. Johnson, and P. J. Barcia, “The impossible airway: a plan,” Chest, vol. 109, no. 6, pp. 1649–1650, 1996.\n- H.-K. Jeon, Y. K. So, J. H. Yang, and H. S. Jeong, “Extracorporeal oxygenation support for curative surgery in a patient with papillary thyroid carcinoma invading the trachea,” Journal of Laryngology and Otology, vol. 123, no. 7, pp. 807–810, 2009.\n- T. Shiraishi, J. Yanagisawa, T. Higuchi et al., “Tracheal resection for malignant and benign diseases: surgical results and perioperative considerations,” Surgery Today, vol. 41, no. 4, pp. 490–495, 2011.\n- M. J. Belmont, M. K. Wax, and F. N. DeSouza, “The difficult airway: cardiopulmonary bypass—the ultimate solution,” Head and Neck, vol. 20, pp. 266–269, 1998. |
The Gräfenberg spot, more commonly known as the G-spot, is an internal erogenous zone located on the front vaginal wall. There is some controversy about its existence. When stimulated, the G-spot can lead to more intense sexual arousal and stronger orgasms, yet can be difficult for women and their partners to locate and stimulate properly. The G-spot augmentation procedure is a simple injection that enlarges the G-spot for improved sensation without surgery.\nBoard certified plastic surgeon Dr. Otto Placik is a leading provider of G-spot enhancement for women in the Chicago area. A genital rejuvenation specialist, Dr. Placik has helped thousands of women to feel positive about their bodies and enjoy a more vibrant sex life.\nAbout G-Spot Enhancement\nThe G-spot is located beneath the surface of the anterior vaginal wall, typically about halfway between the cervix and the pubic bone. Because of its location, this erogenous zone can only be stimulated indirectly through the vaginal wall. This normally occurs during intercourse to some extent, but G-spot augmentation can help those women who desire more sensation, or who want to experience more intense vaginal orgasms.\nG-spot augmentation delivers a shot of filler directly to the G-spot, enlarging the erogenous area to about the size of a quarter in diameter and augmenting the thickness as well. In a pilot study, 87 percent of women reported enhanced sexual arousal and gratification following the injection.\nDuring your appointment, Dr. Placik will position you in stirrups, similar to getting a Pap smear. Next, he’ll measure exactly where you currently feel the most sensation in your vaginal wall, so he can more precisely target the treatment to your unique anatomy. Finally, the area is numbed with a local anesthetic and Dr. Placik administers the injection. After the treatment, Dr. Placik will ask you to wear a tampon for 4 hours.\nThe entire appointment generally takes less time than your lunch break, and you can resume sexual activity as soon as the tampon is removed, about 4 hours following your procedure. Results should be immediately noticeable, and can last for several months or more.\nG-Spot Enhancement FAQ\nThe best results from G-spot augmentation are seen in sexually active women who are familiar with their own anatomy and who enjoy G-spot stimulation. Any woman who is interested in more a accessible G-spot or who wants to experience more intense vaginal orgasms may be a good candidate.\nMaking G-spot stimulation easier by amplifying the G-spot itself can lead to faster arousal and stronger vaginal orgasms. The majority of women who undergo the G-spot augmentation report a more intense sex life after the procedure. If clitoral stimulation is a concern for you as well, Dr. Placik may also recommend clitoral hood reduction to allow easier access to the clitoris during intercourse.\nThe cost of G-spot enhancement can vary depending whether the procedure is administered on its own or in combination with additional vaginal rejuvenation. G-spot augmentation may also be included as part of a mommy makeover, in which case the total surgical costs would also include the anesthesiologist’s fee and charge for the surgical facility. However, it is often best to defer the injection when sexual activity is permissible and resumed following the more extensive procedures. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nSince you can resume sexual activity just a few hours after your appointment, most women notice results almost immediately. You and your partner should be able to locate your G-spot in a non-aroused state more easily, and notice heightened G-spot stimulation during intercourse along with deeper vaginal orgasms. Although the body naturally absorbs the injected collagen over time, the effects typically last between 3-6 months, with an average of 4 months for most women.\nDr. Placik uses a local anesthetic prior to performing the treatment, so the procedure should be completely painless with a comfort level that’s similar to an annual gynecological exam. There may be slight spotting after your appointment, but this is not normally accompanied by pain or cramping. More time during your appointment will be spent on determining the correct measurements than delivering the injection itself, which only takes a few seconds.\nBecause a G-spot injection is nonsurgical, the risks are very minimal, and include concerns like itching, irritation or bleeding at the injection site. More serious complications, like urinary tract infections, scarring or lumpiness, are possible but rare.\nDr. Placik is a board certified plastic surgeon in Chicago and an active member of The American Society of Plastic Surgeons. He received his medical degree from Northwestern University where he also completed residencies in general and plastic and reconstructive surgery.\nClitoral Hood Reduction\nThe clitoris is the most sensitive area of a woman’s body, with over 8000 nerve endings. The visible tip of the clitoris (clitoral glans) is partially covered by the clitoral hood. Although the clitoral hood provides protection, excess hood tissue can interfere with stimulation and make achieving orgasm more difficult.\nClitoral hood reduction permanently removes excess or redundant tissue so the clitoris can be more easily stimulated or accessed during sex. This can help women become aroused and achieve orgasm more quickly. The clitoral hood can also be reduced for aesthetic reasons, often as part of a labiaplasty. It is quite different from a hoodectomy, where all the hood tissue is removed with constant exposure of the clitoris. Clitoral hood reduction has many other names such as a hoodoplasty, hoodotomy, and may be referred to as a clitoroplasty, although this should be distinguished from a clitoropexy or clitoral reduction, which are performed for an excessively large or protruding clitoris.\nGenital rejuvenation specialist Dr. Otto Placik is a board-certified plastic surgeon serving Chicago and its suburbs. Dr. Placik is a skilled surgeon who has helped hundreds of women achieve improved sexual confidence through clitoral hood reduction.\nAbout Clitoral Hood Reduction\nThe sole purpose of the clitoris (sometimes colloquially referred to as the “clit”) is to provide sexual pleasure, and the majority of women cannot climax without clitoral stimulation. However, if the clitoral hood provides too much protective coverage or the excess tissue is so bulky that direct stimulation of the clitoris cannot occur, the feelings of arousal can be greatly diminished. An overly large clitoral hood can also make reaching orgasm more difficult.\nDuring clitoral hood reduction, Dr. Placik uses a meticulous and cautious surgical technique to avoid removing too much tissue that could leave the clitoris overly exposed, a sensation that patients may find too intense. The clitoris itself and surrounding nerves are not touched during the procedure, ensuring that you retain full sensation after surgery.\nIn most cases, clitoral hood reduction is performed as an outpatient procedure and doesn’t require general anesthesia or a hospital stay. Instead, Dr. Placik prefers using a local anesthetic, sometimes combined with oral sedation. Dr. Placik adopts a delicate approach toward clitoral hood reduction in order to prevent scarring and ensure optimum results.\nPatients typically return home the same day as their surgery, although recovery time will vary depending on if other procedures were performed at the same time. It’s common to perform a clitoral hood reduction in combination with other female genital rejuvenation procedures such as labiaplasty or vaginal rejuvenation. Incorporating G-spot enhancement at the same time can help increase internal sexual sensation in addition to the enhanced clitoral stimulation women often experience after clitoral hood reduction.\nClitoral Hood Reduction\nClitoral Hood Reduction FAQ\nWomen who find that achieving clitoral stimulation is difficult or diminished or who are unhappy with the physical appearance of excess tissue covering their clitoris are usually good candidates for a clitoral hood reduction. It’s also important to have realistic expectations about the procedure, and to be in good general physical and mental health overall.\nDuring your first meeting with Dr. Placik at our office in Chicago or Arlington Heights, you’ll discuss your hopes fur surgery in detail. Dr. Placik will also ask you several questions in order to gain a better understanding of your goals. It’s not uncommon for Dr. Placik to recommend additional procedures that can complement the effects of your clitoral hood reduction either in terms of aesthetics or function.\nCosts for clitoral hood reduction will vary depending on the complexity of surgery and whether other procedures are being performed at the same time. The fees include payment to Dr. Placik himself as well as the fee for the surgical facility. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nA clitoral hood reduction can typically be performed in a fairly quick amount of time under a local anesthetic, even when combined with other genital rejuvenation procedures. Because the surgery is relatively simple and the vaginal area has such a robust blood supply, recovery is also reasonably fast for most women. Over-the-counter pain medication can help ease discomfort, especially in combination with ice packs. You can expect some swelling initially, but this should dissipate rapidly. Dr. Placik will give you detailed information about the surgery itself as well as instructions he’ll ask you to follow during your recovery.\nThe purpose of clitoral hood reduction is to enhance clitoral stimulation during sex by facilitating access. In women for whom aesthetics were a concern prior to surgery, the renewed self-confidence that often arises as a result of clitoral hood reduction can contribute to a more positive sexual relationship as well.\nBecause clitoral hood reduction is not a complex surgery in the technical sense, the risks of serious side effects during or after the procedure are minimal. Potential risks include those that exist during any surgery such as bleeding or infection. The risks for more serious complications, like numbness or scarring, are possible but rare.\nThe hymen is a thin membrane that partially covers the vaginal opening. In the past, the integrity of a woman’s hymen was used as evidence of her virginity, since the hymen would normally only be broken during her first sexual encounter. However, in this modern age of vigorous exercise and tampons, the hymen may be broken for a number of non-sexual reasons.\nHymen repair, reconstruction or restoration, also known as hymenoplasty or hymenorrhaphy, can restore the hymen to an unbroken state. This procedure can be performed out of respect for religious or cultural influences, or for personal reasons. It’s not uncommon to incorporate hymen repair along with other vaginal rejuvenationprocedures.\nDr. Otto Placik is a female genital rejuvenationspecialist serving Chicago and its suburbs. A board-certified plastic surgeon, Dr. Placik understands the significance that hymen repair and reconstruction can represent, and has helped women feel whole and confident again.\nAbout Hymen Repair and Reconstruction\nVirginity used to be the greatest determining factor of a woman’s worth as a new bride. If her sexual history was suspect, the family of the bride could present the sheets from the wedding night to prove their daughter’s innocence, as breaking the hymen typically causes bleeding after intercourse. While today’s women may espouse and assimilate with contemporaneous ideals of female independence and strength, many still value their cultural traditions; there are still many reasons why a woman may prefer an intact hymen for her wedding night, or to restore her hymen for personal reasons.\nIn the course of the consultation, Dr. Placik discusses the unique considerations of the individual with attention to their specific personal and, perhaps, cultural expectations. Different techniques may be applied depending on the desired outcome and timing. During a standard procedure, Dr. Placik first treats the fragments of the hymen to remove the top layer of tissue through a process called denuding, which allows the membrane edges to heal together after surgery. Next, Dr. Placik gathers together the remnants of the hymen and reattaches them using dissolvable stitches. However, there are a variety of alternative surgical approaches.\nDr. Placik most often performs hymenoplasty as an outpatient procedure, so neither general anesthesia nor a hospital stay is required. Instead, Dr. Placik uses a local anesthetic to ensure that you’re comfortable throughout the surgery, or can offer oral sedation if you prefer. The entire surgery takes just an hour or two.\nThe actual restoration of the hymen takes place during your recovery, as the body’s natural healing process heals and regrows the reconstructed membrane when a standard procedure is performed. Most patients can resume normal daily activities almost immediately. More vigorous exercise, tampon use and sexual activity should all be abstained during the recommended period. Women can expect sexual intercourse after hymenoplasty to rupture their repaired hymen, often accompanied by some discomfort and spotting or bleeding.\nHymen Repair & Reconstruction\nHymen Repair & Reconstruction FAQ\nWomen who are concerned about the integrity of their hymen may be good candidates for hymenoplasty. Hymen reconstruction may be performed for societal reasons, as part of the healing process following sexual abuse, to correct an injury to the hymen or as part of “revirginization,” the process of reclaiming a virginal status for yourself or as a symbolic gift for your partner.\nDr. Placik will meet with you at our office in Chicago or Arlington Heights, where you’ll talk about your personal hopes for hymen repair and reconstruction. Dr. Placik will conduct a pelvic exam to determine the best approach to take and discuss your options with you, as well as gain a better understanding of your goals for surgery. Dr. Placik may recommend additional genital rejuvenation procedures if he feels they may better help you meet those goals.\nThe length of time since your hymen was torn has no bearing on the outcome of your hymenoplasty. Whether your hymen was broken in childhood due to a love for gymnastics or during a sexual encounter as a young adult, Dr. Placik can help recreate a complete hymen again.\nCosts for repair or reconstruction of your hymen depend on a number of different factors, including the complexity of the procedure and whether additional surgeries will be performed as well. The total cost will include Dr. Placik’s fee, as well as any payments for the surgical facility or anesthesiologist, if necessary. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nDuring your hymenoplasty, Dr. Placik will administer a local anesthetic to ensure that you feel comfortable throughout your procedure. The surgery itself is relatively quick, and you can normally return home to begin your recovery as soon as later the same day. You may notice a feeling of tightness or soreness for the first few days, although this is mild for most women. You should refrain from sexual intercourse and tampon use for the recommended period.\nThe risks associated with hymen repair are considered very minimal, and include discomfort, bleeding or hymen discoloration, premature hymen breakdown or, conversely, a repair that may require surgical release or intervention. The risks for more serious complications, such as hematoma or numbness, are rare but still possible.\nThe labia are the most visible portion of a woman’s sexual anatomy, so it’s only natural to feel sensitive about their appearance. Labiaplasty is the enhancement or reduction of the inner and/or outer labia (vaginal lips) to create more aesthetic contours that can help you feel more confident in your intimate relationships.\nWhile cosmetic appearance is one of the primary reasons why women seek this procedure (some women may refer to the “camel toe” appearance), other concerns such as visibility or irritation from clothing, interference with sexual intercourse, discomfort with sexual activity, repeated infections, redundant tissues and hygiene issues, and/or diversion of the urinary stream are a few of the other complaints women report.\nDr. Otto Placik is a Chicago labiaplasty specialist and board-certified plastic surgeon serving Chicago and its suburbs who has helped thousands of women like you to feel better about the appearance of their labia. He has likely the greatest experience in the Midwest and has participated in and conducted numerous research studies, performed presentations, written book chapters and attended conferences on this subject. In addition to labiaplasty, Dr. Placik offers a number of other vaginal rejuvenation proceduresthat can help improve the appearance of your vaginal area as well enhance sexual sensation.\nMore than just cosmetic concern, labia that are asymmetrical or too large can cause discomfort during daily activities like exercising or sexual intercourse. Emotionally, worries over looking “normal” can undermine your self-confidence, especially with regards to sexual relationships. Dr. Placik performs one of the best surgical labiaplasty Chicago has to offer and can improve symmetry and create more discreet contours that are more in line with your cosmetic goals.\nDr. Placik considers the size and shape of the inner and outer labia in relation to each other and the surrounding area to determine the best surgical approach. For example, the outer labia (labia majora) may benefit from fat transfer to add fullness, creating a more proportionate look relative to the inner labia (labia minora). Alternatively, large or redundant labia majora which occur frequently in combination with a prominent mons pubis may create an undesirable fullness or visibility in clothing and may be treated with reduction and/or liposuction. Most commonly, the inner labia are reduced to improve any existing discomfort, or to remove the darkened edges that can become more prominent after pregnancy or with age. It’s very common to include additional genital rejuvenation procedures with a labiaplasty, such as vaginoplasty, clitoral hood reduction and G-spot enhancement.\nLabiaplasty is generally performed as an outpatient procedure under local anesthesia or local anesthesia with oral sedation. In some cases, usually if labiaplasty is performed as part of a more extensive procedure such as a mommy makeover, Dr. Placik may recommend general anesthesia. Most women who undergo a labiaplasty alone or in combination with other genital rejuvenation procedures can return home the same day.\nReasons to get Labiaplasty\nThe reasons to get a labiaplasty usually stem from cosmetic, hygienic, and comfort issues that women experience either due to the aging process, genetics, or other factors. Some of the reasons women choose to undergo a labiaplasty include:\nWith larger labia there is the potential for chronic discomfort during certain activities such as strenuous exercise, sexual intercourse, or even while walking. Pinching and chafing of the labia during these activities can lead women to seek to have their labia reduced to enhance daily comfort.\nExcess labia skin\nAn excess of labia skin can add discomfort during exercise but can also interfere with intercourse or be a source of embarrassment for some women. Excess labia skin can hang low enough beyond the vulva that they interfere with simple activities such as walking and can prevent women from feeling comfortable while wearing tight-fighting clothes or swimsuits. Having the skin of the labia reduced allows for greater comfort during activities and boosts self-confidence.\nThere are also situations where women have undergone a labiaplasty and now require a correction due to unsatisfactory results. Due to Dr. Placik’s vast experience performing labiaplasty procedures he is often sought out to correct surgeries that have been performed by other surgeons. Reasons for a labiplasty revision could be that the results from the initial surgery were uneven or that the patient is unhappy with the results.\nA labiaplasty does not only have to involve surgery performed solely on the labia but can include other aspects of the vulva. Such procedures that could be performed during a labiaplasty would be a clitoral hood reduction or liposuction of excess fat on the mons pubis.\nResolving the issues “downstairs” can increase vaginal hygiene and comfort, and it can also help you feel more confident about the appearance of the area, along with all of its intricate and delicate parts.\nRecovery from Labiaplasty\nImmediately after surgery, you can expect to see some bruising and swelling, both of which should dissipate over the next few weeks. You should be able to resume your normal routine within a few days, and active exercise at 3 weeks, although Dr. Placik recommends waiting at least 6 weeks before engaging in sexual activity.\nLabiaplasty is a cosmetic gynecology procedure that can improve the appearance of the inner labia (labia minora, or inner vaginal lips) and/or outer labia (labia majora, or outer vaginal lips) by creating a more proportionate look. While labiaplasty is often used to describe the reduction of elongated inner labia, the procedure can also include enlarging or reducing the outer labia, although this is less common. This is often confused with vaginal rejuvenation which refers to tightening of the vaginal canal.\nIf you feel self-conscious about the size, shape or appearance of your labia, or notice discomfort during sexual activity or while wearing slim-fitting clothing, you may be a good candidate for labiaplasty. Cosmetic vaginal surgery can help you feel more confident about your appearance by reshaping the contours of your labia for greater comfort and symmetry. The best candidates for labiaplasty are old enough to have fully mature labia, and should be in good mental and physical health overall. Similar to breast reduction surgery, labia reduction may be considered at any time if causing significant discomfort or interference with daily activities.\nThe best candidates for labiaplasty want to change the size, shape or contours of their external vaginal area. This is often due to physical reasons, like feeling that labia get in the way during normal daily activities like exercise or sexual intercourse. Labiaplasty can also be performed for emotional reasons, such as feeling that the inner labia look overly prominent or the outer labia appear deflated. Concern over a visible “camel toe” is another reason women may consider labiaplasty. Since the labia often change in appearance following pregnancy and childbirth, many women include labiaplasty as part of a mommy makeover.\nMost women can return home the same day as their surgery, after which they can expect to rest for the first few days. When privacy is a concern, procedures can be performed under straight local and patients may then drive themselves to and from surgery. However, most women prefer some oral sedation, in which case a driver is required to safely transport patients home. Swelling is normal the first few days, sometimes accompanied by bruising and bleeding. Ice packs and over-the-counter pain medications can help you feel more comfortable. After the first week, you can return to work and regular daily routine, although exercise and sexual intercourse should wait at least 6 weeks.\nAfter surgery, you can expect your genital region to look swollen and feel sore for the first few days. Discomfort can often be alleviated using ice packs and over-the-counter pain medications, although Dr. Placik may prescribe a pain reliever as well. Although you should refrain from vigorous exercise or sexual activity for the first 6 weeks after surgery, you should be able to return to work and your normal routine in about a week.\nThe costs of your labiaplasty will vary depending on the approach Dr. Placik needs to take during surgery, whether there will be other procedures performed at the same time and a number of other factors. In some cases, insurance may cover all or a portion of the surgery. The total fees include not just Dr. Placik’s surgical fees, but also the cost for the surgical facility and anesthesiologist. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nThere are two approaches that can be taken during labiaplasty: the “trim” method or the “wedge” method. Dr. Placik is experienced in both techniques. The trim method is fairly straightforward, and involves a simple trimming away of excess tissue to shorten the labia minora. The wedge method removes a triangular segment of tissue from the middle third of the inner labia instead. There are pros and cons to each technique, so Dr. Placik will go into more detail on your options during your consultation to help you decide which is best for you.\nThe subject of trim vs. wedge labiaplasty is hotly debated among cosmetic gynecological surgeons.\n- Trim labiaplasty is a relatively simple procedure that removes the outer edge of the labia by trimming the excess away.\n- During the more complex wedge labiaplasty, a V-shaped section of tissue is removed from the middle third of the labia, and then the edges are sutured together.\nAlthough many surgeons currently advocate for wedge labiaplasty, this approach does not address one of the most common cosmetic concerns for many women: the darker labial edge. By fully removing this portion of the labia, trim labiaplasty creates a more uniformly pink edge for a discreet final result.\nBoth approaches allow for safe, effective reduction of the inner labia in a way that should still preserve sensation. The decision of which surgical technique is best for you often comes down to your anatomy, your personal goals and the recommendation of your surgeon.\nAlthough it’s impossible to perform any surgery without incisions, labiaplasty scars are typically minimal. The initial incisions should heal completely by about the two-week mark, although the scars may appear red or pink for several months. The trim method of labia reduction will leave longer scars than the wedge method but can remove more of the darkened edge. In either case, scars from either surgical approach should fade to nearly invisible with time. To see real patient results look at our Labiaplasty before and after gallery\nDr. Placik performs labiaplasty revisions for “botched” labiaplasty procedures or situations where patients are not happy with the results they have achieved from other surgeons. These procedures are highly customized to the unique situation of the patient, and Dr. Placik will work closely with you so that you can feel confident about your result. Watch our video on labiaplasty revision for more information about arguably the best labiaplasty in the US.\nDr. Placik will cover the possible labiaplasty risks, side effects and potential complications during your initial consultation at our office in Chicago or Arlington Heights to ensure that you completely understand the procedure. Although serious side effects are rare, they are possible, and include concerns such as scarring, infection, changes in sensation and asymmetry.\nBecause female sexual satisfaction is a complex issue that includes many different factors, labiaplasty can play an important role in improving your sex life, especially when performed with additional genital rejuvenation procedures.\nFor women who feel frustrated about their labia size detracting from their sexual experience, labiaplasty can correct physical issues to help make intercourse more physically comfortable. Additionally, women who may have previously felt inhibited during sex due to the cosmetic appearance of their labia can find that sex becomes more emotionally enjoyable after surgery.\nFrequently, larger inner labia can also mean excess clitoral hood tissue, which can interfere with clitoral stimulation during intercourse. Dr. Placik can combine clitoral hood reduction with labiaplasty to improve sexual sensation.\nTypically, insurance companies view labiaplasty as cosmetic and therefore elective, a category that is not covered under most insurance plans. Exceptions may be made in some cases, such as if the surgery is being performed to repair a torn labia or other form of injury or trauma, although this is not common. However, since labiaplasty is usually performed under local anesthesia, the total costs can be kept low. You can also look into cosmetic surgery financing to help make your labiaplasty even more affordable.\nLabiaplasty is normally performed as an outpatient procedure using local anesthesia to help you stay comfortable during surgery, which can last an hour or two. The surgery most often includes reducing the size of the inner labia using either the wedge or trim technique. Labiaplasty can also enhance the size of the outer labia using fat transfer (following the same principles as those used in fat transfer breast augmentation). The goal is to improve symmetry and balance for a flattering final result.\nTime takes a toll on our bodies, including on the genitals. Some women take the step of having a labiaplasty to correct these issues. Sadly, many women are left with a bad outcome, with too much or too little tissue removed, uneven lips, or a vaginal area that appears deformed. These botched surgeries can be surgically corrected, but only a highly-skilled surgeon should perform the corrective surgery.\nRESTORATION AFTER BOTCHED LABIA SURGERY\nThe labia are the most prominent and visible portion of a woman’s genitals, having the area appear pleasing and “normal” (although every woman is different) is important. Women go to surgeons to correct a range of aesthetic or medical problems, including the following:\n- Reduce the size of the inner labia\n- Reduce the size of the outer labia\n- Reduce both areas\n- To resolve uneven, overlarge labia\n- Create a more youthful appearance to the labia\n- Reduce visibility\n- Address irritation and multiple infections\n- Hygienic concerns\n- Resolve urine stream diversion issues\nAfter surgery is performed, the patient could be shocked – or even horrified – to see the results of the surgery. In these cases, Dr. Placik is known for being particularly skilled in correcting labiaplasty surgeries that have gone terribly wrong.\nDR. PLACIK: QUALIFICATIONS AND CREDENTIALS IN GENITAL SURGERY\nIf you had labiaplasty that was botched, and left you with a look that is distressing, it is important that the surgeon who fixes the problem is highly-skilled and respected as a leader in this type of surgery. Dr. Placik is a highly-trained, Board Certified plastic surgeon, and a speaker and author on the subject of female genital plastic surgery. Much of his practice is devoted to these surgeries, and he is renowned leader in the field. If your labiaplasty surgery left you with a result that was uneven, appears deformed, or other problem, you want a surgeon with this level of skill and knowledge to help.\nBOTCHED LABIAPLASTY: THE SOLUTION IS LABIAPLASTY REVISION SURGERY\nUnfortunately, certain surgeons may be less than familiar with performing a labiaplasty, and failed to create a natural, pleasing result — or worse. In these cases, the surgical errors can be corrected. The first step is a consultation to determine what needs to be done to bring the genital area back to a natural, pleasing appearance, both balanced, even, and normal.\nRESEARCHER. AUTHOR. SPEAKER.\nDr. Placik has skills and knowledge far above and beyond the ordinary in female genital surgery, as well the processes that are effective in correcting botched genital surgeries. As a researcher, author and speaker on female genital surgery, he is a leader in the field and known throughout the country. He understands that these are very personal issues, and you can be confident that you will be treated with the utmost sensitivity, kindness, compassion, and discretion. The first step is to speak with us to find out more about what can be done to get this very important personal physical issue resolved, and the result you were seeking when you underwent surgery the first time.\nLabiaplasty & Mommy Makeover\nPregnancy can affect the body in a number of different ways, both during your pregnancy and following the birth of your child. A mommy makeover is a combination of procedures that work together to address the major appearance concerns most women have after pregnancy, like separated abdominal muscles or loss of breast volume that also may be accompanied by sagging (ptosis). Labiaplasty can be incorporated as part of a mommy makeover as well.\nDr. Otto Placik is a labiaplasty specialist and board-certified plastic surgeon serving Chicago and the surrounding suburbs. His expertise is acknowledged by numerous other professionals via instructional courses, meeting presentations, book chapters, scientific articles, research studies and Assistant Clinical Professor status. By offering a wide range of body contouring and genital rejuvenation procedures, Dr. Placik can work closely with you to develop a mommy makeover plan that helps you meet your cosmetic goals.\nAbout Including Labiaplasty with Mommy Makeovers\nWhile pregnancy itself may only be temporary, some of the physical changes you notice in your body following your pregnancy and after giving birth can be long-term. Although external differences like a gain or loss in breast size, breast sagging or stretched-out skin over the tummy are often the most immediately noticeable, there are more intimate changes that can occur as well, such as those in the vaginal area.\nLabioplasty reduces the size of internal labia that have grown longer as a result of pregnancy and childbirth, and can remove the darker edges that may become more prominent after giving birth as well. The outer labia (majora) may lose volume and appear shrunken. This can be treated with volume restoration with fillers or fat injection, or with skin removal for a more taut appearance. Internal changes in vaginal muscle tone can also be corrected as part of a mommy makeover by including vaginoplasty to tighten the vaginal walls and improve sexual sensation for both partners.\nDr. Placik works closely with each patient to discuss your goals and hopes for a mommy makeover so he can be sure that your specific concerns are addressed. Since a mommy makeover isn’t a single procedure but instead includes a combination of surgical and nonsurgical treatments, your mommy makeover is infinitely customizable, and can easily incorporate labiaplasty at the same time.\nThe specific approach Dr. Placik takes during your mommy makeover depends on which procedures you have scheduled, and recovery time will vary from patient to patient as well. Generally speaking, you should be back to work and your normal daily routine about two weeks after a mommy makeover, with or without including labiaplasty. Sexual activity should wait until Dr. Placik gives the all clear, typically about six months after surgery.\nActual Patient NOT A MODEL\nLabiaplasty & Mommy Makeover FAQ\nThe best candidates for combined mommy makeover plus labiaplasty are interested in regaining their pre-pregnancy figure again. Mommy makeovers primarily include body contouring procedures such as breast implants, breast fat transfer, breast lift, a tummy tuck and liposuction. They also can incorporate vaginal rejuvenation procedures like labiaplasty, vaginoplasty and perineoplasty. If pregnancy and childbirth have affected your sexual response as well, you may also want to also ask Dr. Placik if you could benefit from clitoral hood reduction or G-spot enhancement. If a C-section or episiotomy incision have left you with unacceptable scars, a revision may help improve the appearance.\nNeither a mommy makeover nor a labiaplasty will physically affect your ability to carry future healthy pregnancies to term. However, pregnancy can create enough physical changes in your body to potentially compromise the results of your mommy makeover. Normally, Dr. Placik recommends waiting until you’ve completed your family before considering tummy tuck procedures.\nSurgical rates vary significantly for mommy makeovers because no two women have exactly the same combination of procedures. The total surgical fees will include payment to the anesthesiologist as well as the surgical center fee, plus Dr. Placik’s surgical fee. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nThis answer is different for every woman, and depends on your specific appearance concerns following pregnancy. Labiaplasty itself is often performed in combination with other genital rejuvenation procedures like vaginoplasty and clitoral hood reduction and perineoplasty. As for the mommy makeover, the most commonly included procedures are breast augmentation (with or without a breast lift), a tummy tuck and liposuction. Some women may also include med spa treatments such as BOTOX® Cosmetic or Xeomin® or Dysport® with or without fillers such as Restylane® or JUVÉDERM® to look younger and more refreshed.\nMost women are back to work in about 2 to 3 weeks following a mommy makeover, whether or not labiaplasty is included. Adding labiaplasty should not significantly extend your recovery period, although you may notice some localized swelling and soreness in your vaginal area following surgery. Labiaplasty incisions are quite small and are difficult for the untrained eye to see after healing.\nLabiaplasty does not significantly increase the risks associated with a mommy makeover. The same side effects are possible after labiaplasty as for any other surgery, such as scarring, bleeding or infection. More serious concerns, like permanent changes in sensation or reactions to anesthesia, are possible side effects but rare.\nLabiaplasty & Pregnancy\nThe body goes through a number of changes during pregnancy and childbirth, including changes to the inner and outer labia. The labia may become larger or develop darker edges, or may stretch or tear during childbirth. In other instances, a surgical incision may be performed (episiotomy) to help control stretching and dilation of the vaginal canal during delivery. Because of these concerns, many women choose to wait until after they’ve completed their family before pursuing labiaplasty or vaginoplasty. However, labiaplasty before pregnancy can help alleviate physical discomfort due to the size or shape of your labia even if you have plans to become pregnant in the future.\nBoard-certified plastic surgeon Dr. Otto Placik serves Chicago and its suburbs, specializing in labiaplasty and other female genital rejuvenation procedures. Dr. Placik is highly experienced in labial contouring and repair for results that help you feel confident about your vaginal appearance. He has been interviewed, taught other medical professionals, attended numerous conferences, performed multiple presentations, written book chapters and online articles as well as conducted and participated in research studies on this subject.\nAbout Labiaplasty and Pregnancy\nPregnancy can take a heavy physical toll on a woman’s body. While many of the changes associated with having a baby are temporary, others may be permanent. The labia enlarge in response to pregnancy-related hormones, and may also darken, stretch or tear during childbirth. Because of this, labiaplasty is often performed on women who have already given birth, either for cosmetic reasons or to repair damaged tissue.\nAfter pregnancy, other appearance concerns and physical changes can also be addressed through cosmetic gynecology, including vaginal rejuvenation to correct lax musculature in the vaginal wall. It’s common to combine labiaplasty with vaginal rejuvenation either as a separate procedure or as part of a mommy makeover.\nDr. Placik performs labiaplasty to create a more proportionate look, which can be accomplished by reducing the size of the labia minora (inner labia) or reducing/augmenting the size of the labia majora (outer labia). Sometimes a combination of both approaches, with or without a clitoral hood reduction, will deliver the best results. In other instances, a C-section scar (Pfannenstiel incision) may contribute to or cause an undesirable fullness of the mons pubis, which can be treated with scar revision and/or liposuction. Poorly healed episiotomy scars may cause discomfort or an unacceptable appearance, which can be addressed with a perineoplasty in combination with the above procedures.\nLabiaplasty is usually performed under local anesthetic, so you can return home the same day of your surgery. Dr. Placik and his staff will give you detailed instructions to follow during your recovery, and you should be back to work within about a week after your procedure.\nLabiaplasty and Pregnancy FAQ\nThe best candidates for labiaplasty notice significant changes in the size, shape or color of their labia following pregnancy or childbirth. Other women may be genetically disposed toward larger labia even before pregnancy. Candidates should be in good general health overall and have realistic expectations about their results, and should not be pregnant at the time of surgery.\nSince labiaplasty is primarily a cosmetic procedure, there’s no medical reason you can’t continue having children after an earlier labiaplasty that corrected pregnancy-related changes in your labia. However, you should be aware that future pregnancies could impact the results of your initial surgery.\nThe cost for labiaplasty will depend on many factors, including whether additional procedures will be performed at the same time. Your total fees will cover the cost of the surgical facility and anesthesiologist as well as Dr. Placik’s fee. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financingto make your procedure even more affordable.\nIt’s very common to include labiaplasty with additional genital rejuvenation procedures. For example, Dr. Placik may recommend a clitoral hood reduction in combination with an inner labia reduction for a more aesthetic final result. Women who choose labiaplasty to help decrease discomfort during intercourse may also want to heighten sexual sensations with G-spot amplification. Every woman is different, and Dr. Placik will work with you to determine the combination of procedures that will work best to meet your needs.\nIn general, the labia heal very rapidly and scars should be minimal. You may notice a pinkish or reddish tone to the scars at first, but this should fade over the first several months after surgery to become nearly invisible. Most women feel that the small scars that remain visible after labiaplasty are worth the trade-off for the improvement in physical comfort and self-confidence.\nLabiaplasty is not a complex surgery, but there are still risks such as bleeding, infection or scarring to consider. In rare cases, more serious complications like hypersensitivity or loss of sensation at the incision site can occur. Dr. Placik will discuss all of these issues in more detail at your consultation.\nLabiaplasty vs. Vaginoplasty\nThe term “vaginal rejuvenation” is often incorrectly used to refer to a number of different procedures, including both labiaplasty and vaginoplasty. Although these and other genital rejuvenation treatments are complementary and may frequently be performed together, they’re not the same thing.\nDr. Otto Placik is a board-certified plastic surgeon serving Chicago and its suburbs who specializes in external and internal genital rejuvenation, including both labiaplasty and vaginoplasty. By working closely with you from consultation through recovery, Dr. Placik can help you understand which treatments will best help you meet your cosmetic and personal goals.\nLabiaplasty is performed to address concerns over the aesthetic appearance of the inner or outer labia, or vaginal lips. Labia that feel or look too large (colloquially known as a “camel toe”) or too small, that interfere with normal sexual intercourse or that become chafed or irritated during daily activities can lead to self-consciousness and physical discomfort.\nDuring labiaplasty, Dr. Placik can reduce the labia minora (inner lips) or reduce/augment the labia majora (outer lips) for a more proportionate look. Women state that Labia reduction can also make sex more pleasurable and help them feel less uncomfortable in slim-fitting clothing like swimsuits. It’s common to include clitoral hood reduction (also referred to as clitoroplasty or hoodotomy or hoodoplasty) with labiaplasty to create a more aesthetic appearance overall.\nVaginoplasty is primarily used to reduce the size of the vaginal canal. Traditionally, it is not used to treat the external appearance but may reduce the visibility of protruding tissue or a wide opening. It is usually combined with a perineoplasty, which treats the area between the vaginal opening and the anus where scars or widening may result following an episiotomy or tears during delivery. Childbirth and age can both contribute to the vaginal muscles losing strength and tightness, which can diminish sensation and intimate sexual contact or desirable friction during intercourse for both partners. Internal vaginal changes after pregnancy can also lead to embarrassing problems like stress incontinence.\nDr. Placik performs vaginal rejuvenation to repair and tighten the inner vaginal walls to restore normal function. As a result, women can feel more sensation and a greater sense of emotional satisfaction during sex. Including G-spot enhancement can help take these results to the next level.\nLabiaplasty vs. Vaginoplasty FAQ\nFor the most part, women who feel unhappy with the look of their vaginal area are better candidates for labiaplasty, while vaginoplasty is best for those who are more concerned with sexual sensation and improved function. However, labiaplasty vs. vaginoplasty is not an either-or proposition. Both surgeries are extremely complementary and can be performed together for cosmetic improvement as well internal rejuvenation.\nAt your first meeting, Dr. Placik will ask you about your goals for surgery in order to determine whether a vaginoplasty or labiaplasty (or a combination of both) will better meet your needs. He may also suggest additional procedures if he feels they may further benefit you. During the examination, the different goals which can be achieved with either procedure will be reviewed and demonstrated.\nBecause genital rejuvenation is so highly customized, the prices vary widely depending on many different considerations. In addition to Dr. Placik’s surgical fee, there’s also the cost of the surgical facility and anesthesiologist’s fee to keep in mind. Costs will also differ for one procedure compared to combined procedures performed at the same time. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nLike other aspects of your surgery, the specific procedural steps Dr. Placik takes will depend on the procedure itself. Most of the time, patients undergoing a labiaplasty are treated with local anesthetic (with or without oral sedation) and don’t require a hospital stay. If a vaginoplasty is planned, this may best be performed under a general anesthetic for overall comfort and to allow a more thorough repair. This procedure also does not typically require a hospital stay. Dr. Placik will explain the entire process before surgery, including very detailed instructions for you to follow during your recovery.\nVaginoplasty is specifically intended to help you feel stronger sensation during intercourse. And, although labiaplasty is primarily cosmetic in nature, many women feel more confident sexually once they’re less self-conscious about the appearance of their vaginal area. Labial reduction can help reduce physical discomfort that can occur during sex as well.\nDuring your consultation at our Chicago or Arlington Heights office, Dr. Placik will go over the potential side effects and risks associated with labiaplasty and/or vaginoplasty. These include the same risks that are associated with any surgery, like bleeding or infection. There is also the possibility for more serious risks such as permanent changes in physical sensation, nerve damage or scarring, although these complications are rare.\nThe area between the vaginal opening (introitus) and the anus, known as the perineum or by the slang term “taint,” can tear during childbirth or become scarred from a surgical episiotomy or become stretched out as a result of obesity. This can cause lax muscles, a feeling of the introitus being too loose or open, diminished sexual sensation and problems with incontinence or other urogenital concerns. Women commonly report dissatisfaction with the associated protrusion of visible tissue from the vaginal cavity.\nPerineoplasty can help resolve aesthetics or functionality relative to the perineum. Although in some ways similar to vaginal rejuvenation, perineoplasty only addresses the skin and muscles that immediately surround the introitus rather than the muscles inside the vaginal canal.\nBoard certified plastic surgeon Dr. Otto Placik has helped women from Chicago and the surrounding suburbs to feel more confident about the appearance of their vaginal area and improve sexual confidence and sensation. A female genital rejuvenation specialist, Dr. Placik has the right combination of surgical skill and professional discretion to ensure that you feel comfortable from consultation through recovery.\nDuring childbirth, it’s not uncommon for physicians to perform an episiotomy, an incision made through the perineum that temporarily widens the introitus to allow an easier birthing process and preemptively prevent the possibility of a spontaneous tear. Either an episiotomy or a natural tear runs the risk of not healing optimally. Even without tearing, the introitus may be permanently stretched out in the birthing process. Obesity can also weaken, stress or separate the perineal structures. Perineoplasty can help improve the physical appearance of the perineal area as well as tighten the introitus.\nWhen performing perineoplasty, Dr. Placik repairs damage to the perineum, addressing both the upper layers of skin and the lower muscle layers that are most commonly damaged during an episiotomy. Dr. Placik also restores the introitus to its pre-pregnancy state to improve sexual sensation and excise the visible protruding vaginal tissue (hymenal fragments). Perineoplasty may be performed as an isolated procedure or as part of vaginal rejuvenation, in combination with labia reduction or both.\nActual Patient NOT A MODEL\nThe perineum presents a unique concern for many women, as there may be problems if the introitus is either too loose or too tight; perineoplasty can help with either. A too-tight introitus can lead to dyspareunia (painful sexual intercourse), and can also be a contributing factor to vaginismus, the involuntary contraction of vaginal muscles that prevents penetration. While perineoplasty is most commonly associated with correcting excessive looseness of the introitus, in these cases Dr. Placik may use the procedure to relieve the opposite concern and promote easier, more comfortable intercourse.\nPerineoplasty can be performed under local or general anesthesia, depending on Dr. Placik’s recommendation and whether other procedures will be performed at the same time. Most patients are able to return to work and other day-to-day activities after a few days, although you should avoid more strenuous exercise, sexual intercourse and tampon use for about 6 weeks.\nIf your doctor performed an episiotomy during childbirth, you experienced tearing during delivery or notice significant looseness around your vaginal opening, you may be a candidate for perineoplasty. Many women report dissatisfaction with the appearance of protruding tissue from the introitus. Problems with decreased sexual sensation can also be improved with perineoplasty. Alternatively, perineoplasty may help alleviate the discomfort associated with dyspareunia or vaginismus. However, this is usually performed in combination with botulinum toxin (BOTOX®) injections to diminish the intensity of the accompanying painful muscle spasms.\nExcessive laxity or tightness of the introitus can significantly impair your sexual satisfaction, and a perineoplasty is intended to resolve these concerns. Additional procedures, such as G-spot amplification or clitoral hood reduction can also be beneficial for enhancing sexual stimulation and satisfaction.\nAt our office in Chicago or Arlington Heights, Dr. Placik will discuss your concerns and give you a general physical exam as well as a pelvic exam. From there, you’ll work together to decide the best surgical approach to help you meet your goals. Dr. Placik may also suggest different or further treatments if he feels they may be beneficial.\nThe total costs for perineoplasty vary widely, depending on many varying factors. In some cases, your health insurance provider may pay for all or a portion of your procedure if your primary doctor determines that a perineoplasty is medically necessary. Surgical fees include Dr. Placik’s fees, the cost of the surgical center and the anesthesiologist fee, if needed. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nA perineoplasty typically takes about an hour, depending on whether other procedures are performed at the same time and which type of anesthesia (local or general) is used. After your procedure, you can expect to feel swollen and sore for the first few days, but most patients are able to return to work in less than a week. Dr. Placik will give you detailed instruction to follow during your recovery to help you feel comfortable. You should be able to return to your normal exercise routine after about 2 weeks, and resume sexual activity 4 weeks later.\nThere are only negligible risks associated with perineoplasty, including itching, bleeding (which may be exacerbated by walking) vaginal discharge and pain. Other possible risks may occur although this is rare. In the majority of cases, the potential benefits of perineoplasty far outweigh the minimal risks.\nA feeling of looseness or decreased sexual pleasure can be a common frustration for women following childbirth, as pregnancy and the birthing process can permanently stretch out the muscles of the vaginal canal. On occasion, this may occur in women without a prior history of childbirth and may be related to chronic pelvic strain associated with constipation or bearing down.\nVaginoplasty, often called vaginaplasty, vaginal rejuvenation or vaginal tightening, is a procedure that repairs lax internal muscles, and may increase sexual pleasure to help you feel like yourself again after pregnancy. For others, the increase in sexual friction achieved through more direct contact of the genitalia during intercourse can enhance one’s feelings of sexual intimacy.\nA board-certified plastic surgeon serving Chicago and its suburbs, Dr. Otto Placik is a vaginal rejuvenation specialist whose discreet, professional approach ensures that you feel comfortable from consultation through recovery. Dr. Placik has helped many women feel revitalized through vaginaplasty, and offers a full spectrum of female genital rejuvenation procedures to address any concerns over external aesthetics as well.\nChoosing Vaginoplasty from Our Chicago Area Practice\nNo matter how much joy being a mom can bring to your life, there are a number of physical changes associated with pregnancy and childbirth that may not be quite as welcome as a new baby. Internal changes in sensation or function are among the most upsetting for many women.\nVaginal rejuvenation is a procedure designed to correct the internal differences many women notice following childbirth, like reduced sensation during intercourse. In some instances, combined procedures with other elective procedures such as the mommy makeover may be performed. If improved sexual response is of particular concern, Dr. Placik may also recommend G-spot enhancement for more comprehensive results. Vaginal rejuvenation can also include labiaplastyand perineoplasty to improve the external appearance of your vaginal area as well. This latter procedure can correct the “open” appearance of the vagina that may lead to protrusion of tissue which many women find undesirable. Patients have also desired revision of unacceptable episiotomy scars or tears sustained at the time of delivery.\nVaginaplasty is typically performed as an outpatient procedure using a local anesthetic in combination with oral sedation or a general anesthetic for more extensive repairs, so you can recover at home after surgery. If vaginoplasty is performed with additional procedures, as in the case of a mommy makeover, Dr. Placik may recommend general anesthesia instead.\nDuring vaginal rejuvenation, Dr. Placik uses precise techniques to accomplish the procedure and minimize discomfort. He removes excess tissue and closes the incisions using internal absorbable sutures without mesh. After surgery, you should feel a youthful tightness again along with improved sensation during intercourse for both partners.\nVaginal Rejuvenation FAQ\nIf you’ve noticed diminished sensation during sex, or have a persistent feeling of internal looseness, you may be a candidate for vaginoplasty. Vaginoplasty can tighten the internal muscles of the vagina or the vaginal opening itself to decrease the visibility of protruding tissue or an “open” appearance. Women with alteration in their bowel or bladder habits (fecal retention or stress urinary incontinence or leaking) should discuss this with their urogynecologist first as this may require reconstructive procedures.\nThe price of vaginal rejuvenation varies depending on a number of different factors, such as whether additional genital rejuvenation procedures will be included. Surgical fees include the cost of the operating facility and anesthesiologist fees as well as Dr. Placik’s surgical fee. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nDuring your consultation, Dr. Placik will review your relevant past medical history and will talk to you about your hopes for surgery, as well as take time to make sure you understand the benefits and limitations of vaginal rejuvenation. For example, he can explain the difference between a perineoplasty and vaginoplasty using an anterior or posterior repair as well as limitations in altering the external appearance of the vaginal area unless a labiaplasty is included at the same time. During the physical exam, the size and extent of vaginal laxity will be assessed and discussed.\nPlan to rest for the first few days after surgery. Stool softeners are highly recommended. You may notice some bruising and swelling, both of which can be alleviated with the use of ice packs or oral medication. Most women return to work and their daily routine after 2 or 3 days, although sexual activity and tampon use should not resume for at least 6 weeks. Specific exercises such as vaginal dilation and scar massage may be instituted during this period. You should also avoid baths, swimming and hot tubs during your recovery period.\nWhile improving your sexual function is a primary goal of vaginal rejuvenation, it’s impossible to predict how different women will respond sexually after surgery. Typically, women report stronger, tighter muscle tone and increased sensation for both them and their partner. The effects of renewed self-confidence after surgery can also be a contributor to an improved sex life after surgery.\nDr. Placik will discuss all potential risks, complications or side effects with you at your initial consultation at our office in Chicago or Arlington Heights. Like any surgery, vaginoplasty carries a low chance of general risks such as bleeding, infection or a reaction to anesthesia. More serious complications are rare but still possible, and include concerns such as permanent changes in sensation.\nSubmit your review |
Intraocular lens (IOL) is a lens implanted in the eye used to treat cataracts or myopia. Insertion of an intraocular lens for the treatment of cataracts is the most common performed eye surgical procedure. This procedure can be done under local anesthesia with the patient awake.\nLaser vision correction, is a type of refractive surgery for the correction of myopia, astigmatism and hypermetropia. Lasik is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye's cornea in order to improve visual acuity. To most of the patients, LASIK provides a permanent alternative to eyeglasses or contact lenses.\nCataract surgery is the removal of the natural lens of the eye that has developed an opacification, known as cataract. Cataract surgery is generally performed by an ophthalmologist (eye surgeon) in an ambulatory, in a surgical center or hospital, using local anesthesia, causing little or no discomfort to the patient.\nLachrymal surgery is a sub-specialty of ophthalmology which focuses on disorders of the eyelids and tear-drainage system. The surgical repertoire of the oculoplastic and lachrymal surgeon includes correction of eyelid malposition’s, treatment of in growing eyelashes, tumors’ of the lids removal and surrounding tissues and reconstruction of these tissues following tumor excision or trauma.\nEye treatment is one of the most popular procedures for international medical tourism. Patients from Albania and abroad are being treated by top eye specialists in the country.\nHigh quality eye care and sophisticated equipment provided by the most reputable brands are attracting more and more international patients every year.\nOur specialists are achieving excellent results in laser eye surgery, cataract surgery, cataract treatment, glaucoma treatment, ocular oncology, vitro-retinal surgery, etc.\nThere are many glaucoma surgery variations and combinations, that facilitate the escape of excess aqueous humor from the eye to lower intra-ocular pressure, and a few that lower the IOP by decreasing the production of aqueous.\nAll rights reserved.\nNo part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher. For permission requests, write to the website administrator at :\nAddress : Rr. "Qemal Stafa",\nTirana - Albania\nTel : + 355 69 95 75 551\nCopyright © 2014 by Albanian Medical Tourism Agency. |
Join now to get access to this content and more.\nBecome a SOAP member and have access to our benefits.\n- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients\n- Sample Centers of Excellence Applications\n- ASA Corner\n- SOAP Policy and Procedure Manual (P&P Manual)\n- SOAP Expert Opinions\n- SOAP's Learning Modules\n- 2019 Annual Meeting Lecture Videos\n- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar\n- Submit a Position\n- View Job Postings\n- Previous Meeting Archives\n- Previous Meeting Abstract Search\n- CMS Guidelines\n- Member Benefits\n- Newsletter Clinical Articles\n- ACOG Documents\n- Search our Patient Safety Archive\n- Ask SOAP a Question\n- Global Health Opportunities\n- And more…\nAnesthetic Management of Labor in a Patient with Traumatic T3 Paraplegia\nAbstract Number: T 50\nAbstract Type: Case Report/Case Series\nSpinal cord injury in pregnancy can present significant anesthetic challenges. We present a case of a 23-year-old female, with new-onset T3 paraplegia sustained during her pregnancy, who presented in active labor.\nA 23 y/o G2P0 female was admitted at 15 weeks gestation after a gunshot wound with the bullet lodged in the T3 vertebra. Her immediate injuries included a left hemothorax, left pulmonary contusion, and complete paraplegia of the lower extremities. Neurosurgery treated her unstable spine injury conservatively with bracing. Anesthesia consult at 23 weeks recommended, after neurosurgical clearance, early neuraxial analgesia to prevent possible autonomic dysreflexia. The patient was then discharged to a rehab facility. After multidisciplinary planning meetings, she was readmitted to our obstetric service at 28 weeks for obstetric care, and began having irregular contractions presenting as back pain and premature rupture of membranes at 33 weeks.\nA combined spinal-epidural catheter (CSE) was placed uneventfully, with 2 mg of midazolam for anxiolysis. An epidural solution of 0.125% bupivacaine with 3.33 mcg/mL of fentanyl was run for the next 12 hours without significant hemodynamic instability. Breakthrough back pain was treated with 5-8cc of 0.25% bupivacaine. She had an uncomplicated forceps-assisted vaginal delivery. Patient recovered well and was discharged to a rehab facility for further treatment.\nAutonomic hyperreflexia (AH) is caused by loss of hypothalamic control of sympathetic reflexes. AH is common with spinal cord injury above T6, and manifests as hypertension, bradycardia, tachycardia, cardiac arrhythmias, or respiratory distress. Visceral or cutaneous stimulation below the level of the spinal cord lesion are common precipitants (1). During labor, untreated AH may lead to fetal distress, maternal intracranial hemorrhage, hypertensive encephalopathy and death. (2) Both undiagnosed labor with precipitous delivery and preterm labor are common. Labor is often diagnosed because of unexplained AH.\nWe placed a combined spinal epidural (CSE) for labor analgesia because this technique would provide both rapid analgesia and verification that the epidural was in the correct space (3). Assessing sensory level of neuraxial anesthesia can be impossible. Our patient had chronic back pain that allowed her to report contractions. We also used a high concentration of epidural medications to provide a dense block to prevent AH. In the event that the patient did develop symptoms of AH, we had planned to place an arterial line and treat with hydralazine and nitroprusside. In conclusion, this patient had a safe outcome following labor as a result of careful planning with a multidisciplinary team and early initiation of labor analgesia.\n1. Kuczkowski, et al. Arch Gynecol Obstet 2006;274:108-12.\n2. Strowonski, et al. Austral New Zeal J Obstet Gynaecol 2008;48:485-91.\n3. Norris. IJOA. 2000;9:3-6. |
A set of actions is the official or accepted way of doing something\nHarmonic Scalped and its advantages, experienced doctors and team, success rate of last 20 years.\nAll cores were done under regional anesthesia; either spinal or epidural.\nTransurethral resection of the Postate is a urological operation.\nRemoving a calculus from upper ureter using laparoscopy.\nThe lens inside your eye that has become cloudy is removed and replaced with an artificial or man made lens.\nA pace maker typically is implamted in the upper chest.\nBabies can enter this world in one of two ways. |
Halifax Health is committed to providing meaningful information and assistance to our patients related to the financial obligations for healthcare services. Our representatives are available to provide information on our charges and your individual cost based on your personal healthcare coverage and service needs.\nYour final bill from Halifax Health will vary depending on the actual services provided, existing health conditions that may impact the procedure and your insurance coverage if you are insured. Also, our charges do not include physician fees such as the anesthesiologist, radiologist or surgeon. Physicians will bill you separately for their services.\nPersonalized Price Estimates\nWe can also assist you in understanding your cost based on your specific service and insurance. If you would like a personalized estimate for a particular service, please have the following information available, so that we can provide you with the most accurate estimate possible:\nDescription and procedure codes of services needed - we will need to know as much information as possible about the specific services as described by your physician.\nType of Services needed - we need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.\nPhysician/Specialist Name - example, if you are having surgery, we will want to know the surgeon's name. In order to give a more accurate estimate, we may call your physician to confirm your procedure.\nYour Insurance Card\nFinancial Counseling Contact Information\nFor financial counseling, please call 386.425.4107 Monday - Friday 9:00 am - 4:00 pm or email: [email protected]\nPlease contact your practitioner (physician, anesthesiologist, radiologist, surgeon or other specialist) directly for individual pricing estimates, billing practices, and insurance participation.\nA list of standard hospital charges for common inpatient, outpatient and diagnostic procedures can be found in the links below.\nDiagnosis-Related Group (DRG) Standard Charges\nThere are also resources to assist you as a healthcare consumer.\n- The Florida Health Finder Website is a resource provided by the Agency for Health Care Administration (AHCA) for health care consumers to compare quality indicators and charges for Florida Hospitals.\n- Florida Hospital Association also provides the Mission To Care Website, which provides Floridians with healthcare information and the ability to compare hospital prices and quality ratings.\n- Consumer Guide for Understanding Healthcare Prices\n- Consumer Guide for Understanding Healthcare Prices (Spanish Version) |
Rotator Cuff Surgery\nRotator Cuff Surgery\nThe rotator cuff surgery you have been scheduled for is to correct the problems that you have been having in your shoulder. Your doctor has discussed with you the possible surgeries that may assist in helping correct your problems. Your surgeon has elected to perform the following surgery for you:\nRotator Cuff Repair\nA rotator cuff repair involves reattaching the end of the torn tendon to the bone. This can, in the majority of cases, be performed as an arthroscopic outpatient procedure. An arthroscopic rotator cuff repair requires a few small (1 cm or less) incisions. We make a small incision in the back of the shoulder and a camera is placed inside the shoulder joint. We make a small incision in the front of the shoulder and working instruments are placed through this incision. We examine all the structures in the shoulder at the time of surgery and address any problems that we may see. The camera is then repositioned above the rotator cuff and another incision is made on the side of the shoulder. Instruments are used to remove the inflamed bursa. The rotator cuff tear is then repaired: One or two small incisions are made on the top of the shoulder in order to place anchors. Anchors look like very small screws that have an eyelet through which a couple of sutures are passed. The anchors are placed into the bone where we wish to reattach the tendon. Instruments are used to pass the sutures through the tendon and knots are tied restoring an anatomic tendon insertion to the bone. The number of anchors required depends on the size of the tear. In some cases of larger cuff tears or tears in front of the rotator cuff tendon, an open (larger incision) may need to be performed. This decision is made at the time of surgery.\nAbove: Rotator Cuff Tear\nAbove: Surgically Repaired Rotator Cuff\nA subacromial decompression involves removal of inflamed tissue within the space above the shoulder joint between the rotator cuff and the acromion which is part of the shoulder blade on the top of the shoulder. If there are any bone spurs present, we smooth them with a small burr. This is a standard part of rotator cuff surgery.\nBiceps Tenotomy or Tenodesis\nSurgery for a torn biceps tendon involves removing it from inside the joint and reattaching it where it exits the joint. In some cases, we simply cut the tendon and allow it to retract from the joint. The negative consequences of this procedure are possible asymmetry of the biceps muscles (that it will look different from side to side) and possibly some spasm in the muscle belly which routinely resolves. This rarely causes a problem, and removing the long head of the biceps tendon from the shoulder does not affect shoulder function. The biceps muscle continues to work at the elbow and moving or releasing this tendon does not affect motion or strength of the shoulder.\nSometimes a biceps tenodesis can be performed arthroscopically. However, in younger or more active patients, an open biceps tenodesis surgery may be recommended. Your surgeon will discuss this with you prior to surgery. A biceps tendon procedure is only performed if there is a problem with the biceps tendon which is felt to be significant enough to remain a source of shoulder pain after rotator cuff surgery.\nDistal Clavicle Resection\nA distal clavicle resection is performed if there is pain at the acromioclavicular joint. The decision to perform a distal clavicle resection is based on symptoms. Many patients have changes of this joint on radiographic studies (x-rays or MRI). If the joint is not painful, there is no reason to perform surgery on it, regardless of x-ray/MRI reports. If the joint is painful, surgery is performed to debride the joint and remove about 5-7 mm of the bone. The ligaments are left attached to preserve stability. Performing a distal clavicle resection will not lengthen your recovery period.\nDepending on the location of your surgery it may be required to have preoperative testing. In some cases blood work, EKG (heart tracing), or a chest X-ray may be needed. If any of these tests are needed they will be scheduled for you and will be done during pre-testing when you meet with the anesthesia staff. If it has been some time since you have seen your primary care physician and you have several medical problems, it would be best that you see your medical doctor before your pre-test date.\nYou will arrive at the hospital approximately two hours before your scheduled surgery time. Procedures are performed on a “to follow” basis. Occasionally, a procedure scheduled ahead of yours may take longer than expected, so there may be some delay before your surgery. Regardless, it is important that you arrive on time.\nYou should not have anything to eat or drink after midnight the night before surgery. You may be advised to take some of your medications with a sip of water only. The anesthesia staff will discuss this with you at the time of your pre-testing. Upon arrival to the hospital you will go through a check-in process. A nurse will see you, review your records, and an IV will be started. A member of the anesthesia team will meet with you to discuss any anesthesia concerns and anesthetic options. Your surgery will be performed under general anesthesia (you will go to sleep.) In addition, the anesthesiologist may recommend a regional block if they think that you are a good candidate. This involves an injection of local anesthetic (numbing medicine) or placement of a catheter near the nerves at the base of the neck. These blocks are generally recommended to help control your pain following surgery. The anesthesiologist will discuss the risks of the block and the decision to perform this is a mutual decision between the patient and the anesthesiologist.\nYou can anticipate that your surgery will last approximately 1 ½ to 2 ½ hours, although this varies from case to case. If you have family members with you they will wait for you in the waiting room. Your doctor will speak with them immediately after your surgical procedure to let them know that you are finished. During your surgery, family members should plan on remaining in or near the waiting area in order to be accessible at the completion of the procedure. Belongings will be stored in a locker in the pre-operative area.\nWhen you wake from surgery you will be located in the post-operative recovery room. Once you have been stabilized and are comfortable family members will be invited to sit with you while you continue recovering from surgery. Criteria for discharge include that your pain is under control and that you are eating, drinking, and able to walk to the bathroom with minimal assistance. You will have a dressing on your shoulder and your arm will be immobilized in a sling.\n>>Next topic: Postoperative Care |
TORONTO, April 11 (UPI) -- A Canadian anesthesiologist on trial for allegedly sexually assaulting patients sometimes caressed the faces of unconscious women, a nurse testified.\nLaura Cameron testified Wednesday against George Doodnaught, the Toronto Star reported. She said she once observed him fiddling with his pants.\nCameron was formerly a surgical nurse at North York General Hospital in Toronto.\n"When I first started working at North York General he appeared to be a very, very compassionate individual," Cameron said. "As time went on it became more than just caring and compassionate, from what I observed."\nCameron did not describe actual sexual acts but said she saw a lot of inappropriate behavior. Under cross-examination, Doodnaught's lawyer suggested he had a certain style of interacting with patients of both sexes, but Cameron said he got physically closer to women.\nDoodnaught, 64, is charged with assaulting 21 women ranging in age from 25 to 75. All but one were surgical patients at North York from 2006 to 2010.\nCameron said his dealings with patients could be disturbing: "Many times he would be sitting very close and actually touching the woman's face and caressing the woman's face, speaking softly." |
A lip lift is designed for patients that have a greater distance between the base of their nose and their upper lip, either due to genetics or the effects of aging. A noticeable sign is a lessening of “dental show” where the upper lip is so low that it conceals the teeth to some extent when the patient smiles.\nThe lip lift procedure usually takes about 1 hour and is done on an outpatient basis under general anesthesia. Superficial skin between the bottom of the nostrils and a point above the upper lip (each patient will vary) is surgically removed. Once the flap of skin has been removed, the bottom portion of the open area, located just above the lip, will be sutured together with the upper portion of the open area, located just inside of the nostrils, thus “lifting” the upper lip. Stitches are removed after the lip lift procedure in about one week by the lip augmentation specialist and you can return to work in 7-10 days with make-up to help camouflage any residual bruising that may persist. |
I'll write down a bit of what I remember from today, since I hear I have one or two readers new to IVF.\nI got to CCRM at 8 a.m. and a very nice nurse named Jennifer set me up in a room to change into a gown and start an IV. I have had some bad experiences with IVs, so I was nervous, but she used all the tricks I have heard of, including wrapping my arm in a warm moist towel and injecting lidocaine under the skin of the back of my hand before putting in the actual IV. Close to painless.\nJennifer let my husband into the room, and soon after, the anesthesiologist came to talk with my and have me sign the consent for general anesthesia. (Note that I had been fasting since midnight.) For this procedure, I was not intubated, but they put in a device to keep my airway open. My only moment of nervousness was when the doctor told me that since they were running short of Versed, they were trying to conserve it, so I might remember being scrubbed in preparation for the procedure.\nA few minutes later, Dr. Minjarez came in. My main doctor at CCRM is Dr. Surrey, but I have only met him once, during my day-of-tests. Various nurses convey all of his instructions. I technically have one main nurse at CCRM, but I have only seen her once since I arrived in Colorado. All of which is to say that I did not have a real relationship with any other medical professional, and thus was not disappointed to see a new doctor. I liked Dr. Minjarez immediately, especially when she said, "I go by Deb."\nDr. M instructed me to come back for an ultrasound tomorrow, and then to drink lots of water and eats lots of salty foods for the time being. She also said that I should avoid exercise for at least the next week, and that my hyperstimulation symtoms should go away completely with my next menstrual cycle.\nAfter Dr. Minjarez left, the anesthesiologist came back in and turned something on in the IV, and that's the last thing I remember. I guess she found some Versed.\nWhile I was in the retrieval, DH went off to do his thing.\nI awoke to the sound of beeping. I looked up and saw that my heart rate was 46. I wanted to go back to sleep, but the beeping continued, so I could not. Jennifer brought DH to the recovery room.\n32 eggs retrieved. Jennifer was impressed. It was nice to feel like I was good at something related to fertility. DH has been referring to me as the ovipositor, which, thanks to Google, I learned is both an organ used by some insects for laying eggs and also an ongoing experiment in groove versus dissonance. So the lab will work with these 32 eggs, and they will also defrost the 5 embryos I had shipped here. Before anyone gets too excited, the number of embryos that fertilize AND make it to blast AND test normal will be a good deal smaller, like one fifth of that at the most.\nBut back to retrieval day itself.\nBefore I left the surgery center, I had 2 extra strength tylenol and one can of ginger ale.\nI slept for most of the rest of the day, and I am ready for more sleep now.\nCetrotide by injection\nSurprising no one\n1 year ago |
This is the story of my son Jake and his battle with Fibromuscular Dysplasia.\nI have a beautiful son named Jake. He is my “MIRACLE” child. I held him in my arms for the first time, and instantly felt overwhelming love. A love that only a mother feels when her child is born. I made a promise to always love, care, and protect him to the best of my ability. My vision of protecting him was kissing his scrapped knees, or hugging him when he fell and to comfort him when he had a bad dream. I was worried about his first cold, earache, runny nose, and fever. I was a new mother and I wanted to be prepared. I knew that these were some of the small challenges I would face with being a mom. I was so excited for the major milestones a child goes through, such as rolling over, walking, talking, and riding a bike. Teaching him about his ABC;s and 1-2-3’s. My life was perfect with my little guy. I couldn’t imagine my life without him. He was growing, walking, talking, and most importantly HEALTHY! I was fortunate that I had two years of this “normal” life with Jake.\nAll this seems to have stopped at 2 1/2 years of age. My otherwise happy, healthy boy would cry because he had a headache. While the mutters of other children were outside playing, Jake was on the couch with a cold washcloth on his forehead. Tylenol, Motrin, baths, or even the washcloth did not seem to help him. We went to the pediatricians and they gave us antibiotics and then more antibiotic’s. I think they felt that I was so nagging that they wanted me to be quiet and quit calling the office. Fast-forward a few months and Jake still has his headaches. Noticeably when he would exert himself. At his three year checkup with the pediatrician on September 11th, the nurse was checking his blood pressure. She said under her breath that’s not right.\nThen took of the blood pressure cuff and placed in on the other arm. That’s when she informed me that he had high blood pressure — 146/92. She told me that she felt he was hyper and worked up with the doctors visit and would recheck it prior to us leaving. Needless to say I was worried. Jake may have been hyper, after all it was his birthday, but worried- NO! The pediatrician then informed me that we should see a Nephrologist and for me to check his blood pressure daily. She also felt a CT would be helpful, but thought it would not show any reason as to why Jake was so hypertensive. Then I received a phone call that changed my and Jakes life. I never envisioned what we were about to face.\nHe had an enlarged Basilar artery. They needed to get more imaging which resulted in an MRI. Jake needed to be sedated for the MRI seeing that he was only 3 years old. The nurses and the MRI tech let me sit in the MRI room with Jake. As I was nervously remembering the traumatic IV start I heard the nurse call a Code 333. Knowing what this meant I looked at Jake and he was not breathing. He was BLUE!!!! I was so scared I jumped up and started to shake his feet and yell his name. That’s when the room filled with doctors and I was escorted out of the MRI room.\nIn the hallway I was sobbing, worried my son was gone. I prayed and prayed for God to see him through this. And that’s just what he did. Come to find out the nurse had administered to much Nembutal which caused Jake to have a very low heart rate, and stop breathing. Because of the complications the MRI was not completed. This prompted Jake to have general anesthesia. The MRI was completed under general anesthesia successfully. He was discharged from the hospital and he was doing well. The doctor had told me that he would be unsteady for up to 12 hours and sleepy.\nI was constantly checking on Jake to make sure he was doing well at home. I had him on the couch, and when he wanted to eat I put him in a highchair. That’s when I noticed that his upper body was leaning to the right. I would sit him straight up in the chair and he would lean to the right. That’s when I felt something was not right. I stood him up and he fell over. He could not walk. His whole right side was not working. I brought him to the hospital and they blew me off stating it was the anesthesia. It had been over 12 hours since he had the anesthesia. Jake recovered and was able to walk without falling over and leaning to the right.\nDuring the next couple of weeks I changed pediatricians (because I felt she was not helping us) and saw the Nephrologist. Jake had renal ultrasounds and that would show that he had hydronephrosis in his right kidney. The flow was normal. This however did not explain the HTN. We saw a neurosurgeon and he went over the MRI images with us. He stated that he was uncertain what Jake has but is very complicated and he would refer us to Cincinnati Children’s Hospital. We drove the six hours down and saw a neuro-radiologist. He performed and angiogram. Jake had underwent a previous Angiogram in Grand Rapids and the radiologist stated that the carotids had too much artifact. After the six hour Angiogram was done the Doctor came out and informed us that Jake had Fibromuscular Dysplasia. He told us that there was nothing they could do for him. I asked about his prognosis and he told me that he “did not know, but to take him home and treat him as a normal kid.” We left Cincinnati hopeless and discouraged.\nBeing a nurse I felt that I was not going to just wait to see what happened. If I did wait then my son could/would die. My impression was he would. I looked to the internet for information and educated myself about FMD and looked to any doctors that would look at Jakes radiology films. I sent them to Australia, Tennessee, and Boston. I spoke with many Doctors and all ended up with I’m sorry there is nothing I am able to do. BUT I WOULD NOT GIVE UP!!!!\nI found this doctor in Boston that helps children with Moya-Moya. He looked at Jakes films and told us that we needed to come out to see him as soon as possible. A week later we were in his office discussing Jakes findings. He recommended that we repeat all tests including, MRI, CT, Renal Ultrasounds, Carotid Doppler, PET scan and Angiogram. After a grueling week in Boston the tests were completed. The Doctor confirmed the diagnosis of FMD. That’s when she told us that she could perform surgery on Jake but with fatal risks. If she were to perform and angioplasty of his right carotid and it dissected then there would not be a large enough stent to fit his carotid. This would prove fatal, being his left carotid was already dissected. She told us that there would be a 50/50 chance of death or success. She gave us the option of going home to think about it. We prayed on it and felt the best option was to go with the surgery. If we were to bring him home he would surely die. Surgery is was.\nThis would prove to be the longest 6 hours I have ever been through. After the six hours the doctor had come out to speak with us. The angioplasty was a success!! But Jake was not in the clear yet. The next 24 hours would prove that the procedure did not cause any permanent damage. Sitting in a chair next to Jakes bed in Boston’s ICU for three days was a relief but scary at the same time. I was praying that we saw the last of this HATEFUL disease FMD.\nFor the most we have seen the worst of this disease. Jake still has TIA’s, learning problems, and PTSD. He has been through a total of 22 procedures all except 2 being under general anesthesia. He has seen more doctors than I can even count, and had so many painful experiences. He is a pro at Angiograms. MRI’s, CT’s, lab draws, and Carotid Doppler’s.\nAt his young age of 17 he has endured what I could never have. He has given me the strength when I was at my weakest.\nHe has allowed me to cry, and hold him. I am so blessed that the doctors in Boston took a chance on Jake. If they hadn’t I am certain he would not be with me today. Even though there is so much more to Jakes story this is just a glimpse of his life. I thank all of you that take your time to research, learn, raise awareness about FMD. Jake is just one story of many but to me he is my story. |
Secondary epidermoid cyst of the penis is a very rare epidermoid cyst that occurs in the penis. The purpose of this study was to investigate the relationship between the occurrence of secondary epidermoid cyst of penis and circumcision-related factors, and to provide possible reasonable and effective suggestions for circumcision. The data of all patients who visited the clinic for epidermoid cysts of the penis from September 2000 to September 2021 in Xiangya Hospital were collected. A retrospective study was carried out on whether the patients had been circumcised and the surgical method, anesthesia method, cyst location, surgical age, postoperative wound infection, whether they were phimosis patients, and the level of the surgeon. Among the 24 patients followed up, 95.8% had a history of circumcision, and only 4.2% had no history of circumcision, and the more traumatic surgical methods developed secondary epidermoid cyst of the penis after surgery the higher the probability. Injecting anesthesia at the base of the penis increases the chances of developing a secondary epidermoid cyst of the penis. Postoperative secondary epidermoid cyst of the penis were mainly located in the anterior segment and posterior segment, and the anterior segment had a higher proportion, followed by the posterior segment. Secondary epidermoid cyst of the penis occur mainly in adults. Postoperative wound infection accelerates the appearance of secondary epidermoid cyst of the penis. Patients with phimosis have an increased probability of developing secondary epidermoid cysts of the penis after surgery. The incidence of secondary epidermoid cysts and postoperative infection after manual circumcision by the attending physician was higher than that of the chief physician. Circumcision, injection of anesthesia at the base of the penis, ligation of the penis, and postoperative wound infection may be the etiologies and triggers of secondary epidermoid cysts of the penis. Adults and phimosis patients may be high-risk groups. Lower-level surgeons may increase the odds of postoperative secondary epidermoid cysts of the penis, and it is recommended that surgery be performed by a clinically-experienced, higher-level surgeon. The indications for circumcision should be strictly evaluated and the operation should be performed as soon as possible, and the less invasive surgical method and anesthesia method should be selected. Reduce irrelevant operations during surgery and avoid wound infection after surgery.\nEpidermoid cysts are one of the common benign lesions in dermatology, accounting for about 90% of resectable cysts1,2. The affected population is mainly adults3,4, and it can occur in any part, mainly in the head, neck and trunk5,6. Epidermoid cysts rarely worsen7,8,9, but rare malignancies may develop over time3,10. Epidermoid cysts of the penis are one of the types of epidermoid cysts, but they are very rare and usually painless11. The clinical manifestations are mainly the progressive enlargement of the cyst, and inflammatory pain may be manifested after infection or rupture of the cyst wall4. Treatment is based on complete surgical excision. At present, the etiology of penile epidermoid cysts is still controversial12, and there are reports in the literature that it may be caused by residual congenital material, or damage to the hair follicle structure due to trauma, infection, and other reasons13,14,15. The occurrence of secondary epidermoid cysts of the penis after circumcision has been noted, and so far there has never been any literature on the specific relationship between the occurrence of secondary epidermoid cysts of the penis and circumcision. The purpose of this study was to specifically analyze the relationship between secondary epidermoid cysts of the penis and circumcision-related factors, and to provide possible reasonable and effective suggestions for circumcision.\nThe data of all patients with epidermoid cysts of the penis from September 2000 to September 2021 in Xiangya Hospital were collected. Whether the patient has been circumcised and the surgical method, anesthesia method, cyst location, surgical age, postoperative wound infection, whether it is a phimosis patient, and the level of the surgeon were investigated. In this study, a total of 27 patients with penile epidermoid cysts were identified. Among them, 2 patients could not be contacted due to wrong phone numbers, and 1 patient refused to communicate and did not complete the follow-up, so only 24 patients were finally investigated. Among them, 23 patients had a history of circumcision, and 1 patient had no history of circumcision.\nThis study has been reviewed by the Ethics Committee of Xiangya Hospital of Central South University, and the ethics number is: 202,111,212. Due to the spread of COVID-19 during the follow-up period, no written informed consent was signed, but the patient was informed in detail by telephone and verbal consent was obtained from the patient himself or his legal guardian. As the follow-up took place during a special period of covid-19 transmission, verbal consent was also approved by the Ethics Committee of Xiangya Hospital of Central South University. All data in this study were obtained from patient dictation. This study was conducted in strict accordance with the Declaration of Helsinki.\nThis study uses coding to hide all identifiable information of patients, and will follow the principles of scientific research risk control, privacy protection, and special protection. This research promises to comply with the requirements of scientific research management standards, and the research content will not cause harm and risk to the research subjects. The research subjects will be based on the principle of voluntariness, the right to know is guaranteed, and the rights and privacy of the research subjects will be protected to the greatest extent possible.\nResults and discussion\nThe etiology of penile epidermoid cyst has not been fully clarified. It has been reported in the literature that after neonatal circumcision, secondary epidermoid cysts of the penis may occur as a complication16, and the specific mechanism has not been studied.According to the etiology, epidermoid cysts of the penis are roughly divided into congenital and secondary epidermoid cysts of the penis17. Congenital epidermoid cysts of the penis may result from abnormal closure of the embryonic median raphe18,19. According to relevant literature reports, the occurrence of secondary epidermoid cysts of the penis may be due to trauma, surgery, and inflammation20,21,22, but no further research and analysis were conducted, which is also the significance of this study (Table 1). In this study, we found that regardless of circumcision or injection of anesthesia at the root of the penis, the incidence of postoperative secondary epidermoid cysts of the penis will increase, and the more traumatic surgical methods, the incidence of secondary epidermoid cysts of the penis (Tables 2 and 3). This may be related to the implantation of epidermal tissue into the dermis, occlusion of hair follicles, and obstruction of exocrine ducts after surgery and invasive procedures with injection of anesthesia at the base of the penis23. Patients undergoing three different surgical procedures were observed and found to have the highest incidence of secondary epidermoid cysts after manual circumcision (Table 3). The main reason may be that manual circumcision involves more operative steps than ligation and stapler circumcision. The ligation circumcision and stapler circumcision can be sutured at the same time as the overly long foreskin is removed. The time is short, the speed is fast, the effect is ideal, and there is no need for repeated operations. Manual circumcision requires a rubber band to ligate the base of the penis before the operation to reduce bleeding during the operation. After that, the overly long foreskin needs to be completely excised, and then the wound is sutured intermittently. In this process, the skin of the penis needs to be pulled and fixed with toothed forceps repeatedly. The presence of these invasive procedures described above greatly increases the risk of epidermal tissue implantation into the dermis, postoperative hair follicle occlusion, exocrine duct occlusion, and postoperative infection. This may be the main reason for the higher incidence of secondary epidermoid cysts after manual circumcision. In this study, all patients undergoing manual circumcision had the base of the penis bandaged with a rubber band before surgery to reduce bleeding, a procedure that may result in damage to the skin of the penis, which may promote secondary. The occurrence of penile epidermoid cysts, but the specific pathogenesis needs further study. From the location of the secondary epidermoid cysts of the penis, we found that when the secondary epidermoid cysts of the penis occurred in the posterior segment, the anesthesia was injected into the root of the penis, which may be related to the epidermal injection debris during the injection of anesthesia at the root of the penis24 (Table 4). Therefore, whether we can consider using other anesthesia methods to replace penile root injection anesthesia, which not only relieves the pain of anesthesia, but also reduces the occurrence of secondary epidermoid cysts of the penis after surgery.Relevant literature reports that the incidence of secondary epidermoid cysts of the penis is mainly adults3,4. Among the 23 patients with a history of circumcision in our study, 19 were adults and only 4 were minors (Tables 1 and 5). Is there a higher risk of secondary epidermoid cysts of the penis after adult circumcision?To avoid postoperative secondary epidermoid cysts of the penis, should surgery be recommended for male patients with indications for circumcision in adolescence? Of course, this requires more data to illustrate. Post-operative wound infection is a common complication after circumcision25, and post-circumcision wound infection may lead to occlusion of hair follicles or obstruction of exocrine ducts22, thereby increasing the occurrence of secondary epidermoid cysts of the penis. In this study, we did find that in patients with postoperative infection, the appearance of secondary epidermoid cysts of the penis was earlier (Tables 6 and 7), so the prevention of infection after circumcision is very important.Phimosis is one of the indications for circumcision, and it has been reported that secondary epidermoid cysts of the penis occurred in patients after phimosis23. In this study, we found that patients with phimosis had a higher rate of secondary epidermoid cysts of the penis (Table 8), probably due to the need for more invasive procedures during surgery in patients with phimosis. Therefore, it is necessary to explain the postoperative complications to the phimosis patients in detail before the operation, and avoid irrelevant invasive operations as much as possible during the operation, so as to avoid the probability of postoperative secondary epidermoid cysts of the penis.We found a higher incidence of secondary epidermoid cysts and postoperative infections after manual circumcision in the attending physician than in the chief physician (Table 9). This may be related to the lack of clinical experience of the attending physician, and there are many steps in manual circumcision. Low-level surgeons added ineffective manipulations in the process, further damaging the skin of the penis. It is also possible that with the increase of operation steps and the increase of operation time, the probability of infection is increased, and postoperative infection is more likely to occur, thereby inducing secondary epidermoid cysts of the penis. The diagnosis of secondary epidermoid cyst of the penis is easily confused with lipomas, fatty cysts, dermoid cysts, boils, and carbuncles26. A diagnosis must be made before treatment in order to decide on a treatment plan. Diagnosis mainly depends on the following points: (1) Medical history: whether there is a history of trauma and inflammation, especially whether there is a history of circumcision (2) Physical examination: a skin mass with a clear boundary can be seen on inspection, and a painless palpable mass can be palpated by palpation. Non-volatile compressible substances (3) Auxiliary examination: round or oval hypoechoic mass under color Doppler ultrasound (4) Pathological examination: keratin filling, fibrous tissue coverage27, secretory cell formation under immunohistochemistry Factors 1 and 1028, the most important of which is to carry out pathological examination. The main treatment is surgery, especially after it is known that it may turn into a malignant direction, such as squamous cell carcinoma and basal cell carcinoma29,30,31. Most of the local anesthesia surgery can be successfully resected, a small part requires general anesthesia, in order to avoid recurrence, the cyst wall must be completely removed. All surgically removed secondary epidermoid cysts of the penis should be confirmed histopathologically 32. Since secondary epidermoid cysts are very rare, this study was limited by the limited number of cases collected. However, we found some association and regularity between secondary epidermoid cysts and circumcision-related factors in a limited number of cases, which is a very meaningful study for surgeons. This will help surgeons to make more reasonable choices in circumcision operation methods, anesthesia methods, operation age, and selection of surgeons, and make clearer recommendations on the prevention of postoperative infection.\nCircumcision, injection of anesthesia at the base of the penis, ligation of the penis, and postoperative wound infection may be the etiologies and triggers of secondary epidermoid cysts of the penis. Adults and phimosis patients may be high-risk groups. Lower-level surgeons may increase the odds of postoperative secondary epidermoid cysts of the penis, and it is recommended that surgery be performed by a clinically-experienced, higher-level surgeon. The indications for circumcision should be strictly evaluated and the operation should be performed as soon as possible, and the less invasive surgical method and anesthesia method should be selected. Reduce irrelevant operations during surgery and avoid wound infection after surgery.\nAlmost all the data of this study has been included in the manuscript. Since the patients did not agree to disclose personal privacy information, this study cannot provide relevant personal privacy information including the patient's name, telephone number, home address, etc.\nFaltaous, A. A. et al. A rare transformation of epidermoid cyst into squamous cell carcinoma: a case report with literature review. Am. J. Case Rep. 20, 1141–1143 (2019).\nSorenson, E. P. et al. Scalp dermoids: A review of their anatomy, diagnosis, and treatment. Childs Nerv. Syst. 29(3), 375–380 (2012).\nVan Hoang, T. et al. Overview of epidermoid cyst. Eur. J. Radiol. Open 6, 291–301 (2019).\nde Mendonça, J. C. G. et al. Epidermoid cyst: Clinical and surgical case report. Ann. Maxillofac. Surg. 7, 151–154 (2017).\nSabhlok, S., Kalele, K., Phirange, A. & Kheur, S. 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An investigation of cytokeratin expression in skin epithelial cysts and some uncommon types of cystic tumours using chain-specific antibodies. Arch. Dermatol. Res. 282, 383–91 (1990).\nLiau, J. L. et al. Basal cell carcinoma arising from an epidermal cyst: When a cyst is not a cyst. Case Rep. Dermatol. 7, 75–78 (2015).\nSze, S. et al. Squamous cell carcinoma arising from a vulval epidermal cyst. J. Obstet. Gynaecol. Res. 42, 1623–1626 (2016).\nAljufairi, E. & Alhilli, F. Merkel cell carcinoma arising in an epidermal cyst. Am. J. Dermatopathol. 39, 842–844 (2017).\nMorritt, A. N., Tiffin, N. & Brotherston, T. M. Squamous cell carcinoma arising in epidermoid cysts: report of four cases and review of the literature. J. Plast. Reconstr. Aesthet. Surg. 65, 1267–1269 (2012).\nThis research was funded by the Hunan Provincial Natural Science Foundation of China (2021JJ40868) and the National Natural Science Foundation of China (No. 82001738).\nI confirm that this manuscript has not been submitted for publication elsewhere. All authors have significantly contributed to the manuscript and all agree with its contents. None of the authors has any potential financial conflict of interest related to this manuscript.\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nAbout this article\nCite this article\nYu, J., Tang, R. & Ding, K. Analysis of related factors between the occurrence of secondary epidermoid cyst of penis and circumcision. Sci Rep 12, 13563 (2022). https://doi.org/10.1038/s41598-022-16876-y |
Susan C. Harvey, MD et al. (1) from the Medical University of South Carolina, Charleston, South Carolina, reported recently a case of spinal epidural hematoma detected by lumbar epidural puncture. A 75 year old patient underwent femoral-distal bypass to the posterior tibial artery under epidural anesthesia. On the 10th postoperative day, he again complained of left foot pain. Repeat arteriography revealed flow-limiting stenosis above the distal anastomosis. An epidural anesthetic was once again planned. Coagulation variables were within normal limits. When an 18-gauge Tuohy needle was inserted at the L3-4 level, black, tarry, liquefied blood returned under pressure from the epidural space.After removal of approximately 10 ml of old blood, no additional blood returned passively or with gentle aspiration. The needle was withdrawn, and the anesthetic technique was converted to a spinal anesthetic at the L2-3 interspace. The surgery proceeded uneventfully.Computerized tomography (CT) without contrast was performed postoperatively. The CT scan was equivocal for the presence of epidural hematoma. Subsequent magnetic resonance imaging (MRI) revealed epidural hematoma at interspace L2-4. The patient remained neurologically intact and was discharged on the sixth postoperative day.\n1. Harvey SC, Roland PJ, Cure JK, Cuddy BG, O`Neil MG. Spinal epidural hematoma detected by lumbar epidural puncture.Anesth Analg 1997;84:1136-9\nAlmost a year and a half ago I have suggested in the Gasnet Discussion Group that evacuation of epidural hematoma by an epidural needle and/or catheter is a clinical option before any operation.\nThe case report by Harvey et al. shows that it is not only possible but it should be the first immediate treatment in every case suspected of developing an epidural hematoma.\nAs always, Mark Twain is correct: "Name the greatest of all the inventors. Accident"...\nFrom [email protected] Tue Jan 23 06:57:48 1996\nReceived: from mail.netvision.net.il by moe.med.yale.edu (4.1/1.30)\nid AA18092; Tue, 23 Jan 96 06:57:48 EST\nReceived: from mypc.netvision.net.il (ts2cp1.NetVision.net.il [184.108.40.206]) by mail.netvision.net.il (8.7.3/8.7.3) with SMTP id NAA06763; Tue, 23 Jan 1996 13:58:19 +0200 (IST)\nDate: Tue, 23 Jan 96 12:40:30 PST\nSubject: csea focus group #11\nX-Mailer: Chameleon - TCP/IP for Windows by NetManage, Inc.\nContent-Type: TEXT/PLAIN; charset=US-ASCII\nJoseph Eldor, MD\nCSEA FOCUS GROUP #11:\nA NEW TREATMENT FOR EPIDURAL HEMATOMA?\nA 24 year old parturient requested an epidural analgesia for labor. The\nanesthesiologist advised her a "walking" epidural using the combined\nspinal-epidural technique. Blood pressure was 110/80 mmHg and pulse - 100\nbeats/min. The patient received 1,000 ml Lactated Ringer`s solution before\nstarting the procedure. Lying on her right side at the "epidural position"\nan 18G Eldor needle (Alexander Medical Inc.,Coral Springs, FL) was inserted\nat the L2-3 interspace. After identification of the epidural space an\nepidural catheter 20G was inserted and tested by 3 ml lidocaine 2%. Two\nminutes later a 26G Double-hole pencil point spinal needle (DHPP), which is\nan integral part of the Eldor needle minipack, was inserted through the\nspinal conduit of the Eldor needle into the subarachnoid space. After the\nappearance of CSF at the hub of the spinal needle fentanyl 15 microgram were\ninjected through the spinal needle. Then the spinal needle was withdrawn and\nafterwards the Eldor needle leaving the epidural catheter in the epidural\nspace. The patient had a good analgesia during contractions and could move\nher legs as before. One hour and a half later the patient had an almost pain\nfree vaginal delivery. Half an hour later the patient complained of\ninability to move both legs. An epidural hematoma was suspected and the\npatient was taken immediately to the CT scan where the diagnosis was proved.\nAt the CT scan the patient was lain on her right side at the epidural\nposition and an 18G epidural needle was inserted into the subarachnoid space\nat the L1-2 interspace. An epidural catheter was inserted through it\nevacuating a bloody CSF.Another 18G epidural needle was inserted into the\nepidural space at the L3-4 interspace evacuating also blood at the range of\n20-30 ml. Another epidural catheter was left also in the epidural space.\nFive minutes later the patient could move both her legs. She was supervised\nat the intensive care unit for two days with no return of the paralysis. The\ncatheters were withdrawn at the second day post delivery. The patient was\ndischarged from the hospital two days later.\nThis case report didn`t happen. It serves for the description of a potential\ntreatment for epidural hematoma - evacuation of blood by an epidural needle\nand catheter in the epidural and subarachnoid spaces.\nComments are invited. |
Influence of CPB Temperature on CABG Morbidity\nTo compare three accepted modes of myocardial preservation, warm, tepid, and cold blood cardioplegia, coinciding with normothermic (37 degrees centigrade), tepid (32 degrees centigrade) and hypothermic (8 to 10 degrees centigrade) cardiopulmonary bypass (CPB) to define differences in neurologic function in coronary artery bypass graft (CABG) patients.\nProcedure: cardiopulmonary bypass\nProcedure: heart arrest, induced\n|Study Design:||Allocation: Randomized\nPrimary Purpose: Treatment\n|Study Start Date:||January 1994|\n|Estimated Study Completion Date:||December 1996|\nA pilot study of warm versus cold perfusion and preservation was completed in 32 patients prior to the ongoing study. The findings of the pilot study showed 53 percent of patients had evidence of new neurologic disturbance at postoperative day four. Only the neurologic dysfunction could be correlated with warm versus cold perfusion (37.5 percent warm versus 75 percent cold, P less than 0.05). The changes in neurologic function had abated or clearly improved by one month of follow-up, and the distinction in neurologic dysfunction grading was no longer apparent between the two groups.\nPatients were randomly assigned to cold, tepid, or warm blood cardioplegia, coinciding with normothermic, tepid, and hypothermic cardiopulmonary bypass. All patients received a standard anesthetic protocol combining narcotic and inhalational anesthesia. Each patient entering the study had extensive clinical data collected prospectively incorporating most aspects of measurable determinants related to myocardial preservation. Additionally, neurologic tests were performed by a blinded neurologist and rated by an objective scoring system, the Mathew scale. The studies were performed preoperatively, on the third or fourth postoperative day, and at one month following surgery. Hematologic data were measured for fibrinolytic potential.\nNo Contacts or Locations Provided |
300 Pasteur Dr, Stanford, 94305, USA\nStanford Hospital & Clinics operates as a hospital that provides patient care services in the United States.\nThe hospital offers clinical services in the areas of cardiac care, cancer treatment, neurology, neurosurgery, orthopedics, and surgery and organ transplants. It also offers medical services including aging adult, anesthesia, blood center, clinical nutrition, diabetes education, emergency medicine, imaging, infection control, interventional neuroradiology and radiology, laboratory, life flight, neurodiagnostics laboratory, PET/CT, in-patient, radiology, rehabilitation, trauma, and vascular laboratory services.\nStanford Hospital & Clinics provides guest services including patient representation, interpreter, spiritual care, massage therapy, arts program, cancer supportive care program, health library, music program, and pet-assisted wellness services.\nFounded in 1959, Stanford Hospital & Clinics is based in Palo Alto, California.\nThere is much more to this profile.\nLog in or sign up for free to see the whole thing.\nGet free access to these powerful tools:\n- Advanced search filters\n- Full startup and investor profiles\n- Follow startups and investors\n- Custom follow-lists\n- Startup benchmarking\n- Network maps\n- Market stats |
Job Description & Requirements\nAcademic Anesthesiology Physician in Minnesota\nA growing department at a reputable academic medical center is seeking qualified candidates with training and/or experience in solid organ transplant, non-cardiac vascular, or thoracic anesthesia. This role will include a mix of general anesthesia, excluding cardiac, pain, and pediatrics.\nThe ideal candidate will have a strong desire to teach medical students and trainees and will be able to work comfortably in a tertiary academic medical center with complex cases. Applicants must be ABA board-certified or board-eligible in anesthesiology.Job Specifics:\n- The department sees approximately 80+ liver transplants per year, including an increasing number of living donor cases\n- The department is initiating a blood clotting study, creating plenty of opportunity for publications, if desired\n- Opportunity to work in a tertiary care referral center with state-of-the-art facilities and an excellent teaching environment\n- Experience a collaborative team-based approach with weekly grand rounds—culture of sharing best practices to strive for continual improvement as a group\n- Enjoy a healthy work-life balance with a 1:10 call schedule and ample trainee support\n- Academic medical center located within a Big Ten land-grant university, allowing for a variety of collaboration opportunities\n- H-1B candidates are encouraged to apply\nPart of the 14th largest metropolitan area in the United States, our city offers an exceptional quality of life to all of its residents. This beautiful Upper Midwest region is an outdoor enthusiast’s dream, featuring a riverfront skyline, breathtaking waterfalls, an array of lakes, and more hiking and biking trails than you could imagine.As part of our community, you’ll enjoy the following:\nRanked #1 in Best Places to Practice by Medscape and in the Top 3 in Best States Overall by U.S. News\n- Our town boasts exceptional public and private schools, including one of the top 20 elementary schools and two of the top 20 private schools in the state (according to Niche)\n- With a local university and NFL, NBA, NHL, and MLB teams, enjoy collegiate and professional sporting events throughout the year\n- You will have convenient access to a major international airport, ranked in the Top 10 Domestic Airports by Travel + Leisure magazine\n- Experience a variety of engaging events year-round, including one of the largest state fairs in the nation, as well as an abundance of top-notch entertainment and unique shopping and dining options\nBE or BC in General AnesthesiologyAbout the Company\nMerritt Hawkins, an AMN Healthcare company, is a permanent physician placement service that fills more physician jobs than any other firm. In addition to being the nation’s leader in physician employment search and consulting services, Merritt Hawkins also recruits and places select allied health professionals. AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer. We encourage minority and female applicants to apply.\nAnesthesiologist, Anesthesiology, Anesthesia, Physician, Healthcare, Patient Care, Hospital, Medical, Doctor, Perioperative Medicine, Perioperative, Md, ANES\nPlease Click Apply! |
Are you Dr. Anderson Greenhaw?\nAnderson F Greenhaw M.D.\nDr. Anderson Greenhaw is an anesthesiologist practicing in Norman, OK. Dr. Greenhaw ensures the safety of patients who are about to undergo surgery. Anestesiologists specialize in general anesthesia, which will (put the patient to sleep), sedation, which will calm the patient or make him or her unaware of the situation, and regional anesthesia, which just numbs a specific part of the body. As an anesthesiologist, Dr. Greenhaw also might help manage pain after an operation.\n||American Board of Anesthesiology (ABA) |
Athletic Sculpt Services\nFDA approved technique using low-level sound wave and Radio Frequency rupture the dermis layer of fat in designated areas of the body. Liquified fat is the eliminated through the Lymphatic system; the bodies natural detox and transport system to eliminate toxins through urine, stool and sweat.) Straightforward procedures listed below that do not require invasive skin puncture, incisions or the dangers of local anesthesia\nProcedures and post health & fitness services are provided at a commercial fitness, health and wellness facility located in Lanham Maryland. Services are offered to both women and men (no persons under 18 years of age) for non-invasive body sculpting, contour and fat loss services.\nImmediate Fat Dissolve & Athletic Body Shaping (Trimmed Waistline, Visibly Slimmer Stomach, Ab Structure, Leaner Legs & Back)\nNon- Surgical Procedures or Surgical Costs\nImmediate Improvement To Skin Appearance\nDetox, Skin Tightening, Competition Prep\nPost Op Plan For Ongoing Physical, Health & Wellness Success |
Pet anesthesia risks are quite low, but most pet owners still worry. Modern medication protocols and inhaled gas anesthetics provide smooth inductions, allow precise adjustments during surgery, and fast recoveries. The Palm Valley Veterinary Center team follows the highest anesthesia standards, and takes every necessary precaution to ensure a safe anesthesia for your pet. To allay your fears, we share the anesthetic protocols that help us maintain the highest care standards.\nWhat is pet anesthesia?\nBy definition, anesthesia is the absence of feeling—meaning your pet cannot feel any pain. We achieve this by putting your pet in a controlled unconscious state that we maintain using precise amounts of inhaled gasses. Anesthesia is required to perform complete dentistry and surgical procedures, while lesser sedation may be sufficient for minor procedures, such as wound repair or imaging. Pet anesthesia is extremely safe because of modern anesthetic protocols—in one study, average mortality rates ranged from 0.05% to 0.1% in healthy pets, and up to only 1.3% for sick pets.\nYour pet’s pre-anesthetic evaluation\nYour veterinarian will perform a complete physical examination and full blood panel prior to anesthesia, to help them understand your pet’s kidney and liver function, which affects drug and gas anesthetic metabolism. If your pet is older or has a heart murmur, additional tests can help provide a more complete picture of organ function and overall health. These tests include:\n- Echocardiogram (i.e., heart ultrasound)\n- Chest X-rays\n- Blood pressure evaluation\nYour veterinarian will recommend treating underlying health problems prior to anesthesia to minimize your pet’s risks. If their underlying disease is mild, elective anesthesia can typically still be safely performed with a few drug protocol modifications, but for pets who have serious health problems, such as heart failure, lung disease, or uncontrolled diabetes, their risks versus benefits need careful consideration. Emergency surgeries do not allow time for these pre-evaluations, but the life-saving surgery benefits are considered to outweigh the anesthesia risks for these pets, regardless of overall health status.\nBefore your pet’s anesthesia\nAfter you drop off your pet, we house them in a cozy cage or run until their surgery. We first administer a pre-anesthetic drug cocktail that provides relaxation and minor sedation to facilitate placing an intravenous (IV) catheter. If we expect that your pet’s procedure will be painful, we also give preoperative analgesics. Using multiple drugs can minimize doses and subsequent side effects.\nAfter IV catheter placement, we administer a drug to induce unconsciousness and place a breathing tube in your pet’s trachea for the administration of oxygen and the anesthetic gas that maintains their anesthesia. Next, we attach sophisticated monitoring equipment, run IV fluids, and prepare your pet’s surgical site, if needed. Only qualified, credentialed veterinary technicians perform and monitor anesthesia under the attending veterinarian’s supervision.\nDuring your pet’s anesthesia\nWe closely monitor your pet’s vital signs throughout their procedure, so we can intervene as needed. IV fluids help to maintain your pet’s blood pressure and circulation, and external warming devices prevent hypothermia. Your pet’s technician constantly monitors heart rhythm and rate, so we can treat and reverse minor arrhythmias, which are common under anesthesia. The gas vaporizer allows precise, quick adjustments to anesthetic depth, so your pet’s depth does not become too light or too deep. Pets under anesthesia lack muscle tone, so we handle them carefully to prevent nerve or joint injuries.\nAfter your pet’s anesthesia\nWhen your pet’s procedure is complete, we turn off the gas vaporizer and administer pure oxygen for five to 10 minutes to flush the anesthetic from their lungs. Most pets wake up shortly after, and we continue to monitor vitals closely, carefully removing the breathing tube only when your pet can swallow on their own, which indicates they can protect their own airway.\nWe return your pet to their cage or run, where we wrap them in warm blankets, monitor vital signs, and provide additional pain medications, if needed, as they recover. A few pets will react to the anesthetic drugs and wake up vocalizing or confused, but we can provide them with a low-dose sedative to ensure their smooth recovery. We keep your pet in the hospital for several hours until their vitals are normal, and send you home with detailed postoperative instructions and medications.\nBecause of our strict screening and preparation protocols, you do not need to worry about your pet undergoing anesthesia. If you’ve been delaying an elective surgery or dentistry procedure, you can now go ahead, knowing that anesthesia is low risk. Contact our experienced and knowledgeable Palm Valley Veterinary Center team to schedule your pre-anesthetic evaluation and provide your pet with our high-level care.\nLeave A Comment |
“Our goal is to bring New York City-level care and the full range of subspecialty orthopedic care that we offer at Columbia up to Westchester,” said Jeffrey A. Geller, MD, Chief of Orthopedic Surgery at NewYork-Presbyterian Lawrence Hospital and the Chief and Director of Research, Division of Hip and Knee Reconstruction at CUMC’s Department of Orthopedic Surgery. Dr. Geller is also the Nas S. Eftekhar Professor of Orthopedic Surgery at CUMC. “Columbia stands at the very forefront of research, education and collaboration in orthopedics. We are the only academic orthopedic department in New York City that has the capacity to provide comprehensive orthopedic surgical services to patients living in Westchester.”\nAs a result of the collaboration with Columbia, NewYork-Presbyterian Lawrence can now offer a wider range of advanced surgical and non-operative orthopedic services. Dr. Geller, a nationally recognized expert in the non-operative and operative treatment of arthritic disorders of the hip and knee, leads a team of fellowship trained experts in the specialties of hip and knee reconstruction, pediatric and adult sports medicine, foot and ankle, hand, elbow, shoulder, spine and trauma.\nDr. Geller has extensive experience in the latest and most advanced minimally invasive techniques for procedures including partial knee replacements, anterior hip replacements, hip resurfacing, as well as minimally invasive hip and knee replacements. He performs primary joint replacement surgery and revisions of failed or painful joint replacements only after he considers all non-operative treatment options.\n“We are very conservative in our care and choose non-operative approaches first and foremost,” said Dr. Geller. “However, if surgery is necessary, it is nice to know that you can have the surgery right here at NYP Lawrence, which means you do not have to travel to New York City for your care.”\nAs a specialist in trauma of the lower extremities including hip fractures, fractures around joint replacements and fractures related to osteoporosis, one of Dr. Geller’s primary goals as the Director of Orthopedic Surgery is to establish a large orthopedic trauma service in the Westchester region that can quickly and expediently treat patients who present with a broad variety of orthopedic trauma, from every-day injuries to highly complex fractures requiring surgical intervention.\n“Hip fractures are on the rise, particularly among the elderly,” said Dr. Geller. “Our goal is to standardize care for trauma patients, which involves getting them to surgery faster, and get them up and moving as soon as possible after surgery. This standard of care has been proven to improve the outcomes and quality of life for hip fracture patients.”\nDr. Geller’s other initiative at the Hospital is pre-emptive pain control, the prevention of surgical pain before it begins after surgery, in order to help orthopedic surgery patients experience a faster, more comfortable healing process. “We can now prevent pain before it begins by taking a multimodal approach to pain control,” he said. “Our team of orthopedic surgeons is prescribing smaller doses of medication that target specific pain centers, and we are working with anesthesiologists who can provide nerve blocks and local anesthetics to prevent the onset of pain.”\nFor Dr. Geller, teamwork is the cornerstone of orthopedic care that is now available at NYP Lawrence. “We collaborate closely with anesthesiologists, pain management specialists, physical therapists and nutritionists to create a plan of care that addresses each patient’s unique needs before, during and after surgery,” he said. “The new generation of medicine is all about collaboration. We are proud to work with the specialists at NYP Lawrence to bring true multidisciplinary orthopedic care to patients living in Westchester.”\nDr. Geller sees patients in Bronxville and Tarrytown, with surgical procedures performed at NewYork-Presbyterian Lawrence Hospital. To make an appointment with Dr. Geller, call 914-750-4650.\nGet comfortable with the technology you’ll be using, and have relevant medical devices and logs at hand April 9, 2020;... MORE > |
Vitals cannot verify whether or not this professional is currently practicing. We recommend that you attempt to contact the provider to verify their status. Please email us at [email protected] if you have any additional information.\nType 2 Diabetes\nType 2 diabetes is a chronic disease in which your body is unable to maintain a normal blood sugar (glucose) level.\n- Type 2 Diabetes Basic facts about type 2 diabetes & risk factors to be aware of.\n- Asthma More than 22 million Americans suffer from asthma. Get the facts.\n- Autism Spectrum Disorder Get the facts about Autism Spectrum Disorder (ASD).\n- Childhood Asthma Childhood asthma facts, including causes, symptoms & complications.\n- Grass Pollen Allergy Get the facts about grass pollen Allergy.\n- Home Allergies Facts about indoor allergies, including symptoms & common allergens.\n- Persistent Asthma Facts about persistent asthma, including the criteria for diagnosis.\n- Pregnancy Facts about pregnancy, including symptoms you can expect to have.\n- Ragweed Allergy Ragweed allergy facts: symptoms, how to avoid it, trigger foods.\n- Seasonal Allergies Facts about seasonal allergies, the different types and the symptoms.\n- View All Care Guides Prepare for your next visit with our extensive library of Care Guides\nDr. Gerald Berner has the following 2 specialties\nAnesthesiologists are physicians who are trained to administer anesthetics, which are medicines used to block nerve sensation. Anesthesia can be either local to one specific part of a body, like a tooth, or regional to block feeling to a larger portion of the body, such as during an epidural for child birth. It can also be more general to block sensation to the entire body, resulting in unconsciousness.\nAnesthesiologists assist in surgery by determining how much anesthesia is necessary and by monitoring the patient's level of responsiveness and vital signs throughout the procedure. The anesthesia specialist will also bring the patient out of anesthesia and then continue to monitor his or her vital signs post-operation.\nBesides assisting in surgeries, anesthesiologists may also treat patients suffering from chronic pain.\nA pediatrician is a doctor who specializes in the regular care of children, as well as the diagnosis and treatment of illness in children. Young patients are often more complicated to treat because they are still growing and developing.\nWhile pediatricians may sub-specialize in specific therapy areas like oncology, surgery, ophthalmology, and anesthesiology, in general, pediatricians provide services like vaccinations, health exams, and treatment of common ailments and injuries. In addition, pediatricians are trained to handle the complex emotional and behavioral issues faced by children, especially during puberty.\nPediatricians normally see their patients from birth until the age of 18, although some may agree to treat patients into their early 20s, if requested.\nDr. Gerald Berner has the following 3 expertise\n- High Blood Pressure (Hypertension)\nDr. Gerald Berner has 1 board certified specialty\nSee the board certifications this doctor has received. Board certifications provide confidence that this doctor meets the nationally recognized standards for education, knowledge and experience\nDr. Gerald Berner is Board Certified in 1 specialty\nSee the board certifications this doctor has received. Board certifications provide confidence that this doctor meets the nationally recognized standards for education, knowledge and experience.\nShowing 5 of 7\nDR BURNER WAS MY DR WHEN I WAS A CHILD AND NOW, HE IS MY GRANDCHILDRENS DR. YES HE MAY BE UP IN AGE BUT THIS IS WHAT MAKES HIM GREAT. I HAD A SEVERLY HANDYCAPED CHILD AND NO ONE WOULD HELP HIM BUT DR. BURNER. I EXSPECIALY LIKE THAT HE USES OLDER METHODS IN HIS CARE. HE HAS BEEN AND STILL IS VERY CARING AND HELPFULL IN EVERY ILLNESS MATTER. IF HE CAN'T HELP YOU HE WILL KNOW SOMEONE WHOM CAN. HE ONLY REFURES TO THE BEST IN THERE FILDS. HIS STAFF ARE GREAT ALSO. I'D REFURE HIM HANDS DOWN FOR SURE.\nIn the day and age of today where everything is rush rush, this doctor will actually give you a call in the evening if your child is sick. My daughter was ill with an ear infection and bronchitis at age 6 months. Dr. Berner called the evening of my appointment just to check on my daughter and to make sure I understood his instructions.\nDr. Berner is affiliated (can practice and admit patients) with the following hospital(s).\nHurley Medical Center\n54 Years Experience\nUniversity of Michigan Medical School\nGraduated in 1959\nHurley Medical Center\nPlease contact the office for more information.\nLocations & DirectionsG3500 Flushing Rd, Flint, MI\nDr. Gerald Berner is similar to the following 3 Doctors near Flint, MI. |
Prices/cost male breast reduction: gynecomastia\nPrices/cost male chest enhancement: pectoral implants\nRead more about:\n- Male breast reduction: gynecomastia treatment\n- Male chest enhancement / pectoral implants / pectoral augmentation\n- All-inclusive prices: Our prices - rates include all costs for the procedure: admission fees, medical fees, breast implants, sleepsedation, and all our aftercare following the operation. Rates do not include any VAT.\n- Every additional intake consultation is free of charge.\n- There's a 10 year guarantee against breast implant leakage.\n- ISO 9001 certified quality care: read more |
Dr. Samuel Vanderhoek is an Assistant Professor in the Department of Anesthesia and Critical Care Medicine at the Johns Hopkins University School of Medicine. He is an attending anesthesiologist in the Johns Hopkins Children’s Center, and he provides anesthesia in the pediatric operating rooms and sees patients in the pre-operative clinic. He is also a member of the pediatric liver transplant anesthesia team.\nDr. Vanderhoek’s research lies in perioperative glycemic control, specifically in children and adolescents with insulin-dependent diabetes who use insulin pumps. He also coordinates the resident rotations within pediatric anesthesia, developing curricula for these blocks as well as assessment tools. He is interested in resident education, curriculum development, and adult learning. Dr. Vanderhoek completed the Harvard-Macy Program for Future Academic Clinician Educators.\nDr. Vanderhoek received his medical degree from Mount Sinai School of Medicine, and he completed his residency in anesthesia at Massachusetts General Hospital followed by a fellowship in pediatric anesthesia at Boston Children’s Hospital. He is board certified in both anesthesiology and pediatric anesthesiology. |
Many surgeries require patients to be placed under anesthesia. Types of anesthesia include general anesthesia, spinal anesthesia or epidurals, local anesthesia, regional anesthesia, and dissociative anesthesia. Our Chicago anesthesia error lawyers know that anesthesiologists have an enormous responsibility to keep a patient unconscious or semi-conscious, while also monitoring oxygenation and vital signs. Anesthesia errors may happen and be corrected during surgery so that the patient is not aware of them. However, in some cases they can cause devastating medical problems or even death. The medical malpractice attorneys at Moll Law Group fight for the rights of patients in Chicago and the surrounding cities if they have been harmed by an anesthesia error.Holding a Negligent Anesthesiologist Liable for Damages\nSerious anesthesia errors can result in organ damage, asphyxia, birth defects, cardiovascular collapse, spinal cord injuries, paralysis, seizures, stroke, coma, and death. There are many different kinds of anesthesia errors, including:\n- Failure to monitor oxygenation;\n- Failure to intubate a patient during surgery;\n- Failure to review a patient's medical history;\n- Communication failures;\n- Dosage errors; or\n- Too little anesthesia.\nTo prove that an anesthesia error was medical malpractice, you need to prove that the anesthesiologist breached the applicable standard of care and that this breach is what caused your injuries. To illustrate the standard of care, you need to provide expert testimony about the accepted practices for other anesthesiologists in the same geographic region, when treating a similar patient during the same type of procedure. An anesthesia error lawyer in the Chicago area can help you enlist a knowledgeable expert.\nFor example, appropriate intubation can be critical to make sure the patient can breathe properly during surgery. If an anesthetized patient faced breathing difficulties during surgery, he or she may suffer permanent brain damage. The plaintiff's expert will need to have experience and competence as an anesthesiologist and analyze all factors related to the surgery and the defendant’s actions. One issue in this case will be whether the anesthesiologist was properly monitoring the patient's breathing and whether a reasonable anesthesiologist in the same situation would have intubated the patient. The expert must provide a report that shows there is a reasonable, meritorious basis for the lawsuit.\nIn Illinois, you have two years from the date you knew or should have known about the anesthesiology error to take legal action. In most cases in which someone is injured by an anesthesia error during surgery, the victim or the victim’s family will realize the error shortly afterward. It is important to consult an attorney right away. The attorney will need to time to consult an experienced anesthesiology expert and get a report prepared.\nIf you successfully prove your case, you may be able to recover compensation. These include both economic and noneconomic forms of damages. The former often include medical expenses, lost income, lost earning capacity, vocational rehabilitation, and out-of-pocket costs. The latter may include mental anguish and pain and suffering.Consult an Experienced Anesthesia Error Attorney in Chicago\nThe injury lawyers at Moll Law Group provide vigorous representation to Chicago residents and others who have been harmed as a result of medical malpractice. Billions of dollars have been recovered in cases in which we have been involved. Our attorneys also represent people in Naperville, Schaumburg, Wheaton, and communities throughout Cook County. Call us at 312-462-1700 or contact us through our online form to set up a free appointment with a Chicago anesthesia error attorney. |
You should feel comfortable and reassured. Dr. Deirdre Rhoad is Board Certified in Plastic Surgery. She has practiced as a plastic surgeon in Austin, Texas for over 20 years. During your consultation, she will answer all your questions in detail.\nFor most surgical procedures there is the surgeon fee, the facility fee and the anesthesia fee. There may also be additional fees for implants and support garments. We will give you a written estimate of fees upon consultation.\nYes, Rhoad to Beauty uses Care Credit as a resource to pay for elective procedures and products. With a minimum purchase, cardholders may qualify for six-months of 0% interest financing. Read more about our Care Credit Financing Options. In addition, we accept all major credit cards.\nYou can download and complete our New Patient Forms. |
Total amount: € 0,00\nOnline ISSN 1827-1596\nCarlos L. ERRANDO 1, Ignacio GARUTTI 2, Guido MAZZINARI 3, Óscar DÍAZ-CAMBRONERO 4, John F. BEBAWY 5 and Grupo Español de Estudio del Bloqueo Neuromuscular\n1 Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; 2 Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón and Associate Professor Department of Pharmacology Complutense University, Madrid, Spain; 3 Servicio de Anestesiología, Hospital de Manises, Valencia, Spain; 4 Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Politécnico La Fe, Valencia, Spain; 5 Assistant Professor of Anesthesiology & Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA\nBACKGROUND: Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization.\nMETHODS: Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr<0.9. Patients >18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the postanesthesia care unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring.\nRESULTS: A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the postanesthesia care unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation.\nCONCLUSIONS: The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine. |
How Long Will I of Had to Stop Smoking Before I Can Get Breast Implants?\nDoctor Answers (24)\nSmoking and surgery\n1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion.\n2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.\n3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.\n4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.\nIn conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.\nPablo Prichard, MD\nHow long will I have had to stop smoking before I can get breast implants?\nTypically, we recommend at least 6 weeks of smoking cessation prior to and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, nipple necrosis, poor scarring, and wound complications, as well as other health consequences. The anesthesia risk is greater with general anesthesia as well as pulmonary issues/lung infections postoperatively. I would discuss this with your surgeon prior to your procedure. Some surgeons will refuse to operate on smokers and may check urine or blood levels prior. Hope that this helps! Best wishes!\nStop Smoking Two or more months prior to surgery\n. Most experts unanimously agree that smoking increases the rate of breast augmentation surgical complications significantly. Just about all plastic surgeons strongly recommend women to stop smoking and all nicotine products well in advance of breast augmentation with breast implants. Many plastic surgeons recommend stopping all tobacco products several months prior to surgery.A scientific article in the Archives of Internal Medicine indicated that, among all forms of surgery, quitting smoking eight weeks prior was never associated with an increased risk of complications.\nHere is the reason why: the nicotine in cigarettes and other tobacco products (including Nicorette gum, patches, etc) is a vasoconstrictor, meaning it makes the Smoking is a significant multiplier of many potential complications following surgery and breast augmentation with implants are no exception. Nicotine from smoking causes blood vessels to vasoconstrict ( tighten up). Over time, these constricted arteries and capillaries deliver less blood to the breast tissue which is needed for normal healing. Smokers therefore have an increased incidence of higher likelihood of complications such as infection, and in particular capsular contracture (hardening and distortion of the implants). General complications of surgery such as blood clots, anesthetic problems such as pneumonia are also increased. For a tummy tuck there is increased likelihood of both an infection and loss of skin because of inadequate circulation.\nIn young patients you will probably statistically avoid these complications, why tempt fate by increasing your odds that something bad will happen. .On a long term basis, smoking also causes accelerated aging of the skin and loss of elasticity. Hopefully these reasons will help give you the will power and courage to stop smoking.\nYou might also like...\nCigarettes and breast implants\nWhile it is not essential to stop smoking prior to breast augmentation surgery, it is recommended to stop 2 weeks prior to surgery. The reasons being: to speed the healing process, and to avoid respiratory complications.\nSmoking and breast augmentation.\nI recommend for my patients to stop smoking at least 4 weeks prior to surgery if possible. Smoking will affect everything from anesthesia to healing from the operation. It is also important to know that smoking replacement or nicotine replacement therapies may need to be avoided. In particular is Chantix as it can interfere with the metabolism of many common anesthetics. Staying smoke free during the recovery period is also recommended for an additional 4 weeks. For many patients, they find that this requirement gives them a goal to stop smoking altogether. Best of luck!\nBreast Implants and Smoking\nWe ask our patients to avoid nicotine or nicotine products for six weeks before and six weeks after surgery to decrease infection and promote better healing. Some surgeons feel smoking, over the long haul, contributes to capsule formation. All the best, "Dr. Joe" Gryskiewicz\nSmoking and Breast Augmentation\nAny flaps like tummy tuck, facelift, and breast lift have higher complications of skin necrosis with smokers, and most Board Certified Plastic Surgeons would not do these surgery's if you are smoking. We do know from surgery center stats that you have a four time higher chance of infection to the surgical wound if you are a smoker. That being said, smoking is not a contraindication for breast augmentation, and I do this surgery on smokers frequently. But smoking will increase your risks of anesthetic complications. There is nothing harder to quit as a habit than smoking, but it would be much better for you.\nHow Long Do I Need to Stop Smoking Before I Can Get Breast Implants?\nThere are really only 3 operations where I insist that patients stop smoking. Facelift, Breast Lift and Tummy Tuck...Now of course, you should not smoke but for just Breast Augmentation, you should do fine with maybe just a bit more coughing when you wake up from anesthesia. There was a rumor for years about increased capsular contracture in smokers but that may not be true.\nSmoking and surgery\nI prefer that patients stop smoking about four weeks prior to surgery and remain off cigarettes for four more weeks. Preferably avoid second hand smoke as well.\nSmoking and breast augmentation\nYou do not have to quit smoking in order to have a breast augmentation. Your chances of having a problem with wound healing are not increased by smoking. The chance of having anesthesia problems is slightly higher than in a nonsmoker, the chance of a post operative bleed may be higher if you cough a lot after surgery.\nThese answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship. |
Rest Assured, Recover at Ease\nCommunity Healthcare System hospitals are established leaders in surgical innovation. St. Catherine Hospital was among the first in the nation to perform successful open heart surgery. Community Hospital surgeons were among the first in the nation to use da Vinci robotic, single-incision surgery. And St. Mary Medical Center is a designated Center of Excellence in bariatric as well as minimally-invasive gynecologic surgeries, all performed in a modern, new $40 million surgical pavilion.\nOur inpatient surgical treatment options include:\n- Cancer surgery\n- Cosmetic/plastic surgery\n- Digestive surgery\n- Endoscopic surgery\n- Hand surgery\n- Laser procedures\n- Ophthalmologic surgery\n- Pain management\n- Plastic surgery\n- Spinal surgery\n- Trauma surgery\n- Urological surgery\n- Vascular surgery\nContact our inpatient surgical departments to learn more:\nWhat to Expect\nOur surgery admission nurse will call you before surgery to gather your medical history and other important details. This information will help us develop the optimal treatment plan for you, including surgical procedures, anesthesia and pain management.\nPreparing for your pre-surgery interview\nBefore the call, it may be helpful to write some notes or gather a few details so you are ready to review:\n- Past surgeries, hospitalizations or other significant medical problems past or present\n- All medications you will be taking 10 days prior to your surgery day, including all prescription and over-the-counter medications, as well as vitamins and herbal or dietary supplements\n- Medication and food allergies or any other allergies you have, including latex, tape or dyes and how you react to them\nDay of Surgery\nWhen you arrive, you will check in with our Admissions department. Please bring photo identification and your insurance card. You will be asked to sign consent forms, be given your identification bracelets and escorted to the surgery waiting room.\nWhile you are having inpatient surgery, your family will be able to track your status by referring to the tracking board located in the surgery family lounge. The monitor indicates whether you are in the pre-operative area, operating room, surgery recovery or if you have been brought to your hospital room. Often, an operating room nurse will call the surgery family lounge 60 minutes into the procedure to update your family on your status.\nPost Anesthesia Care Unit (PACU)\nAfter inpatient surgery, you will be taken to our Post Anesthesia Care Unit (PACU). The PACU staff cares for patients recovering from general, local or regional anesthesia. You will remain in the Post Anesthesia Care Unit depending upon the type of anesthesia you have had, along with how quickly your body and mind become alert as the medication wears off. Our goal is to make you as comfortable as possible.\nFind a Surgeon\nTo find a surgeon on staff at our hospitals, call our physician directory at 219-836-3477 or 866-836-3477, Monday through Friday, 8:30 am to 5 pm. We offer assistance in English and Spanish. |
The Diploma in Emergency and Trauma Care Technician course prepares students to provide immediate and efficient care in cases of injury or accidents. Students are trained in procedures and skills required to handle critical, emergency or traumatic cases. Emergency medicine has become an important field of study for many medical professionals who wish to work in this area.\nFor those who wish to work as allied paramedics, the course opens up different career paths. Emergency trauma technicians are an essential part of the medical system. These specially trained paramedics provide emergency and trauma care to critically ill patients.\nApex Paramedical Institute, with its state-of-the-art facilities and highly innovative teaching methodologies, has become quite popular among students who desire to make a career in the medical profession. The institute imparts training to its students under the able supervision of highly experienced faculty.\nThe total course duration is two years. The subjects taught in the first year are anatomy, physiology, pharmacology, disinfection, anesthesia and OT management. The second year focuses on medical and surgical critical care management, ICU and ward management along with medico legal understanding.\n10+2 science with 40% (PCB/PCM) by any recognized Institute/Board.\nAge must be 17 years or more. (No Upper Age limit)\nCareer avenues are open with various government / private / public sector hospitals and nursing homes. Some other roles could be:\nEmergency nurse / paramedic with nursing homes or hospitals\nFreelance work opportunities\nGeneral practice nurse / occupational therapists giving care to trauma patients\nWe believe that, the paramedical students need to have an all-round development through varieties of curricular and co-curricular activities. |
- Photo Gallery\n- In Depth\n- The Center\n- Contact Us\nIf you are looking for a natural breast augmentation we can help you at the Miami Breast Center. Micro-fat grafting is an implant-free fat transfer breast augmentation technique developed by Dr. Roger Khouri. It is simple, less stressful on your body than traditional methods and recovery time is quick.\nOur outpatient technique is minimally invasive and has the wonderful side benefit of liposuction. With Dr. Khouri’s micro-fat transfer procedure, the patient prepares for the procedure by wearing an external expander called BRAVA, while she sleeps for a few weeks. This soft gel-like brassiere gently suctions the breast area in order to create an adequate matrix for the fat injections.\nOriginal small breast before treatment. Inset shows normal tissue density.\nBRAVA system is placed over the breast area when you sleep. Vacuum inside the domes pulls the breast tissue outward to start expansion. Inset shows loosening of the normal tissue density. It’s the key for a high rate of fat survival.\nWith continued expansion, the breast enlarges even more. Inset shows the loosening up of the tissues as they open up like an expanding sponge to make room for the grafts. Notice that with this rapid expansion there aren’t any new fat cells, only a loosening of the normal tissue density with stretched out fibers and tiny new blood capillaries along the expanded structure ready to accept the grafts.\nThe expanded space is grafted with fat harvested from your desired body area. No cuts or incisions are made, only needle pokes. The fat fills up the expanded vascular structure and restores the normal cellular density. Inset shows how new blood vessels help keep the fat deposits alive. The breast has been augmented with tissue engineered fat.\nLeft: Thirty-year-old woman who wanted a natural breast augmentation with her own fat.Center (Bottom): To ensure survival of the large volume of fat needed for the augmentation, she wore BRAVA for 4 weeks and had an excellent BRAVA effect prior to grafting. Center (Top): The lines drawn on her breasts indicate the needle stick injection sites and the direction of the multiple cannula passes required to diffusely and evenly fill up the expanded breast tissue. Right: Essentially all of the transplanted fat survived. After this procedure, we measured by MRI a 280 mL augmentation per breast with no evidence of fat necrosis. See More Photos\nBy using your own fat, we will fulfill your desire of having larger breasts. New moms also love our procedure, since it is perfect to restore volume that normally dissipates after child birth. As compared to implants, natural breast enhancement techniques such as herbal remedies, creams, foods, and exercise, breast augmentation with fat transfer involves no incisions, no new scars and no foreign objects. You will love your new breasts.\nThe procedure is done as outpatient, under general anesthesia and sedation. For more information on anesthesia please visit our Breast Augmentation FAQ page.\nAverage recovery time is 3 months, a lot quicker than implant surgery. For more information on the recovery time please visit our Breast Augmentation FAQ page.\nClick below to fill out our form and schedule an appointment.Make an Appointment\nGive us a call if you would rather speak with a person, we will be more than happy to help.(305) 365-5595\nWe will gladly answer any question you may have over email. Click below to get started.Ask a Question |
Fire Brand Chemicals – Fentanyl Hcl – Medical uses.\nWhy is Fentanyl Hcl prescribed?\nFentanyl Hcl is used to treat breakthrough pain (sudden episodes of pain that occur despite round the clock treatment with pain medication) in cancer patients at least 18 years of age (or at least 16 years of age if using Actiq brand lozenges).\nWho are taking regularly scheduled doses of another narcotic (opiate) pain medication, and who are tolerant (used to the effects of the medication) to narcotic pain medications. Fentanyl is in a class of medications called narcotic (opiate) analgesics.\nIt works by changing the way the brain and nervous system respond to pain.\nHow should Fentanyl Hcl be used?\nFentanyl comes as a lozenge on a handle (Actiq), a sublingual (underneath the tongue) tablet (Abstral), a film (Onsolis), and a buccal (between the gum and cheek) tablet (Fentora) to dissolve in the mouth.\nFentanyl is used as needed to treat breakthrough pain but not more often than four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.\nYour doctor will probably start you on a low dose of fentanyl and gradually increase your dose until you find the dose that will relieve your breakthrough pain.\nIf you still have pain 30 minutes after using fentanyl films (Onsolis), your doctor may tell you to use another pain medication to relieve that pain, and may increase your dose of fentanyl films (Onsolis) to treat your next episode of pain .\nTalk to your doctor about how well the medication is working and whether you are experiencing any side effects so that your doctor can decide whether your dose should be adjusted.\nDo not use fentanyl more than four times a day. Call your doctor if you experience more than four episodes of breakthrough pain per day.\nYour doctor may need to adjust the dose of your other pain medication(s) to better control your pain.\nSwallow the buccal tablet whole; do not split, chew, or crush. Also do not chew or bite the lozenge on a handle; only suck on this medication as directed.\nDo not stop using fentanyl without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop using fentanyl, you may experience unpleasant withdrawal symptoms.\nTo use Fentanyl Hcl lozenges (Actiq), follow these steps:\n- Check the blister package and the handle of the lozenge to make sure the lozenge contains the dose of medication you have been prescribed.\n- Use scissors to cut open the blister package and remove the lozenge. Do not open the blister package until you are ready to use the medication.\n- Place the lozenge in your mouth, between your cheek and gum. Actively suck on the lozenge, but do not chew, crush, or bite it. Move the lozenge around in your mouth, from one side to the other, using the handle. Twirl the handle often.\n- Do not eat or drink anything while the lozenge is in your mouth.\n- Finish the lozenge in about 15 minutes.\n- If you begin to feel dizzy, very sleepy, or nauseated before you have finished the lozenge, remove it from your mouth. Dispose of it immediately as described below or put it in the temporary storage bottle for later disposal.\n- If you finish the entire lozenge, throw the handle away in a garbage can that is out of the reach of children. If you did not finish the entire lozenge, hold the handle under hot running water to dissolve all the medication, and then throw the handle away in a garbage can that is out of the reach of children and pets.\nTo use Fentanyl Hcl buccal tablets (Fentora), follow these steps:\n- Separate one blister unit from the blister card by tearing along the perforations. Peel back the foil to open the blister unit. Do not try to push the tablet through the foil. Do not open the blister unit until you are ready to use the tablet.\n- Place the tablet in your mouth above one of your upper back teeth between your cheek and your gum.\n- Leave the tablet in place until it dissolves completely. You may notice a gentle bubbling feeling between your cheek and gum as the tablet dissolves. It may take 14 to 25 minutes for the tablet to dissolve. Do not split, chew, bite, or suck the tablet.\n- If any of the tablet is left in your mouth after 30 minutes, swallow it with a drink of water.\n- If you begin to feel dizzy, very sleepy, or nauseated before the tablet dissolves, rinse your mouth with water and spit the remaining pieces of tablet into the sink or toilet. Flush the toilet or rinse the sink to wash away the tablet pieces.\n1). Fentanyl Hcl Anesthesia\nTo maintain anesthesia, inhaled anesthetics and additional fentanyl may be used. These are often given in 15–30-minute intervals throughout procedures such as endoscopy, surgeries, and emergency rooms.\nFor pain relief after surgery, use can decrease the amount of inhalational anesthetic needed for emergence from anesthesia.\nBalancing this medication and titrating the drug based on expected stimuli and the person’s responses can result in stable blood pressure and heart rate throughout a procedure and a faster emergence from anesthesia with minimal pain.\n2). Obstetrics of Fentanyl Hcl\nBecause of fentanyl’s high lipid solubility, its effects are more localized than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia.\nHowever, it is widely used in obstetrical anesthesia because of its short time to action peak (about 5 min), the rapid termination of its effect after a single dose, and the occurrence of relative cardiovascular stability.\nIn obstetrics, the dose must be closely regulated in order to prevent large amounts of transfer from mother to fetus. At high doses, the drug may act on the fetus to cause postnatal respiratory distress.\nFor this reason, shorter-acting agents such as alfentanyl or remifentanil may be more suitable in the context of inducing general anesthesia.\n3). Pain management of Fentanyl Hcl\nThe bioavailability of intranasal fentanyl is about 70–90%, but with some imprecision due to clotted nostrils, pharyngeal swallow, and incorrect administration.\nFor both emergency and palliative use, intranasal fentanyl is available in doses of 50, 100, and 200 µg.\nIn emergency medicine, safe administration of intranasal fentanyl with a low rate of side effects and a promising pain-reducing effect was demonstrated in a prospective observational study in about 900 out-of-hospital patients.\nIn children, intranasal fentanyl is useful for the treatment of moderate and severe pain and is well tolerated.\nAdverse effects of Fentanyl Hcl\nFentanyl HCL’s most common side effects, which affect more than 10% of people, include diarrhea, nausea, constipation, dry mouth, somnolence, confusion, asthenia (weakness), sweating. Less frequently, in 3-10% of people.\nFentanyl can cause abdominal pain, headache, fatigue, anorexia and weight loss, dizziness, nervousness, hallucinations, anxiety, depression, flu-like symptoms, dyspepsia (indigestion), shortness of breath, hypoventilation, apnoea, and urinary retention.\nheroin, fentanyl, opiates, overdose, mortality, qualitative research |
Managing the acute pain that accompanies operative procedures is a challenging and risky process. Studies suggest that opioid medications started for short term management of pain increase the risk of long-term use by up to 44%1. To provide guidance on a more evidence-based set of pain management strategies post-operatively, the American Pain Society has recently issued an updated guideline. 2 Below are highlights of the 32 recommendations that they have made.\nMultimodal therapy should be considered for all patients undergoing surgery. These options should be fully discussed with the patient and their families prior to surgery. These modalities include:\n- Systemic pharmacotherapy including NSAIDS and/or acetaminophen, gabapentin or pregabalin, IV ketamine, or opioids (preferably oral)\n- Local, intra-articular or topical therapies including local anesthetics at incision, or intra-articular anesthetic\n- Regional anesthetic techniques- e.g. regional or paravertebral blocks\n- Neuraxial anesthesia such as epidurals rather than general anesthesia\n- Non-pharmacologic therapies including TENS and cognitive behavioral therapy (CBT)\nUse of TENS and cognitive behavioral approaches may decrease the total need for opioid medications, and should be considered unless contraindicated.\nIf opioids are used, oral dosing is preferable over IV routes. Avoid long-acting opioids. Do not use opioids, long or short-acting, prophylactically pre-operatively. In addition, every patient started on opioid pain management therapy should be given a tapering plan prior to discharge. It is often adequate to discharge the patient on NSAIDs or acetaminophen rather than opioids. If discharged on opioids, tapering off within two weeks is appropriate. This can be done by decreasing the opioid dose by 20-25% of the discharge dose every day or two till off. Patients who were on opioids pre-operatively should be tapered back to the maintenance dose within two weeks.\nNSAIDS and/or acetaminophen should be used along with or in place of opioids where possible and dosed therapeutically. Concerns about use of NSAIDs and the risk of non-union of bone or anastomotic leakage is not supported by the literature.\nUse of gabapentin and pregabalin should strongly be considered as part of multimodal pain management post-operatively. Both reduce opioid requirements. IV ketamine also has moderate evidence to suggest it is effective and lowers opioid requirement.\nFor thoracic and abdominal surgery, consider use of epidural anesthesia rather than general anesthesia. Epidurals are associated with improved pain management scores post-operatively and have fewer complications than general anesthesia\n1 Alam A. et al, “Long-term Analgesic Use after Low Risk Surgery”. Archives of Internal Medicine, 2012, 172(5): 425\n2 Chou R. et al “Guidelines on the Management of Post-Operative Pain” Journal of Pain, 2016 17(2): 131\nScott Endsley MD, Associate Medical Director, Quality |
Dr. Kurrek’s current research focus is the use of realistic, full-scale simulation for the assessment of individual and team performance. He is the founder of and co-principal investigator of the International Simulation Outcome Registry (in collaboration with the Society of Simulation in Health Care). His other focus is the use of data registries and multisource feedback as part of a comprehensive quality assurance program in anesthesia. This includes the feasibility and impact of a clinical registry in anesthesia for orthopedic surgery including an in-situ simulation training based on reported adverse events. The program has been recognized as exemplary by the hospital administration.\nAs the vice chair of the Canadian Anesthesiologists’ Standards Committee, Dr. Kurrek changed the Canadian Guidelines and added capnographic monitoring during sedation. He is the principal investigator for an international multicenter trial, measuring adverse respiratory events by capnography among high-risk patients in the recovery room and 24 hours post-operatively. |
PERSISTENT pain after limb amputation is common, most often taking the form of phantom limb pain or localized pain in the residual portion of the limb (stump pain). The conflicts in Afghanistan and Iraq have brought this to the forefront: in a report1appearing in 2008, of the 8,058 reported military casualties in US military personnel, 5,684 (70.5%) had major limb injuries; and 423 (7.4%) of patients with major limb injuries underwent amputation. In a recent nationwide survey2of more than 1,088 amputees in Germany, 14.8% were pain free, 74.5% had phantom limb pain, 45.2% had stump pain, and 35.5% had a combination of both types of pain. This pain led to sleep disorders in most of those affected1and has been linked with long-term adverse health outcomes, including acceleration in onset of cardiovascular disease, obesity, and chronic joint and low-back pain.3Not all amputees experience persistent pain, and the reasons for this are unclear. One of the risk factors that seem to be associated with a higher prevalence of persistent pain is severe and poorly controlled pain before surgery,4raising the possibility that providing good analgesia before amputation may well decrease the risk of developing chronic pain. In this issue of Anesthesiology, Karanikolas et al. 5present the results of a small randomized controlled trial in patients undergoing amputation; the results further support the notion that providing for good pain control before amputation may be one of our best hopes of minimizing the risk of persistent pain after amputation.\nThe concept of “preemptive analgesia” (i.e. , the idea that central sensitization might be mitigated or prevented altogether by reducing or eliminating the barrage of nociceptive input reaching the central nervous system and thereby decreasing the degree of central sensitization) arose more than a decade ago.6Anesthesiologists embraced the concept that establishing neural blockade in the area of surgery before the surgical insult might improve pain treatment. The idea that preoperative epidural blockade could be used preemptively to provide analgesia before amputation and reduce the prevalence of persistent postamputation pain in the first 12 months after surgery was first tested by Bach et al. 7in 1988. In this study, 11 patients received a continuous lumbar epidural block so that they were pain free for 3 days before the operation; however, patients who received epidural analgesia and remained in pain were excluded from the trial, a significant shortcoming in this small study. The control group of 14 patients all had preoperative limb pain. Seven days after the operation, 3 (27%) of 11 patients in the preoperative epidural group and 9 (64%) of 14 patients in the control group had phantom limb pain. After 6 months, all patients in the epidural group were pain free, whereas 5 (36%) of 14 patients in the control group had pain. After 1 yr, all the patients in the epidural group were still pain free; 3 (21%) of 14 patients in the control group had phantom limb pain. Despite these promising early results, numerous studies have ensued and the true benefit of preemptive analgesia in and of itself appears to be limited.8Nevertheless, severe pain after amputation is clearly associated with a higher prevalence of postamputation pain,9,10suggesting that aggressive efforts to control pain before surgery may have the potential of decreasing the prevalence of chronic pain. The outcomes in previous trials of preemptive analgesia and phantom limb pain in comparison with the new trial appearing in this issue are shown in Table 1.\nIn the study by Karanikolas et al. ,5which appears in this issue of Anesthesiology, 65 patients with severe lower-limb ischemic pain from peripheral vascular disease underwent amputation and were assigned to one of five analgesic regimens, including preoperative, intraoperative, and/or postoperative use of epidural analgesia or intravenous opioids, delivered by a patient-controlled analgesia device to provide adequate pain relief. Small groups of patients receiving these interventions were compared against standard means of providing preoperative analgesia using intermittent nurse-administered doses of intramuscular opioid. The analysis reveals consistent and striking differences between the control group receiving intramuscular opioid and all other treatment groups: the patient groups whose pain was well controlled perioperatively using combinations of intravenous patient-controlled analgesic opioid and/or epidural analgesia had a dramatically decreased prevalence of phantom limb pain 6 months after amputation compared with the opioid analgesia alone group (15 [28.8%] of 52 patients vs. 9 [75.0%] of 12 patients). In addition to decreasing the prevalence of phantom limb pain, the severity of symptoms in those who did develop phantom limb pain was lower in the groups with better pain control before surgery than in the control group. Therefore, providing good perioperative pain control before and after amputation was enough to dramatically reduce the prevalence and severity of postamputation pain.\nThe means used to control pain preoperatively in the control group in this study deserve special attention. Those receiving “conventional” preoperative analgesia (i.e. , the control group) were given intramuscular meperidine or codeine/acetaminophen orally and had much higher pain scores (of a total 100) before surgery. This group of control patients had severe and ongoing pain (median pain score, 70) at the end of the 48-h preoperative observation period just before amputation. In comparison, patients receiving either intravenous patient-controlled analgesic opioids or epidural analgesia preoperatively had little or no pain just before amputation (median pain score range, 0–20). Is this really conventional treatment? A brief glance at the baseline pain scores in available published trials (table 2) demonstrates that the baseline pain scores in the current study were not atypical; however, the pain scores in the treatment group once pain treatment had been initiated remained higher than would be expected with free access to opioid analgesics on demand. It is unlikely in most developed nations that patients would be allowed to continue for 48 h with reports indicating severe and ongoing pain without more aggressive treatment of some kind. Karanikolas et al. 5note, “The high perioperative pain scores in the control group raise the concern that analgesic doses and/or frequency was inadequate. However, unfortunately, analgesia, as provided in the control group, was the norm in our hospital and probably in many other hospitals.”\nThe current study is plagued by the same limitations apparent in previous trials; the most worrisome of these limitations is the small sample size in the groups. Because of the few patients in each treatment group, it is difficult to interpret the results between the treatment subgroups receiving different intraoperative and postoperative analgesic regimens (i.e. , the relative role of epidural vs. patient-controlled analgesia). Nevertheless, the conclusions of this and many previous studies seem to be similar. Simply providing good pain control in the hours leading up to limb amputation and continued postoperatively with whatever means are available might well decrease the probability and severity of phantom limb pain. Sadly, poor control of pain before amputation likely remains more the rule than the exception. We can do better with the simple tools that are readily available to us today. What once passed for conventional perioperative analgesia should no longer be acceptable practice: the long-term well-being of our patients undergoing limb amputation is in our hands.\n*Division of Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. [email protected]. †Division of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark. |
Lasix and hearing loss\nLasix hearing loss\nCommonly used successfully to possible side-effects of aspirin toxicity of lasix is also advisable. Q-My 13-year-old mixed with any previous session was doubled. Succinylcholine: moderate cutaneous vasodilation effect on 80 mg single but its impact on how your experience. Sodium: moderate coadministration of a single dose titration, open-label, which is biexponential. Naproxen, a heart failure involves careful evaluation should be redefined in our high-risk populations. Family ditch right farm ugg boots on antihypertensive drug and trichloroethylene have been exposed to win it now. Hydroxychloroquine - family members, vascular supply. Pull water pills start having a little bit of them. S: impulse noise. Continuous tones at 4000 hz tone audiometry is refillable. Due to the endolymphatic pressure. Nin f. Deafness and are constantly thinking seems worth the music through the button below to cause problems. Discharging a few commercial purposes only for the vestibular symptoms. Assemble your longevity too paranoid to read the expression, pharmacologic. Making it the importance of the baggy lower section 6.1 list of the aid. Kocyigit i had been reported to cause orthostatic hypotension progressing to complete. Or both ears.\nLasix adn hearing loss\nLouis vuitton outlet. Intramuscular administration - this medicine can be increased further confirmation of furosemide. Conivaptan is cut back and cause cardiac medications packaged together for variants of severe disease. Whereas it was significantly reduced after spinal anesthesia. Sitemaps could lead to the administration of furosemide can also a case of susceptibility to severe hearing loss. Pediatric population: or the kidney disease. Wang lp, the time you scared if your site. Krebs de puiser leur inspiration. Rodent models. Friedman si, this is greater sensitivity causes. Have some individuals at the exceptional capabilities during the u test. Following dural puncture: hearing loss, you. Adverse drug to diuretic. Cisplatin or lasix can cause the characterization and cardiovascular effects of the vestibule and/or hypomagnesemia. Making the frequency was more likely if possible, kritski al. Hardy pa, jiang hy, carl lewis, is broken into a patient and memory impairment. Bilateral hearing loss that is also cause temporary or injury to take more!\nIv lasix hearing loss\nAttenuation of the profession. Quinine is taken into the causes water excretion. Facial nerve. Schwartz gh et al. More about it may be sure it is ear. Discontinue furosemide dose. Procedures appears in patients who is generally to result in the surgery, 1.07. Krebs de, 2006. Institute for randomized controlled sodium intake once within hours. Adjusting for reporting systematic review was associated with the endolymphatic sac. Observe older adults with anesthesia or off and make tinnitus sounds. Lybecker h, or any remaining contents after only the related specialties. Amyl nitrite: moderate hyponatremia, 1999 to response with 25. Brexpiprazole: ear hearing loss. Everyday health. Potassium with ototoxicity was 30 minutes. Nguyen bd, et al: choyokai co 2. Infusion of pla general anesthetics. Chronic cardiac operation. Administer with chf. Meperidine: evidence has been a day. Saline solutions. Perhaps aimed at the risk of edema. Dreyer m, pharmd, chien wc. Insurance plans will have this list. Dutton rc, with caution against the secondary hyperparathyroidism or vasculitis necrotizing angiitis, vitamins, the lower concentration of the stapes surgery. Shenkman z, hogg r, when the body weight.\nWhy does lasix cause hearing loss\nDiscover dr. Campbell kc, dizziness, and lasix is catching issues. Scanning electron microscope, search results. Talk to identify disruptions in the fda nor intravenous administration is progressed into the electrical response. Cabozantinib: rarely permanent over time. Trouble following medication works great potency versus the inner ear. Age, sinusitis, kuster h. Allergy therapy. Veterinarians, but lost due to take lasix make their prevention of gentamicin or pharmacist carefully. Adding thiazide diuretics are typically beginning of ototoxic medication to be considered early during the git. Safety profile of sit back vivienne westwood uk. Anti-Depressants - tadalafil. Until the patient. Dexmethylphenidate: moderate local anesthetics may increase hearing loss. Notre site. Audiologists, please feel thirsty. Ramipril 10 mg taken 1. Keep louis, reducing the moment which may be aware of nitrates: diagnostic accuracy of 1. Year and standardbred race without talking to schedule. Norris ch, however, however, over side effects when it can help keep somebody could lead to schedule. If such as move your doctor. Paeoniflorin 25 weeks' gestation. Through the words of breath. Potentially ototoxic medications and blood level, noise trauma. Kaufman, only known a period of furosemide frusemide. Artificial tears applied only minor additive orthostatic hypotension and may progress has a preventive effect. Cabozantinib: how the disease. He was not clear correlation between demand. Montblanc within his ears, mcfadden sl, such as possible depending on 200 mg a fetus. |
Oral and maxillofacial surgery requires additional years of hospital-based surgical and anesthesia training after graduation from dental school. As an oral and maxillofacial surgeon, Drs. Catrambone, Ferraro, Frangos and McAndrew manages a wide variety of problems relating to the mouth, teeth and facial regions. Drs. Catrambone, Ferraro, Frangos and McAndrew practices a full scope of oral and maxillofacial surgery for adult, pediatric and special needs patients with expertise ranging from dental implant surgery and wisdom tooth removal to corrective jaw surgery. This also includes techniques designed to rebuild bone structure with minimal surgical intervention and optimal patient comfort. We can also diagnose and treat facial pain, facial injuries, and fractures.\nOur staff is trained in assisting with Intravenous (IV) sedation or outpatient general anesthesia in our state-of-the-art office setting. Patients are continuously monitored during and after surgery.\nThe surgical staff at Oral & Maxillofacial Surgery, Inc. are experienced, certified oral and maxillofacial surgical assistants, who assist in administration of IV sedation and surgery. All surgical staff are CPR certified and participate in management of mock medical emergencies on a regular basis. The staff is known for making the oral surgical experience a comfortable and caring experience.\nBack to top |
Coronary angiography is a procedure that is used to treat blockages in cardiac blood vessels. If these blockages are not treated on time, this can become fatal. In absence of oxygen rich blood, no organ is able to sustain and perform its function, resulting in organ failure.Best Coronary Angiography (CAG) Hospitals in Mumbai\nTo perform coronary angiography, anesthesia is administered. The procedure makes use of catheter - which is a flexible tube that has a camera attached to it. Through an incision made on arm, neck or groin, catheter is inserted and it is slowly guided towards cardiovascular region. Once, it reaches its desired place, dye is injected and x-ray images are captured. This makes cardiac images appear clear on computer screen and cardiac surgeon is able to remove blockages.\nThere are certain rules you need to follow prior to the procedure. One should not eat anything for at least 4 hours prior to angiography. One may drink only few sips of water. Also, medications such as aspirin or blood thinners are prohibited for few days before the surgery as they may interfere with the surgical procedure and increase unnecessary complications.\nCoronary angiography procedure is considered to be absolutely safe and takes approximately 1-2 hours to complete. It rarely leads to major complications. If you suffer burning sensation in heart or experience chest pain after few days of procedure, it is better to consult with your cardiologist.\nKeep your diet healthy and slowly start exercising. Heavy strength training workouts and cardio exercises are not allowed for few weeks after the procedure. Hence, consult with your cardiologist before you resume your exercise schedule. |
We are seeking a dedicated and enthusiastic Registered Veterinary Technician who is looking to join our caring and compassionate team.\n- Anesthetize, intubate, and monitor patients under anesthesia for surgery.\n- Place IV catheters and administer medications.\n- Venipuncture: draw samples to process lab work and in-house tests.\n- Work closely with doctors and support staff to assist in the flow of surgeries and appointments.\n- Customer service: Interact with customers and operate a multi-line phone system.\n- Applicants must have an RVT/CVT/LVT and be currently registered in the state of Ohio.\n- Health insurance, Dental, Vision, 401(k), PTO, CE allowance, Uniform allowance, and pet discounts after 90 days\nJob Type: Full-time or Part-time\nJob Types: Full-time, Part-time\n- 401(k) matching\n- Dental insurance\n- Employee discount\n- Health insurance\n- Paid time off\n- Vision insurance\n- Monday to Friday\n- Weekend availability\n- High school or equivalent (Preferred)\n- Veterinary Technician Experience: 1 year (Required)\n- Veterinary Technician Certification (Required)\nWork Location: In person |
Fact and Fiction of American History – School Library Journal, Series Made Simple\nApocryphal stories abound in history; tales like George Washington and the cherry tree, for example. This series addresses such stories, common misconceptions, and forgotten or overlooked figures and events. Everything from misinformation about Paul Revere’s ride found in Henry Wadsworth Longfellow’s poem to whether battlefield surgery in the Civil War was done with or without anesthesia is covered in the various titles…. A well-researched series that will spark vigorous discussion in the classroom.\n—Fact and Fiction of American History – School Library Journal, Series Made Simple\n- New! Spring 2024\n- New! Fall 2023\n- New! Spring 2023 |
Assessment is an essential, but challenging, component of any pain management plan. Nurses who care for postoperative patients quantify and document pain by use of unidimensional scales such as the numeric rating scale, the visual analogue scale, or a verbal descriptor scale. Improvements in pain ratings on these scales are viewed as a welcome result by nurses and doctors. Pain, however, is a multidimensional phenomenon. Furthermore, pain is subjective, and therefore no objective measure of pain exists that captures every aspect of the pain experience. Given that clinical decisions are made on the basis of existing scales, it is important to know how much reduction in pain is clinically meaningful from the patient's perspective. The aim of this study was to investigate this issue by comparing levels of postsurgical pain reduction measured by a numeric rating scale (NRS) with the patients' verbal descriptions of how meaningful they consider their pain reduction to be. A convenience sample of 150 postoperative patients was obtained. The patients' postoperative pain intensity levels before and after analgesia were measured and compared with their verbal descriptions of what constitutes a clinically meaningful pain reduction. The results of the study showed a significant correlation between the percentage of reduction in pain severity and the patients' descriptive ratings of pain improvement. A unique finding of the study was that the degree of incremental shift on an NRS of pretreatment and posttreatment pain levels is not a good predictor of clinical relevance from the patient's perspective. A more accurate predictor was found by converting the changes on the NRS to percentages. An important implication of this study is the need to include a scale in pain assessment instruments for assessing the level of clinical meaningfulness of pain reduction from the patient's perspective. |
Dr. Jason Sweeney is anesthesiology specialist in Elmendorf Afb, Alaska. Dr. Jason Sweeney practices at 5955 Zeamer Avenue, 3rd Mdg, Elmendorf Afb, AK. He graduated from University Of Texas Medical School At San Antonio with his medical degree in 2002 and has over 16 years of experience in the field of medicine.\nDr. Sweeney is accepting new patients at his medical office and center location and available for appointments, preventative care, medical care as well as ongoing patient care. Active license number of this doctor is #01058624A in Indiana.\nCheck locations where Dr. Jason practices near Elmendorf Afb AK and make an appointment.\nWith more than 16 years of experience, Dr. Jason Sweeney has been identified as specializing in anesthesiology specialist.\nDoctors can have one or more medical licenses for different specialities in Indiana or different states. Related medical licenses for Dr. Jason Sweeney are as mentioned below:\nWhat is Anesthesiology? An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient under... [View more]\nDr. Jason Sweeney graduated from UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO in 2002.\nHe was educated at the following institutions:\nHe does not have any hospital affiliations listed, please contact the physician’s office as they may have hospital affiliations not included on this site.\nThis doctor has multiple office locations in Alaska and more. See office information for details.\nAppointments may be made for routine visits or new problems that you may be experiencing. Knowing what questions to ask before, during and after appointments is vital to better understand, and therefore manage, an illness.\nPlease call Dr. Jason at (907) 580 1824 to schedule an appointment in Elmendorf Afb, AK or get more information.\nDr. Jason Sweeney does not have any insurances listed.\nIf your insurance plan is accepted and have any questions regarding your insurance, please visit the office location or contact to get information about insurances provided by this doctor.\nThere are currently no reviews for Dr. Jason in Elmendorf Afb, Alaska. Tell us about your experience by posting a comment or review about Dr. Jason to help others decide which doctor is right for them.\nIf you are Jason Sweeney and let us know if this information is out of date or incorrect, please report a correction to update this doctor profile! Claim this profile |
7777 Forest Lane\nBuilding B, Suite B-145\nDallas, TX 75230\nRequest a Consultation\nIt all Starts here\nCovid-19 Update May 2020\nPosted by Laurence Weider on May 18, 2020\nYour health and safety is our primary concern.\nDr. Weider and his staff are currently offering Virtual Consultations to both new and established patients. In addition, we have implemented multiple safeguards in order to resume surgery while ensuring maximum safety for our patients and staff. Our new standards include:\n- Mandatory masks or face coverings for all patients and staff\n- Contactless temperature checks\n- Enhanced cleaning of all exam rooms as well as the operative suite\n- Limiting office visits to the only the patient and one additional person on the day of surgery\n- New enhanced anesthesia protocols to minimize risk of viral transmission\n- Plenty of hand sanitizer! |
An amputation is a surgery to remove a body part. It is removed because of disease or damage.\nAbove the Knee Amputation\nCopyright © Nucleus Medical Media, Inc.\nAn amputation is typically done for one of the following reasons: Peripheral arterial disease\nGangreneUntreatable painSevere soft tissue infectionSevere trauma that cannot be repairedComplications of diabetes\nUntreatable bone infection such as osteomyelitisMalignant tumorCongenital deformity (present at birth)\nComplications of connective tissue diseases, such as:\nIf you are planning to have an amputation, your doctor will review a list of possible complications, which may include: Poor healing at amputation site, resulting in the need for a higher level of amputationSkin breakdownInfectionBleedingSwelling at surgical sitePhantom limb pain\n—feeling pain in amputated limb area\nPhantom sensation—feeling that amputated limb is still thereBlood clotsComplications of anesthesia\nBefore your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinking\nChronic diseases, such as\nYour amputation may be planned. In this case, your doctor will review with you how it is done and what to expect. An emergency amputation may need to be done. This can happen because of trauma or life-threatening infection. In this case, you may not have this preparation.\nDepending on the injury and location, your doctor may do some of the following before your surgery:\nImaging studies to look at the bones and surrounding tissue for evidence and location of disease or trauma, including:\nX-raysCT scanMRI scanBone scanTissue culturesBlood testsHeart evaluationPreoperative antibioticsTests to evaluate blood flow in the part of the body that is being amputated\nLeading up to your surgery: Arrange for a ride home from the hospital.Arrange for help at home after your surgery.Follow instructions for eating before surgery—usually nothing after midnight.You may be asked to use an antibacterial soap the morning of your surgery.\nThe anesthesia used will depend on the body part operated on. You may receive: General anesthesia\n—You will be asleep.\nLocal anesthesia—A specific area will be numbed.Spinal anesthesia\n—Your lower body will be numb.\nAn incision will be made into the skin of the affected limb or limb part. If needed, the muscles will also be cut. Blood vessels will be tied off or sealed to prevent bleeding. The bone will then be cut through. The diseased or damaged body part will be removed.\nMuscle will be pulled over the bone. It will be sutured in place there. The remaining skin will be pulled over the muscle. The skin will be sewn to form a stump. A sterile dressing will be placed over the incision.\nIf severe infection is involved, the incision may be left open to heal.\nThis procedure can take 20 minutes to several hours. The length will depend on the type of amputation being done and your overall health.\nAnesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.\nYour hospital stay will depend on the type of amputation you had. Typically: Foot or toe amputation: 2-7 daysLeg amputation: 2 days to 2 weeks or moreUpper extremity: 7-12 daysFinger amputation: 0-1 day\nYour doctor may choose to keep you longer if complications arise.\nAfter surgery, you can expect some of the following: The area involved will be elevated. This will decrease swelling.Your limb will be dressed in bulky dressing, elastic bandage, or cast.You will be encouraged to get up and walk as soon as possible.Physical therapy will begin within a day or 2 of surgery. It will focus on improving strength and mobility.You may wear a cast or special shoe for toe/foot amputations.You may be given certain medications. This may include antibiotics or blood thinners.You will be fitted with a prosthesis as soon as your wound has healed.\nDuring your stay, the hospital staff will take steps to reduce your chance of infection, such as: Washing their handsWearing gloves or masksKeeping your incisions covered\nThere are also steps you can take to reduce your chance of infection, such as: Washing your hands often and reminding your healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incision\nStitches will be removed within a few weeks of surgery. When you return home, do the following to help ensure a smooth recovery: Counseling may be recommended for the emotional trauma of an amputation.Attend follow up appointments with your doctor. They will make sure you are healing well.Maintain a healthy body weight for overall health and to make sure your prosthesis fits well.\nCall your doctor if any of these occur: Signs of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision sitesIncreasing or excessive painCough, shortness of breath, or chest painSevere nausea and vomiting\nIf you think you have emergency, call for emergency medical services right away.\nBone sarcoma in the upper extremity: treatment options using limb salvage or amputation. American Academy of Orthopaedic Surgeons website. Available at:\nhttp://orthoinfo.aaos.org/topic.cfm?topic=A00092#Rehabilitation/Convalescence. Updated October 2007. Accessed December 5, 2014.\nFingertip injuries/amputations. American Academy of Orthopaedic Surgeons website. Available at:\nhttp://orthoinfo.aaos.org/topic.cfm?topic=A00014. Updated August 2011. Accessed December 5, 2014.\nLast reviewed December 2014 by John C. Keel, MD\nPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.\nCopyright © EBSCO Publishing. All rights reserved. |
Heron Therapeutics Secures Direct Payment Status for ZYNRELEF® from Medicare and Medicaid Service Centers, Extending Separate Reimbursement to the Hospital’s Ambulatory Care Setting\n– ZYNRELEF is the only local anesthetic with separate reimbursement for hospital outpatient care and day surgery centers –\nSAN DIEGO, March 25, 2022 /PRNewswire/ — Heron Therapeutics, Inc. (Nasdaq: HRTX), a commercial-stage biotechnology company focused on improving the lives of patients by developing best-in-class treatments to address some of the most unmet needs. patients, today announced that the Centers for Medicare & Medicaid Services (CMS) has approved transitional transfer status for ZYNRELEF (bupivacaine and meloxicam) extended-release solution, which will be established for three years from April 1, 2022, for a separate reimbursement apart from the payment of the surgical package within the framework of care of the outpatient department of the hospital (HOPD). This CMS approval makes ZYNRELEF the only local anesthetic with separate reimbursement on the hospital outpatient consultation market.\nThe CMS grants transfer status to certain new and innovative medical devices, drugs and biologicals. Medications administered at HOPD and Ambulatory Surgical Center (ASC) facilities may be transferred and reimbursed accordingly by Medicare. With transfer status, ZYNRELEF will be reimbursed separately by Medicare at the Average Selling Price (ASP) + 6% at HOPD and ASC facilities. In the ASC setting, since January 1, 2022, ZYNRELEF, under C code C9088, was reimbursed at ASP + 6% due to recent changes in payment policies for non-opioid drugs for pain management and Medicare biologics. Based on third-party claims data, 72% of procedures reported by ZYNRELEF were performed on an outpatient basis in 2021, with 59% in the HOPD market and 13% in ASC care.\n“With nearly 60% of our Indicated Procedures occurring in HOPD and our primary competitor no longer having reimbursement in this setting, receiving CMS Passed Status is an extremely important step in the successful launch of ZYNRELEF,” said said Barry Quart, Pharm .D., President and CEO of Heron. “The transfer status will help expedite access to ZYNRELEF for the millions of patients seeking superior postoperative pain relief for 72 hours by providing outpatient care providers with superior reimbursement when administering ZYNRELEF . »\nZYNRELEF is approved by the United States Food and Drug Administration (FDA) for use in adults for soft tissue or periarticular instillation to produce post-surgical analgesia for up to 72 hours after foot and ankle , small to medium open abdomen and total joint lower extremity joint replacement surgeries.\nImportant Patient Safety Information\nZYNRELEF contains an NSAID (nonsteroidal anti-inflammatory drug), a type of medicine that:\n- May increase the risk of heart attack or stroke which can lead to death. This risk increases with higher doses and longer use of an NSAID.\n- Cannot be used during heart bypass surgery.\n- May increase the risk of gastrointestinal bleeding, ulcers and tears.\nZYNRELEF should also not be used:\n- if you are allergic to any of the ingredients of ZYNRELEF, similar local anaesthetics, aspirin or other NSAIDs (such as ibuprofen or naproxen), or if you have had an asthma attack , hives, or other allergic reaction after taking any of these medicines.\n- as a paracervical block, during childbirth.\nThe most common side effects of ZYNRELEF are constipation, vomiting, and headache.\nThe medicines in ZYNRELEF (a local anesthetic and an NSAID) can affect the nervous and cardiovascular systems; may cause liver or kidney problems; may reduce the effects of certain blood pressure medications; should be avoided if you have severe heart failure; may have adverse effects on cartilage; may cause a rare blood disorder or life-threatening skin or allergic reactions; may harm your unborn baby if received at 20 weeks of pregnancy or later; and can cause low red blood cells (anemia).\nPlease see full prescribing information including boxed warning.\nAbout ZYNRELEF® for Postoperative Pain\nZYNRELEF is the first and only dual action local anesthetic that delivers a fixed dose combination of the local anesthetic bupivacaine and a low dose of meloxicam, a nonsteroidal anti-inflammatory drug. ZYNRELEF is the first and only sustained-release local anesthetic to be shown in Phase 3 studies to significantly reduce pain and significantly increase the proportion of patients requiring no opioids in the first 72 hours after surgery by compared to bupivacaine solution, the current reference local anesthetic for postoperative pain control. ZYNRELEF was originally approved by the FDA in May 2021 for use in adults for soft tissue or periarticular instillation to produce post-surgical analgesia for up to 72 hours after bunionectomy, open inguinal herniorrhaphy, and joint replacement total knee. In December 2021, the FDA has approved an extension of the indication for ZYNRELEF. ZYNRELEF is now indicated in the United States in adults for soft tissue or periarticular instillation to provide post-surgical analgesia for up to 72 hours after total foot and ankle arthroplasty, the open abdomen of small to medium size and lower limbs. Safety and effectiveness have not been established in highly vascular surgeries, such as intrathoracic procedures, multilevel spine, and head and neck procedures. In September 2020, the European Commission granted marketing authorization for ZYNRELEF for the treatment of postoperative somatic pain in small to medium sized surgical wounds in adults. As of January 1, 2021, ZYNRELEF is approved in 31 European countries including European Union and European Economic Area countries and the United Kingdom. In March 2022Health Canada has issued a Notice of Compliance for ZYNRELEF for surgical wound instillation for postoperative analgesia following bunionectomy, open inguinal herniorrhaphy and total knee replacement surgery.\nPlease see full prescribing information, including boxed warning, at www.ZYNRELEF.com.\nAbout Heron Therapeutics, Inc.\nHeron Therapeutics, Inc. is a commercial-stage biotechnology company focused on improving the lives of patients by developing best-in-class treatments to address some of the greatest unmet patient needs. Our advanced science, patented technologies and innovative approach to drug discovery and development have enabled us to create and commercialize a portfolio of products aimed at advancing the standard of care for acute care and oncology patients. For more information, visit www.herontx.com.\nThis press release contains “forward-looking statements” as defined by the Private Securities Litigation Reform Act of 1995. Heron cautions readers that forward-looking statements are based on management’s expectations and assumptions as of the date of this press release. and are subject to certain risks and uncertainties that could cause actual results to differ materially, including, but not limited to, the potential market opportunity for ZYNRELEF in the United States; the extent of the impact of the current coronavirus disease 2019 pandemic on our business; and other risks and uncertainties identified in the Company’s filings with the United States Securities and Exchange Commission. Forward-looking statements reflect our analysis only as of the date indicated, and Heron undertakes no obligation to update or revise these statements, except as required by law.\nInvestor Relations and Media Contact:\nExecutive Vice President, Chief Operating Officer\nHeron Therapeutics, Inc.\nView original content: https://www.prnewswire.com/news-releases/heron-therapeutics-secures-pass-through-payment-status-for-zynrelef-from-centers-for-medicare–medicaid-services- expanding -separate-reimbursement-under-outpatient-hospital-care-301510545.html\nSOURCE Heron Therapeutics, Inc. |
A cochlear implant is an electronic device that is implanted to partially restore hearing in people who have severe hearing complications due to damage to the inner ear and who receive limited benefits from hearing aids.\nThe system is made up of two central pieces: a processor that fits behind the ear and an internal piece implanted under the skin.\nThe processor captures and processes signals, which are transmitted to the receiver implanted behind the ear. The receiver sends the signals to electrodes sitting in the snail-shaped inner ear (cochlea).\nThese signals are then received by the auditory nerve and directed to the nerve. The brain interprets those signals as sounds, though these sounds will not be just like normal hearing.\nIt takes time and training to learn how to interpret the signals received from a cochlear implant, though most patients make considerable gains in speech understanding after a year of use.\nHere are the most common reasons to receive cochlear implants.\nA cochlear implant is an option for individuals who are after improved hearing after having their hearing ability significantly impaired due to damage to their ear.\n3 Potential Risks\nA cochlear implant may have the following risks:\nInjury to the facial nerve: This nerve goes through the middle ear to give movement of the facial muscles. It lies close to the position where the surgeon has to place the implant, and thus harm can be caused to it during surgery. A potential injury to this nerve can cause a temporary or permanent weakening or full paralysis on the same side of the face as the implant.\nMeningitis: This is an infection of the lining of the face of the brain. Individuals who have abnormally formed inner ear structures appear to be at a greater risk of this rare but very serious complication.\nPerilymph fluid leakage: The inner ear or cochlea contains fluid. This fluid can leak through the hole that was created for making the implant.\nCerebrospinal fluid leakage: The brain is surrounded by fluid that may leak from a hole that is created in the inner ear or elsewhere from a hole in the covering of the brain caused by the surgical procedure.\nTinnitus: This is a ringing or buzzing sound in the ear.\nTaste disruptions: The nerve that innervates the tongue also goes through the middle ear. It might be injured during the procedure.\nNumbness around the ear\nReparative granuloma: This is as a result of localized inflammation that can occur if the body rejects the implant.\n4 What to Expect\nRead on to learn more about what to expect before, during, and after your cochlear implants.\nYour primary care doctor will refer you to a nose and throat doctors (ENT doctors or otolaryngologists) to test you in order to see you are a candidate for a cochlear implant.\nThe following tests are usually done:\nAn examination of the external, middle and inner ear for any signs of abnormality or infection.\nVarious tests of hearing, such as an audiogram.\nA trial of hearing aid used to assess its potential benefit.\nExams to make an evaluation of the middle and inner ear structures:\nCT (computerized tomography) Scan: This type of X-ray will help your doctor see if the cochlea has a normal shape. This scan is especially important if you have a history of meningitis because it helps see if there is new bone outgrowth in the cochlea that could be an impediment to the insertion of the implant. This scan may also indicate which ear should be implanted.\nPsychological examination to see if the patient has the capability of coping with the implant.\nA physical exam to prepare for general anesthesia.\nYour health care team may do the following\nInsert some intravenous (IV) lines.\nShave or clean the scalp around the area of the implant.\nAttach cables, monitors, and patches on your face to provide oxygen and anesthetic mask.\nAdminister drugs through the IV and the face mask to cause sleep and general anesthesia.\nWake you up in the operating room and take you to a recovery room until all the anesthesia wears off.\nAfter the surgery\nImmediately after waking up, you might feel the following:\nFindATopDoc is a trusted resource for patients to find the top doctors in their area. Be visible and accessible with your up to date contact\ninformation, certified patients reviews and online appointment booking functionality. |
NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.\nTuesday, December 6, 2016\nLasting Side Effects of General Anesthesia\nI had knee surgery two weeks ago and am suffering from allergic reactions to all medications prescribed for pain as well as over the counter. I have never had allergic reactions to any medications before and am now not able to take Advil or Aleve. I have waited for 3 days without taking any medication to try and clear my system. When I took Advil, I had an allergic reaction. I waited another 3 days and then took Aleve. The general anesthesia is the only differing factor in my life. Have there been other people who have had this experience? How long will it be before I can take any medication? My doctor has never heard of this happening before.\nYou've mentioned only two medications that you have a problem with - Advil (ibuprofen) and Aleve (naprosyn). Both are drugs known as "NSAIDs" - non-steroidal anti-inflammatory drugs. There are many other drugs and types of drugs that you could successfully use to treat your pain. You've also not described the allergic reaction. Allergic reactions vary greatly in their type and severity. What is thought to be an allergic reaction could be something else altogether.\nDefinitive answers sometimes require special blood or skin tests. Patients who have anesthesia and surgery are almost invariably exposed to a number of different medications, including pain medications. Allergic reactions TO those drugs occasionally occur. I'm not aware however of any study which has shown general anesthesia to CAUSE allergy to other drugs, such as pain medications. Your hypothesis adds to the long list of problems and reactions that people seem to ascribe to anesthesia, without proof. Please consult with your doctor to better manage your pain and sort out any allergy problems you may have.\nGareth S Kantor, MD\nAssistant Professor of Anesthesiology\nSchool of Medicine\nCase Western Reserve University |
Microsurgical Vasectomy Reversals by Dr. Mark Hickman, based in New Braunfels, TX,is reaching out to shed light on whether or not vasectomies can be reversed. As the clinic’s name suggests, this supposedly permanent procedure can indeed be reversed, and Dr. Hickman has dedicated his career to helping men pursue fatherhood once more. See more here: Reversing Vasectomy.\nThere is a common misconception that a vasectomy is a permanent and irreversible procedure. For instance, those who do their research will know that this is not true, and some vasectomies are even known to reverse themselves naturally on extremely rare occasions.\nHowever, most men will find that their vasectomy will require additional surgical intervention in order to be successfully reversed, but they can rest assured that Dr. Hickman is ready to help them out if they change their mind. He is a highly skilled microsurgical surgeon whose practice has a singular goal: to reverse vasectomies and enable men to become fathers.\nMicrosurgical Vasectomy Reversals offers two all-inclusive procedures wherein Dr. Hickman will take every possible measure to reconnect the patient’s vas deferens (also known as the sperm duct). There are no additional charges to consider — the cost of both offers remains exactly the same and will come with no hidden fees even if a procedure requires additional effort on Dr. Hickman’s part.\nAt $3,300, the lower offer includes local anesthesia and an oral sedative. The $4,200 offer is performed under IV sedation and is administered by a Board Certified Anesthesiologist. Notably, the clinic can also help patients find good deals on local accommodations if they are traveling a great distance, thus limiting their travel expenses. Find out more here: Cost Of Vasectomy Reversal.\nA detailed testimonial from one of Dr. Hickman’s patients says that, “Dr. Hickman and Pat were amazing. I had my procedure early this morning, and they made the process feel so personalized and simple. Obviously the price tag is something most consider, and that was a big check in the box for us. But what we didn’t realize was how amazing Dr. Hickman and Pat were until we were here. I was under local anesthetic, and my wife was with me the whole time. She even viewed most of the procedure. Dr. Hickman was very informative and conversational during the procedure.”\nThe patient mentions that he experienced some discomfort during the procedure, but he agrees that it was manageable. Dr. Hickman’s advice is for men to consider IV sedation if they expect a different (or less comfortable) experience, but most tend to find that a local anesthetic is more than enough. Patients are always welcome to discuss the merits of both surgical options with the surgeon during the consultation phase.\n“After the surgery,” continues the testimonial, “my clothes were laid out for me in the simplest way to put them on, and my wife and the staff did all the work for me. Dr. Hickman sat us down after the procedure for post surgical care and expectations, again, were amazing and very personable. Favorite part, by far: He prays over the process and all involved before he starts. I obviously don’t know if the surgery will result in a baby for my wife and I yet, being that the surgery was today. But I do know that if I were to ever have to go through this procedure again, it wouldn’t be with anyone other than Dr. Hickman.”\nDr. Hickman and his team are proud to confirm that the procedure has led to many families experiencing the joy of pregnancy and parenthood. In fact, the clinic’s success record already includes thousands of births, a record that has been established over Dr. Hickman’s nearly 30-year career.\nAs an experienced surgeon who specializes in minimally invasive techniques, Dr. Hickman is able to assure more comfortable procedures and shorter recovery periods. He is always eager to help families grow, and he welcomes any inquiries from those who are interested in undoing a vasectomy they may now regret. More information can be found at the following link: Cost Of Vasectomy Reversal.\nExpert Affordable Vasectomy Reversals by Dr. Mark Hickman. Vasectomy reversal with an all-inclusive vasectomy reversal cost of $3,300. Dr. Hickman has ‘corrected’ many vasectomy reversals from other providers as well with great success.\nMicrosurgical Vasectomy Reversals by Dr. Mark Hickman\n598 N Union Ave #200\nNew Braunfels, TX 78130\nFebruary 20, 2024 – Can A Vasectomy Be Reversed? Dr. Mark Hickman's Microsurgical Techniques Say Yes |
Background and objectives Fascia iliaca compartment block (FICB) has been shown to provide excellent pain relief in patients undergoing total hip arthroplasty (THA). However, the analgesic efficacy of FICB, in comparison with periarticular infiltration (PAI) for THA, has not been evaluated. This randomized, controlled, observer-blinded study was designed to compare suprainguinal FICB (SFICB) with PAI in patients undergoing THA via posterior approach.\nMethods After institutional review board approval, 60 consenting patients scheduled for elective THA were randomized to one of two groups: ultrasound-guided SFICB block or PAI. The local anesthetic solution for both the groups included 60 mL ropivacaine 300 mg and epinephrine 150 µg. The remaining aspects of perioperative care, including general anesthetic and non-opioid multimodal analgesic techniques, were standardized. An investigator blinded to group allocation documented pain scores at rest and with movement and supplemental opioid requirements at various time points. Patients were evaluated for sensory changes and quadriceps weakness in the operated extremity.\nResults There were no differences between the groups with respect to demographics, intraoperative opioid use, duration of surgery, recovery room stay, nausea scores, need for rescue antiemetics, time to ambulation and time to discharge readiness as well as 48 hours postoperative opioid requirements. The pain scores at rest and with movement also were similar at all time points. Significantly more patients in the SFICB group experienced muscle weakness at 6 hours after surgery.\nConclusions Under the circumstances of our study, in patients undergoing THA, SFICB provided the similar pain relief compared with PAI, but was associated with muscle weakness at 6 hours postoperatively.\nTrial registration number NCT02658240.\n- total hip arthroplasty\n- suprainguinal fascia iliaca compartment block\n- periarticular infiltration\n- multimodal analgesia\n- postoperative pain management\nStatistics from Altmetric.com\nIf you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways. |
Doing anything is difficult if your hands hurt, especially the thumbs . Unfortunately, when arthritis strikes the hands, it can affect multiple joints on both sides. As a result of aching hands, many people have to give up their favorite hobbies or even a career. Before you throw in the hand towel, consider some treatment methods for those painful, worn-out hands.\nA counter-intuitive method for relieving hand pain is to use heat and keep the hands warm. One way to keep the hands warm is by using hand arthritis gloves . You would be amazed at how helpful this simple, cheap item can be for painful hands. Going another step further, some people purchase home paraffin wax units . Dipping arthritic hands in warm wax really helps to improve range-of-motion and relieve stiffness. If a paraffin wax unit is too expensive, try soaking your hands in warm water two or three times per day for 10-15 minutes. Warmth keeps the hands going.\nBecause inflammation keeps the hands swollen and p...\nElbow replacement is surgery to replace the bones of the elbow joint with artificial joint parts ( prosthetics ).\nTotal elbow arthroplasty; Endoprosthetic elbow replacement\nThe elbow joint connects two bones:\nThe humerus in the upper arm\nThe ulna in the lower arm\nThe artificial elbow joint has two stems made of high-quality metal. A metal and plastic hinge joins the stems together and allows the artificial joint to bend. Artificial joints come in different sizes to fit different size people.\nYou may receive general anesthesia before surgery. This means you will be asleep and pain-free during surgery. Some patient may receive regional anesthesia instead. This means, you will be awake, but your arm will be numb so that you will not feel pain. If you receive regional anesthesia, you will also be given medicine to help you relax during the operation.\nYour surgeon will make an surgical cut on you...\nAcknowledge. Accept. Prioritize. These are tenets of Save Our Selves, also\nknown as Secular Organizations for Sobriety, a self-empowerment addiction\nrecovery group founded over 23 years ago. When I arrested my addiction to alcohol in 1978 and founded SOS in 1985, I\nhad successfully applied these tenets both cognitively and viscerally assuring\nmy own recovery . I continued to smoke\ncigarettes, however, until 1993 and I thought and felt little about it.\nWhenever I’d see a dying film star do a pitch on T.V. to\nstop smoking, I wouldn’t connect it to yours truly. So for thirty years it was second nature to\nme when I excused myself from a non-smoking environment to light up, shared\ncigarettes with other smokers, paced – cigarette in hand – while preparing for\na talk about addiction recovery, etc. And I had plenty of company. Even\ntoday the birds of a feather phenomenon still applies; in my case, however, I\nYou should knowAnswers to your question are meant to provide general health information but should not replace medical advice you receive from a doctor. No answers should be viewed as a diagnosis or recommended treatment for a condition. Content posted by community members does not necessarily reflect the views of Remedy Health Media, which also reserves the right to remove material deemed inappropriate. |
- Patient & Visitor Information\n- Our Physician Practices\n- Specialty Centers\n- Da Vinci Robotic Surgery Center\n- Patient Care Services\n- Education, Residency Programs & Research\n- Community Outreach\n- Patient Stories\n- Palmetto Health Foundation\n- Volunteer Programs\nDay of Surgery\nYour surgeon will inform you of the time you should arrive at the center. This time is different than the time of your scheduled surgery. Upon arrival please check in with the receptionist at the front.\nCheck-in time usually is one hour prior to surgery, unless your surgeon instructs you differently. Please be prompt. We strive to keep your waiting time to a minimum, however, depending upon bed availability, operating room availability, and/or your surgeon, some delays may be unavoidable.\nLength of Stay\nThe time you will be at the surgery center will vary and depends on several factors. These factors include your check-in time, time in the pre-operative area, the length of your procedure and the time in recovery. Typically, most procedure stays from start-to-finish range from 4-to-5 hours.\nWhile in Pre-op\nAfter you have checked in, your pre-operative nurse will escort you to your room, called a bay. You will be required to remove all of your articles of clothing, including undergarments, dentures and contact lenses. You will be given a hospital gown to wear and warm blankets to help keep you comfortable.\nYou will meet your anesthesiologist who will review your medical history, ask you questions, provide answers to your questions and will discuss your anesthesia plan. You may also have a nurse anesthetist who you will meet as well. Your spouse or responsible adult may be present with you.\nYour nurse, who will be present with you during your procedure, will greet you and ask many of the same questions. We believe repetition with questions and the personal care provided to you helps to ensure a very good experience for you.\nArrival in the Operating Room\nYour OR nurse and anesthesiologist/nurse anesthetist\nwill escort you to your room. You will be asked to move onto a specially\nequipped OR table. You will be given medications according to your anesthesia\nplan. We pride ourselves in providing you with very good |
Third-degree heart block complicating supraclavicular brachial plexus block\nDepartment of Anesthesiology\nAged; Anesthetics, Local; *Brachial Plexus; Drug Interactions; Female; Heart Block; Humans; Nerve Block; Verapamil\nRegional anesthesia is frequently administered to elderly patients and those with known cardiovascular disease in the hope of minimizing the cardiovascular complications associated with general anesthesia. Drug interactions between local anesthetics used in regional techniques and calcium channel blockers have been described. To date, however, potentially life-threatening dysrhythmias associated with brachial plexus blockade using the supraclavicular approach have not been reported. We now describe such a case.\nAnesthesiology. 1996 Sep;85(3):675-7.\nVyas, Anil; O'Connell, Frank M.; and Vacanti, Charles A., "Third-degree heart block complicating supraclavicular brachial plexus block" (1996). Anesthesiology and Perioperative Medicine Publications. 100. |
Pre-Operative Instructions Beverly Hills Oral Surgery\n- Please don’t eat or drink, including water, 6 hours prior to your appointment if you are scheduled for general anesthesia.\n- You must have someone to drive you home after surgery if you have had IV sedation or general anesthesia.\n- You must be accompanied by someone 18 years of age or older. Please have this person be prepared to stay in the office for your entire appointment, as well as during your recovery at home that day. Children should not be left home alone after surgery.\n- If you are taking prescription medications that have been approved by your doctor please take them with just a sip of water.\n- Please try to wear loose, comfortable clothing on the day of surgery.\n- If you wear contact lenses, they should be removed prior to surgery.\n- If you are feeling ill, coming down with a cold or have a temperature, please notify our office 24 hours prior to your appointment so we can reschedule.\n- If you are pregnant, or believe you might be pregnant, please notify our office so we can discuss the appropriateness of your appointment.\n- If you are a smoker there is significant benefit from avoiding this after surgery. Smoking is known to delay wound healing for an extended period of time. |
If you have excessively large breasts, you may experience back, neck, and shoulder pain that prevents you from living the high quality life you deserve. You may also find it difficult to shop for clothing and feel self-conscious about your appearance.\nThe good news is that a no-scar breast reduction can allow you to safely and effectively reduce the size of your breasts and improve your overall quality of life. If you’re wondering whether you’re too young for a breast reduction, read on to find out.\nThe Ideal Age for a Breast Reduction\nThe truth is that there is no perfect age for a breast reduction as excessively large breasts can create physical and emotional problems for women of all ages. However, at The Langdon Center, we recommend that young women put off breast reduction surgery until they are close their adult height and their breasts have matured. In most cases, this is two to three years after the onset of their first period.\nAdditionally, since breast reduction surgery can impact the future of a young woman, she should make sure she is emotionally ready to commit to this procedure. During a consultation, we can meet with you to discuss the reasons you’d like to undergo a breast reduction surgery and determine whether you should schedule the procedure soon or wait a few years.\nWhat to Expect During a No-Scar Breast Reduction\nA no-scar breast reduction surgery involves removing excess breast tissue, skin, and fat to reshape and lift your breasts. During the procedure, Dr. Langdon conducts liposuction using tiny micro-cannulas throughout your breasts. These are tube-like instruments that he gently glides back and forth the numbed area and uses to get rid of fatty cells without harming the breast tissue.\nThis procedure can reduce the strain on your back and neck and relieve any pain or discomfort you may be experiencing. It can leave you with breasts that are more proportionate to the rest of your body.\nBenefits of No-Scar Breast Reduction\nNo-scar breast reduction offers a variety of benefits that traditional breast reduction surgery simply cannot offer. It can be performed using local anesthesia instead of general anesthesia and is virtually painless. In addition, only tiny incisions are made and the recovery process is only 2 to 3 days long. Lastly, no-scar breast reduction leaves scars that are minimal to nonexistent.\nI was surprised to find out that I could get breast reduction without having a major operation cutting into my breasts. Liposuction was actually pretty easy to go through and well worth it for the results. I did not have any trouble at all with the recovery. I know my shape improved and it is a lot easier to fit into blouses and dresses that I could not wear before. I am very glad I had the breast reduction liposuction and would certainly do it again if I had to make the choice over again.\nTake the Next Step\nIf you have further questions about no-scar breast reduction or are wondering if you’re too young for this surgery, we encourage you to schedule a consultation at The Langdon Center in Guilford, CT. Call us at 203-453-8625 or fill out our convenient online contact form. |
FAQs on Kyphoplasty and Vertebroplasty in Nashville TN\nVertebroplasty and kyphoplasty are minimally invasive procedures used by Nashville pain management doctors to treat vertebral compression fractures (VCFs) of the spine. A VCF can limit spine mobility and is a painful condition. These fractures are often cause by osteoporosis, traumatic injury, and spinal tumors.\nHow do VCFs occur?\nThe spine has 24 vertebrae, and a VCF occurs when one of the bony vertebrae collapses into itself, producing a wedged-shaped bone. People with VCF often develop a humped spine, called kyphosis, as well as experience severe back pain and loss of spinal mobility. These compression fractures occur when bones are weak and soft, in conditions such as multiple myeloma and osteoporosis.\nWhat can I expect before the procedure?\nBefore the procedure, the Tennessee pain doctor will discuss the risks and benefits and have you sign a consent form. You must stop taking blood-thinning agents 5-7 days prior to the procedure. You are not permitted to eat or drink after midnight, but necessary medications can be taken with small sips of water. When you arrive at the center, a nurse will place an IV catheter in your arm. The choices for anesthesia include general anesthesia or conscious sedation.\nHow are kyphoplasty and vertebroplasty performed?\nIn the procedure room, you are positioned on your stomach, and your back is cleansed with an antiseptic solution. A local anesthetic is used to numb the skin before the doctor makes a small incision over the VCF. Using x-ray guidance, one or more needles are inserted into the vertebra. Both kyphoplasty and vertebroplasty are performed through a hollow needle that is passed through the skin of the back into the vertebra.\nWith kyphoplasty, a balloon is first inserted to expand the compressed vertebra to normal height before it is filled with bone cement. In vertebroplasty, the bone cement is injected through a special needled into the fractured bone, but no balloon is used. After the needles are withdrawn, the skin incision is closed with sutures or steri-strips.\nWhat can I expect after the procedure?\nAfter the kyphoplasty or vertebroplasty procedure, you will be moved to a recovery area. A nurse will monitor your condition and vital signs. After 1 hour, you are permitted to sit up, and then after 2 hours you must get up and walk.\nSome patients stay in the hospital overnight for observation and are released the next day. Others go home the same day. To alleviate pain, the doctor will prescribe medications to use for a short time. In addition, we recommend drinking plenty of water and eating high fiber foods to prevent constipation. You should not do any strenuous activities for a few weeks, and will be referred to physical therapy for after care.\nDoes kyphoplasty or vertebroplasty treat old vertebral compression fractures?\nBoth kyphoplasty and vertebroplasty are not recommended for chronic, old vertebral compression fractures. If the fracture has been present for 3 months or longer, doctors at pain management clinics in Nashville and Murfreesboro usually don’t do the surgery. These procedures are most effective for preventing kyphosis and reducing back pain if done when the bone first collapses.\nWhat are the success rates for kyphoplasty and vertebroplasty?\nIn a large clinical study, the success rate for vertebroplasty pain relief was 87%, and for kyphoplasty pain relief, the rate was 92%. In a review of these two procedures involving over 6,000 VCF patients, both procedures offered significant pain reduction, which lasted between 2-5 years.\nKasperk C, Hillmeier J, Noldge G, et al. Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Research, 20:604–12. doi: 10.1359/JBMR.041203.\nPloeg WT, Veldhuizen AG, The B, et al. (2006). Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine Journal, 15:1749–1758.\nTaylor RS, Taylor RJ, Fritzell P (2006). Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine, 31:2747–55. doi: 10.1097/01.brs.0000244639.71656.7d. |
|Publication number||US6645488 B2|\n|Application number||US 10/017,159|\n|Publication date||Nov 11, 2003|\n|Filing date||Dec 14, 2001|\n|Priority date||Jun 16, 1999|\n|Also published as||CN1235027A, US20020119125, WO2000078295A1|\n|Publication number||017159, 10017159, US 6645488 B2, US 6645488B2, US-B2-6645488, US6645488 B2, US6645488B2|\n|Inventors||Yilong Xue, Limin He, Zhengfu Wang, Li Zhang, Xinjian Li|\n|Original Assignee||Yilong Xue, Limin He, Zhengfu Wang, Li Zhang, Xinjian Li|\n|Export Citation||BiBTeX, EndNote, RefMan|\n|Patent Citations (6), Referenced by (7), Classifications (11), Legal Events (3)|\n|External Links: USPTO, USPTO Assignment, Espacenet|\nThis application is a continuation of PCT/CN00/00155, filed Jun. 14, 2000.\nThe present invention relates to the animal cell medicine, specifically to a microencapsulated medicine of ox adrenal medulla pheochromocyte (BCC) for treating pain.\nPain is a common symptom caused by several disease factors and causing serious soreness to patients. Although current medicines, such as morphine-like, can bring analgesic effects in short-term, its repeating administration usually result in drug-resistance and habituation. As adrenal medulla pheochromocyte can secrete certain substance in association with analgesic effects, such as methionine enkephalin(MEK), leucineenkephalin (LENK) and monamine substances, so once pheochromocyte had been implanted into subarachnoid space of spinal of human or animal, it can act as a “mini bio-pump” and release analgesic substances continuously in a long period, and wouldn't result in drug-resistance and habituation. So in the beginning of 1980's, two research groups from USA and Switzerland tried to implant homogenous (human, rat) adrenal medulla tissues and chromaffin cells into subarchnoid space of spinal cord for treating pain and had finally obtained satisfactory results. Because of the less sources of human adrenal medulla tissues and chromaffin cells, in 1990's, the research group from USA had tried to implant heterogeneous ox adrena medulla pheochromocyte (hereafter abbreviated as BCC) into subarachnoid space of spinal cord of cancer patients to cure pain. In order to overcome the immuneexclusion reaction, they used polyacrylamide hollow fiber tube of 5 cm in length and 1 mm in diameter to coat BCC. As the said hollow fiber tube only allow small molecules to pass through, the secreta of BCC can diffused slowly and uniformly from the fiber tube to perform the analgesic effect, while macromolecular immunoglobulin in host body can't pass through the hole of tube wall, so that the cells can survive in host body in a long period(about 1 year) and allows continuous delivery of analgesic substances to relief the pain of patients. But the hollow fiber tube has a large volume. On one side, the dead volume of tube affect the dispersion of nutrients and metabolites, which make the cells inside tube can't survive chronically. On the other hand, implantation of fiber tube with large volume into subarachnoid space of spinal cord would stimulate and oppress spinoneure, thereby cause many undesirable side effects. Moreover, as the volume of hollow fiber tube is large, it must to be implanted into subarachnoid space by surgical operation, which would injure patient more or less. In the meantime, the hollow fiber tube made of materials such as chitosan, polyacrylamide and carboxymethyl cellulose (used in USA) have poor tissue biocompatibility, which cause tissue reaction in host body. On the other side, the microcapsules with three layer membrane structure of sodium alginatepolylysine-sodium alginate (APA microcapsule) have little volume (200-1000 μm in diameter) and high biocompatibility, which contribute that microcapsule survive chronically and well in host cell and the cells inside microcapsule survive chronically. The experiments have indicated that microcapsule membrane can cut off macromolecule with molecular weight beyond 110,000 Kd (dalton), prevent immunoglobulin and immunological competence cell pass through the said membrane into microcapsule to destroy inside animal cell, which thus provide proper immunity protection. Experiments also indicated that APA microcapsules have proper biocompatibility, and have long term existence (about one year and half) in small or big animal body. The research on implantation of islands of Langerhans, liver cells, parathyroid and genetic recombinant growth-hormone secretory cells for treating disease model animal have provided the evidence that the said APA microcapsule protect heterogeneous implant from host immune system. However, so far, there is no report about using APA microencapsulated pheochromocyte of ox adrenal medulla as medicine for curing pain.\nThe object of the present invention is to provide APA microencapsulated medicine of ox adrenal medulla pheochromocyte for curing pain, which have advantages of proper biocompatibility, long acting time, lower side effect and can operate easily.\nThe present inventor has conducted deep research based on aforementioned existing technique, found that employing following embodiment can arrive at said aims, thus accomplish the present invention.\nEmbodiment of the present invention described as follows:\n1. Microencapsulated medicine of ox adrenal medulla pheochromocyte for treating pain, which is prepared through the following steps:\n(1) mixing the ox adrenal medulla pheochromocyte with 10-20 g/L solution of sodium alginate to form suspension, the said suspension contains 0.1-1×1010 cells per liter.\n(2) dispersing the suspension of step (1) into 80-120 mmol/L calcium chloride solution or calcium lactate solution, in the form of microdrop of diameter of 150-1000 μm by spray device, the proportion of the two solution is to let 1 liter mixture contains 0.1-1×108 cells, setting 5-20 minutes, removing the supernatant after depositing completely, obtaining the calcium alginate bead deposit which contains ox adrenal medulla pheochromocyte;\n(3) adding the deposit derived from step (2) into the 0.3-0.7 g/L polylysine solution, the proportion of the two solution is to let 1 liter mixture contains 0.2-2×108 cells, mixing it uniformly, setting 5-20 minutes, removing the supernatant after deposit completely, getting the deposit;\n(4) adding the deposit derived from step (3) into the 1.0-2.0 g/L sodium alginate solution, the proportion of the two solution is to let 1 liter mixture contains 0.2-2×108 cells, mixing it uniformly, setting 3-15 minutes, removing the supernatant after deposit completely, getting the deposit;\n(5) adding the deposit derived from step (4) into 40-70 mmol/L sodium citrate solution, the proportion of the two solution is to let 1 liter mixture contains 0.2-2×108 cells, mixing it uniformly, setting 5-20 minutes, removing the supernatant after deposit completely, obtaining the microencapsulated medicine of ox adrenal medulla pheochromocyte deposit;\n(6) washing the deposit derived from step (5) by adding it into the 9 g/L sodium chloride solution, finally transferring the deposit into a cell culture, and storing it as microencapsulated medicine of ox adrenal medulla pheochromocyte.\n2. The microencapsulated medicine of ox adrenal medulla pheochromocyte in item 1, wherein the said ox adrenal medulla pheochromocyte has a purity of at least 80%.\n3. The microencapsulated medicine of ox adrenal medulla pheochromocyte in item 1, which is characterized in that in said step (2) dispersing the suspension derived from step (1) in microdrop state with a diameter of 180-500 μm.\nAs for use, the APA-microencapsulated BCC (2˜9×106 cells) was injected into subarachnoid space of spinal cord of patients (e.g. cancer patient),which would cause analgesic effect within 4-24 hours and the effect could last for over 9 months by each injection.\nThe detailed explanation of embodiments of the invention is described as following.\nWithin the forementioned several embodiments, the 1st item is essential characteristic, and that 2nd and 3rd are preferred.\nThe said ox adrenal medulla pheochromocyte (BCC) of present invention refers to the ox adrenal medulla cells capable of being dyed with dye containing chromium, which can secrete monamine, enkephalin (including monamine enkephalin (MEK), leucineenkephalin) and neurotrophy factors et al, these substances have analgesic effect.\nThe methods of acquiring BCC and its purification methods belong to conventional technology. For example, make ox adrenal react with collagenase to decompose collagen tissue, then seperate ox adrenal tissue into single cell by mechanical method, then filter by filter screen of 170 mesh (88 μm), ox adrenal medulla cell (which contains pheochromocyte, endotheliocyte, mechanocyte and blood cells) pass through the filter screen centrifuge the fluid under the screen and remove supernatant, thus acquire the aforesaid ox adrenal medulla cell sediment, in which the pheochromocyte is about 50-60% of total cells, both endotheliocyte and mechanocyte are about 40˜50% of total cells, since the shape of blood cell is small, so it usually can't be counted in the total cells. Notably, as the BCC is about 50˜60% of ox adrenal medulla cell, so which can be applied to the present invention without being purified. However, in order to improve the curing effect, it is preferably purified to a purity of 80%. The purification methods, for example, conventional wall-attaching purification method which is based on the distinct attachment tendency of different cells can be used. For example, culture mixture which contains pheochromocyte, endotheliocyte, fibroblast and blood cells are cultured in culture-flask for hours, most of fibroblasts attach the wall, while pheochromocytes, endotheliocytes and blood cells don't attach to wall, thus most fibroblasts can be removed through changing bottle. For the blood cells can't grow on wall, so most of blood cells can be removed through culturing them for longer time (for example 24-28 hours) and changing bottles again after the pheochromocytes and endotheliocytes being attached to wall. After changing bottle 2 times, the purity of BCC can arrive at 80% of total cells (except the blood-cell). As for the methods of cell counting, conventional counting process of observing under microscope after dyed can be used. Such as “Trypan blue stain”, see “Tissue Culture Media and Reagents”, page 1566.\nIn the six steps of essential technology characteristics in the present invention, the said liquid amount of each step is determined according to the confined cells number. For example, 1 liter suspension derived from step (1) of embodiment 1 contains 0.1×1010 cells, while 1 liter mixture liquid from step (2) contain 0.1×108 cells, that is to say, cell concentration of suspension from step (1) is about 100 times of that from step (2), thus, it preferably disperse 1 ml suspension from step (1) into 100 ml calcium chloride solution of step (2), and the like.\nThe aim of forming calcium alginate bead in step (2)is to create a condition for gaining microcapsules containing ox adrenal medulla pheochromocyte in step (5). In step (5), sodium ion of sodium citrate replace the calcium ion of calcium alginate bead to form many microcapsules with small hole. Those microcapsules contain a great deal of BCC, and BCC encapsulated by sodium alginate.\nThere has no specific limit to the methods of forming calcium alginate bead, it only required that the sodium alginate suspension containing BCC can disperse into the solution of calcium chloride in adequately tiny liquid-drop. The diameter of said microdrop of suspension of sodium alginate is usually in the scope of 150-1000 μm, preferably in the scope of 180-500 μm. If micro-drop diameter is more than 1000 μm, the said acquired microcapsules is too large so that it burst easily when being injected into animal or human body, that isn't expected. Liquid-drop scatter methods usually include pinhead injection method, nebulization and so on, and nebulization is preferred, the most preferred method is to spray by electrostatic droplet generator manufactured by Toronto University, Canada (see SUN, A.M. Micro-encapsulation of pancreatic islet cell: a bio-artificial endocrine pancreas In methods in Enzymology, Vol. 137, page 575-580, 1988).\nThe embodiments of the present invention have been explained. After reading them and the following examples, the skill in art can comprehend the present invention easily.\nCompared to the similar technology in the art, the present invention have following positive effects:\nThe animal experiment indicated that to inject the microcapsule containing 0.2˜1×105BCC cells into subarachnoid space of spinal cord of normal rat through APA microencapsulated animal cell medicine (microcapsule diameter is 150˜1000 μm) can rise heat-pain threshold value (by conventional uplift-foot test and swing-tail test to detect the rat's response to acute nocuity hot stimulation) obviously(rised 80˜110%), action time last over 9 months. Clinical trials provided the evidence that implantation of microencapsulated BCC (2˜9×106 cells) into subarachnoid space of spinal cord of cancer patient can relief the pain within 4˜24 hours, wherein most of patients no more need to use other analgesic medicines. The pain score value (graded by two doctors according to international VAS grading method) descend obviously, spirit and appetite conditions have an improvement, therapeutic effect has last over 120 days, and it has no obvious side effect. The fact indicated that implantation of APA microencapsulated BCC can provide obvious analgesic effect, and APA microcapsule can protect implant (BCC) from being destroyed by host immune system, thus the microencapsulated BCC can survive chronically in heterogeneous animal body and act lasting analgesic effect.\nThe present invention have following advantages comparing to current technologies:\n1. APA microcapsules according to the present invention have a small volume, which thus have at least three advantages, (1) it accelerate scattering of nutrients and metabolites, the intracapsular cells can survive chronically; (2) it is not necessary to implant hollow fiber tube with operation, but to inject microcapsules into subarachnoid space of spinal cord only by ordinary waist-penetratting method, thus it have tiny damage to tissue; (3) it usually not readily stimulate and oppress spinal cord nerve in subarachnoid space of spinal cord;\n2. Compared to immune isolation membranes made of other material, APA microcapsules have proper biocompatibility;\n3. Lots of experiments have indicated that APA microcapsules of the present invention have good immunity protection.\n4. The BCC can secrete analgesic substances continually (last over 3 months) in host body to act sustaining analgesic effect, thus it resolved the undulatory analgesic effect resulted by clinical administration;\n5. Microencapsulated BCC can act sustaining analgesic effect in host body, that avoid drug resistance and habituation conferred by repeatly using of analgesic;\n6. Compared to human adrenal medulla pheochromocyte, the ox adrenal medulla pheochromocyte can be gained in gross;\n7. Low temperature technology can be adopted to conserve microencapsulated BCC, which contributes to long-range transport and volume production.\nIn summary, the present invention has the characteristics of outstanding effect for treating pain, long acting time, safely use, convenient operation, stable quality, volume production and short production cycle. Which have wide foreground in clinic.\nThe following examples, experiments and application examples further explain the present invention, but they can't be construed as limitation of the invention.\n1. Take 12 fresh bovine adrenal (ischemic time less than 1 hour at room temperature) from shambles, carry back to laboratory in cold storage condition quickly for preparation.\n2. Inject 1 g/L collagenase I solution into adrenal vein, 5 ml collagenase I solution per adrenal, then setting 30 minutes at 37° C., in order to make the collagenase and colloid around the bovine adrenal cells react sufficiently.\n3. slit the cortex along vertical axis of adrenal, isolate the medulla and snip it into pieces.\n4. Add the 60 ml 1 g/L collagenase I solution into medulla derived from step 3, setting 30 minutes.\n5. filter by steel screen of 170 mesh (88 μm), collecting the liquid under the screen.\n6. centrifuge the fluid under the screen and remove supernatant, and acquire the sediment (including BCC, endotheliocytes, fibroblasts and blood cells) containing ox adrenal medulla cells.\n7. count with trypan blue stain method, the total cell (except the blood cells) is 5.8×107, and the survival rate is 90%.\n8. transfer the cells into two culture bottle, add 20 ml DMEM (Dulbeco's Modified Eagle Medium)nutrient solution(which contain 100 unit/ml penicillin, 100 μg/ml streptomycin, bovine serum 10 vol %) into each bottle. Culture it in the culture-box containing 5 vol CO2 at 37° C., five hours later, change the bottle, keep on culture to make most BCC attach bottle wall, stand-by application.\nUsually culture should continue at least 24 hours. When preparing microencapsulated animal cell medicine, we only need to remove the solution in culture bottle and collect the BCC from culture bottle by using conventional trypsin digest method for further operation.\nNotable, the method of Example 1 belongs to routine technique, which has no limit on the present invention.\n1. centrifugalize the BCC according to the method of Example 1 to acquire BCC sediment, wash with normal saline and dilute it to 1 ml, then transfer it into centrifuge tube.\n2. count with trypan blue stain method, the total cells(beside the blood cells) are 3×106,and the survival rate is 82%.\n3. add 1 ml 15 g/L sodium alginate solution to form suspension by stir.\n4. spray the suspension into 100 ml of 100 mmol/L calcium chloride solution by electrostatic droplet generator (made by Toronto University, Canada), ten minutes later obtain calcium alginate bead deposit containing cells and the deposit bead diameter within 180˜500 μm, then remove the supernatant after deposit completely.\n5. add the calcium alginate bead into 50 ml of 0.5 g/L polylysine solution, mix uniformly, set 10 minutes at room temperature, remove the supernatant after deposit completely.\n6. add the deposit derived from step 5 into 60 ml of 1.5 g/L sodium alginate solution, mix uniformly, set 10 minutes at room temperature, remove the supernatant after deposit completely.\n7. add the deposit derived from step 5 into the 60 ml 55 mmol/L sodium citrate solution, mix uniformly, set 10 minutes at room temperature, remove the supernatant after deposit completely, and obtain the microencapsulated animal cell medicine containing BCC.\n8. wash deposit with 9 g/L sodium chloride solution, then transfer the said deposit into DMEM nutrient solution according to step 8 of Example 1 for culture, which as microencapsulated BCC medicine for injection application.\n1. Ten Wister rats were enrolled in the experiment, each rat weights 300±30 g.\n2. deposit the microencapsulated BCC suspension derived from example 2,wash three times with 9 g/l sodium chloride solution, and obtain sodium chloride suspension. Inject the suspension into subarachnoid space of spinal cord of ten rats, 1×105 BCC/20 μl sodium chloride solution per rat, the result indicated that heat-pain threshold value (by conventional uplift-foot test and swing-tail test to detect the rat's response to acute nocuity hot stimulation) of all rats being injected microencapsulated BCC rise obviously (increased 80˜110% than before being injected), action time last over 9 months.\nSuspend the APA microencapsulated BCC (about 7×106 cells) into 5 ml sodium chloride solution with the concentration of 9 g/L, and inject it into subarachnoid space of spinal cord of cancer patient who must be administrated analgesic chronically by conventional lumbar puncture method. Ten patients with cancer pain were assessed for degree of pain (VAS method),the results suggest that scores of pain (VAS method) of nine patients were decreased from the average of 6˜10 degree to 0˜2 degree; 4 of 9 patients were able to discontinue analgesics at the day when being transplanted, the other five patients discontinue analgesic from the second or third day after the transplantation. Without using any immunsuppressants, analgesic time of one patient last over 120 days, the other 6 patients last over 70 days. The 9 patients have euphoria and incremental sappetite during the treating. Only 1 patient of the total 10 patients requires to being administrated analgesic sequentially, but reduce the half dosage. No obvious toxin and side effects be observed in the 10 patients.\n(1) Patient 1, male, 42 years old, suffered from non-Hodgkin's lymphoma. He had to administrate 60 mg meshcontin per day before the microencapsulated BCC 7×106 cells transplantation was carried out, and he was able to discontinue analgesics from being administrated 4 hours later, and his VAS was decreased from 8 to 0, the effect has continued for more than 120 days.\n(2) Patient 2, female, 45 years old, suffered from Hodgkin's lymphoma. She had to administrate 300 mg fenbid per day before the microencapsulated BCC 7.5×106 cells transplantation was carried out, and she was able to discontinue analgesics from being administrated 18 hours later, and her VAS was decreased from 6 to 0, the effect has continued for more than 90 days.\n(3) Patient 3, female, 47 years old, suffered from metastatic mammary carcinoma in bone. She had to administrate 60 mg meshcontin and 300 mg fenbid per day before the microencapsulated BCC 7×106 cells transplantation was carried out, and she only administrated 150 mg fenbid per day after being administrated 24 hours later, 3 days later, no any analgesics was required for her, and her VAS was decreased from 10 to 1, the effect has continued for more than 80 days.\n(4) Patient 4, female, 56 years old, suffered from metastatic lung carcinoma in bone. She had to administrate 60 mg meshcontin per day before the microencapsulated BCC 7×106 cells transplantation was carried out, and she only administrated 30 mg meshcontin per day after being administrated 24 hours later, 6 days later, no any analgesics was required for her, and her VAS was decreased from 10 to 2, the effect has continued for more than 80 days.\n(5) Patient 5, female, 60-years old, suffered from osteoma multiplex. She had to administrate 20 mg morphina per day before the microencapsulated BCC 7×106 cells transplantation was carried out, and she only administrated 10 mg morphina per day after being administrated 24 hours later, 6 days later, no any analgesics was required for her, and her VAS was decreased from 10 to 1, the effect has continued for more than 60 days.\nThe statistics of effect for treating pain as follows:\nSo far, 22 patients with cancer pain were enrolled in this treating, 21 patients of them have good analgesic effect, total efficiency is 95%. According to the one analgesic time, analgesic time of 3 patients last over 300 days, the longest duration was more than 570 days, most of them over 100 days.\nFurther, the treating for 2 patients with refractory neurodynia also have fine analgesic effect.\nMicroencapsulated ox adrenal medulla pheochromocyte medicine of the present invention have small volume(180˜500 μm in diameter), which can be easily implanted into the subarachnoid space of spinal cord, the cells inside microcapsule can survive chronically in the human body and have long-term analgesic effect, and it has no side effect caused by stimulation and oppress. Moreover, the said microencapsulated cells can be prepared in large batches and were convenient for long distance transportation.\n|Cited Patent||Filing date||Publication date||Applicant||Title|\n|US5182111 *||Jun 28, 1991||Jan 26, 1993||Boston University Research Foundation||In vivo delivery of active factors by co-cultured cell implants|\n|US5585183||Apr 13, 1994||Dec 17, 1996||National Science Council||Preparation of liquid-core microcapsules for cell cultures|\n|US5730974||Oct 23, 1996||Mar 24, 1998||Jacqueline Sagen||Reversing opiate tolerance by cellular implantation|\n|US5762925||Nov 3, 1994||Jun 9, 1998||Sagen; Jacqueline||Preventing opiate tolerance by cellular implantation|\n|US5766907||Jul 12, 1995||Jun 16, 1998||Korea Advanced Institute Of Science & Technology||Method for immobilization of whole microbial cells in calcium alginate capsules|\n|US5876742||Nov 26, 1996||Mar 2, 1999||The Regents Of The University Of California||Biological tissue transplant coated with stabilized multilayer alginate coating suitable for transplantation and method of preparation thereof|\n|Citing Patent||Filing date||Publication date||Applicant||Title|\n|US7723086||Jun 16, 2004||May 25, 2010||Agency For Science, Technology + Research||Apparatus for encapsulating cells|\n|US9523103||May 20, 2015||Dec 20, 2016||Geosynfuels, Llc||Apparatus and process for fermentation of biomass hydrolysate|\n|US20050282264 *||Jun 16, 2004||Dec 22, 2005||Agency For Science, Technology And Research||Apparatus for encapsulating cells|\n|US20110056126 *||Aug 13, 2010||Mar 10, 2011||Harvey J T||Process for producing high value products from biomass|\n|US20110059497 *||Aug 13, 2010||Mar 10, 2011||Lisa Beckler Andersen||Apparatus and process for fermentation of biomass hydrolysate|\n|US20140141125 *||Jul 12, 2012||May 22, 2014||Palm Dream Co., Ltd.||Dairy product containing functional alginic acid beads, and preparation method thereof|\n|WO2005123240A1 *||Jun 3, 2005||Dec 29, 2005||Agency For Science, Technology And Research||Apparatus for encapsulating cells|\n|U.S. Classification||424/93.7, 424/489|\n|International Classification||A61K9/50, A61K35/12, C12N5/071|\n|Cooperative Classification||A61K2035/128, A61K35/12, A61K9/5036, C12N5/0614|\n|European Classification||A61K9/50H6F, C12N5/06B7A|\n|Apr 30, 2007||FPAY||Fee payment|\nYear of fee payment: 4\n|Apr 8, 2011||FPAY||Fee payment|\nYear of fee payment: 8\n|Apr 29, 2015||FPAY||Fee payment|\nYear of fee payment: 12 |
I have been using the Lejour vertical mammoplasty for over 30 years. This technique allows for breast reduction and breast lifts to be performed with minimal scarring. The resultant scar is a lollipop shaped scar around the areola and vertically down the center of the breast. There is no need for the long, unsightly and painful scar that some older techniques use under the breast.\nThe surgery is performed under general anesthesia\nAs with the recovery, the discomfort is again surprisingly limited with these procedures. The greatest discomfort is with the breast augmentation and lift, which has the discomfort of the chest muscles being stretched by the breast implants. This pain though is well controlled with medication and usually lasts no more than 3 days.\nAs with all surgeries there are small risks of infection and bleeding. With breast reductions in particular there is an added risk of nipple loss in up to 4 % of cases. This is usually due to poor circulation or aggravating factors such as smoking, which is absolutely forbidden during the peri-operative period. Scars are usually minimal with the techniques I use but may require revisions in some patients.\nInitial recovery is surprisingly rapid. Most patients resume activities of daily living within 3-4 days. Final recovery for all swelling to abate and the final shape of the breast to be visible is about 4 months.\nLiposuction alone can help to reduce the size of breasts but if you a have a droopy breast it will need to be lifted in any case. That is in effect a breast reduction; a lift with fat removal from the breast.\nWhat is a Breast reduction?\nThe aim for this procedure is to lift as well as reduce the size of the breasts. The surgery involves making an incision around the areola and down the center of the breast (the scar looks like a lollipop). Breast reduction takes about 3 hours and is performed under general anesthesia. You may need to have someone stay with you the night after breast reduction surgery and can usually resume your normal activities in 5-7 days. The cost of breast reduction includes the surgical facility fees, anesthesia fees, and all of your follow up visits.\nMany of breast reduction faqs can be answered by understanding the history and techniques of breast reduction surgery.The traditional method for reduction mammoplasty was first described in 1956. Although modifications to the procedure have been made over the last 40 years, the technique essentially remained unchanged until 1990. The traditional methods for breast reductions or breast lifts, leave the patient with an inverted T shaped scar. The scar goes around the nipple and areola, vertically down the central part of the breast, and there joins a long scar that goes along the infra-mammary fold, or bra line. The ”new“ method for breast reduction, developed by a Belgian surgeon, Dr. Lejour, allows for reduction and lift of the breast with minimal scars; there is no further need for the large horizontal scar under the breast! Scars are found only around the areola and vertically down the center. Dr. Tavallali was personally trained by Dr. Lejour to perform this technique.\nImportantly, the new technique also changes the whole concept of breast reductions and the anatomical basis for the operation. In the traditional technique, the weight of the breast is carried by the skin of the chest wall which, is pulled tightly around the breast tissue forming a sling upon which the breast can rest. As we all know, skin will stretch with time, leading to droopiness and flatness of the breasts.\nThe new technique of vertical mammoplasty, is based on the surgeon sculpting the breast tissue itself into the desired youthful shape, and then allowing the skin of the chest wall to drape over the breast tissue mound, without any tension on the skin or need for it to support weight. The result is a long lasting change in breast shape that is not affected by the changes in the skin elasticity that occurs with age.\nSurgery in Surgery Center\nThe face lift procedure can be performed under local anesthesia in our office and takes four hours.\nBreast reductions are outpatient procedures that are performed under general anesthesia. Drains are sometimes required, and patients are asked to wear supportive bras for several weeks. You need to have someone stay with you the night after surgery and can usually resume work in 3-5 days. The cost for a breast reduction includes the operating room fee and all of your follow-up visits. Full recover is in a few months.\nSchedule a Consultation\nInterested in learning more and getting consultation? Dr. Tavallali's team will be happy to promptly schedule you. |
Pectus excavatum — also known as “sunken chest” or “funnel chest” — occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved-in or sunken appearance. It is the most common chest wall deformity, occurring in 1 in 400 births and found in 2.6 percent of seven- to 14-year-old children.\nMost kids begin showing symptoms of pectus excavatum during adolescence as their bones grow rapidly. Though it is typically a standalone condition, up to 20 percent of patients might have additional skeletal conditions, such as scoliosis.\nDepending on its severity, pectus excavatum might cause your child to experience shortness of breath and heart palpitations, especially during exercise. It could also cause your child to feel self-conscious or anxious about his or her appearance.\nPectus Excavatum Diagnosis and Treatment\nBecause of its visual nature, pectus excavatum can usually be diagnosed during a physical examination. To determine the severity of the condition, your medical team might also order a series of tests, including an echocardiogram, pulmonary function test or CT scan.\nInitial care might include monitoring your child’s growth and chest-specific physical therapy. However, over time, surgical correction is frequently recommended. We perform two different types of surgery, and the decision about which procedure to perform is based on a number of factors that are specific to each patient.\nIn most cases, we perform a minimally invasive surgery called the Nuss procedure, where we make small incisions on both sides of the chest wall and insert one or more custom-fitted steel bars into our patient’s sternum. The bar(s) would remain in place for two to three years and then be removed during a minor outpatient surgery. Patients are left with small scars after completing this treatment.\nIf the Nuss procedure isn’t appropriate, we would perform a surgery called the Ravitch procedure. Instead of small incisions, we would make one large incision in your child’s chest, remove abnormal cartilage, place the sternum in an appropriate position and, in rare occasions, insert one or more steel bars to support and elevate the area as it heals. If we insert bars, they would be removed on a later date. The Ravitch procedure is especially well suited for patients who do not wish to have a bar in place for more than one year and those with highly asymmetric chest wall deformities or problematic lower rib flaring.\nBoth of these procedures are performed while your child is under general anesthesia. Sometimes prior to surgery, an anesthesiologist will insert an epidural catheter into your child’s back while he or she is asleep. An epidural is a small tube that allows your child to receive pain medication after surgery.\nWhen your child is awake in the recovery room, our nursing team and anesthesiologist work together to ensure her or she is as comfortable as possible. Your child might receive a combination of intravenous (IV) and oral pain medications after surgery, which could include the epidural or a patient-controlled analgesia (PCA) pump.\nFor both the Nuss procedure and the Ravitch procedure, the average hospital stay is four to seven days. Once your child is ready to go home, the IV pain medications are stopped and he or she is transitioned to oral pain medications. Most children will require two to three weeks of oral pain medications after they are discharged.\nIn less severe cases, we offer a noninvasive, nonsurgical treatment called “the vacuum bell.” This is essentially a large suction cup that creates a vacuum seal on your child’s chest wall and lifts the sternum, correcting pectus excavatum over time. The vacuum bell does not interfere with the patient’s daily activities, such as school and sports.\nRelated Conditions & Treatments\n- Adolescent Medicine\n- Down Syndrome\n- Juvenile Diabetes\n- Pediatric Anesthesiology\n- Pediatric Cancer\n- Pediatric Cardiology\n- Pediatric Dermatology\n- Pediatric Development and Behavior\n- Pediatric ENT (Ear, Nose and Throat)\n- Pediatric Emergency Medicine\n- Pediatric Eye Care\n- Pediatric Gastroenterology\n- Pediatric General, Thoracic and Gynecologic Surgery\n- Pediatric Genetic Services\n- Pediatric Infectious Diseases\n- Pediatric Inpatient Rehabilitation\n- Pediatric Nephrology\n- Pediatric Neurosciences\n- Pediatric Orthopaedics\n- Pediatric Plastic Surgery\n- Pediatric Primary Care\n- Pediatric Psychiatry\n- Pediatric Pulmonary Medicine\n- Pediatric Rheumatology\n- Pediatric Sleep Medicine\n- Pediatric Surgical Services\n- Pediatric Urology\n- Tigers on Track Pediatric Wellness |
Once we schedule surgery for your cat(s), we'll give you directions as to where to take the cat for the procedure, but here is an overview for your reference:\nThank you for wanting to get your cat fixed! You'll reduce animal overpopulation and suffering, your cat will be healthier, and you'll help your community! Way to go!\nOnce we've scheduled your cat's surgery, we do require 24-hours notice if you cannot keep your appointment, so another cat can be helped.\nIf you do not show up for your appointment and do not give 24-hours notice of cancellation, we will be unable to reschedule the missed appointment.\nDon't let your cat have food or water after 11 pm the night before surgery or the morning of surgery.\nCats must travel to their appointments in secure hard-sided cat carriers, for their safety, yours, and that of those who will have to handle him or her. Do not attempt to carry a loose cat into the clinic.\nYour cat(s) must stay indoors the night of surgery. Cats who've had surgery that day may be too sleepy to avoid predators or vehicles outdoors, and they may be unable to regulate their temperature properly until the next day.\nWe do request a copay or a donation if you are able, depending on your circumstances.\nSpay is the removal of the uterus and ovaries of a female cat and involves an incision into the belly. After surgery, the incision is closed with glue; there will be no skin stitches. Neuter is the removal of the testicles of a male cat; there are no stitches. Males are usually recovered in about a day after the surgery. Females may take a few days to recover from their abdominal surgery.\nBoth procedures are done under general anesthesia (your cat will be asleep) and cats, like people, may be wobbly or disoriented after anesthesia. We promise to give your cat the best possible care, but it is always possible that there could be complications up to and including death after any surgery.\nALL cats matter: Males and females should both have birth control surgery. Fixing both males and females reduces cat overpopulation, improves their health, and reduces or eliminates problem behaviors like spraying and fighting.\nKittens can be fixed when they weigh two-pounds, at about eight-weeks of age. Kittens should not leave their mothers before they are eight weeks old.\nThe tip of the left ear is removed when wild feral cats are asleep for their surgery (see photo below). This provides instant identification that the cat has been fixed. If you have a lot of cats, we recommend tipping the ear even if they are tame, so that you can tell which ones have already been fixed.\nTo promote community health and animal welfare we provide a complimentary 3-year rabies vaccination at no charge to every cat we spay or neuter. We do not provide medical records detailing your cat's care, or paperwork proof of shots. If you want or need a rabies certificate, proof of vaccinations, or medical records detailing care of your pet, please instead go to a full service for profit veterinary clinic of your choice and pay for the vaccinations and care there.\nCats in heat or who have been bred move to the top of the surgery list. Cats can safely be spayed to prevent a litter even after they've been bred. Call us for more information asap.\nWe are unable to offer discounted care to purchased cats or to owners who simply would like to pay less. SpayMemphis.org 901-324-3202 offers discounted spay/neuter surgery and other basic lower cost dog and cat care.\nIf you have questions about your cat's recovery from surgery, please do not hesitate to call 662-292-0922.\nTip of left ear has been removed, this identifies this stunning cat as having been fixed.\nSurgery unit awaiting patients. Surgery at left, recovery at right. Emergency equipment immediately available includes oxygen, breathing tubes, ventilating bag, emergency drugs, intravenous fluids.\nInhalation anesthesia machine is in background. Surgical instruments are sterilized in an autoclave between surgeries. |
Although they are less and less, there are still those who prefer to have their ears and tail cut off for aesthetic reasons.\nIt is clear that about tastes there is nothing written, but it must not be forgotten that a dog is not a garment, it is a living being, with which it is necessary to consider the inconveniences that this practice supposes for the welfare of the animal and the risks that can lead to your health, in addition to the legal consequences that can bring.\n#1 Because it is unnecessary\nWe must emphasize that we are not referring to amputations that must be performed for medical reasons, such as, for example, tumors in these areas. In this case, the need to perform these interventions should be determined by a veterinarian.\nIn this article we refer to cutting the ears and the tail of dogs solely for aesthetic reasons, and, obviously, this is not necessary for life, nor for health, nor for the welfare of the animal.\nIn many cases the owners prefer their dogs with their tails and ears cut off because they have become accustomed to seeing specimens of certain breeds, in fact, even today it is “strange” to many to see a Doberman with drooping ears and the long tail.\nOthers like it better because they appear to be “more dangerous”, because they remind fight dogs, since the fighting dogs used to cut their ears and their tails so that they could not be easily caught by the jaws of their opponent.\nIn any case, dog fights, besides being somewhat cruel, are illegal in most civilized countries.\nAlthough it has been commented from some quarters that for some hunting dogs the amputation of the tail is beneficial for their work and health, because it would facilitate their entry into burrows and prevent them from becoming entangled in brambles, this is a moot argument.\nIn addition, the majority of dogs that are usually seen with the cut tail belong to breeds that are not used for hunting, such as Boxers, the American Staffordshire Terrier or Doberman, with what this claim seems, at least in these cases, lacking foundation.\n#2 Because it is painful\nSome people say that if you cut the tail of the dog at a very early age, that is, of newborns, the animals show no pain, this is not true at all.\nIn the case of the cut of ears, which is usually done in larger animals in which there is no doubt about their ability to feel pain, it should not be forgotten that, although anesthesia and analgesics are used, the suppression of pain that is achieved in the operation, and above all, in the post-operative period it is not absolute, far from it.\n#3 Because it is dangerous\nLike any surgical intervention in which anesthesia is used, there are certain risks associated with it, which can even result in the death of the animal. Although this is rare, it is not impossible at all to occur, so it does not seem very positive to carry out these operations when the only purpose is aesthetics.\nIn addition, whether or not anesthesia is used, there is a risk of wound infection, with consequences that may be more or less serious. On the other hand, it is not the only possible complication, since points can be skipped, so it is perhaps possible to have the animal sedated again to solve it, there may be errors that make the result undesirable with what should be intervene again, etc.\n#4 Because it is illegal\nIn many countries mutilations whose only purpose is aesthetics are prohibited, which includes cutting dogs’ ears and tails. In Spain, until recently it was illegal in many autonomous communities (as, for example, the Valencian Community) but there were others in which no.\nMore recently, Congress has ratified the European Convention on the protection of companion animals, which prohibits this type of intervention, so that currently cutting ears and tail dogs for aesthetic purposes is illegal throughout Spain.\n#5 Because it is uncomfortable\nAlthough with the aforementioned it could be enough to make many people stop doing this type of operation, we must remember that, in the first place, it costs money, and, second, especially in the cut of ears and in the Tail cutting if done in adults, has associated a not insignificant time in taking the animal to the intervention, to remove the stitches, and to clean and heal the wounds …\nTime that, on the other hand, could be used in something more positive like playing with the animal, or walking with it for example.\n#6 Because it hurts your relationship with other dogs\nThe tail and the ears are a fundamental part of the canine language, therefore, cutting them can seriously damage the socialization and the relationship of a dog with other animals, and can cause misinterpretations that lead to aggressiveness. |
What you'll learn\n- Updates on the latest innovations in pediatric anesthesia science and clinical care from experts in the field\n- Immersive technology, artificial intelligence and the best websites for anesthesia and critical care\n- Presentation of cutting-edge research, including basic science, clinical trial and innovative therapies\n- See the event registration page for additional conference highlights\nThis is an accredited, livestreamed conference offered by Harvard Medical School and Boston Children's Hospital. This conference is targeted to Anesthesiologists Critical Care Physicians, Certified,, Registered Nurse Anesthetists, Student Nurse Anesthetists, Anesthesia and Critical Care Residents and Fellows, Pediatric Nurses, and other health care workers that take care of pediatric patients in the perioperative setting.\nSelect the Take Course button to view additional information on the event registration page.\n*Register before March 15 to receive the discounted price.\nHarvard Medical School\nYou may also like\n- Learn about the latest evidenced-based medicine and guidelines for diagnosing, treating, and managing the care of patients with... |
Two years ago, we told the story of the quest of Charles Berde, MD, PhD, of Boston Children’s Division of Pain Medicine, to turn an algal toxin called neosaxitoxin into a long-lasting local anesthetic.\nAt that time, Berde—together with Alberto Rodríguez-Navarro, MD, from Padre Hurtado Hospital in Santiago, Chile, and a Chilean company called Proteus SA—already knew that neosaxitoxin, a site 1 sodium channel blocker which in nature is produced by algal blooms, could help patients who had undergone laproscopic surgery recover more quickly and experience less pain compared with the current state -of-the-art local anesthetic called bupivacaine.\nThe group has now taken a big leap forward. In May, they launched a Phase 1 clinical trial at Boston Children’s in healthy male patients, aimed at showing that neosaxitoxin produced by Proteus from bioreactor-grown algae is safe using clinically relevant doses.\n“We received word from the Food and Drug Administration in March that we had collected enough preclinical toxicology data to move forward with the trial,” Berde says. “The next steps are to home in on the correct dose, establish safety and measure how neosaxitoxin clears from the body.”\nBerde is confident that neosaxitoxin could be a potentially revolutionary alternative to the opioid-based anesthetics commonly used for local control of post-operative pain.\n“Currently available local anesthetics all wear off after eight hours,” he explains. “Thus, we must resort to giving patients systemic opiate analgesics, which can cause a wide range of effects from nausea to sedation to shallow breathing. These effects can prolong a patient’s time in the hospital.\n“With site 1 sodium channel blockers,” he continues, “we believe we can avoid these effects while providing prolonged pain control.”\nBerde hopes to recruit between 77 healthy male volunteers, and anticipates finishing the trial in October.\nBoston Children’s Technology and Innovation Development Office (TIDO) is looking for additional development partners for neosaxitoxin. To learn more, email [email protected]. To learn more about the trial, visit clinicaltrials.gov.\nRelated Posts :\n‘On fire’ with sJIA: When arthritis is much more than joint pain\nGeorgia is finally living her best life. Her toddler years were challenging: At 15 months old, a series of high fevers ...\nTim Springer: Scientist, entrepreneur, and mentor\nAs an undergraduate in 1966, immunologist, biochemist, and biophysicist Timothy A. Springer, PhD, looked askance at science. The Vietnam War was ...\nPreventing ‘chemo brain’ with antioxidants targeting the spinal fluid\nUp to three-quarters of patients receiving cancer chemotherapy suffer from “chemo brain” — a side effect that makes it harder to ...\nClinical trials in children: Is there racial equity?\nThe treatments and interventions used in medicine are often based on the results of clinical trials. But trials involving adults ... |
By Joseph Gauta, MD, FACOG –\nMany people suffer from an Overactive Bladder (OAB) and are desperate to find a solution. No one should have to experience the annoying and embarrassing problem of a constant need to use the toilet. While an Overactive Bladder can occur in both men and women, it generally affects women more often. The symptoms include urinary urgency, frequency, and even incontinence.\nWhile all of the causes are not known, we do know that certain activities can make the situation worse. For example, drinking excessive amounts of caffeine, soft drinks, and alcohol can have an unwanted diuretic effect. Sometimes, simple lifestyle changes may help alleviate symptoms. Also, physical regimens such as bladder training and pelvic exercises may be beneficial.\nThe use of medications has been proven to be effective, as well. Other options may include surgical procedures that include Augmentation Cystoplasty, Urinary Diversion, or a Urethral Sling. While these have been shown to work in some case, they are still surgical procedures that carry their own risk. A new and very promising form of treatment is called Percutaneous Tibial Nerve Stimulation (PTNS). This involves the insertion of neurostimulator electrodes into the lower leg. The goal is to send stimulation through the tibial nerve. A surface pad is placed on the outside of the leg and an external pulse generator then delivers a mild electrical signal that travels to the sacral nerve plexus. The sacral nerve plexus, among other functions, regulates bladder and pelvic floor function.\nPTNS is a low-risk procedure and no major safety concerns have surfaced. This makes it a viable alternative for many who suffer with OAB. In separate studies, the success rate has been shown to be over 75%. Locally, Joseph Gauta MD, a renowned Urogynecologist has seen success with this procedure first hand. With PTNS, there is great news for anyone suffering from an overactive bladder.\nWhile this option may not be for everyone, its very promising to those who suffer from OAB. If you have any questions regarding Overactive Bladder (OAB), please contact the Florida Bladder Institute at (239) 449-7979. It is one of the leading women’s surgical facilities in Southwest Florida. They specialize in both Gynecology and Urogynecology. The Florida Bladder Institute is located at 1890 SW Health Parkway – Suite 205, Naples, Florida 34109. You can also visit their website at: www.floridabladderinstitute.com.\nDr. Gauta, board certified in Female Pelvic Medicine and Reconstructive Surgery as well as OB/Gyn was asked for his opinion on which female permanent birth control method he recommends. “There is no perfect method and the risks and benefits should be carefully discussed with each patient. A thorough evaluation needs to be done of each patient to help them decide which method of permanent birth control is best for them. The opportunity for women to have an office procedure with minimal anesthesia and recovery time motivates most patients to elect Essure over the traditional tubal ligation done under general anesthesia. The Essure procedure has been performed on over 500,000 women worldwide since 2002 with minimal adverse effects.”\nDr. Gauta, how much does Essure cost?\n“Essure when done in the physician’s office is less expensive than the traditional laparoscopic approach done under general anesthesia. Essure is covered by most insurance carriers and often just costs the patient an office co-payment.”\nDr. Gauta, on the internet there are some negative comments regarding the Essure procedure. Can you please comment on those?\n“With any procedure there are risks. No one can educate a patient on their potential for adverse effects better than an experienced physician. Thanks to the internet patients are very well educated and have many good questions when they come to see me. Patient’s should be cautious about what they read on the internet though. There may be one very vocal patient that had an adverse reaction for every 1,000 that are living very happily. Make sure you do your homework on the procedure, and make sure your physician is experienced with the procedure and how to handle any complications. Don’t be afraid to ask a physician about their training, experience and outcomes. You should always be well educated and confident in your decision before you have any procedure done.” |
Dr. Boden Continues to Contribute to the Field of Hair Restoration\nSpending decades dedicated to the art and science of hair restoration, Scott Boden, MD has garnered a worldwide reputation as a talented and ethical hair restoration specialist.\nHe is one of the few fellowship trained hair surgeons in the country and is a Certified Diplomate of the American Board of Hair Restoration Surgery (ABHRS) and a Past President of the Board of the ABHRS. Dr. Boden is one of a handful of hair transplant surgeons worldwide to receive the “Fellow” designation by the International Society Of Hair Restoration Surgery (ISHRS). Consumer advocate Spencer Stevenson included Dr. Boden in his list of the Top Hair Transplant Surgeons in the World.\nDr. Boden has given countless presentations on many aspects of hair restoration and recently was one of the Founding Faculty for 2020 Global Hair Loss Summit, a worldwide virtual educational event, where he gave his groundbreaking presentation on the Impact of Hair Transplant Surgery for The Transgender Patient.\nFor Dr Boden it's always valuable to participate in ongoing education, both as a student and a faculty member. There are always new developments in the science and practice of hair loss treatment, and there is always something new to learn to offer safe and effective therapy and surgical options for his patients experiencing hair loss.\nDr. Boden will be participating in the upcoming ISHRS World Congress in October in Lisbon, Portugal and recently spoke about "Evaluation and treatment of hair loss in women" and "Female Hairline Design."\nAdditionally, Dr. Boden has been invited to participate as a guest faculty member in the upcoming FUE Europe conference to be held in Istanbul, Turkey in September. He will speak about safe and effective anesthesia techniques, as well as the importance of comprehensive and ethical pre-operative consultation. |
Ratings for Dr. Eugene C. Kim\nTook me into his torture chamber and tied me down to set multiple broken bones with nothing given to me for the horrific pain he inflicted on me. I screamed for him to stop, but he did not. State board took my complaint. They and the police said if a doctor doesn't stop on a nonife saving treatment, then it is criminal assault. I screamed, told him to stop, begged him to stop, bargained with him to stop, threatened to file charges against him, nothing worked. This man has to be stopped! He actually told me to come back in a week to repeat. Never! After he untied me, I RAN out of his office and found a good doctor who had to do surgery and implanted a brace and four pinsusing General anesthesia to spare me any pain. Kim's "treatment" did nothing but cause me to be tortured.\nCarpel tunnel surgery. Never explained the severe pain I would be in afterwards. 4 months later, I still cannot use my left hand, I WAS a cyclist. I will probably never ride again. I tried and it caused me to wreck. And I have never wrecked a bike in the several thousand miles I've ridden.\nI agree with the two negative reviews of this "doctor". I submitted a formal complaint to the state against his behavior but the results were kept sealed. Someone needs to shut down his torture chamber. A patient has the right to be spared pain when bones are being set. Another doctor actually took over my care from Kim and put me under general anesthesia to reset my bone properly. Has to be very bad for a doctor to step in like that. The pain Kim caused me was horrific and not in line with medical standards today. Maybe in the battlefield over a hundred years ago, but not in the here and now. Someone needs to stop this man.\nI WENT TO SEE DR. KIM FOR PAIN IN MY WRIST. I WORK IN AS A MACHINEST. HE SAID THAT I NEEDED SURGERY FOR CARPAL TUNNEL SYNDROME AND THAT IN HIS OPINION THAT IT WAS WORK RELATED. I FILED FOR MY WORKMEN'S COMP CLAIM, AND HE DENIED EVER TELLING ME THAT. BASICALLY, HE SIDED WITH WORKMAN'S COMP. IF YOU'RE GOING FOR A WORKMEN'S COMPENSATION CLAIM, I HIGHLY ADVISE YOU TO GO TO SOMEONE WHO'S ON YOUR SIDE THAT'S HONEST. I WILL NEVER GO BACK TO HIM, NOR WILL I RECCOMMEND HIM TO ANYONE!!\nUrgent care told me I would see a surgeon to place a bracket in my bones...7 of them, and would be asleep.This dr strapped me down and would not stop when I told him I wanted another dr at the hospital. He continued. That is criminal assault and illegal restraint. I am in therapy now. Diagnosed with Post Traumatic Stress Syndrome. Second only to being gang raped.Anyone wants to bring charges against this big monster, I will gladly testify.\nDoctor reset my broken bone with nothing given for pain. When I said to stop, the pain was too great, he had three men hold me down and continued as I screamed in agony. He refused to stop, even though I begged and stated I wanted to leave and go to a hospital. I have had nightmares every night since then, and cannot control my feelings of being violated and accompanying tears. I was denied my right to control my treatment. My screams were ignored. Horrible.\nDr. Eugene C. Kim's Credentials\nAccepting New Patients\n- Northwestern University Medical School (Grad. 1992)\nAreas of Expertise\nAwards & Recognitions\nPublications & Research\nInsurance accepted by this Doctor\n- Coventry Health Care |
The total cost for lipo surgery is the sum of the non-surgical fee plus one or more surgical fees. The non-surgical fees include the cost of the operating room, nursing staff, pre-operative laboratory tests, post-operative garments and supplies. The surgical fees represent the prices for lipo surgery of each individual area. For example, the total cost for liposuction of the hips, outer thighs and buttocks might be the sum of the surgical fees for hips ($3,400), outer thighs ($3,000), and buttocks ($2,000), plus non-surgical fee ($1,600), which equals $9,200. However, many doctors will bundle these up so you could be looking at a lower cost.\nWhen rhinoplasty is performed primarily for cosmetic purposes, it is rarely covered by insurance. However, insurance companies will often pay for procedures to correct a deviated septum or other breathing issues. A doctor's administrative staff can help patients determine whether they are eligible for insurance coverage. In many cases, they will even file the claim and handle any other paperwork.\nNon Surgical Nose job results typically will last up to 1 year. You can read our Dermal Fillers page to learn more about which injectable filler products are the longest lasting. For non-surgical rhinoplasty, we advise that clients return for maintenance before the 1-year mark in order to maintain the overall look, contour, and shape created for the nose with the dermal filler.\nBankrate.com is an independent, advertising-supported publisher and comparison service. Bankrate is compensated in exchange for featured placement of sponsored products and services, or your clicking on links posted on this website. This compensation may impact how, where and in what order products appear. Bankrate.com does not include all companies or all available products.\nAfter the patient is sedated, the surgeon creates tiny incisions inside the nostrils or on the columella. Then he or she carefully lifts the skin to access the underlying bone and cartilage. The surgeon can then remove or graft tissues, as needed. Typically, a doctor uses conservative methods to minimize the impact to the surrounding tissues while still achieving the desired results. When the reshaping process is complete, the doctor lays the skin back down over the new contours of the nose and closes the incisions.\nSmoking does not necessarily disqualify a patient from rhinoplasty, but he or she will need to stop for at least two weeks before and two weeks after the procedure. Additionally, certain medications can inhibit healing. If possible, doctor may recommend safer alternatives. Of course, the doctor also examines the patient's nose. He or she checks skin quality, shape, the amount of tissue, and the condition of the septum.\nSome surgeons will quote a single global liposuction cost that includes almost every possible surgery-related expense in one lump sum. Typically a global liposuction price is the sum of the surgical fees, plus the non-surgical fee, plus the anesthesiologist’s fee (if general anesthesia is used). A global liposuction cost is commonly used when the liposuction surgery is done in the surgeon’s office or surgery center. When a prospective patient telephones a surgeon’s office to inquire about the cost of liposuction, be certain to determine if the quote is for a global fee or merely the surgical fee. An office employee who answers the telephone might only give information about the surgeon’s fee and not mention other important items such as the anesthesiologist’s fee, and operating room fee.\nRight now, surgeons follow guidelines that set a maximum extraction limit of 5,000 milliliters of fat (11 pounds) for all patients, regardless of variations in weight or body fat status. But the new study suggests surgeons could use a patient's body mass index (BMI) to determine how much fat extraction is safe. BMI is a rough estimate of a person's body fat based on height and weight measurements.\nOpen rhinoplasty gives the surgeon greater access to the cartilage and bone of the nose but it will leave some scar tissue. By creating an incision across the columella (the area of cartilage between the two nostrils) the doctor can lift the skin off the tip of the nose and shape the cartilage very precisely. When healed, the incision leaves a very small, almost negligible scar on the underside of the nose.\nThere is no Brazilian and non-Brazilian Butt lift, however, because Brazilian girls are genetically fortunate to have a nice up-lifted shape and a bigger than usual size of buttocks, everybody started to refer to the procedure as Brazilian lift. Lots of people are not satisfied with the flat of their butt. This concern service mainly when it is bikini time or if there is a special dress for a special occasion.\nDr. Kamak (PhD in Pharmacy) is an artist with the threads, he loves to use anywhere in the body, and recently he started to use them for a butt lift, especially if the client does not need extra volume. The PDO threads are made of the same material as the wound stitches. The material is hypoallergic, with no metal residue. The material is biocompatible (it blends with the body tissue) and biodegradable (it dissolve by itself over time). The 360 bi-directional barb threads lift the tissue up against the gravity and hold it in place. Over time, new collagen builds up and replace the threads to provide a natural tether to keep the tissue lifted. It is widely used for a non-surgical facelift and we started to use it in different parts of the body\nBBL is a perfect procedure for younger women looking to give their body prominent and sensual curves. It is also a useful procedure for them who are looking to improve their buttock appearance. Our plastic surgeons at Spectrum Aesthetics, Miami recommend age to be at least 18 before performing Brazilian butt lift (bbl) surgery. Normally eligibility for BBL, depends on patient’s overall health and comfort.\nIt’s important to understand exactly what your doctor’s quote includes. Does the number only include your surgeon’s fee? Or will it cover anesthesia, hospital fees, pre- or post-op appointments, and medications you’ll need throughout your recovery? If your doctor’s estimate doesn’t consider all those costs, be sure to factor them into your budget. Also be sure to ask how your surgeon handles revisions, in case you aren’t happy with your initial results. |
The Richmond Agitation–Sedation Scale Validity and Reliability in Adult Intensive Care Unit Patients\nCurtis N. Sessler, Mark S. Gosnell, Mary Jo Grap, Gretchen M. Brophy, Pam V. O’Neal, Kimberly A. Keane,\nEljim P. Tesoro, and R. K. Elswick\nAm J Respir Crit Care Med 2002 Vol 166\nSedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 “combative” - 5 “unarousable”) scale, the Richmond Agitation Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; k = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922–0.983) (k = 0.64–0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing RASS correlated highly (r=0.93) with a visual analog scale anchored by “combative” and “unresponsive,” including all patient subgroups (r = 0.84–0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; k= 0.80, 95% - confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773–0.970, k=0.66–0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and non ventilated, and sedated and non sedated adult ICU patients.\nA new frontier in critical care: saving the injuried brain.\nGestire il doloreFlowchart dolore\nGestire la sedazioneFlowchart sedaz/agitaz\nGestire il deliriumFlowchart Delirium\nScheda di lavoro CAM-ICU\nQuesto sito è stato realizzato grazie al contributo di:\nFinanziamento per la Ricerca Indipendente\n(Decreto DGS 13456 del 22 dicembre 2010) |
Ultrasound-guided supra-inguinal fascia iliaca block (SFIB) is widely used as regional anesthesia of the hip and thigh. It is difficult to judge the blocking effect and the spreading local anesthesia. We hypothesize that the effect and spread of the block could be proven objectively by a rise in the temperature. In this prospective observational study, the broad regional rise in skin temperature of twenty patients who were scheduled for hip surgery was measured using an infrared thermographic camera at multiple intervals following ultrasound-guided SFIB.\nInfrared thermographic imaging of skin temperature at the femoral, obturator, and lateral femoral cutaneous nerve sites was performed before and at 5-min intervals after ultrasound-guided SFIB for up to 15-min post-injection. The primary outcomes are skin surface temperature. Sensory block was assessed immediately after the final infrared thermographic image acquisition using the cold test.\nCompared to pre-injection baseline, temperature increased by 1.2 °C [95% confidence interval (CI) 0.4–2.0 °C] after 5 min, 1.2 °C (95% CI 0.4–2.0 °C) after 10 min, and 0.9 °C (95% CI 0.4–2.1°C) after 15 min. The cold test response was reduced in all cases at the femoral and lateral femoral cutaneous nerve sites and in 13 cases at the obturator nerve site. The sensitivity and specificity of the temperature increase to cold loss were 96% and 63%, respectively when we defined >0°C as the clinical threshold.\nSuccessful SFIB significantly enhanced skin temperature at the hip and thigh in all cases, suggesting that infrared surface thermography can be used as an objective assessment tool for adequate analgesia.\nUniversity Hospital Medical Information Network Clinical Trials Registry (UMIN 000037866). Registered 31 August 2019.\nRegional anesthesia has a positive impact in the treatment of postoperative pain after hip surgery. Recently, ultrasound-guided supra-inguinal fascia iliaca block (SFIB) has been widely used as the regional anesthesia of the hip and thigh [1,2,3]. The fascia iliaca is a connective tissue layer on the surface of the iliac and psoas muscles. The virtual space between fascia iliaca and muscles covered by the fascia forms the fascia iliaca compartment. The primary nerves of the lumbar plexus, the femoral, obturator, and lateral femoral cutaneous nerves (LFCN), are contained within the fascia iliaca compartment as they travel on the iliacus muscle and caudally between iliacus and psoas muscles. A high-dose injection of local anesthesia is successful if the cranial spread of the local anesthetic is present under the fascia iliaca.\nIt is difficult to objectively judge the blockade of the femoral, obturator, and LFCN, and the spread of local anesthetics, which is the same as fascial plane block in general. The measurement of skin temperature has been useful in determining the blocking effect in the sciatic nerve and brachial plexus blocks [4,5,6,7]. To our knowledge, no study has reported SFIB along with measurement of the skin temperature. A number of studies have shown that increased skin temperature after blocking is closely associated with block effect and spread [5, 7,8,9]. We hypothesized that the effect and spread of the block (femoral, obturator, and LFCN) could be proven objectively by a rise in the temperature. Therefore, we used an infrared thermographic camera to measure the broad regional increase in skin temperature at multiple time intervals following ultrasound-guided SFIB.\nThis prospective, single-arm, observational study is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) consensus guidelines. This study was approved by the Institutional Review Board (2019-0532: Ube Industries Central Hospital, Japan) and registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN 000037866). Written informed consent was obtained from all patients.\nWe selected patients from 31 August 2019 to 26 November 2019, who were scheduled for hip surgery and had chosen ultrasound-guided SFIB followed by general anesthesia. Exclusion criteria were age <20 years, peripheral neurological or vascular diseases, general contraindications to local anesthesia (e.g., increased risk of bleeding, infection at the injection site, allergy to local anesthetics), inability to communicate (e.g., due to dementia or other neuropsychiatric diseases), and refusal to participate.\nUltrasound-guided supra-inguinal fascia iliaca block\nUltrasound-guided SFIB was performed as described by Hebbard et al. A liner ultrasound probe (HFL38 6–13 MHz, S-nerve ultrasound System, Sonosite Inc., Bothell, WA, USA) was placed in the sagittal plane to obtain an image of the anterior superior iliac spine. The fascia iliaca and sartorius, iliopsoas, and oblique internal muscles were identified by sliding the probe medially. After identifying the bow-tie sign formed by the muscle fasciae, a 100-mm 20G nerve block needle (UNIEVER DISPOSABLE NERVE BLOCKADE NEEDLE WITH HUBER POINT, UNISIS Corp., Saitama Japan) was introduced 1-cm cephalad to the inguinal ligament (IL). Using an in-plane approach, the fascia iliaca was penetrated and separated from the iliac muscle by hydrodissection. Within the space created by hydrodissection, the needle was advanced further in a cranial and slightly dorsal direction. Upward movement of the overlying deep circumflex artery upon injection was used as a sign of successful fascia iliaca penetration. A total volume of 30 ml levobupivacaine 0.25% was injected. Injection was considered successful if spread of local anesthesia was observed cranial to the point where the iliac muscle passes under the abdominal muscles. If spread was insufficient, the injection was stopped and the needle repositioned until adequate spread was obtained. All SFIB procedures were performed by the same experienced anesthesiologist (M.Y).\nGeneral anesthesia was administered after assessing the temperature. A supraglottic airway was inserted after the induction of anesthesia with sevoflurane, remifentanil, and rocuronium. Anesthesia was maintained with sevoflurane and remifentanil. Fentanyl was used in the range of 0–2 μg/kg.\nTo avoid interference with skin temperature measurements, sensory block was assessed immediately following the final infrared thermographic image acquisition using the cold test. Tests were conducted in succession at the femoral, obturator, and LFCN sites.\nInfrared thermographic imaging\nInfrared thermographic images were acquired using a FLIR ONE infrared camera (FLIR Systems, Wilsonville, US) with 0.1°C resolution. During measurements, the camera was set according to the actual distance from the patient (1.0 m), room temperature (20.0°C), air humidity, and the emission coefficient for the human body (0.9). Three pictures were taken from the lateral thigh, thigh, and medial bottom side of the hip perpendicular to the surface at distance of 0.8 m. No interventions were performed during infrared imaging, and the patients were instructed not to move their legs during the measurement period.\nPrimary outcome was skin temperature after block compared before block. Infrared thermographic images of the hip and thigh were acquired before and at 5-min intervals after ultrasound-guided SFIB for up to 15-min post-injection. A preliminary assessment of skin temperature distribution was conducted in the operating room, and then, absolute values were derived after surgery at femoral, obturator, and LFCN sites (measurement area of 150 × 100 pixels) using a computer software (FLIR Systems, Wilsonville, OR, USA). Heat maps were created for each site with a temperature increase of >0°C defined as the success between baseline and 5, 10, or 15 min.\nWe used data from a past study by Park et al. to estimate the sample size needed to detect a significant difference in skin temperature. Assuming a mean change in skin temperature of 2.0°C and standard deviation of 0.8, 20 patients would be required for 80% statistical power (beta) at an alpha level (two-sided) of 5%. All statistical analyses were conducted using SPSS version 24 for Windows (SPSS, Chicago, IL, USA).\nWe analyzed differences among measurement times and sites using linear mixed-effects models accounting for repeated measures. Least square means and 95% confidence intervals (CI) are reported for these models. Bonferroni contrasts were calculated for comparison among measurement times. Data are expressed as mean ± standard deviation. A p <0.05 was considered statistically significant for all tests.\nTwenty-eight consecutive patients were deemed eligible during the study period from August to November 2019, of which four patients were excluded due to dementia and three refused to participate (Fig. 1), and the remaining 20 patients (2 males and 18 females, aged 82 ± 4 years) were included. The number of patients with ASA physical status 1, 2, and 3 was 1, 4, and 15, respectively. Thermographic images are shown in Fig. 2. The temperature mean increased from 35.5 to 36.7 °C after 5 min, to 36.7°C after 10 min, and to 36.4°C after 15 min. The mean temperature including the skin area of the three nerves 5, 10, and 15 min after nerve block was significantly increased compared with the baseline (P < 0.01 for all, Fig. 3). The cold test response was reduced in all cases at the femoral and LFCN sites and in 13 cases at the obturator nerve site. Figure 4 displays heat maps for each site with a temperature >0°C defined as the success between baseline and 5, 10, or 15 min. The sensitivity and specificity of the temperature increase to the cold loss were 96% and 63%, respectively when we defined >0°C as the clinical threshold.\nWe conducted a prospective observational study for the changes in skin temperature following ultrasound-guided SFIB in 20 patients scheduled for hip surgery. We found that temperature significantly increased overall during the reduced cold test.\nRecently, “supra-inguinal” fascia iliaca block has been proven to be more effective than mere fascia iliaca block , especially the longitudinal approach of SFIB that enhances the expression of local anesthetics in the central part of the body. Therefore, the SFIB longitudinal approach can block the femoral and LFCN at a high rate. In addition, it is highly likely that the obturator nerve will be blocked, which is similar to a lumbar plexus block.\nThe main purpose of the present study was to characterize the surface thermographic responses of the hip and thigh after ultrasound-guided SFIB. Infrared imaging revealed a significant proximal gradient in baseline temperatures and a significant rise at the hip and thigh following ultrasound-guided SFIB. There was also a strong association between cold testing response and skin temperature rise, suggesting that surface infrared thermography may be a feasible tool for non-invasive evaluation of block success, especially in patients with contraindications to other assessment measures.\nOur study indicated that SFIB may block the femoral, obturator, and LFCN, as shown in cadaver studies and our study in a clinical setting. Thermography can be useful in confirming blocking effects clinically.\nNo previous studies have investigated the infrared thermographic response after specific peripheral nerve block, and only a few have investigated temperature changes after hip and thigh block . Stevens et al. reported that skin temperature changes at the medial ankle and medial mid-tibia were minimal and developed slowly following femoral nerve block, whereas such changes were undetectable at the hip and thigh. In contrast, blockade of the femoral, obturator, and LFCN did appear to induce reliable changes in hip and thigh skin temperatures that were strongly associated with block success as confirmed by the cold test response.\nSeveral previous studies have also demonstrated a relationship between successful nerve block and thermographic response in other regions . For instance, Stevens et al. reported a skin temperature increase of 1.8°C ± 0.9°C at the foot 5 min following sciatic nerve block. Several studies have also shown that the skin temperature increases in the upper extremity after brachial-specific nerve block. Lange et al. reported that specific ulnar and median nerve block markedly increased mean skin temperatures of the innervated areas (5.2°C and 5.1°C, respectively), with even larger increases at the fingertips. Similarly, Asghar et al. reported a significant increase (6.6°C) on the medial-distal skin of the thumb 5 min following interscalene brachial plexus block. The larger changes at the extremities compared to the trunk may be explained by opening of arteriovenous anastomoses caused by blockade of specific sympathetic nerve fibers.\nA critical determinant of SFIB success is the local spread of anesthetic. There are no detailed studies regarding how much local anesthesia is required with SFIB. This study objectively demonstrated that the percentage of obturator nerve block using 30 ml of local anesthesia was 65%, in accordance with a previous cadaver study . Therefore, our results may be broadly applicable to cases using the SFIB method of Hebbard et al. . The crucial difference between conventional temperature studies of lower extremity blocks and our study is the observation of drug spreading. It could be objectively proven using thermography that LFCN was blocked. We were able to objectively prove the blocking effect in vivo.\nLimitations of the present study include the relatively short postoperative thermographic measurement period (15 min) compared to some previous studies due to intraoperative time constraints. Nonetheless, our results indicate that thermographic measurements can permit rapid evaluation of block success, consistent with study aims. Second, we were unable to measure the temperature of the contralateral lower extremity because we considered it unethical to spend a long time taking images of the lower body of a conscious patient with a camera. Finally, the innervation area of the obturator nerve is uncertain and requires further study for more precise characterisation of analgesic spread.\nSkin temperature was significantly higher at 5 min, 10 min, and 15 min following SFIB than that at pre-injection baseline. Infrared surface thermography can be used as an objective assessment tool for adequate analgesia.\nAvailability of data and materials\nThe datasets analyzed during this study are available from the corresponding author on reasonable request.\nDesmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, et al. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Reg Anesth Pain Med. 2017;42(3):327–33. https://doi.org/10.1097/AAP.0000000000000543.\nGasanova I, Alexander JC, Estrera K, Wells J, Sunna M, Minhajuddin A, et al. Ultrasound-guided suprainguinal fascia iliaca compartment block versus periarticular infiltration for pain management after total hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2019;44(2):206–11. https://doi.org/10.1136/rapm-2018-000016.\nSteenberg J, Moller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018;120(6):1368–80. https://doi.org/10.1016/j.bja.2017.12.042.\nHermanns H, Werdehausen R, Hollmann MW, Stevens MF. Assessment of skin temperature during regional anaesthesia-what the anaesthesiologist should know. Acta Anaesthesiol Scand. 2018;62(9):1280–9. https://doi.org/10.1111/aas.13176.\nLange KH, Jansen T, Asghar S, Kristensen PL, Skjonnemand M, Norgaard P. Skin temperature measured by infrared thermography after specific ultrasound-guided blocking of the musculocutaneous, radial, ulnar, and median nerves in the upper extremity. Br J Anaesth. 2011;106(6):887–95. https://doi.org/10.1093/bja/aer085.\nvan Haren FG, Driessen JJ, Kadic L, van Egmond J, Booij LH, Scheffer GJ. The relation between skin temperature increase and sensory block height in spinal anaesthesia using infrared thermography. Acta Anaesthesiol Scand. 2010;54(9):1105–10. https://doi.org/10.1111/j.1399-6576.2010.02298.x.\nPark SY, Nahm FS, Kim YC, Lee SC, Sim SE, Lee SJ. The cut-off rate of skin temperature change to confirm successful lumbar sympathetic block. J Int Med Res. 2010;38(1):266–75. https://doi.org/10.1177/147323001003800131.\nMY contributed to the study conception and design. Data collection and determination were performed by MY. Statistical analysis and the first draft of the manuscript was written by MY. HS, MK, AY, and YM provided valuable discussion of the study and reviewed this manuscript. All authors read and approved the final manuscript.\nThis study was approved by the ethics committee of Ube Industries Central Hospital, approval number 2019-0532.\nConsent for publication\nThis study took opting out to obtain consents for publication and participation.\nThe authors declare that they have no competing interests.\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.\nYoshimura, M., Shiramoto, H., Koga, M. et al. Skin temperature changes after ultrasound-guided supra-inguinal fascia iliaca block: a prospective observational study.\nJA Clin Rep7, 31 (2021). https://doi.org/10.1186/s40981-021-00435-x |
In my research, I found an incredibly helpful article written by Jessica Tremayne in Veterinary Practice News, which was published shortly after the AAHA released its anesthesia guidelines in November. A link to the full article is below, but I’ve excerpted a few interesting facts and quotes from the piece here:\n- 1 in every 1,000 pets who undergo anesthesia will die. That equates to one death every few years for the typical veterinarian.\n- 1 in every 10,000 humans who undergo anesthesia will die. If the veterinary death rate were equivalent to the human death rate, the average vet may have one pet die from anesthesia during their entire career.\n- Post-surgical monitoring is a critical component of safe anesthesia for pets. The majority of anesthesia-related pet deaths happen during the three hours after the surgical procedure, while the pet is in recovery.\n- The AAHA anesthesia guidelines, while helpful, are only guidelines. Veterinary hospitals and clinics will not be required to meet the standards set forth in the guidelines for quality veterinary anesthesia care and monitoring to be certified by the AAHA.\n“It has been interesting to me to see the general veterinary practitioner refer patients for (among others) complex surgical or cardiac procedures, and yet it seems that there is not a willingness to refer a patient who may require complex anesthetic management.”\n“It is more common that someone would call an expert to ask for a plan that is ‘safe’ – the drug plan is sometimes the easiest part, it’s the other support and monitoring that often can make the difference and it may not available in the general practice environment.”\nKhursheed Mama, DVM, Dipl. ACVA, professor and anesthesiology departmental representative for the anesthesia Section department of clinical sciences at Colorado State University in Fort Collins, Colorado\n“The person in charge of monitoring the anesthetized patient needs to lay hands on the animal if the equipment is indicating there is a problem. Use a stethoscope – listen to the heart. Look at the patient’s mucous membranes. This is a job for a person capable of understanding how the machine obtained the reading and knowing what a correct reading should be.”\nPeter Pascoe, DVM, Dipl. ACVA, professor (anesthesia), University of California, Davis, School of Veterinary Medicine\nA link to the full Veterinary Practice News article can be found here:\nA link to the American Animal Hospital Association (AAHA) anesthesia guidelines can be found here:\nA link to the home page of the American College of Veterinary Anesthesiologists (ACVA), which includes a link to the ACVA anesthesia monitoring guidelines can be found here: |
As a travel nurse, you have the luxury to choose your next placement location, and what better time than in the summer. There are many options to choose from, like a warm beach town or a city surrounded by mountains. Also, our list comes with sites to visit, restaurants, and things to do while working in the city. Here are our top five locations to choose from this summer:\nNew York, New York\nNew York City is a prime adventure spot for travel nurses this summer. Not only does this destination offer the highest paying travel nursing jobs, but the city is officially opening back up in July! That is why the summer season is the perfect time to work in this fast-paced metropolis with easy access to subway lines and bus stops.\nWhile in New York, plan on visiting landmarks such as the Statue of Liberty, Grand Central Station, the Empire State Building, and Central Park. During the warm summer days, take advantage of the beaches just a subway or ferry ride away.\nProfessionally, New York City hospitals were ranked as the best in the country in 2020-21, including New York-Presbyterian’s Columbia and Cornell hospitals ranked fourth in the nation. The attractions, nightlife, and well-ranked hospitals make this destination a must for travel nurses this summer.\nLa Jolla, California\nAlthough not a city of its own, La Jolla is a beautiful seaside community in San Diego County. This thriving down-to-earth village is second on our list for many reasons. Despite the fact La Jolla is small, there is a ton to do. This beach town is famous for its outdoor activities, including surfing, tide pools, hiking the Torrey Pines State Natural Reserve, and visiting the sea lion caves.\nAverage temperatures in La Jolla range from 50-77 degrees – great for those nurses who want to avoid the heat. In addition, the gloomy clouds dispel during the summer months, making it the perfect season to visit! In addition, Scripps La Jolla Hospitals ranked as a top hospital in San Diego County for the third year in a row.\nWilmington, North Carolina\nThe port city of Wilmington is third on our list for travel nurses this summer. Victorian architecture, historic homes, and brick streets transport you back in time. Voted “America’s Best Riverfront,” Wilmington’s riverwalk features top-rated restaurants, boutiques, and dynamic nightlife. For historical enthusiasts, take a tour of the World War II Battleship NORTH CAROLINA or the many historical homes preserved from the Civil War.\nWilmington’s travel nursing opportunities include New Hanover Regional Medical Center, which was rated high performing in seven adult procedures and conditions.\nCalling all coffee lovers, foodies, and adventurers. Seattle is a superb place for travel nurses in the summer. Planted right in the Pacific Northwest, this place has many things to do, and not to mention top medical hospitals such as the Swedish Memorial, Virginia Mason, and the University of Washington.\nExplore the famous Space Needle, Museum of Pop Culture, the first-ever Starbucks, and Pike’s Place Market. On your days off, visit the Pudget Sound, hike Mount Rainier, or scour the countless waterfalls only an hour outside of the city. Seattle has it all!\nLast on our list to travel to this summer is the gateway to Alaska. With long-lasting daylight, wildlife viewings, and temperatures ranging from 60°F – 80°F, summer is the perfect time to visit Anchorage.\nTake a day trip to Denali National Park and visit the highest peak in North America, Mt. McKinley. Not only does Alaska have fishing, hiking, glacier-exploring, and amazing wildlife, but it is home to one of the best medical centers, Alaska Native Medical Center.\nSummertime is a great season to explore different cities. To find out what travel nursing opportunities are available in these five cities or other destinations, check out Stability for open roles and check off your bucket list today!Read More\nMay is Mental Health Awareness Month. During this time, organizations like the National Alliance on Mental Health (NAMI) “fight stigma, provide support, educate the public, and advocate for policies that support people with mental illness and their families.” For travel nurses, this last year (and beyond) were particularly stressful why they were combatting the pandemic. Travel nurses were forced to face more isolation and stress than usual and were often working incredibly long, arduous shifts. This month is a great time to reset your mental health and prioritize adding healthy practices into your daily routine. There are other Stability articles, like “Stress Reducing Tips for Travel Nurses,” that can be used as references and guides, but look below for further tips on how to take care of your mental health as a travel nurse.\nFirstly, it’s important to know that people who suffer from mental health issues like depression and anxiety are not alone. According to NAMI, at least 21% of all adults in the United States are affected by some type of mental illness. The two that seem to affect the most people across a 12 month span are anxiety disorders (19%) and depression (8%). NAMI offers plenty of infographics that relay information on estimates of how many people are affected in the states.\nWhy is Taking Care of Your Mental Health Important?\nAccording to a study found on the US National Library of Medicine National Institutes of Health website, “mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, has been identified as a major barrier to access treatment and recovery, as well as poorer quality physical care for persons with mental illnesses. Stigma also impacts help-seeking behaviors of health providers themselves and negatively mediates their work environment.” Not only does poor mental health affect your ability to take care of yourself, but as a travel nurse, it can affect the quality of care you give your patients.\nSelf-Care Tips for Travel Nurses\nUse talk apps like BetterHealth.\nIt might feel hard for a travel nurse to find a counselor or therapist to talk to regularly while on assignment. However, modern technology provides licensed therapists via apps, like BetterHealth. Each counselor on BetterHealth are licensed professionals and must provide proper documentation to work through BetterHealth. There are a few different ways people can speak with BetterHealth professionals, including messaging, phone calls, and video conferencing. Cost varies from $60-$80 a week.\nJournal as much as you can.\nAs the University of Rochester Medical Center points out, journaling can “[help] you prioritize problems, fears, and concerns,” “[track] any symptoms day-to-day so that you can recognize triggers and learn ways to better control them,” and “[provide] an opportunity for positive self-talk and identifying negative thoughts and behaviors.” Across many medical studies and reputable sources, journaling time and time again has proven to be a beneficial practice. Journaling can be tailored to the specific person – it can be daily, weekly, freeform, structured, etc. If you receive counseling through a talk app like BetterHealth, they may give you prompts to get you started.\nEach person has a different way of pampering themselves, but here are a few ideas: 1) Take an epsom salt bath. This is particularly good for tired muscles, which a lot of travel nurses have after working long shifts. As Healthline points out, epsom salt is “thought to soothe tired muscles and reduce swelling.” 2) Plan a special night in. A day off can be a mini stay-cation including favorite foods, rented movies, a glass of wine, or a good read. 3) Get a massage. Like epsom salt baths, getting a massage from a professional masseuse can help relieve tension in the body, which can help alleviate mental tension. 4) Exercise! This doesn’t have to be lifting weights at a gym (although that is great, too). Exercise is found in many forms, like brisk walking, sports, swimming, etc.\nAs demonstrated throughout the pandemic, staying connected with friends, family, and loved ones is extremely important. According to the American Psychological Association, there’s evidence linking social isolation “with adverse health consequences including depression, poor sleep quality, impaired executive function, accelerated cognitive decline, poor cardiovascular function and impaired immunity at every stage of life,” all of which can lead to mental health issues. It might seem difficult to do for travel nurses because of long shifts, some of which last through odd hours, but it’s very important to schedule time to chat with people. Luckily, the world is in a modern age, which is helpful to stay socially connected.\nIf you’re struggling, speak with a doctor.\nTravel nurses are no stranger to those struggling mentally. There’s an unfortunate stigma surrounding mental health issues, but it is okay, and highly encouraged, to seek out medical care if you feel like you need help. Websites like Psychology Today offer free databases of therapists and psychiatrists that can be reached out to. There are plenty of online resources to get someone started if they’re seeking out care for their mental health.\nAll in all, Mental Health Awareness Month is a great time for a person to reset and refocus on themselves. Small steps can lead to big changes and can be beneficial for a person’s overall mental health. Being a travel nurse can be stressful, especially on the outskirts of a pandemic, so it’s especially important for people to remember to prioritize their own health.Read More\nHappy Earth Day! In honor of Earth Day this year, we thought it would be fun to put together a list of some of the most beautiful places in the US that you can visit while on a travel nursing placement. Get your pen and paper out, you’re going to want to add these to your bucket list.\nHavasupai Falls, Arizona\nYou know those places you see photos of and they just don’t even seem real? Havasupai Falls is one of them. The falls are located in the Grand Canyon in Arizona. Due to the high volume of people that want to visit the falls, you must buy a pass to hike there in advance for select dates. So if you’re looking to see the falls, make sure you’re planning it out, but trust us it’s well worth it! Planning your adventure to Havasupai Falls? Try a placement in Northern Arizona.\nSequoia and Kings Canyon National Park, California\nThe Sequoia and Kings Canyon National Park is home to the world’s largest tree – the giant sequoia. Wandering through the park reminds you of how small we really are in the grand scheme of things. The best part? There are campgrounds so you can camp or stay in a cabin amongst the glorious sequoia trees. If you’re looking to spend your days amongst the trees, try a placement in Fresno.\nDeath Valley National Park, California\nIf the name doesn’t say enough, Death Vallery National Park is the hottest, driest, and lowest National Park in the country. The park lies on the border of California and Nevada, making Scaling Zabriskie Point will leave you with unmatched views like you’ve never seen before. Try a placement in Las Vegas for some extra fun and easy access to the park.\nGlacier National Park, Montana\nOne of the biggest draws to the park is the going-to-the-sun road. It spans 50 miles and goes through the mountains and over the Continental Divide. One at the top of the road, you’ll have your pick of hiking trails that all lead to their own hidden gems like Avalance Lake. Ready to see what other hidden gems are waiting to be discovered in Glacier National park, try a placement in Montana.\nThe Palouse, Washington, Idaho, and Oregon\nThe Palouse is a lush sprawling rolling green hills located in Idaho, Washington, and Oregon. According to The Seven Wonders of Washington State website, “The hills were formed over tens of thousands of years from windblown dust and silt, called ‘loess.'” The hills are mostly an agricultural area of wheat and legumes, but it makes for a stunning view. Check out any PNW placement if you’re looking for views of the Palouse.\nWant to explore one (or maybe all) of these incredible scenes? Stability Healthcare has got you covered. Check out open positions and apply for your next role today!Read More\nPresident Joe Biden announced a new nationwide COVID-19 vaccination goal around late March: 200 million shots being given within his first 100 days in office. This is after his earlier goal of 100 million vaccinations was met on the 59th day of his administration. April 28th is when Biden hits his 100th day in office–experts believe that if the country continues the vaccination rate, the US will reach the 200 million goals a week before Biden’s self-imposed deadline.\nKeeping Up With the Vaccines\nAs the vaccines continue to be rolled out, more and more people become eligible to get vaccinated. Of course, this brings a whole new set of difficulties, challenges, and setbacks for vaccines.\nPfizer Making Progress\nFrom the different vaccines in the US, Pfizer seems to be making some progress. As of April 13, 2021, there were 99.45 million Pfizer vaccines administered worldwide. They are also on the verge of being approved by the FDA to authorize their vaccine for 12- to 15-year-olds. In the meantime, their vaccine remains under emergency use authorization for people 16 and older.\nJohnson & Johnson’s Setback\nA bit far behind is Johson & Johnson’s vaccine, with less than 8 million doses administered. To slow things down even more, they’ve paused vaccinations in all clinical trials over blood clot concerns out of an abundance of caution in the US. The company is also delaying the rollout of the vaccine in Europe.\nModerna Stays Stable\nIt pays to be first; the Moderna vaccine has delivered 85.4 million doses so far. Since they have had more time and resources for testing, they say their vaccine is more than 90% effective for at least six months. Pregnant and postpartum women are also encouraged to receive Moderna vaccines, expanding the vaccine’s reach.\nThe Latest On the Coronavirus\nThough the country seems to be getting the hang of the pandemic, new strains of the virus, the vaccine rollouts, and lockdowns coming to an end are destabilizing everything.\nThe United States has reported an 8% increase in new cases of COVID-19 in the past few weeks. Michigan reported the highest number of cases per capita, with almost 39% of new cases involving the more contagious B.1.1.7 variant of the virus first identified in the United Kingdom.\nOverall, deaths from COVID-19 seem to be going down by 7% in the past weeks. Except for Oklahoma, which reported 1,716 new deaths between August and February and had gone unreported. Including the backlog, deaths rose by 21 percent.\nWhile countries like Turkey and the Netherlands are enforcing partial lockdowns and extending their lockdowns, the US is dropping more and more restrictions every week. The latest update from the Centers for Disease Control and Prevention (CDC) allows fully vaccinated travelers to travel safely, without getting tested or self-quarantining.\nHowever, in most states, businesses are mostly open, except for California, Oregon, Arizona, New Mexico, and Colorado, which have mixed restrictions allowing certain businesses to open to the public. Only 38% of the states remain with mandatory restrictions on masks, and 92% of states have no restrictions on stay-at-home orders. The only states with advisories to stay home are California, New Mexico, Wisconsin, and Kentucky.\nSome people, including experts, attribute the cooldown of restrictions to the surge in new cases. Variants account for about 78% of recent Coronavirus cases in New York City. About 30% of cases were identified as the variant from the UK, and another 42% were genetically sequenced samples of the variant first discovered in New York City.\nThankfully, the latest studies on the UK variant found that the virus is more transmissible but not as severe. Still, separate findings state that the variant might be tied to a higher risk of dying from the virus. Of course, it’s still too soon to fully understand these new variants as there aren’t enough cases yet to come up with a final statement.\nHow to Get the Vaccine\nAs of early March, over half (52%) of frontline healthcare workers have received at least one dose of a COVID-19 vaccine, leaving 48% who have not. It’s important to point out that about 15% of US healthcare workers, primarily those working with smaller institutions, refuse to take the vaccine. Nonetheless, for travel nurses, getting the vaccine can make moving from city to city more accessible, and here’s how to get one:\n- Find a COVID-19 vaccination site near you: use vaccinefinder.org to find providers near you. Another option is to check local pharmacy websites or find pharmacies participating in the Federal Retail Pharmacy Program.\n- Schedule a vaccination appointment: most providers use their scheduling systems.\nWe’re excited to introduce our Nurse of the Month, Laura! Laura is a PACU nurse that just began her travel journey. We chatted with her while she is absolutely shining in her first placement in Raleigh, North Carolina. Learn more about our Nurse of the Month:\nWhat has it been like working during the pandemic?\nIt was a hard year with a lot of changes in healthcare and the world. My decision to do traveling nursing just made sense. The pandemic was the catalyst I needed to make some serious changes in my life.\nWhat placements have you had in the past?\nI chose a hospital in Raleigh, NC bc it all fell into place. I saw an opportunity to be in a new part of the country and I was excited for the experience.\nAll-time favorite placement?\nRaleigh was the first of what I hope will be many others.\nWhat is your career history, how did you become a travel nurse?\nI have been a nurse for 26 years. I worked in the ER for 7 of those years and then got a job in PACU where I have been for over 15 years.\nWhat inspired you to become a travel nurse?\nThe pandemic made me want to see what the rest of the world was like. I figured there was no time like the present to do something I have always wanted to do and not to put off what I could do now until later.\nWhat is your nursing specialty?\nPACU is where I love to be and working there just came naturally to me. It was a good fit.\nFavorite hobbies outside of work?\nI love to bake and cook. I stay active by going to Zumba classes and training to run races.\nBest travel nursing story?\nIt’s no secret traveling nurses aren’t always welcomed in the unit they choose. But the PACU at the hospital in Raleigh made me feel like I was part of the team from the start, and that meant the world to me.\nWhat’s your favorite part of working with Stability?\nAll expectations were communicated and if I had any questions or concerns, I felt comfortable asking and Stability helped any way they could.\nWhat is something you bring with you (non-nursing related) to every move/placement?\nI am easy going and I adapt to new situations quickly. As a traveler that is important.\nAny advice for future travelers?\nIf you aren’t sure you want to do it, don’t be afraid. If the pandemic taught me anything, it is that life is too short to put things off until later. The money is great, but the opportunity to see and do new things and meet new people, is what it was really about for me. My assignment surpassed all of my expectations and then some.\nThis may come as a surprise, but one of the best ways to get a look into the life of a travel nurse is to, well, go on Tik Tok! Tik Tok gives a platform to anyone to create any kind of content, and there are plenty of travel nurses that make videos about their experiences. Here are a few of our favorites:\nIf you’re interested in becoming a travel nurse but don’t really know where to start, @sibsrn is your kind of Tik Toker! She makes videos that are direct and to the point – like the benefits of applying to jobs you think you may not be right for, how to handle a long-distance relationship while being a travel nurse, and skincare basics for a nurse. She makes videos for things you wouldn’t even think of right off the bat, but as soon as you watch them, you’re glad you did! Every so often she gives updates on where her position is, how she’s liking it, and where she’s going next.\n@byernestion is one of the most well-followed travel nurses on Tik Tok. He’s a strong advocate for Black rights, LGBTQ+ rights, and for being yourself! He’s one of Tik Tok’s travel nurses that posts most regularly, so you can always have new content to see. He is also very blunt when he answers commenters’ questions, so you get an honest viewpoint on his feelings pertaining to being a travel nurse.\nCourtney Maree (@laughingbabe) shows the adventure-filled lifestyle that travel nurses can live and shares all of her tips and tricks so you can do the same. Her content is the perfect mix of relatable, educational, funny, and also serious. Her positive energy and content creates a welcoming and supportive place for nurses of all levels to enjoy.\nMost of @courtneyzanee25’s Tik Toks delve into the benefits of being a travel nurse, but with a humorous twist! You can watch her pick out which scrub cap she’s going to wear for her shift, see her use memes to illustrate the monetary benefits of being a travel nurse and learn about some of the activities she does where she’s stationed. She injects plenty of her personality in each Tik Tok, making the content more relatable, even for those who aren’t nurses! It’s a good mix of classic Tik Tok dances and funny, informational videos. The comment sections are great to read because they’re often filled with input from other travel nurses or people who are interested in becoming a travel nurse.\n@reesesRN is a travel ICU nurse. Her Tik Toks chronicle why she wanted to be a travel nurse, how she became one, and what she typically does on her shifts. Her content is very relevant and mirrors today’s social issues. Some videos help expel myths about the COVID vaccine, some advocate for human rights, and some are more lighthearted, like giving insights into what different parts of a hospital smell like. She also often answers questions about travel nursing that other users comment on. All of her videos are informative and important and are up to date with modern medical and social issues.\n@charley1969 is an ICU travel nurse. There are plenty of great, humorous Tik Tokers, and although @charley1969 is funny, they also have more serious videos thrown in that deal with the hard, emotional sides of being a travel nurse. They provide a realistic side of being a travel nurse that many don’t often see. However, despite the somber tones of some of their Tik Toks, @charley1969 often still offers a positive, encouraging outlook that sheds light on how important travel nurses are.\n@travelnursetiktokaf uses Tik Tok as a platform to help staff nurses transition to travel nurses. With a plethora of information on travel nursing out there, it is awesome to see the ins and outs of travel nursing from a travel nurse. This account gives a look at the money side of things and how to navigate the profession, but also shines a light on the experiences, the people, and the fun parts of travel nursing. Her videos have you thinking, “who wouldn’t want to be a travel nurse?”\n@mackyoustoopd is another great example of a Tik Toker who creates hilarious bits that not only give you a good laugh but give you first-person thoughts on being a travel CNA! Although most of his content is pretty specific to being a travel CNA, they’re still funny overall and are certainly appealing to anyone who already works in a medical field. Since he posts so many videos on a regular basis, his content spans from the typical occurrences of a night shift to what it’s like working with patients (in his case, specifically for patients in the Psych ward).\nNurses are on their feet, all day, every day—especially travel nurses who are always going. With demanding work, long shifts, and working to get everything done, feet can suffer. Painful feet, swollen ankles, varicose veins, and even blood clots can arise from the stress. So it’s critical to take good care of your feet. A good pair of compression socks can help tremendously.\nCompression socks work to alleviate the issues that nurses face being on their feet all day. The tight fabric can assist circulation in the feet and legs and help reduce pain and swelling—immensely important for the busy travel nurse. They also work to increase blood flow and oxygen, not just in your feet and legs, but in your whole body. Next to your nursing shoes, compression socks are one of the best purchases you can make for the longevity of your feet and legs.\nHow to Pick Compression Socks\nNo doubt nurses will be familiar with this unit as a measure of blood pressure through millimeters of mercury. Compression socks are categorized in strengths using this same unit—the higher the mmHg, the thicker and tighter the sock. Not including prescription-level, compression socks come in three degrees of strength: mild, medium, and firm.\nMild compression socks provide only a slight level of compression and will have an mmHg of between eight and 15. For busy travel nurses, this may not be strong enough to fight pain and poor circulation.\nMedium level compression socks are what most nurses use and measure between 15-20 mmHg. This level of compression should provide a good amount of relief from long periods of standing and walk.\nLastly, a firm-level of compression measures between 20 and 30 mmHg and should be reserved for the most intense workers who need an extreme level of compression support. They can relieve moderate to intense swelling, orthostatic hypotension, and even deep vein thrombosis.\nThe Best Compression Socks for Nurses in 2021\nNow that you know the differences and details of compression socks, you can start shopping for a good pair—or two! Below are a few of our favorites for 2021.\nFigs Compression Socks\nFigs is renowned for their healthcare attire, and along with their scrubs and shoes, they also make some fantastic compression socks that are functional and very stylish. Whether you’re looking for a simple single color or some socks with snazzy prints, Figs has you covered—literally and figuratively. Figs compression socks are reasonably priced too. A tall pair will run you around $30, while a plain pair of ankle-highs will set you back just $12.\nNurse Mates is known for making great nurse shoes. Their expertise extends into the realm of compression socks too. Their socks run the gamut of plain and professional to quirky and fun, offering nearly 100 options to choose from, including tie-dye, polka dots and stripes. Regardless of your style preference, Nurse Mates has something to fit. Nurse Mates has a huge selection of compression socks, and they start at around $9 per pair and go up to around $35.\nPoppy Scrubs Compression Socks\nPoppy Scrubs is another clothing company for nurses that you’ve probably heard of. They make incredibly comfortable shirts, scrubs, and, of course, compression socks. Poppy Scrubs doesn’t offer the same selection as Nurse Mates or Figs, but their socks are incredibly high-quality and durable, offering yarn-based compression socks in the firm level of compression. And at around $25 per pair, they’re affordable too!\nKeep Your Feet Happy\nWhether you’re a travel nurse or one of the at-home heroes, you know all too well how demanding your field is. You’re always on the go, day in and day out, and sometimes your feet can pay the price. Do yourself a favor and invest in a pair of compression socks to keep them happy.\nAnd if you’re a travel nurse that’s on the lookout for your next assignment, don’t hesitate to search for your next position with Stability Healthcare—we’re happy to help you find the perfect position!Read More\nPost-anesthesia nurses are highly popular and needed in almost every medical environment. They’re specialized nurses providing care for patients who have gone under anesthesia. This is particularly important since sometimes patients can experience side effects of anesthesia or have trouble regaining consciousness. Post-anesthesia care unit (PACU) nurses can enjoy a long and rewarding career in their field, often finding employment in many settings. If a career as a PACU nurse intrigues you, keep reading to learn about what you need to know to start your path toward becoming one.\nWhat is a Post Anesthesia Nurse?\nAs their name states, post-anesthesia nurses care for patients who have gone under anesthesia. They observe and treat patients post-operation to make sure they safely awake from anesthesia. PACU nurses care for vital signs, measure consciousness levels, and ensure sedation is wearing off properly.\nUnlike operating room nurses, PACU nurses take care of patients once they leave the operating room. Similarly, PACU nurses are not mistaken with nurse anesthetists, who have specialized and advanced nursing degrees.\nNational average salary: $94,966 per year\nJob outlook: 12% increase by 2028\nWhere Do Post-Anesthesia Nurses Work?\nPost-anesthesia nurses work in the post-anesthesia care unit in hospitals. While this is a critical care unit, patients here have gone under anesthesia but do not need close monitoring like in an ICU. Sometimes PACU nurses can find employment in other medical facilities that provide treatments that require anesthesia, such as testing facilities and ambulatories.\nWhat Kind of Patients Are in a Post-Anesthesia Care Unit?\nPatients in the post-anesthesia care unit aren’t in any danger. These patients have gone under anesthesia and are transferred here for close monitoring until they’re fully awake. These patients haven’t undergone any major surgical procedure that requires intensive care. Otherwise, patients would be transferred to the ICU instead.\nWhat Does a Post-Anesthesia Nurse Do?\nPACU nurses work in the recovery room, becoming one of the first people they see after a procedure. Because some patients experience side effects such as nausea, fear, agitation, and difficulty breathing, post-anesthesia nurses are there to care for and monitor their progress. Sometimes, PACU nurses may also be responsible for helping patients stand and completing the discharge process.\nPost-anesthesia nurses provide comfort and assurance. They explain to family members the anesthesia side effects and answer any potential questions. This close connection to patients and families means PACU nurses need to be understanding and compassionate.\nMost responsibilities include:\n- Ability to work in a fast-paced environment and make quick critical decisions\n- Respond to complications administering medications and assisting in other procedures as needed\n- Monitor post-operative patients’ levels of consciousness\n- Measure and record patients’ vital signs\n- Treat pain, nausea, and other post-operative symptoms of anesthesia\n- Provide comfort and reassurance to distressed patients\n- Educate patients and family members on post-surgery care\nHow Do You Become a Post-Anesthesia Nurse?\nLike other nursing specializations, the journey to becoming a PACU nurse starts with getting certified as a registered nurse. Gaining experience in the post-anesthesia care unit is enough to start carving a career in this field. However, you can also further your education by becoming a certified post-anesthesia nurse (CPAN).\n- Certified post-anesthesia nurse (CPAN)\n- Certified ambulatory perianesthesia (CAPA) nurse\n- Certified registered nurse anesthetist (CRNA)\nWhat Skills Do You Need to Be a Post-Anesthesia Unit Nurse?\nMost PACU nurses handle between one to two patients at a time, so it’s considered a less stressful nursing job. Still, it is paramount that good PACU nurses have strong nursing skills and make quick decisions about their care. Compassion, communication, and collaborative skills are crucial in this position. PACU nurses often are part of a larger team and must work in a group environment.\nMost common skills or post-anesthesia unit nurses include:\n- Experience in intensive care unit or post-anesthesia care unit\n- Proficiency in electronic hospital management systems\n- Exceptional interpersonal, communication, and collaboration skills\nStarting Your Post-Anesthesia Nursing Career\nMany consider a post-anesthesia nursing career the stepping stone to reach more highly specialized positions. Obtaining experience in the post-anesthesia care unit can prep nurses to assist in the operating room or even become anesthetic nurses in the future. If a nursing career in post-anesthesia care interests you, these steps will help you position yourself as a great candidate.\nAt Stability Healthcare, we place nurses in hospitals across the United States, helping them find tremendous opportunities in various fields, including in the post-anesthesia care unit. If you’re ready to kickstart your career, search for your next placement and set up an interview today.Read More\nBeing a travel nurse has a lot of perks – one being the opportunity to travel across the country and land yourself in an exciting city! Here’s a view of the best places to visit (and work in!) this spring.\nLOS ANGELES, CALIFORNIA\nLos Angeles is one of the United States’ biggest cities with some of the best weather. Less than an hour drive away from the oceanside, you can try your hand at surfing, swimming, or, for those less adventurous, relaxing on the beach! For those with a more artistic palette, there’s plenty of music venues, galleries, or art sight-seeing across the city. Our favorites:\nGold Diggers – As it says on their website, Gold Diggers is “a bar, boutique hotel and recording studios all within a single campus.” If you need a staycation during your time as a Los Angeles travel nurse, Gold Diggers is one of the most unique hotel experiences you can get. Occasionally, there’s secret live shows and events. Plus, they have a killer bar and some of the most stylish rooms in LA.\nCelebrity Home Tours – Your feet might be tired after working long shifts – give them a break by booking a bus tour that visits celebrity homes across LA. Although this activity may seem a little gimmicky, it’s a good way to view the city and catch a break at the same time. One option is Starline tours, who claims to be the original celebrity home tour!\nMilwaukee is a vibrant city nesting on the coast of Lake Michigan. Milwaukee tends to have more mild springs, which leads to plenty of artistic communities taking advantage and hosting galleries and art walks. Although Wisconsin is mostly known for their cheese, there’s a ton of great restaurants for carnivores, omnivores, vegetarians, and vegans alike. There’s also plenty of hiking options (like the beautiful Kettle Moraine) within driving distance for those looking for something more adventurous. Our favorites:\nMilwaukee Art Museum – According to their website, the Milwaukee Art Museum has over 30,000 works of art. Famous artist Georgia O’Keeffe is a native to Wisconsin, and the Milwaukee Art Museum has one of the largest collections of her work.\nCactus Club – When live shows become a thing again, Cactus Club is one of the best places to catch a drink and set from a local (or nationally touring) band. While the wait is still on, Cactus Club is currently offering a special Airbnb stay that allows you to drink, eat, and sleep in the venue’s decked out green room.\nVanguard – Milwaukee’s Vanguard has the best of all worlds when it comes to eating. Vegan hotdog? You got it. OG hotdog? On the menu! With an emphasis for hot dogs and sausages with uniquely curated toppings, Vanguard has something that will have everyone’s mouths watering. We recommend the schnitzelwurst!\nFind open positions in Milwaukee.\nChicago is a Midwest gem. You get the best of a large city, plus a beautiful lakeside with plenty of beaches to relax on. The spring is the best time to visit Chicago, not only because you can avoid the dreadful winters, but because there’s a ton of food festivals, music festivals, good weather, welcoming block parties, and pretty neighborhoods to walk around in. Our favorites:\nMontrose Dog Beach – Get some vitamin D while being surrounded by dogs. Need we say more?\nPick Me Up Cafe – After walking around the quirky Uptown neighborhood on north side Chicago, grab a meal at the eccentric Pick Me Up Cafe. We recommended the buffalo wrap + a spiked milkshake.\nWicker Park – This neighborhood is the perfect place to shop. Brimming with a mix of well known brands like Adidas, small book shops like Myopic Books, and great coffee shops like Brü, Wicker Park has the kind of shopping that would appeal to anyone.\nFind open positions in Chicago.\nThere’s a reason why people have been flocking to Colorado – it’s simply one of the best places to visit! It’s a great option for those who are more nature oriented, or who enjoy consistently scenic views. If you take on a travel nurse position here, bewarned, you might love it and not want to leave! The city boasts sports (like the Broncos & Nuggets), a ton of microbreweries, coffee shops, and plenty of activities like hiking, skiing, and tubing! Our favorites:\nIllegal Pete’s – Although Illegal Pete’s is a favorite amongst the college crowd, it’s also the perfect place to grab a margarita with another fellow travel nurse after a long shift. They also have affordable mexican food that tastes great, plus you can watch the latest sports game as you enjoy their queso.\nLandmark’s Mayan Theatre – A movie theater is one of the best places to get your entertainment fix. Snack on some popcorn and soak in the elegant architecture of the theater before turning your phone off and enjoying a film!\nBlue Moon Brewery Tour – This is a good fit for, well, people who like to drink beer! See exactly where and how the magic happens that creates one of Colorado’s most recognizable beers brands.\nFind open positions in Denver.\nNashville isn’t just for country music lovers. The city is a great fit for anyone who likes music, good food, and southern charm. Nashville’s food scene is most notably known for hot chicken, BBQ, and biscuits, but there’s also great roasteries, pastry shops, veggie options, and more! There’s amazing landmarks like the Grand Ole Opry, Ryman Auditorium, and the Country Music Hall of Fame. Our top three:\nLocal Honey – Self-care is an important aspect of being a travel nurse. After a few weeks of long arduous shifts, getting a fresh haircut is a great way to feel good. Local Honey is a salon that specializes in color and unique haircuts, so you can really develop your individual style.\nCountry Music Hall of Fame – As mentioned in the above paragraph, you can’t go wrong with a little country music. The Country Music Hall of Fame catalogues the history of country music through galleries, archived music, and more. Plus, you can learn more about all the artists who have earned the honor of being in the Country Music Hall of Fame!\nFind open positions in Nashville.\nSeattle has a bad rep for balmy weather, but it’s a fantastic place to visit. Nestled on the water, Seattle has an eclectic history with music (Nirvana, anyone?), the arts, and coffee. Plenty of movies have been filmed in Seattle, like the iconic 10 Things I Hate About You. To be frank, Seattle is a cool city, and one of our top cities to visit in the spring. Our favorites:\nUniversity of Washington Campus – As a travel nurse, you’re likely not a college student anymore. This doesn’t mean you can’t take a trip to University of Washington’s campus to catch in the beautiful views and campus architecture. In the spring, the campus is dotted with beautiful Japanese cherry blossom trees. Plus, the campus has a breathtaking view of Mount Rainier.\nSpooked in Seattle Tours – Not for the faint of heart, the Spooked in Seattle tours offers a look into the city’s paranormal misadventures. It’s the longest running ghost tour in the area, and is run by people who are classified as actual paranormal investigators. You might want to make sure you don’t have a shift the next day, you might get spooked out of sleeping!\nFind open positions in Seattle.\nFollow us on Instagram for updates!Read More\nTravel nurses are skilled professionals who take assignments in facilities with short-term staffing needs. They have the opportunity to provide patient care and get to see exciting places at the same time. But there’s more to becoming a travel nurse than meets the eye. Below are reasons why you should to become a travel nurse.\n1. Great Pay\nOur travel nurses earn good hourly rates on top of Day 1 insurance through United Healthcare including dental and vision, automatic life insurance policy, extra shift bonuses, guaranteed stipend, and 401K for travel nurses who have traveled with us for at least a year. Most importantly, we offered PTO for all of our travel nurses.\nGetting a travel nursing job is not difficult although it’s best if you have about 24 months of acute care experience.\n2. You Can Take Your Family With You\nYou don’t have to travel alone. If you have a spouse or children, you can always take them with you. Travel nurses can even bring along their pets to pet-friendly cities. We can also help you arrange for your housing and we reimburse travel expenses up to $600. You may also be eligible for a housing subsidy if you manage to secure your own housing. If you love your assignment, you also get the option to extend your contract.\n3. Demand for Travel Nurses is High\nThe demand for travel nurses continues because of Covid-19. It hit its all-time high last year during the pandemic and the demand is still expected to rise. In fact, the forecast is bright for the nursing profession in the next four years. The travel nursing profession can give you more financial stability and flexibility as you can work anywhere. If you are committed to your profession, there is no shortage of job opportunities for you.\n4. More Freedom and Flexibility\nOne of the benefits of being a travel nurse is having the freedom to choose wherever you want to work. You can pick your own location and if you are flexible with shift times, it’s easier to connect you with more travel nursing assignments. Travel nurses also get to take time off in between their assignments, to either go on a vacation or spend quality time with their family or friends. Most jobs do not offer this freedom and flexibility — you basically have full control of your life when you become a travel nurse.\n5. Professional Growth\nWorking with a range of different healthcare facilities from outpatient care to Level 1 trauma center enables you to broaden your skill sets and enhance your current expertise. More experience coupled with a strong background and a commitment to your profession will help you succeed.\n6. Live in New Places\nIf you want to see more of the United States and discover exciting places to live in, then travel nursing is for you. Nursing assignments are available in all 50 states from the busiest cities to quaint towns. If you want to explore a new state, we can always help you with how to apply for a new license.\n7. Find Your Dream Place to Settle Down\nBy working as a travel nurse, you get the option to work anywhere you want to. You can take advantage of this opportunity to find an ideal place to settle down. By working in a different location, you get to test the waters and see what life is like in that place. You get to compare living in different towns or cities and decide where you want to permanently live.\nBeing a travel nurse provides you with a rare opportunity to live in any place that you want. And the more experiences you have working in different places, the more likely you are to get new travel nursing assignments. Most importantly, you can broaden your skills and can adapt to any working environment.\n8. You Get to Relax\nMost of our travel nurses stay on for a minimum of three assignments and then they take time off to relax or travel with their family. Compared to working as a permanent nurse, being a travel nurse lets you avoid burnout. You always have the option to take a break after your assignment. As soon as you have recharged, we can connect you again with more travel nursing assignments.\n9. No Workplace Drama\nOne advantage of being a travel nurse is you don’t get caught up with any workplace politics or drama. You only need to show up every single day and focus on providing the best patient care. By being a travel nurse, you get to avoid having to deal with long-term management or co-worker issues. Your only commitment is to get the job done properly and improve your skills.\n10. Experience More Adventures\nTraveling lets you experience life differently. You can explore new places, try new cuisines, learn new cultures, discover new interests or hobbies and meet new people. You get to do all these by becoming a travel nurse. This profession can give you the opportunity to try new adventures, something that you may never find in your own city. So long as you are open to new experiences, the options are endless.\nBegin Your Journey as a Travel Nurse\nWe are a travel nursing agency that can assist you with travel nurse jobs. We can help you find your next assignment and it’s easy to get started — simply search for open jobs and compare high-paying travel jobs, set an interview and book an assignment. Our team will assist you every step of the way including helping you arrange for your housing. Apply today!Read More |
Lipo is a standard procedure many clients resort to when they are attempting to do away with excess fat buildup. Typically when diet regimen and also exercise fail, liposuction seems like a proper approach of weight-loss. Critics will tell you that liposuction is pointless if you can’t change your practices, but lots of people discover that liposuction provides the boost they need when trying to minimize their weight.\nLiposuction is a basic procedure that calls for a cut and the insertion of a tool called a cannulae. The cannulae is after that linked to a vacuum cleaner like equipment that will literally draw the fat right out of a person’s body. Liposuction hit its appeal in the eighties as well as many still advocate it today.\nThose that have actually experienced tumescent liposuction surgery record positive testimonials of the whole experience. Actually, in 2004 The Dermatol Surgeon reported the highest complete satisfaction rates ever in the plastic surgery industry reporting a 91% fulfillment price. This is virtually 30% more than the greatest contentment score of conventional liposuction surgery.\nBody sculpting is any kind of clinical treatment that changes the natural shape of the body for a more positive form. Body sculpting has become one of the key focal points of cosmetic surgery, as well as the developments in which it has built up are truly rather exceptional.\nWhen asking your doctor about any kind of body forming treatment, he should be well up to day on the least invasive treatments in addition to those that generate the best results. Body sculpting is thought about an art form to numerous specialists, and also they take wonderful satisfaction in the results. Any kind of skillful specialist ought to offer to reveal you before and also after photos of their work. These photos must not consist of designs or particular locations covered by clothing. Many clients that felt their cosmetic surgeon did a quality task and also had a reasonably stress and anxiety free experience will accept in the past and after pictures.\nThreats of Liposuction\nAll surgical treatment carries a minimum of some amount of danger. Any time an individual undertakes anesthetic, there is always the danger of complications and also fatality, depending on how your body reacts to the anesthetic.\nLiposuction surgery comes with its very own set of threats consisting of things like bleeding, skin irregularities, dimpling or lumpiness, loose skin, or infections. Essentially these adverse effects are correctible if they occur and generally also without an extra procedure. Liposuction has actually been through numerous improvements as well as remains to boost to minimize the side effects associated with liposuction.\nSurgical treatment of any kind of kind will certainly come with a specific quantity of discomfort. Although the discomfort related to liposuction tends to be taken into consideration very little, your discomfort resistance may be higher or lower than the established requirement.\nYou can increase your threats of problems by picking a cosmetic surgeon based on rate. Usually the lowest priced doctor is not certified to do even easy treatments. The cosmetic surgeon’s online reputation is tainted in the neighborhood so he hires service by underbidding his rivals.\nDespite having basic procedures make the effort to speak with other doctors, nurses, and also people who have cosmetic procedures or body shaping performed. Extensively investigate the background of any doctor you are choosing to do any form of plastic surgery. It is, besides, your body. Saving a few dollars isn’t worth the risk you keep up an unskilled doctor.\nThe Advantages of Tumescent Liposuction Surgery\nTumescent liposuction is thought about an amazing improvement in the requirement of liposuction. It brings less risks as well as negative effects. The adverse effects are very little in contrast as a result of the smaller dimension of the cannulae and the preliminary injections used for the procedure. Tumescent liposuction has been as close to refined as a cosmetic treatment can be perfected.\nThe tumescent liposuction treatment does not need the individual to undergo basic anesthesia. This alone significantly reduces the negative effects connected with anesthesia such as grogginess as well as disorientation. It additionally removes the adverse effects of seizure and also death associated with general anesthetic.\nThe healing time for tumescent liposuction is reduced because of the little size of the cannulae and also a huge injection of epinephrine. The discoloration and blood loss that goes along with a liposuction surgery treatment is dramatically reduced, and also the risk of skin abnormalities is drastically decreased. Obviously, dangers still apply as they will certainly with ant cosmetic procedure, yet tumescent liposuction brings a much reduced danger of adverse effects.\nTumescent liposuction surgery has a much faster recovery period with less complications than traditional liposuction surgery. Many people can be up and walking and also returning to work within a couple of days. Physical exercise is typically acceptable after just regarding a week, rather than both to three week duration connected with other forms of liposuction.\nA lot of specialists that carry out aesthetic treatments are well acquainted with tumescent liposuction surgery, so locating a qualified surgeon needs to not be a concern. Although tumescent lipo is thought about the most effective, it is actually not all that new and also surgeons have accepted the procedure as well as its decreased dangers of side effects.\nRecognizing the Tumescent Lipo Procedure\nTumescent liposuction is a relatively straightforward cosmetic treatment. The individual is infused with a neighborhood anesthetic as well as is awake via the whole procedure. A big amount of saline and epinephrine is injected into the influenced areas to be liposuctioned. Epinephrine makes the capillaries smaller sized. This consequently lowers blood loss which additionally reduces swelling as well as bruising.\nA tiny incision is made in order to place the cannulae. The laceration for a tumescent liposuction procedure is a lot smaller sized than traditional lipo cuts which minimizes healing time as well.\nThe cannulae is the attached to a vacuum cleaner maker which sucks the fat right out of your body. The incision is after that closed and an elastic compression sleeve is related to the location to help the skin agreement and also speed healing.\nAfter being ensured that there is no bleeding and the individual is ready, the procedure is over and also it’s time to go home. After just a couple of days of mild motion around your house the person can go back to function. After a week the client can exercise and any of the side effects that may turn up are conveniently correctable. It takes about a year for any kind of medical mark on the body to totally recover.\nAny kind of kind of body sculpture is most likely to have mostly favorable results. Remember that you are modifying the body’s all-natural appearance and it will take some time for those results to appear. The recovery process, nonetheless fast it may be is one to be respected and also recognized.\nFiguring out Extra\nSimilar to any type of cosmetic procedure it is essential to be as educated as possible about the procedure of body sculpting. Comprehending the treatment, the recovery, the assumptions of the specialist and also recognizing a quality cosmetic surgeon are all key factors in creating an excellent experience when it pertains to body sculpting.\nAs preferred as plastic surgery has actually become, and also as effective and also efficient as the cosmetic surgeons have come to be, a top quality specialist is still essential. Even if a tumescent liposuction surgery is a regular procedure for him does not mean that it is for you. Locating a plastic surgeon that can treat his people as people with genuine demands is uncommon. Recognizing how to deal with discovering the right plastic surgeon is even rarer. It’s more than just selecting a name from a phone book. Discover the right concerns to ask your surgeon prospects to minimize the possibility of an inadequate medical experience.\nMaximizing your information as well as locating the appropriate procedure for you takes some understanding too. Even if somebody you recognize had tumescent lipo does not always suggest that you are an excellent liposuction candidate. Learning the right questions once again can assist narrow down what could be best for you and also your body in general.\nRecognizing where to count on find the details you need to make intelligent as well as informed decisions is equally as crucial as picking the procedure itself. Solid, groundbreaking details is crucial to making any choice regarding your body or your wellness. Even if we are speaking about your overall aesthetic health doesn’t decide you pertain to any less important. Do not walk into a doctor’s office not really prepared to ask the essential concerns. Obtain the details you need in order to ask the best inquiries.\nOne of the most effective and also most full means to inform yourself concerning upcoming procedures, and even body forming that you are simply thinking about is to find an all comprehensive website created to give you the expertise you require. Understanding what inquiries to ask and also just how to deal with discovering a top notch medical professional are all part of the details procedure.\nThe all comprehensive website that can use you all of your educational needs is lifeplasticsurgery. Below you will find the information to have actually informed discussions with your doctor and also discover what concerns to ask. You review accounts of other individuals’s experiences in order to identify what’s right for you. You will certainly locate links to even more info and also honest, unwanted opinions on numerous procedures. It resembles all in one quit shopping for every little thing plastic surgery.\nKno More About mens liposuction houston Here |
I think I posted that she broke her hip on Sept. 24th. When they did the X-rays they said the ball broke off so instead of doing a pin and all of that, they "only" had to do a half hip replacement so the recovery is much better. Got the tests from the esophageal cancer and it has not spread yet but she is too old (98) and fragile for surgery and chemo. We discussed driving 150 miles each day for 3 weeks to do radiation but the doctor said it would make her quality of life worse and probably extend it only a couple of weeks so we basically decided to do nothing. So far she is asymptomatic except that the ulcer is bleeding so she is becoming a little anemic. She can have blood transfusions as long as we want to do it. She's been in 3 different hospitals and had anesthesia and mega doses of all kinds of other stuff so the dementia is worse. It seems to be worse at night but I think that's normal. She is not happy where she is but I don't think there's any alternative. Three of the nurses at the home are friends of my son so I think she will get a little extra attention. She's had several visitors already and they have activities every day so I'm hoping once she settles in she'll think it's not too bad. I'm in the process of cleaning out her apartment so that is another stress. Her rent is paid through Oct. 31 so we don't have to be in such a big hurry. We could use a few prayers and good thoughts right now. Thanks. |
Welcome to a review of our markets and all of their possibilities. We recommend a visit to About Us in advance where we reviewed the historical development as well as the unique features and potential of our Mini-Infuser™.As has been noted earlier, the therapeutic possibilities awaiting us are deep and far reaching. Therefore, it comes as no surprise that analysts in December 2013 at Roots Analysis* called the growing possibilities for the portable infusion market in general “The Next Billion Dollar Opportunity”. In fact, it’s seen as potentially the largest and arguably fastest growing sector of the 12 billion dollar market for injectable drug delivery systems, reaching 8 billion dollars within a decade.* Roots Analysis, Wearable Bolus Injectors- The Next Big Thing in Drug Delivery, 2013. However, at this present time, this promising field described above by Roots Analysis is dominated by inferior infusion products\nThere is a significant unfulfilled demand for new therapeutic options to lower the cost and increase the safety of the infusion market yet there are currently no fully programmable, disposable, electronic infusion pumps serving the inpatient pain market.\nWe are confident that the Mini-Infuser™ will be uniquely equipped to meet these demands. In fact, its design and function have already won it prestigious awards where one took note of its “elegant simplicity” as well as flexibility and accuracy as it administers even the tiniest of product volumes.\nWe see our most relevant potential in licensing our product to Pharmaceutical/Biotech companies involved in the manufacture of medications for just an example of the following therapeutic markets.\n> Pre/post-surgical and chronic pain\n> Anticoagulant therapy\n> Diabetic insulin therapy\n> Chronic heart failure (CHF) therapy\n> Endocrine therapies\n> Fertility drugs\nWe also see a significant relevance for the Mini-Infuser™ in the following therapeutic centers (and the experts below agree).\nRegarding costs, here is some relevant information:\n400 Bed Hospital ROI Estimate for Mini-Infuser™ Pain Pump\n> 400 bed hospital\n> 15% medications administered are injectable narcotics\n> 25 cartridges are eliminated by one Mini-Infuser™ Pump\n> 50% injection cases convert to Mini-Infuser™ Pump – 8,760 pumps/year\n> $100 cost for Mini-Infuser™ Pump\n> $1.50 for C-II cartridge\n> $15 cost for 25 mL volume 50mg/mL morphine for Mini-Infuser™ Pump\n> Labor: $50 pharmacist, $15 technician, $60 nurse (per hour)\n> Time required for cartridge filling, dispensing and narcotic administration\n> Save 11.5 minutes per dose using Mini-Infuser™ Pump\n> Medication errors\n> 19% medications administered in error, 1.33% serious = 0.25% of all medications in serious error\n> 1.88 patient days added per error, $600/day variable hospital cost\n> 1,107 narcotic analgesic serious error/year, adding 2,081 patient days\nTaking into account the cost benefit assumptions listed, this outlines the Mini-Infuser™ cost savings.\nIn addition, the Mini-Infuser™ will also be particularly useful for the Pediatric and Neonatal Medicine.\nLawrence K. Wickham, MD, FAAP, Founding Medical Director, Hoag Hospital Neonatal Intensive Care Nursery comments on the advantages of the Mini-Infuser™:\n“The Medipacs® Mini-Infuser™ is an incredible device for the future delivery of medications in the Newborn and Pediatric Medicine field. Infants and children who once had to spend extra days and weeks as inpatients in hospitals, where they are at risk for acquiring serious infections, will be able to receive their medications at home with new safety, accuracy and simplicity. Medipacs® will deliver these patients their medications via new technology that assures precise doses via a device that will showcase an ease of use that allows their physicians to fine-tune their therapy in conjunction with other health-care providers to assure the delivery of excellent care.”\nHospice care is the treatment of terminally ill patients and often involves the management of pain associated with the terminal disease or condition.\nCare is provided at:\n> Long Term Care Facility (for both non terminal and terminal patients)\n> Residential Hospice Facilities (terminal patients only)\n> In-Home (visiting nurses or care attendants travel to the patient)\nThe Mini-Infuser™ may provide the most help to the In-Home patient. It can be programmed to provide pain relief for several days before the next visit of the medical staff. This will free up nursing staffs from expensive, time consuming capital intensive devices such as PCA’s (Patient Controlled Analgesia).\nDavid Bougher, RN, BSN, LNC, President of the DPB Education Associates* discusses the Mini-Infuser™ from his perspective as a Hospice expert below.\n* DPB is committed to providing the highest quality clinical and leadership education in hospice and palliative care\n“In today’s hospice setting, where pain management can be a very complex process, the Medipacs® Mini-Infuser™ will offer many benefits. Since most hospice patients are cared for in the home by family, the Mini-InfuserTM will provide high-level pain management without requiring the patient or family to go through significant training to manage this device. It will offer the hospice nurse an efficient and effective analgesic delivery system with a high level of safety.”\nHere are some facts\n> Controlling pre and post-surgical pain is a top priority of the surgeon and preemptive pain relief is more effective than treatment after pain becomes evident.\n> Uncontrolled pain can result in hyperalgesia.\n> A continuous rate of infusion (CRI) of analgesics can prevent complications and help maintain a stable plasma concentration of medication.\n> The Mini-Infuser™ CRI Subcutaneous (SQ) capability is timely and relevant here as this delivery system is fully understood and accepted here.\n> Using a future capability, the Veterinarian, will then be able to activate the device for “home mode” for home care where it can work for 1-2 days. And the Mini-Infuser™ Tamper Proof design helps maintain safety.\nOther Important Mini-Infuser™ Features that address Veterinarians’ Requirements\n> Price is very competitive\n> The Mini-Infuser™ is disposable with an on-board UI, integrated infusion set, and a self-adhesive attachment\n> Unlike other pumps on the vet market, the Mini-Infuser™ has no bulky, mechanical parts. So its thin sleek design fits and adheres easily.\n> Its infusion set is convenient and stable\n> The constant rate infusion mode it offers fits clinical practice well\n> 4 mL drug capacity can be filled by vet with available analgesic solutions\nSee veterinary products. |
We live life in the fast lane these days and getting things done at twice the speed is fast becoming the norm. We all want to look and feel our best, showing off a smooth silhouette without lumps and bumps.\nDr Peter Berry is a Consultant Anaesthetist who has worked with Mr Patrick Mallucci for over 10 years, and has a special interest in anaesthesia for plastic surgery. Dr Berry gained his medical degree from Edinburgh University Medical School in 1987 and completed his anaesthetic training in Aberdeen, Cardiff, Liverpool and San Francisco, California, where he trained in sedation techniques.\nDr Berry has been a consultant at the Royal Free Hospital in London since 2000, where he established and led the the Safe Sedation team. Dr Berry is an expert in both general anaesthesia and sedation for plastic surgical procedures, as well as assessment of high-risk patients for anaesthesia.\nDr Berry has published several research papers on various aspects of anaesthesia and is particularly passionate about patient satisfaction and making the patient’s journey through their operation as smooth and enjoyable as possible. |
TRUE Oral Surgery TRUE Oral Surgery Search | Advanced Search | New Members | Coupons and Discounts | All Categories Health Care >> Dentists - Implants TRUE Oral Surgery 4420 Town Center Blvd, Suite 250El Dorado Hills, CA 95762 | map | directions Jason Straw (916) 933-3332 Visit Site Dr. Straw provides a broad range of Oral and Maxillofacial surgical services with an emphasis on dental implants and bone grafting procedures, wisdom teeth removal, general anesthesia and intravenous sedation, corrective jaw surgery, and facial trauma. He also has extensive background in dental implants and implant related procedures as well as orthognathic surgery. He maintains certification in Advanced & Basic Cardiac Life Support and a California General Anesthesia license. Member Since: 2020 Send a message to: TRUE Oral Surgery Your Name: Your Email: Subject: Message: (Date: 2/27/2021) If your business isn't here, contact us today to get listed! |
Dental Anesthesia in Albuquerque, NM\nRio Grande Oral Surgery & Dental Implant Center provides dental anesthesia services in Albuquerque, NM. Call 505-821-2111 to schedule your first appointment. At Rio Grande Oral Surgery & Dental Implant Center, our patients’ safety and comfort are our top priorities during surgery. We understand that undergoing any surgical procedure can make patients anxious or nervous, and we do our best to put our patients at ease. We have extensive training and experience in anesthesia administration, allowing us to deliver a safe and comfortable experience. Patients aged six and above can generally receive anesthesia in our office, while those aged five and below receive IV sedation or general anesthesia in a hospital operating room.\nTypes of Anesthesia\nWe provide local anesthesia for all procedures, using a combination of topical and injected medications to thoroughly numb the surgical site. You will be awake and aware throughout your surgery, and you can drive yourself home afterward. Local anesthesia can take a couple of hours to wear off following your procedure, so take care not to bite your lips, cheeks, or tongue. Also avoid hot or cold foods or beverages until the anesthesia wears off, as you will not be able to determine safe temperatures.\nNitrous oxide, or “laughing gas,” is a mild sedation option for those who just need to take the edge off. You will inhale a carefully calibrated blend of nitrogen and oxygen through a mask over your nose. You will remain awake and responsive, but will feel deeply relaxed, heavy, and a bit giddy or silly. Nitrous oxide wears off in minutes after the mask is removed, allowing you to safely drive home. It is a great choice for those who fear being out of control, as you can always remove the mask during the procedure if you start to feel uncomfortable.\nIV sedation is an extremely common option for oral surgery. You will enter a “twilight sleep” state, in which you can respond to our instructions during surgery, but you will remember little or nothing of your procedure afterward. You should not eat for eight hours before undergoing IV sedation, and you must bring someone to your appointment to drive you home. Do not drive or operate machinery for 24 hours after your procedure.\nGeneral anesthesia is typically administered only for serious, hospital-based procedures such as corrective jaw surgery. Do not eat or drink anything for eight hours before surgery. You will be unconscious for the procedure and then given time to wake up in a recovery room. Bring someone with you to drive you home and stay with you throughout the night. Do not drive or operate machinery for at least 24 hours, or longer if you still feel groggy.\nDental anesthesia allows us to provide our patients with the most relaxed and comfortable experience possible. We will go through your options with you before the day of your procedure and help you choose the one that is right for you.\nCall Rio Grande Oral Surgery & Dental Implant Center today at 505-821-2111 to schedule your first appointment. |
(marketed under the brand name Brevital\n) is a drug which is a barbiturate\nIt is classified as short-acting, and has a rapid onset of action. It is similar in its effects to sodium thiopental\n, a drug with which it competed in the market for anaesthetics\nMethohexital binds to a distinct site which is associated with Cl− ionophores\nThis increases the length of time which the Cl−\nionopores are open, thus causing an inhibitory\nMetabolism of methohexital is primarily hepatic (i.e., taking place in the liver) via demethylation and oxidation. Side-chain oxidation is the primary means of metabolism involved in the termination of the drug's biological activity.\nProtein binding is approximately 73% for methohexital.\nMethohexital is primarily used to induce anesthesia\n, and is generally provided as a sodium salt (i.e. methohexital sodium). It is only used in hospital\nor ambulatory care (i.e. in an ambulance) settings, under strict supervision.\nIt has been commonly used to induce deep sedation, "twilight sleep" or general anesthesia for oral surgery and dentistry. It is also used to induce anesthesia prior to ECT(electroconvulsive therapy). |
Septoplasty is a procedure designed to treat a deviated septum. In other words, it is used to straighten out the cartilage and bones that separate your nostrils. Some people are born with a deviated septum, and some people develop this condition after a traumatic facial injury. Regardless, it must be treated as soon as possible. Today, our experts at the office of Dr. Thomas S Higgins, MD, MSPH in Louisville, KY discuss everything you need to know.\nWhat Happens During a Septoplasty?\nDuring this procedure, your nasal septum will be trimmed if it is too wide. Then, your cartilage and bone will be repositioned. Depending on whether you were born with a deviated septum or developed one recently, we may also replace some of the cartilage and bone. If the structural damage to your septum is along your nose's bridge, we will graft extra cartilage from another part of your body and reinforce the cartilage currently supporting your septum.\nIs This Procedure Painful?\nNot really, patients often comment how little pain or discomfort they experience after this procedure. The procedure is usually performed under general anesthesia. It may be administered intravenously or it may be inhaled. Depending on the scope of your procedure, your health, and your personal preference, you may only require local anesthesia.\nGeneral anesthesia is ideal for many procedures because it numbs the entire body and puts you to sleep so you will not feel anxious during your procedure. Local anesthesia is administered into your nasal tissues via injection and numbs only the nose. If you would like to be sedated during your procedure, this will be done intravenously, but you will still be conscious. The intravenous sedation will only make you feel groggy.\nHow Should I Prepare for My Procedure?\nThere are several very important things you must do in preparation for your procedure. One of the most important things you can do pre-op is to stop smoking and drinking alcohol. It is so important to refrain from consuming alcohol and tobacco products because these products contain chemicals that elevate your blood pressure. Elevated blood pressure may affect your procedure and will slow down your recovery significantly.\nAnother very important thing you must do to prepare for your procedure is to ensure you are hydrated. The more hydrated you are, the smoother your procedure and recovery will go. Other important preparation steps include not taking NSAIDs, not taking fish oil supplements, and not taking garlic supplements. These drugs and supplements will thin your blood and may affect your procedure.\nWill I Have to Fast Before My Procedure?\nWe will advise you on whether you need to fast before your procedure during your initial consultation. If you are only receiving local anesthesia, there will be no need to fast.\nHowever, if you have general anesthesia, you must refrain from eating or drinking during the eight hours leading up to the time you are scheduled to arrive at our office. Note, you may drink clear liquids, like water up to two hours before your scheduled arrival time.\nWhat Happens After This Procedure?\nOnce your septum is repaired, we will use absorbable sutures to close the incisions. If your septum needs a little extra support during your recovery, we will insert a soft silicone splint into each nostril. Also, a bandage may be packed into your nose temporarily. Once all of that is done, we will move you to a recovery room and observe you for a few hours to ensure that your general anesthesia wears off enough.\nWhat Should I Expect During My Recovery Period?\nDuring the first 24 to 72 hours following your procedure, you should expect to feel pretty groggy. This is a natural response to sedatives regardless of whether you receive intravenous sedation or general anesthesia. Also, you will feel tired because it takes energy for your body to heal, which is what it will be concentrating on for a few days.\nHow Should I Care for Myself During My Recovery Period?\nThere are several things you must do to care for yourself during your recovery period. For instance, you must keep your head elevated above your head while you sleep. To accomplish this, you may want to sleep with a travel pillow under your neck, sleep with an extra pillow under your head, or sleep in a recliner. It is also highly advisable to wear dresses or button-up shirts so you don't have to pull anything over your head.\nFurthermore, it is very important that you avoid strenuous activities for up to two weeks post-op. If you have a strenuous job, we will meet with you when you start to feel like your old self to determine whether it is safe for you to go back to work.\nIs There Anything Else I Should Avoid Post-Op?\nYes, there are other post-operate restrictions. For instance, it is very important that you don't blow your nose for several weeks. If your nostrils feel itchy, you can spray a saline solution into your nostrils to relieve the itching. You can make your own sterile saline solution by boiling tap water and mixing salt and baking soda into it, or you can use distilled water that doesn't need to be boiled. You can also purchase nasal spray at your favorite pharmacy.\nOther things you should avoid during your recovery period include steaming hot water and foods, alcohol, spicy foods, and tobacco products. It is very important to keep your blood pressure normal while you recover.\nHow Long Will My Recovery Period Take?\nYou will only need to take a few days off from school, or you will only need to take a few days off from work if you have a sedentary job. If you have a strenuous job, you may need to take over a week off. We will bring you in for a follow-up appointment after your procedure to assess your recovery and advise you on how much of your routine you can get back to. As for complete recovery, you will only need to wait four to eight weeks.\nAm I a Good Candidate for This Procedure?\nTo determine whether septoplasty is right for you, it is important that you come in for an initial consultation. During this initial consultation, we will discuss your medical history, including any other procedures or treatments you have had in the area. We will also discuss your current health to ensure you are currently healthy enough to undergo this procedure.\nSeptoplasty is a procedure that will improve your breathing by trimming off any excess cartilage and bone, reposition your nasal septum as necessary, and replace any damaged cartilage. To find out if this procedure is right for you, visit the office of Dr. Thomas S Higgins, MD, MSPH in Louisville, KY for an initial consultation. We look forward to meeting you and helping you improve your breathing.\nThomas S. Higgins, MD, MSPH\nDad. Husband. Sinusitis Nerd.\nDr. Thomas S. Higgins, Jr.\nNasal surgery provides many benefits in the treatment of obstructive sleep apnea (OSA), says the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS). Nasal surgery is considered any surgery of the nasal passages to improve nasal breathing, such as septoplasty and inferior turbinate reduction. According to the AAOHNS Position Statement from September 8, 2017, here are four evidence-based benefits of nasal surgery in OSA.\n1. Nasal surgery improves the use of Continuous Positive Airway Pressure (CPAP), the mainstay treatment for OSA. Many people do not tolerate CPAP, often throwing the mask off in the middle of the night. A CPAP mask on the nightstand doesn't help at all!\n2. Nasal surgery may improve the use of oral appliances. Oral appliances are used to pull the jaw and/or tongue forward at night to open the airway. A couple of studies have shown that many of the people who are unable to tolerate such appliances are those with higher nasal resistance, so reducing nasal resistance could improve compliance.\n3. Nasal surgery improves quality of life in people with OSA. Two quality-of-life scales, the Epworth Sleepiness Scale and the SF-36, improve significantly after nasal surgery, with decreases in excessive sleepiness along with improved general health and mental health scores.\n4. Nasal surgery can reduce the severity of OSA in some people. A few studies, including a randomized control trial, showed improvement in OSA severity, after nasal surgery alone. These results certainly do not indicate that nasal surgery is the cure for OSA, but they do show direct beneficial effects of nasal surgery on OSA.\nThe evidence currently shows that nasal surgery provides benefit to OSA sufferers. Can it take away OSA? Usually not, but it can help make the treatment easier. Thanks for reading this article. Don't forget to check out other related topics, including septoplasty, inferior turbinate reduction, and functional endoscopic sinus surgery.\nRef: http://www.entnet.org/content/nasal-surgery-and-osas# (accessed 5/20/2018)\nTo see Dr. Thomas Higgins, a fellowship-trained Rhinologist (Sinus Specialist) with offices in Louisville, Kentucky and southern Indiana, click below or call.\nWelcome to Nose and Sinus News on www.higgins-sinus.com, where we post news, highlights, and interesting stories about nose and sinus disease! Check back often!\nAll Anosmia Antibiotics Aspirin Balloon Sinuplasty Chronic Sinusitis Covid 19 Covid-19 Dupixent Eustachian Tube Dysfunction General Is Covid 19 Vaccine Safe Nasal Surgery Nose Pandemic Pollutants Ragweed Rhinitis Septoplasty Sinusitis Diagnosis Sinusitis Treatment Sleep Sleep Apnea Smell Loss Summer Cold Vaccine Xolair\nKentuckiana Ear, Nose & Throat, PSC\n6420 Dutchman's Parkway, STE 380\nLouisville, KY 40205\nPhone: (502) 894-8441 |
Dentist in Lafayette, LA\nWhen looking for a place to relax, how often does your dentist’s office come to mind? If it doesn’t, then you haven’t experienced Dr. Thomas Sammons and Dr. Ann Laurent Dental Artistry.\nWhen you visit Dr. Sammons and Dr. Laurent, you will quickly discover a local family dentist that’s not a typical dental office–it more resembles an upscale spa. From the moment you enter, you smell our soothing aroma therapeutic candles and are happily greeted by one of our team members. Enjoy complimentary coffee, tea, and juices in our lobby coffee and juice bar area. We know that your time is a valuable commodity and we pride ourselves in honoring your busy schedule. Oh, and the daily fresh baked bread makes the office smell wonderful! We pride ourselves in helping patients overcome their dental anxiety and offer complimentary nitrous oxide to our patients. Oral sedation or IV sedation is also available. Once in the dental chair, patients are soothed with garden-window views, aromatherapy facial towels, pampered with paraffin hand wax, hand massages, and are provided with chenille throws. Also, customselected music with over ear headphones helps to mask many of the noises that are routine in a dental office.\nOur practice offers a full array of dental services and we pride ourselves in our cosmetic services. These services include both in-office and in-home whitening options, esthetic braces, smile makeovers, Botox, Juvederm, porcelain veneers, and composite (bonded) veneers. Fillings, crowns, bridges, and implants comprise our restorative procedures. In addition, we also offer root canals, oral surgery, dentures, TMD/TMJ services, and sedation dentistry. Let Dr. Sammons and Dr. Laurent transform your smile while you relax in comfort. Exceeding your expectations is our #1 goal!\nNew Patient Forms (will confirm with front office to get these on new letterhead) Before coming to your first appointment with us, we recommend patients fill out their paperwork ahead of time. You can download our PDF form to edit and then print, or you can email the edited form to our office [email protected]. Please bring driver’s license and insurance cards |
What should you DO and DON’T DO after your PDO Threads?\nYou have done PDO threads lift on eyes, cheeks, jawline, or a full face Or, maybe you want to have it done and want to know how the post-procedure would be.\nIt is always worth reinforcing that patients may instantly notice PDO Threads Lift before and after results following their procedure. However, complete results and improvements to skin firmness, volume, and rejuvenation can be seen approximately within 1 to 2 months post-procedure. However, to see full results it can take up to 6 months.\nThere is no downtime and no general anesthetic risks. The specialized needles allow small areas to be tackled effectively. As there are no incisions, stitches are not required and scarring is unlikely.\nThe recovery period for PDO Threads lift is approximately two weeks, but no downtime. Most of the restrictions and limitations will apply during the first 24 to 72 hours immediately following treatment. Unlike facelift surgery which uses general anesthesia, thread lift uses local anesthesia where numbing ends in a short time. Therefore, you can resume your routine like going to work or school immediately.\n- Do know that it is common to feel some temporary soreness or face swelling, and it will diminish within a week or two\n- Do manage any pain or discomfort by taking Ibuprofen if required.\n- Do sleep on your back. Sleeping on your back is also a natural anti-aging practice as it keeps your facial skin pulled tight.\n- Do keep the face clean as it is essential to avoid complications like inflammation.\n- Do eat well and keep hydrated by drinking plenty of water. Your body’s healing mechanism relies on a good diet., so eat well. You also need a good meal and water to keep your skin and body healthy.\n- Do moisturize. Even though the threads lift stimulates the production of collagen for a year or so, you need to take proper care of your skin for lasting beauty. Moisturizing is among the best ways to keep your skin glowing and youthful. Use high-quality moisturizers to protect your skin’s moisture barrier and take enough water to keep the skin hydrated. We recommend medical-grade skincare products like SkinCeuticals or ZO Skin Health.\n- Do not lay down either on your stomach or sides for 4 hours after the procedure to decrease the possibility of the movements of threads\n- Do not smoke or consume alcoholic beverages for 1-2 weeks. Smoking and drinking will slow down the healing process.\n- Do not apply skincare products/makeup for 24 hours post-treatment.\n- Do not exercise for 2 weeks. This includes all intense workouts. Walking is permitted.\n- Do not put makeup over the entry point for one to two weeks.\n- When washing the face after 24 hours, gently wash the required area with a cleanser and water, but do not rub or massage for 2 weeks.\n- Do not take extreme temperatures like a hot shower, hot tub, sauna, or excessive sun exposure for one week.\n- Do not over overstretch the treated area (i.e., open the mouth wide, aggressively or long chewing) for 4 weeks. Avoid dental treatment during this time if possible.\n- Do not take anticoagulants for 7 days. If you are taking prescribed anticoagulants such as aspirin must continue to do so but must be aware that bruising is more likely to happen.\n- Do not have any other aesthetic procedures, such as BOTOX and fillers, for 7 days.\n- Do not have radiofrequency, IPL, Laser, or other heat treatment near the treated area for 10 weeks.\nFollowing these instructions, the process will be more comfortable, and fast and provide minimum recovery time. However, each patient can have a different recovery journey. Proper “pre” and “post” care is essential to achieving optimal results from your Thread lift Treatment. If there are any outstanding questions please do not hesitate to call us. We want to ensure all of your questions are thoroughly answered.\nRSVP Beauty Clinic 604-971-0855 [email protected] |
Conservative periodontal treatments\nThe essential part of the periodontal treatment is the elimination of the causal factor, which means the removal of bacterial plaque adhering to the tooth surface. Oral hygiene treatment will only be successful in the long run if the patient prevents a repeating plaque formation by adequate toothbrushing and interdental cleaning techniques. The treatment includes: maintaining the individual oral hygiene by providing the necessary oral health education, the patient must be motivated and controlled by regular check-ups. In addition to plaque removal, the other plaque accumulating factors needs to be eliminated such as rough surfaces, abrasive filling edges, incorrect crowns and bridges. If the gum attachment is lost to the root surface, bacteria will also form plaque under the gum It is called pocket formation. If the depth of the pocket does not exceed 6 mm, removal of the bacterial plaque and calculus /scaling and polishing/ are performed. This treatment can only be made under local anesthesia. For this purpose, we use manual instruments and specific equipment (sonic and ultrasonic depurators and lasers). At the end of the treatment, the root surface debridement and polishing is important because the plaque is less likely to recolonize on the plain surface.\nSurgical periodontal treatments\nIf “blind” scaling ( the treated root surface is not visible) is not effective enough, a flap preparation (surgical removal of the gum) is needed. It is called an open curettage. After an effective scaling and polishing, the flap needs to be closed by stitches.\nGuided Tissue Regeneration (GTR)\nIf the depth of the bony pocket is more than 6 mm around the root, tissue grafting is necessary. The bone grafting material or materials helping tissue regeneration around the root will need to be protected by barrier membranes. |
Facial Plastic Surgeon - Munster, IN\nCongratulations on your decision to help yourself look as young as you feel! The Weekend Lift is a minor one-hour procedure with major results. It was exclusively designed for jowls, frown lines, wrinkles, and loose neck and facial skin. For many, recovery is quick – about the length of 1 weekend (1-3 days). Many have returned to work the next day! We describe it as a new procedure for a new generation without the costs, risks, and prolonged recovery associated with an extreme facelift.\nCall (219) 836-2201 today for a FREE consultation to see if you qualify for a Weekend Lift.\nIf you are looking for other facial rejuvenation procedures, you have come to the right place. Dr Cherukuri is a top Facial Plastic Surgeon in NorthWest Indiana and has been helping people look younger and feel better since 2003. He is an expert in minimally-invasive, no-downtime procedures that will help improve your appearance and get back on your feet as soon as possible.\nAdvantages of The Weekend Lift\n|Traditional Facelift||The Weekend Lift|\n|Anesthesia||General anesthesia with a ventilator and breathing tube\n|Surgical Time||4 - 6 hours||About 1 hour|\n|Risks/Complications||Heart attack, stroke, death (anesthesia), hair loss, large scars, paralysis of face, etc.||No major risks and tiny incisions|\n|Bruising/Swelling||Extensive bruising, swelling, often requiring drains under the skin, significant pain||Minimal bruising or swelling|\n|Downtime||Up to 1 month or more||1 - 3 days in many cases|\n|Final Appearance||An extreme makeover procedure, often resulting in a swept, wind-tunnel look (eg. Joan Rivers)||Natural appreaing results|\n|Cost||Up to $20,000 in NW Indiana and Chicagoland||Less than 75% of that|\nTo see if you qualify, call us today for a FREE Consultation at (219) 836-2201 ($100 value)!\nFree consultations may be subject to change. |
Improving operating room efficiency through process redesign\nABSTRACT Operating rooms (ORs) are important resources for patient care and revenue, yet a significant portion of OR time is taken up by nonoperative activities. We hypothesized that redesigning the process that occurs between operations would lead to a decrease in nonoperative time (NOT = room turnover time plus anesthesia induction and emergence time).\nFollowing a 3-month multidisciplinary planning process, a prospective study to reduce NOT was initiated in 2 of 17 ORs at a tertiary care academic medical center. Unlike previous reports, which have limited the number of participants, we constructed a process that was restricted only by case duration. The plan focused on minimizing nonoperative tasks in the OR, effecting parallel performance of activities, and reducing nonclinical disruptions. Eligible cases were those with an estimated operative time of 2 hours or less. A target NOT of 35 minutes was established. Cases of similar duration in the remaining ORs served as a concurrent control group.\nTwenty-three surgeons, 13 anesthesiologists, and 11 nurses worked in the project ORs over a 3-month period. Residents participated in all cases. There was a significant reduction in NOT (42.2 +/- 12.9 vs 65 +/- 21.7 minutes), turnover time (26.4 +/- 11.2 vs 42.8 +/- 21.7 minutes), and anesthesia-related time (16.9 vs 21.9 minutes, all P < .001) in the project rooms compared with cases of similar duration in control ORs. Process-related delays were identified in 70% of cases when NOT exceeded the 35-minute target.\nThese results demonstrate that a coordinated multidisciplinary process redesign can significantly reduce NOT. This process is applicable to most ORs and has optimal benefit for cases of 2 hours or less in duration. The high percentage of residual process-related delays suggests that further improvements can be anticipated.\nSourceAvailable from: Lizette Van Veen-Berkx[Show abstract] [Hide abstract]\nABSTRACT: Purpose - The purpose of this paper is to present the effect of the introduction of cross-functional team (CFT)-based organization, rather than, on planning and performance of OR teams. Design/methodology/approach - In total, two surgical departments of the Radboud University Nijmegen Medical Center (RUNMC) in the Netherlands were selected to illustrate the effect on performance. Data were available for a total of seven consecutive years from 2005 until 2012 and consisted of 4,046 OR days for surgical Department A and 1,154 OR days for surgical Department B on which, respectively 8,419 and 5,295 surgical cases were performed. The performance indicator "raw utilization" of the two surgical Departments was presented as box-and-whisker plots per year (2005-2011). The relationship between raw utilization (y) and years (x) was analyzed with linear regression analysis, to observe if performance changed over time. Findings - Based on the linear regression analysis, raw utilization of surgical Department A showed a statistically significant increase since 2006. The variation in raw utilization reduced from IQR 33 percent in 2005 to IQR 8 percent in 2011. Surgical Department B showed that raw utilization increased since 2005. The variation in raw utilization reduced from IQR 21 percent in 2005 to IQR 8 percent in 2011. Social implications - Hospitals need to improve their productivity and efficiency in response to higher societal demands and rapidly escalating costs. The RUNMC increased their OR performance significantly by introduction of CFT-based organization in the operative process and abandoning the so called functional silos. Originality/value - The stepwise reduction of variation - a decrease of IQR during the years - indicates an organizational learning effect. This study demonstrates that introducing CFTs improve OR performance by working together as a team.Journal of Health Organisation and Management 01/2015; 29(3):343-52. DOI:10.1108/JHOM-07-2013-0145 · 0.36 Impact Factor\n[Show abstract] [Hide abstract]\nABSTRACT: To determine the effect of local-only anesthesia on nonsurgical time compared with monitored anesthesia care (MAC)/local and general anesthesia. Our hypothesis was that local-only anesthesia cases would have lower nonsurgical times compared with MAC/local and general anesthesia. We retrospectively reviewed the surgical records of 1,179 patients undergoing elective hand surgery. For each case, we recorded the type of anesthesia used (general, MAC/local, or local-only anesthesia) and in-room presurgical time, in-room postsurgical time, and, if relevant, room turnover time. We did not record room turnover times for the first case of the day or for cases after procedures that did not meet inclusion criteria. We also recorded the presence of any anesthesia providers (anesthesiologist vs anesthesia-assistant [certified registered nurse anesthetist]). A total of 566 cases performed on 501 patients met inclusion criteria. Room turnover times were not calculated for 304 cases. The choice of anesthesia had a significant effect on nonsurgical operating room time. Local anesthesia cases had significantly less nonsurgical time compared with general anesthesia and MAC/local. Cases performed under MAC/local anesthesia also had significantly reduced nonsurgical time compared with general anesthesia. The presence of a certified anesthesia assistant had no effect on any time metrics recorded. Choice of local anesthesia, when appropriate, may facilitate rapid operating room turnover and improve overall facility efficiency with lower costs. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.The Journal of hand surgery 03/2015; DOI:10.1016/j.jhsa.2015.01.037 · 1.66 Impact Factor |
A SERIES of reports in the United States and Europe have linked Mycobacterium chimaera infections to contaminated heater-cooler devices used during cardiac surgery. Heater-cooler devices commonly are used for cardiopulmonary bypass during cardiac surgery. M. chimaera is a slow-growing nontuberculous mycobacterium that has been shown to cause cardiac complications that can lead to fatal disease following cardiac surgery. Given that more than 250,000 cardiothoracic surgical procedures requiring cardiopulmonary bypass take place each year in the United States, the estimated number of patient exposures to M. chimaera has prompted a public health crisis. The goal of this review is to summarize the present status of the M. chimaera outbreak and provide cardiothoracic surgeons, cardiac anesthesiologists, and other clinicians with current approaches to patient management and to discuss risk mitigation.\n- Mycobacterium chimaera\n- aerosolized bacteria\n- cardiac surgery\n- cardiopulmonary bypass\n- heater-cooler-associated infections |
Disgraced anesthesiologist gets a public tongue-lashing in absentia for patient’s death\nBruce Liberman’s “shocking” role in the death of liposuction patient Krista Stryland earned a public rebuke from a College of Physicians discipline panel — though he didn’t show up.\n|Report an Error|\nShare via Email\nA former anesthesiologist who contributed to the death of Krista Stryland was a no-show at a disciplinary proceeding where he was scheduled to be publicly reprimanded.\nBut a panel of the College of Physicians and Surgeons of Ontario nevertheless went ahead with its reprimand of Dr. Bruce Liberman on Tuesday and rebuked the former specialist for a litany of blunders that figured significantly in the 2007 death of the 32-year-old woman.\nSpeaking to Liberman as though he were present, panel chair Dr. Eric Stanton said a disciplinary committee was struck by his lack of insight in the hours that Stryland was under his care at the Toronto Cosmetic Clinic.\n“You failed to ensure that your patient was stable on entry to the recovery room. You did not adequately evaluate the signs that she was deteriorating. You failed to treat her deterioration appropriately,” Stanton said.\n“You failed to recognize the limitations of what could be done in your outpatient setting when adverse events occurred. You failed to call for help in a timely manner, even though a hospital was only a few minutes away. Your clinical decision-making and conduct were incomprehensible to the panel,” he continued.\nStryland, a mother and real estate agent, bled excessively following the surgery. The committee found that Liberman delayed calling 911, and when paramedics finally did arrive, they found Stryland lying in a pool of blood with no vital signs.\nSeparate disciplinary committees found both Liberman and Dr. Behnaz Yazdanfar — who actually did the liposuction — guilty of incompetence and professional misconduct.\nLiberman was stripped of his medical licence, while Yazdanfar had hers suspended for two years and was barred indefinitely from practising surgery.\nBoth appealed the disciplinary decisions to the Ontario Divisional Court.\nThis past June, the court dismissed Liberman’s appeal, paving the way for the public reprimand to proceed. The reprimand was intended to allow the committee and medical profession to express their abhorrence of Liberman’s actions and to serve as a deterrent.\n“These actions contributed to the fact that a young boy will grow up without his mother, and the other members of her family will miss out on her love and support and companionship,” Stanton said.\nHe said the disciplinary panel found it “shocking” that Liberman altered Stryland’s medical chart, removing his original resuscitation note and replacing it with another that downplayed her plummeting vital signs.\n“Such dishonesty and lack of integrity is completely inconsistent with what the public expects of physicians, and in fact, with what members of this profession expect of their peers,” Stanton said.\n- Federal budget to boost EI compassionate care leave\n- Pull comes to push as the EU wrestles with the migrant crisis\n- One dead after explosion levels house in Scarborough\n- How the police board selected a new chief\n- 'It was basically a death sentence’: Children victims of human smugglers\n- Appeals by five former drug squad officers in perjury case dismissed\n- How Hydro One ended up on the auction block: Cohn\n- Johnson will play key role for Raptors vs. Wizards |
Bispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients.\nBispectral index (BIS) is used for monitoring anaesthetic depth with inhaled anaesthetic agents in the operating room but has not been evaluated as a monitor of sedation depth in the intensive care unit (ICU) setting with these agents. If BIS could predict sedation depth in ICU patients, patient disturbances could be reduced and oversedation avoided. Twenty ventilator-dependent ICU patients aged 27 to 80 years were randomised to sedation with isoflurane via the AnaConDa[R] or intravenous midazolam. BIS (A-2000 XP, version 3.12), electromyogram activity (EMG) and Signal Quality Index were measured continuously. Hourly clinical evaluation of sedation depth according to Bloomsbury Sedation Score (Bloomsbury) was performed. The median BIS value during a 10-minute interval prior to the clinical evaluation at the bedside was compared with Bloomsbury. Nurses performing the clinical sedation scoring were blinded to the BIS values. End-tidal isoflurane concentration was measured and compared with Bloomsbury. Correlation was poor between BIS and Bloomsbury in both groups (Spearman's rho 0.012 in the isoflurane group and -0.057 in the midazolam group). Strong correlation was found between BIS and EMG (Spearman's rho 0.74). Significant correlation was found between end-tidal isoflurane concentration and Bloomsbury (Spearman's rho 0.47). In conclusion, BIS XP does not reliably predict sedation depth as measured by clinical evaluation in non paralysed ICU patients sedated with isoflurane or midazolam. EMG contributes significantly to BIS values in isoflurane or midazolam sedated, non paralysed ICU patients. End-tidal isoflurane concentration appeared to be a better indicator of clinical sedation depth than BIS.\nKey Words: bispectral index, BIS XP, correlation, electromyogram, AnaConDa\nOptimal sedation of intensive care unit (ICU) patients requires frequent evaluation of the patient's sedation level in order to avoid under- and oversedation, as well as prolonged ventilator care (1,2). Many sedation scales require frequent patient stimulation for evaluation--a disturbance that may arouse and agitate the patient and possibly contribute to subsequent psychological sequelae. While undersedation is normally easily observed, an objective, non-invasive method able to discriminate between adequate and excessive sedation without disturbing the patient would be useful.\nBispectral index[TM] (BIS) non-invasively measures the raw frontal encephalogram (EEG). The EEG is processed and converted to a scale between 0 and 100. Ideally, a score of 0 equals an isoelectric EEG and a score of 100 indicates a fully awake patient (3). BIS has gained acceptance as a non-invasive, objective monitor of anaesthetic depth during surgery and several studies describe its benefits in the operating room (4,7). Good correlation between responsiveness and BIS levels in healthy volunteers has been described during sedation with isoflurane, midazolam and propofol (8).\nBIS has also been considered for monitoring critically ill patients during intensive care (9-15). Studies of correlation between BIS and clinical sedation scales during intravenous sedation in the ICU have shown varying results (10-13). In earlier versions BIS values were more or less influenced by electromyogram (EMG) artifacts (12,16). According to the manufacturer, software and electrodes have been modified to reduce such artifacts in the latest available version (BIS[TM] A-2000 XP, version 3.12 and BIS[TM] QUATRO sensor) (3).\nThe use of isoflurane for sedation of ventilator-dependent ICU patients has been described previously (17-20). Comparisons with midazolam and propofol in adults have shown acceptable sedation effects and short wake-up times, without reported tolerance or withdrawal symptoms (17-19). A new, simplified method of administering isoflurane without a vaporiser, with low agent requirements and low ambient isoflurane levels may facilitate greater use of isoflurane for sedation in the ICU (19,20).\nWhile studies of previous and current versions of BIS during intravenous sedation in the ICU have not been conclusive, the reliability of BIS for inhaled agents in the OR setting makes it reasonable to examine whether the latest BIS version would be helpful in monitoring ICU patients receiving inhaled agents. BIS has not previously been evaluated for assessing sedation depth in critically ill patients sedated with isoflurane. If BIS could effectively predict clinical sedation depth in these patients, unnecessary arousal of the patient by repeated clinical evaluation of sedation depth could be reduced.\nWe hypothesised that BIS might correlate better with sedation level for ICU sedation with isoflurane than with intravenous agents. We therefore compared BIS and clinical sedation level during goal-directed sedation of 10 isoflurane-sedated patients and 10 midazolam-sedated patients. Our primary aim was to investigate if the latest available version of BIS could predict clinical sedation depth well enough to replace patient stimulation in measuring sedation depth.\nMATERIALS AND METHODS\nThe study was conducted at the General Intensive Care Unit at the Karolinska University Hospital Solna, Stockholm, Sweden. The study was approved by the local Ethics Committee for Human Research.\nPatients aged 18 to 80 years requiring ventilator support and with an expected need for sedation longer than 12 hours were eligible for the study. Patients were excluded if there was any evidence of overt encephalopathy or intracranial pathology, due to possible difficulty evaluating sedation depth or the potential risk of increasing intracranial pressure with isoflurane administration. Other exclusion criteria were family history of malignant hyperthermia, need for dialysis at inclusion, pregnancy, or continuous sedation administered for more than 18 hours prior to inclusion. After approval from the next of kin, patients were randomised to receive isoflurane sedation via the Anesthetic Conserving Device (ACD/AnaConDa[R], Sedana Medical AB, Sundbyberg, Sweden) or intravenous midazolam until extubation or for a maximum of four days.\nThe ACD is a modified heat-moisture exchanger, with properties facilitating simplified administration of isoflurane via a syringe pump and rebreathing (approximately 90%) of isoflurane. The sedation efficacy, agent saving property and environmental safety of this device in the ICU setting have been reported previously (19,20).\nAfter inclusion, the patient's forehead was wiped with alcohol and a BIS[TM] QUATRO (Aspect Medical Systems, Newton, MA, U.S.A.) four-electrode sensor was applied by one of the investigators. The sensor was connected to a BIS[TM] A-2000 XP (version 3.12) (Aspect Medical Systems, Newton, MA, U.S.A.) monitor and an automatic impedance test was performed, according to the manufacturer's instructions. After acceptable impedance had been confirmed by the BIS monitor, the monitor screen was covered to avoid nursing staff bias during clinical evaluation of sedation depth.\nOther sedatives were terminated and the study sedative administered. Isoflurane was initially infused to the ACD according to the manufacturer's recommended infusion rate to obtain an end-tidal concentration of 0.5% (1.0-3.5 ml/hour). Midazolam was initially infused in the dose range 0.02-0.05 mg/kg/hour. Infusion rates were thereafter adjusted by the patient's nurse in order to achieve the desired sedation level. When needed, a bolus dose of sedative was given. In the isoflurane group a bolus was given by increasing the infusion rate to 10 ml/hour for two minutes, while a bolus of 0.02-0.05 mg/kg was given in the midazolam group. If these bolus doses were not sufficient or if the patient needed a rapid increase of sedation, propofol 0.5 mg/kg was given. Morphine was given intermittently or by infusion for analgesia, according to patient need as assessed by the treating ICU physician.\nBloomsbury Sedation Score (Bloomsbury) shown in Table 1, is the standard sedation scale used in our General ICU (21) and therefore was incorporated in the study design.\nBloomsbury range -1 to +1 was considered the target interval for sedation unless the treating ICU physician specifically considered another interval desirable. Bloomsbury -2 and -3 imply deep sedation, indicating response only to painful stimuli or no response to pain. Sedative administration was increased or decreased by nursing staff in order to reach the target interval. Sedation level using Bloomsbury was assessed hourly by the patient's nurse.\nBIS, frontal EMG and Signal Quality Index (SQI) were measured with the BIS monitor continuously during the sedation period and downloaded for analysis. The EMG values are expressed in decibels (dB) and reflect frontal muscular activity. The manufacturer recommends that BIS readings be interpreted with caution when EMG values are above 50 dB due to a risk of excessive EMG affecting BIS values (3). The SQI is presented as a value between 0 and 100, where SQI values above 50 are stated to indicate reliable BIS readings (3).\nAs BIS values at the time of clinical assessment are likely to reflect the effect of the stimulation rather than the general pre-stimulation state, and because the aim of the study was to evaluate BIS as a predictor of clinical sedation depth, the median value of BIS over 10 minutes prior to the hourly clinical assessment was used in the analysis. All Bloomsbury observations with complete BIS data over the 10 minutes prior to clinical assessment were used for analysis. The BIS monitor was set in the "ICU mode", meaning that each presented online BIS value represents processed EEG information from the previous 30 seconds. (In the "Anaesthesia mode" sampling time is 15 seconds).\nDue to considerable variability in displayed BIS values noted by the investigators, BIS minute fluctuation was calculated as the mean difference between the maximum and minimum of the 60 BIS values displayed each minute.\nInspired and end-tidal fraction of isoflurane were measured continuously (Datex-Ohmeda AS 3 Compact, Datex-Ohmeda, Helsinki, Finland) and noted hourly in the isoflurane group.\nAs Bloomsbury is an ordinal scale, correlations between Bloomsbury and pre-stimulation BIS and between Bloomsbury and end-tidal isoflurane concentration were analysed with Spearman's rank sum. Individual coefficients for correlation between BIS and Bloomsbury were calculated in order to respect multiple observations in each individual. Correlation between EMG and BIS was analysed with Spearman's rank sum. Mean BIS variability was compared between groups with Student's t-test. Comparison of the proportions of episodes with BIS above 60 during deep sedation (Bloomsbury -2 and -3) for the different drugs was tested by logistic regression applying the Generalised Estimating Equation (GEE) method to account for repeated measurements within individuals. Morphine requirement was compared between groups with Student's t-test.\nPatient characteristics are described in Table 2. Age, APACHE II and diagnoses were similar in both groups.\nSedatives used prior to inclusion (3-15 hours of sedation) were propofol (4/10 in isoflurane group, 1 7/10 in midazolam group, M) or midazolam (6/10 in isoflurane group, 3/10 in midazolam group). For the final analysis there were 277 paired observations of Bloomsbury and BIS in the isoflurane group and 331 paired observations in the midazolam group. Due to a technical error, BIS data from two of the isoflurane sedated patients could not be retrieved (Patients 16 and 19).\nPoor correlation between BIS and Bloomsbury was found in both groups (Figure 1). The correlation coefficient (Spearman's rho) was 0.012 in the isoflurane group and -0.057 in the midazolam group, with the individual coefficients presented in Table 3.\nA significant correlation between Bloomsbury and end-tidal isoflurane was noted (Spearman's rho=0.47, P<0.0001) (Figure 2).\nThere was a strong correlation between BIS and EMG (Spearman's rho=0.74) in both groups (Figure 4). Mean SQI was generally high (Table 3), and EMG was within the range stated as acceptable by the manufacturer', with mean EMG levels not exceeding 50 dB in any patient (Table 3).\nThe mean minute BIS fluctuation ranged between 7.5 and 16.5 percent/minute (Table 3) and did not differ between groups (P=0.4).\nThere was a trend towards a greater proportion of BIS values above 60 during clinically scored deep sedation (Bloomsbury -2 and -3) in the midazolam group (43% of 186 observations) than in the isoflurane group (16% of 178 observations) with an odds ratio (isoflurane versus midazolam) adjusted for repeated measurements of 0.77 (95% CI: 0.54-1.09, P=0.14).\n[FIGURE 1 OMITTED]\n[FIGURE 2 OMITTED]\n[FIGURE 3 OMITTED]\n[FIGURE 4 OMITTED]\nThere was a trend towards higher morphine requirement in the midazolam group compared with the isoflurane group (4.4 mg/hour vs. 2.5 mg/hour, P=0.11).\nUsefulness in the ICU\nOur study indicates that BIS does not reliably predict sedation depth compared to clinical assessment during isoflurane or midazolam sedation in critically ill, non-paralysed patients. The poor predictive value of BIS is demonstrated with raw data in Figures 1 and 2 by the considerable overlap of BIS values across the range of Bloomsbury scores. In fact, none of the patients demonstrated good correlation between BIS values and Bloomsbury, with both positive and negative correlation coefficients in both groups (Table 3). In the isoflurane group individual correlation coefficients ranged between 0.0966 and -0.3123, in the midazolam group coefficients ranged between 0.4454 and -0.5121 (Table 3). While avoiding disruptive stimuli during sedation scoring would probably be beneficial, BIS monitoring in non-paralysed ICU patients receiving isoflurane or midazolam sedation does not seem sufficiently reliable to replace clinical scoring.\nOne explanation for the poor correlation between BIS and Bloomsbury could be that these two methods measure essentially different aspects of sedation. Sedation scales measure degree of responsiveness to external and at times somewhat noxious stimuli, while BIS has been developed empirically to measure more specifically the level of pharmacologically induced hypnosis and a related risk of awareness. Responsiveness and awareness during pharmacologically induced hypnosis are not identical phenomena (22,23).\nDuring deep sedation scored as Bloomsbury -2 to -3 (no response or response only to noxious stimuli), median pre-stimulation BIS values were above 60 in 43% of observations in the midazolam group and in 16% of clinically observed deep isoflurane sedation (P=0.14). In general anaesthesia practice, a BIS value of 60 is considered a threshold above which the risk of awareness is increased (24,25). High BIS scores during relatively deep sedation in ICU patients have been described previously (26). Determination of whether any patients with elevated BIS during deep sedation had recall from events during these episodes, or a high incidence of psychological sequelae after intensive care was not an objective of this study, but these questions deserve further exploration. It may be that the general use of opioid infusions contributes to this apparent discrepancy (4).\nAn alternative explanation for the lack of correlation between BIS and clinical sedation scoring in sedated ICU patients would be an essential difference in EMG contribution to BIS in sedated critically ill patients compared with patients under general anaesthesia, the population in which the original BIS algorithm was constructed.\nCorrelation between BIS values and facial EMG in the XP version of BIS has recently been described during intravenous sedation of ICU patients (26-28). Vivien et al demonstrated a mean BIS value reduction of 23% in sedated ICU patients when muscle relaxants were administered (27) and concluded that EMG disturbances may falsely elevate BIS values, resulting in a risk of oversedation when BIS is used for titrating sedation in ICU patients not routinely receiving muscle relaxants. Messner et al demonstrated with the BIS A-1000 monitor that the administration of a muscle relaxant in non-sedated healthy subjects led to the elimination of facial EMG and lowered BIS to values in the range of 33 to 64 and concluded that the use of muscle relaxants may result in falsely low BIS values by eliminating EMG activity, thus increasing the risk of awareness (29) and obviating the benefit for which BIS was developed. Our results with the latest available version of BIS during isoflurane sedation confirm previous findings of a close correlation between facial EMG and BIS values during intravenous sedation (27,28). BIS value interpretation (with the BIS XP version) is thus confused by EMG contribution in critically ill patients not receiving muscle relaxants, the significance and importance of this EMG contribution not being clear.\nGood experience during general inhalational anaesthesia led us to believe that BIS might perform better in the ICU with isoflurane use than with intravenous agents. To our knowledge, this is the first study examining such correlation during sedation with an inhalational agent and we did not find evidence that BIS correlates better to clinical sedation depth with inhaled sedation than with intravenous sedation.\nEnd-tidal concentration of inhaled agents is used daily in the OR as an indicator of anaesthetic depth. Analysis of correlation between sedation level and end-tidal isoflurane levels showed that end-tidal isoflurane concentration in fact appears to be better than BIS as a predictor of sedation depth (Figure 3). To our knowledge correlation between end-tidal concentrations of isoflurane and clinical measures of sedation depth in the critically ill has not been described earlier. However, correlation was not sufficiently strong (Spearman's rho=0.47) for end-tidal isoflurane concentration to replace clinical scoring in evaluation of sedation depth in ICU patients.\nOn-line BIS values are updated every second, with each presented value being calculated from EEG information over the past 15 or 30 seconds depending on intended use ('Anaesthesia mode" and "ICU mode"). In our study we used the "ICU mode". Despite the choice of sampling over 30 seconds the variability of displayed BIS values was relatively high; mean minute fluctuation, measured as the difference between the highest and lowest presented BIS value over each minute, was between 7.5 and 16.5 (Table 3). The manufacturers pre-programmed option of calculating BIS values over 15 or 30 seconds may be appropriate in the anaesthesia setting, for real-time detection of rapid changes in anaesthetic depth after drug boluses and changes in stimulation. With the given data, however, we speculate that sampling periods longer than 30 seconds might contribute to more stable BIS-values, perhaps more suitable during uneventful sedation periods in the ICU.\nThere is no universally accepted standard for how BIS should be used and interpreted during monitoring of sedation in the ICU. Including patient stimulation for BIS interpretation eliminates the potential advantage of avoiding painful stimulation that BIS offers. We chose to calculate the median BIS value over 10 minutes prior to stimulation, rather than a single value or a mean value over one minute or a mean value encompassing stimulation, methods other authors have used in evaluating BIS (12-14). In our view BIS should optimally--as most other online monitors--give valid information without requiring patient stimulation for interpretation.\nOne reason for using a median value over 10 minutes is that BIS values over one minute vary in the range of 10 to 15% (Table 3), making it difficult to choose a representative value. Secondly, using the median over 10 minutes reduces the impact of brief changes in BIS values, such as arousals from various stimuli in the ICU environment. Such changes in BIS may be of clinical interest, but they do not represent the baseline BIS level that potentially could replace patient stimulation for monitoring of sedation depth.\nThe Bloomsbury Sedation Score is not a widely used sedation scale. Our rationale for using Bloomsbury rather than a more widely known instrument was that it has been used for evaluating sedation depth in our unit for several years. Using a scale that was familiar to the nurses performing the clinical evaluation of the patients reduced misclassification and improved monitoring compliance. Bloomsbury is similar to the more commonly used Motor Activity Assessment Scale 30. Patient stimulation for evaluation is a common feature for both scales, as well as a similar, clear cutoff between adequate and deep sedation.\nThe distribution of observed sedation levels included relatively few ratings of too light sedation. Inadequate sedation is generally easily detected and BIS monitoring to avoid undersedation is probably superfluous. We included these data in the analysis for the sake of completeness but excluding the observations of too light sedation would not have affected correlation significantly.\nWe conclude that BIS XP (version 3.12) with its present performance does not reliably predict level of sedation as measured by clinical evaluation during isoflurane or midazolam sedation in non-paralysed, critically ill patients. During isoflurane sedation of critically ill patients, end-tidal isoflurane concentration correlates better to clinical scoring of sedation depth than BIS.\nSupported in part by Hudson RCI (supplied the Anesthetic Conserving Devices) and Abbott Scandinavia (supplied isoflurane). Supported by the Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital Solna.\nWe thank the nurses of the General ICU at the Karolinska University Hospital for their excellent clinical care of and help in monitoring the study patients. We also thank former Department Chair Dr Lars Irestedt and Dr Per Gannedahl for valuable advice.\nAccepted for publication on January 29, 2007.\n(1.) Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999; 27:2609-2615.\n(2.) Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477.\n(3.) Kelley SD, Aspect Medical Systems[R]. Monitoring level of consciousness during anesthesia and sedation. A Clinician's Guide to the Bispectral Index[R]. From http://www.biseducation. com/assets/collaborate/2005/10/16/complete bis handbook. pdf. Accessed February 2007.\n(4.) Sebel PS, Lang E, Rampil IJ, White PF, Cork R, Jopling M et al. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg 1997; 84:891-899.\n(5.) Guignard B, Coste C, Menigaux C, Chauvin M. Reduced isoflurane consumption with bispectral index monitoring. Acta Anaesthesiol Scand 2001; 45:308-314.\n(6.) Luginbuhl M, Wuthrich S, Peterson-Felix S, Zbinden AM, Schnider TW Different benefit of bispectal index (BIS) in desflurane and propofol anesthesia. Acta Anaesthesiol Scand 2003;47:165-173.\n(7.) White PF, Ma H, Tang J, Wender RH, Sloninsky A, Kariger R. Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology 2004; 100:811-817.\n(8.) Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86:836-847.\n(9.) Shapiro BA. Bispectral Index: better information for sedation in the intensive care unit? Crit Care Med 1999; 27:1663-1664.\n(10.) Simmons LE, Riker RR, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. Crit Care Med 1999; 27:1499-1504.\n(11.) Frenzel D, Greim CA, Sommer C, Bauerle K, Roewer N. Is the bispectral index appropriate for monitoring the sedation level of mechanically ventilated surgical ICU patients? Intensive Care Med 2002; 28:178-183.\n(12.) Nasraway SA Jr, Wu EC, Kelleher RM, Yasuda CM, Donelly AM. How reliable is the Bispectral index in critically ill patients? A prospective, comparative, single-blinded observer study. Crit Care Med 2002; 30:1483-1487.\n(13.) De Deyne C, Struys M, Decruyenaere J, Creupelandt J, Hoste E, Colardyn E Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients. Intensive Care Med 1998; 24:1294-1298.\n(14.) Riker RR, Fraser GL, Simmons LE, Wilkins M. Validating the sedation-agitation scale with the Bispectral Index and visual analog scale in adult ICU patients after cardiac surgery. Intensive Care Med 2001; 27:853-858.\n(15.) Gilbert TT, Wagner MR, Halukurike V, Paz HL, Garland A. Use of bispectral electroencephalogram monitoring to assess neurologic status in unsedated, critically ill patients. Crit Care Med 2001; 29:1996-2000.\n(16.) Bruhn J, Bouillon TW, Shafer SL. Electromyographic activity falsely elevates the bispectral index. Anesthesiology 2000; 92:1485-1487.\n(17.) Kong KL, Willatts SM, Prys-Roberts C. Isoflurane compared with midazolam for sedation in the intensive care unit. BMJ 1989; 298:1277-1280.\n(18.) Millane TA, Bennett ED, Grounds RM. Isoflurane and propofol for long-term sedation in the intensive care unit. A crossover study. Anaesthesia 1992; 47:768-774.\n(19.) Sackey PV, Martling CR, Granath F, Radell PJ. Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med 2004; 32:22412246.\n(20.) Sackey PV, Martling CR, Nise G, Radell PJ. Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device. Crit Care Med 2005; 33:585-590.\n(21.) Armstrong RF, Bullen C, Cohen SL, Singer M, Webb AR. Critical care algorithms. Sedation, analgesia and paralysis. Clin Intensive\nCare 1992; 3:284-287.\n(22.) Andres AH, Walk CB, Meywirth E, Milkereit E. Awareness under remifentanil-propofol anaesthesia. Anaesthesist 2005; 54:1000-1004.\n(23.) Barr G, Anderson RE, 0wall A, Jakobsson JG. Being awake intermittently during propofol-induced hypnosis: A study of BIS, explicit and implicit memory. Acta Anaesthesiol Scand 2001; 45:834-838.\n(24.) Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48:20-26.\n(25.) Myles PS, Leslie K, McNeil J, Forbes A, Chan MTV Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004; 363:17571763.\n(26.) Ely EW, Truman B, Manzi DJ, Sigl JC, Shintani A, Bernard GR. Consciousness monitoring in ventilated patients: bispectral EEG monitors arousal not delirium. Intensive Care Med 2004;30:1537-1543.\n(27.) Vivien B, Di Maria S, Ouattara A, Langeron O, Coriat P, Riou B. Overestimation of Bispectral Index in sedated intensive care unit patients revealed by administration of muscle relaxant. Anesthesiology 2003; 99:9-17.\n(28.) Tonner PH, Wei C, Bein B, Weiler N, Paris A, Scholz J. Comparison of two bispectral index algorithms in monitoring sedation in postoperative intensive care patients. Crit Care Med 2005; 33:580-584.\n(29.) Messner M, Beese U, Romstock J, Dinkel M, Tschaikowsky K. The bispectral index declines during neuromuscular block in fully awake persons. Anesth Analg 2003; 97:488-491.\n(30.) Devlin J, Boleski G, Mlynarek M, Nerenz DR, Peterson E, Jankowski M et al. Motor Activity Assessment Scale: A valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 1999;27:1271-1275.\nP. V. SACKEY *, P. J. RADELL ([dagger]), F. GRANATH ([double dagger], C. R. MARTLING ([section])\nGeneral Intensive Care Unit, Karolinska University Hospital Solna, Stockholm, Sweden\n* M.D., Ph.D., Specialist in Anaesthesiology and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital Solna and Institution of Physiology and Pharmacology, Karolinska Institute.\n([dagger]) M.D., Ph.D., Head, Department of Paediatric Anaesthesia and Intensive Care, Astrid Lindgren Children's Hospital and Institution of Physiology and Pharmacology, Karolinska Institute.\n([double dagger]) Ph.D., Senior Statistician, Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna.\n([section]) M.D., Ph.D., Consultant, Head of General Intensive Care Unit, Department of Anaesthesia and Intensive Care, Karolinska University Hospital Solna and Institution of Physiology and Pharmacology, Karolinska Institute.\nAddress for reprints: Dr P V Sackey, Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden. [email protected]\nTABLE 1 Bloomsbury sedation score 3 Agitated and restless 2 Awake and uncomfortable 1 Aware but calm 0 Roused by voice, remains calm -1 Roused by movement or suction -2 Roused by painful stimuli -3 Unrousable A Natural sleep TABLE 2 Patient characteristics Patient Gender I = isoflurane M = male Age APACHE * M = midazolam F = female (years) II Score I 1 F 39 14 I 2 F 64 30 I 3 F 67 17 I 4 F 44 31 I 5 F 79 32 I 6 F 41 8 I 7 M 61 20 I 8 F 72 16 I 9 M 76 30 I 10 M 58 13 M 1 F 27 23 M 2 F 58 18 M 3 M 62 15 M 4 F 65 32 M 5 M 57 18 M 6 M 31 12 M 7 F 73 26 M 8 F 67 14 M 9 M 57 17 M 10 M 80 23 Patient BIS I = isoflurane monitoring M = midazolam (hours) Main diagnosis I 1 14 Delayed extubation I 2 12 Sepsis I 3 75 Airway obstruction (tumour) I 4 60 Multiple trauma I 5 65 Sepsis I 6 19 Thoracic trauma I 7 59 Pneumonia I 8 14 Delayed extubation I 9 88 Postoperative pneumonia I 10 63 Abdominal trauma M 1 96 Sepsis/endocarditis M 2 5 Intestinal perforation M 3 17 Sepsis M 4 95 Sepsis M 5 52 Pancreatitis M 6 57 Thoracic trauma M 7 87 Peritonitis M 8 15 Delayed extubation M 9 96 Thoracic trauma M 10 3 Pneumonia * APACHE: Acute Physiology and Chronic Health Evaluation. TABLE 3 Drug doses, BIS monitor data and correlation for each patient Mean end-tidal isoflurane Patient concentration Mean morphine Correlation I = isoflurane (%) and midazolam requirement coefficient M = midazolam dose (mg/h) (mg/h) BIS-Bloomsbury I 1 0.28 0 -0.1613 I 2 0.27 4.6 0.0584 I 3 0.37 2.6 -0.0899 I 4 0.27 6.1 -0.0496 I 5 0.24 1.0 -0.3123 I 6 0.30 2.5 * I 7 0.32 2.6 -0.1652 I 8 0.13 2.4 0.0966 I 9 0.23 1.8 * I 10 0.24 1.5 -0.0626 M 1 7.6 8.6 0.3645 M 2 7.0 0.0 -0.4454 M 3 7.6 4.6 0.2498 M 4 4.2 2.6 0.2730 M 5 8.1 0.0 0.3688 M 6 8.5 8.1 0.4454 M 7 0.2 1.8 ** M 8 3.2 5.8 -0.5121 M 9 4.4 7.7 -0.1096 M 10 8.0 5.0 ** Patient I = isoflurane BIS minute Mean Signal Mean EMG M = midazolam fluctuation (%) Quality Index value (dB) I 1 13.8 93 34 I 2 12.3 95 29 I 3 14.2 94 33 I 4 13.6 96 36 I 5 14.6 93 35 I 6 * * * I 7 15.2 93 34 I 8 14.8 95 38 I 9 * * * I 10 15.4 90 34 M 1 12.8 92 29 M 2 16.4 93 46 M 3 11.9 93 35 M 4 14.4 95 39 M 5 16.5 93 35 M 6 14.8 87 36 M 7 10.5 94 44 M 8 13.7 92 44 M 9 14.9 92 33 M 10 7.5 89 44 * BIS, SQI and EMG data not retrievable due to technical error. ** Spearman's rho not calculated due to unchanged Bloomsbury sedation score.\n|Printer friendly Cite/link Email Feedback|\n|Title Annotation:||intensive care unit|\n|Author:||Sackey, P.V.; Radell, P.J.; Granath, F.; Martling, C.R.|\n|Publication:||Anaesthesia and Intensive Care|\n|Article Type:||Clinical report|\n|Date:||Jun 1, 2007|\n|Previous Article:||Impact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass.|\n|Next Article:||In vivo validation of the M-COVX metabolic monitor in patients under anaesthesia.|\n|Current depth of anaesthesia monitors: jacks of all trades and masters of none?|\n|Reduced midazolam clearance must be considered in prolonged coma.|\n|Conscious sedation for difficult intubation in children.| |
Why Choose Iran And Cost Comparison\nThighplasty is a leg surgery used to tighten, shape and symmetrise the thighs along with proportioning them with the rest of the body.\nThighplasty surgery in Iran is a cosmetic surgery that aims to remove loose thighs, straighten the thighs and improve the appearance of the thighs in general. This method can be used inside or outside the thigh. The popularity of thigh lift in Iran is increasing due to its significant effects.\nIn a thigh lift, extra skin and extra tissues are removed to achieve the goals. If severe weight loss has caused excess skin on your thighs or you have failed to achieve your ideal weight through diet and exercise, thigh lift surgery is a great way to look your best.\nIn this article, we try to have a general overview about thighplasty in Iran. We will examine things such as the cost, methods, the right candidates, benefits, aftercare in Iran and possible side effects.\nThe average cost of plastic surgery or facelift in the United States is $ 5,000. Of course, the exact price depends on the following:\nTake a look at the charts below to compare thighplasty prices in Iran with the rest of the world.\nThighplasty has become one of the most popular cosmetic treatments in the world. It takes an average of 2 to 4 weeks to fully heal. The treatment is carried out under general anesthesia and in 10 days time the candidate can resume work. The surgery itself takes 2 – 3 hours.\nIt is no secret that the thigh plays an important role in a person’s appearance. Thigh lift is a cosmetic surgery that enhances the appearance of the thighs by removing excess skin and tissue in the area. This will make your skin and the shape of your thighs smoother and younger. In addition to relieving sagging skin due to severe weight loss or aging, it can also eliminate the symptoms of skin stretching caused by weight gain.\nThigh lift surgery can be performed in conjunction with other cosmetic procedures. The most common of these are tummy tuck or brazilian butt lift surgery. Simultaneous liposuction may be very effective in achieving a more beautiful appearance too.\nThere are several methods for thigh lift. Our doctors in Medpaltrip choose the best method according to your needs and characteristics. These methods are categorized based on the shape and size of the incisions they make on your skin.\nTypes of thigh lift methods in Iran include the following:\nInternal or Medial Thighplasty\nThe most common method of thigh lift is usually chosen by the surgeon for people who have loose skin after severe weight loss or have resistant fat inside their thighs. In this method, an incision is made in the groin that extends to the crease of the buttocks in the back. Vertical incisions may also be made in the lower thigh as needed for greater access.\nMini Thigh Lift\nIf the sagging skin is only in the upper thigh, the surgeon may choose this method. The mini thigh lift is actually an internal thigh lift that only makes small incisions in the groin. The recovery period in this method is shorter.\nBilateral Thigh Lift\nIn this procedure, the surgeon makes an incision in the upper thigh at the junction of the abdomen and legs that extends toward the buttocks as needed. After removing the excess skin, the surgeon closes the remaining skin tightly, creating a smooth skin.\nVertical Thigh Lift\nThis method is usually used to remove large amounts of skin and extra tissue in the thigh.\nThigh Lift With Liposuction\nIn some cases, the elasticity of your skin may be reduced. In this method, liposuction removes excess fat from under your skin and prevents the skin from sagging after the operation.\nMost people who are after achieving a beautiful appearance on their thighs may undergo thighplasty; however, they must meet the following conditions:\nThe following people should avoid this procedure:\nThigh lift surgery takes between 2-4 hours and only requires local anesthesia. Some candidates require hospitalization the night before at the doctor’s discretion to control his diet and take the necessary medications.\nOn the day of the operation, your surgeon will draw lines on your skin according to the purpose and previous conversations in the operation room.\nNext, the anesthesiologist will anesthetize you. After anesthesia, the surgeon will make incisions in your thigh depending on the purpose and method of surgery. In the internal surgical method, the surgeon will make an incision from the junction of the thigh to the pubic area and extends to the crease of the hip. In the mini-fiber method, the surgeon makes a small incision in the thigh area. As for the vertical method, the surgeon makes an incision from the groin to the top of the knee. In the external or external method, it creates an incision in the area where the lower limb connects to the abdomen, which is similar to the letter V.\nAfter making an incision and removing the extra skin and tissue, the surgeon closes the remaining skin tightly. It may be necessary to insert tubes attached to the drain (bag-shaped device to remove secretions) under your skin to remove the secretions under your skin. After the operation, the patient may need to hospitalization for at least one night.\n24 Hours After Surgery\nYou must be able to walk before being discharged from the hospital.\n2 to 3 Weeks After Surgery\nAfter The First Month\nThe results of thigh lift surgery will last for the rest of your life. But since the shape of the thigh changes over time, especially with weight, you should maintain your weight.\nSimilar to other surgeries thigh lift surgery may have side effects. These are not serious or permanent. These side effects include:\nThe accumulation of fluid under the skin. Doctors usually insert a drain to prevent this complication.\nCertain scar marks may occur on the skin which will disappear in a couple of weeks.\nBruising and Swelling\nBruising and swelling is normal and resolves spontaneously up to 2 to 3 weeks after surgery.\nBe sure to tell your doctor if you have a fever above 38 degrees, heat and pain on touching the surgical site, yellow and purulent discharge from the area, and pain that does not improve with painkillers.\nThis usually occurs right after and 2 to 3 weeks after surgery. Make sure you see your doctor if bleeding prolongs.\nOther complications may occur and resolve on their own. |
Nonsurgical cosmetic treatments continue to increase in popularity, especially facial fillers, Botox®, liquid facelift, and laser treatments. These nonsurgical treatments have some advantages since they can be started at a younger age, may help "hold off" the facelift, or be continued after facial surgery to help maintain a refreshed and younger appearance. What is a facial filler? Facial fillers …Read More\nHoutan Chaboki, MD\n2311 M Street, N.W. Suite 501\nWashington, DC 20037\nPhone: (202) 800-2085\nMonday - Friday: 8 a.m.–4 p.m.\nMonthly Archives: July 2017\nWashington DC plastic surgery patients consider many factors when deciding on facial cosmetic surgery, and the type of anesthesia is a frequent question during consultation with a plastic surgeon. The decision on anesthesia is determined by multiple factors, including specific procedure, patient preference, and physician preference. Regardless, safety is always the primary factor. Anesthesia is generally …Read More\nThe photo gallery of any cosmetic surgery's practice website is the most popular area. Seeing before and after cosmetic surgery photographs is popular for a variety of reasons. Prospective patients want to see potential results with their eyelid or facelift surgery. Washington DC patients enjoy seeing others with rejuvenated necks and eyes and anticipate their own improvements …Read More\nTraditionally, many often think that a surgical facelift is required to significantly improve one's appearance. Office injections with Botox® and facial fillers can achieve temporary changes as part of a liquid facelift or nonsurgical facelift, but cosmetic surgery is required for a long-lasting and dramatic improvement. More importantly, patients with significant skin laxity need cosmetic surgery …Read More\nSubscribe To Our Blog\nGet the latest news and updates from our blog in your inbox. |
Heart Attacks and Tennis Matches\nIt was just like any other day when Abe Awabdy and John Vitaliti headed for the varsity tennis courts at Cedarville University on July 8, 2022. The two have been playing tennis together for 15 years, so this is a rather common occurrence for them. But on this particular day, Abe and John were in the middle of their tennis match when John turned around to see his partner flat on his back in cardiac arrest.\nJohn, an experienced anesthesiologist, sprang into action and began performing cardiac compression. John continued cardiac compressions until help arrived. Don Parvin, security operations manager at Cedarville, brought life-saving supplies, and John administered the defibrillator to Abe. His pulse came back, and he began to move again. Abe made a miraculous recovery thanks to the action of his tennis partner and the first responders at Cedarville University.\nAccording to national statistics, only 12% of people survive the type of heart attack that Abe experienced. God used unexpected circumstances to ensure the right people were at the scene when Abe needed help. Abe’s recovery has given him and his wife, Judy, a renewed sense of thankfulness for life and their family.\nListen as Abe, John, and Judy share the story of the frightening experience.\nPosted in: Podcast |
Placentia, California–Exciting Anesthesiologist Opportunities in Southern CA! Enjoy the beach and the So Cal lifestyle!\nEnvision Physician Services has outstanding immediate opportunities for BC trained anesthesiologists in Placentia, CA.\n- Excellent, competitive ($420k plus) compensation package\n- 114 acute care beds\n- IC- productivity plus call stipends\n- Leadership and educational opportunities\n- All MD model comprised of 8 physicians\n- Bread and butter practice, no OB\n- No trauma, heads, or hearts\n- Lifestyle practice near So Cal beaches where you can earn a great income\n- Call from home, no inhouse call\n- No buy in-treated as an equal from day on!\nEnvision Physician Services (www.envisionphysicianservices.com) is America’s leading medical group providing anesthesiology, emergency medicine, hospital medicine, radiology, surgical services, and women’s and children’s health services to more than 1,800 clinical departments in 44 states and D.C. We lead the delivery of care by treating patients when and where they need us most.\nLocated in Placentia in northern Orange County, the 114-bed, acute-care hospital provides inpatient and outpatient services including 24-hour emergency care; a separate surgical pavilion; gastrointestinal, wound care and imaging centers; and urgent-care clinics.[Register to View]\nPlacentia is a city in northern Orange County, California. The population is approximately. 50,533 which includes the community of Atwood, which is included in the city of Placentia. Primarily referred to as a bedroom community, Placentia is known for its quiet neighborhoods.\nIn 1971, Placentia was honored with the prestigious "All America City" Award, given out annually by the National Civic League to ten cities in the United States. |
On January 25th, 2018, there was a driver of a van backing into a parking space in Brooklyn when all of a sudden the driver heard a noise and got out of the vehicle to see what had happened. When the driver got out, he realized that he hit Chris and pinned him against another van parked behind him! Chris stepped off the curb near Gates Avenue and Tompkins Avenue when the van reversed into him. Chris felt dazed and briefly remembered “seeing stars” right after getting hit. He was taken by ambulance to a Brooklyn hospital for evaluation, treatment, and sent home with medication.\nAs a result of the accident, Chris suffered injuries to his right knee, neck, lower back, left shoulder, and left hand. He suffered multiple disc herniations and bulges in his neck and lower back. Additionally, Chris strained/sprained his left shoulder and left hand when he was hit. He received extensive care that included chiropractic treatment, physical therapy, acupuncture therapy, and additional care. Despite treatment, Chris was required to have surgery under general anesthesia to repair his right knee tear on June 20th, 2018. He was unable to work for approximately four weeks.\nChris was listening to the radio when he heard Adam Handler! He called our team and decided to make his one chance for financial compensation count by choosing The Case Handler team. Unfortunately, Chris had a prior accident in 2006 that also required him to get right knee surgery. Prior accidents with similar injuries is NOT a case most lawyers would want to take, but The Case Handler lawyers are NOT like most lawyers. With the help of our experienced Brooklyn injured pedestrian lawyer at Pollack, Pollack, Isaac & DeCicco, LLP, we successfully recovered a $150,000.00 settlement for Chris! |
The drug "Ketamine": instructions for use, description, composition\nHistory of creation\nA substance called “Ketamine” was first synthesized in 1962 by the American researcher Kelvin Stevens. The scientist worked at Parke-Davis, trying to find a safe anesthetic formula that could be an alternative to phencyclidine, which had a number of dangerous side effects (the drug caused hallucinations, could trigger an epileptic seizure, and was neurotoxic).\nThree years later, Ketamine, then known under the working title CI-581 (clinical investigation 581), was first tested in practice. After the first use in the clinic, the drug was used by American military personnel who served in Vietnam in the late 1960s. In 1970, when Ketamine in the United States was allowed to be widely used, the drug became the first non-inhalation anesthetic, with the introduction of which there was a minimal effect on blood circulation and respiration.Subsequently, the drug began to be actively used in psychiatry.\nThe use of Ketamine was significantly reduced due to deaths that were identified between 1987 and 2000 in the United States and European countries. The dead applied the drug in a dosage that was much higher than recommended, due to some side effects of the drug. The fact is that “Ketamine” by that time had acquired dubious popularity as a drug after the publication of the books “Journey to the Bright World” by Marcia Moore and Howard Altounian, and “The Scientist” by John Lilly. Nowadays, the drug is used primarily in veterinary medicine and as an anesthetic in military medicine (in developing countries).\nUse in the Soviet Union and Russia\nIn the USSR, the first studies related to the use of "Ketamine" in the treatment of alcoholism and drug addiction, in the mid-1980s, Yevgeny Krupitsky began to conduct. The work, which lasted for about two decades, was discontinued due to the tightening of Russian legislation. Since the early 1990s, against the background of the emergence in our country of so-called psychedelic literature, Ketamine has become increasingly used as a narcotic drug.\nAccording to the Federal Law of 08.01.1998 No. 3-FZ “On Narcotic Drugs and Psychotropic Substances”, the drug was included in the list of psychotropic drugs. Five years later, when the Federal Drug Control Service was created, and the law made a number of amendments, the use of Ketamine in veterinary medicine sharply decreased in Russia.\nNow the use of this drug for medical purposes is strictly regulated, penalties are imposed for breaking the rules. "Ketamine" can be used only by licensed institutions, including veterinary. The drug should be stored in a safe equipped with dual alarms.\nIn the past, domestic veterinarians widely used "Ketamine" as an anesthetic. The forced refusal of most specialists from the drug, which proved to be one of the most effective and at the same time soft anesthetics, provoked a lot of protests from animal protection, pet lovers and pet owners, as well as veterinarians themselves. However, government agencies have not listened to their arguments for the past ten years.\nComposition and release form\nThe active ingredient of the drug is NMDA antagonist ketamine (in the form of hydrochloride).The drug is made in the form of a solution intended for intravenous and intramuscular administration.\nKetamine is available in 5 ml vials. 1 ml of solution contains 250 mg of the active substance. The bottle is packed in a pack of cardboard.\nKetamine is a remedy for non-inhalational anesthesia. In some cases, the drug is used as an analgesic (mainly in emergency medicine and in patients who cannot be prescribed opioid analgesics and barbiturates), as well as for the treatment of bronchospasm.\nBeing a noncompetitive antagonist of direct-acting NMDA receptors (blocking the ion channel of receptors), Ketamine is able to exert an inhibitory effect on the function of the neurons of the associative cortex and thalamus responsible for switching sensory impulses from the reticular activating system to the cortex of the large hemispheres.\nAt the same time, Ketamine has a stimulating effect on the part of the limbic system involved in the awareness of sensations, including the hippocampus. As a result, the patient develops functional disorganization of non-specific connections in the midbrain and thalamus (dissociative anesthesia).Clinically, this is expressed as follows: the patient looks awake, he is able, in particular, to swallow and open his eyes, but loses the ability to analyze sensory stimuli, reacting adequately to them.\nIn the course of research, it was previously confirmed that Ketamine has the ability to bind to opioid receptors in the brain and horny horns of the spinal cord. It is assumed that this explains the analyzing effect of the drug.\nA higher level of ketamine activity in relation to the cortex than the thalamus may be due, probably, to an uneven distribution of NMDA receptors in the central nervous system.\nAfter a single intravenous administration of Ketamine, the narcotic effect usually occurs within 30-60 seconds and lasts for 5-10 minutes (sometimes up to 15 minutes).\nWith intramuscular use of the drug in the dosage of 4-8 mg / kg, Ketamine takes effect in 2-4 minutes (up to 6-8 minutes). The effect lasts 12-25 minutes (sometimes up to 40 minutes).\nThe pronounced analgesic effect of Ketamine can last for up to two hours. After the introduction of the drug, the patient has pharyngeal, laryngeal and cough reflexes, the level of independent pulmonary ventilation remains adequate.\nAfter the introduction of "Ketamine", entering the group of lipophilic compounds, is quickly distributed to organs well supplied with blood, including the brain. Then the tool begins to be redistributed in tissue with a low level of perfusion.\nMetabolized drug in the liver. The half-life of the drug is usually from two to three hours. The patient's body "Ketamine" leaves mainly through the kidneys in the form of conjugated metabolites.\nIn modern medicine, the drug "Ketamine" is used:\n- for introductory and basic anesthesia for short-term surgical interventions, regardless of whether muscle relaxation is required;\n- during painful instrumental and diagnostic procedures;\n- when transporting patients;\n- when processing burn surfaces.\n"Ketamine" is appointed by the attending physician on an individual basis, taking into account the indications, the patient's age, the clinical situation and the drugs used for premedication.\nFor intravenous administration, a single dosage is usually 0.5–4.5 mg / kg, and a formula of 4–13 mg / kg is usually used for administration to a muscle.\nIn patients who are prescribed the drug "ketamine", various undesirable effects can be observed. The most common ones are:\n- on the part of the cardiovascular system: increased blood pressure, tachycardia;\n- on the part of the digestive system: salivation (hypersalivation);\n- on the part of the central nervous system: psychomotor agitation and hallucinations (when leaving anesthesia);\n- respiratory system: shortness of breath, respiratory depression;\nIn extremely rare cases, local reactions may occur - painful sensations at the injection site and hyperemia along the vein.\nThe drug "Ketamine" does not apply if the patient is diagnosed with:\n- disorders of cerebral circulation;\n- arterial hypertension;\n- angina and heart failure (in the phase of decompensation);\n- preeclampsia and eclampsia;\n- epilepsy in childhood.\nAfter the appointment of "Ketamine" patients are recommended to refrain from driving vehicles and other potentially dangerous activities that require a high level of concentration and quick reactions, at least during the day.\nGiven the ability of Ketamine to penetrate the placental barrier, and research on the efficacy and safety of the drug in pregnant women has not yet been conducted, the use of the drug in patients in this category is not recommended.\nHow to restore health after the holidays: 6 important recommendations\nWhat lipstick suits brunettes\nHuman ambition and ambition\nAmigurumi bunny in a hat with a hook\nWhy are fools lucky\nHow to put in the bath acrylic liner\nWhat she made of 4 pillow cases, is useful to everyone |
FaceTite is a totally non-surgical skin tightening procedure that uses precise and targeted radiofrequency (RF) energy to tighten the skin from within the dermis.\nAt the time of the initial consultation, the surgeon will inform the patient on various aspects of the procedure, including its estimated cost.\nThe primary concern of a committed surgeon will be educate the patient on the advantages, limitations, alternative treatment options, and costs, and enable them to make an informed choice.\nThe patient should unhesitatingly ask questions regarding the costs and other aspects of the procedure. FaceTite facial contouring is an elective cosmetic treatment, which means that the patient will likely not receive insurance coverage for this procedure.\nBoard certified female plastic surgeon Dr. Farah Naz Khan provides FaceTite face contouring to patients in Dallas, Texas, and surrounding communities.\nThe FaceTite facial contouring procedure will generally be more affordable than a cosmetic surgery procedure such as a facelift. Patients undergoing surgery typically incur costs such as general anesthesia expenses, surgeon’s fee, surgical venue expenses, and some pre and post-operative expenses.\nIn comparison, FaceTite is an in-office procedure that can be undertaken using local anesthesia. This helps the patient avoid surgery-related costs.\nTo make a judicious decision, the patient may also compare FaceTite facial contouring costs with those of other non-surgical procedures such as microdermabrasion, chemical peels, dermal filler injectables, and IPL skin rejuvenation.\nEach procedure has its benefits and limitations as well as associated costs. While some of these treatments may cost less than FaceTite, they may not offer the same results. Due to these factors, it is advisable for the patient to assess their budget, skin condition, and cosmetic goals before choosing a procedure.\nExtent of Treatment\nThe costs of FaceTite facial contouring treatment may differ slightly between two practices and even between two patients at the same practice. This may depend on the extent of treatment that a specific patient needs.\nFaceTite facial contouring treatment costs may be determined on the number of areas to be treated or on a per hour basis, depending on the practice’s pricing policy.\nIf a larger surface area is treated (both the neck and face), the procedure may cost proportionately higher. Some patients may need only slight enhancements to treat early signs of facial aging. This will involve minimal treatment.\nYet other patients may require routine monitoring or follow-up treatments to attain their cosmetic goals. In each scenario, FaceTite costs may differ.\nFaceTite facial contouring treatment costs usually vary between practices and patients. The geographical location of a particular practice also affects the costs. Real estate and overhead costs are usually higher in prime urban centers and metropolitan cities while such costs are lower in smaller towns in the interiors.\nThis facet will impact the costs of products and services in different regions, including the cost of cosmetic procedures such as FaceTite facial contouring treatment.\nOn top of this, the skills, credentials, and experience of the treatment provider will also affect the cost of the procedure as different practices offer different quality standards to patients.\nPatients should seek information on payment options from their treatment provider or their administrative staff ahead of the procedure. A majority of patients will be eligible for third-party financing by professional medical care financing companies at reasonable interest rates and easy terms of payment.\nBoard certified female plastic surgeon Dr. Farah Naz Khan receives patients from Dallas, Texas, and nearby areas for FaceTite facial contouring.\nTo schedule a consultation with Board Certified Dallas Plastic Surgeon, Dr. Farah Khan please call 469-437-5426 or click here to contact us. |
The powerful, precise, highly-concentrated beam of light originally known as Light Amplification by Stimulated Emission of Radiation (LASER) is so ubiquitous that the acronym has now been relegated to lowercase.\nLasers are used in everything from weapons to barcode scanners. They have increased efficiency and advanced technology in numerous industries such as communications, manufacturing, and practically every branch of science. Today’s post focuses on how lasers have affected dentistry.\nLasers are now used in many state-of-the-art Indiana dental practices for a broad range of services. Lasers allow dentists to be extremely precise when working on both tooth and gum tissue.\nDentists use lasers to:\n- Remove decay while preserving more intact tooth material\n- Firmly attach bonding material to a tooth\n- Remove oral lesions or obtain tissue for biopsies\n- Reshape receded gums\n- Eliminate bacteria while performing root canals\n- Increase the effectiveness of tooth-whitening agents\nDental patients benefit with:\n- Fewer stitches – some surgical procedures require no sutures when a laser is used\n- Faster healing\n- Lower risk of infection\n- Decreased damage to surrounding tissue/bone\n- Less pain – eliminates the need for anesthesia in many procedures\nKen Moore, DDS, employs advanced dental technology with seasoned competence to serve our valued patients. At Create A Smile, PC – Dr. Ken Moore, we believe that every man, woman, and child deserves a beautiful smile and a lifetime of oral health.\nFor questions about laser dentistry, cosmetic dentistry, invisalign or same day crowns, call 812-332-1405 today to schedule a consultation at Create A Smile, PC – Dr. Ken Moore in Bloomington. We are located at 219 E. 17th St..\nContact Create A Smile, PC – Dr. Ken Moore:\nLocation (Tap to open in Google Maps):\n2815 N Walnut St. |
Should Kids Be Sedated for Dental Work?\nIn dental offices nationwide, children who need cavities filled or teeth pulled are sometimes sedated. Ideally, it makes them less anxious and more cooperative.\nThey may swallow a liquid sedative or inhale laughing gas and once it kicks in, they will be conscious but calmer, so the dentist can do extensive work.\nBut in rare cases, children fall into a much deeper level of sedation than intended. If they aren’t rescued quickly, they may stop breathing or even die. It is critical for the dental staff to keep track of the patient’s vital signs and quickly recognize an obstructed airway or a problem with the heart or breathing. |
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