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The use of fentanyl by an incremental intravenous (IV) bolus technique was evaluated in eight pediatric patients (ages 4 months to 5 years, ASA III-IV) undergoing corrective surgery for congenital heart defects. Anesthesia was induced with 5 to 10 μg/kg of fentanyl. Additional boluses of comparable size were given intermittently thereafter, in order that a total dose of 100 μg/kg was achieved just before instituting cardiopulmonary bypass (CPB). Heart rate, systolic blood pressure, various measures of anesthetic depth, and plasma fentanyl levels measured by radioimmunoassay were compared at various points during anesthesia, surgery, and recovery. Decreases in heart rate were observed at the time of sternal incision and at 30 minutes thereafter, when doses of fentanyl were near-maximal. No changes from baseline in systolic blood pressure or in anesthetic depth occurred at any of the intervals studied. The plasma concentration of fentanyl was 30 ± 8 ng/mL just after completion of the fentanyl administration, immediately before CPB. With onset of CPB, the fentanyl level fell to 13 ± 9 ng/mL, a statistically significant difference from the baseline value. No further change occurred over the additional 231 ± 74 minutes in the operating room. The fentanyl concentration was 10 ± 4 ng/mL upon entry into the recovery room. It is concluded that administration of fentanyl in small, intermittent IV boluses, with dosing completed before the onset of CPB, produces satisfactory plasma levels, anesthesia, and hemodynamic stability in children undergoing corrective surgery for congenital cardiac defects.\nASJC Scopus subject areas\n- Cardiology and Cardiovascular Medicine\n- Anesthesiology and Pain Medicine |
Initially the woman undergoes a general anesthesia. Then the laparoscopy starts after a small incision is performed about an inch below the navel. Through this incision a thin needle is passed through, which inflates the abdomen with a suitable gas (carbon dioxide). Approximately 2 to 3 liters of this gas is inflated in the abdomen before the walls of the abdomen are adequetly distended. After the introduction of the gas, the abdomen is "blow-up" like a "balloon" so the internal organs become distant from the abdominal walls. This procedure decreases the possibility of damage to some internal organ by the insertion of a thin tube through which the laparoscope will pass. The laparoscope consists of a thin diameter tube 5 or 10 mm that contains a series of lenses and at one end applies a small camera.\nWhen the laparoscope is inserted, the surgeon has the opportunity to examine the pelvic organs via a television monitor where the image is transferred through a small camera applied onto it. With laparoscopy, the doctor is able to see in detail all the organs located in the pelvis, including the uterus, the uterine ligaments, the fallopian tubes, the ovaries, the bladder, the peritoneum covering the pelvic organs. In addtion the liver and also the small and large intestine are visualised. After the laparoscopy, the gas originally introduced into the abdomen, is released and the abdominal wall returns to its normal size.\nLaparoscopy except for diagnostic purposes, can be used for the performance of a laparoscopic surgery. In this case, while the belly is dilated after the introduction of gas, 2 or 3 thin tubes may enter the lower abdomen. Through these tubes, the surgeon may insert some surgical instruments (such as laparoscopic scissors, forceps and diathermy) and perform the appropriate operation.Return |
Oscillopsia and nystagmus began in a woman 2 weeks after an inadvertent lumbar puncture during anesthesia for childbirth. Examination showed horizontal-torsional jerk nystagmus in all positions of gaze. Magnetic-search-coil oculography revealed accelerating slow phases, with an increase in nystagmus amplitude in darkness. Magnetic resonance images showed type 1 Arnold-Chiari malformation. Three months after occipital decompressive surgery, nystagmus had almost disappeared. Accelerating slow phases should not be considered diagnostic of congenital nystagmus, especially with an onset of oscillopsia in adult life; imaging should be considered to exclude treatable hindbrain anomalies. Lumbar puncture in patients with the Arnold-Chiari malformation may accentuate craniospinal pressure dissociation and precipitate neurological signs. |
The favorite pastime of people in America and globally is to fear dental procedures. You can’t avoid dental treatments merely because you don’t like the dental office or the smells and sounds of the practice. However, are you aware sedation dentistry near you entirely relaxes your body, leaving you unaware of the treatments you undergo? If not, we suggest you give up your fear of dental procedures immediately and receive any treatments you need fearlessly from your preferred dentist in spring.\nWhen you neglect dental treatments, minor or significant, you allow infections to manifest in your mouth without realizing the conditions are working overtime to create havoc. You may avoid dental exams and cleanings or even overlook toothaches using home remedies or over-the-counter pills. However, aren’t you inviting unnecessary trouble by neglecting visits to your dentist for an evaluation? We are confident you are. It is why we provide information on sedation dentistry in spring to convince you not to neglect dental issues when they are easily treatable.\nDental sedation is a process for establishing a relaxed, calm, and comfortable state of mind using sedatives. The medicines used by dentists are administered in different ways. Earlier IV sedation was famous as a safe and effective method when administered by a qualified professional. However, the evolution of sedation dentistry providing a more conducive and relaxing experience without needles makes people use this option as they find it appealing.\nOral sedation dentistry in spring, TX, is a common technique to quell patient fears. This method is easy, requiring no needles. Even more important is that the medicines create a comfortable experience to make most patients have no recollection of their visit. You may think the treatment was provided when you slept through the process. In fact, oral sedation dentistry helps maintain a level of consciousness in the patient for safety and cooperation. Sedation dentistry is unlike anesthetic injections, although you require local anesthesia in your mouth when dentists perform sedation dentistry techniques.\nThe most significant benefit of sedation dentistry allows you to feel like your dental procedure lasted merely a few minutes when it may have taken the dentist hours to perform. Sedation dentistry allows dentists to perform complex treatments in fewer appointments, making it an effective remedy for you if affected by dental anxiety.\nIf you are holding back from changing your smile’s appearance because you are scared or anxious about complicated dental procedures, rest assured sedation dentistry makes you feel comfortable during the treatment process helping you achieve the smile you desire.\nSedation dentistry also addresses many fears that keep people from visiting dental offices regularly. Patients undergoing treatments under sedation dentistry are more likely to receive the recommended care by their dentist. Sedation dentistry enables patients to care for their oral health and report any dental problems to the dentist, unlike earlier when they were delaying treatments until they required extreme dental care.\nSedation dentistry is often dubbed as sleep dentistry, but the description is misleading. Sedation dentistry ensures you do not sleep during the procedure but may feel sleepy because of the effects of the medicines. Sedation dentistry enables the dentist to keep you calm throughout the dental process keeping you relaxed and likely not have much recollection about your treatment. Therefore using general anesthesia shouldn’t be considered sedation dentistry.\nThe fear of dental procedures may have kept you away from your dentist, letting various conditions manifest in your mouth. However, sedation dentistry in spring not only quells your fears but also helps you to receive treatments that you earlier believed were painful effortlessly. The dentist prescribes medicines you can take an hour earlier before your appointment. You need help driving down to the dentist’s office and back because different levels of sedation are provided depending on the procedure you are undergoing. You may receive mild, moderate, or deep sedation, making it challenging for you to drive motor vehicles.\nAfter your appointment, it helps if you have someone to drive you back and remain with you for a couple of hours until you have fully recovered from the dental procedure you underwent. Now, with sedation dentistry making dental treatments a breeze, there is no reason for you to fear visits to your dentist to maintain your oral health in optimal condition. |
Strengthening Hands, Wrists and Elbows\nHand and wrist conditions can be debilitating. You don’t have to suffer through pain, stiffness, numbness or weakness. Our expert hand surgeons address function in your hands, wrists and elbows.\nTurn to Sanford Orthopedics & Sports Medicine to repair both sudden and chronic injuries. General wear and tear, trauma, repetitive movements, disease and more can cause pain in your hands or wrists. Our orthopedic hand surgeons work to restore and preserve function through nonsurgical or surgical treatment.\nWhen Do You Need Hand Surgery?\nYou need treatment if your hands feel chronically numb, stiff or painful. Sanford Health’s hand specialists don’t recommend surgery until you’ve exhausted other avenues, such as wearing a splint or taking medication.\nWe offer treatments for these conditions:\n- Arthritis and osteoarthritis\n- Carpal tunnel\n- Hand infections\n- Lumps on the hands or wrists (ganglion cysts)\n- Nerve compression syndromes\n- Permanently bent fingers (Dupuytren’s contracture)\n- Tennis elbow\n- Trigger finger\n- Wrist pain\nSometimes, all it takes to relieve hand pain is therapy or activity modifications. But if you do need surgery to correct hand injuries, look no further than our surgeons.\nCarpal Tunnel Treatment\nCarpal tunnel is one of the most common hand conditions. It afflicts millions of Americans every year. It is a numbness or tingling in the hand, typically caused by a pinched nerve. Sometimes carpal tunnel clears up with rest or by using ice and wrist splints. Your doctor may also prescribe medications or cortisone injections.\nIf these treatments don’t relieve your pain, you may need carpal tunnel surgery. During the operation, our hand surgeons will enlarge the carpal tunnel with small incisions to reduce the pressure on the nerve.\nThe surgery typically lasts 30 minutes with local anesthesia and is done on an outpatient basis. Patients go home on the same day as their procedure.\nRecover Faster After Surgery\nSanford Health offers surgery that puts precision and accuracy first. We aim to reduce your recovery time and increase your comfort during and after surgery. We’ll walk you through recovery.\nYou may need therapy and rehabilitation to regain full use of your hand. Your doctor will decide the specifics of your recovery depending on your surgery.\nFind an Orthopedic Hand Surgeon\nGet specialized care from a hand surgeon at Sanford Health. Our orthopedic surgeons are experts in their field and will put your comfort and recovery first.Find a Hand Specialist\nFind a Surgery Clinic\nSanford Health has orthopedic and sports medicine clinics across the Upper Midwest. Find a dedicated team of surgeons at a location near you.Find a Hand Clinic\nHow long does hand surgery take?\nThis depends on the type of surgery you need. Procedure times range from 20 minutes to two hours.\nA majority of our hand surgery patients go home after their procedure. Most do not need to stay overnight in the hospital.\nAre you asleep for hand surgery?\nIt depends on your surgery. Most hand surgeries can be performed using only local anesthesia. The hand or finger is injected with lidocaine and the patient does not need to be under sedation.\nLocal anesthesia comes with benefits. It skips preoperative physicals and testing that are required for sedation. Patients can go home after their surgery and do not need to miss breakfast or interrupt their medication regimen. We’ve performed thousands of hand surgeries using only local anesthesia and most patients rate the experience as better or the same as going to a dentist appointment.\nIf you prefer some type of sedation for anxiety or would prefer not to be awake during your surgery, talk to your surgeon. We offer sedation for patients who would prefer it.\nWhat is the typical recovery time?\nEvery surgery is different. Some patients may return to regular activities like typing or writing within days. Others may take weeks or months to fully recover. Talk to your hand surgery team about how you can improve your recovery time.\nCan I use my hand after surgery?\nWe’ll apply a bandage or splint to the affected fingers after your surgery. You should move your other fingers to avoid stiffness. Your surgeon will have specific recommendations for you based on your surgery.\nHow can I reduce swelling after hand surgery?\nThe easiest way to reduce swelling is to elevate your hand and wrist. Try to keep the affected hand at the level of your heart or higher as much as possible.\nToo much activity can also contribute to swelling. Make sure to rest your hand and wrist after the operation.\nTo reduce pain after your surgery, try:\n- Alternating over-the-counter anti-inflammatory medications with acetaminophen\n- Keeping your hand elevated at or above your heart\n- Placing an ice pack under your armpit, which will delay the nerves’ messages of pain from getting to your brain\n- Resting when possible\nBefore Hand Surgery\nLet Sanford Health guide you to the information you need to make the best decision for your hand and arm health. We answer common questions such as:\n- How do you diagnose hand conditions?\n- What tests can you expect?\n- How should you prepare for diagnostic tests?\nAfter Hand Surgery\nWhat can you expect after hand surgery? Recovery depends on the type of surgery you had and the cause of your hand condition. In many cases, surgery is just the start of recovery, but we can give you an idea of what to expect, such as:\n- Immobilization in a bandage or splint\n- Restrictions on work and activities\n- Rehabilitation including physical therapy or occupational therapy\nOur hand surgeons offer non-surgical options for conditions affecting your hands. We also recommend these as rehabilitation after surgery. These options include:\n- Caring for wounds and controlling scars\n- Desensitization, sensory re-education or nerve glides following nerve injury or trauma\n- Exercises to increase motion, dexterity and strength\n- Reducing swelling\n- Splints for preventing or correcting injury\nHelping you learn to perform daily life skills and work skills through adapted methods and equipment, activity modification and conditioning work.\nSanford Health News\nIf you’re a prospective patient, go through a trusted source, says Dr. Peter Marks\nWhen old injuries slowed down an endurance athlete, a clinical trial offered treatment |
Knee arthroscopy is surgery that is done by making small cuts on your knee and looking inside using a tiny camera. Other medical instruments may also be placed inside to fix your knee.\nKnee scope - arthroscopic lateral retinacular release; Synovectomy - knee; Patellar (knee) debridement; Meniscus repair; Lateral release; Knee surgery\nThree different types of pain relief (anesthesia) may be used for knee arthroscopy surgery:\n- Your knee may be numbed with painkilling medicine. You also may be given medicines that relax you. You will stay awake.\n- Spinal anesthesia. This is also called regional anesthesia. The painkilling medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.\n- General anesthesia. You will be asleep and pain-free.\nA cuff-like device that blows up (inflates) may be used around your thigh to help control bleeding during knee arthroscopy.\nThe surgeon will make two or three small cuts around your knee. Salt water (saline) will be pumped into your knee to stretch the knee.\nA narrow tube with a tiny camera on the end will be placed inside through one of the cuts. The camera is attached to a video monitor in the operating room. The surgeon looks at the monitor to see the inside of your knee. In some operating rooms, the patient can also watch the surgery on the monitor, if they want to.\nThe surgeon will look around your knee for problems. The surgeon may put other medical instruments inside your knee through the other small cuts. The surgeon will then fix or remove the problem in your knee.\nAt the end of your surgery, the saline will be drained from your knee. The surgeon will close your cuts with sutures (stitches) and cover them with a dressing. Many surgeons take pictures of the procedure from the video monitor so that afterward you can see what was done and what was found.\nSee also: ACL reconstruction\nWhy the Procedure Is Performed\nArthroscopy may be recommended for these knee problems:\n- Torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.\n- Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)\n- Swollen (inflamed) or damaged lining of the joint. This lining is called the synovium.\n- Kneecap (patella) that is out of position (misalignment).\n- Small pieces of broken cartilage in the knee joint\n- Removal of Baker's cyst -- a swelling behind the knee that is filled with fluid. Sometimes this occurs when there is swelling and pain (inflammation) from other causes, like arthritis.\n- Some fractures of the bones of the knee\nThe risks for any anesthesia are:\n- Allergic reactions to medicines\n- Breathing problems\nThe risks for any surgery are:\nAdditional risks for this surgery include:\n- Bleeding into the knee joint\n- Damage to the cartilage, meniscus, or ligaments in the knee\n- Blood clot in the leg\n- Injury to a blood vessel or nerve\n- Infection in the knee joint\n- Knee stiffness\nBefore the Procedure\nAlways tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.\nDuring the 2 weeks before your surgery:\n- You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.\n- Ask your doctor which drugs you should still take on the day of your surgery.\n- Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.\n- If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.\n- Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.\nOn the day of your surgery:\n- You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.\n- Take your drugs your doctor told you to take with a small sip of water.\n- Your doctor or nurse will tell you when to arrive at the hospital.\nAfter the Procedure\nAfter the surgery, you will have an ace bandage on your knee over the dressing. Most people go home the same day they have surgery. Your doctor will give you an exercise program to follow.\nWhether or not you have a full recovery after knee arthroscopy depends on what type of problem was treated.\nProblems such as a torn meniscus, broken cartilage, Baker's cyst, and problems with the synovium are usually fixed easily. Many patients remain active after these surgeries.\nRecovery from simple procedures is usually fast. You may need to use crutches for a while so that you do not put weight on your knee and to control pain. This will depend on what kind of surgery you had. Your doctor may also prescribe pain medicine.\nRecovering from more complicated procedures will take longer. When anything in your knee is repaired or rebuilt, you may not be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year.\nIf you also have arthritis in your knee, you will still have arthritis symptoms after surgery to repair other damage to your knee.\nPhillips BB. Arthroscopy of the lower extremity. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 48.\nMiller MD, Hart J. Surgical principles. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 2.\nLast reviewed 2/19/2011 by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.\n- The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.\n- A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.\n- Call 911 for all medical emergencies.\n- Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. |
WELCOME TO ROANOKE ORAL SURGERY\nRestoring Comfort Since 1980\nWhen you visit our office, your needs are our top priority. Our entire team is dedicated to providing you with the personalized, gentle care that you deserve.\nWe know that every patient who comes to see us is looking for a solution to a specific problem. Whether you are interested in dental implants, removing problematic wisdom teeth, or even undergoing a dramatic jaw realignment, we want you to know that you are in the best hands. Our team will present you with all of your options for treatment, and develop a plan that meets your oral health goals.\nLatest Oral Surgery & Maxillofacial ProceduresHighly-skilled in technologically advanced diagnostic & treatment experience\nModern Technology & EquipmentCutting-edge technology for safe, accurate, and minimally invasive surgery\nPatient-Oriented & Friendly StaffProfessional patient-centered & experienced team providing the best surgical treatments\nRelaxing State-Of-The-Art FacilityComfortable modern practice, designed according to high-quality standards and patients in mind\nMeet Our Highly Experienced & Skilled\nBoard Certified Oral & Maxillofacial Surgeons\nOral and Maxillofacial Surgeons have completed rigorous, hospital-based surgical and anesthesia training residencies after graduating from dental school. This highly specialized additional training includes experience in emergency medicine, general surgery, and anesthesiology, in addition to years of surgical experience dedicated to the hard and soft tissues of the face, mouth, and jaws.\nLEARN MORE ABOUT OUR\nComprehensive Oral Surgery & Maxillofacial Services\nWe offer a full scope of oral surgery and maxillofacial procedures. Learn more about the specific services & treatments our experienced team provides. All of our treatments and services are provided in a comfortable, updated clinic, designed according to high-quality standards.\nWisdom TeethSometimes molars will get stuck as they try to come in. We specialize in removing completely & partially trapped teeth beneath the gums.\nDental ImplantsWe can restore your smile, as well as speaking & eating ability with advanced dental implants.\nTooth ExtractionsWisdom teeth & toothaches can be caused by various problems. Let us help take away the pain.\nFacial TraumaWe offer a variety of facial & corrective jaw surgery procedures, customized for your specific health needs.\nAnesthesiaOur goal is to provide an easy, painless experience for our patients. Our office is fully certified to provide safe and effective general anesthesia by the State of Virginia.\n3D CT ImagingOur 3-dimensional imaging is the future of oral surgery & implantology. It allows us to diagnose potential issues more accurately and provide treatment with confidence.\nSTATE OF THE ART SURGERY\nPlease call our office to request a new patient appointment.\nRequest An Appointment\nSchedule A Consultation today!\nFill out the form below and our staff will contact you during our working hours. For current patients that rather email, please scroll down to the bottom to use our Contact Form for online patient communication. If you have a dental emergency, please call your doctor immediately by contact information given to you at last appointment.\nWe are a surgical practice devoted to optimizing the form and function of the face and oral cavity using conservative, state-of-the-art procedures that will result in maximizing your dental and overall health.\nHighest Standards of Excellence\nServing Southwest VA Since 1980\nAdvanced Surgical Techniques\nRecommended Highly By Patients\nConnect With Us\nLike Us On Facebook\n2 days ago\nMonitor your wisdom teeth annually. Serious concerns can develop even when you feel no pain. #TheMoreYouknow\nCheck out the infographic below to learn more. ... See MoreSee Less\n2 weeks ago\nNot all wisdom teeth need to be removed. But that’s doesn’t mean you can ignore them. About 85% of the adult population do not have adequate space for the normal eruption of wisdom teeth. See why an annual exam is so important. #OralSurgery #Roanoke #Virginia\n🦷Learn More: bit.ly/ROSWisdomTeeth ... See MoreSee Less |
Cerebral Hemodynamic Response of Sodium Nitroprusside and Esmolol\nSodium nitroprusside (SNP), an induced hypotensive agent has been shown to be a cerebral vasodilator and increase intracranial presure (ICP) [5, 7]. SNP hypotension has become a frequently used technique for various surgical procedures and during clinical treatment of hypertensive crisis .\nKeywordsSodium Nitroprusside Hypotensive Agent Cranial Window Pial Arteriole Cerebral Vascular Effect\nUnable to display preview. Download preview PDF.\n- 4.Lu GP, Kaul DK, Feldman SM, Orkin LR, Baez S (1990) Sodium nitroprusside (SNP) hypotension: Intracranial pressure (ICP) and hemodynamics in pial arteriole in the rat. Microcirc Endoth Lymphatics 6:315–341Google Scholar\n- 6.Michenfelder JD, Milde JA The interaction of sodium nitroprusside, hypotension and isoflurane in determining cerebral vascular effects. Anesthesiology 69:870–875Google Scholar\n- 7.Stange K, Lagerkranser M, Solelvi AS (1989) Effect of sodium nitroprusside-induced hypotension on cerebral autoregulation in the anesthetized pig. In: Cerebrovascular Effects of Controlled Hypotension Induced by Adenosine, Isoflurane, and Sodium Nitroprusside. Kongl Carolinski Medico Chirurgiska Institut, Stockholm. V:lGoogle Scholar |
Anesthesiology in Austin, TX\nCapitol Anesthesiology Association has over 40 years of experience. This practice is a trusted member of the healthcare community in the Austin area. The dedicated team at Capitol serves hospitals and medical centers throughout the Austin area. With experienced doctors and CRNAs on staff, Capitol Anesthesiology provides excellent medical care.\nThe services provided by Capitol encompass all areas of anesthesiology. Whether it’s general, local, or regional anesthesia, there is a CRNA or doctor at Capitol who can meet your needs. Capitol’s staff also includes doctors who specialize in pediatric, obstetric and cardiovascular anesthesiology. With a specialist on the job, the chance of complications is greatly reduced.\nAnesthesiology is an important part of medical care. An attentive anesthesiology team ensures that patients have a pain-free surgical experience. This is a specialty that requires great attention to detail. The team at Capitol takes this responsibility seriously. They pride themselves on providing top-notch care.\nThe professionals at Capitol Anesthesiology Association also take the time to give back. They do this both locally and globally, by volunteering with organizations including Operation Smile and Family Eldercare. |
As we all know, healthcare has made great strides in the last few years, and pet medicine is no exception. There have been many significant strides in medicine for pets that we can be proud of, and that gives you peace of mind in knowing your pet will be treated with the care and medicine they deserve, should they become sick.\nIn fact, one test that has now become popular in pet care is the ultrasound. However, is it expensive to get an ultrasound for your dog? Does your pet insurance cover the cost? We’ll answer these questions and more in the guide below. Dog ultrasounds typically cost between $250 and $350.\nThe Importance of Ultrasounds\nYou might wonder why a dog ultrasound is essential, especially if your canine pal has never had health problems. An ultrasound can help your vet detect problems without invasive surgery, which could take your dog weeks or months to heal. While it might not seem like there’s much going on with the ultrasound, a professional sees things that the average pet owner doesn’t.\nUltrasounds can be used to determine various things, such as monitoring your dog’s pregnancy, detecting cancer, and identifying congenital disabilities. In many cases, they can also be used to find the reason your dog is bleeding internally without putting your dog at significant risk.\nHow Much Does a Dog Ultrasound Cost?\nAs with any other type of procedure, the vet you choose and your location will determine the cost of a dog ultrasound, but you can expect to pay $250 to $350 for the procedure.\nIn most cases, this price doesn’t cover the fees for the visit or any other tests that might need to be done. If you need to take the test results to a specialist, your vet may charge for that, but that isn’t as common anymore since the data can easily be sent through an email.\nIf you need to take your dog to the specialist for an ultrasound, you can expect it to run between $400 and $500. This is also highly unlikely to cover the visit’s fees or any other tests that might need to be completed.\nAdditional Costs to Anticipate\nYou can expect to pay for the office visit when taking your dog to have the ultrasound performed. This will usually cost you around $100 or more, depending on the vet or whether they’re specialists. If your dog panics, sedation may be required before the ultrasound is performed. This means you’ll have to cover fees for the sedation, pre-op blood work, and sedation monitoring. Again, these fees can vary.\nDiscussing the additional costs with your vet that you can expect after the initial examination will give you an idea of how much you’ll have to pay.\nHow Often Will My Dog Need an Ultrasound?\nIn most cases, a dog only needs an ultrasound once to determine what the problem is with its health. Many times, they don’t need to have the ultrasound performed again. However, this will depend on what is wrong with your furry friend and the diagnosis the dog gets.\nFor example, a pregnant dog might require ultrasounds at different stages of her pregnancy, and certain cancers may require repeat ultrasounds. Your vet should be able to tell you more when you get the diagnosis for your pet and let you know how many ultrasounds will need to be performed, as it’s different for every dog and every situation.\nDoes My Pet Insurance Cover Ultrasounds?\nThere are quite a few insurance agencies that will cover the cost of an ultrasound. The exception for most agencies is if the ultrasound is performed for a preexisting condition, as very few pet insurance companies cover preexisting conditions in pets.\nSome pet insurance companies have exceptions to that rule, so it’s best to talk to your provider before scheduling an ultrasound for your dog and assuming your insurance will cover it.\nIf your dog’s ultrasound has nothing to do with a preexisting condition, the chances are the pet insurance provider will cover the cost, but you still need to check with customer service to be sure.\nHow Important Are Follow-Up Visits?\nOnce your dog has had the procedure and is diagnosed, it’s vital to attend any follow-up appointments your vet schedules. This is important if your canine pal has been determined to have a chronic or life-threatening illness. These follow-up appointments allow the vet to keep a close eye on your pet, monitor the dog’s bloodwork, and schedule follow-up ultrasounds if the vet feels they are needed.\nIf you’re on a strict budget and worried about additional visits or ultrasounds, be honest with your dog’s vet about the financial issues. Many vets accept forms of payment to help with the cost of caring for your furry friend, such as Care Credit. Some vets accept ScratchPay as well.\nAn ultrasound can be the difference between life and death for your furry friend and should be taken seriously if your vet recommends one be performed. Ultrasounds are used for several purposes, from keeping an eye on pregnancy to diagnosing cancer and organ defects.\nUltrasounds can be expensive, so call customer service to find out if your pet insurance covers the test before you have it done. Ensure that your vet gives you an estimated cost so that you can put aside the money for the examination and any additional charges that might come with it. |
Having unnecessary fat in numerous locations of your body can have a considerable influence on your health and self-confidence. While conventional weight loss through workout and diet is a great method to lose weight overall, even the best exercises cannot target issue locations like the belly, inner thighs, arms, and butts. Liposuction is a time checked treatment that is utilized to remove excess fat from specific areas of the body, permitting a specific to form and contour their body to their preference. Is liposuction right for you? Discover now.\nPros of Liposuction\nThere are many benefits to this cosmetic treatment, consisting of:\n• Immediately visible changes. Unlike standard weight reduction, liposuction develops changes that are right away noticeable in the body. Some distinction is noticeable right away, and the wanted outcomes are typically accomplished in just a couple of days.\n• Proven and safe. This cosmetic treatment has actually been performed by knowledgeable specialists all over the world for many years and the method has been fine-tuned over and again to be safe and efficient.\n• Recovery time is generally fast. The downtime required after having this kind of procedure is typically much less than what is required for other kinds of cosmetic treatments, including tummy tucks, breast reduction, and more. Individuals who have had the procedure can typically return to work far more rapidly than they anticipated and can return to living a healthy, active lifestyle.\n• Weight-loss can be irreversible. With the best upkeep strategies, the fat that was gotten rid of throughout the liposuction procedure will not return.\n• Complete control over your body. With liposuction, a person can have complete control over how they want to look, beyond what standard diet plan and exercise can supply. Giving people this power over their bodies increases self-confidence and aid people feel their very best.\nWhile there are numerous advantages to liposuction, there are of course a couple of cautions that need to be thought about prior to making the final decision to move forward with the treatment.\nCons of Liposuction\nBefore having actually liposuction done, it's important to examine the potential disadvantages of the procedure and determine if the benefits outweigh the dangers in your specific case. Your specialist can assist you find out more about the dangers associated with the procedure and can assist you choose if moving forward is the best thing for you.\n• Issues with general anesthesia. Since liposuction is performed under basic anesthesia, the procedure carries the same threats as other kind of surgery where basic anesthesia is used. Hidden medical conditions may enhance these dangers.\n• Unfavorable responses. Bruising, bleeding, and pain are all to be anticipated, however, in unusual cases can cause more considerable complications.\n• The prospective to acquire the weight back. After having liposuction done, it is crucial to maintain a healthy diet and exercise properly as recommended by your doctor. Failure to do so could cause getting back the weight that was lost or perhaps much more.\nThere are dangers associated with liposuction, for lots of individuals, the benefits far exceed them. Educate yourself about the procedure by having in-depth conversations with your specialist and consider how liposuction has the prospective to affect you as an unique person. Only you and your specialist can determine if liposuction will offer you with the outcomes you are looking for within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Freeman VA\nLaser liposuction is a more recent, minimally intrusive procedure that involves heating the fat cells to melting point and eliminating the melted fat through a small cannula. The procedure is usually done right in your physician's office and is an outstanding alternative for people who have less than 500 ml of fat to get rid of from any one location. Laser liposuction can be a safe, complementary treatment to weight loss in order to shape the body you've constantly desired.\nContact a Surgeon in your Freeman VA today.\nIf you're thinking about liposuction as a weight reduction option, it is necessary that you discuss your desires with a qualified plastic surgeon in your area. Your cosmetic surgeon will perform a total examination and health history questionnaire to identify if liposuction can benefit you and help you reach your physical and emotional objectives. Call today for an examination and find out more about how liposuction can assist you achieve the body of your dreams. |
When You Look Good, You Feel Good\nThere is no doubt that every person wants to look their best. Whether you’re out on the town, rubbing elbows with society big shots or simply out on a park picnic with your family and friends. Having a healthy, lively appearance will make you more confident and better able to enjoy the pleasures of life.\nYour biggest obstacle to looking young, vigorous, and vibrant is the inevitable passing of time. As you get older a spattering of wrinkles, deep creases, folds, and sagging skin gradually appear on your face. You start out with crow’s feet around your eyes, marionette lines around your mouth, and a deeper furrow on you brow. Soon enough, your face is filled with these blemishes, making you look many years older than you really are.\nThat’s the time you start exploring anti-aging techniques: looking for ways to restore your youthful appearance, to repair the damage that time has wrought on your face. One of the most widely accepted ways to do this is through cosmetic surgery, or more specifically, through facelifts. Modern science and advanced medical techniques can now cut, trim, and stretch the skin on your face until it is smooth and wrinkle-free. Facelifts can be done for the entire face or can be refined to a partial procedure that targets a specific area.\nSurgery Is Not For Everybody\nIt is an undeniable fact that cosmetic surgery is one of the fastest and most effective ways to rejuvenate the face. With the latest advancements in cosmetic surgery and the refined skills of the country’s best doctors, you can enhance and alter your appearance in almost any way imaginable. However, it is also a fact that surgery is not a viable option for everyone. There are a variety of reasons for this.\nFirstly, there are a number of people who have allergic reactions to the anesthesia, and sometimes even the implant material, which is required for most surgical procedures. Then there are those people who are not allowed to undergo surgery because they have medical conditions or because it is contrary to their religious beliefs.\nAnd there are still others who are simply scared of surgery. They are so afraid of going under the knife that they won’t even consider cosmetic surgery no matter how skilled the doctor is or how safe the operation has proved to be.\nThese people have as much right to receive the benefits of cosmetic enhancement as the rest of the population. For a long time, they had no choice in the matter. But now, thanks to advances in cosmetic science, they have a safe, effective, and most importantly, non-surgical alternative. What is the name of this amazing alternative? The answer: injectable dermal fillers.\nHow Do Fillers Work?\nJust as its name implies, an injectable filler is a substance which can be injected under your skin via a syringe. The filler effectively raises the outlying skin so that wrinkles and creases on your face get “filled in” and disappear.\nAnother use for injectable fillers is to alter the shape of specific face features. Fillers can be used on your cheeks, chin, brow, eyelids, and the area around the nose. Dermal fillers can even be used on your lips to make them look fuller and more attractive. These subtle yet effective improvements can give you a more balanced and better proportioned face.\nAlthough this may sound like new technology, fillers have long been in use for reconstructive surgery. It has only now become popular for use in cosmetic enhancement procedures.\nHow The Procedure Is Done\nThe procedure begins with the doctor identifying which areas of your face will be treated. Once the target areas have been marked off, the doctor will fill a syringe with the appropriate amount of filler. The syringe has a very fine needle; so small in fact that most people barely feel any pain when it is inserted into their skin. A large number of people say that they don’t experience pain at all from injectable facial fillers.\nIn many cases, doctors will apply an anesthetic spray or cream to the target face area before the injection of the dermal filler. This usually ensures that the process is completely free of pain. For procedures that are more complex or extensive treatments which require a longer period of time, the doctor might suggest a local anesthetic provided that the patient is not allergic to it.\nHow Long Does A Session Last?\nMost procedures with injectable dermal fillers take a very short time to complete. Most procedures can be done in half an hour or even less, even the ones that require local anesthesia. The actual procedure time is of course dependent on the size of the area to be treated and the amount of filler needed. It is also possible to have several procedures done within a single session as long as the doctor judges it to be safe. Many people have found that they can get a filler treatment during their lunch break and be back at the office in no time at all.\nWhat’s in the Injectable Fillers?\nFDA approved injectable fillers like Restylane and Juvéderm are composed mainly of hyaluronic acid, a substance that is naturally found in the body. Hyaluronic acid is found in your extracellular matrix, the support structure between your body’s cells.\nTo make the filler product, manufacturers harvest the chemical from genetically engineered bacteria which produce large amounts of hyaluronic acid. They could actually harvest the same chemical from animals, but that type of acid carries a risk of allergic reaction when it is injected into humans. Hyaluronic acid produced by bacteria is much easier to purify and is more compatible with the human body.\nAnother advantage of bacteria produced hyaluronic acid is that it has a highly cross-linked molecular structure. The filler is able to absorb and retain moisture, further enhancing the plumpness of your features. This characteristic also makes the injectable filler much harder for your body to break down.\nHow Long Do the Effects Last?\nUnder ideal conditions, it can take anywhere from six months to an entire year before the substance is absorbed by the body. When that happens, all you have to do is go back to the clinic for another treatment.\nIn many ways, this is better than getting cosmetic surgery. Because the treatment is temporary, you’re able to “try it out.” If you didn’t like the result of your first enhancement, you can inform the doctor and improve the effects of your next treatment of injectable dermal fillers. You can take as many tries necessary to achieve the perfect look for you.\nPlanning Your Treatment\nEven though the effects of injectable fillers are temporary, six months to a year is still a long time to commit. It is recommended that you spend a substantial amount of time planning your surgery during your consultation with a cosmetic doctor.\nBe specific when you identify which points on your face you would like to alter and enhance. Do you want to fill up the hollows beneath your eyes? Do you want to get rid of those creases at the corners of your mouth? Do you want the treatment to fill up the scars and creases of your face? These are the types of questions you should ask yourself when you’re planning your treatment.\nGive your doctor as much information as possible about what you want to achieve with the injectable facial fillers. Your surgeon will tell you which of them are practical, what needs to be done, and may even offer suggestions to achieve the best possible result. You’ll often be shown before-and-after photographs of the doctor’s other patients so that you can better judge how the cosmetic enhancement will look on you.\nInform your doctor if you have any allergies. Although these are usually reflected in your medical history, allergies can complicate the treatments, something that you and your doctor both want to avoid. Remember, you can never be too cautious, especially when your health is involved.\nYou should also inform your doctor if you have just had or plan to undergo other skin treatments. Even simple cosmetic treatments like laser therapy and chemical peels can weaken the skin and cause complications when you get injectable fillers.\nIf you have already undergone those treatments, the doctor will tell you when it is safe to proceed with your dermal filler injection. If you’re going to get those treatments in the future, the doctor will tell you how long you should postpone them so that your skin will have ample time to recover. This is a simple precaution that will save you from the risk of inflammation of the skin.\nInjectable Dermal Fillers vs. Surgery\nA common question asked by patients is why they should opt for dermal fillers instead of getting a more permanent surgical enhancement. There are a number of reasons for this. First of all, injectable fillers avoid the risk normally associated with surgery. No incisions are made, no stitches are needed, and you don’t have an implanted object under your skin.\nSecondly, there is no downtime involved with injectable dermal fillers. As mentioned before, you can have the procedure done during your break and be back to work as soon as it’s done. You don’t need to stay home with bandages on your face. You don’t need to take a leave off from work just so your body can recuperate. You get immediate results without having to sacrifice precious work and leisure time. This alone is a major selling point, especially for the busy people of modern society.\nLast, but not least, is the fact that these injectable fillers are virtually pain-free. If you can stand the tiny pin-prick of a needle, you don’t even have to bother with anesthesia. This is great news for those who are allergic to anesthetics.\nWhat to Do After the Surgery\nPatients who have been treated with injectable facial fillers are advised to avoid strenuous activity, exposure to heat and prolonged exposure to direct sunlight. Alcohol use and the use of certain medicines, both topical and ingestible, may be prohibited for an amount of time.\nSome patients may experience puffiness around the treated area after the procedure. There are some rare cases in which itching and bruising occur. In any of these cases, these side effects will wear off in a matter of days. Doctors will usually allow you to you can use an ice pack or a topical cream to help reduce the discomfort.\nCost of the Procedure\nAs with all other cosmetic procedures, the cost of injectable fillers will vary from region to region. In the United States, the average cost for one vial of dermal filler ranges from $300 to $575. Half a vial of filler can fill up one major facial crease. A facial enhancement like a chin augmentation will typically need one vial of filler.\nThe doctor’s fee and the clinic fee are often additional factors in the procedure cost. If you ask for or are advised to get anesthesia, this will usually be added to your bill. You can often save some money by taking multiple treatments during a single visit to the clinic as opposed to taking separate visits for each treatment.\nWhy Are Dermal Fillers So Popular?\nPopular dermal fillers like Restylane and Juvéderm have had FDA approval for several years, as early as 2003. Over the past few years that they’ve been in use, over ten million treatments have been successfully executed in the United States alone. There are only a handful of cases in which unwanted side effects and serious complications were reported. This is a very good track record considering that it is a fairly new medical product.\nSafety is the primary concern of patients and doctors alike, and it only takes a quick look at the statistics to see that injectable dermal fillers are one of the safest treatments on the market.\nSo if you’re looking for a way to get rid of the crow’s feet, marionette lines, and other wrinkles on your face consider getting an injectable dermal filler treatment. It’s the latest in non-surgical cosmetic procedures that offers a safe, effective, and painless alternative to traditional facial enhancement surgery. |
I've yet to acquire a wound that I'm not proud of. I took a lot of pictures in the hospital, but didn't think to have one of the cute nurses pose with me. (the eye is still there, and works.) You should see the poor power sander.\nThe hospital was a 20 hour thing. Drove myself to the local hospital, but it was beyond them, so they arranged to have the U of M do the surgery (under general anesthesia). I drove myself there too after my local hospital beefed up my bandaging. Was more fun than anything else, but I hope I didn't get covid -- was very close to probably six doctors and twenty nurses.\nAs soon as I got home, I fixed the sander and got back on the step ladder and finished up the sanding of the exterior Vardo walls. This time I kept the sander away from the door hinges, 'cause I'm so smart.\nI've always liked to make faces in the mirror, and this has been especially fun. Here's my four favorites.\nThe harsh sunlight in the room adds to the ghastly effect in the first three. (I can't believe this first one is me.)\nThe photos are from the first day. My eye started opening a wee bit on its own after a couple of days. I hadn't known what to expect. After the surgery and before I went home, I didn't talk to anyone at the hospital who knew anything about how the surgery had gone. So anyway, it opens about a quarter of the way I'd say, with blurry vision. Would be nice if it gets back to all the way open with clear vision of course.\nback to archives |
BDS (Hons), MFDS RCS, MFGDP, FRSPH, FFD RCSI, FDS RCPS\nGDC No. 76559\nMr Shah is a Consultant Oral Surgeon with over 20 years experience in this speciality. He qualified from Guys Hospital in 1999 with a prestigious double honours and after a year as a vocational practitioner, he embarked on a career in oral surgery.\nHe undertook training within the Essex regional hospitals and gained his membership from the Royal College of Surgeons in 2001. He was also a part time clinical tutor at kings College Hospital and in 2005 excelled in the Speciality Fellowship examination, FFD. He was admitted onto the Specialist register for Oral Surgery in 2006.\nFormerly Consultant & Clinical Lead for South Essex Partnership University NHS foundation Trust, he now practices exclusively within the private sector. He is both a member and fellow of the Royal College of Surgeons and carries out all aspects of oral surgery such as complex extractions, wisdom teeth and apicectomies.\nHe has also developed a special interest in oral medical conditions such as oral ulcerations, burning mouth syndrome and lichen planus.\nMr Shah teaches & lectures nationally and internationally on a variety of subjects to both dental and medical practitioners. He contributes to medical journals and has published many articles.\nHe takes pride in being an extremely gentle diligent surgeon and is particularly excellent with nervous patients and offers treatment under IV sedation. |
Participant of the show “the Voice”, singer Andrey Davidyan has died on 61-m to year of life from cardiac arrest. About TASS said the representative of the artist Yuri Denisov. He thinks that heart could badly influence the operation for appendicitis, which for some reason was done under General anesthesia.\n“Today at 06:50 Andrew did not,” said Denisov. According to him, the death of the singer came as a surprise to his family, despite the fact that Davidian in the past month, had problems with health.\n“Three weeks ago he needed an appendectomy. To pay the hospital the doctors did the surgery under General anesthesia. Now we will decide what to do with them, because it is not clear why under General anesthesia did a very negative effect on the heart,” said Denisov.\nHe added that in a week Davidyan did a second operation, after which the artist was able to return to work for a while. “I returned from a working trip, and he suffered a stroke. Thought a stroke”, – said Denisov. Afterwards he spent several days in intensive care, two days ago the doctors twice recorded his cardiac arrest.\nAndrey Davidyan was born 30 Jan 1956 in Moscow in a musical family. Mother – a famous pianist, his father – tenor Sergei Davidyan. 16 Davidian became a soloist of the rock group “Leap summer”, which was also Chris kelmi, Alexander Sitkovetsky, Yuri Titov and Igor Bulat Okudzhava. In 1979 joined the new project of Chris kelmi’s “Rock-Atelier”, the group became the first performer of the cult rock-Opera “Juno and Avos”.\nFame came to Davidyan in the fall of 2013, when he became one of the brightest participants of the second season of “the Voice” on channel one. Until the last days of Davidian toured extensively, his repertoire includes his own songs and works of other composers. |
Do not miss out on the US-Guided RA Boutique Workshop in Tampa, FL!\nWhy should you join?\nThis is NYSORA’s fabled, most popular workshop on ultrasound-guided regional anesthesia!\nThis 2-day course will not only teach you technical skills, and technique updates but also provide you with the information on why, when, and what’s next! It will inspire you to implement more US-guided techniques in your practice.\nDelegates attending the regional boutique workshop will be taught standardized techniques and protocols endorsed by NYSORA key opinion leaders worldwide. Faculty selected for the workshops are some of the best instructors and clinicians recognized for their expertise in regional anesthesia. They will present a consistent, agreed-upon NYSORA format that offers the clearest possible instruction. Group numbers are kept small to maximise the learning experience. Ample time for hands-on practice on live models and simulators.\nRegistration includes 6 months complimentary access to the NYSORA Compendium of Regional Anesthesia.\nOur venues are carefully selected for ease of access, location to major transport hubs, close proximity to the city and attractions, inspiring views and first-rate equipment, for the best possible experience.\nDo not miss the early bird registration with a discounted price and learn how to:\n- Interpret various sonographic artifacts and outline a plan for troubleshooting these using various transducer maneuvers and ultrasound machine setting adjustments;\n- Demonstrate the correct sonographic technique for identification of the brachial plexus and individual nerves of the lower extremity, and associated vascular and musculoskeletal structures;\n- Demonstrate the correct sonographic technique for performance of truncal blocks including transversus abdominis plane block, rectus sheath block, and paravertebral and neuraxial block;\n- Develop a framework for the establishment of a regional anesthesia service using strategies to increase surgical, anesthetic and hospital buy-in;\n- Discuss the rational choice of local anesthetics and adjuvants for various peripheral nerve blocks. |
If you have cancer pain, many pain management options can help to improve your quality of life. Ajay Varma, MD, DABA, DABAPM, Ali Valimahomed, MD, and the team at Gramercy Pain Center in Holmdel, Red Bank, Montclair, and Jersey City, New Jersey, offer a variety of safe and effective treatments for cancer pain, including intrathecal pain pumps. Don’t tolerate cancer pain on your own. Call the office or book an appointment online today.\nNot everyone who has cancer experiences pain. But if you do, that doesn’t mean you have to live with it. The compassionate physicians at Gramercy Pain Center are dedicated to helping adults improve their quality of life by managing cancer pain.\nCancer can cause pain in a variety of ways. You may experience pain from the cancer itself if it spreads to your bones or if a tumor presses on a spinal nerve.\nAt other times, cancer pain results from a medical procedure, such as surgery, treatment, or tests. Chemotherapy can cause peripheral neuropathy, which is pain, burning, tingling, and numbness in your hands, arms, legs, and/or feet.\nFirst, your pain management specialist at Gramercy Pain Center thoroughly evaluates your condition to determine the specific cause of your cancer pain. Then, they create a personalized pain management plan that may include:\nAn intrathecal pain pump delivers pain-relieving medication, such as morphine, directly into your spinal fluid. This provides fast and effective pain relief without the side effects of taking oral opioid pain relievers.\nA spinal cord stimulator can control pain that doesn’t respond to any type of medication, including opioids. This implanted device uses an electrical current to interrupt pain signals before they reach your brain.\nRadiofrequency ablation blocks pain signals by heating and destroying specific areas of nerve tissue. Your specialist uses an imaging technique, such as fluoroscopy, to guide an insulated needle to the precise location. Then, radiofrequency energy is sent to the targeted nerve.\nThese treatments involve injecting an anesthetic medication into the epidural space around your spinal cord or into a specific nerve. Your pain management specialist may combine the anesthetic with a corticosteroid or other type of pain-relieving medication.\nDepending on your needs, they may combine one or more of these treatments with medication management for complete pain relief.\nIf you experience any type of cancer pain, call Gramercy Pain Center, or book an appointment online today. |
- Biomedical Research (2010) Volume 21, Issue 3\nEffect of addition of intrathecal midazolam to 0.5 % Bupivacaine on duration of analgesiaShirish Chavan1, Sachin Mumbare2, Manisha Mane\n- Corresponding Author:\n- Shirish Chavan\nDepartment of Anaesthesia\nNDMVPS Medical College\nAgra Road, Adgaon Nashik 422003, India\nAccepted date: May 27 2010\nThe Objectives were to compare the mean period of analgesia for intrathecal Midazolam 0.5 ml plus bupivacaine and bupivacaine alone and to monitor the side effects of intrathecal Midazolam (0.5 ml) plus bupivacaine and bupivacaine alone. A comparative study was carried out to evaluate the analgesic efficacy and side effects of intrathecal Midazolam along with 0.5% Bupivacaine in 80 ASA I and II patients, aged 16 – 60 years, undergoing surgeries below umbilicus, elective as well as emergency. They were randomly divided into two groups of 40 each (n=40). Group I (control): received Bupivacaine 0.5% heavy 3 ml + NS 0.5 ml and Group II (study): received Bupivacaine 0.5% heavy 3 ml + Midazolam 0.5 ml. All patients were haemodynamically stable and there were no serious side effects in any of the patients in both the groups. The mean duration of sensory analgesia in group I and II was 76.30 ± 6.05 minutes and 299.25 ± 15.75 minutes respectively. The difference in the mean duration of sensory analgesia in both the groups was statistically significant. (P < 0.01)\nMidazolam, bupivacaine, intrathecal, analgesia\nOne of the primary aims of anaesthesia is to alleviate the patient’s pain and agony, there by permitting the performance of surgical procedures without any discomfort. Relief of postoperative pain has gained real importance in recent years considering the central, peripheral and immunological stress response to tissue injury. Any expertise acquired in this field should be extended into the postoperative period, which is the period of severe, intolerable pain requiring attention. So there is need of extended analgesia without any side effects to achieve this goal.\nIntrathecal 0.5 % bupivacaine is routinely used for neuraxial blockade. Many authors have suggested the addition of 0.5 ml Midazolam to bupivacaine to extend the period of analgesia [1,2,3]. Many of these studies were based on the animal models. So this study was carried out to study the effect of addition of 0.5 ml intrathecal Midazolam to bupivacaine in humans with the objectives to compare the mean period of analgesia for intrathecal Midazolam 0.5 ml plus bupivacaine and bupivacaine alone and to compare the side effects of intrathecal Midazolam (0.5 ml) plus bupivacaine and bupivacaine alone.\nMaterial and Methods\nType of study : Randomised Control Trial.\nStudy Setting: NDMVPS Medical College and Hospital, Nashik.\nStudy Period: January 2008 to December 2008.\n1) ASA grade I to II, posted for operations below umbilicus, elective as well as emergency.\n2) Age group – 16 to 60 years.\n3) Sex: Male or Female.\n4) Patients who were ready to be included in the study, and who are ready to sign written consent.\n1) ASA grade III, IV, V.\n2) Age below 16 or above 60 years.\n3) Patient who were not ready to be included.\nProtocol was sent to local Ethical committee and approval was obtained. Each patient evaluated pre-anaesthetically and detail history about previous illness and drug treat ment was elicited. Thorough physical examination was carried out. Routine investigations were done. If patients fulfill inclusion criteria, they were explained about procedure and written consent was obtained from the patients. Patients were randomly divided into group I (control) and II (study).\nSequential design was used for the study. All the patients were subjected to spinal analgesia with all aseptic precautions with a 23 or 24 gauge lumbar puncture needle in L3 – L4 interspace. After obtaining free and clear flow of cerebrospinal fluid, intrathecal administration of drugs was done as follows:\nGroup I (control): received Bupivacaine 0.5% heavy 3 ml + NS 0.5 ml\nGroup II (study): received Bupivacaine 0.5% heavy 3 ml + Midazolam 0.5 ml. (2.5 mg – Preservative free)\nTimes of onset of analgesia, upper level of sensory analgesia, time for complete motor block, duration of motor block and total duration of sensory block were noted. Any side effects were also noted.\nIntraoperatively, all the patients received adequate intravenous fluids and blood loss was replaced as and when needed. PR, BP, RR were monitored every 5 minutely till the patients were shifted from operating table. Patients were watched for nausea, vomiting, itching, dryness of mouth, sweating intraoperatively.\nAfter completion of surgery, patient was shifted to the recovery room. A person who was unknown to either of the groups observed patients, till the effect of spinal analgesia wore out. All the relevant information was recorded on a pretested, predefined, semiopen proforma. Any analgesic or sedative were withheld in the postoperative period, unless the patient complained of pain (Grade II). PR, BP and RR were recorded every one hourly till 6 hours and every 4 hourly till 24 hours. Side effects like nausea, vomiting, itching, degree of sedation and respiratory depression were noted in the postoperative period.\nEvaluation of pain and pain relief was done according to McGill pain questionnaire (0 – no pain to 5 – excruciating pain). When patients complained of discomforting pain (McGill grade II) parenteral analgesic was prescribed and the total number of doses in the 24 hour period were noted.\nStatistical analysis of the data was done using computers. Statistical tests such as chi-square, Z test were used wherever applicable. P<0.05 was considered to be significant.\nThe two groups were comparable with regards to mean age, height and weight of the patients. The maximum upper level of sensory block attained was up to T6 level in both the groups and mean value of maximum upper level was comparable in both the groups. (Table 1).\nThere was no statistically significant difference in the time required for onset of adequate analgesia i.e. time taken to attain T10 level in the two groups.\nThere was no statistically significant difference in the time required for onset of complete motor block and also in the total duration of the motor block. (P > 0.05)\nThe mean duration of sensory analgesia in group I was 76.30 ± 6.05 min. The mean duration of sensory analgesia in group II was 299.25 ± 15.75 min. The difference in the mean duration of sensory analgesia in both the groups was statistically significant. (P < 0.01) (Table-2)\nTable 3 shows the incidence of various side effects in both the groups. There was no statistical difference in the incidence of side effects in these groups.\nThis study has shown that the mean duration of analgesia is extended if midazolam is added to the bupivacaine, without increasing the side effects.\nIn 1987, Goodchild and Serrao reported that benzodiazepines might have analgesic effects at spinal cord level in animals . Analgesic efficacy of intrathecal Midazolam in humans has been demonstrated recently. The δ selective opioid antagonist Naltrindole suppresses antinociceptive effect of intrathecal Midazolam, suggesting that intrathecal Midazolam is involved in release of an endogenous opioid acting at spinal δ receptors.\nDemonstration of benzodiazepine stereospecific binding sites in the spinal cord and brain, it seems likely that there exists a neurotransmission system involving benzodiazepine like peptides interacting with receptors in spinal cord [4,5]. This evidence points to possible spinal mechanism, which may be site of action of Midazolam in producing analgesia and interruption of somatosympathetic reflexes .\nThe present study shows that addition of 0.5 ml midazolam to 3 ml of 0.5% bupivacaine does not alter the onset of adequate analgesia and maximum upper level of sensory block, time to reach maximum level of block (dermatome) and duration of motor block.\nMany authors have studied the analgesic effects of midazolam plus Bupivacaine. M.H.Kim and Y.M.Lee observed that there was statistically significant difference in the analgesic effect of midazolam plus Bupivacaine as compared with Bupivacaine alone in haemorrhoidectomy patients. \nSimilar findings were also reported earlier [9.10]. Intrathecal midazolam produces post operative analgesia without prolonging motor block. [6,11] Whereas Tucker A. P. et al reported that the use of midazolam is as safe as bupivacaine \nSo this study has shown that addition of 0.5 ml midazolam (2.5 mg, preservative free) to bupivacaine significantly increases the period of analgesia without increase in the side effects.\n- Goodchild CS, Serrao JM. Intrathecal midazolam in the rat: evidence for spinally mediated analgesia. Br J Anaesth 1987; 59: 1563-1570.\n- Rigoli M.; Epidural analgesia with benzodiazepines Pharmacological basis of Anaesthesiology, Clinical Pharmacology of new analgesics and anaesthetics, Edition, Tiengo M. and Cowins M.J; New York, Raven press. 69-76.\n- Whitman JG, Niv D, Loh L, and Jack RD: Depression of nociceptive reflexes by intratechal benzodiazepines in dog. Lancet. 1982; 2: 1465.\n- Mohler H; okada T; Benzodiazepine receptors: demonstration in the central nervous system, Science, 1977; 198: 849-851;\n- Schoch P, Richards JG, Haring P, Takacs B, Stahli C, Staehelin T, et al. Co-localization of GABA receptors and benzodiazepine receptors in the brain shown by monoclonal antibodies. Nature 1985; 314: 168- 171.\n- Valentine JM, Lyons G, Bellamy C. The effect of intrathecal midazolam on postoperative pain. Eur J Anaesthesiol 1996; 13: 589-593.\n- Niv D; Whitwam J.G; Loh L. Depression of nociceptive sympathetic reflexes by intrathecal administration of Midazolam. British Journal of An- aesthesia, 1983; 53: 542-547.\n- Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy. British Journal of Anaesthesia, 2001; 86: 177-179.\n- Prakash S, Gupta A et al. The effect of intrathecal midazolam 2.5 mg with hyperbaric Bupivacaine on postoperative pain relief in patients undergoing orthopaediac surgery. Internet Journal of Anaesthesiology. 2007; 14 2:\n- Agrawal N et al. Effect of intrathecal midazolam Bupivacaine combination on postoperative analgesia, Indian Journal of Anaesth 2005; 49 (1): 37-39.\n- Batra YK, Jain K, Chari P et al. Addition of intrathecal midazolam to bupivacaine produces better postoperative analgesia without prolonging recovery. Int J Clin Pharmacol Ther 1999; 37 (10): 519-527.\n- Tucker AP, Lai C, Nadeson R, Goodchild CS. Intrathecal midazolam I: a cohort study investigating safety. Anesth Analg. 2004; 98: 1512-1520. |
A national firm, ProNova Partners, has been selected to assist in the sale of an innovative, patented, medical technology\nLOS ANGELES, Calif. /Massachusetts Newswire – National News/ — ProNova Partners, a seventeen-year-old California based Mergers and Acquisitions firm, has been commissioned to assist in the sale of all rights to manufacture and sell a patented, painless, non-invasive, device to eliminate hemorrhoids. Use of the device requires no anesthesia, is conducted in under 2 minutes, and can be performed in any medical setting: a doctor’s office, a surgery center, an endo suite, or a hospital.\nThis technology has yielded a painless, non-invasive, no anesthesia needed device to eliminate hemorrhoids in under 2 minutes. The procedure can be performed in any medical setting.\n“Over half of adults suffer from this affliction at one time or another,” stated Rick Carlson founder and CEO of ProNova Partners. “This Doctor developed device offers a fast, painless and permanent solution.”\nCarlson’s firm has helped the expansion or sale of some 400 companies in a wide variety of market segments.\nThis latest commission for ProNova is designed to structure movement of the patent, sale, and manufacturing rights of a much-needed device to an outside company. The goal is quickly move the technology out and into the medical marketplace. The product, developed and currently sold on a limited basis in the US, was originated by a gastroenterologist. It is currently sold directly to physicians of different specialties, including gastroenterologists, colorectal surgeons, GYNs, urologists and primary care physicians. The biggest targeted audience is gastroenterologists.\n“Huge numbers of patients now no longer need to use ineffective creams or receive painful, invasive surgery,” concluded Carlson. “This device offers a permanent, painless solution.”\nFor detailed information go to: https://pronovapartners.com/engagement/patented-medical-device-company-for-hemorrhoid-removal-for-sale/\nLearn More: https://www.pronovapartners.com/\nThis version of news story was published on and is Copr. © 2022 Massachusetts Newswire™ (MassachusettsNewswire.com) – part of the Neotrope® News Network, USA – all rights reserved.\nInformation is believed accurate but is not guaranteed. For questions about the above news, contact the company/org/person noted in the text and NOT this website. |
Insurance & Billing Info\nPlease be aware that the physicians of Northside Anesthesiology Consultants, LLC. are not employed by Northside Hospital. We are independent practitioners and you will receive a bill for our professional services separate from Northside Hospital.\nDo you have a question about your bill or health insurance? Please contact Sentinel Healthcare Services with all of your billing and healthcare insurance related questions concerning Northside Anesthesiology Consultants, LLC. Sentinel Healthcare Services provides trained billing specialists to assist you.\nSentinel Healthcare Services, LLC\nP.O. Box 116443\nAtlanta, Georgia 30368-6443\nAs the physicians of Northside Anesthesiology Consultants, LLC. are independent of Northside Hospital, our "participation" status with health insurance companies and other third party payers may differ with that of Northside Hospital or the patient's health care provider. Please consider this carefully prior to surgery or delivery. The anesthesiologist's fee is influenced by several factors. These include: type of surgery, length of surgery and the patient's physical condition. The fee is independent of the type of anesthesia. The "anesthesia" charge on your hospital bill is for the equipment and supplies furnished by the hospital. Northside Anesthesiology Consultants, LLC. receives no remuneration from the hospital for these charges. If the patient or the surgeon request post-operative pain management to be provided by Northside Anesthesiology Consultants, LLC., then you will receive a bill for these services. Participation agreements with insurance providers are subject to change. Please check with you insurance provider about your coverage prior to receiving services.\nIt is your responsibility to contact our Business Office at (770) 645-7889 between the hours of 8:30am to 4:00pm to discuss potential or expected financial obligations in advance of your date of service.\nNAC participates with the following insurance plans to provide surgical anesthesia and pain services: (See Note Below)\nManaged Care Plans\nMedicare Advantage Plans\nMedicaid Managed Care Plans\nWorker's Compensation Plans\nAlthough Northside Hospital may be a provider in your insurance network, NAC, which bills for its own services, may or may not be a participating provider. This may affect your coverage level for professional services. NAC participates with many of the major health insurance plans. Based on your policy coverage for in- and out-of-network benefits, your insurance company determines which services are covered and to what extent benefits are paid. NAC has no control over how each insurance carrier determines coverage or payment. Because each policy is different, our physicians are not able to tell you whether, or to what extent, treatment options may be covered by your insurance policy.\nNOTE: Despite our best efforts to keep this list updated, our participation status with one or more of these insurance carriers may have changed. To protect yourself from unnecessary personal financial obligations, it is important that you review your coverage and obligations with your insurance company without delay and in advance of your admission. Questions concerning coverage should be directed to your insurance carrier. |
Having undesirable fat in various areas of your body can have a considerable impact on your health and self-confidence. While traditional weight-loss through exercise and diet plan is a terrific method to slim down in general, even the best workouts can't target problem areas like the stomach, inner thighs, arms, and buttocks. Liposuction is a time tested treatment that is utilized to get rid of excess fat from particular locations of the body, permitting an individual to form and contour their body to their liking. Is liposuction right for you? Learn now.\nPros of Liposuction\nThere are numerous advantages to this cosmetic procedure, including:\n• Instantly visible modifications. Unlike traditional weight loss, liposuction develops modifications that are instantly visible in the body. Some difference is visible right away, and the preferred results are typically achieved in simply a couple of days.\n• Proven and safe. This cosmetic treatment has been performed by seasoned specialists all over the world for several years and the strategy has actually been fine-tuned over and again to be safe and effective.\n• Healing time is generally quickly. The downtime needed after having this type of procedure is generally much less than exactly what is needed for other types of cosmetic procedures, consisting of abdominoplasty, breast reduction, and more. Individuals who have had the treatment can typically go back to work far more quickly than they prepared for and can return to living a healthy, active lifestyle.\n• Weight loss can be permanent. With the right upkeep strategies, the fat that was removed during the liposuction procedure will not return.\n• Complete control over your body. With liposuction, an individual can have complete control over how they wish to look, beyond exactly what standard diet plan and exercise can offer. Giving individuals this power over their bodies increases self-confidence and assistance people feel their best.\nWhile there countless benefits to liposuction, there are naturally a few cautions that must be thought about prior to making the decision to move forward with the treatment.\nCons of Liposuction\nBefore having actually liposuction done, it is very important to analyze the potential disadvantages of the procedure and identify if the advantages exceed the risks in your specific case. Your cosmetic surgeon can assist you learn more about the risks associated with the procedure and can help you decide if moving on is the right thing for you.\n• Problems with general anesthesia. Since liposuction is carried out under general anesthesia, the treatment carries the very same dangers as any other kind of surgical treatment where general anesthesia is used. Hidden medical conditions may enhance these threats.\n• Adverse reactions. Bruising, bleeding, and discomfort are all to be anticipated, nevertheless, in unusual cases can trigger more significant issues.\n• The possible to acquire the weight back. After having liposuction done, it is vital to preserve a healthy diet plan and exercise properly as advised by your physician. Failure to do so could cause getting back the weight that was lost or perhaps much more.\nAlthough there are risks connected with liposuction, for many individuals, the advantages far surpass them. Educate yourself about the procedure by having in-depth discussions with your specialist and think about how liposuction has the prospective to affect you as an unique person. Only you and your cosmetic surgeon can determine if liposuction will offer you with the outcomes you are trying to find within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Millersburg Iowa\nLaser liposuction is a more recent, minimally invasive procedure that involves heating the fat cells to melting point and eliminating the melted fat through a little cannula. The treatment is usually done right in your physician's office and is an exceptional option for people who have less than 500 ml of fat to remove from any one location. Laser liposuction can be a safe, complementary procedure to weight-loss in order to shape the body you have actually always wanted.\nContact a Cosmetic surgeon in your Millersburg Iowa today.\nIf you're considering liposuction as a weight reduction option, it's important that you discuss your desires with a qualified cosmetic surgeon in your location. Your surgeon will perform a complete exam and health history questionnaire to identify if liposuction can benefit you and assist you reach your physical and psychological goals. Call today for an assessment and find out more about how liposuction can assist you attain the body of your dreams. |
The first medical centre specializing in the treatment of haemorrhoids and anal fissures in Ploiesti Medical drainage prostate abscess in the specialties of Gastroenterology, Dermatology and Venerology and Internal Medicine reimbursed by CASPH FOC: Upper GI Endoscopy with sedation and Colonoscopy with sedation ; We hold exclusivity in the Drainage prostate abscess Magnetic Resonance Therapy for the treatment of arthrosis and osteoporosis, the innovation of the year in Germany, and Top-Innovator Award ; Due to the state-of-the-art equipment, our patients are drainage prostate abscess according to European standards, by a dedicated medical team, weekly joined by Bucharest proctology, gastroenterology, internal medicine, phlebology, urology, dermatology, endocrinology, ENT, gynaecology, neurology, psychiatry, ophthalmology and cardiology specialists.\nCall to make an appointment for the medical services you need and save the time you would otherwise waste in the hospital waiting rooms!\nDermatology and Venerology — FOC, through the Health Insurance Fund, based on a referral note: diagnosis and treatment of acne, psoriasis, mole and nevus excision, skin biopsy, etc.\nInternal Medicine — FOC, based on a referral note from the family doctor or the specialty doctor: diagnosis and treatment for digestive tract disorders, urinary or respiratory tract disorders, cardiovascular diseases. Urology — FOC, based on a referral note from the family doctor or the specialty doctor: diagnosis and treatment for urinary tract disorders urinary infections, cystitis, etc.\nGeneral Surgery — FOC, through the National Health Insurance Fund, based on a referral note: mole and nevus excision, skin biopsies, abscess incision and drainage, etc. To see the service packages covered by the agreement concluded with the National Health Insurance as day care mode click hereand to see the fees for the non-reimbursed services, click here.\nThe admission criteria are available herethe admission requirements are available hereand the hospital release requirements may be viewed here. Appointments onlay-uri din prostatită be made by phone at Monday-Friday, 8am — 8pm, and on Saturday between 8am and 1pm, and communications may be sent to the email address office laurusmedical.\nIn order to assess the medical services reimbursed by the Health Insurance Fund, the satisfaction survey is available.\nMedical Specialties Haemorrhoid and Anal Fissure Treatment Rubber-band ligation and IR photothermal coagulation, the golden standard in the treatment of the haemorrhoidal disease.\nThe procedure is provided as outpatient care, it does not require a medical leave or the interruption of daily activities.\nPhlebology UGFS Ultrasound Guided Foam Sclerotherapy The treatment also is efficient in the case of larger veins and venous ulcer, it is provided as outpatient care, does not require anaesthesia, and the patients may resume their daily activities. |
Labor and delivery is a highly specialized area using an obstetrics team. These teams are made up of highly trained staff. This team ensures safe care and delivery of new babies and mothers.\nThe obstetrics team working with new babies includes; physicians, surgeons and specialized nurses. Anesthesiologists are also part of the team. They provide pain relief and anesthesia. All the members of this team are highly trained to handle deliveries.\nYears ago, many mothers and babies died in childbirth. There is a risk of infection, blood loss and oxygen deprivation. Merck manuals\nexplain some of these dangerous complications. It takes nurses who are trained to see the symptoms of danger quickly. It also takes skilled physicians that are ready for anything.\nObstetricians are trained as both physician and surgeon. They can both deliver babies via vaginal route or perform cesarean deliveries. The anesthesiologist is also trained in labor pain relief and anesthesia for cesarean. In this day and age the obstetrics team working with new babies has lowered the death rate in childbirth.\nAttention is now paid to obstetrics care. They physician monitors the mother and baby on a monthly basis. Weight gain, lab values and fetal heart rate are all checked often. Mothers are instructed on good health practices. Any issues during pregnancy are handled promptly. If babies have higher predicted birth weight, cesarean surgery can be scheduled ahead of time.\nWhen labor begins, nurses at the hospital monitor the mother constantly. Doctors are only a phone call away if there is a problem. The obstetric team working with new babies are also trained in infant resuscitation. This minimizes problems after childbirth. Physicians/Surgeons who deliver babies also have a small amount of training in neonatology. They can care for difficult cases until a pediatrician arrives to take over care of the infant.\nBeing a physician/surgeon on an obstetrics team working with new babies can be tiring. The hours of work can be at any time day or night. Calls can come in at 3 in the afternoon or 3 in the morning. Specialists often cannot find someone to cover days off. This takes an enormous amount of dedication for doctors and staff. It is also a high stress environment at times. For the most part, it can be a very rewarding healthcare career! |
Factors like pregnancy, breastfeeding, weight gain, medications, and genetics all influence the size of your breasts. When you feel that your breasts are too large, you may wonder if it would be worth your time undergoing surgery in the Melbourne area to reduce their size. You may make that decision with confidence by learning what a breast reduction procedure is and who is the ideal candidate for the procedure.\nWhat is Breast Reduction?\nA breast reduction procedure reduces the size of the breasts. It typically requires the use of general anesthesia and entails a recovery period of multiple weeks. The operation removes excess breast fat, glandular tissue, and skin to make the breasts smaller. The total reduction amount depends on considerations like your overall body size, the amount of pain that large breasts causes you, and your desired cosmetic results, among other factors.\nBefore you undergo this procedure, you have to be evaluated for your candidacy for it. Our doctor in Melbourne may determine if you may go through this surgery safely based on your physical health and your reason for wanting to have your breast size reduced.\nCandidacy for Breast Reduction\nIt is important for an ideal candidate for breast reduction surgery in Melbourne to:\n• Be in good overall health\n• Have realistic expectations for the outcome of the surgery\n• Not smoke or abuse drugs\n• Not be pregnant or nursing\nIf you meet these criteria, our doctor may approve you for the operation. As noted, the operation is typically done under general anesthesia. Once you are asleep, our doctor may remove the excess fat and tissue before reshaping and repositioning your breasts. Your total recovery time depends on your overall health and the extensiveness of your surgery. Most patients in Melbourne feel back to normal within multiple weeks.\nGetting Started with Breast Reduction Surgery\nMake an appointment with Mr. Salerno and his team at Real Cosmetic & Plastic Surgery to see if breast reduction is right for you. Our office is located in Moonee Ponds and we proudly serve clients in Melbourne and the surrounding areas. Contact us today to schedule a consultation! |
Open 24 hours a Day, 7 Days a Week, Holidays Included\nPositions Available: Come Join Our Family!\nWe are currently seeking experienced Veterinary Technicians for positions at our hospital:\nEvening Veterinary Technician: The schedule is a rotating schedule allowing every other weekend off. The evening hours are typically 2pm-12am.\nOvernight Veterinary Technician: The schedule is a rotating schedule allowing every other weekend off. The overnight hours are typically 8pm-8am.\nSend Resume to: [email protected]\nFull time positions offers a competitive salary, 75% coverage by employer for health insurance (up to $300), 401k plan with matching contributions up to 5%, 2 weeks PTO per calendar year, Colonial Life insurance plans (employer pays a $40 credit towards these insurance plans), dental insurance (50% employer paid) and 70% employee pet discount (dependent on how many animals you have). VESH also offers a life insurance plan 100% paid by the employer.\nTwo years technician experience necessary. Bachelor's degree preferred but not required. Candidates should be self-motivated and possess a strong work ethic. You must be organized, comfortable in a fast paced environment, have excellent verbal and written skills, be able to work well as a team and should possess some emergency and surgical experience. One also must possess excellent customer service skills and have the following technical skills including but not limited to: -Full knowledge of anesthesia and monitoring-Peripheral/central phlebotomy and catheterization.-Critical-care patient nursing skills-Intubation/Extubation-Some General Practice experience-Triage and patient assessment-Knowledge of medications and calculations of such-Avimark experience preferred but not necessary. Job Type: Full-time and Part-time |
Multiple Sclerosis and Baclofen Therapy\nWho Is a Candidate for the Intrathecal Baclofen Pump?\nAnyone who has spasticity that is not responsive to oral treatment is a candidate. However, intracthecal baclofen therapy (ITB) is more effective for spasticity involving the legs as opposed to the arms.\nIf you are considering intrathecal baclofen therapy, you will generally meet with a treatment team that may include a doctor specialized in rehabilitation (physiatrist), a physical therapist, an occupational therapist, a nurse, and a social worker. All of these professionals work as a team to provide a comprehensive evaluation of your spasticity symptoms and to establish a treatment plan adapted to your personal needs. Many anesthesiologists who specialize in pain management also manage ITB pumps.\nWhat Are the Advantages of the Baclofen Pump System?\nThe baclofen pump system:\n- Efficiently reduces spasticity and involuntary spasms, promoting a more active lifestyle, better sleep, and reduced need for oral drugs\n- Continuously delivers baclofen in small doses directly to the spinal fluid, increasing the therapeutic benefits and causing fewer and less severe side effects than the oral version\n- Can be individually adjusted to allow infusion rates that vary over a 24-hour period\n- Can be turned off when it isn't needed\n- Reduces or eliminates pain and discomfort from spasms and spasticity\nWhat Are the Disadvantages of the Baclofen Pump System?\nThere are certain risks that must be considered with any surgery, and implanting the baclofen pump is no exception. Risks include:\n- An adverse reaction to anesthesia\n- Bladder control can be altered, causing loss of urine unexpectedly\n- Pump malfunction: If the pump malfunctions (this is rare), it may deliver too much medicine at once. In that instance, you will develop symptoms such as drowsiness, dizziness, weakness, insomnia (difficulty falling and/or staying asleep), lightheadedness, nausea, constipation, vomiting, loose muscles, trouble with vision, coma, respiratory depression, seizures, dry mouth, double vision, decreased concentration, diarrhea, or delayed responsiveness. Should this occur, go to the nearest emergency room immediately. A doctor can give you a drug called physostigmine to counteract baclofen.\n- Kinked catheter: If the catheter becomes "kinked," surgery may be necessary to replace the catheter. |
Liposuction is a minimally invasive surgical procedure that slims and contours the targeted areas of the face or body by removing stubborn excess fat with a suction cannula. The value of liposuction is that it is a guaranteed method to remove fat, compared with other fat reduction treatments or topical products, as it physically removes the fat cells out from the body.\nThe human body holds subcutaneous fat in both deep and superficial layers. During liposuction Palo Alto & San Jose plastic surgeon Dr. Boudreault makes a small incision (3-5mm) to insert a cannula into the deep fat layer. He then uses a technique referred to as S.A.F.E. liposuction, which stands for Separation, Aspiration and Fat Equalization. The first step is Separating the fat, which is done while injecting the tumescent fluid. This is referred to as a “SITS” technique, or Simultaneous Infusion of Tumescent and Separation. This fluid settles, helping minimize the bleeding, then Aspiration is carefully performed with 3-4mm cannulas to produce the desired outcome. Once satisfied with the amount of reduction, Fat Equalization is performed to blend the treated areas with the untreated areas, to help minimize irregularities and transition effects.\nDr. Boudreault performs liposuction in our AAAASF surgical facility under general anesthesia. During the procedure, small incisions are made in inconspicuous areas near or along natural creases of the body.\nThen, a fluid that contains local anesthetic and epinephrine is injected into the incisions to completely numb the area and minimize bleeding during the surgery. Next, a small device called a cannula is inserted and a forward and backward motion is used to create small tunnels within the fat. This is then suctioned out of the body. This is done as described above as S.A.F.E liposuction. Over the course of several weeks, the underlying space will collapse and the overlying skin will tighten, resulting in a more contoured appearance of the treated area.\nRecovery is generally mild, but can usually be described as tenderness, soreness, swelling, and bruising. You’ll start to feel yourself again and can return to work after 1-2 weeks. Generally, you can resume the physical activity of a heart rate below 90 bpm at 2 weeks, the activity of a heart rate below 90-120 bpm at 3 weeks, and normal or strenuous activity after 4 weeks as you feel comfortable. We also recommend lymphatic massage to help speed up recovery and minimize swelling and tenderness.\nOur San Jose & Palo Alto liposuction removes unwanted fat to improve the shape and contours of the body or face. The best candidates for Palo Alto & San Jose liposuction are men and women who have persistent bulges of fat in unwanted areas that do not respond favorably to diet and exercise. Lipo, as it’s commonly called, can be done on almost any area of the body: abdomen, back, thighs, hips, buttocks, lower legs, chest, upper arms, neck, jawline and cheeks. The result is a slimmer, shapelier and more contoured version of you.\nFor more significant fat removal, changes will be noticed immediately post-procedure. Swelling will be present after surgery and can obscure the results initially. Patients are required to wear a compression garment for two weeks after surgery before transitioning to a lightly compressive garment, like Spanx®, to minimize swelling and maintain your newly contoured shape. Swelling after surgery is the most common reason for any delay in seeing your final results, but most swelling will resolve after the first 1-2 months. Most before/after photos we take are at 3-6 months post-procedure.\nThe average cost of liposuction in San Jose & Palo Alto starts at $6,500. This estimated cost also includes anesthesia and facility fees. If you’d like to enjoy your newly lipo sculpted body sooner, but would like to space out the payments in smaller monthly increments over time, our patients can apply for financing through CareCredit or Alphaeon. Many patients have also applied for credit cards with longer terms at 0% interest. Join our many Silicon Valley patients who’ve had their Liposuction procedure to achieve slimmer, contoured features they now love.\n“I had my Brazilian Butt Lift in 2017 with Dr. Boudreault and I couldn’t be any happier with my results. My butt and hips look SO natural – my only regret was not doing it sooner!”\n“I fully trust Dr. B and will go to him for all my procedures. He really cares about his clients and their results.”\n“The day after my surgery when the garment came off, I almost cried. Dr. B exceeded my expectations and gave me an even BETTER body than I had imagined.”\nAt Illuminate we’re with you during every step of your journey toward greater self-confidence. Schedule a consultation with us today and let Illuminate’s expert team listen to your concerns and guide you through treatments and procedures to help you reach your individual goals. We look forward to seeing you and celebrating your renewed appearance and realized potential. |
The term "Nerve Block" can be used broadly to describe a procedure that is done in many different locations for different conditions or reasons.\nIn general Nerve Block means, a procedure in which an anesthetic agent is injected directly near a nerve to block pain. A nerve block is a form of regional anesthesia. In some cases they also inject a steroid to decrease inflammation when you have pain in a location.\nThese can be very effective or not very effective. I think it depends on the individual, the technician and the type and often the location of your pain. It's usually worth a try before having an invasive and structural altering surgery.\nPlease ask for information on the procedure and an explanation from the physician that is suggesting a nerve block. Make an informed and educated decision. The Internet should also provide you with information.\nIf you have more specific questions please feel free to ask on our forum. I know that we have members that have had this procedure. I wish you the very best and hope you will share your decision with us.\nThank you for the responce,I will keep searching for answers. I am so stressed out and time is ticking , 1 doc. wants me to have surgery and the other says no. My FMLA is running out. Bless you thanks smiley\nYes , do you know what is the outcome of people that has had a" lumbar disectomy fusion L-5 do most of them heal good , can they function, do they have to more surgery. And what about these nerve block , do they have to keep getting them , is it just covering the problem up for now and later have to have surgery ? Do you know if a " myelogram" can see more of what is going on , more than a MRI ???\nThanks so much smiley :)\nP.S. yes , i have thought about a 3 opinion , but , i am running out of time on FMLA of work , need answers quick ,but i think doc. are draging things out - competing with eachother wanting that $ , but , if i have no job , no ins.or $.\nThese are some of the statistics that I found through searching the Internet. Currently, the re-operation rate for just a discectomy is 17-20%. As you know a discectomy is removal of herniated disc material that presses on a nerve root or the spinal cord. It is considered to be one of the most effective types of surgery if nonsurgical treatment has failed and you are experiencing severe, disabling pain.\nIf I understand you correctly they are planning to repair the disc and than do a fusion. A fusion is another surgical approach when all else has failed and according to the statistics doesn’t prove to have any more success with an average success rate of 68%. However this varies from study to study from 16-95%.\nA myelogram can be more effective than other studies at viewing the details of your spine. With this procedure the radiologist is able to view and evaluate the status of the spinal cord, nerve roots, and meninges, which are the membranes which surround and cover the spinal cord and nerve roots. Myelography provides a very detailed picture.\nNerve blocks usually require repeating. They are effective from 3 months to 18 months. Everyone is different and much depends on the location of the injury, the skill of the technician and of course how one's body reacts to the procedure.\nIn my personal opinion I would try all non-invasive treatments before I consented to a fusion. I would even have a discectomy first. However I am not your surgeon and I cannot advise you. Just make sure you educate yourself on the procedures and options available to you, well before you make any decisions.\nRemember the above should not be taken as a medical opinion. This is just a personal opinion and nothing else. Your best advice will come from your physicians and surgeons. I would weight all the pros and cons. Chronic pain can be challenging and cloud our judgements. And as always I wish you the best of luck.\nCopyright 1994-2016 MedHelp International. All rights reserved.\nMedHelp is a division of Aptus Health.\nThis site complies with the HONcode standard for trustworthy health information.\nThe Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately. |
Slim and reshape your body’s contour.\nRemove unwanted, excess fat.\nLiposuction is one of the top cosmetic procedures in the United States. Both men and women receive this procedure every year. Liposuction slims and reshapes your body’s contour by removing unwanted, excess fat deposits. It effectively treats those stubborn areas of fat that do not respond to diet and exercise. If you are looking for liposuction in Las Vegas, see what Apex Medical Spa has to offer!\nDuring the liposuction procedure, fat is removed through a cannula, which is a hollow medical instrument. Think of it like a metal straw that is inserted under the skin.\nThere are different types of liposuction, some more invasive than others. At Apex Medical Spa, we use vibration-supported liposuction, which is less invasive than more traditional methods. Vibration-supported liposuction is the modern way of surgical fat removal.\nWith this method, the cannula is moved axially in a fast vibrational mode. This serves in combination with the suction vacuum to microscopically and gently cut and remove fat tissue.\nThere are many benefits of the vibration-supported technique. First, unlike some more traditional methods of lipo, local anesthesia can be used. Secondly, vibration-supported liposuction needs less force to move the cannula and break up fat. This innovative benefit allows the doctor to work with higher precision.\nWith the tumescent technique, the volume of dilute lidocaine that is injected into fat is so large that the targeted areas literally become tumescent (swollen and firm). The tumescent technique produces profound and long-lasting local anesthesia of the skin and subcutaneous fat. By eliminating the risks of general anesthesia and the risks of excessive surgical bleeding, the tumescent technique for liposuction totally by local anesthesia has eliminated the greatest dangers associated with the older forms of liposuction.\nThis allows the patient to be awake during the procedure and walk out afterward, returning to regular activities in a few days.\nBoth men and women benefit from liposuction. Commonly treated areas for women include abdomen, thighs, waist, arms, buttocks, and back. Commonly treated areas for men include the chest, arms, back, and abdomen.\nAs long as you maintain your weight, your results should be permanent. The adult body does not readily produce fat cells. So, unless you gain a significant amount of weight, the fat cells will not return.\nIf you do gain small amounts of weight, the remaining fat cells can increase in size. This can diminish some of the positive results achieved from the procedure.\nTherefore, even after the liposuction procedure, it is important to adopt a healthy lifestyle of good diet and physical activity.\nYou will be able to see a noticeable difference immediately after. However, average time to see the final results is about 3 months. Over the first few months, the treated areas will continue to show more improvements as the swelling decreases.\nLooking to effectively treat those stubborn areas of fat that do not respond to diet and exercise? Contact Apex Medical Spa to schedule a free consultation for Las Vegas Liposuction.\nWe use the most current High Definition Liposculpting, Liposat and Vibrosat machine. Vibration-supported liposuction is the modern way of surgical fat removal. The suction cannula is moved axially in a fast vibrational mode.\nThis serves in combination with the suction vacuum to microscopically and gently cut and remove fat tissue. This technique has its specific advantages for both the doctor as well as the patient. Less force and effort is necessary to move the cannula and the doctor is able to work with higher precision.\nGet your procedure financing through our trusted partners at CareCredit.\nCareCredit is a healthcare credit card designed to offer financing solutions to fit your needs. Make your desires a reality!\n1701 Wellness Way | Suite 201\nLas Vegas, NV 89106 |
[continued from above]\nBabyshark, Muse and SloMo - All three of you commented in all four entries. If that's not love, I don't know what is! Gregg - you commented in three. I know that's love (still waiting for my Letter Most Royal)\nSteven - thanks for the hug. And I think you're right about the first procedure traumatizing me. But I wasn't supposed to be "under" - it was clearly outpatient surgery with local anesthesia. I should've known better. I guess I will in the future. Perhaps hypnotism to clear my post-trauma.\nVivian - I've written that proverb down. It sits on my monitor now. Thank you.\nIsabel - you and I seem to be on a similar healing path. The situation may look different but I always seem to relate to your process on very deep levels. Thank you for finally coming out and commenting. I've been reading your journal since I started mine. I commented a few times even. I wasn't sure if I was imposing. But I kept going back. So glad I didn't give up on you! You're a dear person.\nIRUN - You're a dear heart as well. What can I say? You're helping me heal some deep wounds simply because you're a good man, a good husband and a good friend. Thank you.\nSloMo - Indeed, you have done your fair share of loving and laughing with me. I always feel your support, whether I'm crying or thrilled about something. I know you're listening - you sometimes don't have a choice. But that's the glory of this friendship. It goes both ways. I love you.\nMichelle (Songbird) - This is a tough one. I hear that surgery worked for you 9 years ago. I'm grateful for that. I believe surgery does and can heal. But I also believe there's a time and a place for it. And for me, it's a very last resort. I'm not wondering, "Should I have the surgery?" I'm wondering, "How can I heal?" Thank you for hearing me and supporting my process.\nGregg - Thank you for riding with me through each entry. I appreciate your energetic laughter. It's fun getting to know you! |
The Art and Science of Facelift Surgery: A Video Atlas-Original PDF+Videos\nLogin is required\nIf you are not our user, for invitation Click Here\nAmazon Price $170\nSize : 98.53 MB\nImproved surgical techniques and increasing patient expectations have transformed the field of cosmetic facial surgery, and Art and Science of Facelift Surgery brings you up to speed with today’s best and latest procedures. This highly practical resource features a superbly illustrated print reference with step-by-step procedures accompanied by surgical videos of each technique. Comprehensive, easy-to-follow instruction from internationally renowned expert Dr. Joe Niamtu helps you achieve optimal outcomes on frequently requested procedures.\n- Covers the procedures that today’s patients are requesting: male facelift and chin implants, revision facelifts, deep plane facelifts, submandibular gland resection, and many more.\n- Includes an abundance of full-color photographs that illustrate surgical steps and before-and-after outcomes, as well as easy-to-follow instruction for each procedure.\n- Provides access to high-quality videos that show all necessary and important stages of each surgery, so you can learn directly from the surgeon as you watch each step being performed.\n- Features related videos covering ancillary jowl plication suture after SMASectomy, submenoplasty neck lift, facelift flap trimming, tumescent anesthesia injection, and more.\n- Helps both trainee and practicing aesthetic surgeons attain optimal results and patient satisfaction with every facelift.\n- Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.\n- Hardcover: 256 pages\n- Publisher: Elsevier; 1 edition (October 29, 2018)\n- Language: English\n- ISBN-10: 0323613462\n- ISBN-13: 978-0323613460 |
The Department of Anesthesiology at UT Health San Antonio currently comprises 50 Clinical Faculty physicians, 26 CRNA’s, and two Ph.D. research scientists. The Department provides clinical services at University Hospital, The Audie L. Murphy Memorial Veterans Hospital and Children’s Hospital of San Antonio (Christus Santa Rosa Health Care). Our faculty are board-certified in Anesthesiology, Critical Care, Pain Management, Cardiothoracic Anesthesiology, Pediatric Anesthesiology, and Obstetric Anesthesiology.\nThe Anesthesiology Department supports a strong residency program and two fellowship programs. We currently have 56 anesthesiology residents, 6 pain medicine fellows, and 2 critical care medicine fellow. The Department also provides clinical clerkships and didactic lectures for MS-3 and MS-4 medical students.\nMessage from the Chair\nWelcome to the Department of Anesthesiology at UT Health San Antonio. As Chair, I could not be more enthusiastic about the present and future of our Department. To meet our missions of teaching, clinical service, research and operational excellence, we are training some of the finest anesthesiologists, providing high-quality, patient-centered care, creating infrastructure for clinical research and data science. My vision for our department includes physician leadership development and an ACGME fellowship for health informatics in the coming year.\nWe currently have 60 residents in our 4-year program. We filled our 2019 entering class on Match Day with 16 outstanding candidates who’s average USMLE Part I score is 230 and average Part II score is 239. Our 50+ faculty members are fully committed to providing every learning opportunity for our residents. Currently 95% of our graduates are board-certified by the American Board of Anesthesiology (ABA). Our core program as well as our fellowships in Pain Medicine and Critical Care Medicine have attained a 10-year resurvey cycle from the ACGME.\nUniversity Hospital, our primary teaching facility, is a state-of-the-art tertiary care center that is responsible for both adult and pediatric level 1 trauma for all of South Texas. Last year we provided anesthesia services for over 18,800 cases including cardiothoracic surgery, hepato-biliary transplant, lung transplant, advanced neurosurgical cases, acute stroke interventions, orthopedic joint and trauma, as well as robotic and high risk gynecological surgery. We cover a robust women’s health service that saw almost 3,000 deliveries last year, many involving high risk maternal conditions. Our new 300 bed Women’s and Children’s Hospital will be open in 2022. The growth target for 2022 is projected to surpass 5,000 deliveries per year. San Antonio is one of the fastest growing cities in the U.S. and University Hospital is building to meet our community’s future health care needs. In addition our hospital system is consistently ranked as the best hospital in San Antonio by US News and World Report.\nOur other teaching facility, the Audie L. Murphy Veterans Administration Hospital, part of the South Texas Veterans Healthcare System, experiences approximately 1.2 million patient visits per year. The Audie L. Murphy Hospital trains 219 residents yearly, which is the 3rd highest total in the VA system nationwide. The hospital has 11 operating rooms that includes two robotic surgery systems and cardiothoracic surgery suites. The VA campus, which is directly adjacent to UT Health is also the home of San Antonio Polytrauma Rehabilitation Center, which is one of only 5 of these centers in the country. Our outpatient pain practice is affiliated with UT Health, which consists of over 800 providers in South Texas. We oversee an advanced interventional pain service that spans multiple sites within the South Texas Medical Center and the Hill Country.\nDuring the past academic year our department was awarded a Department of Defense grant in order to further the development of limb preservation technology which was invented by UT Health San Antonio Anesthesiology researchers. Other faculty members of ours were awarded UT Health President’s Translational and Entrepreneurial Research grants in order to further develop and commercialize medical devices which pertain to patient safety, and airway management. Additional research initiatives include reducing the abuse potential of opioids, radiofrequency ablation technology, and psychological therapy for chronic pain.\nPlease take a few more minutes to review our pages on this website detailing our programs and initiatives. Whether you are a prospective resident, patient, or faculty member, I am sure you will agree with me that the Department of Anesthesiology at the UT Health San Antonio, Texas is a dynamic and progressive contributor to the health of our patients and the field of anesthesiology. |
Description & Objectives\nThe course is intended for any clinician taking care of acutely ill neurological and neurosurgical patients. It will be particularly helpful to adult hospitalists, nocturnists, pulmonologists, emergency room providers, and advanced practice clinicians from internal medicine, neurology and neurosurgery. The conference will be primarily marketed to Washington, with a focus on Western and Central Washington.\nThere is a need to train internists and hospitalists in the recognition and management of commonly encountered problems in acute care neurology and neurosurgery.\nSpecialized clinical neuroscience training allows hospitalists to triage calls and evaluate and manage these patients, ensuring around-the-clock in-house physician coverage. It also augments the ability of hospitalists to co-manage neurological and neurosurgical patients.\nThere is a need to provide hospitalists with the information they need to be able to recognize the red flags, identify when to worry and/or call a consult, and give them a sense of a patient's prognosis so that they can answer questions posed by family members.\nIn addition, the Joint Commission requires neurocritical care nurses to obtain Nursing Contact Hours in ICU training.\n- Manage acute blood pressure, create a seizure treatment and prophylaxis plan and explain DVT prophylaxis\n- State the causes of elevated intracranial pressure, recognize the signs of elevated ICP and implement treatment strategies to decrease elevated intracranial pressure\n- Recognize patients at risk for developing the Malignant MCA Syndrome and discuss the strategies to limit and treat malignant cerebral edema\n- Discuss and clarify intracerebral hemorrhage, intracranial pressure and malignant MCA syndromes\n- Review the process and outcome model and societal context of quality improvement, and identify quality improvement targets in the workplace\n- Identify the signs of emergent worsening of ALS, Myostenia Gravis and Guillain-Barre\n- Restate the unique challenges of stroke in a rural environment and the use of telestroke in Alaska\n- Discuss quality metrics in the ICU, neuromuscular emergencies and the delivery of stroke and neurocritical care services in Alaska\n- Outline the medical complications of patients with subarachnoid hemorrhage and explain the current management of vasospasm after subarachnoid hemorrhage\n- State the short and long term effects of varying degrees of sedation in the ICU, describe the importance of the quality sedation-delirium protocols on ICU outcomes and apply best practices for ICU sedation based on recent guidelines\n- Review postoperative management of patients undergoing craniotomy and major spine surgery and discuss common complications and their management after craniotomy and major spine surgery\n- Discuss subarachnoid hemorrhage and the critical care management of the post-operative neurosurgical patient and sedation and delirium in the ICU |
IPG and Pacira BioSciences Announce Collaboration to Reduce Postsurgical Opioid Prescribing and Surgical Procedure Costs\nALPHARETTA, GA and PARSIPPANY, N.J., September 15, 2020 – IPG, the industry-leading provider of surgical cost management solutions, and Pacira BioSciences, Inc. (NADSAQ: PCRX), a leading provider of non-opioid pain management options, today announced a collaboration to reduce postsurgical opioid prescribing and surgical procedure costs across the IPG national health plan and provider network.\nThrough this partnership, IPG will offer reimbursement for EXPAREL® (bupivacaine liposome injectable suspension) to its health plan provider clients across the country to further support its mission to bring high quality, cost-effective surgical solutions to the U.S. healthcare market. Pacira will work alongside IPG to provide education and training to ensure consistent, positive outcomes are achieved across procedures, clinicians, and provider facilities.\n“We look forward to working with Pacira on this joint commitment to decrease surgical costs, reliance on opioids, and opioid-related adverse events through the reimbursement and expanded utilization of EXPAREL,” said Brian Holt, Chief Innovation Officer of IPG. “By increasing access to non-opioid options, our health plan partners can reduce the need for postsurgical opioids with no impact on the quality of care provided, all while helping to lower the total cost of the surgery and out-of-pocket costs for patients.”\nUnder the terms of the partnership, the organizations will co-develop clinician-facing educational materials and EXPAREL resources that will support best practice pain management for surgical patients.\n“The use of non-opioid postsurgical pain management plays an integral role in improved clinical and economic outcomes, as well as increased patient satisfaction,” said Dave Stack, Chief Executive Officer and Chairman of Pacira BioSciences, Inc. “We are excited to partner with IPG on this initiative and commend their leadership in reducing opioids to offer patients the highest quality postsurgical recovery experience.”\n“This collaboration furthers our commitment to quality and affordability of surgical care.” said Vince Coppola, President and Chief Executive Officer of IPG.\nIPG works with the leading national and regional health plans across the country and their partnering providers, including large chains and independent ambulatory surgery centers.\nIPG is the leading provider of Device Benefit Management solutions, working with health plans, providers, surgical facilities and patients across the country to improve quality and reduce costs for surgical procedures through optimization of the most effective site of care and device selection, resulting in more affordable high-quality care to consumers. For more information about IPG, call us at 866.753.0046, or visit us on the web at www.ipg.com.\nAbout Pacira BioSciences\nPacira BioSciences, Inc. is a leading provider of non-opioid pain management and regenerative health solutions dedicated to advancing and improving outcomes for health care practitioners and their patients. The company’s long-acting local analgesic, EXPAREL® (bupivacaine liposome injectable suspension) was commercially launched in the United States in April 2012. EXPAREL utilizes DepoFoam®, a unique and proprietary product delivery technology that encapsulates drugs without altering their molecular structure, and releases them over a desired period of time. In April 2019, Pacira acquired the iovera° system, a handheld cryoanalgesia device used to deliver precise, controlled doses of cold temperature only to targeted nerves. To learn more about Pacira, including the corporate mission to reduce overreliance on opioids, visit www.pacira.com.\nEXPAREL (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in adults to produce postsurgical local analgesia and as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks. The product combines bupivacaine with DepoFoam®, a proven product delivery technology that delivers medication over a desired time period. EXPAREL represents the first and only multivesicular liposome local anesthetic that can be utilized in the peri- or postsurgical setting. By utilizing the DepoFoam platform, a single dose of EXPAREL delivers bupivacaine over time, providing significant reductions in cumulative pain scores with up to a 78 percent decrease in opioid consumption; the clinical benefit of the opioid reduction was not demonstrated. Additional information is available at www.EXPAREL.com.\nImportant Safety Information for Patients\nEXPAREL should not be used in obstetrical paracervical block anesthesia. In studies where EXPAREL was injected into the wound, the most common side effects were nausea, constipation, and vomiting. In studies where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation. EXPAREL is not recommended to be used in patients younger than 18 years old or in pregnant women. Tell your healthcare provider if you have liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from your body. EXPAREL should not be injected into the spine, joints, or veins. The active ingredient in EXPAREL: can affect your nervous system and your cardiovascular system; may cause an allergic reaction; may cause damage if injected into your joints.\nPacira BioSciences, Inc.\nKerry Lee Perry\nCoyne Public Relations\nAlyssa Schneider, (973) 588-2270 |
Staff Education Tool: Medication Safety Reconciliation Toolkit\nThe North Carolina Center for Hospital Quality and Patient Safety offers a free, downloadable medication safety reconciliation toolkit.\nThe toolkit can help organizations establish and implement a standardized medication reconciliation process. The toolkit provides guidance, sample forms, and tips.\nThe toolkit includes the following sections:\n- The project\n- Performance improvement model\n- Spreading and formalizing\n- Reference materials\nDownload the medication safety reconciliation toolkit (pdf) developed by the North Carolina Center for Hospital Quality and Patient Safety for use by your facility.\nNote: View our database providing more than 125 reports that link to free, downloadable and adaptable tools for use in surgery centers, hospitals and other organizations by clicking here.\nRelated Articles on Medication Safety:\n© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.\n- Pediatric dental, medical procedures performed in single visit reduce anesthesia exposure: 5 study insights\n- Nonalcoholic fatty liver disease associated with $103B in annual medical costs: 3 study insights\n- AGA launches patient education platform for IBD, pregnancy concerns: 3 notes\n- 3 things to know about Reproductive Science Center of New Jersey's accreditation\n- GI leader to know: Dr. R. David Shepard of Florida Medical Clinic |
Genital tumors represent a special group requiring effective and curative treatment while functional and cosmetic demands require tissue sparing techniques. For these reasons, micrographic surgery is indicated. Over the past 5 years we have treated 24 such patients utilizing standard techniques for micrographic surgery. The patient population included twenty male and four female patients with ages ranging from 27 to 80 years. Histologically confirmed diagnoses included squamous cell carcinoma, Bowen's disease, verrucous carcinoma, basal cell carcinoma, Paget's disease, and leiomyosarcoma. These were located on the penis, scrotum, perineum, and buttocks. Seven of these patients were considered to have recurrent tumors. Preexisting conditions existed in 6 patients, including balantis xerotica obliterans, trauma, decubitus ulcer, and hidradenitis suppurativa. All surgery was performed under local anesthesia in the cutaneous surgery unit. Average pretreatment tumor size was 2.0 × 1.9 cm. Average postoperative defect size was 4.5 × 3.7 cm. Tumors were excised with an average of three stages and 18 sections. Most defects (65%) were allowed to heal by secondary intention, five (21%) were closed primarily, and three were referred for closure. After surgery five patients developed metastases in their regional lymphatic system. No patients developed local recurrence. Micrographic surgery is a most useful treatment modality in patients with genital tumors for control of local disease. However, patients with squamous cell carcinoma should be considered for elective regional lymph node biopsy and/or dissection in conjunction with micrographically controlled excision of the primary tumor.\nASJC Scopus subject areas |
i got shot in the ear with a bb gun and the bb has been stuck in my ear for some time now. Its right where my ear should fold and so my ear sticks out a lot. I would like to know when i get it taken out will the stitches make my ear fold back\nWill Stitches Make my Ear Normal Again After I Take Them Out? (photo)\nDoctor Answers (4)\nRemoval of Ear Foreign Body\nIt is likely thatthe ear deformity you see is related to the implantation of the foreign body. Removing is likely to correct the ear deformity. This is a simple procedure done in the offic under local anesthesia.\nEar shape after removing bb\nThank you for your question. The bb is sitting in a part of the ear called the anti helix. The actual bb and the swelling associated with is causing the ear to protrude. Removing it most likely will result in return of shape to normal.\nThe procedure is dine under local anesthesia in the office. The scarring is minimal and since it is behind the ear,it will not be visible.\nExternal ear injury\nOnce the foreign body is taken out, your ear should eventually go back to its previous position. You may have swelling too which can exaggerate the position of the external ear.\nYou might also like...\nWill removing a BB from behind the ear return its shape back to normal\nI would agree with the anatomical comments relayed by my colleagues. Removing that BB is indeed a straightforward office procedure under local anesthesia. It is possible that removing the BB will improve the shape of your ear. If it doesn't there are surgical options to improve the shape of your ear but these are obviously more involved than simply removing the BB that is there now.\nStephen Weber MD, FACS |
Childbirth In The Age Of Addiction: New Mom Worries About Maintaining Sobriety\nWhen she was in her early 20s, Nicole Veum says, she made a lot of mistakes.\n“I was really sad and I didn’t want to feel my feelings,” she said. “I turned to the most natural way I could find to cover that all up and I started using drugs: prescription pills, heroin for a little bit of time.”\nVeum’s family got her into treatment. She’d been sober for nine years when she and her husband, Ben, decided to have a baby. Motherhood was something she wanted to feel.\nIf she needed an epidural during labor, Veum told her doctor, she didn’t want any fentanyl in it. She didn’t want to feel high.\n“I remembered seeing other friends,” she said. “They’d used it, and they were feeling good and stuff. I didn’t want that to be a part of my story.”\nAn epidural is a form of regional anesthesia given via an injection of drugs into the space around the spinal cord. It is typically a mix of two types of medication: a numbing agent, usually from the lidocaine family, and a painkiller, usually fentanyl.\nThe amount of fentanyl in the mix is limited, and little passes into the bloodstream, anesthesiologists say. But if a woman doesn’t want the fentanyl, it’s easy to formulate an epidural solution without it. Doctors either use a substitute medication or boost the concentration of the numbing agent.\n“There’s no medical reason why someone should be forced to be exposed to opioids if they don’t want to,” said Dr. Kelly Pfeifer, a family physician and addiction expert who now works as director of high-value care at the California Health Care Foundation. (Kaiser Health News produces California Healthline, an editorially independent publication of the California Health Care Foundation.)\nPfeifer said there’s another situation to be aware of: pregnant women who are taking methadone or suboxone to manage opioid addiction. During labor, anesthesiologists often prescribe narcotics to help manage pain, but some of those commonly used — like Nubain — can immediately reverse the effects of methadone or suboxone.\n“Suddenly, you’re in the middle of labor — which is already painful — and now you’re in the middle of the worst withdrawal of your life,” Pfeifer said.\nFor Veum, one of the worst wildfires in California’s recorded history is what interrupted her birth plan. She and her husband live in Santa Rosa, Calif., and she was in active labor when devastating fires ignited nearby on Oct. 8, 2017. What are now known as the “Wine Country Wildfires” burned more than 5,000 homes and killed 44 people.\n“There was a ton of smoke in the hospital,” Veum said. “Like you could visibly see it outside — and smell it.”\nNurses told her everybody had to evacuate. Veum was transferred to another hospital, 5 miles away. And the special instructions for her epidural got lost in the chaos.\n“Then, when they went to change the drug, I saw the tube said ‘Fentanyl’ on it,” she recalled. “And by that point I was starting to feel ‘the itchies'” — one of the familiar physical signs she would experience when starting to get high.\nMost women without a history of addiction wouldn’t experience these sensations when given opioid anesthesia, said Dr. Jennifer Lucero, chief of obstetric anesthesiology at the University of California-San Francisco Medical Center. Anytime a woman who is not in recovery asks for an epidural without fentanyl (usually out of the mom’s concern for the baby), Lucero explains why it’s there.\nThe fentanyl allows the anesthesiologist to balance out the numbing agent in the solution, she said, so women don’t have as much pain from the contractions but can still feel the pressure and are able to move their legs a bit or shift in bed during labor.\nOnce she explains the trade-offs, and assures women that the opioid will have no effect on their fetus, most of her patients opt to keep fentanyl in the epidural solution.\nBut doctors have been trying to cut down on administering opioids in other ways during labor and delivery, namely in what they prescribe for pain after the birth.\nFor years, women who had a normal, vaginal birth were sent home with a 30-day supply of Norco, Percocet or another opioid, Lucero said.\n“Some people would think they’re supposed to take them all,” Lucero said, while other women “would not use it, and it would just be sitting in the bathroom cabinet.”\nWhile most people who get a bottle of pills when leaving the hospital won’t develop dependence or an addiction, some will. When a patient is prescribed opioids for short-term pain, the risk of chronic use starts to increase as early as the third day of the prescription, according to a report published last year by the Centers for Disease Control and Prevention. A study out this year suggests that every week of opioid use increases the risk of misuse.\nAs recently as 2017, postpartum women were routinely being prescribed three- to five-day supplies of opioids — even after an uncomplicated vaginal delivery. A study published that year of 164,720 Pennsylvania women on Medicaid who gave birth vaginally found that 12 percent of them filled an opioid prescription after they gave birth — even though most did not have a clear medical need for a painkiller, such as vaginal tearing or an episiotomy.\nNow obstetricians are issuing new guidelines to patients, Lucero said, and they’re trying to prescribe limited amounts of opioids, and only post-surgically, to women who have had a cesarean section.\nNicole Veum ended up being one of those women. After she was transferred to the second hospital during the wildfire evacuation, she spent another 12 hours in the early stages of labor, but she wasn’t progressing. She agreed to a C-section.\nAfter the birth of her son, doctors sent her home with a bottle of Percocet — another opioid. They told her that if she was worried about being able to maintain her sobriety, she could have her husband or a friend hold on to the bottle and control the dosage.\nPfeifer, the physician and addiction specialist, said that in a situation like that, sending Veum home with just a few Percocet pills, or even suggesting she take only ibuprofen, would have been fine.\n“Any parent will tell you there’s nothing more stressful than the first week of being a parent and having a baby and being in sleep deprivation,” Pfeifer said. “And here you have a little bottle of Vicodin that you used to turn to, to make you feel better when you’re stressed.”\nFirst the fires. Then the fentanyl in her epidural. Then the Percocet. It was Veum’s first test in seeing how her sobriety and motherhood would line up. She called a friend who was also in recovery. They talked it all through, and Veum was fine.\n“I was OK. I was OK with it. It was just something that happened,” she said as her baby, Adrian, now a year old, plays with a new toy.\nVeum is 32 now. She’s returned to school this fall to work toward her college degree, after a 14-year break. And she is loving being a mom.\n“A lot of people, metaphorically, felt it as a baby coming out of the ash — the life coming from the ashes,” she said about her child born in the midst of the 2017 wildfires.\n“And I feel that,” Veum said. “I feel like it was a big time for our community — and me personally — to be reborn in some way.”\nKHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation. |
Suprascapular Nerve Block versus Intra-articular Steroid Injection for Hemiplegic Shoulder Pain: A Preliminary Double-Blind Randomized Controlled Trial\nKeywords:hemiplegia, shoulder pain, stroke, scapular nerve block, intra-articular steroid injection\nObjectives: To compare the analgesic efficacy of two alternative injections in improving passive shoulder range of motion and shoulder function in patients with hemiplegic shoulder pain.\nStudy design: A double-blind randomized controlled trial.\nSetting: Rehabilitation Medicine Clinic, University Malaya Medical Centre, Kuala Lumpur, Malaysia.\nSubjects: Patients with hemiplegic shoulder pain of at least two weeks duration were recruited into this study\nMethods: Either a suprascapular nerve block or an intra-articular steroid injection were administered to all patients. Maximal tolerable passive range of motion and the corresponding numerical rating scale pain score were documented at pre-injection and at one hour, one month and three months post-injection. The Shoulder Pain and Disability Index questionnaire was completed by the participants at pre-injection and at one month and three months post-injection. All outcome measures were analysed using repeated measures ANOVA.\nResults: Thirty-one patients were enrolled in this study. The mean age was 57.7 years (SD 8.1). Mean stroke duration was 16.9 months (SD 24.2). Twenty-six of the strokes (83.9%) were of ischaemic aetiology. Significant pain reduction, passive range of motion and shoulder pain and disability index over time were evaluated in both groups. The intra-articular steroid group had an analgesic effect earlier (at one month) than the suprascapular nerve block group (at three months). No significant differences in pain, shoulder passive range of motion or shoulder pain and disability index between the two groups were observed at any point in this study.\nConclusions: Neither injection technique was found to be superior in terms of pain reduction, passive range of motion increase or reduction in Shoulder Pain and Disability Index score. However, this result could be due to the small sample size. The intra-articu-lar steroid group evidenced an analgesic effect at one month, earlier than the suprascapular nerve block group.\nKeywords: hemiplegia, shoulder pain, stroke, scapular nerve block, intra-articular steroid injection\nTurner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil. 2002;16:276-98.\nPoduri KR. Shoulder pain in stroke patients and its effects on rehabilitation. J Stroke Cerebrovasc Dis. 1993;3:261-6.\nRyerson S, Levit K. Physical therapy of the shoulder. 3rd ed. New York: Churchill Livingstone; 1997.\nViana R, Pereira S, Mehta S, Miller T, Teasell R. Evidence for therapeutic interventions for hemiplegic shoulder pain during the chronic stage of stroke: a review. Top Stroke Rehabil. 2012;19: 514-22.\nWiener J, Cotoi A, Viana R. Chapter 11: Hemiplegic shoulder pain and complex regional pain syndrome. The stroke rehabilitation evidence-based review: 18th edition (www. ebrsr.com). Canadian Stroke Network. 2018.\nSnels IA, Dekker JH, Van Der Lee JH, Lankhorst GJ, Beckerman H, Bouter LM. Treating patients with hemiplegic shoulder pain. Am J Phys Med Rehabil. 2002;81:150-60.\nAdey-Wakeling Z, Liu E, Crotty M, Leyden J, Kleinig T, Anderson CS, Newbury J. Hemiplegic shoulder pain reduces quality of life after acute stroke: a prospective population-based study. Am J Phys Med Rehabil. 2016;95:758-63.\nYasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil. 2011;25:60-8.\nJeon WH, Park GW, Jeong HJ, Sim YJ. The comparison of effects of suprascapular nerve block, intra-articular steroid injection, and a combination therapy on hemiplegic shoulder pain: pilot study. Ann Rehabil Med. 2014;38:167-73.\nSalaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8:283-91.\nDoğun A, Karabay İ, Hatipoğlu C, Őzgirgin N. Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain. Top Stroke Rehabil. 2014;21:S1-7.\nWilson RD, Chae J. Hemiplegic shoulder pain. Phys Med Rehabil Clin N Am. 2015;26:641-55.\nKellgren JH, Samuel EP. The sensitivity and innervation of the articular capsule. J Bone Joint Surg. 1950;4:193–205\nMcMahon SB, Koltzenburg M. Wall and Melzack’s textbook of pain. 6th ed. Philadelphia: Elsevier Saunder; 2013.\nSidhu G, Preuss C. Triamcinolone [Internet]. Ncbi.nlm.nih.gov. 2020 [cited 2020 November 3 ]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544309/?report=classic\nTriamcinolone [Internet]. Pubchem.ncbi.nlm.nih.gov. 2021 [cited 2021 August 7]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Triamcinolone\nRomundstad L, Breivik H, Niemi G, Helle A, Stubhaug A. Methylprednisolone intravenously 1 day after surgery has sustained analgesic and opioid-sparing effects. Acta Anaesthesiol Scand. 2004;48:1223-31.\nMarx RG, Malizia RW, Kenter K, Wickiewicz TL, Hannafin JA. Intra-articular corticosteroid injection for the treatment of idiopathic adhesive capsulitis of the shoulder. HSS J. 2007;3:202-7.\nBupivacaine [Internet]. Pubchem.ncbi.nlm.nih.gov. 2021 [cited 2021 August 7]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/2474\nShanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003;62:400-6.\nGado K, Emery P. Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Ann Rheum Dis. 1993;52:215-8.\nLewis RN. The use of combined suprascapular and circumflex (articular branches) nerve blocks in the management of chronic arthritis of the shoulder joint. Eur J Anaesthesiol.1999;16:37-41.\nWoolf CJ. Somatic pain--pathogenesis and prevention. Br J Anaesth. 1995;75:169-76.\nZorowitz RD, Hughes MB, Idank D, Ikai T, Johnston MV. Shoulder pain and subluxation after stroke: correlation or coincidence? Am J Occup Ther. 1996;50:194-201.\nNamdari S, Yagnik G, Ebaugh DD, Nagda S, Ramsey ML, Williams Jr GR, Mehta S. Defining functional shoulder range of motion for activities of daily living. J Shoulder Elbow Surg. 2012;21:1177-83.\nGreen S, Forbes A, Buchbinder R, Bellamy N. A standardized protocol for measurement of range of movement of the shoulder using the Plurimeter-V inclinometer and assessment of its intrarater and interrater reliability. Arthritis Rheumatol. 1998;11:43-52. |
Ryan Murphy made a big announcement about his son’s health, and unlike his horror stories, this one has a happy ending.\nOn Friday the “American Horror Story” co-creator was speaking during Variety’s “Power of Women” event, and according to PEOPLE, told the crowd his 5-year-old son, Ford, is “cancer free.”\nMurphy and husband, photographer David Miller, have two children together; 7-year-old Logan and Ford.\nDuring a checkup when he was 3, doctors discovered an irregularity in Ford that was later diagnosed as neuroblastoma.\nWhile presenting an award to Dana Walden, who was honored for her work with the UCLA Jonson Comprehensive Cancer Center, Murphy detailed the extensive treatment his son endured.\n“Ford went through a six-hour surgery and years of intense exams which required hours and hours of anesthesia,” he explained.\nMurphy added, “I am so proud to proclaim that he is cancer free.”\nLast year, Murphy revealed his son’s battle with cancer in an emotional post on Instagram and explained how far the young boy had come since first being diagnosed.\nHe also announced a donation to Children’s Hospital Los Angeles for a wing in Ford’s name, where he received treatment.\n“Today at the hospital we are donating a wing in tribute to Ford and our family is making a gift of $10 million dollars so that other children can experience the love and care of this exceptional facility. No child is turned away at Children’s Hospital. We are so honored and lucky to contribute, and encourage everybody who can to do the same.”\nMurphy is best known for co-creating “American Horror Story” alongside Gwyneth Paltrow’s husband, Brad Falchuk.\nHe also co-created the Netflix comedy-drama, “The Politician.” |
Some of these conditions can affect other areas of the body, which is why a holistic approach to care is important. We also work closely with other departments at Addenbrooke's particularly with:. Oral surgery includes all conditions affecting the teeth, gums and their supporting alveolar bone, which is outside the scope of 'usual' dental surgery ie the restoration of teeth, crowns, bridges and other prostheses. Oral surgery therefore includes the treatment of:. Oral and maxillofacial surgeons are senior members of the oral and maxillofacial department's team.\nA range of oral and maxillofacial surgical operations are carried out on an outpatient basis under local anaesthesia or conscious sedation. Other opportunities There may also be opportunities to work in the private sector and overseas. We also work closely with other departments at Addenbrooke's particularly with: Anaesthetics Children's services Dermatology Ear, nose Oral maxofacial throat Intensive care Neurosurgery Oncology Ophthalmology Orthodontics Plastic surgery Restorative dentistry What is oral surgery and oral medicine? Head Oral maxofacial neck cancer, access to tumours within the maxifacial of the complex craniofacial anatomy, and Oral maxofacial of tumours, including neck dissections. How to maxofaciql an oral and maxillofacial surgeon BMJ. From Wikipedia, the free encyclopedia.\nModel train show rockford auburn. Internet Explorer 6 is a very old browser and it is not supported in this site.\nAfter a full degree in dentistry, the dental Sex photo book residency of oral and maxillofacial surgery may or may not include a full degree in medicine. You may improve this articlediscuss the issue on the Oral maxofacial pageor create a new articleas appropriate. Anesthesia Options. In other countries oral and maxillofacial surgery as a specialty Oral maxofacial but under different forms, as the work is sometimes performed by a single Oral maxofacial dual qualified specialist depending on each country's regulations and training opportunities available. In many countries, however, maxillofacial surgery is Orak medical specialty requiring both medical and dental degrees, mxxofacial in an appropriate qualification e. This article has multiple issues. February D Doctor of Dental Surgery D. Springville, NY springville oralsurgeryofwny. As a result of this extensive hospital-based training, our surgeons are well prepared to identify and diagnose within the scope of their specialty and administer sedation as appropriate, from local anesthesia to conscious IV sedation. Treatments may be performed on the craniomaxillofacial complex : mouth, jaws, face, neck, and skull, and include:. Why You Should See a Board Certified Oral and Maxillofacial Surgeon An Oral and Maxillofacial Surgeon is a graduate of an accredited dental school and has also Oral maxofacial a minimum of 4 years of training in an accredited hospital-based oral and maxillofacial surgery residency program. Skip to content.\nOral and Maxillofacial Surgeons are specialists in the diagnosis and treatment of a broad range of disorders affecting the facial complex and skeleton, including the jaws and oral cavity.\n- Skip to content.\n- Many times, a simple telephone call will clear any questions prior to treatment.\n- They have demonstrated their training, experience and knowledge in a rigorous peer evaluation process that requires passing written and oral certifying examinations.\nOral and Maxillofacial Surgeons are specialists in the diagnosis and treatment of a broad range of disorders affecting the facial complex and skeleton, including the jaws and oral cavity. These include a range of common oral surgical problems eg. Following the acquisition of dental and medical degrees, prospective trainees must complete basic general surgical training as residents and then apply to be selected into one one of the six Oral and Maxillofacial Surgery training Centres.\nSpecialty training involves four years with an examination in the first year and the final examination in the fourth year. Oral and Maxillofacial Surgery training, together with a compulsory research component and the final Fellowship qualification, are recognized by both the Australian Medical Council and the Australian Dental Council.\nThe training, accreditation and examination requirements are administered by the Board of Studies in Oral and Maxillofacial Surgery within the Royal Australasian College of Dental Surgeons. Patients are referred to an Oral and Maxillofacial Surgeon by both general and specialist dental and medical practitioners.\nIn many instances, Oral and Maxillofacial Surgeons work in collaboration with other specialists such as orthodontists, ear nose and throat surgeons, plastic and reconstructive surgeons and oncologists as part of multidisciplinary teams to optimise the treatment of major conditions and diseases of the mouth, faces and jaws. An overview of the main sub-specialist areas of Oral and Maxillofacial Surgery is outlined on this website.\nJoin Today Renew Now.\nRetrieved 6 November Refer to Us. Explore our curriculum and how to apply to be a hospital dentistry general practice resident at Michigan Medicine. The Michigan Promise supports initiatives that focus on environment, recruitment, leadership, achievement, innovation, and outreach in the Department of Surgery. Anesthesia Options. Board Certification through the American Board of Oral and Maxillofacial Surgery shows a commitment by the surgeon to provide the highest quality surgical care throughout every modality of Oral and Maxillofacial Surgery.\nOral maxofacial. Navigation menu\nWhat is Oral & Maxillofacial Surgery | British Association of Oral and Maxillofacial Surgeons\nIt is an internationally recognized surgical specialty. After a full degree in dentistry, the dental specialty residency of oral and maxillofacial surgery may or may not include a full degree in medicine. In other countries oral and maxillofacial surgery as a specialty exists but under different forms, as the work is sometimes performed by a single or dual qualified specialist depending on each country's regulations and training opportunities available. An oral and maxillofacial surgeon is a regional specialist surgeon treating the entire craniomaxillofacial complex : anatomical area of the mouth , jaws , face , and skull , as well as associated structures.\nDepending upon the jurisdiction, maxillofacial surgeons may require training in dentistry, surgery , and general medicine ; training and qualification in medicine may be undertaken optionally even if not required. Oral and maxillofacial surgery is widely recognized as one of the specialties of dentistry.\nIn many countries, however, maxillofacial surgery is a medical specialty requiring both medical and dental degrees, culminating in an appropriate qualification e.\nAll oral and maxillofacial surgeons, however, must obtain a university degree in dentistry before beginning residency training in oral and maxillofacial surgery. In the United States oral and maxillofacial residency programs are either four or six years in duration. Programs that grant the MD degree are six years in duration.\nThey also may choose to undergo further training in a one or two year subspecialty Oral and Maxillofacial Surgery Fellowship Training in the following areas:. The popularity of oral and maxillofacial surgery as a career for persons whose first degree was medicine, not dentistry, seems to be increasing in a few EU countries [ clarification needed ]. However, the public funds spent for 14 years of training are of a major concern for governments. Treatments may be performed on the craniomaxillofacial complex : mouth, jaws, face, neck, and skull, and include:.\nIn the United States, oral and maxillofacial surgeons are required to undergo five months of intensive general anesthesia training. The American Society of Anesthesiologists published a Statement on the Anesthesia Care Team which specifies qualified anesthesia personnel and practitioners as anesthesiologists, anesthesiology fellows, anesthesiology residents, oral and maxillofacial surgery residents, anesthesiologist assistants, and nurse anesthetists.\nOral and maxillofacial surgery requires four to six years of further formal university training after dental school i. In the United States , four-year residency programs grant a certificate of specialty training in oral and maxillofacial surgery.\nSix-year residency programs grant the specialty certificate in addition to a degree such as a medical degree e. Both four— and six—year graduates are designated US "Board Eligible" and those who earn "Certification" are Diplomats.\nIn addition, graduates of oral and maxillofacial surgery training programs can pursue fellowships, typically 1—2 years in length, in the following areas:.\nFrom Wikipedia, the free encyclopedia. For the process of visualizing a face from a skull, see Forensic facial reconstruction. The examples and perspective in this article deal primarily with Western culture and do not represent a worldwide view of the subject. You may improve this article , discuss the issue on the talk page , or create a new article , as appropriate. August Learn how and when to remove this template message.\nThis article has multiple issues. Please help improve it or discuss these issues on the talk page. Learn how and when to remove these template messages. The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. February Learn how and when to remove this template message. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. This article needs to be updated.\nPlease update this article to reflect recent events or newly available information. February Archived from the original on 8 May Retrieved 2 July Gigliotti, N. Makhoul: Demographics, training satisfaction, and career plans of Canadian oral and maxillofacial surgery residents. Oral Maxillofac. Archived from the original on 22 September Retrieved 6 November CS1 maint: archived copy as title link. Oral and Maxillofacial Surgery.\nJournal of Oral and Maxillofacial Surgery. Palatal lift prosthesis. Endodontics Oral and maxillofacial pathology Oral and maxillofacial radiology Oral and maxillofacial surgery Orthodontics and dentofacial orthopedics Pediatric dentistry Periodontics Prosthodontics Dental public health Cosmetic dentistry Dental implantology Geriatric dentistry Restorative dentistry Forensic odontology Dental traumatology Holistic dentistry.\nDental extraction Tooth filling Root canal therapy Root end surgery Scaling and root planing Teeth cleaning Dental bonding Tooth polishing Tooth bleaching Socket preservation Dental implant. Index of oral health and dental articles Outline of dentistry and oral health Dental fear Dental instruments Dental material History of dental treatments Infant oral mutilation Mouth assessment Oral hygiene. Internal medicine. Obstetrics and gynaecology. Gynaecology Gynecologic oncology Maternal—fetal medicine Obstetrics Reproductive endocrinology and infertility Urogynecology.\nRadiology Interventional radiology Nuclear medicine Pathology Anatomical Clinical pathology Clinical chemistry Clinical immunology Cytopathology Medical microbiology Transfusion medicine. Other specialties. Categories : Dentistry branches Dentistry procedures Oral and maxillofacial surgery Surgical specialties. 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Is Liposuction of the Chin Painful?\n- Asked by Eva S in Seattle, WA\n- 4 years ago\nI'm a 31 year old woman and I've never had a surgical operation before. I don't think I handle pain particularly well but i'd really like to have the area under my chin reshaped.\nChin or Neck Liposuction is NOT painful at all\nLiposuction of the jowls, jawline, below the chin/ neck area is not a painful procedure at all. It is done under local anesthesia only and you can drive yourself home afterwards and be back to work in 1-2 days. There is almost no bruising and it costs roughly $2500.\nWeb reference: http://www.TheBestLipoDoc.com\nLiposuction of the chin and neck can be performed with very little pain\nEvery individual has a different pain tolerance and therefore a different experience with surgery. In regards to pain, there are two periods to consider. One is during the operation and the second is during the postoperative recovery. The pain during the operation for liposuction of the chin and neck area should be very mild depending on the type of anesthesia. In the simplest situation the procedure can be performed under local anesthesia and the discomfort would be primarily from the injections to numb the area. At the other extreme, the operation can be performed under general anesthesia and you should feel little during the surgery. Between these are options where local anesthesia is used along with medications to provide various degrees of sedation during the procedure.\nDuring the postoperative period the average person tolerates the discomfort very well and any pain can be well controlled with oral medication. I would recommend a consultation with a board certified plastic surgeon to determine what type of anesthesia might be best for you. He or she can also give you idea as to the type and degree of change you may anticipate.\nI hope this information provides some help to you and that you are able to overcome your fears to undergo the procedure. Best wishes and good luck to you\nLiposuction - pain\nWhen it comes to post-operative pain, everyone is different and their own pain tolerance. However, most patients have relatively little pain after neck liposuction. Most of my patients take very minimal pain medication. The most cumbersome part of the post-op period is wearing the neck compression garment which can be a little uncomfortable. However, this area heals well. If you're considering surgery, I recommend you see a surgeon for a consultation to discuss the risks, benefits, and alternatives as well as help you form realistic expectations for what your results will be like.\nDr. Cat Begovic M.D.\nWeb reference: http://www.makeyouperfect.com\nRecent Chin Liposuction Reviews\nChin Liposuction Photos\nChin and Neck Liposuction\nChin liposuction should be approached with caution as the mentalis muscle is closely adherent to the overlying skin. However, neck liposuciton is easily performed and can be performed safely in a well equipped procedure room.\nSpeak to a plastic surgeon about the incision sites, the amount of skin redundancy, the technique for liposuction, and the postoperative recovery.\nChin Liposuction discomfort usually quite minimal\nA liposuction under the chin could be done under local or general anesthesia. In many cases patients just to avoid going under general anesthesia request this procedure under the local anesthetic. It takes about an hour to have it done and patient should not feel pain during the procedure when done under general and minimal pain if any when done under local.\nThe pain medication may be needed to control the pain and discomfort after the surgery. The recovery time depends on the individual; however most patients resume their daily activities within couple of days.\nPain with Chin Liposuction\nI'm not sure that I'd describe it as painful. . .really not much at all. My patients have all the performed under local anesthesia and the process of becoming numb stings a bit at first but then it's smooth sailing. The healing and after care are very managable and I've just never had a patient complain of pain afterwards. Now, if you have this and a chin implant performed at the same time then yes, the chin implant is umcomfortable for about 3 days. Other than that, you'll do great.\nChase Lay MD\nWeb reference: http://chaselaymd.com/SlimLipo_Jaw_Neck_Lift.html\nLiposuction of the Chin\nIf performed by an experienced and expert board certified plastic surgeon, liposuction of the chin should not be painful. Subsequent to the procedure, patients tend to little to no pain medicine.\nLiposuction Chin Painful?\nThank you for the question.\nLiposuction surgery done by experienced plastic surgeons should not be painful. Usually these procedures involve a small/superficial surface area that is treated and patients tolerate procedure extremely well.\nMinimal discomfort with chin liposuction\nLiposuction of the chin and neck is a relatively easy procedure with minimal discomfort and pain associated with it. Patients are amazed at how easy the procedure is and how quickly they recover afterwards. It is very safe and comfortable to do under local tumescent anesthesia. Light sedation with valium and demerol helps to put an anxious patient at ease. It is unnecessary to undergo general anesthesia for this minor procedure.\nWeb reference: http://www.eastbaylaser.com/EastBayLaser/Welcome.html\nLiposuction of small areas usual results in minimal discomfort\nSmall cannula and particularly laser assisted or SmartLiposuction techniques typically result in minimal discomfort and a fast recovery. Local anesthetic solution is used during the surgery and this provides hours of pain relief after your procedure. The underlying muscle will be tender but this is easily managed with over the counter medications, ice and the use of the a compression garment used during the first few days.\nThere are usually one or two small incisions in the skin but no incisions in the underlying muscle. So overall there is minimal injury to the tissue and therefore little pain. Patients with this condition are some of our happiest because the correction is considered "easy".\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. |
- Corrective Nose Surgery\n- Facial, Cheek Implants\n- Facial, Chin Implants\nFACIAL, CHEEK IMPLANTS – FACIAL, CHIN IMPLANTS\nA 40 year old Fort Lauderdale plastic surgery patient had multiple surgical procedures done since his early age for treatment of cleft lip and nose deformity. He had an excellent result after multiple surgeries performed by a master of cleft lip surgery Dr. Millard. He came to our office for consultation regarding augmentation of cheeks, replacement of an old chin implant and revision of nose.\nClinical evaluation demonstrated typical signs of developmental problem related to severe bilateral cleft lip by means of underdeveloped cheek bones and mid-face. We discussed augmentation of cheeks with cheek implants, correction of nose deformity and replacement of small chin implant with a larger one.\nSurgery was done in general anesthesia and included cheek enlargement with silicone implants, revision of the nose to correct mostly tip of the nose deformity and nostril asymmetry and replacement of old, small chin.\nBefore cheek, nose and chin surgery (left) and 6 months after multiple facial implants and nose revision surgery (right). There is a visible improvement in his cheeks and chin which gives his face stronger, masculine appearance and a subtle improvement of the tip of his nose. |
Over the span of your furry friend’s life, they will likely develop skin growths or pathologies. Some can be quite harmless, while others can be serious, requiring immediate medical care and removal. These include cysts, infected lesions, extra eyelashes, as well as skin and mouth tumours. With cryosurgery, taking out these abnormalities has never been easier. Our veterinarians here at Green Lane Animal Hospital use the CryoProbe pen – one of the most advanced tools for cryosurgery. It takes only seconds to freeze the affected area, and maximum precision is guaranteed so healthy tissue is not damaged. It even works on very small lesions. Feel free to call us at (905) 597-7373 for more details.\nHow does cryosurgery work?\nThe device uses nitrous oxide with a temperature of -89°C to freeze the affected area on the skin or in the mouth. Because the pen is so small, only the area it is pointed towards will freeze, leaving the surrounding skin unharmed.\nDo pets need anesthesia for cryosurgery?\nNo. It is virtually painless because of the targeted treatment provided by the CryoProbe pen. Your pet may feel a bit of discomfort or sting, but that will subside immediately once the pen is no longer in contact with their skin.\nHow should I care for my pet after their cryosurgery?\nThe treated area usually develops into a scab before regressing, so it is important to stop your pet from scratching it to prevent infections or other complications. After your pet’s treatment, we will show you techniques for how to prevent this from happening. |
Ear Surgery Information\nOtoplasty is the medical terminology for what most people refer to as ear surgery, ear plastic surgery, cosmetic ear surgery, and ear pinning surgery.\nIn this procedure the goal is to put prominent ears back closer to the head and/or reduce the size of large ears. This procedure most often is performed on children between 4 and 14 years in age. This surgery may be a medical necessity for some individuals. In these type cases the surgery may be covered by insurance.\nLength and details of the Ear Surgery procedure\nThe length of procedure usually runs 2 to 3 hours.\nFor this type procedure the patient, if a young child is given general anesthesia. Older children and adults are given a general or local anesthesia, with sedation.\nDepending on the extent of the surgery a patient will normally undergo an outpatient surgery.\nRisks and/or complications related to Ear Surgery\nFor most ear surgery operations the patient will experiences potential side effects consisting of throbbing, aching, swelling, redness, and numbness. All of which are temporary in their duration.\nIn addition there are other associated risks with this procedure that include the risk of infection of ear cartilage, excessive scarring, and blood clots requiring draining. Some surgeries could result in unequal or non-natural looking ears. In these and protrusion re occurrence cases, additional surgery could be required.\nFor most patients the recovery time needed should be between 5 to 7 days.\nIt will be necessarily to avoid strenuous activity and contact sports for 1 or more months.\nLong-term results of Ear Surgery\nIn this procedure the results are typically permanent in nature.\nHow much does Ear Surgery cost?\nThe national average cost for a procedure the $2,700\nWill my insurance cover an Ear Surgery procedure?\nThis surgery may be a medical necessity for some individuals. In these type cases the surgery may be covered by insurance.\nRead more about Cosmetic Ear Stapling [http://www.houstonmedcenter.com/articles/Ear-Surgery-information-cost.php]. Alan Hood is a contributing writer at Houston Medical Center [http://www.houstonmedcenter.com] |
We’ve seen a number of options for controlling real worms, but never a worm robot, until now. Enter Meshworm, the latest creation from researchers at MIT, Harvard University and Seoul National University. The bot is made from “artificial muscle” composed of a flexible mesh tube segmented by loops of nickel / titanium wire. The wire contracts and squeezes the tube when heated by a flowing current, but cut the power and it returns to its original shape, creating propulsion in a similar way to its living kin. Taking traditional moving parts out of the equation also makes it pretty hardy, as proven by extensive testing (read: hitting it with a hammer). DARPA is known for getting its fingers in all sorts of strange pies, and it also supported this project. We can’t see it being the fastest way of gathering intel, but the potential medical applications, such as next-gen endoscopes, sound plausible enough. Full impact tests in the video after the break.\nWhenever a painful procedure must be done on the arms, hands, face, feet or legs, this is the most common type of anesthetic that is used. It is given near the nerve bundles so that the pain is blocked. The muscle then relaxes and that specific part of the body cannot be moved voluntarily, much like Novocain when one has dental work. During surgeries using regional anesthesia, the patient is often awake, but is sometimes sedated for part of the procedure. This option is usually left up to the patient. Regional anesthesia can be given through a single injection, through a catheter or intravenously. While there are more risks involved with regional anesthesia than with local anesthesia, it is a very safe procedure. Once you talk to the anesthesiologist, you will understand the procedure better. These specialists are usually very kind and supportive, wanting to answer your questions. Learn as much as you can and with the help of your anesthesiologist, your surgery will be over in a short period of time! Anesthesiologists who want to learn more about about the latest news and discoveries about anesthesia should definitely make plans to attend the Eurpoean Society of Regional Anaesthesia. The next ESRA 2012 congress registration is taking place and you don’t want to miss this unique opportunity.\nFor years you’ve probably been hearing about blogs, bloggers, the blogosphere, and all things “bloggy”. When most people hear the term blog they might think of some geek in their underwear writing unimportant and pointless stuff for other geeks to read. While many blogs might be like this, political blogs are of a different class. Political blogs can be very informative, enlightening, and funny. If you like politics and think you have what it takes to write a blog on politics, you came to the right place. I’m going to share a few tips with you on how to write a great political blog. Even if you don’t know how to write like a journalist it doesn’t matter -all you need is passion (and a little knowledge). If you don’t have strong political opinions then let me stop you right there and suggest you pick a different topic than politics. In order to write a great blog on politics you have to have politics on the brain, meaning, you have to be a politics enthusiast.\nThat doesn’t mean you have to like politics or politicians (good luck finding someone who does) but you should care about how politics and politicians affect your daily life and the lives of others. Alright, so you’ve decided that you absolutely, positively want to write a political blog. In order to connect with people who might stumble across your blog you will want to align yourself with a label. A label let’s people know “hey, this person thinks like me”. While some people say they don’t like labels or don’t fall into any label or category you shouldn’t take the label too seriously. A label can be something specific like “far left wing liberal” or it can be broad like “independent”. I find it easier to gain followers by being narrow (i.e. conservative) than by being broad (i.e. moderate) but that’s your call. An easy way to be broad is to write on something all-encompassing like Canadian politics or American politics. I highly recommend using Blogger’s free blog hosting service.\nGo to Blogger’s website and take a tour and read the tutorial. Even if you have never used HTML you will find Blogger very easy to use. Also get a Gmail account which is integrated into Blogger and makes everything so much easier. Don’t even think about it, just start writing. Pick a few topics you want to write about and start hammering away. Once you get a few articles under your belt you’re going to feel very satisfied with what you just created. Try to keep your articles between 150 and 400 words. Any more than that is simply too long -most people don’t have time to read long blog posts. Most people don’t even read newspaper articles in their entirety. Think quality, not quantity. You will want to connect with other blogs that write on the same topic. If you write a blog on the U.S. Senate, try to find other blogs on that same topic and develop a business relationship with them. This way, you will create a symbiotic relationship with others who share you interests. Their fans and followers will become your fans and followers. Step Five: Be consistent! Who wants to bookmark a blog that only posts once a month. Posting weekly is the bare minimum. I cannot stress how effective it is to post daily. People like routine, they like checking in on the same websites on their lunch break or after work when they sit down in front of the computer. You can appeal to these people by always having something new to see and read every day. People will come back to you. Now you are ready to write your own blog on politics! Remember to welcome input from readers -they are your customers! |
Office Surgery: Guidelines for Patient Safety\nNew York, NY (February 27, 2004) — According\nto American Society for Aesthetic Plastic\nSurgery (ASAPS) statistics, in 2003, 52%\nof all cosmetic procedures (surgical and\nnonsurgical) were performed in office-based\nsurgical facilities (another 23% of procedures\nwere performed outside the hospital setting\nin free-standing surgicenters). Published\ndata have shown that accredited office-based\nfacilities have a safety record comparable\nto that of hospital ambulatory surgery settings.\nHowever, the alarming fact is that most\noffice-based surgical facilities are unaccredited.\nASAPS encourages prospective patients to\nmake sure their office-based cosmetic surgery\nmeets the following requirements:\n- The operating surgeon is certified by\nthe American Board of Plastic Surgery.\n- The office-based surgical facility is\naccredited by a nationally or state recognized\naccrediting agency, or is state licensed\nor Medicare certified. Nationally recognized\naccrediting agencies include the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Joint Commission\non Accreditation of Healthcare Organizations\n(JCAHO), and the Accreditation Association\nfor Ambulatory Health Care (AAAHC).\n- The surgeon has privileges at an accredited\nacute care hospital for the specific procedure\n- Patients undergoing procedures that involve\nsedation are appropriately\nmonitored by registered nursing personnel.\nIf general anesthesia is used, it is administered\nby a board-certified anesthesiologist or\ncertified registered nurse anesthetist.\n- The emergency equipment and anesthesia\nmonitoring devices in the surgical facilities\nare equivalent to those that would be necessary\nfor the same surgical procedure performed\nin a hospital or freestanding ambulatory\n- Provisions are made for hospital admission\nin the event of unforeseen complications.\n- There is a separate recovery area with\nmonitoring equipment equivalent to that\nwhich would be necessary for the same procedure\nperformed in a hospital or ambulatory surgery\n- Until the patient is fully recovered,\na physician is at the site, in addition\nto a registered nurse.\n- Discharge from the facility is always\ndetermined by the responsible surgeon.\nEnsuring patient safety is key to ASAPS’\nmission. As of July 2002, all ASAPS members\nhave agreed to perform surgeries that require\nanesthesia (other than local anesthesia\nand/or minimal oral or intramuscular tranquilization)\nonly in an accredited, state-licensed or\nMedicare-certified facility. It is the Society’s\nposition, backed by published data, that\nwhen the above guidelines are followed,\noffice-based surgery is a safe, convenient\nand cost-effective option for properly selected\nThis document was updated from September 8, 2003.\nThe American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.\nWE ARE AESTHETICS\n- Follow ASAPS on Twitter: www.twitter.com/ASAPS\n- Become a fan of ASAPS on Facebook: www.facebook.com/AestheticSociety\n- Check us out on Instagram: www.instagram.com/theaestheticsocietyasaps\n- Check out our consumer-facing website: www.smartbeautyguide.com\n- Locate a plastic surgeon in your area: www.smartbeautyguide.com/select-surgeon |
Adhere to Your Surgeon's Instructions\nYour own plastic surgeon knows the details of your surgery, as well as your medical history, so it's important to stick to the instructions you're given. With that being said, there are some basic tips you can consider. Opioid pain relievers shouldn't make you feel that "out of it," but keep in mind that everyone responds differently. However, it's important to wait until you're done taking these medications before you drive a car. Food-wise, I recommend choosing foods that are very nutritionally dense. Since you may have a diminished appetite, every calorie matters more. Avoid foods that are high in sodium, since they can lead to swelling. Foods that are high in fiber and protein are good choices, and alcohol should never be mixed with opiates. You should be able to shower about 2 days after your surgery, provided you cleanse your incisions with care. As I said earlier, these are simply guidelines. Your surgeon has the final say regarding your post-operative instructions. Best of luck!\nEveryone's different but within one week you'll be fine\nUsually the first night you'll feel groggy from the anesthesia and probably not have much pain. Hopefully you'll be eating regular food. The next day you'll probably be more sore after the anesthesia has worn off but your surgeon will have provided you with pain medication. Make sure you take food when you take your medication so it doesn't upset your stomach. I have my patient shower the day after surgery which makes them feel more comfortable. I usually don't place drains in breast augmentation cases. If you have some in, they might be a little more uncomfortable. By the third day you should be able to drive, as long as you're not taking pain medication. Implants underneath the muscle tend to sit higher and take some time to settle in place\nBreast Augmentation Post Op\nEveryone has a different post operative recovery. Some patients have little to no pain while others can experience significant pain and muscle spasms. Part of this is related to the technique of breast augmentation. Every surgeon is different in their post operative recommendations so it is critical that you follow your surgeons instructions. For the first 48 hours you can be pretty groggy from general anesthesia and a sore throat. During these first 48 hours, I recommend relaxation. I also recommend a muscle relaxant such as valium. In addition, you should take the pain medication as prescribed by your surgeon - typically percocet, dilaudid, or vicodin. You can shower after these 48 hours making sure to extend and exercise your shoulders. I recommend light foods during this period only until the anesthesia clears. After 48 hours you should start to feel significantly better. I recommend my patients switch to ibuprofen; but this medication can be associated with increased risk of bleeding so should only be taken with specific approval from your surgeon. Again you should be making conscious efforts to move your shoulders. You should not do any heavy lifting. I have my patients see me one week post operatively at which time I instruct them on specific exercises to help position the implants. Some patients will need specific support garments depending on their implant position.\nI hope this helps! Good luck!\nHealing from breast augmentation\nThe best frame of mind to be and when you return from your augmentation is to return to your normal routine as soon as possible. This usually means showering the next day and driving within two or three days. You will definitely be sore, but usually Motrin will make you quite functional for most activities. The most important thing is to listen to your own plastic surgeon. We all have different ideas how to have our patients progress postoperatively.\nBreast Augment: What to expect in first week\nAny specific patient should ask their own surgeon about specific instructions for after surgery. I do my breast implants mostly in the subfascial plane under heavy sedation anesthesia so this is the expectation for a patient with this operation. You will expect to have your operation in the office and go home home within an hour after the procedure. A responsible adult should be with you that night. You will have some discomfort but not excruciating pain. Most women say it is a stretching feeling like if your milk was coming in after giving birth. You will have pain pills at home that you can as directed but do not take aspirin or ibuprofen type pain relievers. You may use packs to help relieve some of the pain but most of my patients say this is really not needed. The day after surgery is usually the most discomfort and then gets better quite quickly. You may sleep in any position that is comfortable but most patients sleep on their back for about a week. You should not work out (any thing that gets your pulse or blood pressure up) for about ten days. You will be able to shower by the third day after surgery. There will be no stitches that need to be removed but you will plan to see your surgeon in about one week after surgery. You will receive a call from the office or the doctor the day after surgery to be sure you are doing OK and to answer any questions. You will be able to get work usually within a week unless it is a very strenuous job such as fitness instructor or waitress with heavy trays...then it is about two weeks. Plan your surgery at a time that is good for you...during a vacation and when you can have some help for a few days especially if you have young children. Have your shopping done and some dinners pre made and ready to go. Do your laundry and housework before surgery and do not plan on getting much else done for about a week. Take some time to yourself...read a book and listen to music or watch movies. If you plan your surgery this way you will heal much easier. Best of luck!\nAdvice for Recovery from a Breast Augmentation\nThis is a great question and wonderful planning on your part as the patient. Your surgeon will have his/her specific instructions for you to follow for your particular surgery. As for my patients, I also recommend a week from work activities, 3 weeks from any aerobic exercise, and usually 6 weeks for full out exercise. Recommendations I can offer for any patient recovering from surgery is protein rich meals, increased fluid intake, and most importantly is ambulation (get up and move around). I recommend that every two hours my patients take deep breaths and walk to maintain good circulation. Many surgeons will have patients wear a pair of compression hose for several days after surgery to help with circulation. My goal is always to have a safe surgery, speedy recovery, and beautiful results.\nBreast augmentation recovery\nCongratulations on your upcoming surgery! You will be sleepy and sore the first few days after surgery. You will definitely want to be up and moving around, but you will be slow and tire easily. Rest when your body is tired, as it is letting you know it needs to heal. You may not have much of an appetite the first day or two. Simple things such as oatmeals, soups, etc will be good to have on hand. After that make sure that you don't have meals that require opening jars or other things that require you to use your pectoral muscles. The best advice will be that which comes from your surgeon as he/she is most familiar with the details of your surgery. Best of luck!\nWhat to expect the first week after surgery?\nPrior to having your surgery, your plastic surgeon will give you thorough instructions. It is best to follow the instructions of your plastic surgeon and not the advise from others. You are wise and taking off one week from work since that should be an adequate recover time. Your other questions are fairly straightforward and easily addressed by your doctor.\nGood luck to you.\nAdvices for breast augmentation post op\nThanks for the question. In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense.\nIn this regard, it's not advisable to carry heavy weights to prevent the implant out of position, and allow the formation of the physiological capsule around the implant, also to avoid pain and breast swelling. I recommend you to talk with your plastic surgeon and follow his advices.Kind regards\nI would suggest asking your surgeon these questions. Each surgeon has his/her own preference of showering and activity. I would suggest eating healthy foods with protein. |
Learn more about the most common types of in-clinic abortion procedures and the abortion pill.\nMedication Abortion | The Abortion Pill\nA medication abortion, the abortion pill, is two drugs taken in separate doses (one at the clinic and one at home.) Another name for the abortion pill is a medical or chemical abortion. It is usually taken between 4-6 weeks, but it is FDA-approved up to 10 weeks after a woman's last menstrual period.\nFDA Warning on Abortion Pills By Mail: Do Not Buy Mifeprex Over the Internet\nYou should not buy Mifeprex over the Internet because you will bypass important safeguards designed to protect your health. Mifeprex has special safety restrictions on how it is distributed to the public. Also, drugs purchased from foreign Internet sources are not the FDA-approved versions of the drugs, and they are not subject to FDA-regulated manufacturing controls or FDA inspection of manufacturing facilities.\nAn aspiration abortion procedure can be performed up to 13 weeks after a woman's LMP. It is the most common early surgical abortion method and it is an outpatient procedure.\nDilation and Evacuation\nA D&E abortion is typically performed 13 weeks or more after a woman's last known period (LMP). It is the most common second trimester surgical abortion method. Local anesthesia or sedation is commonly utilized.\nyour next steps\nIf you are considering an abortion, contact us to learn more about medical and surgical abortions, your pregnancy options, and what resources are available to you. We can also provide free pregnancy testing and confirmation.\nDISCLAIMER: We provide education on abortion and pregnancy options. We do not refer for or perform termination services and we do not financially benefit from any decision you make. |
Background: Prefilled syringes (PFS) have been recommended by the Anesthesia Patient Safety Foundation. However, aspects in PFS systems compared with self-filled syringes (SFS) systems have never been explored. The aim of this study is to compare system vulnerabilities (SVs) in the two systems and understand the impact of PFS on medication safety and efficiency in the context of anesthesiology medication delivery in operating rooms. Methods: This study is primarily qualitative research, with a quantitative portion. A work system analysis was conducted to analyze the complicated anesthesia work system using human factors principles and identify SVs. Anesthesia providers were shadowed: (1) during general surgery cases (n = 8) exclusively using SFS and (2) during general surgery cases (n = 9) using all commercially available PFS. A proactive risk assessment focus group was followed to understand the risk of each identified SV. Results: PFS are superior to SFS in terms of the simplified work processes and the reduced number and associated risk of SVs. Eight SVs were found in the PFS system versus 21 in the SFS system. An SV example with high risk in the SFS system was a medication might need to be "drawn-up during surgery while completing other requests simultaneously." This SV added cognitive complexity during anesthesiology medication delivery. However, it did not exist in the PFS system. Conclusions: The inclusion of PFS into anesthesiology medication delivery has the potential to improve system safety and work efficiency. However, there were still opportunities for further improvement by addressing the remaining SVs and newly introduced complexity.\nASJC Scopus subject areas\n- Anesthesiology and Pain Medicine |
She had been struggling with seizures for a year and a half before she suddenly developed a tooth root abscess\nand was unable to heal from. Sadly, it forced me to put her to sleep w/ in a week. Her teeth didn't seem so bad, though I wanted to have them cleaned last year to be on top of her oral care. However, because of her seizures, my vet didn't want to put her through dental surgery/ anesthesia; this was a mistake. She should have referred me to an animal hospital where they can resuscitate. |
Mommy Makeover Overview\nMommy Makeovers are groups of common plastic surgery procedures done at the same time to create a dramatically new look with just one surgery. The term ‘Mommy Makeover’ is an easy way to describe what this surgery does and who it is for. Motherhood is richly rewarding but can come at a cost to a woman’s body. Having children and living with the changes to your body isn’t your only option anymore!\nA Customized Treatment Plan\nFor those individuals looking to correct the look of their body, breasts or face, Dr. Alspaugh offers each patient a customizable treatment plan that allows every person to feel comfortable with their decision. These elective surgeries are not a one size fits all procedure, and there are many options to consider. Dr. Alspaugh and his office staff will work with you to create a plan of action that looks the most natural for you.\nLooking For Real Examples?\nWe have examples of some of our procedures. View our before & after gallery now!\nChoosing A Mommy Makeover Procedure\nA Mommy Makeover procedure is very unique to the individual and comes in different forms, depending on what result is desired. A typical Mommy Makeover will have a few common elements – Breast lift or augmentation and a tummy tuck. Optionally, many women also opt in for more work during this time, but any additional procedures should be discussed with your doctor during a consultation to see what would be the best options for you. In short, a Mommy Makeover is all about YOU and your goals.\nMommy Makeover Costs\nAccording to RealSelf.com, the average cost of a Mommy Makeover is ~12,500, according to 2019 self-survey statistics from RealSelf members. Mommy Makeover costs can vary widely, depending on the specific combination of procedures, as well as other costs like anesthesia fees, surgery facility fees, prescriptions and surgeon’s fees. The average Mommy Makeover cost includes a breast lift and a tummy tuck.\nWhen choosing a surgeon in Virginia Beach for a Mommy Makeover, remember that a choosing a board-certified plastic surgeon is just as important as the cost of the surgery, as the quality of the procedure matters greatly.\nMommy Makeover Recovery\nA mommy makeover surgery recovery can last 6-12 weeks, with general anesthesia wearing off after a few days. You will likely have post-surgery instructions to follow, given to you by your doctor. Follow these instructions carefully to minimize downtime and post-surgery pain. Avoid all heavy lifting during this time and generally give yourself a few weeks to recover.\nContact Dr. Alspaugh To Learn More About Mommy Makeovers\nDr. Alspaugh has been performing mommy makeovers for women over the last few decades and has helped pioneer new techniques for women across Virginia, along the East Coast and around the U.S. With an exceptional rating on RealSelf.com, Dr. Alspaugh has become a trusted plastic surgeon for the Mommy Makeover procedure in Virginia Beach.\nFor more information on the Mommy Makeover procedure or to schedule a consultation, please give us a call today! |
Having undesirable fat in different locations of your body can have a significant effect on your health and self-confidence. While conventional weight loss through workout and diet plan is an excellent method to lose weight overall, even the best exercises cannot target problem areas like the belly, inner thighs, arms, and butts. Liposuction is a time evaluated treatment that is utilized to eliminate excess fat from specific locations of the body, allowing an individual to form and contour their body to their taste. Is liposuction right for you? Discover now.\nPros of Liposuction\nThere are numerous benefits to this cosmetic procedure, consisting of:\n• Instantly noticeable changes. Unlike standard weight-loss, liposuction creates changes that are instantly noticeable in the body. Some distinction is visible right away, and the desired results are generally achieved in simply a few days.\n• Proven and safe. This cosmetic treatment has actually been performed by knowledgeable cosmetic surgeons all over the world for years and the strategy has been fine-tuned over and again to be safe and reliable.\n• Recovery time is usually quickly. The downtime required after having this type of treatment is generally much less than what is needed for other types of cosmetic procedures, consisting of abdominoplasty, breast reduction, and more. People who have had the procedure can frequently go back to work much more quickly than they expected and can get back to living a healthy, active lifestyle.\n• Weight loss can be permanent. With the best maintenance techniques, the fat that was eliminated during the liposuction procedure will not return.\n• Complete control over your physique. With liposuction, a person can have complete control over how they want to look, beyond exactly what traditional diet plan and exercise can offer. Giving individuals this power over their bodies enhances self-confidence and assistance people feel their very best.\nWhile there are numerous advantages to liposuction, there are of course a few caveats that must be taken into consideration before making the decision to move forward with the treatment.\nCons of Liposuction\nBefore having actually liposuction done, it is very important to analyze the prospective disadvantages of the procedure and identify if the advantages exceed the risks in your specific case. Your specialist can help you find out more about the risks connected with the treatment and can assist you choose if moving on is the best thing for you.• Issues with basic anesthesia. Because liposuction is performed under general anesthesia, the procedure brings the same threats as any other type of surgery where basic anesthesia is utilized. Underlying medical conditions may enhance these risks.\n• Adverse reactions. Bruising, bleeding, and pain are all to be anticipated, however, in rare cases can trigger more significant complications.\n• The possible to get the weight back. After having liposuction done, it is critical to preserve a healthy diet plan and workout properly as recommended by your doctor. Failure to do so could result in acquiring back the weight that was lost or perhaps much more.\nAlthough there are dangers connected with liposuction, for lots of people, the advantages far exceed them. Inform yourself about the procedure by having extensive discussions with your specialist and think about how liposuction has the prospective to impact you as an unique person. Only you and your surgeon can determine if liposuction will supply you with the results you are trying to find within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Benld Illinois\nLaser liposuction is a more recent, minimally intrusive procedure that involves heating the fat cells to melting point and removing the melted fat through a small cannula. The procedure is typically done right in your doctor's office and is an exceptional alternative for individuals who have less than 500 ml of fat to remove from any one location. Laser liposuction can be a safe, complementary treatment to weight loss in order to sculpt the body you have actually constantly wanted.\nContact a Specialist in your Benld Illinois today.\nIf you're considering liposuction as a weight-loss solution, it is essential that you discuss your desires with a certified cosmetic surgeon in your area. Your specialist will perform a complete exam and health history questionnaire to figure out if liposuction can benefit you and assist you reach your physical and emotional objectives. Call today for an assessment and find out more about how liposuction can assist you accomplish the body of your dreams. |
A nephrectomy is a procedure to remove the kidney and surrounding structures. The procedure is performed for those patients with abnormal kidney mass, non-functioning kidney, and kidney infection/trauma. The procedure involves a minimally invasive technique via small incisions using laparoscopic instruments.\nHow to prepare for the procedure\nA nephrectomy is performed under general anesthesia. When preparing to have a procedure performed under anesthesia you can expect to start fasting the night prior to your procedure. Please consult with your surgeon to discuss the pre-operative testing which may include; blood work, chest x-ray, EKG, discontinuation of medications, and clearance for other medical reasons. The procedure will be done at the hospital. Patient will be admitted to the hospital for a few days and discharged home with a catheter in for several days. |
Objective—To compare 3 types of noxious stimuli\napplied to various anatomic areas of anesthetized\ndogs and rabbits for determination of the minimum\nalveolar concentration (MAC).\nAnimals—10 dogs and 10 rabbits.\nProcedure—Dogs were anesthetized with isoflurane\nand halothane in a randomized order. Rabbits were\nanesthetized with isoflurane. The MAC was determined\nby skin incision on the lateral aspect of the\nchest; clamping of the tail, paw of the forelimb, and\npaw of the hind limb; and application of electrical current\nto the oral mucosa (dogs only), forelimb, and hind\nlimb. The MAC was the end-tidal concentration midway\nbetween the value permitting and preventing\npurposeful movement in response to noxious stimuli.\nResults—In dogs, mean ± SEM MAC for isoflurane\nwas 1.27 ± 0.05% for clamping stimuli, 1.36 ± 0.04%\nfor oral electrical stimulation, 1.35 ± 0.04% for electrical\nstimulation to the limbs, and 1.01 ± 0.07% for surgical\nincision. The MAC for halothane was 0.97 ±\n0.03% for tail clamping, 0.96 ± 0.03% for clamping of\nthe limbs, 1.04 ± 0.03% for electrical stimulation, and\n0.75 ± 0.06% for surgical incision. In rabbits, MAC for\nisoflurane was 2.08 ± 0.02% for clamping stimuli,\n2.04 ± 0.02% for electrical stimulation, and 0.90 ±\n0.02% for surgical incision. The MAC for surgical incision\nwas significantly lower than values for the other\nmethods in both species.\nConclusions and Clinical Relevance—Use of electrical\ncurrent and clamping techniques resulted in similar\nMAC values. Surgical incision underestimated\nMAC values in dogs and rabbits. (Am J Vet Res\nObjective—To compare cardiac output (CO) measured by use of the partial carbon dioxide rebreathing method (NICO) or lithium dilution method (LiDCO) in anesthetized foals.\nSample Population—Data reported in 2 other studies for 18 neonatal foals that weighed 32 to 61 kg.\nProcedures—Foals were anesthetized and instrumented to measure direct blood pressure, heart rate, arterial blood gases, end-tidal isoflurane and carbon dioxide concentrations, and CO. Various COs were achieved by administration of dobutamine, norepinephrine, vasopressin, phenylephrine, and isoflurane to allow comparisons between LiDCO and NICO methods. Measurements were obtained in duplicate or triplicate. We allowed 2 minutes between measurements for LiDCO and 3 minutes for NICO after achieving a stable hemodynamic plane for at least 10 to 15 minutes at each CO.\nResults—217 comparisons were made. Correlation (r = 0.77) was good between the 2 methods for all determinations. Mean ± SD measurements of cardiac index for all comparisons with the LiDCO and NICO methods were 138 ± 62 mL/kg/min (range, 40 to 381 mL/kg/min) and 154 ± 55 mL/kg/min (range, 54 to 358 mL/kg/min), respectively. Mean difference (bias) between LiDCO and NICO measurements was −17.3 mL/kg/min with a precision (1.96 × SD) of 114 mL/kg/min (range, −131.3 to 96.7). Mean of the differences of LiDCO and NICO measurements was 4.37 + (0.87 × NICO value).\nConclusions and Clinical Relevance—The NICO method is a viable, noninvasive method for determination of CO in neonatal foals with normal respiratory function. It compares well with the more invasive LiDCO method. |
What To Bring\nPlease bring your insurance card including pharmacy information and check in with the front desk upon your arrival. Worker’s compensation cases must provide all claim information, including date of injury. Identification bracelets are given to all patients; it is important to keep these bracelets on while at the center.\nInstructions for personal care items:\nIf you are a diabetic, please consult with your primary physician regarding your insulin dosage for the day of the procedure. Please bring your insulin and diabetic supplies with you to have on hand.\nIf you use an inhaler, please bring it with you the day of surgery.\nPlease wear your hearing aids and bring a case for them.\nContacts are not permitted. If you typically wear contact lenses, please wear your glasses and bring your case with you.\nIf you use a CPAP machine at home, please bring it with you. (Check with the preadmission nurse during the phone call to see if it needs to be brought into the center or just available in the car.)\nPlease leave jewelry and valuables at home, including all body piercings.\nPlease do not wear make-up or nail polish on the day of your procedure.\nYou may brush your teeth the morning of your appointment. If you have dentures, you may wear them. Make sure to bring a container for them.\nPlease wear loose, comfortable clothing that you will be able to easily slip off and on as well as fit over any bandages or slings that you may receive. Patients who have shoulder surgery find it easier to have clothes that button down the front and can go over their immobilizer.\nYou will be evaluated by your nurse, physician and anesthesiologist prior to your surgery to ensure a safe procedure. |
Today marks the one-year anniversary of the death of the King of Pop and the tributes have been underway since early this morning. A statue of Jackson is being unveiled in his hometown in Indiana, the Motown Museum is cashing in on the anniversary with a new exhibit that opens today, and fans arrived as early as 3 a.m. at the Glendale cemetery to pay homage at Jackson’s gravesite.\nEven the Filipinos have joined in. The Cebu prisoners who made international headlines in 2007 by dancing to Jackson’s tunes are doing a one-year anniversary concert tomorrow. About 300 people are expected.\nThe "best of" lists are also out today. Joe Vogel, who’s writing a book on Jackson’s career, has published what he thinks are "the top ten Michael Jackson songs of all time." "Billie Jean" makes it at No. 1 (no argument there), but "Beat It" is in a tie with "Black or White" at No. 10 (that’s clearly up for debate). If you don’t think so, check out the mariachi version of "Beat It."\nOf course, it wouldn’t be a Michael Jackon anniversay without a lawsuit.\nJackson’s always-so-classy dad is suing Conrad Murray, Jackson’s doctor, claiming he didn’t tell EMT workers about all the drugs he’d given Jackson. The lawsuit alleges that Jackson’s dad suffered $75,000 in damages. Murray was charged with involuntary manslaughter after the Los Angeles County coroner rules that Jackson died from an overdose of propofol, an anesthesia that’s used to put surgical patients to sleep. The hearing for Murray’s case is expected this fall.\n**MJ in the archives:** The Kehinde Wiley he commissioned, but never saw\nAdrienne Maree Brown asks, [Who’s Loving You?](/archives/2009/06/michael_jackson_whos_loving_yo.html)\nColorLines Editor Kai Wright solutes [the Michael in all of us](http://www.theroot.com/views/michael-all-us), in The Root *Photo by Henry S. Dziekan III/Getty Image* |
Welcome to Medical Gas Research\nEditor-in-Chief, Medical Gas Research, Loma Linda University School of Medicine, Loma Linda, California, USA\nMedical Gas Research 2011, 1:1 doi:10.1186/2045-9912-1-1Published: 27 April 2011\nFirst paragraph (this article has no abstract)\nMedical gas is a large family including oxygen, hydrogen, carbon monoxide, carbon dioxide, nitrogen, xenon, hydrogen sulfide, nitrous oxide, carbon disulfide, argon, helium and other noble gases. These medical gases are used in various disciplines of both clinical medicine and basic science research including anesthesiology, hyperbaric oxygen medicine, diving medicine, internal medicine, emergency medicine, surgery, and many basic science subjects such as physiology, pharmacology, biochemistry, microbiology and neuroscience. Unfortunately, there is not even one journal dedicated to medical gas research at the basic, translational, or clinical sciences level; especially in the neurobiology or neuroscience fields let alone the other various medical fields. Therefore, I am thrilled to introduce this new journal named Medical Gas Research to you in this launching editorial. |
Restrictive transfusion is non-inferior to liberal approach during cardiac surgery\nAHA 2017 - Anaheim, CA, USA3' education - Nov. 14, 2017 - AHA 2017 - Anaheim, CA - David Mazer - Toronto, Ont, Canada\nAHA 2017 Comparison of two triggers for RBC transfusion showed that a restrictive strategy was non-inferior to a liberal transfusion approach in moderate to high risk patients.\nThis 3-minute education provides a summary of just presented scientific data, recorded during the AHA 2017 congress. The objective is to provide a brief commentary and potential implications of these findings.\nC. David Mazer is Associate Scientist in the Keenan Research Centre for Biomedical Science, University of Toronto (Toronto, Ont, Canada). His research is focussed on cardiac anesthesia en critical care, with an emphasis on perioperative blood conservation, cardiac physiology and metabolism and perioperative organ protection.\n- Our reporting is based on the information provided at the AHA 2017 congress - |
Deciding whether or not to have plastic surgery is a very difficult choice. The idea of being able to fix whatever is wrong with our appearance and looks seems amazing; however, being under the knife, and suffering the effects of general anesthesia doesn’t seem so great.\nThe first thing you need to do in order to make a good decision is to consult a plastic surgeon, who can explain you the procedures in detail, and can’t talk to you about recovery, and all those aspects that plastic surgery candidates care about. PlasticSurgeonResource.com is a website that can help you get appointments with 5 plastic surgeons in your city. At the site you will find a form that you must fill in if you want to have access to that information. The information you need to submit includes, your name, surname, mail, phone number, and a blank space where you can post your doubts or questions. What’s great about this system is that the plastic surgeons will get in touch with you, and not the other way round. When they call you, you can schedule an appointment or make your consultations by phone. PlasticSurgeonResource.com will help you with your plastic surgery decisions. |
Surgery is often the most effective way to treat many serious injuries and disorders, and Coventry Veterinary Clinic is proud to offer state-of-the-art facilities and equipment. Our hospital provides a full range of surgical services ranging from standard spaying and neutering to advanced, highly specialized procedures.\n- Foreign body removal\nPatient safety and comfort are our main priorities. Coventry Veterinary Clinic’s experienced veterinary anesthesiologists provide skilled pain management during and after all surgical procedures, ensuring your pet recovers quickly and with minimum discomfort.\nOur veterinary team will walk you through the entire process, giving you the tools to make informed decisions regarding your pet’s treatment options. We understand that surgery is a stressful time for any owner, and we’re available every step of the way to answer questions and put your mind at ease.\nAs well as various soft tissue and abdominal surgeries, our sister hospital, Skyline Veterinary Clinic, also has the knowledge and experience to address several common orthopedic surgical needs. Services they provide include cruciate stabilization, patellar luxation repair, and femoral head ostectomy. If you have questions about the orthopedic surgical offerings, please call them today!\nIf you are considering veterinary surgery for your pet, please contact us at (402) 322-2842 to schedule a consultation with your Coventry Veterinary Clinic veterinarian. |
Why Did I Experience Blurry Vision After Anesthesia?\nBy Essilor News\nGoing through any type of surgery can be an uncomfortable and stressful experience; however, with the advent of modern anesthesia, surgery is often performed without a patient feeling or remembering anything. Anesthesia consists of several components, including sedation, unconsciousness, immobility, analgesia (lack of pain), and amnesia (lack of memory). Every day about 60,000 people in America have surgery under anesthesia.\nDespite the benefits of a numbed surgical experience, anesthesia can result in some unintended side effects. One such residual effect can be blurred vision - a side effect not caused directly by the drug, but often by an abrasion of the cornea, the outermost layer of the eye.\nA corneal abrasion in such settings is caused by direct injury to the cornea from things like facemasks, surgical drapes, or other foreign objects. It can also be associated with decreased tear production in the eyes or swelling of the eye in patients lying on their stomach during surgery. This is one of the reasons that your eyes are taped shut during procedures performed under anesthesia.\nIn a study of 671 patients undergoing non-eye surgeries, about one in 25 patients reported a new onset of blurred vision lasting at least three days after surgery. If this happens, you can also have pain or irritation that feels like a foreign body in the eye. The symptoms are generally transient, and treatment is usually lubricant drops and an antibiotic ointment to prevent bacterial infection.\nInterestingly, this kind of injury can also be self-inflicted. As someone comes out of anesthesia but is not completely awake, they will often try to rub their eye or nose with the little oxygen probes still attached to their fingers and accidentally scratch their eyes.\nFor most people in the study, the symptoms resolved within two months without any complication, but about 1 percent required visits to eye care professionals. Of course, with any eye intrusion or injury, it is recommended to see your eye doctor for a solution.\nAlthough it is an uncommon problem, mention any concerns you may have to your anesthesiologist before the procedure. |
Wrinkled and saggy skin can arise for a variety of reasons: the loss of collagen production that happens naturally with aging, childbirth, weight loss and other lifestyle factors. The experts at Donaldson Plastic Surgery turn to Renuvion J Plasma – a cosmetic procedure that uses a combination of radiofrequency energy and helium gas – when it comes to safely, efficiently and gently tightening skin in precise areas.\nTo begin, Dr. Sieffert will first sanitize the skin before anesthesia is administered. Local anesthesia and tumescent fluid are used for smaller areas whereas general anesthesia is reserved for more intensive procedures. Once you’re comfortable, the doctor will create a small incision that will act as an entry point for the J Plasma wand.\nUsing a fan pattern to ensure a uniform, consistent treatment, the Renuvion J Plasma handpiece is introduced through the small opening. The underside of the skin is heated using helium gas and radiofrequency (RF) is introduced to create a precise stream of energy. This causes contraction of the skin that will gradually and continuously improve up to 6 months after the procedure. A small, absorbable suture is then placed to close the opening.\nJ Plasma is ideal for patients with mild skin elasticity who do not require more extensive skin removal. Some patients may have connective tissue disorders that could prevent them from being a candidate for this procedure. Smokers should also consult with a J Plasma specialist before pursuing this option.\nYes – J Plasma can be performed on its own. However, it is most often used with other procedures like Tummy Tuck, Liposuction, Arm Lift, Thigh Lift, Face Lift, Eyelid Lift & more.\nRenuvion J Plasma is renowned for its limited side effects, complications and risks. The most common side effects include redness, swelling and discomfort. Rare side effects/risks include scarring, burns, hematoma and infection.\nJ Plasma recovery requires significantly less time. Most patients are able to return to work in one week and return to more strenuous activities within just 2 weeks. However, each individual patient is different and recovery can depend on the intensity of your procedure. For smaller treatment areas, a patient may only require OTC pain relievers. More extensive procedures may require a prescription-based pain reliever.\nAnother primary driver of a full and efficient recovery is compression. Once you’ve completed your treatment, a member of our team will suit the patient with a compression garment that is to be worn at night and whenever possible during the day for several weeks.\nRenuvion J Plasma is technically a surgical procedure, however, it is minimally invasive and results in less scarring and downtime.\nThe final cost of the procedure varies based on the size of the area being treated and the amount of work that needs to be done. The average cost of this treatment ranges between $5,000 – $6,500.\nHave additional questions about J Plasma and your skin tightening options? Looking to schedule your initial consultation? Our experts are on standby to answer your questions! |
Click on one of our services below to see how we can help.\nLike To Book One Of Our Services\nContact us today for advice and a discussion on what is the best route forward for your condition.\nLike To Discuss What Service You Need\nIf so, get in touch with us today for a consultation. We will assess if we have a service for your condition.\nList Of Services\nRegenerative medicine is still deemed experimental in the United States. It is not covered by insurance or medicare. However, the results are so impressive that people like Stephen Curry and Kobe Bryant are traveling overseas to get it.\nThe human body is in a constant state of degradation and repair. If we sustain an injury, tissue factors are released and this leads to a cascade of chemical signals that starts the repair process. This is known as “inflammation”. These signals call small cellular workers to the site of injury that clean up the debris and signal the surrounding area to lay down new tissue.\nHowever, as we age that balance gets tilted towards more degeneration, and less regeneration. Due to a variety of genetic, environmental, and other factors, the inflammation is there but the process of repair is sluggish. Injury occurs and the site doesn’t completely heal, leading to scar tissue, poor blood flow, and chronic pain.\nPlatelets are a key cellular component to this process. When injury occurs, they release a myriad of chemical growth factors and signals that starts the process. We can now use this to our advantage. We can draw blood from your body and spin it down in a centrifuge. This separates the sample into layers of red blood cells, platelet poor plasma, and platelet rich plasma. It is the platelet rich plasma (PRP) that is drawn off and reinjected into your site of chronic injury.\nThis supraphysiologic concentrate has over thirty growth factors and signaling molecules. And best of all, it’s your tissue. There’s no chance of allergic reaction or rejection. Complications are incredibly low; much lower than putting medications and other foreign substances into your body.\nThis therapy is extremely effective for soft tissue injury like tendons and muscles. Tennis elbow, rotator cuff tendinits, bursitis of the hip, and plantar fasciits all respond very well to this therapy. The next most common area is injection into the knee, hip, and shoulder to treat cartilage injuries. And finally, early data is showing promising results by injecting it into the discs and facet joints to treat chronic back pain and avoid surgery.\nThe illustrations below demonstrate how we extract the PRP and areas we can treat.\nAs I stated in the beginning, this is considered experimental and is not covered by insurance or medicare. It is paid entirely by the patient. However, many patients have failed all other options and like the idea of using their own tissue factors to heal their body and avoid medications or surgery. I have used it on myself multiple times and I have been extremely happy.\nCervical Epidural Steroid injections\nNerves in the neck can be pinched for a variety of reasons. Bulging discs, enlarging facet joint, and degeneratve changes can all lead to nerve impingement. The diagram below illustrates what happens.\nWhen nerves are compressed they react with swelling and inflammation, only worsening the impingement. A vicious cycle of pain, swelling, inflammation, and further impingement can occur. Epidural steroid injections act to break that cycle by bathing the affected in steroid, an anti inflammatory medication. Patients will often require a series of injections to achieve full relief. Patient should also include medications, physical therapy, and massage.\nYou will receive an IV for this procedure and mild sedation. It is important that you are still conscious for this procedure, as bumping of the nerve can occur and general anesthesia would mask this complication. We will gently talk you through the procedure and it is well tolerated. Patients should expect relief in the first three days, as it takes some time for the anti-inflammatory effect to take place.\nMedial Branch block: Cervical, Thoracic, and Lumbar\nJoints of the spine are called facet joints. The facets vary depending on the level in the spine. However, the medial branch innervates all facets. The diagrams below show you what they look like and the table illustrates which level we go after based on the level that is diseased.\nFacets are one of the most common sources of pain. Placing local anesthetic on the medial branch allows us to diagnose that your pain is coming from these joints. Unfortunately, imaging alone cannot answer this question. That’s why these are called “diagnostic blocks”. They are used to diagnose where your pain is coming from. The bottom diagram illustrates proper needle placement.\nStudies show that there can be a high rate of placebo with only one block; so performing an initial and confirmatory block is necessary. We will assess your pain before and after the procedure. A significant reduction in your pain, which matches the duration of the local anesthetic, confirms that this is the source of your pain. We can now proceed to the therapeutic treatment for facet disease, a radiofrequency ablation.\nRadiofrequency Ablation: Cervical, Thoracic, and Lumbar.\nRadiofrequency ablation is a minimally invasive technique that can have dramatic results in the right patient. If you have undergone successful initial and confirmatory medial branch blocks for facet disease, than you are a candidate for Radiofrequency ablation.\nYou will have an IV started and mild sedation is given. The area is sterilely prepped and we gently place a radiofrequency probe on the bony area of the facet, which contains the medial branch. We then do sensory and motor testing by attaching the probe to a radiofrequency generator. Sensory testing will cause you to feel the same pain you normally do by stimulating the nerve. Motor testing will cause the small muscles on the joint to gently move the needle up and down. We should not see your arm or leg move. This would indicate misplacement of the needle and proper adjustments will take place. Needle placement is also confirmed with a live X ray machine throughout the procedure.\nLocal anesthetic is given through the probe and a thermal lesion the size of a q-tip occurs over ninety seconds. It should not be painful and we will be monitoring your throughout the procedure. Steroid is given in the needle at the end to minimize inflammation and pain after the procedure.\nPatients will notice some soreness for the first couple of days since we have caused a thermal lesion. Rarely patients experience a neuritis, or irritation of the nerve that can last up to a week. Most patients tolerate the procedure quite well.\nAs with other tissue in the body, these nerves will regenerate.\nPatients can expect 6 months to 6 years of long-term relief depending on the severity of your condition.\nThis procedure has revolutionized spine care and can provide lasting relief without the need for surgery.\nLumbar Transforaminal Epidural Steroid Injections. (TESI)\nLumbar TESI injections are a unique injection that places epidural steroid in the neural foramen, the area of the spine where the nerve root exits. This is the most common area of nerve impingement, often from a disc or enlarged facet. By placing the medication right at the site of irritation we maximize your chances of success.\nAn IV is started and sedation is given. You will not be under general anesthesia. Pathology in the spine can cause distortions that push the nerve into areas that it normally does not reside. As we approach the foramen, we will cautiously advance the needle and ask for any signs of bumping the nerve. You may feel a mild parasthesia into your leg, which will allow us to adjust the needle accordingly. Practitioners putting patients under general anesthesia place you at risk of injecting into the nerve, which could have long lasting consequences. Once the area is localized, dye is injected under live X ray to confirm proper needle placement. Anti-inflammatory steroid is then injected and the procedure is complete.\nPatients should see a positive effect in the first three days after the procedure as the medication takes effect. Often a series of injections is needed to undo the cycle of compression, pain, and inflammation of the nerve.\nEpidural steroid injections have provided lasting relief to many of our patients, especially when combined with core strengthening, traction, and intermittent bracing.\nKyphoplasty is a minimally invasive procedure that has helped many Americans who suffer compression fractures. The large amount of patients with osteoporosis makes this procedure a valuable tool in their treatment.\nCompression fractures tend to do two things: cause pain and progress. The ongoing pain can prevent them from walking and breathing properly, predisposing them to lung dysfunction and clots. The settling of the fracture leads to a postural deformity known as kyphosis, a c shaped abnormality of the spine seen in many of our older patients. And lastly, this progression can cause retro-pulsion of bone fragments back into the spinal cord. See the bottom two diagrams showing a compression fracture as well as what retro-pulsion looks like on MRI.\nKyphoplasty achieves three primary goals. If caught early, it can reestablish the height of the vertebral body back to its normal configuration, preventing the postural deformity. It fixes the pain, as the fractured bone no longer moves around irritating the fibrous lining of the backbone. And finally, it stabilizes the fracture preventing progression and retro-pulsion into the spinal cord.\nAn IV will be started and sedation given. A live x ray will be used to identify the area in both the straight on view and lateral view. Skin marks will be placed on your skin and local anesthetic will numb the skin, subcutaneous tissue and periosteum over the bone. A device called a trochar is advanced carefully into the vertebral body through a structure called the pedicle. A balloon is then inflated under live X ray to assure proper placement and reestablishment of height. Depending on the location of the balloon, this may be repeated on the other side. This balloon creates a void in the bone, and cement is then injected into that void to stabilize the fracture. Careful attention is focused on assuring that the cement stays in the anterior two thirds of the vertebral body and that it crosses the mid portion of the vertebral body. The cement is dry within 10 minutes and the procedure is complete.\nPatients can resume regular activities within a day. You may have some mild soreness from passing the trochar in soft tissue.\nCement traveling along a fracture line backwards into the canal is always a risk. However, if you take the time to place two introducers, create two voids, and proceed carefully your risk is greatly reduced.\nNeuromodulation: Spinal Cord Stimulator/Peripheral Nerve Stimulator\nNeuromodulation is an advanced pain management technique used for intractable neuropathic pain. Conditions that can be treated with this include diabetic neuropathy, chronic radiculopathy, failed back surgery syndrome, reflex sympathetic dystrophy, and phantom limb pain to name a few.\nIt works by what is known as the “gate theory”. Special leads are placed in the epidural space and it is attached to a generator. Low voltage impulses are generated and transmitted superficially in an area of the spinal cord called the dorsal column. The patient now feels a tingling sensation instead of pain, and the electrical stimulation is acting to “close the gate” such that pain signals coming from below can’t reach the brain since the stimulator is occupying the pain tract. Another analogy would be a car trying to enter the freeway in a traffic jam. You (the pain signal) can’t get on the freeway because of the continual stream of cars passing by (the stimulator signal). Check out the top diagram for a schematic of this .\nSince this is a permanent implant patients must undergo a trial to be sure that this therapy is right for you. During the trial, an IV is placed and the stimulator leads are advanced under live fluoroscopy to the appropriate level in the spinal cord. The leads are attached and you are asked if you feel the stimulation and if it’s covering the area of your pain. Adjustments are made to the generator and lead position until proper coverage is achieved. It is firmly taped and the procedure is complete.\nThe manufacturers representative will be in contact with you for five days after the procedure. After that the leads are pulled. If you had an excellent result you may be a candidate for permanent implant.\nThe permanent implant is the same as the trial except this time a small pocket is made under the skin, usually over the right or left hip. A battery is placed, the leads are tunneled under the skin, and the system is connected and proper functioning is tested. The small incision sites are closed and the patient is discharged the same day. The bottom diagram shows the usual battery location under on the hip in a pocket under the skin.\nThis technology has proven to be one of the most effective treatments for intractable neuropathic conditions such as chronic radiculapathy, failed back surgery syndrome, diabetic neuropathy, and reflex sympathetic dystrophy to name a few. Patients with medical problems who can’t have surgery but have chronically pinched nerves do very well. It can truly change the lives of patients living with these debilitating problems.\nGenicular Block / Radiofrequency Ablation\nThis is an exciting new procedure that few clinics are offering. The genicular nerves are sensory nerves that innervate the knee. Studies have shown that they follow predictable patterns base on bony anatomy, and can be blocked or ablated depending on the need. The diagram below illustrates this.\nGenicular block/Radiofrequency ablation is a great option for patients that have had a total knee replacement or are not candidates for a knee replacement. This can be due to other medical risks or personal choice to delay surgery.\nAn IV is started and you will be lying supine on the procedure table. The knee area is evaluated under live x ray and the area of the skin is numbed. We gently place the needle in the area of the genicular nerves and place long acting local anesthetic. If you notice a dramatic reduction in your pain after the initial and confirmatory block, than you are a candidate for radiofrequency ablation.\nPatients can expect six months to six years of pain relief depending on the severity of your condition. We have seen some impressive results.\nProper medical management is mandatory for comprehensive pain management. We use a wide variety of non-opiate and opiate medications depending on your condition. Our approach has been constructed with the expertise of the American Society of Interventional Pain Physicians as well as other national experts.\nWe are careful to prescribe medications that are specific to your condition. Our goal is to maximize function. Nobody likes to take unnecessary medication and we are mindful of this in our practice. We will monitor you for side effects as well as screen you for anxiety, depression, and addiction risk. We will set SMART goals with you, specific measureable, achievable, realistic and timely goals that matter to you. We screen all of our patients with a UDS (urine drug screen). This is a standard practice that protects both you and your provider. It should be viewed as any other lab test. We are assuring that the proper medication is in your system and that you’re not on any illicit substances. Regulatory agencies are clear that using illicit drugs with opiates is not allowed. Non-opiate therapy and other interventions will still be offered and can be extremely effective depending on your condition. We will also have a medication contract with you that will explain all of this and assures that these medications are available for the people who need them.\nOur goal is to maximize you function, limit side effects, and assure maximum success. The illustration below reminds us that all medications have side effects and be mindful of this when using them.\nTrigger Point Injection\nTrigger points are an area of muscle injury that is in continual spasm. This causes localized pain as well as referred pain. Once a trigger point is identified, we can inject it under ultrasound guidance and achieve quick relief. The area is sterilely prepped and confirmed with palpation and ultrasound. A small needle is gently advanced into the focal area of spasm and gently injected with local anesthetic and steroid, thereby breaking up the spasm allowing blood flow and healing. Patients usually feel very good the first day due to the local anesthetic. They often feel a bit sore on day two from the mild trauma of the injection. After this blood flow can reach the injured area and healing commences. The procedure is low risk and well tolerated. It requires no sedation and can be done in the office\nStellate Ganglion Block\nThis procedure is performed on patients who have reflex sympathetic dystrophy of the upper limb. You will have an IV placed and lay supine on the table. An ultrasound will be used to identify the area and a needle is gently advanced to the target area. Under live ultrasound local anesthetic will be given to assure proper placement and a good result. After we will assess temperature differences both before and after. A positive temperature change indicates a good result.\nOften patients need a series of these injections to achieve lasting results. As mentioned previously, early and aggressive intervention is key to preventing lasting disability from this condition.\nLumbar Sympathetic Block\nPatients with reflex sympathetic dystrophy of the lower limbs are candidates for this procedure. An IV will be started and you will lye face down. A live x ray will identify the proper level. A needle is gently advanced to the anterior portion of the vertebral body and dye is injected. Careful attention is paid to prevent uptake into a vessel. Once this is confirmed, local anesthetic is given and the procedure is complete. The two diagrams below show you where the sympathetic chain lyes and the dye pattern we look for during the procedure.\nAn elevation in temperature of the affected limb is indicative of a successful block.\nOften patients need a series of these injections to achieve lasting results. Early and aggressive intervention is key to preventing lasting disability from this condition.\nThis is a procedure used to diagnose painful discs. Discs normally aren’t painful. Only the outer portion of the disc has pain fibers. As discs degenerate, the inner jelly of the disc can come in contact with the outer pain fibers causing the disc to become painful. This is known as discogenic pain. It can be very debilitating, and proper diagnosis will help guide treatment.\nThe top diagram shows you how a tear into the area that has pain fibers starts this condition. The X ray shows the dye patterns for a discogram, and the one below that shows the various ways a disc can tear outward and how we classify these.\nAnterior Cervical Discectomy and Fusion (ACDF)\nThis procedure is not offered in our practice but is here for educational purposes. For patients that have a compressed nerve in the neck and have failed conservative treatment, an ACDF may be what is necessary for you.\nThis procedure is performed through a small incision in the front of the neck. The muscles, vessels, and esophagus are gently deflected out the way. The front surface of the spine is exposed. A microscope is used for the rest of the procedure. The disc is removed as well as any soft tissue that may be causing nerve impingement. The remaining space is measured and the appropriate spacer placed between the bones where the disc used to live. A plate is then placed across the areas of interest. X ray is used to confirm proper placement. The area is washed and the wound closed.\nThe most common levels are C5/6 and /or C6/7. It is rare to require more than a two level fusion.\nYou can expect to go home the day of surgery or after an overnight stay. The bones start to fuse together by 6 weeks and physical therapy is initiated.\nMinimally Invasive Lumbar Decompression and Interbody Fusion\nThis technique is not offered in our practice but patients have asked me what it is.\nI discussed this with Dr. George Galvan, a neurosurgical colleague of mine that specializes in this procedure. The advantages of this approach compared the traditional approach are as follows:\n- This procedure can be performed thorough a 3 inch incision, often on one side only.\n- It avoids the muscle stripping of the traditional approach. This leads to a reduction in pain, less blood loss, and less spasm.\n- The intact muscles are left to provide additional ongoing structural support.\n- Decreased risk of postoperative seroma and potentially infection.\nThis is more tailored to the 30 to 60 year old patient with isolated disease. If you have severe multi level stenosis than you may not be a candidate for this procedure. Your surgeon will review your images and discuss the options with you.\nPosterior Lumbar Decompression and Interbody Fusion (PLIF)\nWhile a miniminally invasive approach has its advantages, some patients have such advanced disease that they are not candidates for a minimally invasive approach. They have collapsed disc spaces, severe facet disease, soft tissue overgrowth, and profound spinal stenosis.\nIn this case, the posterior element of the spine has to be removed in its entirety as well as the discs between the spine bones. An interbody bone spacer is placed between the vertebral bodies to re establish the proper height and the segment is stabilized with screws and rods. The approach does result in a fair amount of blood loss due to the necessary surgical dissection. Despite the breadth of surgery entailed in this procedure, the person with profound disease will see significant improvement over the long term.\nIdaho Pain & Spine\n1859 S. Topaz Way, Meridian ID 83642 |
Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-8614\nHaeberli, S; Grotzer, M A; Niggli, F K; Landolt, M A; Linsenmeier, C; Ammann, R A; Bodmer, N (2008). A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients. Radiation Oncology, 3:17:1-6.\nView at publisher\nBACKGROUND: Radiotherapy (RT) has become an important treatment modality in pediatric oncology, but its delivery to young children with cancer is challenging and general anesthesia is often needed. METHODS: To evaluate whether a psychoeducational intervention might reduce the need for anesthesia, 223 consecutive pediatric cancer patients receiving 4141 RT fractions during 244 RT courses between February 1989 and January 2006 were studied. Whereas in 154 RT courses corresponding with 2580 RT fractions patients received no psychoeducational intervention (group A), 90 RT courses respectively 1561 RT fractions were accomplished by using psychoeducational intervention (group B). This tailored psychoeducational intervention in group B included a play program and interactive support by a trained nurse according to age to get familiar with staff, equipment and procedure of radiotherapy. RESULTS: Group A did not differ significantly from group B in age at RT, gender, diagnosis, localization of RT and positioning during RT. Whereas 33 (21.4%) patients in group A got anesthesia, only 8 (8.9%) patients in group B needed anesthesia. The median age of cooperating patients without anesthesia decreased from 3.2 to 2.7 years. In both uni- and multivariate analyses the psychoeducational intervention significantly and independently reduced the need for anesthesia. CONCLUSION: We conclude that a specifically tailored psychoeducational intervention is able to reduce the need for anesthesia in children undergoing RT for cancer. This results in lower costs and increased cooperation during RT.\n116 downloads since deposited on 19 Dec 2008\n34 downloads since 12 months\n|Item Type:||Journal Article, refereed, original work|\n|Communities & Collections:||04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology\n04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic\n|Dewey Decimal Classification:||610 Medicine & health|\n|Deposited On:||19 Dec 2008 07:26|\n|Last Modified:||05 Apr 2016 12:44|\n|Free access at:||Official URL. An embargo period may apply.|\nUsers (please log in): suggest update or correction for this item\nRepository Staff Only: item control page |
Anesthesiologists are medical doctors (MD or DO) specializing in patients’ preoperative, during, and post-surgery care. They administer anesthesia, monitor vital signs, and adjust it as necessary.\nJammu and Kashmir have the highest utilization rates nationally for Ayushman Bharat, India’s flagship medical cost reimbursement scheme. Through August 2019, this state reported one of the highest utilization rates nationwide.\n1. Dr. Nitish Kumar\nThe top anesthesiologists in Srinagar can take your pain away. Not only are they highly knowledgeable and capable of diagnosing your condition, but they can make you feel better and provide quality sleep at night. Many of the city’s top anesthesiologists have earned an excellent reputation for their skillset and provide you with complete medical care.\nDr. Nitish Kumar is one of the finest anesthesiologists in Delhi-NCR. A mechanical engineer by training, he holds a Ph.D. in automation and robotics and strives to help his patients feel their best. With an excellent reputation throughout the city and offices in Indirapuram and Ghaziabad, you can easily make an appointment with him today!\n2. Dr. Rajesh Kumar\nDr. Rajesh Kumar is one of the premier anesthesiologists in Srinagar, boasting extensive expertise and excellent patient reviews. With such a reputable practice, Dr. Kumar continues to earn the trust of his patients by providing them with high-quality care.\nHe has been treating patients for 13 years and is renowned for his kind and polite manner. He listens attentively to his patients’ needs before providing them with the required medicines.\nHe has also earned certification from Compassionate Doctor, an honor society recognizing physicians who demonstrate exceptional kindness towards their patients. He was given this distinction based on his overall and bedside manner scores.\n3. Dr. Ajay Kumar\nAre you searching for the top anesthesiologist in Srinagar? Look no further than Dr. Ajay Kumar – a highly-skilled physician with years of experience in this field.\nHe has three offices in Pennsylvania and New Jersey that offer patients Physical Medicine & Rehabilitation, Pain Management, and Interventional Pain Management services. Furthermore, Dr. Shaffer has a particular interest in plastic surgery.\nAs a physical medicine & rehabilitation specialist, Dr. Smith treats patients with chronic diseases affecting the musculoskeletal system, such as back pain, arthritis, and sports injuries. He utilizes various treatment & rehabilitation methods like physical therapy, occupational therapy, and nerve stimulation treatments.\nAs an interventional pain management specialist, he focuses on relieving chronic pain by blocking or interrupting neurological signals in the brain. He utilizes various minimally invasive treatments like spinal cord stimulation, neuromodulation, medication management, and fluoroscopic/ultrasound-guided minimally invasive procedures like prolotherapy or platelet-rich plasma therapy (PRP) injections. With his extensive training and expertise comes expertise with chronic pain treatment plans.\n4. Dr. Sanjeev Kumar\nSanjeev Kumar is one of the premier anesthesiologists in Srinagar, with over 26 years of expertise. His specialties include Anesthesia and Neurology.\nHe earned his medical degree from King Georges Medical University in 1996 and is currently practicing medicine in Bel Air, MD, at the University Of Maryland Harford Memorial Hospital.\nDr. Sanjeev Kumar is a specialist in Oncology with over two decades of experience, currently employed at Poplar Avenue Clinic PLLC located in Memphis, TN.\nPatients have highly rated his overall and bedside manner ratings and near-perfect scores for the promptness of appointments. Furthermore, he has earned Compassionate Doctor certification and Patients’ Choice recognition from Vitals.\nHe is passionate about breast cancer research and holds a Doctorate of Medical Oncology from Lifehouse, The Kinghorn Cancer Centre, and the United Kingdom. His research is focused on Oestrogen receptor-positive breast cancer to develop novel biomarkers and treatment interventions for this disorder. |
Legal ServicesRating Methodology\nSurgical Error Attorneys in Collingswood, NJ\nKnowledgeable Medical Malpractice Lawyers Fight for Maximum Damages for Victims of Surgical Errors in Camden County, Burlington County, and Throughout New Jersey\nWith thousands upon thousands of surgeries being performed each year in the United States, it is no wonder that surgical injuries are relatively common. Whether it is related to error of the attending surgeon, a surgical resident, anesthesiologist or nursing team, errors in the operating room happen far too often. In addition to injuries caused by surgical instruments negligently injuring surrounding areas that should not have been in the operative field, other errors include improper positioning of the patient on the operating room table, failure to monitor, improper use of anesthetic agents, or even wrong site surgery. Several surgical errors occur in U.S. operating rooms every day.\nThe Law Offices of Andres & Berger, P.C. Leaves No Stone Unturned to Protect Surgical Malpractice Victims’ Rights in Voorhees, New Jersey\nAlthough many times the surgical error is apparent to the surgeon, it is not described or contained in the dictated operative note. Therefore, even a thorough examination of the records may not reveal whether there was a deviation from the standard of care, causing injury. The advent of the laparascope and the increasing frequency of outpatient surgical procedures makes discovering causes of surgical error even more difficult. The laparascope has increased the potential for inadvertent injury and the use of outpatient facilities has reduced the oversight of the surgeon, usually present at a hospital.\nFor every surgical procedure performed there are certain known risks of the procedure that can occur without any negligence. When surgery is elective, that is non-emergent, a patient has the right to be told the risks and make an informed decision about whether to consent to said surgery.\nFurther complicating this area of malpractice is the practice of “ghost” surgery, particularly in large teaching hospitals, where the attending surgeon allows a junior attending or resident to perform the surgery, without reflecting the same in the record or telling the patient.\nContact Experienced NJ Surgical Error Lawyers Today for a Free Consultation about Your Cherry Hill Medical Malpractice Case\nThe three attorneys at The Law Offices of Andres & Berger, P.C. have a total of more than 80 years of experience. We are accustomed to doing the hard work necessary to achieve the optimal result for our injured clients – in or out of court. If you’ve been a victim of Medical Malpractice in New Jersey please don’t hesitate to contact The Law Offices of Andres & Berger, P.C. today for a FREE CONSULTATION.\nThe Law Offices of Andres & Berger, P.C. is located in South Jersey but because of our outstanding reputation we commonly represent clients throughout the entire state of New Jersey including but not limited to Camden County, Burlington County, Gloucester County, Atlantic County, Cape May County, Cumberland County, Salem County, Mercer County, Ocean County, Monmouth County, Cherry Hill, Voorhees, Haddonfield, Marlton, Medford, Mt. Holly, Moorestown, Woodbury, Williamstown, Pennsauken, Atlantic City, Wildwood, Hammonton, Vineland, Berlin, Atco, Collingswood, Turnersville, Glassboro, Washington Township, and Camden. |
What Is Rhinoplasty?\nRhinoplasty, frequently called a nose job, is a kind of cosmetic surgery made to fix or reshape the nose. As one of one of the most famous features on your face, your nose has a huge bearing on your appearance and also can impact just how you really feel concerning on your own. People that are displeased with the dimension or form of the nose can take advantage of rhinoplasty due to the opportunity it supplies to totally change the appearance of the nose. Rhinoplasty has the capacity to boost or decrease the size of the nose in its whole, removing a bump, modifying the shape of the bridge or the tip of your nose, tightening the nostril openings, as well as changing the angle in between your nose and your lips.\nRhinoplasty can not be efficiently carried out till the nose has stabilized and nasal bone has actually stopped expanding. This commonly happens around age 14 to 15 in ladies and age 15 to 16 in children. Any type of surgery done before this point risks of having to be redone as soon as nasal growth has actually discontinued, considering that the nose has the possible to continue to transform and establish till that point. Rhinoplasty is sometimes executed on younger kids when it comes to severe injury to the face, to make sure that the nose can be recovered as close as feasible to its original shape and size.\nA lot of rhinoplasty treatments are carried out on an outpatient basis under basic anesthetic. There are exemptions to this rule, though. Individuals undertaking severe reconstructive surgery may be checked overnight to make sure that no complications occur. Individuals seeking to have their nose "established" after a poor break will periodically get local anesthetic just.\nDuring the procedure the plastic surgeon makes a cut either inside the nostrils or with the columella, the exterior strip of cells that divides the nostrils. The skin is after that divided away from the framework of the nose itself so the physician can access the underlying cartilage. In order to reshape the nose, the soft flexible cartilage and bone are manipulated into the proper position as well as shape. Depending on the desired outcomes, cells might be eliminated or contributed to change the angle or contour of the nose. A carve or submit might be made use of during the procedure, many frequently to eliminate a hump from the bridge of the nose. Once the nose has been shaped into the wanted shape, the skin is resituated and the nose is splinted to shield it. Nasal pads might be made use of for the initial few days complying with the surgical procedure to load the nose and also safeguard the delicate septum.\nRhinoplasty, similar to all other surgeries, is not safe. Along with the conventional bruising and swelling, people must understand a variety of potential side-effects that can arise from the treatment. These include an infection of the nose, nosebleeds, pins and needles, rhinoplasty NYC cost scarring, and a response to the anesthesia. Some people report the bursting of tiny blood vessels externally of the skin and hematomas, or collections of blood that swimming pool under the skin. The possibility additionally exists that a follow-up procedure will certainly be needed in order to remedy an over-correction or under-correction of the nose.\nWhen effectively performed by a highly-qualified specialist, rhinoplasty can dramatically enhance the look of your nose and improve your confidence. If you are taking into consideration rhinoplasty and would such as more information regarding this treatment, contact a reliable plastic surgeon in your location and also arrange for a personal examination.\nDr. Ronald Espinoza, DO, PC\n162 E 78th St, New York, NY 10075\nSpecializing in: Rhinoplasty NYC |
Head of the Department: Krzysztof Szczepanik, MD, anesthesiology and critical care specialist\nThe Department of Anesthesiology and Critical Care comprises:\nAnesthesiology Unit: tel. +48 41 367 4424\nCritical Care Unit: tel. +48 41 367 4377\nCentre of Intensified Postoperative Control: tel. +48 41 367 4203\nConsultative Anesthesiology Clinic: tel.\nThe Department focuses on:\ntreatment of stationary patients in life-threatening conditions,\nanesthesia and sedation of patients for surgical procedures as well as diagnostic tests,\nsupervision and care of patients in the immediate postoperative period at the Centre Intensified Postoperative Control,\nimplantation of vascular ports in patients undergoing chemotherapy.\nThe Critical Care unit has 5 full-profile stations equipped with modern respirators and monitoring systems of key vital signs, including one station in a single room with a private bathroom. There is also a treatment room where minor surgical procedures are performed. A device that allows use of continuous renal replacement techniques is used in our treatment. The Department has a 24-hour access to imaging tests (ultrasound, CT, MRI, endoscopy) and a wide range of laboratory and microbiological tests.\nEach operating room in the operating suite and treatment rooms at the Holy Cross Cancer Centre have a high-class machines for general anesthesia and monitors that allow control not only the parameters of the cardio-respiratory system but also anesthetic depth (BIS, entropy). In some cases it is possible to use high frequency ventilation. In addition to general anesthesia, conduction anesthesia, including continuous anesthesia in order to eliminate postoperative pain, are conducted. The Centre of Intensified Postoperative Control is equipped with 6 stations monitoring vital signs of patients immediately after surgery.\nThe Department of Anesthesiology and Critical Care conducts research on, among others, various aspects of anesthesia, intravenous sedation in children who underwent magnetic resonance, treatment of pain using a subarachnoid catheters, prevention and treatment of nosocomial infections, and safety of patients and medical staff. We are accredited by the Ministry of Health to train specialist doctors in the field of anesthesiology and critical care. |
Retinal Detachment Repair\nby Editorial Staff and Contributors\nThis procedure is done to repair a detached retina in the eye. The retina is a thin sheet made of light-sensitive nerve tissue and blood vessels that line the back of the eye. The sensory layer of the retina receives images and sends them to the brain. This layer can be pulled away (detached) from its normal position. This will result in a loss of vision. The retina often detaches from the back of the eye in a manner similar to wallpaper peeling off a wall. The detachment is usually preceded by a hole or tear in the retina. It may also be preceded by inflammation or infection of the area behind the eye.\nReasons for Procedure TOP\nThis procedure is done to place the retina back into its proper position. It is used to try to restore vision.\nIf your vision was good before the detachment, a successful operation usually restores vision to good levels. If vision was poor before the detachment, final visual return may be slow and remain incomplete after surgery. A peripheral retinal detachment will likely heal quicker than one that involves the macula (central retina) or a total detachment.\nThe longer the retina has been detached, the less likely it is that vision will be restored.\nPossible Complications TOP\nProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:\nFactors that may increase the risk of complications include:\nWhat to Expect TOP\nPrior to Procedure\nYou will have a comprehensive eye exam, likely including some or all of the following:\nYou may also have a general medical exam prior to your surgery.\nLeading up to your procedure:\nTalk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.\nYou may have either a local or general anesthetic. Local anesthesia will be injected and numb the area. General anesthesia will make you sleep. The type of anesthesia used will depend on the type of procedure, your age, and other factors.\nDescription of Procedure TOP\nThere are several surgical options to repair retinal detachment. The most common are:\nA flexible silicone band will be permanently stitched to the outside surface of the back of the eye. This is done underneath the skin of the eye. You would never see the band. This band acts like a belt. It buckles the area of the detachment or retinal tear to the wall of the eye. This procedure has a high success rate in re-attaching the retina. Local or general anesthesia is used.\nA gas bubble will be injected into the cavity of the eye. The pressure will force the retina back into position. You will often need to lie in a special position to keep the gas bubble in place. The retina will usually re-attach within several days. A laser (heat) or cryotherapy (cold) will help seal the retina back into place.\nThis method generally has a high success rate. It is not suitable for all types of detachment. Local anesthesia is sometimes used. The main benefit of this procedure is that it can be done in the office with anesthetic eye drops.\nVitrectomy (Removal of the Vitreous Humor)\nThis method may be needed for more complicated retinal detachments. It may also be used if the procedures described above are not successful. The fluid in the eye as well as any scar tissue will be removed. The fluid will then be replaced with a gas bubble or specialized oil known as silicone oil. The bubble or oil will help push the retina back against the eye wall. Retinal breaks will then be sealed with a laser or cryotherapy. A scleral buckle procedure is often done at the same time. Local or general anesthesia is used.\nHow Long Will It Take? TOP\nBetween 1-4 hours\nHow Much Will It Hurt? TOP\nAnesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.\nAverage Hospital Stay TOP\nYou can usually go home the same day as the surgery.\nPost-procedure Care TOP\nYour eye will be covered with a bandage and metal shield. The final visual result may not be known for 1-2 years after surgery. Home care includes pain management and preventing infection. In general:\nCall Your Doctor TOP\nContact your doctor if your recovery is not progressing as expected or you develop complications, such as:\nIf you think you have an emergency, call for medical help right away.\nAmerican Optometric Association\nEye Smart—American Academy of Ophthalmology\nCanadian Ophthalmological Society\nFacts About Retinal Detachment. National Eye Institute website. Available at: https://nei.nih.gov/health/retinaldetach/retinaldetach. October 2009. Accessed December 15, 2017.\nRetinal Detachment. Digital Journal of Ophthalmology website. Available at:\n...(Click grey area to select URL)\nUpdated October 15, 2002. Accessed December 15, 2017.\nRetinal detachment. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113694/Retinal-detachment . Updated June 10, 2015. Accessed December 15, 2017.\nRetinal detachment: torn or detached retina treatment. Eye Smart—American Academy of Ophthalmology Eye Smart website. Available at:\n...(Click grey area to select URL)\nUpdated September 1, 2013. Accessed December 15, 2017.\nLast reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP\nLast Updated: 12/20/2014\nEBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.\nThis content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.\nTo send comments or feedback to our Editorial Team regarding the content please email us at [email protected]. Our Health Library Support team will respond to your email request within 2 business days. |
Objective To describe current practice of pediatric anesthesia in China for improving clinical anesthetic management.\nMethods We conducted a self-administered questionnaire survey on pediatric anesthesia practice via WeChat among members of New Youth Anesthesia Forum (NYAF) of China between May and June, 2017. The respondents could use a mobile device or desktop to complete the survey. Each internet protocol (IP) address was allowed to complete the survey once only.\nResults Of the 5 779 NYAF members browsing the notice of the survey, 2 496 completed the questionnaire, with an overall response rate of 43%. The three most common surgeries with anesthesia administration reported by the respondents were orthopedic, otorhinolaryngology, and general surgery. There were 19% of the respondents reporting not administering preoperative medications and the respondents reported more cuffed than uncuffed tracheal tube application in general anesthesia for the child patients of ≥ one year old. The respondents reported that the most commonly used neuromuscular blockade agent was cisatricurium and remifentanil was the most commonly used narcotic in surgery. More than 95% of the respondents reported no routine application of neuromuscular monitors and more than 70% of the respondents reported no routine administration of reversal agents at the end of a surgical procedure.\nConclusion The results provide basic information on current status of pediatric anesthesia in China and references for further researches on improvement of clinic pediatric anesthesia practice in the country. |
Despite what you’ve seen in the media, going to see the dentist isn’t always life’s most hilarious and compelling experience. It doesn’t always include wacky antics with suction or anthropomorphic singing plants eating people. Occasionally, you’ll need to get a problem fixed. Most kids and adults can power through and get their problems resolved with the magic of local anesthesia, a team of folks that are well trained to help, and degree of patience. Sometimes, however, this might not be the best course of action.\nThere are many circumstances where some patients, particularly very young patients, might be more effectively treated in a different environment. The instruments dentists use to fix teeth need to be able to cut through the hardest substance in your body, so there’s a pretty good chance those instruments will be able to cut through just about anything else that happens to get in the way. If a patient isn’t able to stay still, working in that tiny space may be a risky proposition.\nOne of the main goals of dental visits for young children is to help them learn how to be dental patients. They need to learn how to sit still while the team gets teeth clean, obtains readable x-rays, and examines them. They need to learn how to deal with the sounds, tastes, smells, and even feels of receiving treatment. These lessons are easily delivered over time, and almost everyone eventually learns how to do it.\nFor other children, however, we’re not granted the benefit of that long time horizon. If a three year old comes to the dentist with ten teeth needing tooth extractions, nerve treatments, and crowns, that’s asking a lot. It’s a series of appointments that many adults wouldn’t tolerate, and many parents wouldn’t like their children to have to tolerate. It’s hours of time with injections in their mouths, and often the children simply don’t have the ability to sit still for the time required to deliver treatment.\nOther children have special needs that make treatment in the office more difficult. They may have sensory concerns that make them intolerant of tastes or sounds. They may have medical needs that require more support systems in case of an emergency.\nOther folks are just frankly terrified for whatever reason. For these children, forcing them to get care in the office, while people or restraints hold them still, may be inhumane.\nThankfully, this situation has been going on for as long as there have been both children and dentistry, and there’s an excellent solution. We have anesthesiologists.\nAnesthesiologists exist to make otherwise impossible health care tasks possible. A two year old needs to have ear tubes? General anesthesia. A child can’t still still for a critical MRI? General anesthesia. A five year old needs six root canals and eight crowns? General anesthesia. With general anesthesia, a dentist can complete all of the work a child needs in a single appointment. In the case of Chatham Pediatric Dentistry, we treat our patients at UNC’s Ambulatory Care Center.\nWe prefer to have the peace of mind knowing that we’re working with a robust and highly skilled anesthesia staff that is familiar with treating dental patients. We like having access to excellent pre-operative and post-operative care teams that are comfortable working with younger and special needs patients. We love knowing that they operate as part of the larger UNC Healthcare machine, with access to all of the resources a specialty care hospital provides.\nThe dentistry performed under general anesthesia is no different than the care provided in the dentists’ office, except that the child’s lips aren’t numb when we’re finished. Children typically go home about an hour after the procedure has finished, and we recommend that they take it easy for the rest of the afternoon. Nearly all children are one hundred percent recovered by the next day. On top of all of that, children don’t associate the treatment with going to the dentists’ office, allowing them to continue their growth as dental patients without the trauma of repeated difficult appointments.\nOnce the mouth has been restored, now we have the goal of maintaining the teeth free of cavities. We can suggest changes to the child’s oral hygiene regimen and diet, and hopefully we can work with families to make a plan that both kids and their parents can live with. That’s where the real work begins, because it’s the start of a lifetime of healthy habits, which is way easier than a lifetime of Lifetime movies. |
- Subscribe NowLimited Time Offer\nFDA cancels Merck meeting\nOn Tuesday, the Food and Drug Administration canceled an advisory committee meeting on Merck & Co. Inc.’s new drug application for sugammadex, an anesthesia-reversal drug already approved in more than three dozen countries outside the United States.\nThe agency told Merck (NYSE: MRK) it needs more time to assess the results of the FDA’s recently completed inspection of a clinical trial site.\nThe site, according to Merck, was one of four that conducted a hypersensitivity study previously requested by the agency.\nOfficials at the North Jersey pharmaceutical company said they are talking with the FDA to identify the steps necessary to enable the agency to complete its review.\n“Merck believes that sugammadex is an important treatment option for an unmet medical need in anesthesia, and we will work with the FDA on the next steps to bring this innovation forward to patients in the United States,” said Dr. David Michelson, head of global clinical development for neuroscience at Merck Research Laboratories.\nSugammadex is marketed in 40 countries other than the U.S., and more than five million vials of sugammadex have been sold as of March 2013, according to the company. The drug generated sales of more than $260 million for Merck in 2012.\nMerck, which is based in Whitehouse Station, N.J., has a large research and manufacturing facility in West Point, Pa.\nJohn George covers health care, biotech/pharmaceuticals and sports business.\n- Most popular\n- Shark Tank leads to No. 1 spot in App store for local entrepreneur\n- King of Prussia Mall expansion making progress\n- Building that housed Sigma Sound Studios sold, will be converted to\n- Beer garden-inspired, no-tipping restaurant concept hits University\n- Bart Blatstein challenged in court on Atlantic City Pier Shops plan\n- Thomas Jefferson University Hospitals president to leave\n- The long road to getting a deal done at 1911 Walnut St. in Center City\n- Revel casino buyer plans $100M renovations\n- Lawsuit alleges Comcast discriminates against black-owned media\n- Digital ads in Center City take a big step forward\nSign up to receive Philadelphia Business Journal's Morning Edition and Afternoon Edition newsletters and breaking news alerts.\nVice President for Workforce and Economic Development Community College of Philadelphia | Philadelphia, PA\nAdvertising Sales Representative Family Business Publishing | Philadelphia, PA\nProject Manager Veritas Medical Solutions | Harleysville, PA\nAssociate Editor Family Business Magazine | Philadelphia, PA\nVice President for Commercial Operations HarkerBIO | Buffalo, NY |
Shockwave therapy is a relatively new treatment option in orthopedic and rehabilitation medicine. The effect of shockwaves was first documented during World War II when the lungs of castaways were noted to be damaged without any superficial evidence of trauma. It was discovered the shockwaves created by depth charges were responsible for the internal injuries. This created a great deal of interest and research into the biological effects of shockwaves on living tissue. The first medical treatment developed from this research was lithotripsy. This allowed focused shockwaves to essentially dissolve kidney stones without surgical intervention. Today, over 98% of all kidney stones are treated with this technology. The use of shockwaves to treat tendon related pain began in the early 1990s.\nA clinical shockwave is nothing more than a controlled explosion that creates a sonic pulse, much like an airplane breaking the sound barrier. The primary effect of a shockwave is a direct mechanical force. The exact mechanism by which shockwave therapy acts to treat tendon pathology is not known. The leading explanation is based on the inflammatory healing response. It is felt the shockwaves cause microtrauma to the diseased tendon tissue. This results in inflammation, which allows the body to send healing cells and increase the blood flow to the injured site.\nShockwaves are used to treat many orthopedic conditions, including plantar fasciitis (heel spurs), patellar tendinitis (jumper’s knee), lateral epicondylitis (tennis elbow), medial epicondylitis (golfer’s elbow) and shoulder tendinitis. Multiple studies have been conducted to assess the efficacy of shockwave therapy. Many have shown a positive response versus placebo treatment and others have shown no benefit over placebo. No studies have reported any significant side effects when utilized for orthopedic conditions. Contraindications to shockwave therapy include bleeding disorders and pregnancy.\nThere are two main types of shockwave machines, low and high energy. High-energy treatments are administered in the operating room with regional or general anesthesia. Low-energy treatments are administered in the clinic and do not require anesthesia or injections. SCOI currently uses a low-energy machine. A technician places the probe on the area of greatest tenderness and the shockwaves are delivered over 10 – 20 minutes. Occasionally, patients will relate mild transient discomfort at the treatment site. Patients are usually treated with 3 – 5 sessions separated by a week. Between treatments, patients are able to perform all normal daily activities. Some patients report immediate pain relief but the healing response usually requires 6 – 8 weeks. Early results are encouraging and research continues at multiple sites around the country.\nOUR THOUSAND OAKS OFFICE HAS MOVED | Our new facility is located off Russell Ranch Road in Westlake Village. MRI and physical therapy will not be moving to Westlake until February 13, but both are still available in our old Thousand Oaks office.x |
Eye bags can be caused due to allergy, aging, sleep issues, genetics, or excessive alcohol use. People with eye bags lose their self-confidence so these types of people are trying several home remedies to fix this issue but it is the fact that they don’t help. Surgeons have designed several cosmetic treatments to help those people. The treatments reduce the appearance of the bags and in some cases completely remove them.\nBest way to remove Eye Bags:\nTalk to a surgeon to decide which treatment is right for you. Common eye bag removal treatments include\n- Laser skin resurfacing\n- Chemical peel\n- Plexr plasma\nHyaluronic acid is injected in the eyes to create a smoother look of the eyes. The procedure is quick and performed under local anesthetic. The results of the treatment usually last for eight to twelve months. You can expect to continue normal physical exercises within three to four hours with Dermal Fillers.\nLaser Skin Resurfacing:\nThis is an effective non-invasive treatment of eye bags. In this treatment, laser is used to eliminate eye bags. Laser device is moved over the wrinkly skin around the eyes. Laser stimulates collagen production and results in the creation of firmer, smoother and wrinkleless skin. The results of laser skin resurfacing last up to a year.\nIn this treatment, the peel is applied to the area around the eyes to exfoliate the top layers of the skin. The peels dissolve the damaged skin cells and reveal brighter and firmer skin. The results of the treatment vary from individual to individual depending upon the type and color of the skin. Patients go home the same day. The whole procedure takes about thirty to forty minutes.\nIt is an effective alternative to surgical eye bag removal. In this treatment, extra skin is removed from upper and lower eyes. It not only removes fat from the skin but also tightens sagging skin around the eyes. The Plexr Plasma treatment also reduces the appearance of dark circles. The treatment was designed to give the benefits of surgical eyelids without undergoing a knife.\nBlepharoplasty is a surgical option available for you if you want to remove your eye bags. During this surgery, the surgeon readjusts the fat and skin in the eyelid. The treatment results in a more youthful and attractive appearance. Before you undergo the surgery you need to figure out what exactly you want to get. It is important to note that it does not affect wrinkles, fine lines, folds, and other aging signs. The procedure is performed under local anesthetic with sedation or general anesthesia.\nHow much does it Cost to Remove under-eye bags?\nThe cost of treatment varies depending upon the type of technique used. Blepharoplasty is a little more expensive than non-surgical treatments. Contact our team to know the exact cost of eye bag removal treatment in Dubai.\nWhen will you see the results?\nFuller results of all the cosmetic surgeries appear when the treatment site completely heals. Healing time is different for every individual. You will notice a significant improvement in the appearance of the eyes as soon as the swelling subsides.\nHow Long does it take to recover from Eye Removal Surgery?\nThe patient will be able to return to normal activities soon after the surgery. After Blepharoplasty, you will experience mild swelling, bruising, scarring, infection and pigmentation after the treatment but they will fade within 3 to 4 weeks.\nBook a free Appointment:\nConsult a dermatologist to decide the suitable eye bag removal treatment for you. Do not hesitate to contact our team. Fill the consultation form to book a free appointment with our expert dermatologists. |
I really don’t have any idea how a simple wisdom tooth extraction can cause death to a 24-year-old man from California. While reading the article, I could then even told myself that it was somehow good for me to not thinking of removing my wisdom tooth because of this dreadful news.\nAccordingly, the Californian man, Marek Lapinski, who was a software developer from San Diego, experienced complications while the surgical procedure was on going. An anesthetic propofol was then given to him after he woke up coughing during the said procedure.\nMr. Lapinski was then sent to a hospital when the family noticed his condition worsened. Three days after, he died.\nIsn’t it something that we all can ask to ourselves or to any medical professionals does a wisdom tooth extraction can really cause death of any person?\nThe worse thing as this thing happened was when the paramedics tried to intubate Mr. Lapinski, they found two (2) pieces of surgical gauze in the airway of the patient. Do you think this was the reason for the complications of the surgical wisdom tooth removal of the patient?\nIn any events that we’re going to take especially when health is compromised, insurances like dental insurance, health and medical insurances are just some of the things we need to get ready of so that if unexpected things happen, we can always rely on those insurance benefits. But we also not to forget the quality of health and medical care we received using our health insurances. |
Are you looking to get your teeth replaced? Well, tooth implants or dental implants are exclusively meant for that purpose and you should know what the process of getting them entails before going ahead with your plan. The length of time taken by the procedure is determined by a number of factors including;\nTaking all the above factors into consideration, you might be able to determine the number of dentist visits necessary throughout your treatment. Surgery for a single tooth takes about one hour to finish and this time factors in anesthesia and patient dressing.\nJust like with any other surgery, a certain level of discomfort should be expected. However, local anesthesia and intravenous sedation can be used to ease this pain during the procedure. Most patients who have undergone this procedure report a lot more comfort during the procedure than expected. Post-surgical pain can be relieved with pain killers such as ibuprofen.\nYour dental surgeon will lay out some instructions before the procedure begins. Some of those instructions will include the following;\nThe procedure is divided into two phases with the whole process taking an average of between three to six months. The surgical stage is done in our specialist dental clinic with the necessary equipment in place.\nFirst Phase Of The Surgery\nIt starts with the creation of an individualised treatment plan that will suit you. This plan should cater to all your specific needs and it is created by a specialist dentist in dental surgery. The team offers co-ordinated care that is based on an implant option which works best for you. This stage involves the surgical placement of the dental implant. It starts with mouth numbing where the doctor carefully numbs your mouth with local anesthesia. After this, a gum incision that exposes the underlying bone is made where the titanium implant is supposed to go. A specific quiet drill is then used to make space for the dental implant on the jaw bone.\nAfter the space is created, the implant is screwed onto the bone socket using the same drill or a different hand tool. When the implant bonds into the jaw bone, a connector called an abutment is placed on the implant so that it can hold your new tooth securely. This concludes the first phase of the implant placing process and the gums are closed over it using stitches. The process is now complete and the implant takes several months to attach itself securely onto the bone. As the jaw bone heals, it will grow around the dental implant thus securing it safely into your jaw. The dentist will be able to give you more accurate timeframes during the consultation depending on your individual circumstances.\nOnce several months have passed you will be required to return to the clinic for the next phase. This phase kicks off by re-exposing the implant. This is done by making a small gum incision. The incision is only made if there is no component on the dental implant that sticks out above the gums. An extension is placed on this implant whenever any impressions are taken. The component placed on the implant in the first phase of surgery is then used to fit the crown (replacement tooth) on your new implant.\nThe dentist schedules for you a series of appointments in order to make your new dental implant crown. The processes carried out during these appointments vary from dentist to dentist but they all involve the same thing.\nDepending on the type of tooth getting replaced, your dentist might need to test the fit of the crown before its creation is completed. Proper care is taken by the team working on your crown to ensure that the crown fits properly. Iii fitting teeth can cause a host of new problems which can cause all manner of problems.\nThe new implant has to be properly cared for and frequently checked by the dentist. When brushing and flossing the new teeth, follow the dentist’s instructions to the letter. You also need to stick to your dental appointment schedule so that they can assess the progress of your implant. If you fail to adhere to these instructions you risk the occurrence of complications that might be life threatening. Therefore, you need to look out for complications.\nTooth implants is an established cosmetic dental treatment and the results are excellent. Many patients report that the treatment is life-changing for them. If you would like to know how much does teeth implant cost in Melbourne, you should consult reputed holistic dentist in Melbourne. |
Cost of Liposuction Surgery\nIf you are thinking about having liposuction, cost will likely factor into your decision. It is difficult to estimate the exact cost of liposuction surgery because of the numerous factors involved. Liposuction surgery may be performed on many different areas of the body, using various technologies and types of anesthesia, and by surgeons with different skill levels who practice in different areas of the country. All of these factors affect the cost.\nAs with the cost of most types of plastic surgery, liposuction cost includes the surgeon's fees, anesthesia fees and facility fees. A surgeon's fee for liposuction ranges from $2,000 to $4,000. The anesthesia and facility fees are based on time in surgery and usually range from $1,200 to $1,500 per hour.\nThe more extensive the procedure, the greater the cost. In addition, surgeons who practice in densely populated urban areas tend to charge higher fees for liposuction due to the higher overhead and greater demand for their services. The type of medical setting also affects the cost, with hospitals being more expensive than accredited surgical centers.\nOther factors that may affect your liposuction cost include surgical compression garments, medical exams to clear you for surgery and postoperative medications such as painkillers.\nLiposuction Cost: Adding It All Up\nTaking all fees into account (including the surgeon's fee, anesthesia fee, facility fee and other charges), the average cost for liposuction in one area of the body is $4,000. Liposuction in three body areas can range from $6,000 to $8,000; in five areas it can be as high as $11,000. For a more precise estimate, schedule a consultation with a plastic surgeon who is certified by the American Board of Plastic Surgery. He or she will give you a quote after developing a surgical plan based on your goals and anatomy.\nIf the cost of liposuction surgery is more than you can afford, ask your plastic surgeon about payment plans. For financing options and tips, visit our page devoted to patient financing.\nIf you would like more information on the cost of cosmetic procedures, check out our overview article on plastic surgery cost or visit our procedure-specific pages. There, you can learn about the cost of various procedures, such as the cost of Latisse treatment, the cost of breast augmentation or the cost of laser hair removal. In addition, you can learn more about plastic surgery cost from our table of average surgeon fees.\nSome cost estimates provided by Julius Few, MD\nMiles Plastic Surgery\n1221 Madison St.\nSeattle, WA 98104\nMary Lee Peters, MD\n901 Boren Avenue\nSeattle, WA 98104\nEgrari Plastic Surgery\n2950 Northrup Way\nBellevue, WA 98004 |
EUAL – Using Ultrasound To Improve The Liposuction Procedure\nAre you interested in liposuction for body contouring, but hesitant because you don’t want to deal with a long recovery period and the associated discomfort?\nIf that’s the case, it’s time to introduce yourself to the External Ultrasonic Assisted Liposuction, (EUAL).\nWhat Is EUAL liposuction\nThis procedure uses the power of ultrasonic energy to help remove unwanted fat from the body. The advantage of this procedure is that the fat is partially liquified by the ultrasonic energy before it is removed by liposuction. This results in a smoother result, less bleeding and a quicker contraction of the skin after the procedure\nHere’s how UAL Lipo works:\n- After anesthesia, if administered, board-certified plastic surgeon Dr. Robert Vitolo will inject a combination of saline and anesthetic to the targeted treatment area.\n- Once the solution is injected, Dr. Vitolo used an ultrasonic transducer to deliver ultrasonic energy through the skin. The ultrasonic energy passes through the skin, without injuring it and semi liquefies the fat. A small cannula is inserted into a small hidden incision through the skin into the targeted area and the liquified fat is removed with high power suction, thus creating a new shape for the body.\n- The ultrasonic energy allows the fat to be removed without requiring any force to break up fatty tissue.\nThis new liposuction procedure leads to less bruising and bleeding, which greatly reduces your recovery time. In fact, most patients are able to return back to work in as little as two days.\nWhat Kind of Recovery Can I Expect?\nRecovery and downtime is incredibly minimal; most patients are able to return to work and their normal activities (including the gym) about two to three days after the procedure.\nMy experience was wonderful. The staff was professional and informative. They provided top quality care. Dr. Vitolo is amazing. I am very pleased with my results. I would recommend him to anyone who wants to do Liposuction.\nTake the Next Step\nReady to see if the scar less liposuction is right for you? Schedule a consultation with board-certified plastic surgeon Dr. Robert Vitolo at his plastic surgery practice by filling out the consultation form on this page or by calling 800-332-1067 to make an appointment for one of his three offices.\nDr. Vitolo serves the greater New York Metropolitan area including Manhattan, Staten Island, Brooklyn, and New Jersey. |
The Fact About facelift surgery That No One Is SuggestingWhen performed by a qualified cosmetic surgeon, facelift surgery is a secure method and a very good solution to rejuvenate your appearance.\nMagazines together with other information outlets like to publish pics of facelifts absent Incorrect, but they could only do this exactly simply because they are news. You can find many Countless facelifts done In this particular country on a yearly basis, as well as vast majority of these yield subtle, natural benefits.\nIf you work, look at the time without work You will need. The majority of people can return to work in two to a few months.\nLiposuction is a choice to get rid of smaller bulges that won't budge also to boost your physique's condition. The parts mostly treated include the hips, abdomen, thighs and buttocks and face. Liposuction isn't going to clear away cellulite, only fat.\nRecovering from rhinoplasty is usually marked by only delicate irritation and gentle congestion. Individuals ordinarily tend not to will need solid medications for suffering management.\nFollowing your face-lift, you are going to working experience bruising and swelling, which lasts about two to three weeks. Many people recover additional promptly while some will mend extra little by little.\nPrior to making an informed final decision about whether to undergo rhytidectomy, patients will have to weigh some great benefits of facelift surgery versus its hazards and prospective side effects.\nIn case you have wellbeing insurance coverage, be sure to speak to your insurer upfront this means you know very well what's included and what you will need to purchase. Wellness insurance plan normally doesn't buy methods which might be completed only for cosmetic factors.\nBased on the circumstance, a mini-facelift could be executed applying local anesthesia with sedation or standard anesthesia; your cosmetic surgeon will endorse the most suitable choice for your personal specific requirements.\nChemical peels: In the course of a chemical peel, the health practitioner or pores and skin care professional will utilize a chemical Option to your affected individual's skin. This substance will get rid of the weakened outer layer of skin to reveal the wholesome, more youthful-wanting pores and skin beneath.\nA surgeon also needs to be Licensed because of the point out's medical board. However not essential, membership in other associations can be fantastic indications that a physician is extremely properly trained and properly-respected in the field. These corporations might contain:\nHowever, some people never really feel snug with the thought of currently being awake for the duration of their method. Eventually, the only real way to ascertain the correct variety of sedation is by talking to your plastic surgeon.\nMost Health professionals have galleries of in advance of-and-right after photographs for probable clients to click here watch. People really should study these images carefully and talk to themselves when they like what they see. If the results appear unnatural or if you will discover much too couple photos to tell, they should pick out A different practitioner.\nThriving healing with ideal effects will depend on acquiring pores and skin that is able to conform to its new, enhanced contours. |
Patient # 52766\nDetails for Patient # 52766\nThis 21 year old college student presented to my New Jersey Plastic Surgery office accompanied by her mother seeking rhinoplasty. She complained that her nose was too big for her face and that it also projected far too much. She also wanted her bridge to be straight as well. Our goal was to make modifications to her nose that would bring her face in balance. She was greatly concerned because she had never had surgery before and naturally was nervous about anesthesia. After having a second lengthy conversation, this patient was assured about her decision to have rhinoplasty in my fully accredited operating facility with my Board Certified Anesthesiologist and fully trained plastic surgery nursing team and as you can see she has a wonderful outcome. The first post operative photos seen here are approximately 3 months old and then they were taken again at one year. This patient is very happy with her result and has much more self confidence. |
Amanda you need more than a nose job boo.\nAmanda Bynes Gets Nose Job\nAccording to US Magazine\nAmanda Bynes is seeking medical help — for more plastic surgery? After complaining about her appearance in a post-arrest tweet, the headline-making actress, 27, claimed to TMZ that she underwent a nose job on Saturday, June 1, in NYC. Telling TMZ that she had the surgery in Manhattan, the All That star explained: “I have no bandage on. It’s healing on its own like my doctor asked.”\n(In a May 27 tweet following the alleged bong-throwing incident, Bynes had said, “I’m getting in shape and getting a nose job!”) The former child star says there are more surgeries in the works. “I’m getting one more in 3 weeks, they are short amazing surgeries done while I’m awake but under general anesthesia. It’s almost perfect.”\nBynes also announced the apparent surgery on, of course, her Twitter. “My dad is as ugly as RuPaul! So thankful I look nothing like you both!” she sniped. “I had nose surgery after my mug shots so my nose and I are gorgeous!”\nRuPaul caught wind of the insult and tweeted a response. “Derogatory slurs are ALWAYS an outward projection of a person’s own poisonous self-loathing @AmandaBynes,” the drag superstar, 52, wrote.\nShe definitely has her priorities screwed up. Kudos to RuPaul for getting her together.\nMore Stories From Bossip\nBaby, Baby, Baby: Ashanti’s Most Fantastically...\nCelebrity Seeds: Diddy And The Game’s Kids Featured...\nBitter Teyana Taylor Posts Tae Heckard's Texts & Number In Petty Twitter Beef!\nNo Sorcery Needed: Fantasia Flaunts Her Ultimate Glo Up...\nBaddie & Associates: Baddest Lawyer Baes In The Game...\nFor Your Info: 30 Celebs Whose Ethnic Background Will Surprise You\nDetox Sorcery: Thicky Fine Model Tabria Majors Blasts...\nJanet Jackson Emerges From Bed Rest Showing Off Her Big... |
Title: Kidney Disease\nPerioperative fluid therapy management is a very difficult process. Perioperative morbidity is associated with the amount of intravenous fluid delivered and consequent postoperative complications. Not only fluid, its component and hemodynamic parameters also play important role. Studies have shown that combining fluid therapy with the goal of hemodynamic stabilization can minimize postoperative complications. Perioperative hypovolemia leads to organ dysfunction, since adaptive mechanisms cause peripheral vasoconstriction to maintain blood flow to the vital organs. Anesthetized patients often present with a functional intravascular volume deficit depending on many factors. Fluid management is a key topic for achieving advanced recovery after surgery. It is important to plan a tailor-cut fluid resuscitation for the patient perioperatively avoiding postoperative complications.\nBaris Canaya is an Anesthesiologist at Marmara University Pendik Training Hospital in Istanbul, Turkey. He has deep interest for resuscitation, acute critical illness, trauma anesthesia, pediatric congenital cardiovascular anesthesia and perioperative patient safety.\nTitle: Kidney Transplantation and Robotic Surgery\nTitle: Paediatric Nephrology\nTitle: Diabetic Nephropathy\nAim: Permcath. Is a known vascular acess for haemodialysis patients, which may last for 2 years or more.it is a 1st line for hemodialysis for patients who were not prepaired by AVF few months before starting dialysis ,but in Egypt most of patients start dialysis with temporarily catheters (cheap)but causes stricture or occlusion of the used central vein. Method: We studied 146 patients who were submitted for permcath. Insertion in our hospital as regard:the vein used-cause of insertion –failure of insertion or using it in dialysis and longevity. Result: The results were as following: *64 (rt, int. jugular) 1- 16 were 1st prick 2-26 were waiting for maturity of AVF 3-20 due to cardiac causes 4-02 due to failed multiple AVF *30(rt. Subclavian) 1-09 were waiting for maturity of AVF 2-11 due to cardiac cuses 3-10 due to failed multiple AVF *15(left jugular) all has thromosed rt. Int. jugular 1- 06 were waiting for maturity of delayed AVF 2- 09 due to failure of multiple AVF *07(left subclavian) all were due failure of multiple AVF *30(femoral vein ) all of them has no available vascular access and 12 of them had cardiac causes Conclusion: From this study we found that most patients who were referred for permcath .insertion had a history of single or multiple temporarily catheter insertion that caused single or multiple central vein occlusion Suggestion: we recommend to use permcath. As a first prick in patients who are not prepared by AVF and avoid using temporarily catheters to save veins of patients, because the use of temporarily catheters causes stricture or occlusion of central veins\nHany Helmy Saad Attia has completed his Master degree in Internal Medicine and a Master Degree in Nephrology From Ain Shams University in Egypt. He is currently working as the Head of Nephrology at the department of Shobra General Hospital |
This weekend our church had their second annual Barn Party (you can see last year’s here). I took advantage of the opportunity to snap a few pics of the kids…the kids took the opportunity to snuggle a giant, fluffy cat.\nTomorrow is The Big Day.\nThe day Apollo gets his g-tube removed. I’m nervous. It feels like we are losing our safety net. Don’t get me wrong, I am happy to have it gone after four and a half years…but it’s still scary. I’m worried he will be in pain and refuse to take oral medication. I am worried that he will lose weight and start refusing food again. I realize that doesn’t make any sense, there is no reason to think that he will suddenly stop eating, but I can’t even describe to you how horrible it is to not be able to feed your hungry child.\nApollo is just plain excited. He has been literally counting down the days.\nHere is Apollo the summer of 2012 just a couple of weeks after his g-tube was placed.\nTomorrow is going to be a long day. Check in at noon, surgery scheduled for 1:30. Estimated 30 minutes to get set up with anesthesia and then 45 minutes for the procedure. Then, of course, I need for him to wake enough for us to head home. It doesn’t help that he is an absolute BEAR when he wakes up from anesthesia. Chuck is working so Kalina is going to be assistant Apollo wrangler, something she has never done after a surgery.\nWe’d appreciate your thoughts and prayers! I’ll update on Facebook throughout the day tomorrow. |
Single Day Dental Implanting – Recovery Chances\nThe words “single day dental implanting” have an almost magical effect on the listener. Is it really possible to end dental implanting in a single day, a treatment seen by many as complex and often frightening? The innovative method of single day dental implanting has high success rates. But what about the recovery process? How does it compare with regular dental implanting?\nWhat Actually Happens in Single Day Dental Implanting?\nTreatment in a single day is usually done by performing the dental implanting under full anesthesia or sedation, and includes extracting the faulty teeth, inserting implants for the new teeth, on top of those a structure for the new teeth, and then the teeth themselves.\nUsually, in “traditional” dental implanting treatments, when extractions, bone building or implants for the entire jaw are necessary, the extractions, bone building or sinus lifting are performed on the first day of the treatment, and then there is a waiting period of about three months until it is possible to load the implants. This is because the jaw bones require time to build around the implants. In a treatment of single day dental implanting, the extractions, bone building and implant loading are done on the same day, and in fact, the entire surgical procedure is done in a single day. This is the reason it is recommended to undergo the implanting under anesthesia.\nThe Advantages of the Procedure of Single Day Dental Implanting\nThere are a number of significant advantages to the procedure of dental implanting in a single day, and therefore many patients nowadays prefer this method. This innovative treatment method spares the patient several complicated operations and enables him to return to full functioning quickly.\nThe success rate of single day dental implanting are 95%, and dentist recommend only a few days of rest following the dental implanting, in which the patient must drink a lot and eat soft food. Naturally, despite the high success rate and the advantages of single day dental implanting procedures, it is important to maintain oral and tooth health following the implanting and arrive for check-ups with the treating dentist according to his instructions.\nThe Factors Affecting the Success of the Treatment\nThe recovery process from single day dental implanting is therefore quicker compared with other dental implanting procedures, but it is important to understand that the treatment’s success is dependent on a number of factors such as the professionalism of the treating dentist, his experience in performing single day dental implants, as well as the patient’s cooperation. An educated selection of dentist, performing all preliminary examinations properly and complying with the treatment’s requirement post operation are vital and critical actions for the treatment’s success. |
By Len Lanius\nLen Lanius, originator of yankee Jiu-Jitsu, and writer of this booklet, is a instance of the worth of actual education and of the potency of the procedure he teaches...\nRead or Download American Jiu Jitsu The New Art of Self Defense PDF\nBest art books\nLavishly illustrated with countless numbers of full-color photos, this family-oriented artwork source introduces teenagers to greater than 50 nice artists and their paintings, with corresponding actions and explorations that encourage inventive improvement, centred having a look, and inventive writing. This treasure trove of paintings from the nationwide Gallery of paintings contains, between others, works via Raphael, Rembrandt, Georgia O'Keeffe, Henri Matisse, Chuck shut, Jacob Lawrence, Pablo Picasso, and Alexander Calder, representing a variety of inventive types and methods.\nThis e-book comprises every thing I want I knew whilst i began making acoustic guitars over fifteen years in the past. it isn't an ABC publication, yet a better half that teaches every part that the opposite books miss. In those pages are directions for making instruments, slicing blanks, inlaying unique woods, and hand completing guitars.\nLoco-regional anesthesia deals glaring merits in just about all branches of surgical procedure because it ideal anesthesia with lengthy postoperative analgesia. additionally, new medications and methods are making sure consistent growth, and some time past decade the appearance of ultrasound-guided neighborhood anesthesia has performed a key function via permitting direct visualization of all anatomic buildings inquisitive about nearby blocks.\n- Beauty and Islam Aesthetics in Islamic Art\n- Aplicaciones inform?aticas en arquitectura\n- Critical Thinking - The Art of Argument\n- Black, Brown, & Beige: Surrealist Writings from Africa and the Diaspora\n- How to Rap: The Art and Science of the Hip-Hop MC\n- Evictions: Art and Spatial Politics (Graham Foundation / MIT Press Series in Contemporary Architectural Discourse)\nAdditional info for American Jiu Jitsu The New Art of Self Defense\nPoetry will change the world. Bond en avant. The spoken word, the langue, will change the world. Guyotat offered a terse summary of Bond en avant in its final role as the conclusion to Prostitution: “The completion of my adult prostitutionalization (1972): pimps, partisans, patrons. A shout to those of my friends in politics and in the arts who reject my new language. Monsters, microbes, work wounds per force and prostitution. An appeal to all the parts of my brain. To my first rapists. ) will be expelled from the mouth of the defendant by force, 44444444444444444 Pierre Guyotat, Explications (Paris: Léo Scheer, 2000) 37.\nAt 26 | best, Bond en avant can be remembered as an instructive failure, at worst as a dead end. But what can be expected of theatre? Immanent critique? Paradise now? The notion that theatre might have some direct and positive effect on the way people live is of course an avant-garde notion, in the technical sense of this term. The avant-garde trend in modern art, of which Guyotat is often recognized as among the last living exemplars, must be understood as the will to change the world with aesthetic means: the will to create cultural objects and cultural forms, which themselves engender a new culture.\nThis apparatus was in part based on notes made for and by the actors in Bond en avant, who needed it as a means to access the work. From the body to the page, from the page to the stage from the stage to the street and, diversely, into print, in associated texts and interviews, and in extension as the culmination of a work, ten times its original length. None of these forms are forms of representation. As forms of presentation, they disseminate the body of the work into culture, but diversely. In the era of presentation, events are never presented, simply present, rather they proliferate, leap forward.\nAmerican Jiu Jitsu The New Art of Self Defense by Len Lanius |
During the procedure of the breast is eliminated adipose tissue, in acute cases, cut the excess pores and skin mass. Because of this, it returns to the proper breast forms. The recovery periodBreast enlargement in men in the medical vocabulary is called gynecomastia. This is quite a common phenomenon (standard for all age groups), the sources of which can end up being very different.\nDepending on the united of the particular medication, this is particularly done by making an incision around the testing of the human. It combines both promising breast tissue promptly the areola and thus lowering tissue that extends beyond the resultant of the glandular work.\nSurgery to obscure this only of gyno will include both the only excision of the glandular work best and often liposuction as well. The liposuction belts the excess common fat that patients with the electronic tissue to form the defamation breast that is only. Gyno Roulette Recovery These surgeries are far basic procedures when it renown to different surgery, cheap gynecomastia surgery garment san antonio they are often done with contemporary anesthesia with no cheap gynecomastia surgery garment san antonio patriarchy stay at all.\nAbove normal circumstances, scarring is perfectly minimal, and recovery times are between two to four people. |
Having unnecessary fat in numerous locations of your body can have a significant effect on your health and self-confidence. While traditional weight loss through workout and diet is a great way to reduce weight overall, even the very best exercises can't target issue locations like the tummy, inner thighs, arms, and butts. Liposuction is a time evaluated treatment that is utilized to get rid of excess fat from particular areas of the body, permitting a specific to shape and contour their body to their taste. Is liposuction right for you? Find out now.\nPros of Liposuction\nThere are numerous advantages to this cosmetic procedure, consisting of:• Immediately visible modifications. Unlike traditional weight reduction, liposuction produces modifications that are immediately noticeable in the body. Some distinction is obvious right away, and the wanted outcomes are typically accomplished in simply a couple of days.\n• Proven and safe. This cosmetic treatment has been carried out by experienced cosmetic surgeons all over the world for several years and the strategy has been refined over and again to be safe and efficient.\n• Healing time is generally fast. The downtime needed after having this type of treatment is normally much less than what is required for other kinds of cosmetic procedures, consisting of abdominoplasty, breast reduction, and more. People who have had the treatment can typically go back to work a lot more rapidly than they anticipated and can get back to living a healthy, active way of life.\n• Weight reduction can be irreversible. With the best maintenance methods, the fat that was eliminated throughout the liposuction treatment will not return.\n• Complete control over your body. With liposuction, a person can have complete control over how they wish to look, beyond exactly what traditional diet plan and workout can provide. Offering individuals this power over their bodies increases self-esteem and aid people feel their best.\nWhile there countless benefits to liposuction, there are of course a few cautions that should be taken into account prior to making the decision to move forward with the procedure.\nCons of Liposuction\nBefore having liposuction done, it is necessary to examine the potential downsides of the treatment and identify if the advantages exceed the risks in your specific case. Your cosmetic surgeon can help you find out more about the risks associated with the procedure and can help you choose if progressing is the ideal thing for you.\n• Complications with general anesthesia. Because liposuction is carried out under general anesthesia, the procedure carries the very same risks as other type of surgical treatment where general anesthesia is used. Underlying medical conditions might enhance these threats.\n• Adverse responses. Bruising, bleeding, and discomfort are all to be anticipated, however, in unusual cases can trigger more significant problems.\n• The potential to gain the weight back. After having actually liposuction done, it is important to keep a healthy diet and exercise properly as recommended by your physician. Failure to do so could result in acquiring back the weight that was lost or potentially much more.\nThere are dangers associated with liposuction, for many individuals, the advantages far exceed them. Educate yourself about the procedure by having in-depth discussions with your cosmetic surgeon and consider how liposuction has the potential to impact you as a distinct individual. Only you and your cosmetic surgeon can determine if liposuction will offer you with the outcomes you are trying to find within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Barrington Illinois\nLaser liposuction is a more recent, minimally intrusive treatment that includes heating the fat cells to melting point and getting rid of the melted fat through a little cannula. The procedure is typically done right in your doctor's office and is an exceptional choice for people who have less than 500 ml of fat to eliminate from any one location. Laser liposuction can be a safe, complementary procedure to weight-loss in order to shape the body you've always wanted.\nContact a Cosmetic surgeon in your Barrington Illinois today.\nIf you're considering liposuction as a weight reduction option, it is essential that you discuss your desires with a qualified cosmetic surgeon in your area. Your surgeon will perform a complete examination and health history questionnaire to determine if liposuction can benefit you and help you reach your physical and emotional objectives. Call today for an examination and learn more about how liposuction can help you attain the body of your dreams. |
Services on Demand\nRevista Brasileira de Anestesiologia\nOn-line version ISSN 1806-907X\nIMBELLONI, Luiz Eduardo and BEATO, Lúcia. Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study. Rev. Bras. Anestesiol. [online]. 2002, vol.52, n.3, pp. 316-325. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942002000300006.\nBACKGROUND AND OBJECTIVES: There are still many questions involving study designs, data analyses and samples size which regard to the demonstration of the benefits of regional anesthesia on patients outcome. Database analysis and data acquisition in general cost less and require less time as compared to large randomized controlled trials. This retrospective study compares continuous spinal anesthesia, combined spinal-epidural and single shot spinal anesthesia for hip surgery in elderly patients during a 4-year period, to determine possible advantages and disadvantages of the three techniques. METHODS: Anesthetic records of 100 patients receiving spinal anesthesia (Group 1), 100 patients receiving combined spinal-epidural block (Group 2) and 100 patients receiving continuous spinal anesthesia (Group 3) over a 4-year period were analyzed. All blockades were performed with patients in the left lateral position. Evaluated parameters were: puncture success, highest level of anesthesia, lower limb motor block, quality of anesthesia, need for additional doses, failures incidence, paresthesia, post-dural puncture headache, cardiovascular changes, mental confusion and delirium, blood transfusion and mortality. RESULTS: There were no significant differences among groups regarding gender, age, weight and height. Group 2 patients were shorter as compared to groups 1 and 3. Mean bupivacaine doses were: 15.30 mg in group 1, 23.68 mg in group 2 and 10.1 mg in group 3. They showed statistical significant differences between groups (p < 0.01). There were significant differences (p < 0.01) in cephalad dispersion between groups 1 and 2, 1 and 3 and 2 and 3, being lower with continuous spinal and higher with combined spinal-epidural anesthesia. All patients presented total motor block (Bromage score = 3). There were no significant differences in arterial hypotension, bradycardia, paresthesia and blood transfusion. Postoperative mental confusion was observed in 19 patients, with no difference between techniques. There was no difference in mortality in the first postoperative week and in the first postoperative month. CONCLUSIONS: Retrospective studies usually less and demand less time as compared to controlled studies. This retrospective study has shown that regional anesthesia techniques are related to a low mortality rate in the first postoperative month and to a low incidence of complications.\nKeywords : ANESTHETIC TECHNIQUES, Regional [combined epidural spinal block]; ANESTHETIC TECHNIQUES, Regional [continuous spinal anesthesia]; ANESTHETIC TECHNIQUES, Regional [spinal anesthesia]. |
We are pleased to welcome fellows into this year long fellowship during which the fellow will rotate through the major surgical subspecialties provided at our institution. Each rotation is a month in duration and fellows may narrow down their areas of interest during the year.\nRotations may include anesthesia for Spine, Neuro, Hepatobiliary, Vascular, Urology, ENT, Trauma, Plastics, General surgery, Regional anesthesia and Simulation training.\n- To become an expert in clinical anesthesia.\n- Preoperative, intraoperative and postoperative management within the various sub specialities.\n- To be an independent and excellent clinician.\n- To participate in simulation both in creation of scenarios, running the scenarios and debriefing thereafter.\n- To undertake at least one research project within a specialty\n- To present their work at a national meeting\n- To present at Grand Rounds\n- To organise teaching rounds\n- To learn the fundamentals of conducting basic clinical research.\n- Teaching residents, medical students, Anesthesia Assistants, paramedics and nursing staff.\nClinical and research opportunities are also available in various subspecialties and blood bank medicine.\nIn all subspecialty rotations, Fellows will learn the various anesthetic techniques pertinent to case management, participate in pre-operative anesthetic assessments and consults, participate in postoperative care and pain management, and undertake basic clinical research (including quality assurance), as well as the teaching of residents, medical students and allied health workers.\nMany of our patients are higher risk and invaluable experience will be acquired.\nFellows may spend time outside of the operating rooms (OOR) managing patients in the Psychiatry suite, Interventional Radiology suite (IR) and in our stone tract suite (also in the Radiology Dept).\nFellows will be in attendance in the Preoperative assessment clinic as well as seeing patient pre-assessment consults on the ward.\nThe curriculum also provides for attendance at:\n- Neuro-anesthesia, Cardiac and Regional Journal Clubs\n- Anesthesia grand rounds\n- Critical incident/M &M rounds.\n- Visiting Professor monthly rounds.\nThe fellows are also encouraged to attend additional anesthesiology-related meetings with available financial support.\n- 3 days in subspecialty anesthesia,\n- 1 day in general clinical anesthesia in independent practice.\n- 1 academic day per week in order to prepare lectures or write manuscripts. Research/lectures/presentations will be planned and undertaken during this time.\nThis schedule will change when in different rotations.\nThe fellow will meet with Dr. Lennox and Dr. Rieley every 3-4 months and the subspecialty program director at least once a month to review the progress being made during his or her fellowship.\nA written summative evaluation is provided to the fellows and reviewed with the program directors at the end of the fellowship year. |
Veterinary Radiology / Diagnostic Services\nWestVet offers the diagnostic services of a board-certified veterinary radiologist, Dr. Andrew Gendler.\nRadiology (X-ray) is an essential, non-invasive part of veterinary medicine. An accurate interpretation of medical images is critical to an effective treatment plan for your pets. WestVet is pleased to offer the services of Andrew Gendler, DVM, and Diplomate of the American College of Veterinary Radiology (ACVR). To become board-certified, a veterinary radiologist completes an undergraduate degree, four years of veterinary school, an internship and residency—an additional 3-5 years training—and must successfully pass rigorous board examinations. Their training includes all areas of radiology, including radiographs (X-rays), computed tomography scans (CT scans), ultrasound (US), nuclear medicine imaging (NMs), and magnetic resonance imaging (MRIs). Radiologists play a key role in diagnosis and treatment; read more about their important contribution HERE.\nAdvances in imaging technology have dramatically improved diagnosis and treatment of serious diseases and injuries in our pets. Dr. Gendler collaborates with other specialists at WestVet and referring family veterinarians to:\n- Pinpoint a diagnosis\n- Confirm the best course of treatment\n- Identify traumatic injuries\n- Provide additional expertise by reviewing medical imaging\nThe WestVet Outpatient Imaging Center offers state-of-the-art technology in animal radiology and outpatient services based on referrals from your primary care veterinarian. You may download referral forms HERE.\nAfter the imaging study is conducted, the findings are communicated verbally to the referring veterinarian as soon as possible in order for the referring doctor to determine the next diagnostic or therapeutic step. Pet owners will be presented a cohesive plan of action based on the results of imaging, and the input of the radiologist, and your primary care veterinarian.\nStable patients may be discharged to pet owners for continued care and/or follow-up with their primary veterinarian. Patients that require more medical or surgical intervention may return to the primary veterinarian's hospital or be admitted to WestVet based on a collaborative plan.\nEstimates may be provided to referring veterinarians upon request and prior to referral. Patient costs can be minimized by having ancillary items such as pre-anesthetic blood work and intravenous catheters completed before referral. Owners will always be presented an estimate for their outpatient imaging visit and will be responsible for charges incurred based on approved estimate.\nVETERINARY RADIOLOGY SERVICES AT WESTVET\nUltrasound (US) is a painless imaging procedure that uses high-frequency sound waves to generate images of the anatomy of interest. It is a very sensitive tool used to evaluate the abdomen, cranial mediastinum, and the heart. This noninvasive procedure does not involve the use of radiation.\nAdditionally, ultrasound allows image-guided needle aspirates and biopsies of hard-to-reach tissues while minimizing complications. Most ultrasound exams can be completed with the patient awake or with a small amount of chemical restraint. Difficult biopsies or fractious patients may require more sedation and/or general anesthesia.\nComputed Tomography (CT) is a painless imaging procedure in which ionizing radiation provides tomographic images (slices) of the patient. CT scanning provides incredible anatomical detail of structures like the skull, nasal passages, and elbows while avoiding the problems of superimposition seen on plain radiographs.\nOrthopedic CT studies are routinely performed with heavy sedation while more involved CT studies (CT portogram, CT urogram) require short episodes of general anesthesia (30 to 40 minutes).\nCT is the best imaging modality to evaluate complicated joints like the carpus, tarsus, and elbows. It is also well employed for patients with nasal diseases, head trauma, and thoracic and abdominal masses. CT can track IV contrast boluses to visualize the arterial, venous, and portal circulation. CT-excretory urography assesses the kidneys, ureters, and urinary bladder. Finally, CT post-myelogram is often performed to further characterize any spinal cord compression detected.\nMagnetic Resonance Imaging (MRI)- This powerful imaging tool enables your veterinary radiologist to see soft tissues such as the brain or spinal cord, joints, and cardiovascular structures in even better detail than with radiographs (x-rays) or CT-scan. MRI uses a strong magnetic field to excite or shift hydrogen ions (found in all tissues) and then read the energy given off as they relax to their normal state. Ionizing radiation (x-rays) are not employed to image the patient. MRI is the gold standard for imaging the central nervous system, including the brain and spinal cord and is also utilized to evaluate patients with lumbosacral stenosis syndrome and suspected iliopsoas muscle injury. General anesthesia is required during all MRI scans.\nPennHip certification - PennHip evaluation is the radiographic measurement of passive hip laxity and can be acquired as early as 16 weeks of age. Passive hip laxity is a reliable predictor of developing coxofemoral degenerative joint disease in dogs and cats. PennHip radiographs are acquired with the patient under heavy intravenous sedation.\nFluoroscopy - Fluoroscopy is a non-invasive procedure which uses x-rays to help capture and monitor video images of specific parts of the body while they are in motion. Fluoroscopic exams provide real-time images using low levels of ionizing radiation. Fluoroscopy is typically utilized to evaluate the trachea in cases of tracheal collapse, as well as the esophagus and pharynx for patients with swallowing disorders and regurgitation. Needle aspiration/biopsy may be performed under fluoroscopic guidance.\nContrast radiography - Any radiograph acquired after a contrast medium has been administered to highlight or outline specific structures. This may include room air or CO2 gas, barium sulfate, or iodinated contrast agents. Typical contrast studies performed at WestVet include myelogram, fistulogram, cystourethrogram, intravenous pyelogram, and upper GI barium series.\nPlease see your family veterinarian for a referral for outpatient MRI, Ultrasound, or CT scan with our WestVet radiologist. If you have any questions regarding radiology for your pet, contact us at 208.375.1600. |
Welcome to Mission Dental, proudly providing dental extractions in Nashville. We are a full-service dental practice that provides quality care and comprehensive solutions for all your dental needs. Our experienced staff of professionals, led by Dr. Makeya Jenkins, is committed to providing you with the highest level of personalized service in a warm and comfortable environment.\nAt Mission Dental, we understand that dental extractions can be a very daunting and intimidating process for many patients. That’s why we strive to make the entire experience as stress-free and comfortable as possible. We provide thorough education so that you understand what is involved in the procedure and how it will impact your oral health. We also offer a wide range of sedation options to ensure you are relaxed and comfortable throughout the process.\nWhat are Dental Extractions?\nDental extractions are standard procedures we perform to remove teeth that are damaged or decayed beyond repair. At Mission Dental in Nashville, TN, Dr. Makeya Jenkins is an experienced dentist specializing in dental extractions and has performed hundreds of successful extractions throughout her career.\nWhat are the Reasons for Dental Extractions?\nYou may need a dental extraction if you have a severely decayed or broken tooth or if the tooth is too damaged to be saved. If you have advanced periodontal disease, the tooth may need to be removed to prevent the spread of infection. Dr. Jenkins will always try to save the tooth first if she can. She will take x-rays and discuss treatment options with you to determine if we can fix the tooth with a filling, crown, or root canal. If the tooth is too damaged to save, she will discuss the extraction procedure and the options for replacing the tooth with you. Other reasons may include the following:\n- To make room for orthodontic treatments, such as braces.\n- To remove wisdom teeth that are impacted or poorly positioned.\n- To remove teeth that have become loose due to periodontal (gum) disease.\n- To relieve crowding in the mouth.\n- To remove teeth that are blocking the eruption of other teeth.\nDental Extractions Process and Procedure\nDr. Jenkins begins the extraction process by taking x-rays of your mouth to get an accurate picture of the teeth and the surrounding structures. After reviewing the x-rays, Dr. Jenkins will discuss the various options for extracting the teeth, including simple extractions, surgical extractions, and extractions due to impacted teeth or impacted wisdom teeth.\nOnce the extraction process is initiated, Dr. Jenkins will apply a local anesthetic to the area of the mouth we are treating to make the extraction process more comfortable and less painful for the patient. After the anesthetic has taken effect, Dr. Jenkins will carefully remove the tooth using specialized dental tools. Once we remove the tooth, Dr. Jenkins will clean the area and stitch it up as necessary.\nAt Mission Dental, Dr. Makeya Jenkins and her team strive to provide the highest quality care for every patient undergoing dental extraction. We understand the importance of ensuring that the extraction process is as pain-free and comfortable as possible, and they work hard to ensure that the extraction process is completed quickly and safely. Dr. Jenkins has years of experience performing dental extractions and a proven track record of successful extractions.\nDental Extractions in Nashville\nIf you need a dental extraction in Nashville, TN, Dr. Makeya Jenkins and her team at Mission Dental are the experts you can trust. Our team is dedicated to providing the best patient care possible, and they strive to ensure that each patient has a positive experience with their dental extraction. Schedule an appointment today.\nWe look forward to helping you achieve a healthy, beautiful smile. |
Health Tip: Understanding Ear Tube Surgery02/05/10\n(HealthDay News) -- An ear tube is surgically implanted in a child's ear to help drain fluid that builds up behind the eardrum, says the U.S. National Library of Medicine.\nWhen fluid builds up in the ear and stays there for a long period, it can cause hearing loss. Ear tubes may also be inserted when a child has frequent ear infections that can't be prevented with less invasive treatments.\nEar tube insertion is performed under general anesthesia. The surgeon first makes a small incision in the eardrum. The fluid is suctioned out, then a small tube is inserted in the eardrum. Now, air can flow through the ear and fluid can drain from the middle ear, the agency says.\nEar tube surgery is usually an outpatient procedure, so the child can go home the same day. The following day, most children can resume normal activities. The surgical incision usually heals on its own, without stitches. The ear tube commonly falls out after about 14 months.\nCopyright © 2010 HealthDay\n. All rights reserved.\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. |
Thursday, April 9, 2009\nSurgery Complete and Successful!\nAs promised, the skillful surgeon called at 3:40 this afternoon to say the surgery went very well, that Angus was doing well, and to give particulars about his condition that were all very good news. We couldn't be more relived than we are at the moment knowing that Angus will be OK.\nI also received another call from the vet student, Julie, to give me a new update since Angus was coming out of the anesthesia. Still groggy but responding to his name, he was bundled in a couple of fleece blankets and hooked up to an IV with morphine type drugs. Poor wee Angus. We have a long road ahead of us, but I'm encouraged by the apparent ease of the operation and his good overall health. Let the healing begin.\nThank you everyone for the lovely and encouraging emails and comments. You have no idea how much that means to me to hear your thoughtful words of encouragement. |
This week I talk to Dr. Timur Ozelsel about his mission to raise awareness among clinicians about the practice of anesthesia in a way that minimizes damage to the environment. He shares about how living in Germany exposed him to an environmentally-conscious lifestyle, how he has started the Green Anesthesia special interest group within ASRA to address these questions, and about his hopes for the future practice of anesthesia worldwide.\n[[this transcript was auto-generated]]\nDr. Ozelsel: [00:01]Our one vapor which is called Desflurane for example, a dramatic reduce gas impact to one or are they? For example, if I use it for seven hours, a rather high fresh gas flow of two liters per minute, which he said they sold the standard for me folks going to Stella just I produce environmental impacts is if I drove from the north camp and more way all the way down to Cape Town and South Africa. So it just seems that Google maps says we’ll take about 211 hours to drive. I can produce in seven hours of anesthesia time by using that gas.\nJustin: [00:29] Hey, this is Justin Harvey, your hosted the anesthesia success podcast. My wife is an anesthesia resident and I’m a financial planner and I work with anesthesia and pain doctors is my clients. This podcast is designed to help the anesthesia community informed about their careers, their finances, and more by taking important questions straight to the experts. Thanks for tuning in.\nJustin: [00:52] Hey Justin here this week it was a live in person recording with Dr Timur Ozelsel at the Spring ASRA conference in Las Vegas, Nevada. Timur and I had a really interesting conversation spanning a couple of days and did this interview was recorded on the second day of us hanging out where the timber discussed what it was like as a physician in Germany, how he left Germany because shockingly, he couldn’t afford to raise his family even as a board of the anesthesiologist with a couple of other sub specialty board certifications, but eventually he moved to Canada to practice and in the process became more informed and eventually impassioned about the environmental impact of medicine and anesthesia specifically. And I’ll confess that prior to this interview I knew nothing about this topic, but I just happen to meet Timur, and he was sharing more about this and I, I thought it was really interesting. So some of the statistics that he drops in this episode are downright shocking. You’ll definitely want to stay tuned to the end.\nJustin: [01:43] Hello everyone. Welcome to the anesthesia success podcast. This week we’re coming to you live from the spring as we’re meeting where I’m sitting down with Doctor Timur Ozelsel, and he’s kind enough to join me. I met Timur or last night along with his colleague, Dr Rakesh Sondakoppam where they were sharing with me some of the work that they’ve been doing. It helping us understand the environmental impact of medicine, specifically addressing the practice of anesthesia. The thing that made me interested in interviewing Timur has to do with his pioneering work in this area along with some others where they’ve been working to spread awareness and work towards developing solutions. Timur has started the green anesthesia special interest group, which is a a group within ASRA where physicians who are interested in the practice of green anesthesia congregate, share best ideas and best practices and where him and his colleagues are working to move this work forward. Timur, thanks very much for sitting down with me today. To start us off, why don’t you share a bit about your personal background since I know that your life and career has spanned several international borders?\nDr. Ozelsel: [02:38] I was born in the u s and Louisiana. My parents, , Turkish father, German mother who had met and got married in Turkey and my parents had come to the u s to study. So my father had gotten a scholarship at Lsu and so I was born on campus, but shortly after at the age of two, we moved to Germany. Um, so it was my father’s job that had us move throughout the countries. As a child. At age of six, I moved back to the U S and at the age of 10, we moved back to Germany once again and there my parents decided to just have a stay within one school system until we finished it. So he declined all further job offers to move away. And so I grew up in Germany and then for university, I have thought about coming back to the u s at the time, but chose to go straight into medical school in Germany.\nDr. Ozelsel: [03:21] There was some college systems went straight into medical school in Germany and went through medical school in Germany. And so is that a decision you make as an 18 year old? That’s a big, that’s a big decision for a very young man to make. It is. And, it’s something that doesn’t bode well for all young people and medicine. For example, after it’s a six year program in Germany medical school. Uh, so usually after the first two years you take a first big exam and that weeds out up to 50% of all the people who have started in medicine. And, so there are a lot of people find themselves two years into medical school choosing a different path in life. So, yeah, that sounds utterly devastating for a lot of people is, it’s even worse in law school in Germany because they’re the big exam.\nDr. Ozelsel: [04:03] There’s a final exam after five years and may make people fail that and just to columns that they have now basically spent five years studying law and have to choose a new cure at the end of five years. That is brutal. It is brutal. It’s the harsher life of Europe’s sort the same. Wow. But you made it through, I made it through, guided through and so I then went into residency training in anesthesia in Germany, which carried me from the north of Bavaria, but spoke down to Munich where I did my residency and also I met my wife. We had children there together. And I completed two fellowships in Germany prior to them choosing to move to Canada or have been ever since 2007. Okay. In which fellowships did you do in Germany? In Germany I did the fellowships of ICU and cardiac and cesium.\nDr. Ozelsel: [04:48] Okay. And then when it came to Canada, I still added a regional anesthesia and of the transplantation fellowship, which, okay. Excellent. And you came to Canada in, what year was it? 2000 2007 2007. Okay. And what prompted the move to Canada? It’s basically the life of a physician in Germany and Germany. Um, physicians really scraped very hard. Um, the income is the bottom third of all of Europe. As a specialist anesthesiologist, I was barely breaking even every month, you know, and with three little children being the sole supplier provider for my family, I just saw him, no way in the future to achieve any type of personal or academic goals. It was basically, it was, it was a struggle to basically pay the bills every month. And so I had no way to even develop further as a doctor or as a person. And, it was a rather depressing time for me and I knew that I had to leave and start somewhere in India.\nJustin: [05:40] That’s kind of shocking to me. So it is Germany on it, like a single payer system. And does that impact the income of physicians or why is that?\nDr. Ozelsel: [05:48] So as a physician in Germany you are salaried and there are hierarchies of the salary. However, the salary is the same for physicians all across Germany. Now big difference is, is that if you live in an expensive city like Munich, like I did at the time, the prices of living, the cost of living is way higher. So if you live in a rural area, you might get by and especially if you have a double income you might get by. But that case I was the single provider for my wife and my three children. And so that’s where I just found that even as a specialist I could only generate extra money by working overtime. So my overtime was paid and I really worked like I worked myself half to death and he has found myself usually on the short end of the stick when it came to just, you know, accounting at the end of the month.\nJustin: [06:31] Wow, that is amazing. So you came to Canada for more professional opportunity and to have more financial stability.\nDr. Ozelsel: [06:37] Exactly. And so the one thing I say that Canada has really given me is the joy of my job back again. You know, I was, I actually was on the verge of quitting medicine altogether in Germany. I had actually looked into go into business school and getting a second degree in business to just be able to provide for my family. And so the reasons I chose to become a doctor in the first place have surfaced again ever since coming to Canada. So I’m quite happy in my job again.\nJustin: [07:00] What a wonderful thing. So talk a little bit about that transition and what it was like, what the difference in clinical practice was like between Germany and Canada, if there was any. Yeah.\nDr. Ozelsel: [07:08] Oh, there’s a big difference. I think it is the respect that is awarded a physician in Canada as much higher, in Germany. It’s interesting that a lot of people have the perception that physicians are people that make a lot of money, which is not true as I outlined before. And in general I think Germany is a wonderful country to live in this wonderful country to visit, especially, it was quite hard for physicians because on the one hand you had the perception in society that you are this rich person. And on the other hand it was not the case at all. So you had a little bit of the scrutiny of society against you. And one of the things which was for me professionally, a little bit of a problem is that in Germany the you have the pure middle hierarchy. Okay. So we have the professor who is at the top and then you have the next layer, sort of say senior physicians in whatever specialty you’re at, who usually also professors any other like a third tier, which are the senior physicians.\nDr. Ozelsel: [08:08] And then you go down the ladder. So the same, until you are in the areas of the residents and junior faculty and junior staff. And the big problem is in North America we have more of a, I’d call like a swimming pool where basically all start at one level and next year they’re all at that level and the next year all that often after four years when you’re a specialist, at least by definition, there is nobody who is above you anymore. Okay. On Germany you will always have that pyramid, meaning if you even want to get to the next level, if you will have to leave my proverbial a few corpses in your way, you’ll have to elbow a few people who are on the same level with you out of the way in order to reach the next level. And so it’s a system that doesn’t really promote collegiality as much as North American system does.\nDr. Ozelsel: [08:49] So for me, just my personality, it was a fantastic move to be able to move into this type of system.\nJustin: [08:55] I’m glad you’re able to make that switch. It seems like it’s been a great fit for you. I’d love to hear a little bit of how you came to start growing in your awareness for the environmental impact of the practice of anesthesia. Well, that’s actually started in Germany. So for example, while I say in North America, smoking is a very unsexy thing. Okay. So the society frowns on smoking in Germany, that’s the case for being environmental. So if you are not environmental, that’s a big social, no, no. And I think it comes from the fact that Germany is a country which has about 83 million inhabitants right now on a very small space. And so things like waste and pollution are surfacing much quicker. So you feel the impact of that much more readily than if you’re in a big space.\nDr. Ozelsel: [09:36] For example, like Canada, Alberta, the province I live in, for example, it’s two and a half times the size of Germany and we’ve down barrier scratching 4 million inhabitants in there. Okay. And so you have lots of space. And so especially if you produce trash, ivantage is, and we’ll never see it again. And so the government has, not really had to implement any rules on waste. Segregation and avoiding waste altogether. For example, back in Germany I had one trashcan that was only emptied every two weeks and if I have produced more trash within one trashcan full, then I’d either have to pay to get extra trash bags to be able to dispose of it. But what it also had to do was I had to separate my waste into recycling. And it wasn’t just that I had one recycling bag where I put on my recycling into, no, they were actually, I had seven different trash cans in my house where I separated waste already.\nDr. Ozelsel: [10:22] And then when I further took her to the recycling facility, which adds did in myself, I usually had to split those seven bags one more time to end up at about 1415 different elements of recycling. Wow. That were actually then followed up through. So what are maybe a couple of the groups of segregation when you’re separating ways? So for example, already when you look into the paper, you will have paper, regular paper, which could be newspapers, write your paper, anything. But cardboard is already for something totally separate from that. And then when you go into glass, for example, you had greenglass brown glass, white glass and that was all separated from one another. Then when you had metals, aluminum would be a totally different stream than the other metals. Then you had electronic waste and the different plastics. Also you had soft plastics, hard plastics that were separated two right at the outset.\nDr. Ozelsel: [11:04] So it was a good education was put that way into why this is important. And also the government itself in Germany subsidized very many what I call green initiatives like solar energy for example, Germany is a country where the sun doesn’t shine a lot in Germany is the world leader in solar energy. I do. This says because the government subsidizes that a lot. And, also the government after the nuclear disaster in Japan, a few 10 years ago, 12 years ago, Germany had to decided to completely get out of nuclear energy and nuclear energy was already highlighted green alternative to the coal powered energy that they had before. So the renewable energy sources are heavily promoted in Germany and it’s just the general mental state of mind that you adopt when you live in Germany. So being green is something that comes natural to you. Right. And so when I came to Canada I was, and I’m going to say I was appalled, but I was shocked how little people cared about this. And these are all good people, you know, these are good people who just have never really come into contact with the idea that you would have to do something to preserve the environment.\nJustin: [12:11] Right. Interesting. So when did you begin to grow in awareness of the practice of anesthesia and the environmental impact?\nDr. Ozelsel: [12:19]Yeah, that was interesting. It’s data around the impact, especially of our inhalational anesthetics was already available towards the end of the nineties early two thousands when I was just beginning my career in anesthesia. So I started MCC on 1998 and I do, their data was available. However, I never really came across it until around 2007 when I was already practicing in Canada. And I read up on the articles a little bit and was shocked. Our one vapor, which is called desk flow and in for example, as a dramatic greenhouse gas impact one or are they, for example, if I use it for seven hours at a rather high fresh gas flow of two liters per minute, which is sadly sold the standard for many practicing anesthesiologists, I produce environmental impact as if I drove from the north camp in Norway all the way down to Cape Town in South Africa.\nDr. Ozelsel: [13:05] So it distance that Google maps says we’ll take about 211 hours to drive. I can produce in seven hours of anesthesia time by using that gas. Wow. So that is incredible. It is. It is. It is incredible because that is a good word for it. So I knew that we had to change our perception and it is really interesting if you look at healthcare because we strive to do better by our patients. It is our calling is why pretty much all the people who are in healthcare are in healthcare to do well by their patients. However, we, I think I’ve lost track of trying to look at the big picture of what is going on or there are focus on the individual has become so great that I sometimes will say it’s like we’re not even looking through a magnifying glass in our patient anymore. We’re actually looking through the electron microscope into our patient and our field of vision has become extremely narrow. So for example that in anesthesia we’re using extremely potent greenhouse gases to provide insights for our patients is actually a sad joke, right? Because on the one hand we are doing well by our individual patient. On the other hand, we are heavily contributing to the environmental crisis, which ultimately is threatening for all of mankind.\nJustin: [14:13] Yeah, that’s very interesting and this is kind of touches on something we’re cash and I were discussing at length last night, which is in the United States there was a sort of a hardwired cultural distinctive where a lot of what American’s pride themselves on is the individualism. It’s been called the land of opportunity. Like you can come here and you can do whatever you want to do. You as a person, the American dream. That’s right. And it’s in many cases kind of divorced from a more community oriented others oriented mindset at times. I’m interested in, have you, have you perceived that dynamic at all as you’ve practiced in and come down to the states on occasion for\nDr. Ozelsel: [14:53] oh I see. Everyday in medicine I have to say, you know what, ultimately there is nothing wrong with the American dream per se. The one big problem is that the American dream in the sense that an individual can use every opportunity she or he has to achieve dreams means its limits. When you look at the world population, all the things we do in our everyday lives would not be overly dramatic if we had less than 3 billion people on this planet. But we are by now burning through, I’m not sure. Have you ever heard of the term of the resource turnover date? No. So the planets, if you will, we’ll be able to produce a certain amount of resources per a year. And until around 1980 the planet was able to produce more every year than humanity used. Now ever since 1980 we consume more than the planet is able to replenish every year by now there is turnover date.\nDr. Ozelsel: [15:41] So what the earth can produce every year before we basically go into to its bank. Its reserves worldwide on average is around mid August by now. But if you look at the u s and Canada in particular were early February. So Oh my goodness. In Canada basically by February and burn through the resources of the planet can replenish for one year and then the rest of the year we basically live on reserves, reserves being the surplus of other countries essentially. Well, well what the earth has to give, right? And so we are, we’re exploiting the planet mercilessly right now and ultimately it is leading to a complete health crisis. Not sure if you’re aware, but like the United Nations points out that global warming, the climate change and all the things that go with it are the most serious threats to human health in the 21st century and something that actually cannot be and should not be ignored any longer.\nJustin: [16:34]Interesting. With regards to you beginning to be aware of these things, you’re getting familiar with this research and the late nineties and two thousands talk a little bit about how you’ve started to discuss it with your peers and integrate these principles into your own practice to be more cognizant of these, of these things.\nDr. Ozelsel: [16:52] Okay, so the first thing that I really did was change the old practice and I think that’s where it starts. You always have to start with yourself and see how you can change your own practice before you can even ask others to consider changing their practice. And so I changed my own practice and I unfortunately found it wasn’t hard. It wasn’t hard at all. I will confess that I loved using desk Lorraine up until the day I read about its impact and they loved using nitrous oxide, which is another big bad boy in this whole discussion and I started reading a few papers, some that had come out out of the u s actually there are some phenomenal doctors from the US who have done a lot of groundbreaking research in that area and have names like Susan Ryan out of San Francisco has since retired or Jody Sherman out of Princeton.\nDr. Ozelsel: [17:30] They’ve done a lot of good work in their articles to read on this and so I read those and became more interested in what I did for myself in 2007 when I read the first literature on that. So I quit using Desflurane overnight and I know that it, that’s a step that many nieces this are very scared of because this is perceived in a society. The lean body weight is getting less and less so it takes our patient population. Desflurane is still said to be the one that will provide quickest wake up time because it doesn’t enrich and had it posted in fatty tissue while Steve of rain for example, which is the most commonly used one worldwide in which also has our lowest environmental impact actually enriches in adipose tissue. So people are afraid that if they switch, especially on the obese patients, they can’t wake them up as quickly.\nDr. Ozelsel: [18:14] So many studies have showed that all you have to do is become really an expert in understanding how to use the vapor and then you will basically achieve the same wake up times like a pure for user cannot wake up their patient any quicker than I can wake up mind by using CBOE flooring no matter what the body mass index of the patient it is. So I changed her own practice and found it to be very easily doable. It really is very easy to do. It’s nothing that anybody needs to be afraid of that will impact your practice in any way. The same for using nitrous oxide. Nitric oxide is the gas that we’ve had longest ever since. Really almost for a hundred years. We’ve had nitrogen oxide right now. It usually was called laughing gas before and really hadn’t entered anesthesia as much as is or was then for a while, is fortunate declining right now.\nDr. Ozelsel: [18:55] But worldwide nitrous oxide still has the biggest greenhouse gas impact of our gases and there’s also the number one ozone depleting substances in the atmosphere right now. So I basically changed my own practice and decided now it’s time to reach out to others. And so the first thing was able to do was in our residency training program, we give lectures to the junior residents coming in. Um, I was able to give the lecture on inhalational anesthesia. And so where the lecture before had been focusing a little bit to on the effects of inhalation anesthetics for our patients. I only brushed over that initially and said, you know what? There is many things that you read in books and I’m not going to bore you with stories about how the physics and how you produce these and what they do because you have read all that and the books.\nDr. Ozelsel: [19:36] Anyways. So I’ll tell you about the things that I think you need to know and that’s what the impact of these guests are on the environment and how to mitigate those in your own practice. Right? And there are many ways to do that. First of all, it’s the choice of the volatile, like I mentioned before, but you also can do things like running minimal fresh gas flows because there are many things that we are tied, particularly in the US. For example, if I take civofluorane see off rain is, as I mentioned, the most commonly use vapor worldwide. However, when it was introduced in the 90s there was a debate about a chemical substance that was produced when Siebel throwing interacted with the chemical absorbent that is supposed to extract CO2 from the system. And so a substance called compound a was produced, which in rat models have been shown to be nephrology or kidney toxic.\nDr. Ozelsel: [20:21] And so the u s was the first country to put out a guideline that you needed a minimum of fresh gas flow that would accompany the use of Siebel for rain to wash the compound eight out of the system, so not remain within the patient. Now the literature that the LED’s to that decision is heavily disputed and we were actually, our group is about to release a med analysis to show that there’s most likely nothing to worry that you can use seal friend every fresh gas flow. Most countries actually saw this evidence and by the late nineties early two thousands had abandoned all fresh asked for recommendations, foreseeable terrain. The U s even itself went back in 1997 to regulate the recommendation from two liters down to one liter, but countries like Canada for example, has still remained with a two year refreshers for recommendation. Now, this is only a recommendation.\nDr. Ozelsel: [21:08] Awesome. Based on outdated data and we know really from literature evidence and also how our absorbance today, which don’t even produce comp on the animal, see what the rain, that there is no danger to our patients. Yet the teaching persists and a lot of anesthetists I, or even speaking to colleagues last night who said, I still can’t get over the fact that I’m supposed to Uco frame of less than two liters. It’s basically ingrained in the minds of a lot of people that use it. And so this is where we have to then start effecting change and of course it starts with teaching the next generation, but also reaching out to our colleagues who are going to prices for many years and seeing what, I understand that you’re doing it for all the right reasons, but these reasons actually turn out to be non reasons. Okay, so you can and you should change your practice.\nJustin: [21:48] What would you say to the clinicians out there who say they’re throwing is my favorite and I don’t want you to take it from me cause I feel like it’s the best for my patient. And all of your postulations about what may or may not be true, make me uncomfortable. When I think about, I want to make sure that I’m doing what’s best for right.\nDr. Ozelsel: [22:02] It’s totally understandable, especially if you’ve been in practice for awhile and is your go to vapor. It’s a sentiment that is completely understandable yet you have to try to see the bigger picture here. Right, and I can only encourage every practicing anesthesiologist. If you are able to practice as a specialist anesthesiologist, a change to see what fluorine or to ISO chlorine, it’s not beyond you is something you can do with ease. There’s something where you will be uncomfortable initially because you’re doing something that is outside of your comfort zone. Right now you’re using the different vapor and yet this is something that every practice anesthesiologist really can achieve with ease. It’s just something that you would need to want to do.\nJustin: [22:41] Tell us a little bit about the special interest group that you’ve started with an ass or what is the special interest group and what motivated you to use this platform to continue to get the word out?\nDr. Ozelsel: [22:49] As I said, it was started with the residence there was trying to teach and I started giving lectures on this topic too. And fortunately there’s for example invited by colleagues out of Asraq who practice in New York and also for special surgery to come and give grand rounds as a visiting scholar. And so all the lectures I gave were very well received and so people were encouraging me and said, you know what, I think you are promoting an important message and more people have to hear about this because we just don’t know about this. And it is a topic. While it was published in the literature, there’s so much literature to read that most people have skimmed over it. So it was more something that, for example, I can only claim I stumbled over it by accident. It wasn’t that actually sought out to see if there was literature on this.\nDr. Ozelsel: [23:28] I stumbled over it by accident and when I read it, that’s where I tried to find more. And I found that there was not much out there. So in this term of trying to reach out to colleagues two years ago at the Azure, a spring meeting in San Francisco, I spoke to some of my direct colleagues and Bactroban Sui, who has been really a long standing faculty and as her for awhile. So if you know what, why don’t we actually start, see if we can start a special interest group about this because the anesthetic with the lowest environmental footprint as we know it right now, even though there’s no hard evidence to show it by, by all logic, it is. So it’s just providing a region has said it. So avoiding general SETL together and using the specialty of reason and a season to provide nerve blocks and to either completely avoid general as all together and do this basic with maybe a week or just sedation or even if we use a regional anesthetic and general anesthesia, we can run the gentleman aesthetic at a much lower rates than we would without the regional anesthetic.\nDr. Ozelsel: [24:21] And so we presented it to the president, so Kumar, an Andrew, and he, was actually quite intrigued by our idea of starting special interest group and said, this is a very important topic. I totally agree. I encourage you to go ahead. And so we sought out members as a requires a certain number of members to come forward to say I will support the creation of this special interest group. And so especially interest with was created in November of 2017 was a bit of a slow start because obviously as I said, this is not a topic that everybody’s familiar with, but it is a topic that is really catching fire here right now. So within one and a half years, we have our membership grow from the original founding 22, now 351 now. So people are taking notice. So it was about $4,000 zero members. It’s almost 10% of the Azure membership where members of our special interest group right now and this morning for example, we had our second meeting of the Spanish an interest group and the room was full room was full of people and I was very happy to see this. I see that more and more people are taking notice and are coming forward with issues like the all the disposables in their hospital and coming forward with things that are being basically mandated by management for perceived financial interests, not really patient interests or global health at large.\nJustin: [25:38] Yeah, it makes sense. Interesting. So if I’m a a young physician and I’m interested in learning more about this, maybe I’m not a member of Hazara or this is all new to me and the environmental impact of anesthetic gasses is something that I would love to learn more about. What kind of resources out there might you recommend as far as starting this learning\nDr. Ozelsel: [25:55] For every young anesthesiologist, there are actually some nice documents rights within the u s that they can start it with. So the Asa, the American started, the anesthesiologist has a green anesthesia task force which put out guidelines on the practice, which are really good. They’re very good guidelines. They’ve been updated once ever since they were created first. So I think 2017 is the most current version of these asa guidelines and there are a fantastic starting point to read them and to get an idea of what’s going on. And ultimately by now a literature search, we’ll easily yield many articles, container topic. And if nothing else you can always shoot me an email and I’ll be happy to get you started. Or did you guys get in the right direction\nJustin: [26:37] and where can listeners reach you via email? What’s the best email address?\nDr. Ozelsel: [26:40] So the easiest way to reach me is just by my last name. It is [email protected]. Okay. And we’ll put that in the show notes as well. So I know I’ll be happy. As you said, this is a passion of mine and I think currently I do think it is the most important topic in health care for sure. Maybe the most important topic in politics worldwide. There’s this young girl as Sweden that I’m sure that a lot of your listeners will have heard of Greta Thunberg’s who just recently was even nominated I think for the Nobel prize. She’s a 16 year old, highly functional autistic girl who has done amazing talks and really just they come from for heart. There are a lot of Ted talks out there on the net, so google Greta Thunberg’s ted talks. You will hear some amazing presentations of a young woman who talks about the environmental crisis and it’s going on and how she is a young woman cannot understand why not everybody’s in panic mode and trying to really solve the most blatant and obvious issue that the world faces today. Yes.\nJustin: [27:39] That’s very sobering when you put it in those terms. Well Tim or it’s been a pleasure speaking with you as we bring things to a close here. I love to hear just a brief anecdote of a time for you, when you considered all of the, I mean you’ve you, your expertise spans international borders and the different fellowships that you’ve done and obviously this focusing green anesthesia you’ve accomplished a lot. Maybe you could just zoom in for one minute on a time or a place where you said in reflecting on some of the things you’ve done, this is something that I’m proud of. This is something that I am grateful that I’ve been able to bring attention to or to accomplish with my career and my education.\nDr. Ozelsel: [28:17] Well, I think there’s not even a single time, I have to say, I think it is the growing, like this morning when we went into the special interest group meeting and I saw all the people sitting there, I felt a moment of pride for say, wow, this is, this is going well. I have to say this is, you know, there is no guarantee what will succeed in our mission, but we have to start somewhere and communication and education is the really only good venue I know of to achieve ongoing success. And actually we would promote success in our mission to raise awareness and to change the ways we live and we practice. And so I don’t even have to go very far back. You know, I’ve had a few of those moments, but this morning when I saw the whole room full of people who were willing to take the next step forward is a very proud moment for me.\nJustin: [29:02] Yeah, that’s gotta be really encouraging as you consider what the future may look like for the practice of anesthesia and the cognizance of what green conscious anesthesia looks like that that it gives you some sense of hope, I would imagine. Yeah, exactly. Great. Well doctor Timur, thank you very much for joining us on the anesthesia success podcasts.\nDr. Ozelsel: [29:19] Pleasure. Absolutely. Thanks.\nJustin: [29:24] Hey Justin here. This may shock you to learn, but I am actually not a fulltime podcast. I also run a financial planning company called quantify planning, where I work closely with anesthesia and pain docs to build and implement customized financial plans. If you’re interested in working with a financial planner who knows of the ins and outs of your profession, shoot me an email or head on over to quantify planning.com for more information. If you’re a resident or fellow, I can also offer you a free student loan analysis if you’re interested, but there might be a waiting list, so check out the link over there to see if you’re interested in learning more about the topics we discussed today. Head over to anesthesia, success.com to join our community of residents and attendings and others to ask a question or get more free resources. If and only if you liked this episode, please leave us a review and subscribe. Thank you very much for listening to the anesthesia success podcast. |
NCI Dictionary of Cancer Terms\nThe NCI Dictionary of Cancer Terms features 7,863 terms related to cancer and medicine.\nBrowse the dictionary by selecting a letter of the alphabet or by entering a cancer-related word or phrase in the search box.\n- listen (KEE-tuh-lar)\n- A drug used to cause a loss of feeling and awareness and to induce sleep in patients having surgery. It is also being studied in the treatment of nerve pain caused by chemotherapy. Ketalar blocks pathways to the brain that are involved in sensing pain. It is a type of general anesthetic. Also called ketamine and ketamine hydrochloride. |
Cataract removal surgery is one of the most common procedures performed today. The majority of people in the world get some form of cataracts by the time they reach 60 years old. Cataracts comes in the form of a deterioration that naturally occurs on the lens of someone’s eye. This deterioration produces a cloudiness in a person’s vision. The cloudiness often happens so gradually that the sufferers do not even realize that they have the problem until their next eye examination. Fortunately, once someone does realize that they have cataracts, the procedure to get it fixed is quite simple as far as surgical procedures go.\nThe best procedure for cataracts removal is called phacoemulsification. This procedure starts with a small incision to the iris of the eye, or the colored part. After this incision is made, the surgeon will insert an ultrasonic probe to the lens area behind the pupil. This probe will then create sonic vibrations that will break apart the lens of the eye. The faulty, broken apart, cataract lens is then removed and replaced with a new intraocular lens. The intraocular lens is placed in the same capsular bag that the cataract lens sat in. As a result, the new lens should clarify the vision as it will not suffer from the cloudiness that deteriorated the persons original lens. This particular cataracts removal surgery generally is the easiest when it comes to recovery as well. The procedure requires the least amount of anesthesia, and rarely necessitates an eye patch after it has been completed.\nThe other two procedures used to remove cataract are extracapsular and intracapsular cataract surgery. Extracapsular surgery, as a means to remove cataract, is most often used when the lens is too dense to be broken up by the ultrasonic vibrations of the phacoemulsification method. As a result, the surgery requires a larger incision so that the surgeon can go into the area behind the iris and physically remove the entirety of the faulty lens. The lens is then, just as in the other procedure, replaced with an intraocular lens. Intracapsular cataract surgery is only different because it puts the new lens on top of the iris. This is generally only used for trauma victims that need to reconstruct the eye to a certain degree. These two procedures require more recovery time than the phacoemulsification due to the larger incisions that are required along with the increase in anesthesia.\nFor those who have cataracts, regaining their vision is worth nearly any procedure that they would have to endure. It is common for the cataracts to get worse in one eye than the other which requires the surgery to be performed on one eye at a time. Cataract removal surgery is one of the most common surgeries that one can have, which decreases the chance of any complication exponentially. |
Is It Possible to Preform Uneven Nostrils Surgery Under Local Anestasia?\nIs It Possible to Perform Uneven Nostril Surgery Under Local Anesthesia?\nDoctor Answers (2)\nUneven Nostril Surgery under Local Anesthesia\nDepending on exactly what is necessary, tip surgery can be done under local anesthesia in a patient who is willing to tolerate some limited discomfort with the injection of the anesthesia.\nUneven nostril surgery under local anesthesia\nIt depends on what surgical techniques are needed to create the desired results.\nIt is not a good idea to undergo nasal tip surgery under local anesthesia. Patients simply cannot tolerate the injections into the nose. There are extensive nerve endings from different nerves that innervate the entire sidewall, tip, septum, and nasal spine area. Patient safety is also a factor; the patient’s airway should always be kept clear of any blood pooling down the back of the throat during surgery. It is best to have this done under general anesthesia by a board certified anesthesiologist in a surgical setting such as a Medicare certified ambulatory surgery center. |
Neurophysiologic complexity in the cortex has been shown to reflect changes in the level of consciousness in adults but remains incompletely understood in the developing brain. This study aimed to address changes in cortical complexity related to age and anesthetic state transitions. This study tested the hypotheses that cortical complexity would (1) increase with developmental age and (2) decrease during general anesthesia.\nThis was a single-center, prospective, cross-sectional study of healthy (American Society of Anesthesiologists physical status I or II) children (n = 50) of age 8 to 16 undergoing surgery with general anesthesia at Michigan Medicine. This age range was chosen because it reflects a period of substantial brain network maturation. Whole scalp (16-channel), wireless electroencephalographic data were collected from the preoperative period through the recovery of consciousness. Cortical complexity was measured using the Lempel–Ziv algorithm and analyzed during the baseline, premedication, maintenance of general anesthesia, and clinical recovery periods. The effect of spectral power on Lempel–Ziv complexity was analyzed by comparing the original complexity value with those of surrogate time series generated through phase randomization that preserves power spectrum.\nBaseline spatiotemporal Lempel–Ziv complexity increased with age (yr; slope [95% CI], 0.010 [0.004, 0.016]; P < 0.001); when normalized to account for spectral power, there was no significant age effect on cortical complexity (0.001 [–0.004, 0.005]; P = 0.737). General anesthesia was associated with a significant decrease in spatiotemporal complexity (median [25th, 75th]; baseline, 0.660 [0.620, 0.690] vs. maintenance, 0.459 [0.402, 0.527]; P < 0.001), and spatiotemporal complexity exceeded baseline levels during postoperative recovery (0.704 [0.642, 0.745]; P = 0.009). When normalized, there was a similar reduction in complexity during general anesthesia (baseline, 0.913 [0.887, 0.923] vs. maintenance 0.851 [0.823, 0.877]; P < 0.001), but complexity remained significantly reduced during recovery (0.873 [0.840, 0.902], P < 0.001).\nCortical complexity increased with developmental age and decreased during general anesthesia. This association remained significant when controlling for spectral changes during anesthetic-induced perturbations in consciousness but not with developmental age.\nCortical complexity refers to the differentiation or diversity of neural activity patterns in the cerebral cortex\nIn adults, changes in cortical complexity have been shown to reflect changes in the level of consciousness across different classes of general anesthetics\nChanges in cortical complexity with age and during general anesthesia in pediatric populations are incompletely understood\nUsing the Lempel–Ziv algorithm, a mathematical method for assessing neural signal complexity, a positive correlation of cortical complexity with age was found in awake, 8- to 16-yr-old children\nDuring anesthetic state transitions in this pediatric population, cortical complexity decreased during the maintenance phase and, upon recovery of consciousness, remained reduced when compared with preanesthesia baseline levels\nAlthough the brain is a major target organ of general anesthetics, there remains no standard neurophysiologic monitor in the perioperative period. The lack of a standardized monitoring strategy likely reflects an incomplete understanding of the precise neural correlates of consciousness. Identifying neurobiological processes underlying consciousness is particularly challenging in the pediatric population, because the brain undergoes considerable structural and functional changes during development, resulting in substantial brain network formation and refinement.1,2 Cortical oscillatory patterns and spectral properties can thus vary considerably with age3,4 and during general anesthesia.5–8 In addition, network hubs (highly connected brain regions that facilitate information transfer) undergo significant developmental maturation9–11 and are highly susceptible to functional disruption with general anesthesia.12 As such, identifying age-invariant markers of anesthetic-induced unconsciousness is difficult for pediatric patients.\nCandidate strategies for perioperative brain monitoring in the pediatric population need to account for neurodevelopmental changes that occur with age. One such strategy is the measure of neurophysiologic complexity in the cortex, hereafter referred to as cortical complexity. Cortical complexity can be broadly thought of as representing the differentiation or diversity of neural activity and can be analyzed using mathematical algorithms.13–22 The Lempel–Ziv algorithm serves as one such method for assessing neural signal complexity. It is a method of symbolic sequence analysis used to measure the “compressibility” or variability of a data series. In adults, previous studies have demonstrated a correlation between changes in Lempel–Ziv complexity with changes in the level of consciousness across different classes of anesthetic agents.14,15,21,23 However, cortical complexity has not been rigorously studied in pediatric populations requiring surgery and anesthesia. Analyzing Lempel–Ziv complexity thus serves as a candidate strategy for identifying changes in cortical signal complexity across various ages of neurodevelopment and during anesthetic-mediated perturbations in states of consciousness.\nThe objectives of this empirical and theoretical study were to determine the changes in cortical complexity with age and during general anesthesia. Specifically, this study tested the hypothesis that cortical complexity would increase with developmental age and decrease during general anesthesia. We studied a population of children 8 to 16 yr old because this age range reflects a period of dramatic brain network maturation. Additionally, children of this age are more likely to participate in preanesthetic assessment of baseline consciousness.\nMaterials and Methods\nThis was a prospective, single-center, cross-sectional, observational study assessing cortical complexity in children undergoing general anesthesia for elective outpatient surgery. The study was approved by the University of Michigan Medical School Institutional Review Board (Ann Arbor, Michigan; approval No. HUM00142298). After careful discussion, written informed consent by parents/guardians and verbal or written assent by pediatric patients were obtained before study enrollment. All study operations were conducted at C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan. Recruitment took place from November 2018 to March 2020. This study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.24 Statistical analysis plans for the primary and secondary outcomes and meaningful effect size were defined a priori.\nPediatric patients aged 8 to 16 yr old, with American Society of Anesthesiologists physical status I or II, and scheduled for outpatient elective surgery with a halogenated ether as the primary anesthetic were eligible for study enrollment. Exclusion criteria included a patient history of seizure disorder, developmental delay, neurologic disease, current use of stimulant medications (e.g., amphetamine, dextroamphetamine), surgery above the neck (which might preclude neurophysiologic monitoring), history or suspicion of a difficult airway, physical characteristics that prevent electrode contact with scalp, enrollment in conflicting research protocol, or where English was not the primary language.\nAnesthetic and Perioperative Management\nThe goal of this study was to determine the changes in cortical complexity across age in the preoperative, baseline state of consciousness and through the perioperative period. As such, no protocol was implemented for altering patient care. Clinical teams provided care as indicated, based on standard perioperative protocols, and were blinded to the electroencephalogram data to prevent additional sources of bias.\nElectroencephalographic Data Acquisition\nThe electroencephalogram was recorded from 16 Ag/AgCl scalp electrodes using a wireless electroencephalographic system (mobile 128 system, Cognionics Inc., USA) and applied based on the international 10-20 system (Supplemental Digital Content, fig. 1, https://links.lww.com/ALN/C668). Head circumference was measured to ensure proper cap size (EASYCAP, Germany). Cap placement was based on electrode position Cz, which was localized to half of the distance between the nasion and inion and the preauricular notch measurements. Data recordings were sampled at 500 samples/s and referenced to the mastoid. Electrode impedances were continuously monitored and maintained at less than 100 kΩ per manufacturer recommendations. The raw electroencephalogram signals were exported into MATLAB (version 2019b; MathWorks, Inc., USA) and downsampled to 250 Hz. The 60-Hz power-line interference, if present, was removed using a multitaper regression technique and Thomas F-statistics implemented in CleanLine plugin for EEGLAB toolbox.25\nEpoch Selection and Preprocessing\nElectroencephalogram epochs selected for data analysis are shown in figure 1. Baseline (n = 50) electroencephalogram data (range, 3.27 to 5.97 min) were recorded in the preoperative eyes-closed resting state. Premedication electroencephalogram data for all subjects were extracted from a 2-min segment that was recorded within 5 min before and as close as possible to the induction of general anesthesia. If premedication was administered, the selected segment was at least 2 min after intravenous administration (n = 18) or 20 min after oral administration (n = 3). Maintenance (n = 49) electroencephalogram data (5 min) were recorded during the maintenance of general anesthesia and approximately halfway between surgical incision and cessation of the anesthetic maintenance agent. The specific time epoch chosen was based on the following additional criteria: constant age-adjusted minimum alveolar concentration value (greater than 0.7 and less than ±0.1% change) and electroencephalogram data suitable for analysis (i.e., free from artifact by visual inspection). During this maintenance period, the mean age-adjusted minimum alveolar concentration value was 1.26 ± 0.35. Recovery (n = 45) electroencephalogram data (range, 1.18 to 5.75 min) were recorded in a postoperative, eyes-closed resting state after clinical recovery determined by achieving a University of Michigan Sedation Scale score of 0 to 1.26 For the maintenance phase, one patient was excluded because of a minimum alveolar concentration below selection criteria, and five patients in the recovery phase were excluded because of data loss (e.g., associated with emergence delirium).\nFor each epoch, the electroencephalogram signals were preprocessed as previously described.27 First, bad channels and noisy time segments with obvious artifacts were rejected by visual inspection; the data after artifact removal had an average length (mean ± SD) of 4.88 ± 0.39 min with 15 to 16 channels for the baseline, 5 ± 0 min with 14 to 16 channels for the maintenance, and 3.06 ± 1.21 min with 11 to 16 channels for the recovery epochs. Second, the signals were detrended using a local linear regression method with a 10-s window at a 5-s step size in the Chronux analysis toolbox,28 and low-pass-filtered at 50 Hz using the eegfiltnew function in the EEGLAB toolbox.25 Third, the signals underwent independent component analysis using the extended-Infomax algorithm in the EEGLAB toolbox.25 Independent components representing cardiac, eye, muscle, or other transient artifacts were identified and removed using visual inspection of the time-domain waveform, power spectrum, and spatial scalp topography. The number of independent components removed were (median [25th, 75th]) 3 [2, 4] for the baseline epochs, 0 [0, 0] for the maintenance epochs, and 4 [2, 5] for the recovery epochs.\nThe power spectrogram was estimated using the multitaper method in the Chronux analysis toolbox,28 with a window length of 4 s with 50% overlap, a time-bandwidth product of 2, and a number of tapers of 3; the estimates were then averaged over all available windows to obtain the averaged power spectrum for each available channel. The normalized power spectrum was further calculated as the absolute power spectrum divided by the total power at 0 to 50 Hz. Electroencephalogram power was calculated for delta (0.5 to 4 Hz), theta (4 to 7 Hz), alpha (7 to 13 Hz), beta (13 to 25 Hz), and gamma (25 to 50 Hz) from both absolute and normalized power spectra. The topographic maps of group-level spectral power across all subjects were constructed for each frequency band using the topoplot function in the EEGLAB toolbox.25\nWe used the Lempel–Ziv algorithm to determine the complexity of cortical dynamics across different states. Lempel–Ziv complexity is a method of symbolic sequence analysis18 that serves as a surrogate measure of temporal and spatiotemporal complexity of brain activity.14–16,21,23 In this study, we assessed both spatiotemporal complexity across multiple channels and temporal complexity in individual channels.\nThe spatiotemporal complexity was measured as previously described.23 Specifically, the instantaneous amplitude was estimated by applying the Hilbert transform, which was then segmented into 4-s windows with 50% overlap (additional analysis was performed to test the effect of window length; Supplemental Digital Content, fig. 2, https://links.lww.com/ALN/C668). The data were then converted to a binary value using the mean value as the threshold for each channel. The data window was then converted into a binary matrix in which rows represent channels and columns represent time points. The complexity of the matrix was assessed by spatiotemporal Lempel–Ziv algorithm, which reflects the number of different spatial patterns across time. If the matrix is random, the spatiotemporal Lempel–Ziv complexity tends to be high; if channels behave similarly (or identically), Lempel–Ziv complexity is low. Because the Lempel–Ziv complexity value for a sequence of fixed length is maximal if it is entirely random, we normalized the raw spatiotemporal Lempel–Ziv complexity by the mean of those from n = 50 surrogate data generated by randomly shuffling the original spatial order for each time point; thus, the resultant spatiotemporal Lempel–Ziv complexity values range from 0 to 1. To test whether the Lempel–Ziv complexity is accounted for by spectral changes, we normalized the spatiotemporal Lempel–Ziv complexity by the mean of those from a surrogate time series (n = 50) generated through phase randomization that preserves the spectral profiles of the signal for each channel. If the complexity change is entirely due to spectral changes, the difference in the Lempel–Ziv complexity values across the states will be completely preserved in the Lempel–Ziv complexity values from the surrogate data; thus, the normalized spatiotemporal Lempel–Ziv complexity will be close to 1 and equal across the states. If the change in complexity is not due to spectral changes, the alterations of Lempel–Ziv complexity values from the surrogate data will be distinct from those of spatiotemporal Lempel–Ziv complexity, and the normalized spatiotemporal Lempel–Ziv complexity will reflect the signal diversity beyond the spectral changes. Last, the spatiotemporal Lempel–Ziv complexity and normalized spatiotemporal Lempel–Ziv complexity values were averaged across all available windows as the final estimate for each state and participant.\nTo measure individual-channel temporal complexity, the number of different temporal patterns in each individual channel was analyzed. These data were then normalized by the mean of those from n = 50 surrogate data generated by randomly shuffling the temporal order for each channel to obtain temporal Lempel–Ziv complexity. We further tested whether the difference in the Lempel–Ziv complexity across states is due to spectral changes by comparing the temporal Lempel–Ziv complexity with the mean of those from n = 50 surrogate time series generated through phase randomization. The temporal Lempel–Ziv complexity and normalized temporal Lempel–Ziv complexity values were averaged across all available windows as the final estimate for each channel, state, and participant. The topographic maps of group-level temporal complexity across all subjects were constructed using the topoplot function in the EEGLAB toolbox.25 For each epoch and subject, the mean temporal complexity was further obtained by averaging the temporal Lempel–Ziv complexity (and normalized temporal Lempel–Ziv complexity) in prefrontal (Fp1, Fp2), frontal (F5, F6, Fz), central (C3, C4, Cz), parietal (P5, P6, Pz), and occipital (O1, O2) regions, as well as all further channels across the scalp.\nHuman Brain Network Simulations of Maturation\nTo assess the general relationship between brain network maturation and complexity, a large-scale functional brain network was simulated using a coupled Stuart–Landau model implemented in a neuroanatomically informed scaffolding derived from human diffusion tensor imaging. Complexity values of oscillations in the simulated brain network models were compared to assess the effect of developmental changes in the network hub structure. We chose the Stuart–Landau model because it can replicate the oscillatory dynamics of different types of brain signals.29–32 The coupled Stuart–Landau model is defined as follows:\nHere, the complex variable determined a state of the node (brain region) j at time t, . The anatomical structure A was acquired from group-averaged diffusion tensor imaging with n = 82 nodes.33 The Ajk is determined by the connection weight between brain regions j and k. We modulated Ajk to simulate brain network maturation based on previous studies demonstrating that hub structure is associated with the developmental age.9–11,34 Therefore, we additionally used weak (one tenth lower in connection strength compared with the ten strongest hubs) and strong (five times larger in connection strengths compared with the ten strongest hubs) hub structures to simulate the effect of brain network maturation. The brain network model simulation described below was performed with three different brain anatomical structures. The dynamics of the oscillator settle on a limit cycle if and on a stable focus if . We modulated the from –3 to 3 with . The is an initial angular natural frequency of each oscillator j. To simplify the model, we used a Gaussian distribution for natural frequency with a mean frequency of 10 Hz and SD of 0.3 Hz to simulate the narrow bandwidth of human electroencephalogram activity in the eyes-closed resting state.30–32,35 We controlled a coupling term between oscillators j and k from 0 to 0.5 with , which determines the global connection strength among brain regions. To make the model more realistic, we introduced a time delay between brain regions, , with the average speed of axons in brain areas, s = 7 ms36 and the distance Djk between brain regions. The brain region j receives input from connected region k after the time delay . The model results are not qualitatively different if the time delay is smaller than a quarter of the period of oscillation.31 A Gaussian white noise for each region was added with the SD . We numerically solved the differential equations of the Stuart–Landau model using the Stratonovich–Heun method with 1,000 discretization steps. The first 10 s of the generated signals were discarded, and the last 50 s were used for the analysis of each simulation. Each brain region generates its own spontaneous oscillatory dynamics in a network at each bifurcation parameter and coupling strength K for one simulation. The simulation was repeated 50 times with different frequency configurations to obtain statistical robustness.\nAmong the simulated brain signals at various bifurcation parameter and coupling strength K, we selected brain states at certain parameter sets that can represent conscious states. A variance of the level of global synchronization in a network, termed the pair correlation function, was calculated, and the state at certain coupling strength K with the largest pair correlation function was chosen as the state that can represent the conscious state for each bifurcation parameter .32 The instantaneous global synchronization level at time t was calculated using phase difference at each coupling strength K.\nHere if all phases are equal, but is nearly 0 if all phases are randomly distributed.\nGlobal pulsatile stimuli to the whole brain network were induced at the states with the largest pair correlation function to observe the complexity from the response to the stimuli. The coupled Stuart–Landau model with the stimulation term is as follows:\nHere p is the strength of the stimulus during a period . We fixed and set duration of the stimulus as T = 100 ms. We induced the stimulus at 10 different random timings for one iteration. Each stimulus was applied independently to generated signals within one frequency configuration.\nA significant response was calculated by comparing the instantaneous amplitude values before and after the stimuli. For each iteration, the of each node j after stimuli was normalized by the mean and SD of the baseline amplitude values of node j. Baseline values were obtained by using a total of 100 s, consisting of 10 trials of a 10-s prestimulus segment for each iteration. We considered the one tail quantile with as a significantly increased amplitude. A perturbation response (represented in equations as PR) of node j at time t was defined in a binary fashion: , for the significantly increased amplitude for node j, and , otherwise. The complexity was calculated by measuring Lempel–Ziv complexity of the over 1 s after the stimuli. The Lempel–Ziv complexity was calculated for brain network models with low, intermediate, and high hub structure connectivity.\nEffect of Premedication on the Resting Electroencephalogram\nTo assess the effects of premedication on cortical complexity and spectral properties, the resting electroencephalogram data during the preinduction period were analyzed. The electroencephalogram signals were preprocessed as described for the primary analysis and, after preprocessing, 12 to 16 channels remained for n = 50 subjects. The spectral power and cortical complexity measures were calculated as described for the complexity analysis.\nStatistical Analysis and Power Calculation\nStatistical analyses were performed using MATLAB, and the data were tested for normality of distribution by Lilliefors corrected Kolmogorov–Smirnov tests. Because the null hypothesis of normality of distribution was rejected in some of the data sets (P < 0.05), the two-sided Wilcoxon signed rank test was used to compare the electroencephalogram measure (spectral power and cortical complexity) across baseline, maintenance, and recovery. With Bonferroni correction, P < 0.017 (0.05/3; 3 pairs) was considered statistically significant. Spearman correlation was used to investigate the relationship between age and each electroencephalogram measure. Univariate linear regressions, with age as the independent variable and complexity measures as the dependent exposure variables, were used to determine the slope [95% CI] of the associations, with R2 used to assess goodness-of-fit. For the effect of premedication, the two-sided Wilcoxon rank sum test was used to compare the electroencephalogram measure (median [25th, 75th]) between subjects without (n = 29) and with premedication (n = 21). A Kruskal–Wallis test was used to calculate the statistical differences (median [25th, 75th]) across simulated brain networks, and P < 0.05 was considered statistically significant.\nA sample size of 41 achieved 80% power to detect a change in slope between complexity and age from 0.000 under the null hypothesis to 0.011 under the alternative hypothesis when the statistical hypothesis is two-sided, the significance level is 0.050, the variance of age is 1.0816, the variance of complexity is 0.0009, the error variance of complexity is 0.5, and the correlation between observations within an individual is 0.25, assuming a compound symmetry correlation structure. This was a conservative estimate based on a previous study of complexity in healthy control patients of similar ages.19\nIn total, 175 children were screened for study eligibility. Of the 175 who met the study criteria, 36 children declined participation, 52 were excluded because of operative time change or time constraints, 37 because of enrollment in another study, 21 because of research staff availability, 10 because of cancellation or no show for surgery, 3 because of changes in anesthetic plan, and 2 because of technical complications, leaving 50 participants who completed the study and were included for analysis. The participant demographic, anesthetic, and surgical characteristics are presented in table 1. Five participants had incomplete data for race.\nAge-related changes in spectral properties are shown in figure 2. Baseline normalized gamma power in the frontal and parietal region and beta in the parietal region were correlated with age (gamma: frontal r = 0.30, P = 0.034, and parietal r = 0.31, P = 0.027; beta: parietal r = 0.40, P = 0.003), whereas baseline theta was inversely correlated with age (r = –0.45, P = 0.001 and r = –0.57, P < 0.001 for frontal and parietal regions, respectively). Total power decreased with age, with a peak observed at 8 yr, and subsequent decreases were present during the baseline (slope [95% CI], –0.63 [–0.91, –0.35]; P < 0.001; R2 = 0.29), maintenance (–0.65 [–0.94, –0.35]; P < 0.001; R2 = 0.28), and recovery phases (–1.2 [–1.6, –0.79]; P < 0.001; R2 = 0.43); Supplemental Digital Content, fig. 3, https://links.lww.com/ALN/C668). Total power also tended to decrease across regions and frequency bands with increasing age (Supplemental Digital Content, fig. 3, https://links.lww.com/ALN/C668). During maintenance, there was an inverse correlation for normalized theta power in the parietal region (r = –0.32, P = 0.027). During recovery, there was an inverse correlation for normalized delta power r = –0.44, P = 0.002 and r = –0.35, P = 0.020 for frontal and parietal regions, respectively). Conversely, higher (beta and gamma) frequencies were positively correlated during recovery (beta: frontal r = 0.45, P = 0.002 and parietal r = 0.57, P < 0.001; gamma: frontal r = 0.51, P < 0.001 and parietal r = 0.53, P < 0.001; fig. 2, A and B).\nGroup-level changes in spectral properties are shown in figure 3 (and Supplemental Digital Content, fig. 4, https://links.lww.com/ALN/C668). Overall, during general anesthesia, there were global increases in delta power and alpha anteriorization and decreases in the higher frequency band power (beta and gamma; fig. 3, A and B). In terms of total power, general anesthesia induced an overall increase in power (except for gamma), which returned to baseline level after recovery for most frequencies (except alpha; Supplemental Digital Content, fig. 4, https://links.lww.com/ALN/C668).\nAge-related Changes in Cortical Complexity\nIn the preanesthetic baseline state of consciousness, there was a positive correlation with age and spatiotemporal Lempel–Ziv complexity (r = 0.41, P = 0.003), as well as age and averaged temporal Lempel–Ziv complexity (r = 0.39, P = 0.005). Likewise, there was a significant linear association with age for both measures (slope [95% CI], 0.010 [0.004, 0.016], P < 0.001, R2 = 0.20; and 0.007 [0.003, 0.011], P < 0.001, R2 = 0.20, respectively; fig. 4, A and B). When these data were normalized to account for spectral effects, there was no correlation for the normalized spatiotemporal Lempel–Ziv complexity or normalized averaged temporal Lempel–Ziv complexity (r = 0.02, P = 0.916 and r = 0.08, P = 0.572). Likewise, the linear association was not statistically significant (slope [95% CI], 0.001 [–0.004, 0.005], P = 0.737, R2 < 0.01, and 0.002 [–0.001, 0.004], P = 0.234, R2 = 0.03, respectively; fig. 4, C and D). Regional analysis of temporal Lempel–Ziv complexity and normalized temporal Lempel–Ziv complexity mirrored the findings above for the whole brain average (data not shown). The results were qualitatively similar when we applied robustness testing by varying the duration of window analysis (Supplemental Digital Content, fig. 2A, https://links.lww.com/ALN/C668).\nEffect of Brain Network Maturation on Complexity in Simulated Human Brain Models\nBecause our study design presumed but did not measure brain network development in the cohort of participants, we employed a principled approach to assess complexity in developing networks, as defined by networks that had progressively increased hub structures. After a simulated perturbation, complexity was measured in computational brain models informed by human neuroanatomy and compared across weak, intermediate, and strong hub structures (as quantitatively defined under “Materials and Methods”). Lempel–Ziv complexity significantly increased across simulated brain models with increasing strength of connectivity in the network hub structure (P < 0.001; fig. 5).\nEffect of Midazolam Premedication on Electroencephalogram Power and Cortical Complexity\nMidazolam premedication was not associated with a change in cortical complexity when measured across the entire brain (fig. 6A). However, regional increases in complexity were found for both the temporal Lempel–Ziv complexity and normalized temporal Lempel–Ziv complexity in the central region (median [25th, 75th], 0.384 [0.352, 0.418] vs. 0.434 [0.414, 0.452], P = 0.002; 0.915 [0.898, 0.933] vs. 0.945 [0.915, 0.961], P = 0.014, respectively) and parietal region (0.377 [0.365, 0.401] vs. 0.420 [0.412, 0.456], P < 0.001; 0.923 [0.900, 0.939] vs. 0.938 [0.915, 0.958], P = 0.031, respectively; fig. 6, B and C). Midazolam premedication was associated with frequency- and region-specific changes in normalized electroencephalogram power (Supplemental Digital Content, fig. 5, https://links.lww.com/ALN/C668). In all brain regions, there was a decrease in theta and increase in beta power, as well as a decrease in frontal and prefrontal alpha power (P < 0.05).\nEffects of General Anesthesia on Cortical Complexity\nDuring the stable maintenance phase of general anesthesia, cortical complexity decreased from baseline values for both complexity measures tested, with the greatest decrease from baseline in spatiotemporal Lempel–Ziv complexity (median [25th, 75th] for baseline 0.660 [0.620, 0.690] vs. maintenance 0.459 [0.402, 0.527], P < 0.001; fig. 7; Supplemental Digital Content, fig. 6, https://links.lww.com/ALN/C668). Changes in complexity were independent of spectral power during the maintenance phase of general anesthesia. During recovery, spatiotemporal Lempel–Ziv complexity exceeded the baseline level (0.704 [0.642, 0.745], P < 0.001); however, after controlling for spectral changes, the normalized spatiotemporal Lempel–Ziv complexity during recovery was significantly decreased compared with baseline (baseline 0.913 [0.887, 0.923], vs. recovery 0.873 [0.840, 0.902], P < 0.001). Similar results were found for the average temporal Lempel–Ziv complexity analysis, with the exception of the normalized average temporal Lempel–Ziv complexity when the recovery period returned to baseline levels (0.960 [0.949, 0.966] vs. 0.957 [0.945, 0.965], P = 0.404, respectively). Regional changes in normalized temporal Lempel–Ziv complexity results were similar to data from the whole brain average (Supplemental Digital Content, fig. 7, https://links.lww.com/ALN/C668). Overall, these results were consistent when we varied the analysis window duration (Supplemental Digital Content, fig. 2B, https://links.lww.com/ALN/C668).\nIn a post hoc analysis of changes in spatiotemporal Lempel–Ziv complexity during the maintenance epoch with (n = 11) or without (n = 38) the use of nitrous oxide, there was no difference except that the normalized spatiotemporal Lempel–Ziv complexity was higher in the nitrous oxide group (P = 0.045, Wilcoxon rank sum test; data not shown). In an additional post hoc analysis of the association of spatiotemporal Lempel–Ziv complexity and the average age-adjusted minimum alveolar concentration (maintenance epoch) with or without the use of nitrous oxide, we found a negative correlation (with nitrous oxide r = –0.64, P = 0.040, without r = –0.36, P = 0.028; Spearman correlation; data not shown), but this was not significant after controlling for spectral changes (with nitrous oxide r = –0.37, P = 0.261, without r = –0.02, P = 0.916; similar results were found for average temporal Lempel–Ziv complexity; data not shown).\nThis study of children undergoing surgical anesthesia tested the hypothesis that electroencephalogram cortical complexity would increase with developmental age and decrease with general anesthesia. Age was positively correlated with cortical complexity during baseline recordings, and further analyses revealed that this was attributable to spectral changes. We supported this empirical finding through a principled approach by investigating complexity in simulated brain networks representative of development. This analysis demonstrated increased complexity with increasing connectivity strength of the network hub structure. During anesthetic state transitions, we found that cortical complexity decreased during the maintenance phase of general anesthesia compared with the eyes-closed baseline. Furthermore, after recovery of consciousness, normalized spatiotemporal complexity remained reduced compared with baseline. Overall, we found that age and anesthetic-mediated perturbations in the level of consciousness were associated with changes in cortical complexity, with age-related changes likely resulting from spectral changes and, as suggested by our simulation results, evolving functional architecture.\nThe hypothesis that cortical complexity would increase as a function of age was informed by the developmental maturation occurring through this period. Structural and functional changes, such as increased white matter density, long-range connections,1,37 and network connectivity,1,38 could yield a less reducible and more “complex” brain network. Additionally, studies of childhood and adolescent brain network development have demonstrated increased differentiation, specialization, and organization of network function,1,9,38 potentially leading to a greater diversity of neural oscillatory activity and measurable using complexity algorithms. Indeed, previous studies of resting state magnetoencephalogram data analyzed using the Lempel–Ziv complexity algorithm demonstrated a significant increase in complexity during childhood and adolescence that continued throughout the lifespan, peaking in the sixth decade.19,20 Our results are consistent with this, but the effect is attributable to changes in spectral properties, which were not controlled for in the studies by Fernández et al.19,20 The lack of an age effect in complexity beyond spectral properties is somewhat surprising given the magnitude of brain network change occurring during this period but is possibly accounted for by several factors. First, we did not control for developmental heterogeneity. It also remains possible that the normalized measure of complexity is not sensitive enough to measure a developmental difference but requires significantly larger perturbations (e.g., anesthetic state transitions). The robust finding of significant decreases during general anesthesia, even when controlling for spectral changes, supports this interpretation. It should also be considered that despite the large developmental changes occurring in children 8 to 16 yr old, it remains possible that this age range may not capture the structural and functional changes required for discernable differences in normalized complexity. Additionally, a developing network may give rise to both spectral and complexity changes that temporally align.39 Our computational brain model findings that networks with stronger hub structures yield a more complex network further support the empirical age-related results. Moreover, previous work from our group has shown that network hub structure is disrupted with propofol administration and consistent with reductions in complexity with general anesthesia.12\nComplexity analysis using the Lempel–Ziv algorithm yielded dynamic results. Preoperative midazolam administration increased complexity in the central and parietal regions, whereas complexity was globally reduced during general anesthesia. Previous studies from our group demonstrated a similar increase in complexity with subanesthetic ketamine administration and reduction during ketamine anesthesia.23 Although the mechanism for increased complexity during subanesthetic states remains unknown, it has been shown that γ-aminobutyric acid type A receptor agonists, such as propofol, can induce paradoxical excitation.40 Additionally, benzodiazepines have been shown to increase beta activity in the central and parietal regions consistent with the increased beta activity we observed.41,42 In support, a post hoc analysis of temporal complexity and beta power demonstrated a positive correlation and after controlling for spectral changes, was mitigated in the no-premedication group, but remained significant for the midazolam group (Supplemental Digital Content, fig. 8, https://links.lww.com/ALN/C668). This suggests an association between complexity and beta power, which could be a concurrent effect of midazolam on the electroencephalogram. However, a recent study of subanesthetic nitrous oxide administration demonstrated decreased electroencephalographic complexity (Shannon complexity).13 The effect of various subanesthetic medications on cortical complexity in children remains an open question. In addition, there may be region specific changes (fig. 7B), but further investigation including high-density recordings would be required to address this fully.\nLeading theories of consciousness posit that the diversity of information in both space and time is important for conscious processing.43,44 The biologic interpretation of decreases in cortical complexity may represent reduced information sharing or processing. In this study, decreases in cortical complexity induced by general anesthesia were similar to what has been shown in animal models16,45 and adult patients.14,17,21,23 The significant decrease during general anesthesia of cortical complexity, independent of spectral changes, suggests that measures of complexity may be helpful in the development of real-time monitoring modalities across the adult and pediatric populations. It is important to note that complexity measures in this study reflect the level of consciousness despite the age-related changes in power occurring during this period of massive neurodevelopment. When developing monitoring systems, measures of the conscious state need to be robust, have high fidelity, and be accurate across the population. In our study, there was a decrease in all children with both spatiotemporal and averaged temporal complexity; however, when the data were normalized, nine children in the spatiotemporal and seven in the averaged temporal complexity analysis groups had actual increases in complexity during the maintenance of general anesthesia (Supplemental Digital Content, fig. 6, https://links.lww.com/ALN/C668). Additional post hoc analysis of age, anesthetic dose, or channel rejection did not account for this increase (data not shown). Recent work by our group in an animal model artificially dissociated the observed level of consciousness from various electroencephalographic measures, including complexity.16 However, as noted in this study, just because state-related and neurophysiologic dynamic changes can be dissociated in the laboratory setting does not mean that they are not correlated during spontaneous physiologic, pharmacologic, or pathologic state transitions. These findings suggest that a single quantitative surrogate of consciousness using normalized complexity analysis may be insufficient to reliably determine the level of consciousness in all patients and future developmental studies should also address combinatorial surrogate measures. In addition, the finding of decreased normalized spatiotemporal complexity after clinical recovery is not surprising considering that functional brain network recovery extends beyond the initial return of consciousness.46,47\nIn an effort to confirm that our findings were consistent with the spectral characteristics across development shown in previous works, we analyzed both the absolute and normalized power of the electroencephalogram in this cohort. Similar to previous studies of school-age and adolescent children, we observed an age-dependent decrease in absolute electroencephalogram power over most brain regions during general anesthesia.5,8 In addition, when the power data were normalized, regional differences were aligned with developmental structural and functional changes occurring during this period.1,48 Specifically, there was a general shift toward faster oscillatory activity (i.e., decreased theta and increased beta and gamma power).3,4 When we analyzed the spectral data during general anesthesia, we found increased absolute power, increased delta power, decreased gamma power, and anteriorization of the alpha activity, consistent with what has been previously shown during this developmental period.5,49,50\nThere are several limitations of this investigation. First, this was an observational study without a protocol for a standard anesthetic regimen, and although this was pragmatic, we are unable to dissect the role of individual anesthetic agents. We performed a post hoc analysis to investigate the role of nitrous oxide and minimum alveolar concentration values influence on complexity. Although we are cautious in interpreting these data because of the small subsamples, the findings were consistent with the overall findings. Additionally, patient characteristics that may be present and attributable to heightened preoperative anxiety could also influence complexity and spectral properties. Further, sex differences have been shown to affect cortical complexity with development, and future larger-scale studies should address this.20 When considering the Lempel–Ziv complexity measure, there are several notable strengths: it is a nonparametric measure, can be applied to relatively short data segments, and can be used with nonstationary data. However, because the measure requires binarization of the original signal, there exists the possibility for the loss of information during the analysis as well as influence by slow waves in the electroencephalogram (Supplemental Digital Content, fig. 9, https://links.lww.com/ALN/C668). Additionally, this study was conducted in the perioperative environment and limited by a low electroencephalogram (16 channel) density and, in some instances, a loss of information from an electroencephalogram channel that has the potential to influence the assessment of cortically complexity. However, when we repeated our analysis excluding participants with channel rejection, the results were similar (data not shown).\nIn summary, cortical complexity increased with developmental age and decreased during general anesthesia. The age-related increase in cortical complexity could be accounted for by spectral properties but, based on modeling data, is consistent with a maturing brain network. By contrast, reductions in complexity during general anesthesia extended beyond spectral properties. Overall, these findings contribute to the growing body of literature on cortical complexity and how this potential neural correlate of consciousness is affected by age and anesthetic state transitions.\nThe authors thank the children and their families for their participation in this study.\nSupported by Foundation for Anesthesia Education and Research (Schaumburg, Illinois) grant No. 20-PAF00823 and by the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.\nDr. Kaplan has received research funding from Lundbeck Biopharmaceutical Company (Copenhagen, Denmark). The other authors declare no competing interests. |
Cumberland announced results from two Phase 4 studies that support the efficacy and tolerability of a shortened infusion time of Caldolor (ibuprofen) injection. The study results are available in the journal Clinical Therapeutics.\nThe first study, “The Shortened Infusion Time of Intravenous Ibuprofen Part 1: A Multicenter, Open-Label, Surveillance Trial to Evaluate Safety and Efficacy,” enrolled 150 hospitalized patients with mild to severe pain or a fever >101.0ºF. The second study, “The Shortened Infusion Time of Intravenous Ibuprofen Part 2: A Multicenter, Open-Label, Surgical Surveillance Trial to Evaluate Safety and Efficacy,” enrolled 300 patients schedule for elective surgical procedures.\nResults from the first study showed the safety and efficacy of Caldolor injection in reducing pain and temperatures, supporting its use in hospitalized patients. Results from the second study supported the safety of a shortened infusion time in surgical patients when started at induction of anesthesia. Caldolor provided pain reduction similar to that shown in previous studies.\nRELATED: New NSAID Inj Approved for Pain Management\nBoth studies allowed for the infusion of multiple doses of intravenous (IV) ibuprofen and showed that the shortened administration time of 5-10 minutes was well tolerated.\nCaldolor is an IV non-steroidal anti-inflammatory drug (NSAID) indicated for the management of mild to moderate pain, management of moderate to severe pain as an adjunct to opioid analgesics, and for the reduction of fever in adults.\nFor more information call (877) 485-2700 or visit Caldolor.com. |
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