Delayed Emergence from Anesthesia

“Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of
inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy.”

Cascella
Continue reading

2020 WSES updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Pisano M, Allievi N, Gurusamy K, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020 Nov 5;15(1):61. Free full-text.

Conclusions, knowledge gaps and research recommendations: “ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.”

2020 WSES Flowchart for the management of patients with acute calcolus cholecystitis.
Continue reading

Carotid endarterectomy for symptomatic carotid stenosis

“Stroke is the third leading cause of death and the most common cause of long‐term disability. Severe narrowing (stenosis) of the carotid artery is an important cause of stroke. Surgical treatment (carotid endarterectomy) may reduce the risk of stroke, but carries a risk of operative complications. This is an update of a Cochrane Review, originally published in 1999, and most recently updated in 2017.” (Rerkasem)

Rerkasem
Continue reading

Direct Anastomosis of Recurrent Laryngeal Nerves Injured During Thyroidectomy

“Recurrent laryngeal nerve (RLN) paralysis is the most common and significant complication of thyroid or parathyroid cancer surgery. Unilateral RLN paralysis is often due to the adhesions that accompany thyroid cancer. Even with no signs of paralysis preoperatively, a cancerous thyroid gland may be found firmly adherent to RLN intraoperatively, in which case a segment of RLN must be sacrificed for the sake of cancer eradication.””Recurrent laryngeal nerve (RLN) paralysis is the most common and significant complication of thyroid or parathyroid cancer surgery. Unilateral RLN paralysis is often due to the adhesions that accompany thyroid cancer. Even with no signs of paralysis preoperatively, a cancerous thyroid gland may be found firmly adherent to RLN intraoperatively, in which case a segment of RLN must be sacrificed for the sake of cancer eradication.”

Continue reading

Refractory Variceal Bleed in Cirrhosis

Acute variceal bleeding is the major cause of mortality in patients with cirrhosis. The standard medical and endo-scopic treatment has reduced the mortality of variceal bleeding from 50% to 10–20%. The refractory variceal bleedis either because of failure to control the bleed or failure of secondary prophylaxis. The patients refractory to standardmedical therapy need further interventions. The rescue therapies include balloon tamponade, self-expanding metalstents (SEMS) placement, shunt procedures, including transjugular intrahepatic portosystemic shunt (TIPS),balloon-occluded retrograde transvenous obliteration (BRTO), and endoscopic ultrasound (EUS) guided coiling.

Continue reading

Indication of a Modified Sugiura Procedurein the Management of Variceal Bleeding

“Study results indicate that the modified Sugiura procedure is an effective rescue therapy in patients who are not candidates for selective shunts, transhepatic porto-systemic shunt, or transplantation. Emergency settings and decreased liver function are associated with an increased morbidity.”

Continue reading