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Medicine Jan 2024Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these... (Review)
Review
Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these techniques and determines if there is significant difference in complication rates. A comprehensive literature search revealed 6 articles studying thoracentesis techniques and their complication rates, reviewing 20,815 thoracenteses: 80 (0.4%) by gravity, 9431 (45.3%) by manual aspiration, 3498 (16.8%) by vacuum-bottle suction, 7580 (36.4%) by wall suction and 226 (1.1%) unspecified. Of the 6 studies, 2 were smaller with 100 and 140 patients respectively. Overall, there was a 4.4% complication rate including hemothoraces, pneumothoraces, re-expansion pulmonary edema (REPE), chest discomfort, bleeding at the site, pain, and vasovagal episodes. The pneumothorax and REPE rate was 2.5%. Sub-analyzed by each method, there was a 47.5% (38/80) complication rate in the gravity group, 1.2% (115/9431) in the manual aspiration group including 0.7% pneumothorax or REPE, 8% (285/3498) in the vacuum-bottle group including 3.7% pneumothorax or REPE, 4% (309/7580) in the wall suction group all of which were either pneumothorax or REPE, and 73% (166/226) in the unspecified group most of which were vasovagal episodes. Procedure duration was less in the suction groups versus gravity drainage. The 2 smaller studies indicated that in the vacuum groups, early procedure termination rate from respiratory failure was significantly higher than non-vacuum techniques. Significant complication rate from thoracentesis by any technique is low. Suction drainage was noted to have a lower procedure time. Symptom-limited thoracentesis is safe using vacuum or wall suction even with large volumes drained. Other factors such as procedure duration, quantity of fluid removed, number of needle passes, patients' BMI, and operator technique may have more of an impact on complication rate than drainage modality. All suction modalities of drainage seem to be safe. Operator technique, attention to symptom development, amount of fluid removed, and intrapleural pressure changes may be important in predicting complication development, and therefore, may be useful in choosing which technique to employ. Specific drainage modes and their complications need to be further studied.
Topics: Humans; Thoracentesis; Pneumothorax; Thoracic Surgical Procedures; Drainage; Suction; Pulmonary Edema; Respiratory Aspiration
PubMed: 38181250
DOI: 10.1097/MD.0000000000036850 -
World Neurosurgery Aug 2023Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical...
BACKGROUND
Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical dexterity, which depend on visual identification of cisternal microvasculature. We describe a novel standardized operative sequence to allow for bloodless arachnoid dissection when cisternal anatomy is challenging.
METHODS
We used the reported technique in 1928 cases over the past 5 years (2018-2022). The outer arachnoid was incised to enter the cisternal space. A cotton pledget was placed in contact with an inner membrane and gently pushed laterally and superficially with the suction cannula at medium suction power. When the arachnoid membranes dried, arachnoid trabeculae were cut and microvasculature were released at the convexity of their loops and gently transposed off the dissection trajectory. The same principle was used to release parent and perforating arteries from the aneurysm dome.
RESULTS
The microcisternal drainage technique enabled safe and efficient access through adhered arachnoid in all cases. A complex anterior communicating artery aneurysm in a 52-year-old lady demonstrated the use of the microcisternal drainage technique during access through the pericallosal cistern. This technique was used in all cases where cisternal dissection was needed.
CONCLUSIONS
The microcisternal drainage technique uses deliberate and strategic suction, dynamic retraction, and nuanced scissor cuts to enable precise and bloodless microdissection of adherent arachnoid cisterns. This technique combines common neurosurgical maneuvers in a novel standardized sequence to improve efficiency and safety during arachnoid dissection.
Topics: Female; Humans; Middle Aged; Subarachnoid Space; Arachnoid; Microsurgery; Intracranial Aneurysm; Drainage
PubMed: 37105274
DOI: 10.1016/j.wneu.2023.04.087 -
Journal of Thoracic Disease Apr 2024The postoperative outcomes of suction drainage versus non-suction drainage after uniportal video-assisted thoracoscopic surgery (UniVATS) come with little consensus....
BACKGROUND
The postoperative outcomes of suction drainage versus non-suction drainage after uniportal video-assisted thoracoscopic surgery (UniVATS) come with little consensus. This study aimed to prospectively compare the postoperative outcomes of suction drainage versus non-suction drainage in patients who underwent UniVATS.
METHODS
Between October 2022 and January 2023, patients undergoing UniVATS were prospectively enrolled. The choice of drainage strategy (suction or non-suction) was at the surgeon's discretion. The primary outcome was chest tube duration, with secondary outcomes including postoperative drainage volume, pain scores, postoperative complications, length of hospital stay, and hospitalization cost. Baseline characteristics and postoperative outcomes were compared. Univariable and multivariable analyses were used to identify risk factors for postoperative outcomes.
RESULTS
A total of 206 patients were enrolled in this study, with 103 patients in each group. Baseline characteristics were well-balanced. The chest tube duration did not significantly differ between the two groups. However, suction drainage exhibited a significantly lower total drainage volume compared to non-suction drainage (280.00 400.00 mL, P=0.03). Suction drainage was associated with a significantly shorter postoperative hospital stay (3.00 4.00 days, P<0.001) and lower pain score on the second postoperative day (POD). Multivariable analyses also confirmed that suction drainage was significantly correlated with a lower total drainage volume and a shorter postoperative hospital stay.
CONCLUSIONS
These findings suggested that the suction drainage was superior to non-suction drainage in terms of postoperative drainage volume and length of hospital stay in patients undergoing UniVATS.
PubMed: 38738235
DOI: 10.21037/jtd-23-1852 -
Cureus Jul 2023Airway suctioning is routinely performed in the majority of care circumstances, including acute care, subacute care, home-based settings, and long-term care. Using an... (Review)
Review
Airway suctioning is routinely performed in the majority of care circumstances, including acute care, subacute care, home-based settings, and long-term care. Using an artificial airway to suction the patient allows for the mobilization and evacuation of secretions. When a patient can't independently remove all of the secretions from their respiratory tract, suction is used. This can occur when the body produces excessive secretion or it is not eliminated quickly enough, causing the respiratory system's upper and lower respiratory secretions to accumulate. Airway blockage and inadequate breathing may result from this. Ultimately, this leads to a shortage of oxygen and carbon dioxide from the air, both of which are necessary for ideal cellular activity. Artificial airway suctioning is one of the most crucial components of airway care and a core competency for medical professionals trying to ensure airway patency. Artificial airway suctioning is a standard treatment carried out every day globally and is frequently done in both outpatient and inpatient patients. Therefore, specialists must know the safest and most efficient ways to perform surgery and any potential side effects. In ventilated infants and children, the removal of obstructive secretions by endotracheal suctioning is frequently done. It is unknown how suctioning affects the mechanics of breathing. This study used a prospective observational clinical design to examine the immediate impact of airway resistance in endotracheal suctioning, tidal volume, and dynamic lung regulation in mechanically ventilated adult patients and mechanically ventilated pediatric patients. The preparation, process, and indications for intraoperative fusion treatment in various circumstances are covered in this systematic review.
PubMed: 37641766
DOI: 10.7759/cureus.42579 -
Cureus Nov 2023Purpose To evaluate the role of a closed-suction drain in orbital mass excision following anterior orbitotomy. Methods This is a prospective, randomized comparative...
Purpose To evaluate the role of a closed-suction drain in orbital mass excision following anterior orbitotomy. Methods This is a prospective, randomized comparative study of consecutive patients undergoing anterior orbitotomy and mass excision enrolled into two groups: group A (with drain) and group B (without drain). Clinical data included visual acuity assessment, proptosis measured by exophthalmometry, pain score assessment, eyelid swelling, and ocular motility. Postoperative data were compared for one to five days and at 14 and 30-day follow-upsĀ in the two groups to evaluate the efficacy of closed-suction drain in orbital mass excision. Results Twenty-five patients planned for anterior orbitotomy were divided into two groups: group A (drain, n = 12) and group B (without drain, n = 13). The subsidence of proptosis (p = 0.041), eyelid swelling (p = 0.04), and restoration of ocular motility (p = 0.04) were faster in the drain group as compared to the non-drain group, which was observed as statistically significant. The outcomes at 30 days were comparable in both groups and none of the patients developed any long-term complications. Conclusion The use of orbital drains aids early postoperative recovery with faster subsidence of proptosis and eyelid edema, and rapid recovery of ocular movements but does not affect the final outcome. Orbital surgeons can individualize the use of closed-suction drains after anterior orbitotomy in cases with expected postoperative edema.
PubMed: 38084189
DOI: 10.7759/cureus.48624 -
Indian Journal of Ophthalmology Dec 2023Surgery, by nature, involves blood loss. Thus, suction plays an important role in ensuring a clean operating view and ease of access. In ophthalmology, there is a void...
Surgery, by nature, involves blood loss. Thus, suction plays an important role in ensuring a clean operating view and ease of access. In ophthalmology, there is a void for an efficient and flexible suction apparatus that is yet to be filled. Our innovation, the Eyespirator, is made using recycled or inexpensive parts, is easy to assemble, and can serve as a cost-effective alternative to the current apparatus under use. It helps to overcome the difficulties caused by large instruments and non-pliable suction tips, unregulated generation of vacuum, and high pressures generated causing trauma to the delicate structures, and can prove to be of immense use in fields such as ophthalmology where the small surgical field is a big challenge. It creates a vacuum by using a simple water pump and is regulated by a foot pedal. This can be deployed even in rural settings, and small modifications can allow its usage in a wide variety of surgical fields.
Topics: Humans; Suction; Vacuum
PubMed: 37991310
DOI: 10.4103/IJO.IJO_720_23 -
Biomimetics (Basel, Switzerland) Feb 2024Under water, on land, or in the air, creatures use a variety of grasping methods to hunt, avoid predators, or carry food. Numerous studies have been conducted to... (Review)
Review
Under water, on land, or in the air, creatures use a variety of grasping methods to hunt, avoid predators, or carry food. Numerous studies have been conducted to construct a bionic surface for grasping tasks. This paper reviews the typical biomimetic structures and surfaces (wedge-shaped surface, suction cup surface and thorn claw surface) for grasping scenarios. Initially, progress in gecko-inspired wedge-shaped adhesive surfaces is reviewed, encompassing the underlying mechanisms that involve tuning the contact area and peeling behavior. The applications of grippers utilizing this adhesive technology are also discussed. Subsequently, the suction force mechanisms and applications of surfaces inspired by octopus and remora suction cups are outlined. Moreover, this paper introduces the applications of robots incorporating the principles of beetle-inspired and bird-inspired thorn claw structures. Lastly, inspired by remoras' adhesive discs, a composite biomimetic adhesive surface is proposed. It integrates features from wedge-shaped, suction cup, and claw thorn surfaces, potentially surpassing the adaptability of basic bioinspired surfaces. This surface construction method offers a potential avenue to enhance adhesion capabilities with superior adaptability to surface roughness and curvature.
PubMed: 38534829
DOI: 10.3390/biomimetics9030144 -
Journal of Visualized Experiments : JoVE Sep 2023With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and...
With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and instruments, including a dilator, a beveled working sleeve, and an endoscope with a 20-degree angle and 177 mm length, equipped with a 9.3-diameter oval shaft and a 5.6 mm diameter working channel. Additionally, the procedure involves using a Kerrison punch (5.5 mm), rongeur (3-4 mm), punch (5.4 mm), tip control radioablator applying a radiofrequency current of 4 MHz, fluid control irrigation and suction pump device, 5.5 mm oval burr with lateral protection, burr round, and the diamond round. During the surgery, it is essential to identify significant landmarks, including the caudal pedicle, ascending facet, annulus fibrosis, posterior longitudinal ligament, and the exiting nerve root. The steps of the technique are relatively easy to follow, especially when utilizing the appropriate instruments and having a good understanding of the anatomy. Research studies have demonstrated comparable outcomes to open microdiscectomy techniques. ETALD presents itself as a safe option for lumbar discectomy, as it minimizes tissue disruption, results in low postoperative surgical site pain, and allows for early mobilization.
Topics: Humans; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Lumbar Vertebrae; Endoscopy; Diskectomy; Pain, Postoperative; Treatment Outcome; Retrospective Studies
PubMed: 37747222
DOI: 10.3791/65508 -
Reproductive Health Aug 2023Most treatments for postpartum haemorrhage (PPH) lack evidence of effectiveness. New innovations are ubiquitous but have not been synthesized for ready access. (Review)
Review
BACKGROUND
Most treatments for postpartum haemorrhage (PPH) lack evidence of effectiveness. New innovations are ubiquitous but have not been synthesized for ready access.
NARRATIVE REVIEW
Pubmed 2020 to 2021 was searched on 'postpartum haemorrhage treatment', and novel reports among 755 citations were catalogued. New health care strategies included early diagnosis with a bundled first response and home-based treatment of PPH. A calibrated postpartum blood monitoring tray has been described. Oxytocin is more effective than misoprostol; addition of misoprostol to oxytocin does not improve treatment. Heat stable carbetocin has not been assessed for treatment. A thermostable microneedle oxytocin patch has been developed. Intravenous tranexamic acid reduces mortality but deaths have been reported from inadvertent intrathecal injection. New transvaginal uterine artery clamps have been described. Novel approaches to uterine balloon tamponade include improvised and purpose-designed free-flow (as opposed to fixed volume) devices and vaginal balloon tamponade. Uterine suction tamponade methods include purpose-designed and improvised devices. Restrictive fluid resuscitation, massive transfusion protocols, fibrinogen use, early cryopreciptate transfusion and point-of-care viscoelastic haemostatic assay-guided blood product transfusion have been reported. Pelvic artery embolization and endovascular balloon occlusion of the aorta and pelvic arteries are used where available. External aortic compression and direct compression of the aorta during laparotomy or aortic clamping (such as with the Paily clamp) are alternatives. Transvaginal haemostatic ligation and compression sutures, placental site sutures and a variety of novel compression sutures have been reported. These include Esike's technique, three vertical compression sutures, vertical plus horizontal compression sutures, parallel loop binding compression sutures, uterine isthmus vertical compression sutures, isthmic circumferential suture, circumferential compression sutures with intrauterine balloon, King's combined uterine suture and removable retropubic uterine compression suture. Innovative measures for placenta accreta spectrum include a lower uterine folding suture, a modified cervical inversion technique, bilateral uterine artery ligation with myometrial excision of the adherent placenta and cervico-isthmic sutures or a T-shaped lower segment repair. Technological advances include cell salvage, high frequency focussed ultrasound for placenta increta and extra-corporeal membrane oxygenation.
CONCLUSIONS
Knowledge of innovative methods can equip clinicians with last-resort options when faced with haemorrhage unresponsive to conventional methods.
Topics: Female; Pregnancy; Humans; Postpartum Hemorrhage; Oxytocin; Misoprostol; Placenta; Hemostatics
PubMed: 37568196
DOI: 10.1186/s12978-023-01657-1 -
Actas Urologicas Espanolas 2024To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. (Review)
Review
OBJECTIVE
To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones.
BASIC PROCEDURES
A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded.
MAIN FINDINGS
Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure.
CONCLUSION
Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
Topics: Adult; Humans; Child; Artificial Intelligence; Suction; Treatment Outcome; Kidney Calculi; Ureter
PubMed: 37302691
DOI: 10.1016/j.acuroe.2023.06.001