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At least 73 records · Page 4Linked to original sources

PubMed2004

Procedural sedation in paediatric minor procedures: a prospective audit on ketamine use in the emergency department.

OBJECTIVES: To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children. METHODS: A prospective audit of ketamine use in a UK district general hospital involving 89 children requiring minor procedures. Children received topical anaesthesia followed by an intramuscular injection of ketamine 4 mg/kg and intramuscular atropine 0.02 mg/kg. The procedure was assessed by way of a physician completed form and by evaluation of questionnaires given to parents to gauge levels of satisfaction. RESULTS: No child required admission to hospital and there were no serious complications. A high level of satisfaction was expressed by all the parents/guardians of the children treated. CONCLUSIONS: High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.

Analgesics↗

PubMed1998

The tensionfree vaginal tape procedure (TVT) for treatment of female urinary incontinence. A minimal invasive surgical procedure.

BACKGROUND: To test the suitability of a new surgical procedure for treatment of female urinary incontinence to be used as an ambulatory and minimal invasive operation. METHODS: Thirty-one consecutive patients with urodynamically proven stress incontinence had a tensionfree vaginal tape procedure performed. Operation time, the amount of anesthetics and analgetics used, postoperative mobilization, voiding patterns, residual urine volumes, per- and postoperative complications, hospital stay and need for sick leave were prospectively recorded. RESULTS: All 31 patients were cured from stress incontinence. Local anesthesia was used in all cases and additional analgetics were needed in only small doses. Seventy per cent of the patients were released from the hospital on the same day of the operation. By medical criteria 90% could have been released on the same day. No significant per- or postoperative complications occurred. Three patients needed postoperative catheterization. All but one patient was able to empty her bladder within 24 hours from the operation. An average of 15 days sick leave was prescribed. CONCLUSION: The tensionfree vaginal tape procedure seems to fulfil the criteria for being regarded as a minimal invasive surgical procedure for treatment of female urinary stress incontinence. It is highly effective and is associated with very few intra and postoperative side effects.

Ambulatory Surgical Procedures↗

PubMed2003

When is a patient safe for discharge after procedural sedation? The timing of adverse effect events in 1367 pediatric procedural sedations.

STUDY OBJECTIVES: The optimal timing of discharge from the emergency department (ED) after pediatric procedural sedation and analgesia has not been well studied. Because concern about delayed adverse effects commonly delays discharge after sedation, we attempted to establish the timing of adverse effects in our cohort of procedural sedations. METHODS: We analyzed data from a prospectively generated database comprising consecutive sedation events throughout a 2-year period. We determined the timing of serious (eg, hypoxia, stridor, hypotension) and other adverse effects from final medication administration and calculated adverse effect risk ratios in relation to sedation characteristics. RESULTS: In 1341 sedation events, there were 184 (13.7%) adverse effects, of which 159 (11.9%) were serious. The median age of children with and without adverse effects was similar (64 months in both groups). Most adverse effects occurred during the procedure (92%) rather than after the procedure (8%). Serious adverse effects occurred a median of 2 minutes after final medication dose (range -106 to +40 minutes). One hypoxic episode occurred each at 26, 30, and 40 minutes after final medication administration; all were repeated occurrences in children who had experienced previous hypoxia during the expected peak drug effect. CONCLUSION: Adverse effects were common; however, serious adverse effects rarely occurred after 25 minutes from the final medication administration. Those that did occur this late were all preceded by a separate similar adverse effect during the expected peak drug effect, which suggests that when similar medication regimens are used, discharge from the ED may be safe at approximately 30 minutes after final sedation medication administration if no adverse effects have occurred.

Adjuvants, Anesthesia↗

PubMed1987

Sinus node shift after the Senning procedure compared with the Mustard procedure for transposition of the great arteries.

To investigate the nature of the dominant intrinsic cardiac pacemaker activity after the Senning procedure, endocardial mapping of the systemic venous atrium was accomplished a mean of 13 months after operation in 10 patients, aged 22 +/- 6 months. Multiple endocardial sites were measured to find the earliest atrial electrical activity timed back from the QRS complex. These data were compared with data from endocardial mapping performed in 6 patients late after the Mustard procedure. In 8 of 10 patients who had undergone the Senning procedure, the earliest activation time, corresponding by definition to the origin of the intrinsic pacemaker, was located in the inferior medial portion of the superior limb of the systemic venous atrium. In the other 2 patients who had undergone the Senning procedure, the earliest activity was in the high superior limb of the baffle at its junction with the superior vena cava. In contrast, the earliest activity in all patients who underwent the Mustard operation was at the junction of the superior vena cava and the superior limb of the systemic venous atrium. In response to programmed extrastimulation, the electrophysiologic behavior of the intrinsic pacemaker in the Senning group was abnormal compared with known normal sinus node (SN) data in only 3 of 10 patients, whereas all patients in the Mustard group had SN dysfunction. Abnormal SN function was noted in both patients in the Senning group, in whom a shift in the position of the earliest endocardial activation point was not seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗

PubMed2004

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture.

This retrospective study evaluated the results of the Darrach procedure and the Sauve-Kapandji procedure for the treatment of distal radio-ulnar joint derangement following malunion of dorsally displaced, unstable, intraarticular fractures of the distal radius in patients under 50 years of age. Twelve of 18 possible patients in the Sauve-Kapandji group completed the disabilities of the arm, shoulder, and hand survey at a mean of 4 years postoperatively and nine of the 18 returned for a follow-up examination at a mean of 2 years. Twenty-one of 30 possible patients in the Darrach group completed the disabilities of the arm, shoulder, and hand survey at a mean of 6 years postoperatively and 13 of these 30 returned for follow-up examination at a mean of 4 years. The Darrach procedure and the Sauve-Kapandji procedure yielded comparable and unpredictable results with respect to both subjective and objective parameters.

Adolescent↗

PubMed1999

Semilunar valve switch procedure: autotransplantation of the native aortic valve to the pulmonary position in the Ross procedure.

BACKGROUND: The Ross procedure has gained wide acceptance in young patients with aortic valve disease. The durability of the pulmonary autograft in the aortic position has been proved, with up to 24 years of follow-up. The homograft pulmonary valve, however, has limited longevity. To circumvent this problem we harvested, repaired, and reimplanted the native aortic valve with intact commissures in the pulmonary position in 13 patients undergoing the Ross procedure for aortic insufficiency. METHODS: The cause of aortic insufficiency was rheumatic in 6 patients, congenital in 4, post-aortic valvotomy in 2, and bacterial endocarditis in 1. Patient age ranged from 5 to 45 years (mean, 17+/-9 years). Root replacement technique with coronary artery reimplantation was used. In the first 4 patients, the native aortic valve was sutured into the right ventricular outflow tract, and a polytetrafluorethylene patch was used to reconstruct the main pulmonary artery. In the last 9 patients, the aortic valve and polytetrafluorethylene patch were made into a conduit by another surgeon while the left-sided reconstruction was performed. RESULTS: All patients had marked reduction of left ventricular dilation and good function of the reimplanted native aortic valve, with up to 50 months of follow-up (mean, 29.9+/-14.2 months; range, 12 to 50 months). Two patients died 15 and 26 days, respectively, of a false aneurysm rupture at the distal aortic anastomosis. In the remaining 11 patients, 9 (82%) had mild or absent, and 2 (18%) had mild to moderate, neoaortic valve regurgitation. Similarly, 9 patients (82%) had mild or absent, and 2 (18%) had mild to moderate, neopulmonary valve regurgitation. Mild neopulmonary valve stenosis was present in 6 patients (54%) (mean gradient, 29+/-4 mm Hg; range, 25 to 35 mm Hg). All surviving patients are in functional New York Heart Association functional class I. CONCLUSIONS: We conclude that use of the native aortic valve with the Ross procedure makes the procedure attractive and potentially curative. The diseased aortic valve works well in the pulmonary position because of lower pressure and resistance. The valve leaflets should remain viable and grow in both the pulmonary and aortic positions because they derive nutrition directly from the blood.

Adolescent↗

PubMed2000

Semi-invasive and invasive procedures for the diagnosis and staging of lung cancer. II. Bronchoscopic and surgical procedures.

Each of the various techniques used for the diagnosis and staging of lung cancer has its advantages and limitations (Table 1). Imaging has a major role in guiding these procedures and deciding which of them is most appropriate in a given clinical setting. A CT examination by which the size and location of the parenchymal lesion and the presence and location of enlarged lymph nodes can be determined is a prerequisite for all sampling procedures. As a general rule, when attempting to diagnose a solitary pulmonary nodule or mass, central lesions are more easily approached by the bronchoscopic route, whereas a transthoracic route is preferred for peripheral lesions. Bronchoscopy is often performed using fluoroscopic guidance, and the recently developed CT fluoroscopy and endoscopic ultrasound have the potential to facilitate transbronchial needle aspiration. A recent advent in imaging of lung cancer has been the introduction of positron emission tomography to the diagnostic work-up of lung cancer. Although this technique has been shown to be highly accurate in determining the malignant or benign nature of lesions, it does not enable histologic diagnosis. In each case, the most appropriate diagnostic procedure should be tailored to suit the specific requirements determined by the characteristics of the disease process, institutional availability of the various diagnostic procedures, and patient preferences, when possible.

Biopsy↗

PubMed1997

Office procedures. Education, training, and proficiency of procedural skills.

Clinical competence exists when a practitioner has sufficient knowledge and skill such that a procedure can be performed to obtain intended outcomes without harm to the patient. Practitioners who want to be competent in performing clinical procedures should examine how the procedures are relevant to their practice, place the procedures in a familiar context, learn what outcomes are expected, and practice self-evaluation. Competence has several components, including knowledge, clinical decision making, judgment, technical skills, attitudes, professional habits, and interpersonal skills. Each of these must be mastered using a variety of sources of information and skill acquisition.

Clinical Competence↗

PubMed2001

The Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF): validation of a rating scale for children's and adults' behaviors during painful medical procedures.

This study evaluated the concurrent and construct validity of the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF), a behavior rating scale of children's acute procedural distress and coping, and the coping promoting behaviors and distress promoting behaviors of their parents and the medical personnel who were present in the medical treatment room. Sixty preschool children undergoing immunizations at a county health department served as subjects. Videotapes of the procedures were scored using three observational measures in addition to the CAMPIS-SF. Also, parent, nurse, and child report measures of child distress, fear, pain, and cooperation were obtained. Results indicated that the validity of the CAMPIS-SF codes of Child Coping, Child Distress, Parent Coping Promoting, Parent Distress Promoting, Nurse Coping Promoting, and Nurse Distress Promoting behaviors was supported by multiple significant correlations with the other measures. The interrater reliability of the 5-point CAMPIS-SF scales was good to excellent. The results emphasize that the CAMPIS-SF scales can be used to monitor not only children's acute procedural distress, but also their coping and the various adults' behaviors that significantly influence children's distress. Further, because of the CAMPIS-SF's ease of use, it is likely that the study of the effects of the social environment on children's distress and coping will be facilitated.

Adult↗

PubMed2005

The Ross procedure is not the procedure of choice for the teenager requiring aortic valve replacement.

The Ross procedure was a remarkable technical achievement when it was introduced in 1967. Although the long-term results for the procedure when performed in adults using the technique of intra-aortic subcoronary freehand implantation have been satisfactory, the results for children using the technique of complete aortic root replacement have been less satisfactory. Not only have early outgrowth, calcification, and shrinkage of the pulmonary homograft used to reconstruct the right ventricular outflow tract been a problem but in addition some children have experienced excessive dilation of the neoaortic root as well as neoaortic valve regurgitation. In contrast to the Ross procedure, aortic valve repair and other forms of aortic valve replacement do not exclude the possibility of reoperation in the future using more advanced options such as tissue engineered leaflets or valves. Until more information is available regarding long-term performance of the pulmonary root when implanted as a neoaortic root, as well as improved results for reconstruction of the right ventricular outflow tract, the Ross procedure should be used rarely.

Adolescent↗

PubMed2003

Results of a modified left atrial maze procedure as a combined procedure.

Starting in November 1999, we performed a left atrial radiofrequency ablation procedure concomitantly to a variety of cardiac surgical procedures. By January 2001, this ablation procedure had been performed on 100 patients (age 65.7 +/- 10.4 years, 53 % male, 47 % female, left atrium 51.0 +/- 7.5 mm) suffering either from chronic or paroxysmal atrial fibrillation. Primary cardiac pathology was mitral valve disease in most cases (43), aortic valve disease (28) or coronary heart disease (27). After bilateral pulmonary veins isolation, an additional ablation line was directed from the left pulmonary veins to the mitral valve annulus (Thermaline probe, Boston Scientific Corporation, USA). Finally, the left atrial appendage was resected. Surgical success was evaluated in the immediate postoperative course, 3 and 6 months postoperatively (ECG and echocardiography), and every year after that. Operative time was 229.7 +/- 56.5 min, ablation time 18.8 +/- 6.9 min. Follow-up is 95 % complete at the time of writing. Mean follow-up time was 7.3 months, ranging from 3 to 23 months. Success (sinus rhythm and atrial contraction) was proven in 72 out of 90 patients (80.0 %) (75.0 % mitral valve surgery, 84.0 % other cardiac surgery). The reported results support a broad spectrum of indications for this left atrial ablation procedure.

Aged↗

PubMed2002

Are modified procedures significantly better than conventional procedures in percutaneous transhepatic treatment for complicated right hepatolithiasis with intrahepatic biliary strictures?

BACKGROUND: Conventional percutaneous procedures for treating patients with recurrent hepatolithiasis associated with complicated intrahepatic biliary strictures require multiple dilation sessions before stone extraction. We modified the approach, reducing the number of dilation sessions required and using newer lithotripsy and irrigation methods. We suggest that the modified procedures are superior to conventional management and demonstrate their utility in clearing hepatolithiasis. METHODS: Percutaneous transhepatic stricture dilation and cholangioscopic lithotripsy were performed to treat patients with right recurrent hepatolithiasis with complicated intrahepatic biliary strictures. Conventional methods were used in 40 patients (Group A). Modified methods, including simplification of tract establishment and stricture dilation and electrohydraulic lithotripsy (EHL) were used in 60 patients (Group B). RESULTS: Group B patients had fewer complications (massive hemobilia: 0% versus 15%, P = 0.0032, cholangitis: 0% versus 17.5%, P=0.0012), tolerated the procedures better (intolerable pain: 0% versus 12.5%, P=0.0087), had a higher rate of success (residual stones: 3.3% versus 20%, P=0.0132; remaining asymptomatic and stone-free: 81% versus 50%, P = 0.0021), a shorter hospital stay (17.8 +/- 4.4 days versus 36.2 +/- 5.5 days, P < 0.001) and lower overall expense (USD 2689 versus USD 3848) than Group A patients. CONCLUSION: We believe that the modified methods are superior to conventional treatment in that they effectively decrease procedural complications and cost, and significantly improve treatment results.

Adult↗

PubMed1999

Application of the bootstrap procedure provides an alternative to standard statistical procedures in the estimation of the vitamin B-6 requirement.

The bootstrap procedure is a versatile statistical tool for the estimation of standard errors and confidence intervals. It is useful when standard statistical methods are not available or are poorly behaved, e.g., for nonlinear functions or when assumptions of a statistical model have been violated. Inverse regression estimation is an example of a statistical tool with a wide application in human nutrition. In a recent study, inverse regression was used to estimate the vitamin B-6 requirement of young women. In the present statistical application, both standard statistical methods and the bootstrap technique were used to estimate the mean vitamin B-6 requirement, standard errors and 95% confidence intervals for the mean. The bootstrap procedure produced standard error estimates and confidence intervals that were similar to those calculated by using standard statistical estimators. In a Monte Carlo simulation exploring the behavior of the inverse regression estimators, bootstrap standard errors were found to be nearly unbiased, even when the basic assumptions of the regression model were violated. On the other hand, the standard asymptotic estimator was found to behave well when the assumptions of the regression model were met, but behaved poorly when the assumptions were violated. In human metabolic studies, which are often restricted to small sample sizes, or when statistical methods are not available or are poorly behaved, bootstrap estimates for calculating standard errors and confidence intervals may be preferred. Investigators in human nutrition may find that the bootstrap procedure is superior to standard statistical procedures in cases similar to the examples presented in this paper.

Adult↗

PubMed1996

The Perception of Procedures Questionnaire: psychometric properties of a brief parent report measure of procedural distress.

Reported the reliability and validity of the Perception of Procedures Questionnaire (PPQ), a 19-item parent-report measure developed to assess child and parent distress related to lumbar punctures and bone marrow aspirates in the diagnosis and treatment of childhood cancer. PPQ data from 140 mothers and 96 fathers of children and adolescents with leukemia in a first remission were analyzed separately. Factor analyses yielded five factors for mothers and fathers: Parent Satisfaction; Child Distress: During; Child Distress: Before; Parent Distress; and Parent Involvement. Internal consistency (Cronbach's alpha) was high for the total score and the five factor scores as were interrater reliabilities between mothers and fathers. Validity was determined using the Parenting Stress Index-Short Form, the Pediatric Oncology Quality of Life Scale, and parent and nurse ratings during procedures. Factors 2 and 3, assessing child distress, show strong associations with the validation measures and support the distinction between distress before and during procedures. This developing scale is recommended for use in the assessment and evaluation of child and parent procedure-related distress in pediatric oncology.

Adolescent↗

PubMed2005

Brief report: Optimizing children's memory and management of an invasive medical procedure: the influence of procedural narration and distraction.

OBJECTIVE: To evaluate the influence of two interventions on children's memory of and distress during a voiding cysto-urethrogram (VCUG, X-ray of the kidneys). METHODS: Sixty-two children (aged 2.5-7.5 years) were allocated to one of three conditions. In one (CI + D), they received complete procedural information during the VCUG, with a cartoon video. In a second (PI + D), children received limited procedural information, with a cartoon video. In a third (standard care, PI), they received limited procedural information. VCUGs were videotaped and distress was coded using the CAMPIS-R. To assess memory, children were interviewed 1 week later. RESULTS: Relative to the PI condition, children in the CI + D condition recalled more information, appraised the VCUG as less painful, and were less distressed. There were no differences between the PI + D and PI conditions. CONCLUSIONS: An inexpensive, theoretically driven intervention can enhance children's memory and reduce distress during an invasive procedure.

Attention↗

PubMed2004

Prolonged pre-procedure fasting time is unnecessary when using titrated intravenous ketamine for paediatric procedural sedation.

BACKGROUND: Paediatric procedural sedation (PPS) is a common procedure in most general EDs. Many departmental guidelines suggest mandatory fasting times for children undergoing PPS, in an attempt to decrease the incidence of postoperative vomiting and (theoretically) aspiration pneumonitis, despite there being little or no evidence in the literature to support these mandatory fasting times. OBJECTIVES: To prospectively address the relationship between preprocedure fasting time and intraprocedure or postprocedure vomiting in children aged 1-12 years undergoing procedural sedation with intravenous ketamine in the ED. METHODS: From January 1999 to May 2000 all children presenting to the Royal Darwin Hospital Emergency Department with a condition requiring ketamine PPS were enrolled for data collection after parental consent was obtained. Titrated intravenous ketamine was administered via protocol. Prospective ED procedural sedation data collection forms of 272 consecutive cases of titrated intravenous ketamine sedation were reviewed. RESULTS: Fasting time was accurately recorded on 257 (95%) data collection forms. There was no intraprocedure vomiting. Overall rate of postprocedure vomiting was 13.9%. No statistically significant association between decreased fasting time and increased incidence of vomiting was found. In fact, there was a trend towards increased incidence of vomiting with increased fasting time (P = 0.08). The rate of vomiting of those children fasted 3 h or greater preprocedure (20/127 or 15.8%) was over twice the rate of those fasted less than 1 hour (2/30 or 6.6%). Incidence of vomiting was significantly associated with increasing age (P = 0.0007). No clinically evident aspiration pneumonitis occurred. CONCLUSION: Prolonged preprocedure fasting time did not reduce the incidence of postprocedure vomiting in this case series; to the contrary there was a increased incidence of vomiting with longer fasting times (P = 0.08). There was an increase in postprocedure vomiting with increasing age of the patients.

Age Distribution↗

PubMedDate not supplied

Indications for the tracheoesophageal diversion procedure and the laryngotracheal separation procedure.

Impaired protective function of the larynx can lead to intractable aspiration, a severe and potentially fatal disorder. If medical therapy fails to prevent intractable aspiration, surgical separation of the upper respiratory tract from the digestive tract is necessary to prevent recurrent contamination of the respiratory system in these patients. Two such surgical procedures are the tracheoesophageal diversion procedure and the laryngotracheal separation procedure. Our approach to patients with intractable aspiration and the indications for the use of these surgical procedures for the prevention of aspiration are discussed.

Esophagus↗

PubMed2005

Alternative to the modified jones procedure: outcomes of the flexor hallucis longus (FHL) tendon transfer procedure for correction of clawed hallux.

BACKGROUND: The modified Jones procedure is the traditional operative procedure for correction of a clawed hallux, although the deformity may be caused by overpull of one of three different muscles. In this study we present the radiographic and functional outcomes of flexor hallucis longus (FHL) tendon transfer as treatment for clawed hallux. The transfer is performed by drawing two thirds of the FHL tendon up through a drill hole in the proximal phalanx and then suturing it medially back to the remaining third. METHODS: We retrospectively identified 19 patients (22 feet) who had FHL tendon transfer for correction of clawed hallux over a period of 5 years. Followup was an average of 51.0 (range 6 to 74; +/- 3.8) months after the procedure. Outcome and patient satisfaction were determined using the Long-Form Musculoskeletal Function Assessment (MFA) score. Patients were asked whether they were satisfied, somewhat satisfied, or dissatisfied with the overall outcome and were asked about shoewear limitations. Preoperative and postoperative radiographs were evaluated in 15 patients (17 feet). We measured the hallux valgus and interphalangeal (IP) angles on the anteroposterior (AP) radiographs. On the lateral view we measured the angle of the IP joint, the metatarsophalangeal (MTP) joint, and the talometatarsal angle. Statistical analysis was done using a repeated measures ANOVA (p < 0.05). RESULTS: On the lateral radiographs, the hallux IP joint angle (p < 0.0012; n = 15) and hallux MTP joint angle (p < 0.0265; n = 15) were significantly reduced postoperatively. On AP radiographs, the hallux valgus angle (p < 0.0334) was significantly reduced; however, the IP angle and the talometatarsal angle were not significantly different after surgery. Patients had an average MFA score of 14.6 (+/-3.8 standard error, range 1 to 35; n = 19). Thirteen patients were fully satisfied and six were somewhat satisfied with the overall result of the surgery. Four patients thought that their hallux limited the types of shoes they could wear, while 15 did not. CONCLUSION: It has been shown that clawed hallux can result from excessive motor function in one of three muscles: FHL tendon, peroneus longus (PL), and extensor hallucis longus (EHL). This study suggests that transfer of part of the tendon of the FHL is an effective alternative operative procedure for correction of clawed hallux.

Adolescent↗