Benefits of ultrasound-guided transversus abdominis plane block for open appendectomy in children

  BACKGROUND: One of the most frequently performed emergency surgical procedures in children is an appendectomy. The aim of this study was to determine the benefits of supplementing standard, general anaesthesia with the ultrasound-guided right TAP block. METHODS: We analyzed the medical records of 90 children of both sexes, aged 4–16 years with a body mass of 16–78 kg who underwent general anaesthesia for open appendectomy. Sixty-two individuals were anaesthetized using the standard method, while 28 patients had an additional right-sided TAP block under ultrasound guidance. Subsequently these groups were divided into 2 subgroups: children under 8 years and those older. We evaluated the total consumption of opioids, intraoperative fentanyl requirement, the amount of non-opioid analgesic and antiemetic drugs used during the whole hospitalization, time to recovery of digestive track function and length of hospital stay. RESULTS: TAP block performed under USG guidance reduced the overall consumption of opioids (0.36 vs. 0.42 mg kg-1, P = 0.048), significantly shortened time of fasting after the surgery (17 vs. 29 hours, P = 0.003) as well as reduced the need for antiemetic drugs: ondansetron were used only in 21.4% of children in the group with TAP block vs. 38.7% of children with standard protocol. Additionally, we noted that the application of the TAP block shortened the length of hospitalization (3 vs. 4 days, P = 0.045). CONCLUSION: The application of the TAP block, as a supplementary treatment to standard general anaesthesia for open appendectomy in children is a valuable component of multimodal analgesia, which might improve the quality of life of the patient and shorten the length of hospitalization.  BACKGROUND: One of the most frequently performed emergency surgical procedures in children is an appendectomy. The aim of this study was to determine the benefits of supplementing standard, general anaesthesia with the ultrasound-guided right TAP block. METHODS: We analyzed the medical records of 90 children of both sexes, aged 4–16 years with a body mass of 16–78 kg who underwent general anaesthesia for open appendectomy. Sixty-two individuals were anaesthetized using the standard method, while 28 patients had an additional right-sided TAP block under ultrasound guidance. Subsequently these groups were divided into 2 subgroups: children under 8 years and those older. We evaluated the total consumption of opioids, intraoperative fentanyl requirement, the amount of non-opioid analgesic and antiemetic drugs used during the whole hospitalization, time to recovery of digestive track function and length of hospital stay. RESULTS: TAP block performed under USG guidance reduced the overall consumption of opioids (0.36 vs. 0.42 mg kg-1, P = 0.048), significantly shortened time of fasting after the surgery (17 vs. 29 hours, P = 0.003) as well as reduced the need for antiemetic drugs: ondansetron were used only in 21.4% of children in the group with TAP block vs. 38.7% of children with standard protocol. Additionally, we noted that the application of the TAP block shortened the length of hospitalization (3 vs. 4 days, P = 0.045). CONCLUSION: The application of the TAP block, as a supplementary treatment to standard general anaesthesia for open appendectomy in children is a valuable component of multimodal analgesia, which might improve the quality of life of the patient and shorten the length of hospitalization

Haemodynamics imaging of swine segmental kidney artery using duplex Doppler technique

Introduction: The aim of the study was to assess the usefulness of duplex Doppler to objectify swine renal arterial flow in physiological conditions. The pig kidney was selected for its morphological similarities to the human and for the results therefore offering data to wider research. Material and Methods: Six White Large x Landrace sows, of 48.5–53 kg b.w. were used. Vascular flow parameters were acquired with a convex probe USG device with a duplex Doppler function using pulsed waves (frequency range of 5–7.5 MHz). Segmental kidney arterial flow was measured. Results: The RI values were within the 0.57 (min) to 0.6 (max) range, ̄xRI was 0.58 (±0.014), and the SD2 value was 0.0002. The PI index values ranged from 1.21 (min) to 1.3 (max), and ̄xRI was 1.24 (±0.035). The value of SD2 was 0.00123. In the S/D index, the results fell between 2.2 (min) and 2.49 (max), with ̄xS/D of 2.29 (±0.117). The value of variance SD2 was 0.0139. A double analysis of correlation between indices showed this to be almost certain and highly positive as confirmed by high correlation coefficients: r RI & PI 0.857, rhoRI & PI 0.739, rRI & S/D 0.930, rhoRI & S/D 0.941, rPI & S/D 0.913, and rhoPI & S/D 0.754. The segmental kidney arterial flow spectrum evinced falls in PSV and PSV/LDV ratio, also noticed in the filling of the spectral window, comparing the renal to an interlobar artery. Conclusion: Swine were selected because of renal anatomical and haemodynamic similarity to humans. The most relevant values and indices approximated those in humans. The study anaesthetic protocol had a minor influence on the average RI, PI, and S/D indices

Survey of Patient's Expectations, Satisfaction and Willing to Return to Emergency Department at King Fahd Hospital

Abstract Background: Emergency Department (ED) provides crucial services for life threatening conditions. The number of patient utilizing ED is increasing. Patients' expectations are important aspects to be considered in order to improve their satisfaction and willingness to return to ED in case of future events. The objective of this study was to explore patients' expectations, level of satisfaction and willingness to reuse the ED

Effect of suspended solids in secondary wastewater effluent on DOC removal by enhanced coagulation

Wastewater recycling is increasingly seen as a sustainable solution to meet the increasing water demand. However, organic matters and suspended solids (SS) affects its treatment, distribution and use in many different ways, including fouling of membrane when membrane process is adopted. Enhanced coagulation can effectively remove both SS and organic matters, consequently increasing the performance of membrane. However, it is still unknown how dissolved organic carbon (DOC) removal is affected by the presence of SS, especially when microbes and bio-molecules are present in the effluent. Thus, this study aims to investigate the impact of SS on DOC removal by enhanced coagulation (with ferric chloride), from secondary wastewater effluent (SWWE). Results indicated two-stage DOC removal for a single coagulation pH over lower and higher doses of coagulant. In the first stage, DOC removal was compromised when SS was present at concentrations as low as 8.8 mg/L, suggesting removal of SS prior to coagulation is important for effective DOC removal and sludge reduction