Decerebration induced by surgical transection of cerebral ganglion of crayfish

Background: Since the neural structures of the crayfish brain closely resemble their equivalent in the mammals. This can be suggested by observing the similarity that exists in the brain divided by the surgical transection of the crayfish brain in which the protocerebrum remains attached to the first two cranial nerves, findings also described by Frederic Bremer in 1935 in cats with cerebral transection.Methods: Total 11 Adult male crayfish were trained to respond with defense reflex, the animals were placed in water at 0°C, remained without any movement, and subsequently through a small incision of 3 mm in diameter in the medial antero region and dorsal cephalothorax region, a surgical section of the cerebral ganglion was performed. Immediately after surgery, metal microelectrodes were implanted to collect the activity of the photoreceptors and visual fibers.Results: Once the defense reflex begins to recover in previously decerebrated crayfish, it means that it shows signs of reconnection. The isolated protocerebrum with the deutocerebrum olfactory lobe remain alive for several days and the neuronal connections were reestablished, as measured throughout the bilateral defense activity. The defense reflex was observed in all animals and then recovered after surgery.Conclusions: The crayfish is an excellent model to work the visual activity, all coding of visual information was suppressed in de-cerebrated crayfish. The recovery of the neural disconnection is observed from 40 days, where the defence reflex appears again before visual stimuli.

Heparin-induced bleeding treatment in microsurgery

Microsurgery is associated with prolonged surgical times with an increased risk of deep vein thrombosis, pulmonary embolism and myocardial infarction. The use of antithrombotic means is a commonly employed tactic to prevent vascular thrombosis after microvascular free flap surgery. Flap loss is a devastating complication of microsurgical procedures that leads to detrimental outcomes. A 32-year-old male patient has a ruptured calcaneal tendon. He underwent 5 surgical cleanings with multiple failed sequential attempts at wound closure. Traumatology department in its microsurgery division where it is proposed to perform neo-tendon with graft of palmaris longus of the right thoracic extemity and radial antebrachial microvascular flap. The neo tendon was performed in addition to the micro surgical coverage with the radial antebrachial flap.When having vascular control with micro-clamps, 6000 U of unfractionated heparin was initiated, approximately 20 minutes after the end of the microvascular anastomosis, there was incoercible bleeding, which is initially treated with spray fibrin. Continued bleeding after 3 hours, so it was decided to reverse the effect of heparin with transfusion of fresh frozen plasma, 10 mg of vitamin K and fibrinogen. The effect of heparin was reversed without having thrombotic complications of microvascular anastomoses. The flap was not reexplored since they showed no signs of vascular compromise. If anticoagulants have been used and an incoercible hemorrhage is found, the effect of heparin must be reversed. In the transfer of tissues with microsurgery, the recommended and safe anticoagulation are prophylactic doses and not therapeutic doses

Current treatment of difficult airway: a practical review of advanced techniques for airway management

The airway by definition is a conduit through which the air passes; or it is the route by which the air travels from the nose or mouth to the lungs. An exhaustive review was performed with the available literature using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2009 to 2021. The search criteria were formulated to identify reports related to difficult airway management. To allow controlled ventilation, the airway must meet two characteristics in priority order, be permeable and airtight. In assessing risk, in addition to looking for predictors of difficult airway, it was important to understand the global clinical circumstances. Faced with a patient with a difficult airway, decision-making must be agile and correct since any decision can modify the clinical outcome

Acute pulmonary non-cardiogenic edema after extubation with laryngospasm: a case report

Acute pulmonary edema post extubation due to negative pressure with laryngospasm in the early postoperative period has been reported and may occur at any time during anesthesia. The usual treatment consists of respiratory support and diuretics. We present the clinical case of a 15-year-old patient who underwent laparoscopic appendectomy, who presented acute non-cardiogenic pulmonary edema in the postoperative period. This complication can be presented in any surgical patient intubated, so it is important to know the pathophysiological basis to be able to diagnose and treat this pathology

Affordable laparoscopic simulator to acquire basic skills in undergraduate surgery students

Background: The simulation emerges as an option that allows students to practice in a safe environment, all this in a scenario that resembles the real situation.Methods: We developed a prototype of a low-cost simulator that mimics the dimensions of the abdominal cavity and allows the undergraduate students to acquire the basic skills in minimally invasive surgery.Results: In the 10 competencies evaluated, statistically significant improvement was found in both groups being higher in the students who were trained by our simulator of laparoscopic surgery compared with students who attended surgeries and participated as seconds assistants, taking as reference a value of p ≤0.05.Conclusions: The simulation as new teaching strategy generates a real environment and scenarios that can be recreated in multiple occasions, being able to change depending on the objectives for the acquisition of skills. This simulator gives the user skills for more types of simulation as it progresses in its surgical training

Transfusion related acute lung injury-TRALI: a review

Acute pulmonary damage caused by transfusion is characterized by the sudden onset of respiratory distress in newly transfused patients within 6 hours after the transfusion, bilateral infiltrative changes in chest X-ray, PaO2/FIO2 <300 mmHg, absence of other risk factors for acute lung injury and absence of signs suggesting cardiogenic origin of pulmonary edema. Being one of the most serious complications of blood transfusion, plasma is the most involved factor, although all blood components can cause it, and is caused by antigen reactions/leukocyte antibody and lipid activity with ability to modify the biological response on primitive leukocytes. The diagnosis is based on the integration of clinical, radiological and gasometric elements, ruling out the rest of the possible causes of acute lung injury. Its differential diagnosis should include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products and transfusion hemolytic reaction. The treatment is supportive measures based on the needs and does not differ from the treatment of acute lung injury secondary to other etiologies, severe cases require endotracheal intubation and mechanical ventilation while the non-severe can be managed with oxygen therapy

Therapeutic alternatives for the prevention of intra peritoneal adhesions

Intestinal adhesions are bands of fibrous tissue created by the intimate contact of two injured surface tissues; these appear in 93% of the patient undergoing intra-abdominal or gastrointestinal surgery. The comorbidities associated with the formation of adhesions have an impact on quality care offered to patients, leading to an increase in healthcare. Goals of this study was to perform a review that includes different therapeutic alternatives in basic and clinical research to prevent the formation of postoperative abdominal peritoneal adhesions. A bibliographic search was conducted in different databases including Pub med, Medline, Cochrane, science direct, from the years 2000 to 2018 using the keywords: gastrointestinal adhesions, small bowel obstruction, prophylaxis, treatment. Only experimental and clinical articles were selected. The development of peritoneal adhesions in most of the experimental studies occurred with cecal abrasion, studying the effect of biodegradable materials, drugs and gels such as mXG Hydrogel. Nanofiber membranes, agents created with recombinant technology such as periostin antisense oligonucleotide and aerosol applications such as polysaccharide 4DryField PH, are positioned to replace in the future the actual limited mechanical barriers application commonly used in abdominal surgery such as seprafilm and interceed. There are several anti-adhesion agents in experimental phase with different mechanism of action that could be used in the short term to prevent the formation of post-surgical intestinal adhesions. The inclusion of gastrointestinal surgeons in basic research is increasing and necessary with multidisciplinary collaboration. It is expected in short term the study and development of a greater number of materials to minimize tissue trauma and decrease the formation of post-surgical adhesions

Failed limb salvage by microsurgery, resolved by super-microsurgery

Advances in perforating artery flaps have improved reconstruction in various body parts, particularly the lower extremities, offering benefits in patient quality of life and reduced public health service costs. The use of flaps and microsurgery extends beyond trauma to address conditions like osteomyelitis, tumor resection, osteoarthritis, and post-radiation necrosis. Notably, the superficial circumflex iliac artery perforator flap (SCIP) is highlighted for its thin profile and utility in limb coverage, minimizing donor site morbidity. Microsurgical techniques contribute to limb salvage, reducing amputation risks in severe fractures and post-osteosynthesis complications. A 29-year-old male with cerebral palsy suffered bimalleolar fracture from a high-energy motor vehicle accident. Initial ALT flap reconstruction failed, leading to flap removal and osteosynthesis exposure. After 48 hours, removal of the flap was necessary due to venous thrombosis. Salvage with SCIP flap involved anastomosis to perforators of both posterior tibial artery and vein. This case details a patient with a bimalleolar fracture post-motorcycle accident, initially treated with conventional microsurgery using an ALT flap. Complications arose from venous thrombosis, necessitating flap removal. Salvage was achieved through a SCIP flap with supermicrosurgery techniques, employing 0.5 mm anastomosis for improved functionality and reduced complications in flap recovery and donor site comorbidities. Successful outcomes in microsurgery and supermicrosurgery necessitate comprehensive training. Specialized limb salvage centers must possess specific equipment and instruments for these techniques. The literature reviewed doesn't indicate contraindications related to the patient's mental state for the execution of microsurgery and supermicrosurgery

Postoperative analgesia in total knee arthroplasty

Total knee arthroplasty is commonly performed in patients with end-stage osteoarthritis or rheumatic knee arthritis to relieve joint pain, increase mobility, and improve quality of life. Despite advances in surgical techniques, postoperative pain management in these types of patients is still deficient. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to total knee replacement and pain management. Pain after total knee arthroplasty has been shown to involve both peripheral and central pain pathways, which is why various postoperative pain management strategies are currently applied, including patient-controlled analgesia, continuous peripheral nerve blocks, or single injection or local infiltration analgesia. Today local techniques such as periarticular injections are becoming more common in total knee replacement due to their effectiveness in controlling pain without causing muscle weakness. The development of minimally invasive techniques associated with multimodal and preventive analgesia improves recovery rates and early rehabilitation in patients undergoing total knee arthroplasty, reducing in-hospital costs, risk of complications, and improving patient satisfaction with chronic osteoarthropathy.

Transfusion related acute lung injury: a case report

Transfusion Related Acute Lung Injury (TRALI) is one of the most serious complications of blood transfusion. All blood components have been implicated and most often those that contain plasma. The diagnosis is based fundamentally on the integration of clinical, radiological and gasometry elements, once the rest of the possible causes of acute lung injury have been ruled out. The differential diagnosis of a patient who develops a sudden pattern of respiratory failure after a transfusion of blood products must include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products, haemolytic transfusion reaction and TRALI. Author presented the clinical case of a 33-year-old female patient with grade III hypovolemic shock due to a ruptured ectopic pregnancy, reanimated with crystalloid solutions, globular packages and fresh frozen plasma. The patient developed TRALI for what was managed with ventilatory and hemodynamic support in ICU