Sedation for Esophagogastroduodenal Endoscopy

Different anesthetic techniques and drugs can be used for esophagogastroduedonal endoscopy. However, the scientists are still searching for appropriate drugs and protocols for sedation during esophagogastroduedonal endoscopy. The aim of this review is to discuss the topics related with sedation and esophagogastroduedonal endoscopy in the light of literature. Today standard procedure for diagnostic esophagogastroduedonal endoscopy usually consists of topical pharyngeal anesthesia, minimal sedation or anxiolysis, which may be complemented with analgesia when needed. When a prolonged, complex, or particularly troublesome or painful examination is foreseen, deeper sedation with multiple drugs and in closed observation of a staff may be required

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Controlling the Near-wake of a Circular Cylinder with a Single, Large-scale Tripwire

Control of the flow past a circular cylinder using a single tripwire on its surface has been studied experimentally as a function of the wire angular location for different wire-to-cylinder diameter ratios (0.029Ph.D

A bulk-micromachined fully-differential MEMS accelerometer with interdigitated fingers

This paper proposes a novel bulk-micromachined MEMS accelerometer employing interdigitated sense fingers that provide a fully-differential (FD) signal interface, where the accelerometer can be fabricated by a modified Silicon-on-Glass (M-SOG) process utilizing a ; Silicon-on-Insulator (SOI) wafer. The accelerometer combines the feasibility of fabricating large mass and high aspect ratio structures using bulk-micromachining together with the high sensitive interdigitated sense finger triplets that are connected with multi-layer metal interconnects on an SOI-glass bonded wafer. The fabricated accelerometer is packaged for system level tests with a 4 th order Σ-Δ readout circuitry to evaluate its performance. The measurement results show that the accelerometer achieves a bias instability of 66.1 μg and a velocity random walk of 17.5 μg/√Hz, while operating in a range of ±8 g

A Bulk-Micromachined Fully Differential MEMS Accelerometer With Split Interdigitated Fingers

This paper proposes a novel bulk-micromachined MEMS accelerometer employing split interdigitated sense fingers that provide a fully differential signal interface, where the accelerometer can be fabricated by a modified silicon-on-glass process using a silicon-on-insulator (SOI) wafer. The accelerometer combines the feasibility of fabricating large mass and high aspect ratio structures using bulk-micromachining together with the highly sensitive split interdigitated sense finger triplets that are connected with multilayer metal interconnects on an SOI-glass bonded wafer. The fabricated accelerometer is packaged for system level tests with a fourth-order Sigma-Delta readout circuitry to evaluate its performance. The measurement results show that the accelerometer achieves a bias instability of 50 mu g and a velocity random walk of 11.5 mu g/root Hz. The accelerometer operates in a range of +/- 5 g with a nonlinearity of 1140 pp