Anesthetic considerations for robot-assisted gynecologic and urology surgery

Robotic surgery was first conceived by the United States military in the 1980s. It rapidly developed in both complexity and utility and, in the early 21st century, modern robotic surgery for gynecologic and urologic surgery gained approval in the United States. Today, an ever-increasing number and variety of surgical procedures enlist robotic-assistance. Numerous anesthetic considerations for robotic surgery exist. A few of the most important aspects of conducting a safe anesthetic include: investigating the patient’s co-morbid conditions, realizing the risks associated with the robotic equipment, and positioning the patient with care. This manuscript reviews the current literature on robotic-assisted surgery for gynecologic and urologic procedures with emphasis on history, marketplace, type, variety, and expansion of surgery in these fields. The review focuses on practical considerations for the anesthesiologist caring for patients undergoing robotic surgery. Preoperative, intraoperative and postoperative issues are explored in detail. The rapid expansion of robotic surgery worldwide requires thoughtful consideration of the technique’s weaknesses and associated risks. This review provides a roadmap to adequately prepare anesthesiologists for care of gynecologic and urologic patients undergoing robot-assisted surgery

Ultrasound imaging of the sciatic nerve division in the popliteal fossa: A volunteer study

Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx® with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites

The crucial role of bilateral infraclavicular nerve blocks in the anesthetic management of a trauma patient

Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques

Aid Allocation of the Emerging Central and Eastern European Donors

The paper examines the main characteristics of the (re)emerging foreign aid policies of the Visegrád countries (the Czech Republic, Hungary, Poland, Slovakia), concentrating on the allocation of their aid resources. We adopt an econometric approach, similar to the ones used in the literature for analyzing the aid allocation of the OECD DAC donors. Using this approach, we examine the various factors that influence aid allocation of the Visegrád countries, using data for the years between 2001 and 2008. Our most important conclusion is that the amount of aid a partner county gets from the four emerging donors is not influenced by the level of poverty or the previous performance (measured by the level of economic growth or the quality of institutions) of the recipients. The main determining factor seems to be geographic proximity, as countries in the Western-Balkans and the Post-Soviet region receive much more aid from the Visegrád countries than other recipients. Historical ties (pre-1989 development relations) and international obligations in the case of Afghanistan and Iraq are also found to be significant explanatory factors. This allocation is in line with the foreign political and economic interests of these new donors. While there are clear similarities between the four donors, the paper also identifies some individual country characteristics

The systematics of the genera of Cardiochilinae (Hymenoptera : Braconidae) with a revision of Australasian species / Paul C. Dangerfield.

Copies of author's previously published articles inserted .Errata slip pasted on back endpaper.Bibliography : leaves 220-233.xi, 233, [49] leaves : ill., maps ; 30 cm.Members of the wasp subfamily Cardiochilinae (Hymenoptera: Braconidae) are endoparasitic in lepidopterous larvae and have proven and potential importance as biocontrol agents of agricultural pests. This thesis examines the taxonomy of species in the Australasian region, and develops a phylogenetic framework for world genera based on cladistic methodology.Thesis (Ph.D.)--University of Adelaide, Dept. of Crop Protection, 199

Mechanisms of PECAM-1-Mediated Leukocyte transmigration in murine models

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Idioscopus clypealis (Lethierry), a second new leafhopper pest of mango in Australia (Hemiptera: Cicadellidae: Idiocerinae)

The first Australian record of Idioscopus clypealis, a serious pest of mango in south-east Asia, is reported following the discovery of the species in northern Queensland in October 1999. This follows the discovery of I. nitidulus (Walker) on mainland Australia in 1997. Descriptions and illustrations of both species are provided to enable the two species to be distinguished. Notes on the economic importance of the species are provided

Overcoming Communication Barriers: An evaluation of communication devices for healthcare providers wearing powered air-purifying respirators (PAPRs)

Introduction The COVID-19 pandemic has resulted in an increased use of Powered Air Purifying Respirators (PAPRs), by health care providers to mitigate the risk of viral transmission, especially for aerosol-generating procedures. In this study, we evaluate communication devices that could be used concurrently with PAPRs to promote improved communication. Methods We tested two devices, a Bluetooth earpiece and a throat microphone that operated over mobile networks, against a control scenario in a simulated operating room environment with participants donning PAPRs. Participants read a short paragraph to each other, transcribed short phrases, and evaluated the scenarios according to speech intelligibility, ease of use, and comfort. Results There were 30 participants of varying PAPR experience. The Bluetooth headset had the most accurate transcriptions, followed by control, and lastly the neckpiece (94.7%vs 88.4%vs 76%, p\u3c0.001). Conclusion Communication devices have the potential to bridge but also worsen communications barriers between providers donning PAPRs