MyMedR

Fulltext The importance of intraoperative evaluation in the management of anorectal atresia

Ramesh JC, Lu, Balasingh D, Qureshi A

Med J Malaysia, 2002 Sep;57(3):361-3.

We report a neonate with anorectal atresia in whom preoperative evaluation prior to definitive operation revealed a short gap atresia. However, bidigital evaluation at operation revealed a septal atresia that was easily perforated from below through the anus. Unnecessary division of the anorectal sphincter complex was thus avoided.

Matched MeSH terms: Intraoperative Care*

Prospective study comparing scrape cytology with frozen section in the intraoperative identification of parathyroid tissue

Rohaizak M, Munchar MJ, Meah FA, Jasmi AY

Asian J Surg, 2005 Apr;28(2):82-5.

PMID: 15851358

Intraoperative identification of parathyroid tissue is crucial during parathyroid surgery. Frozen section is the most common tool, but is time-consuming and expensive. Scrape cytology is a modification of imprint cytology that provides rapid and cheap intraoperative identification of parathyroid tissue, but its reliability remains controversial. We assessed the sensitivity and specificity of scrape cytology in the intraoperative identification of parathyroid tissue.

Matched MeSH terms: Intraoperative Care*

Fulltext Early experiences of intra-operative trans-oesophageal echocardiography (TEE) in mitral valve repair

Sim EK, Mestres CA, Lim MC, Adebo OA, Lee CN

Med J Malaysia, 1992 Mar;47(1):77-80.

PMID: 1387456

Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.

Matched MeSH terms: Intraoperative Care

Fulltext Neurological deficit after surgery for spinal deformity--the value of normal intra operative wake-up tests in large sagitta curves. A report of two cases from an institution

Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:80-5.

PMID: 11814258

Neurological deficit after surgery for spinal deformity is a rare but devastating complication. Factors that have been associated with a post surgical deficit are congenital curves, large curves, kyphotic deformities, anterior and posterior surgery, ligation of multiple anterior vessels and hypotension; controlled or otherwise. Intra operative wake up tests have been used alone or in combination with spinal cord monitoring: to detect evolving neurological deficit in spinal deformity surgery. Despite these checks, major neurological deficits still occur post surgery. This is a report of two cases with normal intra operative wake up tests, but developed neurological deficit twelve hours after the end of surgery.

Matched MeSH terms: Intraoperative Care*

Fulltext Antegrade intraoperative colonic lavage

Ng PE

Med J Malaysia, 1993 Jun;48(2):217-21.

PMID: 8350799

Emergency left-sided colonic resections have traditionally been dealt with by employing staged resections due to the dangers of an anastomosis in unprepared bowel. A small series of 6 patients with left-sided colonic obstruction is presented in which a single stage primary anastomosis was done after an antegrade intraoperative colonic lavage. There were no deaths, infective complications or anastomotic leaks. Major series in the last decade using intraoperative colonic lavage are reviewed as well, to confirm that the method is safe, effective and warrants wider usage locally.

Matched MeSH terms: Intraoperative Care*

Normal saline versus balanced-salt solution as intravenous fluid therapy during neurosurgery: effects on acid-base balance and electrolytes

Hafizah M, Liu CY, Ooi JS

J Neurosurg Sci, 2017 Jun;61(3):263-270.

PMID: 25854455 DOI: 10.23736/S0390-5616.16.03221-5

BACKGROUND: This prospective, randomized controlled study compared the changes in acid-base balance and serum electrolytes with the use of intravenous balanced and non-balanced crystalloid solutions intraoperatively during elective neurosurgery.

METHODS: Thirty consented adult patients who underwent craniotomy were randomly allocated into two groups of 15 patients each. The non-balanced group received 0.9% normal saline while the balanced group received Sterofundin®ISO as the intraoperative fluid for maintenance. Biochemical indices for acid-base balance and serum electrolytes were analyzed periodically.

RESULTS: In the non-balanced group, significant changes were noted in the pH, base excess and bicarbonate values over time compared to its respective baseline values (P<0.01). Four patients (27.7%) also developed a pH<7.35 and 5 patients (33.3%) developed marked acidosis with base excess

Matched MeSH terms: Intraoperative Care/methods*

Fulltext Persistent left superior vena cava and absence of innominate vein during coronary artery bypass surgery

Tan JH, Ng ZQ, Vendargon S

BMJ Case Rep, 2018 Apr 17;2018.

PMID: 29666108 DOI: 10.1136/bcr-2018-225271

Matched MeSH terms: Intraoperative Care/methods

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Hasan MS, Choe NC, Chan CYW, Chiu CK, Kwan MK

J Orthop Surg (Hong Kong), 2017 May-Aug;25(2):2309499017718951.

PMID: 28675975 DOI: 10.1177/2309499017718951

BACKGROUND: Massive blood loss during posterior spinal fusion for adolescent idiopathic scoliosis remains a significant risk for patients. There is no consensus on the benefit of acute normovolemic hemodilution (ANH) or intraoperative cell salvage (ICS) in scoliosis surgery.

METHODS: Patients were randomized to one of two groups. Group A received ANH and ICS during operation, while group B received only ICS. Patients' age, sex, height, weight, body blood volume, number of fusion level, Cobb angle, number of screws, duration of surgery, and skin incision length were recorded. Hemoglobin and hematocrit levels were obtained preoperatively and postoperatively (0 h and 24 h).

RESULTS: There were 22 patients in each group. There was no significant difference in total blood loss. The perioperative decrease in hemoglobin levels between preoperation and postoperation 24 h (group A 2.79 ± 1.15 and group B 2.76 ± 1.00) showed no significant difference ( p = 0.93). Group A observed a larger decrease in hemoglobin levels at postoperative 0 h relative to preoperative level (2.57 ± 0.82 g/dl), followed by a smaller decrease within the next 24 h (0.22 ± 1.33 g/dl). Group B showed a continued drop in hemoglobin levels of similar magnitude at postoperation 0 h (1.60 ± 0.67 g/dl) and within the next 24 h (1.16 ± 0.78 g/dl). One patient from group B received 1 unit of allogenic blood transfusion ( p = 0.33).

CONCLUSIONS: The addition of ANH to ICS in posterior spinal fusion surgery for AIS resulted in a similar decrease in hemoglobin levels between preoperative values and at 24 h postoperatively.

Matched MeSH terms: Intraoperative Care*

External laryngeal nerve in thyroid surgery: recognition and surgical implications

Aina EN, Hisham AN

ANZ J Surg, 2001 Apr;71(4):212-4.

PMID: 11355727

Injury to the external laryngeal branch of the superior laryngeal nerve during thyroid surgery is not uncommon. Most surgeons tend to avoid rather than expose and identify the external laryngeal nerve (ELN). The aim of the present study was to analyse the frequency and types of ELN crossing the avascular space in relationship to the structures to the upper pole of the thyroid and related thyroid pathology.

Matched MeSH terms: Intraoperative Care/methods*

Fulltext Evaluation Study of Intraoperative Cytology Smear and Frozen Section of Glioma

Zulkarnain S, Yunus N, Kandasamy R, Zun AB, Mat Zin AA

Asian Pac J Cancer Prev, 2020 Oct 01;21(10):3085-3091.

PMID: 33112571 DOI: 10.31557/APJCP.2020.21.10.3085

OBJECTIVE: Glioma is the commonest primary malignant brain tumour. Diagnosis is made based on cytology smear, frozen section and histopathological examination. Intraoperative pathological diagnosis using either cytology smear, frozen section or combination of both, plays a crucial role in patient's future management and prognosis. This study aims to determine the accuracy of cytology smear and frozen section in glioma, and to compare the difference between both techniques.

METHODS: A cross-sectional study was conducted involving 22 cases of glioma diagnosed intraoperatively from January 2013 until August 2019 in Hospital Universiti Sains Malaysia. The selected tissues were processed for cytology smear and frozen section. The remaining tissues were proceeded for paraffin section. The diagnosis was categorized as either low-grade or high-grade glioma based on cellularity, nuclear pleomorphism, mitotic count, microvascular proliferation and necrosis. The sensitivity and specificity of frozen section and cytology smears were determined based on paraffin section being as the gold standard. The accuracy of both techniques was compared using statistical analysis.

RESULTS: The overall sensitivity and specificity of cytology smear were 100% and 76.9%, respectively. Meanwhile, the sensitivity and specificity of frozen section were 100% and 84.6%. There was no significant difference in diagnostic accuracy between cytology smear and frozen section in glioma (p>0.05).

CONCLUSION: Cytology smears provides an alternative method for frozen section due to good cellularity and morphology on smear. Cytology smear is rapid, inexpensive, small amount of tissue requirement and less technical demand. This finding may benefit to the hospital or treatment centres where frozen section facility is unavailable.

Matched MeSH terms: Intraoperative Care*

Intraoperative methylene blue sentinel lymph node mapping in colorectal cancer

Chan SH, Ng C, Looi LM

ANZ J Surg, 2008 Sep;78(9):775-9.

PMID: 18844907 DOI: 10.1111/j.1445-2197.2008.04648.x

Isosulfan blue is not available for clinical use in Malaysia. This study describes the use of methylene blue as an alternative to isosulfan blue in colorectal sentinel node mapping.

Matched MeSH terms: Intraoperative Care

Monte Carlo skin dose simulation in intraoperative radiotherapy of breast cancer using spherical applicators

Moradi F, Ung NM, Khandaker MU, Mahdiraji GA, Saad M, Abdul Malik R, et al.

Phys Med Biol, 2017 Jul 28;62(16):6550-6566.

PMID: 28708603 DOI: 10.1088/1361-6560/aa7fe6

The relatively new treatment modality electronic intraoperative radiotherapy (IORT) is gaining popularity, irradiation being obtained within a surgically produced cavity being delivered via a low-energy x-ray source and spherical applicators, primarily for early stage breast cancer. Due to the spatially dramatic dose-rate fall off with radial distance from the source and effects related to changes in the beam quality of the low keV photon spectra, dosimetric account of the Intrabeam system is rather complex. Skin dose monitoring in IORT is important due to the high dose prescription per treatment fraction. In this study, modeling of the x-ray source and related applicators were performed using the Monte Carlo N-Particle transport code. The dosimetric characteristics of the model were validated against measured data obtained using an ionization chamber and EBT3 film as dosimeters. By using a simulated breast phantom, absorbed doses to the skin for different combinations of applicator size (1.5-5 cm) and treatment depth (0.5-3 cm) were calculated. Simulation results showed overdosing of the skin (>30% of prescribed dose) at a treatment depth of 0.5 cm using applicator sizes larger than 1.5 cm. Skin doses were significantly increased with applicator size, insofar as delivering 12 Gy (60% of the prescribed dose) to skin for the largest sized applicator (5 cm diameter) and treatment depth of 0.5 cm. It is concluded that the recommended 0.5-1 cm distance between the skin and applicator surface does not guarantee skin safety and skin dose is generally more significant in cases with the larger applicators.

HIGHLIGHTS: • Intrabeam x-ray source and spherical applicators were simulated and skin dose was calculated. • Skin dose for constant skin to applicator distance strongly depends on applicator size. • Use of larger applicators generally results in higher skin dose. • The recommended 0.5-1 cm skin to applicator distance does not guarantee skin safety.

Matched MeSH terms: Intraoperative Care

Fulltext APSIC guidelines for the prevention of surgical site infections

Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, et al.

Antimicrob Resist Infect Control, 2019;8:174.

PMID: 31749962 DOI: 10.1186/s13756-019-0638-8

Background: The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices.

Method: The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section.

Results: It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions.

Conclusions: Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.

Matched MeSH terms: Intraoperative Care

Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma

Wong M, Isa SH, Zahiah M, Azmi KN

World J Surg, 2007 Mar;31(3):586-92.

PMID: 17322973

This study assessed the sensitivities of preoperative localisation modalities such as computed tomography (CT), magnetic resonance imaging (MRI), arteriography and arterial stimulation venous sampling (ASVS) using serum insulin and C-peptide gradients to intraoperative techniques in localising insulin-secreting tumours in our institution.

Matched MeSH terms: Intraoperative Care

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