International journal of surgery
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Randomized Controlled Trial Comparative Study
Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy: a new device for day-case procedure.
All over the World laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis; use of local long lasting anesthetics reduces post-operative pain. Levobupivacaine is one of the most effective local anesthetics. The aim of our study is to test the effectiveness of local anesthetics comparing pre- versus post-operative trocar site's infiltration. 50 patients were enrolled in our study and 25 five patients were randomized into pre-I group (pre-incisional infiltration) and 25 into post-I group (post-operative infiltration); all the operations were performed with the same technique (Anglo-Saxon with 4 accesses) by 4 expert laparoscopic surgeons; our results showed different analgesic consumption between the 2 groups of patients; in the pre-I group the mean intravenous dose of Ketorolac post-operative used was 124 mg while in the post-I group was 339 mg: this difference was statistically significant.; the mean VAS was 10.7 in the post-I group while in the pre-I group was 5.1, also the i-VAS score's difference was statistically significant: in fact in the post-I group i-VAS was 8.8 while in the post-I group 14.8. Our study demonstrated that infiltration of the trocar site with long lasting local anesthetic is extremely effective for the treatment of post-operative pain after laparoscopic cholecystectomy; pre-incisional local infiltration seems to be better in term of pain perception and intravenous post-operative analgesic consumption.
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Many patients undergoing day surgery are at low-risk of venous thromboembolic events. However, given that pulmonary embolism is the most common preventable cause of hospital death, the risk-benefit profile of thromboprophylaxis should be accurately balanced. In this narrative review, we will briefly discuss some topics of thromboprohylaxis in ambulatory surgical procedures: venous thromboembolic risk stratification, venous thromboembolic risk during laparoscopic surgery, use of antithrombotic drugs in case of neuraxial anesthesia/analgesia, American College of Chest Physicians recommendations for thromboprophylaxis.
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Review
Laparoscopic cholecystectomy as day-surgery procedure: current indications and patients' selection.
To review the current indications, to establish predictive factors of success and the safety of LC as a day-surgery procedure. ⋯ Day-case laparoscopic cholecystectomy is feasible with an acceptable discharge rate and level of patient satisfaction. The success depends on appropriate patient selection and on well-trained staff and skilful operative technique together with safe anaesthesia.
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The aim of this review is to analyse anaesthesiologic preoperative assessment, intraoperative management and postoperative complications of patients with thyroid disease. A special care is paid to difficult airway recognition and resolving this situation. Anaesthetist's and surgeon's point of view of perioperative and postoperative complications is both discussed with special interest on early surgical complications and the need for urgent anaesthetic treatment. Particularly total intravenous anaesthesia and recurrent laryngeal nerve monitoring actually are two end-points in the thyroid surgery.
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Comparative Study
Percutaneous radiofrequency thermal ablation of renal cell carcinoma: is it possible a day-hospital treatment?
The aim of this study is to evaluate the feasibility of the procedure in day-hospital and discuss prognostic factors, efficacy and complications of percutaneous radiofrequency ablation in the treatment of renal cell carcinoma. ⋯ Preliminary results with RFA of RCC are promising. Radiofrequency thermal ablation could prove to be a useful treatment for patients who are unsuitable for surgery; in this study we demonstrate the feasibility of the treatment in day-hospital for selected patients.