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Purpose This study investigated the impact of an advanced analytics software solution in the operating room (OR) on tracking and evaluating controlled substance discrepancies. The authors hypothesized that the software would increase identification of these discrepancies and improve the efficiency of the preexisting manual process. Methods In this evaluation comparing data from before to after implementation of the software, data were collected using the preexisting manual process for 50 days before implementation, followed by a 25-day period for acclimation to the new software, and ending with a 49-day postimplementation review period. Data collected included the total number of medication discrepancies, time required for discrepancy review and reconciliation by an OR analyst, types of discrepancies, and number of discrepancies leading to provider audits. Results Before implementation of the analytics software, there were 7,635 OR cases with a total of 674 charting discrepancies (8.83 discrepancies per 100 total OR cases) discovered across 439 OR cases. After implementation, there were 7,454 OR cases with a total of 930 charting discrepancies (12.48 discrepancies per 100 total OR cases; P < 0.0001) discovered across 680 OR cases. While discrepancies increased by 38%, the median review time for the OR analyst per case decreased (P < 0.0001) and the percentage of incidents resolved by the OR analyst increased by 14% while the number of cases requiring additional documentation by the provider decreased by 10%. Conclusion Implementation of advanced analytics software in the OR significantly increased the number of controlled substance charting discrepancies identified compared to the preimplementation review process while increasing the efficiency of the OR analyst. [ABSTRACT FROM AUTHOR]

Impalement injuries happen when an object penetrates a body cavity or organ and remains in situ. We present a case of a 35-year-old fisherman whose act of violence resulted in the lodging of an antique iron spear in segment V of the liver, which was then referred to our institution on the day after the accident. Despite the challenges posed by patient transfer, diagnosis, resuscitation, and, most importantly, handling in the operating room, the object was successfully removed via hepatotomy, and the patient is now in good health. Impalement by an ancient African iron spear, repurposed as a fishing tool in modern times, remains undocumented in the literature, necessitating reporting and a call for further research by the medical community into managing impalement injuries of varying severity. [ABSTRACT FROM AUTHOR]

Lay Summary: The growing availability of surgical digital data and developments in analytics such as artificial intelligence (AI) are being harnessed to improve surgical care. However, technical and cultural barriers to real-time intraoperative AI assistance exist. This early-stage clinical evaluation shows the technical feasibility of concurrently deploying several AIs in operating rooms for real-time assistance during procedures. In addition, potentially relevant clinical applications of these AI models are explored with a multidisciplinary cohort of key stakeholders. [ABSTRACT FROM AUTHOR]

Background: Hospital waste adds to the ecological footprint of the healthcare system, whereas inattention to recyclables may increase costs. The primary objective of this study was to assess the amount of recyclable and nonrecyclable intraoperative waste produced across representative otolaryngology surgical procedures. Methods: Representative surgical cases across four otolaryngology subspecialties at a tertiary care military medical institution were prospectively identified. Waste was collected, divided, and weighed across two categories: recyclable and nonrecyclable. This study was performed in conjunction with a hospital-approved quality improvement project. Results: The study included 22 otolaryngology surgeries performed across four otolaryngology subspecialties: facial plastics, pediatrics, otology, and head and neck oncology. Overall, 197.4 kg of waste was collected of which 40.2 kg (20%) was recyclable and 157.2 kg (80%) was nonrecyclable. An average of 1.8 kg of recyclable materials and 7.1 kg of nonrecyclable materials were collected per case. Conclusion: This study supports that otolaryngology surgical procedures generate a significant amount of waste, a large component of which is recyclable. It highlights the need for proper disposal of this waste and the implementation of a recycling program at our institution with the potential for both ecologic and economic benefits. [ABSTRACT FROM AUTHOR]

Ruptured aortic aneurysms carry a high risk of morbidity and mortality, particularly if not rapidly identified. We present an 87-year-old male, with a history of hypertension and prior endovascular aortic repair, who presented to the Emergency Department (ED) with several days of epigastric abdominal pain radiating to his back and flanks. The patient acutely deteriorated in the ED, and point-of-care ultrasound rapidly identified active extravasation from an abdominal aortic aneurysm with visualization of prior endograft. Point-of-care ultrasound in this patient expedited the diagnosis, resuscitation, and transfer to the operating room with definitive repair by vascular surgery. The patient recovered and was discharged in stable condition. [ABSTRACT FROM AUTHOR]

Objective To explore the optimal set of trauma activation criteria predicting paediatric patients' need for acute care following multi-trauma, with particular attention to Glasgow Coma Scale (GCS) cut-off value. Methods A retrospective cohort study of paediatric multi-trauma patients aged 0 to 16 years, performed at a Level 1 paediatric trauma centre. Trauma activation criteria and GCS levels were examined with respect to patients' need for acute care, defined as: direct to operating room disposition, intensive care unit admission, need for acute interventions in the trauma room, or in-hospital death. Results We enrolled 436 patients (median age 8.0 years). The following predicted need for acute care: GCS <14 (adjusted odds ratio [aOR] 23.0, 95% confidence interval [CI]: 11.5 to 45.9, P < 0.001), hemodynamic instability: (aOR 3.7, 95% CI: 1.2-8.1, P = 0.01), open pneumothorax/flail chest (aOR: 20.0, 95% CI: 4.0 to 98.7, P < 0.001), spinal cord injury (aOR 15.4, 95% CI; 2.4 to 97.1, P = 0.003), blood transfusion at the referring hospital (aOR: 7.7, 95% CI: 1.3 to 44.2, P = 0.02) and GSW to the chest, abdomen, neck, or proximal extremities (aOR 11.0, 95% CI; 1.7 to 70.8, P = 0.01). Using these activation criteria would have decreased over- triage by 10.7%, from 49.1% to 37.2% and under-triage by 1.3%, from 4.7% to 3.5%, in our cohort of patients. Conclusions Using GCS<14, hemodynamic instability, open pneumothorax/flail chest, spinal cord injury, blood transfusion at the referring hospital, and GSW to the chest, abdomen, neck of proximal extremities, as T1 activation criteria could decrease over- and under-triage rates. Prospective studies are needed to validate the optimal set of activation criteria in paediatric patients. [ABSTRACT FROM AUTHOR]

Hemangiomas are rarely found in the axilla, with the most commonly identified axillary mass being lymphadenopathy. We report a unique case report of a post-partum female with an axillary mass that became larger and symptomatic while breastfeeding. On imaging, the mass was found to be complex and cystic, and aspiration was attempted several times. With a rapid return of swelling and worsening symptoms, there was concern for bleeding into the cystic cavity. Ultimately, the >10 cm mass had to be formally excised in the operating room, yielding definitive relief of symptoms. Final pathology reported the mass as a vascular malformation, either a hemangioma or arteriovenous malformation. It has been postulated that estrogen and progesterone may stimulate the growth of hemangiomas, which may explain this patient's post-partum presentation. This case demonstrates a perplexing axillary mass that continued to re-accumulate until final excision. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Hybrid operating rooms (HOR) have been increasingly used for image-guided lung surgery, and most surgical teams have used percutaneous localization for small pulmonary nodules. We evaluated the feasibility and safety of augmented fluoroscopic bronchoscopy localization under endotracheal tube intubation general anaesthesia followed by thoracoscopic surgery as a single-stage procedure in ab HOR. METHODS We retrospectively reviewed clinical records of patients who underwent single-stage augmented fluoroscopic bronchoscopy localization under general anaesthesia followed by thoracoscopic surgery in an HOR between August 2020 and March 2022. RESULTS Single-stage localization and resection were performed for 85 nodules in 74 patients. The median nodule size was 8 mm [interquartile range (IQR), 6–9 mm], and the median distance from the pleural space was 10.9 mm (IQR, 8–20 mm). All nodules were identifiable on cone-beam computed tomography images and marked transbronchially with indigo carmine dye (median markers per lesion: 3); microcoils were placed for deep margins in 16 patients. The median localization time was 30 min (IQR 23–42 min), and the median fluoroscopy duration was 3.3 min (IQR 2.2–5.3 min). The median radiation exposure (expressed as the dose area product) was 4303.6 μGym2 (IQR 2879.5–6268.7 μGym2). All nodules were successfully marked and resected, and the median global operating room time was 178.5 min (IQR 153.5–204 min). There were no localization-related complications, and the median length of postoperative stay was 1 day (IQR, 1–2 days). CONCLUSIONS Single-stage augmented fluoroscopic bronchoscopy localization under general anaesthesia followed by thoracoscopic surgery was feasible and safe. [ABSTRACT FROM AUTHOR]

Penetrating rebar injuries are extremely rare occurrences, but they are very life-threatening, particularly when involving the thoracic and abdominal cavities. The surgical approach to these traumatic injuries depends upon the length and diameter of the rebar as well as the path of penetration into the abdominal and thoracic regions. Due to the highly uncommon occurrence of penetrating rebar injuries, there is very limited information and studies pertaining to this topic in the literature. In this case report, we present a 43-year-old male patient sustaining a rebar penetrating injury, with the entry site being the left flank and the exit site being the anterior left chest. Upon arrival, the patient was emergently taken to the operating room and underwent simultaneous exploratory laparotomy and a left thoracotomy. The operation was successful in removing the rebar and the patient survived. [ABSTRACT FROM AUTHOR]

A male in his 40s presented to the trauma center via air ambulance after colliding with a cement wall at highway speeds. Cross-sectional imaging revealed a right ventricular pseudoaneurysm, confirmed by echocardiography. He was taken emergently to the operating room where he was found to have a pericardial laceration, hemopericardium and a right ventricular rupture, which was primarily repaired. Postoperatively, the patient was transferred to intensive care and after 34 days in the hospital was ultimately discharged home. [ABSTRACT FROM AUTHOR]

Objective Compliance with perioperative antibiotic prophylaxis is crucial for preventing surgical site infection. Anesthesiologists can play a significant role in reducing surgical site infections by following clinical practice guidelines for antibiotic prophylaxis and redosing during surgery. A quality assurance initiative was implemented at a tertiary hospital with the goal of improving cefazolin perioperative antibiotic compliance. Design This was a retrospective observational study Setting Main operating room of a tertiary care teaching hospital in New York, USA. Our main operating room includes 22 operating rooms that incorporates surgeries from general surgery, vascular surgery, neurology, gynecology, urology, orthopedics, ear, nose and throat (ENT) etc. Participants All cases in the main operating room from March 1, 2018 to March 31, 2021 that received first dose of Cefazolin and in which the duration of surgery was more than 4 hrs. Intervention A multifaceted intervention was initiated to address low compliance with cefazolin redosing. Multifaceted interventions included the development of a perioperative antibiotic guide for anesthesia providers, automated reminders in anesthesia electronic medical records, grand rounds education, survey and email communications, and regular feedback reports to the anesthesia department. Main outcome Measures Cefazolin perioperative redose compliance rate. Results Rates of redose compliance were examined in three time periods: preintervention, intervention and postintervention. Cefazolin redosing compliance was 58% in the preintervention period and 90% in the postintervention period. There was a significant positive change in the trend of compliance during the intervention period, indicating that the odds of compliance increased by 13% per month in the intervention period compared to the preintervention period (odds ratio = 1.13, P  < 0.001). Redose compliance improvements were sustained a year after the postintervention period (an average of 91%). Surgical site infection rates for colon, coronary artery bypass graft and hip surgeries did not show any significant trend during these time periods. Conclusion Multifaceted interventions led to significant and sustained improvements in cefazolin redosing compliance in the main operating room of a tertiary hospital. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The most severe combinations of cardiac malformations exist in individuals having jumbled-up thoracic and abdominal organs. These patients make up 2 distinct syndromes. As yet, the consensus is lacking on how best to describe the subsets. The subsets are frequently grouped together in terms of 'heterotaxy'. The surgical approaches to the subsets, however, are markedly different. We reviewed our experiences with regard to the anatomy as observed in the autopsy room, by the analysis of computed tomographic studies, and in the operating room, to assess whether the lesions might be segregated on the basis of isomerism of the atrial appendages. METHODS AND RESULTS A review of our findings from the examination of specimens from several archives, along with investigation of a large cohort of patients being prepared for surgical treatment, showed that individuals can uniformly be segregated into subgroups on the basis of isomeric arrangement of the atrial appendages. In all instances, this was made possible by using the criterion of the extent of the pectinate muscles within the appendages as judged relative to the atrial vestibules. Segregation on this basis, which correlated excellently with the bronchial arrangement, sets the scene for an appropriate description of the remainder of the heart, providing the cardiac surgeon with all the inferences required for appropriate surgical intervention. CONCLUSIONS When assessing individuals having the features of so-called 'heterotaxy', it is possible to segregate the groups into subsets of individuals having either isomeric right or left atrial appendages. This approach provides the framework for the assessment of appropriate surgical management. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Machine learning (ML) has great potential, but there are few examples of its implementation improving outcomes. The thoracic surgeon must be aware of pertinent ML literature and how to evaluate this field for the safe translation to patient care. This scoping review provides an introduction to ML applications specific to the thoracic surgeon. We review current applications, limitations and future directions. METHODS A search of the PubMed database was conducted with inclusion requirements being the use of an ML algorithm to analyse patient information relevant to a thoracic surgeon and contain sufficient details on the data used, ML methods and results. Twenty-two papers met the criteria and were reviewed using a methodological quality rubric. RESULTS ML demonstrated enhanced preoperative test accuracy, earlier pathological diagnosis, therapies to maximize survival and predictions of adverse events and survival after surgery. However, only 4 performed external validation. One demonstrated improved patient outcomes, nearly all failed to perform model calibration and one addressed fairness and bias with most not generalizable to different populations. There was a considerable variation to allow for reproducibility. CONCLUSIONS There is promise but also challenges for ML in thoracic surgery. The transparency of data and algorithm design and the systemic bias on which models are dependent remain issues to be addressed. Although there has yet to be widespread use in thoracic surgery, it is essential thoracic surgeons be at the forefront of the eventual safe introduction of ML to the clinic and operating room. [ABSTRACT FROM AUTHOR]

Introduction: Previous analyses of head, face, and neck (HFN) surgery in the deployed military setting have focused on the treatment of injuries using trauma databases. Little has been written on the burden of disease and the requirement for follow-up care. The aim of this analysis was to provide the most comprehensive overview of surgical workload in a contemporary role 3 MTF to facilitate future planning.Method: The operating room database and specialty surgical logbooks from a U.S.-led role 3 MTF in Afghanistan were analyzed over a 5-year period (2016-2020). These were then matched to the deployed surgical TC2 database to identify reasons for treatment and a return to theatre rate. Operative records were finally matched to the deployed Armed Forces Health Longitudinal Technology Application-Theater outpatient database to determine follow up frequency.Results: During this period, surgical treatment to the HFN represented 389/1989 (19.6%) of all operations performed. Surgery to the HFN was most commonly performed for battle injury (299/385, 77.6%) followed by disease (63/385, 16%). The incidence of battle injury-related HFN cases varied markedly across each year, with 117/299 (39.1%) being treated in the three summer months (June to August). The burden of disease, particularly to the facial region, remained constant throughout the period analyzed (mean of 1 case per month).Conclusions: Medical planning of the surgical requirements to treat HFN pathology is primarily focused on battle injury of coalition service personnel. This analysis has demonstrated that the treatment of disease represented 16% of all HFN surgical activities. The presence of multiple HFN sub-specialty surgeons prevented the requirement for multiple aeromedical evacuations of coalition service personnel which may have affected mission effectiveness as well as incurring a large financial burden. The very low volume of surgical activity demonstrated during certain periods of this analysis may have implications for the maintenance of surgical competencies for subspecialty surgeons. [ABSTRACT FROM AUTHOR]

Small Bowel Obstruction (SBO) is one of the most common diagnoses that general surgeons encounter. Adhesive disease, hernia, and neoplasm are the most common causes. A more rare cause is bezoar. A 66-year-old female with a history of prior abdominal surgery presented with clinical concern for SBO. CT scan of the abdomen and pelvis demonstrated SBO with a transition point in the left lower abdomen. The patient failed nonoperative management and was taken to the operating room for exploration. On exploration, a segment of hemorrhagic jejunum was found with an intraluminal bezoar. SBO secondary to bezoar can be managed endoscopically or operatively depending on location and size of the stone. Operative intervention can vary between laparoscopic milking of the bezoar distally, enterotomy with stone extraction, or bowel resection and anastomosis. This case illustrates the importance of maintaining a broad differential for common surgical disease processes. [ABSTRACT FROM AUTHOR]

Introduction: Inflatable penile prosthesis (IPP) is commonly performed in a hospital or ambulatory setting which involves overnight stay. However, recent literature has demonstrated that IPP surgery is increasingly being performed as same-day procedures in outpatient settings with patients not requiring overnight stay. Objective: We sought to investigate the rate of complications following day surgery insertion of an IPP. The following was collected within six weeks of their procedure, 1. infection, 2. hospital admission, 3. emergency/urgent care visits, and 4. additional prescription for analgesia. Methods: A prospective study is being performed since March 2023 of all patients undergoing day surgery insertion of an IPP at Men's Health Clinic Manitoba (MHC). MHC is an outpatient ambulatory surgical centre. Only patients that are classified as ASA 1 or 2 and suitable for day surgery are deemed eligible for surgery at MHC. Patients are enrolled and consented on the day of the procedure. Patients were prescribed Bactrim BS BID two days prior to surgery along with a Dexedin/Hibiclens wash. Vancomycin and Gentamycin were given pre-operatively. Intraoperative Irricept wash was used during the case for irrigation and implant prep. All procedures involved a three-piece prosthetic device and were performed under spinal anesthesia with an infrapubic approach, with patients discharged with a catheter and a drain. Post-operatively, Gabapentin, Celebrex and Tylenol were given for analgesia. Results: Currently, 15 patients are enrolled in this study with a mean patient age +/- SD of 64.3 +/- 8.2 years. All procedures were performed successfully with no intra-operative complications. The mean procedure length defined as time from of incision to when the dressing is placed on the surgical wound was 70.7 +/- 19.8 minutes. The mean post-operative duration of stay defined as patient entry into post-operative recovery room to time they leave the clinic was 135.6 +/- 78.8 minutes. Patients were cleared for device after six weeks. Thus far, no patients have required hospital admission or emergency room visits, nor have there been any documented cases of post-operative infection. 20% of the patients have required additional post-operative analgesia (n=3). Conclusions: This study will aim to evaluate whether outpatient IPP implantation can yield a similar complication risk to those performed in an inpatient hospital setting. If successful, our findings could help increase accessibility and reduce wait times for patients as they could avoid limited hospital operating room use. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific. [ABSTRACT FROM AUTHOR]

Objectives: To assess the complications that have occurred in a small volume centre. Methods: The andrology unit started to perform penile prosthesis implant after a programmed organization five years ago, two urologist/andrologist were working together. Prospective data of consecutive patients were included from 2017 to 2021. The following characteristics were collected: date of birth, chronic diseases, year of beginning of (erectile dysfuction) ED and the cause, treatments received, toxic habits, American Society of Anesthesiologist score, height and weight, date of the surgery, type of implant. Complications were collected as local: haematoma, infection; difficulties to learn to use it, limited use of the device. Descriptive analysis: mean and range and percentage. Results: 20 male patients were collected. Mean age was 62 years (49-79). By cause of ED: 5 radical pelvic surgery, 3 multifactorial, 2 vascular, 1 diabetes, 1 peyronie disease, 6 unknown, 1 medullary lesion. Seven patients have concomitant peyronie disease. By chronic disease: 14 have hypertension, 8 diabetes, 7 obese, 10 overweight. 12 were activo or ex smokers. 2 were replacements and 18 first-implant surgeries. By type of implant we performed: 3 semirrigid, 7 2-piece and 10 3-piece. Complications: 1 patients died due to previous oncological disease, 1 required to extract the device, 4 peno-escrotal haematoma without requiring drain, 3 reported difficulties to learn how to use it and 9 lack of use. The pandemic period, limited operating room available and reduced budget are the main enemies to increase the volume of implants. Conclusions: Few complications were reported in our small volume center. A step period of surgeries and small group of surgeons are the key of the results. Conflicts of Interest: None. [ABSTRACT FROM AUTHOR]

In this paper, we present a patient who was treated for a pontine abscess at our institution. This patient underwent sub-occipital craniotomy for microscopic abscess drainage after which cultures grew Streptococcus intermedius. She was treated with antibiotics but failed to show clinical improvement and was taken back to the operating room for repeat abscess drainage. Clinical improvement was seen after the second operation. This case report describes open surgical technique as a safe and effective way of treating brainstem abscess. [ABSTRACT FROM AUTHOR]

Keywords: Lung cancer; Localization; Sublobar resection EN Lung cancer Localization Sublobar resection 1 2 2 02/07/23 20230101 NES 230101 A hybrid operating room (OR) is an OR that uses advanced imaging techniques, such as multidetector computed tomography (CT), cone-beam computed tomography (CBCT), fluorescence imaging and magnetic resonance imaging [[1]]. Yang I et al. i [[2]] reported a feasibility study of single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid OR. [Extracted from the article]

Penile rings may be used to enhance sexual function. Prolonged constriction greater than 30 minutes may lead to pain, edema and ultimately ischemic end organ damage. Failure to remove the ring warrants prompt evaluation and can be a surgical emergency. The purpose of this video abstract is to review and demonstrate the management strategies to remove a constricting penile ring. Conservative interventions which can be attempted at the bedside are reviewed. These include but are not limited to sliding the penile ring off of the penis using available lubrication as well as cutting the rings using pliers or bolt cutters. Interventions performed under general anesthesia include repeated attempts at sliding off or cutting the ring, and when these maneuvers fail, utilization of mechanical drills or saws may be indicated. The case presented is a 41 year old gentleman who presented with a thick silver metallic ring placed on the base of his penis. The penis had been entrapped for greater than 24 hours. Conservative measures at the bedside were not successful and the ring was ultimately removed in the operating room using a microsurgical saw. The patient experienced a complete cosmetic recovery and did not experience any long-term detriment to his voiding habits. Prolonged penile entrapment by placement of a constricting ring risks ischemic end organ damage and is a rare surgical emergency. The conservative and more invasive management approaches are demonstrated in this video. No [ABSTRACT FROM AUTHOR]

Background: Cancellation of elective operations is a sensitive indicator of operating room management. It results in loss of time, resources and affects quality of care. Operating room cancellation of elective operations is defined as cases that appeared in the definitive operative room list that ultimately were not performed on that day. Objectives: To measure cancellation rate at Cardiothoracic AinShams University hospital, Egypt and to identify causes and factors associated to cancellations. Methods: Cross-sectional study that included 254 operations in all operating rooms of Cardiothoracic Ain Shams university hospital which provides specialized tertiary level of care. Results: The overall cancellation rate is 21.7%, The most frequent cause of cancellation is standby operations accounting for 29.4%. Pareto chart shows that vital few causes are "patient prepared as stand by", "previous long operation", "change in Patient's clinical status", "equipment failure" and "ICU bed unavailable". These causes are responsible for 80% of cancellations. Conclusion and Recommendation: The avoidable causes of the problem should be addressed. Policy changes are recommended as well as continuous documentation and analysis of cancellation and its causes. Periodic awareness lectures for health care providers are suggested. [ABSTRACT FROM AUTHOR]

Background: Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuraxial block is used for postoperative pain management and decrease analgesic use. Objective: To compare the analgesic duration of intravenous and perineural administration of Dexamethasone in interscalene block during arthroscopic shoulder surgery. Patients and Methods: Interventional randomized Double-Blind Study. This study was conducted in Ain Shams University Hospitals’ operating rooms throughout six months. In our study, 60 patients were randomly divided into two equal groups: Group A (30 patients): Block with 20 ml Bupivacaine 0.5% (þ 2ml Dexamethasone ‘8 mg’) & 5 ml normal saline was injected IV. Group B (30 patients): Block with 20 ml Bupivacaine 0.5% (þ 2ml normal saline) & 5 ml Dexamethasone ‘8 mg’ was injected IV. Results: Our study showed that addition of 8mg dexamethasone to bupivacaine in interscalene brachial plexus nerve block prolongs post-operative analgesia & reduced numbers of rescue analgesia doses more than injecting dexamethasone intravenously. Conclusion: Addition of perineural dexamethasone to bupivacaine in interscalene brachial nerve block prolongs post-operative analgesia & reduced numbers of rescue analgesia doses more than injecting dexamethasone intravenously. Dexamethasone was seen to be a potent adjunct to local anaesthetic to prolong post-operative analgesia with negligible side effects. [ABSTRACT FROM AUTHOR]

Background: Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, Email: predictable recovery with minimal post-operative sequels. Aim of the Work: to study the effect of dexemdetomidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. Patients and Methods: In our study, 50 patients were randomly divided into 2 equal groups. group DF received dexmedtomidine loading dose 1μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery. And group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results: Our study showed that dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines, and propofol. Conclusion: dexmedetomidine in combination with fentanyl is useful to provide conscious sedation for non operating room procedures in adults and it may be a valuable alternative to ketamine. [ABSTRACT FROM AUTHOR]