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Purpose: Nurses routinely assess respiration of hospitalized children; however, respiratory rate measurements are technically difficult due to rapid and small chest wall movements. The aim of this study is to reveal the respiratory status of small children undergoing minor surgery with load cells placed under the bed legs, and to test the hypothesis that respiratory rate (primary variable) is slower immediately after arrival to the ward and recovers in 2 h., Methods: Continuous recordings of the load cell signals were performed and stable respiratory waves within the 10 discriminative perioperative timepoints were used for respiratory rate measurements. Apnea frequencies were calculated at pre and postoperative nights and 2 h immediately after returning to the ward after surgery., Results: Continuous recordings of the load cell signals were successfully performed in 18 children (13 to 119 months). Respiratory waves were appraisable for more than 70% of nighttime period and 40% of immediate postoperative period. There were no statistically significant differences of respiratory rate in any timepoint comparisons (p = 0.448), thereby not supporting the study hypothesis. Respiratory rates changed more than 5 breaths per minute postoperatively in 5 out of 18 children (28%) while doses of fentanyl alone did not explain the changes. Apnea frequencies significantly decreased 2 h immediately after returning to the ward and during the operative night compared to the preoperative night., Conclusion: Respiratory signal extracted from load cell sensors under the bed legs successfully revealed various postoperative respiratory pattern change in small children undergoing minor surgery., Clinical Trail Registration: UMIN (University Hospital Information Network) Clinical Registry: UMIN000045579 ( https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052039 )., (© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Background: To investigate minor procedures performed in general practice, to alleviate the burden on the economy, patients and secondary care physicians., Aims: To determine the range of minor surgical procedures performed in a single group general practice, subsequent referrals made to secondary care, follow-up surgical procedures required and post-operative complications within a patient group., Methods: Retrospective data collection from the electronic records of a single group general practice consisting of 5101 active patients within the previous 12 months. Through use of Socrates software program and statistical analysis, patients were stratified into demographics, including, age, gender, the cost of the procedure, the type of procedure being carried out, the post-operative referral rate to secondary care and any subsequent procedures required. The patients were excluded if their minor procedure was classified as a joint injection., Results: 133 procedures were carried out over the 12-month period. Of these patients, the majority were male, and the mean age was 44 years old. The most common procedures included the removal of ingrown toenails, lesion excisions and punch biopsies. Histological analysis was done on biopsies, with a low rate of misdiagnosis pre-operatively. Additionally, there were minimal referrals and no complications recorded., Conclusions: This study has demonstrated the ability for minor surgery to be safely carried out in primary care. The integration of general practice, general surgery and plastic surgery could provide a higher level of patient care and exchange of skills to help reduce waiting lists and alleviate the burden secondary care., (© 2022. The Author(s).)

Background: Although opioids are effective for neonatal postoperative pain management, cumulative opioid exposure may be detrimental. Pain management practices vary among providers, but practice guidelines may promote consistency and decrease opioid use., Purpose: To develop a pain management guideline (PMG) for neonates undergoing minor surgical procedures with the overarching goal of reducing opioid use without compromising the pain experience. The specific aim was for neonatal intensive care unit providers to adhere to the PMG at least 50% of the time., Methods: An interdisciplinary pain and sedation work group in a large level IV neonatal intensive care unit developed an evidence-based PMG for minor surgical procedures. Nurses and providers were educated on the new guideline, and rapid cycle quality improvement methodology provided an opportunity to adjust interventions over 3 months., Results: The PMG was used for 32 neonates following minor surgical procedures: 18 (56%) of the neonates received only acetaminophen and no opioids, 32% required 0.15 mg/kg dose equivalent of morphine or less, and only 9% required more than 0.15 mg/kg dose equivalent of morphine. Overall, opioid use decreased by 88% compared with rates before implementation of the PMG. Providers adhered to the PMG approximately 83.3% of time., Implications for Practice: A PMG is a systematic approach to direct nurses and providers to appropriately assess, prevent, and treat neonatal pain following minor surgery while alleviating opioid overuse., Implications for Research: Future research should focus on determining and mitigating barriers to nurse/provider use of the PMG and developing and implementing a PMG for major surgical procedures., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 by The National Association of Neonatal Nurses.)

Purpose: The purpose of the study was to conduct validity and reliability testing of the Turkish version of the Parent Self-Efficacy Scale for Child Autonomy toward Minor Surgery (PSESCAMS)., Design: The research is a methodological study., Methods: Data were collected using an Introductory Form and the PSESCAMS. Factor analysis, Cronbach's alpha, and item-total score analysis were used for the data analysis., Findings: The scale consisted of 18 items and four subscales. The Cronbach's alpha coefficient for the overall scale was 0.95, and the Cronbach's alpha values for the subscales were 0.64-0.92. The total factor loading was > 0.45 for both exploratory and confirmatory factor analyses. GFI, AGFI, and CFI were > 0.90, RMSEA was 0.06., Conclusion: PSESCAMS was found to be a valid and reliable measurement tool for Turkish culture., (Copyright © 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Although routine coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) are performed before surgery to identify the risk of perioperative bleeding, bleeding complications are rare in minor surgeries, and false-positive results are often observed. Therefore, this study aimed to analyze the common causes of abnormal results of preoperative coagulation tests in previously healthy children undergoing elective minor surgery and determine the usefulness of performing these tests. Additionally, it aimed to identify the distribution of factor XII activity in children with prolonged aPTT., Methods: The medical records of 363 pediatric patients aged 0 - 18 years, who were referred to the pediatric hematology-oncology department due to abnormal preoperative coagulation tests prior to undergoing minor surgery at the Kyung Hee University Medical Center between March 2008 and October 2020, were retrospectively review-ed., Results: The majority of patients (n = 348, 96%) had prolonged aPTT, few (n = 29, 8%) had a prolonged PT international normalized ratio, and a small number (n = 14, 4%) had both prolonged PT and aPTT. On repeating the coagulation tests, 194 children showed persistent abnormal results. Of these, 184 patients underwent mixing tests, and 176 showed correction for factor deficiency (n = 26) and lupus anticoagulant positive (n = 14). Factor deficiencies included factor XII (n = 16), possibility of von Willebrand disease (vWD; n = 4), factor XI (n = 2), factor VIII (n = 1), factors IX and XII (n = 1), factor VII (n = 1), and factor V (n = 1). The severity of factor deficiency was mild (25 - 38%). One patient with factor VII deficiency received preoperative clotting factors but had postoperative bleeding requiring clotting factor replacement. Another patient with possible vWD received fresh frozen plasma after surgery and had mild symptoms. Linear regression showed no significant correlation between factor XII activity and aPTT in patients with prolonged aPTT (R2 = 0.0002, p = 0.84) or factor XII activity according to aPTT results in those with factor XII deficiency (R2 = 0.04749, p = 0.40)., Conclusions: These results suggest that coagulation tests may be selectively performed in previously healthy children undergoing minor surgery with positive bleeding and/or family history. The distribution of factor XII should be investigated further.

Aim: Minor Surgery (MS) is an ever-increasing programmed activity in Primary Health Care Centres (PHC). The aim of this study is to establish the clinical and histopathology diagnostic agreement between PHC and MS and evaluating the efficacy of this activity., Methods and Materials: A retrospective, observational, and reliability study was performed. A total of 234 patient specimens were sent to Histopathology between January 2014 and December 2018 in basic health area of San Benito-La Laguna, Santa Cruz de Tenerife. Of these, 203 specimens met criteria, with 31 being excluded due to death or absence of diagnosis. Sociodemographic and diagnostic variables were analysed, and 10 possible diagnoses were grouped into 3 categories according to their nature. Cohen kappa coefficient was used as the main evaluation measure., Results: The majority of specimens were obtained from women (51.2%), and the mean age was 52.82±17.82 years. The most frequently referred lesion was the epidermoid cyst (20.2-21.67%). A clinical-pathological agreement of 60% was obtained in Minor Surgery, with a specificity of 98.3% and a sensitivity of 61.9%. In Primary Care agreement was 36.1%, with a specificity of 98.4% and a sensitivity of 42.8%. Infectious lesions represented the largest concordance difference obtained, with 27% less in Primary Care compared to Minor Surgery., Conclusions: Minor Surgery is an effective support in the initial diagnosis of lesions referred for evaluation at Primary Care. However, it is necessary to implement improvements in diagnostic efficacy of Primary Care., (Copyright © 2020 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The provision of minor surgical services is an established part of the task profile of general practitioners (GPs) in many countries in Europe and elsewhere. This study aimed to collect data on the clinical process and outcomes for specified minor surgical procedures undertaken in Irish general practice by GPs experienced in minor surgery in order to document the scope and safety of minor surgery being undertaken., Methods: Over a six-month period, 24 GPs in 20 practices recorded data on a pre-determined list of procedures undertaken in adults (aged 18 and older); procedures for ingrown toenails were also recorded for those aged 12-18 years. Clinical data were rendered fully anonymous by the participating GPs, entered onto the Excel database template and returned to the project team monthly., Results: On average, each practice undertook 212 procedures in a six-month period. The four most frequent procedures include two relatively non-invasive procedures (cryosurgical ablation of skin lesions and aspiration and/or injection of joints) and two more invasive procedures (full thickness excision of skin lesion and shave, punch or incisional biopsy). Overall, 83.8% of relevant specimens were submitted for histology. Combining benign and malignant cases, there was an overall 87% clinical and histological concordance; 85% of malignancies were suspected clinically. A complication was recorded in 0.9% after 1 month., Conclusions: Irish GPs with experience in minor surgery can provide a range of surgical services in the community safely.

Objectives: To explore the knowledge, practice, barriers and reported self-confidence of family medicine (FM) residents in Riyadh, Kingdom of Saudi Arabia, in performing minor surgical procedures (MSP)., Methods: A cross-sectional study was conducted by distributing questionnaires to 267 family medicine residents in Riyadh, Kingdom of Saudi Arabia between May and July 2016. The questionnaire includes 7 categories with 71 questions about: knowledge, interest, experience and confidence in performing different MSPs, prior training in MSPs, perceived barriers to performing MSPs and ways to improve basic surgical skills., Results: The response rate was 71.9%. Residents had a mean knowledge score of 15.75% and a mean interest score of 10.4 out of 12. Out of 23 MSPs surveyed, residents had performed a mean average of 9.18. The mean of residents' confidence scores was 26.6 out of 63. The most common barrier to performing MSPs was a lack of training (n=115; 59.9%), while the least common barrier was a lack of interest (n=113; 58.9%). Participants consider intensive education to be the the most effective way to improve their performance, while increasing the duration of some rotations found to be the least effective way for improvement., Conclusion: A majority of FM residents were interested in MSP, but had low perceived knowledge, low reported confidence and infrequent practice. Family medicine programs should provide continuous standardized training by a qualified and interested trainer within the FM setting.

Purpose: Procedural sedation is commonly performed in the emergency department (ED). Having safe and fast means of providing sedation and anxiolysis to children is important for the child's tolerance of the procedure, parent satisfaction and efficient patient flow in the ED., Objective: To evaluate fasting times associated with the administration of intranasal midazolam (INM) and associated complications. Secondary objectives included assessing provider and caregiver satisfaction scores., Methods: A prospective observational study was conducted in children presenting to an urban pediatric emergency department who received INM for anxiolysis for a procedure or imaging. Data collected included last solid and liquid intake, procedure performed, sedation depth, adverse events and parent and provider satisfaction., Results: 112 patients were enrolled. The mean age was 3.8 years. There were no adverse events experienced by any patients. Laceration repair was the most common reason for INM use. The median depth of sedation was 2.0 (cooperative/tranquil). The median liquid NPO time was 172.5 min and the median NPO time for solids was 194.0 min. 29.8% were NPO for liquids ≤2 h and 62.5% were NPO for solids ≤2 h. Parent and provider satisfaction was high: 90.4% of parents' and 88.4% of providers' satisfaction scores were a 4 or 5 on a 5 point Likert scale., Conclusion: Our data suggest that short NPO of both solids and liquids are safe for the use of INM. Additionally, parent and provider satisfaction scores were high with the use of INM., (Published by Elsevier Inc.)

Background: Haemodynamic instability during the induction of anaesthesia and surgery is common and may be related to hypovolaemia caused by pre-operative fasting or chronic diuretic therapy. The aim of our prospective, controlled, randomized study was to test the hypothesis that a predefined fluid bolus given prior to general anaesthesia for minor surgery would increase haemodynamic stability during anaesthetic induction., Methods: Two hundred and nineteen fairly healthy adult patients requiring minor surgery were enrolled. All received standard treatment, including a pulse contour analysing device for non-invasive measurement of cardiac index. Infusion therapy was started in all patients at induction. The intervention group (106 patients) was randomized to receive an additional fluid bolus of 8 mL/kg Ringer's acetate solution before the induction of anaesthesia. The primary endpoint was the incidence of haemodynamic instability, defined as a significant reduction of blood pressure or cardiac index during induction of anaesthesia., Results: The interventional group had a lesser incidence of haemodynamic instability during induction (41.5% vs 56.6%, P = .025). This group also had higher cardiac index, stroke volume index, systolic and mean blood pressure and a greater left ventricular end-diastolic area., Conclusions: A fluid bolus prior to anaesthesia reduced the incidence of haemodynamic instability during induction of general anaesthesia. The total fluid volume was slightly greater in the intervention group compared to the control group (1370 ± 439 mL vs 1219 ± 483 mL, P = .007). We conclude that a defined fluid bolus can help stabilizing haemodynamics in patients undergoing general anaesthesia., (© 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Introduction: To work in the National Health Service (NHS) as a dentist, the practitioner needs to be on the UK dental "performer's list". To apply for access to this list and work as a General Dental Practitioner (GDP), dentists must be qualified from the European Economic Area (EEA) or, those trained in the UK, must undertake Dental Foundation Training (DFT). Dentists interested in further taught learning or pursuing specialist training must continue working as "Dental Core Trainees" (DCTs). Most of these jobs are available in Oral and Maxillofacial Surgery (OMFS) Units and require dentists to undertake unsupervised surgical procedures. It is currently estimated that over 400 "junior dentists" undertake DCT a year. It is the aim of this study to ascertain whether confidence in simple surgical procedures improves when compared to GDPs of similar experience., Methods: One hundred and two junior dentists, 34 DFTs, 20 DCT1s, 21 DCT2s and 27 second and third year post-DFT GDPs all working across the Midlands, UK, had Likert scale responses about confidence in 14 minor surgical skills assessed. Results were analysed to ascertain whether gender, year group and number of extractions had any effect on confidence., Conclusions: We conclude that confidence in minor surgical procedures improves significantly when undertaking DCT OMFS posts, with the most significant improvement in confidence occurring within the first 6 months. Dental Core Trainees become significantly more confident in their surgical ability within the first 6 months when compared to GDPs with longer postgraduate experience., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Nowadays minor surgery is performed by di- fferent professionals at primary as well as specialized care. Being a healthcare technology, minor surgery must be assessed in order to achieve an organizational efficiency. User's satisfaction must be one of the quality criteria. That is why an analysis of the quality perceived by users according to where minor surgery takes place and who carries it out is made., Methods: This study explores, conducting telephone surveys, the satisfaction of a sample of 275 minor surgery patients of two hospitals and three primary healthcare areas of Asturias. The survey is based on the SERVQUAL model adapting the one used by the Spanish Ministry of Health in 1977. A behavior pattern of satisfaction was established in terms of the variables that increase or diminish it., Results: In every item, satisfaction was perceived as good or very good at least in 84% of the survey users and in the majority was over 95%. There was a significant difference in favour of primary care with respect to waiting time (p less than 0,001), explanations received (p=0,002) and security perceived (p=0,015). The more explanatory variables of excellent satisfaction were the sense of security and the staff attention. The kind of professional did not represent a conditioning factor and the level of healthcare only appeared to be so among those who did not feel safe showing to be less satisfied those treated in primary care., Conclusions: Good quality perceived by users does not seem to be penalized by the fact that minor surgery can be carried out at different healthcare levels or which specialist performs it., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The Internet is used worldwide, but its effect on hospital selection of minor surgical disease has not hitherto been thoroughly studied. To investigate the effect of the Internet dissemination on hospital selection of minor surgical disease and information affecting selection, we conducted a survey of patients who underwent laparoscopic surgery from January 2016 to April 2017. We analyzed the questionnaire responses of 1916 patients. Over 80% of patients in all groups selected the hospital based on Internet information. Among patients aged over 60 years, 65.1% selected the hospital based on Internet information. With regard to hospital selection factors, the highest number of responses was for sophisticated surgical treatment (93.1%). The second highest was for a simplified medical care system (33.0%); third was a comprehensive nursing care system (18.1%). Among responses about surgical treatment, the most were obtained for short operation time and fewer hospitalization days (81.5%)., (Copyright © 2018 John Wiley & Sons, Ltd.)

Objective: To compare the health related quality of life (HRQoL) perceptions in parents and physician regarding the patient undergoing ambulatory surgery, and to analyse the evolution of HRQoL before and after the ambulatory surgery., Method: 36 patients underwent ambulatory surgical interventions taken part in this study. The questionnaires EQ-5D-Y were administered to the patients and questionnaires EQ-5D-Y proxy to parents and physicians. Variable TTO was used., Results: Statistical differences were found at baseline between answers of patients and physicians (p < 0.05). However, after surgery, answers of patients and proxies were similar., Conclusions: Paediatric patients undergone to a minor surgery improve HRQoL after the operation and this improvement goes on a month after the surgery., (Copyright: © 2018 SecretarÍa de Salud)

Importance: Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery., Objective: To determine the incidence of new persistent opioid use after minor and major surgical procedures., Design, Setting, and Participants: Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure). For patients filling a perioperative opioid prescription, we calculated the incidence of persistent opioid use for more than 90 days among opioid-naive patients after both minor surgical procedures (ie, varicose vein removal, laparoscopic cholecystectomy, laparoscopic appendectomy, hemorrhoidectomy, thyroidectomy, transurethral prostate surgery, parathyroidectomy, and carpal tunnel) and major surgical procedures (ie, ventral incisional hernia repair, colectomy, reflux surgery, bariatric surgery, and hysterectomy). We then assessed data for patient-level predictors of persistent opioid use., Main Outcomes and Measures: The primary outcome was defined a priori prior to data extraction. The primary outcome was new persistent opioid use, which was defined as an opioid prescription fulfillment between 90 and 180 days after the surgical procedure., Results: A total of 36 177 patients met the inclusion criteria, with 29 068 (80.3%) receiving minor surgical procedures and 7109 (19.7%) receiving major procedures. The cohort had a mean (SD) age of 44.6 (11.9) years and was predominately female (23 913 [66.1%]) and white (26 091 [72.1%]). The rates of new persistent opioid use were similar between the 2 groups, ranging from 5.9% to 6.5%. By comparison, the incidence in the nonoperative control cohort was only 0.4%. Risk factors independently associated with new persistent opioid use included preoperative tobacco use (adjusted odds ratio [aOR], 1.35; 95% CI, 1.21-1.49), alcohol and substance abuse disorders (aOR, 1.34; 95% CI, 1.05-1.72), mood disorders (aOR, 1.15; 95% CI, 1.01-1.30), anxiety (aOR, 1.25; 95% CI, 1.10-1.42), and preoperative pain disorders (back pain: aOR, 1.57; 95% CI, 1.42-1.75; neck pain: aOR, 1.22; 95% CI, 1.07-1.39; arthritis: aOR, 1.56; 95% CI, 1.40-1.73; and centralized pain: aOR, 1.39; 95% CI, 1.26-1.54)., Conclusions and Relevance: New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders. This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.

Aim: To describe the minor surgery (MS) characteristics in a Primary Care (PC) centre, and to evaluate the clinical pathological concordance and patient satisfaction., Design: Descriptive and retrospective study., Setting: Primary Care, urban health care centre, Almería, Spain., Participants: The population were the patients belonging to urban Primary Health Care centre, referred by their family physicians or paediatricians for the performing of MS during year 2013, and who consented to the intervention. A sample of 223 patients was obtained., Main Measurements: Variables analysed were: sex, age, locations of the lesions, type of intervention, clinical diagnosis, histopathology diagnosis, complications, and patient satisfaction. The data were extracted from the medical history, the histopathology reports, and by using a satisfaction questionnaire completed by post or telephone by the patients., Results: The population consisted of 53.8% males, and had a mean age of 51.12 years (SD 19.02). The location of the most intervened lesions was in the head (35.4%). Electro-surgery was the most used procedure (62.8%), with only 16.9% of the lesions being biopsied, of which the most frequent was fibroids (32.3%). The clinical pathological concordance was >80% and the Kappa index was 0.783 (P<.001). The complications presented were low. The patient's satisfaction was high., Conclusions: Although a simple MS technique like electro-surgery has become more extensive, MS in PC remains safe and satisfactory for the user., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

Background: Minor surgery is a well-established part of family practice, but its safety and cost-effectiveness have been called into question., Aim: To audit the performance of GP minor surgeons in three different settings., Design and Setting: A community-based surgery audit of GP minor surgery cases and outcomes from three settings: GPs who carried out minor surgery in their practice funded as enhanced (primary care) services (ESGPs); GPs with a special interest (GPwSIs) who worked independently within a healthcare organisation; and GPs working under acute trust governance (Model 2 GPs)., Method: An audit form was completed by volunteer GP minor surgeons. Data were collected about areas of interest and aggregated data tables produced. Percentages were calculated with 95% confidence intervals (CIs) and significant differences across the three groups of GPs tested using the χ(2) test., Results: A total of 6138 procedures were conducted, with 41% (2498; 95% CI = 39.5 to 41.9) of GP minor surgery procedures being on the head/face. Nearly all of the samples from a procedure that were expected to be sent to histology were sent (5344; 88.8%; 95% CI = 88.0 to 89.6). Malignant diagnosis was correct in 69% (33; 95% CI = 54.2 to 79.2) of cases for ESGPs, 93% (293; 95% CI = 90.1 to 95.5) for GPwSIs, and 91% (282; 95% CI = 87.2 to 93.6) for Model 2 GPs. Incomplete excision was significantly more frequent for ESGPs (17%; 9; 95% CI = 7.5 to 28.3, P<0.001). Complication rates were very low across all practitioners., Conclusion: GP minor surgery is safe and prompt. GPs working within a managed framework performed better. Consideration needs to be given on how better to support less well-supervised GPs., (© British Journal of General Practice 2016.)

Background: Nitrous oxide's safety and efficacy for minor procedures is an alternative to general anesthesia, complex sedation protocols, or local anesthetic alone., Methods: A retrospective review of prospectively-collected data (2000-2012) identified 1,058 children who received single-agent nitrous oxide for minor surgery., Results: Children (n = 1,058, male 42 %, female 58 %) aged 1-23 years (mean = 9.8 + 5.1 years) were identified. Only nine children (0.9 %) fasted. ASA status was I-II in 1,053 (99.5 %) of patients; five (0.5 %) had an ASA III. There were no major complications (desaturation, emergency admission, apnea, airway obstruction, bradycardia) or aborted procedures. Minor complications occurred in 1.8 %; there was no association between these complications and ASA, fasting status or maximum nitrous oxide percentage administered (all p > 0.05). Post-operatively, 98 % of patients denied getting an injection. Eighty-two percent reported mild or no procedural pain., Conclusion: This is the longest reported study using non-anesthesiologist-administered nitrous oxide as a single-agent for minor surgical procedures. The technique provides safe sedation and excellent amnesia, allowing pain and anxiety-reduced surgery with no fasting or postoperative monitoring.

Objective: To determine the effect of surgical invasiveness on plasma levels of arginine, citrulline, ornithine, and nitric oxide (NO) in humans., Background: Surgical trauma may have a profound effect on the metabolism of NO. However, human studies reported both increased and decreased NO levels after hemorrhagic shock. Arginine, citrulline, and ornithine are key amino acids involved in NO metabolism, but studies evaluating these amino acids together with NO and during 2 types of surgery are lacking. This study tests the hypothesis that major surgery has a more profound effect on plasma levels of arginine, citrulline, NO, and ornithine than minor surgery., Methods: Fifteen patients undergoing minor surgery (vulvectomy) and 13 patients undergoing major surgery (laparotomy) were prospectively followed up for 4 days. Plasma was collected for evaluation of levels of arginine, citrulline, NO, and ornithine., Results: Throughout the experiment, arginine levels did not significantly differ between experimental groups. Perioperative plasma citrulline levels were significantly lower in the laparotomy group than in the vulvectomy group, whereas both groups showed a decrease in citrulline levels at the end of the operation and 24 hours postoperatively. Roughly the same pattern was seen for plasma NO and ornithine levels. However, ornithine levels in the laparotomy group showed a more drastic decrease at the end of the operation and 24 hours postoperatively than citrulline and NO levels., Conclusions: The level of surgical invasiveness has the most profound effect on plasma levels of ornithine. In addition, heavier surgical trauma is paired with lower postoperative levels of citrulline and NO metabolites than lighter surgery. It is suggested that surgical trauma stimulates the laparotomy group to consume significantly more ornithine, possibly for use in wound healing.

Background and Objectives: Preoperative tests aim to reduce morbidity and mortality of surgical patients, cost of perioperative care, and preoperative anxiety. Clinical evaluation allows defining the need for additional tests and strategies to reduce the surgical-anesthetic risk. The aim of this study was to evaluate the benefit of routine preoperative testing of low-risk patients undergoing minor and medium surgical procedures., Methods: A descriptive cross-sectional study of 800 patients seen at the preanesthetic assessment department of Hospital Santo Antonio, Salvador, BA. Patients with physical status ASA I, aged 1-45 years and scheduled to undergo elective minor and medium surgeries were include in the study. We evaluated changes in blood count, coagulation profile, electrocardiogram, chest X-ray, blood sugar, kidney function, sodium and potassium levels, and eventual change in clinical approach occurring due to these changes., Results: Of 800 patients evaluated, a blood count was performed in 97.5%, coagulation in 89%t, electrocardiogram in 74.1%, chest X-ray in 62%, fasting glucose in 68%, serum urea and creatinine in 55.7%, and plasma levels of sodium and potassium in 10.1%. Of these 700 patients, 68 (9.71%) showed changes in preoperative routine tests and only 10 (14.7%) of the patients with abnormal tests had a preoperative modified approach (i.e., new tests ordered, referral to a specialist or surgery postponement). No surgery was suspended., Conclusion: We found that preoperative additional tests are excessively ordered, even for young patients with low surgical risk, with little or no interference in perioperative management. Laboratory tests, besides generating high and unnecessary costs, are not good standardized screening instruments for diseases., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)

Background: This study investigates whether long-term treatment with an angiotensin-converting enzyme inhibitor (ACEI) impairs the haemodynamic regulation during total intravenous anaesthesia (TIVA) for minor surgery., Methods: In a prospective, two-armed observational study, 36 patients undergoing TIVA for minor surgery were studied. Seventeen were taking ACEIs regularly but no other antihypertensive medication (ACEI group); 19 patients without any cardiovascular medication served as controls (non-ACEI group). Haemodynamic variables were measured every minute during induction and every 5 min during surgery. The plasma levels of renin, angiotensin II, vasopressin and catecholamines were measured before and 18 min after the induction of anaesthesia., Results: The mean arterial pressure decreased to the same extent in both the groups during the induction of TIVA. There were also no differences between the groups regarding the heart rate, systolic and diastolic arterial pressure, as well as the use of vasoconstrictors, and fluids during induction and throughout surgery. In the ACEI group, the plasma renin concentration was higher at baseline and after the induction of anaesthesia presumably due to the interruption of the negative renin-angiotensin feedback loop (P<0.05). Angiotensin II increased only in the non-ACEI group (6.2 ± 2.2 before vs. 9.6 ± 3.5 pg/ml after induction; P<0.05). In both groups, the plasma norepinephrine concentration decreased after the induction of TIVA (P<0.05). Plasma vasopressin and plasma epinephrine concentrations did not change in either group., Conclusion: Long-term ACEI treatment does not further aggravate the blood pressure decrease under TIVA during minor surgery, provided the induction procedure is slow, the patient is kept well hydrated and vasoconstrictors are promptly applied., (© 2011 The Authors. Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.)

The use of sterile gloves as part of asepsis during surgery goes back to the end of the nineteenth century, but now the preventive value of this measure during minor surgery is questioned. One randomized study showed no difference in wound infection rates whether sterile or nonsterile gloves were used for repair of uncomplicated lacerations of the skin. An observational and a retrospective study in minor dermatological surgery confirm that the use of sterile or nonsterile gloves makes no difference for excisions of tumours as long as no reconstructions of the skin are performed. However, in more complicated minor dermatological surgery, 80% less wound infections were observed when sterile gloves were used. In conclusion, the available evidence is too limited to change the recommendation to use sterile gloves for minor surgery.

According to the practice guideline of the Dutch Workingparty on Infection Prevention (WIP) sterile gloves have to be worn during minor surgery by the general practitioner. This is based on the microbiological principles of Spaulding and is not supported by other evidence. Current literature suggests that using clean, nonsterile gloves, instead of sterile gloves, does not result in a greater risk of wound infection in primary closed wounds after minor surgery. Also, in daily practice, only 24% of general practitioners actually wear sterile gloves. We therefore propose to modify the guideline: using clean, nonsterile gloves during minor surgery is sufficient.

Report awarded first prize in the Fourth Officially Announced Contest for the Betadine Prizes in 2009. This report details the operating protocol for the Health Center Salud II in the Ensanche neighborhood in Pamplona where the antiseptic preferred for use is this product.

The effect of severe pain and its hazardous stress-related cardiocirculatory consequences have been well documented for the perisurgical setting. Independently of surgical intervention however, even short and simple measures (e.g. thorax drain removal, repositioning a limb fracture) and longer diagnostic procedures such as MRI are potentially very painful or stressful to the patient. Though longer diagnostic procedures are frequently supported by systemic medication, short interventions regularly lack this aspect. Specific challenges result from the need to counteract sometimes great changes in pain intensity. Moreover procedural analgesia represents a multidisciplinary measure not restricted to anaesthesiology, as most of these measures are performed without anaesthesia. To avoid endangering the patient, the choice of drugs and patient monitoring have to meet certain professional and technical standards. Competence in respiratory management is of paramount importance. This paper outlines these requirements and serves as an orientation outside the anaesthesiological speciality.

Background: Minor surgical procedures performed under local anesthesia are the most common surgical procedures routinely carried out in every plastic surgical practice., Objective: The objective was to evaluate the prevalence of immediate local and systemic complications of such procedures., Methods and Materials: Records of 2,600 procedures performed under local anesthesia on 2,431 patients between November 2001 and May 2004 were reviewed. Local anesthetic complications and all surgical-related complications were recorded., Results: Procedure-related complications were 51 presyncope (1.9%), 4 true syncope (0.16%), 2 minor burns (0.08%), and 1 facial laceration (0.04%)., Conclusions: True allergic reaction to lidocaine is extremely rare and none was noted in our study. Most patients who claimed that they had suffered from such a reaction were probably experiencing symptoms related to intravenous injection administration, a reaction to the added vasoconstrictor (adrenaline), or a vasovagal reaction, which is a common trait among young adults.

Background: Procedural sedation is increasingly more common in pediatric emergency departments. We report our experience with intranasal midazolam (INM) using a unique atomization delivery device, specifically the efficacy and safety of this method of sedation., Methods: We performed a retrospective chart review of children who received INM sedation in the emergency department from April 1, 2005, through June 30, 2005. All children aged 1 to 60 months who received INM as the initial means of sedation were eligible for the study. Patients were excluded if they were older than 60 months., Results: There were 205 patients who received INM for sedation and who met the study criteria. The mean age was 31.3 +/- 13.2 months (range, 1.5-60 months). The mean and median initial INM dose was 0.4 mg/kg (range, 0.3-0.8 mg/kg). Laceration repair was the most common procedure necessitating sedation (89%). The median degree-of-sedation score achieved was 2.0 (anxiolysis). Eleven patients (5.4%; 95% CI, 3%-9%) required an additional sedative to complete the procedure. Ten of the 11 patients received ketamine as the adjunctive sedative, and 1 patient required additional INM. The average time of last oral intake to start of sedation was 3.5 hours (range, 0.5-10.0 hours). Thirty six patients (18%) were NPO for 2 hours or less. There was 1 adverse event (0.5%; 95% CI, 0%-3%). This was a minor desaturation episode following ketamine administration requiring brief blow by oxygen. There were no adverse events (0%; 95% CI, 0%-2%) in patients who received INM alone., Conclusion: We conclude that atomized INM is effective in providing anxiolysis to children undergoing minor procedures in the pediatric emergency department. We are encouraged that no adverse events occurred with the use of INM alone despite relatively short fasting times.

Objective: To determine the value of routine pre-operative investigations in children scheduled to undergo routine minor elective surgical procedures under general anesthesia., Methods: We conducted a retrospective chart review of 342 children who presented for elective minor surgical procedures in the Division of Pediatric Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2004 to December 2004. Pre-operative investigations (full blood count, urea and electrolytes) were analyzed in terms of frequency of abnormalities and whether or not the preoperative management was changed when the results were abnormal. We also examined the relationship between abnormal results and complications and the costing of the tests., Results: During a one year period, 342 children were admitted to the pediatric surgical unit for routine minor elective surgery. A total of 684 tests were performed, of which 63 (9.2%) were abnormal. Nine children had abnormal hemoglobin results (the lowest was 8.5 g/dL). Thirty-two children had clinically insignificant platelets or white blood cell counts. There were 22 abnormal electrolyte results. These abnormalities were very insignificant. No case was postponed because of these investigations. Three complications arose, none of which could have been predicted by the pre-operative screening tests., Conclusion: This results indicate that pre-operative blood testing in children undergoing minor surgical procedures has very limited value in patient management. It may be unpleasant for the patient and parents. A careful history and physical examination are of greater importance than routine laboratory test in determining a child's fitness for surgery.

Background: This prospective study was designed to compare the incidence of urinary retention after spinal anesthesia between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in patients who underwent minor orthopedic and general surgeries., Methods: Eighty patients aged 18-40 were randomly assigned to receive either hyperbaric bupivacaine or tetracaine for spinal anesthesia. Intravenous fluids were administered for maintenance of basal requirement, replacement of blood loss and prevention of hypotension. The highest level of analgesia, regression time of sensory block to L5 level, length of time from spinal injection to spontaneous urinary voidance, and volume of perioperative fluid administered were recorded., Results: Of the 80 patients who received either hernioplasty, fistulectomy, hemorroidectomy or orthopedic surgery, two were catheterized (2.5%) because of urinary retention. They were administered less than 800 mL of fluid intraoperatively. Intraoperative blood loss was less than 100 mL in all cases. There were no statistical differences in demographic data, types of surgery, sensory blockade and perioperative fluid administration between the two groups. Although the regression time of sensory blockade with tetracaine (means +/- SD, 259.3 +/- 39.6 min) was significantly longer than that of bupivacaine (225.0 +/- 38.6 min, P < 0.01), the time elapsing from the spinal injection to the first spontaneously voiding after surgery did not show statistical difference between two groups (433.9 +/- 89.1 vs. 411.0 +/- 98.3 min, P = 0.286)., Conclusions: Our results show that, in younger surgical patients who did not receive large amount of fluid intraoperatively, the incidence of urinary retention was low, although prolonged sensory blockade by both long-acting local anesthetics was evident. Thus, urinary catheterization should not be a routine must for every patient undergoing minor surgery with long-acting spinal local anesthetics. From the viewpoint of financial expense, avoidance of complication and annoyance of urinary catheterization, careful observation of urinary bladder fullness in the form of lower abdominal distension, discomfort, bradycardia, or vomiting after surgery is superior to routine retention urinary catheterization just for ease with work in younger patients under-going minor surgery under long-acting spinal local anesthetics.

Background: The objectives of this study were to assess whether children exposed to environmental tobacco smoke (ETS) present for surgery with poorer pulmonary function, and experience a more pronounced deterioration in pulmonary function following anesthesia and surgery, than non-ETS-exposed children., Methods: Fifty-four children aged 5-15 years with a history of ETS exposure from one or both parents and 54 children with no such ETS history were included in the study. All participants were presenting for ambulatory surgery and were judged to conform to American Society of Anesthesiology class I or II. Spirometry was performed preoperatively, postoperatively in the recovery ward when the child met criteria for discharge (Aldrete score 8), and before discharge from the day ward., Results: The ETS-exposed group had a significantly lower mean preoperative peak expiratory flow rate (PEFR) (9.5 points lower percent predicted, 95% confidence interval -18.1 to -1.0, P = 0.03). Although not statistically significant, they also had lower percent predicted baseline mean values of the other spirometric variables that were measured (forced expiratory volume in 1 s -4.5%, P = 0.07; forced vital capacity -4.1%, P = 0.10; forced expiratory flow between 25% and 75%-3.6%, P = 0.44). Pulmonary function tests (PFTs) performed in recovery were between 8% and 14% worse than preoperative values, but the results were similar in the two groups of children. PFTs performed before hospital discharge demonstrated an near-complete recovery to baseline values. Again the pattern was similar in exposed and nonexposed children., Conclusions: Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia.

Objectives: We used intravenous midazolam and ketamine for children undergoing minor operative procedures with satisfactory results. We aimed to further evaluate its efficacy and adverse effects in pediatric ward setting., Methods: This was a prospective study of all children undergoing minor operations with sedation in our pediatric general and oncology wards from July 1998 to June 1999. The procedures included lumber puncture+/-intrathecal chemotherapy, bone marrow aspiration+/-trephine biopsy, central venous catheter removal, skin biopsy, or their combination. All sedation procedures were started with midazolam 0.1 mg/kg and ketamine 1 mg/kg; they were increased gradually to 0.4 and 4 mg/kg, respectively, if necessary. Heart rate and SaO2 were continuously monitored., Results: Altogether, 369 minor operations were performed in 112 patients (male:female=2:1, median age 6 years, range 5 months-17 years). All achieved adequate sedation, with 96% within 30 s and 75% required just the starting dose. Younger children required a higher dosage (p=0.003 for midazolam, p<0.001 for ketamine). The median recovery time was 87 min, with no association with age, sex, or dosage of sedation, but was longer in patients having hallucination (p=0.001). Adverse effects included tachycardia (27.9%), increased secretion (17.6%), agitation (13.6%), nausea and vomiting (9.2%), hallucination (8.7%), desaturation (8.4%), and cataleptic reaction (0.8%). All desaturation episodes were transient and responded to oxygen supplement alone. None developed bronchospasm or convulsion. Some adverse effects were dose-related. Half of the children who received 0.3 mg/kg midazolam developed desaturation., Conclusions: Intravenous midazolam-ketamine can provide rapid, effective, and safe sedation for children undergoing minor operations in ward setting. Adverse effects are mild. Midazolam above 0.3 mg/kg should be used with caution.

The Streamlined Liner of the Pharyngeal Airway, SLIPA (Hudson RCI) is a new disposable supraglottic airway device that has no inflatable cuff and has features designed to reduce aspiration risk. This study aimed to assess the insertion success and effectiveness of the SLIPA in 60 patients who presented for elective surgery. Ethics committee approval was obtained. Patients were excluded if they were less than 18 years, had not provided written consent or were at risk of pulmonary aspiration. The first 20 SLIPA were inserted by the principal investigator (Group A) followed by another 40 inserted by medical officers and anaesthetists of varying experience (Group B). Twenty-one males and 39 females were recruited into the study. Median time to ventilation was 20.4 seconds in Group A (range 12.9-109) and 24.8 seconds in Group B (range 8.2-82.5). Overall success rate was 100% in Group A and 92.5% in Group B. The lowest recorded SpO2 was 91% in Group B. The incidence of blood and sore throat score >3 (0-10 scale) was 23% and 7% respectively (Groups A and B). Group B reported that use of the device was very easy in 16%, easy in 76%, difficult in 5%, and very difficult in 3%. The SLIPA proved to be a reliable airway providing adequate ventilation in both spontaneous breathing and assisted respiration. Most users found the SLIPA to be easy or very easy to use.

Temporary interruption of oral anticoagulation to perform invasive procedures is a frequently occurring medical problem. There are only a few studies available on the optimal clinical approach in this situation. The published clinical studies and guidelines are summarized.

The effect of smoking for postoperative pulmonary complications (PPCs) in minor surgical patients who have an early recovery has not been evaluated. Smoking may also affect intraoperative sputum volume. We thus evaluated whether smoking had a relation to intraoperative sputum volume or PPCs in minor surgical patients. Smoking status was determined through the interviewer-assisted questionnaires. Intraoperative sputum volume was judged using the number of trials to suck up sputum from the trachea. Current and Ex-smokers were significantly more likely to have an increased intraoperative sputum volume when compared with Non-smokers (18.3% and 17.9% vs. 9.4%) although the relationship between smoking and PPCs was not demonstrated. In the multivariate models, Current and Ex-Smokers was identified as an independent risk factor of an increased intraoperative sputum volume (odds ratio, 2.7; 95% confidence interval, 1.6-4.6). The patients with < 2 months smoking cessation were more likely to have an increased intraoperative sputum volume. In conclusion, smoking is the risk factor of an increased intraoperative sputum volume, and preoperative smoking cessation > or = 2 months is recommended to reduce the risk of an increased intraoperative sputum volume, although the relationship between smoking and PPCs was not elucidated in minor surgical patients.

Objectives: To further evaluate the safety profile and efficacy of intramuscular ketamine for procedural sedation during paediatric minor procedures in the emergency department and to ascertain parental satisfaction with the treatment of their children., Methods: A prospective audit of ketamine use in a UK district general hospital involving 89 children requiring minor procedures. Children received topical anaesthesia followed by an intramuscular injection of ketamine 4 mg/kg and intramuscular atropine 0.02 mg/kg. The procedure was assessed by way of a physician completed form and by evaluation of questionnaires given to parents to gauge levels of satisfaction., Results: No child required admission to hospital and there were no serious complications. A high level of satisfaction was expressed by all the parents/guardians of the children treated., Conclusions: High levels of satisfaction among parents and staff together with the avoidance of hospital admission and improved resource management should be a sufficient incentive for hospital trusts to consider the establishment of this type of service.

Background: Caudal epidural block (CEB) has become increasingly important for pediatric analgesia in recent years. However, data regarding CEB in adult ambulatory surgery are scarce. The aim of this study was to verify whether CEB could be applied as a simple, safe and economic method of anesthesia for adult patients undergoing minor gynecologic procedures (MGP)., Methods: One hundred and seventy-two female patients were enrolled in this study. Each patient received a 20-mL bolus of 1.5% lidocaine caudal epidural injection. The efficacy of CEB was evaluated. Types and duration of surgery, success rate, sensory level of analgesia, caudal epidural depth, complications and duration in the postanesthesia care unit (PACU) were also under investigation., Results: No side effects occurred and only few hemodynamic changes were noted in the study. All patients experienced excellent surgical anesthesia except seven patients, who required rescue supplement opioids (4.1% of failure rate). The success rate of CEB was 95.9% (165/172). Duration of anesthesia and surgery were 46.66 +/- 11.76 min and 23.08 +/- 9.54 min, respectively. The highest sensory dermatome level reached below T10. The average epidural depth was 3.06 +/- 0.23 cm. No postoperative anti-emetic was given in the study. Only three patients required postoperative narcotics. Four patients had spontaneous voiding before discharge. The average PACU stay was 74.30 +/- 10.80 min., Conclusion: Single-dose CEB with 1.5% lidocaine 20-mL was an easy and simple technique. It provided satisfactory anesthesia for MGP and did not prolong patients' discharge time. CEB may be another choice of anesthetic technique in such cases of clinical practice.