Day 2 :
Ulf Thorsten Zierau is the Head of Vascular Surgery at the Charité. After specialist examination in surgery in 1994, he continued the training in the field of vascular surgery, first at the venous center Malente (Mühlenberg Clinic), then at the 2nd University Clinic Cologne. He passed the Vascular Surgery Examination in 1996 and beginning of independent clinical work as a Senior Physician and Head of the Department of Vascular Surgery at the Gransee Hospital. Later, he turned to cathederal medicine; study Stanford University, USA and in the Heart Center Berlin-Buch. He started working in private practice since 1997.
We report about 7-years results of a prospective comparative study of VenaSeal®-Closure in the treatment of 2250 saphenous veins in 1250 patients. The present research paper sheds light on the advantages and disadvantages and presents the 84-month results of a single-center ambulatory clinical study with prospective design. In the base, all varicose veins should be treated actively. This we can find in nearly all guidelines worldwide. Since 20 years by now, varicosis has been increasingly treated endovenously. Before this, the varicose veins were treated radically with the stripping-method, a 110 years old radical surgery method. At the start, the rather inconvenient VNUS® Closure Plus procedure and the more convenient linear laser procedure were used, and these were followed in 2006/2007 by the bipolar RFITT® catheter, the VNUS® ClosureFast system and the radial laser. Thus, in the course of the last few years, plenty of experience has been gathered with endoluminal therapy, quality criteria have been defined and standards for the different techniques have been developed. In addition, 16 years ago, far from the beaten tracks of radio wave and laser, the development of a fascinatingly simple, yet nevertheless highly effective method of sealing veins-the VenaSeal® closure technique - was initiated. After CE approval had been granted in the autumn of 2011, a number of vein centers in Germany and Europe started using the VenaSeal®-system. Today there is an approval in all countries, also in USA since 2 / 2015. The author has applied VenaSeal™ for the first time in a great saphenous vein on 1st August 2012.
Seoul National Univeristy, South Korea
Keynote: Effects of intraoperative magnesium sulphate administration on the incidence of chronic postsurgical pain in patients undergoing total knee arthroplasty
Time : 10:35- 11:10
Sang-Hwan Do is specialized in Orthopaedic Anesthesia and has quite a few clinical experiences of using magnesium sulphate during surgeries of diverse kinds. Through his numerous publications on magnesium, he stresses the efficacies of this mineral in surgical patients, such as improvement of postoperative pain, potentiation of intraoperative neuromuscular blockade and so on. Now, he is working at Seoul National University Bundang Hospital.
Magnesium sulphate (MgSO4) is an effective analgesic adjuvant for acute postoperative pain. However, the effect of MgSO4 on chronic postsurgical pain (CPSP) remains unknown. We investigated this effect of MgSO4 in patients undergoing total knee arthroplasty (TKA) retrospectively. The operation was conducted by the same experienced surgeon under spinal anesthesia, unilaterally (n=355), staged bilaterally (n=489, at 1-week interval) or simultaneous bilaterally (n=31). The magnesium group received MgSO4 (50 mg/kg) over 15 min followed by a continuous infusion (15 mg/kg/h) during the operation. Medical records of a total of 875 patients [control group (n = 780) and the magnesium group (n = 95)] for 6 years (2012~2017) were reviewed retrospectively. In case of insufficient records, telephone interview was added. The incidences of CPSP at postoperative one year were compared between the two groups. The incidence of CPSP at one year after TKA in the magnesium group (7.4%) was significantly lower than that of the control group (16.4%) (P = 0.031). Intraoperative administration of MgSO4 was effective for preventing the occurrence of CPSP after TKA
Kent Berg has completed his MD, MBA Degrees from Tufts University School of Medicine in Boston. He completed his Anesthesia Residency and Adult Cardiothoracic Anesthesia Fellowship from the University of Florida (UF), Gainesville, FL, USA in 2009. He joined the faculty at UF in 2009 until he moved to Thomas Jefferson University, Philadelphia, PA, where he currently practices cardiothoracic anesthesia and is the Anesthesia Vice Chair of Information Systems and Technology.
Telemedicine is defined as the remote delivery of health care services and clinical information using telecommunications technology. As the internet evolves and high-speed cable or satellite technology becomes more available, healthcare providers are exploring new ways to accelerate care or reach patients in remote areas. Clinicians are now applying these techniques in the field of anesthesiology. The business market for telemedicine is growing in USA and the world with new devices or applications being released almost daily. In the anesthesia literature, there are published examples of using telemedicine in ICU and preoperative clinic settings, as well as intra-operative consultations between continents. Application of this technology does, however, create concerns over medical licensure, potential liability, and reimbursement challenges.
Prince Sultan Military Medical City, Saudi Arabia
Ashraf EL-Molla, M.B., B.Ch., M.Sc., M.D, Consultant Anesthesiologist, Ministry Of Health, Egypt, Cairo. He is interested in airway management, his recent publication “Bridging Bronchus, type six as a new rare case of a bronchial anomaly
Introduction: Health care system is an extremely risky domain as the third leading cause of death in America is medical errors. The operating theatre (OT) is recognized as a high-risk, accident prone environment where consequences of failure can be catastrophic. OT is also regarded as a complex, dynamic and tightly coupling system that can spring nasty surprise.
Multiple Case Reports: We will describe multiple cases in which various factors have led to human errors which induced anesthetic crises. The problem of morbidity and mortality from adverse events in healthcare has undergone over 15 years of intensive scrutiny and research worldwide; despite of dramatically intensified efforts to increase safety of the healthcare system and reports have suggested that safety has not improved. The adverse event rate has remained the same suggesting that our current solution to the problem is not working. We will explain an approach to counteract this defect in anesthetic care system through a multi-dimensional protective vision (MDPV) which is composed of knowledge and is the catalogue of most common anesthetic errors. Their classification and types with over emphasis on correcting cognitive errors which are thought process errors that lead to incorrect diagnoses and/or treatment. We will define anesthetic non-technical skills (ANTS) which are cognitive, mental, behavioral and interpersonal abilities that are crucial to guarantee maximum safety and reduce the risk of errors. They are expressed as art of decision making, task management, situation awareness, communication, team work and stress management. We will explain the science of high reliability organizations (HROs) which are those organizations like aviation industry and nuclear power stations that are running high risk tasks with excellent safety records. We will show the behavioral markers by which HRO teams promote safety.
Conclusion: We strongly recommend adopting (MDPV) via pre and post graduate program composed of comprehensive training in human factors and understanding the key types of cognitive errors specific to anesthesia which can be the first step towards training in metacognition de-biasing strategies and continuous education on ANTS as well as the science of HROs in addition to coordination strategies used by Crisis Resource Management (CRM). We suggest implementing a white box (WB) which is an audio/video record in the operating room to detect good performance to learn from and correct poor performance.