Grisel’s syndrome is a rare cervical spine disorder characterized by non-traumatic rotary subluxation of the atlantoaxial joint. This article provides a systematic review to collect evidence on its pathogenesis, clinical manifestations, diagnosis, treatment, complications, and risk management, in order to guide clinical diagnosis and treatment. The syndrome is often associated with adenotonsillectomy. Patients typically present with neck stiffness, pain, and a “cock robin posture” (chin tucked in and head tilted forward). Diagnosis relies on MRI and CT scans. After timely diagnosis, most patients can control the condition through conservative treatment. However, those with ineffective conservative treatment or severe subluxation may require surgical intervention. Therefore, early diagnosis and treatment are crucial. This article focuses on the progress in the diagnosis and treatment of Grisel’s syndrome after adenotonsillectomy, which will provide new insights into the diagnosis and treatment of this rare disease.
Perioperative neurocognitive disorder (PND) is one of the common perioperative complications in surgical patients, which has been concerned by most researchers. With the gradual increase of the elderly population in China, the complexity of individual diseases and the risk of PND is more and more severe. In recent years, a large number of studies have confirmed the close relationship between intestinal flora and neurological diseases and various studies have also proved that gut microbiota may contribute to the occurrence and development of PND. Based on the current studies, this article summarizes the effects of gut microbiota on PND, including possible mechanisms and intervention measures, providing some ideas for researchers and treatment of PND.
The strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery. Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected. According to whether the patients were discharged on the same day, they were divided into same-day discharge group and delayed discharge group. The differences in gender, age, first surgical procedure (surgical method, hepatectomy or not, intraoperative choledochoscopy or not), choledochoscopic lithotomy (first choledochoscopy or not, lithotomy method, number of stones and site of stones), operation duration, hospital stay, hospital cost, and postoperative complications (fever, poor drainage, and T tube dislodgement) between the two groups were compared and analyzed. Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy. Results All patients were admitted and discharged within 24 h, among them, 557 cases (91.8%) were discharged on the same day and 50 cases (8.2%) were discharged the next day. The results of multiple logistic regression analysis showed that choledochoscopy for the first time [odds ratio (OR)=2.359, 95% confidence interval (CI) (1.303, 4.273), P=0.005], lithotomy after electrohydraulic lithotripsy [OR=1.857, 95%CI (1.013, 3.402), P=0.045], and multiple stones (number of stones ≥2) [OR=2.741, 95%CI (1.194, 6.288), P=0.017] were independent risk factors for delayed discharge. Conclusion The operation of same-day choledochoscopic lithotomy is mature, and choledochoscopy for the first time, lithotomy after electrohydraulic lithotripsy, and multiple stones (number of stones ≥2) are independent risk factors for delayed discharge.
In order to optimize the postoperative rehabilitation path of patients undergoing fourth-level day surgery, West China Hospital of Sichuan University has learned from the abroad “recovery hotel” mode and innovatively regarded the primary rehabilitation institution as an extended service carrier for thoracoscopic lung nodule day surgery. This extended rehabilitation mode based on primary rehabilitation institutions is not only beneficial for shortening the hospitalization period and reducing medical costs, but also ensures medical safety through a standardized postoperative monitoring system, providing innovative solutions for the full process management of day surgeries. This article will introduce the specific implementation methods and preliminary practical results of the extended rehabilitation mode mentioned above.
As the concept of enhanced recovery after surgery (ERAS) has promoted the revolution of day surgery, more complicated surgery such as radical resection of early cancer and other fourth-level surgery can be performed in day surgery mode. Since 2010, West China Hospital of Sichuan University has introduced ERAS program and gradually performed fourth-level surgery in day surgery center. With the measures of reasonable inclusion criteria, team construction, and optimization of treatment and nursing procedures, the quality and safety of day surgery are guaranteed. Between January 2019 and August 2023, a total of 2531 patients underwent 24-hour fourth-level day surgery for early cancer, with a delayed discharge rate of 2.09%, a readmission rate of 2.57%, and a readmission rate of 1.11%, without death case, and the patient satisfaction was above 98%. The perioperative management scheme of fourth-level day surgery provides a reference for the management of day surgery for more diseases.
With the rapid development of day surgery in China, ensuring continuous recovery services for patients after discharge has become an urgent issue. In response, this paper outlines the concept and development status of day surgery, emphasizes the importance of establishing an extended recovery system, summarizes relevant model innovation cases, discusses key elements for building an extended recovery system, including social resource engagement, multidisciplinary collaboration, institutional safeguards and technical support, and docking system platform to smooth the transmission of information, and proposes suggestions for future development. This paper provides theoretical and practical references for developing an extended recovery system for day surgery in China.
ObjectiveTo investigate various methods and strategies of lowering central venous pressure (CVP) during hepatectomy.MethodThrough literature review, the definition, implementation, related complications, and prognosis of low CVP were reviewed and summarized and the most appropriate CVP in the liver surgery was also summarized.ResultsThe low CVP had been widely applied in the different clinical settings. Its effect of reducing hemorrhage and transfusion had been recognized. There were many techniques to intraoperatively reduce the CVP such as the volatile anesthetics, vasoactive agents, fluid restrictive strategy, inferior vena cava clamping, low tidal volume, etc. However, there was no consensus on the best strategy to reduce the CVP and there were no studies focusing on the prognosis of patients underwent the low CVP hepatectomy. Maintaining the CVP between 2.1–3 mm Hg (1 mm Hg=0.133 kPa) intraoperatively might be appropriate, once the section had been made normal hemodynamic state of the patient should be restored immediately.ConclusionsApplication of low CVP could reduce blood loss and transfusion in hepatectomy. Prognosis of patients receiving low CVP is not clear. Application of low CVP in specific population should be cautious.
