The Experts below are selected from a list of 1728 Experts worldwide ranked by ideXlab platform
Mihaela Visoiu - One of the best experts on this subject based on the ideXlab platform.
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re ultrasound guided bilateral Rectus Sheath block with and without dexmedetomidine in pediatric umbilical hernia repairs a retrospective interrupted time series analysis
Regional Anesthesia and Pain Medicine, 2020Co-Authors: Mihaela VisoiuAbstract:To the Editor After carefully reading the report by Hartzell and colleagues[1][1] on the use of dexmedetomidine for Rectus Sheath blockade in pediatric umbilical hernia repair, I have a few comments regarding the clinical significance of this study. The authors reported a statistically significant
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development of a novel technique for bilateral Rectus Sheath nerve blocks under laparoscopic guidance
Journal of Pediatric Surgery, 2017Co-Authors: Alessandra Landmann, Mihaela Visoiu, Marcus M MalekAbstract:Abstract Background Bilateral Rectus Sheath blocks have proven to be superior to local anesthetic infiltration for umbilical incisions and have been gaining popularity for the treatment of perioperative pain in children. We aim to develop a technique of surgeon performed Rectus Sheath blocks under laparoscopic-guidance alone. Methods In phase I, we observed the laparoscopic appearance of a Rectus Sheath block. The pain management team performed an ultrasound-guided Rectus Sheath nerve block as we visualized the posterior Rectus Sheath with the laparoscope. In phase II, after completion of the laparoscopic procedure, we performed a Rectus Sheath nerve block. Ultrasound was used to identify where the local anesthetic had been injected. Results Nineteen patients were included in this study, accounting for 38 Rectus Sheath blocks. In phase I, we observed with the laparoscope the delivery of ten ultrasound-guided Rectus Sheath blocks. In phase II, 28 laparoscopic-guided Rectus Sheath blocks were completed with immediate ultrasound confirmation of correct placement. Conclusions We have demonstrated that the Rectus Sheath nerve block can be performed reliably under laparoscopic-guidance alone. The efficacy of the laparoscopic-guided nerve block compared to the ultrasound-guided approach will need further study in a prospective, randomized trial. Type of study Retrospective review. Level of evidence 3.
Thomas M Austin - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided bilateral Rectus Sheath block with and without dexmedetomidine in pediatric umbilical hernia repairs a retrospective interrupted time series analysis
Regional Anesthesia and Pain Medicine, 2020Co-Authors: Cheryl J Hartzell, Justin B Long, William M White, Daniel Machado, Thomas M AustinAbstract:Bilateral Rectus Sheath block (RSB) is frequently used to provide analgesia following umbilical hernia repair in pediatrics.[1][1] Dexmedetomidine use in pediatric truncal nerve blocks has increased despite limited evidence of its efficacy and safety,[2][2] with no studies evaluating its effect in
Humphrey Lam - One of the best experts on this subject based on the ideXlab platform.
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Rectus Sheath catheters for continuous analgesia after laparotomy without postoperative opioid use
Pain Medicine, 2011Co-Authors: Randall J Malchow, Lisa Jaeger, Humphrey LamAbstract:Objective. Opioid and epidural analgesia have been the mainstay for postoperative pain control following laparotomies, yet have many potential side effects, risks, and limitations. This case report offers an alternative to opioid as well as epidural analgesia, which may be beneficial in some patients. Design. We report a case of a patient who underwent a laparotomy with extensive lysis of adhesions who was treated postoperatively with continuous bilateral Rectus Sheath catheters and multimodal adjuncts including gabapentin, clonidine, and nonsteroidal anti-inflammatories. Results. We successfully used a novel, multimodal approach that avoided the use of epidural analgesia and postoperative opioids. The patient was extremely satisfied, reported minimal discomfort, ambulated early, advanced her diet quickly, and was discharged home after a short hospital stay. Conclusions. This report may be the first description of a successful multimodal postoperative analgesic regimen including continuous bilateral Rectus Sheath blocks without inpatient postoperative opioid use or epidural analgesia following a midline laparotomy.
Lawrence J Gottlieb - One of the best experts on this subject based on the ideXlab platform.
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autologous posterior Rectus Sheath as a vascularized onlay flap a novel approach to hiatal hernia repair
Journal of Gastrointestinal Surgery, 2021Co-Authors: Yalini Vigneswaran, Lawrence J Gottlieb, Ava Ferguson Bryan, Brian Ruhle, John C AlverdyAbstract:INTRODUCTION Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques. METHODS Here we describe the use of vascularized fascia harvested from the posterior Rectus Sheath with peritoneum during robotic hiatal hernia repair in two patients with large complex diaphragmatic defects. RESULTS Successful harvesting and onlay of the right posterior Rectus Sheath based on a falciform vascular pedicle was achieved robotically by rotating and securing the flap to the diaphragmatic hiatus as an onlay flap following cruroplasty of the hiatal defect. CONCLUSIONS In patients with difficult to repair large paraesophageal hernias, we demonstrate a promising new technique to restore the dynamic hiatal complex with the tensile strength of autologous vascularized fascia and peritoneum.
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expanding the envelope the posterior Rectus Sheath liver vascular composite allotransplant
Plastic and Reconstructive Surgery, 2013Co-Authors: Justine C Lee, Oyedolamu K Olaitan, Reynold Lopezsoler, John F Renz, Michael J Millis, Lawrence J GottliebAbstract:BACKGROUND Primary abdominal wall reconstruction after liver transplantation presents a challenge in patients with size mismatch, multivisceral transplants, and prior recipient abdominal surgery. The authors report their experience with a novel technique for abdominal wall reconstruction with a new vascular composite allotransplant. METHODS Five posterior Rectus Sheath-liver composite vascular allotransplants were procured by a multidisciplinary team and transplanted into four patients over the course of 2 years. Liver transplantation was performed in the standard manner, and the posterior Rectus Sheath was inset as an inlay flap. RESULTS Abdominal wall integrity was reestablished with vascularized fascia in all five cases. In two cases, the fascia was closed immediately at the time of initial transplantation. In three cases, the abdomen was left open for a planned second look and closed definitively when the liver appeared satisfactory. In one patient, hepatic artery thrombosis was detected 11 days after transplantation, requiring a second posterior Rectus Sheath-liver transplant. Skin closure was performed for all transplants in either an immediate or a delayed fashion. Reoperation requiring elevation of the posterior Rectus Sheath flap for a suprahepatic vena cava stenosis was performed in one patient. CONCLUSIONS Closure of the abdominal cavity is critical to the success of liver transplantation for organ survival and overall patient morbidity and mortality. The authors describe their institutional experience with a novel method of concurrent abdominal wall reconstruction and liver transplantation using the posterior Rectus Sheath-liver vascular composite allotransplant in situations of size mismatch, multivisceral transplants, and compromised abdominal wall of the recipient. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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liver and vascularized posterior Rectus Sheath fascia composite tissue allotransplantation
American Journal of Transplantation, 2010Co-Authors: Shailesh Agarwal, Amir H Dorafshar, Robert C Harland, J M Millis, Lawrence J GottliebAbstract:Abdominal wall closure in pediatric solid organ recipients may be confounded by donor size discrepancy and structural insults from previous surgery. Here we describe the novel use of vascularized donor abdominal wall posterior Rectus Sheath fascia, as a composite tissue allotransplant (CTA), to achieve abdominal wall closure in a liver and double kidney pediatric recipient who could not be closed primarily due to donor/recipient size mismatch. The posterior Rectus Sheath fascia was procured in continuity with the liver and falciform ligament. Blood supply was achieved using the single hepatic artery anastomosis as part of the standard liver transplantation procedure. Specimens of posterior Rectus Sheath fascia taken on postoperative days 3 and 30 showed no signs of acute rejection. The patient succumbed to an overwhelming fungal infection on day 51, with no signs of intraabdominal involvement. The patient received no additional immunosuppression in conjunction with the posterior Rectus Sheath fascia allotransplant.
Kayleigh M Litton - One of the best experts on this subject based on the ideXlab platform.
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Rectus Sheath hematoma with low molecular weight heparin administration a case series
BMC Research Notes, 2014Co-Authors: Laura E J Sullivan, Dale C Wortham, Kayleigh M LittonAbstract:Background Rectus Sheath hematoma is an uncommon but potentially serious bleeding complication that can occur spontaneously or as a result of anticoagulation administration.