Integration of a variable action suction adapter into ultrasonic aspirators.

PURPOSE: Use of ultrasonic aspirators has become a mainstay in the neurosurgical armamentarium. The handpiece design and ultrasonic parameters have evolved to maximize its safe and efficacious use. Despite these modifications, continuous suction through the tip of the aspirator can result in neurovascular damage, especially when the aspirator is working in the cavernous sinus region or cerebellopontine angle. CONCEPT: We describe the integration of a variable suction adapter into the existing handpiece of an ultrasonic aspirator to minimize potential injury from the continuous forceful suction normally associated with the use of these devices. RATIONALE: The integration of such an adapter can reduce the potential for suction injury to cranial nerves or microvascular structures or smaller-caliber arteries and veins. DISCUSSION: This variable action suction adapter can decrease suction injuries to cranial nerves or the microvasculature.     

Proximal suction tracheotomy tube reduces aspiration volume

OBJECTIVE: Conventional cuffed tracheotomy tubes do not prevent aspiration of secretions. Aspiration of saliva may be decreased with the use of a subglottic suction port. STUDY DESIGN: Prospective. METHODS: Shiley Disposable Cuffed Tracheotomy (DCT) tubes sizes 4, 6, and 8 (Tyco Healthcare, Pleasanton, CA) were compared to Portex Blue Line Ultra Suctionaid (BLUS) tracheotomy tubes sizes 6, 7, and 8 (Fig 1; Smiths Medical, Watford, UK). All tubes were tested in a simulated tracheal model using 10 cc of human saliva with no suction, intermittent suction, and constant suction (15 minutes). RESULTS: There was a significant decrease in aspirate between the larger Shiley and BLUS tubes with intermittent suction (mean 8.38 mL Shiley 6 vs 1.60 mL BLUS 7; 8.50 mL Shiley 8 vs 2.80 mL BLUS 8). There was a significant decrease in aspirate between all sizes of Shiley and BLUS tubes with continuous suction. For BLUS 7 and 8, there was a significant difference between intermittent suction (mean, 1.60 mL, 2.80 mL, respectively) and continuous suction (mean, 0.20 mL, 0.60 mL respectively). Shiley and BLUS without suction were equivalent. CONCLUSION: Subglottic suction tracheotomy tubes reduce the risk of aspiration beyond the cuff in a bench-top model.     

Bacteriologic contamination of suction tips during hip arthroplasty

We obtained positive cultures from 12 out of 22 suction tips used in total hip arthroplasty performed in operating theaters with conventional ventilation. We recommend that the suction tubes be turned off when not in use and that the tubes be changed during operations.     

Bacteriologic contamination of suction tips during hip arthroplasty

We obtained positive cultures from 12 out of 22 suction tips used in total hip arthroplasty performed in operating theaters with conventional ventilation. We recommend that the suction tubes be turned off when not in use and that the tubes be changed during operations.     

Atraumatic suction tip for microneurosurgery--clinical experience.

Our two-year experience with a new atraumatic tip for the neurosurgical suction tube is described. During microneurosurgical procedures the tip reduces injury to fragile vital brain structures and protects them from being aspirated into the suction tube. The perforated membrane of the appended suction tip does not impede evacuation of blood in any situation and can be easily cleaned off without demounting. The device can be immediately attached to the tube and disconnected. The neurosurgeon need not concentrate on its use, in contrast to those systems with active suction pressure control. The atraumatic suction tip is available in several sizes to fit different callibers of suction tubes.     

New microsurgical suction tubes

A set of new suitable microsurgical suction tubes has been designed especially suitable for fragile and delicate tissues such as the nervous and vascular tissues in the brain and spinal cord. The set provides two different shafts and five different tubes for superficial of deep micro- as well as macro-operations. These new suction tubes have two major advantages compared to traditional suction tubes. Firstly: the perforated smooth suction-tip allows continuous suction without damage to the tissue and secondly: the tubes are quickly and easily exchanged from the suction shaft when necessary.     

Efficient atraumatic liquid suction by means of slit suction tubes combined with a pressure control unit

Summary In 1976 a modified suction system for neurosurgery and precision surgery was presented. It was developed to meet the need for efficient and atraumatic liquid suction. The system consists of suction tube ends provided with three vertical slits in the suction edge (W-tubes), a Pressure Control Unit (PCU) and an independent suction pump with an air capacity of 25–30 litres per min. This system has subsequently been modified for microsurgery. The PCU normally controls the negative pressure to 20 kPa (corresponding to 200 cm of water) for atraumatic suction of liquid, which is needed during most of the operating time. For suction of various tissues or cleaning the system, the surgeon can set the pressure limit to 50 or 90 kPa by means of a foot-operated IR-transmitter in a pedal with a kick-down function. The PCU and the W-tubes, which neutralize the pressure load on tissue and the sudden interruption of liquid flow that are inevitable with conventional suction tips, form a system with a high liquid suction capacity in spite of the atraumatic suction pressure. This is possible because the slits maintain a large active suction area. Crushed or soft tissues and coagulated blood are aspirated as and when required, if necessary by elevation of the negative pressure limit. The W-tubes are not provided with an air inlet hole on the tube because that method of pressure control proved unpredictable and variable and reduced the suction capacity by interfering with the flow. The system permits continuous efficient and safe suction of liquid in contact with nervous tissue and hence provides a good range of vision in the operation field even in cases of extensive haemorrhage (> 500 ml of blood per min). The system forms a good complement to ultrasonic aspiration, which is mainly intended for atraumatic tissue elimination.     

Techniques of liver resection. Comparison of suction knife, ultrasonic dissector, and contact neodymium-YAG laser

Liver resections were performed in 18 pigs with an inexpensive disposable plastic suction knife, an ultrasonic dissector, or a contact neodymium (Nd)-YAG laser. Technical aspects and intraoperative and postoperative data were compared. Intraoperative blood loss was less with the suction knife (112 +/- 28 mL) than with the ultrasonic dissector (149 +/- 45 mL) or Nd-YAG laser (174 +/- 25 mL). Operating time was similar in all groups. The number of ligatures used in the Nd-YAG laser group (12 +/- 1) was significantly less than in the ultrasonic dissector (27 +/- 2) or suction knife (32 +/- 2) groups. In the ultrasonic dissector group, there was an increase in postoperative white blood cell count and liver enzyme levels compared with the other two groups. Light microscopy revealed dilated bile ducts in the ultrasonic dissector resection group, which may reflect biliary stasis. There were no significant differences in mortality among the three experimental groups. Results indicated that the ultrasonic dissector and the contact laser method were not substantially better than an inexpensive, easily modified plastic suction catheter in performing a major nonanatomic liver resection in piglets.     

Sinusoidal neck suction for evaluation of baroreflex sensitivity during desflurane and sevoflurane anesthesia

Sevoflurane and desflurane modulate autonomic nervous activity by different mechanisms. We tested the hypothesis that these anesthetics also exhibit different effects on short-term baroreflex regulation of arterial blood pressure. Forty ASA physical status I patients, aged 20 to 42 yr, were randomly assigned to receive either 1.0 minimum alveolar anesthetic concentration of sevoflurane or desflurane for the maintenance of anesthesia. Patients were studied during awake conditions and 20 min after the anesthesia induction using sinusoidal neck suction at 0.2 Hz (baroreflex response mediated mainly by vagal activity) and 0.1 Hz (baroreflex response mediated by vagal and sympathetic activity), whereas respiratory frequency was fixed at 0.25 Hz. RR interval and arterial blood pressure responses were evaluated by power spectral analysis and complex transfer function analysis. Sevoflurane and desflurane did not disturb the linear relationship between baroreceptor stimulation and effector response, expressed as squared coherence of signals, i.e., the equivalent of the correlation coefficient of power spectra. Sevoflurane and desflurane depressed the response of the heart rate to neck suction in a similar way without affecting the time delay between baroreceptor stimulation and vagal-mediated cardiac response. The gain of the transfer function between neck suction and oscillation in arterial blood pressure at 0.1 Hz decreased with sevoflurane and desflurane to comparable values. Both anesthetics increased the delay of systolic blood pressure response to baroreceptor stimulation from approximately 3.5 to 4.3 s. Baroreflex-mediated short-term control of arterial blood pressure is similar between desflurane and sevoflurane during steady-state conditions. IMPLICATIONS: Despite exhibiting different effects on autonomic activity, sevoflurane and desflurane depress the baroreflex-mediated short-term control of heart rate and blood pressure in a similar manner.     

Environmental contamination during tracheal suction

The extent of airborne environmental bacterial contamination which occurs following tracheal suction has been investigated in patients undergoing intermittent positive pressure ventilation in the intensive therapy unit. Two methods of performing suction, one using a conventional open technique and one using a closed system (Stericath), have been compared. Significantly lower levels of environmental contamination were observed when the closed system was used.     

Modified Device for Easy Infiltration of Tumescent Solution in Liposuction

Background Managing large amounts of tumescent fluid may be cumbersome and a waste of time. To solve the problems of an easy, quick, reliable, and cost-effective jet infiltration technique for large tumescent volumes, the authors describe a simple handpiece that connects with standard air-driven wound irrigation systems. On the basis of former observations with a modified irrigation system previously published by our group, a newly developed multi-use irrigation infiltration cannula handpiece was used successfully for 63 patients without any complications. Methods An infiltration cannula with a handpiece and standard luer lock adapter that connects with an air-driven wound irrigation system required for liposuction procedures was developed and clinically tested. Results Between 2003 and 2005, a total of 63 patients with moderate- to large-volume suction (1,500–4,500 ml) were treated by subcutaneous infiltration of tumescent solution using the air-driven irrigation system and the newly developed infiltration cannula. The device proved to be reliable and efficient. No disconnection of the system was seen. The time savings and ease of use were most noticeable in cases of larger volume infiltration. Wiring and tubing of this device was facilitated in any case. No adverse side effects were noted. Conclusion A simple infiltration cannula system that connects with standard wound irrigation systems facilitates the liposuction procedure in terms of cost effectiveness and time savings.     

组配碎石吸石系统处理尿路结石

目的 探讨利用原有器械组配碎石吸石系统,处理膀胱结石、肾结石等尿路结石的方法.方法 2010年12月至2011年8月收治膀胱结石患者4例.均为男性.年龄42～79岁,平均63岁.两例合并尿道狭窄,其中一例患者曾有骨盆骨折、尿道断裂史,尿道狭窄几近闭锁,留置有膀胱造瘘管.另两例为前列腺增生合并膀胱结石.通过医院原有设备,...     

Postoperative wound suction drainage and its effect on wound healing

The positive as well as the negative effects of wound suction drainage on wound healing are outlined and the inherent physical laws which still were unclear are subject to an experimental analysis. The findings and conclusions which had been determined resulted in a modification of the clinical application practice and evidence points to the up to now daily change of suction bottle by routine as being a significant risk. Contamination of physical conditioned secretion reverse flow while opening the wound drainage system and the proven spreading ability of the bacteria within the drainage tubes leaves the possibility of a postoperative retrograde bacteria contamination reaching up to the wound site. To prophylactically reduce these risks instrumental improvements of the wound drainage system will be presented and discussed.     

Prospective randomized trial compares suction versus water seal for air leaks

BACKGROUND: Surgeons treat air leaks differently. Our goal was to evaluate whether it is better to place chest tubes on suction or water seal for stopping air leaks after pulmonary surgery. A second goal was to evaluate a new classification system for air leaks that we developed. METHODS: Patients were prospectively randomized before surgery to receive suction or water seal to their chest tubes on postoperative day (POD) #2. Air leaks were described and quantified daily by a classification system and a leak meter. The air-leak meter scored leaks from 1 (least) to 7 (greatest). The group randomized to water seal stayed on water seal unless a pneumothorax developed. RESULTS: On POD #2, 33 of 140 patients had an air leak. Eighteen patients had been preoperatively randomized to water seal and 15 to suction. Air leaks resolved in 12 (67%) of the water seal patients by the morning of POD #3. All 6 patients whose air leak did not stop had a leak that was 4/7 or greater (p < 0.0001) on the leak meter. Of the 15 patients randomized to suction, only 1 patient's air leak (7%) resolved by the morning of POD #3. The randomization aspect of the trial was ended and statistical analysis showed water seal was superior (p = 0.001). The remaining 14 patients were then placed to water seal and by the morning of POD #4, 13 patients' leaks had stopped. Of the 32 total patients placed to seal, 7 (22%) developed a pneumothorax and 6 of these 7 patients had leaks that were 4/7 or greater (p = 0.001). CONCLUSIONS: Placing chest tubes on water seal seems superior to wall suction for stopping air leaks after pulmonary resection. However, water seal does not stop expiratory leaks that are 4/7 or greater. Pneumothorax may occur when chest tubes are placed on seal with leaks this large.     

A suction bottle for post-anesthesia evaluation of the distribution of consumed carbon dioxide absorber granules in the canister

Anesthetic methods, apparatus, and respiratory care patterns have changed greatly in the past several decades. New scrutiny must be applied to patterns of carbon dioxide absorber consumption in the canisters in anesthesia circuits. Fine examination may be performed by extracting absorber granules by suction to avoid jumbling the granules in the canister. However, a general surgical suction apparatus has too narrow suction tubes, a low flow volume and too large reservoir bottles. We constructed a reservoir bottle of 1.5 l to trap the granules. The bottle is closed with an easily removable lid penetrated by inlet (with a larger diameter) and outlet cannulas. A conventional heat and moisture exchange filter is affixed to the outlet to prevent contamination of the suction system by alkaline absorber dust. Suction may be applied by a vacuum cleaner with a higher flow rate. Traditional recommendation to use baffles along the inside wall of the canister to prevent "channeling of exhaled gases by the wall effect" may turn out to be misleading.     

Nasogastric tube "suction-buster holes" release mucosal occlusion despite high suction.

Aspiration devices can persistently malfunction if moderate (not just high) suction causes mucosal occlusion of every opening. The standard pattern of uniformly large orifices was modified by supplementing half the nasal tubes with smaller (one tenth of the area) openings. Ten pairs of postoperative patients sipped water while suction applied to their nasal tubes varied from 40 to 300 mm Hg. Unmodified tubes consistently functioned only when applied vacuum was below 60 mm Hg. At 60 mm Hg, 20% (2/10) of tubes malfunctioned, with swallows failing to return on three consecutive attempts even at this gentle level. The failure rate rose with increasing applied suction. All 10 devices evidenced persistent occlusion when the vacuum exceeded 90 mm Hg. Each adverse result was confirmed by continued malfunction when suction was increased by another 10 mm Hg. The brisk flow through large esophageal openings dramatically differs from restricted inflow. Supplementing the standard set of uniform, large-bore aspiration orifices with additional small openings results in unimpeded function over the full range of available hospital vacuum. The additional small openings permitted the turbulent evacuation characteristic of large-bore patency. No device with accessory "suction-buster" orifices malfunctioned at even the highest available suction (300 mm Hg).     

Anterior periosteal dermal suspension with suction curettage for lateral thigh lipectomy

The standard excisional approach to lipectomy has now been expanded by the use of suction curettage either as an adjunct or a primary procedure. In severe cases of steatomeria (a term used to designate trochanteric obesity and eliminate the misuse of the term lipodystrophy), curettage serves to prepare and shape the flaps, while excision and periosteal dermal suspension are sometimes necessary to achieve adequate contour and lift. Periosteal anchoring ensures adequate permanent suspension and a tension-free closure. Achievement of lateral thigh contouring by an anterior approach is facilitated by the use of the suction curette. Undermining of the superior flap and contouring with suction, as well as overlapping the closure with buried dermal-fat suspension flaps, eliminates bulging above or below the incision. Periosteal dermal suspension decreases the possibility of scar widening and eventual ptosis, provides a fixation technique that permits more lift, and eliminates scarring from the lateral thigh. Lateral thigh suction lipectomy with periosteal dermal suspension has been done alone or in conjunction with buttock reduction or with medial thigh or abdominal lipectomy in 14 patients. The operating time was short, and the results were good with minimal morbidity.     

Fat suction versus abdominoplasty

The author describes his fat-suction technique for the treatment of abdominal adiposity. He stresses the importance of the proper selection of patients prior to surgery and the indications for such surgery, analyzing especially the accumulation of subcutaneous adiposity and muscular flaccidity. He divides surgical techniques into four separate groups: isolated fat suction; fat suction associated with infraumbilical cutaneous resection; fat suction associated with conventional abdominoplasty; and, conventional abdominoplasty. The criteria of indications for each separate procedure are strongly emphasized.     

减压式吸管用于负压吸宫术的临床观察

目的探讨一次性双腔减压式流产吸管在施行人工流产术的临床效果。方法对2008年3月至2009年2月孕42～60 d、年龄40岁健康妇女480例,随机使用一次性减压吸引管或金属吸管进行人工流产术,比较两种吸管的使用效果。结果减压式吸管在疼痛、出血量、手术时间、副反应优于金属吸管,差异有统计学意义(P0.05)。结论一次性减压式吸管为一次性产品,安全可靠,适用于终止孕60 d内的早期妊娠,能有效地减少术中副反应,且操作方便,可在临床推广使用。     

Percutaneous suction aspiration for osteomyelitis. Report of two cases

The nucleotome, a recently developed instrument for percutaneous disc excision, was used for suction aspiration in two cases of osteomyelitis of the spine. The technique obtained significant amounts of pus, serosanguinous material, and tissue, which provided adequate samples for histologic examination and culture. Both patients obtained immediate relief of pain after a significant amount of pus and infected material was removed. Appropriate antibiotics were used for subsequent control of the infections. The risk and morbidity of this technique are no greater than with conventional needle biopsy.