Dr. Yoshihara focuses on the importance of reporting postoperative medication use as it relates to spinal surgeries, but a similar plea can be made with regard to nonsurgical therapies (interventional as well as noninterventional) for spine-related pain. Evaluation of postoperative/post-therapy medication usage in the context of pain that may have multiple sources may be challenging but can be an important component of comprehensive outcomes assessments that will allow us to assess the utility and value of our interventions more accurately.

oncology, domains which surgeons around the world are attempting to preserve despite the COVID-19 pandemic. In the authors' centres in the United Kingdom, there has been anecdotal avoidance of laparoscopy surgery based on the above guidelines.

A137 with maternal hypertension. Early diagnosis and treatment through regular antenatal check-up is a key factor to prevent PIH and its complications. Interventions to improve maternal health through information, education and counselling of women of child bearing age should be implemented.Objectives: Increased perioperative blood pressure (BP) variability in cardiac surgery is associated with negative clinical outcomes and increased health resource utilization (HRU). Clevidipine, an ultrashort-acting, arterial selective calcium channel blocker reduces BP variability and may reduce HRU in this setting. The current model evaluates the one year budget impact of adding clevidipine to an intravenous antihypertensive (IVAH) treatment mix in a sample US hospital. MethOds: A spreadsheet model was developed using treatment specific HRU data from a clevidipine clinical trial (ECLIPSE) in cardiac surgery. Treatment distribution for IVAH agents (clevidipine, nicardipine, nitroglycerin, and nitroprusside), case volumes and comparable IVAH dosages were obtained from the Premier Hospital database. Unit costs for IVAH are US Wholesale Acquisition Costs (WAC). Thirtyday event costs were from the published literature. The model inputs may be customized to more accurately represent a given healthcare system. Results: The base case assumed a sample hospital with 468 coronary artery bypass graft (CABG) cases and 322 heart valve (HV) cases annually. Clevidipine usage in the base case was minimal (0% in CABG; 1% in HV). The base case predicts a one year total cost of $19,045,453 with the largest proportion of costs from general ward, ICU and operative suite time (approx. 30%, 21%, and 20% respectively). One year IVAH costs totaled $93,958 or 0.5% of total costs. Increasing the proportion of cases receiving clevidipine to 5% for both procedures increased drug acquisition costs by $13,005 and decreased HRU-related costs by $48,439 for a net decrease in costs of $35,434 for one year. cOnclusiOns: This analysis predicts a net savings with an increase in clevidipine use. In this example case, a minimal increase in IVAH costs was offset by savings in HRU-related costs resulting from improved outcomes associated with reduced perioperative BP variability.

A 39 year old woman, 40 weeks into her second pregnancy, was admitted for elective caesarean section because of her previous obstetric and medical history. In March 1999 she underwent an emergency caesarean section following failed induction of labour. Her past medical history included an emergency appendicectomy and left salpingo-oophorectomy. Her platelet count at that time was higher than normal at 673x10 9 /l, but no cause for this was found on investigation. She had also experienced several episodes of polyarthritis and viral infection. No cause for her polyarthritis was found, despite comprehensive investigations. In addition, she had lost the vision in her right eye many years previously through panuveitis. This pregnancy was uneventful until a full blood count taken at an antenatal check up late in the second trimester revealed a low platelet count. One week prior to elective caesarean section her platelet count was 122x10 9 /l, but it dropped to 82x10 9 /l on the day of the surgery (see Table 1). Current practice is to avoid spinal and epidural anaesthesia when the platelet count is less than 100x10 9 /l, in particular because of the increased risk of epidural haematoma if a blood vessel is inadvertently punctured, leading to compression of spinal nerves and paralysis of the lower limbs. The potential risks of spinal anaesthesia were explained to the patient and she agreed to a general anaesthetic for the caesarean section. The patient received a standard anaesthetic procedure, in which analgesia was provided by opioids including fentanyl 100µg and morphine 10mg. The surgery was uneventful, and the baby was healthy. In the recovery room the patient complained of pain. Her verbal rating pain score on a scale of 0 -10 was 9 (where 0 was no pain and 10 was the worst possible pain). She was given tramadol 100mg intravenously and two doses of morphine 5mg. Her pain score remained persistently high and in addition she developed side effects from the opioids, particularly nausea and retching. She had already received ondansetron as part of the anaesthetic, so cyclizine was administered but she continued to experience nausea and retching.At this point, acupuncture was offered as an additional non-pharmacological treatment for pain relief and nausea, and the patient gave her consent. Needles were inserted at LI4 and PC6 on the right Acupuncture for acute postoperative pain relief in a patient with pregnancy-induced thrombocytopenia -a case report Susmita Oomman, David Liu, Mike Cummings Abstract A 39 year old woman, scheduled for elective caesarean section in her second pregnancy, developed thrombocytopenia. Therefore, at the time of surgery, spinal anaesthesia and non-steroidal analgesic drugs were avoided and she was given a standard general anaesthetic procedure including fentanyl 100µg and morphine 10mg. In the early postoperative period she received tramadol 100mg and a further 10mg of morphine. These drugs did not control her pain, but caused side effects -in particular nausea and retching. Acupuncture ...

Latex rubber gloves have become increasingly common over the last 30 years. This has led to an increase in allergy to natural rubber latex (NRL) proteins in health care professionals using protective gloves and/or in those exposed to products made of NRL. This has led to a growing need to monitor the allergenicity of gloves and other latex goods to prevent sensitization and clinical allergy. There is still considerable amount of misinformation regarding latex allergy. In this article, we examine the history behind the "invention" of the surgical glove, the emergence of latex allergy and the diagnostic tests available and possible remedies. We searched PubMed and MedLine using key words such as Latex allergy, surgical gloves, rubber, immunoglobulin E proteins, radioallergosorbent test. Recent and old papers on the subject were reviewed and analyzed. Surgical gloves were a huge milestone in the field of surgery as it allowed the development in the field of asepsis. It was instrumental in reducing the rates of infection and making health care professionals think about aseptic techniques. However, the emergence of latex allergy over the last few decades has proved a challenge in the perioperative setting. Surgical gloves are important tools in performing safe surgery. However, the increasing incidence of latex allergy and its effects on theatre personnel is of great concern.