Johann Nemrava

By Dinko Bagatin, Tomica Bagatin, Judith Deutsch, Katarina Sakic, Johann Nemrava, Eduardo Isomura and Martina Sarec Ivelj

Ultrasound assisted liposuction technology is a selective technique to emulsify fatty tissue and improve the removal of fat. This technique can be used on many areas of the body such as: chin neck, back, buttocks, abdomen, legs, arms. Fatty areas, as well as, skin and cellulite can be molded in a process known as ultrasound cavitation. Results can produce significant skin contraction and smoothing of areas. Using this method reduces the need for surgical intervention and requires less energy to achieve similar results. This method is also good for treatment of fibrous scar tissue, producing less bruising and blood loss. The advantages of the VASER ultrasound prepared liposuction in comparison to the mechanical liposuction method are better with fat extraction, less blood loss, and smoother results. While the disadvantages of VASER ultrasound method are possible thermal injuries, the need for larger incisions for protective ports, increased incidence of seromas, slightly increased cost and longer preparation and operative times. However further presentation will show the benefits of this newer generation of liposuction method. Also, various probes for better fat extraction and specific treatment areas will be discussed.

Part of the book: Enhanced Liposuction

By Dinko Bagatin, Tomica Bagatin, Judith Deutsch, Katarina Sakic, Johann Nemrava, Eduardo Isomura and Martina Sarec Ivelj

Plastic surgery can be considered an art form, molding and shaping areas of the body to provide enhancement and visual improvements. During this process, anesthesia is a key role player, for both local and general aspects. Proper combinations of local and general anesthesia can provide not only great pain relief and the ability to perform the artwork of plastic surgery, but can also lead to better and faster postoperative recovery of patients. Take a moment to imagine doing our skills without anesthesia, not only would it be barbaric, but also unethical. The method of using fan-shaped anesthesia application will be explored as a technique to improve patient recovery. This, instead of the classic straightforward areal injection application, seems to provide improved anesthetic distribution, penetrates layers better, and offers a swifter and more efficient way of blocking pain receptors. Choosing an appropriate anesthetic from the various ones available today is very important for pain control and postoperative recovery, as well as combining it with other drugs to increase its duration of action. This medley of drug combinations provides patient satisfaction and enhanced recovery.

Part of the book: Topics in Regional Anesthesia

By Judith Adrianne Deutsch, Kata Šakić, Dinko Bagatin, Johann Nemrava and Tomica Bagatin

Anesthesia is a specialization which in past history has branched off of surgery. It needs to be very creative in its delivery, in order to accommodate the many operating positions, needed by the surgeon. The patient positions must also be safe and adequate for proper ventilation, throughout the operative procedure. There are times when multiple positions must be used, turning the patient over, even several times. Careful planning and team discussions prior to an operation are absolutely necessary, to form anesthetic and operative plans. The aim of the supraglottic airway device (Intersurgical i-gel) prone position induction method is to describe, detail and present its safe efficacy for certain planned operative procedures. Patient fasting preparation is a must, nil by mouth for 8 h. This method and sequence alleviates the use of muscle relaxants for patient rotation. This increases patient safety by keeping muscle tone normal, reduced drug use, minimizing rotation of the patient, and reduces possible injury of patient and among staff involved in rotating. Some may say induction in the prone position may be unsafe due to aspiration risks, but knowing anatomy and gravitational physics, in the event of any secretions projected, they will project forwards onto the operating table (through the gastric port of the i-gel), not into the tracheal area. This similar technique and principle are seen and used for the recovery position, to aid in free drainage of fluid from within the oral cavity. The method is used for a variety of operations worldwide and introduced in 2018 at Poliklinika Bagatin (PB). Approximately, 80 prone position inductions or 10% of all general anesthesias are performed every year at PB. More than 240 anesthesized patients in the prone position with an i-gel have used this method, since it was introduced. All have been with excellent results, minimal risk and appropriate ventilation of patients. I-gel placement in prone position was successful everytime. This method is advantageous to avoid multiple rotations of patients and avoid the use of muscle relaxants, otherwise used, with classic endotracheal intubation methods. The exact process will be discussed in more detail and described within the chapter.

Part of the book: Updates in Anesthesia