In 2015, we experienced the largest in-hospital Middle East respiratory syndrome (MERS) outbreak outside the Arabian Peninsula. We share the infection prevention measures for surgical procedures during the unexpected outbreak at our hospital. We reviewed all forms of related documents and collected information through interviews with healthcare workers of our hospital. After the onset of outbreak, a multidisciplinary team devised institutional MERS-control guidelines. Two standard operating rooms were converted to temporary negative-pressure rooms by physically decreasing the inflow air volume (−4.7 Pa in the main room and −1.2 Pa in the anteroom). Healthcare workers were equipped with standard or enhanced personal protective equipment according to the MERS-related patient's profile and symptoms. Six MERS-related patients underwent emergency surgery, including four MERS-exposed and two MERS-confirmed patients. Negative conversion of MERS-CoV polymerase chain reaction tests was noticed for MERS-confirmed patients before surgery. MERS-exposed patients were also tested twice preoperatively, all of which were negative. All operative procedures in MERSrelated patients were performed without specific adverse events or perioperative MERS transmission. Our experience with setting up a temporary negative-pressure operation room and our conservative approach for managing MERS-related patients can be referred in cases of future unexpected MERS outbreaks in non-endemic countries.The Middle East respiratory syndrome (MERS) is a serious acute respiratory disease caused by the MERS coronavirus (MERS-CoV), and the mortality rates in infected patients are estimated at 20-40% 1 . Since the first case report in Saudi Arabia in 2012 2 , MERS outbreaks have occurred mainly in Middle Eastern countries and a small number of imported cases arose in Europe, Asia, United States, and Africa 3-7 . From May to July 2015, South Korea experienced the largest MERS outbreak outside the Arabian Peninsula 8,9 . The South Korean outbreak resulted in 186 laboratory-confirmed MERS cases, 92 of which were associated with our tertiary care hospital 10,11 . According to our institutional policy during the MERS outbreak, all elective surgeries for MERS-related patients were postponed when possible. However, several MERS-related patients inevitably required emergency operations under anesthesia. Two of the 92-MERS confirmed cases and four MERS-exposed patients underwent surgery. Although there is some literature regarding infection prevention during operative procedures for severe acute respiratory syndrome (SARS) coronavirus 12,13 , guidelines or references for MERS prevention during perioperative patient care were very limited. Therefore, we developed institutional guidelines for perioperative MERS infection prevention and we set up a temporary negative-pressure operating room.In this globalized era, along with small and large outbreaks that persist in the Arabian Peninsula, MERS outbreaks may recur in any other regions, especially if a super spreader i...

Pure laparoscopic donor right hepatectomy (PLDRH) is not a standard procedure for living donor liver transplantation but is safe and reproducible in the hands of experienced surgeons. However, the perioperative outcomes of PLDRH have not been fully evaluated yet. We used propensity score matching to compare the perioperative complications and postoperative short-term outcomes of donors undergoing PLDRH and open donor right hepatectomy (ODRH). A total of 325 consecutive donors who underwent elective, adult-to-adult right hepatectomy were initially screened. After propensity score matching, all patients were divided into two groups: PLDRH (n = 123) and ODRH (n = 123) groups. Perioperative complications and postoperative outcomes were compared between the two groups. Postoperative pulmonary complications were significantly more common in the ODRH than in the PLDRH group (54.5 vs. 31.7%, P < 0.001). The biliary complications (leak and stricture) were higher in PLDRH group than in the ODRH group (8% vs. 3%), but it failed to reach statistical significance (P = 0.167). Overall, surgical complication rates were similar between the two groups (P = 0.730). The opioid requirement during the first 7 postoperative days was higher in the ODRH group (686 vs. 568 mg, P < 0.001). The hospital stay and time to the first meal were shorter in the PLDRH than in the ODRH group (P = 0.003 and P < 0.001, respectively). PLDRH reduced the incidence of postoperative pulmonary complications and afforded better short-term postoperative outcomes compared to ODRH. However, surgical complication rates were similar in both groups.Laparoscopic liver surgery has become widely accepted, affording many benefits including fewer overall complications, less blood loss, lower pain scores, better donor quality-of-life during the early postoperative period, and a shorter hospital stay, compared to open surgery 1-3 . As surgical techniques advanced over time, laparoscopic surgery for living donor liver transplantation (LDLT) became possible 2 . After the first successful reports of laparoscopic left lateral sectionectomy during adult-to-child LDLT in 2002 4 , many centers adopted the laparoscopic approach as the standard for living liver donors undergoing small graft resections 5,6 . However, the use of laparoscopic procedures to perform larger graft resections (such as right hepatectomies) was initially limited by technical complexities and the steep learning curve associated with the procedures. However, a series of laparoscopic right hepatectomies performed by experienced surgeons at living donor centers showed that the results open Scientific RepoRtS | (2020) 10:5314 | https://doi.

Background: Shoulder surgery in the beach chair position frequently causes hypotensive bradycardic events (HBEs), which are potentially associated with an increased risk of cerebral hypoperfusion. Here, we aimed to investigate the incidence and characteristics of symptomatic HBEs that require pharmacological interventions, and to identify specific risk factors associated with symptomatic HBEs. Methods: We retrospectively examined the records of all patients aged ≥ 18 years who underwent shoulder arthrotomy in the beach chair position between January 2011 and December 2018 at a tertiary hospital. For patients who experienced HBEs while in the beach chair position, the minimum heart rate and systolic blood pressure were noted, as was the total dose of ephedrine or atropine. Results: Symptomatic HBEs occurred in 61.0% of all cases (256/420). Two patients with symptomatic HBEs experienced postoperative neurological complications. Multivariable logistic regression analysis showed that preoperative interscalene brachial plexus block (ISB) and advanced age were risk factors associated with symptomatic HBEs