r DCS, and an SCA of <79.1 degrees demonstrated significant diagnostic value for the detection of DCS.Patients in the DCS group had a lower SCA and a higher T1s. Both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of less then 79.1 degrees demonstrated significant diagnostic value for the detection of DCS. Access to timely neurosurgical care in particular remains limited worldwide, and is associated with increased morbidity and mortality, a decrease in overall life expectancy, and catastrophic economic costs. To date, access to neurosurgical care has not been completely studied and reported in the Caribbean neurosurgical literature. In this study, we aim to understand the geographic distribution of hospital facilities with neurosurgical capacity among the CARICOM member states to determine timely access to neurosurgical care. We assessed geographical access to facilities capable of providing neurosurgical care in the Caribbean. The GPS coordinates of the hospitals that provide neurosurgical care were identified using street addresses and satellite imaging from Google Maps. Facilities with neurosurgical care were mapped in ArcGIS Pro (Version 2.6.0). using Manhattan distance. We identified the area around each facility and stratified by 30- minute, 1-hour, 2-hour, and 4-hour geographic driving intervals. A close the gap. We have provided long-term data on clinically meaningful pain alleviation for drug-refractory headache disorders using occipital (ONS) and supraorbital nerve stimulation (SONS). We performed a retrospective review of 96 patients with migraine, cervicogenic headache, cluster headache, neuropathic pain of the scalp, tension-type headache, and new daily persistent headache who had undergone ONS (61.5%), SONS (11.5%), or combined ONS plus SONS (27.1%) trial implantation and definitive implantation from 2007 to 2017. Changes in pain perception over time were monitored using the visual analog scale (VAS) for pain. The cohort consisted of 60.4% women and 39.6% men, with a mean age of 46.9 ± 11.5 years and pain duration of 14 ± 14.1 years. Of the 96 patients, 65 (67.7%) were treatment responders to a trial (≥30% amelioration in the average or maximum VAS score for pain and/or number of headache days) that had lasted 22.5 ± 8.8 days. The reduction in their average VAS score for pain was to 37% ± 24.4% of baseline compared with 99.1% ± 24.1% of baseline for those without a response (P < 0.01). Of the 56 patients who had undergone implantation and had long-term follow-up data available for ≤10 years, 32 (57.1%) reported a ≥50% reduction in their average VAS score for pain. Four patients (6.5%) had requested hardware explantation. 1,2,3,4,6-O-Pentagalloylglucose price Stage II complications included 1 infection (1.6%) and 6 electrode dislocations (9.7%). The study limitations included the retrospective nature, lack of controls receiving placebo intervention, and randomization. After careful patient selection according to a positive response to a trial of ONS and/or SONS, clinically meaningful long-term benefit was achieved in 57.1% of our patients with various chronic headache conditions.After careful patient selection according to a positive response to a trial of ONS and/or SONS, clinically meaningful long-term benefit was achieved in 57.1% of our patients with various chronic headache conditions. To assess whether sequential (one after the other with a delay of 120s) or combined (freshly prepared mixture) administration of 2% lidocaine and 0.5% bupivacaine in supraclavicular brachial plexus block (SCBPB) provides faster onset and prolonged duration of block. Randomised controlled double blinded study. Single centre study in an operating theatre of a tertiary care facility between November 2018 and May 2020. Ninety-seven patients of either sex, aged between 18 and 65years, belonging to ASA I to III and undergoing surgery suitable to be performed under SCBPB were enrolled. Ultrasound guided SCBPB was performed with 20mL of freshly prepared mixture of 2% lidocaine and 0.5% bupivacaine (10mL each) in group C (combined) and 10mL 2% lidocaine followed 120s later by 10mL 0.5% bupivacaine in group S (sequential). Time to onset of complete sensory block was the primary outcome while time to onset of first sensory block and complete motor block, duration of sensory and motor block, duration of analgesia, use of intraoperative supplement, rescue analgesic consumption, and pain scores at rest and with movement were secondary outcomes. There was no significant difference between group C and group S in time to onset of complete sensory block [median (IQR) 16 (11, 20.5) and 15.5 (13, 21.75) minutes respectively] (p-value 0.58). The time to onset of first sensory block and motor block, duration of sensory and motor block, duration of analgesia, use of intraoperative supplement, postoperative pain scores and rescue analgesic requirement were also similar (p-value >0.05). There was no advantage of sequential administration of 2% lidocaine and 0.5% bupivacaine over the administration of combination of both LAs in terms of onset and duration of block.There was no advantage of sequential administration of 2% lidocaine and 0.5% bupivacaine over the administration of combination of both LAs in terms of onset and duration of block. It is unclear what the body mass index (BMI) should be when performing surgery involving the airway at an outpatient surgery facility. The objective of this study was to evaluate the association of Class 3 obesity versus a composite cohort of Class 1 and 2 obesity with same-day hospital admission following outpatient tonsillectomy in adults. Retrospective cohort study. Multi-institutional. Patients undergoing outpatient tonsillectomy. None. We used the National Surgical Quality Improvement Program (NSQIP) to analyze association of BMI to same-day admission and 30-day readmission following outpatient tonsillectomy from 2017 to 2019. We looked at six BMI cohorts 1) ≥30 and<40kg/m (reference cohort), 2) ≥20 and<30kg/m , 3) <20kg/m , 4) ≥40 and<50kg/m , 5) ≥50 and<60kg/m , and 6) ≥60kg/m . We used multivariable Poisson regression with robust standard errors and controlled for various confounders to calculate risk ratios (RR) and 99% confidence intervals (CI). There were 12,287 patients included in the final analysis, at which 697 (5.