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At least 325 records · Page 18Linked to original sources
PubMed1996

Clinical evaluation of a prototype motion artifact resistant pulse oximeter in the recovery room.

The frequency and nature of spurious pulse oximetry readings were compared using both a conventional pulse oximeter (CPO) and a prototype Masimo signal extraction technology pulse oximeter (Masimo SET). At a university hospital, 50 ASA physical status I-IV adult patients who underwent general or spinal-epidural anesthesia were selected from a group of 250 patients on the basis of high-alarm generation with routine postoperative pulse oximetry. Pulse oximetry data were recorded simultaneously from both devices with a computer. Overall, the CPO alarm frequency (i.e., oxygen saturation < 90%, or complete signal loss) was once every 13 min, and 87% of these alarms were considered false. Alarms were considered false based on reference electrocardiographs (16 patients), arterial blood gases (7 patients), and clinical assessment. The prototype Masimo SET device alarm frequency was once every 30 min, and 59% of these were considered false. During arm motion with 15 patients, the CPO device produced spurious signals on 54 occasions compared with five for the prototype Masimo SET. The incidence of artifactual pulse oximetry events during patient motion appear to be substantially reduced with the prototype Masimo SET device, relative to a CPO device.

Adult↗
PubMed2006

Postoperative pain after paediatric adenoidectomy and differences between the pain scores made by the recovery room staff, the parent and the child.

CONCLUSIONS: The parents scored the postoperative pain higher than the nurse. The nurse's score correlated better than the parent's to the child's score. There was no gender difference regarding the pain after adenoidectomy. OBJECTIVE: To evaluate the correlation between the parents and the health care professionals regarding how postoperative pain is estimated and to identify age and gender differences regarding the pain after adenoidectomy. PATIENTS AND METHODS: The study included 100 children aged 3-10 years scheduled for adenoidectomy. The nurse and the parent assessed the postoperative pain of the child at different time intervals using a visual analogue scale (VAS). The child rated its pain by using the Wong-Baker FACES pain rating scale. RESULTS: The postoperative pain scores were higher at 10 min after the operation than after 30 min. The parents scored the pain higher than the nurse did, but there was still a strong correlation between the observers' rating of the pain. The correlation between the nurse's and the child's assessments was stronger than the correlation between the parent's and the child's assessments. There was no gender difference in how the pain was perceived by the child. The parents tended to score the pain higher with older age of the child.

Adenoidectomy↗
PubMed2005

The impact of the joint commission for accreditation of healthcare organizations pain initiative on perioperative opiate consumption and recovery room length of stay.

The enhanced organizational emphasis on the management of pain in hospitalized patients mandated by the Joint Commission for Accreditation of Health Care Organizations (JCAHO) pain initiative precipitated a number of changes by the perioperative services at our facility. In October 2002, a numeric pain scale became mandatory in our postanesthesia care unit (PACU). Response to analgesia in the PACU was recorded using this scale. In addition, an acceptable pain score was required for discharge from the PACU. We evaluated the effects of these changes in the pain management of 1082 patients undergoing general, orthopedic, neurosurgical, urologic, and gynecologic surgeries. We detected an overall increase in the average consumption of opiates (morphine equivalents) in 2002 compared with 2000 (46.6 +/- 20.4 mg versus 40.4 +/- 13.2 mg, P <0.001). This increase was most significant in the PACU (10.5 +/- 10.4 mg versus 6.5 +/- 7.3 mg, P <0.001 between the 2 periods, respectively). This increase in opiate use was not associated with an increased length of stay, an increase in the requirement for naloxone, or an increase in treatment for postoperative nausea and vomiting. We conclude that the increase in opiate use, which could be explained by compliance with the JCAHO pain initiative, was not associated with additional opiate-induced morbidity in the immediate postoperative period.

Adolescent↗
PubMed2005

Opioids: other routes for use in recovery room.

Opioids remain the main pharmacological tools for pain control in the postoperative patient. Recent concerns about chronic use of non-steroidal anti-inflammatory drugs have put extra pressure on health care workers to device and develop new medications and delivery methods to provide patients with appropriate pain relief after surgery. New technologies and better understanding of the pharmacology of the opioids administered by non-traditional ways will be reviewed in this manuscript. Understanding the anatomy of the nose cavity is important to use the inhaled way to deliver fentanyl, sufentanyl or butorphanol in surgical patients. High concentration and small volume are keys to good absorption and effect by nasal administration. Transdermal delivery of fentanyl has been used in chronic pain for some years. A new fentanyl self-administration method is in advanced trials for clinical use. It has a huge potential in giving good pain relief with lower side effects and more patient independence because of its reduced size and lack of tubing attached to it. Day surgery patients could be great candidates for this therapeutic alternative. Finally, oral transmucosal fentanyl is also in the market. Better suited to be used in controlling breakthrough pain in chronic settings, it has been so far marketed in the perioperative period. Side effects are a concern in its use for preoperative sedation in children. Large studies are now required for drugs approval and for new indications at regulatory agencies level. Good clinical judgment is more relevant now than ever before to avoid complications and new withdraw of old good medications inappropriately prescribed from the market place.

Administration, Cutaneous↗
PubMed1995

[Clinical care in a recovery room. Triennial review].

OBJECTIVES: To evaluate clinical practice in our intensive care unit over a period of 3 consecutive years (January 1991-December 1993). PATIENTS AND METHODS: Retrospective computer analysis of clinical data recorded for the 1157 patients admitted during the study period. RESULTS: Seven hundred thirteen men and 443 women were admitted. Mean age was 58.8 years. Eighty-nine percent had undergone elective or emergency surgery, 7% were non surgical emergency admissions and 4% were transferred from other hospital wards. The mean stay was 3.8 days, though the mean stay for elective surgery patients was significantly shorter (p < 0.001). We assess the usefulness of the APACHE-II scale applied during the first 24 hours of admission, finding that mean scores were significantly lower (p < 0.001) for the 1089 survivors (10.2 +/- 4.7) than for the 68 patients who died (23.6 +/- 9.4). The score on the APACHE II scale was above 16 for 82% of those who died. Overall mortality for the unit was 5.9%, though the proportion was statistically higher (p < 0.001) in emergency patients. Complications developed in 299, though the number of complications was significantly lower (p < 0.001) for elective surgery patients. The patients who died required more use of invasive monitoring and mechanical ventilation (p < 0.001). CONCLUSIONS: Our review shows that mortality, lengthy of stay in the unit and number of complications were all greater among emergency admissions. The patients who died had higher mean APACHE-II scores and required more care. Computerized data collection and later analysis is a useful way to assess clinical practice and facilitate future studies.

APACHE↗
PubMed2001

Reduction of operating and recovery room times and overnight hospital stays with interscalene blocks as sole anesthetic technique for rotator cuff surgery.

BACKGROUND: The effort to decrease hospital stays and to increase operating room efficacy has become an important consideration in the practice of anesthesia. METHODS: Fifty-three patients who underwent shoulder rotator cuff repair in the sitting position were divided into four groups according to the anesthesia technique used: Group 1 (general anesthesia), Group 2 (interscalene block), Group 3 (interscalene combined with general anesthesia) and Group 4 (general anesthesia combined with local injection of local anesthetics). Interscalene blocks were performed preoperatively, using a nerve stimulator. After appropriately locating the brachial plexus, a mixture of 40 ml of 2% lidocaine and 0.5% bupivacaine (v/v) was injected. RESULTS: As compared to general anesthesia, the use of an interscalene block alone reduced the following operating room times: 1) from the patient's arrival in the operating room to the beginning of surgery and 2) from the end of surgery to the patient's departure from the operating room. Use of the interscalene block also resulted in a reduction of recovery time when compared to Groups 1, 3 and 4 by 40, 56 and 66%, respectively. Compared to Group 1, this anesthesia technique was furthermore associated with a 64% decrease in the number of patients hospitalized overnight. CONCLUSIONS: This study confirms that the interscalene block as sole anesthesia technique is safe and effective and can contribute to shorten the hospital length of stay of patients undergoing shoulder rotator cuff surgery.

Adult↗
PubMed1990

Incidence of hypoxemia in the postanesthetic recovery room in patients having undergone intravenous sedation for outpatient oral surgery.

This study prospectively quantitated the incidence of hypoxia in outpatients in a postanesthetic recovery unit following intravenous (IV) sedation. After identifying the high incidence of hypoxia by the use of pulse oximetry, supplemental oxygen was given to another group of patients and the incidence of the hypoxia was again monitored. Twenty of 100 patients experienced hypoxic episodes in the postanesthetic recovery unit when no supplemental oxygen was administered; only 3 of an additional 100 patients who received supplemental oxygen had episodes of hypoxia. The difference between the groups receiving and not receiving supplemental oxygen was both clinically and statistically significant. As result of this study, the use of supplemental oxygen is recommended for all patients undergoing IV sedation for outpatient oral surgery.

Adolescent↗
PubMed1994

[Postoperative warming therapy in the recovery room. A comparison of radiative and convective warmers].

Hypothermia (Tcore < 36 degrees C) can be observed in 60%-80% of all admissions to the post-anaesthetic recovery unit. Effective warming devices may accelerate rewarming, improve patient comfort, and suppress shivering thermogenesis. This study was designed to compare the efficiency of warming devices in extubated postoperative patients and their effect on postoperative oxygen uptake (VO2). METHODS. Thirty-five ASA I and II patients after laparoscopic hernioplastic repair with core temperatures < 36 degrees C were randomly assigned to either postoperative nursing under a radiant heater (group R, n = 11, Aragona Thermal Ceilings CTC X, Aragona Medical AB, Täby, Sweden), a forced air system (group L, n = 12, Bair Hugger, Augustine Medical Inc., Eden Prairie, Minnesota, USA), or a normal cotton hospital blanket (group K, n = 12). Anaesthesia was conducted totally intravenously with propofol, alfentanil, and vecuronium. Mean body temperature and total body heat were calculated from urinary bladder temperature and four subcutaneous temperature measurements. The rate of thermogenesis was calculated from continuous measurement of VO2 (Datex Deltatrac Metabolic Monitor, Datex Instrumentarium Corp., Helsinki, Finland). Heat balance was derived from the increase in total body heat minus body heat production. Heart rate and noninvasive blood pressure were measured by the Cardiocap (Datex Instrumentarium Corp., Helsinki, Finland). All data were transferred to an IBM-compatible computer at 60-s intervals. Measurements were stopped when core temperature reached 37 degrees C. The rate of change was calculated for each variable for the period 15 min after the beginning of rewarming to attainment of 37 degrees C. Data are presented as median, minima, and maxima (min<==>max); the Mann-Whitney U test was used to test for significance of group differences. RESULTS. All groups were comparable for body weight, height, age, and amount of postoperative infusions. Temperatures at admission were 35.2 (33.4<==>35.9), 34.7 (34.3<==>35.8), and 35.4 (34.3<==>35.9) degrees C for groups R, B, and K, respectively. No significant differences in the rate of central rewarming could be found for these groups with 0.81 (0.41<==>1.32), 0.76 (0.40<==>1.07), and 0.70 (0.37<==>1.13) degrees C/h (Fig. 1). The mean VO2 of 3.41 (3.07<==>3.73), 3.55 (2.78<==>4.06), and 3.79 (2.51<==>7.00) ml/kg/min also did not differ significantly (Fig. 3). Significant differences between groups R and B [4.39 (3.74<==>6.19) and 4.30 (3.46<==>6.67) ml/kg/min] and K [5.92 (3.79<==>10.64) ml/kg/min] were found for VO2 maxima during the course of investigation (Fig. 4). The heat balance revealed significant differences among treatment and control groups with -88 (-226<==>+30), -41 (-212<==>+12), and -191 (-265<==>-86) kJ/h for groups R, B, and K. We additionally calculated the heat balance as a quotient, which showed 0.70 (0.22<==>1.07), 0.86 (0.44<==>1.04), and 0.49 (0.31<==>0.79) for groups R, B, and K (Fig. 4). The mean rate-pressure product of all groups did not differ significantly during the period of investigation. CONCLUSIONS. Neither external heat supply by radiant heat nor by a forced warm air system significantly reduced rewarming time in extubated, awake patients. As measured by heat balance, both active treatments saved about 20% more body heat production than in the control group. Continuing peripheral vasoconstriction may be the reason for the low efficiency of heat transfer. Thermal treatment did reduce the peak load (max. VO2) on the oxygen transport systems, though shivering was treated by pethidine if it occurred. External rewarming did not reduce the average load (mean VO2). Thus, concerning the goal of accelerating rewarming, it appears more rational to prevent intraoperative heat loss. For a comparison of efficiency of different warming devices, postoperative extubated patients do not appear to be an ideal model for study.

Adult↗
PubMed1992

Method of intraoperative monitoring of neuromuscular function and residual blockade in the recovery room.

We evaluated the method used intraoperatively to assess the degree of neuromuscular blockade prior to pharmacologic reversal to determine its role in preventing residual blockade in the postanesthesia care unit (PACU). We studied 38 patients who received a nondepolarizing muscle relaxant during general anesthesia for carotid endarterectomy or thoracotomy. The anesthesiologist assessed the degree of neuromuscular blockade intraoperatively prior to pharmacologic reversal either by the standard method of visually counting the number of evoked thumb twitches elicited by supramaximal train-of-four stimulation of the ulnar nerve (i.e., thumb train-of-four count), or by an alternative method such as 1) visually counting the number of evoked orbicularis oculi muscle twitches elicited by supramaximal train-of-four stimulation of the facial nerve, or 2) observing the patient for clinical evidence of partial recovery (e.g., swallowing or attempts to breathe). Residual blockade in the PACU was defined as 1) a train-of-four ratio less than 0.70 (measured by a mechanomyograph), or 2) the inability of the patient to perform clinical tests of neuromuscular function (e.g., a sustained head lift for 5 seconds) and evidence of neuromuscular weakness that was resolved following administration of edrophonium. Five of the 22 patients (23%) in whom one of the alternative methods was used had residual blockade in the PACU; none of the 16 patients with a thumb train-of-four count of 3 or 4 before pharmacologic reversal of NMB had residual blockade in the PACU (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗