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At least 433 records · Page 24Linked to original sources
PubMed1981

The big toe in the recovery room: peripheral warm-up patterns in children after open-heart surgery.

To evaluate the usefulness of toe temperature warm-up patterns in predicting survival in a group of pediatric patients after cardiac surgery, the condition of 70 children [age 3.9 years + / - 3.8 yr] was evaluated for 24 hours postoperatively by direct and indirect cardiac monitoring, including toe temperature, while in a heat controlled environment. Two groups were identified 60 survivors and 10 nonsurvivors. The volume balance, pH and urine output of all patients were maintained within acceptable values, but nonsurvivors had a persistently lower blood pressure. Systemic vascular resistance separated survivors from nonsurvivors but cardiac index did not. A toe temperature that did not reach 32 degrees C within 4 hours of operation was associated with increased mortality. With peripheral warm-up patterns a nomogram was constructed, its predictive accuracy was identified [99% valid] and the tow temperature trends were correlated with traditional monitoring techniques. The authors conclude that measurement of tow temperature is a useful, inexpensive and noninvasive addition to established methods of monitoring after open-heart operations.

Adolescent↗
PubMed1993

[Capnography. A new monitoring method may improve patient safety during anesthesia and in the recovery room].

This review describes the diagnostic possibilities of capnography: the graphic presentation of carbon dioxide concentrations in respiratory gas during the entire respiratory cyclus. The monitoring may confirm that the tube used for intubating the patient's trachea is positioned in the patient's airway, and indicates dysfunction of the tube or of the ventilator. Capnography can also rapidly provide important information about a patient's ventilation, circulation and metabolism. This may improve patient safety during anaesthesia and in the intensive care unit. Patients without artificial airways may also be monitored by capnography. The method may reduce the number of arterial blood gases required to check the degree of ventilation.

Anesthesia, General↗
PubMed1995

Incidence of malignant hyperthermia reactions in 2,214 patients undergoing muscle biopsy.

To determine the incidence of malignant hyperthermia (MH) reactions after trigger-free anaesthesia in a large population of MH-susceptible (MHS) patients, the charts of 2,214 patients who underwent elective muscle biopsy for malignant hyperthermia were reviewed. Either general or regional anaesthesia with non-triggering drugs was used. For general anaesthesia, the trachea was intubated in the absence of muscle relaxants. The halothane/caffeine contracture test was performed on the biopsied muscle. Suspected MH reactions were identified according to their site of occurrence (in the operating room, recovery room or ward). Ninety-seven percent of patients received a general anaesthetic; 3% received a regional anaesthetic or field block. Of the 2214 patients whose muscles were biopsied, 1082 patients were biopsy-positive for MH. Five patients in whom MH reactions were diagnosed in the recovery room were all subsequently proved to be biopsy-positive for MH. Four of the five received intravenous dantrolene as part of their therapy; the fifth received only symptomatic therapy as parenteral dantrolene was not commercially available. All patients recovered completely from their reactions. We conclude that the incidence of MH reactions in biopsy-positive patients who receive a trigger-free anaesthetic for minor surgery is small (0.46%, (0.15-1.07%, 95% CI)). These reactions occur in the immediate postoperative period.

Adolescent↗
PubMedDate not supplied

Early anesthesia evaluation of the ambulatory surgical patient: does it really help?

STUDY OBJECTIVE: To evaluate whether early evaluation by the anesthesiologist is more beneficial for the ambulatory surgical patient than a day-of-surgery visit. DESIGN: A randomized study evaluating patients with different surgical procedures. SETTING: Ambulatory surgical outpatients at a university-affiliated integrated ambulatory surgical unit. PATIENTS: Sixty-three ASA physical status I and II women scheduled to undergo elective dilatation and curettage or gynecologic laser surgery. INTERVENTIONS: Approximately half of the patients received an early (1 to 7 days preoperative) anesthesia evaluation, and half received a day-of-surgery evaluation. All patients underwent the surgical procedures with a standardized general anesthetic. MEASUREMENTS AND MAIN RESULTS: The effect of an early versus a day-of-surgery anesthesia visit was evaluated with regard to patient anxiety levels; patient satisfaction with the surgical and anesthetic experience; operating room, recovery room, and ambulatory surgery unit time; anesthetic and analgesic requirements; and frequency of postoperative problems within 72 hours at home. There were no differences between the groups in demographic characteristics, anesthesia or analgesic requirements, degree of satisfaction with the ambulatory surgical experience, time spent in recovery room, or frequency of problems on postoperative follow-up. We were unable to demonstrate any differences between those patients seen early versus those seen on the day of surgery in anxiety levels preoperatively and postoperatively. CONCLUSIONS: Healthy ASA physical status I and II ambulatory surgical patients do not benefit from reducing preoperative anxiety by visiting the anesthesiologist prior to the day of surgery.

Adult↗
PubMed1992

Evaluation of users' abilities to recognize musical alarm tones.

The problem of accurate identification of alarm sounds in the operating room, recovery room, and intensive care environment has persisted for many years. Monitors made by different companies may have different alarm sounds for the same monitored variable, and similar alarm sounds for different variables. In an effort to illustrate universal alarms sounds, a system of six musical alarm tones was designed with musical themes from popular songs used for oxygenation, ventilation, cardiovascular monitoring, temperature monitoring, artificial perfusion, and drug administration systems. These melodies were played for a group of anesthesiologists and others, who were initially asked to guess the organ system for each melody. The answers were then given to the participants, and after a short delay the melodies were played again in a different order. Seventy-nine response sheets were collected. The expected random score was 1.0 +/- 1.0 SEM correct. The observed score on the first hearing was 1.5 +/- 1.6 SEM, p = 0.01 compared with the random score. The observed score on the second testing was 4.3 +/- 2.2 SEM, p = 0.001 compared with the first hearing. Indeed, 42 of 79 (53%) respondents got all six answers correct on the second testing, versus three respondents for the first testing. The implications of these findings are discussed in the context of integrated alarm systems used in complex medical environments such as the operating room.

Association Learning↗
PubMed2005

Cytogenetic tests performed on operating room personnel (the use of anaesthetic gases).

OBJECTIVES: Personnel exposure to anaesthetic gases in the health sector, whether in the operating room, recovery room, or in the context of outpatient clinics, may entail a health risk. The goal of this research was to study the cytogenetic effects of chronic exposure to small doses of pollutants in operating theatres. METHODS: Results of cytogenetic analyses [structural chromosomal aberrations (SCAs), sister chromatid exchange (SCE) and micronucleus (MN) test] of anaesthetists and other personnel handling anaesthetic gases, who only occasionally work in zones of ionizing radiation, were compared with results from radiologists, occupationally exposed to ionizing radiation only, and with the results obtained from a group of Slovene citizens who were never exposed to genotoxic agents. RESULTS: This study involved 153 workers handling anaesthetic gases. The average frequency of SCAs in the group working with anaesthesia was 2.693. The result was statistically significantly higher than in the group of radiologists and Slovene citizens. The frequency of SCE and MN was also statistically significant. A number of authors, who used the same cytogenetic tests, found similar results in the group of anaesthetist. CONCLUSION: The results of our study indicate that exposure to anaesthetic gases induced changes in human chromosomes.

Adult↗
PubMed2003

Demographic and socioeconomic aspects of hernia repair in the United States in 2003.

Data from the National Center for Health Statistics reveals that approximately 800,000 groin hernia repairs were completed in the United States in 2003. More than 90% of these operations involve the use of mesh prosthesis and are performed on an outpatient basis. The two most common groin hernia repair techniques are the Lichtenstein and plug hernioplasties. Economic evaluation of groin hernia surgery demonstrates that the most important component of cost effectiveness is the aggregate time the patient spends in the operating room, recovery room, and the length of his or her overall stay in the facility.

Digestive System Surgical Procedures↗
PubMed1993

Relationship between supranormal circulatory values, time delays, and outcome in severely traumatized patients.

OBJECTIVE: To describe the temporal patterns of hemodynamics and oxygen transport in survivors and nonsurvivors of severe trauma in relation to time delays, mortality, and morbidity. DESIGN: Prospective, empiric analysis. SETTING: University-run, inner city county hospital with a Level I trauma center. PATIENTS: A series of 90 consecutively monitored, severely ill trauma patients. METHODS: We followed 90 patients from admission through their hospital course, and divided the study group into patients with estimated blood loss of < or = 3000 mL and those patients with an estimated blood loss of < 3000 mL. For each patient, vital signs were recorded in the Emergency Department, operating room, recovery room, and surgical ICU. Hemodynamic and oxygen transport variables were measured at least every 12 hrs for 96 hrs postadmission. Final outcome and complications were recorded. RESULTS: In the first 24 hrs, the values of 60 survivors were significantly higher than the values of 30 nonsurvivors for mean cardiac index (4.52 +/- 1.45 vs. 3.80 +/- 1.20 L/min/m2; p < .05), oxygen delivery (670 +/- 230 vs. 540 +/- 200 mL/min/m2; p < .01), and oxygen consumption (166 +/- 48 vs. 134 +/- 47 mL/min/m2; p < .01). Thirteen (50%) of 26 patients who never attained mean survivors' values (defined as the mean survivors' values listed above) died. Also, 12 (57%) of 21 patients who took > 24 hrs to attain these values died. In contrast, only five (12%) of 43 patients who reached mean survivors' values in < or = 24 hrs died. Thirty-five of 90 patients lost < 3000 mL of blood; 17 of these 35 patients failed to reach survivors' values within 24 hrs, and 12 (71%) patients died. However, of 18 patients with an estimated blood loss of > 3000 mL, who reached survivors' values in < or = 24 hrs, only two (12%) died. The patients reaching survivors' values in < or = 24 hrs, > 24 hrs, or not at all had similar Injury Severity Scores (28 +/- 13, 26 +/- 13, and 26 +/- 12, respectively) and Trauma Scores (12 +/- 3, 13 +/- 3, and 12 +/- 3, respectively). Only six (12%) of 43 patients reaching survivors' values in < or = 24 hrs developed adult respiratory distress syndrome (ARDS), while 27 (57%) of 47 patients showed these values in > 24 hrs or never developed ARDS. CONCLUSIONS: Reaching supranormal circulatory values, especially within 24 hrs of injury, may improve survival and reduce the frequency of shock-related organ failure in severely traumatized patients.

Hemodynamics↗
PubMed1994

Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target.

BACKGROUND: Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR. METHODS: The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics. RESULTS: Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older. CONCLUSIONS: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of in-hospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival.

Adult↗
PubMed1997

A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery.

PURPOSE: Intermittent pneumatic compression of the calf and/or thigh effectively decreases the incidence of deep venous thrombosis and other thrombotic sequelae but clinical data comparing these modalities are currently lacking. MATERIALS AND METHODS: A total of 90 patients undergoing major urological surgery was randomly assigned to receive calf length or thigh length pneumatic compression for antithrombotic prophylaxis. Duplex ultrasound of the lower extremities was performed preoperatively and twice postoperatively to evaluate for deep venous thrombosis. Health care providers in the operating room, recovery room and ward were asked to compare the compression systems, and a cost analysis was performed. RESULTS: A total of 47 patients wore the thigh length sequential pneumatic sleeves and 43 wore calf length uniform compression systems. A pulmonary embolus without evidence of deep venous thrombosis was detected in 1 patient (2%) using the thigh length system. A thrombus was detected in the common femoral vein by duplex ultrasonography in 1 patient (2%) with the calf length system. Nursing personnel found the calf length sleeves easier to apply and more comfortable by patient account but they were satisfied with both systems. There was a significant cost savings with the calf length pneumatic compression system. CONCLUSIONS: Calf and thigh length pneumatic compression systems similarly decrease the risk of deep venous thrombosis in patients undergoing urological surgery. The calf length system has the added advantage of being less expensive and easier to use.

Aged↗