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PubMed1980

Occupational exposure to anaesthetics in 20 hospitals.

The nitrous oxide and halothane contamination in the inspired air of anaesthetists and in the atmospheres of operating theatres, anaesthetic induction and recovery rooms, were measured during normal unmodified working sessions in 20 hospitals using integrated personal samplers. The nitrous oxide (and halothane) levels ranged from < 10 to 3000 ppm (< 0.1 to 60 ppm) in the different areas with an average of 388.5 ppm (2.8 ppm) for the inspired air of the anaesthetists during 2 hour sampling periods. There was no correlation between the levels of the anaesthetists' exposures and those in the static air samples and this appeared to be due primarily to a wide variation in work practices and techniques. Thus it is potentially misleading to assess anaesthetists' occupational exposure by collecting ambient air samples in the operating rooms. Comparisons with more prolonged measurements in one hospital indicated that the installation of relatively simple active scavenging devices will be effective in most hospitals.

Air Pollution↗

PubMed1994

Noise pollution in the anaesthetic and intensive care environment.

Noise in the operating theatre, recovery room and intensive care unit is above internationally recommended levels. The psychological and physiological effects of noise are reviewed. Equipment and conversation among the staff are major sources of noise in these areas. Equipment design, modification of nursing care procedures, and increased awareness of noise created by the staff may be effective in reducing noise pollution in these areas.

Equipment Design↗

PubMedDate not supplied

[Current situation of anesthesiology and resuscitation in Spain. National Survey (II): surgical units].

We have studied the data from the surgical blocks of 170 hospitals. Hospitals have been classified in three groups according their size (less than 500 beds, from 500 to 1,000 beds and greater than 1,000 beds). A second criterium of classification was the distinction between public and private hospitals. The geographical distribution of the hospitals was our third criterium of classification. We report the results concerning the anaesthetic techniques applied, the availability of the human resources, the physical space and installations, the instrumental equipment, some of the surgical specialties developed in the hospitals, and the characteristics of their recovery rooms.

Anesthesia↗

PubMed2004

Perioperative parathyroid hormone levels in thyroid surgery: preliminary report.

OBJECTIVES/HYPOTHESIS: An immediate method of accurately predicting postoperative hypocalcemia after total thyroidectomy would allow for selective early discharge of patients at low risk. The objective of the study was to determine the utility of perioperative parathyroid hormone measurement in predicting postoperative hypocalcemia after a thyroid surgery that places total parathyroid function at risk. STUDY DESIGN: Prospective case series. METHODS: Twenty-seven patients undergoing total or completion thyroidectomy had three blood samples drawn for parathyroid hormone measurement before dissection, 10 minutes after specimen removal, and in the recovery room. Serial ionized calcium levels were measured in the postoperative period. Preoperative, postresection, and recovery room levels were compared with postoperative ionized calcium levels. RESULTS: The average values before resection, after resection, and in the recovery room were 69.3 (range, 13-163), 42.3 (range, 0-120), and 37.4 (range 7-79) pg/mL, respectively. The incidence of hypocalcemia was 11% (3 of 27 patients). The rate of hypocalcemia was significantly higher (50%) in patients with recovery room parathyroid hormone values of 10 pg/mL or less relative to patients with recovery room parathyroid hormone values greater than 10 pg/mL (4%) in this setting (P =.01). Among patients with a parathyroid hormone value of less than 15 pg/mL in the recovery room, an increasing parathyroid hormone level in the recovery room relative to the level after resection predicted normocalcemia without calcium supplementation on chi analysis (P =.01). CONCLUSION: The study demonstrated that perioperative parathyroid hormone values can help predict patients who are at highest risk for postoperative hypocalcemia after thyroid surgery.

Calcium↗

PubMed1999

[Occupational exposure in the hospital to laughing gas and the new inhalation anesthetics desflurane and sevoflurane].

BACKGROUND AND OBJECTIVE: There have been few studies of the occupational exposure of the new volatile anaesthetic agents desflurane and sevoflurane. Because a health risk through long-term exposure to these inhalants cannot as yet be definitely excluded, we undertook to measure the concentrations of these three anaesthetics in different parts of the Frankfurt University Medical Centre. Considering the results the relevance of exposure for surgical and anaesthesia personnel, possible consequences due to laws and possibilities of improvement were shown. METHODS: The concentration of the three anaesthetics was measured during and after 345 procedures under general anaesthesia, using photoacoustic infra-red-spectrometry every 90 sec in the breathing zone of the same operating room personnel or in the recovery room and the intensive care unit. RESULTS: Exposure of personnel in the air-conditioned operating rooms was very low, but in those rooms that were not or inadequately air conditioned was a times very high. The level of the concentrations was also significantly related to the anaesthesia system and the distance of the exposed person to the patient. The concentration of nitrous oxide was below the maximal working-place concentration (MWC) of 100 ppm, but it exceeded the threshold concentration of 0.1 MAC, as laid down in the "Maternal Protection Law" in the surgical intensive care unit and the recovery room. There are no limiting concentrations for desflurane and sevoflurane yet but their concentrations were clearly below the MWC laid down for isoflurane and enflurane. CONCLUSION: In principle the use of inhalation anaesthetics can be considered to be without occupational health risk under the present legally defined standards of air-conditioning and the requirements of a modern occupational protection law. Because of the increased concentrations in the recovery room and intensive care unit pregnant and breast-feeding women should not work in these areas.

Air Conditioning↗

PubMed1996

Cryoprostatectomy consistently elevates serum creatine kinase-MB isoenzyme.

STUDY OBJECTIVE: To measure serum CK-MB, a market of myocardial infarction (MI), in elderly men before and after cryoprostatectomy. DESIGN: Serum CK-MB was measured on each patient before and after cryoprostatectomy. Each patient's preoperative result was used as control measurement for comparison with measurements made after cryoprostatectomy. SETTING: Inpatient operating room and postanesthetic recovery unit of a university-affiliated general hospital. PATIENTS: 38 male patients, mean (SEM) age 69.1 +/- 1.4 years, undergoing cryoprostatectomy. INTERVENTIONS: All patients had a 12-lead ECG prior to surgery, in the recovery room, and 24 hours after surgery. Serum CK-MB was measured prior to induction of anesthesia, on arrival in the recovery room, and at 8 and 24 hours after surgery. Lactate dehydrogenase (LDH) and isoenzymes also were measured in 10 patients before and after cryoprostatectomy. MEASUREMENTS AND MAIN RESULTS: All patients underwent uneventful cryoprostatectomy. No patients had new ECG changes after surgery. All patients had normal serum CK and CK-MB concentrations before surgery. Serum CK and CK-MB were significantly elevated after cryoprostatectomy (p < 0.001). Enzyme values were greatest 8 hours after surgery: total CK mean 1453 +/- 145 U/L (range 199 to 3,356 U/L); CK-MB mean 52 +/- 3 ng/ml (range 12 to 114 ng/ml) or 5.0 +/- 0.5% of total CK (range 1.6% to 12.4%). All patients had significant elevations of LDH after cryoprostatectomy but did not show an increase in the ratio of LDH1 to LDH2 isoenzymes. Finally, unlike patients with an acute MI, the activity of CK-MB isoenzyme when measured by gel electrophoresis was two to three times greater (mean, 2.6 +/- 0.7) than the concentration measured with the monoclonal antibody assay in patients after cryoprostatectomy. CONCLUSION: Serum CK-MB is an unreliable test to diagnose an MI in patients who have undergone cryoprostatectomy.

Aged↗

PubMed1978

Prevention of post-anaesthesia shivering.

This study involves ventilation of the lungs with warmed humidifed anaesthetic gases during prolonged elective abdominal operations. Tympanic, oesophageal and toe temperatures were compared bewteen twenty warmed and twenty un-warmed patients at various times during operation and recovery. Fifty per cent (10/20) unwarmed patients shivered in the recovery room, while none of the warmed patients shivered. Our data indicate that pulmonary ventilation with warm humidified anaesthetic gases provides heat transfer by the lungs, preventing hypothermia during operation and post -anaesthesia shivering is prevented by maintaining the patient normothermic in both the operating room and the recovery room.

Anesthesia, General↗

PubMed1989

Hygiene aspects of occupational exposure to waste anaesthetic gases in Ontario hospitals.

Exposure of workers to waste anaesthetic gases in the operating and recovery rooms of hospitals is an ongoing concern because a number of epidemiological and mortality studies have reported significant adverse effects. To evaluate the health risks if any, and to assist in the development of guidelines or regulations for the hospital sector in Ontario, the Health and Safety Support Services Branch of the Ontario Ministry of Labour conducted this extensive study. The results of the hygiene study show that exposure to waste anaesthetic occurs because of leaks in the anesthetic equipment. The three major sources of leaks (i.e. exhalation valves, masks and high-pressure fittings) produced concentrations above the limit of detection of nitrous oxide (1000 ppm of N2O) in a significant number of samples. Of the samples taken at leak sources those taken at the exhalation valve had the highest percentage of samples above 1000 ppm, which suggested that scavenging systems were not receiving proper service and maintenance. Only 23% of the operating rooms surveyed met the Ontario Ministry of Health Criterion of 24 air changes per hour. Dilution ventilation was less effective than scavenging in keeping down concentrations of air contaminants. The sampling data show that the anaesthetists have the highest time-weighted average exposure (median value range 56-79 ppm) of the major group of occupations surveyed and that the general surgeons' TWA is much lower (28 ppm). It was concluded that the dilution ventilation rate of 24 air changes per hour should be maintained in all operating rooms and that there should be no recirculation of exhaust air when operations are in progress. To keep down concentrations of anaesthetic gases scavenging systems should be provided in all operating rooms. In each hospital maintenance should be the responsibility of a qualified staff member who has been adequately trained in the repair and maintenance of anaesthetic delivery systems. Finally, a qualified staff member should be responsible for conducting periodic personal monitoring in operating rooms (ORs) and recovery rooms (RRs) and the sampling strategy should include individuals and the exhaust grilles.

Air Pollutants, Occupational↗

PubMed1998

[Use of the laryngeal mask in oral and dental surgery].

OBJECTIVE: The suitability of the laryngeal mask (LM) for anesthesia in oral and dental surgery of the face was investigated considering in particular the risks of aspiration and dislocation. We also examined acceptability to the surgeon. METHODS: In a prospective study, a total of 105 patients (ASA I-III) was included. Provided with flexible LMs, patients were operated upon the third molars (n = 64), around the dentoalveolar area (n = 32) and extraorally (n = 9). The number of placing efforts, preoperative leakage pressure, cuff pressure and complications occurring during the course of anesthesia were recorded. After the operation, the procedure was compared to endotracheal anesthesia (ETA) by the surgeon. A retrospective study comparing LM with ETA was performed on 1395 patients examining the time in between two operations, the period from the end of operation to the beginning of control of vital signs in the recovery room, and the time spent in the recovery room. The number of patients necessitating a change of anesthesia from LM to ETA was recorded. RESULTS: In 33 patients (31%), intraoperative leakage due to dislocation was observed. 33 patients (31%) had obstruction of the airway. Only when leakage occurred together with obstruction of the airway, SaO2 fell below 94% (n = 11). This was seen in particular during exposure of the wisdom teeth. In 2 of these cases, SaO2 decreased below 70 or 34% respectively. Aspiration of blood, gastric juice or dental and bone fragments was not observed. In one case, ETA became necessary. 19 patients complained of local pains (cough, sore throat, dysphagia). Operative conditions for the surgeon were comparable to oral ETA in 79% of the cases. The time in between two operations decreased about 35%, the period from the end of operation until first control of vital signs in the recovery room was reduced of about 41%, and the time spent in the recovery room decreased by 37% when compared to ETA. Out of 1111 anesthesias performed with the LM, 17 had to be exchanged for ETA. CONCLUSION: Leakage due to dislocation of the LM and airway obstruction only leads to a relevant risk of SaO2 to drop if both components occur simultaneously. With increasing experience and close cooperation between surgeon and anesthesiologist, they may be almost completely avoided so that even exposure of the lower, wisdorri teeth will seldom iiecessiiate the LM to be replaced by ETA. In relation to the tongue depressor, cuff pressure should be kept at low levels in order to obtain better flexibility of the LM. The LM provides sufficient protection against aspiration of intraoperative fluid in the pharynx. Acceptability to the surgeon is high because of good operative conditions and shortened periods in between two operations when compared to ETA. Improved protective reflex responses after the operation and its advantages when used in patients with tightness of the jaw make the LM a suitable instrument for anesthesia in oral and dental surgery.

Adult↗

PubMed2000

Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD.

BACKGROUND: Flumazenil is a benzodiazepine antagonist indicated for reversal of the sedative effects of benzodiazepines. Previous studies suggest that flumazenil may shorten recovery time after endoscopy, but there are few data on actual recovery room times and charges. METHODS: Fifty patients undergoing routine upper endoscopy were sedated with midazolam alone in the usual titrated manner. Patients were randomized in a double-blind fashion to receive either flumazenil or saline immediately after procedure. Assessments of responsiveness, speech, facial expression, and ptosis (Observer's Assessment of Alertness/Sedation [OAA/S] scale) were made before procedure, immediately after procedure and every 15 minutes thereafter. The patient was discharged from the recovery room when vital signs and OAA/S scale reached preprocedure levels. Recovery room times and charges were recorded. RESULTS: The flumazenil group demonstrated shorter recovery room times and recovery room charges than the placebo group (p < 0.001). The difference in recovery room charges was not statistically different when flumazenil charges were included (p = 0.09). CONCLUSIONS: The routine use of flumazenil after midazolam sedation for upper endoscopy significantly shortened recovery time and charges but did not statistically reduce overall charges.

Adult↗

PubMed1989

Recovery from anaesthesia in children.

There are no published comprehensive surveys of paediatric recovery room experience and the incidence of complications. A prospective survey was made of 16,700 consecutive admissions to the recovery room at the Royal Manchester Children's Hospital during the years 1985-1988. The incidence of respiratory complications was low, with laryngospasm 0.85%. The incidence of hypotension was higher than that in adult studies; over 50% of children recorded a decrease in blood pressure in the recovery room of more than 20%, compared to values before operation. The incidence of vomiting in the recovery room was also lower than in comparable adult studies. Certain aspects of recovery room practice changed during the 4 years of the study; these included routine oxygen administration, parents in the recovery room, and our approach to postoperative analgesia. The implications of these changes are discussed.

Anesthesia Recovery Period↗

PubMed2001

Pulse oximetry for perioperative monitoring.

BACKGROUND: Monitoring with pulse oximetry might improve patient outcome by enabling an early diagnosis and consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomised clinical trials of pulse oximetry have been performed during anaesthesia and in the recovery room which describe perioperative hypoxaemic events, postoperative cardiopulmonary complications and cognitive dysfunction. OBJECTIVES: To study the effect of perioperative monitoring with pulse oximetry to clearly identify the adverse outcomes that might be prevented or improved by the use of pulse oximetry. SEARCH STRATEGY: Trials were identified by computerised searches of the Cochrane Library, MEDLINE, EMBASE, and by checking the reference lists of trials and review articles. SELECTION CRITERIA: All controlled trials that randomised patients to either pulse oximetry or no pulse oximetry during the perioperative period, including the operating and recovery room. DATA COLLECTION AND ANALYSIS: We collected data in relation to events detectable by pulse oximetry, any serious complications that occurred during anaesthesia or in the postoperative period, intra- or postoperative mortality, and duration of recovery or intensive care stay. Formal statistical synthesis of individual trials was not performed in view of the variety of outcomes studied. MAIN RESULTS: Searching identified six reports; four studies with data from a total of 21,773 patients were considered eligible for analysis. Only two studies specifically addressed the outcomes in question; both found no effect on the rate of postoperative complications using perioperative pulse oximetry. Two studies used hypoxaemia detectable by pulse oximetry to assess the value of perioperative monitoring, although outcomes were not given. It was found that hypoxaemia was reduced in the pulse oximetry group both in the operating theatre and in the recovery room. During observation in the recovery room, the incidence of hypoxaemia in the pulse oximetry group was 1.5-3 times less. The postoperative cognitive function using the Wechsler memory scale and continuous reaction time was independent of perioperative monitoring with pulse oximetry. The other study showed that postoperative complications occurred in 10% of the patients in the oximetry group and in 9.4% in the control group. The two groups did not differ in cardiovascular, respiratory, neurologic, or infectious complications. The duration of hospital stay was a median of 5 days in both groups, and an equal number of in-hospital deaths was registered in the two groups. REVIEWER'S CONCLUSIONS: The studies confirmed that pulse oximetry can detect hypoxaemia and related events. However, we have found no evidence that pulse oximetry affects the outcome of anaesthesia. The conflicting subjective and objective results of the studies, despite an intense, methodical collection of data from a relatively large population, indicates that the value of perioperative monitoring with pulse oximetry is questionable in relation to improved reliable outcomes, effectiveness and efficiency.

Humans↗

PubMed1996

A comparative study of early postoperative hypoxemia in infants, children, and adults undergoing elective plastic surgery.

To determine the influence of age on postoperative hypoxemia, we studied postoperative hypoxemia in 1152 patients, from infants to adults, ASA physical status I, undergoing elective plastic surgery. Subjects were divided into four groups on the basis of age: Group 1, infants aged 1 yr or less (n = 108); Group 2, children aged 1-3 yr (n = 240); Group 3, children aged 3-14 yr (n = 482); and Group 4, adults aged 14-58 yr (n = 322). Arterial oxygen saturation (Spo2) levels were recorded while patients were breathing room air in the postanesthesia recovery room shortly after arrival (0 min), and 5, 10, 15, 20, 30, 40, 50, 60, 120, and 180 min thereafter. Younger patients showed lower Spo2 levels and a higher incidence of hypoxemia during the early postoperative period. The incidences of hypoxemia (Spo2 = 86%-90%) and severe hypoxemia (Spo2 < or = 85%) in the recovery room were 30.6% and 16.7%, respectively, in Group 1, 20.0% and 10.0% in Group 2, 14.1% and 3.3% in Group 3, and 7.8% and 0.6% in Group 4. Hypoxemia occurred most commonly within 1 h after anesthesia, particularly during the first 40 min in infants and during the first 15 min in older children and adults. A significant correlation was found by linear regression analysis between low Spo2 levels on admission to the recovery room and children's age. Thereafter, Spo2 levels and the incidence of hypoxemia during the early postoperative period were related only to infants' recovery scores.

Adolescent↗

PubMed1995

A hospital administrator's view of the operating room.

The need for greater efficiency in OR management will become apparent as hospitals are forced to respond to a myriad of pressures imposed by the external environment. The most effective strategy in dealing with this challenge will be realized by adopting a "systems" approach to OR functions as opposed to the more traditional methodology that emphasizes a review of individual problematic components. One issue that challenges many ORs is "throughput": the backlog of patients in ORs that occurs because the recovery room is filled to capacity. The traditional approach is to focus on the recovery room's inefficiency and to expend energy on improving recovery room function. A "systems" approach would examine all factors that affect recovery room function and analyze the interdependencies that exist between the recovery room and other hospital service functions. These might include the way cases in the OR are scheduled, as well as issues that involve patient transfer from the recovery room to intensive, intermediate, and routine floor care. By establishing a dialogue with parties outside of the traditional OR community, the opportunity to solve problems that affect the OR but that are outside of its direct sphere of control, presents itself. This approach will require the acquisition of new skills by those responsible for OR management in addition to promulgating a change in the culture that dominates many ORs today. An insular approach that reinforces the concept of the OR as a microcosm unto itself is an outmoded one. The hospital community at large will benefit from the expert skills possessed by those proficient in efficient OR management, while enabling the OR to fulfill its mission in the challenging times ahead.

Appointments and Schedules↗

PubMed1975

A consideration of ketamine dreams.

This study was designed to see whether covering of the eyes during and after ketamine anaesthesia would reduce the incidence of dreams. One hundred and fifty patients, randomly divided into three groups, underwent therapeutic abortion with ketamine as the sole anaesthesia. One hundred patients had their eyes completely covered, 50 in the operating room only and 50 in the operating room and in the recovery room. The third 50 were controls, with their eyes uncovered. All patients were questioned post-operatively about dreams, nausea and vomiting, headache, dizziness and experiences, and also how frequently they dreamed at home. Although covering the eyes in the recovery room only reduced the incidence of dreams marginally, it became obvious that the patients who dreamed after ketamine (in all 3 groups) were those who normally dreamed at home. There were 82 patients who were recorded as not being home-dreamers, and only two of these dreamed after ketamine. In contrast, of the 68 home-dreamers, 50 dreamed after ketamine, and 17 of these had unpleasant dreams. In the home-dreamers, covering the eyes reduced the incidence of dreams from 86 per cent in Group 1 to 72 per cent in Group 2 and 64 per cent in Group 3. It is suggested that goggles may be advantageous when dealing with home-dreamers, and a question about the patient's tendency to dream should be included in the preoperative questioning. Alterations in premedication and the use of a quiet dark room during recovery may even further reduce unpleasant dreams in this group.

Anesthesia, Intravenous↗

PubMed2001

Anaesthetic clinical indicators in public hospitals providing anaesthetic care in Hong Kong: prospective study.

OBJECTIVES: To assess the quality of anaesthetic services as defined in the six anaesthetic clinical indicators against preset standards and to identify risk factors for adverse events in the recovery room. DESIGN: Prospective study. SETTING: All public hospitals providing anaesthetic care in Hong Kong. PATIENTS: Eighteen thousand, seven hundred and fifty-nine patients receiving elective or emergency anaesthesia administered by anaesthetists from June 1998 to July 1998. MAIN OUTCOME MEASURES: Patient demographics, American Society of Anesthesiologists status, category and nature of operation, presence of preoperative anaesthetic visit in ward, type of anaesthesia, reasons for a recovery room stay of more than a 2-hour duration, intubation to relieve respiratory distress in the recovery room, presence of hypothermia in the recovery room for operations lasting more than 2 hours, and dental or ocular injuries attributable to anaesthesia. RESULTS: There are two major findings from this study. Firstly, a high incidence of hypothermia in the recovery room was reported. Secondly, a greater risk of prolonged stay in the recovery room was identified for patients older than 65 years, major operations, and anaesthetic techniques using combined general and regional anaesthesia. CONCLUSION: The six anaesthetic clinical indicators reflected the provision of anaesthetic care in public hospitals in Hong Kong. Good compliance to the preset standard of the anaesthetic clinical indicators was achieved during the study period.

Adolescent↗

PubMed1999

Adenotonsillectomy in the very young patient: cost analysis of two methods of postoperative care.

Postoperative management of the patient younger than 36 months undergoing adenotonsillectomy has been the subject of many debates. Concerns for early postoperative complications such as airway obstruction, emesis, dehydration, and hemorrhage have led many physicians to consider overnight hospitalization following adenotonsillectomy in very young children. Trends in health care management have had increasing focus on cost effective means of treating patients to limit unnecessary expenditure on the part of the patient, physician, and hospital facility. The purpose of this retrospective review was to analyze two methods of early postoperative management in children less than 36 months old undergoing adenotonsillectomy at the Children's Hospital, San Diego from 1992 to 1997. Three hundred and seven cases were reviewed. Same-day discharge was compared with overnight inpatient observation based on the cost analysis of these two methods of postoperative care. Postoperative care was based on length of stay in the recovery room and as an inpatient. Expense of postoperative care was based on cost calculation for the recovery room and overnight hospitalization. Of the 307 patients, 194 went home the day of surgery and 113 were observed overnight in the hospital. Average hospital cost was higher in the outpatient group than in the inpatient group (P < 0.001). This difference reflects longer recovery room stay (350 min) in the outpatient group compared to the inpatient group (108 min) (P < 0.001). Outpatient adenotonsillectomy in the patient under 36 months may be safe; however, prolonged recovery room stays may actually make outpatient surgery less cost-effective than overnight admission. Recovery room costs are significantly higher per unit time than costs of inpatient hospitalization. Further investigation of cost-effective outpatient observation units may improve cost containment in the outpatient surgical setting.

Adenoidectomy↗

PubMed1993

Epidural narcotic analgesia after thoracotomy.

The benefits of epidural narcotic analgesia (ENA) have been documented in mixed surgical populations. To assess the safety and utility of ENA after thoracic surgery and to assess potential interactions with intraoperative intravenous narcotics (IIN), we retrospectively examined the records of 130 consecutive patients having thoracotomy. The 116 patients who received ENA required a mean of 0.19 mg/kg of intravenous morphine sulfate (MS) within the first 48 postoperative hours, as opposed to 0.44 mg/kg for patients who did not receive ENA. The place in which nonepidural patients were extubated most frequently was the operating room (71%), followed by the intensive care unit (21%) and the recovery room (7%). Percentages were similar for epidural patients: 71% were extubated in the operating room, 20% in the intensive care unit, and 9% in the recovery room. Nonepidural patients had an immediate mean postoperative PCO2 of 39.2 mm Hg, epidural patients a mean of 40.1 mm Hg. There were no technical complications due to epidural catheter placement, and no reintubation was required within the first 72 postoperative hours. The concomitant administration of IIN did not produce a significant difference in postextubation PCO2 in either group of patients, although increasing doses resulted in a lower percentage of patients extubated in the operating room or recovery room. We conclude that ENA may be safely administered to patients having thoracotomy, and it diminishes the need for postoperative intravenous narcotics.

Adult↗