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PubMed2001

Intravenous ketoprofen in thyroid and parathyroid surgery.

UNLABELLED: We compared the ketoprofen-propacetamol combination relative to propacetamol alone in thyroid and parathyroid surgery in terms of postoperative analgesic efficacy, bleeding, and incidence of nausea and vomiting to determine whether ketoprofen results in any benefit in this type of surgery. Patients were distributed in two parallel groups to be managed by anesthesiologists habitually prescribing (Ketoprofen group) or not prescribing (Control group) ketoprofen in this situation. The same anesthetic technique was used for all patients. Postoperative analgesia consisted of 2 g of propacetamol every 6 h and morphine boluses if the pain score measured by the numerical rating scale pain exceeded 40 (3 mg IV every 10 min in the recovery room, then 5 mg SC every 4 h in the ward). The Ketoprofen group received 100 mg of ketoprofen IV during surgery (starting on resection of specimen) and 8 h later. In the recovery room, patients received oxygen if the SpO(2) while they were breathing room air was < 95% on admission and at 1 and 2 h. Pain scores, opioid consumption, the volume of the cervical draining fluid, and the concentration and mass of hemoglobin in this fluid collected over 24 h were recorded. The 214 patients were distributed into two groups (n = 107 in each group) that were comparable in terms of age, weight, sex, duration of surgery, type of endocrinopathy, surgeon involvement, and the intraoperative dose of sufentanil (P > 0.2). The Ketoprofen group had lower numerical rating scale (P < 0.05), received less morphine during the first 24 h after surgery (7.4 +/- 5 vs 11.7 +/- 6 mg, P < 0.05), had fewer nausea and vomiting episodes (21 vs 38, P < 0.05), and were less likely to require oxygen breathing after 1 h in the recovery room (33 vs 59 patients, P < 0.05). The two groups had the same 24-h volume of cervical draining fluid (72.5 +/- 43 vs 70 +/- 42 mL, P > 0.2) and the same concentration (5.9 +/- 3.4 vs 6.4 +/- 2.8 g per 100 mL, P > 0.1) and mass of hemoglobin (3.9 +/- 2.8 vs 4.2 +/- 2.5 g, P > 0.2) in this collected fluid. Two cervical hematomas necessitating reintervention occurred in the Control group, compared with none in the Ketoprofen group. Ketoprofen reduces the pain score after thyroid and parathyroid surgery, as well as morphine requirements and related adverse effects, without increasing the risk of cervical bleeding. IMPLICATIONS: In a prospective open study, ketoprofen reduced the pain score after thyroid and parathyroid surgery, as well as morphine requirements and related adverse effects, without increasing the risk of cervical bleeding.

Acetaminophen↗
PubMedDate not supplied

Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty.

BACKGROUND AND OBJECTIVES: This study was conducted to ascertain whether there is any advantage to the continuous-infusion femoral 3-in-1 nerve block over the single-injection femoral nerve block for postoperative analgesia after total knee arthroplasty. METHODS: A double-blind, randomized, controlled study was made of 33 patients undergoing total knee arthroplasty, who were randomized into three groups. Group 1 received a single-injection femoral 3-in-1 nerve block with 20 mL 0.5% bupivacaine with 1:200,000 epinephrine. Group 2 had a catheter placed in the femoral nerve sheath, through which a continuous femoral 3-in-1 nerve block was established. Group 3 patients served as controls. All blocks were performed and assessed prior to induction of standardized general anesthesia. All patients received morphine via patient-controlled analgesia. Pain was recorded on a 100-mm visual analog scale at rest and with motion of the knee. Opioid consumption and side effects were recorded; P = .05 was considered statistically significant. RESULTS: In the recovery room, pain scores with motion were lower in the single-injection and continuous-infusion groups (P < .05). There were no significant differences between any of the groups regarding pain scores or morphine requirements beyond the recovery room. The incidence of nausea was higher in the control group. There were no differences between the groups with respect to overall patient satisfaction. CONCLUSIONS: We were unable to confirm improvements in analgesia provided by continuous-infusion femoral 3-in-1 nerve block for total knee arthroplasty except in the recovery room.

Aged↗
PubMed1989

Preanesthetic medication in children: a comparison of oral transmucosal fentanyl citrate versus placebo.

Initial studies have suggested that oral transmucosal fentanyl citrate (OTFC) in a dose of 15-20 micrograms/kg may be a safe and effective preanesthetic medication in children and adults, but this has not been demonstrated in a randomized, double-blind fashion. The purpose of this study was to determine in a randomized, double-blind manner, the efficacy of a lollipop containing fentanyl citrate as a preanesthetic medication before surgery in children. Forty health ASA physical status 1 or 2 children 3-12 yr of age were divided randomly and in double-blind fashion into two groups. Group 1 received the lollipop containing OTFC and group 2 received a placebo lollipop. An appropriate size lollipop was chosen so that if the patient received fentanyl, the total dose would be 15-20 micrograms/kg. Anxiety, sedation, and separation scores were assessed preoperatively and ease of induction was rated. Oxygen saturation and respiratory rate were monitored. Time intervals from preanesthetic to induction and from recovery room (PACU) admission to discharge were noted. Recovery room behavior was assessed upon admission and discharge. Complications and the need for postoperative opioids were noted. OTFC produced significantly more sedation and less anxiety compared with that following placebo. Respiratory rate was significantly decreased in the OTFC group, but oxygen saturation was not significantly different between groups. Anxiety and separation scores and the quality of induction were better in the OTFC group. There was a higher incidence of nausea and pruritus in the fentanyl group. OTFC did not prolong the PACU stay.

Administration, Oral↗
PubMed1997

Laser prostatectomy versus transurethral resection of the prostate for benign prostatic hypertrophy: comparative changes in haemoglobin and serum sodium.

A prospective study was undertaken to examine differences in haemoglobin concentration and serum electrolytes in two patient groups undergoing surgical treatment for benign prostatic obstruction. Group one underwent conventional transurethral resection of the prostate (TURP), and group two were treated by laser ablation of the prostate (LAP). Twenty-six patients were enrolled in LAP group, 25 in the TURP group. Both patient groups had the procedure performed under epidural anaesthesia. Serial measurements of haemoglobin and sodium were performed at three time intervals: immediately preoperatively, in the recovery room and 24 hours postoperatively. A fall in serum sodium levels between the mean preoperative reading (140 mmol/l) and 24 hours post surgery (138 mmol/l) was the only statistically significant alteration sustained in the laser patients (P < 0.0001). A fall in haemoglobin from preoperative measurement to recovery room measurement of 0.71 g/l was statistically significant (P < 0.0001), but did not persist to the 24 hour postoperative time period. The TURP group demonstrated statistically significant falls in both sodium and haemoglobin levels at both postsurgery measurements. Mean serum sodium levels fell from 141 mmol/l preoperatively to 138 mmol/l (P < 0.0001) in the recovery room and 137 mmol/l (P < 0.0001) at 24 hours. Preoperative haemoglobin fell from 14.8 g/l to 13.6 g/l (P < 0.0001) in recovery and 13.7 g/l (P < 0.0001) at 24 hours.

Aged↗
PubMed2004

Effect of preemptive retrobulbar analgesia on perioperative hemodynamics and postoperative pain after enucleation.

PURPOSE: To determine the preemptive pain and hemodynamic effects of preincisional retrobulbar analgesia in enucleation. METHODS: This double-blinded, placebo-controlled study enrolled 69 patients scheduled for enucleation. Patients were stratified into two groups: those who used daily analgesics before surgery and those who did not. Each group was randomly assigned to receive a preincisional retrobulbar injection containing either a mixture of bupivacaine, lidocaine, epinephrine, and hyaluronidase; or saline placebo. All patients received postoperative retrobulbar injection containing the analgesic mixture. The outcome measures were intraoperative and postoperative blood pressure, heart rate, postoperative pain, and pain medication consumption. RESULTS: Groups that received preincisional analgesia had a significantly lower mean intraoperative blood pressure (109/59 versus 127/69 mm Hg; P< 0.05). Visual analog scale pain assessment (VAS) was lower in both treatment groups upon recovery room entry (VAS, 0.3 versus 15.8, P=0.08) and after 30 minutes in the nonanalgesic use group (VAS, 5.6 versus 19.4, P=0.11). Among nonchronic analgesic users, fewer patients in the treatment group had pain requiring analgesic rescue in the recovery room (5% versus 25%, P=0.08). Postoperative pain medicine consumption in the first 24 hours did not differ significantly among the groups. CONCLUSIONS: Preemptive retrobulbar analgesia was associated with improved intraoperative hemodynamics during enucleation and a trend toward reduced pain on entry in the recovery room and fewer pain rescues in the early postoperative period. A trend toward reduced pain severity in the early postoperative period was observed in those patients without daily preoperative analgesic use.

Analgesia↗
PubMed1984

Surgonomics: the cost of cholecystectomy.

Health care costs presently comprise more than one tenth of the nation's gross national product: One third of these expenditures are made by Medicare-Medicaid. National reimbursement changes for Medicare under a Diagnostic-Related Group system began October 1, 1983. Hospital charges (excluding physician charges) for all patients who underwent cholecystectomy without common bile duct exploration (Diagnostic-Related group 197 and 198) from Jan. 1, 1983 to March 31, 1983 were examined to quantify mean charges, variances, and components of hospital charges. Twenty-one patients (mean age 46.1 years) underwent elective cholecystectomy and 24 patients (mean age 64.9 years) underwent emergency cholecystectomy. The mean charge for elective cholecystectomy was $4763 +/- $1656; the mean length of stay (LOS) was 8.0 +/- 3.2 days. Low and high trim points were $3211 to $10,639 and 5 to 19 days LOS. Quartile cost analysis of the cost per patient showed that Q1 = 18.5%, Q2 = 21.2%, Q3 = 24.0%, and Q4 = 36.3%. Analysis of services showed that laboratory work (urinalysis, hematology, coagulation, microbiology, and biochemistry) averaged $451 +/- $298 (9.5% of total), room and board $2635 +/- $1044 (55.3% of total), operating and recovery room $924 +/- $167 (19.4% of total), and central supply-pharmacy $350 +/- $158 (7.4% of total). The mean charge for patients undergoing emergency cholecystectomy was $11,436 +/- $4185; mean LOS was 17.8 +/- 6.5 days. Low and high trim points were $6353 to $19,734; LOS was 9 to 30 days. Services as percent of total were laboratory 15.8%, room and board 53.7%, operating and recovery room 9.14%, central supply-pharmacy 7.3%, and radiology 8.2%. Several important findings are noted: (1) For a given disease there is marked variance of hospital charges. (2) Mean charges of emergency patients were 240% that of elective patients. (3) Consumption of services varies significantly within each group and between groups. This study demonstrates the importance of in depth financial analysis of therapies. This is a first step to identify the components of variance where reduction will not affect quality of care.

Aged↗
PubMedDate not supplied

General versus epidural anesthesia for femoral-popliteal bypass surgery.

This study examines whether epidural anesthesia is more effective than general anesthesia using an inhalation agent in controlling cardiovascular responses during femoral-popliteal bypass surgery. Nineteen patients were randomized into two groups: general anesthesia (n = 10) and epidural anesthesia (n = 9). The patients who underwent general anesthesia received sodium pentothal and succinylcholine for induction of anesthesia and 60% N2O, 40% O2, and 1% to 1.5% isoflurane for maintenance. Fifteen minutes before extubation, the patients received morphine sulfate 0.05 mg/kg intravenously (IV). The group that underwent epidural anesthesia received anesthesia to T-10 (through a catheter placed in the L4-5 interspace using 3% 2-chloroprocaine). Thirty minutes after the last dose, 0.05 mg/kg IV was administered. Hemodynamic variables were recorded at selected intervals during the operation and for 60 minutes in the recovery room. In the general anesthesia group, mean arterial pressure (MAP) and rate pressure product (RPP) significantly decreased (p less than 0.05) during the operation as compared with preoperative values. Following intubation and skin incision, 5 minutes after extubation, and after 60 minutes in the recovery room, MAP, heart rate (HR), and RPP were significantly greater (p less than 0.05) as compared with intraoperative periods. In the epidural anesthesia group, there were clinically important decreases in MAP and RPP after reaching T-10 and skin incision. The general anesthesia patients showed higher MAP, HR, and RPP 5 minutes after extubation and after 60 minutes in the recovery room. Epidural anesthesia patients showed stable hemodynamic patterns throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Outcomes following a shortage of high dependency unit beds for surgical patients.

In an environment of resource rationing there are numerous patients who are unable to be admitted to a high-dependency unit (HDU) postoperatively despite the belief that this is the optimal discharge destination for them from the recovery room. It is unknown if this is associated with an increase in adverse outcomes. We performed an observational study, over a two-month period, comparing outcomes between patients who were admitted to HDU postoperatively and patients who, although an HDU bed was preferred, were discharged from the recovery room to the general ward due to an unavailability of HDU beds. Our primary outcome variable was hospital length-of-stay. We found an almost twofold increase in hospital length-of-stay in the group of patients admitted to the HDU. ASA IV patients were more likely to be admitted to HDU. However, the increased length-of-stay in the HDU group persisted even after stratifying patients according to ASA status. There was no difference between groups in all other baseline demographic variables, including POSSUM score, which is used as a predictor of postoperative morbidity and mortality. We believe that the most likely explanation for our findings is that the baseline risk between groups is, in fact, subtly different. This is not detected by preoperative scoring systems. However, clinical judgement in the recovery room appears to select a group of patients for HDU admission who subsequently have a slower postoperative recovery, despite no measurable increase in complication rate. That there was no increase in adverse events in the group of patients unable to be admitted to HDU due to a lack of bed availability suggests that current clinical judgement in a resource-rationed environment is functioning adequately, but the study was not powered to detect such a difference.

Adult↗
PubMed2003

Is perioperative hypothermia a risk factor for post-Cesarean infection?

OBJECTIVE: To determine whether hypothermia during Cesarean delivery is a risk factor for postoperative infection. METHODS: An historical cohort investigation was conducted on all women delivered by Cesarean at our center during 2001. Initial recovery-room temperature, taken via the oral or axillary route, was used as a surrogate for intraoperative temperature. Adding 0.5 degrees C to axillary temperatures generated oral temperature equivalents. Women with chorioamnionitis were excluded, as were those with an initial recovery-room temperature that exceeded 37.9 degrees C or was recorded more than 20 minutes after the end of surgery. Prophylactic antibiotics (cefazolin, 1 g) were given during Cesarean delivery. RESULTS: A total of 42 women (7.6%) were diagnosed with postoperative infections. Infections included endometritis (n = 25), wound abscess (n = 7), wound cellulitis (n = 7) and urinary tract infection (UTI) (n = 4). No cases of septic pelvic thrombophlebitis or pelvic abscess occurred. One woman had both endometritis and a UTI. Mean temperatures were higher, rather than lower, for women who subsequently had postoperative infections compared with those who did not (36.4 +/- 0.8 degrees C vs. 35.9 +/- 0.7 degrees C; p < 0.001). Mean temperatures for the various postoperative infections were as follows: endometritis, 36.5 +/- 0.8 degrees C (p < 0.001 vs. uninfected group); wound abscess 36.0 +/- 0.8 degrees C (p = 0.63); wound cellulitis, 36.3 +/- 0.6 degrees C (p = 0.14); UTI, 36.7 +/- 0.9 degrees C (p = 0.04). CONCLUSIONS: Women who develop post-Cesarean infections have higher initial recovery-room temperatures than those who do not develop such infections. This suggests the presence of subclinical infection at the time of Cesarean. Evaluating whether intraoperative warming has any role during Cesarean delivery requires a randomized clinical trial.

Adult↗
PubMed1996

Neuromuscular monitoring: does it make a difference?

PURPOSE: The objective of the present prospective study was to evaluate the influence of neuromuscular monitoring on the level of neuromuscular blockade from induction of anaesthesia until extubation of the trachea. METHODS: Forty-two patients aged between 18 and 73 yr undergoing a range of surgical procedures under general anaesthesia were randomly distributed into two groups of 21 patients each. In both groups a Datex NMT Monitor was used and electromyographic responses of the ulnar muscles to supramaximal stimulation of the ulnar nerve were recorded. In Group 1, the anaesthetist could see the movements of the stimulated hand, but not the monitor. In Group 2, the anaesthetist could see neither the stimulated hand nor the monitor. The same anaesthetist administered the neuromuscular relaxants which were succinylcholine 1.5 mg.kg-1 for tracheal intubation and vecuronium 0.1 mg.kg-1 for neuromuscular relaxation during surgery, followed by 1 to 2 mg maintenance injections. Possible residual curarization was evaluated in the recovery room by head life tests and pulse oximetry. RESULTS: Patients in Group 1 had deeper neuromuscular block throughout surgery, despite the use of a comparable dose of vecuronium (10.1 mg for G1 vs 11.2 mg for G2). The EMG values of T1 and train-of-four values were not different at tracheal intubation or at extubation. No patients presented signs of residual curarization in the recovery room. CONCLUSION: The study demonstrates that with the same amount of vecuronium the neuromuscular relaxation was deeper with the use of a simple neuromuscular monitoring (visual evaluation of the thumb movements). Despite the deeper neuromuscular block in the monitored group, there was no residual curarization in the recovery room.

Adolescent↗
PubMed2001

[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].

This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. Anaesthesia was induced with 5 mg/kg thiopentone and 1 vol.-% halothane. Subsequently, 0.4 mg/kg rocuronium or 0.075 mg/kg vecuronium were administered, respectively. Anaesthesia and post-operative care were conducted by independent anaesthetists, who were unaware of the drug used and of the relaxometric data obtained. All children were monitored in the recovery room by pulse oximetry until they reached a Steward Score of 6. Demographic data did not differ between the groups. No differences were recorded between the non-depolarizing relaxants regarding intubation time (R: 24.1 +/- 4.2 min, V: 25.8 +/- 6.8 min) and the time interval from end extubation to leaving the operating theatre (R: 2.3 +/- 0.8 min, V: 2.6 +/- 1.2 min), respectively. Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.

Adenoidectomy↗
PubMed1988

Hospital resources used for inpatient and ambulatory surgery.

New hospital and physician payment schemes encourage physicians to participate actively in efforts to minimize hospital resource use. As an example of the type of evaluations anesthesiologists may conduct, we examined hospital resources used for comparable groups of inpatients (INPTs) and day surgery unit (DSU) patients. Although INPTs and DSU patients undergoing surgical arthroscopy of the knee or diagnostic laparoscopy were similar with regard to age, physical status, and staff surgeon, more preoperative tests were performed for INPTs than for DSU patients (P less than .05). Hospital costs for these tests were four times greater for INPTs than for DSU patients. Operating room time was from 20 to 45 min longer for INPTs than for DSU patients (P less than .05). Recovery room time was from 25 to 52 min longer for DSU patients (P less than .05). Per patient nursing labor costs paralleled operating and recovery room times. These kinds of analyses are important in identifying opportunities to improve resource use, in assessing institutional costs for surgical care, and in designing strategies that allow institutions and physicians to respond to cost containment pressures.

Ambulatory Surgical Procedures↗
PubMed2003

Standard Laryngeal Mask Airway and LMA-ProSeal during laparoscopic surgery.

STUDY OBJECTIVE: To compare the frequency of airway seal and sore throat with the LMA-ProSeal (PLMA) and the standard Laryngeal Mask Airway (LMA) during laparoscopic surgery. DESIGN: Prospective, controlled, randomized, nonblinded clinical study. SETTING: University-affiliated hospital. PATIENTS: 60 adult, ASA physical status I, II, and III patients undergoing laparoscopic surgery with general anesthesia, without contraindication to the use of the laryngeal mask. INTERVENTIONS: Patients were randomized to receive mechanical ventilation [tidal volume (V(T)) 7 mL/kg(-1); positive end-expiratory pressure (PEEP) 10 cmH(2)O] through the PLMA or the standard LMA, both equipped with a gastric tube. MEASUREMENTS: Heart rate, arterial pressure, inspiratory and expiratory V(T), airway pressure, end-tidal CO(2) partial pressure, and pulse oximetry were recorded. The leak fraction was calculated as the difference between the inspiratory and expiratory V(T) divided by the inspiratory V(T). Postoperative sore throat frequency was scored in the recovery room ("early") and 1 week after surgery ("late"). MAIN RESULTS: All patients were successfully ventilated through the assigned laryngeal mask. The leak fraction was 7 +/- 3% with the LMA and 7 +/- 4% with the PLMA (p = 0.731). In one patient, the PLMA drainage tube was not patent despite a leak fraction of 5%, and there was no clinically detectable air leak. During the recovery room stay, the frequency of sore throat was scored as mild in 13% and 10% of patients with the standard LMA and the PLMA, respectively, and was absent in the remaining patients (p = 0.99, between groups). There were no differences in the frequency of sore throat between the "early" and "late" evaluations (p = 0.99). CONCLUSIONS: The PLMA and the LMA show similar airtight efficiency during laparoscopy. The patency of the PLMA drainage tube should always be confirmed. The sore throat evaluation performed in recovery room appears as reliable as later evaluations.

Anesthesia, General↗
PubMed1988

Physical status score and trends in anesthetic complications.

Since deaths due to anesthesia have now become rare, emphasis in quality assurance of anesthetic care must focus on morbidity rather than only on mortality. To facilitate comparisons of outcomes, data from a large anesthesia follow-up program (N = 112,000 anesthetics) were used to evaluate the usefulness of the American Society of Anesthesiologists' Physical Status score (PS) as an independent predictor of nonfatal adverse anesthetic complications. For each patient, the anesthesiologist filled out a form containing information about the patient, the anesthetic, the operative procedure, and outcomes in the operating and recovery rooms. Postoperative complications were assessed by a designated anesthesia follow-up nurse. We calculated the PS-specific complication rate by dividing the number of complications to patients in each PS category by the number of anesthetics given to patients in the same category. We found that PS-specific complication rates increased with increasing PS scores for most complications sought. For intraoperative and recovery room complications, the PS-specific rates increased from 1978-80 and 1981-83 as compared to 1975-77. However, there was no increase over time in the rate of postoperative major complications. After adjusting for patient, anesthesia, and surgery-related variables by multiple logistic regression, the relative odds of having an intraoperative or postoperative major complication were increased for patients classified PS2, PS3 and PS4 & 5 as compared to PS1. However, those in higher PS categories were less likely to have a recovery room complication than PS1 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine.

UNLABELLED: We investigated postoperative residual curarization after administration of either vecuronium or rocuronium with reversal by pyridostigmine in 602 consecutive patients without perioperative neuromuscular monitoring. On arrival in the recovery room, neuromuscular function was assessed both by acceleromyography in a train-of-four (TOF) pattern and also clinically by the ability to sustain a head-lift for >5 s and the tongue-depressor test. Postoperative residual curarization was defined as a TOF ratio <0.7. One fifth of 602 patients (vecuronium, 24.7%; rocuronium, 14.7%) had a TOF <0.7 in the recovery room. There were no significant differences in the TOF ratios between 10 mg and 20 mg of pyridostigmine. The patients with residual block had several associated factors: the absence of perioperative neuromuscular monitoring, the use of pyridostigmine, which is less potent than neostigmine, a larger dose of vecuronium, shorter time from the last neuromuscular blocker to TOF monitoring, or peripheral cooling. We conclude that significant residual neuromuscular block after vecuronium or rocuronium was not eliminated even with reversal by a large dose of pyridostigmine. IMPLICATIONS: Without monitoring, the significant residual neuromuscular block after vecuronium or rocuronium is not eliminated even by reversal with a large dose of pyridostigmine and can still be a problem in the recovery room.

Adult↗
PubMed2002

Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia.

BACKGROUND: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia. METHODS: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5-point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery. RESULTS: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying. CONCLUSIONS: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery.

Abdomen↗
PubMed2006

A randomized trial of local anesthesia with intravenous sedation vs general anesthesia for the vaginal correction of pelvic organ prolapse.

The purpose of this study is to compare the feasibility of local anesthesia with IV sedation versus general anesthesia for vaginal correction of pelvic organ prolapse. Patients with pelvic organ prolapse who were scheduled for an anterior or posterior colporrhaphy, or an obliterative procedure, and who did not have a contraindication or preference to type of anesthesia were randomized to one of the two anesthesia groups. Nineteen patients were randomized to the general group and 21 patients were randomized to the local group. Mean operating room, anesthesia, and surgical time were similar in each group, and 10 patients in the local group bypassed the recovery room. Requests and doses of antiemetics, postoperative verbal numerical pain scores and length of hospital stay were similar between the two groups. Mean recovery room and total hospital costs were significantly lower in the local group. Local anesthesia with IV sedation is a feasible alternative for vaginal surgery to correct pelvic organ prolapse.

Aged↗
PubMed1989

The effects of regional and general anesthesia on blood pressure control after carotid endarterectomy.

We retrospectively reviewed the influence of preoperative blood pressure control and regional vs. general anesthetic techniques on the incidence of intraoperative and postoperative (recovery room and intensive care unit) hypotension and hypertension in 249 carotid endarterectomy patients. Preoperative blood pressure was classified as uncontrolled hypertension (systolic blood pressure >/= 170 mm Hg and/or diastolic blood pressure >/= 95 mm Hg), controlled hypertension (blood pressure <170/95 mm Hg on chronic antihypertensive therapy), or normotension (blood pressure <170/95 mm Hg without antihypertensive therapy). Hypotension, as defined by the requirement for vasopressor administration to maintain a systolic blood pressure of at least 120 mm Hg, occurred more frequently after regional than after general anesthesia (p < 0.05). Postoperative hypertension was defined as a systolic blood pressure >/= 200 mm Hg and/or a diastolic blood pressure >/= 110 mm Hg in the recovery room or in the Intensive Care Unit. Preoperative hypertension was not associated with acute postoperative hypertension in the intensive care unit in either the regional anesthesia (n = 190) or the general anesthesia (n = 59) groups, although with either type of anesthesia, preoperative hypertension was associated with an increased incidence of hypertension in the recovery room (p < 0.01 regional; p < 0.005 general).

Journal Article↗