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PubMedDate not supplied

Efficacy of promethazine suppositories dispensed to outpatient surgical patients.

Postoperative nausea and vomiting frequently complicate outpatient anesthesia and surgery. The duration of treatment for this complication must occasionally extend beyond discharge from the hospital. In this study, we evaluated the commonly used anti-emetic promethazine for its efficacy in the post-discharge period. Adult outpatient surgical patients who had excessive postoperative nausea and vomiting in the recovery room, or who were at risk for postoperative nausea and vomiting following discharge were given two promethazine suppositories (25 mg) for home use. All patients were contacted by our recovery room nurses on the first business day after their surgery and questioned as to their use of the suppositories and, if used, their efficacy. We found that 55 percent of patients given promethazine suppositories for home use had nausea and vomiting in the post-discharge period. Of the patients given promethazine, 89 percent used the suppositories. All of these patients reported improvement in their symptoms following use of the suppositories. None reported adverse effects from the promethazine suppositories. In conclusion, we found promethazine suppositories to be an inexpensive and efficacious treatment for nausea and vomiting in adult outpatient surgical patients following discharge from the hospital. Side-effects were minimal, and our patients voiced no complaints about this mode of therapy. We recommend this therapy for treatment of nausea and vomiting after hospital discharge following adult outpatient surgery.

Aged↗
PubMed1986

Monitoring middle cerebral artery blood velocity during carotid endarterectomy.

Transcranial pulsed Doppler ultrasound and spectral analysis were used to monitor blood velocities in the middle cerebral artery of nineteen patients (mean age 61 +/- 9 years) during carotid endarterectomy. A Javid shunt was used in all patients. The intensity weighted mean Doppler frequency for each spectral sweep (at 5 ms intervals) was time-averaged over the cardiac cycle to obtain a mean value for blood velocity in the middle cerebral artery. The range of such values found in the 19 patients was: 12-38 cm s-1 after anaesthesia (baseline); 12-69 cm s-1 during diathermy; 0-30 cm s-1 during carotid clamping; 16-32 cm s-1 during shunting and 18-60 cm s-1 in the recovery room. The average change in middle cerebral artery blood velocity from baseline values showed significant increases during diathermy (P less than 0.005), shunting (P less than 0.05) and in the recovery room (P less than 0.005). Clamping of the internal carotid artery showed a significant decrease in middle cerebral artery blood velocities of all patients (P less than 0.005), three of whom showed no flow in the middle cerebral artery during clamping. Abnormally high amplitude Doppler signals at the commencement of shunting were detected in 17 of the 19 patients. Such Doppler signals are consistent with turbulent blood flow or the introduction of micro-air bubbles by the shunt. Backbleeding in the internal carotid artery before insertion of the shunt was associated with diminished flow in the ipsilateral middle cerebral artery of ten patients, oscillatory forward/reverse flow in three patients and cessation of flow in the remaining six patients.

Adult↗
PubMed2004

Reduction of nosocomial pressure ulcers in patients with hip fractures: a quality improvement program.

Pressure ulcers (PUs) continue to be a distressing medical problem. The Nursing Quality Improvement Unit of Israel's Hadassah Mount Scopus Medical Center designed and implemented a quality improvement intervention program to reduce the incidence of nosocomial PUs. Assessing data, it was found that 46.7 percent of nosocomial PUs develop inpatients with hip fractures. Following the first audit of all patients with hip fractures, an intervention program was focused on the orthopedic ward and the recovery room. Intervention in the orthopedic ward included providing each patient with a visco-elastic mattress and a specially designed cushion for the elevation of the affected limb. In the recovery room, pressure-relieving practices were introduced. Following the implementation of the intervention program, the second audit revealed a reduction in the incidence of nosocomial PUs from 12.9 percent to 0 percent. Although patients with hip fractures are still at very high risk of developing nosocomial PUs, prevention is feasible.

Aged↗
PubMed1990

The experience of the person ventilating the lungs does influence postoperative nausea and vomiting.

One hundred and ninety-eight patients undergoing elective abdominal hysterectomy were anaesthetized with isoflurane in nitrous oxide and oxygen. Ventilation before endotracheal intubation was carried out either by an experienced senior or by an inexperienced junior member of the anaesthetic team. The incidence and severity of emesis (none, nausea, retching or vomiting) were assessed five times during the first 24 h after operation. Patients whose lungs had been ventilated by experienced members of staff had significantly less (P less than 0.05 to 0.01) postoperative emesis in the recovery room (incidence of emesis 35%) and 2-6 h after operation (incidence 27%) when compared to patients whose lungs had been ventilated by inexperienced members of staff (incidence of emesis 54% and 40% in the recovery room and after 2 to 6 h, respectively). The results suggest that the experience of the person ventilating the lungs is associated with postoperative nausea and vomiting.

Adult↗
PubMed1996

Sunny hospital rooms expedite recovery from severe and refractory depressions.

Bright light therapy is an effective treatment for seasonal affective disorder, an uncommon condition marked by mild winter depression. Bright lights have been used as adjuncts in the pharmacological treatment of other types of depressive illness. The rooms in our psychiatric inpatient unit are so placed that half are bright and sunny and the rest are not. Reasoning that some patients were getting light therapy inadvertently, we compared the lengths of stay of depressed patients in sunny rooms with those of patients in dull rooms. Those in sunny rooms had an average stay of 16.9 days compared to 19.5 days for those in dull rooms, a difference of 2.6 days (15%): P < 0.05.

Bipolar Disorder↗
PubMed1997

The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children.

The safety of performing tonsillectomy as an outpatient procedure is still questionable. This study determined whether there was an increased risk of postoperative bleeding by performing tonsillectomy as an outpatient procedure. A six years' retrospective chart review was made of 363 children who underwent tonsillectomy. Out of 363 children, 43 had been selected as an inpatient group before the operation, 264 patients were discharged home 6 h after the operation and were the outpatient group, and 56 children had to be kept overnight because of complications that had occurred. We compared the haemorrhage rate in the outpatient and the inpatient groups. We found no increase in the postoperative haemorrhage rate in the outpatient group. No statistically significant correlations were found between the children's ages, indication for surgery, type of operation or intra-operative complications and the risk of postoperative haemorrhage. Only children who had haemorrhage in the recovery room were identified as a high risk subgroup for recurrent bleeding. On the basis of our findings we believe that tonsillectomy can be performed as an outpatient procedure regardless of age, indication for surgery, or type of procedure, as long as good recovery room supervision exists for 4 to 6 h.

Adolescent↗
PubMed2001

Extraperitoneal laparoscopic hernia repair with local anesthesia.

BACKGROUND: This review aimed to compare laparoscopic preperitoneal herniorrhaphy (LPPH) using a laryngeal mask airway and local anesthesia with conventional open herniorrhaphy using similar anesthetic conditions. METHODS: A retrospective review of 238 hernia operations was conducted from October 1996 through September 1998. Laparoscopic preperitoneal hernia repairs with the patient under laryngeal mask airway anesthesia were performed initially using 10 ml of 0.5% bupivacaine (LPPH+10 group). This was compared with hernia repair using 30 ml of 0.5% bupivacaine (LPPH+30 group). Both LPPH groups were compared with a plug and patch "Gilbert" hernia repair group. Postoperative pain was compared in the recovery room and outpatient suite. RESULTS: The LPPH+30 group required significantly less postoperative pain medication than the LPPH+10 group. The LPPH+30 group required slightly more pain medication in the recovery room than the open hernia repair group, but in the postanesthesia care unit (PACU) unit, the LPPH+30 group used less pain medication. A similar number of LPPH+30 patients, and open hernia repair patients required no pain medication. CONCLUSIONS: The use of a long-acting local anesthetic, (30 ml of 0.5% bupivacaine via laryngeal mask airway) for laparoscopic preperitoneal hernia repair compared favorably with conventional open hernia repair using similar anesthetic techniques.

Analgesics, Opioid↗
PubMedDate not supplied

Back pain following epidural anesthesia with 2-chloroprocaine (EDTA-free) or lidocaine.

BACKGROUND AND OBJECTIVES: Severe lumbar pain following epidural injection of 2-chloroprocaine is usually associated with the Nesacaine-MPF solution available in the United States. The purpose of this study was to determine if the solution distributed in Canada (Nesacaine-CE), which contains calcium disodium edetate (0.1 mg/mL) and sodium bisulfite (0.7 mg/mL) but no disodium ethylenediaminetetraacetic acid, is associated with back pain or spasm when compared with epidural lidocaine. METHODS: With use of a prospective, double-blind, randomized design, 30 patients scheduled to undergo outpatient knee arthroscopy under epidural anesthesia were divided into two groups to received 30 mL of either Nesacaine-CE 3% (group A) or lidocaine 1.33% (group B). Postoperative pain in the lumbar area was assessed twice by a 10-cm visual analog scale (VAS) before patients left the hospital and 24 hours later by phone. The lumbar area was palpated to search for muscle spasm before discharge from hospital. RESULTS: More patients receiving Nesacaine-CE than receiving lidocaine suffered from back pain in the recovery room (four vs none P = .03) and before leaving the hospital (nine vs one P = .001). Higher VAS scores (mean +/- SE) were obtained after Nesacaine CE then after lidocaine in the recovery room (0.5 +/- 0.24 vs 0.0 +/- 0.0, p = .049) and before leaving the hospital (1.8 +/- 0.5 vs 0.1 +/- 0.1, P = .001). No difference existed 24 hours later between the two groups with regard to the prevalence of back pain or VAS scores. No muscle spasm was detected. CONCLUSION: No cases of severe backache were observed. However, epidural Nesacaine-CE 3% was associated with mild back pain, generally confined to the area of needle insertion, when compared with lidocaine 1.33%.

Adult↗
PubMed1991

Muscle relaxants and reversal agents.

This article has discussed the anatomy and physiology of the neuromuscular junction and excitation-contraction coupling. The pharmacokinetics and pharmacodynamics of various depolarizing and nondepolarizing neuromuscular blocking agents were presented. Techniques of reversal and the need for concomitant administration of anticholinergics were discussed. Assessment of the postoperative patient, including types of neuromuscular blockade, criteria for successful extubation, and drugs and physiologic states that could prolong neuromuscular blockade were outlined. Because the recovery room nurse is relied on for continuous assessment of the postoperative patient, it is imperative that the nurse have a comprehensive knowledge of intraoperative factors that relate to the patient's recovery. The recovery room nurse should be an expert in the assessment of postoperative patients.

Cholinesterase Inhibitors↗
PubMed1991

Use of desflurane for outpatient anesthesia. A comparison with propofol and nitrous oxide.

Desflurane's induction and recovery characteristics were compared to those of propofol-nitrous oxide in outpatients undergoing laparoscopic procedures. Ninety-two healthy patients were randomized to receive either: 1) propofol induction and propofol-nitrous oxide maintenance (control), 2) propofol induction and desflurane-nitrous oxide maintenance, 3) desflurane-nitrous oxide, or 4) desflurane alone for induction and maintenance of anesthesia. Inhalation induction with desflurane-nitrous oxide was faster than with desflurane alone (100 +/- 35 vs. 124 +/- 43 s). Inhalation inductions were associated with a high incidence of apnea (17 and 26%), breath-holding (26 and 39%), and coughing (30 and 22%) in groups 3 and 4, respectively. The emergence time after discontinuation of desflurane in oxygen (4.5 +/- 2.1 min.) was significantly less than that after propofol-nitrous oxide (7.3 +/- 3.9 min.). However, times from arrival in the recovery room until the patients were judged fit for discharge were similar for all four treatment groups. Digit-symbol substitution test results and sedation visual analogue scores also were similar during the first 2 h in the recovery room. A lower incidence of moderate-to-severe nausea was reported in group 1 (15% vs. 52, 52, and 59% in groups 2, 3, and 4, respectively). In conclusion, induction of anesthesia with desflurane was rapid but is associated with a high incidence of airway irritation. Emergence and recovery profiles after maintenance of anesthesia with desflurane compared favorably to a propofol-nitrous oxide combination. However, propofol was associated with a lower incidence of nausea than was desflurane after outpatient anesthesia for laparoscopic surgery.

Adult↗
PubMedDate not supplied

Intravenous droperidol decreases nausea and vomiting after alfentanil anesthesia without increasing recovery time.

The frequency rate of nausea and vomiting after an alfentanil-based anesthetic is high, with reported frequencies of 38% to 68%. This study was undertaken to evaluate the efficacy of low-dose and moderate-dose droperidol in decreasing the frequency of postoperative nausea and vomiting and to evaluate whether droperidol has any effect on slowing recovery after a standard alfentanil-based anesthetic. Sixty normal adults who were scheduled to undergo short surgical procedures requiring general anesthesia were assigned randomly in a double-blind manner to one of three groups of 20: (1) control--normal saline; (2) droperidol 10 micrograms/kg; or (3) droperidol 20 micrograms/kg. A standard alfentanil-based anesthetic was used, and the study drug was given immediately after induction of anesthesia. In the post-anesthesia recovery room, all patients were evaluated according to the Aldrete score, noting the time to achieve a score of 10. Presence or absence and severity of nausea and vomiting were noted. To assess psychomotor recovery, a Trieger dot test was performed by every patient preoperatively, at the time of an Aldrete score of 10, and upon discharge from the recovery room. There was no statistical difference between the groups in age, sex, type of procedure, weight, total dose of alfentanil, or duration of anesthetic. The frequency of nausea and vomiting was significantly less (p less than 0.05) for the 20 micrograms/kg group (5%) than for the 10 micrograms/kg group (25%) or the control group (40%). A dose-response relationship was evident for the antiemetic effect of droperidol. An analog scale for severity of nausea and vomiting also demonstrated a dose response effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures.

Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care, and who could not be satisfactorily examined or treated, were administered one of three medications--ketamine (Ketalar), 3 mg/kg; midazolam (Versed), 0.4 mg/kg; or sufentanil (Sufenta), 1.5 or 1.0 micrograms/kg--intranasally in a randomized, double-blinded protocol. The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse's arms. Cardiorespiratory monitors were applied when tolerated, and the child was placed on the operating room table. Each child was injected locally with up to one dental cartridge of 2% lidocaine with 1:100,000 epinephrine before dental extractions. A sedation score was recorded using a scale where 1 = hysterical/untreatable, 5 = ideal sedation, and 10 = obtunded and desaturated, requiring airway management assistance. Midazolam administration resulted in acceptable sedation (mean score: 4) with no desaturations below 90% as measured by pulse oximetry and a mean recovery room observation time of only 3 +/- 2 min (+/- SD). Ketamine also had a mean sedation score of 4 and a short recovery period (7 +/- 7 min); however, two children experienced brief desaturations. Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily sedated children (mean score 7), with a high incidence of significant oximetry desaturation (80%) and prolonged recovery room duration (58 +/- 40 min). Use of 1.0 microgram/kg sufentanil resulted in no desaturations, less sedation (mean score 4), and a brief recovery time (7 +/- 13 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intranasal↗
PubMed1985

Rectal methohexitone induction in pediatric outpatients: physostigmine does not enhance recovery.

Rectal methohexitone (25 mg X kg-1) was used to induce anaesthesia in 15 unpremedicated children scheduled to undergo bilateral myringotomies as outpatients. Induction time ranged from 4 to 11 minutes. In the recovery room, all children received a slow intravenous injection of physostigmine (60 micrograms X kg-1), or saline in a double blind randomized fashion. The use of physostigmine did not significantly decrease the recovery room stay as compared to placebo (34 vs. 43 minutes). Vomiting and soiling were two side-effects associated with the use of physostigmine.

Age Factors↗
PubMed2004

Locally administered ketorolac and bupivacaine for control of postoperative pain in breast augmentation patients.

With recent developments in the field of analgesia, the question arises whether there is a role for placing local anesthetics, nonsteroidal anti-inflammatory drugs, or both into the breast implant pocket. The objective of this study was to test the effectiveness of locally administered intraoperative ketorolac and bupivacaine with epinephrine at reducing pain in the postoperative period. The study was a prospective, randomized, double-blind clinical trial. One hundred consecutive retropectoral breast augmentation patients were enrolled, and informed consent was obtained. A standard anesthetic protocol and surgical procedure were followed. Normal saline, ketorolac alone (30 mg), bupivacaine alone (150 mg), or ketorolac and bupivacaine (30 mg and 150 mg respectively) were placed into the implant pocket before implant insertion. All patients completed the study. The power of this study to detect a 20 percent difference with respect to the primary outcome was 0.90 and confidence intervals of 95 percent were used to determine significance. The primary outcome was pain as measured by the visual analogue pain scale. The secondary outcome was time spent in the recovery room. Intraoperative placement of ketorolac combined with bupivacaine reduced pain in the postoperative period. It did not appear that anesthesiologist, anesthesia time, surgeon, operating room time, difficulty of dissection, breast incision, or implant size had a significant effect on postoperative pain. There was a trend that the ketorolac and bupivacaine patients spent less time in the recovery room and used fewer analgesics postoperatively than the other patients. There were no hematomas requiring reoperation and no complications. Locally administered intraoperative ketorolac and bupivacaine with epinephrine significantly reduced pain in the postoperative period.

Anesthetics, Local↗
PubMed2000

[Anesthesia with sevoflurane and orotracheal intubation for pediatric ophthalmic surgery of medium length in day hospital] .

BACKGROUND: The aim of this study was to evaluate the discharge rate of children undergoing ophthalmic surgery of medium length (69-120') in a day-hospital regime under general anesthesia with orotracheal intubation and using Sevoflurane as the only anesthetic agent. METHODS EXPERIMENTAL PROTOCOL: prospective study. SETTING: the study was carried out in the operating theatre of the Ophthalmic Clinic at Florence University. PATIENTS: 58 pediatric patients aged 2-10 years, ASA I-II, 13-34 kg. OPERATIONS: correction of strabismus, cataract, glaucoma, palpebral ptosis and intubation of lacrimal tracts. Parameters measure: Any signs of reactivity in the airways to Sevoflurane on induction or reawakening (cough, bronchospasm, laryngospasm and psychomotor agitation), hemodynamic variables (heart rate and NIBP); reawakening time (from turning off the vaporiser to extubation), discharge time from recovery room (SatO2 > or = 97% in ambient atmosphere), discharge time from hospital (stable vital signs, response to simple and complex commands). RESULTS: The mean reawakening time was 7 min, discharge time from the recovery room was 20 min, discharge time from the hospital 80% after four hours, 100% after six hours. No respiratory and/or cardiovascular complications were reported nor psychomotor agitation. CONCLUSIONS: General anesthesia with Sevoflurane and Atracurium was found to be a realistic and reliable technique in pediatric ophthalmic surgery of medium length performed in day hospital.

Ambulatory Surgical Procedures↗
PubMed1993

Postoperative recovery of arterial oxygen saturation determined by pulse oximetry in pediatric patients.

Small children are physiologically subject to arterial oxygen desaturation. However, few reports have referred to the risk factors related to postanesthetic hypoxemia and the duration of hypoxemia. The purpose of this study was to clarify these two aspects. Eighty-five ASA physical status I infants and children were included in the study. They were scheduled for minor surgery. Fifty-six underwent oral endotracheal intubation, and 29 patients breathed from a mask. Anesthesia was maintained with Enflurane or Halothane and nitrous oxide. Arterial oxygen saturation was measured with a pulse oximeter. The measurements were started shortly after patients' arrival in the recovery room, and conducted every 5 min at least for 1 hour. Ten patients had SpO2 values of less than 95%. In all except one, SpO2 decreased within 10 min after arrival in the recovery room. Age, height, and weight of these 10 children were significantly different from the remaining 75, but there were no significant differences in anesthetic duration and postanesthetic awakefulness between the group with postanesthetic hypoxemia and the one without. The importance of monitoring the clinical condition of pediatric patients after general anesthesia is universally acknowledged. Monitoring with the pulse oximeter has proven very useful and shows that, unless oxygen saturation is monitored, all children should receive supplemental oxygen.

Journal Article↗
PubMed1988

Treatment of urinary complications after total joint replacement in elderly females.

Urinary retention and the possible consequence of infection after total joint replacement is an important subject to urologists and orthopedic surgeons. A prospective, randomized study was performed in 77 elderly female patients with total joint replacement to test whether twenty-four-hour catheterization perioperatively or straight catheterization postoperatively in the recovery room might reduce the control group's incidence of postoperative urinary tract infection (9%), urinary retention (57%), and subsequent urinary catheterizations. In 16 percent of the patients who had straight catheterization in the recovery room a urinary tract infection developed postoperatively, and 65 percent of these patients required at least one more catheterization with 13 percent requiring a subsequent indwelling Foley catheter. The patients who had perioperative (immediately preoperatively and for 24 hours postoperatively) catheter drainage had a zero incidence of retention and only a 4 percent incidence of urinary tract infection. We recommend this regimen for elderly female patients undergoing total joint replacement under spinal anesthesia.

Aged↗
PubMed1998

Analgesic effect of bupivacaine on extraperitoneal laparoscopic hernia repair.

UNLABELLED: Local anesthetics decrease postoperative pain when placed at the surgical site. Patients benefit from laparoscopic extraperitoneal hernia repair because this allows earlier mobilization than the more classical open surgical approach. The purpose of this study was to determine the pain-sparing efficacy of local anesthetics placed in the preperitoneal fascial plane during extraperitoneal laparoscopic inguinal hernia surgery. Forty-two outpatients were included in a double-blind, randomized, placebo-controlled, institutional review board-approved study. At the conclusion of a standardized general anesthetic, 21 patients received 60 mL of 0.125% bupivacaine into the preperitoneal fascial plane before incisional closure, whereas the other 21 patients received 60 mL of the isotonic sodium chloride solution placebo. Postoperative pain was assessed 1, 4, 8, 24, and 72 h postoperatively. In addition, postoperative fentanyl and outpatient acetaminophen 500 mg/hydrocodone 5 mg requirements were recorded. All hernia repairs were performed by the same surgeon. Appropriate statistical analyses were used. There were no significant differences between the bupivacaine and isotonic sodium chloride solution groups with regard to postoperative pain scores, length of postanesthesia care unit stay, or analgesic requirements. Furthermore, neither unilateral versus bilateral repair nor operative time affected the measured parameters. The addition of 60 mL of 0.125% bupivacaine into the preperitoneal fascial plane during extraperitoneal laparoscopic hernia repair did not significantly alter pain scores, supplementary analgesic requirements, or recovery room length of stay. IMPLICATIONS: The placement of 60 mL of 0.125% bupivacaine into the preperitoneal fascial plane during extraperitoneal laparoscopic hernia repair did not significantly alter pain scores, supplementary analgesic requirements, or recovery room length of stay.

Anesthetics, Local↗