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PubMed1990

Does perioperative tactile evaluation of the train-of-four response influence the frequency of postoperative residual neuromuscular blockade?

The authors conducted a randomized controlled clinical trial to evaluate the usefulness of perioperative manual evaluation of the response to train-of-four (TOF) nerve stimulation. A total of 80 patients were divided into four groups of 20 each. For two groups (one given vecuronium and one pancuronium), the anesthetists assessed the degree of neuromuscular blockade during operation and during recovery from neuromuscular blockade by manual evaluation of the response to TOF nerve stimulation. In the other two groups, one of which received vecuronium and the other pancuronium, the anesthetists evaluated the degree of neuromuscular blockade solely by clinical criteria. The use of a nerve stimulator was found to have no effect on the dose of relaxant given during anesthesia, on the need for supplementary doses of anticholinesterase in the recovery room, on the time from end of surgery to end of anesthesia, or on the incidence of postoperative residual neuromuscular blockade evaluated clinically. The median (and range of) TOF ratios recorded in the recovery room were 0.75 (0.33-0.96) and 0.79 (0.10-0.97) in the vecuronium groups monitored with and without a nerve stimulator, respectively. These ratios were significantly higher than those found in the pancuronium groups, which wre 0.66 (0.06-0.90) and 0.63 (0.29-0.95), respectively. However, no difference was found between the vecuronium and pancuronium groups in the number of patients showing clinical signs of residual neuromuscular blockade, as evaluated by the 5-s head-lift test.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

[Economic aspects of modern inhalation anesthetics with sevoflurane as an example].

The economic impact of the new German health care laws requires an awareness of cost-effectiveness when using newer drugs. The main goal in patient care, i.e., effective treatment, must be achieved by the rational use of restricted resources at a maximum degree of effectiveness. Economic aspects of the new inhalational anaesthetics such as sevoflurane are discussed in this article. The cost of inhalational anaesthetic agents accounts for up to 5% of all the running expenses of an anaesthesia department. The consumption and cost of an inhalational agent depend on fresh gas flow, vapour setting, and duration of anaesthesia. Comparing the cost for 1 MAC-h of anaesthesia, desflurane is more expensive at current market prices than sevoflurane and isoflurane. However, at low or minimal fresh gas flows, the price for one MAC-h is almost the same for these volatile anaesthetics. Total intravenous anaesthesia using propofol is even more expensive, partly due to wastage, i.e., opened ampoules with a remainder of propofol that has to be discarded after each case. When choosing an anaesthetic agent, the price of 1 ml liquid anaesthetic is an important factor. However, the overall cost-effectiveness analysis must balance the cost of the agent with its pharmacodynamic advantages such as more rapid recovery from anaesthesia. Furthermore, the indirect costs of side effects have to be taken into account. For example, nausea and vomiting lead to a prolonged stay in the recovery room after anaesthesia for outpatient surgery, which in turn incurs additional costs for antiemetic drugs and the extra time for nursing care. Therefore, a lower incidence of nausea and vomiting and a more rapid recovery from anaesthesia leading to earlier discharge from the recovery room may compensate for the higher price. Volatile agents account for up to 1% of the total intraoperative costs. In analysing the costs of 1 h of anaesthesia, other products such as plasma substitutes and blood products account for a much higher proportion than anaesthetic agents, and reductions or increases in costs pertaining to these products have a bigger impact on overall costs than do volatile anaesthetics. We conclude that volatile anaesthetics account for only a minor portion of the anaesthesia department budget and the cost of anaesthesia delivery. The higher market price of the new agents may be compensated for by the economic impact of fewer side effects and a shorter post-anaesthesia stay in the hospital. In analysing data for sevoflurane, this agent may be cost-effective, for example, for outpatient anaesthesia.

Anesthesia Department, Hospital↗
PubMed1983

The effect of instrumentation with a telescope during bronchoscopy on arterial oxygen tension and acid-base balance.

The effect of instrumentation with a telescope during bronchoscopy on the arterial oxygen tension and acid-base status was studied in 17 unselected, anaesthetized patients using a ventilating technique based on Sanders' method (1). After ventilating the patients with a bronchoscope and a telescope in the trachea, in the left main bronchus or in the right main bronchus, the PaO2 value was always statistically significantly higher than after ventilating only with a bronchoscope. During the course of the bronchoscopy as well as after 1 h in the recovery room, the arterial acid-base status was within normal limits and the mean PaO2 value during bronchoscopy ranged from 175 to 240 mmHg (23.3-31.9 kPa) and was 138 mmHg (18.4 kPa) in the recovery room when the patients breathed about 35% oxygen in air. The present results suggest that instrumentation with a telescope during bronchoscopy ameliorates rather than impairs the ventilation and oxygenation of the patients.

Acid-Base Equilibrium↗
PubMed1982

Nursing care for the severely obese patient.

Care of the morbidly obese person (BMI greater than or equal to 30) during the perioperative period is specific and differs from routine nursing care. Effective communication, preplanning, and psychologic and physiologic assessment, with appropriate intervention (pulmonary and circulatory), result in positive care outcomes. Preoperative care emphasizes both psychologic and physiologic support concurrent with evaluation of vital signs, fluid status, teaching, and administration of preoperative medications (see Table 1). Intra- and postoperative care incorporates the necessity of additional personnel, transport precautions, physical protection, positioning, oxygenation, and early ambulation coupled with accurate arterial blood gas sampling, intraarterial line care, and cardiopulmonary and fluid status monitoring (see Tables 2 and 5). New information regarding hypothermia and shivering documented to occur in the recovery room underlines the need for accurate core temperature monitoring (see Tables 3 and 4; Figs. 1 and 2). An assessment tool (see Fig. 3)--an effective reminder of important aspects of patient care in the recovery room and until hospital discharge--provides a systematic guide to facilitate nursing care, recording, and reporting.

Humans↗
PubMed1992

Poor predictive value of hematocrit and hemodynamic parameters for erythrocyte deficits after extensive elective vascular operations.

Fluid resuscitation and transfusion therapy are particularly critical in patients undergoing extensive vascular operations because of diffuse atherosclerosis and the risk of perioperative myocardial infarction. Sophisticated perioperative monitoring has reduced the mortality rate substantially, but indications for transfusion remain controversial. We determined erythrocyte volume, (EV), total blood volume (TBV) and plasma volume (PV) preoperatively and 18 to 24 hours postoperatively in 41 elderly patients (68.8 +/- 1.3 years) undergoing elective vascular operations (30 abdominal aortic aneurysmorrhaphy, ten aortofemoral bypass and one carotid endarterectomy). EV was measured using 51chromium-labeled autologous erythrocytes; TBV and PV were calculated from EV and total body hematocrit (peripheral venous hematocrit [HCT] x 0.89). Ideal blood volumes were calculated from nomograms based on body surface area and gender. Relationships between body volumes (percentage of ideal), simultaneously measured peripheral venous HCT and hemodynamic parameters heart rate, mean arterial pressure, central venous pressure, pulmonary capillary wedge pressure, cardiac index and systemic vascular resistance index were studied by stepwise regression. In 24 patients, blood volumes and hemodynamic parameters were also measured in the recovery room. HCT significantly correlated with EV at all three time periods (p less than 0.001), but the ability of HCT to predict EV in an individual patient was relatively poor (r = 0.50 preoperatively; r = 0.54 in recovery room and r = 0.66 24 hour postoperatively). By 24 hours postoperatively, EV had decreased to 78.3 +/- 2.4 percent of ideal EV (range of 47 to 112 percent). However, only two patients had HCT less than 30 despite the fact that 13 of 41 patients had an EV deficit of greater than 30 percent. No patient had a HCT of less than 25 percent. Hemodynamic parameters did not contribute to the prediction of EV, PV or TBV at any time. Two patients had myocardial infarctions postoperatively associated with 24 hour EV deficits of 18.5 and 29.6 percent. One patient died of a pulmonary embolus. Because of these findings, the concept of a "transfusion trigger" must be viewed with caution, since many patients undergoing vascular operations will have considerable EV deficits despite an "acceptable" HCT.

Age Factors↗
PubMed2006

Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery.

BACKGROUND: Cataract surgery is commonly performed under local anaesthesia with midazolam sedation. Dexmedetomidine, a sedative-analgesic, is devoid of respiratory depressant effects, and its use in cataract surgery has not been reported. This double-blind study compared the use of dexmedetomidine and midazolam in patients undergoing cataract surgery. METHODS: Forty-four patients undergoing cataract surgery under peribulbar anaesthesia randomly received either i.v. dexmedetomidine 1 microg kg(-1) over 10 min; followed by 0.1-0.7 microg kg(-1) h(-1) i.v. infusion (Group D), or midazolam 20 microg kg(-1) i.v.; followed by 0.5 mg i.v. boluses as required (Group M). Sedation was titrated to a Ramsay sedation score of 3. Mean arterial pressure (MAP), heart rate (HR), readiness for recovery room discharge (time to Aldrete score of 10), and patients' and surgeons' satisfaction (on a scale of 1-7) were determined. RESULTS: MAP and HR were lower in Group D compared with Group M [86 (se 3) vs 102 (3) mm Hg and 65 (2) vs 72 (2) beats min(-1), respectively] (P<0.05). Group D patients had slightly higher satisfaction with sedation [median (IQR): 6 (6-7) vs 6 (5-7), P<0.05], but delayed readiness for discharge [45 (36-54) vs 21 (10-32) min, P<0.01] compared with patients in Group M. Surgeons' satisfaction was comparable in both groups [5 (4-6) vs 5 (4-6)]. CONCLUSION: Compared with midazolam, dexmedetomidine does not appear to be suitable for sedation in patients undergoing cataract surgery. While there was a slightly better subjective patient satisfaction, it was accompanied by relative cardiovascular depression and delayed recovery room discharge.

Adult↗
PubMed1994

The effect of clonidine on intra-operative requirements of fentanyl during combined epidural/general anaesthesia.

The study evaluates the analgesic effects of epidural clonidine in patients undergoing abdominal hysterectomy under combined epidural/general anaesthesia. Forty ASA 1-2 patients were divided into two groups who received epidurally either clonidine 300 micrograms (group 1) or placebo (group 2). Anaesthesia was maintained with oxygen/nitrous oxide, a midazolam infusion, vecuronium, and boluses of fentanyl 100 micrograms administered as needed to maintain cardiovascular stability. The mean (SD) intraoperative fentanyl requirements were 2.05 (0.18) and 3.66 (0.3) micrograms.kg-1.h-1 for groups 1 and 2 respectively (p < 0.001). Patients in Group 1 had a lower heart rate after tracheal intubation and surgical incision (p < 0.02). In the recovery room, pain intensity was lower in group 1 (p < 0.003) and the mean (SD) time until analgesia request was increased from 48.5 (8.4) min in group 2 to 235.7 (33.2) min in group 1 (p < 0.001). Our results demonstrate that epidural clonidine produces decreased fentanyl requirements, improved cardiovascular stability, reduced pain intensity and effective postoperative analgesia in the recovery room.

Adult↗
PubMed1987

Effect of clonidine on haemodynamic responses to endotracheal intubation and on gastric acidity.

Sixty-three patients (ASA 1-2), scheduled for elective surgery under general anaesthesia, were randomly given either oral clonidine (225-375 micrograms) + diazepam (5 15 mg), cimetidine (300 mg the night before and 300 mg in the morning) + diazepam or only diazepam for premedication. Anaesthesia was induced with thiopentone and maintained with N2O + O2 (70:30), enflurane and fentanyl. Vecuronium bromide was used as a muscle relaxant. The sleep dose of thiopentone was significantly smaller in the patients pretreated with clonidine than in the other groups. The mean maximal increase in heart rate was lowest in the clonidine-pretreated patients, but there were no significant differences in the mean arterial pressure changes associated with intubation. Before and just after intubation and in the recovery room, the arterial pressures were lowest in the patients pretreated with clonidine. During anaesthesia, marked bradycardia (less than or equal to 45 beats min-1) did not occur more often when clonidine was used, but in the recovery room there were statistically significantly more patients with bradycardia in the clonidine group than in the other groups. On the electrocardiogram (ECG) during the endotracheal intubation, the incidence of bigeminy was higher in the diazepam patients (5/20) than in the cimetidine patients (2/20) and the clonidine patients (0/23). There were significantly more gastric content samples with a pH above 2.5 in the cimetidine group than in the other groups, and clonidine patients did not differ from diazepam patients in this respect. The high incidence of bradycardia with the concomitant hypotension may limit use of this drug to highly selected patients.

Administration, Oral↗
PubMed1991

Ibuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery.

The authors compared the analgesic efficacy of one dose of oral ibuprofen with that of intravenously administered fentanyl for relief of pain after outpatient laparoscopic surgery. Thirty healthy female patients received either 800 mg of oral ibuprofen preoperatively or 75 micrograms of intravenous fentanyl intraoperatively plus respective intravenous or oral placebos in a randomized, double-blind manner. Patients recorded their degree of pain and nausea in the recovery room, in the same-day surgery stepdown unit, during the ride home, and upon arrival at home. The postanesthesia care nurse recorded the amount of fentanyl and droperidol needed to treat pain and nausea in the recovery room. Patients who received ibuprofen were more comfortable in the stepdown unit (P less than 0.05) and after arrival home (P less than 0.05) than those in the fentanyl group. Additionally, patients who received ibuprofen had lower nausea scores in the step-down unit (P less than 0.05); this may have been related to the lower total fentanyl dose in these patients. The authors conclude that ibuprofen may be a useful alternative to fentanyl for providing postoperative analgesia for outpatient surgery.

Administration, Oral↗
PubMed1996

[Stress hormone response during midazolam/fentanyl anesthesia combined with epidural anesthesia for abdominal total hysterectomy].

Stress hormone response was investigated during midazolam/fentanyl/oxygen/air anesthesia combined with epidural anesthesia in six patients undergoing abdominal total hysterectomy (group MF). A control group of six patients received nitrous oxide/oxygen/sevoflurane anesthesia combined with epidural anesthesia (group C). We evaluated plasma concentrations of ACTH, cortisol, aldosterone and beta-endorphin during the control period, 10 min, 60 min after incision, and in the recovery room. In group C, plasma concentrations of ACTH, cortisol, aldosterone and beta-endorphin increased significantly 60 min after incision compared with control concentrations. But in group MF, they did not increase significantly during anesthesia. In the recovery room there were significant differences compared with preinduction concentrations in both groups. It is concluded that midazolam/fentanyl anesthesia combined with epidural anesthesia is more effective than nitrous oxide/oxygen/sevoflurane anesthesia combined with epidural anesthesia to control the stress response to surgery.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Preemptive analgesia in children. Does it exist?

BACKGROUND AND OBJECTIVES: Preemptive analgesia has been evident in animals, but few adult human studies exist demonstrating this concept exist, and there are fewer still in children. Caudal epidural blocks with local anesthetics are often placed for postoperative analgesia in children. This study evaluated whether these blocks are more effective when placed prior to surgical incision. METHODS: Children aged 1-6 years and ASA I and II (n = 51), undergoing elective herniorrhaphy, orchidopexy, or circumcision were randomly assigned to receive a caudal epidural block with 0.6 mL/kg of 0.25% bupivacaine with 1:200,000 epinephrine, either before incision (n = 28) or after surgery (n = 23). In all patients, anesthesia was induced and maintained with oxygen, nitrous oxide, and halothane, and caudal epidural blocks were placed. Postoperative pain was scored by a blinded observer using a Faces Pain Scale in the recovery room and was also assessed at home by the parents. Analgesic requirement during the 24-hour period was recorded. RESULTS: The Faces Pain Scale scores and analgesic requirements did not differ between the groups, either in the recovery room or at home (P > .05). CONCLUSIONS: Although preemptive analgesia has been successfully demonstrated in some earlier clinical studies, our results indicate that pre- and postincisional caudal epidural blocks with 0.25% bupivacaine were equally effective in children.

Abdomen↗
PubMed1994

Recovery characteristics of desflurane versus halothane for maintenance of anesthesia in pediatric ambulatory patients.

BACKGROUND: Desflurane is a new potent, inhaled anesthetic agent with low blood-gas solubility that should allow for the rapid induction of and emergence from anesthesia. However, its extreme pungency makes desflurane unacceptable for induction of anesthesia in children. This study was undertaken to determine the airway properties of desflurane administered by mask after anesthetic induction with halothane and nitrous oxide, and to compare the emergence and recovery properties of minimum alveolar concentration (MAC)-equivalent concentrations of desflurane or halothane in nitrous oxide in pediatric patients undergoing ambulatory surgery. METHODS: Forty-five children undergoing ambulatory surgery for inguinal hernia repair, orchiopexy, and/or circumcision were randomized into two groups. Both groups were premedicated with intranasal midazolam and given halothane and nitrous oxide by mask to induce anesthesia. A caudal block was placed in children in both groups after anesthetic induction. For maintenance of anesthesia, group I patients (n = 22) were switched over to desflurane (1 MAC) and nitrous oxide, and group II patients (n = 23) continued to receive halothane (1 MAC) and nitrous oxide. All patients breathed spontaneously throughout the entire procedure, and all anesthetics were terminated abruptly at the conclusion of surgery. Recovery indicators (time to first response, length of time in the recovery room and length of time in the hospital) and the quality of the anesthetic emergence were assessed by a nurse blinded to each patient's anesthetic. This observer was present with the patient throughout his or her ambulatory hospitalization and continuously assessed the recovery indicators according to preset criteria. RESULTS: The groups did not differ with respect to age, weight, or dose of midazolam. Although group I (desflurane) had a longer anesthesia time (52 +/- 12 min vs. 42 +/- 10 min), their time to first response (9.5 +/- 6.8 min vs. 20.9 +/- 14.7 min) and their recovery room time (21 +/- 10.7 min vs. 29 +/- 14.6 min) were less than those in group II (halothane). There was a trend for patient emergence from desflurane anesthesia to be associated with a higher incidence of emergence delirium (50% vs. 21%). The two groups were similar with respect to overall duration of postoperative ambulatory hospitalization. CONCLUSIONS: In children premedicated with intranasal midazolam, desflurane maintenance anesthesia allows for a faster recovery. However, depending on the institution's criteria for ambulatory surgical patient discharge, desflurane may or may not affect the overall hospitalization time.

Ambulatory Surgical Procedures↗
PubMed2003

Amethocaine or ketorolac eyedrops provide inadequate analgesia in pediatric strabismus surgery.

PURPOSE: Corrective strabismus surgery is associated with moderate pain after surgery. Postoperative analgesia for these patients may include topical local anesthetic agents and topical non-steroidal anti-inflammatory drugs. In this prospective randomized, double-blind placebo controlled clinical trial we compared the effect of placebo to intraoperative 0.5% topical amethocaine or 0.5% topical ketorolac on pain control after strabismus surgery in children. METHODS: Following Institutional Ethics Committee approval and parental consent, we prospectively studied 51 healthy children between the ages of two and seven years who were undergoing elective bilateral recession surgery in a randomized, double-blind controlled clinical trial. Children were randomized to receive either placebo (normal saline), 0.5% amethocaine or 0.5% ketorolac eye drops at the start and end of strabismus repair surgery. Pain was assessed with a modified Children's Hospital of Eastern Ontario Pain Score in the recovery room. If the pain score was greater than 6, the patient was administered a single oral dose of acetaminophen (20 mg x kg(-1)). RESULTS: The groups had similar demographic data. Duration of surgery and anesthesia, time spent in recovery room and length of hospital stay between the three groups were similar. Pain scores and analgesic requirements while in the hospital were also similar between the groups as was the time to first analgesic administration. There were no side effects observed in any of the three treatment arms. CONCLUSION: We conclude that there is no improvement in postoperative pain control after the intraoperative administration of topical 0.5% ketorolac or 0.5% amethocaine when compared to placebo in children undergoing strabismus surgery.

Anesthesia, Local↗
PubMed1985

The effect of transcutaneous electrical nerve stimulation on pain after thoracotomy.

The effect of postoperative transcutaneous electrical nerve stimulation (TENS) was evaluated in 24 patients in two randomly selected groups who underwent thoracotomy. The patients in one group received TENS through periincisional electrodes, and the remaining patients were treated with sham stimulator setups. The stimulators remained in place for 48 hours after operation. Subjective pain scores, duration of stay in the recovery room, tolerance to chest physical therapy, complaints of nausea, time to end of mechanical ventilation, and narcotic requirements were evaluated. Patients in the TENS group had significantly lower pain scores during the first 24 hours postoperatively (p = 0.014), shorter recovery room stays (p = 0.013), and better tolerance of chest physical therapy on both day 1 (p = 0.018) and day 2 (p = 0.006). No respiratory complications occurred in either group.

Analgesics, Opioid↗
PubMed1977

Urinary excretion of morphine during and after valvular and coronary-artery surgery.

The urines of 34 patients anesthetized with morphine for mitral-valve or aortic-valve replacement operations or for coronary-artery disease revascularization procedures were analyzed for morphine and morphine-3-glucuronide before, during and for two hours after operation. Patients who had coronary-artery disease had higher urinary flow rates and excreted greater proportions of the administered morphine during induction of anesthesia, throughout operation, and for two hours postoperatively than patients with valvular heart disease. Correlation of total urinary output with total free morphine excreted after two hours in the recovery room was high, r = .84. Urinary morphine in the glucuronide form increased progressively from the time of induction of anesthesia to the postoperative period and was greater than 91 per cent for all patients after two hours in the recovery room. Patients who had coronary-artery disease required mechanical postoperative ventilation for significantly shorter periods than did those with valvular heart disease. The duration of postoperative ventilation was negatively correlated with total urinary output and total free morphine excreted in the urine from induction of anesthesia until two hours postoperatively (r = .80 and r = .77, respectively). The data demonstrate that urinary excretion of free morphine and morphine-3-glucuronide during and early after operation is greater in patients who have coronary-artery disease than in those with valvular heart disease. The findings also suggest that duration of mechanical ventilation after morphine anesthesia and operation is inversely related to urinary output and excretion of free morphine. (Key words: Analgesics, narcotic, morphine; Biotransformation (drug), morphine.)

Anesthesia↗
PubMedDate not supplied

Problems with telemetry monitoring systems.

The purchaser of telemetry monitoring systems for operating and recovery rooms has little information available on the practical aspects of ownership and usage. To explore this problem, we recorded 76 telemetry failures (both operator and machine failure) occurring over six months among 18 telemetry channels located in operating and recovery rooms. We experienced approximately one telemetry failure every three days or every 60 surgical procedures. Factory repairs were required on 29 transmitters and 19 receivers during a two-year period. We observed that 28% of the failures were attributable to lead and electrode problems, 25% to battery depletion, 22% to mechanical or electronic component failures, 12% to inappropriate control settings and frequency mismatching, and 13% to miscellaneous difficulties. The following problems were observed. Transmitters were dropped frequently and occasionally immersed in liquids. Thus, waterproofing is recommended for OR use, and lead-failure warning circuitry is mandatory. Inappropriate control settings and frequency mismatching led to a previously unrecognized hazard: that is, it is possible to receive and display ECG data from the wrong patient located in a distant room. (Stethoscopic monitoring can be used to confirm that the data being displayed are from the correct patient.) Battery failure can occur at inopportune times, e.g., during cardiac arrest. Transmitters are frequently "lost" because of their small size and high mobility. This study indicated to us that, in the operating room, telemetry is not desirable because of its high cost compared to hard wired systems, poor reliability, and the possible hazard of displaying data from the wrong patient if improperly used.

Biomedical Engineering↗
PubMed2002

Clinical evaluation of the Life Support for Trauma and Transport (LSTAT) platform.

INTRODUCTION: The Life Support for Trauma and Transport (LSTAT trade mark ) is a self-contained, stretcher-based miniature intensive care unit designed by the United States Army to provide care for critically injured patients during transport and in remote settings where resources are limited. The LSTAT contains conventional medical equipment that has been integrated into one platform and reduced in size to fit within the dimensional envelope of a North Atlantic Treaty Organization (NATO) stretcher. This study evaluated the clinical utility of the LSTAT in simulated and real clinical environments. Our hypothesis was that the LSTAT would be equivalent to conventional equipment in detecting and treating life-threatening problems. METHODS: Thirty-one anesthesiologists and recovery room nurses compared the LSTAT with conventional monitors while managing four simulated critical events. The time required to reach a diagnosis and treatment was recorded for each simulation. Subsequently, 10 consenting adult patients were placed on the LSTAT after surgery for postoperative care in the recovery room. Questionnaires about aspects of LSTAT functionality were completed by nine nurses who cared for the patients placed on the LSTAT. RESULTS: In all of the simulations, there was no clinically significant difference in the time to diagnosis or treatment between the LSTAT and conventional equipment. All clinicians reported that they were able to manage the simulated patients properly with the LSTAT. Nursing staff reported that the LSTAT provided adequate equipment to care for the patients monitored during recovery from surgery and were able to detect critical changes in vital signs in a timely manner. DISCUSSION: Preliminary evaluation of the LSTAT in simulated and postoperative environments demonstrated that the LSTAT provided appropriate equipment to detect and manage critical events in patient care. Further work in assessing LSTAT functionality in a higher-acuity environment is warranted.

Adult↗
PubMed2001

Sevoflurane titration using bispectral index decreases postoperative vomiting in phase II recovery after ambulatory surgery.

UNLABELLED: We tested the hypothesis that titration of sevoflurane using bispectral index (BIS) of the electroencephalogram decreases postoperative nausea and vomiting and improves recovery after outpatient gynecologic laparoscopy. After propofol induction, anesthesia was maintained in all patients with sevoflurane in 65% nitrous oxide and oxygen. In the BIS-Titrated group (n = 32), sevoflurane was titrated to maintain the BIS between 50 and 60 during surgery. In the Control group (n = 30), sevoflurane was adjusted to keep hemodynamic variables within 25% of control values. The severity of pain, postoperative nausea and vomiting, and recovery variables were recorded. In the Control group, 30% of the patients had BIS <40 during surgery (versus 0 in the BIS-Titrated group). Orientation and ability to drink were achieved earlier in the BIS group (P < 0.05). At 30 min after cessation of nitrous oxide, patients in the BIS group performed better in the psychomotor recovery test (P < 0.01). In Phase II recovery room, these patients had significantly less vomiting than the patients in the Control group (16% versus 40% of the patients, respectively, P < 0.05). No differences were found in times to achieve home readiness. IMPLICATIONS: In patients undergoing outpatient gynecologic laparoscopy, the monitoring of bispectral index decreases vomiting in Phase II recovery room, but it has no effect on the time to achieve home readiness.

Adult↗