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PubMed1990

[Epidural anesthesia with high dose fentanyl for abdominal surgery].

An epidural catheter was inserted at T9-L2 interspace and 10 micrograms.kg-1 fentanyl with (E+) or without (E-) epinephrine 1:100,000 was given for 82 elective abdominal surgeries. N2O 66%, enflurane and muscle relaxant were used as needed. The onset and the duration of the action were estimated to be approximately 15 minutes and 4 hours, respectively. Anesthesia was maintained with enflurane below 0.4% (0.22 +/- 0.09%) in 70 patients (85.4%). E+ group needed significantly lower concentration of enflurane than E- group. There was no severe hemodynamic change during the operation. Systolic pressure, diastolic pressure and heart rate during the operation were 115.2 +/- 16.0 mmHg, 69.4 +/- 10.8 mmHg and 74.2 +/- 11.4 min-1, respectively, each of which was about 18% less than the values on arrival in the operating room. Sixty-one patients (82.5%) woke rapidly. Almost all patients felt well and had no pain during the recovery period. Naloxone 0.05-4 mg was administered intravenously in 21 patients (31.7%) whose respiratory rate was below 10 min-1. The patients with shorter operation time (shorter than 2.5 hours) needed more naloxone. Troubles of respiratory depression did not occur in the recovery room and in the ward in both naloxone and non-naloxone groups. This anesthesia method which induces mild depression of blood pressure and heart rate may be indicated for patients with ischemic heart disease or with poor cardiac function, but has no advantages in patients with poor respiratory function who need early extubation after a short operation.

Abdomen↗
PubMed1980

Premedication for outpatient adenoidectomy: comparison between ketamine and pethidine.

A comparison of intramuscular ketamine and pethidine as premedicants was carried out in a series of 32 children under two years of age who were given thiopentone-N2O-O2-succinyl choline anesthesia for elective outpatient adenoidectomy. Fourteen (87.5%) of the 16 children premedicated with ketamine (3 mg./kg.) were calm or asleep when brought into the operating room as compared to 4 (25.0%) of the 16 children (p less than 0.001) premedicated with pethidine (1 mg/kg.). Immediate recovery was similar in the groups premedicated with ketamine and pethidine. These two small groups of children did not differ significantly in their emotional state during recovery room observation, nor during the 48 postoperative hours at home, either. It is suggested that ketamine administered intramuscularly is a suitable agent for outpatient premedication of small children because of its rapid action, excellent sedative and analgesic properties and low incidence of side-effects.

Adenoidectomy↗
PubMed2002

Perioperative use of transesophageal echocardiography by anesthesiologists: impact in noncardiac surgery and in the intensive care unit.

BACKGROUND: The American Society of Anesthesiologists (ASA) has published practice guidelines for the use of perioperative transesophageal echocardiography (TEE) but the role and impact of TEE performed by anesthesiologists outside the cardiac operating room (OR) is still poorly explored. We report our experience in the use of TEE in the noncardiac OR, the recovery room and in the intensive care unit (ICU) in a university hospital, and analyze the impact of TEE on clinical decision making. METHODS: Two hundred fourteen patients were included and TEE indications were classified prospectively according to the ASA guidelines. The examinations and data sheets were reviewed by two anesthesiologists with advanced training in TEE. For each examination, it was noted if TEE altered the management according to five groups: 1) changing medical therapy; 2) changing surgical therapy; 3) confirmation of a diagnosis; 4) positioning of an intravascular device; and 5) TEE used as a substitute to a pulmonary artery catheter. RESULTS: Eighty-nine (37%), 67 (31%) and 58 (27%) patients had category I, II and III indications. The impact was more significant in category I where TEE altered therapy 60% of the time compared with 31% and 21% for categories II and III (P < 0.001). The most frequent reason for changing management was a modification in medical therapy in 53 instances (45%). CONCLUSION: Our results confirm a greater impact of TEE performed by anesthesiologists on clinical management for category I compared to category II and III indications in the noncardiac OR surgical setting and in the ICU.

Anesthesiology↗
PubMed1997

Avoidance of nitrous oxide and increased isoflurane during alfentanil based anesthesia decreases the incidence of postoperative nausea.

Postoperative nausea and vomiting have been associated with the use of nitrous oxide. Alfentanil, when combined with nitrous oxide, also results in a high incidence of postoperative nausea and vomiting. To further define this emesis-potentiating effect of N2O, 119 patients were chosen for study and divided into two groups: group A (n = 59) was administered a mixture of alfentanil, N2O, and O2 with 0.25% isoflurane, group B (n = 60) was administered a mixture of oxygen, room air, isofluorane, and alfentanil. The incidence of postoperative nausea and vomiting was ascertained by a blinded observer in the recovery room. All 119 patients were scheduled for extra-abdominal procedures (excluding thoracotomial, intracranial, ophthalmologic, and middle ear surgery). Patients with a previous history of nausea and vomiting, hiatal hernias, reflux esophagitis, or morbid obesity were excluded. The incidence of vomiting was 5% (3/60) in group B and 15% (8/59) in group A (P = 0.067). Forty-four percent (26/59) of the patients in group A and 20% (12/59) in group B were nauseated postoperatively (P = 0.005). Our data suggest that elimination of N2O from alfentanil-based anesthetics lessens the incidence of nausea.

Adolescent↗
PubMed1993

Ketorolac and indomethacin are equally efficacious for the relief of minor postoperative pain.

Injectable ketorolac is an effective analgesic in ambulatory surgery patients. However, no studies have compared ketorolac with other NSAIDs in this setting. The analgesic efficacy of intramuscular ketorolac, rectal indomethacin and placebo was compared in healthy women undergoing gynaecological or breast surgery as outpatients. Ninety patients received 30 mg im ketorolac, 100 mg pr indomethacin or placebo in a prospective, randomized, double-blind manner. A standardized anaesthetic protocol was followed. Patients graded their pain on a 10 cm visual analogue scale in the recovery room, twice in the surgical day care unit and during the car ride home. The patients' postoperative fentanyl requirements, time to recovery milestones, and side effects were recorded. The placebo group received more fentanyl in the PACU but did not achieve the same pain relief as either of the NSAID-treated group (ketorolac 44 +/- 53 micrograms, indomethacin 39 +/- 55 micrograms, placebo 87 +/- 100 micrograms, P < 0.05). Patients who received an NSAID had less pain at 15 and 90 min (P < 0.05). The PACU stay was longer for the placebo group (ketorolac 50 +/- 13 min, indomethacin 49 +/- 12 min, placebo 62 +/- 35 min, P < 0.05). Time to ambulation was also longer in the placebo group (ketorolac 117 +/- 25 min, indomethacin 121 +/- 49 min, placebo 140 +/- 51 min, P < 0.05). However, no differences were observed between the two NSAIDS. Side effects were similar in all groups. We conclude that im ketorolac and pr indomethacin are equally effective analgesics in this group of patients.

Administration, Rectal↗
PubMed1991

Effect of clonidine on the circulation and vasoactive hormones after aortic surgery.

After completion of abdominal aortic graft, 29 patients received an i.v. infusion of placebo (n = 16) or clonidine 7 micrograms kg-1 (n = 13) over 120 min in a double-blind study. Cardiovascular variables were measured and plasma samples obtained up to 5 h after arrival in the recovery room, for assay of noradrenaline, adrenaline, vasopressin and renin concentrations. Noradrenaline, adrenaline and vasopressin concentrations decreased in the clonidine group throughout recovery (P less than 0.001, 0.05 and 0.05, respectively, vs placebo). Heart rate was less in the clonidine group (P less than 0.01). There was no significant difference in mean arterial pressure between groups. Stroke volume was larger (P less than 0.01) and there were fewer episodes of hypertension (P less than 0.05) and tachycardia in the clonidine group. In addition, a reduction in the number of circulatory interventions (P less than 0.05) and episodes of shivering was noted in the clonidine group. Mean (SD) postoperative volume requirements were larger in the clonidine group (total postoperative input: clonidine 1462 (604) ml; placebo 1064 (348) ml (P less than 0.05]. These data are consistent with the observation that clonidine modifies endocrine and circulatory status after major surgery.

Aorta, Abdominal↗
PubMed2000

A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis.

UNLABELLED: The optimal dose and timing of 5-HT(3) antagonist administration for prophylaxis against postoperative nausea and vomiting (PONV) remains controversial. Although 5-HT(3) antagonists seem to be most effective when administered near the end of surgery, there are no data on the comparative efficacy or costs associated with the 5-HT(3) antagonists dolasetron and ondansetron when administered at the end of the operation. In this double-blinded study, 200 outpatients undergoing otolaryngologic procedures with a standardized general anesthetic received 4 (O4) or 8 mg (O8) of ondansetron or 12.5 (D12.5) or 25 mg (D25) of dolasetron IV within 30 min before the end of surgery. A blinded observer recorded the emetic episodes, maximum nausea score, recovery room resource and drug use, nursing time spent managing PONV, times to achieve discharge criteria from the Phase 1 and 2 recovery units, postdischarge emesis, and patient satisfaction. Total costs were calculated by using the perspective of a free-standing surgicenter. There were no differences in patient demographics, incidence of PONV, need for rescue medications, time spent in the recovery areas, unanticipated hospital admissions, or patient satisfaction among the four treatment groups. The mean total costs (95% confidence intervals) to prevent PONV in one patient were lowest in the D12.5 group: $23.89 (17.18-28.79) vs $37.81 (30.29-45.32), $33.91 (28.92-39.35), and $75.18 (61.13-89.24) for D25, O4, and O8, respectively. Excluding nursing labor costs did not alter this finding: $18.51 (14.18-22.85), $34.77 (28.03-41.49), $31.77 (28. 92-39.35), and $71.76 (58.17-85.35) for D12.5, D25, O4, and O8, respectively. We conclude that 12.5 mg of dolasetron IV is more cost effective than 4 mg of ondansetron IV for preventing PONV after otolaryngologic surgery and is associated with similar patient satisfaction. IMPLICATIONS: When administered at the end of surgery, 12.5 mg of dolasetron IV is as effective as 25 mg of dolasetron IV, 4 mg of ondansetron IV, and 8 mg of ondansetron IV in preventing emetic symptoms after otolaryngologic surgery and was associated with similar patient satisfaction at a reduced cost. There were no differences in the antiemetic efficacy of the 4 and 8 mg doses of ondansetron.

Ambulatory Surgical Procedures↗
PubMed1995

Faster recovery after anesthesia in infants after intravenous induction with methohexital instead of thiopental.

BACKGROUND: To determine possible delays in recovery after intravenous anesthesia induction with thiopental, the drug was compared with methohexital in infants 1-12 months of age who were scheduled for hernia repair or circumcision. METHODS: The infants were given equipotent doses of methohexital (3.0 mg/kg, n = 21) or thiopental (7.3 mg/kg, n = 20), in random and blind fashion. After tracheal intubation, anesthesia was maintained with isoflurane in nitrous oxide/oxygen. All children received 0.75 ml/kg caudal bupivacaine (2.5 mg/ml). Isoflurane was discontinued at the beginning of skin closure, and nitrous oxide was terminated immediately after the last suture (end of surgery). RESULTS: There were no differences between the two groups with respect to age, weight, or duration of surgery, which lasted 19 min (14-23 min) in the methohexital group and 16 min (15-19 min) in the thiopental group (median and inner quartile range). Time from termination of nitrous oxide to extubation did not differ significantly between the groups. Time to spontaneous eye opening after end of surgery was 23 min (5-44 min) after methohexital induction and 55 min (25-74 min) after thiopental induction (P < 0.05). Recovery, assessed as postanesthetic recovery scores by a blinded observer, was significantly more rapid in the methohexital group at arrival in the recovery room and 5, 15, and 45 min after arrival. After 120 min, almost all infants of both groups were awake. CONCLUSIONS: Recovery after short surgical procedures in infants is faster after intravenous induction with methohexital than with thiopental.

Anesthesia Recovery Period↗
PubMed2002

Comparison of sevoflurane and nitrous oxide mixture with nitrous oxide alone for inhalation conscious sedation in children having dental treatment: a randomised controlled trial.

We studied 411 children aged 3-10 years who were referred for dental treatment. They were randomly allocated to have inhalation conscious sedation with either sevoflurane/nitrous oxide mixture or nitrous oxide alone. Dental treatment was satisfactorily completed in 215/241 children who were given sevoflurane/nitrous oxide mixture (89%) compared with 89/170 who were given nitrous oxide alone (52%) (Chi square 70.3, p < 0.0001). All children remained conscious and responsive to verbal contact throughout the treatment and in the recovery room. No adverse side-effects were recorded in either group and there were no significant differences in oxygen saturation, heart rate, recovery profile, or time to discharge home between the groups. The study concluded that, for every 100 children treated with sevoflurane/nitrous oxide mixture, 37 children would be saved a general anaesthetic if given combined sevoflurane and nitrous oxide mixture rather than nitrous oxide alone. The use of sevoflurane in low concentrations 0.1-0.3% to supplement nitrous oxide and oxygen for inhalation conscious sedation is safe, practical, and significantly more effective than nitrous oxide alone in children having dental treatment.

Administration, Inhalation↗
PubMed1997

The effect of general anaesthesia on breathing patterns in elderly patients during the early post-operative period.

This study was designed to investigate the incidence of critical events in breathing following light general anesthesia compared with normal sleep during the first 12 h after transfer from the recovery room. There were no significant differences in the incidence of apnoea or desaturation episodes between normal sleep and the post-operative recovery period. There was a close correlation between the pre-operative and post-operative incidence of apnoea (r = 0.93), pre-operative and post-operative desaturation periods (r = 0.81), pre-operative and post-operative mean SpO2 values (r = 0.54) and pre-operative and post-operative minimal SpO2 values (r = 0.90) in all the patients. In the early post-operative period, breathing patterns and oxygenation were similar to those observed during normal night-time sleep in elderly patients undergoing ophthalmological surgery.

Aged↗
PubMed2006

Validation of AKACID plus as a room disinfectant in the hospital setting.

AKACID Plus, a novel polymeric guanidine with broad antimicrobial activity against multiantibiotic-resistant bacterial strains, was used in the present study as a room disinfectant. Disinfection of closed rooms experimentally contaminated with antibiotic-susceptible and multiresistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Escherichia coli was performed using AKACID Plus at concentrations of 0.1, 0.25, and 0.5% for 100 min. Bacterial suspensions were distributed on plastic and stainless steel plates and placed in a test room. Recovery of the test microorganisms was determined before nebulizing, 60 and 100 min after initiation, and 4 h after the end of room disinfection by a simple swab-rinse technique. The swab-rinse method demonstrated a dose- and time-dependent effectiveness of AKACID Plus in eradicating S. aureus, E. coli, and P. aeruginosa on plastic and stainless steel plates. Nebulized 0.5% AKACID Plus was successful in eliminating all hospital pathogens within 340 min. After the use of 0.25% AKACID Plus, MRSA was still detectable on microbial carrier plates. The test concentration of 0.1% AKACID Plus achieved a significant reduction of S. aureus and P. aeruginosa on plastic and stainless steel plates but was sufficient to eradicate only E. coli. These results suggest that nebulized AKACID Plus at a concentration of 0.5% is a potent substance for eradication of pathogenic organisms in the hospital setting.

Disinfectants↗
PubMed1992

Oxygen desaturation after dental anaesthesia.

The incidence of oxygen desaturation (less than 91%) was measured by pulse oximetry during recovery from outpatient dental anaesthesia in 120 ASA grade I and II children. Alternate cases were given supplementary oxygen 5 litre min-1 by mask. Eighteen of 60 children (30%) given air and 14 of 60 (23%) given oxygen exhibited desaturation (P greater than 0.05). Desaturation was more likely to occur if the child was cared for during recovery by locum rather than permanent nursing staff: 22 of 64 (34%) compared with 10 of 56 (18%) (P less than 0.05). It is concluded that significant desaturation is common after brief dental anaesthesia, that the incidence of desaturation is not reduced significantly by supplementary oxygen and that careful supervision of patients by experienced recovery room staff is necessary after dental anaesthesia.

Adolescent↗
PubMed1990

Salvage after postoperative thrombosis of the carotid artery.

When dense hemiparesis has developed appropriate to the operated vessel after carotid surgery, the patient has been immediately returned to the operating room for reexploration of the vessel and thrombectomy. Over a 5-year period, we identified four patients who developed dense hemiparesis in the recovery room postoperatively. A fifth patient with a similar problem after carotid subclavian bypass was included for analysis. All patients were found to have thrombosis of the operated vessel. Direct closure had been used after endarterectomy. All vessels were thrombectomized and patched with autogenous vein. Interposition graft was used in the patient who underwent carotid subclavian bypass. There were no deaths, and only one patient did not improve. Our experience encourages us to continue this practice but also suggests that the frequency of this problem may be reduced further by patch angioplasty.

Adult↗
PubMed2002

Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD.

BACKGROUND: Sedation and analgesia are routinely used to improve patient tolerance for GI endoscopy. Currently, assessment of postprocedure recovery uses cardiovascular and respiratory parameters but not psychomotor function. The two aims of this study were to determine degree of psychomotor recovery after conscious sedation for endoscopy when patients meet established discharge criteria, and to identify a sensitive method of testing psychomotor recovery, and thereby provide meaningful predictions regarding the ability of patients to return to daily activities. METHODS: Outpatients undergoing elective EGD were recruited. Four psychometric tests were used to establish baseline psychomotor function before sedation and analgesia: Critical Tracking, Manual Dexterity, Multiple-Choice Reaction Time, and Letter Cancellation. Meperidine and midazolam were administered intravenously per standard nomogram. The tests were repeated immediately after the procedure and at 15-minute intervals until patients were deemed ready for discharge by recovery room personnel. Discharge criteria included an Aldrete discharge score of 10 and the ability to ambulate unhindered and carry on a simple conversation. Recovery personnel were blinded to psychometric test results. Psychomotor scores at discharge were compared with baseline scores to determine percent recovery. RESULTS: Thirty-one patients (12 men, 19 women; mean age 43 years, range 18-72 years) were enrolled. When Aldrete discharge criteria were met, the average psychomotor recovery was only 60% to 70% compared with baseline. At the time of discharge, average psychomotor recovery was 86.5% of baseline. Letter Cancellation and Multiple-Choice Reaction Time had the highest sensitivity in detecting depression of psychomotor function versus baseline, with mean recovery of, respectively, 64% and 63% (p < 0.0001). CONCLUSIONS: Psychomotor function remains significantly impaired when patients reach an Aldrete discharge score of 10. The Letter Cancellation test was most sensitive in detecting psychomotor impairment and recovery. Incorporating psychometric tests with current discharge criteria may identify patients who are better able to resume normal daily activities without supervision.

Adolescent↗
PubMedDate not supplied

Antiemetic effectiveness of intraoperatively administered droperidol in pediatric strabismus outpatient surgery--preliminary report of a controlled study.

Low doses (0.05 mg/kg) of intravenously administered droperidol were given intraoperatively to randomly assigned pediatric strabismus patients in a controlled double-masked paradigm. No difference between control and treatment groups in the severity of vomiting was noted in the postanesthesia recovery room, but such a difference was probably present in the hospital rooms during the interval between room arrival and the meeting of hospital discharge criteria. Administration of the drug did not appear to produce somnolence sufficient to delay postoperative recovery.

Adolescent↗
PubMed2003

[Surgery in children and adolescents].

The authors explain the second phase in surgery procedure which is known as intra-operative, developing a standardized model of nursing care for children and adolescents during the intra-operative phase. This phase commences in the operating room from the moment the child/adolescent arrives after being brought from a hospital ward and lasts until the child/adolescent is transferred to the recovery room. The authors perform a systematic and holistic evaluation, using the Gordon Functional Health Patterns. The authors select the Nursing Diagnoses of NANDA, the North American Nursing Diagnosis Association, which most frequently appear in this intra-operative phase: risk of lesion, risk of infection, risk of hypothermia, and risk of asphyxiation. The authors also mention the potential complications which could appear during an operation according to the age of the child, the type of anesthesia used, the surgical technique used, and the overall health of the patient prior to surgery. Finally, the authors describe the nursing treatments related to the potential complications and the outlined nursing diagnoses.

Adolescent↗
PubMedDate not supplied

A patient temperature audit within a theatre recovery unit.

Hypothermia in the postoperative recovery phase can be a source of potential danger for patients emerging from anaesthesia. In spite of the vast amount of literature dealing with principles of care in the recovery room, information regarding the incidence of hypothermia appear very limited. This article presents a patient temperature audit to assess whether patients were being discharged from a theatre recovery unit hypothermic. In addition, patient temperatures were recorded both pre- and postoperatively, as well as on discharge from recovery, to monitor the incidence of hypothermia throughout the theatre suite. The results show that patients were being discharged with core body temperatures ranging from 34.8 to 38 degrees C with no incidence of hypothermia recorded when the operating room temperature was above 23 degrees C. In general, the coldest theatres were orthopaedic, with this group of patients showing the most incidence of hypothermia. This article aims to demonstrate the use of clinical audit to investigate and evaluate current practice.

Adult↗
PubMedDate not supplied

A simple method for calculating component dilution during fluid resuscitation: the Leuven approach.

STUDY OBJECTIVES: To test the reliability of the Leuven approach, a balance between oversimplified empiric rules and more complex calculations requiring the use of nomograms or computers, to determine blood component dilution during large transfusions. To present schemes for blood component dilution and stabilization, as well as four examples showing the practicability of the method. DESIGN: Prospective study. SETTING: Orthopedic operating rooms at a university hospital. PATIENTS: 108 patients undergoing total hip replacement with expected large blood loss. INTERVENTIONS: Component concentrations were measured after patient arrival in the recovery room. Blood loss was followed clinically. MEASUREMENTS AND MAIN RESULTS: Preset target component concentrations [hematocrit (Hct) 31%; total serum protein (TSP) 5.0 g/dl; prothrombin time (PT) 50%; blood platelets (BLPL) 50,000/microliters)] were compared with concentrations measured on arrival in recovery after dilution and stabilization, according to the transfusion scheme. Average blood loss was 3,226 +/- 1,600 ml (mean +/- SD). End component concentrations were Hct, 33.4% +/- 3.3%; TSP, 5.2 +/- 0.5 g/dl; PT, 52% +/- 12%; BLPL, 97,000/microliters. Hct and TSP showed significant (p < 0.05) but clinically unimportant differences from target concentrations. Possible reasons for variability in end concentrations are discussed. CONCLUSION: The Leuven approach produces reliable blood component concentrations after extensive transfusions. It allows the clinician to decide for himself or herself, in accordance with general consensus and the patient's individual needs, when to stabilize blood components.

Blood↗