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Moncef Sellami, Sarhan Feki, Zied Triki, Jamil Zghal, Imen Zouche, Boutheina Hammami, Ilhem Charfeddine, Mohamed Chaari, Abdelmonem Ghorbel
BACKGROUND AND OBJECTIVE: We conducted a prospective double-blind randomized study assessing bupivacaine end-of-surgery wound infiltration for pain relief in thyroid surgery. METHODS: Patients were randomly divided into two groups: Group S, local wound infiltration with saline solution; Group B, bupivacaine 0.5% was administered. Pain perception was measured using visual analogue scale (VAS) during post-anaesthetic care unit (PACU) stay every 10 min and during the 24 postoperative hours admission at 2, 4, 6, 12, and 24 h after surgery...
March 13, 2018: European Archives of Oto-rhino-laryngology
Skip R Hickman, Kathleen M Mathieson, Lynne M Bradford, Casey D Garman, Richard W Gregg, Douglas W Lukens
PURPOSE: Results of a study comparing pain control outcomes with preoperative oral versus intraoperative i.v. acetaminophen use in adults undergoing total hip or knee arthroplasty are reported. METHODS: A single-center, randomized, placebo-controlled, equivalence trial was conducted. Patients were assigned (1:1) to receive 2 500-mg capsules of acetaminophen before surgery, with an i.v. placebo infusion during surgery (the oral group), or 2 oral placebo capsules followed by an i...
March 15, 2018: American Journal of Health-system Pharmacy: AJHP
A Pym, E Ben-Menachem
Postoperative nausea and vomiting (PONV) is a common and distressing problem for patients and increases the burden of care in post-anaesthesia care units (PACU). As such it has been a recent focus for quality improvement. Evidence-based guidelines have demonstrated the benefit of PONV risk stratification and prophylaxis, but may be underutilised in clinical practice. This prospective pre-/post-intervention study was conducted at an adult tertiary hospital in non-cardiac adult surgical patients at higher-risk of PONV...
March 2018: Anaesthesia and Intensive Care
Alexandra M Arambula, Deborah X Xie, Amy S Whigham
OBJECTIVES: To characterize postoperative respiratory complications following adenotonsillectomy (AT) in children with obstructive sleep apnea (OSA) and to identify variables associated with pediatric intensive care unit (PICU) admission. METHODS: Retrospective analysis of 133 pediatric OSA patients with prior AT. Assessment of the postoperative hospital course informed patient stratification based on respiratory event severity, PICU admission status, and unscheduled escalation of care...
April 2018: International Journal of Pediatric Otorhinolaryngology
Karina Woodling, Juan Fiorda-Diaz, Bradley A Otto, Christie A Barnes, Alberto A Uribe, Sergio D Bergese, Vedat Yildiz, Nicoleta Stoicea, Michael G Guertin
Background: Obstructive sleep apnea (OSA) may be related to episodes of oxygen de-saturation, hypercapnia, cardiovascular dysfunction, cor-pulmonale, and pulmonary hypertension. STOP-BANG is an acronym for eight specific questions used to assess the likelihood of OSA. If the individual exhibits three or more of these indicators, he/she should be considered to be at high risk for OSA complications. Therefore, the decision of proceeding with inpatient versus outpatient ENT surgery still remains controversial...
February 2018: Laryngoscope Investigative Otolaryngology
Marcella G Willis-Gray, Katherine E Husk, Taylor J Brueseke, Jennifer M Wu, Alexis A Dieter
OBJECTIVES: Our primary objective was to evaluate age as a predictor of postanesthesia care unit (PACU) opioid administration in women undergoing reconstructive pelvic surgery. Our secondary objective was to identify additional predictors of PACU opioid administration. METHODS: We conducted a retrospective cohort study of women undergoing outpatient urogynecologic surgery for pelvic organ prolapse and/or stress urinary incontinence between September 2015 to October 2016 at 1 academic medical center...
February 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
Emily B Le Souder, Arash Azin, Dhruvin H Hirpara, Richard Walker, Sean Cleary, Fayez Quereshy
BACKGROUND: Simultaneous resection for colorectal cancer with synchronous liver metastases is an established alternative to a staged approach. This study aimed to compare these approaches with regards to economic parameters and short-term outcomes. METHODS: A retrospective cohort analysis was conducted between 2005 and 2016. The primary outcome was cost per episode of care. Secondary measures included 30-day clinical outcomes. A multivariate analysis was performed to determine the adjusted effect of a simultaneous surgical approach on total cost of care...
February 26, 2018: Journal of Surgical Oncology
Mengqi Zhu, Yuechao Gu, Xia Sun, Xi Liu, Wankun Chen, Changhong Miao
OBJECTIVE: To explore the feasibility, effectiveness and safety of ultrasound-guided intercostal nerve block (ICNB) for immediate relief of moderate and severe pain following esophagectomy in a post-anesthesia care unit (PACU). METHODS: Eighty-one patients who complained of moderate to severe pain on arrival to the PACU after an Ivor Lewis esophagectomy were randomly assigned to two groups: a sufentanil treatment group (Group A, n=41) and an intercostal nerve block treatment group (Group B, n=40)...
February 26, 2018: Pain Practice: the Official Journal of World Institute of Pain
Frédéric Aubrun, Noël Zahr, Olivier Langeron, Nicolas Boccheciampe, Nathalie Cozic, Lisa Belin, Jean-Sebastien Hulot, Frederic Khiami, Bruno Riou
BACKGROUND: Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES: To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics...
February 22, 2018: European Journal of Anaesthesiology
Canser Yilmaz Demir, Nureddin Yuzkat
BACKGROUND: Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20 min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty...
February 20, 2018: Aesthetic Plastic Surgery
Richard L Purcell, Kyle E Nappo, Daniel W Griffin, Michael McCabe, Terrence Anderson, Michael Kent
PURPOSE: A newer formulation of bupivacaine, encapsulated within carrier molecules, has garnered attention for its role in providing extended post-operative analgesia. The purpose was to evaluate the addition of liposomal bupivacaine to fascia iliaca blockade during hip arthroscopy. METHODS: Retrospective cohort study of patients undergoing hip arthroscopy with a pre-operative fascia iliaca blockade with either liposomal bupivacaine (Group 1; 266mg + 20 cc 0...
February 16, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Maria Bautista, Meilyn Muskus, Adolfo Llinás, Guillermo Bonilla, Carlos Guerrero, Jairo Moyano
BACKGROUND: Previous studies of soft tissue infiltration in hip arthroplasty present variable results. The purpose of this study is to identify whether injection of an analgesic mixture improves pain management during the immediate post-operative period. MATERIALS AND METHODS: This cohort study compared 129 patients that received peri-articular soft tissue injection with 20 ml of 0.25% bupivacaine and 2 ml of ketorolac (30 mg/1 ml) in 28 ml of saline solution, with 71 patients who did not received injections...
February 13, 2018: International Orthopaedics
Sebastian Heiderich, Christian Thoben, Nils Dennhardt, Wolfgang Koppert, Terence Krauß, Robert Sümpelmann, Stefan Zimmermann, Werner Klingler
BACKGROUND: Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S): The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN: A prospective observational study...
February 9, 2018: European Journal of Anaesthesiology
Todd Lingren, Senthilkumar Sadhasivam, Xue Zhang, Keith Marsolo
BACKGROUND AND AIM: Many clinical research studies claim to collect data that are also captured in the electronic medical record (EMR). We evaluate the potential for EMR data to replace prospective research data collection. METHODS: Using a dataset of 358 surgical patients enrolled in a prospective study, we examined the completeness and agreement of EMR and study entries for several variables, including the patient's stay in the post-operative care unit (PACU), surgical pain relief and pain medication side effects...
March 2018: International Journal of Medical Informatics
Sooyoung Cho, Youn Jin Kim, Kyungah Jeong, Hye-Sung Moon
PURPOSE: Rectus sheath block (RSB) is an anterior abdominal wall block that reduces postoperative pain associated with midline incisions. This study aims to investigate the effect of ultrasound-guided bilateral RSB (US-BRSB) on postoperative pain and analgesic consumption in patients undergoing laparoscopic gynecologic surgery. METHODS: Sixty patients who underwent laparoscopic gynecologic surgery were allocated to RSB (n = 30) or control (n = 30) group. A bilateral US-BRSB procedure (30 ml of 0...
February 8, 2018: Journal of Anesthesia
Matthew T Philippi, Timothy L Kahn, Temitope F Adeyemi, Travis G Maak, Stephen K Aoki
Many hip arthroscopy patients experience significant pain in the immediate postoperative period. Although peripheral nerve blocks have demonstrated efficacy in alleviating some of this pain, they come with significant costs. Local infiltration analgesia (LIA) may be a significantly cheaper and efficacious treatment modality. Although LIA has been well studied in hip and knee arthroplasty, its efficacy in hip arthroscopy is unclear. The purpose of this retrospective study is to determine the efficacy of a single extracapsular injection of bupivacaine-epinephrine during hip arthroscopy in reducing the rate of elective postoperative femoral nerve blocks...
January 2018: Journal of Hip Preservation Surgery
Mary Jane Genuino
The 2014 national percentage for 30-day readmissions among Medicare recipients from Post-Acute Care Unit (PACU) showed: Heart Failure (HF) with major complications and co-morbidities, an average of 24.09%, and Chronic Obstructive Pulmonary Disease (COPD) with complications and co-morbidities 23.12%. The percentage of readmissions for New Jersey among PACU showed: HF with major complications and co-morbidities, an average of 24.40% and COPD 26.35% (Avalere Health, 2014). For this study site, the hospital readmission rate was not specifically broken down according to condition/diagnosis...
February 2018: Applied Nursing Research: ANR
Natalia Afonso Luis, Maria Asunsión Acosta Mérida, Joaquín Marchena Gómez
A 75-year-old male who underwent an Ivor Lewis esophagectomy due to a distal adenocarcinoma had a leak at the gastroplasty on the 5th day after surgery, which required two surgeries and a primary suture. He was transferred to our hospital due to a poor outcome and endoscopy revealed a 2.5cm gap perianastomotically on the gastroplasty wall, for which a stent was placed. Due to hemodynamic impairment, a thoracotomy procedure was performed, which revealed stent protrusion into the cavity. The patient underwent an esophagogastric anastomosis resection, cervical esophagostomy and gastrostomy...
February 9, 2018: Revista Española de Enfermedades Digestivas
Dae Hee Kim, Go Un Roh, Young Bok Lee, Chang Ik Choi, Jae Moon Lee, Yun Jeong Chae
Purpose: The development of emergence agitation (EA) is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA...
2018: Therapeutics and Clinical Risk Management
Anuj Jain, Varadarajan Muralidhar, Sanjeev Aneja, Anil Kumar Sharma
Background and Aims: Mostly, institutions in India have single post-anaesthesia care unit (PACU) which follows traditional time-based discharge (TBD) method. Recently, it has been classified into PACU Phase I and Phase II, and criteria-based discharge (CBD) method has been used. This study primarily compares CBD versus TBD methods in moving patients through PACU, and other non-clinical factors causing delay in shifting. Methods: One hundred patients, aged 18-65 years, American Society of Anesthesiologist's physical status I and II, scheduled for elective minor surgeries under general anaesthesia were studied...
January 2018: Indian Journal of Anaesthesia
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