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Post Anesthesia Care

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https://www.readbyqxmd.com/read/28099325/intraoperative-clinical-decision-support-for-anesthesia-a-narrative-review-of-available-systems
#1
Bala G Nair, Eilon Gabel, Ira Hofer, Howard A Schwid, Maxime Cannesson
With increasing adoption of anesthesia information management systems (AIMS), there is growing interest in utilizing AIMS data for intraoperative clinical decision support (CDS). CDS for anesthesia has the potential for improving quality of care, patient safety, billing, and compliance. Intraoperative CDS can range from passive and post hoc systems to active real-time systems that can detect ongoing clinical issues and deviations from best practice care. Real-time CDS holds the most promise because real-time alerts and guidance can drive provider behavior toward evidence-based standardized care during the ongoing case...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28099323/anesthesia-and-databases-pediatric-cardiac-disease-as-a-role-model
#2
David F Vener, Sara K Pasquali, Emad B Mossad
Large data sets have now become ubiquitous in clinical medicine; they are particularly useful in high-acuity, low-volume conditions such as congenital heart disease where data must be collected from many centers. These data fall into 2 categories: administrative data arising from hospital admissions and charges and clinical data relating to specific diseases or procedures. In congenital cardiac diseases, there are now over a dozen of these data sets or registries focusing on various elements of patient care...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28096581/role-of-preemptive-tapentadol-in-reduction-of-postoperative-analgesic-requirements-after-laparoscopic-cholecystectomy
#3
Ghanshyam Yadav, Gaurav Jain, Abhishek Samprathi, Annavi Baghel, Dinesh Kumar Singh
BACKGROUND AND AIMS: Poorly managed acute postoperative pain may result in prolonged morbidity. Various pharmacotherapies have targeted this, but research on an ideal preemptive analgesic continues, taking into account drug-related side effects. Considering the better tolerability profile of tapentadol, we assessed its role as a preemptive analgesic in the reduction of postoperative analgesic requirements, after laparoscopic cholecystectomy. MATERIAL AND METHODS: In a prospective-double-blinded fashion, sixty patients posted for above surgery, were randomized to receive tablet tapentadol 75 mg (Group A) or starch tablets (Group B) orally, an hour before induction of general anesthesia...
October 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28096574/awareness-during-general-anesthesia-an-indian-viewpoint
#4
Reshma P Ambulkar, Vandana Agarwal, Priya Ranganathan, Jigeeshu V Divatia
BACKGROUND AND AIMS: The incidence of intra-operative awareness with explicit recall in the Western world has been reported to be between 0.1% and 0.2% in the general surgical population and up to 1-2% of patients at high risk for this complication. Awareness in the Indian population has never been studied; we therefore wanted to detect the incidence of awareness in patients who were at high risk of experiencing awareness during surgery in our population. MATERIAL AND METHODS: We conducted a prospective single-center observational study at a 600-bedded tertiary cancer care referral hospital...
October 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28093564/postoperative-conversion-disorder-presenting-as-inspiratory-stridor-and-hemiparesis-in-a-pediatric-patient
#5
Erik J Nelson, Jennifer Y Wu
BACKGROUND Postoperative conversion disorder is rare and has been reported. The diagnosis is usually made after all major organic causes have been ruled out. CASE REPORT We describe a case of a 13-year-old female who presented in the post-anesthesia care unit with acute-onset inspiratory stridor and unresponsiveness to verbal or painful stimuli after receiving a general anesthetic for upper endoscopy. Later in the post-anesthesia care unit, she presented with acute-onset right hemiplegia and sensory loss. She was first evaluated for causes of her stridor and unresponsiveness...
January 17, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28079776/enhanced-recovery-program-and-length-of-stay-after-laparotomy-on-a-gynecologic-oncology-service-a-randomized-controlled-trial
#6
Elizabeth L Dickson, Erica Stockwell, Melissa A Geller, Rachel Isaksson Vogel, Sally A Mullany, Rahel Ghebre, Boris J N Witherhoff, Levi S Downs, Linda F Carson, Deanna Teoh, Michelle Glasgow, Matt Gerber, Colleen Rivard, Britt K Erickson, Jacob Hutchins, Peter A Argenta
OBJECTIVE: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. METHODS: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding...
January 9, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28057455/comparison-of-botulinum-toxin-with-surgery-for-the-treatment-of-acute-onset-comitant-esotropia-in-children
#7
Michael J Wan, Iason S Mantagos, Ankoor S Shah, Melanie Kazlas, David G Hunter
PURPOSE: To determine whether botulinum toxin is as effective as strabismus surgery in the treatment of acute-onset, comitant esotropia in children. DESIGN: Retrospective, non-randomized, comparative clinical study. METHODS: Setting: Tertiary care pediatric hospital. STUDY POPULATION: 49 children with acute-onset, comitant esotropia. INTERVENTION: Treatment with either botulinum toxin ("chemodenervation group") or standard incisional strabismus surgery ("surgery group")...
January 2, 2017: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/28050702/selective-induction-of-il-1%C3%AE-after-a-brief-isoflurane-anesthetic-in-children-undergoing-mri-examination
#8
Emmett E Whitaker, Fievos L Christofi, Kristen M Quinn, Brianne Z Wiemann, Jason C Xia, Joseph D Tobias, Bruno Bissonnette
PURPOSE: To determine if isoflurane anesthesia without surgery causes systemic inflammation in children. Inflammation is targeted as responsible for the development of many neurologic pathologies. The effect will be evaluated by measuring serum cytokine levels before and after isoflurane anesthesia. The possible neurotoxic effect of anesthetic agents is a concern in pediatric anesthesia. Questions remain as to the true effects of anesthesia alone on systemic inflammation. The current study assesses systemic inflammatory response to general anesthesia in children not exposed to surgical stress...
January 3, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28041617/-postoperative-surveillance-in-neurosurgical-patients-usefulness-of-neurological-assessment-scores-and-bispectral-index
#9
Silvia Herrero, Enrique Carrero, Ricard Valero, Jose Rios, Neus Fábregas
BACKGROUND AND OBJECTIVES: We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. METHODS: We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG)...
December 29, 2016: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28027453/pethidine-efficacy-in-achieving-the-ultrasound-guided-oblique-subcostal-transversus-abdominis-plane-block-in-laparoscopic-cholecystectomy-a-prospective-study
#10
Caius Mihai Breazu, Lidia Ciobanu, Adrian Bartos, Raluca Bodea, Petru Adrian Mircea, Daniela Ionescu
Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0...
December 27, 2016: Bosnian Journal of Basic Medical Sciences
https://www.readbyqxmd.com/read/28025374/effect-of-local-anesthetic-concentration-0-2-vs-0-1-ropivacaine-on-pulmonary-function-and-analgesia-after-ultrasound-guided-interscalene-brachial-plexus-block-a-randomized-controlled-study
#11
Andrew K Wong, Lauren Georgiades Keeney, Liting Chen, Rebekah Williams, Jiabin Liu, Nabil M Elkassabany
OBJECTIVE: This study aims to assess diaphragmatic excursion and measure pulmonary functions as measures of the degree to which the phrenic nerve is blocked after ISB with two different concentrations of ropivacaine: 0.2% and 0.1%. DESIGN: Randomized, double-blinded study. SETTING AND PATIENTS: Ambulatory surgical facility. SUBJECTS: Fifty patients undergoing shoulder arthroscopy for rotator cuff repair. METHODS: Patients were randomized to receive ultrasound-guided ISB with 20 mL of either 0...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28017174/benefit-of-general-anesthesia-monitored-by-bispectral-index-compared-with-monitoring-guided-only-by-clinical-parameters-systematic-review-and-meta-analysis
#12
Carlos Rogério Degrandi Oliveira, Wanderley Marques Bernardo, Victor Moisés Nunes
BACKGROUND: The bispectral index parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding the benefits of bispectral index monitoring. The objective of this systematic review with meta-analysis is to evaluate the clinical impact of monitoring with the bispectral index parameter. METHODS: The search for evidence in scientific information sources was conducted during December 2013 to January 2015, the following primary databases: Medline/PubMed, LILACS, Cochrane, CINAHL, Ovid, SCOPUS and TESES...
January 2017: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/28012533/a-review-of-acute-postoperative-sialadenitis-in-children
#13
Michael T Yim, Yi-Chun C Liu, Julina Ongkasuwan
OBJECTIVE: Acute postoperative sialadenitis is a previously described rare entity that has occurred following general anesthesia and has also been associated with prolonged neurosurgical procedures. We aim to better characterize this entity while performing a literature review regarding potential etiologies, diagnosis, airway management and treatment options. METHODS: A retrospective chart review was performed at a pediatric tertiary care center from 2000 to 2014...
January 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28012528/the-effect-of-iv-dexamethasone-versus-local-anesthetic-infiltration-technique-in-postoperative-nausea-and-vomiting-after-tonsillectomy-in-children-a-randomized-double-blind-clinical-trial
#14
Zoher Naja, Saleh Kanawati, Rania Al Khatib, Fouad Ziade, Zeina Z Naja, Ahmad Salah Naja, Mariam Rajab
BACKGROUND: Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain. OBJECTIVES: To compare the effect of intravenous dexamethasone versus pre-incision infiltration of local anesthesia in pediatric tonsillectomy on postoperative nausea and vomiting (PONV). The secondary objective was postoperative pain. METHODS: A randomized double-blind clinical trial was conducted at a tertiary care teaching hospital...
January 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28007589/rectovaginal-splenosis-an-unexpected-cause-of-dyspareunia-approached-by-laparoscopy
#15
Hélder Ferreira, Cristina Maciel, Alexandre Morgado, António Pereira
STUDY OBJECTIVE: To demonstrate the technique of laparoscopic approach in a rare case of rectovaginal splenosis with severe dyspareunia and dyschesia. DESIGN: A step-by-step explanation of the patient's condition, diagnosis, surgical technique, and postoperative results. SETTING: Splenosis consists of ectopic functioning splenic tissue that can be located anywhere within the abdomen or pelvis. Fragments are often multiple and range in diameter from a few millimeters to a few centimeters...
December 19, 2016: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28007227/the-perioperative-surgical-home-model-facilitates-change-implementation-in-anesthetic-technique-within-a-clinical-pathway-for-total-knee-arthroplasty
#16
Seshadri C Mudumbai, Tessa L Walters, Steven K Howard, T Edward Kim, Gregory Milo Lochbaum, Stavros G Memtsoudis, Zeev N Kain, Alex Kou, Robert King, Edward R Mariano
BACKGROUND: The challenge of knowledge translation in medical settings is well known, and implementing change in clinical practice can take years. For the increasing number total knee arthroplasty (TKA) patients annually, there is ample evidence to endorse neuraxial anesthesia over general anesthesia. The rate of adoption of this practice, however, is slow at the current time. We hypothesized that a Perioperative Surgical Home (PSH) model facilitates rapid change implementation in anesthesia...
December 2016: Healthcare
https://www.readbyqxmd.com/read/27990189/effects-of-modification-of-pain-protocol-on-incidence-of-post-operative-nausea-and-vomiting
#17
Ran Schwarzkopf, Nimrod Snir, Zachary T Sharfman, Joseph B Rinehart, Michael-David Calderon, Esther Bahn, Brian Harrington, Kyle Ahn
BACKGROUND: A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol...
2016: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/27989078/intravenous-recombinant-tissue-plasminogen-activator-therapy-for-acute-basilar-artery-ischemic-stroke-following-transfemoral-transcatheter-aortic-valve-implantation
#18
Nicholas J Montarello, Adam J Nelson, Samuel L Sidharta, Stephen G Worthley
Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing, and every effort must be made to improve patient outcome should stroke occur...
January 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/27965560/ketamine-50-years-of-modulating-the-mind
#19
REVIEW
Linda Li, Phillip E Vlisides
Ketamine was introduced into clinical practice in the 1960s and continues to be both clinically useful and scientifically fascinating. With considerably diverse molecular targets and neurophysiological properties, ketamine's effects on the central nervous system remain incompletely understood. Investigators have leveraged the unique characteristics of ketamine to explore the invariant, fundamental mechanisms of anesthetic action. Emerging evidence indicates that ketamine-mediated anesthesia may occur via disruption of corticocortical information transfer in a frontal-to-parietal ("top down") distribution...
2016: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/27924205/risperidone-in-a-child-with-untractable-emergency-delirium-a-case-report
#20
Young Hee Shin, Seung Hyeon Lee, Dae Yoon Kim
A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him...
December 2016: Korean Journal of Anesthesiology
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