Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 2019
Randomized Controlled TrialHigh-Flow Nasal Oxygen Improves Safe Apnea Time in Morbidly Obese Patients Undergoing General Anesthesia: A Randomized Controlled Trial.
Morbidly obese patients undergoing general anesthesia are at risk of hypoxemia during anesthesia induction. High-flow nasal oxygenation use during anesthesia induction prolongs safe apnea time in nonobese surgical patients. The primary objective of our study was to compare safe apnea time, between patients given high-flow nasal oxygenation or conventional facemask oxygenation during anesthesia induction, in morbidly obese surgical patients. ⋯ High-flow nasal oxygenation, compared to conventional oxygenation, provided a longer safe apnea time by 76 seconds (40%) and higher minimum SpO2 in morbidly obese patients during anesthesia induction. High-flow oxygenation use should be considered in morbidly obese surgical patients.
-
Anesthesia and analgesia · Oct 2019
Development and Validation of an Electronic Postoperative Morbidity Score.
Electronic health records are being adopted due to numerous potential benefits. This requires the development of objective metrics to characterize morbidity, comparable to studies performed in centers without an electronic health record. We outline the development of an electronic version of the postoperative morbidity score for integration into our electronic health record. ⋯ We present a variant of postoperative morbidity score based on objective electronic metrics. Discriminative performance appeared comparable to gold-standard definitions for discharge outcomes. Electronic postoperative morbidity score may allow characterization of morbidity within our electronic health record, but further study is required to assess external validity.
-
Anesthesia and analgesia · Oct 2019
Meta AnalysisSide Effect Rates of Opioids in Equianalgesic Doses Via Intravenous Patient-Controlled Analgesia: A Systematic Review and Network Meta-analysis.
Why is this important?
Despite growth of regional and non-opioid analgesic options, opioids remain the mainstain of peri-operative management of moderate to severe pain. IV patient-controlled analgesia (PCA) is a safe, common and reliable delivery mechanism.
What did they do?
Dinges et al. performed a network meta-analysis of 63 studies covering 16 different PCA opioids, comparing side-effects at equianalgesic doses. Morphine was used as the baseline comparator.
And they found?
Although there were some small difference in the incidence of nausea & vomiting (fentanyl having lowest N&V risk, buprenorphine highest) and pruritus (nalbuphine, butorphanol, methadone, and pethidine/meperidine resulting in least pruritis), there were significant differences for sedation and satisfaction.
Pethidine/meperidine, fentanyl & oxymorphone showed the lowest sedation scores, although respiratory depression events were too infrequent to show differences. Oxycodone, alfentanil, remifentanil, fentanyl & pethidine/meperidine resulted in the highest patient satisfaction and tramadol was the least satisfying.
Take-home message
Although some PCA-opioids perform better than others in small ways, overall side-effect profiled are very similar and comparably safe. Oxycodone, alfentanil and remifentanil however result in significantly higher patient satisfaction.
The big picture...
Rather than focusing on the small differences among opioids, there is almost certainly more to be gained by a disciplined, multi-modal analgesic focus that reduces opioid use and thus side-effects.
summary -
Anesthesia and analgesia · Oct 2019
Comparative StudyRates of Mechanical Ventilation for Patients With Dementia in Ontario: A Population-Based Cohort Study.
The number of elderly patients with dementia receiving invasive mechanical ventilation is increasing over time in the United States, while the balance of potential benefits and harms of intensive care interventions in this population is unclear. In this report, we describe trends in use of invasive mechanical ventilation in elderly individuals with and without dementia in Ontario, Canada, and provide projections of the use of invasive mechanical ventilation through 2025. We show that rates of invasive mechanical ventilation for elderly patients with dementia are increasing faster than for the rest of the elderly (nondementia) population.
-
Anesthesia and analgesia · Oct 2019
Real-Time Measurement of Xenon Concentration in a Binary Gas Mixture Using a Modified Ultrasonic Time-of-Flight Anesthesia Gas Flowmeter: A Technical Feasibility Study.
Xenon (Xe) is an anesthetic gas licensed for use in some countries. Fractional concentrations (%) of gases in a Xe:oxygen (O2) mixture are typically measured using a thermal conductivity meter and fuel cell, respectively. Speed of sound in such a binary gas mixture is related to fractional concentration, temperature, pressure, and molar masses of the component gases. We therefore performed a study to assess the feasibility of developing a novel single sterilizable device that uses ultrasound time-of-flight to measure both real-time flowmetry and fractional gas concentration of Xe in O2. ⋯ The adapted ultrasonic flowmeter estimated Xe (%), but the level of accuracy is insufficient for clinical use. With further work, it may be possible to develop a device to perform both flowmetry and binary gas concentration measurement to a clinically acceptable degree of accuracy.