Journal of clinical anesthesia
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Postoperative nausea and vomiting (PONV) is one of the common complications in patients who have undergone surgery with general anesthesia. The association of intraoperative use of remifentanil with PONV has remained controversial. The aim of the current study was to determine the association of dose of intraoperative remifentanil administration with incidence of PONV. ⋯ This retrospective observational study revealed a dose-dependent association between dose of intraoperative remifentanil administration and increase in the risk of PONV. Time-weighted average of remifentanil greater than 0.2 μg/kg per minute was independently associated with risk of PONV.
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To determine perioperative treatments and events associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) responses among patients who undergo total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). ⋯ These data suggest that chronic use of nonsteroidal anti-inflammatory drugs is associated with improved overall satisfaction and satisfaction with pain in THA patients. Furthermore, increased PACU opioid use was negatively associated satisfaction with pain management. Age, lengths of stay preadmission medications, anxiolytic medications, and PACU pain scores are associated with patient satisfaction with regards to both pain management and overall satisfaction in TKA patients.
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Observational Study
An in vitro evaluation of the pressure generated during programmed intermittent epidural bolus injection at varying infusion delivery speeds.
Programmed intermittent bolus injection of epidural anesthetic solution results in decreased anesthetic consumption and better patient satisfaction compared with continuous infusion, presumably by better spread of the anesthetic solution in the epidural space. It is not known whether the delivery speed of the bolus injection influences analgesia outcomes. The objective of this in vitro study was to determine the pressure generated by a programmed intermittent bolus pump at 4 infusion delivery speeds through open-ended, single-orifice and closed-end, multiorifice epidural catheters. ⋯ Using a pump designed for programmed intermittent infusion boluses, the delivery speed of saline solution through epidural catheters was directly related to the peak pressures. Future work should evaluate whether differences in the delivery speed of anesthetic solution into the epidural space correlate with differences in the duration and quality of analgesia during programmed intermittent epidural bolus delivery.
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Case Reports
Successful recovery after amniotic fluid embolism in a patient undergoing vacuum-assisted vaginal delivery.
Amniotic fluid embolism (AFE) is a rare, catastrophic emergency that requires prompt recognition and treatment. Despite early recognition and supportive therapy, the morbidity and mortality remain high. We report a case of AFE after vacuum-assisted vaginal delivery resulting in hemodynamic collapse and subsequent multiorgan failure. ⋯ The patient was able to make a full recovery with minimal sequelae. In AFE with multiorgan failure, extracorporeal membrane oxygenation and continuous veno-venous hemodialysis can be valuable therapies. Proper management requires effective communication and the combined efforts of physicians of several disciplines.
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Letter Case Reports
Emergency surgery for RhD-negative patients in the Asia region.