Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Dec 2011
ReviewManagement of postdischarge nausea and vomiting after ambulatory surgery.
Although there are extensive studies of postoperative and postdischarge nausea and vomiting (PONV/PDNV) up to 24 h, few investigate 'delayed PDNV'. With an increasing outpatient surgical population, specific 'delayed PDNV' risk identification and management is necessary for improving outcomes and helping patients after discharge. This review will discuss possible PDNV specific risk factors, successful prevention and management of PDNV following ambulatory anesthesia and the principles and pharmacology of these interventions. ⋯ Further PDNV specific research is needed, including PDNV predictive models in directing antiemetic interventions. Long-acting antiemetics and postdischarge oral antiemetics are effective in PDNV pharmacologic management. Neurokinin-1 receptor antagonists are effective in reducing the incidence of vomiting, but not nausea. The addition of nonpharmacologic interventions such as acustimulation may reduce PDNV. Multimodal analgesia including nonopioid analgesics and ambulatory continuous peripheral nerve blocks are encouraged to achieve adequate postoperative analgesia and reduce opioid induced PDNV.
-
Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range from 10-70% after surgery. Postoperative delirium was found to be associated with persisting cognitive deficits, increased physical dependence and institutionalization, and increased mortality. It is a condition particularly relevant to patients with increasing age. ⋯ Delirium may have an impact on patients' outcomes beyond their stay in hospital, depending on preoperative comorbidities. Delirium can be devastating for activity of daily living, cognitive performance and survival. Predisposing factors should be recognized preoperatively; precipitating factors such as preoperative fasting, deep sedation and choice of psychotropic drugs, including sedatives, should be reconsidered. Regular structured delirium screening is the precondition for early detection and treatment. Treatment options include cognitive training programmes, anti-inflammatory measures and antipsychotic drugs.
-
Curr Opin Anaesthesiol · Dec 2011
ReviewAssessing recovery after ambulatory anaesthesia, measures of resumption of activities of daily living.
There are several aspects that should be considered when measuring the outcome of ambulatory anaesthesia. Major complications and admission/readmission rate are classical measures. Fast-track eligible, pain, and postoperative nausea and vomiting during the early recovery and time to discharge are commonly reported. There is, however, an increasing interest in quality of recovery in a more protracted perspective taking various aspects of resumption of activities of daily living into account. The aim of the present review is to provide an update around postoperative quality of recovery assessment tools. Resumption of activities of daily living or defined functional capacities back at baseline are measures that provide further insight to the quality of recovery. ⋯ The quality of recovery in a more protracted perspective, resumption of activity of daily living is a measure that needs to be considered in studies of perioperative interventions in ambulatory anaesthesia.