Anesthesiology clinics
-
Pain management in the postanesthesia care unit (PACU) is continually evolving, with several new nonopioids expanding the list of available agents. Pain in the PACU is not an inevitable outcome of surgery. ⋯ Accurate assessment of the characteristics of pain will direct rational drug choices while minimizing side effects. Better management of pain in the PACU setting will likely improve patient satisfaction and facilitate shorter PACU stays.
-
Anesthesiology clinics · Sep 2012
Review Case ReportsInterdisciplinary rounds in the postanesthesia care unit: a new perioperative paradigm.
Patients in the perioperative and postanesthesia care unit (PACU) experience several transitions in patient care at the same time that the majority of major morbidities will arise. The transitions for these patients are at the critical juncture between surgery and a steady sustained recovery. Historically these important medical problems have been addressed as a nonformalized process. The authors have introduced a formalized process, based on interdisciplinary rounding strategies used in intensive care units, to attend patients and address problems.
-
General anesthesia and surgery are associated with changes in the shape of the chest that result in atelectasis, a major factor in the development of postoperative respiratory failure. Postoperative noninvasive positive pressure ventilation (NIPPV) has been shown to improve oxygenation and ventilation for high-risk patients. NIPPV has been used as rescue therapy for patients developing acute respiratory distress postoperatively, and appears to be most frequently successful in patients whose problem is atelectasis or obesity. Failure to respond to NIPPV after 20 minutes is usually an indication of intubation, mechanical ventilation, and transfer to the intensive care unit.
-
Perioperative hyperglycemia has potential significant adverse consequences of increased mortality and morbidity including surgical site infection, renal insufficiency and anemia requiring transfusion. Both diabetic and non-diabetic patients are affected adversely by perioperative hyperglycemia. ⋯ Moreover, ideal target glucose range as well as the appropriate patient population(s) for whom glycemic control offers the most benefit have yet to be fully elucidated. However, there are clear potential adverse consequences of tight control such as hypoglycemia.