AANA journal
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Perioperative beta blockade has been proven to significantly reduce the incidence of myocardial ischemia and myocardial infarction and of long-term overall mortality related to cardiac events after various surgeries in patients at intermediate or high risk for such events. The major physiologic effects of beta blockers result in a positive balance of myocardial oxygen supply and demand. Although the optimal time frame for initiation of treatment is not clear from the available data, it has been shown that beta blocker therapy is effective when started at least 1 week before the scheduled surgery and continued throughout the postoperative period. The current recommendations for perioperative beta blockade for patients at intermediate and high risk for a perioperative cardiac event are to use a beta1 blocking agent, begin therapy several weeks before a planned operation, titrate the dose to achieve a heart rate of 60 to 70 beats per minute, and taper the dose of the beta blocker after the postoperative period.
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Randomized Controlled Trial
The effect of transdermal scopolamine on the incidence and severity of postoperative nausea and vomiting in a group of high-risk patients given prophylactic intravenous ondansetron.
Specific risk factors place patients at greater risk for postoperative nausea and vomiting (PONV). Routinely, these patients are treated prophylactically with intravenous (IV) ondansetron or transdermal (TD) scopolamine. No study has examined what effect using a combination of these prophylactic treatments would have on the incidence of PONV in a group of high-risk patients. ⋯ No difference in demographics or the incidence of side effects was noted between groups. Patients in the scopolamine group had a lower incidence of PONV (P = .043), longer time to first reported nausea (P = .044), longer time to first episode of emesis (P = .031), and decreased supplemental antiemetic requirements (P = .016) compared with the placebo group. Based on this study, we recommend using a combination of TD scopolamine and IV ondansetron to prevent PONV in patients identified as high risk for PONV.
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The purpose of this article is to describe the benefits of using the Universal Oxygen Connector. Until now, an oxygen hose was only able to connect to a 22-mm fitting, such as those found on humidifiers used in the recovery room, and oxygen tubing was only able to connect to a Christmas tree type adapter. The Universal Oxygen Connector, manufactured and sold by International Medical, Inc (Burnsville, Minn), was developed to allow the practitioner to attach either a 22-mm oxygen hose, oxygen tubing, or a 15-mm oxygen adapter to the same connector. ⋯ As such, oxygen should be administered during transport from the operating room to the recovery room, in the recovery room, and at times during transport to the patient room and in the patient room. Oxygen also should be administered whenever a patient receiving oxygen is transported. Use of the Universal Oxygen Connector decreases material waste, decreases hospital costs, saves time and effort and, most importantly, promotes patient safety by providing a versatile system for oxygen delivery.
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Review Case Reports
Off-pump coronary artery bypass grafting: a case report.
It is easy to take for granted the seemingly effortless way cardiovascular surgeons are able to bypass atherosclerotic coronary arteries. The process used today was developed over many years of rigorous study, experimentation, success, and failure. Early cardiac surgery was performed blindly, through small incisions, on a beating heart. ⋯ A case report of a 72-year-old female who underwent OPCAB is outlined. Included is a discussion of some of the benefits and potential complications of CABG and OPCAB. Anesthetic considerations for OPCAB procedures also are presented.
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Replacing an existing endotracheal (ET) tube with a tracheostomy tube can be a challenging and high-risk procedure for the patient, surgeon, anesthetist, and operating room staff. This article describes an approach designed to reduce the risks involved and, at the same time, provide a safe, efficient, and simplified approach to surgically securing the airway. ⋯ This approach has been used extensively at an academic medical center's operating room without reports of outcome failure or complications. A review of the literature revealed occasional, unreferenced mention of "advancing the tube forward," but the current report is the first detailed description of the procedure to appear in the literature.