Articles: postoperative.
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The transversus abdominis plane block has become popular since it has been combined with ultrasound-guided techniques. In abdominal surgery, and especially in subumbilical surgery, it improves postoperative analgesia and reduces morphine consumption. Although it has been shown to be an effective technique, there are wide variations in reported doses and volumes of local anaesthetic used. ⋯ The ED50 of ropivacaine in TAP blocks in reversal of ileostomy is close to the toxic threshold. Anaesthesiologists should always be aware of the systemic toxicity risk and use weight-based doses when performing a TAP block.
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Review Meta Analysis
A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade.
We systematically reviewed peripheral nerve blockade guided by ultrasound versus electrical stimulation. We included 26 comparisons in 23 randomised controlled trials of 2125 participants. Ultrasound reduced the rate of pain during the procedure, relative risk (95% CI) 0.60 (0.41-0.89), p = 0.01. ⋯ The rate of rescue was unaffected by the addition of electrical stimulation to ultrasound, relative risk (95% CI) 1.07 (0.54-2.10), p = 0.85. Ultrasound, with or without electrical stimulation, reduced the pooled rate of vascular puncture, relative risk (95% CI) 0.23 (0.15-0.37), p < 0.0001. There was no difference in the rate of postoperative neurological side-effects, relative risk (95% CI) 0.76 (0.53-1.09), p = 0.13.
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To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours. ⋯ Epidural 1% chloroprocaine, in doses of 0.4-3 mL/h (1.5-6.1 mg/kg per hour), was well tolerated in both mechanically ventilated and spontaneously breathing infants for up to 96 hours with no identified adverse effects or tachyphylaxis.
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Pediatr Crit Care Me · Sep 2015
Randomized Controlled TrialPostoperative Hydrocortisone Infusion Reduces the Prevalence of Low Cardiac Output Syndrome After Neonatal Cardiopulmonary Bypass.
Neonatal cardiac surgery with cardiopulmonary bypass is often complicated by morbidity associated with inflammation and low cardiac output syndrome. Hydrocortisone "stress dosing" is reported to provide hemodynamic benefits in some patients with refractory shock. Development of cardiopulmonary bypass-induced adrenal insufficiency may provide further rationale for postoperative hydrocortisone administration. We sought to determine whether prophylactic, postoperative hydrocortisone infusion could decrease prevalence of low cardiac output syndrome after neonatal cardiac surgery with cardiopulmonary bypass. ⋯ Prophylactic, postoperative hydrocortisone reduces low cardiac output syndrome, improves fluid balance and urine output, and attenuates inflammation after neonatal cardiopulmonary bypass surgery. Further studies are necessary to show if these benefits lead to improvements in more important clinical outcomes.
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Reg Anesth Pain Med · Sep 2015
ReviewRegional Anesthesia in Patients With Preexisting Neurologic Disease.
Since publication of initial recommendations in 2008, there is limited new information regarding the performance of regional anesthesia in patients with preexisting neurologic diseases. However, the strength of evidence has increased since 2008 regarding (1) the concern that diabetic nerves are more sensitive to local anesthetics and perhaps more susceptible to injury and (2) the concern that performing neuraxial anesthesia and analgesia in patients with preexisting spinal canal pathology may increase the risk of new or worsening neurologic symptoms. This increased evidence reinforces our initial recommendations. In addition, since the initial recommendations in 2008, the concept of postsurgical inflammatory neuropathy has been described and is potentially a contributor to postoperative neurologic dysfunction.