Articles: postoperative.
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Anesthesia and analgesia · Jan 2015
Randomized Controlled Trial Comparative StudyNicardipine Is Superior to Esmolol for the Management of Postcraniotomy Emergence Hypertension: A Randomized Open-Label Study.
Emergence hypertension after craniotomy is a well-documented phenomenon for which natural history is poorly understood. Most clinicians attribute this phenomenon to an acute and transient increase in catecholamine release, but other mechanisms such as neurogenic hypertension or activation of the renin-angiotensin-aldosterone system have also been proposed. In this open-label study, we compared the monotherapeutic antihypertensive efficacy of the 2 most titratable drugs used to treat postcraniotomy emergence hypertension: nicardipine and esmolol. We also investigated the effect of preoperative hypertension on postcraniotomy hypertension and the natural history of postcraniotomy hypertension in the early postoperative period. ⋯ Nicardipine is superior to esmolol for the treatment of postcraniotomy emergence hypertension. This type of hypertension is thought to be a transient phenomenon not solely related to sympathetic activation and catecholamine surge but also possibly encompassing other physiologic factors. For treating postcraniotomy emergence hypertension, nicardipine is a relatively effective sole drug, whereas if esmolol is used, rescue antihypertensive medications should be readily available.
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Randomized Controlled Trial Multicenter Study
Effects of two different anesthesia-analgesia methods on incidence of postoperative delirium in elderly patients undergoing major thoracic and abdominal surgery: study rationale and protocol for a multicenter randomized controlled trial.
Delirium is a common complication in elderly patients after surgery and associated with increased morbidity and mortality. Studies suggest that deep anesthesia and intense pain are important precipitating factors of postoperative delirium. Neuraxial block is frequently used in combination with general anesthesia for patients undergoing major thoracic and abdominal surgery. Compared with general anesthesia alone and postoperative intravenous analgesia, combined epidural-general anesthesia and postoperative epidural analgesia decreases the requirement of general anesthetics during surgery and provided better pain relief after surgery. However, whether combined epidural-general anesthesia plus epidural analgesia is superior to general anesthesia plus intravenous analgesia in decreasing the incidence of postoperative delirium remains unknown. ⋯ Results of the present study will provide information to guide clinical practice in choosing appropriate anesthesia-analgesia method for elderly patients undergoing major thoracic and abdominal surgery.
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JBI Database System Rev Implement Rep · Jan 2015
ReviewThe effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol.
The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings. ⋯ Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education. While Johansson et al. included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013.Kruzik also reported benefits of decreased length of stay, reduced pain medication requested post-operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.Types of education involved in this systematic review are patient education, pre-operative education, and discharge education. Only one study discussed discharge education and the outcome from this review. The outcomes that have been discussed in this systematic review include length of stay, satisfaction, pain level,, 21 cost of care, functional abilities, knowledge, anxiety, and quality of life.Major outcomes discussed in these studies are length of stay, pain,, 21 functional abilities, and anxiety. Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement. A study on spinal surgery patients and the effects of pre-operative education, which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain.This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.
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Randomized Controlled Trial
Effect of scalp blocks with levobupivacaine on recovery profiles after craniotomy for aneurysm clipping: a randomized, double-blind, and controlled study.
This study was conducted to evaluate the effect of scalp blocks using levobupivacaine on recovery profiles including postoperative pain, patient-controlled analgesia (PCA) consumption, postoperative nausea and vomiting (PONV), and other adverse events in patients undergoing frontoparietal craniotomy for aneurysm clipping. ⋯ Scalp blocks with 0.75% levobupivacaine improved recovery profiles in that it effectively lowered postoperative pain and PCA consumption without severe adverse events and also reduced the requirement for a postoperative antihypertensive agent and the incidence of PONV in patients who underwent frontoparietal craniotomy for aneurysm clipping.
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J Anaesthesiol Clin Pharmacol · Jan 2015
Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study.
Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery. ⋯ POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.