Articles: postoperative.
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Observational Study
Effects of Neostigmine Reversal of Nondepolarizing Neuromuscular Blocking Agents on Postoperative Respiratory Outcomes: A Prospective Study.
We tested the hypothesis that neostigmine reversal of neuromuscular blockade reduced the incidence of signs and symptoms of postoperative respiratory failure. ⋯ Neostigmine reversal did not affect oxygenation but was associated with increased atelectasis. High-dose neostigmine or unwarranted use of neostigmine may translate to increased postoperative respiratory morbidity.
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Whether carotid artery stenosis predicts stroke after noncardiac surgery remains unknown. We therefore tested the primary hypothesis that degree of carotid artery stenosis is associated with in-hospital stroke or 30-day all-cause mortality after noncardiac surgery. As carotid artery stenosis is also a marker for cardiovascular disease, our secondary hypothesis was that degree of carotid artery stenosis is associated with postoperative myocardial injury. ⋯ This cohort represents a high-risk population, as carotid duplex examinations were likely prompted by neurological symptoms. There was nonetheless no association between carotid artery stenosis and perioperative stroke or 30-day mortality after noncardiac surgery.
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialThe addition of tramadol to the standard of IV acetaminophen and morphine infusion for postoperative analgesia in neonates offers no clinical benefit: a randomized placebo-controlled trial.
Tramadol is used following neonatal cardiac and general surgery. However, its ability to opioid-spare or facilitate earlier extubation in postoperative neonates is unquantified. ⋯ Tramadol's addition to standard analgesia in this small group of postsurgical neonates did not appear to have any positive effect on time to extubation, morphine or midazolam exposure, or pain scores. This questions the benefit of tramadol for postsurgical neonates. Importantly, no seizures occurred in these ill neonates who may potentially be at greater risk of tramadol toxicity compared with adults.
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Regional anesthesia is associated with recognized physiological advantages; however trials evaluating its impact on postoperative outcomes have shown contrasting results, probably because these effects have not been utilized in a multimodal perioperative care program. Enhanced recovery has attracted clinical interest because of its standardized, coordinated, multidisciplinary perioperative care plan that incorporates several evidenced-based interventions with positive influence on postoperative patient recovery. ⋯ Clearly, there are synergistic benefits derived from integrating specific regional anesthetic and analgesic techniques with other perioperative elements characteristic of a particular surgical procedure. This challenge requires a team approach in delivering such integrated care, ultimately providing the best cure for patient.
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The aim of this study was to clarify the roles of calcitonin gene-related peptide (CGRP) in postoperative pain and inflammatory pain. ⋯ These results suggest that contribution of the αCGRP system depends on the modality of pain and the stage of inflammation.