Articles: postoperative.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2014
Review[Anaesthesiological management of patients with dementia].
The aging society challenges anaesthesiologists with a growing number of patients with dementia. These and their relatives worry about an aggravation of an already existing dementia or even the postoperative evocation of one. Common volatile anaesthetics and propofol are suspected to increase dementia - associated protein tau and amyloid-betalevels in the brain. ⋯ In dementia, perioperative malfunction of cognition, memory, attention, information processing, communication and social interaction abilities is of profound influence on the perioperative management. This review mentions actual knowledge about dementia forms and symptoms in brief. Recommendations for the anaesthesia care are given in more detail.
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The aim of this study was to characterize patients readmitted following inpatient general surgery procedures. We hypothesized that a decreased length of stay would increase risk for readmission. ⋯ Contributors to postoperative readmissions are multifactorial. Perioperative factors predict risk for readmission and may help determine a target length of stay. Prevention of postoperative complications may reduce readmission rates.
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Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown. ⋯ Given the infrequent side effects, this single, low dose of perphenazine should be encouraged as a low-risk adjunct to any multimodal PONV prophylaxis regimen, based on the selection criteria described.
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This article reports a case of massive postoperative pneumocephalus in a patient following general anesthesia for a urological procedure. The patient had sustained a severe head injury more than 10 years ago with long-term treatment in an intensive care unit (ICU) including decompressive craniectomy, tracheostomy followed by rehabilitation, decanulation and cranioplasty. The patient recovered but suffered severe hemiparesis and mild neurocognitive deficits. ⋯ A cranial computed tomography (CT) scan revealed massive intracranial air and frontobasal skull defects. After frontobasal reconstruction, removal of an old lumboperitonal shunt and placement of a ventriculoperitoneal shunt, intracranial air was no longer observed. In summary a frontobasal injury may become symptomatic many years after injury, especially when face mask ventilation with positive pressure is applied during surgical interventions.
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J Anaesthesiol Clin Pharmacol · Apr 2014
Low dose intrathecal clonidine and fentanyl added to hyperbaric bupivacaine prolongs analgesia in gynecological surgery.
We undertook this study to ascertain if a small dose of clonidine (30 μg) when added to a bupivacaine-fentanyl mixture improves spinal analgesia, without producing side effects, as compared to a bupivacaine-fentanyl or a bupivacaine-clonidine mixture. ⋯ Low-dose clonidine (30 μg) when added to a bupivacaine-fentanyl mixture increased the duration of effective analgesia and the duration of sensory and motor block in gynecological surgery. The incidence of intraoperative pain and requirement of postoperative analgesics was significantly less when clonidine was added to intrathecal bupivacaine with or without fentanyl.