Articles: postoperative.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2014
Review[Nausea and vomiting after anaesthesia for children - Big problems for little patients].
Postoperative nausea and vomiting are undesirable and unpleasant side effects after surgery and anaesthesia associated with delayed oral intake and postoperative recovery, and impaired parental satisfaction. Since current modalities against PONV are cheap, highly effective, and almost free from relevant side-effects - providing contraindications are appropriately considered -, recommendations tend to move away from risk-score guided administration of antiemetic towards a more liberal administration policy or even favour routine administration to children undergoing general anaesthesia for surgery combined with total-intrevanous anaesthesia using propfol and reduction of perioperative opioid administration.
-
To review left ventricular assist device physiology, initial postoperative management, common complications, trouble shooting and management of hypotension, and other common ICU problems. ⋯ Intensivists are increasingly likely to encounter patients requiring mechanical circulatory support with left ventricular assist devices at various points in the trajectory of their disease, from the immediate postimplant period to subsequent admissions for complications, and at end of life. A basic understanding of left ventricular assist device physiology is essential to the safe and effective care of these patients.
-
Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialParecoxib and paracetamol for pain relief following minor day-stay gynaecological surgery.
Paracetamol and non-steroidal anti-inflammatory drugs are often administered for postoperative analgesia. Dilatation and curettage, with or without hysteroscopy, is a common day-stay procedure that is associated with pain that is partly mediated by prostaglandins. This study aimed to investigate the analgesic efficacy of adjunctive paracetamol and parecoxib in this setting. ⋯ There were no significant differences in patient satisfaction or recovery. We conclude that paracetamol or parecoxib does not produce a clinically important reduction in pain in this setting. Women having uterine curettage and receiving intravenous fentanyl do not appear to benefit from administration of these non-opioid analgesics.
-
Reg Anesth Pain Med · Jan 2014
Are Patients Satisfied After Peripheral Nerve Blockade? Results From an International Registry of Regional Anesthesia.
Peripheral nerve blockade (PNB) is associated with superior outcomes compared with opioids; however, little is known regarding patients' perceptions of the care they have received. Patient satisfaction is emerging as an important indicator of quality of health care, and identifying deficiencies in discrete aspects of satisfaction may allow targeted interventions to improve quality. In this study, we analyze data relevant to patient satisfaction from the International Registry of Regional Anesthesia. The primary objective of this analysis was to report the results of a patient-satisfaction questionnaire and to determine predictors associated with unwillingness to have PNB repeated in the case of future surgery. ⋯ A high proportion of survey respondents were willing to undergo repeat PNB in case of future surgery and were satisfied with their anesthetic care. Targeted interventions to improve quality of PNB should be aimed at improving comfort, information provision, and physician-patient interaction.
-
National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients.