Articles: postoperative.
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Qatar medical journal · Jan 2012
Survey and management of anaesthesia related complications in PACU.
It is the first prospective study about anaesthesia related postoperative complications conducted in Hamad General Hospital. Total 1128 adult patients admitted to the Post Anaesthesia Care Unit (PACU) during a period of three months were surveyed for anaesthesia related complications. Documented complications were found in 48 patients i.e. 4.25% of patients' population. ⋯ Most of the complications happened to healthy ASA I and II patients. Factors that play major role in determining the immediate postoperative complications were the ASA status, the level of anaesthesia seniority attending the patient, the urgency and the nature of procedure. We tried to find other factors that may influence complications in addition, discussed below.
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The aim of this study was to determine the incidence of early postoperative hypoxia after general anesthesia and to evaluate the need of oxygen supplementation. A total of 150 patients aged between 18-60 years belonging to ASA I or II were studied. Patients were alternately allocated to two groups of 75 each. ⋯ Group-II (n=75) patients did not receive oxygen either during transfer or in the recovery room. Twenty percent in Group-II developed hypoxaemia during transfer from operation theatre to recovery room out of which 24% developed mild (SaO2 86-90%), 2.66% moderate (SaO2 85-81%), and 1.33% extreme (SaO2 <76%) hypoxaemia. None of the patients in Group - I, who received oxygen supplementation, developed hypoxaemia in the early postoperative period.
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Interscalene block (ISB) is commonly performed using 20-40 mL of local anesthetic. Spread to adjacent structures and consequent adverse effects including paralysis of the ipsilateral hemidiaphragm are frequent. Pain ratings, analgesic requirements, adverse events, satisfaction, function and diaphragmatic excursion were compared following interscalene block (ISB) with reduced initial bolus volumes. ⋯ ISB provided reliable surgical analgesia with 5 mL, 10 mL or 20 mL ropivacaine (0.75%). The 20 mL volume was associated with increased complaints of dyspnea. The 5 mL volume was associated with statistically higher pain scores in the immediate postoperative period. Lower volumes resulted in a reduced incidence of dyspnea compared to 20 mL, however diaphragmatic impairment was not eliminated. Compensatory increases in contralateral diaphragmatic movement may explain tolerance for ipsilateral paresis.
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The i-gel™, LMA-Supreme (LMA-S) and Laryngeal Tube Suction-D (LTS-D) are single-use supraglottic airway devices with an inbuilt drainage channel. We compared them with regard to their position in situ as well as to clinical performance data during elective surgery. ⋯ All devices were suitable for ventilating the patients' lungs during elective surgery.
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The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. Most of the studies in adults have demonstrated the positive effects of clonidine on intra- and postoperative analgesia when used as an adjunctive agent or in some cases as a single to regional techniques. In the pediatric population, there are only few trials involving clonidine as an adjunct to regional anesthesia, and the analgesic benefits are not definite in this group of patients. The evidence concerning perineural administration of clonidine is so far inconclusive in children, as different types and volume of local anesthetic agents have been used in these studies. Moreover, the efficacy of regional anesthesia is largely affected by the operator's technique, accuracy and severity of operation. ⋯ Clonidine appears promising more as an adjuvant in 0.2% ropivacaine and less than alone in the SLPB plus femoral block in children undergoing mild to moderate painful foot surgery, with no side effects.