Articles: operative.
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Observational Study
Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting.
Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes. ⋯ PONV medication administration compliance modestly improves with CDS in conjunction with post-hoc reporting; however, no improvement in PACU rates of PONV occurred.
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Anesthesia and analgesia · Jun 2023
Tracheostomy, Feeding-Tube, and In-Hospital Postoperative Mortality in Children: A Retrospective Cohort Study.
Neuromuscular/neurologic disease confers increased risk of perioperative mortality in children. Some patients require tracheostomy and/or feeding tubes to ameliorate upper airway obstruction or respiratory failure and reduce aspiration risk. Empiric differences between patients with and without these devices and their association with postoperative mortality have not been previously assessed. ⋯ Patients requiring tracheostomy, feeding tube, or both are generally sicker than patients without these devices. Despite this, having a feeding tube was associated with lower 3-day mortality overall and lower 30-day mortality when the data were stratified by the number of CCCs. Having both devices was associated with lower 3-day mortality in patients presenting for low-risk surgery, and surgery during urgent or emergent hospitalizations.
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Successful anesthetics occur when safe, effective perioperative care is coupled with patient satisfaction. We present the case of a 63-year-old woman with advanced Parkinson's disease who presented for a deep brain stimulation (DBS) device battery change under monitored anesthesia care (MAC). While MAC is commonly utilized for a DBS battery change, our patient reported previously experiencing intraoperative pain, anxiety, and the inability to communicate discomfort under MAC, leading to posttraumatic stress disorder. This case report highlights the importance of preoperative informed consent, discussion of patient expectations, and proactive planning for intraoperative communication strategies when MAC is the chosen method.
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Pulmonary injury can occur during liver transplantation in patients with prior liver surgery, infection, or hepatocellular carcinoma treatments. Compromise of gas exchange during liver transplantation mandates rapid, multidisciplinary decision-making. ⋯ Since oxygenation and pH were stable, we proceeded with liver transplantation to minimize graft ischemic time, followed by thoracic repair. The postoperative course was notable for adequate early liver function and discharge after prolonged postoperative ventilation and tube thoracostomy drainage.