Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 7 Articles
Objective: The objective is to investigate the incidence and consequences of arterial line occlusion\nduring invasive blood pressure monitoring in the form of questionnaire survey. Methods: The\nquestionnaires were randomly distributed to the anesthesiologists who participated the 22nd annual\nmeeting of Chinese society of anesthesiology. The main contents of this survey included the\narterial line managing status, the incidence of arterial line occlusion, the effects of arterial line occlusion\non the anesthesiologistsâ�� therapy and consequences caused by arterial line occlusion. Results:\nTotally 294 questionnaires were collected, in which 261 questionnaires were valid. In all\nrespondents, 28.3% expressed that they could not flush arterial line on time, and 95.4% had experienced\nflushing arterial line only or sometimes or occasionally when the arterial waveform was\nnot normal. Furthermore, 93.9% had experienced partial occlusion of the arterial line, and 79.3%\nhad experienced complete occlusion. According to the serious recall of the respondents, the incidence\nof partial arterial line occlusion was 17.7% �± 22.0%, and the incidence of complete arterial\nline occlusion was 3.6% �± 8.1%. For all the respondents, 89.7% had experienced suspecting arterial\nline occlusion while real hypotension occurred, 65.1% had experienced not treating hypotension\ntimely due to this suspicion, and 31% had experienced serious consequences caused by\nthis suspicion. Conclusion: The incidence of arterial line occlusion is high during invasive blood\npressure monitoring, which is a threat to the patientsâ�� safety. So, intensive attention should be\npaid to the arterial line management....
Background: Under the assumption that postoperative nausea and vomiting (PONV) may occur after total hip\narthroplasty (THA) regardless of the anesthetic technique used, it is not clear whether general (GA) or spinal (SA)\nanesthesia has higher causal effect on this occurrence. Conflicting results have been reported.\nMethods: In this observational study, we selected all elective THA interventions performed in adults between 1999\nand 2008 in a Swiss orthopedic clinic under general or spinal anesthesia. To assess the effect of anesthesia type on\nthe occurrence of PONV, we used the propensity score and matching methods, which allowed us to emulate the\ndesign and results of an RCT.\nResults: Among 3922 procedures, 1984 (51 %) patients underwent GA, of which 4.1 % experienced PONV, and\n1938 underwent SA, of which 3.5 % experienced PONV. We found that the average treatment effect on the treated,\ni.e. the effect of anesthesia type for a sample of individuals that actually received spinal anesthesia compared to\nindividuals who received GA, was ATET = 2.00 % [95 % CI, 0.78ââ?¬â??3.19 %], which translated into an OR = 1.97 [95 % CI\n1.35; 2.87].\nConclusion: This suggests that the type of anesthesia is not neutral regarding PONV, general anesthesia being\nmore strongly associated with PONV than spinal anesthesia in orthopedic surgery....
Background: Compared to conventional tidal volume ventilation, low tidal-volume ventilation reduces mortality\nin cased of acute respiratory distress syndrome. The aim of the present study is to determine whether low\ntidal-volume ventilation reduces the production of inflammatory mediators in the lungs and improves\nphysiological status during hepatic surgery.\nMethods: We randomly assigned patients undergoing hepatectomy into 2 groups: conventional tidal-volume\nvs. low tidal-volume (12 vs. 6 mLââ?¬Â¢kgâË?â??1 ideal body weight) ventilation with a positive end-expiratory pressure of\n3 cm H2O. Arterial blood and airway epithelial lining fluid were sampled immediately after intubation and every\n3 h thereafter.\nResults: Twenty-five patients were analyzed. No significant changes were found in hemodynamics or acidââ?¬â??base\nstatus during the study. Interleukin-8 was significantly elevated in epithelial lining fluid from the low tidal-volume\ngroup. Oxygenation evaluated immediately after admission to the post-surgical care unit was significantly worse\nin the low tidal-volume group.\nConclusions: Low tidal-volume ventilation with low positive end-expiratory pressure may lead to pulmonary\ninflammation during major surgery such as hepatectomy....
Background: Postoperative nausea and vomiting (PONV) is one of the most common adverse outcomes after\nstrabismus surgery. The primary outcome of this prospective, randomized, double-blind study was to compare the\nincidences of nausea or vomiting, and patient satisfaction of ondansetron and ramosetron after strabismus surgery\nunder general anesthesia. The secondary outcome was to investigate whether the number of involved extraocular\nmuscles (EOMs) in strabismus surgery was related to PONV.\nMethods: One hundred and five patients (aged 18ââ?¬â??60 years) undergoing strabismus surgery were allocated randomly\nto one of the three groups: placebo, ondansetron, or ramosetron. Patients received 2 ml placebo, 4 mg ondansetron, or\n0.3 mg ramosetron at the end of surgery. Each of the three groups was subdivided into two subgroups according to the\nnumber of EOMs involved in the surgery: subgroup S, single-muscle correction; subgroup M, multiple-muscle correction.\nThe incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as primary\noutcome. With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, incidences of nausea\nor vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as seconadary outcome.\nResults: The incidence of nausea was significantly lower in the ramosetron group at 2 h (9.4 %) than in the placebo (45.\n2 %) and ondansetron (34.7 %) groups (P < 0.05). The incidence of nausea was also significantly lower in the ramosetron\ngroup at 24 h than in the other groups (P < 0.05). Patients in the ramosetron group were more satisfied at 2 h (8.11 Ã?± 0.\n98) and 24 h (8.50 Ã?± 0.67) after surgery than those in the other groups (P < 0.05). With regard to subgroups S and M in\nthe placebo, ondansetron and ramosetron groups, there were no significant differences in either the incidence of\nnausea or patient satisfaction....
Background: A high ability to visualize the needle on the ultrasonic images is necessary to perform\nthe ultrasound-guided nerve block safely. The Rafa Tuohy needleR (Vygon, Paris, France, Rafa) is a\nnon-stimulating Tuohy needle with sand-blasted steel at the tip of the bevel. We examined the degree\nto which the Rafa enhanced the visibility of ultrasonic images compared with the non-coated\nTuohy needle. Methods: We punctured the Blue Phantom. The dimensions of both the Rafa and the\nnon-coated Tuohy needles were 18 G Ã?â?? 80 mm. The puncture angle is 30 degrees and 45 degrees\nfrom the Blue Phantom. We measured the intensity of the tip of the bevel at a depth of 0.5, 1.0, 1.5\nand 2.0 cm for the puncture angle of 30 degrees, and 0.5, 1.0, 1.5, 2.0, 2.5 and 3.0 cm for the puncture\nangle of 45 degrees. Six anesthesiologists with more than seven years of experience performed\nthree punctures using each needle. Results: As an outcome, we concluded that at a puncture\nangle of both 30 degrees and 45 degrees, the intensity of the non-coated Tuohy needle decreased\nwith the depth. On the other hand, at an angle of 30 degrees, the intensity of the Rafa\nneedle did not decrease, and at an angle of 45 degrees the intensity only decreased very slightly as\nthe depth increased. Conclusions: The Tuohy needle with sand-blasted steel at the tip of the bevel\nprovided greater visualization than the non-coated Tuohy needle on the ultrasound images....
Background: Despite international data indicating that Enhanced Recovery After Surgery (ERAS) programs, which\ncombine evidence-based perioperative strategies, expedite recovery after surgery, few centers have successfully\nadopted this approach within the U.S. We describe the implementation and efficacy of an ERAS program for\ncolorectal abdominal surgery in a tertiary teaching center in the U.S.\nMethods: We used a multi-modal and continuously evolving approach to implement an ERAS program among\nall patients undergoing colorectal abdominal surgery at a single hospital at the University of California, San\nFrancisco. 279 patients who participated in the Enhanced Recovery after Surgery program were compared to\n245 previous patients who underwent surgery prior to implementation of the program. Primary end points\nwere length of stay and readmission rates. Secondary end points included postoperative pain scores, opioid\nconsumption, postoperative nausea and vomiting, length of urinary catheterization, and time to first solid\nmeal.\nResults: ERAS decreased both median total hospital length of stay (6.4 to 4.4 days) and post-procedure length\nof stay (6.0 to 4.1 days). 30-day all-cause readmission rates decreased from 21 to 9.4 %. Pain scores improved\non postoperative day 0 (3.2 to 2.1) and day 1 (3.2 to 2.6) despite decreased opioid. Median time to first solid\nmeal decreased from 4.7 to 2.7 days and duration of urinary catheterization decreased from 74 to 46 h. Similar\nimprovements were observed in all other secondary end points.\nConclusions: These results confirm that a multidisciplinary, iterative, team-based approach is associated with a\nreduction in hospital stay and an acceleration in recovery without increasing readmission rates....
Introduction: Although inhalational anesthesia and nitrousoxide (N2O) are known to affect the\nintraocular pressure (IOP), little is known about the effect of nitrousoxide on the IOP during sevoflurane\nand remifentanil anesthesia. In the present study, we examined the effect of balanced\nanesthesia on the IOP. Materials and Methods: After obtaining informed consent, the patients undergoing\nabdominal surgery under general anesthesia were divided into two groups: N2O group (n\n= 10) and control group (n = 12). General anesthesia was maintained with remifentanil (0.05 - 0.3\n�¼g/kg/min), 33% O2 and 1.2% sevoflurane to keep ETCO2 of 35 - 40 mmHg following tracheal intubation.\nAfter baseline measurement of IOP (T0, 20 minutes after injection of anesthesia), the patients\nin the N2O group received 67% nitrousoxide, and the patients in the control group received\nair, with O2 and 1.2% sevoflurane. Then, IOP was measured at 1 hour (T1), 2 hours (T2), and 3\nhours (T3) after anesthesia induction in the supine position. Blood pressure and heart rate were\nrecorded at the same time interval. Results: There was no significant difference in the IOP at any\nperiod between the two groups. In both groups, the IOP at the T3 was significantly higher than that\nat T0. Conclusion: These results suggest that N2O does not affect the IOP in patients undergoing\nabdominal surgery under sevoflurane and remifentanil anesthesia....
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