Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 2015
The Impact of Incident Postoperative Delirium on Survival of Elderly Patients After Surgery for Hip Fracture Repair.
The impact of delirium on survival of elderly patients remains undetermined with conflicting results from clinical studies and meta-analysis. In this study, we assessed the relationship between long-term mortality and incident postoperative delirium in elderly patients undergoing hip fracture repair. ⋯ Incident postoperative delirium was not significantly associated with decreased survival in elderly patients undergoing hip fracture repair.
-
Anesthesia and analgesia · Nov 2015
A Perioperative Evaluation of Respiratory Mechanics Using the Forced Oscillation Technique.
The forced oscillation technique is a new approach for assessing perioperative respiratory function. ⋯ The forced oscillation technique is a clinical tool that can be used to assess the effects of perioperative ventilation strategies on respiratory mechanics.
-
Anesthesia and analgesia · Nov 2015
The Association Between Sjögren Syndrome and Adverse Postoperative Outcomes: A Historical Cohort Study Using Administrative Health Data.
Sjögren syndrome is a chronic autoimmune disorder of the exocrine glands associated with cardiovascular events. We aimed to evaluate postoperative complications in patients with Sjögren syndrome undergoing noncardiac surgery. Specifically, we tested the primary hypothesis that patients with Sjögren syndrome have a greater risk of postoperative cardiovascular complications than those without the disease. Our secondary hypotheses were that patients with Sjögren syndrome are at greater risk of thromboembolic complications, microcirculatory complications, and mortality. ⋯ The presence of Sjögren syndrome does not place patients at an increased risk for postoperative complications or in-hospital mortality.
-
Anesthesia and analgesia · Nov 2015
Observational StudyFailed Obstetric Spinal Anesthesia in a Nigerian Teaching Hospital: Incidence and Risk Factors.
In a retrospective survey, we found 1% cases with complete and partial failure of spinal anesthesia for cesarean delivery between 2008 and 2010, which we attributed to underreporting because of the study design. In this prospective study, we determined the incidence of failed spinal anesthesia and identified the factors that increased its risk. ⋯ The rate of failed spinal anesthesia from this study was high. The independent predictors of failure were multiple lumbar puncture attempts, use of the L4/L5 interspace, and the level of experience of the anesthesia provider. It is imperative to develop clear guidelines to standardize our obstetric spinal anesthetic practice as well as the management of failures.
-
Anesthesia and analgesia · Nov 2015
Comparative Study Clinical TrialMorphine Glucuronidation and Elimination in Intensive Care Patients: A Comparison with Healthy Volunteers.
Although morphine is used frequently to treat pain in the intensive care unit, its pharmacokinetics has not been adequately quantified in critically ill patients. We evaluated the glucuronidation and elimination clearance of morphine in intensive care patients compared with healthy volunteers based on the morphine and morphine-3-glucuronide (M3G) concentrations. ⋯ Under the assumptions in the model, M3G elimination was significantly decreased in intensive care patients when compared with healthy volunteers, which resulted in substantially increased M3G concentrations. Increased M3G levels were even more pronounced in patients with increased serum creatinine levels. Model-based simulations show that, because of the reduction in morphine clearance in intensive care patients with renal failure, a 33% reduction in the maintenance dose would result in morphine serum concentrations equal to those in healthy volunteers and intensive care patients with normal renal function, although M3G concentrations remain increased. Future pharmacodynamic investigations are needed to identify target concentrations in this population, after which final dosing recommendations can be made.