Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2015
Randomized Controlled Trial Comparative StudyExcess Costs and Length of Hospital Stay Attributable to Perioperative Respiratory Events in Children.
This prospective matched-cohort study from Thailand found that children experiencing a perioperative respiratory event were subsequently hospitalized twice as long, incurred 30% higher hospital costs, along with 58% higher indirect costs.
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Anesthesia and analgesia · Feb 2015
Randomized Controlled TrialThe Influence of Positive End-Expiratory Pressure on Surgical Field Conditions During Functional Endoscopic Sinus Surgery.
Functional endoscopic sinus surgery (FESS) is the mainstay of surgical treatment for sinonasal disease. This surgery carries certain risks. Most of these risks relate to the quality of the surgical field. Thus, mechanisms by which the surgical field can be improved are important to study. We sought to determine whether positive end-expiratory pressure (PEEP) had a deleterious effect on the quality of the surgical field in patients undergoing primary FESS. ⋯ During FESS surgery if PEEP is added, it is important to keep the mean inspiratory pressure below 15cm H2O to avoid worsening surgical field conditions.
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Anesthesia and analgesia · Feb 2015
The Incidence and Risk Factors for Perioperative Cardiac Arrest Observed in the National Anesthesia Clinical Outcomes Registry.
Cardiac arrest is a rare but important event in the operating room and postanesthesia care unit, when surgical patients are most intensively monitored. Several recent publications have reported the rate of cardiac arrest in surgical patients during the subsequent hospital stay but have not uniquely identified the immediate perioperative period. We hypothesized that cardiac arrest during this time (intraprocedure and postanesthesia care) would occur at a lower frequency than that described for inpatient hospital care in the available literature. ⋯ The National Anesthesia Clinical Outcomes Registry is an emerging resource for examination of perioperative and anesthesia-related outcomes. Cardiac arrest is less frequent in the periprocedural setting than later in the hospital course, with most arrests predictably occurring in patients with ASA physical status III-V. The finding of increased risk of mortality in male patients cannot be readily explained and should prompt future research attention.
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Anesthesia and analgesia · Feb 2015
Observational StudyAn Ultrasound Evaluation of Laryngeal Mask Airway Position in Pediatric Patients: An Observational Study.
In children, the laryngeal mask airway (LMA) is frequently displaced within the hypopharynx, resulting in repositioning of the device. When the tip of the LMA is placed in the esophageal inlet, the arytenoids are moved ventrally. When the LMA is rotated or deviated, the ventral movement of the arytenoids may result in asymmetric elevation of an arytenoid cartilage, which can be detected with ultrasound (US). In this study, we sought to estimate the incidence of LMA malposition detected with US in pediatric patients. The primary end point was to compare the incidence of LMA malposition between US and fiber optic bronchoscopy (FOB). The secondary end points were to find the interrelationship between US-detected and FOB-detected malposition of the LMA and to locate the diagnostic performance of US in detecting LMA malposition. ⋯ Although US could not detect the suboptimal depth of an LMA, US has promise of being an accurate tool in detecting a rotated LMA.
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Anesthesia and analgesia · Feb 2015
Spontaneous Pain-Like Behaviors Are More Sensitive to Morphine and Buprenorphine Than Mechanically Evoked Behaviors in a Rat Model of Acute Postoperative Pain.
Nonevoked spontaneous pain is most problematic for postoperative patients. Physicians assess this form of pain using the human visual analog scale or verbal numeric rating scale. Recent studies have proposed that spontaneous foot-lifting (SFL) behaviors are an expression of spontaneous pain in animals after spinal nerve injury or adjuvant-induced inflammation. In the current study, we characterize SFL behaviors in a rat model of acute postoperative pain, which includes comparisons with evoked behaviors to analgesic treatments. ⋯ The present study demonstrates that a hindpaw plantar incision induces SFL behaviors in rats and that these behaviors have higher bioassay sensitivity to analgesic interventions with morphine and buprenorphine compared with mechanically evoked behaviors.