Journal of clinical anesthesia
-
Obese patients regularly present for surgery and have greater hypoxemia risk. This study aimed to identify the risk and incidence of intraoperative hypoxemia with increasing body mass index (BMI). ⋯ Despite existing practices to limit hypoxemia in obese patients, the odds of experiencing intraoperative hypoxemia increase significantly with increasing categories of BMI. Further practices may need to be developed to minimize the risk of intraoperative hypoxemia in obese patients.
-
Observational Study
Postoperative delirium: age and low functional reserve as independent risk factors.
The aim of this study was to determine the incidence of postoperative delirium (POD) and the presence of previous conditions related to its development. ⋯ The incidence of POD in the study population (11%) is consistent with that described in the literature (5%-15%). The comorbidities associated with its development were ischemic heart disease, hypertension, chronic kidney disease, LFR, and chronic obstructive pulmonary disease. Age ≥65years and LFR were independent risk factors for POD development.
-
It is recommended to correct intravenous induction doses by up to 50% for patients older than 65 years. The objectives were to determine (a) the degree to which anesthesia providers correct induction doses for age and (b) additionally adjust for American Society of Anesthesiologists physical status (ASA-PS) class (severity of illness) and (c) whether postinduction hypotension is more common among patients aged >65. ⋯ This study shows that the administered dose of anesthetic induction agents is significantly higher than that recommended for patients older than 65 years. This failure to age-adjust dose may contribute to hypotensive episodes.
-
A 19-year-old man with large malignant pleural and pericardial effusions with tamponade physiology and signs of congestive heart failure presented for emergent subxiphoid pericardial window. Surgical drainage of the pericardium was complicated by a paradoxical cardiovascular collapse that failed to respond to pressors and intravenous fluids. ⋯ It is proposed that, in patients presenting with tamponading pericardial and pleural effusions, drainage of the pleural effusion be given priority. The pathophysiology of low cardiac output states resulting from pericardial and large pleural effusion is discussed and the literature reviewed.