BMC anesthesiology
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Randomized Controlled Trial
Pain management after thoracotomy with dexamethasone and bupivacaine through a peripleural cather: a randomized controlled trial.
Thoracotomy procedures can result in significant pain and cause nausea/vomiting. Glucocorticoids have anti-emetic and analgesic effects due to their anti-inflammatory and nerve-blocking properties. This study investigates the additive effect of local dexamethasone with bupivacaine as sole analgesic medication through a peripleural catheter after thoracotomy. ⋯ In thoracotomy patients, administering local dexamethasone + bupivacaine through a peripleural catheter can reduce postoperative pain, analgesic consumption, and length of hospital stay.
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Observational Study
Preoperative psychological factors influence analgesic consumption and self-reported pain intensity following breast cancer surgery.
Psychological factors such as anxiety and mood appear to influence acute postoperative pain; however, there is conflicting evidence on the relationship between preoperative psychological parameters and the severity of postoperative pain. In the context of the stressful setting of initial surgery for breast cancer, we conducted a prospective observational study of patients who were scheduled to undergo initial breast cancer surgery. ⋯ Preoperative state anxiety, in particular, is associated with the severity of postoperative pain experienced by women undergoing initial breast cancer surgery. Formal preoperative assessment of anxiety may be warranted in this setting with a view to optimize perioperative analgesia and wellbeing.
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During laparoscopic surgery, pneumoperitoneum and Trendelenburg positioning applied to provide better surgical vision can cause many physiological changes as well as an increase in intracranial pressure. However, it has been reported that cerebral autoregulation prevents cerebral edema by regulating this pressure increase. This study aimed to investigate whether the duration of the Trendelenburg position had an effect on the increase in intracranial pressure using ultrasonographic optic nerve sheath diameter (ONSD) measurements. ⋯ It was determined that as the Trendelenburg position duration increased, the ONSD values increased. This suggests that as the duration of Trendelenburg positioning and pneumoperitoneum increases, the sustainability of the mechanisms that balance the increase in intracranial pressure becomes insufficient.
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Failure to adhere to perioperative fasting requirements increases aspiration risk and can lead to delay or cancellation of surgery. Point of care gastric ultrasound may guide decision-making to delay, cancel or proceed with surgery. ⋯ It is feasible to use preoperative point of care gastric ultrasound to determine stomach contents and risk-stratify pediatric patients presenting for elective surgical procedures with fasting non-adherence. Preoperative gastric ultrasound may have a role in determining changes in anesthetic management in this patient population.
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Emergence agitation is a transient confusional state of a child associated with consciousness from general anaesthesia, commonly occurs in the postoperative setting which delays their recovery and exposes them to traumas. The main objective of the current study was to investigate the magnitude of emergence agitation, its interventions and associated factors among paediatric surgical patients at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. ⋯ Almost half of the study participants experienced emergence agitation which is high magnitude. Ear, nose, throat surgery and oral maxillofacial surgeries were predictive factors of emergence agitation while propofol administration at the end of procedure and arrival of patient to recovery awake significantly decreased risk of emergence agitation. Therefore, anaesthesia personnel should have essential skills and knowledge to effectively care for children perioperatively including to minimize and treat emergence agitation.