Anesthesiology clinics
-
Anesthesiology clinics · Sep 2012
ReviewManagement of postoperative nausea and vomiting: how to deal with refractory PONV.
Postoperative nausea and vomiting (PONV) constitutes a significant factor in delaying recovery after anesthesia and impairing patient satisfaction. To date the prevention of PONV using single or multimodal interventions, usually based on risk assessment, has gained some popularity. ⋯ This review comments mainly on the management of refractory PONV. As the data on coping with established PONV are rare, further studies focusing on treatment of established PONV are needed.
-
General anesthesia and surgery are associated with changes in the shape of the chest that result in atelectasis, a major factor in the development of postoperative respiratory failure. Postoperative noninvasive positive pressure ventilation (NIPPV) has been shown to improve oxygenation and ventilation for high-risk patients. NIPPV has been used as rescue therapy for patients developing acute respiratory distress postoperatively, and appears to be most frequently successful in patients whose problem is atelectasis or obesity. Failure to respond to NIPPV after 20 minutes is usually an indication of intubation, mechanical ventilation, and transfer to the intensive care unit.
-
Perioperative hyperglycemia has potential significant adverse consequences of increased mortality and morbidity including surgical site infection, renal insufficiency and anemia requiring transfusion. Both diabetic and non-diabetic patients are affected adversely by perioperative hyperglycemia. ⋯ Moreover, ideal target glucose range as well as the appropriate patient population(s) for whom glycemic control offers the most benefit have yet to be fully elucidated. However, there are clear potential adverse consequences of tight control such as hypoglycemia.
-
Postoperative anxiety has received less attention historically than preoperative anxiety. Recognition that anxiety occurs throughout the perioperative period has led to increased interest in identifying and treating anxiety in the postoperative period. This article outlines the causes of postoperative anxiety, how it is classified, the effects of anxiety on outcomes after surgery, and some of the clinical procedures that produce the highest levels of anxiety for patients. In addition, an attempt is made to delineate the major risk factors for developing postoperative anxiety and the classic therapeutic modalities used to reduce symptoms and treat the psychological manifestations of anxiety.
-
Spinal and epidural anesthesia and analgesia, and the combination of the two techniques, have been excellent choices for the management of certain surgical procedures and continue to grow in popularity. The demand for increased patient mobility and quicker discharge for both inpatients and outpatients lends itself to the benefits of regional anesthesia. A neuraxial block is indicated for any surgical procedure in which the appropriate sensory level can be accomplished without any adverse outcome. This article outlines the indications and contraindications for these techniques.