Articles: post-operative.
-
Anesthesia and analgesia · Aug 2022
Multicenter Study Observational StudyOutlying End-Tidal Carbon Dioxide During General Anesthesia Is Associated With Postoperative Pulmonary Complications: A Multicenter Retrospective Observational Study From US Hospitals Between 2010 and 2017.
Postoperative pulmonary complications (PPCs) occur in up to 33% of patients who undergo noncardiothoracic surgery. Emerging evidence suggests that permissive hypercapnia may reduce the risk of lung injury. We hypothesized that higher intraoperative end-tidal carbon dioxide (Etco2) concentrations would be associated with a decreased risk of PPCs. ⋯ Both a very low (<28 mm Hg) and a high Etco2 (>45 mm Hg) were associated with PPCs within 30 days. The lowest PPC incidence was found in patients with an Etco2 of 35 to 38 mm Hg. Prospective studies are needed to clarify the relationship between postoperative PPCs and intraoperative Etco2.
-
Anesthesia and analgesia · Aug 2022
Randomized Controlled Trial"My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial.
Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery. ⋯ Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.
-
Anesthesia and analgesia · Aug 2022
Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review.
Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. ⋯ Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials' and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia.
-
Curr Opin Anaesthesiol · Aug 2022
ReviewRespiratory monitoring of nonintubated patients in nonoperating room settings: old and new technologies.
Postoperative mortality in the 30 days after surgery remains disturbingly high. Inadequate, intermittent and incomplete monitoring of vital signs in the nonoperating room environment is common practice. The rise of nonoperating room anaesthesia and sedation outside the operating room has highlighted the need to develop new and robust methods of portable continuous respiratory monitoring. This review provides a summary of old and new technologies in this environment. ⋯ Respiratory monitoring is required in several situations and patient categories outside the operating room. The chosen modality must be able to detect respiratory compromise in a timely and accurate manner. Combing several modalities in a nonobtrusive, nontethered system and having an integrated output seems to give a reliable and responsive signal.
-
Randomized Controlled Trial
Effects of transcranial direct current stimulation in pain and opioid consumption after spine surgery.
Transcranial direct current stimulation (tDCS) has shown promising results in alleviating different types of pain. The present study compares the efficacy of three sessions of anodal tDCS applied over primary motor area (M1) or the left dorsolateral prefrontal cortex (DLPFC) or sham on reducing pain and the total opioid consumption in postoperative spine surgery patients. ⋯ tDCS is a promising tool for alleviating pain in the field of postoperative spine surgery.