Articles: postoperative.
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Cardiovascular autonomic neuropathy is frequently observed in patients with diabetes mellitus. As anaesthesia has a marked effect on peri-operative autonomic function, the interplay between diabetic neuropathy and anaesthesia may result in unexpected haemodynamic instability during surgery. The objective of this literature review was to examine the association of cardiovascular autonomic neuropathy with peri-operative cardiovascular complications. ⋯ Depending on the type of anaesthesia, the presence of cardiovascular autonomic neuropathy in surgical patients can markedly affect peri-operative haemodynamics and postoperative recovery. Pre-operative testing of the extent of autonomic dysfunction in particular populations, like diabetics, may contribute to a reduction in haemodynamic instability and cardiovascular complications. Non-invasive diagnostic methods assessing autonomic function may be an important tool during pre-operative risk assessment.
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Acta neurologica Belgica · Mar 2015
Randomized Controlled TrialEffect of dexamethasone on the incidence of post-dural puncture headache after spinal anesthesia: a randomized, double-blind, placebo-controlled trial and a meta-analysis.
The effect of dexamethasone on post-dural puncture headache (PDPH) after spinal anesthesia has not been well elucidated. This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing a cesarean at the Qilu Hospital, Shandong University. The subjects were randomly divided into a placebo and a dexamethasone group. ⋯ The results indicated that prophylactic administration of 8 mg dexamethasone did not have any protective effect against PDPH (31 vs. 18, P = 0.054) and even increased the incidence of PDPH in the first 24 h in parturient patients (25 vs. 11, P = 0.016). Furthermore, the meta-analysis also showed that dexamethasone did not prevent the incidence of PDPH in the postoperative follow-up days (RR 1.05; 95 % CI 0.46-2.38; P = 0.91) and may even have increased the trend in the first 24 h. Prophylactic administration of 8 mg dexamethasone does not have any protective effect against PDPH and may even increase the incidence of PDPH in the first 24 h in patients with spinal anesthesia.
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Randomized Controlled Trial
Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients.
Delirium is the most common postoperative psychiatric condition in intensive care settings and can lead to increased complications and costs. ⋯ The patient education appeared to be effective in improving knowledge and reducing days of mechanical ventilation. Hearing impairment was an unexpected predictor of adverse outcomes for patients but may be amenable to nursing intervention.
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Case Reports
Effect of buprenorphine on total intravenous anesthetic requirements during spine surgery.
Buprenorphine is a partial mu receptor agonist and kappa/delta antagonist commonly used for the treatment of opioid dependence or as an analgesic. It has a long plasma half-life and a high binding affinity for opioid receptors. This affinity is so high, that the effects are not easily antagonized by competitive antagonists, such as naloxone. ⋯ She had drastically reduced anesthetic requirements during this case, suggesting buprenorphine's profound effect on anesthetic dosing. This case report elegantly illustrates that discontinuation of buprenorphine is likely warranted for patients who present for major spine surgery, which necessitates the avoidance of volatile anesthetic and paralytic agents. The addition of ketamine may be necessary in patients maintained on buprenorphine in order to ensure a motionless surgical field.
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Postoperative nausea and vomiting (PONV) is a debilitating condition that occurs in approximately 30% of patients undergoing general anesthesia. Premedication with 5-HT3 receptor antagonists and glucocorticoids is effective in clinical practice; however, 10% to 20% of patients still develop PONV. Currently, little is known about the treatment of refractory PONV. We present a case that illustrates the use of fosaprepitant for the treatment of refractory postoperative nausea and vomiting.