Articles: postoperative.
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Journal of anesthesia · Dec 2014
Comparative StudyEffects of ketoprofen for prevention of postoperative cognitive dysfunction in aged rats.
Postoperative cognitive dysfunction is a common geriatric complication that may be associated with increased mortality. Here, we investigated the effects of postoperative analgesia with ketoprofen on cognitive functions in aged animals and compared its effectiveness to morphine. Rats were randomly allocated to one of four groups: isoflurane anesthesia without surgery (group C), isoflurane anesthesia with laparotomy (group IL), and isoflurane anesthesia with laparotomy plus postoperative analgesia with ketoprofen or morphine. ⋯ However, both ketoprofen and morphine could attenuate the increase in memory errors following surgery to a similar degree. Conversely, ketoprofen showed no effect on cognitive function in the nonsurgical rats that did not experience pain. Our findings suggest that postoperative analgesia with ketoprofen can prevent the development of surgery-associated memory deficits via its pain-relieving effects.
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Anesthesia and analgesia · Dec 2014
Sodium Homeostasis During Liver Transplantation and Correlation with Outcomes.
Reports of perioperative serum sodium increase in liver transplant (LT) recipients are mostly restricted to unintentional rapid serum sodium overcorrection with subsequent development of central pontine myelinolysis. We examined intraoperative serum sodium changes and their effect on short-term outcomes after LT. ⋯ A larger intraoperative increase in ΔNa is associated with worse recipient short-term outcomes. Patients with preoperative hyponatremia may be at particular risk. ΔNa increases with the intraoperative use of NaHCO3, quantity of FFP, and PRBCs transfused, as well as with intraoperative hyperglycemia. Potential differences on sodium homeostasis between NaHCO3 and tromethamine use for intraoperative pH adjustment should be prospectively investigated.
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Case Reports
Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach.
The conventional ultrasound-guided interscalene block targets the C5 and C6 nerve roots at approximately the level of the cricoid cartilage where they lie in the groove between the anterior and middle scalene muscles. This technique, although effective at providing regional anesthesia of the shoulder, is associated with risks of phrenic nerve palsy, injury to the dorsal scapular and long thoracic nerves, and long-term postoperative neurologic symptoms. In this case report, we describe the ultrasound-guided superior trunk block. This procedure targets the C5 and C6 components of the brachial plexus more distally after they unite into the superior trunk but before the suprascapular nerve branches off. ⋯ The enhanced anatomical knowledge provided by ultrasound-guidance has allowed anesthesiologists to devise new block techniques and refine existing ones. The superior trunk block is an example of this refinement and is intended as an alternative to the conventional interscalene block for anesthesia of the shoulder. Further research is planned to confirm the efficacy and safety of the technique.
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Worldviews Evid Based Nurs · Dec 2014
Instituting best practice for monitoring for opioid-induced advancing sedation in hospitalized patients.
Adverse events related to opioid-induced unintended advancing sedation and respiratory depression in hospitalized patients are occurring with increased frequency, and these adverse events can have a negative impact on quality and cost outcomes. ⋯ Nurse executives and nurse managers assume accountability for ensuring that patient care is aligned with the best evidence, practices, and regulatory mandates. The framework presented in this paper can help prevent opioid-induced advancing sedation and respiratory depression, and assist nurse leaders in implementation strategies to guide policies and practice.