Articles: postoperative.
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Journal of anesthesia · Jan 2012
Incidence of unanticipated difficult airway in obstetric patients in a teaching institution.
Airway experience was analyzed among patients who had pregnancy-related surgery under general anesthesia from January 2001 through February 2006. A difficult airway was defined as needing three or more direct laryngoscopy (DL) attempts, use of the additional airway equipment after the DL attempts, or conversion to regional anesthesia due to inability to intubate. Airway characteristics were compared between patients with and without a difficult airway. In addition, pre- and postoperative airway evaluations were compared to identify factors closely related to changes from pregnancy. ⋯ Unanticipated difficult airways accounted for 0.56% of all pregnancy-related surgical patients. More than 99.9% of all obstetric patients could be intubated. A difficult airway is more likely to be encountered by anesthesia providers with <1 year of experience. Proper use of airway equipment may help secure the obstetric airway or provide adequate ventilation. Emergency CD did not add an additional level of difficulty over nonemergency CD.
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The i-gel™, LMA-Supreme (LMA-S) and Laryngeal Tube Suction-D (LTS-D) are single-use supraglottic airway devices with an inbuilt drainage channel. We compared them with regard to their position in situ as well as to clinical performance data during elective surgery. ⋯ All devices were suitable for ventilating the patients' lungs during elective surgery.
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The aim of this study was to determine the incidence of early postoperative hypoxia after general anesthesia and to evaluate the need of oxygen supplementation. A total of 150 patients aged between 18-60 years belonging to ASA I or II were studied. Patients were alternately allocated to two groups of 75 each. ⋯ Group-II (n=75) patients did not receive oxygen either during transfer or in the recovery room. Twenty percent in Group-II developed hypoxaemia during transfer from operation theatre to recovery room out of which 24% developed mild (SaO2 86-90%), 2.66% moderate (SaO2 85-81%), and 1.33% extreme (SaO2 <76%) hypoxaemia. None of the patients in Group - I, who received oxygen supplementation, developed hypoxaemia in the early postoperative period.
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Interscalene block (ISB) is commonly performed using 20-40 mL of local anesthetic. Spread to adjacent structures and consequent adverse effects including paralysis of the ipsilateral hemidiaphragm are frequent. Pain ratings, analgesic requirements, adverse events, satisfaction, function and diaphragmatic excursion were compared following interscalene block (ISB) with reduced initial bolus volumes. ⋯ ISB provided reliable surgical analgesia with 5 mL, 10 mL or 20 mL ropivacaine (0.75%). The 20 mL volume was associated with increased complaints of dyspnea. The 5 mL volume was associated with statistically higher pain scores in the immediate postoperative period. Lower volumes resulted in a reduced incidence of dyspnea compared to 20 mL, however diaphragmatic impairment was not eliminated. Compensatory increases in contralateral diaphragmatic movement may explain tolerance for ipsilateral paresis.
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Journal of pain research · Jan 2012
Pattern of postoperative pain management among adult surgical patients in a low-resource setting.
Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria). ⋯ Despite recent advances and the development of more effective techniques for postoperative pain control, a high proportion of patients still experience moderate to severe postoperative pain. Intermittent intramuscular injection of analgesic medication remains the mainstay of postoperative pain management at the ABUTH Zaria. Anesthetists should be more involved in postoperative analgesia prescriptions and should include other forms of multimodal pain management in their regimens. With proper application of current knowledge and training, postoperative pain management can be improved.