Articles: postoperative.
-
Quality of recovery is recognized as a valid and important outcomes measurement in clinical care and research. The increasing interest in evaluating quality of recovery reflects the overall increased interest in patient-focused assessments. Assessment of quality of recovery incorporates measuring many dimensions or domains including physiologic endpoints, adverse events and psychosocial status. Unlike 'traditional' outcomes that focus on major morbidity and mortality, quality of recovery assesses 'nontraditional' outcomes focused around patient-oriented endpoints. By adversely influencing the many domains assessed by quality of recovery, postoperative pain may have a general detrimental effect on quality of recovery. ⋯ Higher levels of postoperative pain typically correlate with a decrease in quality of recovery. Different analgesic techniques and regimens may differentially influence quality of recovery, with preliminary evidence suggesting that some regional analgesic techniques may provide superior quality of recovery, quality of life and patient satisfaction. Further studies are needed to elucidate the effects of different analgesic techniques on quality of recovery.
-
The purpose of this review is to present the most important recent studies into the clinical use of peripheral nerve blocks for anesthesia and postoperative analgesia of the lower limb surgery. ⋯ Introduction of new methods and techniques are increasing and improving the use of lower peripheral nerve blocks. These techniques are gaining interest after the important increase of the lower molecular weigh heparins.
-
Preoperative pediatric anxiety is characterized by stress, worry, nervosism and concern and may be expressed in different ways. Postoperative behavior changes, such as nocturnal enuresis, dietary problems, apathy, insomnia, nightmares and agitated sleep may be results of this anxiety. In some children, these changes persist for one year. This study aimed at evaluating anxiety-related aspects affecting children and parents in the preoperative period, as well as pharmacological or non-pharmacological interventions to minimize them. ⋯ The preoperative period is accompanied of an emotional overload for the whole family, especially the child. For many children, a turbulent preoperative period may translate into several behavior changes lasting for long periods of time. The presence of parents during anesthetic induction and the preoperative preparation of children and parents may be useful for selected cases, taking into account age, temperament and previous hospital experience. Preanesthetic medication with benzodiazepines, especially midazolam, is clearly the most effective method to decrease postoperative anxiety in children and their related behavior changes.
-
Postoperative administration of paracetamol or its prodrug propacetamol has been shown to decrease pain with a morphine sparing effect. However, the effect of propacetamol administered intra-operatively on post-operative pain and early postoperative morphine consumption has not been clearly evaluated. In order to evaluate the effectiveness of analgesic protocols in the management of post-operative pain, a standardized anesthesia protocol without long-acting opioids is crucial. Thus, for ethical reasons, the surgical procedure under general anesthesia with remifentanil as the only intraoperative analgesic must be associated with a moderate predictable postoperative pain. ⋯ Intraoperative propacetamol administration with remifentanil based-anesthesia improved significantly early postoperative pain by sparing morphine and shortening the delay to achieve pain relief.
-
Rev Bras Anestesiol · Aug 2004
[Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation.].
Clonidine and dexmedetomidine are alpha2-adrenergic agonists with analgesic proprieties which potentiate local anesthetic effects when epidurally administered. The goal of this study was to evaluate the analgesia and sedation promoted by clonidine or dexmedetomidine associated to epidural ropivacaine, in the postoperative period of subcostal cholecystectomy. ⋯ Our results allowed to conclude that the association of clonidine or dexmedetomidine to 0.75% ropivacaine induces analgesia and sedation in 2 and 6 hours after anesthetic recovery in patients submitted to subcostal cholecystectomy and that clonidine promotes more prolonged analgesia.