Articles: postoperative.
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To compare awake craniotomy using conscious sedation technique versus conventional general anesthesia (GA) for excision of low-grade glioma encroaching on eloquent brain. ⋯ Compared to GA, awake craniotomy is a relatively simple non-expensive procedure that allows tumor removal guided by physiology rather than anatomy.
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Shivering-the "Big Little Problem" has an incidence of 60% in early recovery phase following general anaesthesia. A number of techniques have been tried to prevent postoperative shivering. Previous study showed that, ondansetron in higher doses reduces postoperative shivering. ⋯ Groups P and G differ significantly than in Group S (p<0.05). However, the difference between Groups P and G was not statistically significant (p>0.05). The prophylactic use of granisetron (40mcg.kg(-1)) and pethidine(25mg) intravenous were found to be effective in preventing postoperative shivering.
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Ther Clin Risk Manag · Feb 2009
Management of postoperative nausea and vomiting: focus on palonosetron.
Postoperative nausea and vomiting (PONV) remains a significant problem in modern anesthetic practice, with an incidence in high-risk groups of up to 80%. In addition to being unpleasant and distressing for the patient, PONV has the potential to adversely affect patient and surgical outcomes. Advances in PONV prophylaxis over recent years include using non-pharmacological means to reduce baseline risk, a change to less emetogenic anesthetic techniques and the combination of multiple antiemetic drugs. ⋯ Palonosetron is a second-generation 5-HT(3) antagonist that has recently been approved for prophylaxis against PONV. It has unique structural, pharmacological and clinical properties that distinguish it from other agents in its class. This review summarizes current evidence on PONV prophylaxis, reviews the 5-HT(3) antagonists in particular and focuses on the established and future roles of palonosetron.
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Awareness with explicit recall of intra-operative events is a rare and distressing complication that may lead to severe psychological symptoms. Candidate depth of anesthesia monitors have been developed, partly with the aim of preventing this complication. Despite conflicting results from clinical trials and the lack of incisive validation, such monitors have enjoyed widespread clinical adoption, in particular the bispectral index. The American Society of Anesthesiologists has called for adequately powered and rigorously designed clinical trials to determine whether the use of such monitors decreases the incidence of awareness in various settings. The aim of this study is to determine with increased precision whether incorporating the bispectral index into a structured general anesthesia protocol decreases the incidence of awareness with explicit recall among a subset of surgical patients at increased risk for awareness and scheduled to receive an inhalation gas-based general anesthetic. ⋯ This trial has been designed to complement two other clinical trials: B-Unaware and MACS (ClinicalTrials.gov numbers, NCT00281489 and NCT00689091). With the large patient numbers and complementary rigorous designs, it is envisaged that pre-specified meta-analyses will address some of the outstanding controversies and questions relating to processed electroencephalography monitoring.
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Pediatr Crit Care Me · Jul 2008
CommentStage I palliation for hypoplastic left heart syndrome: Is a right ventricle to pulmonary artery conduit associated with improved outcomes? Critical appraisal of Cua et al: Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit (Pediatr Crit Care Med 2006; 7:238-244).
To review the findings and discuss the implications of studies comparing Norwood procedure with either modified Blalock-Taussig shunt (NW-BT) or right ventricle to pulmonary artery conduit (NW-RVPA) in stage I palliation of hypoplastic left heart syndrome (HLHS). ⋯ NW-RVPA has theoretical advantages over NW-BT and is associated with excellent outcome results. However, available data are insufficient to prove benefit in terms of mortality or morbidity. A multicenter randomized trial is currently being conducted, which should provide more conclusive information.