Articles: postoperative.
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Management of hemostasis of cardiopulmonary bypass (CPB) patients is still a major challenge. New monitoring methods, new hemostatic drugs and new platelet function inhibitors are being added to the pre, intra and postoperative periods. The multifactorial nature of CBP-induced hemostasis disorders requires the understanding of their pathophysiology and the accurate hemostasis evaluation for effective coagulation during CPB, in addition to the maintenance of adequate postoperative hemostasis. Activated clotting time (ACT) and coagulogram are not enough for this management. A broader evaluation is needed with monitors able to measure platelet function and hemostatic process dynamics as a whole. ⋯ Thromboelastograph is an important hemostasis monitor for patients submitted to CPB. It has been incorporated to hemostatic disorders evaluation protocols and transfusion therapy, with good results.
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When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV). Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1) If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU)?; 2) Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3) If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? ⋯ 5-HT3-antagonists are the most common choice for treatment of established PONV for outpatients when no prophylaxis is used, and also following prophylactic regimens that include a 5HT3 antagonist, regardless of the number of prophylactic antiemetics given. Whereas 3%-7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% of practitioners would re-dose the 5-HT3-antagonist for PONV treatment.
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A considerable number of patients require opioids during recovery after laparoscopic sterilization. This implies nausea, dizziness and sedation and increases the number of unplanned admissions. Gabapentin has shown excellent postoperative analgesic effect in a number of recent studies with few side effects. This study was designed to test whether gabapentin given preoperatively can reduce the number of patients needing morphine in the recovery period. ⋯ The postoperative analgesic effect of gabapentin given preoperatively was confirmed in this study. For this procedure, with pain predominantly in the immediate recovery period, and of less intensity than after major surgical procedures, the effect demonstrated is much less pronounced than in similar studies of major surgery. General use of gabapentin as analgesic for laparoscopic sterilization is not supported by this study.
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To evaluate the evidence regarding decisions made in the perioperative management of patients undergoing ambulatory surgery for the following: the elderly, hyper-reactive airways disease, coronary artery disease, diabetes, obesity, obstructive sleep apnea, the ex-premature infant and the child with an upper respiratory infection. ⋯ Evidence indicates that ambulatory anesthesia is currently very safe. Ambulatory surgery, however, is being offered to a population with increasing co-morbidity. As the population undergoing ambulatory surgery changes over time, the evidence regarding patient outcomes will need re-examination.
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In this review, the most recent and relevant developments in the field of emergence agitation in children, as related to its assessment, etiology, and management, are discussed. ⋯ It is recommended that children at high risk are identified in order to decrease their level of preoperative anxiety, to supplement low-solubility inhalational agents with adjuvant drugs, to prevent postoperative pain and to allow parents to be with their children during recovery from anesthesia.