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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: anesthesia (Page 1 of 2)

Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients

Abstract

Introduction. Post-operative pain control improves surgical outcome and many hospitals created multidisciplinary teams, called “Acute Pain Services” (APS). We collected APS data on 10,760 adult patients over a five year period, including complications, side effects and patient satisfaction.

Methods. Data on patients managed by APS in a high surgical-volume university hospital over a 5-year period were collected and analyzed. Data included demographic characteristics, primary analgesic modality, adjuvant analgesic treatment, type of surgical procedure, Visual Analogue Scale, and analgesia-related side-effects and complications.

Results. Patient controlled analgesia with morphine was used in 4,992 surgical patients while epidural analgesia was used in 3,687 surgical patients and 1,670 pregnant women for delivery analgesia. A total of 411 patients received other forms of analgesia. No epidural haematoma was observed. A single case of respiratory depression occurred in an elderly patient using the patient controlled analgesia system. Acetaminophen was the most frequently adjuvant drug prescribed. Postoperative nausea and vomiting was the most frequent analgesia-related side effect. Visual Analogue Scale at rest and on movement was low on day one (0.84±1.15 and 2.05±1.67) and decreased thereafter with epidural analgesia associated with better pain control following hip and liver surgery, and with less postoperative nausea and vomiting (5.0%) when compared to morphine patient controlled analgesia (7.2%).

Conclusions. An APS, with daily postoperative visits, permits adequate post-operative pain control without serious adverse events. Epidural analgesia was associated with less postoperative nausea and vomiting and had at least similar pain control than morphine patient controlled analgesia.

Key words: acute pain service, epidural analgesia, patient controlled analgesia, anesthesia, surgery

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Anesthesia for carotid endarterectomy: where do we stand at present?

Abstract

Carotid endarterectomy (CEA) is a surgical procedure performed to reduce the incidence of embolic and thrombotic stroke. Although only a preventive procedure, CEA carries the risk of perioperative complications. There is constant searching for an optimal anesthetic technique. There are pros and cons for both anesthetic techniques used: regional (RA) and general anesthesia (GA). A large number of studies have compared RA and GA techniques in CEA surgery patients. The primary outcome was the proportion of patients with stroke, myocardial infarction, or death. However, neither the GALA trial nor the pooled analysis was adequately powered to reliably detect an effect of type of anesthesia on mortality. It may therefore be appropriate to consider other additional parameters (stress response, incidence of postoperative delirium and cognitive impairment, functional recovery, total surgery time, intensive care unit requirement, hospital stay, hospital costs and patients satisfaction) when comparing the outcomes of the two techniques.

Although, the debate continues as to whether regional anesthesia or general anesthesia is safer, the choice of anesthetic technique is a complex decision and surgical teams should be able to offer both RA and GA. The individual approach is the ideal choice and should be determined at the discretion of the surgeon, anesthetist and patient depending on the clinical situation and own preferences.

Key words: surgery, carotid endarterectomy, anesthesia, general, regional, outcome

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Anesthesia techniques for carotid endarterectomy

Abstract

Stroke is one of the leading causes of death in the modern countries. Mainstay treatment for stroke prevention is carotid endarterectomy (CEA). Patients scheduled for surgery often have many associate systemic illnesses that pose a risk of perioperative cardiac and neurological complications. Detailed preoperative evaluation of neurological and cardiac function with optimization of the systemic illnesses therapy is obligatory. Ideal anesthesiology technique should provide adequate analgesia, minimal stress response, optimal brain perfusion and oxygenation, optimal hemodynamic and myocardial oxygen balance while assuring calm and relaxed patients with good surgical comfort. Both regional anesthesia and general anesthesia have some advantages and drawbacks. Regarding to cerebral and myocardial ischemia and adverse outcome after CEA, especially in high risk patients, today still it is not clear which anesthesia technique is preferred for CEA. Greatest risk in the early postoperative period is new neurological deficit caused by cerebral ischemia end myocardial infarction caused with hemodynamic instability and therefore CEA patients are placed in the Intensive Care Unit for at least six or more hours where they are monitored for neurological and hemodynamic complications.

 

Key words: anesthesia, carotid endarterectomy

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Perioperative Cardiac Arrests

Abstract

Perioperative cardiac arrests represent the most serious complication of anesthesia and surgery. It is believed that the incidence and mortality of cardiac arrest has declined, however, a more recent review questioned whether these rates have changed over the last 5 decades. It is difficult to compare the reports from different epochs, because medical practice has advanced, surgical acuity increased, and patients in extremes of age undergo surgery today. In the present article we review the information regarding the incidence of perioperative cardiac arrests and predictors of survival covering the period since the first comprehensive report by Beecher and Todd in 1954. We focus on our publications that report perioperative cardiac arrest at Mayo Clinic for adult noncardiac surgery, during regional anesthesia, and arrests in our pediatric surgical practice.

Key words: anesthesia, cardiac arrest, mortality

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Anesthetic management in awake craniotomy

Abstract

Resection of brain tumors may cause neurological sequelae, according to the site and size of the brain tissue removed. Awake craniotomy has been proposed as a surgical approach to satisfy criteria of radical surgery while minimizing eloquent brain damage. The most critical aspect of awake craniotomy is to maintain adequate patient comfort, analgesia, immobility and cooperation during a long surgical operation, ensuring in the meanwhile the safety, control and maintenance of vital functions. Apart from pharmacological, surgical, technical knowledge and skillfulness, the ability to maintain close psycho-emotional
contact and support with the patient throughout the operation is a fundamental task that the anesthesiologist has to pursue for the operation to be successfully managed.
This review summarizes the current opinion on anesthetic management of patients undergoing awake craniotomy.

Key words: anesthesia, awake craniotomy, brain mapping, brain tumor, neuro-oncology

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