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Postanesthesia Care Unit (postanesthesia + care_unit)
Selected AbstractsDetecting postoperative urinary retention with an ultrasound scannerACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2002L. A. Rosseland Background: Retention of urine is a common postoperative problem associated with risk of overdistention and permanent detrusor damage. Prevention of urinary retention by insertion of indwelling catheter may increase the risk of urinary infection. We have performed a reliability test of an ultrasound scanner, implemented in the postoperative monitoring equipment. Methods: Patients were monitored after different types of surgery under spinal anesthesia with an ultrasound scanner in the postanesthesia care unit (PACU). Patients: Patients who according to current guidelines required a urinary bladder catheter, were scanned before a catheter was inserted and urine volume was measured. These two urine volumes were compared and analyzed for agreement. Results: Nineteen female and 17 male patients were included. The mean difference between ultrasound estimates and catheter urine volume measurements was ,,21.5 mL, and limits of agreement, calculated as a 95% confidence interval, were ,,147 and +,104 mL. This means that the urine volume estimated by ultrasound was on average 21.5 mL smaller than the urine volume when the bladder was emptied. Conclusion: This study confirms a good agreement between the ultrasound scanner estimates of urinary bladder volume and urine volume measured after emptying the bladder. Nurses in the PACU could operate the ultrasound scanner after a brief instruction and training period. Considering the potentially serious long-term consequences of undiagnosed postoperative urinary retention, introducing this equipment for routine monitoring of urinary bladder volume should be considered. [source] Emergence agitation after cataract surgery in children: a comparison of midazolam, propofol and ketaminePEDIATRIC ANESTHESIA, Issue 9 2010JIAYAO CHEN MD Summary Objectives:, The aim of this study was to determine whether the concurrent use of either of a subhypnotic dose of midazolam, propofol or ketamine with fentanyl just before discontinuing the sevoflurane anesthesia would effectively sedate the children as they recovered and significantly decrease the incidence and severity of emergence agitation and would not delay patient awakening and discharge. Background:, Postoperative emergence agitation may occur in children after general anesthesia with volatile anesthetics. Children who undergo cataract surgery after sevoflurane induction and sevoflurane,remifentanil maintenance may experience this type of agitation. Methods/Materials:, In 120 un-premedicated children aged 1,7 years, mask induction with sevoflurane was performed and they were then randomly assigned to one of the three antiagitation postoperative groups (n = 40). We studied the postoperative antiagitation effects of subhypnotic doses of midazolam combined with fentanyl, propofol with fentanyl or ketamine with fentanyl administered just before discontinuing the sevoflurane anesthesia. A score for the level of agitation can be assigned based on the recovery mental state (RMS) scale and the recently published pediatric anesthesia emergence delirium scale (PAED). Postoperative factors assessed included emergence behaviors, the time to eye opening, the time to discharge from the postanesthesia care unit (PACU) to the ward. Results:, There were significantly more agitated children in the ketamine-group when compared to the midazolam-group or to the propofol-group at all time P < 0.05), especially at 10 and 15 min. The PAED scale showed a significant advantage for midazolam,fentanyl [5 (2,15)] and propofol,fentanyl [6 (3,15)] versus ketamine,fentanyl [10 (3,20)] (P < 0.05). The time to discharge from the PACU to the ward was not significantly different among the groups. Conclusions:, Intravenous administration of a subhypnotic dose of midazolam or propofol in addition to a low dose of fentanyl just before discontinuing the sevoflurane anesthesia was both effective on decreasing the incidence and severity of emergence agitation in children undergoing cataract extraction without significant delaying recovery time and discharge. The effect of midazolam was clearer than that seen with propofol. [source] Effects of therapeutic suggestion in children undergoing general anesthesia: a randomized controlled trialPEDIATRIC ANESTHESIA, Issue 1 2010MICHELLE A. FORTIER PhD Summary Objectives and aim:, The goal of this randomized controlled trial was to examine the effect of intraoperative positive therapeutic suggestion on postoperative nausea and vomiting (PONV) in children undergoing general anesthesia and otolaryngological surgery. Background:, Because of the high incidence of PONV following otolaryngological surgery and its negative impact on recovery, researchers have examined various nonpharmacological interventions to target this phenomenon. To date, the effectiveness of therapeutic suggestion has not been studied in children. Methods:, Participants were 67 children undergoing tonsillectomy and adenoidectomy and their mothers. Children received a standardized anesthetic procedure and were randomly assigned to one of three interventions administered under general anesthesia: therapeutic suggestion, story (prosody control), or standard operating room noise. Children, parents, and healthcare personnel were blinded to group assignment. Nausea and vomiting were recorded in the postanesthesia care unit (PACU) and for the first 3 days at home. Results:, Results demonstrated a decrease in nausea severity across the first 3 days, F2,49 = 10.37, P < 0.001, but no group differences in nausea severity in the PACU (F2,49 = 0.87, P = 0.43) or at home (F2,49 = 0.80, P = 0.46). There were also no group differences in vomiting episodes in the PACU (,2 (2) = 1.25, P > 0.05) or at home (F2,49 = 1.59, P = 0.21). Conclusions:, In this blinded controlled trial, therapeutic suggestion delivered intraoperatively did not impact children's PONV. However, because this is the first study of this kind, replication may be needed. [source] The efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy,PEDIATRIC ANESTHESIA, Issue 3 2007DIDEM DAL MD Summary Background :,A few previous studies have suggested the efficacy of i.v. ketamine for postoperative pain relief in children after adenotonsillectomy, but none has investigated the efficacy of peritonsillar infiltration of ketamine in these children. Methods :,This randomized, placebo-controlled study evaluated the effects of peritonsillar infiltration of ketamine in children undergoing adenotonsillectomy. Ninety ASA I-II children were randomized three groups of 30 each. Group I received: 2 ml i.v. saline, group II received i.v. ketamine (0.5 mg·kg,1) and group III received a local peritonsillar infiltration of ketamine (0.5 mg·kg,1). All medications were 2 ml in volume which was applied 1 ml per tonsil 3 min prior to tonsillectomy. Modified Hannallah pain scale [observational pain scores (OPS)], nausea, vomiting, bleeding, rescue analgesia, sedation and Aldrete scores were recorded at first, 15th, 30th and 60th min postoperatively. Patients were interviewed on the day after surgery to assess the postoperative pain, nightmares, hallucinations, vomiting and bleeding. Results :,Group I had higher OPS scores than group II and group III. Group II and group III had comparable scores, which were not statistically significant (P > 0.05). Group II had higher sedation score at 15th min (P = 0.015). Thirty-two children, 19 of whom were in group I had rescue analgesia in postanesthesia care unit (P < 0.05) and the time to first analgesic requirement was significantly shorter in group I than the other groups (P = 0.006). Group II and group III also had less pain than group I at home (P = 0.023). Conclusions :,Low dose ketamine given i.v. or by peritonsillar infiltration perioperatively provides efficient pain relief without side-effects in children undergoing adenotonsillectomy. [source] The postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne's muscular dystrophy,PEDIATRIC ANESTHESIA, Issue 2 2006MICHAEL GIRSHIN MD Summary Anesthesia may be administered to patients with Duchenne's muscular dystrophy, but cases are reported in which apparently healthy children suffer hyperkalemic cardiac arrest. We present the case of a 5-year-old boy whose muscular dystrophy was discovered following a fatal, perioperative cardiac arrest in the postanesthesia care unit. [source] Postoperative shivering in children and causative factorsPEDIATRIC ANESTHESIA, Issue 12 2005AYNUR AKIN MD Summary Background:, The aim of this study is to investigate the incidence of shivering in children and to reveal the causative factors as well as any possible clinical implications. Methods:, This study was conducted on 1507 children who underwent surgery under general anesthesia. The patients were admitted to the postanesthesia care unit after the operation and their body temperatures measured from the tympanic membrane. The type of operation, operative time, method of anesthesia induction, age, and number of cases in which caudal block had been used were recorded. Results:, Of the 1507 children, 53 (3.5%) experienced shivering. The use of intravenous induction agents, age older than 6 years, and prolonged duration of surgery were associated with shivering. The type of the operation and gender had no effect. The frequency of shivering was lower in children who underwent caudal block with a statistical significance (P < 0.05). Conclusions:, The overall incidence of shivering in children is low (3.5%). Use of intravenous induction agents, age older than 6 years, and prolonged duration of surgery were associated with shivering; prophylaxis is not necessary in children, treatment is given only when shivering occurs. [source] | ||||||||||