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Recovery Room (recovery + room)
Selected AbstractsOutpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: Six-hour versus overnight observationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2004CHEE-KIN HUI Abstract Background and Aim:, The purpose of the present retrospective study was to compare the proportion of post-endoscopic retrograde cholangiopancreatography (ERCP) complications detected with 6-h observation followed by same-day discharge (SDD) versus overnight observation (OO) after therapeutic ERCP. Methods:, There were 134 outpatients in the SDD group and 178 outpatients in the OO group. The SDD group was discharged after a 6-h observation while the OO group was discharged after overnight observation. Patients in the SDD group were admitted from the recovery room for evaluation if they had systolic blood pressure (BP) < 100 mmHg, pulse > 100/min, temperature > 37.5°C, or post-procedure abdominal pain. The primary outcome of the present study was the proportion of post-ERCP complications detected within the observational period between the SDD group and the OO group. Results:, The post-ERCP complication rate of therapeutic ERCP in the SDD and OO groups were 9.7% and 9.6%, respectively (P = 0.964). Eleven patients (8.2%) in the SDD group and 13 patients (7.3%) in the OO group were found to have post-ERCP complications within the observation period. There was no significant difference in the proportion of post-ERCP complications detected within the observational period between the two groups (P = 0.672). Conclusion:, Outpatient therapeutic ERCP with observation of 6 h can detect the same proportion of patients with post-ERCP complications as overnight observation. © 2004 Blackwell Publishing Asia Pty Ltd [source] Does intraarticular morphine improve pain control with femoral nerve block after anterior cruciate ligament reconstruction? (Vanderbilt University Medical Center, Nashville, TN) American Journal of Sports Medicine 2001;29:327,332.PAIN PRACTICE, Issue 4 2001Eric C. McCarthy In a prospective, randomized, double-blinded manner, the authors of this study compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty-two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the 2 groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. A comparison of the visual analog pain scale scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block. No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc analysis revealed that the study power reached 87% with a significance level of 5%. Conclude that the postoperative femoral nerve block was effective and intraarticular morphine provided no additional benefit. Comment by Alan David Kaye, M.D., Ph.D., and Erin Bayer, M.D. This prospective, randomized, double blinded study compared the effects of preoperative intraarticular injection of morphine or a placebo along with postoperative femoral "three-in-one" block on postoperative pain. 62 patients underwent arthroscopic ACL reconstruction under general anesthesia. After induction of anesthesia, patients were injected with either morphine 5 mg or placebo along with local anesthetics intraarticularly. Femoral nerve blocks were performed in the recovery room with a total of 3 mg/kg bupivacaine. The VAS of pain was assessed immediately postoperatively and at six time points afterward up to 24 hours. This study concluded that there were no statistical differences between the two groups comparing VAS. Also no significant difference was observed in postoperative narcotic use in the recovery room or at home. The study included antiemetics; however, the results did not include if the morphine group had a larger incidence of nausea or vomiting postoperatively. Finally, the authors suggest that there are no advantages to use of intraarticular morphine with a femoral nerve block post-operatively. A future study employing preoperative femoral nerve block with or without use of intraarticular morphine might be interesting to see on arthroscopic ACL repairs to obtain adequate analgesia as the authors suggested. [source] Recovery characteristics of sevoflurane or halothane for day-case anaesthesia in children aged 1,3 yearsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2000H. Viitanen Background: Our objective was to compare the recovery characteristics of sevoflurane and halothane for short day-case anaesthesia in a specifically limited age group of children 1,3 yr. Methods: Eighty unpremedicated children undergoing day-case adenoidectomy were randomly assigned to receive inhalational induction with either sevoflurane 8% or halothane 5% and nitrous oxide in oxygen (70/30) via a face mask. Tracheal intubation was performed without a muscle relaxant. Anaesthesia was continued with the volatile anaesthetic, adjusted to maintain heart rate and blood pressure within ±20% of initial values. Recovery was evaluated using a modified Aldrete score, a Pain/Discomfort scale and by measuring recovery end-points. A postoperative questionnaire was used to determine the well-being of the child at home until 24 h after discharge. Results: Emergence and interaction occurred significantly earlier after sevoflurane than halothane but discharge times were similar. More children in the sevoflurane group achieved full Aldrete scores within the first 30 min after anaesthesia, although this group suffered more discomfort during the first 10 min. The amount of postoperative analgesic administered was higher and the first dose given earlier in the sevoflurane group. Postoperative vomiting was more common with halothane, but side-effects in the two groups were otherwise similar in the recovery room and at home. Conclusions: In children 1,3 yr, sevoflurane provided more rapid early recovery but not discharge after anaesthesia of <30-min duration. Apart from more vomiting with halothane and more discomfort during the first 10 min after awakening with sevoflurane, the quality of recovery was similar with the two anaesthestics. [source] Unilateral groin surgery in children: will the addition of an ultrasound-guided ilioinguinal nerve block enhance the duration of analgesia of a single-shot caudal block?PEDIATRIC ANESTHESIA, Issue 9 2009NARASIMHAN JAGANNATHAN MD Summary Background:, Inguinal hernia repair, hydrocelectomy, and orchidopexy are commonly performed surgical procedures in children. Postoperative pain control is usually provided with a single-shot caudal block. Blockade of the ilioinguinal nerve may lead to additional analgesia. The aim of this double-blind, randomized controlled trial was to evaluate the efficacy of an adjuvant blockade of the ilioinguinal nerve using ultrasound (US) guidance at the end of the procedure with local anesthetic vs normal saline and to explore the potential for prolongation of analgesia with decreased need for postoperative pain medication. Methods:, Fifty children ages 1,6 years scheduled for unilateral inguinal hernia repair, hydrocelectomy, orchidopexy, or orchiectomy were prospectively randomized into one of two groups: Group S that received an US-guided ilioinguinal nerve block with 0.1 ml·kg,1 of preservative-free normal saline and Group B that received an US-guided nerve block with 0.1 ml·kg,1 of 0.25% bupivacaine with 1 : 200 000 epinephrine at the conclusion of the surgery. After induction of anesthesia but prior to surgical incision, all patients received caudal anesthesia with 0.7 ml·kg,1 of 0.125% bupivacaine with 1 : 200 000 epinephrine. Patients were observed by a blinded observer for (i) pain scores using the Children and Infants Postoperative Pain Scale, (ii) need for rescue medication in the PACU, (iii) need for oral pain medications given by the parents at home. Results:, Forty-eight patients, consisting of 46 males and two females, with a mean age of 3.98 (sd ± 1.88) were enrolled in the study. Two patients were excluded from the study because of study protocol violation and/or alteration in surgical procedure. The average pain scores reported for the entire duration spent in the recovery room for the caudal and caudal/ilioinguinal block groups were 1.92 (sd ± 1.59) and 1.18 (sd ± 1.31), respectively. The average pain score difference was 0.72 (sd ± 0.58) and was statistically significant (P < 0.05). In addition, when examined by procedure type, it was found that the difference in the average pain scores between the caudal and caudal/ilioinguinal block groups was statistically significant for the inguinal hernia repair patients (P < 0.05) but not for the other groin surgery patients (P = 0.13). For all groin surgery patients, six of the 23 patients in the caudal group and eight of the 25 patients in the caudal/ilioinguinal block group required pain rescue medications throughout their entire hospital stay or at home (P = 0.76). Overall, the caudal group received an average of 0.54 (sd ± 1.14) pain rescue medication doses, while the caudal/ilioinguinal block group received an average of 0.77 (sd ± 1.70) pain rescue medication doses; this was, however, not statistically significant (P = 0.58). Conclusions:, The addition of an US-guided ilioinguinal nerve block to a single-shot caudal block decreases the severity of pain experienced by pediatric groin surgery patients. The decrease in pain scores were particularly pronounced in inguinal hernia repair patients. [source] Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bedPEDIATRIC ANESTHESIA, Issue 2 2009ELI HERSHMAN MD Summary Objective:, To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed. Design:, Case report. Setting:, A tertiary pediatric critical care unit. Patient:, A healthy 7-year-old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure. Interventions:, Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy. Conclusion:, In children, local anesthetic infiltration of the adenoid bed may cause life-threatening medullary injury and its routine use should be re-considered. [source] Life threatening subcutaneous emphysema following surgical repair of tracheocutaneous fistulaPEDIATRIC ANESTHESIA, Issue 4 2003Virender Kumar Mohan MD Summary A 9-year-old male child posted for closure of tracheocutaneous fistula developed extensive subcutaneous emphysema resulting in acute respiratory distress immediately after transfer to recovery room. The clinical management, precautions and other complications of closure of tracheocutaneous fistula are discussed. [source] Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesiaPEDIATRIC ANESTHESIA, Issue 5 2002JENNIFER W. COLE MD Background: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia. Methods: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5-point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery. Results: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying. Conclusions: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery. [source] Comparison of recovery after intermediate duration of anaesthesia with sevoflurane and isofluranePEDIATRIC ANESTHESIA, Issue 4 2001Pierre-Yves Le Berre MD Background:,The purpose of this study was to compare recovery from anaesthesia after sevoflurane and isoflurane were administered to children for more than 90 min. Methods:,After parental informed consent and ethical committee approval, children aged between 2 months and 6 years, ASA I or II, were randomly allocated to sevoflurane (n=20) or isoflurane (n=20) groups. Halogenated agents were discontinued following skin closure and patients were ventilated mechanically with 100% oxygen until minimum alveolar concentration (MAC) values awake were obtained (endtidal concentrations 0.6 MAC for sevoflurane and 0.4 MAC for isoflurane). Effective perioperative analgesia was provided by a caudal block. Results:,The mean (± SD) duration of anaesthesia was 132 ± 38 min and 139 ± 49 min for sevoflurane and isoflurane, respectively. Early recovery occurred sooner in the isoflurane group (time to extubation was 16 ± 7 min and 11 ± 5 min, P<0.01; Aldrete's score at 0 min was 5.5 ± 1.5 and 7.4 ± 1.8, P<0.001, respectively). But the time to be fit for discharge from recovery room was similar at 136 ± 18 min and 140 ± 20 min, respectively. Conclusions:,After intermediate duration of anaesthesia administered to children for up to 90 min, isoflurane and sevoflurane allow recovery after approximatively the same lapse of time. [source] Overnight Hospital Stay Is Not Always Necessary after Uvulopalatopharyngoplasty,THE LARYNGOSCOPE, Issue 1 2005FACS, Jeffrey H. Spiegel MD Abstract Objectives: To determine whether patients with obstructive sleep apnea who undergo uvulopalatopharyngoplasty (UPPP) have a significant incidence of postoperative complications that would justify overnight postoperative observation in the hospital. Study Design: Part 1: review of published medical literature to determine incidence of postoperative complications. Part 2: retrospective review of 117 patients undergoing UPPP with or without additional procedures. Methods: A literature search for existing studies describing the postoperative complications after UPPP for obstructive sleep apnea was conducted. After this, the records of 117 patients who had undergone UPPP at a university-based medical center during a 5-year span were reviewed. Results: Respiratory events occur in 2% to 11% of cases. These include airway obstruction (e.g., laryngospasm), postobstructive pulmonary edema (POPE), and desaturation. Airway obstruction occurred in the immediate postoperative setting. POPE was rare and usually occurred within minutes after the conclusion of the surgical procedure. Desaturation could occur at any time, but the severity was usually equivalent to that found on preoperative sleep study. Hemorrhage occurred in 2% to 14% of cases and had a biphasic incidence, occurring either immediately postoperatively or several days after surgery. Depending on definition, hypertension was observed in between 2% and 70% of patients postoperatively. This was most commonly diagnosed and treated in the immediate postoperative setting. In most reports, arrhythmia and angina occurred in less than 1% of cases. Conclusions: The majority of complications after UPPP with or without additional procedures occur within 1 to 2 hours after surgery. Postoperative oxygen desaturation is usually no worse than that that was observed on preoperative polysomnography findings. A 2 to 3 hour observation period may be suitable for patients after UPPP; if a patient experiences no complications and is maintaining adequate oxygenation and analgesia, same-day discharge from recovery room may be considered. [source] Monitoring of sympathetic tone to assess postoperative pain: skin conductance vs surgical stress indexANAESTHESIA, Issue 7 2009T. Ledowski Summary The number of fluctuations in skin conductance per second has been described as a potential tool for monitoring postoperative pain. More recently, the surgical stress index has shown promising correlations with intra-operative painful stimuli. We compared both methods for their ability to assess postoperative pain, in 100 postoperative patients who were also asked to quantify their level of pain at different time points in the recovery room. The number of fluctuations per second and surgical stress index were significantly different between pain scoring , 5/10 and > 5/10 on a numeric rating scale (mean (SE) number of fluctuations per second 0.12 (0.02) vs 0.21 (0.03), respectively; p = 0.017, and surgical stress index 57 (1.4) vs 64 (1.9) points, respectively; p = 0.001). Both number of fluctuations in skin conductance per second and surgical stress index identified timepoints with moderate to severe pain with only moderate sensitivity and specificity. [source] Pulse oximetry-induced third-degree burn in recovery roomANZ JOURNAL OF SURGERY, Issue 4 2009Hee Y. Kwak MD No abstract is available for this article. [source] Analysis of peripheral blood for prostate cells after autologous transfusion given during radical prostatectomyBJU INTERNATIONAL, Issue 3 2005John T. Stoffel OBJECTIVES To determine if cells expressing prostate-specific antigen (PSA) can be detected in blood collected by a cell-saver during radical prostatectomy (RP) or in the peripheral blood after intraoperative autotransfusion (IAT). PATIENTS AND METHODS In all, 112 men with clinical T1c,T2 prostate cancer undergoing RP were prospectively assessed. A cell-saver system was used in each to collect blood from the surgical field after prostate manipulation. IAT was given based on clinical indications. Standardized peripheral blood samples were collected from patients before RP, in the recovery room afterward, and at 3,5 weeks after surgery. A reverse-transcriptase-polymerase chain reaction assay for PSA mRNA was used to detect prostate cells in cell-saver and peripheral blood samples. Patients were followed after surgery with PSA measurements to assess biochemical failure. RESULTS PSA-expressing cells were detected in 88% of cell-saver reservoir and 13% of preoperative blood samples. No PSA-expressing prostate cells were detected in any peripheral blood samples collected 3,5 weeks after surgery. Analysis of data with 40 months of follow-up showed IAT was not an independent predictor of biochemical failure in multivariate analysis. CONCLUSIONS Although IAT blood contains PSA-expressing cells, none could be detected 3,5 weeks after surgery. IAT during RP was not associated with a greater risk of biochemical failure. [source] | ||||||||||