Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used. RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures. CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments. TRIAL REGISTRATION NUMBER: RoPR ID 43191.

[Lactic acidosis in a 24-year-old woman with status asthmaticus].

A 24-year-old woman with asthma presented with symptoms of upper airway infection and tachypnoea and wheezes. She had a history of admissions to intensive care units (ICU) due to respiratory insufficiency. The initial lactate concentration was 2.1 mmol/l. The treatment consisted of inhaled and intravenous ß ² agonists. Hereafter, the lactate concentration rose to 9.8 mmol/l, and the patient was admitted to the ICU due to severe asthma exacerbation. The elevation of lactate concentration cleared after discontinuation of ß ² agonist therapy. Although lactic acidosis is a rare side effect to ß ² agonist treatment, it is important to recog-nize it when present.

Nitrous oxide provides safe and effective analgesia for minor paediatric procedures--a systematic review.

INTRODUCTION: Pain and distress during minor hospital-related procedures is a familiar problem in many children. Inadequate relief of children's procedural pain and distress not only affects the experience of the children and their parents, but also adversely impacts procedural success. We aimed to review the safety and efficacy of nitrous oxide during brief, but painful paediatric procedures and to compare nitrous oxide with some of the commonly used pharmacological and non-pharmacological treatments for relieving anxiety and mild to moderate pain in Denmark. METHOD: We searched MEDLINE (PubMed) and the Cochrane Database of Systematic Reviews with the MeSH term nitrous oxide combined with midazolam, surgical procedures minor, analgesia or conscious sedation. The references in the articles acquired that were not found in the MEDLINE search were further investigated. Only articles written in English and published after 1980 were included to ensure optimal data collection. RESULTS: Nitrous oxide is an effective sedative/analgesic for mildly to moderately painful paediatric procedures. Furthermore, it is safely administrated, particularly for short procedures (< 15 min.). Serious and potentially serious adverse events are rare and occur in less than 0.5% of cases, while minor events typically occur amongst 4-8% of patients. CONCLUSION: Nitrous oxide is a safe and effective method to achieve analgesia and sedation during minor, but painful procedures. It can be safely administered by a dedicated staff member. This helpful method is still underused in Denmark, and we believe that it could be an alternative or the first choice of treatment in emergency and paediatric departments.