Respiratory depression following cesarean section with single-shot spinal with 100 µg morphine.

PURPOSE: Little evidence is available regarding bradypnea measured using continuous monitoring following cesarean section. We aimed to evaluate the rate of cumulative bradypnea time (total bradypnea time/total monitoring time) and its related factors in these parturients. METHODS: This prospective observational study included women undergoing cesarean section under single-shot spinal anesthesia of 0.1 mg morphine. The Berlin Questionnaire was used to screen for sleep apnea syndrome preoperatively. Respiratory rate and oxygen saturation (SpO2) were monitored continuously using an adhesive acoustic respiration sensor and pulse oximeter, respectively, at least 6 h after cesarean section. Bradypnea was defined as a respiratory rate < 8 breaths/min lasting at least 25 s (sustained bradypnea) or at least 15 s (immediate bradypnea). Hypoxemia was defined as SpO2 < 92% lasting at least 25 s (sustained hypoxemia) or at least 15 s (immediate hypoxemia). Multiple regression analysis was applied to assess factors related to the rate of cumulative sustained bradypnea. RESULTS: Of 159 patients, the Berlin Questionnaire was positive in 16.3%, and 77 (48.4%) experienced sustained bradypnea. The median rate of cumulative sustained bradypnea time was 0.70% (interquartile range 0.35-1.45%) without any related factors. The incidence of immediate bradypnea and sustained and immediate hypoxemia were 58.5%, 24.5%, and 37.7%, respectively. However, none of the factors were significant. CONCLUSION: After cesarean section was performed with 0.1 mg intrathecal morphine, respiratory depression events were commonly observed. However, the rate of cumulative bradypnea time was very low and there were no related factors.

Effects of a False Window on the Change of Cognitive Function in Patients Admitted to a Neurological Ward.

False windows can display a variety of outdoor scenery in rooms without real windows. We aimed to assess the effects of three different hospital beds on the change in the frontal assessment battery scores in patients aged ≥ 20-year-old admitted in our neurological ward. We included 24 patients on the window side, 12 patients on the aisle side with a false window, and 12 patients on the aisle side without a false window. There were no statistical differences in the change of cognitive function among the three hospital beds. Only the length of hospital stay was a significant associated factor.

Preoperative sleep disruption and postoperative functional disability in lung surgery patients: a prospective observational study.

PURPOSE: Our aims were to evaluate the prevalence of preoperative acute sleep disruption in the hospital and to assess perioperative sleep quality and the effects of acute sleep disruption on postoperative functional recovery in a surgical setting. METHODS: This prospective observational study included 24 patients aged ≥ 20 years who underwent video-assisted thoracoscopic surgical lobectomy for lung cancer under general anesthesia at a tertiary hospital in Japan between October 2016 and May 2017. Actigraphy was performed for 7 days in the hospital, including the night before surgery. We defined acute sleep disturbance as less than 85% preoperative sleep efficiency and analyzed its effect on postoperative functional disability using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and Mann-Whitney U testing. The perioperative change in sleep efficiency was compared using a Dunn analysis. A high score on the WHODAS 2.0 is indicative of impaired function. RESULTS: Nineteen (79.1%) patients had low sleep efficiency in the hospital prior to surgery. Three months after surgery, the 12-item WHODAS 2.0 score was higher in patients with acute sleep disturbance than in those without it (38.8 versus 33.3, p = 0.02, effect size 0.5). Sleep efficiency decreased significantly on the 5th postoperative day in patients with acute sleep disturbance. CONCLUSIONS: Our results showed a high prevalence of acute sleep disturbance. Patients with acute sleep disruption had low postoperative sleep efficiency and impaired functional ability three months after surgery.

Factors associated with anesthetic satisfaction after cesarean delivery under neuraxial anesthesia.

INTRODUCTION: Evaluating patient satisfaction with anesthesia is critical for improving their experiences. We investigated perioperative anesthetic satisfaction and associated predictive factors in patients receiving cesarean delivery under neuraxial anesthesia (spinal anesthesia only or combined spinal-epidural anesthesia). METHODS: This was an institutionally approved retrospective chart review of patients who received cesarean delivery under spinal anesthesia and postoperative evaluation administered by anesthesiologists from January 2009 to December 2013. Multiple pregnancies and patients reporting headache prior to cesarean delivery were excluded. Patients were divided into satisfied and not satisfied groups according to their scores from the 4-point Likert scale. Multivariate analysis was used to identify explanatory factors associated with satisfaction. RESULTS: Of 813 patients enrolled, 425 (52.2%) were classified as satisfied. Combined spinal-epidural anesthesia (CSEA) (odds ratio, 3.3; 95% confidence interval, 1.08-10.1) was positively associated with satisfaction. Paresthesia during needle insertion (odds ratio, 0.56; 95% confidence interval, 0.42-0.76), lightning pain during neuraxial anesthesia (odds ratio 0.62; 95% confidence interval, 0.39-0.98), failed block (odds ratio 0.28; 95% confidence interval, 0.09-0.87), and intraoperative use of antiemetic (odds ratio 0.71; 95% confidence interval, 0.53-0.94) were negatively associated with satisfaction. In the 792 patients receiving spinal anesthesia only, the same factors except for CSEA were associated with satisfaction. CONCLUSIONS: The addition of epidural to spinal anesthesia for cesarean delivery can increase patient satisfaction, whereas paresthesia during needle insertion, lightning pain, failed block, and the use of intraoperative antiemetic were major obstacles to patient satisfaction.