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INTRODUCTION: Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status. AIM: To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques. MATERIALS AND METHODS: Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden. RESULTS: In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3-5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9-2.3, p < 0.001). CONCLUSIONS: All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.
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Artroplastia de Quadril , Fraturas do Quadril , Osteoartrite do Quadril , Sistema de Registros , Humanos , Artroplastia de Quadril/mortalidade , Suécia/epidemiologia , Idoso , Feminino , Masculino , Idoso de 80 Anos ou mais , Fraturas do Quadril/cirurgia , Fraturas do Quadril/mortalidade , Osteoartrite do Quadril/cirurgia , Osteoartrite do Quadril/mortalidade , Pessoa de Meia-Idade , Fatores Etários , Estudos de Coortes , Fatores de TempoRESUMO
OBJECTIVE: To investigate how levels of the soluble urokinase plasminogen activator receptor (suPAR) and erythrocyte sedimentation rate (ESR) correlate with disease activity and prognosis in pulmonary tuberculosis (PTB).DESIGN: This was a retrospective analysis of patients with active PTB (n = 500) in Gondar, Ethiopia, for whom the suPAR (n = 301) and ESR (n = 330) were analysed at the start of treatment. Both biomarkers were available for 176 patients. Human immunodeficiency virus (HIV) status, chest X-ray (CXR) findings, classification according to the clinical TBscore and treatment outcome were all recorded.RESULTS: In a multivariable logistic regression analysis adjusted for age, sex and HIV status, surrogate markers of disease activity such as advanced CXR patterns correlated with increased levels of suPAR (adjusted OR [aOR] 8.24, P < 0.001) and of ESR (aOR 1.63, P = 0.030), whereas ESR only correlated significantly with a TBscore >6 points. Increased levels of both suPAR and ESR were associated with unsuccessful treatment outcomes (aOR 2.93, P = 0.013; aOR 2.52, P = 0.025). The highest quartile of suPAR (aOR 13.3, P = 0.029) but not ESR levels correlated independently with increased mortality.CONCLUSION: SuPAR and ESR levels correlate with disease activity in PTB; however, the clinical role of these potentially prognostic biomarkers needs to be verified in prospective studies.
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Sedimentação Sanguínea , Receptores de Ativador de Plasminogênio Tipo Uroquinase/sangue , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/mortalidade , Adolescente , Adulto , Antituberculosos/uso terapêutico , Biomarcadores/sangue , Etiópia/epidemiologia , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Prognóstico , Radiografia Torácica , Estudos Retrospectivos , Índice de Gravidade de Doença , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/tratamento farmacológico , Adulto JovemRESUMO
BACKGROUND: The diagnosis of chronic obstructive pulmonary disease (COPD) is often based on spirometry, which is not sensitive to early emphysema. We have recently described a method for assessing distal airspace dimensions by measuring recovery of nanoparticles in exhaled air after a single-breath inhalation followed by breath-hold. Recovery refers to the non-deposited particle fraction. The aim of this study was to explore differences in the recovery of exhaled nanoparticles in subjects with COPD and never-smoking controls. A secondary aim was to determine whether recovery correlates with the extent of emphysema. METHOD: A total of 19 patients with COPD and 19 controls underwent three repeats of single-breath nanoparticle inhalation followed by breath-hold. Particle concentrations in the inhaled aerosol, and in an alveolar sample exhaled after breath-hold, were measured to obtain recovery. FINDINGS: The patients with COPD had a significantly higher mean recovery than controls, 0·128 ± 0·063 versus 0·074 ± 0·058; P = 0·010. Also, recovery correlated significantly with computed tomography (CT) densitometry variables (P<0·01) and diffusing capacity for carbon monoxide (DL,CO ; P = 0·002). INTERPRETATION: Higher recovery for emphysema patients, relative to controls, is explained by larger diffusion distances in enlarged distal airspaces. The nanoparticle inhalation method shows potential to be developed towards a tool to diagnose emphysema.
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AIM: To evaluate three types of ventilation systems for operating rooms with respect to air cleanliness [in colony-forming units (cfu/m3)], energy consumption and comfort of working environment (noise and draught) as reported by surgical team members. METHODS: Two commonly used ventilation systems, vertical laminar airflow (LAF) and turbulent mixed airflow (TMA), were compared with a newly developed ventilation technique, temperature-controlled airflow (TcAF). The cfu concentrations were measured at three locations in an operating room during 45 orthopaedic procedures: close to the wound (<40cm), at the instrument table and peripherally in the room. The operating team evaluated the comfort of the working environment by answering a questionnaire. FINDINGS: LAF and TcAF, but not TMA, resulted in less than 10cfu/m3 at all measurement locations in the room during surgery. Median values of cfu/m3 close to the wound (250 samples) were 0 for LAF, 1 for TcAF and 10 for TMA. Peripherally in the room, the cfu concentrations were lowest for TcAF. The cfu concentrations did not scale proportionally with airflow rates. Compared with LAF, the power consumption of TcAF was 28% lower and there was significantly less disturbance from noise and draught. CONCLUSION: TcAF and LAF remove bacteria more efficiently from the air than TMA, especially close to the wound and at the instrument table. Like LAF, the new TcAF ventilation system maintained very low levels of cfu in the air, but TcAF used substantially less energy and provided a more comfortable working environment than LAF. This enables energy savings with preserved air quality.
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Ambiente Controlado , Salas Cirúrgicas , Temperatura , Ventilação/métodos , Microbiologia do Ar , Poluição do Ar em Ambientes Fechados , Contagem de Colônia Microbiana , Humanos , Satisfação Pessoal , Inquéritos e QuestionáriosRESUMO
Background: We have previously reported that stroke volume is reduced in a majority of elderly patients undergoing surgical repair of hip fracture before and after intrathecal injection of anaesthetic. We aimed to investigate these observations further in a prospective study of elderly patients undergoing elective hip or knee arthroplasty under spinal anaesthesia. Methods: Patients ≥65 yr undergoing elective arthroplasty were monitored with LiDCOplus™ preoperatively (baseline), before and continuously for 45 min after spinal anaesthesia. Postspinal hypotension was defined as systolic blood pressure (bp) < 100 mm Hg or > 30% decrease from baseline. Associations between post-spinal hypotension and haemodynamic changes before (i.e. between baseline and before injection) spinal anaesthesia were analysed by logistic regression analysis. Results: Twenty patients with a mean age of 74 (range 66-89) yr were included. Stroke volume index decreased by 14% (95% CI 9.3%-19%) before spinal anaesthesia. When patients were categorised according to post-spinal hypotension (Y/N) the patterns of haemodynamic changes differed. In the hypotensive patients, cardiac index progressively decreased whereas it increased initially in the non-hypotensive patients. Reduction of cardiac index from baseline before spinal anaesthesia was associated with increased risk of hypotension: OR 0.79 (95% CI 0.60, 0.91). The predictive value of reduced cardiac index was good (AUC under ROC curve 0.91). Conclusions: A decrease in cardiac output from baseline before spinal anaesthesia and an inability to increase it after induction may be important features of postspinal hypotension in elderly patients.
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Raquianestesia/efeitos adversos , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Débito Cardíaco/efeitos dos fármacos , Hipotensão/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Masculino , Estudos ProspectivosRESUMO
BACKGROUND: High frequency jet ventilation (HFJV) is a method of ventilation that has gained renewed interest over the recent years as it can reduce organ movement to near static conditions, thus enhancing surgical precision in minimal invasive procedures, for example, ablation procedures for atrial fibrillation and solid organ tumours. The aim of this review was to create a summary of the current evidence concerning the clinical use of HFJV for ablative procedures. METHOD: PubMed was searched for the key words high frequency ventilation and ablation January 1990-December 2016. RESULT: The search initially identified 34 papers, 14 met the inclusion criteria. Articles in other languages than English (n = 1), comments regarding other articles (n = 4) and articles that did not include HFJV or ablative procedures (n = 15) were excluded. Two articles were added from references in papers included from the primary search. Sixteen studies were finally included in the review; four updates/reviews and 12 papers with results from studies of HFJV on humans, with a total of 889 patients; 498 patients ventilated with HFJV and 391 controls. There were no randomised studies. The overall scientific quality of the studies was low. CONCLUSION: There is a lack of well-designed studies evaluating HFJV during ablation procedures. The available information, while sparse, supports the effect of less tissue movement, resulting in better surgical precision and outcome; such as shorter procedural time, fewer shock waves (ESWL) and less recurrence of atrial fibrillation. Randomised controlled studies are needed in this promising area of research to prove its superiority to standard ventilation.
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Técnicas de Ablação/métodos , Ventilação em Jatos de Alta Frequência/métodos , Humanos , Cuidados Intraoperatórios , Movimento , PubMedRESUMO
Predictors for postoperative recovery after colorectal cancer surgery are usually investigated in relation to length of stay (LoS), readmission, or 30-day morbidity. This study describes patient characteristics and surgery-related factors associated with patient-reported recovery 1 and 6 months after surgery. In total, 153 consecutively included patients who were recovering from colorectal cancer surgery reported their level of recovery using the Postoperative Recovery Profile. Multiple logistic regression analysis was used to calculate associations with recovery, defined as good or poor, divided into five recovery dimensions: physical symptoms, physical functions, psychological, social and activity. Better preoperative health predicted good recovery regarding three dimensions 1 month after surgery. Regarding all dimensions 1 month after surgery, poor recovery was predicted by a poor recovery on the day of discharge within corresponding dimensions. Higher age was associated with good recovery 6 months after surgery, while chemotherapy showed negative associations. Overall, a majority of factors had a negative impact on recovery, but without any obvious relation to one specific dimension or point in time. Those factors were: high Body Mass Index, comorbidity, abdominoperineal resection, loop ileostomy, colostomy and LoS. This study illustrates the complexity of postoperative recovery and a need for individualised follow-up strategies.
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Neoplasias Colorretais/cirurgia , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Colectomia , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/psicologia , Colostomia , Comorbidade , Convalescença , Feminino , Humanos , Ileostomia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Recuperação de Função FisiológicaRESUMO
INTRODUCTION: Epidural analgesia is commonly used for management of pain during childbirth. Need for emergent Caesarean section e.g. because of signs of foetal distress or lack of progress is however not an uncommon event. In females having an established epidural; general anaesthesia, top-up of the epidural or putting a spinal are all possible options. Dosing of the spinal anaesthesia in females having epidural is a matter of discussion. PRESENTATION OF CASE: We describe a healthy 32 years, 0 para mother in gestation week 36 having labour epidural analgesia but due to foetal distress scheduled for an emergent Caesarean section category 2 that developed upper extremity weakness and respiratory depression after administration of standard dose high density bupivacaine/morphine/fentanyl intrathecal anaesthesia. She was emergent intubated and resumed motor function after 15-20min. DISCUSSION: A too extensive cephalic spread was the most plausible explanation to the event. Whether or not reducing the dose for a spinal anaesthesia in mothers having an established labour epidural analgesia is a matter of discussion. It is of course of importance to achieve a rapid and effective surgical anaesthesia but also avoiding overdosing with the risk for a too high cephalic spread. CONCLUIOSN: To perform spinal anaesthesia for emergent Caesarean in patients having an epidural for labour pain is a feasible option and should be considered in category 2-3 section. The dose for a convert spinal block should be assessed on an individual basis and reasonably reduced.
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Available general and local anaesthetics, third generation inhaled anaesthetics, propofol and amide class local anaesthetics are effective and reassuringly safe. They are all associated to low incidence of toxicology and or adverse-effects. There is however a debate whether anaesthetic drug and technique could exhibit effects beyond the primary effects; fully reversible depression of the central nervous system, dose dependent anaesthesia. Anaesthetics may be involved in the progression of neurocognitive side effects seen especially in the elderly after major surgery, so called Postoperative Cognitive Dysfunction. On the other hand anaesthetics may exhibit organ protective potential, reducing ischemia reperfusion injury and improving survival after cardiac surgery. Anaesthetics and anaesthetic technique may also have effects of cancer reoccurrence and risk for metastasis. The present paper provides an update around the evidence base around anaesthesia potential contributing effect on the occurrence of postoperative cognitive adverse-effects, organ protective properties and influence on cancer re-occurrence/metastasis.
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Analgésicos/farmacologia , Anestésicos/farmacologia , Transtornos Cognitivos/induzido quimicamente , Recidiva Local de Neoplasia/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Anestesia/efeitos adversos , Humanos , Complicações Pós-Operatórias/induzido quimicamente , Substâncias Protetoras/farmacologiaRESUMO
Although evidence for mitochondrial dysfunction in the pathogenesis of bipolar disorder (BD) has been reported, the precise biological basis remains unknown, hampering the search for novel biomarkers. In this study, we performed metabolomics of cerebrospinal fluid (CSF) from male BD patients (n=54) and age-matched male healthy controls (n=40). Subsequently, post-mortem brain analyses, genetic analyses, metabolomics of CSF samples from rats treated with lithium or valproic acid were also performed. After multivariate logistic regression, isocitric acid (isocitrate) levels were significantly higher in the CSF from BD patients than healthy controls. Furthermore, gene expression of two subtypes (IDH3A and IDH3B) of isocitrate dehydrogenase (IDH) in the dorsolateral prefrontal cortex from BD patients was significantly lower than that of controls, although the expression of other genes including, aconitase (ACO1, ACO2), IDH1, IDH2 and IDH3G, were not altered. Moreover, protein expression of IDH3A in the cerebellum from BD patients was higher than that of controls. Genetic analyses showed that IDH genes (IDH1, IDH2, IDH3A, IDH3B) and ACO genes (ACO1, ACO2) were not associated with BD. Chronic (4 weeks) treatment with lithium or valproic acid in rats did not alter CSF levels of isocitrate, and mRNA levels of Idh3a, Idh3b, Aco1 and Aco2 genes in the rat brain. These findings suggest that abnormality in the metabolism of isocitrate by IDH3A in the mitochondria plays a key role in the pathogenesis of BD, supporting the mitochondrial dysfunction hypothesis of BD. Therefore, IDH3 in the citric acid cycle could potentially be a novel therapeutic target for BD.
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Transtorno Bipolar/metabolismo , Isocitrato Desidrogenase/metabolismo , Adulto , Animais , Transtorno Bipolar/líquido cefalorraquidiano , Encéfalo/metabolismo , Expressão Gênica/genética , Humanos , Isocitrato Desidrogenase/líquido cefalorraquidiano , Isocitratos/metabolismo , Masculino , Metabolômica/métodos , Mitocôndrias/metabolismo , RatosRESUMO
BACKGROUND: Post-Operative Quality of Recovery Scale (PQRS) has been revised to allow for the normal variation in cognitive performance seen in healthy volunteers. This modification could result in exclusion of test subjects because of poor baseline performance. Our aim was to investigate the impact of severe disease and waiting for cancer surgery on PQRS baseline cognitive performance and exclusion rate, and also on variation in cognitive performance at test re-test. METHODS: Sixty-one subjects, 31 women diagnosed with breast cancer and waiting for surgery and 30 healthy women, performed the PQRS cognitive, nociceptive and emotional domains three times in 48 h. Exclusion rate, change in score and the proportion fulfilling 'recovery' criteria at re-tests were assessed. RESULTS: Nine out of 31 patients (29%) and two out of 30 controls (7%) had too low baseline score to be further assessed (P = 0.043). The change in score at re-tests was similar between the groups. Sixty-four per cent and 83% at 20 h and 79% and 86% at 48 h in the patient and control groups respectively fulfilled the 'recovery' criteria (P = 0.45). The 'recovery' for nociceptive and emotional distress was similar between the groups, but anxiety and sadness absolute scores were significantly higher in the patient group. CONCLUSION: Women with breast cancer waiting for surgery expressed a higher level of emotional distress, performed lower at baseline but showed no difference in test re-test variability in cognitive performance according to the PQRS when compared with controls. The considerable exclusion rate among patients waiting for cancer surgery should be acknowledged.
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Neoplasias da Mama/psicologia , Cognição , Emoções , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
UNLABELLED: Postoperative nausea and vomiting (PONV) still represents one of the most distressing side effects of anaesthesia and surgery. Clinical risk scores e.g. Apfel score is today commonly used to identify patients at risk. We found in a previous study different platelet counts in patients with and without PONV. The aim of the present explorative study was to assess whether females experiencing PONV after breast surgery had any difference in preoperative platelet count and/or volume assessed by platelet testing. METHODS: All women scheduled for elective breast cancer surgery at Danderyds Hospital, Stockholm, Sweden, during one year were asked to participate in this study. Occurrence of PONV during the 24 first postoperative hours was studied. Blood samples collected preoperatively were analysed by platelet counts determined by impedance (PTLi) and optical (PTLo) methods, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). Platelet data were compared between patients with and without PONV. RESULTS: In all 183 patients were included in the study, 65 (35%) suffered from PONV, increasing incidence with increased risk score 4 out 5 with 4 risk factors. Mean platelet count was 266 [114-538], mean platelet volume 8.59 [5.94-12.1] and mean platelet weight 16.17 [14.2-25.9] but no differences in any platelet test variables studied were found between patients with or without PONV or with increasing risk factors. CONCLUSION: One third of patients' experienced PONV, increased incidence associated to Apfel score but platelet numbers and simple platelet test provided no additional information around risk for PONV.
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Neoplasias da Mama/sangue , Náusea e Vômito Pós-Operatórios/diagnóstico , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Humanos , Incidência , Volume Plaquetário Médio , Contagem de Plaquetas , Período Pré-Operatório , Estudos Prospectivos , Fatores de RiscoRESUMO
This literature review provides an overview of ten studies which assessed the patient's general recovery after discharge from hospital following elective surgery and anaesthesia. Ten multi-dimensional tools were identified and these included six common domain assessments: pain, physiological function, activities of daily living (ADL), emotions, nausea/vomiting and nutrition/elimination. Most of the tools assessed the recovery process by using patient-subjective reported outcomes on visual analogue (VAS) or pre-graded scales.
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Procedimentos Cirúrgicos Ambulatórios , Alta do Paciente , HumanosRESUMO
BACKGROUND: The impact of anaesthetic agents on cognitive recovery during the first post-operative week in a middle-aged population undergoing general anaesthesia is insufficiently studied. We hypothesised that patients receiving anaesthesia based on desflurane would have a quicker recovery and regain cognitive capacity faster than patients receiving anaesthesia based on propofol. METHODS: We performed a prospective, randomised, single-blinded study comparing the effects of desflurane and propofol as primary anaesthetic agents on cognitive recovery in 59 American Society of Anesthesiologists Physical Status Classification System I-II women undergoing breast surgery. Cognitive recovery was evaluated using the Cognitive Failure Questionnaire and a modified version of the Post-operative Quality of Recovery Scale. RESULTS: Post-operative cognitive recovery according to Cognitive Failure Questionnaire was 65% and 66% at 72 h, and 71% and 72% at 1 week for the desflurane and the propofol groups, respectively. Recovery according to Post-operative Quality of Recovery Scale was 52% and 50% at 2 h, increasing to 71% and 87% at 48 h for the desflurane and the propofol groups, respectively. At the final point of measurement (Cognitive Failure Questionnaire 1 week, Post-operative Quality of Recovery Scale 48 h), many of the patients had still not reached their baseline cognitive performance. There was no difference in overall cognitive recovery between the desflurane and propofol groups. CONCLUSION: Cognitive recovery was not complete 1 week after surgery in any of the groups. There was no difference in the rate of cognitive recovery in middle-aged patients receiving desflurane or propofol anaesthesia during ambulatory breast surgery.
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Procedimentos Cirúrgicos Ambulatórios , Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Cognição/efeitos dos fármacos , Isoflurano/análogos & derivados , Propofol/farmacologia , Adulto , Idoso , Anestesia Geral/métodos , Desflurano , Feminino , Humanos , Isoflurano/farmacologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Método Simples-Cego , Adulto JovemRESUMO
To date, postoperative quality of recovery lacks a universally accepted definition and assessment technique. Current quality of recovery assessment tools vary in their development, breadth of assessment, validation, use of continuous vs dichotomous outcomes and focus on individual vs group recovery. They have progressed from identifying pure restitution of physiological parameters to multidimensional assessments of postoperative function and patient-focused outcomes. This review focuses on the progression of these tools towards an as yet unreached ideal that would provide multidimensional assessment of recovery over time at the individual and group level. A literature search identified 11 unique recovery assessment tools. The Postoperative Quality of Recovery Scale assesses recovery in multiple domains, including physiological, nociceptive, emotive, activities of daily living, cognition and patient satisfaction. It addresses recovery over time and compares individual patient data with base line, thus describing resumption of capacities and is an acceptable method for identification of individual patient recovery.
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Atividades Cotidianas , Período de Recuperação da Anestesia , Período Pós-Operatório , Recuperação de Função Fisiológica , Cognição , HumanosRESUMO
Multimodal pain management, combining analgesics with different mode of action in order to minimize occurrence of side-effects still providing safe and efficacious pain management after ambulatory surgery has become standard of care. The combined use of local anaesthesia in order to reduce noxious influx during the procedure and reduce postoperative pain is strongly recommended whenever feasible. Providing oral analgesics paracetamol, and none-steroid anti-inflammatory drugs or selective Cox-II-inhibitors already prior to induction in order to provide effective therapeutic concentrations at end of surgery is a simple and easy way to facilitate the recovery. Single iv. preoperative dose dexamethasone has been shown not only to be effective in reducing postoperative nausea and vomiting but also to improve recovery reduce pain and improve satisfaction. Pregabalin may be used in order to further enhance the recovery and pain management.
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Procedimentos Cirúrgicos Ambulatórios/métodos , Analgésicos não Narcóticos/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Analgésicos não Narcóticos/efeitos adversos , Anestesia por Condução , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , HumanosAssuntos
Satisfação do Paciente , Cuidados Pré-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Relações Profissional-Paciente , Inquéritos e QuestionáriosAssuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia/métodos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Anestésicos , Artroscopia , Traumatismos em Atletas/cirurgia , Austrália , Mama/cirurgia , Canadá , Colecistectomia Laparoscópica , Europa (Continente) , Feminino , Humanos , Masculino , Meniscos Tibiais/cirurgia , Entorpecentes , Corrida/lesões , Inquéritos e Questionários , Lesões do Menisco Tibial , Estados UnidosRESUMO
BACKGROUND: Spinal anesthesia with different doses of intrathecal morphine has been shown to relieve post-operative pain. We studied in a prospective randomized, double-blind fashion the effects of morphine 0, 100, 200, or 300 µg added to intrathecal bupivacaine on first post-operative 24 h patient-controlled analgesia morphine (PCA-morphine) consumption after abdominal hysterectomy under general anesthesia. METHODS: One hundred and forty-four American Society of Anesthesiologists I-II women were assigned to receive spinal anesthesia with 12 mg of hyperbaric bupivacaine combined with 100, 200, and 300 µg morphine or saline before standardized general anesthesia was induced. Low transverse incision abdominal hysterectomy was performed. Post-operative outcome measures were recorded at 1, 2, 4, 6, 12, and 24 h. Primary outcome was 24 h PCA-morphine. Secondary outcomes were pain by visual analogue scale (0-10), nausea, pruritus, sedation, and respiratory depression. RESULTS: Intrathecal morphine reduced accumulated 24 h post-operative morphine consumption. Morphine 100 µg significantly reduced morphine consumption vs. placebo at 0-6 h, 6-12 h, and for the entire 0-24 h time interval post-operation. Morphine 200 µg further significantly reduced morphine consumption vs. morphine 100 µg at 0-6 h and for the entire 0-24 h post-operation. There was no further reduction of morphine consumption seen with morphine 300 µg. No serious side effects were seen. Emesis was similar in all groups, and pruritus was experienced only in the morphine groups. CONCLUSION: Intrathecal morphine supplementation to bupivacaine reduces first 24 h PCA-morphine consumption after abdominal hysterectomy under general anesthesia, and we found no benefit from increasing the dose over 200 µg.