The Effectiveness of Capnography Versus Pulse Oximetry in Detecting Respiratory Adverse Events in the Postanesthesia Care Unit (PACU): A Narrative Review and Synthesis

Neurocognitive adverse events have been observed with the widespread use of 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors or “statins,” which reduce low-density lipoprotein cholesterol (LDL-C) levels and subsequently cardiovascular risk. The United States Food and Drug Association directed manufacturers of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors to monitor for neurocognitive adverse events due to their potent effects on LDL-C reduction, which is a proposed mechanism for neuronal cell dysfunction. Other proposed mechanisms for PCSK9 inhibitor-associated neurocognitive adverse events include N-methyl-d-aspartate receptor modulation, dysregulation of lipid and glucose metabolism, and patient-specific risk factors for cognitive impairment. The purpose of this narrative review article is to describe the proposed mechanisms, incidence of neurocognitive adverse events from phase II and III trials for PCSK9 inhibitors, neurocognitive assessments utilized in clinical trials, and clinical implications. Given the increasing prevalence of PCSK9 inhibitor use and the neurocognitive adverse events observed with prior lipid-lowering therapies, clinicians should be aware of the risks associated with PCSK9 inhibitors, especially when therapy is indicated for patients at high risk for cardiovascular events. Overall, the incidence of PCSK9 inhibitor-associated neurocognitive appears to be uncommon. However, additional prospective studies evaluating cognitive impairment may be beneficial to determine the long-term safety of these agents.

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Managing adverse events after endoscopic ultrasound‐guided (EUS) drainage of the biliary tract and pancreatic fluid collections: a narrative review (with video)

Digestive Endoscopy ◽

10.1111/den.14080 ◽

2021 ◽

Author(s):

Mateus Pereira Funari ◽

Igor Braga Ribeiro ◽

Marcos Eduardo Lera dos Santos ◽

Sergio Eiji Matuguma ◽

Eduardo Guimarães Hourneaux de Moura

Keyword(s):

Adverse Events ◽

Biliary Tract ◽

Endoscopic Ultrasound ◽

Narrative Review ◽

Ultrasound Guided ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Fluid Collections

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SGLT2 inhibitors: a narrative review of efficacy and safety

Journal of Osteopathic Medicine ◽

10.1515/jom-2020-0153 ◽

2021 ◽

Vol 121 (2) ◽

pp. 229-239

Author(s):

Donald S. Nelinson ◽

Jose M. Sosa ◽

Robert J. Chilton

Keyword(s):

Adverse Events ◽

Sglt2 Inhibitor ◽

Sglt2 Inhibitors ◽

Narrative Review ◽

Atherosclerotic Cardiovascular Disease ◽

Comorbid Conditions ◽

Postprandial Plasma Glucose ◽

Renal Outcomes ◽

Glucose Levels ◽

Wide Range

Abstract Type 2 diabetes mellitus (T2DM) is a cardio-renal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). The sodium-glucose co-transporter-2 (SGLT2) inhibitors, which lower glycated hemoglobin, fasting and postprandial plasma glucose levels, body weight, and blood pressure, as well as reduce the risk of a range of cardiovascular and renal outcomes without increasing hypoglycaemic risk, have heralded a paradigm shift in the management of T2DM. These drugs are compatible with most other glucose-lowering agents and can be used in patients with a wide range of comorbid conditions, including ASCVD, HF, and CKD, and in those with estimated glomerular filtration rates as low as 30 mL/min/1.73 m2. However, there are misunderstandings surrounding the clinical implications of SGLT2 inhibitors’ mechanism of action and concerns about the key adverse events with which this class of drugs has been associated. This narrative review summarizes the data that support the efficacy of SGLT2 inhibitors in reducing the risks of cardiovascular and renal outcomes in patients with T2DM and comorbid conditions and clarifies information relating to SGLT2 inhibitor-related adverse events.

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False Alarms and Sensitivity of Conventional Pulse Oximetry Versus the Masimo SET™ Technology in the Pediatric Postanesthesia Care Unit

Anesthesia & Analgesia ◽

10.1097/00000539-200006000-00013 ◽

2000 ◽

Vol 90 (6) ◽

pp. 1336-1340 ◽

Cited By ~ 30

Author(s):

Shobha Malviya ◽

Paul I. Reynolds ◽

Terri Voepel-Lewis ◽

Monica Siewert ◽

David Watson ◽

...

Keyword(s):

Pulse Oximetry ◽

Postanesthesia Care Unit ◽

False Alarms

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The Incidence of Low Saturation by Pulse Oximetry in the Postanesthesia Care Unit

Korean Journal of Anesthesiology ◽

10.4097/kjae.2005.49.3.360 ◽

2005 ◽

Vol 49 (3) ◽

pp. 360

Author(s):

Mi Kyeong Kim ◽

Ji Young Kim ◽

Bon Nyeo Koo ◽

Kwang Yeon Cho ◽

Yang Sik Shin

Keyword(s):

Pulse Oximetry ◽

Postanesthesia Care Unit

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Preoperative nutritional factors and outcomes after radical cystectomy: A narrative review

Canadian Urological Association Journal ◽

10.5489/cuaj.4471 ◽

2017 ◽

Vol 11 (12) ◽

pp. 419-24

Author(s):

Janie Allaire ◽

Tal Ben-Zvi ◽

Benoît Lamarche ◽

Karine Robitaille ◽

Yves Fradet ◽

...

Keyword(s):

Venous Thromboembolism ◽

Adverse Events ◽

Nutritional Status ◽

Radical Cystectomy ◽

Mortality Risk ◽

Prospective Studies ◽

Intervention Studies ◽

Narrative Review ◽

Nutritional Factors ◽

The Impact

Only a few nutritional factors have been identified to predict the risk of developing complications after radical cystectomy (RC). This narrative review delineates the current known effects of preoperative nutritional status factors in this context. The report highlights the heterogeneity between study methods and results. We determined that low albuminemia values increase mortality risk and overall complications. In addition, obesity tends to increase the risk of developing venous thromboembolism and adverse events. Additional prospective studies, using standardized methods to both define and report complications, should be conducted to strengthen the connections between preoperative nutritional status factors and post-RC complications. Furthermore, intervention studies testing the impact of strategies to improve nutritional status on the risk of complications after RC are also needed.

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Quality and Safety Improvement in Spine Surgery

Global Spine Journal ◽

10.1177/2192568219839699 ◽

2020 ◽

Vol 10 (1_suppl) ◽

pp. 17S-28S

Author(s):

Fan Jiang ◽

Jamie R. F. Wilson ◽

Jetan H. Badhiwala ◽

Carlo Santaguida ◽

Michael H. Weber ◽

...

Keyword(s):

Adverse Events ◽

Spine Surgery ◽

Practice Guidelines ◽

Prediction Models ◽

Narrative Review ◽

Quality And Safety ◽

Ovid Medline ◽

Modern Health Care ◽

Safety Improvement ◽

Modern Era

Study Design: Review article. Objectives: A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. Methods: A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. Results: Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. Conclusion: Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.

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Patient Monitoring

Anesthesia Outside of the Operating Room ◽

10.1093/med/9780195396676.003.0003 ◽

2011 ◽

pp. 20-27

Author(s):

Samuel M. Galvagno Jr ◽

Bhavani Kodali

Keyword(s):

Adverse Events ◽

Pulse Oximetry ◽

Patient Care ◽

Operating Room ◽

Patient Monitoring ◽

Standard Of Care ◽

Physiological Monitoring ◽

Substandard Care ◽

Severity Of Injury

The expertise and skill of the modern anesthesiologist is increasingly required when anesthesia is administered for procedures performed outside of the operating room (OOOR). The OOOR environment is fraught with challenges and often requires a great deal of flexibility without compromising patient care. In the practice of anesthesiology, physiological monitoring of patients is imperative and is recognized as a standard of care. Although definitive data are lacking, some studies have suggested that adverse events occurring in the OOOR environment have a higher severity of injury and may result from substandard care, including lack of adherence to minimum monitoring guidelines.1 , 2 This chapter will focus on the physics, physiology, limitations, and recommendations for standard physiological monitors that should be utilized in the OOOR environment. A special emphasis is placed on pulse oximetry and capnography.

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