Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

Abstract ABSTRACT Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

10.21203/rs.2.9307/v3 ◽

2019 ◽

Author(s):

Denise Battaglini ◽

Chiara Robba ◽

Patricia Rieken Macêdo Rocco ◽

Marcelo Gama De Abreu ◽

Paolo Pelosi ◽

...

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Emergency Surgery ◽

Unit Length ◽

Peep Level ◽

Anaesthetic Management ◽

Plateau Pressure ◽

High Morbidity ◽

Postoperative Pulmonary Complication ◽

The Impact

Abstract Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

10.21203/rs.2.9307/v2 ◽

2019 ◽

Author(s):

Denise Battaglini ◽

Chiara Robba ◽

Patricia Rieken Macêdo Rocco ◽

Marcelo Gama De Abreu ◽

Paolo Pelosi ◽

...

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Emergency Surgery ◽

Unit Length ◽

Peep Level ◽

Anaesthetic Management ◽

Plateau Pressure ◽

High Morbidity ◽

Postoperative Pulmonary Complication ◽

The Impact

Abstract ABSTRACT Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery

10.21203/rs.2.9307/v1 ◽

2019 ◽

Author(s):

Denise Battaglini ◽

Chiara Robba ◽

Patricia Rieken Macêdo Rocco ◽

Marcelo Gama De Abreu ◽

Paolo Pelosi ◽

...

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Emergency Surgery ◽

Unit Length ◽

Peep Level ◽

Anaesthetic Management ◽

Plateau Pressure ◽

High Morbidity ◽

Postoperative Pulmonary Complication ◽

The Impact

Abstract Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.

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Anaesthetic management in patients suspected of, or at risk of, having Creutzfeldt-Jakob disease

British Journal of Anaesthesia ◽

10.1093/bja/80.4.516 ◽

1998 ◽

Vol 80 (4) ◽

pp. 516-518 ◽

Cited By ~ 4

Author(s):

J Hernàndez-Palazón ◽

J F Martínez-Lage ◽

J A Tortosa ◽

J M García-Cayuela

Keyword(s):

At Risk ◽

Anaesthetic Management ◽

Jakob Disease

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Anaesthesia for non-obstetric surgery

Obstetric Anaesthesia ◽

10.1093/med/9780199688524.003.0022 ◽

2020 ◽

pp. 569-576

Author(s):

Martin Garry

Keyword(s):

Pregnant Woman ◽

General Anaesthesia ◽

Emergency Surgery ◽

Fetal Loss ◽

Fetal Monitoring ◽

Anaesthetic Management ◽

Management Plan ◽

Premature Labour ◽

Obstetric Surgery

It is not uncommon for a woman to require urgent or emergency surgery for many differing co-incidental reasons during pregnancy. It invariably causes a degree of concern to both the woman and the responsible anaesthetist, particularly if general anaesthesia is necessary, as surgery can precipitate onset of premature labour and fetal loss. This chapter highlights the anaesthesia and surgical issues for the pregnant woman, recommendations for fetal monitoring and the effect of anaesthesia drugs on the developing fetus. An anaesthetic management plan is set out based on the pregnancy trimester, with postpartum considerations highlighted.

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Anaesthesia for urological surgery and for robotic surgery in urology and gynaecology

10.1093/med/9780199642045.003.0062 ◽

2017 ◽

Author(s):

Suzanne Odeberg-Wernerman ◽

Margareta Mure

Keyword(s):

At Risk ◽

Open Surgery ◽

Enhanced Recovery ◽

Vital Signs ◽

Early Mobilization ◽

Anaesthetic Management ◽

Abdominal Pressure ◽

Robot Assisted ◽

Carbon Dioxide Pneumoperitoneum ◽

Patients At Risk

Laparoscopic and robot-assisted laparoscopic surgical procedures are commonly used in both urology and gynaecology. These minimally invasive techniques result in early mobilization and short hospital stay and robot-assisted operations are increasingly favoured by patients and surgeons. A complex physiological response is created by the combined effects of carbon dioxide pneumoperitoneum, elevated intra-abdominal pressure, and sometimes a profound Trendelenburg position. Healthy patients tolerate this situation well, but compromised patients are at risk of developing heart failure, ischaemia, or both. Correct interpretation of vital signs can be challenging in this situation. This chapter gives an overview of the physiology during laparoscopic and robot-assisted laparoscopic surgery and gives recommendations for anaesthesia and monitoring. The field of urology and gynaecology also includes major open surgery as well as transurethral surgery and techniques for the management of urinary tract stones. The anaesthetic management and perioperative care of major open surgery, including the increasingly adopted ‘enhanced recovery after surgery’ concept, are also covered. The syndrome of transurethral resection of the prostate can still place patients at risk despite increased knowledge and improved selection of irrigation fluid.

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COMPARATIVE STUDY OF METOCLOPRAMIDE AND ONDANSETRON WITH PANTOPRAZOLE IN ELECTIVE CAESEREAN SECTION UNDER SPINAL ANAESTHESIA FOR ASPIRATION PNEUMONITIS PROPHYLAXIS.

10.36106/gjra/6705116 ◽

2021 ◽

pp. 66-69

Author(s):

Nimta Kishore ◽

A. Varshneya ◽

A. Nagrath

Keyword(s):

At Risk ◽

Caesarean Section ◽

Spinal Anaesthesia ◽

Elective Caesarean Section ◽

Anaesthetic Management ◽

Gastric Volume ◽

Aspiration Pneumonitis ◽

P Value ◽

Gastric Aspirate ◽

Patients At Risk

BACKGROUND- Caesarean delivery, one of the most commonly performed surgical procedure. The choice of anaesthesia is spinal blockade for elective caeserean-section,unless general anaesthesia is specically indicated. Aspiration pneumonitis remains an important cause of morbidity and mortality in anaesthesia practise,particularly in obstetric patients,prophylaxis against it is paramount importance in pre-anaesthetic management. AIMS AND OBJECTIVES- The aim of this study was to compare pH and volume of gastric contents after administration of combination of metoclopramide and pantoprazole versus ondansetron and pantoprazole during elective caesarean section under spinal anaesthesia for prophylaxis against aspiration pneumonitis. METHODS: It is a prospective study where 100 parturient women, ASA 1 and 2 scheduled for elective caesarean section. They were divided into 2 groups: ondansetron(4mg) and pantoprazole(40mg),and metoclopramide(10mg), pantoprazole(40mg) administered intravenously 2hours before surgery. Gastric aspirate was taken in various positions before giving spinal anaesthesia and at the end of operation. Patients at risk were according to criteria of gastric volume more than 0.4ml/kg with pH <2.5. RESULTS:Patients at risk were 7(14%) in metoclopramide group and 1(2%) in ondansetron group before giving spinal anaesthesia(p=0.027) and 6(12%) in metoclopramide group and 0(0%) in ondansetron group at end of operation(p=0.012) . Since p-value was less than 0.05 there was signicant difference between two groups. CONCLUSION: As there was signicant difference between ondansetron and metoclopramide , it is recommended to use ondansetron and pantoprazole for prophylaxis against aspiration pneumonitis.

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