scholarly journals Perioperative Hypothermia—A Narrative Review

2021 ◽  
Vol 18 (16) ◽  
pp. 8749
Author(s):  
Simon Rauch ◽  
Clemens Miller ◽  
Anselm Bräuer ◽  
Bernd Wallner ◽  
Matthias Bock ◽  
...  
Keyword(s):  
Core Temperature ◽  
Surgical Site Infections ◽  
Temperature Management ◽  
Common Side Effect ◽  
Negative Effects ◽  
Post Anaesthesia Care Unit ◽  
Perioperative Hypothermia ◽  
Transfusion Requirements ◽  
Duration Of Surgery ◽  
Anaesthesia Care

Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient’s requirements and the local possibilities.

EFFECT OF DEXAMETHASONE GARGLE AND MgSO4 GARGLE ON INCIDENCE AND SEVERITY OF POST OPERATIVE SORE THROAT IN PATIENTS UNDERGOING SURGERY UNDER GA : A RANDOMISED COMPARATIVE STUDY

2021 ◽  
pp. 40-42
Author(s):  
Tamanna Baktier ◽  
Akash Gupta ◽  
Neeharika Arora ◽  
Ankur Garg ◽  
Ekta Singh ◽  
...  
Keyword(s):  
Comparative Study ◽  
General Anaesthesia ◽  
Sore Throat ◽  
Magnesium Sulphate ◽  
Lower Incidence ◽  
Post Anaesthesia Care Unit ◽  
Duration Of Surgery ◽  
The Mean ◽  
Anaesthesia Care ◽  
To Receive

BACKGROUND: Post operative sore throat (POST) is an unpleasant and troublesome sequelae after endotracheal intubation . The present study compares the efcacy of dexamethasone gargle versus magnesium sulphate gargle on incidence and severity of post operative sore throat in patients under General Anaesthesia. METHODS : 60 patients were randomly allocated to receive either magnesium sulphate gargle or dexamethasone gargle . 15 mins prior to induction of GA , the dexamethasone gargle group (n=30) received 8mg dexamethasone dissolved in 20ml of 5% dextrose whereas the magnesium sulphate gargle group received 1 gm of MgSO4 dissolved in 20ml of 5% of dextrose. Patients were assessed for incidence and severity of post operative sore throat , cough and hoarseness of voice in post anaesthesia care unit at 0hr, 2hrs, 4hrs, 6hrs and 24 hrs . RESULTS : Our study revealed that there was signicant (p<0.01) difference in the severity of sore throat between the groups at 0 hr, 2 hrs, 4 hrs , 6 hrs with patients receiving MgSO4 gargles showing decreased severity than gargling with dexamethasone. The two groups were found to be demographically comparable . In our current study , the mean duration of surgery in both groups was 2-2.5 hours and difference was statistically insignicant . SUMMARY : Among patients who gargled with 1gm of MgSO4 exhibited lower incidence and severity of POST as compared to patients who gargled with 8mg of dexamethasone

Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia – a prospective observational cohort study

VASA ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 89-97
Author(s):  
Karin Yeung ◽  
Jonas Peter Eiberg ◽  
Henrik Kehlet ◽  
Eske Kvanner Aasvang
Keyword(s):  
Lower Limb ◽  
Severe Pain ◽  
Observational Cohort Study ◽  
Limb Ischaemia ◽  
Post Anaesthesia Care Unit ◽  
Lower Limb Ischaemia ◽  
Acute Complications ◽  
Observational Cohort ◽  
Anaesthesia Care ◽  
Pacu Stay

Abstract. Background: Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. Patients and methods: Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. Results: In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). Conclusions: Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.

Inadvertent perioperative hypothermia and surgical site infections

2015 ◽  
Vol 5 (6) ◽  
pp. 349-353
Author(s):  
Artur Adamiec ◽  
Hanna Misiołek
Keyword(s):  
Surgical Site Infections ◽  
Perioperative Hypothermia

scholarly journals Factors associated with low levels of patient satisfaction following peripheral nerve block

2021 ◽  
pp. 0310057X2097240
Author(s):  
Anthony D Hade ◽  
Satomi Okano ◽  
Anita Pelecanos ◽  
Adrian Chin
Keyword(s):  
Patient Satisfaction ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Moderate Intensity ◽  
Post Anaesthesia Care Unit ◽  
Negatively Associated ◽  
Factors Associated ◽  
Low Levels ◽  
Anaesthesia Care

Peripheral nerve blocks can provide surgical anaesthesia as well as excellent postoperative analgesia. When questioned postoperatively, however, some patients report low levels of satisfaction with their nerve block experience. At our hospital, patients undergoing regional anaesthesia have their patient characteristics, block characteristics and postoperative feedback routinely recorded in a block registry. We analysed data from 979 consecutive patients undergoing peripheral nerve block for orthopaedic surgery to identify factors associated with low levels of patient satisfaction. The primary outcome was patient satisfaction with their peripheral nerve block (scale 1–5: 4–5 is ‘satisfied’, 1–3 is ‘not satisfied’). Eighty-nine percent (871/979) of patients reported being ‘satisfied’ with their block. Factors negatively associated with patient satisfaction were rebound pain (adjusted odds ratio (aOR) 0.19, 95% confidence interval (CI) 0.04 to 0.85 for moderate rebound pain; aOR 0.11, 95% CI 0.03 to 0.48 for severe rebound pain), discomfort during the block (aOR 0.37, 95% CI 0.16 to 0.82 for moderate discomfort; aOR 0.19, 95% CI 0.05 to 0.76 for severe discomfort) and pain in the post-anaesthesia care unit (aOR 0.30, 95% CI 0.17 to 0.55 for pain ≥8/10). Only 24% (26/108) of patients who reported being ‘not satisfied’ stated that they would be unwilling to undergo a hypothetical future nerve block. Rebound pain of at least moderate intensity, procedural discomfort of at least moderate intensity and severe pain in the post-anaesthesia care unit are all negatively associated with patient satisfaction. Of these factors, rebound pain occurs most frequently, being present in 52% (403/777) of our respondents.

Abstract 10475: Heat Loss Augmented by Extracorporeal Circulation is Associated with Overcooling in Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Byungkook Lee ◽  
Dong Hun Lee
Keyword(s):  
Water Temperature ◽  
Core Temperature ◽  
Neurological Outcome ◽  
Temperature Management ◽  
Extracorporeal Circuit ◽  
Matched Cohort ◽  
Maintenance Period ◽  
Neurological Outcomes ◽  
The Core ◽  
Poor Neurological Outcome

Introduction: Extracorporeal circuit-based salvage therapy can affect targeted temperature management (TTM) in comatose out-of-hospital cardiac arrest (OHCA) survivors. We investigated the association of patients with extracorporeal device with TTM and neurological outcome. Methods: We performed a retrospective analysis using prospectively collected data from adult comatose OHCA survivors who underwent TTM between October 2015 and December 2020. We defined patients with ECMO and/or CRRT as the extracorporeal group. We calculated the cooling rate during the induction period; the minimum, maximum, and mean time-weighted core temperatures (TWCT), and the standard deviation (SD) of the core temperature and water temperature during the maintenance period based on the temperature measured every minute. We defined the sum of TWCT more and less than 33°C as positive and negative TWCT, respectively. The primary outcome was a poor neurological outcome, defined as cerebral performance category 3-5. We used propensity score (PS) matching to adjust the characteristics of patients who required an extracorporeal circuit device. Results: Of the 223 included patients, 140 (62.8%) patients had poor neurological outcome and 40 (17.9%) patients were categorized into the extracorporeal group. The extracorporeal group had a rapid cooling rate (2.08°C/h [1.13-3.73] vs. 1.24°C/h [0.77-1.79]; p < 0.001). The extracorporeal group had lower mean core temperature; higher core temperature SD; lower positive TWCT; higher negative TWCT; and higher maximum, minimum, and mean water temperature than the no-extracorporeal group. In PS matched cohort, the extracorporeal group had a lower minimum core temperature, lower mean core temperature, higher core temperature SD, higher negative TWCT, higher maximum water temperature, and higher mean water temperature. The neurological outcomes were not different between the two groups, in either the whole or PS-matched cohort. Conclusions: The extracorporeal group achieved the target temperature earlier. The core temperature distribution during the maintenance period was further skewed below 33°C in the extracorporeal group. The extracorporeal group had similar neurological outcomes to the no-extracorporeal group.

National quality improvement indicators project: an initial descriptive study

2021 ◽  
pp. 0310057X2110278
Author(s):  
Daniel P Ramsay ◽  
Phillip Quinn ◽  
Veronica Gin ◽  
Timothy D Starkie ◽  
Robert A Fry ◽  
...  
Keyword(s):  
Quality Improvement ◽  
New Zealand ◽  
Respiratory Distress ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Public Hospitals ◽  
Nausea And Vomiting ◽  
Post Anaesthesia Care Unit ◽  
National Quality ◽  
Anaesthesia Care

Background Anaesthesia Quality Improvement New Zealand developed a set of five quality improvement indicators pertaining to postoperative nausea and vomiting, pain, respiratory distress, hypothermia and a prolonged post-anaesthesia care unit stay. This study sought to assess the proportion of eligible institutions that were able to measure and provide data on these indicators, produce an initial national estimate of these, and a measure of variability in the quality improvement indicators across hospitals in New Zealand. Methods All public hospitals that provide a representative to Anaesthesia Quality Improvement New Zealand were eligible for inclusion. Participating institutions were required to provide the number and proportion of patients with each of the five quality improvement indicators over a continuous 2-week period between 1 June 2019 and 25 October 2019. The overall percentage of patients and the median percentage with each outcome were calculated. Results A total of 79.2% of eligible hospitals participated. The median incidence of the indicators ranged from 1.67% for respiratory distress to 6.31% for prolonged post-anaesthesia care unit stay. The indicator with the largest interquartile range was hypothermia and the smallest was respiratory distress (13.48 and 2.29, respectively). A large variation was seen for prolonged post-anaesthesia care unit stay, hypothermia, pain and postoperative nausea and vomiting. Conclusion The majority of eligible institutions were able to measure and provide data on the quality improvement indicators. There was a low rate of respiratory distress with low variability. A large amount of variability was observed in the other indicators. Future studies are needed to explore the nature of this variability.

scholarly journals Incidence of hypoxemia in a post-anaesthesia care unit and relevant risk factors: a retrospective study of 14604 patients with general anaesthesia

2019 ◽  
Author(s):  
Shuai Tang ◽  
Liangyan Zhang ◽  
Wei Han ◽  
Yang Xue ◽  
Yi Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Regression Analysis ◽  
Retrospective Study ◽  
Retrospective Cohort ◽  
Post Anaesthesia Care Unit ◽  
Postoperative Hypoxemia ◽  
Total Incidence ◽  
American Society ◽  
Anaesthesia Care

Abstract Background This article is aim to investigate the incidence and risk factors for postoperative hypoxemia in a post-anaesthesia care unit (PACU). Methods The retrospective cohort assessed 14604 postoperative patients who were admitted to PACU between January 2015 and December 2015. A pulse oximeter was used to monitor and record pulse oxygen saturation (SpO2) every 5 minutes. Clinical data were collected for all these patients, and the incidence of and risk factors for postoperative hypoxemia were analysed. Results The total incidence of hypoxemia was 21.83% (SpO2 ≤ 95%) and 2.79% (SpO2 ≤ 90%). Multiple regression analysis indicated that the risk factors were age ≥50-year old, body mass index (BMI) ≥25kg/m2, American Society of Anaesthesiologists (ASA) II and III, limb surgery, and thoracic surgery. Conclusions Therefore, hypoxemia was common in postoperative patients in the PACU. Age, BMI, ASA classification, and surgical site are associated with postoperative hypoxemia. More attention should be paid to these patients to prevent hypoxemia in the PACU.

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