Perianesthesia Period Research Articles

Analysis of anesthesia related severe adverse events in congenital catheterization cases from a single institution.

Analysis of anesthesia related severe adverse events in congenital catheterization cases from a single institution.

Perianesthesia emergency repair of a cut endotracheal tube’s inflatable tube: A case report

BACKGROUNDDuring the perianesthesia period, emergency situations threatening the life and safety of patients can occur at any time. When dealing with some emergencies, occasional confusion is inevitable.CASE SUMMARYThis case report describes the rare situation wherein a surgeon inadvertently detached the inflatable tube of an endotracheal tube during a tonsillectomy, and positive pressure ventilation could not be provided. While reintubation may increase the risk of respiratory tract infection and aspiration, patients with a difficult airway might die due to apnea. The best treatment method is to optimize the damaged tracheal tube junction to avoid secondary intubation and ensure patient safety. An intravenous needle and cannula were used to repair the damaged gap in the current case. Following the repair, the anesthesia machine showed no indication of low tidal volume, and there was no deflation of the endotracheal tube cuff. Subsequently, the patient was transferred to the post-anesthesia recovery room, and the tracheal tube was removed with satisfactory results.CONCLUSIONUsing an intravenous needle to repair a break in the inflatable tube surrounding an endotracheal tube is safe and reliable.

Esketamine increases neurotransmitter releases but simplifies neurotransmitter networks in mouse prefrontal cortex

General anesthesia induces a profound but reversible unconscious state, which is accompanied by changes in various neurotransmitters in the cortex. Unlike the "brain silencing" effect of γ-aminobutyric acid (GABA) receptor potentiator anesthesia, ketamine anesthesia leads the brain to a paradoxical active state with higher cortical activity, which is manifested as dissociative anesthesia. However, how the overall neurotransmitter network evolves across conscious states after ketamine administration remains unclear. Using in vivo microdialysis, high-performance liquid chromatography-mass spectrometry (HPLC-MS) analysis, and electroencephalogram (EEG) recording technique, we continuously measured the concentrations of six neurotransmitters and the EEG signals during anesthesia with esketamine, an S-enantiomer of ketamine racemate. We found that there was an increase in the release of five cortical neurotransmitters after the administration of esketamine. The correlation of cortical neurotransmitters was dynamically simplified along with behavioral changes until full recovery after anesthesia. The esketamine-increased gamma oscillation power was positively correlated only with the concentration of 5-hydroxytryptamine (5-HT) in the medial prefrontal cortex. This study suggests that the transformation of the neurotransmitter network rather than the concentrations of neurotransmitters could be more indicative of the consciousness shift during esketamine anesthesia.NEW & NOTEWORTHY In this study, we found that esketamine significantly increased the cortical concentration of multiple neurotransmitters in mice. However, esketamine dynamically simplified the overall network of cortical neurotransmitters at different behavioral states during the perianesthesia period. The concentration of 5-HT in the medial prefrontal cortex (mPFC) was highly correlated with the esketamine-increased gamma oscillation. These findings suggested that the transformation of the neurotransmitter network rather than the concentrations of neurotransmitters could be more indicative of the consciousness shift during esketamine anesthesia.

Implementing Perioperative Evidence-Based Interventions for OSA: Increasing Risk Awareness, Enhancing Patient Care

<h3>Introduction</h3> The majority of Obstructive Sleep Apnea (OSA) cases are reported to be undiagnosed, including surgery patients. Perioperative nurses are in a unique position to recognize OSA not diagnosed in the perianesthesia period. <h3>Identification of the problem</h3> OSA has been identified as a factor for prolonging PACU stays and, more importantly, a contributing factor to respiratory compromise for those receiving opioids postoperatively. This population has an increased risk for adverse respiratory events once discharged. Implementing and sustaining interventions to safely discharge the patient can be a challenge. <h3>EBP Question/Purpose</h3> . <h3>PICO question. Databases utilized</h3> Can increasing nursing knowledge of OSA risk and perioperative nursing interventions optimize perioperative care for surgical patients with diagnosed and undiagnosed OSA? The American Society of Anesthesiologist published guidelines for perioperative management of patients with OSA in 2006. Since then, the ASPM published guidelines for monitoring opioid induced sedation in 2011 and in 2012 ASPAN published practice recommendation for obstructive sleep apnea in the adult patient. Various literature has been published on implementing these guidelines. <h3>Methods/Evidence</h3> Initial data showed patients with oxygen desaturation less than 92%, had STOPBANG scores of 4-8 52%. A pre-survey was distributed to nurses working in the pre-op and post-op area to assess their knowledge of OSA, OSA risk identification, and interventions to initiate with OSA and at-risk populations. Education was then given regarding identification of undiagnosed sleep apnea, recognition of post-operative hypoventilation and apneic events, and implementation of enhanced monitoring and nursing interventions. OSA screening information was added to electronic documentation, including assessments of at home CPAP/BiPAP use. A literature review identified post-anesthesia patient education points for patient diagnosed with or at risk for OSA. Educational points were incorporated into discharge teaching and discharge documents. A post survey was completed. <h3>Significance of Findings/Outcomes</h3> The initial desaturation data was thought to be skewed as nurses were unwilling to document low saturations on their patients, waiting to document until the patient was encouraged to take deep breaths, repositioned the airway, or provided other interventions. <h3>Implications for perianesthesia nurses and future research</h3> Encourage frontline nurses to recognize the significance of respiratory compromise and improve quality of care with resources and increased knowledge of interventions.

Chronic Calcineurin Inhibition via Cyclosporine A Impairs Visuospatial Learning After Isoflurane Anesthesia.

Clinical studies implicate the perioperative period in cognitive complications, and increasing experimental evidence shows that the anesthetic agents can affect neuronal processes that underpin learning and memory. Calcineurin, a Ca-dependent phosphatase critically involved in synaptic plasticity, is activated after isoflurane exposure, but its role in the neurological response to anesthesia is unclear. We investigated the effect of chronic calcineurin inhibition on postanesthetic cognitive function. Mice were treated with 30 minutes of isoflurane anesthesia during a chronic cyclosporine A regimen. Behavioral end points during the perianesthesia period were quantified. Visuospatial learning was assessed with the water radial arm maze. Total and biotinylated surface protein expression of the α5β3γ2 γ-aminobutyric acid (GABA) type A receptors was measured. Expression of the GABA synthesis enzyme glutamate decarboxylase (GAD)-67 was also measured. Mice treated with cyclosporine A before anesthesia showed significant deficits in visuospatial learning compared to sham and cyclosporine A-treated mice (n = 10 per group, P = .0152, Tukey post hoc test). Induction and emergence were unaltered by cyclosporine A. Analysis of hippocampal protein expression revealed an increased surface expression of the α5 GABA type A receptor subunit after isoflurane treatment (P = .019, Dunnett post hoc testing), as well as a decrease in GAD-67 expression. Cyclosporine A did not rescue either effect. Our results confirm the work of others that isoflurane induces changes to inhibitory network function and exclude calcineurin inhibition via cyclosporine A as an intervention. Further, our studies suggest that calcineurin mediates a protective role in the neurological response to anesthesia, and patients receiving cyclosporine A may be an at-risk group for memory problems related to anesthesia.

Adult Perianesthesia Do Not Resuscitate Orders: A Systematic Review

The purpose of this systematic review is to assess if Do Not Resuscitate (DNR) orders should be routinely rescinded during anesthesia, determine if consensus on retaining DNR orders exists in the literature, and explore the current state of clinical practice. This systematic review followed preferred reporting items for systematic reviews and meta-analyses guidelines. In June 2018, the Cumulative Index to Nursing and Allied Health Literature and PubMed databases were systematically searched using defined inclusion/exclusion criteria. Ninety-one articles from the databases were pooled with 16 works identified as formative to the research questions. Forty-nine articles were analyzed and included in this study. It is unethical to automatically rescind DNR orders during anesthesia. Patients have the right to retain their DNR orders unaltered or modify them for the perianesthesia period. Sufficient evidence exists to create meaningful policy at every level. A consensus exists among professional organizations that the standard of care is a required reconsideration of DNR orders before anesthesia.

The study of safety and saving efficacy on bispectral index-based closed-loop target controlled infusion propofol with bispectral index-target controlled infusion pump for gynecological laparoscopic surgery

Objective To observe hemodynamic change and saving efficacy in patients undergone gynecological laparoscopic surgery under closed-loop control of target controlled infusion(TCI) propofol guided by BIS with BIS-TCI pump. To explore the guiding effect and reference value of BIS-TCI pump on accurate implementation of total intravenous anesthesia. Methods Forty patients who experienced gynecological laparoscopic surgery were enrolled in this study and divided into two groups randomly. The anesthesia was maintained with closed-loop control of propofol TCI guided by BIS with BIS-TCI pump in the closed-loop group. While the anesthesia was maintained with manually regulating plasma concentration 2-5 mg/L of propofol TCI guided by BIS with TCI pump in the opened-loop group. The target BIS value was 50±5. The plasma concentration 4 μg/L of remifentanil TCI was used for analgesia. BIS value, MAP, HR were recorded for each patient at the time point of pre-anesthesia, tracheal intubation, 1 min after tracheal intubation, 5 min after tracheal intubation, skin incision, 30 min after skin incision, skin suture, the end of surgery, consciousness recovery, extubation, 5 min after extubation. The consumption of propofol, the anesthesia recovery time, the score of numerical rating scale(NRS) and Ramsay were also recorded. Results The dosage of propofol during the anesthesia was decreased by 10% in the closed-loop group which compared with opened-loop group[(6.2±1.4) mg·kg-1·h-1 vs (6.9±1.0) mg·kg-1·h-1(P>0.05). BIS value, MAP, HR between the two groups had no significant differences at the each time point (P>0.05), but the hemodynamic change at the time point of skin incision was less in the closed-loop group compared with opened-loop group(P 0.05). Conclusions Compared with the opened-loop control of propofol TCI guided by BIS with TCI pump, the closed-loop control of propofol TCI guided by BIS with BIS-TCI pump could be safely applied in clinic, made the infusion of anesthetics more individually, and decreased the consumption of propofol. At the same time, closed-loop controlled infusion with BIS-TCI pump can also decrease the anesthesiologist's workload and make patients pass the peri anesthesia period smoothly and safely. Key words: Bispectral index; Target controlled infusion; Propofol; Laparoscopic surgerical procedures

In Retrospect – Peri-Anesthesia Nursing Practice in the Philippines: Onwards to a Model and Standards

The Peri-Anesthesia period begins when the patient is informed about procedure until recovery and continues until the patient resumes his or her usual activities.

“I was scared about just the whole thing... it made me feel better.” The effect of unit tours on pediatric patients in the perioperative setting

Objective: Anxiety is a major issue for surgical patients during the perianesthesia period, especially pediatric patients and their families. The surgical experience can be extremely stressful to children and their caregivers. Offering preoperative tours to children and their families may increase their sense of control and positively affect their overall perioperative experience. The purpose of the research was to explore the effect of unit tours on pediatric patients in the perioperative setting. The research question for this study was: What is the effect of unit tours on pediatric patients in the perioperative setting? The tours implemented during the study were designed and conducted specifically for this study.Methods: Naturalistic inquiry and descriptive qualitative were used in this study. The sample included 33 children, 7-11 years old (y.o.) who were scheduled for otolaryngological and urological surgeries (minor procedures) through the Ambulatory Surgery Center at a 528-bed acute-care facility in western New York, and their parents. The sample size of 33 children was appropriate for this qualitative study. Children excluded from the study were those: who had not participated in a tour prior to surgery; whose surgery was canceled on DOS; who were medicated prior to the interview; who had an unplanned hospital admission; and children with a medical history that would impact normal developmental stages. The primary investigator collected all of the data and was mentored through the process in a nursing research fellowship program by the director of the Department of Nursing Research. Data were collected through interviews with children, open-ended questionnaires with parents, participant observation, and record review of patient clinical data. Data from interviews and questionnaires were analyzed using constant-comparative analysis to identify emergent themes. Participant observations and clinical data were utilized in the overall analysis.Results: Four themes were identified - two from the children’s interviews and two from the parents’ interviews including: Child Theme I - The children thought that the tours were very beneficial; Child Theme II - The tours provided the children with feelings of control during a stressful event; Parent Theme III - Parents believed the tours were an informative experience; and, Parent Theme IV - Parents appreciated having their questions and concerns addressed prior to surgery as well as having the opportunity to become familiar with the environment prior to their child’s surgery.Conclusions: The perioperative tours had a positive impact on anxiety and provided an understanding of the upcoming surgical experience for both the children and their parents. The tours allayed fears about the surgery, made the children feel more comfortable about the impending surgery, provided an opportunity to ask questions, and, familiarized families with the operative surgical environment. The results of this study suggest the importance of unit tours for pediatric patients and their parents. The results contribute to the limited research in the current professional literature.

The effects of music intervention on the emotion, haemodynamics and endocrine hormone level of senile patients during the perianesthesia period

Purpose: to explore the effects of music intervention on haemodynamics and endocrine hormone level of senile patients. Methods: choosing ASA II-III level and selecting 60 senile patients performed with intraspinal anesthesia; randomly dividing them into the intervention group and control group with 30 cases in each group. Both the two groups of patients completed the SAS before entering the operating room. When the patients of the intervention group entered the operating room, selected music would be played in a continuous loop immediately till the end of the operation while the doctors of the control group just told the patient to relax without music or other special treatment. Recording and comparing the SAS scores, SBP, HR and salivary cortisol concentration of the two groups before and after intervention. Results: the SAS scores, SBP, HR and salivary cortisol concentration of the intervention group were significantly decreased compared with the value before intervention and the differences within and between the groups were significant (P < 0.05). Conclusion: music intervention can effectively reduce the preoperative anxiety, ease intranperative tension and maintain the stability of hemodynamics, so it is beneficial for senile parents to live through the perianesthesia period.

Guidelines for the Perianesthesia Care of the Duchenne Muscular Dystrophy/Becker Muscular Dystrophy Patient

More patients suffering with Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are presenting to perianesthesia settings for emergent and nonemergent treatment and care. A group of collaborative health care providers at Rush University Medical Center in Chicago developed a multidisciplinary DMD/BMD Task Force to study this disorder and create a set of guidelines to aid those engaging in the planning, execution of care, and recovery of this unique population in the perianesthesia setting. Attention to detail, well-executed preplanning, meticulous awareness of the patient, and prearranged implementation and intervention has proven to offset potential problems and complications and is the key to a successful perianesthesia period.

Órdenes de no reanimación y anestesia

Given the poor results derived from cardio-pulmonary resuscitation (CPR), some decades ago, so-called do not resuscitate orders were established. These include unilateral medical decisions taken in extreme situations when the survival rate or recuperation of the patient is considered nil. Currently, and given the development of individual guaranties and their adoption in clinical practice, do not resuscitate orders are understood as agreements between physicians and patients (or their legal representatives) to not undertake CPR in the case of cardiac arrest. The definition of the clinical practice limits has slowly been accepted in view of the subsequent results in individuals’ lives. However, the compatibility of these decisions —considered restrictive— on patients who will be treated under anesthesia is not yet clear. The purpose of this article is to present a conceptual framework for this dilemma and to provide answers to the formulation, consequences, and implications of do not resuscitate orders in the perianesthesia period.

Do not resuscitate orders and anesthesia

Given the poor results derived from cardio-pulmonary resuscitation (CPR), some decades ago, so-called do not resuscitate orders were established. These include unilateral medical decisions taken in extreme situations when the survival rate or recuperation of the patient is considered nil. Currently, and given the development of individual guaranties and their adoption in clinical practice, do not resuscitate orders are understood as agreements between physicians and patients (or their legal representatives) to not undertake CPR in the case of cardiac arrest. The definition of the clinical practice limits has slowly been accepted in view of the subsequent results in individuals’ lives. However, the compatibility of these decisions – considered restrictive – on patients who will be treated under anesthesia is not yet clear. The purpose of this article is to present a conceptual framework for this dilemma and to provide answers to the formulation, consequences, and implications of do not resuscitate orders in the perianesthesia period.

Listening to Music During Regional Anesthesia: Patients' Experiences and the Effect on Mood

Many patients experience a sense of anxiety and insecurity during the perianesthesia period. It is important to the care relationship that the nurse be able to help the patient to establish a degree of control over their situation and thus regain their own sense of security. Music therapy can be a useful tool to accomplish this. The purpose of this study was to determine the effect of a music intervention on patient's mood and self-reported satisfaction. A multimodal research design using an open-ended interview and quantitative anxiety scale was used. A total of 15 patients were interviewed with an open question in addition to completing the Hospital Anxiety and Depression (HAD) scale. The interviews were analyzed using qualitative content analysis and the HAD scale according to standard practice. An analysis of the interviews revealed a main theme: a feeling of satisfaction, and three subthemes: positive experience, inner peace, and detachment from reality. It emerged from the interviews that it was important for the patients to select music themselves. Patients had a positive experience, inner peace, and detachment from reality with changes in the patients' state of mind before and after the musical intervention. The anxiety level significantly decreased (P = .019) after the patients listened to music during surgery compared with the prevalence of anxiety before listening to music. This study shows that music has a positive impact on patients undergoing anesthesia.

Simultaneous bicoherence analysis of occipital and frontal electroencephalograms in awake and anesthetized subjects

ObjectiveOccipital electroencephalogram (EEG) activity is known to be different from the frontal EEG during wakefulness and anesthesia. However, less is known about occipital non-linear dynamics analyzed by EEG-bicoherence, which can reflect the oscillatory features that are dependent on thalamocortical modulation. MethodsForty patients were anesthetized using sevoflurane (1% or 3%) combined with remifentanil. Frontal and occipital EEGs were simultaneously collected, and bicoherence was analyzed before and after induction of anesthesia. ResultsOccipital awake EEGs often demonstrate a bicoherence α peak, differing from frontal awake EEGs in the absence of bicoherence growth. With 1% sevoflurane, occipital α bicoherence disappeared and frontal α bicoherence peaks appeared. Although 3% sevoflurane caused an increase in occipital δ-θ normalized power, similar to the frontal region (peak relative δ-θ power, 13.1±2.2% vs. 12.2±2.7%, p>0.05), occipital bicoherence showed no growth in any frequency area, contrasting with the frontal bicoherence spectrum with a conspicuous peak in the δ-θ area (19.8±8.9 vs. 43.6±13.8, p<0.05). ConclusionsThe occipital bicoherence spectrum in the peri-anesthesia period is quite different from the frontal bicoherence spectrum, which is not usually obvious in the power spectrum. SignificanceNonlinear regulation of the occipital EEG is different from the frontal EEG during every stage of anesthesia.

Caring for the Patient With Obstructive Sleep Apnea: Implications for Health Care Providers in Postanesthesia Care

Obstructive sleep apnea (OSA) is a sleep disorder affecting 18 million Americans. The prevalence of OSA is increasing due to an epidemic rise in obesity, which is a major contributing factor. The primary treatment for OSA is continuous positive airway pressure, designed to maintain a patent airway for unobstructed breathing. OSA patients may experience postoperative hypoventilation due to residual anesthetic, analgesic requirements, and other comorbidities. Postoperative health care providers must be prepared to assess for hypoventilation and intervene using evidence-based interventions to improve outcomes. It is incumbent that the PACU nurse be aware of and implement evidence-based clinical guidelines for patients with OSA. Therefore, the purpose of this manuscript is to (1) describe the physiology, comorbidities, diagnosis, and treatment of OSA; (2) identify the effects of anesthesia in persons with OSA; (3) discuss clinical guidelines; and (4) describe implications for care in an effort to improve health outcomes in persons with OSA during the perianesthesia period.

Do-Not-Resuscitate Orders: Providing Safe Care While Honoring the Patient's Wishes

A do-not-resuscitate order means that a patient should be allowed to die naturally (ie, no resuscitation is provided) in the event the patient experiences respiratory or cardiac arrest. A do-not-resuscitate order is initiated by the patient; however, it does not mean that treatment is withheld if the patient needs medical intervention. Clinicians may have differing interpretations of what a do-not-resuscitate order means, especially when a patient is undergoing a surgical procedure that requires anesthesia. In this instance, a do-not-resuscitate order can create the ethical dilemma of how to safely care for the patient while honoring his or her wishes and values. Many perioperative clinicians view do-notresuscitate orders as being inconsistent with anesthesia administration and surgery, and, historically, do-not-resuscitate orders have been suspended during the perianesthesia period of patient care. Beginning in the 1960s, the widespread use of cardiopulmonary resuscitation (CPR) as an automatic treatment whenever a patient experienced cardiac or respiratory arrest became common. Because of this, uncertainty arose and discussions

Surgical Cancellations: A Review of Elective Surgery Cancellations in a Tertiary Care Pediatric Institution

The purpose of this two-phase quality improvement audit was to analyze elective surgery cancellations in a tertiary pediatric care institution and identify and recommend nursing practice changes in the preoperative assessment clinic (POAC) to potentially influence the overall cancellation rate. A prospective review of cancellation data was conducted over a 6-month period in 2008 and again in 2010. In both phases of the audit, illness was the leading cause for surgical cancellation between the preoperative assessment and the day of surgery, with otolaryngology service representing the highest number of cancellations. Cancellations at or between the preoperative assessment and the day of surgery may be viewed as POAC successes that may have otherwise increased the day-of-surgery cancellation rate. Educating families on the prevention of illness in the perianesthesia period may be a critical nursing role in the prevention of surgical cancellations.

A Concept Analysis of Control in the Perianesthesia Period

Control is a word used frequently with many connotations and nuances. It has emerged as thematic in recent qualitative studies of patients' experiences of the perianesthesia period. The purpose of this paper was to conduct a concept analysis of control in the perianesthesia period, using Walker and Avant's eight-step method. The literature was reviewed, which identified the defining attributes. Model, borderline, contrary, and illegitimate cases are presented, and antecedents and consequences are identified. Control in the perianesthesia period is defined as the perception of the power of choice. Sometimes that choice is to relinquish control to others. The purpose of this concept analysis of control was to clarify the concept and to provide insight into the patients' perspective, enabling nurses to assess and approach patients from a different viewpoint--one that seeks to help the perianesthesia experience become a less threatening, frightening one and instead a partnership that enhances the well-being of the individual.

Selective and Nonselective Nonsteroidal Anti-inflammatory Drugs in Perianesthesia Pain Management

Despite advances in pain management techniques, there remains room for further improvement in optimizing postoperative patient comfort. Although nonsteroidal anti-inflammatory drugs (NSAIDs) that are more selective in the inhibition of the cyclooxygenase (COX) enzyme have become more popular over recent years, the use of traditional nonselective NSAIDs remains efficacious in reducing postoperative pain. Both nonselective and selective NSAIDs have an important role in perianesthesia pain management. This article reviews the benefits and risks of both nonselective NSAIDs and COX-2 NSAIDs in the perianesthesia period.