Postoperative Respiratory Rate Research Articles

Post-operative Pain Control: A Comparison between Bupivacaine and Tramadol Local Wound Infiltration in Children Undergoing Herniotomy and Orchidopexy.

Post-operative pain control improves patient's satisfaction and affects the period of admission. Local wound infiltration following hernia surgery using xylocaine or bupivacaine has been a common practice. The use of tramadol for such infiltration is relatively new and has not been studied in our environment. This study compared the efficacy of post-operative pain control between Bupivacaine and Tramadol wound infiltration in children who underwent herniotomy and orchidopexy. This was a prospective randomised study involving 104 patients. A simple random method was used to allocate the study group into two equal groups (A, n = 52 and B, n = 52) using sealed envelopes with contents labelled A or B. Pre- and post-operative respiratory rate, heart rate, and C-reactive protein (CRP) were all recorded. Time to first and subsequent analgesia was determined using face, legs, activity, cry, consolability (FLACC) pain score. Fifteen patients in Group A and 18 patients in Group B received each two doses of supplemental analgesia within the first 24 h, ( P = 0.527). Time to first analgesia was significantly different between the two groups, (6.93 ± 0.80 h and 6.11 ± 1.08 h, P = 0.020). The mean FLACC pain score at the time of first analgesia in hours was 4.93 ± 0.59 and 4.72 ± 0.67 for Group A and B, respectively, P = 0.350. The changes in CRP were not different in the two groups, ( P = 0.665). Four patients in Group A, but none in Group B had an episode each of post-operative vomiting. Tramadol showed comparable efficacy with bupivacaine in post-operative pain control by wound infiltration in children who had unilateral herniotomy or orchidopexy. Tramadol, however, achieves a longer duration of action before rescue analgesic is required. Caution is necessary to avoid post-operative vomiting.

Opioid-free general anaesthesia for transthoracic oesophagectomy: does it improve postoperative analgesia and other recovery criteria? A prospective randomised study

BackgroundSide effects related to intraoperative opioid administration are well known. Recently, it was found that opioids may inhibit cellular immunity through their effects on natural killer cell activity, stimulate angiogenesis and accentuate cancer cell growth. Hence, peri-operative use of opioids might affect long-term oncological outcomes in cancer surgical patients. Opioid-free anaesthesia (OFA) is a methodology that dodges narcotic use during anaesthesia by using blends of several drugs added to common anaesthetic agents.The study aims to test the impact of OFA in transthoracic oesophagectomy in comparison with opioid-based anaesthesia technique (OBA) on postoperative analgesia and recovery criteria (hemodynamics, respiratory rate and haemoglobin oxygen saturation).ResultsThe postoperative VAS was significantly lower in OFA group (A) than OBA group (B) in the measured time points (immediate postextubation, 30 min, 2 and 4 h postoperative) with P values 0.001, 0.001, 0.0012 and 0.0065 respectively. The time passed till first rescue analgesia requested was significantly longer in OFA group (A) than OBA group (B) and the total dose of rescue analgesia given to the patients were significantly higher in group B than group A. The recorded postoperative respiratory rate was significantly faster in OBA group (B) than OFA group (A), and the haemoglobin oxygen saturation (SPO2) showed statistically significant lower values in the OBA group (B) than the OFA group (A).ConclusionsWe emphasise the perioperative safety and efficacy of the opioid-free anaesthesia techniques provided for transthoracic oesophagectomy with better postoperative analgesia and other post recovery criteria.Trial registrationWe carried out our trial at Ain-Shams University Hospitals, Cairo, Egypt, between June 2020 and November 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University and then registered in the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) with the following ID (PACTR202010907549506).

Variations in respiratory rate do not reflect changes in tidal volume or minute ventilation after major abdominal surgery

Monitoring of postoperative pulmonary function usually includes respiratory rate and oxygen saturation measurements. We hypothesized that changes in postoperative respiratory rate do not correlate with changes in tidal volume or minute ventilation. In addition, we hypothesized that variability of minute ventilation and tidal volume is larger than variability of respiratory rate. Respiratory rate and changes in tidal volume and in minute ventilation were continuously measured in 27 patients during 24 h following elective abdominal surgery, using an impedance-based non-invasive respiratory volume monitor (ExSpiron, Respiratory Motion, Waltham, MA, US). Coefficients of variation were used as a measure for variability of respiratory rate, tidal volume and minute ventilation. Data of 38,149 measurements were analyzed. We found no correlation between respiratory rate and tidal volume or minute ventilation (r2 = 0.02 and 0.01). Mean respiratory rate increased within the first 24 h after abdominal surgery from 13.9 ± 2.5 to 16.2 ± 2.4 breaths/min (p = 0.008), while tidal volume and minute ventilation remained unchanged (p = 0.90 and p = 0.18). Of interest, variability of respiratory rate (0.21 ± 0.06) was significantly smaller than variability of tidal volume (0.37 ± 0.12, p < 0.001) and minute ventilation (0.41 ± 0.12, p < 0.001). Changes in postoperative respiratory rate do not allow conclusions about changes in tidal volume or minute ventilation. We suggest that postoperative alveolar hypoventilation may not be recognized by monitoring respiratory rate alone. Variability of respiratory rate is smaller than variability in tidal volume and minute ventilation, suggesting that adaptations of alveolar ventilation to metabolic needs may be predominately achieved by variations in tidal volume.

Observational Study of Postoperative Respiratory Rate After Cesarean Delivery Among a Convenience Sample of Women Undergoing Spinal Anesthesia With and Without Neuraxial Opioids

Observational Study of Postoperative Respiratory Rate After Cesarean Delivery Among a Convenience Sample of Women Undergoing Spinal Anesthesia With and Without Neuraxial Opioids

Unilateral approach painless vertebroplasty for osteoporotic vertebral compression fractures of critically ill patients under lateral decubitus position

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures (OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78.5±13.2)years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II (APACHE II) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3±2.9)months]. The operation time was (69.2±25.9)minutes, and the amount of intraoperative bleeding was (7.5±2.6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation (P>0.05). No surgical discontinuation or deterioration occurred. The APACHE II score was (15.2±3.7)points before operation and (8.4±0.7)points at 24 hours after operation (P 0.05). The Cobb angle was (25.6±9.3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8.5±1.2)points before operation, (2.1±0.3)points at one week after operation, and (3.2±1.1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS (P 0.05). The ODI value was 39.9±3.4 before operation, 20.2±5.2 at one week after operation, and 17.2±2.0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI (P<0.05), showing improvement trend during the follow-up (P<0.05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine. Key words: Spinal fractures; Osteoporotic fractures; Vertebral augmentation

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria.

Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.

Respiratory events with sugammadex vs. neostigmine following laparoscopic sleeve gastrectomy: a prospective pilot study assessing neuromuscular reversal strategies.

From September 2012 to February 2013, in a prospective randomized pilot study, two different muscle relaxant reversal agents were administered at the end of surgery in 57 patients undergoing laparoscopic sleeve gastrectomy: sugammadex 2 mg/kg (32 patients) vs. neostigmine 2.5 mg (25 patients). We compared the occurrence of early and late respiratory events/complications by the type of reversal agent. Postoperative respiratory rate, oxyhemoglobin saturation (SpO2), number of patients with SpO2 lower than 95% in PACU, the minimum value of SpO2 in PACU, train-of four counts (TOF) before reversal, unexpected ICU admissions, duration of hospitalization and incidence of reintubation were recorded. SpO2 in the PACU was significantly lower in the neostigmine group - 95.80 (± 0.014)) vs. in sugammadex group - 96.72 (± 0.011) (p < 0.01), despite a lower TOF count measured in the sugammadex group before reversal, meaning a deeper level of residual relaxation in this group before the administration of the reversal agent (2.53 ± 0.98 vs. 3.48 ± 0.58 p < 0.01). Also, the minimal SpO2 was significantly lower in the PACU in the neostigmine group: 93% vs. 94% (p = 0.01). Respiratory rates were not different. After the administration of reversal, both groups had TOF counts of 4 with no fade assessed visually. There were no postoperative respiratory events or complications. The use of sugammadex (as compared to neostigmine) as a reversal agent following laparoscopic sleeve gastrectomy surgery was associated with higher postoperative SpO2 despite the lower TOF count before the administration of reversal agent. Despite the statistical difference in SpO2, its clinical importance seems to be minimal. The lack of difference in the other measured variables may stem from the small number of patients studied (pilot).

Avaliação da aplicação do índice de tobin no desmame da ventilação mecânica após anestesia geral

The predictive index for discontinuing mechanical ventilation is a prognostic parameter. The objective of this study was to evaluate the use of the Tobin index before tracheal extubation in patients undergoing general anesthesia.Eighty patients, 40 (50%) men and 40 (50%) women undergoing cholecystectomy under general anesthesia were analyzed. The mean age of the patients was 57.7 +/- 12.4 (33 to 82 years) and mean body weight was 70.85 +/- 11.07 (48 to 90 kg). Thirty-seven patients (46.2%) were smokers. The Tobin index was obtained through the relationship between respiratory rate and tidal volume in cycles/Liter/minute (c.L-1.min-1). Age, weight, smoking, anesthetic-surgical risk, duration of the procedure, expired tidal volume, and postoperative respiratory rate, length of time in the recovery room, intraoperative clinical intercurrences and severity of the clinical intercurrences after extubation were studied. Parametric and non-parametric statistical tests, and analysis of univariate and multiple logistic regression were used.Age (p = 0.019), body weight (p = 0.006), smoking (p = 0.014), anesthetic risk (p = 0.0001), tidal volume (p < 0.0001), respiratory rate (p < 0.0001), length of time in the recovery room (p < 0.0001), and post-extubation clinical intercurrences (p < 0.0001) had a significant influence in the Tobin index. The independent variables with risk of failure to wean included advanced age and elevated body weight (p = 0.023).Weaning patients off mechanical ventilation in the postoperative period with a Tobin Index > 80 c.L-1.min-1 and < 100 c.L-1.min-1 was associated with elevated risk of postoperative clinical intercurrences after extubation. Patients with a Tobin index > 80 c.L-1.min, advanced age and increased body weight were independent variables of risk of failure to discontinue mechanical ventilation.

Dexmedetomidine: A new α-agonist anesthetic agent for facial rejuvenation surgery

The ideal anesthetic adjunctive agent is one that has sedative, analgesic, and anxiolytic properties and produces a predictable hemodynamic response without respiratory depression. We sought to determine the efficacy of dexmedetomidine as a multifunctional sedative agent for patients undergoing facial rejuvenation surgery. A retrospective study was conducted of 50 randomly selected, nonintubated patients undergoing extended superficial musculoaponeurotic system (SMAS) face lifts by the same surgeon. Forty-seven of the 50 patients were women; the mean age was 56.1 years. All patients received dexmedetomidine as the primary sedative agent. A total of 73 ancillary procedures were performed. Intraoperative and postoperative respiratory rate, hemodynamic stability, postoperative emergent rates, and adverse events were evaluated. A continuous, titrated infusion of dexmedetomidine (0.2-0.7 mug/kg/h) controlled blood pressure with a systolic blood pressure of 120 mm Hg or less over the course of the 3- to 6.7-hour procedure in all but 8 patients, who required an intraoperative antihypertensive agent. The mean (SD) dose of midazolam and fentanyl was 4.4 (1.3) mg and 201 (64) mug, respectively, and a propofol drip was titrated for additional sedation. All patients maintained a normal respiratory rate, without obstruction or desaturation, and were taken from the operating room directly to a stage 2 recovery area. No patient required antiemetics for postoperative nausea or emesis. There was one complication consisting of a hematoma that occurred 72 hours postoperatively. In our population of nonintubated patients undergoing facial rejuvenation surgery, dexmedetomidine fulfilled the properties sought in a sedative agent.