Anesthesia Recovery Period Research Articles

The Scheduling Mode of Anesthesia Nurses Affects Postanesthesia Care Unit Efficiency: A Single-Center Retrospective Study From China

PurposeAnesthesia nurses play an important post-surgical role during anesthesia recovery period, which is characterized by a high incidence of complications related to anesthesia and surgery. Strengthening staff allocation and skill management in LOS (PACU) is therefore particularly important. We aim to investigate the effect of two schedule modes for anesthesia nurses on PACU efficiency. DesignA retrospective observational cohort study. MethodWe conducted a retrospective study in a large tertiary academic medical center. In 2018, the PACU operated with traditional scheduling and the nurse-to-patient ratio was 1.2:1. The PACU implemented intensive scheduling and this ratio was adjusted to 1:1 in 2019 by adjusting the anesthesia nurse allocation scheme. We compared the number of admitted patients, length of PACU stay, the incidence of anesthesia-related complications, and nurse satisfaction with the two modes. FindingsThe total number of admitted patients was 10,531 in 2018 and 10,914 in 2019. PACU admitted 401 more patients in 2019 than in 2018, even with 2 fewer nurses per day. Nevertheless, the median length of PACU stay in 2019 was statistically significantly shorter than in 2018 [29 (22–40) vs. 28 (21–39), P＜0.001], while the incidence of anesthesia-related complications including postoperative pain, nausea and vomiting, hypertension, and shivering were comparable in the two years (P > 0.091). The intensive scheduling implemented in 2019 received more satisfaction from nurses than the traditional scheduling applied in 2018 (P < 0.01). ConclusionThe scheduling of anesthesia nurses affects PACU efficiency. The intensive scheduling mode implemented in 2019 resulted in a comparable number of admitted patients, a better quality of care, and higher nurse satisfaction than those under the traditional scheduling mode.

Low-Dose Alfentanil Inhibits Sufentanil-Induced Cough During Anesthesia Induction: A Prospective, Randomized, Double-Blind Study.

Cough is one of the most common complications following intravenous administration of sufentanil during anesthesia induction. The study aimed to investigate the protective effect of alfentanil, afentanyl derivative with short onset time and short duration, in reducing sufentanil-induced cough. Eighty patients that scheduled for thyroid surgery under general anesthesia were randomly divided into the alfentanil group and normal saline group, with 40 cases per group. Patients in the alfentanil group received intravenous administration of 2 μg/kg alfentanil prior to sufentanil injection during general anesthesia induction, while the same dose of normal saline was administered in the normal saline group. The outcomes measures included the incidence and severity of cough and common side effects of opioids following the administration of sufentanil during the induction of general anesthesia, intraoperative hemodynamics parameters and major adverse events during anesthesia recovery period. The incidence of cough within one minute after the injection of sufentanil during anesthesia induction was 40% in the normal saline group, and the pretreatment of alfentanil significantly reduced the incidence of sufentanil-induced cough to 5% (p < 0.05). Correspondingly, the patients in the alfentanil group had decreased severity of sufentanil-induced cough compared with the normal saline group (p < 0.05). No significant differences in the incidences of common side effects of opioids (dizziness, nausea and vomiting, chest tightness and respiratory depression) within one minute after sufentanil injection were found (p > 0.05). Furthermore, there were no significant differences between the two groups in intraoperative hemodynamic parameters, extubation time, or the incidences of emergence agitation, respiratory depression, delayed recovery from anesthesia and postoperative nausea and vomiting during Postanesthesia Care Unit stay (p > 0.05). Pretreatment with low-dose alfentanil (2 μg/kg) effectively and safely reduced both the incidence and severity of sufentanil-induced cough during anesthesia induction. Chinese Clinical Trial Registry (identifier: ChiCTR2300069286).

Impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery

BackgroundThis study aimed to investigate the impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery.MethodsA prospective observational study was conducted based on inclusion and exclusion criteria. A total of 384 elderly patients undergoing abdominal surgery under general anesthesia were enrolled in a grade A tertiary hospital in Chengdu, Sichuan Province from October 2021 and October 2022. After anesthesia induction, inflatable warming blankets were routinely used for active heat preservation, and nasopharyngeal temperature was monitored to observe the occurrence of intraoperative hypothermia. Patients were divided into hypothermia group and nonhypothermia group according to whether hypothermia occurred during the operation. Anesthesia recovery time and the incidence of adverse events or unwanted events during anesthesia recovery between the two groups were compared.ResultsThe numbers (percentage) of 384 patients who underwent abdominal surgery developed intraoperative hypothermia occurred in 240 (62.5%) patients, all of whom had mild hypothermia. There were statistically significant differences between mild hypothermia after active warming and nonhypothermia in the occurrence of shivering (χ2 = 5.197, P = 0.023) and anesthesia recovery time (Z = -2.269, P = 0.02) in elderly patients undergoing abdominal surgery during anesthesia recovery, and there were no statistically significant differences in hypoxemia, nausea or vomiting, hypertension, hypokalemia, hypocalcemia, analgesic drug use,postoperative wound infection or postoperative hospitalization days.ConclusionsThe incidence of intraoperative mild hypothermia after active warming was high in elderly patients who underwent abdominal surgery. Mild hypothermia increased the incidence of shivering and prolonged anesthesia recovery time in elderly patients undergoing abdominal surgery.

Retracted: Efficacy of High-Quality Nursing Service for the Patients during the Anesthesia Recovery Period: A Meta-Analysis.

[This retracts the article DOI: 10.1155/2022/3528915.].

The ED50 and ED95 of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy: a prospective, double-blinded trial

BackgroundThis study aims to estimate the safety, efficacy, and median effective dose (ED50) of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy.Methods54 patients undergoing laparoscopic cholecystectomy were prospectively randomized into two groups (group C and group E). Different doses of esketamine were intravenously administered before the skin incision in Group E. The patients in group C received the same dose of saline at the same time. General population characteristics were recorded. The median effective dose (ED50) and 95% effective dose (ED95) were calculated using Dixon’s up-and-down method. Hemodynamic parameters were monitored, and pain intensity was assessed using a visual analog scale. We also recorded the condition of anesthesia recovery period and postoperative adverse reactions.ResultsThe ED50 of esketamine for preventing early postoperative pain was 0.301 mg/kg (95%CI: 0.265-0.342 mg/kg), and the ED95 was 0.379 mg/kg (95%CI: 0.340-0.618 mg/kg), calculated by probability unit regression. Heart rate (HR) was significantly lower in the esketamine group compared to the control at the skin incision (p < 0.05). The total VAS score at resting was significantly lower in the esketamine group compared to the control group during the awakening period (p < 0.05). There was no significant difference between the two groups regarding the incidence of adverse reactions (p > 0.05).ConclusionsIn this study, esketamine can prevent early postoperative pain effectively. The ED50 and ED95 of esketamine for controlling early postoperative pain were 0.301 mg/kg and 0.379 mg/kg, respectively.Trial registrationChiCTR2200066663, 13/12/2022.

Ocimum basilicum essential oil in pacu Piaractus mesopotamicus: anesthetic efficacy, distribution, and depletion in different tissues.

This study aimed to evaluate the anesthetic activity of Ocimum basilicum essential oil and the distribution and depletion of its major compounds in different tissues of the pacu, Piaractus mesopotamicus. Juveniles (319.08 ± 9.14g) were individually anesthetized with six concentrations of essential oil from O. basilicum (150, 180, 210, 240, 270, and 300mg L-1), while in a second experiment, fish (492.39 ± 51.51g) were subjected to a 10min immersion bath with essential oil from O. basilicum (300mg L-1). After anesthetic recovery, blood and tissue samples of the brain, gills, liver, spleen, and white muscle were collected at 0, 0.5, 1.0, 3.0, 6.0, 12.0, and 24h. A 300mg L-1 concentration induced anesthesia in the shortest time (193.11 ± 9.31), while at 270 and 300mg L-1 concentrations, the anesthetic recovery period was the longest (244.33 ± 12.44) Methyl chavicol and linalool were quantified in all tissue samples. The plasma concentrations of methyl chavicol differed (p < 0.05) at all evaluated times. Linalool decreased (p < 0.05) from 0 to 1h and decreased again only after 12h. Reduction percentages in 24h were 92.9% for methyl chavicol, and 97.2% for linalool. Elimination of the compounds methyl chavicol and linalool is slower in the gills, where lower elimination constants (0.03 and 0.15 per h) and longer half-lives (25.84 and 4.53h), respectively, are noted. In general, essential oil from O. basilicum compounds was readily eliminated, showing promising potential for use as an anesthetic in aquaculture.

Risk factors for acute postoperative hypertension in non-cardiac major surgery: a case control study

PurposeAcute postoperative hypertension (APH) is a common complication during the anesthesia recovery period that can lead to adverse outcomes, including cardiovascular and cerebrovascular accidents. Identification of risk factors for APH will allow for preoperative optimization and appropriate perioperative management. This study aimed to identify risk factors for APH.Patients and methodsIn this retrospective single-center study, 1,178 cases were included. Data was entered by two investigators, and consistency analysis was performed by another. Patients were divided into APH and non-APH groups. A predictive model was built by multivariate stepwise logistic regression. The predictive ability of the logistic regression model was tested by drawing the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Hosmer and Lemeshow goodness-of-fit (GOF) test was performed to reflect the goodness of fit of the model. Calibration curve was created to represent the relationship between predicted risk and observed frequency. Sensitivity analysis was performed to evaluate the robustness of the results.ResultsMultivariate logistic regression analysis showed that age over 65 years (OR = 3.07, 95% CI: 2.14 ~ 4.42, P < 0.001), female patients (OR = 1.37, 95% CI: 1.02 ~ 1.84, P = 0.034), presence of intraoperative hypertension (OR = 2.15, 95% CI: 1.57 ~ 2.95, P < 0.001), and use of propofol in PACU (OR = 2.14, 95% CI: 1.49 ~ 3.06, P < 0.001) were risk factors for APH. Intraoperative use of dexmedetomidine (OR = 0.66, 95% CI: 0.49 ~ 0.89, P = 0.007) was a protective factor. Higher baseline SBP (OR = 0.90, 95% CI: 0.89 ~ 0.92, P < 0.001) also showed some correlation with APH.ConclusionsThe risk of acute postoperative hypertension increased with age over 65 years, female patients, intraoperative hypertension and restlessness during anesthesia recovery. Intraoperative use of dexmedetomidine was a protective factor for APH.

Warning and Nursing Experience of Anesthesia Depth Monitoring for Patients with General Anesthesia Delayed to Leave Anesthesia Recovery Room and Delirium.

Affected by the residues of narcotic drugs, patients under general anesthesia are vulnerable to emergence of agitation, delirium, hemodynamic changes, and other adverse events in the recovery period of anesthesia. Therefore, it is necessary to strengthen the observation and care of these patients. Depth of anesthesia monitoring (DAM) has always been a concern for anesthesiologists, but there are few reports related to it. This study compared the early warning value of DAM for patients under general anesthesia with delayed exit from the anesthesia recovery unit (PACU) and delirium and summarized the related nursing experience. The results showed that DAM could reduce the incidence of complications in patients under general anesthesia, reduce the incidence of delirium, shorten the time of postoperative anesthesia recovery and PACU observation time, reduce the workload of nursing staff, and improve nursing satisfaction. DAM plays an important role in improving the quality and efficiency of care in PACU.

Effects of different anesthetic depth during propofol anesthesia on postoperative recovery 24h after arthroscopic day surgery: A randomized clinical trial.

Background: This study aimed to compare the effects of different depths of sedation during propofol anesthesia on postoperative recovery 24 h after knee arthroscopy day surgery in adult patients. Methods: This prospective randomized controlled trial involved 126 patients (ASA physical status 1–2) who were scheduled to undergo arthroscopic day surgery. Patients were randomly divided into two groups: the light-sedation (L-Group) or deep-sedation (D-Group). In the L-group, the bispectral index values were kept in the range of 50–59; in the D-group, the bispectral index values were maintained in the range of 40–49. The Quality of Recovery-15 (QoR-15) score assessed 24 h postoperatively using a 15-item questionnaire was the primary outcome. Secondary outcomes included Athens Insomnia Scale scores, postoperative pain scores, nausea or vomiting. Results: The total QoR-15 score 24 h postoperatively was similar in the two groups (L-group median:130, IQR [127–132] vs. D-group median:131, IQR [126–135], p = 0.089). But among the five dimensions of the QoR-15, physiological comfort was significantly better in the D-group than L-group (p < 0.001). The time to open eyes (p < 0.001), follow the command (p < 0.001) and to extubation (p < 0.001) after surgery in the L-group were shorter than the D-group. The Athens Insomnia Scale scores (p < 0.001) and incidence of dreaming (p = 0.041) at the first postoperative night in the L-group was significantly higher than those in the D-group. Propofol consumption in the L-group was less than D-group (p < 0.001). Conclusion: For patients undergoing arthroscopic day surgery, general anesthesia with high-bispectral-index (50–59) cannot improve the total QoR-15 score 24 h postoperatively after surgery, but can lessen propofol consumption, reduce the time of extubation and anesthesia recovery period, compared with low-bispectral-index (40–49). Patients exposed to general anesthesia with low-bispectral-index values (40–49) may have better quality sleep and physical comfort than those with high-bispectral-index values (50–59). Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=126526, identifier ChiCTR2100046340

Efficacy of High-Quality Nursing Service for the Patients during the Anesthesia Recovery Period: A Meta-Analysis.

Background To investigate the efficacy of high-quality nursing service for the patients during the anesthesia recovery period. Methods We used the National Library of Medicine (PubMed), Cochrane Library of Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Wanfang, and very important person (VIP) databases for conducting a systematic literature study. We employed the fixed-effects model for evaluating the standardized mean differences (SMDs) with 95% confidence intervals (CIs). The sensitivity and publication bias were estimated for determining the efficacy of high-quality nursing services during the recovery period of anesthesia. Results In our study, the result showed that the efficiency of recovery time of spontaneous respiration was significantly improved in the experimental group (SMD = −1.48, 95%CI = [−1.62, −1.34]). In this analysis, the extubation time of the experimental group was lower than that of the control group. In control group [WMD = −15.54, 95% CI (-21.24, -9.83), P < 0.00001], the improvement of extubation time was more obvious on high-quality nursing. Moreover, the incidence of agitation in the experimental group was lower than that of the control group, and the score of nursing satisfaction was higher than that in the control group (P = 0.01). The funnel plots identified no publication bias during the identification of efficacy. Conclusions The high-quality nursing care for patients during the resuscitation period can shorten the recovery time of their self-consciousness and self-breathing, reduce the occurrence rate of restlessness, improve patients' anxiety and depression, reduce complications, and play a certain clinical application effect.

A systematic review and meta-analysis on the efficacy and safety of dexmedetomidine combined with sevoflurane anesthesia on emergence agitation in children.

BackgroundThe incidence of restlessness in the wake-up period of sevoflurane inhalation anesthesia is high. Although many studies have explored the relationship between dexmedetomidine and restlessness in the wake-up period of sevoflurane anesthesia in children, they can’t keep consistent conclusions and lack evidence-based medical evidence. Meta-analysis was conducted to explore the efficacy and safety of dexmedetomidine in the treatment of restlessness during the recovery period of sevoflurane anesthesia in children, and to provide reference for clinic.MethodsRelevant articles were retrieved from PubMed, Embase, MEDLINE, Science Direct, The Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chinese Science and Technology Periodical Database, and the Chinese BioMedical Literature Database (CBM). The Chinese and English search keywords included “dexmedetomidine”, “children”, “sevoflurane”, and “emergence agitation”. The articles included were independently evaluated and cross-checked by 2 professionals in strict accordance with the 5 evaluation criteria for randomized controlled trials (RCTs) in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1).ResultsA total of 16 articles were included in this meta-analysis. Of the 16 RCTs, 14 described the generation of random sequences in detail, 8 described allocation concealment in detail, no patient blinding was described due to different surgical methods, 8 articles used operator blinding, and all 16 articles had complete outcome measures. The incidence of emergence agitation in the 0.5 µg/kg dexmedetomidine group was significantly lower than that in the control group, and the difference was statistically significant [odds ratio (OR) =0.22, 95% CI: 0.13, 0.40, P<0.00001]. The incidence of analgesic rescue in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.29, 95% CI: 0.13, 0.63, Z =3.13, P=0.002). The incidence of postoperative nausea and vomiting in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (OR =0.33, 95% CI: 0.20, 0.55, Z =4.29, P<0.0001).DiscussionThe results of this meta-analysis confirmed that dexmedetomidine could reduce the incidence of emergence agitation, postoperative analgesic rescue, and nausea and vomiting in children after sevoflurane anesthesia.

Effect of Parecoxib Sodium Preemptive Analgesia on the Recovery Period of General Anesthesia in Patients Undergoing Glioma Resection.

Objective To investigate the effect of parecoxib sodium preemptive analgesia on postoperative complications and postoperative recovery of patients undergoing glioma resection. Methods A total of 200 eligible patients with low-grade gliomas in the functional brain area scheduled for an awake craniotomy between January 2017 and December 2020 were reviewed. The subjects were divided into two groups: the study group (n = 100) given dexmedetomidine plus parecoxib sodium for pre-emptive analgesia 30 minutes preoperatively, and the control group (n = 100) receiving dexmedetomidine alone. Venous blood was collected before surgery, at the time of postoperative recovery, and 24 hours after operation, mean artery pressure (MAP) and heart rate (HR) were recorded during surgery. Sedation satisfaction, agitation rate, numerical pain score (NRS), postoperative complications, minimental state examination (MMSE) scores, quality of life (QoL) scores, and incidence of adverse events were also investigated after the surgery. Results There were no significant differences in operation time, awakening time, intraoperative awakening time, and extubation time between the two groups (P > 0.05). Compared with the control group, the ΔMAP (7.26 ± 2.21 versus 5.78 ± 2.36 mmHg) and the ΔHR (11.35 ± 3.66 versus 8.84 ± 2.47 beats/min) were significantly lower in the study group (P < 0.05). Compared with the control group, the satisfaction was higher and agitation rate was lower in the study group (P < 0.05). The incidence of intracranial infection and pulmonary infection decreased after operation (P < 0.05). The NRS of the study group was remarkably lower than the control group at 12 hours postoperatively Preoperative MMSE score and QoL score showed no statistical difference (P > 0.05), while postoperative MMSE and QoL scores showed statistical difference (P < 0.05). Conclusion This study suggests that parecoxib sodium can significantly improve the level of sedation and analgesia in patients undergoing glioma resection, reduce the incidence of intracranial infection and pulmonary infection.

Prediction and Evaluation of Machine Learning Algorithm for Prediction of Blood Transfusion during Cesarean Section and Analysis of Risk Factors of Hypothermia during Anesthesia Recovery.

Prediction and Evaluation of Machine Learning Algorithm for Prediction of Blood Transfusion during Cesarean Section and Analysis of Risk Factors of Hypothermia during Anesthesia Recovery.

An Analysis of Risk Factors for a Fracture or Luxation in Recovery From General Anesthesia in Horses: A Single Centre Study☆

Catastrophic fractures or luxations (FoL) sustained during recovery from general anesthesia are a significant cause of mortality during equine anesthesia. There is a lack of evidence regarding potential risk factors for a FoL occurring in the immediate anesthetic recovery period. A single center, retrospective, case-matched study was performed to identify risk factors for sustaining a catastrophic FoL during recovery from general anesthesia. Clinical data were obtained for horses which sustained a catastrophic FoL when recovering from general anesthesia from January 2011 to June 2020 in a single center referral population. Multivariable logistical regression analysis was performed to identify risk factors which were significant in horses where a FoL occurred. Statistically significant risk factors in our population of horses of sustaining a FoL in recovery included intraoperative administration of intratracheal salbutamol, intraoperative administration of ketamine and increasing age. Further research in this area, particularly with regards to salbutamol administration, is required.

Effect of Nursing Intervention in Operating Room for Patients with Gastric Cancer during Anesthesia Recovery Period

Objective: To analyze the effect of nursing intervention in operating room for gastric cancer patients in anesthesia recovery period. Methods: From June 2021 to December 2021, 78 patients who underwent gastric cancer surgery in our hospital were selected for research. Combined with the random number table method, they were divided into the control group (providing routine nursing care in operating room) and the observation group (providing nursing intervention in operating room) with 39 patients in each group respectively. The body temperature of the two groups during operation, during abdominal closure and after operation, the time of leaving anesthesia room, extubation, postoperative wakefulness and hospitalization, degree of satisfaction with nursing work was compared. Results: Compared with the control group, the body temperature in the observation group tended to be more normal during operation, during abdominal closure and after operation (P 0.05). The time of leaving anesthesia room, extubation, postoperative wakefulness and hospitalization in the observation group were shorter than those in the control group (P 0.05). The satisfaction degree of the observation group with nursing work was higher than that of the control group (P 0.05). Conclusion: Nursing intervention in operating room is effective for gastric cancer patients in anesthesia recovery period, which can maintain their perioperative temperature stability, promote their postoperative recovery and enhance their satisfaction with nursing work. It is worth adopting.

Balance impairment caused by diazepam in 2 dogs with vestibular disease: case reports

Following intravenous (IV) administration of diazepam as a preanesthetic agent, sudden balance impairment, such as falling, leaning, and rolling, was identified in 2 canine cases. The 2 dogs were anesthetized for brain magnetic resonance scan to diagnose about a history of head tilt. After end of the diagnostic procedures, during the anesthetic recovery period, balance impairment was also observed. However, the symptoms gradually ceased by IV administration of flumazenil. These 2 canine cases indicated that diazepam premedication was responsible for the acute balance impairment.

The effect of operating room nursing intervention on the psychological status and incidence of emergence agitation in the recovery period of general anesthesia: A protocol for systematic review and meta-analysis.

During the recovery period of general anesthesia, patients are disturbed by residual anesthetic drugs, manifesting as clinical signs of confusion, drowsiness and disorientation, and even abnormal psychology and limb agitation at varying degrees in severe cases. These stress reactions are detrimental to the postoperative recovery, which can be life-threatening. Operating room nursing intervention (ORNI) is a novel nursing model that prevents stress reactions during the recovery period of general anesthesia. However, whether ORNI can improve the psychological condition and reduce the incidence of emergence agitation in the recovery period of general anesthesia remains controversial. Therefore, this study aims to evaluate the effect of ORNI on the psychological status and incidence of emergence agitation in the recovery period of general anesthesia through a systematic review and meta-analysis, thus providing clinical evidence to support it. Randomized controlled trials reporting the effect of ORNI on the recovery period of general anesthesia published before October 2021 will be searched in the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Embase, the Cochrane Library, and Web of Science. Eligible literatures will be screened out according to inclusion and exclusion criteria, and their quality will be assessed using the Cochrane Risk of Bias Assessment Tool. Meta-analysis will be performed using Revman 5.4 software. This study will evaluate the effect of the ORNI on the recovery period of general anesthesia by calculating the incidence of emergence agitation, and grading the self-rating anxiety scale and self-rating depression scale scores. This study will provide a reliable evidence-based basis for the application of ORNI in the recovery period of general anesthesia. DOI 10.17605/OSF.IO/P3A4T.

Thirst Relief Effect of 0.75% Citric Acid Spray During the Anesthesia Recovery Period: A Randomized Controlled Trial

PurposePostoperative thirst is a common clinical issue. The discomfort caused by thirst during the perioperative period is strong and significant. Postoperative thirst is associated with emotional changes, giving rise to a series of adverse psychological and physical problems to patients. This study aimed to explore the effect of 0.75% citric acid spray on thirst relief during the anesthesia recovery period in China. DesignA randomized controlled trial was conducted on subjects immediately after the removal of the endotracheal tube in a postanesthesia care unit. MethodsA total of 112 patients with TI scores ≥3 on 0–10 numeric rating scale were randomized to the intervention group (0.75% citric acid spray group; n = 56) or control group (cool water spray; n = 56) by computerized randomization. Thirst assessment was performed before and 5 minutes after the intervention. Five minutes after the intervention, if the TI score was still ≥3 points, the spray would be added and the thirst assessment would be performed again until the TI score was <3 points. The onset time, duration time, and the number of additional sprays within 20 minutes was recorded. FindingsFive minutes after the intervention, the thirst intensity score of the 0.75% citric acid spray group decreased from 5.57 ± 1.35 to 3.09 ± 1.20. The onset and duration times were 0.77 ± 0.47 min and 4.41 ± 2.59 min, respectively, and the number of spray additions in 20 min was 1.09 ± 0.92. The thirst intensity score of the cool water spray group decreased from 5.29 ± 1.52 to 3.73 ± 1.54. The onset and duration time were 0.84 ± 0.42 min and 2.77 ± 1.80 min, respectively, and the number of spray additions was 1.91 ± 1.24. No incidence of adverse events, including choking, aspiration, and allergies occurred. ConclusionFor thirsty patients during the anesthesia recovery period, the spray method is safe and has fewer side effects, including choking, aspiration, and allergies. Thus, 0.75% citric acid spray and cool water spray are both safe and effective; however, the 0.75% citric acid spray has a better thirst relief effect that lasts longer than the cool water spray.

Cardiopulmonary effects of an intravenous infusion of fentanyl in cats during isoflurane anesthesia and with concurrent acepromazine or dexmedetomidine administration during anesthetic recovery.

To determine the cardiopulmonary effects of IV administration of fentanyl to cats anesthetized with isoflurane and during anesthetic recovery with concurrent administration of acepromazine or dexmedetomidine. 6 healthy adult cats. Cats received an IV bolus (5 μg/kg) followed by an IV infusion (5 μg/kg/h) of fentanyl for 120 minutes during isoflurane anesthesia and for 30 minutes after discontinuing isoflurane. Cats were randomly assigned in a crossover study to receive acepromazine (0.05 mg/kg) or dexmedetomidine (2.5 μg/kg), IV, when isoflurane was discontinued. Cardiopulmonary data were obtained during anesthesia and for 30 minutes during the anesthetic recovery period. The administration of fentanyl during isoflurane anesthesia resulted in a transient increase in arterial blood pressure, mean pulmonary artery pressure, and oxygen delivery. Compared with values during isoflurane anesthesia, administration of dexmedetomidine during anesthetic recovery resulted in significant decreases in cardiac index, stroke index, and oxygen delivery and significant increases in arterial, central venous, and mean pulmonary artery pressures; systemic vascular resistance index; and oxygen extraction ratio. Administration of acepromazine resulted in increases in heart rate, cardiac index, oxygen uptake, and oxygen extraction ratio. Oxygen extraction ratio did not differ between acepromazine and dexmedetomidine. Fentanyl transiently improved indices of cardiopulmonary performance when administered to healthy cats anesthetized with isoflurane. The cardiovascular effects of acepromazine and dexmedetomidine in healthy cats receiving fentanyl during recovery from isoflurane anesthesia differed, but measured cardiopulmonary parameters remained within acceptable limits.

Analysis of influence factors of pharmacodynamics of propofol with target-controlled infusion during anesthetic recovery period.

To explore the pharmacodynamic (PD) characteristics of propofol during anesthetic recovery period with target-controlled infusion (TCI), and to identify the clinical variables related to the PD parameters. 20 patients scheduled for otolaryngology surgery were enrolled. After the surgery was finished, target effect site concentration was gradually decreased, blood samples were measured at 7 time points and the differences between the target and measured plasma concentration were compared. Observer's assessment of alertness/sedation (OAA/S) and Narcotrend index (NI) were used as two PD indicators by fitting sigmoid Emax model. Correlations between PD parameter and clinical variables were evaluated. Performance of the TCI system showed a positive bias at the end of the anesthesia sedation period and a negative bias in the anesthetic recovery period. PD parameters (EC50, r) calculated with OAA/S and NI were significantly different, EC50 of OAA/S was lower than EC50 of NI (1.53 ± 0.70 vs. 2.16 ± 0.99 µg/mL), r of OAA/S was higher than r of NI (57.07 ± 56.39 vs. 4.35 ± 4.42). Propofol dosage and hemodynamic parameters were significantly correlated with EC50 (OAA/S), lean body weight and gender were significantly correlated with EC50 (NI). NI provided a more stable and adequate assessment of the depth of anesthesia than OAA/S, and the influence factors should be taken into account for precise dosing.