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Basics of flexible bronchoscopy and equipment
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Antoinette Wannes Daou, Carolyn Wallace, Joshua Shannon, Cherie A. Torres-Silva
Every sedated patient needs to be monitored and observed until they are awake and back to their baseline status. Patients who have persistent problems post-procedure with hypoxemia, altered mental status, increased work of breathing or difficulties with airway clearance should be observed for a longer period in the post-anesthesia care unit (PACU) or be admitted for observation and monitoring overnight. The level of care necessary at the time of admission will be determined by the patient's clinical status, operative complications, and identified risk factors. (Refer to Tables 2.2, 2.3, and 2.4.)
Paediatric Anaesthesia
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Only start a case if there are facilities to finish it. In emergency cases without appropriate facilities, the anaesthetic team must oversee the patient's recovery. NEVER start a new case until the last patient is safe. Post-anaesthesia care unit (PACU)—trained competent staff, emergency equipment (drugs, anaesthetic machine).High-dependency unit or intensive care unit.Patients should only be discharged when fully conscious, appropriately hydrated, and pain-free with appropriate analgesia prescribed, and with full handover of the post-operative care to the ward.On discharge, patients should be given information sheets about their procedure that contain contact details should they have any problems.
Converting a total disc replacement to an ACDF
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Joseph D. Smucker, Rick C. Sasso
In almost all circumstances, patients are taken to the traditional PACU following these surgical procedures. Exceptions may be made when there is a need for retention of the endotracheal tube beyond the first hour of the postsurgical course. Consideration is made for elevation of the head of the patient's bed and judicious use of perioperative steroids to assist with anterior soft-tissue swelling. An ICU placement may be considered for patients requiring prolonged intubation or in whom neurological assessments are required on a continuous basis. Upright radiographs postoperatively may assist with assessment of anterior soft-tissue swelling.
Sixth Annual Enhanced Recovery After Surgery Symposium highlights: work in progress or standard care?
Published in Baylor University Medical Center Proceedings, 2023
Lucas Fair, Elizabeth Duggan, Evan P. Dellinger, Nicole Bedros, Kimberly Godawa, Cynthia Krusinski, Rachel Curran, Charlette Hart, Alex Zhu, Walter Peters, James Fleshman, Alessandro Fichera
Intravenous dexmedetomidine has been utilized for intraoperative sedation and perioperative analgesia. A 2012 meta-analysis examining early dexmedetomidine data demonstrated reduced pain scores and decreased consumption of morphine in the postanesthesia care unit (PACU) through postoperative day 1.38 However, a 2013 meta-analysis revealed only early pain relief with fading effects at 24 hours.39 More recently, a 2022 meta-analysis specifically examined the impact of dexmedetomidine on quality of surgical recovery.40 The data demonstrate a reduction of pain scores in the PACU as well as reduced postoperative nausea and vomiting, emergent delirium, postoperative cough, and shivering without increasing time to extubation, sedation in the PACU, or PACU length of stay. However, as expected, it did increase the incidence of hypotension, and the drug efficacy was only explored in the recovery room in a monitored environment.
Dexmedetomidine decreases stress post-operative in pediatrics
Published in Egyptian Journal of Anaesthesia, 2022
Taha Magdy AllamFarrag, Mai Abd El Fattah Ahmed Madkour, AbdelhayAbdelgayed Abdelhay Ebade, Victor Farouk JaccoubMetry
In the Post-anesthesia care unit (PACU), the patient was assessed for the following: Hemodynamic – HR, SBP, DBP and MAP (Tables 2, 3, 4 and 5)Adverse events recorded in both groups (Table 6).Cough score (Table 11)Pain score using the Wong-Baker Faces pain rating [9] scale, where 0 denotes the least pain and 10 denotes the worst pain.Sedation score recorded using Aono’s four-point scale [9] – every 10 min in PACU until being discharged from there (Table 7).
Evaluation of unilateral ultrasound guided paravertebral block for perioperative analgesia in cancer patients undergoing lower limb sparing surgeries: A prospective randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2021
Yasmen F. Mohamed, Sayed M. Abed, Tamer M. Khair, Ahmed Abdalla Mohamed, Enas Samir, Walaa Y. Elsabeeny
In both groups, one reading of mean arterial pressure and heart rate were taken before induction of general anesthesia and were defined as baseline readings and then were recorded intraoperatively at 15-min intervals. Additional bolus doses of fentanyl 0.5 μg/kg were given when the mean arterial blood pressure or heart rate rose above 20% of baseline levels. Hypotension, which was diagnosed with drop of blood pressure more than 20% of baseline reading, was treated with 0.9% normal saline and/or 5 mg ephedrine in incremental doses in order to maintain mean blood pressure above 70 mmHg. Ringer acetate was infused in order to replace their fluid deficit, maintenance, and losses. Extubation was performed at the end of surgery after reversing of residual neuromuscular block and complete recovery of airway reflexes. Patients were transferred to the post anesthesia care unit (PACU) room then to the ward. Heart rate, mean arterial blood pressure and VAS scores were recorded on arrival to PACU and at 2, 4, 6, 12, 18, and 24 h postoperatively. In the first 24 hours postoperatively, all patients received multimodal analgesia using paracetamol 1 gm IV every 8 hours, ketorolac 30 mg was given, in addition to a bolus of 3 mg morphine if VAS ≥ 4. The total amount of morphine given in 24 h was recorded in the two groups. Patients in Group P were observed for any complications as hematoma, accidental nerve injury, inadvertent epidural injection and paravertebral muscle spasm. Side effects such as nausea, vomiting, hypotension, or bradycardia were recorded.