RESUMEN
AIM: This study aimed to determine the relationship between pregnant women's anxiety levels related to concerns about the effect of coronavirus on prenatal attachment. DESIGN AND METHOD: This a descriptive and correlational design study was conducted from September 2020 to January 2021; it included 101 pregnant women who were more than 20 weeks pregnant. Introductory questionnaire, the Coronavirus Anxiety Scale and the Prenatal Attachment Inventory were used as data collection tools. RESULTS: Of the participants, 80.2% were 35 years old or younger. The participants' mean Coronavirus Anxiety Scale score was 8.85 ± 5.02 (min: 0, max: 17), which was close to the scale's cut-off value. Of the participants, 68.3% had high levels of perceived anxiety about coronavirus. The participants' mean Prenatal Attachment Inventory score was 60.08 ± 21.26 (min: 21, max: 84). Of the participants, 54.3% had high levels of Prenatal Attachment Inventory. Correlation analysis found a negative, but significant relationship between the participants' scores on the Coronavirus Anxiety Scale and the Prenatal Attachment Inventory (r = -244, p = 0.014). CONCLUSION: The participants' prenatal attachment levels increased as their perceived anxiety scores about coronavirus decreased.
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Infecciones por Coronavirus , Coronavirus , Adulto , Ansiedad , Femenino , Humanos , Embarazo , Mujeres Embarazadas , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Evaluation of the mental health of pregnant women during the early and peak stages of the Covid-19 outbreak DESIGN: Online survey PARTICIPANTS: Pregnant women over the age of 18 years with no mental disorder during the pre-pregnancy period (N = 729). MEASUREMENTS AND FINDINGS: Mental disorders were assessed using the "Depression Anxiety Stress Scale" and social support was determined using the "Multidimensional Perceived Social Support Scale." Pregnant women had moderate levels of anxiety and depression and mild levels of stress. Anxiety, depression, and stress of moderate or high severity was reported in 62.2%, 44.6%, and 32.2% of the women, respectively. Pregnant women who lost their jobs during the pandemic period showed a 3-fold increase in the risk of anxiety, a 6-fold increase in the risk of depression, and a 4.8-fold increase in the risk of stress. An increase in the perception of social support has protective effects against all three mental disorders during pregnancy. In pregnant women with at least one obstetric risk, the risk of antenatal anxiety is 2 times higher than that in women with no risk. Similarly, women with a chronic physical illness before pregnancy have a higher risk of anxiety during pregnancy than healthy women. Financial strain has predictive value for anxiety and depression, and advanced age is a predictor for depression. KEY CONCLUSIONS: The incidence of mental disorders in pregnant women during the pandemic period was much higher than that during the pre-pandemic period. The high frequency of antenatal mental disorders can lead to an increase in the frequency of obstetric and maternal complications in the short and long term. IMPLICATIONS FOR PRACTICE: Early detection of inadequate social support and economic difficulties of pregnant women during the pandemic period is recommended for protecting their mental health. Pregnant women should have easy access to psychosocial support, and they should be provided obstetric counseling during the pandemic conditions.
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Ansiedad , COVID-19 , Depresión , Complicaciones del Embarazo , Estrés Psicológico , Desempleo/psicología , Adulto , Ansiedad/diagnóstico , Ansiedad/epidemiología , Ansiedad/prevención & control , COVID-19/epidemiología , COVID-19/psicología , Depresión/diagnóstico , Depresión/epidemiología , Depresión/prevención & control , Femenino , Encuestas Epidemiológicas , Humanos , Salud Materna , Salud Mental/tendencias , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/prevención & control , Complicaciones del Embarazo/psicología , Atención Prenatal/métodos , Atención Prenatal/estadística & datos numéricos , SARS-CoV-2 , Apoyo Social , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/prevención & control , Turquía/epidemiologíaRESUMEN
AIM: The research was conducted as a randomized controlled pilot study to evaluate the effects of reflexology on lactation in mothers who delivered by cesarean section (CS). METHODS: A single-blind randomized controlled experimental study was conducted with a total of 60 postpartum women in the reflexology application (n = 30) and control groups (n = 30). After the CS, the mothers in the control group were given approximately 3-h routine nursing care after recovering from the effects of anesthesia; the introductory information form was applied, and the Breastfeeding Charting System and Documentation Tool (LATCH) and visual analog scale (VAS) for the signs of the onset of lactation were implemented on the first and second days. Reflexology was applied to the women in the intervention group after an average of 3 h following the mother's condition had become stable and she had recovered from the effects of anesthesia. Reflexology was applied a total of 20 min - 10 min for the right foot, 10 min for the left foot - twice a day with 8-h intervals on the first and second days after CS. After the last reflexology application, the LATCH and VAS for the signs of the onset of lactation were applied. RESULTS: Of the women, 70% breastfed their babies within 60 min after delivery; 46.7% of the mothers received breastfeeding training and 81.7% needed support for breastfeeding after the CS. The LATCH breastfeeding scores of the women in the intervention group on both days were significantly higher compared to those of the women in the control group (p < 0.001). On the first day after the CS, apart from breast pain, there was no significant difference between the two groups in terms of breast heat and breast tension (p > 0.05). On the second day after the CS, apart from breast tension, there was no significant difference between the groups in terms of breast heat and breast pain (p < 0.05). In the study, women in the intervention group were found to have higher scores in terms of all three symptoms compared to the control group (p < 0.05). CONCLUSIONS: In the study, it was determined that LATCH scores and signs of the onset of breastfeeding increased in the mothers who received reflexology after CS.
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Lactancia Materna , Manipulaciones Musculoesqueléticas , Cesárea , Femenino , Humanos , Lactante , Lactancia , Proyectos Piloto , Embarazo , Método Simple CiegoRESUMEN
PURPOSE: This study aims to determine the effect of individualized care provided based on Swanson's Caring Theory on the grief, depression, anxiety, and stress levels of women who had a miscarriage. DESIGN AND METHODS: A total of 104 women who experienced a miscarriage were randomized as study (n = 52) and control (n = 52) groups. FINDINGS: The women's physical, emotional, behavioral, and cognitive grief symptoms decreased after receiving Swanson's care (P < .001). Negative feelings about the future, level of depression, and anxiety levels diminished after receiving Swanson's Care (P < .001). PRACTICE IMPLICATIONS: Supportive care and counseling provided after miscarriage were found to contribute to women's psychosocial well-being and to improve their ability to cope with psychological symptoms.
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Aborto Espontáneo , Consejo , Pesar , Aborto Espontáneo/psicología , Adaptación Psicológica , Ansiedad , Depresión , Femenino , Estado de Salud , Humanos , Embarazo , Apoyo Social , Estrés PsicológicoRESUMEN
We report on a 30-year-old female acromegalic patient treated with the growth hormone (GH) receptor antagonist pegvisomant at a low dose after the failure of long-acting lanreotide, neurosurgery and radiotherapy treatment to restore IGF-1 levels. The combination treatment was well tolerated and produced a dramatic improvement in the patient's condition (reduction in visual field defects, relief of headache and excessive perspiration), normalization of IGF-I levels and a considerable decrease in tumor size, enabling a dramatic decrease in lanreotide dosage and, ultimately, its withdrawal.
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Acromegalia/tratamiento farmacológico , Adenoma/tratamiento farmacológico , Resistencia a Antineoplásicos , Adenoma Hipofisario Secretor de Hormona del Crecimiento/tratamiento farmacológico , Hormona de Crecimiento Humana/análogos & derivados , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Acromegalia/etiología , Acromegalia/patología , Adenoma/complicaciones , Adenoma/patología , Adulto , Antineoplásicos/uso terapéutico , Quimioterapia Adyuvante , Femenino , Adenoma Hipofisario Secretor de Hormona del Crecimiento/complicaciones , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Hormona de Crecimiento Humana/uso terapéutico , Humanos , Inducción de Remisión , Somatostatina/uso terapéutico , Carga Tumoral/efectos de los fármacosRESUMEN
We analyzed the postoperative short- and mid-term outcomes of a series of patients with annuloaortic ectasia who underwent a modified Bentall operation in our clinic from September 2000 through March 2006. The study included 44 patients. Their average age was 53.4 +/- 14.1 years. The underlying disease was degenerative aortic aneurysm in 42 patients (95.5%) and acute aortic dissection in 2 patients (4.5%). Six patients (13.6%) had Marfan phenotype. Aortic insufficiency was moderate in 30 patients (68.2%) and severe in 14 patients (31.8%). In our modification of the Bentall technique, we completed the resection of the aortic root while leaving 5 to 10 mm of native aortic wall tissue to support the anastomosis. A long piece of Teflon felt (width, 0.5-1 cm) was laid on the annulus, and nonpledgeted 2-0 polyester sutures were passed in turn through the Teflon felt, the preserved aortic tissue, and the aortic annulus. A thin piece of Teflon felt was also used in the coronary artery reimplantation sites. Fibrin glue was routinely applied to all anastomoses. There were no intraoperative deaths. One patient died in the hospital after surgery for acute type I aortic dissection. Another patient died 1 year after the operation from prosthetic-valve endocarditis. No patient required surgical correction of excessive postoperative bleeding. Kaplan-Meier curves showed overall survival of 0.94 (95% confidence intervals, 0.9-0.99). We consider our approach an easy, effective way to minimize bleeding from the anastomoses and at the aortic root--a common challenge in aortic surgery.
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Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Materiales Biocompatibles/uso terapéutico , Hemostasis Quirúrgica/métodos , Politetrafluoroetileno/uso terapéutico , Hemorragia Posoperatoria/prevención & control , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Estudios Retrospectivos , Técnicas de Sutura , Resultado del TratamientoAsunto(s)
Puente de Arteria Coronaria/efectos adversos , Enfermedades del Nervio Oculomotor/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Anciano , Blefaroptosis/etiología , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Mesencéfalo/patología , Monitoreo Intraoperatorio/métodos , Enfermedades del Nervio Oculomotor/etiología , Complicaciones Posoperatorias/etiología , Enfermedades RarasRESUMEN
OBJECTIVE: The aim of this study was to compare the effects of two different cardioplegic solutions on nitric oxide (NO) release from coronary vasculature in patients with type II diabetes mellitus undergoing coronary artery bypass grafting (CABG) surgery. METHODS: Forty patients undergoing elective CABG surgery were randomized to be given crystalloid (Group 1) or blood (Group 2) cardioplegia. Aortic and coronary sinus blood samples were taken at three different time periods and the release of NO from the coronary vasculature was determined by measuring its stable end-products, nitrite and nitrate. The difference between the aortic and coronary sinus concentrations of nitrite and nitrate represents the amount of NO released by coronary vascular bed. RESULTS: Before application of aortic cross-clamp, at T1 period, the levels of nitrite/nitrate from the coronary vasculature were similar in both groups (6.53+/-1.21 microM vs 6.07+/-1.24 microM , p>0.05). However after the removal of cross-clamp, a significant decrease in NO was observed in Group 1 as compared with Group 2 (4.21+/-0.73 microM vs 4.92+/-1.02 microM, p<0.01) . This decrease persisted at T3 period, after 30 minutes of reperfusion in group 1 being significantly different from group 2 (3.86+/-0.49 vs 4.37+/-0.72 microM, p<0.05). CONCLUSION: This study has shown that in patients with type II diabetes mellitus crystalloid cardioplegia causes a decrease in the release of NO from coronary vascular bed during aortic cross-clamp and reperfusion period whereas more physiologic blood cardioplegia did not. Our findings indicate that blood cardioplegia protects endothelial function better than crystalloid cardioplegia in diabetic patients.
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Soluciones Cardiopléjicas/uso terapéutico , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/cirugía , Diabetes Mellitus Tipo 2 , Óxido Nítrico/metabolismo , Anciano , Soluciones Cardiopléjicas/administración & dosificación , Enfermedad de la Arteria Coronaria/sangre , Vasos Coronarios/metabolismo , Endotelio Vascular/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Óxido Nítrico/sangre , Resultado del TratamientoRESUMEN
BACKGROUND: Since the presence of pulmonary hypertension (PHT) affects the prognosis of the patients, it is important to manage and evaluate PHT. The aim of this study was to compare the hemodynamic effects of inhaled nitroglycerin and iloprost during early postoperative period, in patients with PHT undergoing mitral valve replacement surgery. MATERIALS AND METHODS: One hundred patients with PHT (mean pulmonary artery pressure (MPAP) >25 mmHg at rest), were randomized to receive either inhalation of nitroglycerin (group I; n=50) or iloprost (group II; n=50) in the postoperative period. In both groups, baseline hemodynamic parameters were recorded before the treatment (T(0)). Then, patients in group I received 20 microg.kg(-1) nitroglycerin and those in group II received 2.5 microg.kg(-1) iloprost. The same parameters were recorded immediately after the end of the treatment (T(1)). RESULTS: In both study groups MPAP and pulmonary vascular resistance (PVR) were found to be significantly lower at T(1) when compared to that of T(0) period (p<0.05). MPAP and PVR were significantly lower and mean arterial pressure (MAP) was significantly higher in group II when compared to group I at T(1) period (p<0.05). In addition to decreases in PVR and MPAP, iloprost also increased cardiac output (CO)(4.9+/-1.3 vs 5.1+/-0.9, p<0.05) and stroke volume (SV)(48+/-13 vs 56+/-13, p<0.05). CONCLUSION: Inhaled iloprost and nitroglycerin, both effectively reduce MPAP and PVR without affecting MAP, systemic vascular resistance (SVR) and CO. However, iloprost seems to be a more powerful pulmonary vasodilator, therefore we suggest iloprost inhalation in patients with severe PHT.
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Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Hipertensión Pulmonar/tratamiento farmacológico , Iloprost/administración & dosificación , Válvula Mitral , Nitroglicerina/administración & dosificación , Presión Esfenoidal Pulmonar/efectos de los fármacos , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Resultado del Tratamiento , Vasodilatadores/administración & dosificaciónRESUMEN
BACKGROUND: Aprotinin is a serine protease inhibitor used extensively in cardiac operations to reduce postoperative bleeding. It also has cardioprotective effects in ischemia/reperfusion injury. In this study, the effects of aprotinin on the release of cardiac markers were evaluated in patients who had good ventricular function and were undergoing coronary artery bypass grafting with cardiopulmonary bypass (CPB). METHODS AND RESULTS: Eighty male patients with an ejection fraction >or=40%, were randomized into either an aprotinin (Group-I; n=40) or control (Group-II; n=40) group. Patients in the aprotinin group received the full Hammersmith doses of aprotinin (2 x 10(6) KIU pre-CPB, 2 x 10(6) KIU at pump prime, 500,000 KIU/h during CPB), whereas the patients in the control group received only saline solutions. Cardiac troponin-I (cTnI) levels were measured before surgery, immediately after surgery, and at postoperative 6(th), 12(th), 24(th) h and 5(th) day. Creatine kinase (CK)-MB measurements were performed at the same time except for the postoperative 5(th) day. Cardiac index (CI), mixed venous oxygen saturation and lactate dehydrogenase (LDH) measurements were also performed. CONCLUSION: Although all patients were in reasonable condition, less myocardial enzyme leakage occurred on the aprotinin group, suggesting that aprotinin has a protective effect on the myocardium beyond that achieved with blood cardioplegia and systemic hypothermia. Because of aprotinin's effects on multiple targets of metabolism, its protective value might increase in more complicated cases.
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Aprotinina/uso terapéutico , Puente Cardiopulmonar/métodos , Daño por Reperfusión/tratamiento farmacológico , Inhibidores de Serina Proteinasa/uso terapéutico , Adulto , Anciano , Aprotinina/farmacología , Enfermedad de la Arteria Coronaria/cirugía , Forma MB de la Creatina-Quinasa/sangre , Método Doble Ciego , Corazón/efectos de los fármacos , Corazón/fisiopatología , Paro Cardíaco Inducido/efectos adversos , Humanos , Hipotermia/fisiopatología , L-Lactato Deshidrogenasa/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Daño por Reperfusión/sangre , Daño por Reperfusión/fisiopatología , Daño por Reperfusión/prevención & control , Inhibidores de Serina Proteinasa/farmacología , Troponina T/sangreRESUMEN
PURPOSE: Despite the well-documented impairment of pulmonary function after cardiopulmonary bypass, effective precautions and ideal management strategies for this problem are still under debate. This study aimed to evaluate the effects of continuous positive airway pressure (CPAP) applied during cardiopulmonary bypass on respiratory and hemodynamic variables. METHODS: In this randomized, prospective, controlled trial, 120 male patients, aged 45 to 70 yr undergoing first-time elective bypass surgery, were randomly assigned to receive either 10 cm H2O of CPAP (Group I; n = 60) during cardiopulmonary bypass, or serve as control (Group II; n = 60), where the patient's lungs were vented to atmosphere during the bypass period. RESULTS: Alveolar-arterial oxygen partial pressure difference and shunt fraction were significantly higher in the control group compared with the CPAP group after cardiopulmonary bypass (T2) and after closure of sternum (T3), (P < 0.05). No differences between groups with respect to hemodynamic variables were observed at any time. Postoperative pulmonary function variables were lower in both groups compared to baseline values. CONCLUSIONS: Continuous positive airway pressure administered during cardiopulmonary bypass decreased shunt fraction and alveolar-arterial oxygen partial pressure difference during surgery, but had no sustained effect on either variable postoperatively. We conclude that, in patients with normal preoperative pulmonary function, application of 10 cm H2O CPAP does not improve lung function after cardiac surgery.
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Presión de las Vías Aéreas Positiva Contínua , Puente de Arteria Coronaria , Pulmón/fisiopatología , Anciano , Dióxido de Carbono/sangre , Puente Cardiopulmonar , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Estudios ProspectivosRESUMEN
The purpose of this study was to evaluate the acute cardioprotective effect of high-dose methylprednisolone (25 mg/kg) in the controlled in vivo model of myocardial ischemia-reperfusion injury occurring during cardiopulmonary bypass. Forty nondiabetic male patients with three-vessel disease undergoing first-time bypass surgery were enrolled for this double-blind prospective study. Patients were randomized to be given 25 mg/kg methylprednisolone (Group I) and saline (Group II) 1 h before cardiopulmonary bypass. The levels of cardiac troponin-I (cTnI) were used as a marker of myocardial tissue damage in myocardial ischemia-reperfusion injury. The cTnI levels were measured before surgery, at the second hour after cardiopulmonary bypass, at the 6th and 24th hours, and 5th day postoperatively. There was no significant difference between the two groups in respect to the duration of ischemia and reperfusion. The preoperative cTnI levels were 0.22+/-0.29 ng/ml in Group I and 0.23+/-0.28 ng/ml in Group II. cTnI levels increased to 2.40+/-1.0 ng/ml in Group I and 3.19+/-0.88 ng/ml in Group II at the 2nd hour after cardiopulmonary bypass. When the differences between T1 and T0 level that showed the amount of troponin release occurring due to ischemia-repefusion injury was calculated and then compared, there was a significant difference between Groups I and II (P=0.024). The cTnI levels measured at 6 h after CPB were 1.98+/-0.63 ng/ml in Group I and 2.75+/-1.15 ng/ml in Group II (P=0.049). cTnI levels decreased to 0.22+/-0.10 ng/ml in Group I and 0.49+/-0.25 ng/ml in Group II on the postoperative day 5 (P=0.0001). Univalent regression analysis showed that preoperative high-dose corticosteroid usage decreased the troponin release in about 12% and this effect was statistically significant (R2=0.12, P<0.05). A single dose of intravenous methylpredisolone (25 mg/kg) given 1 h before ischemia reduced myocardial ischemia-reperfusion injury. These results demonstrated that the acute cardioprotective effect of corticosteroids has much potential in the future for reducing ischemia-reperfusion injury occurring during cardiopulmonary bypass when it is inevitable.
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Puente Cardiopulmonar , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Glucocorticoides/administración & dosificación , Metilprednisolona/administración & dosificación , Daño por Reperfusión Miocárdica/prevención & control , Anciano , Enfermedad Coronaria/sangre , Método Doble Ciego , Glucocorticoides/farmacología , Humanos , Masculino , Metilprednisolona/farmacología , Persona de Mediana Edad , Estudios Prospectivos , Troponina I/sangreRESUMEN
Inguinal herniorrhaphy is commonly performed on an outpatient basis under nerve blocks or local or general anesthesia (GA). Our hypothesis is that use of paravertebral blocks (PVB) as the sole anesthetic technique will result in shorter time to achieve home readiness and improved same-day recovery over a 'fast-track' GA. Fifty patients were randomly assigned to receive either PVB or GA under standardized protocols (PVB = 0.75% ropivacaine, followed by propofol sedation; GA = dolasetron 12.5 mg, propofol induction, rocuronium, endotracheal intubation; desflurane; bupivacaine 0.25% for field block). Eligibility for postanesthetic care unit (PACU) bypass and data on time-to-postoperative pain, ambulation, home readiness, and incidence of adverse events were collected. More patients in the PVB group (71%) met the criteria to bypass the postanesthetic care unit compared with patients in the GA group (8%; P < 0.001). Only 3 (13%) of patients in the PVB group requested treatment for pain while in the hospital, compared with 12 (50%) patients in the GA group, despite infiltration with local anesthetic (P = 0.005). Patients in the PVB group were able to ambulate earlier (102 +/- 55 minutes) than those in the GA group (213 +/- 108 minutes; P < 0.001). Time-to-home readiness and discharge times were shorter for patients in the PVB group (156 +/- 60 and 253 +/- 37 minutes) compared with those in the GA group (203 +/- 91 and 218 +/- 93 minutes) (P < 0.001). Adverse events (e.g., nausea, vomiting, sore throat) and pain requiring treatment in the first 24 hours occurred less frequently in patients who had received PVB than in those who had received GA. In outpatients undergoing inguinal herniorrhaphy, PVB resulted in faster time to home readiness and was associated with fewer adverse events and better analgesia before discharge than GA.
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Periodo de Recuperación de la Anestesia , Anestesia General/métodos , Bloqueo Nervioso Autónomo/métodos , Hernia Inguinal/cirugía , Adulto , Anciano , Amidas/uso terapéutico , Distribución de Chi-Cuadrado , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Hernia Inguinal/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Ropivacaína , Método Simple CiegoRESUMEN
BACKGROUND: Both general and nerve block anesthesia are effective for shoulder surgery. For outpatient surgery, it is important to determine which technique provides more efficient recovery. The authors' goal was to compare nerve block with general anesthesia with respect to recovery profile and patient satisfaction after rotator cuff surgery. METHODS: In this clinical trial, 50 consenting outpatients (aged 18-70 yr) were randomly assigned to receive either fast-track general anesthesia followed by bupivacaine (0.25%) wound infiltration or interscalene brachial plexus block (0.75% ropivacaine), each under standardized protocols. Blinded recovery room nurses assessed the need for pain treatment and rated patient eligibility for bypass of the phase 1 postanesthesia care unit and for discharge home. Patients were followed up for 2 weeks postoperatively. The primary outcome measures were postanesthesia care unit bypass and same-day discharge. Other same-day recovery outcomes included severity of and treatment for pain and time to ambulation. Postoperative outcomes at home included satisfaction with the anesthesia technique and absence of complications (at 2 weeks). RESULTS: Patients who received nerve block (vs. general anesthesia) bypassed the postanesthesia care unit more frequently (76 vs. 16%; P < 0.001), reported less pain, ambulated earlier, were ready for home discharge sooner (123 vs. 286 min; P < 0.001), had no unplanned hospital admissions (vs. 4 of 25 patients who underwent general anesthesia; P = 0.05), and were more satisfied with their care. No complications were reported in either treatment group. CONCLUSIONS: Nerve block anesthesia for outpatient rotator cuff surgery provides several same-day recovery advantages over general anesthesia.
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Procedimientos Quirúrgicos Ambulatorios , Anestesia General , Bloqueo Nervioso , Procedimientos Ortopédicos , Manguito de los Rotadores/cirugía , Adolescente , Adulto , Anciano , Periodo de Recuperación de la Anestesia , Plexo Braquial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Resultado del TratamientoRESUMEN
It has been suggested that use of peripheral nerve blocks (PNBs) may have some potential benefits in the outpatient setting. There have been no studies specifically comparing PNBs performed with short-acting local anesthetics with general anesthesia (GA) in patients undergoing outpatient knee surgery. We hypothesized that a combination of lumbar plexus and sciatic blocks using a short-acting local anesthetic will result in shorter time-to-discharge-home as compared with GA. Patients scheduled to undergo knee arthroscopy were randomized to receive a GA (midazolam, fentanyl, propofol, N(2)O/O(2)/desflurane via laryngeal mask airway) or lumbar plexus/sciatic block (PNBs; 2-chloroprocaine). Patients given GA also received an intraarticular injection of 20 mL 0.25% bupivacaine for postoperative pain control. Patients in the PNB group were given midazolam (up to 4 mg) and alfentanil (500-750 microg) before block placement and propofol 30-50 microg . kg(-1) . min(-1) for intraoperative sedation. Relevant perioperative times, postanesthesia care unit bypass rate, severity of pain, and incidence of complications were compared between the two groups. Fifty patients were enrolled in the study; 25 patients each received GA or PNBs. Total operating room time did not differ significantly between the 2 groups (97 +/- 37 versus 91 +/- 42 min). Seventy-two percent of patients receiving PNB met criteria enabling them to bypass Phase I postanesthesia care unit compared with only 24% of those receiving GA (P < 0.002). Time to meet criteria for discharge home (home readiness) and time to actual discharge were significantly shorter for patients given PNBs than for patients given GA (131 +/- 62 versus 205 +/- 94 and 162 +/- 71 versus 226 +/- 96, respectively). Under the conditions of our study, the combination of lumbar plexus and sciatic blocks with 2-chloroprocaine 3% was associated with a superior recovery profile compared with GA in patients having outpatient knee arthroscopy.
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Periodo de Recuperación de la Anestesia , Anestesia General , Artroscopía , Rodilla/cirugía , Bloqueo Nervioso , Nervios Periféricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: General anesthesia (GA) and brachial plexus block have been used successfully for surgery on the upper extremities. Controversy exists as to which method is more suitable in outpatients undergoing hand and wrist surgery. The authors hypothesized that infraclavicular brachial plexus block (INB) performed with a short-acting local anesthetic would result in shorter time to discharge home as compared with "fast-track" GA. METHODS: After obtaining written informed consent, 52 patients (aged 18-65 yr, American Society of Anesthesiologists physical status I-III) were randomly assigned to receive either an INB or GA under standardized protocols (INB = 3% 2-chloroprocaine + HCO3 + epinephrine 1:300000, followed by propofol sedation; GA = 12.5 mg dolasetron, propofol induction, followed by laryngeal mask airway insertion and desflurane for maintenance; 0.25% bupivacaine for wound infiltration). At the conclusion of the procedure, nurses blinded to the study goals and the anesthetic technique used a modified Aldrete score to decide whether patients could bypass the postanesthesia care unit. Additional data were collected regarding time to postoperative pain, ambulation, home readiness, and incidence of adverse events. RESULTS: More patients in the INB group (79%) met the criteria to bypass the postanesthesia care unit compared with patients in the GA group (25%; P < 0.001). Compared with patients in the GA group, fewer patients in the INB group had pain (visual analog scale score > 3) on arrival to the postanesthesia care unit (3% vs. 43%; P < 0.001). None of the patients in the INB group requested treatment for pain while in the hospital, compared with 48% of patients in the GA group (P < 0.001). Patients in the INB group were able to ambulate earlier (82 +/- 41 min) compared with those in the GA group (145 +/- 70 min; P < 0.001). Time to home readiness and discharge times were shorter for patients in the INB group (100 +/- 44 and 121 +/- 37 min) compared with those in the GA group (203 +/- 91 and 218 +/- 93 min; P < 0.001). Adverse events (e.g., nausea, vomiting, sore throat) occurred less frequently in patients undergoing INB as compared with those undergoing GA. CONCLUSION: Infraclavicular brachial plexus block with a short-acting local anesthetic was associated with time-efficient anesthesia, faster recovery, fewer adverse events, better analgesia, and greater patient acceptance than GA followed by wound infiltration with a local anesthetic in outpatients undergoing hand and wrist surgery.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Anestesia General , Mano/cirugía , Bloqueo Nervioso , Procedimientos Ortopédicos , Muñeca/cirugía , Adolescente , Adulto , Anciano , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Periodo de Recuperación de la Anestesia , Anestesia General/efectos adversos , Anestésicos Locales , Plexo Braquial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Alta del Paciente , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: Considerable controversy exists over the relationship of paresthesia to nerve stimulation. The purpose of this study was to determine the frequency with which patients report paresthesia at the point that an acceptable motor response is obtained to low-intensity current electrical stimulation. METHODS: Low-intensity current nerve stimulation (0.6 mA, 200 microseconds, 2 Hz) was used to identify the brachial plexus in 64 consecutive patients having shoulder or arm surgery with an interscalene block. During nerve localization and while maintaining a motor response (0.20 mA-0.40 mA), the patients were queried regarding any radiating sensation or pain (paresthesia) in the shoulder or extremity on the side of the blockade. Sensory distribution of the block, motor strength of the arm muscles, and adequacy of anesthesia were used to assess the extent of blockade. RESULTS: Ninety-five percent of patients had satisfactory surgical anesthesia. None of the patients spontaneously reported having a paresthesia during nerve stimulation. However, on careful questioning, half of the patients (55%) reported electrical paresthesia, defined as dull tingling sensation traveling down to their hands and coinciding with the motor response. In addition, most patients (71%) spontaneously reported having a mild, radiating paresthesia on initial injection of local anesthetic. CONCLUSIONS: Painful paresthesiae should be infrequent when a low-stimulating current is used to identify the neural components of the brachial plexus and when the block needle is advanced slowly. Low-current intensity nerve stimulation can be used to achieve successful interscalene block with minimal discomfort to the patient.
Asunto(s)
Plexo Braquial , Parestesia/etiología , Nervios Periféricos/fisiología , Adulto , Brazo/cirugía , Estimulación Eléctrica , Humanos , Neuronas Motoras/fisiología , Bloqueo Nervioso/métodos , Hombro/cirugíaRESUMEN
BACKGROUND: The aim of this study was to investigate the postoperative hemodynamic effects of nitroglycerin inhalation on patients with pulmonary hypertension undergoing mitral valve replacement surgery. METHODS: Twenty patients who underwent mitral valve replacement surgery were included in the study. In the surgical intensive care unit, at T0 (before the inhalation of nitroglycerin), basal systemic and pulmonary hemodynamics were recorded. Then, 2.5 microg x kg-1 x min-1 nitroglycerin liquid nebulized by a 2-l gas flow of 40% oxygen and air mixture was administered to the patients who were diagnosed as having pulmonary hypertension (mean pulmonary arterial pressures > 25 mmHg). The same parameters were measured at the first (T1), third (T2), and fifth (T3) hours after the beginning of this treatment and 1 h after the end of nitroglycerin inhalation (T4). RESULTS: There were no statistically significant differences at T0, T1, T2, T3, or T4 with respect to heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, mixed venous oxygen saturation, arteriovenous oxygen content difference, or arterial carbon dioxide tension. However, mean pulmonary artery pressure, pulmonary vascular resistance, and intrapulmonary shunt fraction were significantly lower, and the arterial oxygen tension/fraction of inspired oxygen ratio was higher at T1, T2, and T3 when compared to that of T0 and T4. CONCLUSION: The results suggest that nitroglycerin inhalation produces a significant reduction in both mean pulmonary artery pressure and pulmonary vascular resistance in patients after mitral valve operations without reducing mean arterial pressure and systemic vascular resistance. Therefore, it might be a safe and useful therapeutic intervention during the postoperative course.