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Abstract Background: Alarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU). Methods: This is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency. Results: A total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04-0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status. Conclusion: Customizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors.
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BACKGROUND: Alarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU). METHODS: This is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency. RESULTS: A total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04-0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status. CONCLUSION: Customizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors.
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Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.
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Humanos , Tosse/prevenção & controle , Intubação Intratraqueal , Período Pós-Operatório , Extubação , Anestesia Geral , Anestesia Local , Anestésicos LocaisRESUMO
BACKGROUND: Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. OBJECTIVES: To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. METHODS: Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. RESULTS: The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR.á=.á0.55; 95% CI: 0.42 to 0.72; p.á<.á0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p.á=.á0.49). CONCLUSION: Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.
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Tosse , Intubação Intratraqueal , Humanos , Tosse/prevenção & controle , Anestésicos Locais , Anestesia Local , Período Pós-Operatório , Extubação , Anestesia GeralRESUMO
Objetivo: Identificar o conhecimento da equipe de enfermagem que atua na recuperação anestésica acerca da avaliação do bloqueio neuromuscular residual (BNMR) em pacientes cirúrgicos. Método: Estudo quantitativo, transversal, realizado em um hospital privado de São Paulo. Amostra composta por 50 profissionais, sendo 18 enfermeiros e 32 técnicos de enfermagem, que responderam um questionário validado por um corpo de cinco juízes. Coleta realizada de janeiro a março de 2022, utilizando-se a plataforma REDCap. Realizadas análises descritiva e inferencial, medidas de tendência central e de dispersão, testes de correlação de Pearson e t-Student, considerando-se nível de significância de 5%. Pesquisa conduzida segundo a Resolução 466/2012. Resultados: A média de acertos geral foi de 43%, sendo 44,4% entre enfermeiros e 42,2% entre técnicos. Seis (12%) profissionais já tinham feito algum treinamento sobre bloqueio neuromuscular e 10 (20%) relataram já ter atendido pacientes com BNMR. Não foram observadas diferenças estatisticamente significativas entre a média de acerto das questões e o tempo de formação e atuação profissional, especialização, experiência prévia ou execução de treinamentos. Conclusão: O estudo evidenciou déficits de conhecimento da equipe de enfermagem acerca do BNMR e a assistência durante esta intercorrência. Ressalta-se a importância de ações de educação permanente, com vista à capacitação dos profissionais para o atendimento desta complicação e melhoria dos cuidados de enfermagem prestados na recuperação anestésica para garantia da segurança do paciente
Objective: To identify the knowledge of the nursing team involved in anesthetic recovery regarding the assessment of residual neuromuscular blockage (RNB) in surgical patients. Method: This is a quantitative, cross-sectional study conducted in a private hospital in the state of São Paulo, Brazil. The sample com-prised 50 professionals, 18 nurses and 32 nursing technicians, who answered a questionnaire validated by five judges. The collection was carried out from January to March 2022, using the REDCap platform. Descriptive and inferential analyses, central tendency and dispersion measures, Pearson's correlation and Student's t-test were performed, considering a significance level of 5%. The research was conducted in accordance with Resolution 466/2012. Results: The average num-ber of correct answers was 43%, 44.4% among nurses and 42.2% among technicians. Six (12%) professionals had already took some training on neuromuscular blockade and 10 (20%) reported having treated patients with RNB. We observed no statistically significant differences between the average of correct answers of the questions and the length of training and professional performance, specialization, previous experience, or carrying out training. Conclusions: We identified deficits in the nursing team's knowledge of the RNB and care during this procedure. The importance of continuing education actions is emphasized, with a view to training professionals to treat this complication and improve the nursing care provided during anesthetic recovery to guarantee patient safety
Objetivo: Identificar el conocimiento del equipo de enfermería que trabaja en la recuperación anestésica respecto a la evaluación del bloqueo neuromuscular residual (BNMR) en pacientes quirúrgicos. Método: Estudio cuantitativo, transversal, realizado en un hospital privado de São Paulo. Muestra compuesta por 50 profesionales, 18 enfermeros y 32 técnicos de enfermería, quienes respondieron un cuestionario validado por un panel de cinco jueces. Recolección realizada de enero a marzo de 2022, utilizando la plataforma REDCap. Se realizaron análisis descriptivos e inferenciales, medidas de tendencia central y dispersión, pruebas de correlación de Pearson y t-Student, considerando un nivel de significancia del 5%. Investigación realizada según Resolución 466/2012. Resultados: El promedio global de aciertos fue del 43%, 44,4% entre enfermeros y 42,2% entre técnicos. Seis (12%) profesiona-les ya habían recibido algún entrenamiento en bloqueo neuromuscular y 10 (20%) informaron haber tratado ya pacientes con BNMR. No se observaron diferencias estadísticamente significativas entre el número medio de respuestas a las preguntas y el tiempo de formación y desempeño profesional, espe-cialización, experiencia previa o ejecución de la formación. Conclusión: El estudio destacó déficits de conocimiento entre el equipo de enfermería sobre el BNMR y la asistencia durante este incidente. Se destaca la importancia de acciones de educación continua, con miras a capacitar profesionales para enfrentar esta complicación y mejorar los cuidados de enfermería brindados durante la recuperación anestésica para garantizar la seguridad del paciente
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Período de Recuperação da Anestesia , Conhecimentos, Atitudes e Prática em Saúde , Recuperação Demorada da Anestesia/enfermagem , Equipe de Enfermagem , Estudos TransversaisRESUMO
BACKGROUND: Emergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile). METHODS: A five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale. RESULTS: The PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach's alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3-10 years). CONCLUSIONS: The translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children.
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Delírio , Delírio do Despertar , Humanos , Criança , Pré-Escolar , Delírio do Despertar/diagnóstico , Período de Recuperação da Anestesia , Delírio/epidemiologia , Reprodutibilidade dos Testes , Comparação TransculturalRESUMO
BACKGROUND: The postoperative care transition from the postanesthetic recovery room (PACU) to the common ward or even home discharge represents a critical step of the surgical patients' handover. Although some systems have been proposed to measure the ability to discharge after an anesthetic-surgical procedure effectively, there is no consensus defining which variables should necessarily be evaluated by these instruments. The instruments routinely used do not evaluate important domains for discharge and are laborious to fill, which compromises the professionals' adhesion. The objectives are to describe the creation of a new recovery room discharge tool (SAMPE checklist) and determine the degree of agreement of the new tool with two classical scales. METHODS: In a cross-sectional observational study, 997 patients were selected from the general population undergoing a wide range of surgical procedures in a quaternary care hospital. At 90 minutes after leaving the operating room (OR), patients were evaluated and information was collected to fill out the new SAMPE checklist and two other scores (Aldrete and White) to examine the degree of agreement between them. RESULTS: SAMPE checklist has presented a satisfactory agreement with the White score and lower agreement with Aldrete modified score. CONCLUSION: This new instrument, as demonstrated in this study with nearly 1000 patients from different contexts, is easy to apply, has high adhesion potential, and can be considered a new option to formalize the discharge from the recovery room.
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Transferência da Responsabilidade pelo Paciente , Sala de Recuperação , Período de Recuperação da Anestesia , Lista de Checagem , Estudos Transversais , Humanos , Alta do PacienteRESUMO
Objetivo: analisar as frequências das complicações em Sala de Recuperação Pós-Anestésica (SRPA) por especialidades cirúrgicas e sua associação com variáveis pré, intra e pós-operatórias imediatas. Método: estudo transversal, com 98 pacientes. Utilizaram-se dados perioperatórios, coletados por meio de entrevista, exame físico e prontuário eletrônico; e análises descritivas, bivariadas e regressão logística. Resultados: hipotermia foi mais frequente nas cirurgias geral e ginecológica em mulheres, sendo associada às anestesias geral ou raquidiana e ao posicionamento litotômico (p<0,05). Náuseas em cirurgias gerais e ginecológicas (p=0,05), e vômitos nas gerais (p=0,01). Dor nas cirurgias gerais, associada à anestesia geral e à prescrição de analgésicos no intraoperatório (p<0,05). Cirurgia geral aumenta 3,5 vezes as chances de dor em SRPA (p=0,01). Conclusão: encontrou-se maior frequência de hipotermia, dor e náuseas/vômitos, associadas às especialidades ginecológica e geral, ao sexo feminino, posicionamento cirúrgico litotômico, à prescrição de analgésicos no intraoperatório e às anestesias raquidiana e geral.
Objective: to analyze the frequencies of complications in the Post-Anesthetic Care Unit (PACU) by surgical specialties and their association with pre-, intra- and immediate postoperative variables. Method: cross-sectional study with 98 patients. Perioperative data were used, collected through interviews, physical examination and electronic medical records; and descriptive, bivariate and logistic regression analyses. Results: hypothermia was more frequent in general and gynecological surgeries in women, being associated with general or spinal anesthesia and lithotomy positioning (p<0.05); nausea in general and gynecological surgeries (p=0.05), and vomiting in general (p=0.01); pain in general surgeries, associated with general anesthesia and intraoperative prescription of analgesics (p<0.05). General surgery increased the chances of pain in the PACU by 3.5 times (p=0.01). Conclusion: there was a higher frequency of hypothermia, pain and nausea/vomiting associated with gynecological and general specialties, female sex, lithotomy surgical position, intraoperative analgesic prescription and spinal and general anesthesia.
Objetivo: analizar las frecuencias de las complicaciones en la Unidad de Cuidados Post Anestésicos (UCPA) por especialidades quirúrgicas y su asociación con variables pre, intra y postoperatorias inmediatas. Método: estudio transversal con 98 pacientes. Se utilizaron datos perioperatorios, recolectados a través de entrevistas, examen físico y prontuario electrónico; y análisis de regresión descriptiva, bivariada y logística. Resultados: la hipotermia fue más frecuente en cirugías generales y ginecológicas en mujeres, asociándose a anestesia general o espinal y posicionamiento litotómico (p<0.05). Náuseas en general y cirugías ginecológicas (p=0.05), y vómitos en general (p=0.01). Dolor en cirugías generales, asociado a anestesia general y prescripción intraoperatoria de analgésicos (p<0.05). La cirugía general aumenta las posibilidades de dolor en la UCPA 3.5 veces (p=0.01). Conclusión: hubo mayor frecuencia de hipotermia, dolor y náuseas/vómitos, asociados a especialidades ginecológicas y generales, sexo femenino, posicionamiento quirúrgico litotómico, prescripción analgésica intraoperatoria y anestesia raquídea y general.
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Humanos , Complicações Pós-Operatórias , Período Pós-Operatório , Procedimentos Cirúrgicos Operatórios , Enfermagem Perioperatória , Período de Recuperação da AnestesiaRESUMO
Paro cardiaco en salas de recuperación posanestésica, entidad poco frecuente en esterilizacion tubaria. Factores descencadenantes como sobresedación, bloqueo espinal alto, uso de opioides, toxicidad sistémica por anestésicos locales. La ligadura tubárica como prevención de embarazo definitivo, se realiza preferentemente con bloqueo raquídeo. Paciente de 35 años en su puerperio de 12 horas, se somete a salpingoclasia bilateral bajo anestesia raquidea, con dosis de fentanil de 20 mcg y bupivacaina pesada de 12 mg. Nivel de dermatoma alcanzado de T6 (ideal para el procedimiento quirúrgico), sin ninguna otra administración medicamentosa. En la unidad de recuperación posanestésica presenta paro cardiaco con inicio inmediato soporte vital avanzado con buenos resultados posteriores. Se le practican los exámenes complementarios e interconsultas correspondientes. Paciente con alta hospitalaria sin secuelas neurológicas a los 4 días posteriores al evento. Se recomienda prevenir y tratar la causa de todo evento cardiaco.
Cardiac arrest in post-anesthetic recovery period, a rare entity in sterilization tubal . Descending factors such as over-sedation, high spinal block, use of opioids, systemic toxicity from local anesthetics. Tubal ligation as prevention of definitive pregnancy, is preferably performed under spinal anesthesia. A 35-year-old patient in his 12-hour puerperium, undergoes Sterrilization Tubal under spinal anesthesia, with fentanyl doses of 20 mcg and hiperbaric bupivacaine of 12 mg. Dermatome level reached of T6 (ideal for the surgical procedure), without any other drug administration. In the post-anesthesia recovery period, she presented cardiac arrest with immediate initiation of advanced life support with good later results. Complementary exams and corresponding consultations are given. Patient released from hospital with no neurological sequelae 4 days post the incident. It is recommended to prevent and treat the cause of all cardiac events.
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Cuidados Pós-OperatóriosRESUMO
INTRODUCTION: Spinal anesthesia combined with sedation and general anesthesia combined with epidural are two techniques often used for patients undergoing abdominal hysterectomy. There is no consensus that one of these techniques is superior regarding the perception of patients towards the quality of postoperative recovery. This observational cross-sectional study aimed to assess the quality of postoperative recovery in women undergoing open abdominal hysterectomy by comparing both anesthetic techniques. METHOD: We recruited 162 women aged between 30 and 74 years to be submitted to abdominal hysterectomy. The anesthetic technique used followed the preference of the attending anesthesiologist without interference of the investigators. After applying the exclusion criteria, 80 patients underwent spinal anesthesia combined with sedation (Group 1) and 62 women underwent epidural anesthesia combined with general anesthesia (Group 2). The quality of postoperative recovery was evaluated using the questionnaire Quality of Recovery-40 (QoR-40) completed 24 hours after the end of the surgery. RESULTS: Eighty patients in Group 1 answered the QoR-40 questionnaire with an average rating of 179.4 points, median of 186.5, standard deviation of 17.4 and a confidence interval of 3.8. The 60 patients in Group 2 answered the QoR-40 with an average of 174.9 points, median of 178 points, standard deviation of 16 points and a confidence interval of 4.0 (p = 0.024). CONCLUSION: Women who received spinal anesthesia combined with sedation considered quality of postoperative recovery better.
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Anestesia Epidural , Raquianestesia , Anestésicos , Adulto , Idoso , Período de Recuperação da Anestesia , Anestesia Geral , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-OperatórioRESUMO
Objetivo: Identificar a frequência, o perfil e o tempo de permanência de pacientes intensivos admitidos na sala de recuperação pós-anestésica (SRPA). Método: Estudo transversal e retrospectivo, realizado com base em registros de admissões na SRPA de um hospital público no Rio Grande do Sul, entre julho de 2012 e julho de 2017. Resultados: No período estudado, admitiram-se no setor 22.333 pacientes, sendo 717 (3,2%) pacientes intensivos por indisponibilidade de leito na unidade de terapia intensiva. Destes, 67,6% eram do sexo feminino, 61,2% em idade adulta, submetidos à neurocirurgia (61,5%). O tempo de permanência médio no setor foi de 10,7 horas, e 4,1% dos pacientes foram a óbito. Conclusão: A permanência de pacientes intensivos na SRPA requer adequação do setor em sua estrutura física e operacional, especialmente no que diz respeito à equipe assistencial tanto em quantidade de pessoal quanto em capacitação técnica necessária para assegurar uma assistência de qualidade.
Objective: To identify the frequency, profile, and length of stay of intensive care patients admitted to the post-anesthesia care unit (PACU). Method: This is a retrospective cross-sectional study based on PACU admission records of a public hospital in Rio Grande do Sul, Southern Brazil, between July 2012 and June 2017. Results: In the study period, 22,333 patients were admitted to the PACU; 717 (3.2%) of them were intensive care patients due to the unavailability of beds in the intensive care unit. Among them, 67.6% were women, 61.2% were adults, and 61.5% were individuals submitted to neurosurgery. The mean length of stay in the unit was 10.7 hours, and 4.1% of patients died. Conclusion: The stay of intensive care patients in the PACU requires adapting the physical and operational structure of the unit, particularly in aspects related to the care team, including the number of personnel and the technical training necessary to ensure the quality of care.
Objetivo: Identificar la frecuencia, perfil y tiempo de estancia de los pacientes de cuidados intensivos ingresados en la Sala de Recuperación Posanestésica (SRPA). Método: Estudio transversal y retrospectivo, realizado a partir de los registros de ingreso en la UCPA de un hospital público de Rio Grande do Sul, entre julio de 2012 y julio de 2017. Resultados: En el período estudiado ingresaron al sector 22.333 pacientes, 717 (3,2%) pacientes de cuidados intensivos por indisponibilidad de camas en la Unidad de Cuidados Intensivos. De estos, el 67,6% eran mujeres, el 61,2% adultos, sometidos a neurocirugía (61,5%). La estancia media en el sector fue de 10,7 horas y falleció el 4,1% de los pacientes. Conclusión: La permanencia de los pacientes de cuidados intensivos en la SRPA requiere la adecuación del sector en su estructura física y operativa, especialmente en lo que se refiere al equipo asistencial, tanto en el número de personal como en la formación técnica necesaria para asegurar una atención de calidad.
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Humanos , Qualidade da Assistência à Saúde , Período de Recuperação da Anestesia , Anestesia , Sala de Recuperação , Tempo de Permanência , Tempo de InternaçãoRESUMO
Abstract Myotonic dystrophy type-1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine-based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.
Resumo A Distrofia Miotônica (DM) tipo-1 (Doença de Steinert) é uma doença multissistêmica progressiva autossômica dominante em que a crise miotônica pode ser desencadeada por vários fatores, incluindo dor, estresse emocional, hipotermia, tremores e estímulo mecânico ou elétrico. O presente relato descreve anestesia geral realizada com dexmedetomidina em combinação com peridural torácica para colecistectomia laparoscópica em paciente com Doença de Steinert. Para evitar laringoscopia, a intubação traqueal foi realizada utilizando cateter de intubação Aintree guiado por broncofibroscopia óptica. Os efeitos anestésicos prolongados do propofol foram revertidos e a recuperação anestésica foi acelerada pelo uso de infusão intravenosa de teofilina.
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Humanos , Feminino , Colecistectomia Laparoscópica/métodos , Analgésicos não Narcóticos , Dexmedetomidina , Anestesia Epidural/métodos , Anestesia Geral/métodos , Distrofia Miotônica/complicações , Teofilina/administração & dosagem , Período de Recuperação da Anestesia , Propofol , Broncoscópios , Analgésicos Opioides , Hipnóticos e Sedativos , Intubação Intratraqueal/métodos , Pessoa de Meia-IdadeRESUMO
Myotonic dystrophy type-1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine-based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.
Assuntos
Analgésicos não Narcóticos , Anestesia Epidural/métodos , Anestesia Geral/métodos , Colecistectomia Laparoscópica/métodos , Dexmedetomidina , Distrofia Miotônica/complicações , Analgésicos Opioides , Período de Recuperação da Anestesia , Broncoscópios , Feminino , Humanos , Hipnóticos e Sedativos , Intubação Intratraqueal/métodos , Pessoa de Meia-Idade , Propofol , Teofilina/administração & dosagemRESUMO
BACKGROUND AND OBJECTIVES: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. METHODS: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. RESULTS: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p<0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24hours (p<0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction. CONCLUSION: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.
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Período de Recuperação da Anestesia , Ansiedade/complicações , Doadores Vivos/psicologia , Nefrectomia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Prospectivos , Adulto JovemRESUMO
Abstract Background and objectives: It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy. Methods: Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated. Results: The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p < 0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24 hours (p < 0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction. Conclusion: Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.
Resumo Justificativa e objetivos: Estima-se que 38-45% dos pacientes apresentem ansiedade pré-operatória. Observamos que doadores vivos submetidos à nefrectomia para doação apresentam ansiedade. A ansiedade pré-operatória pode complicar a recuperação anestésica e controle pós-operatório de dor do paciente. O presente estudo mediu as taxas de ansiedade no pré-operatório e seus efeitos na recuperação anestésica e dor pós-operatória em pacientes doadores submetidos a nefrectomia. Método: Quarenta e oito doadores vivos submetidos a nefrectomia para doação de rim foram incluídos neste estudo de coorte prospectivo observacional. A ansiedade pré-operatória foi medida usando os inventários IDATE-I e IDATE-II. As relações entre os escores de ansiedade e dados relacionados a demografia, recuperação da anestesia e escores de dor no pós-operatório foram estudadas. Resultados: Os achados foram notáveis porque os escores de ansiedade de doadores renais vivos se correlacionaram de maneira significante com as variáveis de recuperação, a saber, tempo para respiração espontânea, tempo para respiração adequada, tempo para extubação e tempo para alta da RPA (p < 0,01). Os escores de ansiedade apresentaram correlação significantemente positiva com os escores de dor do 30o minuto e horas 1, 2, 4, 8, 12 e 24, e a quantidade total de analgésicos administrada nas 24 horas (p < 0,05). Foi observada também correlação significantemente negativa entre os escores de ansiedade e satisfação dos pacientes. Conclusão: Nosso estudo mostrou que doadores vivos submetidos a nefrectomia para doação com altos níveis de ansiedade apresentaram tempos de recuperação tardios e altos escores de dor no pós-operatório. Assim, a identificação dos pacientes com alto nível de ansiedade no pré-operatório é crucial para propiciar recuperação da anestesia e controle da dor no pós-operatório satisfatórios durante a nefrectomia para doação de órgão.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Ansiedade/complicações , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/epidemiologia , Período de Recuperação da Anestesia , Doadores Vivos/psicologia , Nefrectomia , Estudos Prospectivos , Período Pré-Operatório , Pessoa de Meia-IdadeRESUMO
Objetivo: Identificar o conhecimento de acadêmicos de enfermagem relacionado aos cuidados e às ações desenvolvidas pelo enfermeiro em sala de recuperação pós-anestésica com vistas à segurança do paciente. Método: Estudo descritivo-exploratório, de abordagem qualitativa, realizado com 30 acadêmicos de enfermagem de uma instituição privada de ensino superior da Região Sul do Brasil. A coleta de dados ocorreu no mês de outubro de 2018, mediante aplicação de questionário semiestruturado. Empregou-se a análise de conteúdo de Bardin para tratamento dos dados. Resultados: Com base nos depoimentos dos entrevistados, emergiu a seguinte categoria: Cuidados e ações do enfermeiro para segurança do paciente, em sala de recuperação pós-anestésica, percebidos pelos acadêmicos de enfermagem. Cuidados rotineiros e mecanicistas, comunicação, liderança, aplicação do processo de enfermagem e uso de protocolos e escalas foram reconhecidos pelos acadêmicos como fundamentais para a segurança do paciente na recuperação. Conclusão: Os acadêmicos de enfermagem reconheceram elementos promotores do cuidado seguro relacionados à assistência de enfermagem na recuperação anestésica.
Objective: To identify the knowledge of nursing students about nursing care and actions in the post-anesthesia care unit regarding patient safety. Method: This is an exploratory descriptive study with a qualitative approach, conducted with 30 nursing students from a private higher education institution in Southern Brazil. Data were collected by administering a semi-structured questionnaire in October 2018. We adopted Bardin's content analysis for data processing. Results: The following category emerged based on the interviewees' statements: Nursing care and actions in the post-anesthesia care unit regarding patient safety, perceived by nursing students. The students acknowledge routine and mechanistic care, communication, leadership, nursing process application, and use of protocols and scales as fundamental for patient safety when recovering. Conclusion: Nursing students identified safe care elements related to nursing care in anesthesia recovery
Objetivo: identificar el conocimiento de los estudiantes de enfermería relacionados con la atención y las acciones desarrolladas por las enfermeras en la sala de recuperación postanestésica, con miras a la seguridad del paciente. Método: Este es un estudio descriptivo y exploratorio con un enfoque cualitativo, realizado con 30 estudiantes de enfermería de una institución privada de educación superior en el sur de Brasil. La recopilación de datos tuvo lugar en octubre de 2018, mediante la aplicación de un cuestionario semiestructurado. El análisis de contenido temático de Bardin se utilizó para el procesamiento de datos. Resultados: surgió la siguiente categoría: Atención de enfermería y acciones para la seguridad del paciente en una sala de recuperación postanestésica, según lo perciben los estudiantes de enfermería. Los cuidados académicos y de rutina, la comunicación, el liderazgo, la aplicación del proceso de enfermería y el uso de protocolos y escalas fueron reconocidos por los académicos como críticos para la seguridad del paciente en la recuperación. Conclusión: los estudiantes de enfermería reconocieron elementos que promueven la atención segura, relacionados con la atención de enfermería en la recuperación anestésica
Assuntos
Humanos , Sala de Recuperação , Enfermagem , Anestesia , Enfermagem Perioperatória , Período de Recuperação da Anestesia , Segurança do PacienteRESUMO
Objetivo: Verificar o conhecimento dos profissionais de enfermagem no que concerne à segurança do paciente na Sala de Recuperação Pós-Anestésica (SRPA), após a implantação de um protocolo assistencial no referido setor. Método: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa, do tipo convergente assistencial, envolvendo sete profissionais da equipe de enfermagem, atuantes na SRPA de um hospital do oeste catarinense. Resultados: Com base nos achados, surgiram duas categorias: "Segurança do paciente na sala de recuperação pós-anestésica" e "Protocolos Assistenciais" (PA), que proporcionaram efetividade de tais protocolos na sistematização do processo de cuidar, considerando, tanto a segurança do paciente, quanto a do profissional. Conclusão: A aplicação do protocolo, por meio de checklist, além de nortear as ações da equipe, possibilitou que estas ocorressem de forma sistemática e rápida, levando-se em conta a complexidade do atendimento na SRPA.
Objective: To verify the knowledge of nursing professionals about patient safety in the Post-Anesthesia Recovery Room (PARR) after the implementation of a care protocol in the sector. Method: This is a descriptive, exploratory, convergent-care study with qualitative approach, involving seven professionals of the nursing team from the PARR of a hospital in Western Santa Catarina. Results: Based on the findings, two categories emerged: "Patient safety in post-anesthesia recovery room" and "Care Protocols", which provided effectiveness of such protocols in the systematization of the care process, considering both the patient's and the professional's safety. Conclusion: Applying the protocol through a checklist, besides guiding the actions of the team, allowed them to act systematically and quickly, taking into account the service complexity in the PARR.
Objetivo: Verificar el conocimiento de los profesionales de enfermería en lo que concierne a la seguridad del paciente en la Sala de Recuperación Pos-Anestésica (SRPA), tras la implantación de un protocolo asistencial en el referido sector. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, del tipo convergente asistencial, involucrando siete profesionales del equipo de enfermería, actuantes en la SRPA de un hospital del oeste catarinense. Resultados: Con base en los hallazgos, surgieron dos categorías: "Seguridad del paciente en la sala de recuperación pos-anestésica" y "Protocolos Asistenciales" (PA), que proporcionaron efectividad de tales protocolos en la sistematización del proceso de cuidar, considerando, tanto la seguridad del paciente, cuanto a del profesional. Conclusión: La aplicación del protocolo, por medio de checklist, además de guiar las acciones del equipo, posibilitó que estas ocurriesen de forma sistemática y rápida, tomándose en cuenta la complejidad de la atención en la SRPA.
Assuntos
Humanos , Período de Recuperação da Anestesia , Segurança do Paciente , Time Out na Assistência à Saúde , Protocolos Clínicos , Conhecimentos, Atitudes e Prática em Saúde , Guias como AssuntoRESUMO
Introdução: Apesar de haver rigorosas determinações para avaliação pré-anestésica do paciente cirúrgico, bem como cuidados no transoperatório e no pós-operatório, ainda se verifica a permanência de complicações pós-operatórias. Objetivo: Identificar complicações pós-operatórias imediatas ocorridas na Sala de Recuperação Pós-Anestésica (SRPA) em um Hospital Geral do Sul de Santa Catarina. Métodos: Estudo transversal que incluiu pacientes submetidos à anestesia geral em cirurgias eletivas e de urgência. Foram coletados dados acerca do perfil do paciente e do procedimento cirúrgico. Também foram registrados dados dos monitores cardíacos à beira leito do paciente, assim como temperatura axilar, frequência cardíaca e saturação de oxigênio. Prontuários médicos foram revisados. Foram considerados como complicação os sintomas referidos pelo paciente no momento de aplicação do questionário, além de distúrbios da temperatura corporal, da frequência cardíaca ou da saturação de oxigênio. Resultados: Considerando os 350 pacientes incluídos no estudo, a prevalência de complicações pós-operatórias imediatas foi de 74,0%. A complicação mais comum verificada foi dor no local cirúrgico (56,9%), seguido de tontura (21,4%). A maioria dos pacientes apresentou apenas uma complicação (47,9%), sendo que apenas um paciente (0,4%) apresentou seis complicações. Houve uma tendência de associação entre o tipo de cirurgia e a ocorrência de complicações (p=0,059), e houve associação estatisticamente significante entre tipo de anestesia e a ocorrência de complicações (p<0,001). Conclusão: Houve incidência de 74,0% de complicações pós-operatórias, e a dor de fraca intensidade foi a complicação mais comum. Estes dados permitem conhecimento mais abrangente pelos anestesiologistas das principais complicações pós-operatórias, possibilitando condutas mais direcionadas às complicações que são mais comuns entre os pacientes.
Background: Although there are rigorous determinations for pre-anesthetic evaluation of the surgical patient, as well as transoperative and postoperative care, the permanence of postoperative complications is still verified. Objective: To identify immediate postoperative complications occurred in the Post-Anesthesia Care Unit (PACU) at a General Hospital in the South of Santa Catarina. Methods: Cross-section study with patients undergoing general anesthesia in elective and emergency surgeries. Data on patients' profile and their surgical procedure were collected. Cardiac monitors data at the patients' bedside were also registered, as well as the axillary temperature, heart rate and oxygen saturation. The medical records were reviewed. Another symptoms reported by the patient at the time of the application of the questionnaire were considered as complications, besides the body temperature, heart rate and oxygen saturation. Results: Considering the 350 patients included in the study, the prevalence of immediate postoperative complications was 74.0%. The most common complication verified was pain at the surgical site (56.9%), followed by dizziness (21.4%). The majority of patients presented only one complication (47.9%), and just one (0.4%) had six complications. There was a tendency of association between the type of surgery and the occurrence of complications (p = 0.059), and there was a statistically significant association between the type of anesthesia and the occurrence of complications (p <0.001). Conclusion: There was an incidence of 74.0% of postoperative complications, and the pain of low intensity was the most common complication. These data allow a more comprehensive knowledge of the main prostoperative complications by the anesthesiologists, enabling more directed conducts to the complications that are more common among the patients.
RESUMO
STUDY OBJECTIVES: The aim of the present study was to assess the quality of recovery from anesthesia in patients undergoing laparoscopic cholecystectomy (LC) under total intravenous anesthesia, who received either methadone or morphine for post-surgical analgesia by means of questionnaire Quality of Recovery-40 (QoR-40). DESIGN: Prospective Randomized Clinical Trial. SETTING: The setting was at an operating room, postoperative recovery area and hospital ward. PATIENTS: Seventy patients who underwent LC under remifentanil-based anesthesia were randomly assigned to receive methadone 0.1â¯mgâ¯kg-1 or morphine 0.1â¯mgâ¯kg-1. MEASUREMENTS: The primary outcome was the quality of recovery, using the Quality of Recovery Questionnaire (QoR-40). Secondary outcomes included time to eye opening, the occurrence of nausea and vomiting, pain score, use of supplemental analgesics, and PACU length of stay. MAIN RESULTS: No differences were observed in the total or individual QoR-40 dimension scores. During the PACU stay, the occurrence of PONV and pain scores were similar between groups. Opioid consumption (pâ¯<â¯0.02) and the level of sedation (pâ¯<â¯0.01) were higher in the morphine group. There were no differences in the amount of time required to achieve PACU discharge criteria. The frequency of nausea or emesis, the severity of pain, and tramadol consumption were comparable between both groups while on the ward. CONCLUSIONS: Pain scores and the Quality of Recovery did not differ between patients who underwent LC under total intravenous anesthesia, who received either methadone or morphine for post-surgical analgesia.
Assuntos
Analgésicos Opioides/uso terapêutico , Colecistectomia Laparoscópica/efeitos adversos , Metadona/uso terapêutico , Morfina/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Adulto , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Anestesia Intravenosa/efeitos adversos , Anestesia Intravenosa/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Remifentanil/administração & dosagem , Remifentanil/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
Objetivo: a satisfação do paciente é um conceito complexo e multifatorial que ganhou muita importância nas últimas décadas, através dos processos de acreditação. Além disso, a satisfação do paciente influencia o relacionamento com a equipe multidisciplinar e, até mesmo, a adesão ao tratamento proposto. A percepção do paciente quanto à qualidade de recuperação pós-operatória é um dos componentes que influenciam essa satisfação. O objetivo dessa revisão foi avaliar os fatores relacionados ao ato anestésico e cirúrgico que interferem na percepção do paciente quanto à qualidade de recuperação pós-operatória. Método: durante o período entre 01 de março e 31 julho de 2018, a presente revisão integrativa pesquisou os descritores nas bases de dados e encontrou 52000 citações de artigos publicados entre janeiro de 2011 e julho de 2018. Através dos operadores booleanos, combinaram-se os termos da pesquisa e excluíram-se os artigos duplicados; 256 artigos foram avaliados e 51 foram selecionados para essa revisão. Conclusão: a utilização de medicamentos e técnicas que minimizem a permanência hospitalar ou evitem efeitos colaterais como dor, náuseas e vômitos, melhora a percepção do paciente quanto à qualidade de recuperação.(AU)
Objective: patient satisfaction is a complex and multifactorial concept that has gained much importance in the last decades, through the accreditation processes. In addition, patient satisfaction influences the relationship with the multidisciplinary team and, even, adherence to the proposed treatment. The patient's perception of the quality of postoperative recovery is one of the components that influence this satisfaction. The purpose of this review was to evaluate the factors related to the anesthetic and surgical procedure that interfere in the patient's perception of the quality of postoperative recovery. Method: during the period between March 1 and July 31, 2018, this integrative review researched the descriptors in the databases and found 52,000 citations of articles published between January 2011 and July 2018. Through the Boolean operators, the search terms were combined and the duplicate articles were deleted; 256 articles were evaluated and 51 were selected for this review. Conclusion: the use of drugs and techniques that minimize hospital stay or prevent side effects such as pain, nausea and vomiting, improves the patient's perception of the quality of recovery.(AU)
Objetivo: la satisfacción del paciente es un concepto complejo y multifactorial que ha adquirido mucha importancia en las últimas décadas, a través de los procesos de acreditación. Además, la satisfacción del paciente influye en la relación con el equipo multidisciplinario y, incluso, la adhesión al tratamiento propuesto. La percepción del paciente en cuanto a la calidad de recuperación postoperatoria es uno de los componentes que influencian esa satisfacción. El objetivo de esta revisión fue evaluar los factores relacionados al acto anestésico y quirúrgico que interfieren en la percepción del paciente en cuanto a la calidad de recuperación postoperatoria. Método: durante el período comprendido entre el 1 de marzo y el 31 de julio de 2018, la presente revisión integrativa investigó los descriptores en las bases de datos y encontró 52000 citas de artículos publicados entre enero de 2011 y julio de 2018. A través de los operadores booleanos, combinó los términos de la investigación y excluyó los artículos duplicados, evaluó 256 artículos y seleccionó 51 artículos para esa revisión. Conclusión: la utilización de medicamentos y técnicas que minimicen la permanencia hospitalaria o eviten efectos colaterales como dolor, náuseas y vómitos, mejora la percepción del paciente en cuanto a la calidad de recuperación.(AU)