5％复方利多卡因乳膏涂布气管导管全麻后在麻醉恢复室中拔管观察

目的观察5％复方利多卡因乳膏涂布气管导管后在麻醉恢复室（PACU）中拔管时发生的气道不良事件与血流动力学的变化。方法选择ASAⅠ-Ⅱ级择期行腹部手术,无气道梗阻、高血压等合并症全麻患者100例,随机分为两组：术前5％复方利多卡因乳膏涂布气管导管组（A组）和气管导管乳膏非涂布组（B组）,每组50例,记录手术结束时（T1）,拔除即刻（T2）,拔除后5min时（T3）的收缩压、舒张压、心率及动脉血氧饱和度（SpO2）,以及发生咽痛、呛咳及低氧血症的病例数。结果-5％复方利多卡因乳膏涂布气管导管组较非涂布组呛咳反应少,低氧血症和咽痛的发生率低,血流动力学变化小。结论5％复方利多卡因乳膏涂布气管导管后不良气道事件发生率低．应激反应小,有利于PACU中麻醉管理。     

Perioperative opioid requirements are decreased in hypoxic children living at altitude

Objectives: To investigate the effect of altitude on perioperative opioid requirements in otherwise healthy children. Aim: To investigate whether children living and having surgery at high altitude received different doses of fentanyl than those living and having surgery at sea level. Background: Recent studies in animals (Anesthesiology, 105, 2006 and 715) and children with obstructive sleep apnea (Anesthesiology, 105, 2006 and 665; Anesthesiology 100, 2004 and 806) suggest that analgesic effects of exogenous opioids are enhanced by hypoxia. However, the effects of hypoxia on perioperative narcotic requirements in otherwise healthy children have not been previously reported. Methods/materials: We reviewed retrospectively the opioid requirements of pediatric patients who underwent cleft lip or palate surgery during Smile Network International mission trips to Cusco and Lima, Peru between 2007 and 2009. Patients who had surgery at high altitude were compared to those who had surgery at sea level. All patients received a standardized anesthetic with intravenous fentanyl as the only perioperative opioid. Results: Hundred and two patients had surgery at 3399 m above sea level (masl) (Cusco) and 169 patients had surgery at 150 masl (Lima). Patients at high altitude had significantly lower baseline oxygen saturations (92 ± 4% vs 98 ± 3%; P < 0.001) and received 40% less opioid (1.2 ± 0.8 vs 2.0 ± 1.4 μg·kg^?1 per h; P < 0.001) compared to patients at sea level. Conclusions: Opioid administration was reduced in otherwise healthy children with altitude‐induced chronic hypoxia when compared to non‐hypoxic children undergoing similar operations under similar anesthetic regimens. Whether this difference is due to altitude or altitude‐induced hypoxia, requires further study.     

多元化带教方法在PACU带教中的应用

【摘要】目的：探讨多元化带教方法在PACU临床实习护生带教工作中的应用效果。方法：选取2018年6月—2019年2月在安徽省某三甲医院PACU实习的44名护生,按照实习时间阶段分为传统组和多元组。传统组采用传统一对一带教方法,多元组采用多元化带教方法。实习结束后,比较两组的带教效果。结果：多元组护生理论和操作考核成绩、对带教的满意度以及老师对护生的评分均优于传统组（P＜0.05）。结论：在PACU临床实习护生带教工作中,应用多元化带教方法能充分调动护生自主学习能动性,从而使护生对理论知识和临床操作有更好的掌握,提高临床带教质量。     

安全隐患自查模式联合安全隐患警示牌在麻醉恢复室护理安全管理中的运用

[目的]探讨安全隐患自查模式联合安全隐患警示牌在麻醉恢复室(PACU)护理安全管理中的运用效果。[方法]选取2017年1月—2018年12月医院收治并符合纳入标准,手术后在PACU麻醉后复苏与观察的200例病人作为研究对象。其中2017年1月—2017年12月收治的98例病人为对照组,采用常规PACU护理安全管理方法;2018年1月—2018年12月收治的102例病人为试验组,采用安全隐患自查模式联合安全隐患警示牌的方法实施护理安全管理。比较实施两种护理安全管理方法期间病人麻醉复苏期不良事件(包括管道脱落、心搏骤停需心肺复苏、休克、苏醒延迟、循环系统相关不良事件、呼吸系统相关不良事件等)发生率与PACU护士对PACU安全管理知识、态度、行为及意识变化。[结果]试验组病人麻醉复苏期不良事件发生率明显低于对照组(P<0.05);安全隐患自查模式联合安全隐患警示牌的方法实施后PACU护士对PACU安全管理知识、态度、行为及意识明显优于实施前(P<0.05)。[结论]安全隐患自查模式联合安全隐患警示牌在PACU护理安全管理中运用,能有效提高PACU护士对PACU安全管理知识、态度、行为及意识,降低麻醉复苏期不良事件发生率,提高PACU护理安全管理质量。     

Patient recovery and post-anaesthesia care unit (PACU)

Patient recovery is the time from the end of anaesthesia/surgery to regaining full control of airway reflexes. During recovery immediate postoperative complications may arise. Major complications arise in 3–17% of inpatient surgical procedures. These complications should be managed either in theatre or in a designated recovery area (post-anaesthesia care unit).     

Analysis of the Risk Factors for the Onset of Postoperative Hypothermia in the Postanesthesia Care Unit

PurposeRecent studies on hypothermia typically focused on a single anesthesia method or a particular surgical procedure. Although there are multiple risk factors leading to hypothermia, such as the use of cold solutions or nonhumidified and nonheated anesthetic gases, few studies have reported the incidence of postoperative hypothermia among patients in the postanesthesia care unit (PACU).DesignThis is a retrospective analysis of patients who underwent surgery and were admitted to the PACU immediately after surgery at the Fourth Affiliated Hospital, College of Medicine, Zhejiang University, from September 2018 to March 2019.MethodsPatient data were collected and analyzed in two groups to understand the factors affecting the occurrence of hypothermia. Hypothermia was defined as a core temperature of less than 36°C. On the basis of body temperature, patients in the PACU were divided into hypothermic and nonhypothermic groups. Factors influencing hypothermia were studied by the univariate method, followed by logistic regression analysis to identify the risk factors for hypothermia onset.FindingsOf a total of 1,788 patients were enrolled in the study, 113 (6.32%) exhibited hypothermia (<36°C) in the PACU. The hypothermic and nonhypothermic groups displayed significant differences (P < .05) in the anesthesia method used as well as the American Society of Anesthesiologists physical classification status. The body temperature at the time the patients were admitted to the operating room influenced the occurrence of postoperative hypothermia (P < .01). These parameters were recognized as independent risk factors for postoperative hypothermia in the PACU.ConclusionsSignificant risk factors for the onset of hypothermia were general anesthesia and higher American Society of Anesthesiologists grade. However, epidural anesthesia was found to have a protective effect.     

Incidence and Risk Factors of Postoperative Severe Discomfort After Elective Surgery Under General Anesthesia: A Prospective Observational Study

PurposePatient comfort is an important concern in patients receiving surgery, but the seriousness of discomfort during recovery is unknown. We investigated the incidence of postoperative discomfort based on the Standardized Endpoints in Perioperative Medicine initiative for patient comfort, and identified the risk factors.DesignThis was a single-center prospective observational study.MethodsWe enrolled adult patients who underwent elective surgery under general anesthesia between July and December 2018 at West China Hospital of Sichuan University (ChiCTR1800017324). The primary outcome was the incidence of postoperative severe discomfort (PoSD), defined as occurring when a patient experienced a severe rating in two or more domains in the six domains in the Standardized Endpoints in Perioperative Medicine initiative on the same day, including rest pain, postoperative nausea, and vomiting, dissatisfaction of gastrointestinal recovery, dissatisfaction of mobilization, sleep disturbance, and recovery. A generalized estimated equation was constructed to find risk factors of PoSD.FindingsIn total, 440 patients completed the study. The incidence of PoSD was 28% on postoperative day (POD) 1, 13% on POD 2, 9% on POD 3, and 3.6% on both POD 5 and 7. The most common discomfort was serious sleep disturbance, ranging from 43% to 10% in the first week after surgery. Longer operative time (odds ratio [95% confidence interval]: 1.56 [1.19 to 2.05], P = .001), gastrointestinal surgery (5.03[2.08,12.17], P < .001), orthopaedic surgery (3.03 [1.35,6.79], P = .007), ear, nose, and throat (ENT) surgery (3.50 [1.22,10.02], P = .020) and postoperative complications (1.77 [1.03-3.04], P = .038) were significant risk factors of PoSD.ConclusionsThe incidence of PoSD after elective surgery under general anesthesia is high. Sleep disturbance was the most common problem identified. Anesthesia providers and perianesthesia nurses may need to optimize anesthetic application, combine different anesthesia methods, improve perioperative management, and provide interventions to reduce and to treat discomfort after surgeries.