The first 24 hours after surgery

The first 24 hours of the postoperative course of 2153 consecutive patients who had operations at the Nottingham Hospitals were studied in detail. Five per cent of patients had serious complications during this period; 15% of those having major operations, 1.8% having intermediate operations and 1.4% having minor operations. Thus, a significant number of patients were in an unstable condition for many hours after they were discharged from the main theatre recovery areas to the surgical wards. In 17 out of 23 patients who died and six out of six patients who suffered severe disability as a result of their surgery, the final outcome was a direct result of a sequence of events which began with an initial deterioration within 24 hours of surgery. We considered that, for at least 10 of these 29 patients, the outcome might have been different had more sophisticated postoperative facilities been available. In the light of this study we have identified the operations for which high dependency facilities are most likely to be required.     

Postoperative sore throat after ambulatory surgery

Background. Sore throat is a common complication of anaesthesiathat affects patient satisfaction after surgery. Methods. We studied 5264 ambulatory surgical patients prospectivelyto determine the patient, anaesthetic, and surgical factorsassociated with sore throat. Results. In 5264 patients, 12.1% reported a sore throat. Patientswith tracheal tube had the greatest incidence, 45.4%, followedby patients with laryngeal mask airway, 17.5%, while patientswith a facemask had a lower incidence of sore throat, 3.3%.Female patients had more sore throats than male patients (13.4vs 9.1%). Airway management had the strongest influence on theincidence of sore throat. Sore throat in ambulatory surgicalpatients was associated with female sex, younger patients, useof succinylcholine, and gynaecological surgery. Conclusion. Airway management, female sex, younger patients,surgery for gynaecological procedure, and succinylcholine predictspostoperative sore throat. Increased awareness of the predictivefactors can help to avoid this combination and improve patientsatisfaction. Br J Anaesth 2002; 88: 582–4     

Postanaesthetic considerations and complications after ambulatory anaesthesia

Ambulatory or day-case surgery is being employed to an ever-increasing extent. Although it has many advantages, it is not suited to the needs of every patient. For example, patients who live alone, particularly the elderly, might well not be able to care for themselves adequately after such surgery and are probably at a higher risk of developing complications, including infections. Furthermore, pain treatment may be insufficient, as a consequence of which recovery can be prolonged and the resumption of normal daily activities might be delayed. Nausea, dizziness and vomiting can also prolong recovery and need to be adequately treated after ambulatory surgery. Therefore, the often cited cost effectiveness of ambulatory surgery is questionable if complications cannot be prevented or treated effectively.     

Myocardial function after preservation for 24 hours

The orthotopically transplanted heart undergoes several steps between harvest from the donor and reperfusion in the recipient: cardioplegic arrest and cooling, ischemia during the operation, in most cases a preservation or storage period of varying duration, and reperfusion. Each of these steps represents a period during which damage to the heart can occur. In this study we have quantified the degree of damage sustained by a donor heart during each of these steps. This objective was achieved by evaluating the function of rabbit hearts via Langendorff procedures following (Group 1) cooling and reperfusion; (Group 2) cardioplegic arrest, cooling, and reperfusion; (Group 3) arrest, cooling, 1 hour of ischemia (5 degrees or 25 degrees C), and reperfusion; (Group 4) arrest, cooling, 24 hours of preservation, and reperfusion; and (Group 5) arrest, cooling, 24 hours of preservation, 1 hour of ischemia (25 degrees C), and reperfusion. Comparisons were made between groups and to control hearts. Cooling and reperfusing the heart (Group 1) led to no loss of function, although recovery to precooling function levels required approximately 25 minutes. Hearts that were arrested before cooling (Group 2) regained full function without the slow recovery time. Hearts that were arrested, cooled, and made ischemic at 5 degrees C (Group 3) recovered 95% of preischemic contractile function: maximum systolic pressure and the maximum positive derivative of the systolic pressure curve. No change in diastolic compliance was detected. Hearts that were arrested, cooled, and made ischemic at 25 degrees C (Group 3) recovered 89% of preischemic contractile function (maximum systolic pressure and the maximum positive derivative of the systolic pressure curve). Again, no change in diastolic compliance was detected. Hearts that were arrested, cooled, preserved for 24 hours, and reperfused (Group 4) recovered 84% of control contractile function (maximum systolic pressure and the maximum positive derivative of the systolic pressure curve), whereas hearts that had the additional hour of ischemia at 25 degrees C (Group 5) recovered only 75% of control contractile function. In the latter two groups diastolic compliance was also compromised. Group 4 had a 20% decrease in the volume required to reach 10 mm Hg, and Group 5 had a 26% decrease. Pressure-volume curves suggest a loss of contractility and a loss of compliance in these hearts. These data indicate that while significant damage occurred as a result of ischemia and reperfusion, this damage was masked by the larger decrease in function occurring as a result of the preservation period.     

Obstructive symptoms associated with the Lap-Band in the first 24 hours

Background: The Lap-Band is a gastric restrictive procedure for the treatment of morbid obesity. We review the etiology of obstructive complications that present in the first postoperative 24 h. Methods: Fifty-six Lap-Band procedures were performed by one surgeon between January and September 2002. Results: Six patients presented with obstruction within 24 h of surgery: gastric slippage in three patients, gastric edema in one patient, and esophageal hypomotility in two patients. Conclusions: Placing the band in an esophagogastric position as per Belachew and Weiner reduced our incidence of gastric slippage to none. Endoscopy with placement of a nasogastric feeding tube can relieve obstruction caused by esophageal hypomotility. Gastric edema with no clinical signs of obstruction will resolve with time. Clinicians must be aware of the unique complications that come with the advent of this new procedure.     

Postoperative headache in young patients after spinal anaesthesia

Spinal anaesthesia was performed on 247 young adult patients with a 25-G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre-operatively did not influence the incidence of postlumbar puncture headache.     

Postoperative symptoms and failure after antireflux surgery

BACKGROUND: Outcomes in patients having surgery for gastroesophageal reflux disease are most commonly determined by symptomatic assessment. Objective testing is usually reserved for symptomatic patients. HYPOTHESIS: To evaluate the relationship between symptomatic and objective outcomes after antireflux surgery. DESIGN: Retrospective analysis of prospectively collected data. SETTING: A tertiary care teaching hospital with a comprehensive esophageal physiology laboratory. INTERVENTIONS: A 360 degrees (Nissen) fundoplication or a 270 degrees (Toupet) posterior fundoplication was performed based on esophageal motility. Twenty-four-hour pH monitoring was used as a gold standard for assessing postoperative acid reflux. PATIENTS: Two hundred nine consecutive patients with preoperative and postoperative symptomatic and objective testing performed between January 1, 1996, and June 15, 2001. MAIN OUTCOME MEASURES: Data on preoperative and postoperative symptoms, DeMeester scores, and esophageal motility were prospectively collected. Objective testing was performed after at least 6 months. RESULTS: The preoperative median DeMeester score was 50.0 (interquartile [IQ] range, 30.3-87.0). One hundred eighty patients had a Nissen and 29 patients had a Toupet fundoplication. After a median postoperative interval of 7.7 months (IQ range, 6.7-9.5 months), 174 patients (83.3%) had normal DeMeester scores (median, 2.2; IQ range, 0.8-5.0; P<.001). Of 58 patients (27.7%) who had reflux symptoms after surgery, only 17 (29.3%) had abnormal DeMeester scores (median, 36.9; IQ range, 748.4-20.0; P =.001). Eighteen (11.9%) of the 151 asymptomatic patients had abnormal DeMeester scores (median, 32.5; IQ range, 22.2-57.5; P =.006). CONCLUSIONS: There is poor correlation between postoperative reflux symptoms and actual reflux (abnormal DeMeester scores). Surgeons must be careful to define their terms when reporting success or failure rates after antireflux surgery. Routine use of medical therapy for suppressing postoperative gastroesophageal reflux disease symptoms is not supported by these data, and postoperative therapy should be based on objective testing only.     

Postoperative lymphocytopenia and leucocytosis after epidural and general anaesthesia

Few investigations have demonstrated a positive effect of epidural blockade on the leucocytosis and lymphocytopenia secondary to surgery. Thirty elderly patients undergoing total hip replacement were randomly allocated to two groups: epidural analgesia and general anaesthesia. The leucocyte and lymphocyte counts per- and postoperatively were registered. Significant leucocytosis and lymphocytopenia were found in both groups, but no significant difference was found between the groups.     

24小时危险游戏，与黑暗抢夺时间

三更半夜去健身房健身、与朋友喝茶聊天、坐在电脑前工作……不打烊的24小时生活形态使我们如同一台永不停止的机器，可你知道吗？当我们“取消”了夜晚，就要为此付出极大的健康代价。[编者按]     

Recovery after day-case anaesthesia. A 24-hour comparison of recovery after thiopentone or propofol anaesthesia

Sixty patients who presented for day-case dilatation and curettage were allocated randomly to receive either thiopentone or propofol for induction and maintenance of anaesthesia. One anaesthetist administered all the anaesthetics whilst all assessments were made by one other. The results indicate that early recovery of memory function, critical flicker fusion frequency and subjective feelings of tiredness, drowsiness and alertness were superior in the propofol group. There was a significant difference in subjective feelings of tiredness and drowsiness recorded by the two study groups at 24 hours. Memory function assessed by Wechsler logical memory function passages at 24 hours was impaired in the propofol group in comparison to a group of 'reference' subjects.     

Severe neuroexcitatory symptoms after anaesthesia--with focus on propofol anaesthesia

Delayed neuroexcitatory symptoms after an uneventful anaesthesia are uncommon, although described in many reports. We want to report on two cases. The first patient developed muscle hypertonicity, jerky movements and unconsciousness after an uneventful anaesthesia with propofol, and later the same thing happened after anaesthesia with thiopentone. The second patient developed similar symptoms after an uneventful anaesthesia with propofol, but she never recovered completely after this and is now severely disabled. A search of the literature and the Swedish adverse drug reactions register revealed many similar cases. In both our patients the causal relationship between propofol and the neuroexcitatory symptoms remains uncertain, but we want to alert readers about this possible adverse reaction.     

Regional anaesthesia for ambulatory surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

Epidural anaesthesia in ambulatory surgery

There is a growing demand for the performance of more surgical procedures on a day care basis. Regional anaesthetic techniques allow early and painless return of function after surgery. In 1991 and 1992 we used epidural anaesthesia for day care surgery in 180 patients and we reviewed the merits and problems involved with this regional technique.     

Regional anaesthesia in ambulatory surgery

Regional anaesthesia provides many advantages and can be practised safely in ambulatory surgery. It provides better postoperative pain control, avoids many complications associated with general anaesthesia and shortens recovery time. However, extra time required, associated complications and acceptance of patients are the factors of concern in practising regional anaesthesia in an ambulatory setting. This review will discuss various regional anaesthesia techniques suitable for outpatients.     

Recent advances in ambulatory anaesthesia

Outpatient surgery is no longer restricted to young, healthy patients having brief, minor procedures. Even high-risk patients may be acceptable candidates for ambulatory surgery if their systemic diseases are well controlled preoperatively. The development of new short-acting anaesthetics with fewer unpleasant side effects, innovations in pain management, and technological advances have all contributed to the dramatic growth of ambulatory surgery. Moreover, recent liberalization of fasting instructions for clear liquids and advances in antiemetic therapy have helped eliminate, or at least attenuate, some of the more unpleasant aspects of the anaesthetic-surgical experience. This paper highlights current practice in preoperative preparation, selection of anaesthetic techniques and agents, prevention and therapy of nausea and vomiting, and management of problems that present in the postanaesthesia care unit (PACU).