Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history / 대한마취과학회지

Background@#This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. @*Methods@#The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence. @*Results@#Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). @*Conclusions@#Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

Advanced cardiac life support training by problem-based method: effect on the trainee's skills, knowledge and evaluation of trainers

Cardiopulmonary-cerebral resuscitation [CPCR] training is essential for all hospital workers, especially junior residents who might become the manager of the resuscitation team. In our center, the traditional CPCR knowledge training curriculum for junior residents up to 5 years ago was lecture-based and had some faults. This study aimed to evaluate the effect of a problem-based method on residents' CPCR knowledge and skills as well as their evaluation of their CPCR trainers. This study, conducted at Tehran University of Medical Sciences, included 290 first-year residents in 2009-2010 - who were trained via a problem-based method [the problem-based group] - and 160 first-year residents in 2003-2004 - who were trained via a lecture-based method [the lecture-based group]. Other educational techniques and facilities were similar. The participants self-evaluated their own CPCR knowledge and skills pre and post workshop and also assessed their trainers' efficacy post workshop by completing special questionnaires. The problem-based group, trained via the problem-based method, had higher self-assessment scores of CPCR knowledge and skills post workshop: the difference as regards the mean scores between the problem-based and lecture-based groups was 32.36 +/- 19.23 vs. 22.33 +/- 20.35 for knowledge [p value = 0.003] and 10.13 +/- 7.17 vs. 8.19 +/- 8.45 for skills [p value = 0.043]. The residents' evaluation of their trainers was similar between the two study groups [p value = 0.193], with the mean scores being 15.90 +/- 2.59 and 15.46 +/- 2.90 in the problem-based and lecture-based groups, respectively. The problem-based method increased our residents' self-evaluation score of their own CPCR knowledge and skills

Oral clonidine premedication reduces nausea and vomiting in children after appendicectomy

Clonidine is an alpha2-agonist which is used as a sedative premedication in children. There are conflicting results in the published literature about the effect of clonidine on the incidence of post operative nausea and vomiting [PONV]. We therefore decided to evaluate the effect of oral clonidine given preoperatively on the incidence of PONV in children after appendectomy. Sixty children, 5-12 years old, classified as American Society of Anesthesiologists physical status I and II, who were scheduled for appendicectomy were enrolled in this randomized double blinded clinical trial. Patients were randomly assigned into two groups of 30 patients. Patients in clonidine group were given 4 micro g/kg-1 clonidine in 20 cc of apple juice and patients in control group were given only 20 cc of apple juice 1 hour before transporting to operating room. The protocol of general anesthesia and postoperative analgesia was the same for two groups. Incidence of PONV and antiemetic usage of patients were assessed during 0-24 hours after anesthesia. The patients' characteristics were similar in two groups. Patients who had received clonidine had significantly less episodes of PONV and also less rescue antiemetic usage than patients in control group. We showed that oral clonidine at a dose of 4 microg.kg -1 administered preoperatively is associated with a reduced incidence of postoperative vomiting in children who have undergone appendectomy

comparative study on the efficacy of rectal diazepam and midazolam for reduction of pre-operative anxiety in pediatric patients

Children, due to their great parental dependency, are amongst the cases that should receive preoperatively medication to reduce their fear and anxiety. The objective of this study was to compare the efficacy of rectal diazepam and midazolam for this purpose in pediatric patients scheduled for elective surgery. 60 children, aged between 1 and 6 years, scheduled for elective surgery, were included in this double blind, randomized controlled trial. Patients were randomly allocated into three equal groups. Patients in midazolam and diazepam groups received the drugs 0.3 mg/kg and 0.5 mg/kg respectively [in normal saline at a final volume of 2.5 ml] and placebo group received only 2.5 ml of normal saline 20 min before arriving operation room through rectal applicator. Sedation and anxiety scores at the time of separation from their parents before arriving operating room were recorded for all groups. There was a significant reduction in anxiety level in midazolam and diazepam groups as compared to placebo group [P<0.001]. Sedation rate was 65% for midazolam, 60% for diazepam, and 15% for placebo group [P=0.007]. There were no significant changes in hemodynamic parameters in the three study groups. With respect to effective anxiolytic and sedative activity, rectal midazolam [0.3 mg/Kg] and diazepam [0.5 mg/Kg] can be used as an anesthetic premedicant for children at pre-operative period and their use is safe regarding hemodynamic variables and related side-effects