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Post Dural Puncture Headache (PDPH) remains a prominent clinical concern to the present day and common complication seen in the field of anesthesiology and pain medicine. Identification of such risk factors is a crucial step in the rational modification of anesthetic practice and evaluation of therapeutic interventions. This study was conducted to demonstrate the incidence and risk factors of PDPH in patients after spinal Anesthesia during three days' post operations at general hospital in Tripoli, Libya. In this study certain factors related to patient history, baseline clinical state or anesthetic technique might be associated with an increased risk for this side effect, so it was collected historical, physiologic, and technical data to determine their association with PDPH. Out of total of 100 patients distributed over 5 different hospitals admitted over a period (from November 2020 to April 2021) 27% of them have a PDPH, while 92.5% of cases with PDPH are females, that 55.6% of PDPH cases are between 20 and 25 years old, and this percentage getting smaller as patients get older, most of the operations were caesarean section, at a rate of 58%, followed by lower abdominal surgeries with 19% of cases, and orthopedic surgeries with 17% of cases, while the lowest percentage was for the Urologic surgeries. 55% of cases with PDPH are classified as (case I), and 44% of them are classified as (case II), 81.5% of PDPH cases used noncutting needles. In this study the PDPH remains the most problem in hospitalized patients after spinal Anesthesia at Tripoli hospitals can be caused by variety of risk factors, associated with ASA physical states, nonprofessional technique, the females are more common than males and the percentage increasing in early age group
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Humanos , Masculino , Femenino , Cefalea Pospunción de la DuramadreRESUMEN
El estudio tuvo por Objetivo: Determinar la relación entre la calidad del cuidado de enfermería y la satisfacción en pacientes postoperados del servicio de cirugía del Hospital Santa María del Socorro, Ica 2021. Material y métodos: Estudio descriptivo, cuantitativo y transversal, no experimental-correlacional, con muestra de 147 pacientes postoperados, empleándose la técnica de encuesta y como instrumento 2 cuestionarios validados, y con alta confiabilidad. Resultados: La calidad del cuidado de enfermería fue de nivel regular 49%, nivel deficiente 28.6% y nivel bajo 22,4%; según sus dimensiones, se encontró mayor predominio de calidad de nivel regular en accesibilidad 73,5%, explica y facilita 69,4%, conforta 71,4%, se anticipa 59,9%, mantiene relación de confianza 61,2%, y monitorea-hace seguimiento 73,5%. La satisfacción fue de nivel medio 46,3%, nivel bajo 26,5% y nivel alto 27,2%; según sus dimensiones se encontró mayor proporción nivel medio en el trato recibido 52,4%, continuidad del cuidado 42,9%. y resultado del cuidado 41,5%. Se halló relación significativa entre la calidad del cuidado de enfermería y la satisfacción del paciente postoperado (r=0.434; p=0.000), y con las dimensiones trato recibido (r=0,257; p=0,002), continuidad del cuidado (r=0,493; p=0,000), y resultado del cuidado (r=0,353; p=0,001). Conclusiones: La calidad del cuidado de enfermería se relaciona significativamente con la satisfacción en los pacientes postoperados del servicio de cirugía del Hospital Santa María del Socorro de Ica, 2021.
The study had the Objective:To determine the relationship between the quality of nursing care and satisfaction in postoperative patients of the surgery service of the Hospital Santa María del Socorro, Ica 2021. Material and methods: Descriptive, quantitative and cross-sectional, non-experimental study. correlational, with a sample of 147 postoperative patients, using the survey technique and 2 validated questionnaires as an instrument, and with high reliability. Results: The quality of nursing care was at a regular level 49%, poor level 28.6% and low level 22.4%; According to its dimensions, a greater predominance of regular level quality was found in accessibility 73.5%, explains and facilitates69.4%, comforts 71.4%, anticipates 59.9%, maintains a relationship of trust 61.2%, and monitors-follows up 73.5%. Satisfaction was medium level 46.3%, low level 26.5% and high level 27.2%; According to their dimensions, a higher proportion was found at the average level in the treatment received 52.4%, continuity of care 42.9%. and outcome of care 41.5%. A significant relationship was found between the quality of nursing care and postoperative patient satisfaction (r=0.434; p=0.000), and with the dimensions of treatment received (r=0.257; p=0.002), continuity of care (r=0.493; p=0.000), and care outcome (r=0.353; p=0.001). Conclusions: The quality of nursing care is significantly related to satisfaction in postoperative patients of the surgery service of the Santa María del Socorro Hospital in Ica, 2021
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Resumen Objetivo: Determinar los beneficios musculoesqueléticos que conlleva la terapia física temprana en pacientes posoperadas de mastectomía. Método: Se comenzó el programa de terapia física, con el consentimiento de pacientes posoperadas de mastectomía en el Hospital Militar de Especialidades de la Mujer y Neonatología, registrando las evaluaciones de amplitud de movilidad y de fuerza muscular, dando inicio con la terapia en las primeras 24 a 48 horas posteriores a la cirugía, con ejercicios isométricos de baja intensidad durante una semana, movilizaciones activas en la segunda y tercera semana y ejercicios isotónicos con movilizaciones activas en la cuarta y quinta semana (grupo en estudio). Asimismo, antes de iniciar con el proyecto de investigación, se identificaron pacientes posoperadas de mastectomía que no se habían sometido a ningún programa de terapia física. (grupo control). Resultados: En el programa de terapia física temprana, se analizaron los datos estadísticos de la muestra, que estuvo integrada por 19 pacientes del grupo en estudio y 9 pacientes del grupo control, en los cuales se obtuvo un promedio de edad de 53.21±11.86 años en el grupo en estudio y 50.44±9.95 años en el grupo control no habiendo diferencia estadísticamente significativa (p=0.26), por lo que respecta a los aspectos demográficos; no se encontraron situaciones que limitaran la investigación; asimismo, se identificó que la cirugía de mayor incidencia fue la mastectomía radical modificada derecha, siendo en consecuencia la lateralidad más frecuente, de igual forma en el análisis de varianza en los resultados de medición en el progreso en la mejoría de arcos de movilidad y de fuerza muscular se obtuvo una diferencia estadísticamente significativa (p< 0.0001), con diferencias positivas en la mejoría de las pacientes del grupo en estudio en comparación con las pacientes del grupo control. Conclusiones: La terapia física temprana en pacientes posoperadas de mastectomía, produce beneficios musculoesqueléticos que ayudan a mejorar la amplitud de los arcos de movilidad del miembro torácico afectado y aumenta la fuerza muscular.
Abstract: Objective: Determine the musculoskeletal benefits of early physical therapy in post-mastectomy patients. Method: The physical therapy program was started, with the consent of post-mastectomy patients at the Military Hospital of Women's Specialties and Neonatology, recording the evaluations of range of mobility and muscle strength, starting the therapy in the first 24 to 48 hours after surgery, with low-intensity isometric exercises for one week, active mobilizations in the second and third week and isotonic exercises with active mobilizations in the fourth and fifth weeks (study group). Likewise, before starting the research project, post-mastectomy patients who had not undergone any physical therapy program were identified. (control group). Results: In the early physical therapy program, the statistical data of the sample were analyzed, which was made up of 19 patients from the study group and 9 patients from the control group, in which an average age of 53.21±11.86 years was obtained. in the study group and 50.44±9.95 years in the control group, with no statistically significant difference (p=0.26), regarding demographic aspects; no situations were found that limited the investigation; Likewise, it was identified that the surgery with the highest incidence was the right modified radical mastectomy, consequently laterality being more frequent, likewise in the analysis of variance in the measurement results in the progress in the improvement of ranges of mobility and of muscle strength, a statistically significant difference was obtained (p< 0.0001), with positive differences in the improvement of the patients in the study group compared to the patients in the control group. Conclusions: Early physical therapy in post-mastectomy patients produces musculoskeletal benefits that help improve the range of motion of the affected thoracic limb and increase muscle strength.
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Objective:To investigate the risk factors of postoperative hypoxemia in patients admitted to intensive care unit (ICU) for resuscitation.Methods:Clinical data of 220 postoperative patients admitted to the ICU for resuscitation in Shandong Provincial Hospital Affiliated to Shandong University from June to August 2020 were collected and retrospectively analyzed. According to their oxygenation index within 30 minutes after admission to ICU, they were divided into hypoxemia group (oxygenation index≤ 300 mmHg, 1 mmHg≈0.133 kPa) and non-hypoxemia group (oxygenation index > 300 mmHg). Baseline data and perioperative indicators were compared between the two groups, and risk factors for early postoperative hypoxemia were analyzed. The improvement of oxygenation index of patients with hypoxemia in next morning after admission to ICU was observed, and the factors related to the improvement of hypoxemia were analyzed.Results:The incidence of hypoxemia was 36.8% (81/220) in the cohort. The majority cases of hypoxemia were from general surgery department, accounting for 42.0% (34/81). The incidence rate of hypoxemia from orthopaedic was the highest at 53.3% (16/30). Univariate analysis showed that body mass index (BMI), intraoperative hypoxemia, minimally invasive surgery were all risk factors of postoperative hypoxemia (test values were -2.566, 12.352 and 0.033; P values were 0.010, 0.000 and 0.019, respectively). Multivariate analysis showed that intraoperative hypoxemia and BMI were independent risk factors for postoperative hypoxemia [intraoperative hypoxemia: odds ratio ( OR) = 3.602, 95% confidence interval (95% CI) was 1.143-3.817, P = 0.001; BMI: OR = 1.119, 95% CI was 1.026-1.208, P = 0.036]. The improvement rate of hypoxemia next morning after admission to ICU was 63.0% (51/81). Pulmonary dysfunction was the independent risk factor for the improvement of hypoxemia ( OR = 0.200, 95% CI was 0.052-0.763, P = 0.019). Conclusions:Hypoxemia might occur early after surgery. Intraoperative hypoxemia and BMI were independent risk factors for postoperative hypoxemia.
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BACKGROUND: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. METHODS: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. RESULTS: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. CONCLUSION: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.
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Humanos , Demografía , Cuidados Críticos , Unidades de Cuidados Intensivos , Prevalencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Patient-controlled analgesia has been used with increasing frequency to provide postoperative pain relief for children. We compared the effects of continuous plus bolus patient-controlled fentanyl analgesia with those of bolus patient-controlled fentanyl analgesia. METHODS: One hundred and thirty four children (aged 3-8 yr) undergoing orthopedic surgeries received one of two analgesic regimens of fentanyl based patient-controlled analgesia (PCA); bolus infusion of 0.4microgram/kg with a 15 minute lock-out interval (group B) or continuous (0.2microgram/kg/hr) and bolus infusion (0.2microgram/kg) with a 15 minute lock-out interval (group C). We compared the two groups in terms of degree of analgesia, sedation and nausea. RESULTS: Analgesic effects were better in group B at 1 and 2 hours after surgery. The incidence of sedation in group C was greater than in group B at 1 and 2 hours after surgery, and the groups were similar in terms of the incidences of nausea. CONCLUSIONS: We concluded that bolus infusion of fentanyl in children did not increase the incidence of side effects and that it was associated with a better analgesic effect than continuous and bolus fentanyl infusion.
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Niño , Humanos , Analgesia , Analgesia Controlada por el Paciente , Fentanilo , Incidencia , Náusea , Ortopedia , Dolor PostoperatorioRESUMEN
Objective To investigate the influence of sufentanial in postoperative patient controlled epidural analgesia(PCEA) in hemorheology after total hip replacement and its inhibitory effect on thrombosis.Methods Fifty patients,ASA Ⅰ-Ⅱ,undergone total hip replacement were randomly divided into PCEA group (n=25) and control group (n=25), and received continuous epidural anesthesia.After operation,5 mL 0.2% ropivacaine was administered in PCEA group,and then PCEA pump was used,analgesia liquid included 0.4 mg?L-1 sufentanial,0.2% ropivacaine and saline.Petidine was administered intramuscuarly according to pain in control group.VAS scores 1,12,24 and 48 h after operation and changes of various parameters of hemorheology at diffenent time after anesthesia were observed.Results ①The VAS scores 1,12,24,48 h after operation were lower than those in control group (P
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Objective To measure intestinal permeability of postoperative fasting patients and evaluate their intestinal barrier function.Methods Twenty patients after moderate or minor operation ,10 male and 10 female,were included in the study .After 3 to 5 days of fasting,when their bowel functon returned to normal,10 ml solution of lactulose(2g) with mannitol (1g) were given orally,urine of 6 hours was collected.As a control group,20 healthy volunteers were also included.There were no statistical differences in sex and age between two groups.Results The L/M of the patients and healthy volunteers were 0.1989?0.1186 and 0.4398? 0.2165 respectively,the difference was significant.Conclusions The intestinal permenbility of postperative fasting patients was elevated when compared with that of volunteers.