Analgesia for Medically Induced Second Trimester Termination of Pregnancy: A Randomized Trial.

OBJECTIVE: To compare the efficacy between intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) in women undergoing medically induced second trimester termination of pregnancy (TOP). METHODS: We conducted a randomized trial in a Canadian quaternary care hospital. We included in the study women of gestational age 12 weeks to 23+6 weeks who were undergoing second trimester induction of labour between June 2012 and January 2014. Participants were computer-randomized to receive either IVPCA with fentanyl or PCEA with bupivacaine and fentanyl, with the option to cross over between treatment groups. We administered Quality of Recovery-40 (QoR-40) questionnaires pre-procedure, at the time of discharge, and 24 hours after discharge. Pain scores, satisfaction scores, and obstetrical complications also were noted. RESULTS: One hundred thirty-eight women were approached for participation in the study; 80 declined and 16 were ineligible, leaving 42 participants. Three women subsequently withdrew consent, and two were not included in the results because of protocol violations. A total of 37 women completed the study. Twenty (54%) were allocated to the IVPCA group and 17 (46%) to the PCEA group. Although the QoR-40 values at the time of discharge and at 24 hours after discharge were significantly higher in the PCEA group, they also were significantly higher before the procedure in that group. The within-group differences in QoR-40 (between QoR-40 at discharge and QoR pre-procedure, and between QoR-40 at 24 hours after discharge and QoR pre-procedure), maximum pain scores, satisfaction, and obstetrical complication rates did not differ significantly between the two groups. CONCLUSION: IVPCA and PCEA provide similar quality of recovery, quality of analgesia, and satisfaction for women undergoing second trimester TOP.

Predictors of desaturation in the postoperative anesthesia care unit: an observational study.

STUDY OBJECTIVE: To evaluate predictors of desaturation and to identify practice for patient transport following general anesthesia. DESIGN: Observational quality assurance study. SETTING: Postanesthesia Care Unit (PACU) of a university-affiliated, tertiary-care hospital. PATIENTS: All adult postsurgical patients who received general anesthesia and who were admitted to the PACU. MEASUREMENTS: Patients were observed over a three-month study period during transfer to the PACU with or without oxygen supplementation. Sixteen variables related to patient, surgery, and anesthesia were recorded. RESULTS: The study recorded a total of 502 PACU admissions. The practice pattern showed that 57% of patients were transferred without oxygen and 19% of the entire sample had an initial oxygen desaturation of less than 90% on arrival to the PACU. Only 0.8% of patients experienced oxygen desaturation when they were transferred with oxygen supplementation. After logistic regression analysis, the most significant predictor of desaturation was transport without oxygen. CONCLUSIONS: The majority of anesthesiologists did not use supplemental oxygen for patient transfer. As a result, a higher incidence of postoperative desaturation was noted in their patients. Significant predictors of desaturation after general anesthesia included patients' sedation score, low respiratory rate, and transport without oxygen. The use of oxygen almost completely prevented desaturation during transport.