Perioperative Automated Noninvasive Blood Pressure- (NIBP-) Related Peripheral Nerve Injuries: An Anesthetist's Dilemma-A Case Report and Review of the Literature.

Peripheral nerve injury following regional or general anesthesia is a relatively uncommon entity but, potentially, a serious complication of anesthesia. Most nerve injuries are related to either regional anesthesia or position-related complications, and they are rarely seen in association with the use of automated blood pressure monitoring. We describe a patient who developed neurological dysfunction of all the three major nerves, median, ulnar, and radial, after general anesthesia. The distribution of sensory motor deficit along with the nerve conduction study demonstrated the location of the anatomical nerve lesions coinciding with the automatic noninvasive blood pressure (NIBP) cuff. No other cause of nerve injury was identified except for the use of the NIBP cuff. In the absence of another identifiable cause, we strongly suspected the NIBP cuff compression as a possible cause for the nerve injuries. In this article, we will discuss the possible risk factors, mechanisms, diagnosis, and prevention of perioperative nerve injury.

Patient outcomes related to the daytime versus after-hours surgery: A meta-analysis.

BACKGROUND: It has been investigated in multiple subspecialties that surgery timing may have an impact on patient outcomes, yet no definitive evidence is reached. OBJECTIVES: To analyze current literature on this topic and investigate whether day versus after-hours surgery may have an effect on postoperative outcomes. DATA SOURCES: MEDLINE, EMBASE and Cochrane Library. STUDY ELIGIBILITY CRITERIA: Studies reporting on the surgery timing as well as postoperative mortality and morbidity were included. PARTICIPANTS AND INTERVENTIONS: There were 119,213 and 46,196 surgery cases that occurred during daytime and after-hours shifts, respectively. STUDY APPRAISAL AND SYNTHESIS METHODS: Thirteen studies (12 retrospective case controls and 1 prospective study) published in English between February 2003 and May 2018 were scrutinized by two reviewers. The odds ratio (OR) for each clinical outcome data was presented with a 95% confidence interval (CI). Pooled estimates of effects were calculated using random-effect models. RESULTS: Among the included studies, 10 reported morbidities and 10 reported death rates. The pooled OR was 0.67 (95% CI: 0.51-0.89; p = 0.005) for postoperative mortality and 0.71 (95% CI: 0.53-0.94; p = 0.02) for overall postoperative complications in patients who underwent daytime versus after-hours surgery. CONCLUSION: After-hours surgery was associated with significantly increased postoperative mortality and morbidity, which might be related to state of urgency, availability of resource and/or fatigue factor of the personnel.

Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse.

Many patients are admitted to the intensive care unit (ICU) for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α(2)) agonist, has been used successfully to facilitate withdrawal and detoxification of various drugs and also to control delirium in ICU patients. Herein, we report a case of a chronic opioid abuse (heroin) patient admitted with acute overdose complications leading to a prolonged ICU course requiring sedative-analgesic medication; the drug withdrawal-related symptoms further complicated the weaning process. Dexmedetomidine infusion was successfully used as a sedative-analgesic to control the withdrawal-related psychomimetic symptoms and to facilitate smooth detoxification and weaning from opioid and other sedatives.