RESUMO
STUDY OBJECTIVE: To investigate patient recall of therapeutic paralysis (TP) in a surgical critical care unit. DESIGN: Prospectively applied structured interview of patients undergoing TP over 18 months. SETTING: Surgical critical care unit with 27 beds at a tertiary care university teaching hospital. PATIENTS: Forty patients admitted for postoperative care after coronary artery bypass graft surgery, trauma, or gastrointestinal surgery. INTERVENTIONS: Patients received TP and concurrent sedation with benzodiazepines, propofol, and narcotics. MEASUREMENTS AND MAIN RESULTS: After the end of TP patients were asked to recall the experience, and their responses were ranked on a four-point ordinal scale. Four of 11 patients recalled mostly negative events and experiences with TP, such as sleeplessness, discomfort, pain, anxiety, and inconsistent caregiver communication. All patients with recall experienced fear, anxiety, and sleeplessness. Single-drug therapy with propofol and inadequate benzodiazepine dosing were linked to patient recall. CONCLUSIONS: Patient recollection from TP may be more common than appreciated and is generally unpleasant. Adequate dosing with benzodiazepines and narcotics is warranted to prevent recall and discomfort.
Assuntos
Unidades Hospitalares , Rememoração Mental/fisiologia , Paralisia/cirurgia , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Cognição/fisiologia , Cuidados Críticos , Pessoas com Deficiência/psicologia , Seguimentos , Escala de Coma de Glasgow , Hemodinâmica , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/uso terapêutico , Infusões Intravenosas , Entrevistas como Assunto , Lorazepam/administração & dosagem , Lorazepam/uso terapêutico , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Monitorização Intraoperatória , Bloqueio Neuromuscular , Testes Neuropsicológicos , Dor/etiologia , Dor/psicologia , Paralisia/complicações , Paralisia/psicologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/psicologia , Propofol/administração & dosagem , Propofol/uso terapêutico , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/psicologia , Fatores de TempoRESUMO
Patients who sustain complex orthopaedic fractures related to a traumatic event can develop devastating complications. Patients who sustain open fractures are at greater risk for complications such as wound and systemic infections and nonunion of the fracture itself. This article describes the management of open complex extremity fractures through a case study approach.
