INTRODUCTION: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. METHODS: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30-60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). RESULTS Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of >60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4-18] vs 4 days [range 2-8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis.
Aged ; Anesthesia ; Anesthesia Recovery Period ; Delirium/etiology* ; Humans ; Incidence ; Postoperative Complications/etiology* ; Prospective Studies ; Risk Factors

BACKGROUND: The aim of this prospective, double-blind randomized study was to compare the recovery characteristics of desflurane-remifentanil and propofol-remifentanil anesthesia in patients undergoing a laparoscopic cholecystectomy under BIS monitoring. METHODS: Eight patients (ASA I-II, 20-65 yr) undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol-remifentanil anaesthesia or desflurane-remifentanil. The BIS was monitored and maintained between 45-55. At the end of surgery all anesthetics were discontinued. Time to eye opening and time to extubation was recorded. Subsequently, the patients were transported to the post-anesthetic care unit (PACU) and the modified aldrete score, visual analogue scale (VAS), blood pressure, heart rate, and postoperative nausea and vomiting (PONV) were recorded upon arrival at the PACU, as well as at 15 min, 30 min, 1 hr, 2 hr, and 24 hr. RESULTS: There were no significant differences in the incidence of PONV between the two groups. Modified aldrete scores were significantly higher in the propofol group at 15 min postoperative period (P = 0.013, Propofol = 9.87, Desflurane = 9.62). Further, VAS scores were significantly higher in the desflurane group at 30 min (P = 0.037, Propofol = 4.26, Desflurane = 5.0), and the number of antiemetic injections were significantly higher in the desflurane group at arrival to the PACU (P = 0.035, Propofol = 0, Desflurane = 0.11 +/- 0.052) and at 24 hr (P = 0.03, Propofol = 0.41 +/- 0.562, Desfluarane = 0.62 +/- 0.157). CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy with BIS monitoring, there is no significant differences in the incidence of PONV. The use of propofol is associated with less postoperative pain.
Anesthesia ; Anesthesia Recovery Period ; Anesthetics ; Blood Pressure ; Cholecystectomy, Laparoscopic ; Consciousness Monitors ; Eye ; Heart Rate ; Humans ; Incidence ; Isoflurane ; Pain, Postoperative ; Piperidines ; Postoperative Nausea and Vomiting ; Postoperative Period ; Propofol ; Prospective Studies

Either tacrine (THA) with succinylcholine or alcuronium was used on a randomized basis for laparoscopic procedures in twenty young females. The technique using THA with succinylcholine was found to be more suitable and predictable for this procedure and gave a smoother anaesthetic course, brighter recovery and minimal postoperative complications.
Alcuronium - adverse effects ; Aminoacridines - adverse effects ; Anesthesia Recovery Period ; Laparoscopy - methods ; Postoperative Complications - prevention & ; control

BACKGROUND: Remifentanil could require an appropriate pain strategy to prevent unacceptable pain in the postoperative period. We investigated the effect of perioperative ketamine for nociception and remifentanil hyperalgesia after gastrectomy when we used intraoperative remifentanil infusion for hemodynamic control. METHODS: Eighty patients scheduled for gastrectomy were randomly included in this trial. In control group (C), patients received normal saline. In ketamine group (K), patients received ketamine perioperatively. In remifentanil group (R), patients received remifentanil during operation. In remifentanil and ketamine group (RK) patients received remifentanil intraoperatively and ketamine perioperatively. Hemodynamic indexes were recorded during anesthesia. Visual analogue scale (VAS), cumulative analgesic requirement, and side effects were recorded during 36 h after operation. RESULTS: The requirement of vasodepressants was significantly increased in C and K group. Morphine consumption and agitation were significantly increased in R group at the postanesthetic recovery room. The analgesic demand of R group was greater than that in other groups. The VAS scores of K group were significantly lower than those of other groups at the ward. CONCLUSIONS: Intraoperative use of remifentanil with sevoflurane may be related to increased pain during early postanesthetic period. Perioperative low-dose ketamine decreased intraoperative remifentanil use and postoperative morphine consumption without increasing the incidence of side effects.
Anesthesia ; Dihydroergotamine ; Gastrectomy ; Hemodynamics ; Humans ; Hyperalgesia ; Incidence ; Ketamine ; Methyl Ethers ; Morphine ; Nociception ; Pain, Postoperative ; Piperidines ; Postoperative Period ; Recovery Room

BACKGROUND: Ketorolac has been used to inhibit some types of postoperative pain and reduce opioids requirement. The purpose of this study is to determine if the intravenous administration of ketorolac immediately before surgery would reduce pain in the immediately postoperative period. METHODS: The children were divided into three groups randomly. Two groups were anesthetized with propofol and fentanyl. The children of one of these group (group 2) received ketorolac 1 mg/kg during the induction of anesthesia. The children of third group received ketorolac 1 mg/kg during the induction of anesthesia and anesthetized with enflurane. Pain was assessed on the arrival in the recovery room and 15minute, 30minute and 60minute thereafter. RESULTS: Pain behavior score (PBS) and faces scale (FS) on the arrival in the recovery room in group 2 were lower than those of group 1 significantly. PBS and FS at 15 min, 30 min and 60 min after arrival in the recovery room in group 3 were higher than those of group 2. CONCLUSIONS: Intravenous administration of ketorolac during anesthetic induction has postoperative analgesia after tonsillectomy and adenoidectomy in 87 children.
Adenoidectomy ; Administration, Intravenous ; Analgesia ; Analgesics, Opioid ; Anesthesia ; Child* ; Enflurane ; Fentanyl ; Humans ; Ketorolac* ; Pain, Postoperative* ; Postoperative Period ; Propofol ; Recovery Room ; Tonsillectomy*

PURPOSE: This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy. METHODS: Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 microg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded. RESULTS: There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention. CONCLUSION: A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure.
Anesthesia* ; Anesthesia, Spinal ; Bupivacaine ; Headache ; Hemorrhoidectomy* ; Humans ; Infusions, Spinal ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Complications* ; Postoperative Period ; Prospective Studies* ; Pruritus ; Recovery Room ; Urinary Retention ; Water

BACKGROUND: Emergence agitation (EA) is one of the most common complications after general anesthesia. The goal of this retrospective study was to determine the risk factors of EA in adult patients who underwent general anesthesia. METHODS: We retrospectively investigated the medical records of 5,358 adult patients who stayed in the postanesthesia care unit (PACU) of our hospital after general anesthesia during the 1-year period from January 2014 to December 2014. Psychological and behavioral status in the PACU was determined by the Aono four-point scale. Grade of 3 or 4 were considered as manifestations of EA. Multiple variables assessed EA risk factors. RESULTS: Two-hundred-forty-five patients (4.6%) developed EA. In multivariate analysis, male gender (OR = 1.626, P = 0.001), older age (OR = 1.010, P = 0.035), abdominal surgery (OR = 1.633, P = 0.002), spine surgery (OR = 1.777, P = 0.015), longer duration of anesthesia (OR = 1.002, P < 0.001), postoperative nausea and vomiting (OR = 20.164, P < 0.001) and postoperative pain (OR = 3.614, P < 0.001) were risk factors of EA. CONCLUSIONS: Male gender and older patients were risk factors of EA after general anesthesia in adult patients. Careful attention is needed for patients who receive abdominal or spine surgery, and who receive prolonged anesthesia. Adequate postoperative analgesia and antiemetic therapy should be provided to reduce the incidence of EA.
Adult* ; Analgesia ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, General* ; Delirium ; Dihydroergotamine* ; Humans ; Incidence ; Male ; Medical Records ; Multivariate Analysis ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Retrospective Studies ; Risk Factors* ; Spine

OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Postoperative Period

The length of stay in the postanesthesia care unit (PACU) following general anesthesia in adults is an important issue. A model, which can predict the results of PACU stays, could improve the utilization of PACU and operating room resources through a more efficient arrangement. The purpose of study was to compare the performance of neural network to logistic regression analysis using clinical sets of data from adult patients undergoing general anesthesia. An artificial neural network was trained with 409 clinical sets using backward error propagation and validated through independent testing of 183 records. Twenty-two inputs were used to find determinants and to predict categorical values. Logistic regression analysis was performed to provide a comparison. The neural network correctly predicted in 81.4% of situations and identified discriminating variables (intubated state, sex, neuromuscular blocker and intraoperative use of opioid), whereas the figure was 65.0% in logistic regression analysis. We concluded that the neural network could provide a useful predictive model for the optimization of limited resources. The neural network is a new alternative classifying method for developing a predictive paradigm, and it has a higher classifying performance compared to the logistic regression model.
Adult ; Anesthesia Recovery Period* ; Anesthesia, General/methods* ; Female ; Human ; Length of Stay* ; Logistic Models* ; Male ; Neural Networks (Computer)* ; Postoperative Care ; Predictive Value of Tests ; Recovery Room* ; Retrospective Studies

BACKGROUND: Continuous epidural morphine infusion is a good and popular method to control postoperative pain. But intravenous morphine infusion after general anesthesia can avoid anxiety during operation and also control postoperative pain. We compared analgesia and side effects between continuous epidural infusion and continuous intravenous infusion of morphine sulfate to control of postoperative pain after cesarean section. METHODS: Forty women who received cesarean section were randomly divided into epidural and IV groups. Morphine 0.08 mg/kg was administered intravenously as an initial loading dosage for both groups. Morphine 0.08 mg/kg for epidural group or morphine 0.8 mg/kg for IV group was diluted into 96ml of normal saline. A mixture was injected into Two-day Infusor which is continuously infused 2 ml/hr. The patients received morphine solution into epidural or intravenous route with Two-day Infusor according to their allocated group. The assessments for pain score with VAS, VRS, patient's satisfaction score and side effects were made at recovery room, 0.5, 3, 12, 24, 36, 48 and 60 hours after operation. RESULTS: The VAS in IV group was significantly higher than that in epidural group at 3, 12, 24 and 36 hours after the operation (P<0.05). The VRS in IV group was significantly higher than in epidural group at recovery room and 3 hours of postoperative period (p<0.05). The frequency of pruritus, nausea, vomiting, back pain and urinary retention were less in IV group than in epidural group. The patient's satisfaction scores were similar in both groups. CONCLUSIONS: The management of postoperative pain in epidural group was more effective than the continuous intravenous morphine infusion. But the incidence of complications was more frequent in the epidural group while patient's satisfaction scores were similar in both groups. Therefore, the continuous intravenous morphine infusion can be used effectively as a postoperative pain management.
Analgesia* ; Anesthesia, General ; Anxiety ; Back Pain ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Infusions, Intravenous ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Period ; Pregnancy ; Pruritus ; Recovery Room ; Urinary Retention ; Vomiting