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Paul G Barash - One of the best experts on this subject based on the ideXlab platform.

J P Mathew - One of the best experts on this subject based on the ideXlab platform.

  • Emergency tracheal intubation in the Postanesthesia Care Unit : physician error or patient disease ?
    Anesthesia & Analgesia, 1990
    Co-Authors: J P Mathew, S H Rosenbaum, Theresa Z. O'connor, Paul G Barash
    Abstract:

    Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the Postanesthesia Care Unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October

  • emergency tracheal intubation in the Postanesthesia Care Unit physician error or patient disease
    Anesthesia & Analgesia, 1990
    Co-Authors: J P Mathew, S H Rosenbaum, Theresa Z Oconnor, Paul G Barash
    Abstract:

    Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the Postanesthesia Care Unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October

  • Emergency tracheal intubation in the Postanesthesia Care Unit: physician error or patient disease?
    Anesthesia and analgesia, 1990
    Co-Authors: J P Mathew, S H Rosenbaum, T O'connor, P G Barash
    Abstract:

    Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the Postanesthesia Care Unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October 1988. Twenty-six patients (26/13,593 = 0.19%) required the insertion of an endotracheal tube while in the PACU. Seventy-seven percent (20/26) of the intubations occurred within 1 h of extubation and/or admission to the PACU. Intubation was more common at the extremes of age; 54% of those intubated were more than 60 yr old (P = 0.003); 19% were less than 3 yr old (P less than 0.05). Twenty-three percent of the intubated patients had undergone otolaryngologic procedures (P = 0.008). Interestingly, 73% of the intubations occurred during the months of January through June (P = 0.016). Median PACU admission scores were lower for the intubated group (P less than 0.001). There was no association between intubation and gender (P = 0.74), anesthetic technique (P = 0.41), or anesthetic agent (P = 0.49). Of the 26 intubations, 18 (69%) were considered to be directly related to anesthetic management. Despite the extremely low incidence of emergency tracheal intubation in a heterogeneous group of patients admitted to our PACU, preventable anesthesia-related etiologic factors including excessive sedative or anesthetic effect, inappropriate fluid management, persistent muscle relaxant effect, and upper airway obstruction contributed to the majority of these intubations.

John F Bebawy - One of the best experts on this subject based on the ideXlab platform.

  • residual neuromuscular blockade in the Postanesthesia Care Unit observational cross sectional study of a multicenter cohort
    Minerva Anestesiologica, 2016
    Co-Authors: Carlos L Errando, Ignacio Garutti, Guido Mazzinari, Oscar Diazcambronero, John F Bebawy
    Abstract:

    BACKGROUND: Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization. METHODS: Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr 18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the Postanesthesia Care Unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring. RESULTS: A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the Postanesthesia Care Unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation. CONCLUSIONS: The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine.

  • Residual neuromuscular blockade in the Postanesthesia Care Unit. Observational cross-sectional study of a multicenter cohort.
    Minerva Anestesiologica, 2016
    Co-Authors: Carlos L Errando, Ignacio Garutti, Guido Mazzinari, Oscar Diaz-cambronero, John F Bebawy
    Abstract:

    Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization. Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr<0.9. Patients >18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the Postanesthesia Care Unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring. A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the Postanesthesia Care Unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation. The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine.

B Riou - One of the best experts on this subject based on the ideXlab platform.

  • predictive factors of severe postoperative pain in the Postanesthesia Care Unit
    Anesthesia & Analgesia, 2008
    Co-Authors: Frederic Aubrun, Nathalie Valade, P Coriat, B Riou
    Abstract:

    BACKGROUND:IV morphine titration (IMT) is widely used in the Postanesthesia Care Unit to achieve pain relief. Numerous factors contribute to variability in postoperative pain or morphine consumption. We analyzed prospectively the pre- and intraoperative predictive factors of severe postoperative pai

  • predictive factors of severe postoperative pain in the Postanesthesia Care Unit
    Anesthesia & Analgesia, 2008
    Co-Authors: Frederic Aubrun, Nathalie Valade, P Coriat, B Riou
    Abstract:

    BACKGROUND: I.v. morphine titration (IMT) is widely used in the Postanesthesia Care Unit to achieve pain relief. Numerous factors contribute to variability in postoperative pain or morphine consumption. We analyzed prospectively the pre- and intraoperative predictive factors of severe postoperative pain defined as a dose of IMT >0.15 mg/kg or a failure of IMT. METHODS: We assessed the role of preoperative information about pain, medical treatments, and intraoperative events and their role on postoperative pain. After IMT, patients were divided into two groups: severe pain (SP) and nonsevere pain. Data are expressed as mean +/- SD. RESULTS: Three hundred forty-two patients were included in the study: 200 (58%) in the nonsevere pain group and 142 (42%) in the SP group. Using a univariate analysis, there was no significant difference between groups related to medical or surgical history except for more frequent preoperative treatments in the SP group (P 0.6 microg/kg) (Odds ratio = 2.68, P < 0.001), a general anesthetic procedure (Odd ratio = 3.96, P = 0.03), and the use of preoperative analgesic drugs (Odds ratio = 1.91, P < 0.01) were independent factors associated with severe postoperative pain. CONCLUSION: A higher intraoperative dose of sufentanil, general anesthesia, and preoperative treatment with analgesics were significantly associated with severe postoperative pain.

S H Rosenbaum - One of the best experts on this subject based on the ideXlab platform.

  • Emergency tracheal intubation in the Postanesthesia Care Unit : physician error or patient disease ?
    Anesthesia & Analgesia, 1990
    Co-Authors: J P Mathew, S H Rosenbaum, Theresa Z. O'connor, Paul G Barash
    Abstract:

    Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the Postanesthesia Care Unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October

  • emergency tracheal intubation in the Postanesthesia Care Unit physician error or patient disease
    Anesthesia & Analgesia, 1990
    Co-Authors: J P Mathew, S H Rosenbaum, Theresa Z Oconnor, Paul G Barash
    Abstract:

    Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the Postanesthesia Care Unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October

  • Emergency tracheal intubation in the Postanesthesia Care Unit: physician error or patient disease?
    Anesthesia and analgesia, 1990
    Co-Authors: J P Mathew, S H Rosenbaum, T O'connor, P G Barash
    Abstract:

    Inadequate airway maintenance has been a major factor in perioperative morbidity. To determine the incidence and etiology of emergency tracheal intubations in the Postanesthesia Care Unit (PACU), we retrospectively reviewed 13,593 consecutive admissions to our PACU from October 1986 through October 1988. Twenty-six patients (26/13,593 = 0.19%) required the insertion of an endotracheal tube while in the PACU. Seventy-seven percent (20/26) of the intubations occurred within 1 h of extubation and/or admission to the PACU. Intubation was more common at the extremes of age; 54% of those intubated were more than 60 yr old (P = 0.003); 19% were less than 3 yr old (P less than 0.05). Twenty-three percent of the intubated patients had undergone otolaryngologic procedures (P = 0.008). Interestingly, 73% of the intubations occurred during the months of January through June (P = 0.016). Median PACU admission scores were lower for the intubated group (P less than 0.001). There was no association between intubation and gender (P = 0.74), anesthetic technique (P = 0.41), or anesthetic agent (P = 0.49). Of the 26 intubations, 18 (69%) were considered to be directly related to anesthetic management. Despite the extremely low incidence of emergency tracheal intubation in a heterogeneous group of patients admitted to our PACU, preventable anesthesia-related etiologic factors including excessive sedative or anesthetic effect, inappropriate fluid management, persistent muscle relaxant effect, and upper airway obstruction contributed to the majority of these intubations.