Pressure support ventilation via ProSeal™ laryngeal mask airway during general anesthesia improves ventilation in pediatric patients undergoing ambulatory surgery. However, this did not translate to a difference in clinical outcome among our study patients.
Background: Post-craniotomy pain has been reported to be moderate to severe. Management of post-craniotomy pain is often inadequate, yet limited by the side effects of opioids. We aim to find out the efficacy of oral oxycodone as compared to oral codeine for the treatment of post-craniotomy pain in our institution. Methods: A randomized, double-blinded controlled trial was used to evaluate the efficacy of oral oxycodone versus oral codeine. 40 patients were randomized to the control group of codeine (n = 20) or the experimental group receiving oxycodone (n = 20) in addition to regular oral paracetamol for both groups of patients. Results: There was no difference in the visual analogue scale scores at 24 hours (2.78 versus 1.85, p = 0.11) or side effects in the oxycodone group compared with the codeine group. Conclusions: Oral oxycodone had similar efficacy as oral codeine in the management of post-craniotomy pain.
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.
Conclusion: PACU delirium is common in elderly patients with risks factors presenting for major
surgery.
Keywords: Geriatrics, major non-cardiac surgery, postoperative delirium
Introduction: Post-anaesthesia care unit (PACU) delirium affects 5%–45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable but it remains under-recognised due to a lack of awareness for its diagnosis. Nursing Delirium Screening Scale (Nu-DESC) has been validated in diagnosing PACU delirium but is not routine locally. This study aim was to use the Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. Methods: With IRB approval and informed consent, we conducted an audit of eligible patients undergoing major surgery in three major public hospitals in Singapore over one week. Patients were assessed for delirium 30–60 minutes following their arrival in the PACU using the Nu-DESC with a score of ≥ 2 as indicative of delirium. Results: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%) and 9/146 (6.2%) in patients over 65 years old. PACU delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic Regression analysis showed that the use of BIS (p < 0.001) and the presence of malignancy (p<0.001) were significantly associated with a higher incidence of PACU delirium. Conclusion: In this first local study, the incidence of PACU delirium was 3.8%, with the incidence increasing to 6.2% in those older than 65 years old. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long term morbidities and mortality of PACU delirium.
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