Abstract:
BACKGROUND:The aim of this study was to identify patient and procedural characteristics associated with postoperative respiratory depression or sedation requiring naloxone intervention. METHODS:We identified patients who received naloxone to reverse opioid-induced respiratory depression or sedation within 48 hours after discharge from anesthetic care (transfer from the postanesthesia care unit or transfer from the operating room to postoperative areas) between July 1, 2008, and June 30, 2010. Patients were matched to 2 control subjects based on age, sex, and exact type of procedure performed during the same year. A chart review was performed to identify patient, anesthetic, and surgical factors that may be associated with risk for intervention requiring naloxone. In addition, we identified all patients who developed adverse respiratory events (hypoventilation, apnea, oxyhemoglobin desaturation, pain/sedation mismatch) during phase 1 anesthesia recovery. We performed conditional logistic regression taking into account the 1:2 matched set case-control study design to assess patient and procedural characteristics associated with naloxone use. RESULTS:We identified 134 naloxone administrations, 58% within 12 hours of discharge from anesthesia care, with an incidence of 1.6 per 1000 (95% confidence interval [CI], 1.3-1.9) anesthetics. The presence of obstructive sleep apnea (odds ratio [OR] = 2.45; 95% CI, 1.27-4.66; P = 0.008) and diagnosis of an adverse respiratory event in the postanesthesia recovery room (OR = 5.11; 95% CI, 2.32-11.27; P < 0.001) were associated with an increased risk for requiring naloxone to treat respiratory depression or sedation after discharge from anesthesia care. After discharge from anesthesia care, patients administered naloxone used a greater median dose of opioids (10 [interquartile range, 0-47.1] vs 5 [0-24.8] IV morphine equivalents, P = 0.020) and more medications with sedating side effects (n = 41 [31%] vs 24 [9%]; P < 0.001). CONCLUSIONS:Obstructive sleep apnea and adverse respiratory events in the recovery room are harbingers of increased risk for respiratory depression or sedation requiring naloxone after discharge from anesthesia care. Also, patients administered naloxone received more opioids and other sedating medications after discharge from anesthetic care. Our findings suggest that these patients may benefit from more careful monitoring after being discharged from anesthesia care.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Weingarten TN,Herasevich V,McGlinch MC,Beatty NC,Christensen ED,Hannifan SK,Koenig AE,Klanke J,Zhu X,Gali B,Schroeder DR,Sprung Jdoi
10.1213/ANE.0000000000000792subject
Has Abstractpub_date
2015-08-01 00:00:00pages
422-9issue
2eissn
0003-2999issn
1526-7598journal_volume
121pub_type
杂志文章abstract::Four patients underwent laryngoscopy and general anesthesia surgery without apparent perioperative complications. Within days of their procedure, throat and mouth pain were reported and intraoral examination in all cases revealed exposed bone in the posterior mandible. The sequestra were easily removed and healing was...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181e0cdcd
更新日期:2010-08-01 00:00:00
abstract::The effects of adenosine-induced hypotension on central as well as myocardial hemodynamics and metabolism were studied in five neurolept-anesthetized patients without known heart or lung diseases, who were undergoing cerebral aneurysm surgery. Adenosine (217 +/- 32 micrograms.kg-1.min-1) decreased mean arterial pressu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00
abstract:BACKGROUND:We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an impl...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003861
更新日期:2019-08-01 00:00:00
abstract::The pandemic of heart failure and the limited options for treatment of end-stage disease have resulted in an increase in the utilization of left ventricular assist devices (LVADs). Improvements in device technology and patient survival have led to an expanding population of patients requiring noncardiac surgery while ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000002669
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we exam...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3181bd1612
更新日期:2009-12-01 00:00:00
abstract::There is precedent in medicine for recognizing and accepting intact decisional capacity and the subsequent ability to provide valid consent in one treatment domain, while simultaneously recognizing that the patient lacks decisional capacity in other domains. As such, obtaining consent for anesthesia for a surgical pro...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181c7eb12
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abstract:BACKGROUND:The switch from International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for coding of inpatient procedures in the United States increased the number of procedural codes more than 19-fold,...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003340
更新日期:2019-06-01 00:00:00
abstract::We investigated the incidence of transient neurologic symptoms (TNS) after the use of hyperbaric lidocaine as compared with hyperbaric bupivacaine in patients undergoing cesarean delivery under spinal anesthesia. Two hundred women scheduled for cesarean delivery were randomly allocated to receive spinal anesthesia wit...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200102000-00023
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:Every facility that performs cases on holidays has in some way decided on its operating room (OR) and anesthesia staffing for holidays. Previous studies have not examined how best to calculate appropriate holiday staffing. METHODS:We analyzed weekend and holiday data from a university hospital. RESULTS:The...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000237176.10774.17
更新日期:2006-12-01 00:00:00
abstract::Apnea and airway obstruction are common during monitored anesthesia care (MAC). Because their early detection is essential, we sought to measure the efficacy of capnography as an indicator of apnea during MAC at a variety of oxygen flow rates compared with thoracic impedance. Anesthesia care providers using standard A...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ANE.0000131964.67524.E7
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:We tested the hypothesis that inhibition of cyclooxygenase (COX) attenuates in vivo ventilator-induced lung injury (VILI) in a prospective, randomized laboratory investigation in a university-affiliated laboratory. Adult male rats were anesthetized and randomized with or without nonselective COX inhibition (...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181fe4841
更新日期:2011-01-01 00:00:00
abstract::One-hundred and eight-five pairs of gas samples were collected from inspired gas (10 cm behind the head at nose level) and end-tidal gas of persons administering anesthesia in 3 operating rooms during daily routine anesthesia. Mean operating-room N2O concentrations from 22 to 144 ppm (volume/volume [V/V]) were measure...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197803000-00012
更新日期:1978-03-01 00:00:00
abstract::It has been proposed that propofol has antiemetic effects even in nonsedative doses. The aim of this study was to investigate whether propofol influences vomiting induced by the dopamine agonist apomorphine. Ten healthy male volunteers received apomorphine infusion (1 mg/min) until vomiting was induced on four differe...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199505000-00019
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:There are profound racial and ethnic disparities in obstetric outcomes in the United States, but little is known about disparities in risk of postpartum hemorrhage (PPH). We explored the association of race and ethnicity on the risk of PPH due to uterine atony with sequential adjustment for possible mediatin...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182691e62
更新日期:2012-11-01 00:00:00
abstract:UNLABELLED:The transient hyperemic response (THR) in the middle cerebral artery (MCA) after the release of brief compression of the ipsilateral common carotid artery has been used to study cerebral autoregulation. We conducted the present study to evaluate the reliability of THR to detect changes in cerebral autoregula...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199810000-00018
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:In this study, we compared the effect of light sedation with remifentanil versus propofol on intracranial (ICP) and cerebral perfusion pressure (CPP) of patients undergoing stereotactic brain tumor biopsy under regional anesthesia. METHODS:This was a prospective, open-label, randomized, and controlled study...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e3181a3ea3a
更新日期:2009-07-01 00:00:00
abstract::We compared the effect of the lithotomy position on the systolic blood pressure (SBP) with the horizontal position after spinal block. The lithotomy position was performed 5 min after spinal block. The change in SBP was expressed as percent of depression from the baseline value. The SBP increased by the lithotomy posi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199507000-00019
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Anesthesiologists may contribute to postoperative infections by means of the transmission of blood and pathogens to the patient and the environment in the operating room (OR). Our primary aims were to determine whether contamination of the IV hub, the anesthesia work area, and the patient could be reduced af...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000000854
更新日期:2015-11-01 00:00:00
abstract::The intracranial and systemic hemodynamic effects of sufentanil (20 micrograms/kg) were studied in 10 mongrel dogs. Baseline anesthesia was maintained with 0.7% end-tidal isoflurane and 50% nitrous oxide in oxygen. Catheters were inserted for blood pressure measurement, arterial and sagittal sinus blood sampling, radi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199102000-00006
更新日期:1991-02-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-06-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1985-04-01 00:00:00
abstract:UNLABELLED:Acute withdrawal syndromes, including agitation and a long weaning time, are common adverse effects after long-term sedation with midazolam. We performed this study to determine whether the sequential use of midazolam and propofol could reduce adverse effects as compared with midazolam alone. We studied 26 p...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:The American Society of Anesthesiologists has announced that perioperative normothermia is a "Quality Incentive in Anesthesiology." We examined whether we could meet this quality incentive in a simple population: patients undergoing anesthesia for electroconvulsive therapy (ECT). METHODS:We compared infrare...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31817b7c35
更新日期:2008-11-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e31828a73be
更新日期:2013-05-01 00:00:00
abstract:UNLABELLED:We studied the in vitro effects of sevoflurane, isoflurane, and propofol anesthesia on platelet function. Thirty patients undergoing minor surgical procedures were divided into three groups (n = 10 each). Induction of anesthesia was achieved by using 5 mg/kg thiopental i.v., and 0.1 mg/kg vecuronium i.v. was...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199902000-00039
更新日期:1999-02-01 00:00:00
abstract:UNLABELLED:A synergistic effect of nonselective cyclooxygenase (COX) inhibitors on morphine-induced decrease of isoflurane minimum alveolar concentration (MAC(ISO)) has been observed in the rat. We studied the influence of specific COX-2 inhibitors on this decrease of MAC. Sixty-four female rats were anesthetized with ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000097849.18820.c4
更新日期:2004-02-01 00:00:00
abstract::Minimally invasive fetoscopic surgery for spina bifida aperta is a new therapeutic approach to preserve neurologic function by protecting exposed neural tissue. The anesthetic management is of paramount importance for the success of the procedure. Therefore, our protocol was developed with particular attention to safe...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001896
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard f...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003545
更新日期:2018-10-01 00:00:00
abstract::Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000180217.57952.FE
更新日期:2005-11-01 00:00:00
abstract:UNLABELLED:We compared the ketoprofen-propacetamol combination relative to propacetamol alone in thyroid and parathyroid surgery in terms of postoperative analgesic efficacy, bleeding, and incidence of nausea and vomiting to determine whether ketoprofen results in any benefit in this type of surgery. Patients were dist...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200104000-00047
更新日期:2001-04-01 00:00:00