Abstract:
BACKGROUND:The purpose of this study was to determine the relationship of four postanesthesia care unit (PACU) cardiovascular events to long-term outcomes (unplanned critical care admission or mortality) and to evaluate the contribution of anesthetic management compared with other perioperative factors in predicting these events. METHODS:For patients admitted to the PACU after receiving general anesthesia (n = 18,380), the risk of long-term outcomes was examined for patients in the PACU with hypertension, tachycardia, bradycardia, or hypotension. Using logistic regression (P < 0.05), risk factors (grouped as patients, surgical, anesthetic, operating room observations, and other PACU observations) for each cardiovascular event were determined. For each factor grouping, the relative contributions to each cardiovascular event were compared using maximum likelihood chi-square analysis. RESULTS:Patients in the PACU with hypertension or tachycardia had more unplanned critical care admissions (2.6% and 4.0% vs. 0.2% for patients with no events) and greater mortality (1.9% and 2.3% vs. 0.3% and 0.4%) (P < 0.01). For PACU hypertension (rate 2.0%), age, smoking, renal disease, female gender, and angina were significant risk factors. For PACU tachycardia (0.9%), intraoperative tachycardia and dysrhythmia were the major contributors. Patient factors also increased the risk of bradycardia (2.5%); namely age, ASA physical status 1 or 2, and preoperative beta blocker therapy. For hypotension (2.2%), duration of surgery > 2 h, completion after 6 PM, and gynecologic intraabdominal procedures were significant risk factors. Compared to patient, surgical, intraoperative, or PACU observations, anesthetic factors studied (premedication, induction agent, ventilation, use of opioids) provided only a small contribution in predicting these events. CONCLUSIONS:Hypertension and tachycardia in the PACU, although infrequent, are associated with increased risk of unplanned critical care admission and mortality. Patient, surgical, intraoperative, or PACU observations contribute more to cardiovascular events in the PACU than do differences in anesthetic management identified in this study.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
Rose DK,Cohen MM,DeBoer DPdoi
10.1097/00000542-199604000-00003subject
Has Abstractpub_date
1996-04-01 00:00:00pages
772-81issue
4eissn
0003-3022issn
1528-1175journal_volume
84pub_type
杂志文章相关文献
ANESTHESIOLOGY文献大全abstract:BACKGROUND:Factors determining renal function at organ recovery in deceased kidney donors are not well established. METHODS:The authors studied the prevalence and risk factors associated with elevated prerecovery creatinine and calculated glomerular filtration rate in 458 deceased organ donors identified through the C...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318194ca8a
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Effects of volatile anesthetic agents on N-methyl-D-aspartate (NMDA) receptor-mediated excitatory synaptic transmission have not been well characterized. The authors compared effects produced by halothane and isoflurane on electrophysiologic properties of NMDA and non-NMDA receptor-mediated synaptic response...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200001000-00035
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:The effects of anesthetics on ischemia-induced ventricular arrhythmias remain poorly studied. This study investigated the effects of propofol and sevoflurane on the survival rate and morbidity as a result of ventricular arrhythmias, and defined a possible mechanism for the arrhythmogenic properties of anesth...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318190b537
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Cardiac protection by volatile anesthetic-induced preconditioning and ischemic preconditioning have similar signaling pathways. Recently, it was reported that augmentation of protein modified with O-linked β-N-acetylglucosamine (O-GlcNAc) contributes to cardiac protection. This study investigated the role of...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31822fcede
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Good postoperative recovery is increasingly recognized as an important outcome after surgery. The authors created a new Post-operative Quality Recovery Scale (PQRS) that tracks multiple domains of recovery from immediate to long-term time periods in patients of varying ages, languages, and cultures. METHODS...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181d960a9
更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:The general anesthetics, isoflurane and sevoflurane, cause developmental abnormalities in neonatal animal models via incompletely understood mechanisms. Despite many common molecular targets, isoflurane and sevoflurane exhibit substantial differences in their actions. The authors sought to determine whether ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318291c04e
更新日期:2013-08-01 00:00:00
abstract::This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of three different PCEA solutions. After establishing effective epidural analgesia with 12 ml of 0.25% bupivacaine, 72 parturients in active labor were randomly assigned to one of four groups: phy...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199001000-00009
更新日期:1990-01-01 00:00:00
abstract::The hemodynamic interactions of verapamil and isoflurane were studied in eight dogs. Left ventricular function was analyzed using a right heart bypass preparation to permit rigid hemodynamic control. Hemodynamic studies were performed at 0.7, 1.05, and 1.40% isoflurane before and during the maintenance of two stable l...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198308000-00012
更新日期:1983-08-01 00:00:00
abstract:BACKGROUND:Hypotension is a common side effect of general anesthesia induction, and when severe, it is related to adverse outcomes. Ultrasonography of inferior vena cava (IVC) is a reliable indicator of intravascular volume status. This study investigated whether preoperative ultrasound IVC measurements could predict h...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000001002
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:The authors sought to determine whether subjects with pathophysiological conditions that are characterized by increased concentrations of aldosterone have increased susceptibility to the side effects of neonatal anesthesia with sevoflurane. METHODS:Postnatal day 4-20 (P4-P20) rats were exposed to sevofluran...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318266c62d
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Age is often the sole criterion for determining the need for preoperative electrocardiograms. However, screening electrocardiograms have not been shown to add value above clinical information. This study was designed to determine whether it is possible to target electrocardiograms ordering to patients most l...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0b013e31819fb139
更新日期:2009-06-01 00:00:00
abstract::It is a common practice for anesthesia to substitute for one another, especially for short breaks during long surgical procedures. The assets and liabilities of this practice of relief have not been examined previously. In the course of gathering 1,089 reports of preventable errors and failures associated with anesthe...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198206000-00010
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:Global cerebral ischemia is associated with delayed neuronal death. Given the role of caspases in apoptosis, caspase inhibitors may provide neuronal protection after cardiac arrest. To this end, the authors generated a transgenic rat line expressing baculovirus p35, a broad-spectrum caspase inhibitor, in cen...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200307000-00020
更新日期:2003-07-01 00:00:00
abstract::Premedication with diazepam, hydroxyzine or secobarbital significantly increased ketamine-induced sleep time (137 +/- 3.5 min, 135 +/- 9.2 min, 128 +/- 4.7 min) over that of unpremedicated controls (98.5 +/- 4.4 min) in man. The corresponding mean plasma half-lives (t1/2) of ketamine were longer in patients premedicat...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197509000-00007
更新日期:1975-09-01 00:00:00
abstract:BACKGROUND:The degree to which intrathecally administered morphine can alleviate hypersensitivity in animals after peripheral nerve injury is controversial, and the mechanisms by which morphine works in these circumstances are uncertain. In normal animals, morphine induces adenosine release, and in vitro data suggest t...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200502000-00027
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Caveolae are a nexus for protective signaling. Trafficking of caveolin to mitochondria is essential for adaptation to cellular stress though the trafficking mechanisms remain unknown. The authors hypothesized that G protein-coupled receptor/inhibitory G protein (Gi) activation leads to caveolin trafficking t...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000000295
更新日期:2014-09-01 00:00:00
abstract::Complications after major surgery are a leading cause of morbidity and mortality. The etiology of postoperative complications is complex, but poor cardiorespiratory reserve appears to be a key factor. There is increasing interest in the use of central and mixed venous oxygen saturation to guide therapeutic interventio...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181af59aa
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Inhalational anesthetics inhibit the nitric oxide-guanylyl cyclase signaling pathway, but the site of this inhibition is not yet clear. This study was designed to test the hypothesis that receptor activation or downstream signaling events leading to nitric oxide synthase activation are important sites for th...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199605000-00018
更新日期:1996-05-01 00:00:00
abstract::The effect of chronic renal failure (RF) on the pharmacokinetics of morphine was studied in nine patients with end-stage RF, aged 58 +/- 8 yr (SD), and in seven control patients, aged 58 +/- 15 yr, undergoing peripheral surgery under general anesthesia. All patients received 0.2 mg X kg-1 as an intravenous bolus injec...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198703000-00011
更新日期:1987-03-01 00:00:00
abstract:BACKGROUND:Anesthetics are protective during ischemic-reperfusion injury and associated inflammation; therefore, the authors hypothesized that anesthetic pretreatment may provide protection in culture from cytokine-induced cell death. METHODS:Rat vascular smooth muscle (VSM) cell and human umbilical vascular endotheli...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200207000-00005
更新日期:2002-07-01 00:00:00
abstract::The authors investigated the value of high-dose thiopental (TH) therapy after 16-min complete global brain ischemia (GBI) in three groups of pigtailed monkeys, using a neck cuff model of GBI with 96 h intensive care postischemia (PI). Control group (n18): Normotension was restored within 2 min PI; paralysis/controlled...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198402000-00002
更新日期:1984-02-01 00:00:00
abstract::Hepatic drug-metabolizing enzymes and hepatic ultrastructure were studied in rats after two hours of anesthesia with 1 MAC halothane or diethyl ether. Twelve hours after cessation of either anesthetic smooth endoplasmic reticulum was increased in centrilobular but not in periportal hepatocytes. This change persisted a...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197805000-00005
更新日期:1978-05-01 00:00:00
abstract::The serum and urinary concentrations of fluorinated metabolites of isoflurane after inhalation of three different concentrations of isoflurane were studied in 18 ASA physical status 1 or 2 patients, scheduled for orthopedic or otolaryngeal surgery. Isoflurane was administered for 60 min during fentanyl-nitrous oxide-o...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:
更新日期:1988-08-01 00:00:00
abstract:BACKGROUND:Since the effects of antiemetic doses of droperidol on the QT interval have not been previously studied, the authors designed a randomized, double-blind, placebo-controlled study to evaluate the intraoperative and postoperative effects of small-dose droperidol (0.625 and 1.25 mg intravenous) on the QT interv...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-200506000-00007
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Pneumocephalus occurs in a variety of clinical settings and has important anesthetic implications, particularly if N2O is used. One common cause of pneumocephalus is a craniotomy or craniectomy, and therefore, patients undergoing these neurosurgical procedures may be at increased risk for the development of ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199405000-00009
更新日期:1994-05-01 00:00:00
abstract::Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly combined with intravenous morphine patient-controlled analgesia to relieve postoperative pain. NSAIDs have a documented 30-50% sparing effect on morphine consumption. However, most of the studies have not demonstrated a decrease in morphine adverse effects. A m...
journal_title:Anesthesiology
pub_type: 杂志文章,meta分析
doi:10.1097/00000542-200506000-00027
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:The authors' objective was to assess the role of protein kinase C (PKC) and nitric oxide synthase (NOS) in mediating the effects of propofol on diabetic cardiomyocyte contractility, intracellular free Ca2+ concentration ([Ca2+]i), and myofilament Ca2+ sensitivity. METHODS:Freshly isolated ventricular myocyt...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200605000-00014
更新日期:2006-05-01 00:00:00
abstract:BACKGROUND:Ethical conduct in human research in anesthesia includes approval by an institutional review board (IRB) or ethics committee and informed consent. Evidence of these is sometimes lacking in journal publications. METHODS:The authors reviewed all publications involving human subjects in six leading anesthesia ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200311000-00030
更新日期:2003-11-01 00:00:00
abstract::The effects of gamma-aminobutyric acid (GABA) on the induction of convulsions by local anesthetics were investigated in mice and rats. Intraventricular administration of 0.8-1.6 mg GABA protected rats against convulsions induced by procaine, lidocaine, cocaine, and tetracaine in a dose-related manner. Intraperitoneal ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198205000-00007
更新日期:1982-05-01 00:00:00
abstract:BACKGROUND:Buprenorphine, a partial μ-opioid receptor agonist and κ-opioid receptor antagonist, is an effective analgesic. The effects of buprenorphine on sleep have not been well characterized. This study tested the hypothesis that an antinociceptive dose of buprenorphine decreases sleep and decreases adenosine concen...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31822e9f85
更新日期:2011-10-01 00:00:00