1/5. pharmacology review: the role of ondansetron in the management of children's nausea and vomiting following posterior fossa neurosurgical procedures.The management of nausea and vomiting is fundamental to the post-operative nursing care of children. Children who have neurosurgical procedures, especially those that involve the posterior fossa, are likely to experience nausea and vomiting in the post-operative period. The proximity of brainstem emetic centres to the surgical site compounds the usual post-operative risk factors for nausea and vomiting. ondansetron is discussed as an agent that may be more effective than the traditionally-used antiemetics, such as dimenhydrinate and metoclopramide, in this population. nurses must advocate for effective therapeutic measures to manage children's post-operative nausea and vomiting. Advocacy requires knowledge of high-risk groups, accurate assessment, timely intervention, and thorough evaluation of pharmacological and non-pharmacological measures.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/5. Intracerebral hemorrhage after spinal anesthesia.A rare case of intracerebral hematoma after spinal anesthesia is reported along with a review of the literature. The patient demonstrated a remarkable recovery after a timely diagnosis and surgical evacuation.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
3/5. Postoperative vomiting causing esophageal rupture after antiemetic use. A case report.BACKGROUND: Antiemetic medications are commonly used in the postoperative patient. Despite the lack of evidence-based data, these medications have also been increasingly used in the management of postoperative ileus. This practice is dangerous and increases the risk for morbidity and mortality. CASE: A 77-year-old woman underwent an uneventful total abdominal hysterectomy and bilateral salpingo-oophorectomy. The patient developed abdominal distention and vomiting, which were managed with antiemetic medication. The patient continued to vomit, developed esophageal rupture (Boerhaave's syndrome) and died of sepsis and multiorgan failure. CONCLUSION: Despite no scientific evidence for it, the practice of using antiemetic medications and prokinetic agents in the management of postoperative ileus continues. This places the patient at increased risk for completely preventable morbidity, including aspiration, pneumonia, esophageal perforation, prolonged hospital stay and death.- - - - - - - - - - ranking = 27.029842223981keywords = mortality (Clic here for more details about this article) |
4/5. hypothermia and excessive sweating following intrathecal morphine in a parturient undergoing cesarean delivery.OBJECTIVE: Intrathecal morphine has been used for the relief of postoperative pain following cesarean delivery. We report a case of postoperative hypothermia down to 33.6 degrees C associated with excessive sweating in patient undergoing elective cesarean delivery under spinal bupivacaine anesthesia who received intrathecal morphine for postoperative pain management. Case Report: A healthy 31-year-old multigravida presented for elective cesarean delivery. Following prehydration with 500 mL hemaccel, she had a subarachnoid block, using hyperbaric bupivacaine 12 mg and morphine 200 microgram, via a 25-gauge Whitacre needle. In the recovery room, 3 hours after induction of spinal anesthesia, the patient's sublingual temperature was 33.6 degrees C and she was noted to be sedated and sweating excessively. During the next 2 hours, the patient was still hypothermic despite active warming. She also complained of severe nausea, vomiting, and moderate pruritis. Following administration of naloxone 400 microgram sedation, vomiting, and pruritis were relieved. Also, the patient experienced excessive shivering, and her body temperature started to increase in association with a concurrent decrease of sweating. The postoperative hypothermia and excessive sweating in our patient may be related to the cephalad spread of the intrathecal morphine within the cerebrospinal fluid (CSF) to reach the level of opioid receptors in the hypothalamus, causing a perturbation of the thermoregulatory center. This effect could be counteracted by administration of naloxone. CONCLUSIONS: Intrathecal morphine may cause disruption of thermoregulation resulting in hypothermia associated with excessive sweating.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
5/5. Obstructive sleep apnea uncovered after high spinal anesthesia: a case report.PURPOSE: To illustrate how a patient's previously undiagnosed obstructive sleep apnea was uncovered after administration of a spinal anesthetic with a high sensory blockade, and to discuss possible explanations for this occurrence and anesthetic implications. CLINICAL FEATURES: A 55-yr-old male presented for osteotomy and open reduction and internal fixation of his left femur secondary to malunion from a previous fracture. Past medical history consisted of hypertension, hypercholesterolemia, bipolar disorder, gastroesophageal reflux disease, and cluster headaches. A combined spinal-epidural technique was chosen. Isobaric bupivacaine 0.5% (15 mg), was provided for the spinal anesthetic, along with 1 mg iv midazolam for procedural sedation and 0.5 mg iv droperidol for mild nausea. Throughout the operation, many apneic events were noted, often with respiratory efforts. The patient was easily arousable during each event and would breathe normally until the next episode. vital signs remained stable throughout. Postoperative respirology consultation was requested, and a sleep study revealed severe obstructive sleep apnea. The patient was subsequently started on continuous positive airway pressure with marked improvement in symptoms, including the cluster headaches. CONCLUSION: Recent literature suggests that high spinal blockade can result in altered levels of arousal by producing a de-afferentation of peripheral proprioceptive and sensory stimuli necessary for maintaining an awake state. In patients predisposed to upper airway obstruction, decreasing the level of consciousness can result in airway obstruction as occurs during sleep in these patients. This serves to underline the importance of considering capnography for all cases utilizing a neuraxial anesthetic technique.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |