Background Surgery on bariatric patients is being performed more frequently as the obesity rates continue to rise, presenting potential difficulty for airway management during the perioperative and postoperative period (Bakhamees, El-Halafawy, El-Kerdawy, Gouda & Altemyatt, 2007). As reported by Altiparmak & Celebi (2016), approximately one third of the American adult population is obese; resulting in greater oxygen consumption and airway resistance but decreased function of respiratory muscles and functional residual capacity requiring more effort to maintain ventilation. Formulation of a safe and effective anesthetic plan for the obese patient population can be challenging; requiring anesthesia providers to explore new evidence, aimed at …show more content…
Evidence Evidence Synthesis Although narcotics are effective in attenuating pain during the perioperative period, obese patients undergoing surgery are susceptible to complications well into the postoperative time frame due side effects such respiratory depression. Dexmedetomidine offers a safer alternative to administration of narcotics in the bariatric population. Singh et al. (2017) state that the sedative effect of dexmedetomidine is comparable to the opioid remifentanil but without the adverse effects. Prompting formulation of the question “Does dexmedetomidine decrease pain without respiratory depression compared to narcotics during the perioperative period in obese patients?”. This PICO question guided the search for evidence to evaluate the comparison between dexmedetomidine and narcotic use in the obese surgical patient. A literature search was conducted on October 22, 2017 using the PubMed and EBSCOhost databases. The search terms entered included “dexmedetomidine”, “obese”, “surgery” and (narcotic or opioid) returning 3,921 results. The search terms were reduced to “dexmedetomidine” “obese” and “surgery”, parameters were set to include articles in the English language, published between 2007 and 2017, yielding 29 results. Articles abstracts were appraised for content to include analgesic and respiratory effects of dexmedetomidine in
According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.
This is a mix of qualitative and quantitative research that uses descriptive and cross-sectional survey design methods to evaluate the patient’s anxiety level and discomfort preoperatively and postoperatively. The level of evidence in this study is III, with controlled trial without randomization (LoBiondo-Wood, 2013). Methods used to collect data are logical, as it corresponds to the phenomenon of interest in this research as listed in the critiquing guideline table in appendix A. This study was conducted in the general surgery unit of a university hospital in 2011 with a sample size of ninety-nine patients. Definitive features, visual analogue scale (VAS) and State and Trait Anxiety Inventory (STAI) tools were used to collect data, refer to appendix A for details. The fasting protocol reported by the nurses in the surgical unit was no solid food on the day before surgery after 10:00 p.m. and no liquid after 12:00 a.m. In the meantime, the patients were on isotonic sodium chloride from beginning of anaesthesia until the 24th hour postoperatively. The result shows that patients who fasted for more than twelve hours has significant increase in anxiety level according to the STAI score, and higher hunger, thirst, nausea, and pain as shown in VAS scores compared to the patients whom fasted for less than twelve
Ward also touches on other groups of patients who may need to be treated postoperatively. These patients include, the elderly, patients who have a tolerance, patients with persistent pain, and patients with sleep apnea. The author is able to create an easy to follow model that guides a person who is dosing these patients. For instance, the model helps to see if a patient needs to have a decreased dose due to a limitation or if they may need a stronger dose due to a
Weight loss surgery, also known as bariatric surgery is recommended by many physicians to people who are unable to benefit from traditional weight loss methods. However, choosing to undergo weight loss surgery isn’t an easy decision. It is an important decision that will drastically and permanently impact a person’s life. Therefore, before making such a significant decision, an individual should be aware of both the risks and benefits associated with weight loss surgery (McGowan & Chopra ix).
Opioids are commonly used in the intensive care unit (ICU) to control painful conditions and overall to alleviate the intensity of pain. Clinical uses of opioids has been occurring for thousands of years and includes pain relief of acute pain post surgery, injury or trauma, cancer pain and pain from chronic and disabling diseases. Two conventional opioids used in the ICU are morphine and fentanyl. Although both are used, one appears to have greater benefits through patient outcomes and lower costs with that being fentanyl as the preferred opioid in the ICU in both adults and children. Yet, morphine and fentanyl are still being used interchangeably in the ICU. It is uncertain whether physicians know that costs are decreased and adverse reactions
Postoperative surgical pain can often be moderate to severe leaving the client in a state of discomfort that requires the administration of opioid analgesic medications. Morphine intravenous (IV) patient-controlled analgesia (PCA) is commonly provided through a pump to treat postoperative surgical pain, but with advances in the medication administration field, a fentanyl iontophoretic transdermal system (ITS) has become another popular method (Lindley, Pestano, & Gargiulo, 2009). Morphine and fentanyl are similar medications in that they are both opioid analgesics and are both equally effective to reduce pain, but they offer differences through their administration techniques, comfort for the client, and providing care in a timely manner by the nurse. The nurse must take into consideration these differences to choose the proper medication for their specific client.
Numerous studies have been conducted on the use of local anesthetic agents with adjuvants such as clonidine (a partial α2-adrenoreceptor agonist) and tramadol3, 4 for a brachial plexus block to improve the quality and duration of anesthesia, and these studies have shown that the adjuvants may prolong anesthesia and analgesia. Moreover, dexmedetomidine is a α2-receptor agonist that has more selectivity than clonidine and has analgesic and sedative properties.5, 6 Although several studies have described the effects of dexmedetomidine on neuroaxial and peripheral nerve blocks,7, 8, 9 to date, there is only 1 study available, performed by Esmaoglu et al,10 on the effect of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. In view of the idea that decreasing the dose of dexmedetomidine may help to reduce side effects such as bradycardia and hypotension, we wanted to evaluate the effect of dexmedetomidine at a lower dose than that used in their study and the results. We think that more studies on this issue are needed.
Ketamine may be used for postoperative pain management. Low doses of ketamine reduce morphine use and nausea and vomiting after surgery. High quality evidence in acute pain is insufficient to determine if ketamine is useful in this
Chronic, acute, somatic and oncologic are all types pain - each with their own symptoms, reliefs, and evaluations. As pain has been explored, we have learned more about it; however, it remains an anomaly. In the postoperative setting, nurses are the first line of pain management. Their assessments of the patient’s pain, including questions and scaling is imperative when dosing medications and evaluating the patient. Studies continue to determine that healthcare providers undertreat and mismanage pain control and assessment. According, to the American Society of Interventional Pain Physicians, “80% to 90% of physicians have had no formal training in prescribing controlled substances, and only five out of one hundred thirty-three medical schools in the U.S. have required courses on pain management” (Glowacki, p. 37). The American Nurse Credentialing Center reported that “as of 2013, only one thousand six hundred seventy two registered nurses in the U.S. were certified in pain management” (Glowacki, p. 37). According to the CDC, about 50% of postoperative patients report unrelieved pain (Centers for Disease Control and Prevention, 2013). Effective postoperative pain control is necessary for successful care and treatment. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing (Francis &
Feld et al (2003) randomized thirty obese patients undergoing gastric bypass into two groups: one receiving sevoflurane and fentanyl while the other group received a sevoflurane and non-opioid regimen. The non-opioid regimen
Discussion: The onset of sensory and motor block was faster and time taken to attain complete sensory and motor block to occur was shorter in the nalbuphine group as compared to bupivacaine group. Postoperative regression of both sensory and motor block was significantly slower in group N than in group B and the first rescue analgesic requirement in group N was significantly late than in group B. 0.8mg intrathecal nalbuphine as an adjunct to spinal bupivacaine prolongs the postoperative analgesia with minimal side effects and with desirable sedation intraoperatively which helps in taking care of psychological impact of operation theatre environment. Rawal et al found that nalbuphine was the least irritating to neural tissue even when used in large doses and was associated with minor behavioral and EEG changes
Even with the availability of pain medication like narcotics, these medications come with multiple side effects that are a risk to their health like respiratory distress (Barranger, 2017). A lifestyle change is an essential treatment in the management of this condition. In other to minimize the excessive use of narcotics, patients need to derive other no pharmacological means of managing pain like the distraction of pain and proper hydration. Patients need to avoid high altitude or cold temperatures (Barranger,
The most common use is for cough syrup (4). There are many controversies surrounding the topic of codeine, including using an alternative for post-surgery recovery (6). However, when studies were done, it was found that the effects of codeine when compared to nonsteroidal anti-inflammatory drugs containing caffeine were significantly more effective in reducing pain. Although, after 3 days, caffeine was found to reduce more swelling (6). Therefore codeine is more efficient for reducing pain because the opioid painkillers act like endorphins, natural pain-reducing chemicals, found in the brain and spinal cord (6). Codeine can be found in liquid form in cough syrups or in solid form as painkiller
Multimodal or balanced analgesic techniques involving the use of smaller doses of opioids in combination with non-opioid analgesic drugs (eg, local anesthetics, ketamine, acetaminophen, and NSAIDs) are becoming increasingly popular approaches to preventing pain after surgery [36]. There is evidence showing the benefits of multimodal analgesic techniques, but major surveys have reported that these techniques are underused in clinical practice [37]. Multimodal analgesia is achieved by combining different analgesics that act by different mechanisms at different sites in the nervous system, reducing the incidence of side effects owing to the lower doses of the individual drugs. In our study from all the prescribed analgesics only 23 (19.2%) charts were done according to the multimodal pain management for postoperative pain where as the remaining 97 (80.8%) prescriptions were not in accordance with MAPP (Table
Only a few studies in nursing research provide some kind of study that looks into experiences of patients who choose to undergo bariatric surgical procedures or investigation. Within the growth of science in bariatric nursing, there is that need of information to support both the patient that is receiving the care and the physician that is providing the care and the support. In this time of continues growth in this bariatric procedures, it is a most that all healthcare providers initiate and Evaluate necessary changes in practice that will enhance the well-being and health of patients that undergo this procedure. With the current increase in the rate of obesity, people have now turned to bariatric surgery because they