Background
Emergence delirium (ED) after general anaesthesia (GA) is a well‐known phenomenon, yet the risk factors are still unclear. The aims of this study were to determine the incidence and ...independent predictors of ED and secondly to determine to which degree ED has any relevant, clinical consequences to medical staff as well as to patients.
Method
This prospective, observational cohort study assessed adult patients emerging from GA in the operating room, using the Richmond Agitation–Sedation Scale (RASS). Signs of ED, defined as RASS≥1 along with possible clinical consequences were noted. Patients with ED were re‐evaluated in the post‐anaesthesia care unit (PACU) and concomitant patient and anaesthesia related factors were noted.
Results
Among the 1970 patients enrolled, 73 (3.7%) showed signs of ED when emerging from anaesthesia. When reassessed in PACU, the number had declined to 25 patients (1.3%). Male sex, endotracheal tube (ETT) and volatile anaesthetics were found to be significantly related to developing ED after anaesthesia. In 20 cases, additional staff had to be called for and in one case, an i.v. access was accidentally removed. Neither patients nor staff were hurt.
Conclusion
Male sex, volatile anaesthetics and ETT were factors significantly related to ED. Whether gender, choice of respiratory devices and anaesthetics are true predictors or derived factors of surgery procedures, duration of surgery and the patients’ physical condition need further investigation. The most notable clinical consequence of ED was the need of additional staff in order to restrain the agitated patient.
Fascia iliaca compartment block is used for hip fractures in order to reduce pain, the need for systemic analgesia, and prevent delirium, on this basis. This systematic review was conducted to ...investigate the analgesic and adverse effects of fascia iliaca block on hip fracture in adults when applied before operation.
Nine databases were searched from inception until July 2016 yielding 11 randomised and quasi-randomised controlled trials, all using loss of resistance fascia iliaca compartment block, with a total population of 1062 patients. Meta-analyses were conducted comparing the analgesic effect of fascia iliaca compartment block on nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and other nerve blocks, preoperative analgesia consumption, and time to perform spinal anaesthesia compared with opioids and time for block placement.
The analgesic effect of fascia iliaca compartment block was superior to that of opioids during movement, resulted in lower preoperative analgesia consumption and a longer time for first request, and reduced time to perform spinal anaesthesia. Block success rate was high and there were very few adverse effects. There is insufficient evidence to conclude anything on preoperative analgesic consumption or first request thereof compared with NSAIDs and other nerve blocks, postoperative analgesic consumption for preoperatively applied fascia iliaca compartment block compared with NSAIDs, opioids and other nerve blocks, incidence and severity of delirium, and length of stay or mortality.
Fascia iliaca compartment block is an effective and relatively safe supplement in the preoperative pain management of hip fracture patients.
Background
Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this ...study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries.
Methods
Adult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups.
Results
Ninety‐seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2‐receptor antagonists were used 31% (30/97) of the units. Twenty‐three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP.
Conclusions
In this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.
In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a ...review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. Our primary aim was to compare the effectiveness and safety of postoperative administered ketamine in addition to opioid for i.v. PCA compared with i.v. PCA with opioid alone. Studies were identified from the Cochrane Library 2003, MEDLINE (1966–2009), and EMBASE (1980–2009) and by hand-searching reference lists from review articles and trials. Eleven studies were identified with a total of 887 patients. Quality and validity assessment was performed on all trials included using the Oxford Quality Scale with an average quality score of 4.5. Pain was assessed using visual analogue scales or verbal rating scales. Six studies showed significant improved postoperative analgesia with the addition of ketamine to opioids. Five studies showed no significant clinical improvement. For thoracic surgery, the addition of ketamine to opioid for i.v. PCA was superior to i.v. PCA opioid alone. The combination allows a significant reduction in pain score, cumulative morphine consumption, and postoperative desaturation. The benefit of adding ketamine to morphine in i.v. PCA for orthopaedic or abdominal surgery remains unclear. Owing to huge heterogeneity of studies and small sample sizes, larger double-blinded randomized studies showing greater degree of homogeneity are required to confirm these findings.
This experiment investigates the emotional consequences of viewing strangers' positive posts on Instagram. From a social comparison perspective, strangers' positive posts on social media are expected ...to negatively affect viewers' emotions. From an emotional contagion perspective, strangers' positive posts should positively affect viewers' emotions. The current lab experiment examines both the social comparison and the emotional contagion perspective while taking individual differences into account. Participants viewed positive, neutral, or no posts of confederates. In support of the social comparison perspective, individuals who tend to compare themselves to others reported lower positive affect if they had viewed positive posts than if they had viewed neutral or no posts. In support of the emotional contagion perspective, individuals who tend not to engage in social comparison reported higher positive affect after viewing positive posts than after viewing neutral or no posts. These findings indicate that individual differences in processing tendencies lead people to respond to social information on social media in opposite ways.
Introduction
Somatization, defined as a number of medically unexplained physical symptoms for many years, is a resource‐intensive condition with much suffering. Adult somatization has been linked to ...childhood trauma in both men and women. Among women, sexual trauma affects somatization level to a greater extent than nonsexual trauma. Early diagnosis of a somatization disorder would be of great help for both patients and society. The purpose of this scoping review is to map and summarize the literature on symptoms within somatization in women who have been sexually abused, and investigate if any specific symptom can be linked to previous sexual abuse.
Material and methods
A scoping review methodology was used. The databases PubMed, PsycINFO, and the Cochrane Library were searched for original qualitative and quantitative research published between 2008 and 2019 that matched the objectives of the review.
Results
The database search identified 195 articles, of which 43 were retrieved in full text. Seven articles were included, involving 2076 women. All studies were quantitative. The included studies were heterogeneous. Four studies showed inconsistent findings regarding a link between sexual abuse and chronic or acute pain. Two studies showed an association between sexual abuse and increased incidence of somatic symptoms. One study showed an association between sexual abuse and symptoms of irritable bowel syndrome. No specific somatic symptoms in somatization were identifiable within the scope of this study.
Conclusions
This is to our knowledge the first scoping review on sexual abuse and symptoms of somatization. The findings suggest a link between sexual abuse and somatic symptoms, but the identified association with pain and irritable bowel syndrome is inconsistent. No studies have clearly identified specific symptoms within somatization associated with sexual abuse. Qualitative research on the topic was identified as a knowledge gap.
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