Preoperative pulmonary status and postoperative extubation outcome of patients undergoing elective cardiac surgery

Article Abstract:

Patients who undergo thoracic surgery, particularly those with certain characteristics, are at risk for pulmonary complications after surgery. Mechanical ventilation required during surgery may be needed for a long period afterwards as well, which can cause complications. Pulmonary status is often assessed in patients prior to undergoing cardiac surgery to identify any who might be at risk for pulmonary complications following surgery. Studies examining correlations between preoperative pulmonary assessment and postoperative complications have focused on measurements of pulmonary function, but none have examined clinical evaluation of current and past health status. This study examined the correlation between preoperative health status and postoperative extubation outcome or when the mechanical ventilator could be removed. Preoperative health status was examined in 47 patients who underwent heart surgery. After surgery, patients were categorized as having either normal postoperative extubation or delayed extubation. Results showed that 12 (25.5 percent) of the patients required prolonged intubation, with two of these patients dying before tubes were removed. Patients who had prolonged intubations had on average significantly longer hospital stays and significantly higher incidence of atelectasis (lung tissue collapse) than patients with normal intubation periods. A number of patients had risk factors for pulmonary problems, with smoking being the most common risk. None of these risk factors correlated with postoperative difficulty in extubation. These results indicate that preoperative health status assessment is not a good predictor of postoperative problems in extubation. They do confirm that delayed extubation is a serious problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Artificial respiration, Mechanical ventilation, Respiratory insufficiency, Atelectasis

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Relaxation technique and postoperative pain in patients undergoing cardiac surgery

Article Abstract:

Fear of post-surgical pain is a significant concern for most patients awaiting cardiac surgery, and ranks second only to fear of death. Between 60 and 80 percent of all surgical cases receive inadequate treatment for acute postoperative pain and few patients are satisfied with the manner in which their postsurgical pain is clinically handled. Nurses play a vital role in helping the patient control postsurgical pain, and alternative methods for coping with pain to pain-reducing medication should be considered. Narcotic drugs are often accompanied by adverse side effects, including nausea, decreased respiration rate, changes of brain function, drops in blood pressure, and rarely, physiologic dependence (addiction). The present study explores the value of using a relaxation technique related to meditation to reduce pain, by decreasing anxiety and relieving muscle tension. Twenty-nine patients (26 men and 3 women) were divided into two groups: those receiving instruction on relaxation techniques on the night preceding surgery, and a control group of patients who were not so instructed but rather treated for pain in the conventional manner. Although there was no statistically significant effect of the relaxation technique upon several psychological indices of postsurgical pain, important physiologic parameters were influenced. These included a lowering of blood pressure, heart rate, and respiration rate in those patients using relaxation methods. It is noteworthy that 73.3 percent of these patients claimed that this simple method was helpful in controlling pain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Prevention, Physiological aspects, Pain, Heart, Meditation, Heart surgery

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Postoperative hyperglycemia: clinical benefits for insulin therapy

Article Abstract:

Surgery disrupts many normal physiologic mechanisms, including those which are involved in the maintenance of proper levels of blood sugar. These effects are caused by the trauma of the surgical procedure itself, anesthesia, loss of blood, pain, and the psychological stress resulting from the anticipation of the surgery. As a result, it is usual to see blood glucose (blood sugar) levels rise following surgery, in both normal and diabetic patients. While the glucose level returns rapidly to normal values in the nondiabetic patient, the elevation can be a significant problem for the diabetic patient. Nurses are in a good position to observe patients during the recovery process and they should keep these issues in mind when treating their postsurgical patients. The physiologic mechanisms that underlie this phenomenon are discussed, as is the role of the nurse in monitoring the patient's recovery. The usual method of dealing with the hyperglycemia of the diabetic surgery patient is to administer insulin by syringe. Other concerns in the management of the diabetic surgical patient and appropriate protocols are discussed. Although there is a prevailing notion that the diabetic patient is at greater risk following surgery than a nondiabetic patient, this is not supported by research. Diabetic patients, when properly clinically managed by an individually tailored therapeutic strategy, can safely undergo many forms of surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diabetics, Control, Hyperglycemia

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