Postoperative hypoxemia in orthopedic patients with obstructive sleep apnea.

Criteria to determine which patients with obstructive sleep apnea (OSA) require intensive postoperative monitoring are lacking. Our postoperative OSA patients are all intensively monitored in the PACU and can provide such data. Thus, we reviewed patient records to determine incidence and risk factors for postoperative hypoxemia in OSA patients and subsequent association with postoperative complications.

Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study.

Background: It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA) after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications.

Methods: Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia.

Evidence basis for ultrasound-guided block characteristics: onset, quality, and duration.

Background And Objectives: This systematic review summarizes existing evidence for superior onset, quality, and duration of block for ultrasound (US) guidance versus other techniques for nerve localization.

Methods: MEDLINE was systematically searched from 1966 to September 2009 for randomized controlled trials (RCTs) comparing US guidance to another technique for peripheral nerve blocks.

Results: Sixteen RCTs were identified for upper-extremity peripheral nerve blocks and 8 for lower extremity.

A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms.

Background: Visualization with ultrasound during regional anesthesia may reduce the risk of intraneural injection and subsequent neurological symptoms but has not been formally assessed. Thus, we performed this randomized clinical trial comparing ultrasound versus nerve stimulator-guided interscalene blocks for shoulder arthroscopy to determine whether ultrasound could reduce the incidence of postoperative neurological symptoms.

Methods: Two hundred thirty patients were randomized to a standardized interscalene block with either ultrasound or nerve stimulator with a 5 cm, 22 g Stimuplex insulated needle with 1.

Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review.

Ultrasound guidance has become popular for performance of regional anesthesia and analgesia. This systematic review summarizes existing evidence for superior risk to benefit profiles for ultrasound versus other techniques. Medline was systematically searched for randomized controlled trials (RCTs) comparing ultrasound to another technique, and for large (n > 100) prospective case series describing experience with ultrasound-guided blocks.