Jung T. Kim

Evaluation of Aromatherapy in Treating Postoperative Pain: Pilot Study

Abstract:  This study compared the analgesic efficacy of postoperative lavender oil aromatherapy in 50 patients undergoing breast biopsy surgery. Twenty‐five patients received supplemental oxygen through a face mask with two drops of 2% lavender oil postoperatively. The remainder of the patients received supplemental oxygen through a face mask with no lavender oil. Outcome variables included pain scores (a numeric rating scale from 0 to 10) at 5, 30, and 60 minutes postoperatively, narcotic requirements in the postanesthesia care unit (PACU), patient satisfaction with pain control, as well as time to discharge from the PACU. There were no significant differences in narcotic requirements and recovery room discharge times between the two groups. Postoperative lavender oil aromatherapy did not significantly affect pain scores. However, patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group (P = 0.0001).

Preoperative Evaluation Clinic Visit Is Associated with Decreased Risk of In-hospital Postoperative Mortality.

Background:As specialists in perioperative medicine, anesthesiologists are well equipped to design and oversee the preoperative patient preparation process; however, the impact of an anesthesiologist-led preoperative evaluation clinic (PEC) on clinical outcomes has yet to be fully elucidated. The authors compared the incidence of in-hospital postoperative mortality in patients who had been evaluated in their institution’s PEC before elective surgery to the incidence in patients who had elective surgery without being seen in the PEC. Methods:A retrospective review of an administrative database was performed. There were 46 deaths from 64,418 patients (0.07%): 22 from 35,535 patients (0.06%) seen in PEC and 24 from 28,883 patients (0.08%) not seen in PEC. After propensity score matching, there were 13,964 patients within each matched set; there were 34 deaths (0.1%). There were 11 deaths from 13,964 (0.08%) patients seen in PEC and 23 deaths from 13,964 (0.16%) patients not seen in PEC. A subanalysis to assess the effect of a PEC visit on deaths as a result of failure to rescue (FTR) was also performed. Results:A visit to PEC was associated with a reduction in mortality (odds ratio, 0.48; 95% CI, 0.22 to 0.96, P = 0.04) by comparison of the matched cohorts. The FTR subanalysis suggested that the proportion of deaths attributable to an unanticipated surgical complication was not significantly different between the two groups (P = 0.141). Conclusions:An in-person assessment at the PEC was associated with a reduction in in-hospital mortality. It was difficult to draw conclusions about whether a difference exists in the proportion of FTR deaths between the two cohorts due to small sample size.

Case series: Septa can influence local anesthetic spread during infraclavicular brachial plexus blocks.

Purpose: To ultrasonically identify the presence of septae within the neurovascular sheath and to assess their effect on local anesthetic spread when performing infraclavicular brachial plexus blocks.Clinical features: Thirty ASA status I and II patients scheduled for minor hand surgeries were enrolled in the study. Ultrasound guided infraclavicular brachial plexus blocks were performed on 28 patients. The images of the local anesthetic spread and the effect of the septum within the neurovascular sheath were analyzed. Septae were present in four of six patients where unilateral local anesthetic spread was seen. Septae were not visualized in the 22 patients with unrestricted local anesthetic spread after the initial injection. All 28 patients underwent their planned operations successfully with adequate anesthesia.Conclusions: Our study shows that the presence of septae within the neurovascular sheath may influence the pattern of local anesthetic spread associated with the infraclavicular approach to brachial plexus blocks.RésuméObjectif: Identifier par échoguidage la présence de septa dans la gaine neurovasculaire et évaluer leur effet sur la diffusion de l’anesthésique local lors de blocs infraclaviculaires du plexus brachial.Éléments cliniques: Trente patients ASA statut I et II devant subir des chirurgies mineures de la main ont participé à cette étude. Vingt-huit patients ont eu des blocs infraclaviculaires du plexus brachial échoguidés. Les images de la diffusion de l’anesthésique local et l’effet du septum dans la gaine neurovasculaire ont été analysés. Des septa étaient présents chez quatre des six patients chez qui on avait observé une diffusion unilatérale de l’anesthésique local. Aucun septum n’a été observé chez les 22 patients où la propagation de l’anesthésique local n’a pas été restreinte après l’injection initiale. Les chirurgies prévues chez les 28 patients se sont bien déroulées avec une anesthésie satisfaisante.Conclusion: Notre étude montre que la présence de septa dans la gaine neurovasculaire peut influencer le mode de diffusion de l’anesthésique local associé à une approche infraclaviculaire pour les blocs du plexus brachial.

Ultrasound-Guided Lumbar Plexus Block for Open Reduction and Internal Fixation of Hip Fracture

Purpose: Ultrasound technology has been applied to increase both efficacy and safety of certain peripheral nerve blocks. This case report describes the first successful ultrasound‐guided lumber plexus block.

Iatrogenic Carotid Artery Pseudoaneurysm Recognized by Ultrasound

The use of ultrasound has been advocated for central venous catheter placement. Previous studies have shown that by using ultrasound the placements were performed more efficiently with fewer complications.1 The authors present another advanage of using ultrasound in the management of internal jugular enous catheter placement as shown by the following case. The patient was a 75-year-old man (170 cm and 70 kg) who riginally presented to the hospital for an open 6-cm abdominal ortic aneurysm repair. He had a history of hypertension, atrial brillation, coronary artery disease, and renal insufficiency. eneral plus thoracic epidural anesthesia was planned with rterial and central venous catheters. In the operating room, the pidural catheter was placed uneventfully, and general aneshesia was induced. The patient then was prepared for right nternal jugular venous catheter placement. The 8.5F percutaeous sheath introducer kit (Product No. AK007802; Arrow nternational, Reading PA) was used for the traditional anterior pproach.2 The patient exhibited good anatomic features, and, therefore, the authors decided to proceed without ultrasound guidance.3 After identifying the superficial anatomic landarks, the patient’s right neck was punctured with an 18-gauge ntry needle. Venous needle placement was identified by the olor of the blood and the lack of pulsations. After a guidewire as inserted and the needle was withdrawn, the 8.5F percutaeous sheath introducer was inserted using the Seldinger techique. Blood was aspirated; however, it soon became apparent hat the carotid artery was entered rather than the internal ugular vein. Pulsatile flow and brightly colored blood were