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    Anesthesia and postoperative respiratory compromise following major lower extremity surgery: Implications for combat casualties

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    Author
    Galvagno, S.M., Jr.
    Brayanov, J.
    Williams, G.
    Date
    2017
    Journal
    Military Medicine
    Publisher
    Association of Military Surgeons of the US
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.7205/MILMED-D-16-00048
    Abstract
    Care of military casualties requires not only assessment of patient, injury, and setting, but also the consequences of care decisions on other organ systems. In contemporary conflicts, pelviperineal and lower extremity trauma are common injuries, yet the optimal perioperative anesthetic and analgesic care remains unclear. Residual anesthesia and opioids can cause respiratory depression, specifically postoperative respiratory depression and opioid-induced respiratory depression. This observational study quantified and compared the incidences of respiratory depression following general anesthesia (GA) and spinal anesthesia (SA) for lower extremity surgery. Respiratory data were collected from 173 patients receiving either GA (n = 43) or SA (n = 130) via a bioimpedance-based respiratory volume monitor. Patients were further subdivided by postoperative opioid administration. The overall incidence of respiratory depression was significantly higher in the SA group (48/130 vs. 6/43, p = 0.004). These findings suggest that, while SA may be considered the safer alternative, it may in fact introduce confounding factors, which increase the risk of respiratory depression. Ensuring adequate respiratory status is particularly critical for the military population, as combat casualties are often monitored in understaffed environments following surgery. Using an SA strategy instead of GA may not prevent postoperative respiratory depression, and respiratory volume monitor monitoring may be useful to optimize care. Copyright Association of Military Surgeons of the U.S. All rights reserved.
    Keyword
    Military Personnel
    Anesthesia--adverse effects
    Lower Extremity--surgery
    Respiratory Insufficiency--etiology
    Wounds and Injuries--surgery
    Analgesics, Opioid--adverse effects
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85015182377&doi=10.7205%2fMILMED-D-16-00048&partnerID=40&md5=1734072ec447861af04e842bc57d3274; http://hdl.handle.net/10713/11276
    ae974a485f413a2113503eed53cd6c53
    10.7205/MILMED-D-16-00048
    Scopus Count
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    UMB Open Access Articles 2017

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