International Journal of Anesthesiology & Pain Medicine

Description

Despite recent advances in anesthesiology and postoperative care, postoperative nausea and vomiting are common complaints. Although acupuncture techniques have received attention in anesthesiology, the ideal technique and selection of the most appropriate acupuncture points are still under debate. This study compared the efficacy of two simultaneous acupuncture points with that of a single point in the prevention and treatment of postoperative nausea and vomiting following general anesthesia through a double-blind, randomized, controlled trial involving 227 surgical patients undergoing general anesthesia who were randomly assigned into two groups.

Advanced Practice Providers

Non-physician Advanced Practice Providers (APPs) such as nurse practitioners and physician assistants are being increasingly utilized as critical care providers in the United States. The objectives of this study were to determine the utilization of APPs in the Intensive Care Units (ICUs) of Academic Medical Centers (AMCs) and to assess the perceptions of critical care fellowship Program Directors (PDs) regarding the impact of these APPs on fellowship training.

The first group received acupuncture by stimulation only on the PC6 point, and the second group underwent concomitant stimulation of the PC6 and the L14 acupuncture points during surgery under general anesthesia. The prevalences of postoperative nausea and vomiting were compared between the two groups. No significant differences were observed between the two groups. Of 115 patients in the combined group, 80 complained about nausea and vomiting compared with 96 in the single group, a significantly lower proportion. Our findings favor a combination of PC6 and LI4 stimulation for the treatment of postoperative nausea and vomiting. The applicable standards of care regarding personnel and monitoring are determined by the depth of sedation, not by the location where the procedure will be done. The specific procedure being performed and the physical status of the patient also impact the sedation and monitoring requirements but to a lesser extent.

Despite significant advances in anesthetics and postoperative care, nausea and vomiting still occur in surgical patients. Pharmacological prevention has not been completely effective in this regard. Antiemetic drugs, even in lower doses, may be associated with adverse effects. This may lead to worsening of a condition that is already hard to manage. Support for this instrument comes from an assortment of examination concentrates on that show entrancingly incited decreases in skin reflex on the arm nerve reaction in the jaw, and muscle reaction in the lower leg.

Randomization

Using a computer-based number-generating program, an independent researcher randomly allocated the patients to either of the two study groups following induction of anesthesia. The surgeon, patients, and investigator collecting the data were all blinded to the study groups. The concentrate by Kiernan and partners has gotten specific consideration since it shows that ideas for absense of pain were related with the spinal nociceptive reflex, a reaction that has barely anything to do with higher request focal sensory system handling. All the more as of late, Danziger and partners observed two unmistakable examples of R-III reflex related with entrancing absense of pain. Utilizing a technique like that of Kiernan et al., these agents observed that subjects showed solid restraint, and showed solid assistance of the R-III reflex with entrancing. Albeit the explanations behind such contrasts accordingly are not handily clarified, they truly do demonstrate that profoundly suggestible people show an obvious change in R-III reflex when given mesmerizing absense of pain ideas. As brought up by J. Holroyd, entrancing impacts on sensory system hindrance at the level of the spinal line have likewise been exhibited by modifications in galvanic skin reaction. Tragically, be that as it may, these are restricted by the shortfall of control bunches with nonhypnotized patients, as are many examinations on the physiological impacts of spellbinding.

Patients were visited by the relevant surgeon each day and evaluated for any possible complication or for fulfilling the discharge criteria. The occurrence of nausea and vomiting was assessed subjectively within the first 24 postoperative hours by an independent trained nurse who was blinded to the study groups. Other postoperative outcomes were also assessed and recorded in the study dataset.

Mean survey scores were calculated for each demographic variable and tested for statistically significant differences by analysis of variance. Questions within each domain that were internally consistent with each other within domains were identified by Cronbach’s alpha. P-values were considered statistically significant. Cronbach’s alpha analysis showed strong internal consistency for 10 dependent outcome questions in the practice factor-related domain, 6 dependent outcome questions in the peer factor-related domain, and 8 dependent outcome questions in the personal factor-related domain.

A significant and increasing physician shortage exists in the United States. The Association of Academic Medical Colleges (AAMC) estimated that by the year 2025 there may be a shortage of up to 159,000 physicians. In regard to critical care physician specialists in particular, the demand continues to outpace supply since this gap was first reported over a decade ago. Non-physician advanced practice providers (APPs) such as nurse practitioners and physician assistants are being utilized extensively to meet this demand. The shortage of CCM physicians has become more widespread since 2003 when the Accreditation Council for Graduate Medical Education (ACGME) mandated resident duty hour limits became increasingly stringent. The physician trainee work pool, which has traditionally provided the majority of direct patient care in Intensive Care Units (ICUs) at Academic Medical Centers (AMCs), has thus become increasingly restricted.