Synthesis of a Medical Literature Review Literature Review

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[. . .] , 2013).

Summary of the conclusion and recommendations for further research

Conclusions of the study; patients with HR-OSA have a greater post-surgical respiratory complications incidence, with moderate/mild hypoxia being the most common respiratory adverse event that occurred in the immediate post-surgical duration among HR-OSA patients. In addition, HR-OSA patients also had more comorbidities such as congestive cardiac failure, ischemic cardiac disease, diabetes treatable with insulin, hypertension, dyslipidemia, and chronic respiratory disease. Patients with HR-OSA also needed a longer period of stay in the hospital, and ARE was not determined by HR-OSA (Pereira et al., 2013).

3. OIRD management

Both policy-makers and clinicians are trying hard to come up with solutions that increase the effective management of OIRD incidences. In the preoperative phase, screening is vital ro establish those at an increased risk of OIRD and to recommend the appropriate management strategies as well as monitoring.

i. Naloxone

Naloxone is often used as the first defense line in case a high-risk patient developing OIRD and any complications. Naloxone is utilized as a life-saving drug for the reversal of an opioid overdose in ambulance settings and hospitals (Weingarten et al., 2015).

Summary of the research questions posed by the studies

How are the preclinical features and different perioperative variables, with the inclusion of pulmonary specific events in Phase 1 of recovery connected with the administration of naloxone after discharge from care involving anesthesia (within 48 hours of discharge from the surgical room to the post-operative room) (Weingarten et al., 2015).

Summary of the sample populations used

Grownup patients underwent general anesthesia and had tracheas extubated or in a post-anesthesia care unit and were administered naloxone within a time frame of 48 hours following discharge.

Summary of the limitations of the studies

The study was dependent on naloxone administration to act as a surrogate indicator for opioid-induced pulmonary/respiratory depression. The less serious cases might have been solved with the more traditional approaches like withholding opioids till the patient got more and more alert or instead through utilizing non-invasive pulmonary ventilation procedures. It is likely that our act of extending the Phase 1 duration of recovery for patients facing pulmonary specific events might have led to a somewhat reduced post-operative naloxone administration incidence. The study does not assess whether patients needing naloxone have higher major post-operative mortality or morbidity, and thus the absences of connection in this particular study cannot be utilized as proof that a plausible connection exists. This study was short of comprehensive records to establish the chronicity of benzodiazepine and outpatient opioid usage (Weingarten et al., 2015).

Summary of the conclusion and recommendations for further research

Respiratory events in the first phase of recovery and OSA are both connected to the high possibility of the administration of naloxone for opioid instigated pulmonary depression.

ii. Close monitoring

Close monitoring of high-risk opioid patients especially those in homecare is very important. When opioid painkillers are prescribed but the individual gets identified as a high-risk patient, treatment involving opioid might be cautiously tried with very close monitoring of the individual as well as specific measurable outcomes to gauge the efficiency and basis for continuing with the treatment.

Summary of the research questions posed by the studies

How do patterns of opioid prescription connect to overdose-related deaths in Tennessee?

Summary of the sample populations used

Residents of Tennessee under prescription for controlled opioid medication by the state’s prescribers and filled by the state’s pharmacies from 1st of January 2007 to 31st of December 2011(Baumblatt et al., 2014; Sun et al., 2015).

Summary of the limitations of the studies

It is possible that the number of patients under opioid prescription was underestimated. Additionally, the TNCSMP doesn’t really need reporting from federal facilities, hospital pharmacies, programs of methadone treatment or pharmacies outside Tennessee that fill out prescriptions for the state’s residents. The actual figure of dispensed opioid prescriptions is thus even higher than the reported figure. Furthermore, PDMP data and information are just a proxy for use of opioid; opioids diversions as well as other illegal uses have not been stated (Baumblatt et al., 2014; Sun et al., 2015).

Summary of the conclusion and recommendations for further research

Close monitoring actually has the potential of decreasing high-risk behavior. High-risk usage involving prescription opioids in Tennessee is connected with overdose deaths.

iii. Oxygen saturation

Pulse oximetry refers to a non-invasive technique for monitoring an individual’s pulse rate and levels of blood-oxygen saturation (Fu et al., 2004).

Summary of the research questions posed by the studies

Tested hypothesis; (1) desaturation following inpatient non-cardiovascular operation is regular and frequently extended; and (2) the oxygen saturation that was recorded during nursing care undervalues the duration and magnitude of post-surgical desaturation (Sun et al., 2015).

Summary of the sample populations used

Grownup patients going through non-cardiovascular operation and with cardiac complications and are registered in the VISION study at the Cleveland Clinic Main Campus and Juravinski Hospital of Hamilton Health Services.

Summary of the limitations of the studies

The study did not cover major respiratory or pulmonary complications nor did we try to link hypoxemia to other adverse events.

Summary of the conclusion and recommendations for further research

Hypoxemia was prolonged and prevalent amongst patients following a non-cardiovascular surgery. The SpO2 values recorded heavily indicate the incidence and severity of hypoxemia post-surgery. The research points to the need for further research to find out whether the clinical interventions normally utilized actually help to enhance outcomes and that such research should involve more participants and should use randomized test study design for more accuracy and reliability (Sun et al., 2015).

4. Risk factors to high-risk opioid patients

There are many risk factors that determine whether someone is a high risk patient or not. They include: family environments, social environments, peer pressure, younger age, untreated mental disorders, and a history of substance abuse.

i. Duration after surgery

The most sensitive or critical time after surgery for high-risk patients is the next twenty-four hours after surgery. The most vulnerable duration of time for OIRD is normally the initial six hours after an operation. About 34 percent of critical post-surgery respiratory complications usually occur within this time window (Taylor et al., 2005). 

Summary of the research questions posed by the studies

In case someone is going to experience a post-surgery respiratory complication because of opioid or narcotic use, the complication will very likely manifest itself within the very first 24 hours after the surgery (Taylor et al., 2005).

Summary of the sample populations used

The sample populations used in the study are over 18-year-old non-trauma patients who have undergone a surgical operation that requires them to stay for at least 24 hours.

Summary of the limitations of the studies

The limitations are those of retrospective cohort studies.

Summary of the conclusion and recommendations for further research

One of the most important objectives of emergency or surgical care is pain management after a surgical operation. The conclusion of this study is that the initial 24 hours after surgery is the time window when a patient with a history of narcotic use is most likely to experience an adverse respiratory event and, therefore, efforts should be focused on making sure the patient is as safe as possible during the window (Taylor et al., 2005).

ii. Undiagnosed health complications

One of the biggest risk factors contributing post-operation cardiovascular complications is UOSA.

Summary of the research questions posed by the studies

There are two research questions: (1) To identify and define the post-surgery adverse events linked to elective NCS among those with undiagnosed or diagnosed OHS and (2) To investigate the relationship between the adverse events/ complications and OHS’s defining characteristics which include the apnea-hypopnea index, hypercapnia, and BMI (Kaw et al., 2016).

Summary of the sample populations used

The population that was used for the study included only those: (1) With a body mass index of at least 30 kg/m2 and (2) had blood grown drawn at least twice within the inter-operative and pre-operative periods. Specifically excluded from the study were patients who had had tracheostomy surgery, thoracic surgery, and cardiac surgery.

Summary of the limitations of the studies

The biggest and most significant limitation for this study was the fact that most of the patients who had OHS were undiagnosed at the time of their operations. This is because OHS was only suspected in case of hypercapnia (Kaw et al., 2016).

Summary of the conclusion and recommendations for further research

The conclusion of the study was that among patients afflicted by OSA, those with OHS had higher morbidity than those only with OSA.

iii. Comorbidities and clinical ill-health conditions

Conditions such as OSA and others like depression and anxiety are linked to the increase in OIRD among vulnerable patients recovering in home settings.

Summary of the research questions posed by the studies

Compared to controls, DOSA patients have a higher risk of experiencing complications. Some of the important risk factors include OSA severity, patient comorbidities, and… [END OF PREVIEW] . . . READ MORE

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Cite This Literature Review:

APA Format

Synthesis of a Medical Literature Review.  (2019, June 30).  Retrieved January 28, 2020, from

MLA Format

"Synthesis of a Medical Literature Review."  30 June 2019.  Web.  28 January 2020. <>.

Chicago Format

"Synthesis of a Medical Literature Review."  June 30, 2019.  Accessed January 28, 2020.