ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05545.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05546.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: As quality assurance, risk analysis and documentation become more important, rapid access to accurate information of departmental activity is needed. In this paper we describe a system for routine data recording of anaesthesia‐related information, and we give examples of how this information can be used.Methods: For each anaesthesia procedure we record 20 variables in a database. The variables are related to the patient, the procedure, and the anaesthesia. Both the type and severity of intraoperative problems are recorded. All information is routinely written on the standard anaesthetic chart, and later entered into a database. All charts are quality checked before data entry.Results: With small modifications, we have used this system for 10 years, and it is well integrated as part of our departmental routine. From 1985 to 1995 we have recorded an increased incidence of ‘minor’ intraoperative problems, while the increase in ‘severe’ problems has been small. During the period 1993–95 the total problem incidence has been stable at around 14%. We have found the incidence of problems related to technical equipment to be 0.14%, and of ‘minor’ severity, and therefore equipment failure has not warranted extensive quality assurance efforts. We also investigated the impact of our routines for gastric emptying of non‐fasting patients, and found an incidence of pulmonary aspiration of 0.03%. Our results made us conclude that our recommendations concerning anaesthetic technique and gastric emtying are safe. The system has proven to be simple enough to be practicable, and yet detailed enough to be informative for educational, quality assurance, research and administrative purposes.Conclusion: A simple database for information related to anaesthetic care and problems can be a useful tool for anaesthesiology departments. We have used the system for a variety of quality assurance efforts, for educational and administrative purposes and in research. To get reliable data it is important to keep the system simple, with the information recorded kept to a minimum. The software chosen must make it possible for people within the department to write and modify reports. A constant focus on data quality is important, and motivated nurses and doctors as well as leadership enthusiasm are necessary to make the system work properly. The atmosphere of problem recording should be one of ‘openness and confidence’, rather than ‘inspection and control’.Conclusions: We conclude that development and use of a simple database related to anaesthesia care and problems are possible in a busy clinical setting. Our database is now an integrated part of our departmental routine, and plays an important part in quality assurance strategies, educational purposes, research activities and administrative matters.However, the system is not self running. It needs close management and follow up. In addition, leadership enthusiasm and allocation of resources are necessary to make the system work, particularly to ensure the quality of the data. Even in a simple system such as ours, with minimal data and great efforts being made to make data entry simple, our experience is that doctors and nurses need reminding and encouragement to make the system work properly. Most of this follow‐up education is carried out during monthly problem meetings, when specific patients and group of patients are discussed. Motivation is best achieved by getting relevant information back to the suppliers, to make them feel that their efforts are worthwhile. The problem recording is a cornerstone of our system, and is a motivation factor for the whole system. This is an important aspect, as relevant and interesting feedback to the data suppliers possibly is an effective way to increase the quality of information in the whole system. The key words to make our system work as a routine in a clinical setting have been ‘simplicity’ for the data system, and ‘openness’ and ‘conf

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05547.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The aim of this study was to determine the incidence and severity of pulmonary aspiration of gastric contents during anaesthesia, to determine the short‐ and long‐term morbidity, and to evaluate present routines for preoperative gastric emptying. During the study period, preoperative gastric emptying was done only when intestinal obstruction was suspected.Methods: We routinely record prospectively all problems during and after anaesthesia by means of a database. All data for the 5 years from 1989 to 1993, a total of 85 594 anaesthetic procedures, were analyzed. The hospital charts were also reviewed for those patients where aspiration to the lungs had occurred.Results: Pulmonary aspiration of gastric contents was detected in 25 cases; all occurred in patients receiving general anaesthesia. The incidence was 4.1 times higher in emergency procedures than in electives. There were no aspirations in 30 199 patients receiving regional anaesthesia. The complication occurred in all phases of anaesthesia, but clinical morbidity was low in most cases. Three cases showed serious morbidity immediately after the event, but recovered. Two cases showed serious long‐term morbidity, but also recovered completely. No patients died. No cases, except possibly one, might have been prevented by stricter routines for preoperative gastric emptying.Conclusion: We found a low incidence of pulmonary aspiration. When it occurs, it carries a low risk for serious morbidity. Emergency cases for general anaesthesia are most at risk. Regional anaesthesia is considered safe. There is no evidence that preoperative gastric emptying should be routinely done in emergency cases, except in patients with suspected ileus/sub

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05548.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Investigations of the Centers for Disease Control into postoperative infections have implicated extrinsically contaminated propofol.Methods: To evaluate the infectious risk associated with intravenous anaesthetic agents, we surveyed the literature from 1971 to 1995 using the Medline database. Papers covering infections related to intravenous anaesthetic agents were included.Results: The review of the literature on infections associated with propofol and other intravenous anaesthetics shows that this infectious risk is minimal and often caused by breakdowns in aseptic techniques.Conclusions: We conclude that, if standard hygienic precautions are taken, the risk of in‐use contamination of intravenous anaesthetics is low. If strict hygienic guidelines are followed in handling propofol, this agent can be safely administered to patient

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05549.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Perioperative hypothermia is common and likely contributes to morbidity, but the efficacy of prophylactic fluid warming has hardly been analyzed systematically. We tested the hypothesis that the use of an infusion/blood warmer, based on the principle of countercurrent heat exchange, reduces incidence and degree of severe hypothermia following aortic surgery.Methods: In a prospective randomized investigation of patients (n = 50) undergoing elective abdominal aortic aneurysm surgery, all fluids/blood products (approx. 3500 ml) administered intraoperatively were infused either (n = 25) via countercurrent‐like heat exchangers (Hotline™ Level 1 Technologies Inc.) or without (n = 25) taking special precautions (infusions stored at 21°C, blood products heated to 37°C in a water bath). Anaesthesia was standardized using a thiopentone, fentanyl, vecuronium induction sequence, and maintained by isoflurane in N2O/O2.Results: The perioperative decrease of oesophageal temperature (−0.35°C ± 0.4) in the group managed with heat exchangers was significantly smaller (P<0.0001) than in the control group (−1.5°C± 0.54), and oesophageal temperature at the end of surgery was considerably higher (35.1°C ± 0.45 vs. 34.2°C ± 0.7;P<0.0001). Furthermore, while postoperative hypothermia below 34.5°C was observed in 16 patients (incidence: 64%) of the control group, it occurred in only 2 patients (incidence: 8%) managed with heat exchangers (P<0.001).Conclusions: The efficacy of fluid/blood warmers has hitherto only been evaluated in bench tests. Our results demonstrate that the use of heat exchangers alone, while not completely preventing hypothermia, markedly reduces the incidence of severe perioperative hypothermia, and lessens its degree during abdominal aorti

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05550.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The haemodynamic effect of volume load at elective Caesarean delivery may be modulated by atrial natriuretic peptide (ANP) especially in pre‐eclamptic women in whom basal ANP levels are increased.Methods: We followed the haemodynamic parameters and determined the peripheral venous levels of ANP before and after an intravenous volume preload of 1000 ml of Ringer's acetate solution, followed by a further load of the same volume under spinal anaesthesia in 7 healthy and in 6 pre‐eclamptic women.Results: During the preload period the median ANP level increased more (from 14.8 to 22.1 pmol/l, P=0.03) in pre‐eclamptic than in healthy women (from 8.0 to 8.5 pmol/l, NS); while an increment in central venous pressure (CVP) was also greater in pre‐eclamptic than in healthy women. The increase in the concentrations of ANP correlated significantly (P<0.05) with the increase in CVP in the total study group. A signify cant increase in ANP levels in healthy pregnant women was not seen until during the second infusion period under spinal anaesthesia; in pre‐eclamptic women the levels increased further during that period.Conclusion: These findings concur with the theory that atrial stretch is a stimulus for ANP release. An exaggerated release of ANP in response to volume loading may aid in the adaptation of maternal circulation to volume load at elective Caesarean delivery in pre‐ecla

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05551.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Since pre‐incisional peritonsillar infiltrations of local anesthetic solutions have been suggested to reduce postoperative pain after tonsillectomy, we compared the efficacy of either pre‐ or postoperative local anesthetic infiltration upon post‐tonsillectomy pain.Methods: After the induction of general anesthesia, 68 consecutive healthy patients, ranging in age from 8 to 65 years, were randomly allocated to either receive peritonsillar infiltration with 0.25% bupivacaine (group 1) or normal saline (group 2) before incision. A third group (group 3) had their peritonsillar region infiltrated with 0.25% bupivacaine after the completion of surgery but before the patients were awakened from anesthesia. All the patients were treated in the same way in the postoperative period: NSAIDs were given intravenously to adults and rectally to children. Acetaminophen was given intravenously or rectally (children aged<15 yr) if additional analgesic support was requested by the patient. Additional acetaminophen consumption was recorded daily. Pain scores were assessed on every patient with the use of a visual analogue scale (VAS) at rest, 1, 5, 9, 13, 17, 21 and 36 h after surgery, and also on swallowing during the first postoperative day.Results: Global VAS pain scores were lower in the groups treated with bupivacaine infiltration during the first 24 h after surgery (P<0.05). Supplementary analgesic consumption was lower in group 3 than in group 2 during the 0–9 h interval immediately following surgery (P<0.05). There were no statistically significant differences for any other parameters between the 3 groups.Conclusion: These results suggest that the timing of peritonsillar infiltration with bupivacaine is not of clinical importance and does not affect the quality of postoperative analgesia in patients undergoing tonsil

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05552.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Intravenous regional guanethidine Bier block (IVRGBB) has been used predominantly in Europe for treating reflex sympathetic dystrophy (RSD). Our experience in the United States, where its use has been limited, is reported. Methods: Fifty‐five patients received IVRGBB for RSD. Upper extremities received 20 mg (10 mg/ml) of guanethidine in 30–50 ml of 0.5% lidocaine; lower extremities received 40 mg in 40–75 ml of lidocaine (volume adjusted for size, weight, or prior adverse effect). Pain severity (mild, moderate, severe, excruciating) was obtained pretreatment. Pain severity and a global clinical assessment (GCA) (resolved, improved, no change, worse) were obtained following each treatment. The final GCA was analyzed vs: pretreatment score; age; sex; pain duration; number of treatments; and precipitating event. Adverse effects were documented.Results: Of 55 enrolled patients, 2 were lost to follow‐up, and 2 returned 1 and 4 years later for repeat treatment. Therefore, 53 patients were evaluated for 55 treatments. Age: 38.2 − 14.8 (SD) (range 10–77) years. Sex: 11 males, 44 females. Average pain duration: 2.0 − 1.7 years (3 days ‐ 7 years). Final assessment occurred at 3.88 − 5.21 months (6 days ‐ 2 2/3 years). Effect on pain: resolution‐9.1%; improved‐14.5%; no change‐61.8%; worsening‐14.5%. No significant relationship was found between GCA and the factors evaluated. There was a significant positive linear association between pretreatment pain and post treatment GCA (P= 0.032). Fifty‐six adverse effects occurred in 19 (34.5%) patients (nausea, vomiting, orthostatic hypotension, dizziness, diarrhea, weakness).Conclusions: IVRGBB does not provide long‐term pain relief and is associated with adverse ef

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05553.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Nonsteroidal anti‐inflammatory drugs have been documented to be effective in the treatment of postoperative pain. The aim of this study was to evaluate the analgesic effect of local intra‐articular injection of tenoxicam compared with intravenous injection on postoperative pain after arthroscopy.Methods: After day‐case arthroscopy, 60 patients were randomized to receive either tenoxicam 20 mg in 20 ml of normal saline intra‐articularly and 2 ml of normal saline i.v., or 20 ml of normal saline intra‐articularly and 2 ml tenoxicam 20 mg i.v. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements.Results: Pain scores were significantly lower in the intra‐articular group at rest and during active flexion of the knee at 1,2 and 4 hours postoperatively and during walking at 6 hours postoperatively (P<0.05). Significantly more patients in the intravenous group required supplemental opioid analgesia within the first 4 hours postoperatively (P<0.05).Conclusion: Intra‐articular tenoxicam 20 mg provided better analgesia and decreased the requirements for postoperative analgesic compared with i.v. te

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1996.tb05554.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY