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Sample records for preoperative anesthesia consultation

  1. Memory Loss, Alzheimer’s Disease and General Anesthesia: A Preoperative Concern

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    Thaler, Adam; Siry, Read; Cai, Lufan; García, Paul S.; Chen, Linda; Liu, RenYu

    2012-01-01

    Background The long-term cognitive effects of general anesthesia are under intense scrutiny. Here we present 5 cases from 2 academic institutions to analyze some common features where the patient’s or the patient family member has made a request to address their concern on memory loss, Alzheimer’s disease and general anesthesia before surgery. Methods Records of anesthesia consultation separate from standard preoperative evaluation were retrieved to identify consultations related to memory loss and Alzheimer’s disease from the patient and/or patient family members. The identified cases were extensively reviewed for features in common. We used Google® (http://www. google.com/) to identify available online information using “anesthesia memory loss” as a search phrase. Results Five cases were collected as a specific preoperative consultation related to memory loss, Alzheimer’s disease and general anesthesia from two institutions. All of the individuals either had perceived memory impairment after a prior surgical procedure with general anesthesia or had a family member with Alzheimer’s disease. They all accessed public media sources to find articles related to anesthesia and memory loss. On May 2nd, 2011, searching “anesthesia memory loss” in Google yielded 764,000 hits. Only 3 of the 50 Google top hits were from peer-reviewed journals. Some of the lay media postings made a causal association between general anesthesia and memory loss and/or Alzheimer’s disease without conclusive scientific literature support. Conclusion The potential link between memory loss and Alzheimer’s disease with general anesthesia is an important preoperative concern from patients and their family members. This concern arises from individuals who have had history of cognitive impairment or have had a family member with Alzheimer disease and have tried to obtain information from public media. Proper preoperative consultation with the awareness of the lay literature can

  2. Validation of measures of parents' preoperative anxiety and anesthesia knowledge.

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    Miller, K M; Wysocki, T; Cassady, J F; Cancel, D; Izenberg, N

    1999-02-01

    Parents' anxiety about their children's anesthesia may adversely affect the children's outcomes and compromise the quality of informed consent. Studies of these issues have been limited by the lack of validated measures of parental anxiety and knowledge surrounding anesthesia. In the present study, we evaluated psychometric properties of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Standard Anesthesia Learning Test (SALT) among 85 parents who participated in an evaluation of the effects of a videotape about pediatric anesthesia. The results supported the internal consistency, test-retest reliability, and concurrent validity of both instruments and documented the equivalence of two forms of the SALT. Factor analysis supported the previously demonstrated factor structure of the APAIS, further confirming its construct validity. We conclude that the APAIS and SALT are reliable and valid measures of parental anxiety and knowledge of pediatric anesthesia that can be used for clinical and research purposes. This study verified the reliability and validity of two questionnaires for measuring parents' knowledge and anxiety about pediatric anesthesia. These questionnaires can be used in further research on factors affecting parental anxiety and knowledge before their children's surgery.

  3. The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

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    Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

    2017-08-01

    Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

  4. Tourniquet-induced cardiovascular responses in anterior cruciate ligament reconstruction surgery under general anesthesia: Effect of preoperative oral amantadine

    Directory of Open Access Journals (Sweden)

    Ashraf Abd Elmawgood

    2015-01-01

    Conclusion: Preoperative oral amantadine reduced tourniquet induced hypertension and postoperative analgesic requirements in anterior cruciate ligament reconstruction surgery under general anesthesia.

  5. Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery.

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    Pettersson, Monica E; Öhlén, Joakim; Friberg, Febe; Hydén, Lars-Christer; Carlsson, Eva

    2016-11-08

    The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse. The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer. The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis RESULTS: The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns. There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing

  6. The effect of videotaped preoperative information on parental anxiety during anesthesia induction for elective pediatric procedures.

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    McEwen, Andrew; Moorthy, Claire; Quantock, Christopher; Rose, Hannah; Kavanagh, Richard

    2007-06-01

    The purpose of this study was to determine whether audiovisual information, describing the process of undergoing and recovering from anesthesia, could reduce anxiety levels in parents before their child's induction of anesthesia. One hundred and eleven parents were recruited into this study. Of these 56 were randomized to a control group and 55 to an intervention group. All parents completed the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaires on admission to hospital on the day of surgery and then again just before accompanying their child to the anesthetic room. In addition to the normal preoperative preparation, parents randomized into the study group watched a short 8-min information video after completing the first questionnaire. The video illustrated the events and procedures surrounding a child's admission to hospital for day-case surgery, including the induction of anesthesia. The results were analyzed using repeated measures of anova. There was a statistically significant reduction in anxiety and desire for information in the intervention group compared with the control group (P anxiety in the intervention group indicates that preoperative information videos are an effective method of reducing anxiety in parents. Furthermore, the reduction in need for information score in the intervention group indicates that preoperative videos may be a useful tool for providing parents with information.

  7. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

    OpenAIRE

    Walid Hamed Nofal; Mohamed Sidky Mahmoud; Azza Atef Abd Al Alim

    2014-01-01

    Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placeb...

  8. Optimizing preoperative blood ordering with data acquired from an anesthesia information management system.

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    Frank, Steven M; Rothschild, James A; Masear, Courtney G; Rivers, Richard J; Merritt, William T; Savage, Will J; Ness, Paul M

    2013-06-01

    The maximum surgical blood order schedule (MSBOS) is used to determine preoperative blood orders for specific surgical procedures. Because the list was developed in the late 1970s, many new surgical procedures have been introduced and others improved upon, making the original MSBOS obsolete. The authors describe methods to create an updated, institution-specific MSBOS to guide preoperative blood ordering. Blood utilization data for 53,526 patients undergoing 1,632 different surgical procedures were gathered from an anesthesia information management system. A novel algorithm based on previously defined criteria was used to create an MSBOS for each surgical specialty. The economic implications were calculated based on the number of blood orders placed, but not indicated, according to the MSBOS. Among 27,825 surgical cases that did not require preoperative blood orders as determined by the MSBOS, 9,099 (32.7%) had a type and screen, and 2,643 (9.5%) had a crossmatch ordered. Of 4,644 cases determined to require only a type and screen, 1,509 (32.5%) had a type and crossmatch ordered. By using the MSBOS to eliminate unnecessary blood orders, the authors calculated a potential reduction in hospital charges and actual costs of $211,448 and $43,135 per year, respectively, or $8.89 and $1.81 per surgical patient, respectively. An institution-specific MSBOS can be created, using blood utilization data extracted from an anesthesia information management system along with our proposed algorithm. Using these methods to optimize the process of preoperative blood ordering can potentially improve operating room efficiency, increase patient safety, and decrease costs.

  9. Preoperative Anxiety before Spinal Anesthesia: Does Internet-based Visual Information/Multimedia Research Decrease Anxiety and Information Desire? A Prospective Multicentered Study

    OpenAIRE

    Tulgar, Serkan; Boga, Ibrahim; Piroglu, Mustafa Devrim; Ates, Nagihan Gozde; Bombaci, Elif; Can, Tuba; Selvi, Onur; Tas, Zafer; Kose, Halil Cihan

    2017-01-01

    Background: Preoperative anxiety may lead to peroperative or postoperative problems when not overcome. Aims: The aim of this study was to examine the effect of seeking information and other factors on the anxiety of patients preoperatively. Settings and Design: This study was a prospective, multicentered survey. Materials and Methods: Patients scheduled to undergo surgical procedures under spinal anesthesia, preoperatively evaluated as the American Society of Anesthesia 1?3 and where spinal a...

  10. Implications of National Anesthesia Workload on the Staffing of a Call Center: The Malignant Hyperthermia Consultant Hotline.

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    Dexter, Franklin; Rosenberg, Henry; Epstein, Richard H; Semo, Judith Jurin; Litman, Ronald S

    2015-08-01

    Recently, we analyzed data from the American Society of Anesthesiologist's (ASA) Anesthesia Quality Institute (AQI) to report the United States (U.S.) anesthesia workload by time of day and day of the week. The AQI data were reported using the Central Time zone. Times for the N = 613 calls to the Malignant Hyperthermia Association of the United States (MHAUS) Malignant Hyperthermia (MH) Hotline from August 1, 2012, through March 7, 2014, were adjusted similarly. The MH Hotline effectively provides at all times to each anesthesia group an additional board-certified anesthesiologist who has expertise in managing, diagnosing, and/or preventing MH crises. We compared the timing of calls with the MH Hotline consultants relative to times of most anesthesia workload nationally. The interval 6:30 AM to 6:30 PM Central Time on regular workdays accounted for most (P Hotline (62.5% ± 2.0% [mean ± standard error]). However, the interval accounted for significantly less than the 82.2% of anesthesia minutes and 84.5% of general anesthesia minutes during that interval nationally (both P Hotline occurred when anesthesia groups nationwide were the busiest. Weekends accounted for 15.3% ± 1.5% of MH Hotline calls, significantly greater than the rates of 5.2% of anesthesia minutes and 4.3% of general anesthesia minutes during weekends nationally (both P Hotline was used proportionately more often when anesthesia providers have fewer colleagues present and available for consultation (all P < 0.0001). These findings may be expected of other (future) national support centers for anesthesia.

  11. Parental anxiety and stress before pediatric anesthesia: a pilot study on the effectiveness of preoperative clown intervention.

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    Agostini, Francesca; Monti, Fiorella; Neri, Erica; Dellabartola, Sara; de Pascalis, Leonardo; Bozicevic, Laura

    2014-05-01

    As induction of pediatric anesthesia can elicit anxiety in children and parents alike, this study was aimed at evaluating the effectiveness of clown intervention in decreasing maternal anxiety and stress in the preoperative phase. Before anesthesia induction, 25 children were randomly assigned to clown intervention and 25 to a control group with a routine procedure. In the waiting room and after separation from the child, maternal anxiety and stress were measured. The results showed that after separation, only in the clown group, maternal state anxiety significantly decreased and the tendency to somatization did not increase. Moreover, after clown intervention, older children's mothers significantly reduced the level of perceived stress. As clown intervention can positively influence maternal anxiety and stress in the preoperative period, its promotion in clinical-hospital environments is recommended.

  12. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

    Directory of Open Access Journals (Sweden)

    Walid Hamed Nofal

    2014-01-01

    Full Text Available Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH, also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Results: Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05. Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05. The incidence of sedation was more in gabapentin group 11 (26.19% versus placebo group 3 (6.81%. Neonatal outcomes were statistically insignificant between both groups. Conclusion: Pre-operative administration of gabapentin has no effect on incidence of (PDPH but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby.

  13. Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair.

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    Bergmann, Hannes M; Nolte, Ingo; Kramer, Sabine

    2007-10-01

    To compare analgesic efficacy of preoperative versus postoperative administration of carprofen and to determine, if preincisional mepivacaine epidural anesthesia improves postoperative analgesia in dogs treated with carprofen. Blind, randomized clinical study. Dogs with femoral (n=18) or pelvic (27) fractures. Dogs were grouped by restricted randomization into 4 groups: group 1 = carprofen (4 mg/kg subcutaneously) immediately before induction of anesthesia, no epidural anesthesia; group 2 = carprofen immediately after extubation, no epidural anesthesia; group 3 = carprofen immediately before induction, mepivacaine epidural block 15 minutes before surgical incision; and group 4 = mepivacaine epidural block 15 minutes before surgical incision, carprofen after extubation. All dogs were administered carprofen (4 mg/kg, subcutaneously, once daily) for 4 days after surgery. Physiologic variables, nociceptive threshold, lameness score, pain, and sedation (numerical rating scale [NRS], visual analog scale [VAS]), plasma glucose and cortisol concentration, renal function, and hemostatic variables were measured preoperatively and at various times after surgery. Dogs with VAS pain scores >30 were administered rescue analgesia. Group 3 and 4 dogs had significantly lower pain scores and amount of rescue analgesia compared with groups 1 and 2. VAS and NRS pain scores were not significantly different among groups 1 and 2 or among groups 3 and 4. There was no treatment effect on renal function and hemostatic variables. Preoperative carprofen combined with mepivacaine epidural anesthesia had superior postoperative analgesia compared with preoperative carprofen alone. When preoperative epidural anesthesia was performed, preoperative administration of carprofen did not improve postoperative analgesia compared with postoperative administration of carprofen. Preoperative administration of systemic opioid agonists in combination with regional anesthesia and postoperative administration

  14. Prolonged analgesia following preoperative bupivacaine neural blockade for oral surgery performed under general anesthesia.

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    Chapman, P J; Ganendran, A

    1987-03-01

    The effectiveness of prolonged neural blockade following removal of impacted third molars under general anesthesia was evaluated in a controlled clinical study. There was a significant reduction in the amount of postoperative pain experienced, and no complications, either local or systemic, occurred. The technique has advantages, especially when general anesthesia is administered to outpatients.

  15. Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.

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    Fu, Teresa; Corrigan, Nicole J; Quinn, Charles T; Rogers, Zora R; Buchanan, George R

    2005-07-01

    Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated. We hypothesized that children with sickle cell anemia (Hb SS) who have minor elective surgical procedures develop few complications even without pre-operative transfusion. We accessed our Comprehensive Sickle Cell Program's Database to identify all such procedures performed during a 13-year period. Medical records were reviewed to characterize the surgical procedure, the use of transfusions, and perioperative complications. Twenty-eight children with Hb SS had a total of 38 minor surgical procedures. No perioperative transfusions were given in 34 of the cases (85%). Five of these 34 surgeries (15%) were associated with minor post-operative complications (fever or transient pain). No post-operative acute chest syndrome was encountered. Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed.

  16. Preoperative Anxiety before Spinal Anesthesia: Does Internet-based Visual Information/Multimedia Research Decrease Anxiety and Information Desire? A Prospective Multicentered Study.

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    Tulgar, Serkan; Boga, Ibrahim; Piroglu, Mustafa Devrim; Ates, Nagihan Gozde; Bombaci, Elif; Can, Tuba; Selvi, Onur; Tas, Zafer; Kose, Halil Cihan

    2017-01-01

    Preoperative anxiety may lead to peroperative or postoperative problems when not overcome. The aim of this study was to examine the effect of seeking information and other factors on the anxiety of patients preoperatively. This study was a prospective, multicentered survey. Patients scheduled to undergo surgical procedures under spinal anesthesia, preoperatively evaluated as the American Society of Anesthesia 1-3 and where spinal anesthesia was agreed on beforehand, were included. Patients completed State-Trait Anxiety Inventory Scale-State (STAI-S) survey preoperatively. Patients who sought information were also asked to complete the Amsterdam Preoperative Anxiety and Information Scale survey. Quantitative data were compared with one-way ANOVA with post hoc analysis or Kruskal-Wallis test. Comparison of two groups of parameters showing normal distribution was compared using Student's t-test. Comparison of groups versus anxiety was performed using Chi-square and Fisher's exact tests. A total of 330 patients were included. Average STAI-S scores were similar when evaluated for patients' demographic data, gender, marital status, place of residence, type of operation, preoperative fasting time, and comorbidities. University graduates were found to have lower anxiety when compared to other educational statuses. Seeking information from the internet caused a significant decrease in surgical anxiety (P anxiety. Interestingly, those seeking information had higher information desire levels compared to patients who had not sought other sources of information (P information regarding surgical procedure and/or spinal anesthesia have lower preoperative anxiety levels, their information desire remains high. Apart from detailed information given by the anesthesiologist or surgeon, having access to correct and validated information in multimedia form may decrease anxiety and information desire.

  17. Prevention of hypotension after induction of anesthesia after preoperative tune-up - A preliminary report of the Groningen tune-up study

    NARCIS (Netherlands)

    Girbes, ARJ; Ligtenberg, JJM; Sonneveld, JPC; Wierda, JMKH

    1999-01-01

    Objective: To investigate whether the frequently occurring hypotension after induction of anesthesia can be prevented by preoperative treatment at the ICU guided by hemodynamic data obtained from a pulmonary artery (PA) catheter. Design: Prospective controlled open randomized single center study Set

  18. An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia

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    P. Shetty, Krishna; V. Satish, Sarvepalli; Kilaru, Krishnarao; Chakravarthi Ponangi, Kalyana; M. Luke, Alexander; Neshangi, Srisha

    2016-01-01

    Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation. Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah’s Dental Anxiety Scale (DAS). After checking the vital signs the initial pulpal oxygen saturation (initial SpO2) was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2) was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2) was measured. Results. The mean initial (SpO2) was 96.37% which significantly decreased to 90.76% (SpO2) after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2) after administration of local anesthetic solution. Statistical significance was set at Pcavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury. PMID:27092212

  19. Comparative evaluation of oral gabapentin versus clonidine as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anesthesia

    OpenAIRE

    Saikat Majumdar; Anjan Das; Haripada Das; Sambhunath Bandyopadhyay; Bimal Kumar Hajra; Dipankar Mukherjee

    2015-01-01

    Background: Laryngoscopy and endotracheal intubation (L and I) is associated with rise in blood pressure (BP), heart rate (HR), leading to adverse cardiological outcome especially in susceptible individuals. To compare the BP, HR during L and I as well as to evaluate the preoperative sedation status between oral clonidine (Group C) and oral gabapentine (Group G) as premedication for the patients undergoing major surgery under general anesthesia (GA). Materials and Methods: From April 2008...

  20. Society of Anesthesia and Sleep Medicine Guideline on Preoperative Screening and Assessment of Patients With Obstructive Sleep Apnea.

    Science.gov (United States)

    Chung, Frances; Memtsoudis, Stavros; Krishna Ramachandran, Satya; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandes, Adrian; Kaw, Roop; Kezirian, Eric; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R; Auckley, Dennis

    2016-06-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

  1. Effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn in moderate preeclamptic undergoing elective cesarean section under spinal anesthesia

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    Nashwa S. Elzayyat

    2014-07-01

    Full Text Available This study was designed to investigate and compare the effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn in moderate preeclampsia undergoing elective cesarean section. A total of fifty parturients having moderate preeclampsia scheduled for elective cesarean section were included. They were randomly allocated into two equal groups 25 each, magnesium group (GMg received preoperative magnesium sulfate infusion and control group (GC then both received spinal anesthesia, serum troponin measured preoperative then at 6, 12 and 24 h postoperative. Mean arterial pressure and heart rate were also recorded. Baseline serum cardiac troponin was higher above normal and was comparable at the rest of times in both groups. Mean arterial pressure readings were significantly lower in GMg compared to GC at induction of spinal, skin incision and skin closure (P < 0.05 and were comparable at the rest of times. Serum cardiac troponin (cTn levels were comparable in parturients received magnesium sulfate infusion preoperatively with those did not receive magnesium sulfate.

  2. Hypnosis and dental anesthesia in children: a prospective controlled study.

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    Huet, Adeline; Lucas-Polomeni, Marie-Madeleine; Robert, Jean-Claude; Sixou, Jean-Louis; Wodey, Eric

    2011-01-01

    The authors of this prospective study initially hypothesized that hypnosis would lower the anxiety and pain associated with dental anesthesia. Thirty children aged 5 to 12 were randomly assigned to 2 groups receiving hypnosis (H) or not (NH) at the time of anesthesia. Anxiety was assessed at inclusion in the study, initial consultation, installation in the dentist's chair, and at the time of anesthesia using the modified Yale preoperative anxiety scale (mYPAS). Following anesthesia, a visual analogue scale (VAS) and a modified objective pain score (mOPS) were used to assess the pain experienced. The median mYPAS and mOPS scores were significantly lower in the H group than in the NH group. Significantly more children in the H group had no or mild pain. This study suggests that hypnosis may be effective in reducing anxiety and pain in children receiving dental anesthesia.

  3. Effects of preoperative psychological state on the results of general anesthesia%术前心理状态对全麻效果的影响

    Institute of Scientific and Technical Information of China (English)

    冯晋潞; 乔阳

    2007-01-01

    Objective To study the effects of preoperative psychological state on calm time、recovery time and the level of pain about female tumer patients with general anesthesia.Methods We selected 105 female tumer patients whose ages were from 39 years to 66 years.They were divided into two groups according to SAS grade.We observed the calm time,recovery time and the VAS about the two groups.Results The calm time and reeovery time in disquieting group was significant longer than that of the normal group.There was a significant difference between group A and group B(P<0.01).Otherwise the grade of VAS after operation was significant greater than that of the normal group.Conclusion The disquieting preoperative psychological state would effect the results of general anesthesia.The anesthetist should pay attention to the visiting patients before operation.%目的 研究术前心理状态对妇科肿瘤切除术患者全麻镇静时间、苏醒时间和术后疼痛的影响.方法 选择年龄在39~66岁,行择期妇科肿瘤切除术的患者105例,按照Zuang焦虑自评量表(SAS)对患者进行焦虑状态自评的分数,将105例患者分为对照组(A组)和焦虑组(B组)两组.观察上述两组全麻镇静时间、苏醒时间和术后视觉模拟(VAS)评分情况.结果 焦虑组全麻镇静时间、苏醒时间均明显长于对照组(P<0.01),焦虑组的术后VAS评分也明显大于正常组(P<0.01).结论 术前患者的焦虑心理状态对全麻效果有一定的影响,麻醉医师应重视术前访视患者.

  4. Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training:A randomized controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    Bingqiang Ma; Hongguang Bao

    2009-01-01

    Objective: To evaluate the effects of preoperative inspiratory muscle training (IMT) on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods: Thirty two high-risk paticnts undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical trial, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment (CT). The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results: Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis (P = 0.25). Median duration of postoperative hospitalization was 13 days (range, 10~17 days) in the IMT group versus 16 days (range, 11~23 days) in the CT group (Mann-Whitney U statistics, Z =-2.22, P = 0.03). Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion: Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

  5. Preoperative measurement of maternal abdominal circumference relates the initial sensory block level of spinal anesthesia for cesarean section: An observational study.

    Science.gov (United States)

    Kuok, Chi-Hang; Huang, Chung-Hsin; Tsai, Pei-Shan; Ko, Yuan-Pi; Lee, Wei-Shih; Hsu, Yung-Wei; Hung, Fang-Yu

    2016-12-01

    Lumbosacral cerebrospinal fluid volume is decreased as the enlarging uterus compresses the inferior vena cava during pregnancy. A subsequent greater cephalad spread of sensory blockade is observed. Gravid uterus plays a crucial role in affecting the spinal anesthesia level. We hypothesized that maternal abdominal circumference can reflect compressive effect of the uterus and investigated the relationship between abdominal circumference and the level of sensory blockade, and incidence of hypotension following spinal anesthesia with hyperbaric bupivacaine in term parturients. Forty-two term parturients scheduled for elective cesarean section were studied. Abdominal circumference was measured before spinal anesthesia; 0.5% hyperbaric bupivacaine (2 mL, 2.2 mL, or 2.4 mL) was injected in to the subarachnoid space at the L3-L4 intervertebral level according to the parturient's height. The level of sensory blockade was assessed using an ice cube 1 minute, 5 minutes, 10 minutes, and 15 minutes after the spinal injection. The level of sensory blockade at the 15(th) minute was defined as the level of maximum sensory blockade. Statistical correlation coefficients were evaluated with Spearman's rank correlation. The correlation coefficient between the abdominal circumference and spinal level measured by cold sensation loss at 5 minutes after spinal anesthesia was significantly positive (right side ρ=0.43, p=0.005; left side ρ=0.46, p=0.003). No significant correlation was found between abdominal circumference and the level of maximum sensory blockade, the incidence of hypotension, ephedrine dosage, nausea, and vomiting after spinal anesthesia. Parturients with greater abdominal circumference value have a higher level of sensory blockade at 5 minutes after spinal anesthesia. Abdominal circumference cannot predict the maximum sensory blockade level and the incidence of hypotension. Copyright © 2016. Published by Elsevier B.V.

  6. The sedative effects and the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation in pediatric patients: a randomized comparison between two different doses of preoperative intranasal dexmedetomidine.

    Science.gov (United States)

    Wang, Shan-Shan; Zhang, Ma-Zhong; Sun, Ying; Wu, Chi; Xu, Wen-Yin; Bai, Jie; Cai, Mei-Hua; Lin, Lin

    2014-03-01

    Premedication with intranasal dexmedetomidine (DEX) has shown to be an effective sedative in pediatric patients. This prospective, randomized, and controlled investigation was designed to evaluate whether the difference in intranasal DEX dosing would produce different beneficial effects on the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation. Forty children, aged from 3 to 6 years, of American Society of Anesthesiologists physical status I or II and scheduled for elective adenotonsillectomy randomly received intranasal DEX 1 μg·kg(-1) (group D1) or 2 μg·kg(-1) (group D2) 30 min before anesthesia induction. Anesthesia was induced with sevoflurane in oxygen flow. Mean arterial pressure (MAP) and heart rate (HR) as measurements of cardiovascular response and bispectral index (BIS) as an index of arousal response were recorded every 5 min after intranasal DEX administration and measured every 1 min for 5 min after intubation. Sedation status, behavior scores, and mask induction scores were also assessed. Mean arterial pressure did not show statistical differences during the anesthesia induction, but did demonstrate significantly milder responses to laryngoscopy and intubation in group D2 compared with group D1. Change in HR was consistent with MAP during laryngoscopy and intubation. Patients who received 2 μg·kg(-1) DEX presented with deeper sedation and less anxiety by the assessments of the alertness scale, behavior score, and BIS scores. Group D2 dosing achieved more favorable scores in children undergoing mask induction. Intranasal DEX 2 μg·kg(-1) administered 30 min before anesthesia induction provides considerable effect to attenuate the increase in MAP caused by intubation response. Changes in HR and BIS also demonstrate that this kind of premedication provides effective attenuation of intubation response. And preoperative intranasal DEX 2 μg·kg(-1) produces optimal-sedation, more favorable

  7. Pediatric outpatient anesthesia.

    Science.gov (United States)

    Hannallah, R S

    1987-02-01

    Successful anesthetic management of children undergoing outpatient surgery requires that the surgeon and anesthesiologist be actively involved in all aspects of management. Guidelines should be established in consultation with the surgeons, nurses, and administrators to ensure proper selection and preoperative preparation of patients. The psychological evaluation and preparation of children, and the use of pharmacologic premedication when indicated, will ensure a pleasant experience for all involved. The anesthesiologist should choose a specific anesthetic agent and a technique that are appropriate for each individual child. Use of "routine" induction techniques is rarely, if ever, appropriate. Early ambulation and discharge are very desirable in outpatients. Long-acting drugs and techniques that are associated with excessive drowsiness or nausea and vomiting should not be utilized. Special attention must be paid to the analgesic requirements of the child. Regional blocks should be used whenever possible to supplement "light" general anesthesia and to limit the need for narcotics during recovery. Specific criteria for discharge ensure the safety and protection of the child and staff.

  8. 术前咨询干预对美容受术者术后满意度的影响%Effecttion of postoperative satisfaction on the subject of preoperative consulting in patients receiving cosmetic surgery

    Institute of Scientific and Technical Information of China (English)

    何清莲; 刘鸿雁; 蒋欣

    2012-01-01

    Objective To investigate the effecttion of postoperative satisfaction on the subject of preoperative consulting in patients receiving cosmetic surgery. Methods Five hundred patients receiving cosmetic surgery before surgery in our department from January 2008 to May 2011,who were randomly divided into the experimental group and control group.stochastic investigate the effecttion of postoperative satisfaction at one time on the subject of two different preoperative consulting methods in patients receiving cosmetic surgery. Results No difference of preoperative expecttion between the five hundred patients receiving cosmetic surgery (P>0.05).Two months after surgery,Self -assessment of the satisfaction rate in the experimental group (246 cases,97.3%) was remarkably higher than that in the control group (224 cases,90.7%),the bad review rate in the experimental group (7 cases,2.8%) was lower than that in the control group (23 cases,9.3%) (P<0.06). Conclusion An objective and personal preoperative consulting in patients receiving cosmetic surgery before surgery can increase the satisfaction rate in them.and is a most important to the medical cosmetic surgery.%目的:探讨美容受术者术前咨询经历对其术后的满意度的影响.方法:将2008年1月~2011年5月在我科进行美容术前咨询并实施手术者500例,随机分为实验组和对照组,随访分析两种咨询方法在术后一定时间内对受术者效果自评的影响.结果:500例受术者术前期待组间差异无统计学意义(P>0.05),术后两个月自评,实验组满意246例(97.3%),差7例(2.8%),对照组满意224例(90.7%),差23例(9.3%),组间比较差异有统计学意义(P<0.05).结论:术前提供客观、个性化的咨询服务能够增加美容受术者对手术的满意率,是医学美容手术前值得重视的环节.

  9. Comparative evaluation of oral gabapentin versus clonidine as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anesthesia

    Directory of Open Access Journals (Sweden)

    Saikat Majumdar

    2015-01-01

    Results and Analysis: Preoperative sedation between two groups were similar but group C attenuated HR, systolic blood pressure (SBP, diastolic blood pressure (DBP, and mean blood pressure (MBP more significantly before induction, during L and I, 1, 3, and 5 min, following L and I, while comparing with group G. Again gabapentin-reduced HR, BP, (SBP, DBP, MBP significantly more at 7 and 10 min after L and I on comparison clonidine. Conclusion: Oral clonidine is equally effective in producing preoperative sedation in comparison to oral gabapentin, while on the contrary oral clonidine is more efficacious in reducing laryngoscopic stress response than oral gabapentin.

  10. Effects of preoperative anxiety on early postoperative pain and anesthesia recovery in total knee arthroplasty%全膝关节置换术前焦虑对术后疼痛及麻醉恢复的影响

    Institute of Scientific and Technical Information of China (English)

    李林涛; 符培亮; 袁帅; 周义钦; 吴宇黎; 吴海山

    2015-01-01

    目的:探讨初次全膝关节置换术( TKA)患者术前焦虑状态对术后镇痛效果及麻醉恢复情况的影响。方法纳入长征医院骨科2012年9月至2013年9月间84例行TKA手术的住院患者进行前瞻性队列研究,通过术前贝克焦虑量表( BAI )将患者分为高焦虑组( A组)和低焦虑组( B组)。对比两组的一般资料、手术时间、麻醉时间、拔管时间及麻醉后副反应,分别于术后1、2、4、8、12、24 h进行视觉模拟量表( VAS)评分并记录12、24 h的曲马多用量。结果共有38(45.24%)的患者术前处于高焦虑状态,两组间的一般资料、手术及麻醉时间没有统计学差异,但B组拔管时间、麻醉后副反应少于A组,术后2、4、8、12 h的VAS评分低于A组,术后曲马多用量少于A组,结果有统计学意义( P<0.05)。结论 TKA患者术后疼痛程度与术前焦虑情绪有关。高焦虑状态会影响麻醉恢复及镇痛效果,增加药物用量。%Objective To evaluate the impacts of preoperative anxiety on postoperative pain and recovery from anesthesia in the patients undergoing total knee arthroplasty (TKA).Methods A total of 84 patients with osteoarthritis who underwent unilateral TKA between September 2012 and September 2013 were separated into two groups according to Beck′s anxiety inventory ( BAI):the patients with anxiety were enrolled in the high-anxious patient group (group A) and the patients without anxiety were enrolled in the low-anxious group ( group B ) .During the perioperative period , all the patients received patient-controlled analgesia (PCA) for 24h postoperatively.General information, duration of surgery, duration of anesthesia, extubation time, adverse effects, drug dosage for 12 and 24h, and Visual analog score ( VAS) were assessed and compared between the two groups .Results Among all the patients, 38 patients (45.24%) had preoperative anxiety according to the

  11. Anesthesia information management systems

    Directory of Open Access Journals (Sweden)

    Feri Štivan

    2014-08-01

    Full Text Available Introduction: The use of anesthesia information management systems (AIMS is on the increase. This is particularly true for academic anesthesia departments. The main reasons for slow adoption of these systems in the past are financial barriers associated with implementation of these systems and their not so traditionally obvious potential to improve patient care. In addition, a major obstacle to acceptance of this technology is the concern of users over the impact of the electronic anesthesia record on malpractice exposure.Conclusions: The experience reported by departments using AIMS indicates that these systems are useful for managing malpractice risk. AIMS can enhance the efficiency and effectiveness of preoperative, intraoperative, and post-operative anesthesia care. However, AIMS are able to increase the quality of care and improve operating room efficiency only with careful planning, installation, and customization. Strengths, weaknesses, opportunities and threats (SWOT analysis performed for AIMS could help departments in making better decisions when implementing AIMS.

  12. Seniors and Anesthesia

    Science.gov (United States)

    ... Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia Awareness Obesity and Anesthesia Sleep Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Seniors and Anesthesia The older you are, the more ...

  13. Anesthesia and pulmonary hypertension.

    Science.gov (United States)

    McGlothlin, Dana; Ivascu, Natalia; Heerdt, Paul M

    2012-01-01

    Anesthesia and surgery are associated with significantly increased morbidity and mortality in patients with pulmonary hypertension due mainly to right ventricular failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Preoperative risk assessment and successful management of patients with pulmonary hypertension undergoing cardiac surgery involve an understanding of the pathophysiology of the disease, screening of patients at-risk for pulmonary arterial hypertension, analysis of preoperative and operative risk factors, thorough multidisciplinary planning, careful intraoperative management, and early recognition and treatment of postoperative complications. This article will cover each of these aspects with particular focus on the anesthetic approach for non-cardiothoracic surgeries.

  14. Anesthesia Awareness

    Science.gov (United States)

    ... biopsy or a dental procedure Local or regional anesthesia, such as an epidural or spinal block, or a nerve block To reduce your risk of experiencing awareness during procedures with general anesthesia, it is important to tell your physician anesthesiologist ...

  15. Preoperative anxiety in neurosurgical patients.

    Science.gov (United States)

    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo

    2009-04-01

    Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (PAmsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

  16. Psychological aspects of pediatric anesthesia.

    Science.gov (United States)

    Drasković, Biljana; Simin, Jovana M; Kvrgić, Ivana M

    2015-01-01

    Surgery and anesthesia cause a significant emotional stress in both parents and children. Since the consequences of this stress develop immediately after surgery and can last even when the hospital treatment is over, the role of the anesthesiologist is to ensure psychological as well as physiological well-being of the patient. In order to reduce emotional stress induced by anesthesia and operation, the anesthesiologist has to understand certain developmental phases that children go through and to identify situations which a child could potentially see as a danger or a threat. This can usually be achieved by careful preoperative assessment and by administering preoperative sedation. During the preoperative visit to the patient, the anesthesiologist can evaluate the levels of anxiety of both parents and children as well as assess the child's medical condition.

  17. Impact of pre-operational teeth-brushing on oropharyngeal bacteria colonization of patients undergoing general anesthesia%术前常规刷牙对全麻患者口咽部细菌定植的影响

    Institute of Scientific and Technical Information of China (English)

    卢玉林; 章学美; 李莉; 殷婕

    2016-01-01

    目的:通过在经口气管插管全身麻醉前行常规刷牙,探讨常规刷牙对口咽部细菌定植和口腔清洁的影响。方法150例患者随机分为3组,每组50例,A组为对照组,不进行任何干预,B组用生理盐水含漱, C组采用刷牙方法。刷牙及口咽含漱在气管插管前30 min进行。采集刷牙前后口咽部标本进行细菌培养和菌落计数,并观察患者口臭及清洁度的改变情况。结果常规刷牙在减轻和消除口臭,增加口腔清洁度上有统计学差异(P0.05)。结论生理盐水口咽含漱和常规刷牙仅能清洁口腔,不能杀灭口咽常见细菌,不利于减少经口气管插管患者因气管插管动作使口咽部细菌顺延导管下移至下呼吸道的数量。建议使用口腔含漱液配合刷牙对患者进行口腔护理,减少细菌定植数量。%Objective To study the impact of pre-operational teeth-brushing on oropharyngeal bacteria coloni-zation and oropharyngeal cleaness of patients undergoing general anesthesia. Methods A total of 150 patients were ran-domly divided into three groups (n=50) . Group A was the control group without any intervention. Patients of Group B gargled with physiological saline. While Group C adopted teeth-brushing method. Teeth-brushing and gargling with phys-iological saline were both carried out 30 minutes before the orotracheal intubation. Oropharyngeal specimens before and after the interventions were collected to carry out the bacterial culture, and the changes of patients' halitosis and cleanli-ness were observed. Results There were statistical significance for conventional teeth-brushing to reduce or eliminate halitosis, and increase oral cleanness (P0. 05 ) . Conclusions Gargling with physiological saline and brushing the teeth can only clean mouth, but can't sterilize the common oropharyngeal bacteria and was not helpful for reducing the oropharyngeal bacteria shifting to the lower respiratory tract along the tube during the

  18. Anesthesia Basics

    Science.gov (United States)

    ... the Risks? en español Conceptos básicos sobre la anestesia What Is Anesthesia? No doubt about it, getting ... down into three main categories: general, regional, and local. All of these can be given through various ...

  19. General Anesthesia

    Science.gov (United States)

    ... unconscious and unable to feel pain during medical procedures. General anesthesia usually uses a combination of intravenous drugs ... 1998-2017 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

  20. Preoperative and intraoperative continuous use of ...

    African Journals Online (AJOL)

    2016-09-13

    Sep 13, 2016 ... in clinics to improve patient safety and effectiveness with. Introduction ... and control group according to different use of drugs. The two ... Key words: Anesthesia, dexmedetomidine, effect, intervention, preoperative, recovery, remifentanil .... will lead to postoperative pain in patients and severe agitation after ...

  1. Situational Consultation

    Science.gov (United States)

    Rimehaug, Tormod; Helmersberg, Ingunn

    2010-01-01

    Situational Consultation (SC) is presented as a framework for flexible integration of several models and methodologies in consultation practice by choosing an approach adapted to the specific situation. In SC, models and their characteristic role positions are considered interchangeable tools with qualitative differences in strengths and…

  2. Administration of Anesthesia

    Science.gov (United States)

    ... a Surgeon What We Do Administration of Anesthesia Administration of Anesthesia Oral and maxillofacial surgeons are extensively ... Injury Wisdom Teeth Management Procedures Administration of Anesthesia Administration of Anesthesia Oral and maxillofacial surgeons are extensively ...

  3. Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients

    OpenAIRE

    Lee, Jong-Hyuk; Jung, Han-Kil; Lee, Gang-geun; Kim, Han-Young; Park, Sun-Gyoo; Woo, Seong-Chang

    2013-01-01

    Background Children and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used. Methods A total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia...

  4. Propofol anesthesia.

    Science.gov (United States)

    Short, C E; Bufalari, A

    1999-05-01

    Although questions may still remain regarding the use of this unique sedative-hypnotic drug with anesthetic properties in high-risk patients, our studies have provided cardiopulmonary and neurological evidence of the efficacy and safety of propofol when used as an anesthetic under normal and selected impaired conditions in the dog. 1. Propofol can be safely and effectively used for the induction and maintenance of anesthesia in normal healthy dogs. Propofol is also a reliable and safe anesthetic agent when used during induced cardiovascular and pulmonary-impaired conditions without surgery. The propofol requirements to induce the safe and prompt induction of anesthesia prior to inhalant anesthesia with and without surgery have been determined. 2. The favorable recovery profile associated with propofol offers advantages over traditional anesthetics in clinical situations in which rapid recovery is important. Also, propofol compatibility with a large variety of preanesthetics may increase its use as a safe and reliable i.v. anesthetic for the induction and maintenance of general anesthesia and sedation in small animal veterinary practice. Although propofol has proven to be a valuable adjuvant during short ambulatory procedures, its use for the maintenance of general anesthesia has been questioned for surgery lasting more than 1 hour because of increased cost and marginal differences in recovery times compared with those of standard inhalant or balanced anesthetic techniques. When propofol is used for the maintenance of anesthesia in combination with a sedative/analgesic, the quality of anesthesia is improved as well as the ease with which the practitioner can titrate propofol; therefore, practitioners are able to use i.v. anesthetic techniques more effectively in their clinical practices. 3. Propofol can induce significant depression of respiratory function, characterized by a reduction in the rate of respiration. Potent alpha 2 sedative/analgesics (e.g., xylazine

  5. [Preoperative fasting guidelines: an update].

    Science.gov (United States)

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2010-01-01

    and keywords (surgery) or (operation) or (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search April 2010. Selection criteria Randomized controlled trials that recruited people who smoked prior to surgery, offered......Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text...

  7. Anesthesia for outpatient female sterilization.

    Science.gov (United States)

    Fishburne, J I

    1983-04-01

    laparoscopy or minilaparotomy, local anesthesia with proper preoperative counselling and premedication should provide adequate relief of pain and is the method of choice, unless the patient cannot be examined awake or is totally uncooperative. The decision to utilize either general or local anesthesia should be made by the patient after thorough counselling by the surgical team. In many cases, the circumstances of the surgical environment will dictate the choice, but patient comfort and safety should always be the goal.

  8. [Bioclimatic consultation].

    Science.gov (United States)

    Cordes, H; Reinke, R

    1975-01-23

    The climatological environment may effect the human state of health, disadvantageously or favourably. This knowledge, confirmed by empiric as well as scientific research can be used by e.g. changing the place of residence towards a healthy and benefical climate. For a professional climatological planning of such a project the "Deutscher Wetterdienst" renders bioclimatic consultations within the Federal Republic of Germany. For this purpose individual reactions as well as state health of the person in question have to be considered. A method will be shown how to combine medical diagnostic facts and bioclimatic consultation.

  9. Spinal and epidural anesthesia

    Science.gov (United States)

    ... you epidural or spinal anesthesia is called an anesthesiologist. First, the area of your back where the ... Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: ...

  10. Anesthesia & Down Syndrome

    Science.gov (United States)

    ... Health Care » Associated Conditions » Anesthesia & Down Syndrome Anesthesia & Down Syndrome Complications of anesthesia (sedation during surgery) occur in ... histories are complicated. Why Would an Individual With Down Syndrome Need A nesthesia? 40-60% of infants born ...

  11. Obesity and Anesthesia

    Science.gov (United States)

    ... Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Obesity and Anesthesia More than one-third of Americans ... Sleep Apnea, a chronic medical problem common with obesity, can present with serious breathing problems before, during, ...

  12. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: info@sambahq.org Copyright | 2016 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  13. The value of peri-operative consultation on a general surgical ward by the internist

    NARCIS (Netherlands)

    Mollema, R; Berger, P.; Girbes, ARJ

    2000-01-01

    Background: Medical peri-operative consultation plays an important role in the practice of the internist. It represents 13-33% of the total consultation done by the internist. The value of preoperative consultation by the internist is still unclear and the place of the consultations is under discuss

  14. Assessment of patient satisfaction with the preoperative anesthetic evaluation

    Directory of Open Access Journals (Sweden)

    Gebremedhn EG

    2014-09-01

    Full Text Available Endale Gebreegziabher Gebremedhn, Vidhya Nagaratnam Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The evaluation of patient satisfaction is a core aspect of the continuous quality improvement in anesthesia service that can be affected by the preoperative anesthetist visit. This visit enables the anesthetist to know about the patient's general health status and the nature of surgery, to choose the type of anesthesia, and to discuss perioperative complications and their management with the patient. Patients have sometimes complained about the information given during the preoperative anesthetic evaluation in the University of Gondar teaching and referral hospital. The aim of this study was to determine the level of patient satisfaction with the preoperative anesthetist visit. Methods: A cross-sectional study was conducted from February 15 to April 15, 2013. All consecutive elective patients who were operated upon under anesthesia during the study period were interviewed 24 hours after operation. A pretested questionnaire and checklists, which were developed based on the hospital's anesthetic evaluation sheet, were used for data collection. Results: A total of 116 elective patients were operated upon under anesthesia during the study period. Of these, 102 patients were included in our study, with a response rate of 87.9%. Anesthetists introduced themselves to ~24% patients; provided information about anesthesia to ~32%, postoperative complications to ~21%, postoperative analgesia to ~18, and postoperative nausea and vomiting to ~21%; and spent adequate time with ~74%. Patients' questions were answered by the anesthetist in ~65% of cases, and ~65% of patients had reduced anxiety after the anesthetist visit. The patients' overall satisfaction with the preoperative anesthetist visit was ~65%. Conclusion and recommendation: Patient satisfaction with the

  15. Placement of a gastric tube at varied preoperative moments in patients scheduled for gastrointestinal operation under general anesthesia:the effect of timing on cortisol level%术前置胃管时间对全麻胃肠道手术患者皮质醇的影响

    Institute of Scientific and Technical Information of China (English)

    袁玉萍; 尹罗庚; 贡国娟; 吴红梅

    2012-01-01

    Objective To observe the effect of preoperative placing timing of gastric tube on cortisol level of patients scheduled for gastrointestinal operation under general anesthesia. Methods Forty patients scheduled for gastrointestinal operation under general anesthesia were commensurately randomized into two groups. The gastric tube was placed in the morning on the day when patients were to receive the gastrointestinal surgery in the control group, while it was placed after induction of general anaesthesia in the observation group. Mean arterial pressure, heart rates and serum cortisol level were recorded on the operation morning, before induction of general anesthesia, 2 and 5 minutes after endotracheal intubation. Results There was significant group effect between the two groups in mean arterial pressure, heart rates and serum cortisol level at varied time points (P<0. 05 for all). Conclusion Placement of a gastric tube after induction of general anaesthesia alleviates discomfort of patients, avoids abrupt icrease in blood pressure, heart rates and serum cortisol level, and lessens stress-induced reaction.%目的 观察术前置胃管时间对全麻胃肠道手术患者皮质醇的影响.方法 将40例胃肠道手术需要置胃管的患者随机分为两组,各20例.对照组于术晨病房常规置胃管,观察组于全麻诱导后置胃管.每组分别监测术晨,麻醉诱导前,气管插管后2 min及5 min时平均动脉压、心率及血清皮质醇.结果 两组不同时段各观察指标比较,干预主效应均P<0.05.结论 将手术患者置胃管时间放在麻醉诱导后进行能减少患者的不适感,避免血压、心率及皮质醇急剧升高,减轻应激反应.

  16. Anxiety in preoperative anesthetic procedures.

    Science.gov (United States)

    Valenzuela Millán, Jaquelyn; Barrera Serrano, José René; Ornelas Aguirre, José Manuel

    2010-01-01

    Preoperative anxiety is a common and poorly evaluated condition in patients who will undergo an anesthetic and surgical intervention. The objective of this study was to determine the prevalence of anxiety in a group of patients undergoing elective surgery, as assessed by the Amsterdam Anxiety Preoperative and Information (AAPI) scale. We studied 135 patients scheduled for elective surgery applying the AAPI scale 24 h before the surgical procedure to evaluate the presence of anxiety and patient characteristics. A descriptive analysis with mean +/- standard deviation for categorical variables was done. For intragroup differences, chi(2) test was used. Pearson correlation for the association between anxiety and postoperative complications was carried out. A value of p =0.05 was considered significant. One hundred six patients were surgically treated, 88% were female (average age 44 +/- 12 years). Some degree of preoperative anxiety was present in 72 patients (76%; p = 0.001) with a grade point average on the AAPI scale equal to 17 +/- 7 points, of which 95 (70%, OR = 5.08; p = 0.002) were females. Results of this study suggest the presence of high levels of preoperative anxiety in patients scheduled for elective surgery. The origin of the anxiety appears to be related to many factors that can be evaluated in pre-anesthetic consultation. Further study is needed to prevent the presence of this disorder.

  17. Does Obstructive Sleep Apnea Influence Perioperative Outcome? A Qualitative Systematic Review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing.

    Science.gov (United States)

    Opperer, Mathias; Cozowicz, Crispiana; Bugada, Dario; Mokhlesi, Babak; Kaw, Roop; Auckley, Dennis; Chung, Frances; Memtsoudis, Stavros G

    2016-05-01

    Obstructive sleep apnea (OSA) is a commonly encountered problem in the perioperative setting even though many patients remain undiagnosed at the time of surgery. The objective of this systematic review was to evaluate whether the diagnosis of OSA has an impact on postoperative outcomes. We performed a systematic review of studies published in PubMed-MEDLINE, MEDLINE In-Process, and other nonindexed citations, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment up to November 2014. Studies of adult patients with a diagnosis of OSA or high risk thereof, published in the English language, undergoing surgery or procedures under anesthesia care, and reporting ≥1 postoperative outcome were included. Overall, the included studies reported on 413,304 OSA and 8,556,279 control patients. The majority reported worse outcomes for a number of events, including pulmonary and combined complications, among patients with OSA versus the reference group. The association between OSA and in-hospital mortality varied among studies; 9 studies showed no impact of OSA on mortality, 3 studies suggested a decrease in mortality, and 1 study reported increased mortality. In summary, the majority of studies suggest that the presence of OSA is associated with an increased risk of postoperative complications.

  18. [Anesthesia management of geriatric patients with arterial pressure-based cardiac output monitoring FloTrac sensor for emergency surgery].

    Science.gov (United States)

    Yamamoto, Shunsuke; Goto, Koji; Yasuda, Norihisa; Kusaka, Junya; Hidaka, Seigo; Miyakawa, Hiroshi; Noguchi, Takayuki

    2009-06-01

    In cases of emergency surgery for geriatric patients, immediate anesthesia induction and careful intraoperative management is necessary without sufficient preoperative information. We report anesthesia management of a 96-year and a 90-year old patients with FloTrac sensor which is an arterial pressure-based cardiac output monitoring device and is able to manage critical patients effectively and safely during anesthesia.

  19. 术前股神经阻滞对全麻下全膝关节置换术老年患者的超前镇痛效果分析%Analysis of effect of preoperative femoral nerve block for preemptive anal-gesia in elderly patients undergoing total knee arthroplasty under general anesthesia

    Institute of Scientific and Technical Information of China (English)

    王海兰

    2016-01-01

    目的:探讨全麻下全膝关节置换术前股神经阻滞对老年患者超前镇痛的效果。方法:86例接受全麻下全膝关节置换术治疗的老年患者随机分为观察组(n =43)与对照组(n =43),观察组给予术前股神经阻滞+全身麻醉,对照组给予单纯全身麻醉,对比两组患者术后疼痛视觉模拟评分(visual Analogue Scale,VAS)、镇痛药物使用情况及不良反应。结果:术后24 h 观察组 VAS 评分显著低于对照组(P <0.01);观察组术后首次使用镇痛药物时间显著长于对照组(P <0.01),术后48 h内镇痛药物使用次数显著少于对照组(P <0.01),术后48 h 镇痛药物使用率显著低于对照组(P <0.05);观察组不良反应发生率为显著低于对照组的48.8%(P <0.01)。结论:术前股神经阻滞用于全麻下老年全膝关节置换术的超前镇痛,能够更加有效的缓解患者围手术期疼痛程度,减少镇痛药物使用量,降低不良反应发生率,值得推广。%Objective:To discuss the Analysis of effect of preoperative femoral nerve block for preemptive analgesia in elderly patients undergoing total knee arthroplasty under general anesthesia.Methods:86 elderly patients undergoing total knee arthroplasty un-der general anesthesia were randomly divided into observation group (n =43 )and control group(n =43 ),the observation group re-ceived preoperative femoral nerve block and general anesthesia,general anesthesia was used in the control group,postoperative pain vis-ual analogue scale(visual analogue scale,VAS),usage of analgesic drug and adverse reactions were compared in the two groups.Re-sults:24 h after operation,visual Analogue Scale(VAS)score in the observation group was significantly lower than that in the control group(P <0.01 ).After operation,the time of the usage of analgesic drugs in the observation group for the first time was longer than that in the

  20. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes

    Directory of Open Access Journals (Sweden)

    Kim S

    2014-12-01

    Full Text Available Sunghye Kim,1 Amber K Brooks,2 Leanne Groban21Department of Hospital Medicine, 2Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors – including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility – which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented. Keywords: frailty, mobility

  1. Topical anesthesia

    Directory of Open Access Journals (Sweden)

    Mritunjay Kumar

    2015-01-01

    Full Text Available Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

  2. Anesthesia for fetoscopic intervention

    Directory of Open Access Journals (Sweden)

    Jamil S Anwari

    2014-01-01

    Full Text Available This is the first case report on anesthesia for fetoscopy performed in Saudi Arabia. Epidural anesthesia was given to the mother in her late second trimester for the fetoscopic intervention. The anesthesia related issues such as physiological and anatomical changes in pregnancy, tocolytic medications and their interactions with anesthesia, anesthetizing/sedating the primary patient are discussed.

  3. Individual Consultations

    Directory of Open Access Journals (Sweden)

    Ian Walkinshaw

    2015-09-01

    Full Text Available Responding to calls for research into measurable English language outcomes from individual language support consultations at universities, this study investigated the effect of individual consultations (ICs on the academic writing skills and lexico-grammatical competence of students who speak English as an additional language (EAL. Attendance by 31 EAL students at ICs was recorded, and samples of their academic writing texts before and after a 9-month interval were compared. Participants’ academic writing skills were rated, and lexico-grammatical irregularities were quantified. No statistically significant positive shifts manifested, due to the relatively short research period and limited participant uptake, but there were encouraging predictors of future shifts given continued utilization of the service. First, although a Wilcoxon signed-rank test showed no association between attendance at ICs and shifts in academic writing ability, a Spearman’s rho calculation suggested a tentative relationship to positive pre–post shifts in three academic writing sub-skills: Task Fulfillment, Grammar, and Vocabulary. Second, instances of four common lexico-grammatical irregularities (subject/verb, wrong word, plural/singular, and punctuation declined at post-testing. Although only regular, sustained attendance would produce statistically significant shifts, there is a potential association between participants’ use of ICs and improved academic writing skills/lexico-grammatical competence.

  4. Anesthesia methods used by anesthetic specialists for circumcision cases

    Science.gov (United States)

    Altaş, Cafer; Küçükosman, Gamze; Yurtlu, Bülent S.; Okyay, Rahşan D.; Aydın, Bengü G.; Pişkin, Özcan; Çimencan, Murat; Ayoğlu, Hilal; Hancı, Volkan; Özkoçak-Turan, Işıl

    2017-01-01

    Objectives: To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision. PMID:28042634

  5. [Preoperative information for paediatric patients. The anaesthesiologist's point of view].

    Science.gov (United States)

    Orliaguet, G

    2006-04-01

    Medical information is mandatory before any medical procedure, including pediatric anesthesia. Preoperative information covers many aspects, including medico-psychologic and judicial aspects. When the patient is a child, information must be delivered to the parents in priority. However, the French law has given a particular attention to the opinion of the child. In 70% of the cases, preoperative anxiety of the parents is more related to anesthesia than to the surgical procedure itself. We have to explain the most frequent adverse effects, as well as the more severe and well known complications to the parents, even though they are very infrequent. The only cases where preoperative information is not required are: emergency cases and refusal of the patient or the parents to be informed. While information is necessarily oral, it may be completed using a written document. The quality of the preoperative information directly influences the quality of the psychological preoperative preparation of the parents, and thereafter of the child. Preoperative preparation programs have been developed, but controversial results have been observed. The great majority of the studies on preoperative programs were performed in the USA, where the demand for preoperative information is very important. It is far from sure that the results of all these studies may be extrapolated to French parents, and French studies are needed.

  6. 右美托咪定滴鼻对小儿七氟烷麻醉术前焦虑和术后躁动的影响%Effects of intranasal dexmedetomidine as premedication on preoperative anxiety and emergence delirium after sevoflurane anesthesia in children

    Institute of Scientific and Technical Information of China (English)

    高燕春; 谢言虎; 柴小青; 侯冠峰; 方才

    2012-01-01

    目的 观察右美托咪定(DM)滴鼻对小儿术前焦虑和术后躁动的影响.方法 将60例1-4岁疝气手术小儿随机均分为三组.七氟烷麻醉诱导前30 min,Ⅱ、Ⅲ组分别予以DM 0.5μg/kg和1μg/g滴鼻,Ⅰ组滴生理盐水0.4ml对照.连续监测BP、HR、SpO2、PET CO2.观察患儿入室的镇静情绪评分、诱导时间、麻醉时间、苏醒时间、不良反应及术后患儿的躁动评分.结果 Ⅲ组患儿术前镇静满意率明显高于Ⅰ组和Ⅱ组(45% vs.10%和15%)(P<0.05).与Ⅰ组、Ⅱ组比较,Ⅲ组躁动评分和诱导时间明显降低(P<0.01).三组间苏醒时间差异无统计学意义(P>0.05).结论 诱导前应用DM 1 μg/kg滴鼻可有效改善小儿术前焦虑情绪,缩短七氟烷麻醉诱导时间,降低苏醒期躁动的发生率,且不延长苏醒时间.%Objective To observe the effects of intranasal dexmedetomidine ( DM ) as premedication on preoperative anxiety and emergence delirium after sevoflurane anesthesia in children. Methods Sixty of 1-4 year-old children undergoing hernia surgery under sevoflurane anesthesia were equally randomized into tree groups of A(intranasal DM 0. 5 fig/kg) .B( intranasal DM 1 μg/kg) and C (intranasal normal saline 0. 4 ml). Sevoflurane anesthesia was induced at 30 minutes after intranasal administration. BP, HR and Sp()z were monitored during the operation. The sadation scores, the times for induction,anesthesia and awaken, adverse reactions, agitation scores were recorded. Results The satisfaction rate for preanesthesia sedation was significantly higher in group B than that in groups of A and C(45% vs. \\0% and 15%)(P0. 05). Conclusion Intranasal DM 1 fig/kg as premedication is effective for reducing anxiety and the incidence of emergence delirium without delaying the awakening time.

  7. [New developments in anesthesia-reanimation for ambulatory procedures].

    Science.gov (United States)

    Hick, G; Kirsch, M; Janssens, M; Larbuisson, R; Joris, J; Lamy, M

    2007-01-01

    The one day clinic possesses its own structure and organisation; patient management is also specific. Preoperative visit and assessment are programmed at least 48 hours before anesthesia. Preoperative examinations and choice of anesthetic technique (sedation associated with local anesthesia or not, general anesthesia, locoregional anesthesia, or hypnosedation) are discussed and determined depending upon medical history, clinical examination, and type of procedure. General recommandations, instructions about fasting, interruption of some therapies, and introduction of new medication(s) are explained orally and also provided in a written document. New anesthetics and analgesics allow quick awakening and recovery of vital functions, and subsequently rapid hospital discharge. Prevention and aggressive treatment of postoperative nausea and vomiting are also a major concern in our anesthesic management of ambulatory patient.

  8. Preoperative prediction of severe postoperative pain.

    Science.gov (United States)

    Kalkman, C J; Visser, K; Moen, J; Bonsel, G J; Grobbee, D E; Moons, K G M

    2003-10-01

    We developed and validated a prediction rule for the occurrence of early postoperative severe pain in surgical inpatients, using predictors that can be easily documented in a preoperative setting. A cohort of surgical inpatients (n=1416) undergoing various procedures except cardiac surgery and intracranial neurosurgery in a University Hospital were studied. Preoperatively the following predictors were collected: age, gender, type of scheduled surgery, expected incision size, blood pressure, heart rate, Quetelet index, the presence and severity of preoperative pain, health-related quality of life the (SF-36), Spielberger's State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The outcome was the presence of severe postoperative pain (defined as Numeric Rating Scale > or =8) within the first hour postoperatively. Multivariate logistic regression in combination with bootstrapping techniques (as a method for internal validation) was used to derive a stable prediction model. Independent predictors of severe postoperative pain were younger age, female gender, level of preoperative pain, incision size and type of surgery. The area under the receiver operator characteristic (ROC) curve was 0.71 (95% CI: 0.68-0.74). Adding APAIS scores (measures of preoperative anxiety and need for information), but not STAI, provided a slightly better model (ROC area 0.73). The reliability of this extended model was good (Hosmer and Lemeshow test p-value 0.78). We have demonstrated that severe postoperative pain early after awakening from general anesthesia can be predicted with a scoring rule, using a small set of variables that can be easily obtained from all patients at the preoperative visit. Before this internally validated preoperative prediction rule can be applied in clinical practice to support anticipatory pain management, external validation in other clinical settings is necessary.

  9. Anesthesia Management in Diabetic Cardiovascular Autonomic Neuropathy

    Directory of Open Access Journals (Sweden)

    Feride Karacaer

    2016-06-01

    Full Text Available Cardiovascular autonomic neuropathy is frequently observed in patients with diabetes mellitus and encompasses damage to the autonomic nerve fibers, resulting in abnormalities in heart rate control and vascular dynamics. There is an increased mortality and morbidity rate among these patients. A series of cardiovascular reflex tests known as Ewing's battery tests are used for diagnosis cardiac autonomic neuropathy and provide valuable information to the clinical assessment of these patients. As anesthesia has a major influence on perioperative autonomic function, the interplay between cardiovascular autonomic neuropathy and anesthesia may result in unexpected haemodynamic instability during surgery and postoperative recovery. A comprehensive preoperative assessment and perioperative cautious monitoring are necessary for successful anesthesia management. [Archives Medical Review Journal 2016; 25(2.000: 140-151

  10. 术前服用硝苯地平对吸入七氟醚麻醉中体感诱发电位监测的影响%Effects of using nifedipine preoperative during sevoflurane anesthesia on somatosensory evoked potentials

    Institute of Scientific and Technical Information of China (English)

    冯颖辰; 韩如泉; 王纲; 王明然

    2012-01-01

    目的 研究术前含服硝苯地平对吸入七氟醚麻醉中体感诱发电位(SEP)监测的影响.方法 30例ASAⅠ~Ⅱ级Ⅱ期高血压患者,术前SEP检查无异常,随机分为两组,术前1 h A组舌下含服硝苯地平片,B组舌下含服淀粉片.入室后常规快速诱导.维持用药:吸入七氟醚,使吸入浓度分别达到0.5、1.0、1.5 MAC,并维持15 min,观察记录并比较两组患者间血压、心率的变化以及P15、N20、P25波的潜伏期和P15-N20、N20-P25波幅的改变.结果 术前含服硝苯地平组插管期MAP明显低于对照组(P0.05).结论 术前含服硝苯地平对吸入七氟醚麻醉中体感诱发电位监测的影响较小,可以安全地用于需监测体感诱发电位高血压患者术前降压治疗.%Objective To investigate the effects of using nifedipine preoperative during sevoflurane anesthesia on somatosensory evoked potentials ( SEP) in neurosurgical patients. Methods Thirty hypertensive patients with ASA Ⅰ - Ⅱ , and normal SEP undergoing neurosurgery were divided into two groups randomly. Group A was treated nifedipine one hour before operation. Group B was treated a piece of amylum. After tracheal intubation, sevoflurane was inhaled and sevoflurane concentrations of intra-alveoli reached to 0. 5 MAC,1. 0 MAC and 1. 5 MAC in turn. The mean arterial blood pressure, heart rate, and SEP were recorded in both groups. The correlation among them was calculated. Results NIBP and MAP decreased significantly after induction in both groups. With increasing concentrations of sevoflurane, MAP decreased significantly. There was a positive correlation between the latency of LP15,LN20,LP25,P15-N20 wave,N20-P25 wave and concentration of sevoflurane ( P < 0. 05 ). There were no significant differences between the two groups. Conclusions There is no significant effect on SEP with using nifedipine preoperative during sevoflurane anesthesia in neurosurgical patients.

  11. Anesthesia Maintenance During Mini-Invasive Cardiac Valve Surgery

    Directory of Open Access Journals (Sweden)

    L. A. Krichevsky

    2013-01-01

    Full Text Available Based on own experience and published data the authors analyze the features and specific components of anesthesia maintenance during mini-invasive cardiac valve surgery. The following clinically relevant aspects of anesthesia and perioperative intensive care were identified: preoperative patient selection and surgical and anesthesia risk prediction; one-lung ventilation; peripheral connection of circulation and specific features of its performance; control of oxygen delivery in the bed of aortic arch branches; and echocardiographic monitoring. The main risks and probable complications due to these interventions, such as cerebral hypoxia, respiratory failure, pulmonary hypertension, etc., are described. The mechanisms of their development and the modes of prevention and treatment are shown. Key words: anesthesia in cardiac surgery, mini-invasive cardiac surgery, one-lung ventilation, anesthesia during cardiac valve surgery.

  12. Study on preoperative gradual muscles relaxation training to reduce restlessness of patients in analepsia period of general anesthesia%术前渐进性肌肉放松训练减轻全身麻醉病人苏醒期躁动程度的研究

    Institute of Scientific and Technical Information of China (English)

    谢珍; 李瑞英; 向承红

    2011-01-01

    Objective: To investigate the effect of gradual muscles relaxation training to reduce restlessness of patients in analepsia period of general Anesthesia.Methods: A total of 60 patients selected from general surgery, five sense organs, gynecology , liver and gall department who were scheduled for accepting tracheal intubation and combined intravenous and inhalation anesthesia were randomly divided into test group and control group.Patients of control group wcre just received routine visiting.Patients of test group were received preoperative visiting on the day before operation and were carried out gradual muscles relaxation training.Then heart rate, blood pressure.blood oxygen saturation (SpO2 ) , scoring of restless - sedation in analepsia period,and incidence of restless of the two group patients had recorded before the induction, right after operation, on the time of extubation,5 minutes and 10 minutes after the extubation respectively.Results : In terms of heart rate and blood pressure, there were statistical significant differences between the two group patients (P<0.05).The score of restless - sedation in test group patients was 0.65±0.34 and was 1.98 ± 0.38 in control group cases.There was statistical significant difference between the two groups (P<0.05).The incidence of restless in test group patients was 13.3% and was 46.7% in control group.There was statistical significant difference between the two groups (P<0.05).Conclusion: The gradual muscles relaxation training was helpful to decrease the incidence and the degree of restlessess of patients in analepsia period of general anesthesia.%[目的]探讨渐进性肌肉放松训练对减轻全身麻醉病人苏醒期躁动程度的影响.[方法]选择普外科、五官科、妇科、肝胆科拟行气管插管静脉吸入复合麻醉的手术病人60例,随机分为实验组和对照组.实验组术前1d访视并进行渐进性肌肉放松训练,对照组常规术前访视.记录两组病人诱

  13. Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

    OpenAIRE

    Berger, Richard A; Sanders, Sheila A.; Thill, Elizabeth S.; Sporer, Scott M.; Della Valle, Craig

    2009-01-01

    Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia ...

  14. Preoperative anxiety-an important but neglected issue: A narrative review

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2016-01-01

    Full Text Available Anxiety is an emotional state characterized by apprehension and fear resulting from the anticipation of a threatening event. The incidence of preoperative anxiety ranges from 11% to 80% in adult patients and also varies among different surgical groups. Preoperative anxiety may lead to various problems and a wide range of physiological and psychological responses. A variety of objective and subjective methods are available for measuring preoperative anxiety. Every patient scheduled for surgery should be assessed for the presence of anxiety in their routine preoperative anesthesia assessment, and counseling should be done by anesthesiologist in patients with a high level of anxiety. Surgery information reduces anxiety in the preoperative period.

  15. Consulting in Collection Development.

    Science.gov (United States)

    Ash, Lee

    1980-01-01

    Considers the role of the consultant in the areas of library collection development and weeding, and offers suggestions on determining the need for a consultant, obtaining one, and what to do when the consultant arrives. (FM)

  16. Anesthesia information management systems.

    Science.gov (United States)

    Williams, Joe R

    2005-06-01

    Documentation is the last component of anesthesia patient management to be affected by technology. Anesthesia information management systems (AIMS) have been introduced in a limited number of practice sites. The automated systems provide unbiased reporting of most patient information. This results in improved patient care and possible medical legal advantages. AIMS also allow anesthesia departments to monitor their business related activity.

  17. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes.

    Science.gov (United States)

    Kim, Sunghye; Brooks, Amber K; Groban, Leanne

    2015-01-01

    Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors - including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility - which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented.

  18. [Automated anesthesia record system].

    Science.gov (United States)

    Zhu, Tao; Liu, Jin

    2005-12-01

    Based on Client/Server architecture, a software of automated anesthesia record system running under Windows operation system and networks has been developed and programmed with Microsoft Visual C++ 6.0, Visual Basic 6.0 and SQL Server. The system can deal with patient's information throughout the anesthesia. It can collect and integrate the data from several kinds of medical equipment such as monitor, infusion pump and anesthesia machine automatically and real-time. After that, the system presents the anesthesia sheets automatically. The record system makes the anesthesia record more accurate and integral and can raise the anesthesiologist's working efficiency.

  19. A preoperative checklist in esthetic plastic surgery

    OpenAIRE

    Anger,Jaime; Letizio,Nelson; Orel,Maurício; Souza Junior,José Leão de; Santos,Márcio Martines dos

    2011-01-01

    The authors present a checklist to be used at the last stage of a preoperative visit for esthetic plastic surgery composed of 29 yes/no questions, four blank spaces for entering data, and one question for ranking the level of risk of deep vein thrombosis. The criteria are divided into three tables relating to three areas: anesthesia, psychological aspects, and clinical risk factors. The answers are framed in four colors that identify the level of risk and suggest the degree of attention warra...

  20. Optimization of Spinal Anesthesia in Surgery of Intervertebral Disks

    Directory of Open Access Journals (Sweden)

    V. I. Gorbachev

    2006-01-01

    Full Text Available The paper gives the data of preoperative evaluation of autonomous nervous system tone and its correction, pharmacokinetics of local anesthetics in the subarachnoidal space, as well as the optimization of a procedure for spinal anesthesia in patients operated on for lumbosacral radiculitis. 

  1. The Study of Oral Clonidine Effect in Duration of Spinal Anesthesia with Lidocaine and Its Complications

    Directory of Open Access Journals (Sweden)

    M. Baalbaki

    2003-07-01

    Full Text Available There are many kinds of intervention to prolong the duration of spinal anesthesia which one of them is preoperation oral drugs. The purpose of this study was determination of clonidine effects in duration of spinal anesthesia and its complications. This study was a double - blinded randomized controlled clinical trial in 40-60 years old males of Mobasher and Ekbatan hospitals in Hamadan. In this study there were 40 cases candidated for spinal anesthesia and we divided them to 2 groups i.e. test and control then the results were recorded on questionnaire sheets. The test cases were prescribed 0.2 mg clonidine P.O. preoperatively and their duration of spinal anesthesia prolonged 11 minutes averagely and decreased its complications related to control prescribed placebo. Hence , the result showed preparation oral clonidine prolongs the duration of spinal anesthesia and decreases its complications like hypotention , nausea and vomiting.

  2. Robotics and regional anesthesia.

    Science.gov (United States)

    Wehbe, Mohamad; Giacalone, Marilu; Hemmerling, Thomas M

    2014-10-01

    Robots in regional anesthesia are used as a tool to automate the performance of regional techniques reducing the anesthesiologist's workload and improving patient care. The purpose of this review is to show the latest findings in robotic regional anesthesia. The literature separates robots in anesthesia into two groups: pharmacological robots and manual robots. Pharmacological robots are mainly closed-loop systems that help in the titration of anesthetic drugs to patients undergoing surgery. Manual robots are mechanical robots that are used to support or replace the manual gestures performed by anesthesiologists. Although in the last decade researchers have focused on the development of decision support systems and closed-loop systems, more recent evidence supports the concept that robots can also be useful in performing regional anesthesia techniques. Robots can improve the performance and safety in regional anesthesia. In this review, we present the developments made in robotic and automated regional anesthesia, and discuss the current state of research in this field.

  3. Regional anesthesia for pediatrics

    OpenAIRE

    Türk, Hacer Şebnem; Işıl, Canan Tülay; Açık, Mehmet Eren; Ediz, Naim; Sayın, Pınar; Tombul, Merih; Oba, Sibel

    2015-01-01

    Objectives: Relevancy to regional anesthesia in pediatrics has increased, because it is complementary to general anesthesia, allows conscious postoperative analgesia without respiratory depression, technical difficulties have been defeated and new local anesthetics have been improved. Therefore we reported data of patients who underwent pediatric surgery and received regional anesthesia.Patients and methods: We retrospectively analyzed data of all patients, who were operated in the pediatric ...

  4. Anesthesia information management systems

    OpenAIRE

    Feri Štivan; Janez Benedik; Tomaž Lužar

    2014-01-01

    Introduction: The use of anesthesia information management systems (AIMS) is on the increase. This is particularly true for academic anesthesia departments. The main reasons for slow adoption of these systems in the past are financial barriers associated with implementation of these systems and their not so traditionally obvious potential to improve patient care. In addition, a major obstacle to acceptance of this technology is the concern of users over the impact of the electronic anesthesia...

  5. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  6. Anesthesia for a Patient with Myotonic Dystrophy

    Directory of Open Access Journals (Sweden)

    Dilek Kalaycı

    2016-09-01

    Full Text Available Myotonic dystrophy is the most common myotonic syndrome causing abnormalities of the skeletal and smooth muscles as well as problems related to the cardiac, gastrointestinal and endocrine systems. In affected people, reduced functional residual capacity, vital capacity, and peak inspiratory pressure are observed within the respiratory system. As would be expected, anesthetic management of these patients is challenging for anesthesiologists. In addition, delayed recovery from anesthesia and cardiac and pulmonary complications may develop in the intraoperative and early postoperative periods due to sensitivity to sedatives, anesthetic agents, and neuromuscular blocking agents. Myotonic dystrophy can be performed with the use of appropriate anesthesia procedures as well as carefully communication between anesthesiologists and surgeons. In conclusion, myotonic dystrophy has variations, which makes it important to preoperatively determine specific surgical and anesthetic management strategies for each patient. In this article, we present a patient with myotonic dystrophy who underwent laparoscopic cholecystectomy surgery for symptomatic cholelithiasis and to discuss the relevant literature.

  7. [Induction of general anesthesia in pediatric patients].

    Science.gov (United States)

    Ota, Chiharu; Taniguchi, Akihiro

    2007-05-01

    The induction of general anesthesia is one of the most stressful procedures during the perioperative period for pediatric patients. Postoperative negative behavioral changes, such as nightmares or separation anxiety are reported in the children undergoing general anesthesia. To avoid these problems, the anesthesiologists have to pay more attention to the psychological needs of young patients as well as the technical aspects. Preoperative interview is important to identify the child who has extreme fear and anxiety. Premedication with sedatives and psychological preparation are effective for the smooth induction. In this article, preparation for the induction and practical skills of the induction in children, newborns, as well as patients with difficult airway and with full stomach are summarized.

  8. Tribal Consultation Tracking System

    Data.gov (United States)

    U.S. Environmental Protection Agency — The consultation-related information the AIEO Consultation Team working with our Tribal Portal contractors has developed a Lotus Notes Database that is capable of...

  9. Campaign Consultants - Client Payments

    Data.gov (United States)

    City of San Francisco — Campaign Consultants are required to report ���economic consideration�۝ promised by or received from clients in exchange for campaign consulting services during the...

  10. Optimizing Consulting Delivery Systems.

    Science.gov (United States)

    Spottswood, Curran

    1980-01-01

    Summarizes a study of several types of consulting groups in the Bell System and describes characteristics which are associated with high-impact consulting. A strategy which is designed for internal consulting organizations to maximize the likelihood of both initial success and long-term survival of the group is proposed. (Author/MER)

  11. Bioethics Consultations and Resources

    OpenAIRE

    Thomas, Jennie

    2011-01-01

    Making difficult healthcare decisions is often helped by consultation with a bioethics committee. This article reviews the main bioethics principles, when it is appropriate and how to call a bioethics consult, ethical concerns, and members of the consult team. Bioethics resources are included.

  12. Anatomy of an anesthesia information management system.

    Science.gov (United States)

    Shah, Nirav J; Tremper, Kevin K; Kheterpal, Sachin

    2011-09-01

    Anesthesia information management systems (AIMS) have become more prevalent as more sophisticated hardware and software have increased usability and reliability. National mandates and incentives have driven adoption as well. AIMS can be developed in one of several software models (Web based, client/server, or incorporated into a medical device). Irrespective of the development model, the best AIMS have a feature set that allows for comprehensive management of workflow for an anesthesiologist. Key features include preoperative, intraoperative, and postoperative documentation; quality assurance; billing; compliance and operational reporting; patient and operating room tracking; and integration with hospital electronic medical records.

  13. Mouse anesthesia and analgesia.

    Science.gov (United States)

    Adams, Sean; Pacharinsak, Cholawat

    2015-03-02

    Providing anesthesia and analgesia for mouse subjects is a common and critical practice in the laboratory setting. These practices are necessary for performing invasive procedures, achieving prolonged immobility for sensitive imaging modalities (magnetic resonance imaging for instance), and providing intra- and post-procedural pain relief. In addition to facilitating the procedures performed by the investigator, the provision of anesthesia and analgesia is crucial for the preservation of animal welfare and for humane treatment of animals used in research. Furthermore, anesthesia and analgesia are important components of animal use protocols reviewed by Institutional Animal Care and Use Committees, requiring careful consideration and planning for the particular animal model. In this article, we provide technical outlines for the investigator covering the provision of anesthesia by two routes (injectable and inhalant), guidelines for monitoring anesthesia, current techniques for recognition of pain, and considerations for administering preventative analgesia. Copyright © 2015 John Wiley & Sons, Inc.

  14. [Measure of preoperative anxiety and need for information with six issues].

    Science.gov (United States)

    Wattier, J-M; Barreau, O; Devos, P; Prevost, S; Vallet, B; Lebuffe, G

    2011-01-01

    A questionnaire for self-assessment, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) translated into French has been compared to a background questionnaire to validate their use as screening tool and assessment of anxiety and information needs of patients. An epidemiological study was conducted anonymously. Patients completed a questionnaire comprising a French version of APAIS and Spielberger Anxiety Inventory (STAI). A study of correlation between scores for each questionnaire was conducted. A high level of anxiety was investigated. So 1800 questionnaires were distributed, 1504 were usable. The first 100 questionnaires have confirmed the internal validity of the questionnaire APAIS. The following questionnaires in 1404 accounted 49.7% of men 55.7 ± 15.7 years old and 50.2% of women 50.8 ± 15.2 years old. The correlation coefficient (r) between STAI state and appeasement was of 0.675 (Panxiety by Spielberger's inventory. No correlation was found between the STAI state and the need for information (r=0.252; Panxiety and information needs of patients. This questionnaire has metrological capabilities and ease of execution that make it a screening tool for use in anesthesia consultation. A score above 10 out of 20 reflects a high level of anxiety. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  15. Outpatient Preoperative Education Needs Identified by Nurses and Patients.

    Science.gov (United States)

    2007-11-02

    PREOPERATIVE EDUCATION NEEDS IDENTIFIED BY NURSES AND PATIENTS Cheryl Anne Reilly APPROVED: Supervising Prdessor Date APPROVED: / "Sanfor• Miller , P... anesthesiologist will visit them before 5 4 3 2 1 surgery to discuss what anesthesia would be used. 27. Their incision may pull, bum, or itch while it is 5 4...such as, giving me an injection & asking me to empty my bladder. 26. An anesthesiologist would visit me before Yes No 5 4 3 2 1 surgery to discuss

  16. [A clinical and experimental study of the role of long-lasting perioperative epidural anesthesia in the prevention of phantom limb pain].

    Science.gov (United States)

    Ovechkin, A M; Kukushkin, M L; Gnezdilov, A V; Reshetniak, V K

    1994-01-01

    The aim of this study was to investigate the possible onset of phantom limb pain (PLP) and its development depending on preoperative limb pain and type of anesthesia during limb amputation. It was experimentally proved that preliminary local anesthesia of rat sciatic nerve slowed down the development of pain syndrome after the operation as well as reduced the number of rats with pain syndrome, as compared to the group subjected to preliminary painful electrical stimulation of the operated on limb. The clinical data presented reveal a significant reduction in the incidence of PLP after perioperative epidural anesthesia, as compared to patients with preoperative pain operated on under general anesthesia.

  17. [Possibility of rice porridge for preoperative feeding in children].

    Science.gov (United States)

    Kushikata, T; Matsuki, A; Murakawa, T; Sato, K

    1996-08-01

    To determine the effect of rice porridge feeding before elective surgery on preoperative gastric fluid pH, volume and starvation, a prospective study was undertaken in pediatric patients. Twenty healthy children ranged in age from 5 to 12 years were allocated randomly to either a fasted or rice porridge group. The children of fasted group (control group) were allowed to take solid food until midnight before the operation. The rice porridge group (study group) patients received a small amount of rice porridge 5 hours 30 minutes before the induction of anesthesia. The patients of both groups were permitted to take clear fluid until 5 hours before the induction of anesthesia. After the induction of anesthesia, gastric fluid was aspirated through an orogastric tube. The mean gastric fluid volume was 0.43 +/- 0.32 ml.kg-1 in the control group and 0.5 +/- 0.6 ml.kg-1 in the study group. The mean gastric fluid pH was 1.43 +/- 0.27 ml.kg-1 in the control group and 1.89 +/- 0.75 ml.kg-1 in the study group. There were no significant differences between the two groups concerning the gastric fluid volume and pH. The patient of the study group complained of less hunger. Preoperative rice porridge feeding is a possible preoperative feeding for pediatric patients.

  18. Citrus aurantium blossom and preoperative anxiety.

    Science.gov (United States)

    Akhlaghi, Mahmood; Shabanian, Gholamreza; Rafieian-Kopaei, Mahmoud; Parvin, Neda; Saadat, Mitra; Akhlaghi, Mohsen

    2011-01-01

    Reducing anxiety is very important before operation. Preoperative visit and use of premedication are popular methods to achieve this goal, but the role of anxiolytic premedication remains unclear and postoperative side-effects may result from routine premedication. Citrus aurantium is used as an alternative medicine in some countries to treat anxiety, and recently the anxiolytic role of this medicinal plant was established in an animal model study. The aim of this study was to assess the anxiolytic effect of Citrus aurantium blossomon preoperative anxiety. We studied 60 ASA I patients undergoing minor operation. In a randomized double-blind design, two groups of 30 patients received one of the following oral premedication two hours before induction of anesthesia: 1) Citrus aurantium blossom distillate 1mL.kg(-1) (C-group); 2) Saline solution 1mL.kg(-1) as placebo (P-group). Anxiety was measured before and after premedication using the Spielberger state-trait anxiety inventory (STAI-state) and the Amsterdam preoperative anxiety and information scale (APAIS) before operation. After premedication, both the STAI-state and the APAIS scales were decreased in C-group (ppreoperative anxiety before minor operation. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  19. Consulting on Academic Library Buildings.

    Science.gov (United States)

    Mason, Ellsworth

    1980-01-01

    Addresses the following aspects of consulting on library buildings: new trends, the need for a consultant, selecting a consultant, timeliness in hiring, expectations, following through, and the cost of consulting. (FM)

  20. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Joaquín Hernández-Palazón

    2015-03-01

    Full Text Available Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A and Amsterdam Preoperative Anxiety and Information Scale (APAIS and to identify the influencing clinical factors. Patients and Methods: This prospective, longitudinal study was performed on 300 cardiac surgery patients in a single university hospital. The patients were assessed regarding their preoperative anxiety level using VAS-A, APAIS, and a set of specific anxiety-related questions. Their demographic features as well as their anesthetic and surgical characteristics (ASA physical status, EuroSCORE, preoperative Length of Stay (LoS, and surgical history were recorded, as well. Then, one-way ANOVA and t-test were applied along with odds ratio for risk assessment. Results: According to the results, 94% of the patients presented preoperative anxiety, with 37% developing high anxiety (VAS-A ≥ 7. Preoperative LoS > 2 days was the only significant risk factor for preoperative anxiety (odds ratio = 2.5, CI 95%, 1.3 - 5.1, P = 0.009. Besides, a positive correlation was found between anxiety level (APAISa and requirement of knowledge (APAISk. APAISa and APAISk scores were greater for surgery than for anesthesia. Moreover, the results showed that the most common anxieties resulted from the operation, waiting for surgery, not knowing what is happening, postoperative pain, awareness during anesthesia, and not awakening from anesthesia. Conclusions: APAIS and VAS-A provided a quantitative assessment of anxiety and a specific qualitative questionnaire for preoperative anxiety in cardiac surgery. According to the results, preoperative LoS > 2 days and lack of information related to surgery were the risk factors for high anxiety levels.

  1. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety.

    Science.gov (United States)

    Boker, Abdulaziz; Brownell, Laurence; Donen, Neil

    2002-10-01

    To compare three anxiety scales; the anxiety visual analogue scale (VAS), the anxiety component of the Amsterdam preoperative anxiety and information scale (APAIS), and the state portion of the Spielburger state-trait anxiety inventory (STAI), for assessment of preoperative anxiety levels in same day admission patients. Patients completed the three anxiety assessment scales both before and after seeing the anesthesiologist preoperatively. The scales used were the STAI, the six-question APAIS, and the VAS. APAIS was further subdivided to assess anxiety about anesthesia (sum A), anxiety about surgery (sum S) and a combined anxiety total (i.e., sum C = sum A + sum S). These scales were compared to one another. Pearson's correlation (pair-wise deletion) was used for validity testing. Cronbach's alpha analysis was used to test internal validity of the various components of the APAIS scale. A correlation co-efficient (r) > or = 0.6 and P scale sets were completed by 197 patients. There was significant and positive correlation between VAS and STAI r = 0.64, P anxiety components of the APAIS (sum C) and desire for information were 0.84 and 0.77 respectively. In addition to VAS, the anxiety component of APAIS (sum C) is a promising new practical tool to assess preoperative patient anxiety levels.

  2. Preoperative anxiety in surgical patients - experience of a single unit.

    Science.gov (United States)

    Matthias, Anne Thushara; Samarasekera, Dharmanbandhu Nandadeva

    2012-03-01

    Preoperative anxiety has a significant effect on the outcome of anesthesia and surgery. At present, there is no published data on the preoperative anxiety levels in Sri Lankan patients. In the West, several validated questionnaires such as The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and State Trait Anxiety Inventory (STAI) are used. To measure the preoperative anxiety levels in patients using APAIS and to analyze the factors affecting anxiety and the role played by the anesthetist in allaying anxiety. One hundred patients scheduled for elective surgery were prospectively studied using the APAIS. The internal consistency was checked using Cronbach's alpha. The ages varied 25 to 72 years (mean=48.7 years, SD=13.6). Reliability of the APAIS was high; Cronbach's alpha=0.864 in the overall component and 0.84, 0.73 and 0.97 in the anxiety related to surgery, anesthesia and in the information desire components, respectively. Females were more anxious than males (p=0.02) and those who had never sustained surgery were more anxious than those who previously had surgery (p=0.05). An anesthetist's visit and premedication reduced total anxiety scores (Z=-3.07, p=0.002) and anesthesia related anxiety scores (Z=-3.45, p=0.001). The prevalence of anxiety is high among Sri Lankan patients. Females are more anxious than males and those who have never had surgery are more anxious than those who have had surgery. The anesthetist's visit could reduce anxiety. Sinhala version of the APAIS is highly reliable in assessing the preoperative anxiety levels. Copyright © 2012. Published by Elsevier B.V.

  3. [Anesthesia for ambulatory patients].

    Science.gov (United States)

    Landauer, B

    1975-11-13

    The specific problems of outpatient anesthesia are discussed with respect to the patient's condition, the anesthesist's qualification and pharmacological properties of anesthetics used. Methohexitone seems to be the best choice for induction. Problems may arise from the use of Propanidid, Ketamin and Diazepam. Nitrousoxide and Enflurane are a suitable completion. Endotracheal intubation, if needed, is facilitated by Suxamethonium, which is rapidly eliminated. Practical aspects of timing, premedication, induction, maintenance and ending of anesthesia are pointed out. After 1-2 hours the patient can be allowed to leave the hospital accompanied by a responsible person. Driving a car is not recommended before 24 hours have elapsed since anesthesia.

  4. Designing consultancy on energy

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Lene [Danish Energy Authority, Copenhagen (Denmark)

    2005-07-01

    There is a wide tradition for using energy consultancy in all end-using sectors and in various models. A lot of aspects have to be taken into consideration when a consultant scheme is to be launched. This paper will contribute to the discussion of the role of the consultant in the different energy end-use sectors: Energy consultancy is defined. The process for energy consulting is related to the eight fundamental objectives for effective management consulting (Arthur N. Turner): responding to a client's request for information; providing solutions to specific problems; giving an in-depth, accurate diagnosis; presenting a program of recommended corrective actions; implementing changes; building consensus and commitment; facilitating client learning; and enhancing organizational effectiveness. The role of the consultant is divided into 4 categories (expert, diagnostician, sparring partner, process consultant) depending on the consultant's focus (process or cases) and methodology (analysis or dialogue). Designing energy consultancy should reflect the end-use sector (household, industry etc.)

  5. Meningitis after spinal anesthesia

    National Research Council Canada - National Science Library

    Mouchrif, Issam; Berdaii, Adnane; Labib, Ismail; Harrandou, Moustapha

    2016-01-01

    Meningitis is a rare but serious complication of epidural and spinal anesthesia. Bacterial meningitis is mainly caused by Gram-positive cocci, implying an exogenous contamination which suggests a lack of asepsis...

  6. Pediatric anesthesia and neurotoxicity

    DEFF Research Database (Denmark)

    Disma, Nicola; Hansen, Tom G.

    2016-01-01

    Many studies have demonstrated a neurodegenerative effect of anesthetic drugs in cubs and young animals, raising the concern that similar effects can happen in children, and that the administration of anesthesia in young children undergoing surgical or diagnostic procedures may cause long- Term...... neurocognitive impairment. Thus, several epidemiological studies have been performed with the aim to find a possible association between early anesthesia exposure and poor long- Term outcome, like learning disabilities or worse school grading and two prospective trials are currently running, the GAS...... and the PANDA study. Interim results from the GAS study, which compared infants undergoing general and regional anesthesia for hernia repair, have demonstrated that a single exposure of about one hour of anesthesia does not affect the neurological outcome at 2 years of age. Nowadays, most of the knowledge...

  7. Making consultations run smoothly

    DEFF Research Database (Denmark)

    Jespersen, Astrid Pernille; Jensen, Torben Elgaard

    2012-01-01

    This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from...... the field of science and technology studies (STS), including notions of relationality, multiplicity and otherness. Through this lens, and based on extensive fieldwork, it describes the daily work of arranging time before, during and after consultations. In conclusion, it suggests that a STS...

  8. Advances in pediatric anesthesia.

    Science.gov (United States)

    Burns, L S

    1997-03-01

    Advances in many aspects of pediatric anesthesia have resulted in a significant reduction in morbidity and mortality in children. Research and development have created vast improvements in pharmacology. Sophisticated monitoring and improvements in equipment evolved from advances made in scientific technology. Recognition of the psychological needs of children of all ages likely has reduced the incidence of lasting psychological effects after hospitalization. Finally, these important advances have made pediatric anesthesia a safer and more compassionate specialty.

  9. Awareness under general anesthesia.

    Science.gov (United States)

    Bischoff, Petra; Rundshagen, Ingrid

    2011-01-01

    Awareness while under general anesthesia, and the later recall of what happened during surgery, can be experienced by patients as horrific events that leave lasting mental trauma behind. Patients may have both auditory and tactile perception, potentially accompanied by feelings of helplessness, inability to move, pain, and panic ranging to an acute fear of death. For some patients, the experience of awareness under anesthesia has no sequelae; for others, however, it can lead to the development of post-traumatic stress disorder, consisting of complex psychopathological phenomena such as anxiety, insomnia, nightmares, irritability, and depression possibly leading to suicidality. The literature on the subject was selectively reviewed. In the absence of risk factors awareness phenomena occur in one to two per 1000 operations under general anesthesia (0.1% to 0.2%) and are thus classed as an occasionally occurring critical event. In children, the risk of such phenomena occurring is 8 to 10 times higher. These phenomena are due to an inadequate depth of anesthesia with incomplete unconsciousness. They can be promoted by a number of risk factors that are either patient-related (ASA class III or above, medication abuse), surgery-related (Caesarean section, emergency procedures, surgery at night), or anesthesia-related (anesthesia without benzodiazepines, use of muscle relaxants). Strategies for avoiding awareness phenomena under anesthesia include the training of staff to know about the problem and, specifically, the use of benzodiazepines, the avoidance of muscle relaxants if possible, and shielding the patient from excessive noise. EEG monitoring is effective but provides no guarantee against awareness. If awareness under anesthesia occurs despite these measures, the patient must be given expert, interdisciplinary treatment as soon after the event as possible in order to minimize its potential sequelae.

  10. [Anesthesia for geriatric patients : Part 2: anesthetics, patient age and anesthesia management].

    Science.gov (United States)

    Herminghaus, A; Löser, S; Wilhelm, W

    2012-04-01

    Part 2 of this review on geriatric anesthesia primarily describes the multiple influences of age on the pharmacokinetics and pharmacodynamics of different anesthetic agents and their impact on clinical practice. In the elderly the demand for opioids is reduced by almost 50% and with total intravenous anesthesia the dosages of propofol and remifentanil as well as recovery times are more determined by patient age than by body weight. As a result depth of anesthesia monitoring is recommended for geriatric patients to individually adjust the dosing to patients needs. With muscle relaxants both delayed onset of action and prolonged duration of drug effects must be considered with increasing age and as this may lead to respiratory complications, neuromuscular monitoring is highly recommended. The following measures appear to be beneficial for geriatric patients: thorough preoperative assessment, extended hemodynamic monitoring, use of short-acting anesthetics in individually adjusted doses best tailored by depth of anesthesia monitoring, intraoperative normotension, normothermia and normocapnia, complete neuromuscular recovery at the end of the procedure and well-planned postoperative pain management in order to reduce or avoid the use of opioids.

  11. Local Anesthesia in Cataract Surgery-A Comparison of Different Methods

    Institute of Scientific and Technical Information of China (English)

    Nolan; J; Aziz; M; Ahmad; M; Shehata; M; Iqbal; F

    1993-01-01

    Seven groups of thirty patients undergoing cataract extraction under local anesthesia were each given different combinations of local anesthesia. These varied from a maximum approach using supra-orbital, infra-orbital and facial blocks with Hyalase, orbital compression and pre-operative Acetazolamide down to a minimum group receiving purely an infra- orbital and supra-orbital block with a Ugnocaine/Bupivacaine mixture. There was no significant difference in local analgesia or in the complication rates b...

  12. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

    Science.gov (United States)

    Ellakany, Mohamed Hamdy

    2014-01-01

    Aim: A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Background: Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. Materials and Methods: A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. Results: Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. Conclusion: This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay

  13. Preoperative preparation of children

    Directory of Open Access Journals (Sweden)

    Priya Reshma Aranha

    2017-01-01

    Full Text Available Surgery is a stressful and anxiety provoking experience for children. Millions of children undergo surgery every year. The majority of children experience significant preoperative anxiety which intern can affect their recovery. Preoperative anxiety may bring about physical and physiological changes in children, which can be particularly evident in terms of increased heart rate and blood pressure. To identify various strategies used to minimize the preoperative anxiety of children and update their clinical effectiveness among children undergoing surgery, the authors searched PubMed, MEDLINE, CINAHL, ScienceDirect, Google Scholar, Scopus, and Cochrane Library for identifying the relevant studies and retrieved available literature. It is concluded that utilization of the strategies available to reduce the preoperative anxiety of children will be a promising intervention to reduce anxiety, to promote relaxation, satisfaction, and speedy recovery. Many of these techniques are simple, cost-effective and can be easily carried out by nurses. It is essential to use the age appropriate and individualized methods in preparing children for surgery. Further research is required to strengthen the evidence.

  14. The Dream Consultant

    DEFF Research Database (Denmark)

    Muhr, Sara Louise; Kirkegaard, Line

    2013-01-01

    for work. We draw on Lacan's notion of desire as the Other's desire and analyze the consultants' desire as controlled by a need for recognition at work. We show how consultants need off-work fantasies to maintain the illusion of wholeness – of being more than work. Only with this illusion of wholeness can...

  15. The Contemporary Consultant

    DEFF Research Database (Denmark)

    Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

    This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...

  16. Modified technique of iontophoretic anesthesia for myringotomy in children.

    Science.gov (United States)

    Epley, J M

    1977-06-01

    A modified technique is described for iontophoretic anesthesia in children who require myringotomy and insertion of a tube (tympanostomy). Principal modifications include the following procedures: (1) preoperative parenteral sedation; (2) relatively painless injection of lidocaine hydrochloride-epinephrine hydrochloride solution into the external auditory canal skin after iontophoresis alone to eliminate the extreme bony canal wall tenderness; (3) injection of lidocaine-epinephrine solution into an atelectatic middle ear to anesthetize the promontory for painless tube insertion; (4) substitution of a disposable ECG electrode for a metal plate electrode to eliminate the possibility of electrical burn from metal-to-skin contact. These modifications enhance the effectiveness and the safety of iontophoretic anesthesia, minimize the need for general anesthesia, and liberalize the indications for tympanostomy.

  17. Measuring preoperative anxiety in patients with intracranial tumors: the Amsterdam preoperative anxiety and information scale.

    Science.gov (United States)

    Goebel, Simone; Kaup, Lea; Mehdorn, Hubertus Maximilian

    2011-10-01

    Preoperative anxiety is a major problem in patients with brain tumors and is of high clinical relevance. However, to date no instruments have been validated for the assessment of preoperative anxiety for this patient group. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has shown promising results for the assessment of preoperative anxiety. The aim of this study was to determine its psychometric properties and the optimal cutoff score for patients with intracranial tumors to make it applicable in the neurosurgical setting. The sample totaled 180 neurosurgical patients with intracranial tumors. Patients were administered the APAIS along with the Hospital Anxiety and Depression Scale as the gold standard against which the APAIS was compared. Patients scoring 11 or above in the anxiety subscale of the Hospital Anxiety and Depression Scale were defined as clinical cases having anxiety. The psychometric properties of the APAIS were evaluated for a postulated 2-factor structure, Cronbach α, and correlations. The postulated 2-factor structure could not be replicated. Instead, we found a 3-factor solution (anxiety about the operation, anxiety about the anesthesia, information requirement). The area under the receiver operating characteristics curve ranged from ≥0.65 to ≥0.77. Optimal cutoff scores were calculated. The cutoff score for the anxiety scale was ≥10 for the whole sample and men only, and was ≥11 for women only. Analysis of the psychometric properties yielded satisfactory results (eg. Cronbach α for the anxiety scale >0.84). Despite its brevity, the APAIS is valid and recommendable for the assessment of preoperative anxiety in patients with intracranial tumors. As this is the first validation study focusing on patients with severe diseases and major surgeries, we recommend the application of our cutoff scores also for patients similar to our study population with regard to disease and surgery severity.

  18. Appropriate practice of anesthesia: A plea for better training

    Directory of Open Access Journals (Sweden)

    O P Adudu

    2011-01-01

    Full Text Available Background: The role of the anesthesiologist is often unknown among patients. But, the situation where the anesthesiologist is uncertain of his/her function gives more cause for concern. Methods: A questionnaire survey on the appraisal of anesthetic practices was carried out over 5 months using the style of clinical practice. Results: One-third of the anesthesiologists who responded to the survey attached little importance to the work they did by not communicating the same to their patients while 45.2% did not discuss the intraoperative findings with the surgeons. Although 57 (59.4% of the respondents usually visit their patients on the ward preoperatively, only 16 (21.6% discussed the proposed anesthetic procedure with the patients. Thirty-nine (40.2% respondents claimed that they do not wear ward coats to the ward at the preoperative visit. Less than 20% consistently conducted a postoperative visit. The majority of the respondents would treat all patients as important, irrespective of social status, while 74.5% of them considered obtaining informed consent for anesthesia from patients as significantly important. Conclusion: The current practice of anesthesia has been found wanting in several aspects. Knowledgeable discussion by anesthesiologists with surgeons as well as enlightenment of patients and their relatives about their work will improve the quality of anesthesia care remarkably. Changes in the anesthesia training curriculum to reflect these deficiencies would be helpful.

  19. Risk management in anesthesia.

    Science.gov (United States)

    Cabrini, L; Levati, A

    2009-11-01

    Anesthesia is considered a leading discipline in the field of patient safety. Nevertheless, complications still occur and can be devastating. A substantial portion of anesthesia-related adverse events are preventable since risk factors can be detected and eliminated. Risk management (RM) in anesthesia includes preventive and remedial measures to minimize patient anesthesia-related morbidity and mortality. RM involves all aspects of anesthesia care. Classically, the following four steps are needed to prevent critical incidents or to learn from them: (1) detection of problems, (2) assessment, (3) implementation of solutions, and (4) verification of effectiveness. Problems and solutions can be identified into the fields of structures, processes and personnel. Authoritative agencies like the World Health Organization, the World Federation of Societies of Anesthesiologists, the Section and Board of Anesthesiology of the European Union of Medical Specialties and the Italian Scientific Society of Anesthesiologists (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva SIAARTI) have proposed initiatives addressing safety in the operating room. The central role of a well-trained, constantly present anesthesiologist and the usefulness of checklists have been highlighted. Cost cutting and production pressure in medical care are potential threats to safety. A shared knowledge of the best standards of care and of the potential consequences of unscrupulous actions could make the daily management of conflicting interests easier. A correctly applied RM can be a powerful, highly beneficial aid to our practice.

  20. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Møller, A; Villebro, N

    2005-01-01

    Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation....

  1. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Oturai, P; Erichsen, C J

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

  2. Isoflurane compared with fentanyl-midazolam-based anesthesia in patients undergoing heart transplantation

    Science.gov (United States)

    Hsu, Che-Hao; Hsu, Yung-Chi; Huang, Go-Shine; Lu, Chih-Cherng; Ho, Shung-Tai; Liaw, Wen-Jinn; Tsai, Yi-Ting; Lin, Chih-Yuan; Tsai, Chien-Sung; Lin, Tso-Chou

    2016-01-01

    Abstract Inhalation anesthetics provide myocardial protection for cardiac surgery. This study was undertaken to compare the perioperative effects between isoflurane and fentanyl-midazolam-based anesthesia for heart transplantation. A retrospective cohort study was conducted by reviewing the medical records of heart transplantation in a single medical center from 1990 to 2013. Patients receiving isoflurane or fentanyl-midazolam-based anesthesia were included. Those with preoperative severe pulmonary, hepatic, or renal comorbidities were excluded. The perioperative variables and postoperative short-term outcomes were analyzed, including blood glucose levels, urine output, inotropic use, time to extubation, and length of stay in the intensive care units. After reviewing 112 heart transplantations, 18 recipients with fentanyl-midazolam-based anesthesia, and 29 receiving isoflurane anesthesia with minimal low-flow technique were analyzed. After cessation of cardiopulmonary bypass, recipients with isoflurane anesthesia had a significantly lower mean level and a less increase of blood glucose, as compared with those receiving fentanyl-based anesthesia. In addition, there was less use of dobutamine upon arriving the intensive care unit and a shorter time to extubation after isoflurane anesthesia. Compared with fentanyl-midazolam-based anesthesia, isoflurane minimal low-flow anesthesia maintained better perioperative homeostasis of blood glucose levels, less postoperative use of inotropics, and early extubation time among heart-transplant recipients without severe comorbidities. PMID:27583900

  3. NEURAXIAL ANESTHESIA and OBESITY

    Directory of Open Access Journals (Sweden)

    Aynur sahin

    2013-09-01

    Full Text Available Obesity is one of the serious condition that commonly effects health in modern age. It was reported that obesity was three-fold increased in the last three decades. According to the statement by World Health Organisation in 2005, 700 million people will be estimated obese in 2015. While neuraxial anesthesia is a commonly used technique in the worldwide, the process may have difficulties in obese patients. In this review, the pathophysiological changes and challenges in neuraxial anesthesia procedure in obesity were assessed with current literatures. [J Contemp Med 2013; 3(3.000: 234-236

  4. Family Practice Consultation.

    African Journals Online (AJOL)

    gauge the patients' opin:on on the family doctors' role regardirg prayer ... family practice consultation arc presented. ... patients' expectation of prayer and ..... New developments and frequently asked questions covering - high and low BMI, ...

  5. Pain after major elective orthopedic surgery of the lower limb and type of anesthesia: does it matter?

    Science.gov (United States)

    Pereira, Diogo Luís; Meleiro, Hugo Lourenço; Correia, Inês Araújo; Fonseca, Sara

    Total knee arthroplasty and total hip arthroplasty are associated with chronic pain development. Of the studies focusing on perioperative factors for chronic pain, few have focused on the differences that might arise from the anesthesia type performed during surgery. This was a prospective observational study performed between July 2014 and March 2015 with patients undergoing unilateral elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) for osteoarthritis. Data collection and pain evaluation questionnaires were performed in three different moments: preoperatively, 24 hours postoperatively and at 6 months after surgery. To characterize pain, Brief Pain Inventory (BPI) was used and SF-12v2 Health survey was used to further evaluate the sample's health status. Forty and three patients were enrolled: 25.6% men and 74.4% women, 51,2% for total knee arthroplasty and48.8% for total hip arthroplasty, with a mean age of 68 years. Surgeries were performed in 25.6% of patients under general anesthesia, 55.8% under neuraxial anesthesia and 18.6% under combined anesthesia. Postoperatively, neuraxial anesthesia had a better pain control. Comparing pain evolution between anesthesia groups, neuraxial anesthesia was associated with a decrease in "worst", "medium" and "now" pain at six months. Combined anesthesia was associated with a decrease of "medium" pain scores at six months. Of the three groups, only those in neuraxial group showed a decrease in level of pain interference in "walking ability". TKA, "worst" pain preoperatively and general were predictors of pain development at six months. Patients with gonarthrosis and severe pain preoperatively may benefit from individualized pre- and intraoperative care, particularly preoperative analgesia and neuraxial anesthesia. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. [Pain after major elective orthopedic surgery of the lower limb and type of anesthesia: does it matter?

    Science.gov (United States)

    Pereira, Diogo Luís; Meleiro, Hugo Lourenço; Correia, Inês Araújo; Fonseca, Sara

    Total knee arthroplasty and total hip arthroplasty are associated with chronic pain development. Of the studies focusing on perioperative factors for chronic pain, few have focused on the differences that might arise from the anesthesia type performed during surgery. This was a prospective observational study performed between July 2014 and March 2015 with patients undergoing unilateral elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) for osteoarthritis. Data collection and pain evaluation questionnaires were performed in three different moments: preoperatively, 24hours postoperatively and at 6 months after surgery. To characterize pain, Brief Pain Inventory (BPI) was used and SF-12v2 Health survey was used to further evaluate the sample's health status. Forty and three patients were enrolled: 25.6% men and 74.4% women, 51,2% for total knee arthroplasty and48.8% for total hip arthroplasty, with a mean age of 68 years. Surgeries were performed in 25.6% of patients under general anesthesia, 55.8% under neuraxial anesthesia and 18.6% under combined anesthesia. Postoperatively, neuraxial anesthesia had a better pain control. Comparing pain evolution between anesthesia groups, neuraxial anesthesia was associated with a decrease in "worst", "medium" and "now" pain at six months. Combined anesthesia was associated with a decrease of "medium" pain scores at six months. Of the three groups, only those in neuraxial group showed a decrease in level of pain interference in "walking ability". TKA, "worst" pain preoperatively and general were predictors of pain development at six months. Patients with gonarthrosis and severe pain preoperatively may benefit from individualized pre- and intraoperative care, particularly preoperative analgesia and neuraxial anesthesia. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. Pain after major elective orthopedic surgery of the lower limb and type of anesthesia: does it matter?

    Directory of Open Access Journals (Sweden)

    Diogo Luís Pereira

    Full Text Available Abstract Background and objectives: Total knee arthroplasty and total hip arthroplasty are associated with chronic pain development. Of the studies focusing on perioperative factors for chronic pain, few have focused on the differences that might arise from the anesthesia type performed during surgery. Methods: This was a prospective observational study performed between July 2014 and March 2015 with patients undergoing unilateral elective total knee arthroplasty (TKA or total hip arthroplasty (THA for osteoarthritis. Data collection and pain evaluation questionnaires were performed in three different moments: preoperatively, 24 hours postoperatively and at 6 months after surgery. To characterize pain, Brief Pain Inventory (BPI was used and SF-12v2 Health survey was used to further evaluate the sample's health status. Results: Forty and three patients were enrolled: 25.6% men and 74.4% women, 51,2% for total knee arthroplasty and48.8% for total hip arthroplasty, with a mean age of 68 years. Surgeries were performed in 25.6% of patients under general anesthesia, 55.8% under neuraxial anesthesia and 18.6% under combined anesthesia. Postoperatively, neuraxial anesthesia had a better pain control. Comparing pain evolution between anesthesia groups, neuraxial anesthesia was associated with a decrease in “worst”, “medium” and “now” pain at six months. Combined anesthesia was associated with a decrease of “medium” pain scores at six months. Of the three groups, only those in neuraxial group showed a decrease in level of pain interference in “walking ability”. TKA, “worst” pain preoperatively and general were predictors of pain development at six months. Conclusions: Patients with gonarthrosis and severe pain preoperatively may benefit from individualized pre- and intraoperative care, particularly preoperative analgesia and neuraxial anesthesia.

  8. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

    OpenAIRE

    Gaonkar V; Daftary Swati

    2004-01-01

    In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25) or peri-incisional infiltration (n=25) pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia...

  9. Local anesthesia: a review.

    Science.gov (United States)

    Malamed, S F; Sykes, P; Kubota, Y; Matsuura, H; Lipp, M

    1992-01-01

    Local anesthetics are the most widely administered drugs in dentistry. Significant advances have been made in past decades that have greatly increased both the safety and the efficacy of these important drugs. This paper reviews the history of local anesthesia, pharmacokinetics and clinical implications, techniques, complications, and future directions in the quest for more effective pain control in dentistry.

  10. The Develoment of Anesthesia.

    Science.gov (United States)

    Davis, Audrey B.

    1982-01-01

    Until the eighteenth century, doctors were reluctant to use chemicals to alleviate pain because they accepted the religious/moral beliefs of their day, claiming that pain was beneficial for the body. Traces technical developments in the control of pain, discussing relationships of anesthesia to social, cultural, and scientific factors and…

  11. The Develoment of Anesthesia.

    Science.gov (United States)

    Davis, Audrey B.

    1982-01-01

    Until the eighteenth century, doctors were reluctant to use chemicals to alleviate pain because they accepted the religious/moral beliefs of their day, claiming that pain was beneficial for the body. Traces technical developments in the control of pain, discussing relationships of anesthesia to social, cultural, and scientific factors and…

  12. Anesthesia for pediatric dentistry.

    Science.gov (United States)

    Saxen, M A; Wilson, S; Paravecchio, R

    1999-04-01

    The administration of anesthesia to young patients creates a unique series of problems for the anesthesiologist. This article details these various problems and tackles the primary challenge facing clinicians in this environment: providing an environment that allows technically complex dental treatment to be delivered without inflicting any adverse psychological impact on the child or physical harm to the child or others.

  13. Pre-operative anaemia.

    Science.gov (United States)

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  14. The heart rate variability when conducting anesthesia

    Directory of Open Access Journals (Sweden)

    Khmel'nitskiy I.V.

    2016-03-01

    Full Text Available The study was performed on the base of 10 years of using different methods of analysis of heart rate variability as an indicator of direct and reverse connection of the sympatho-adrenal system in the preoperative diagnosis and anesthetic monitoring. The possibility of predicting the depth of anaesthesia was analyzed, for depending on significant amounts of external and internal conditions, the level of anesthesia changes significantly. In this regard the influence of drugs and technological means of influencing the condition of all life-supporting systems, and the autonomic nervous system in particular, before, during and after anesthesia is of great practical interest. The balance of the pharmacological protection of the vegetative balance in the surgical aggression is studied, as well as the use of heart rate variability as a non-specific method in relation to nosological forms of pathology, both under internal and external influences. A review of a number of sources confirms that heart rate is virtually the only high-speed method to present the sympatho-vagal regulation, the most accessible somatic parameter for estimation of the cardiovascular system functioning in anesthesiology. The heart rate variability serves as an indicator of functional condition of autonomous (vegetative nervous system. It is proposed to perform the continuous monitoring of the autonomic indices of the heart rhythm, which allows to register sympaho-vagal imbalance. Dynamic monitoring, timely interpretation of heart rate variability are constantly in the spotlight, but the approach and methodology of the domestic and foreign authors distinctly differ on the following points: heart rythmography as a visual method of assessing information about the dynamics of slow-wave processes, spectral analysis of the heart sinus rhythm as the best method of analysis of large and small wave activity, tests of functional diagnostics for subsequent measurement of the autonomic nervous

  15. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  16. Role of multimodality cardiac imaging in preoperative cardiovascular evaluation before noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Fathala Ahmed

    2011-01-01

    Full Text Available The preoperative cardiac assessment of patients undergoing noncardiac surgery is common in the daily practice of medical consultants, anesthesiologists, and surgeons. The number of patients undergoing noncardiac surgery worldwide is increasing. Currently, there are several noninvasive diagnostic tests available for preoperative evaluation. Both nuclear cardiology with myocardial perfusion single photon emission computed tomography (SPECT and stress echocardiography are well-established techniques for preoperative cardiac evaluation. Recently, some studies demonstrated that both coronary angiography by gated multidetector computed tomography and stress cardiac magnetic resonance might potentially play a role in preoperative evaluation as well, but more studies are needed to assess the role of these new modalities in preoperative risk stratification. A common question that arises in preoperative evaluation is if further preoperative testing is needed, which preoperative test should be used. The preferred stress test is the exercise electrocardiogram (ECG. Stress imaging with exercise or pharmacologic stress agents is to be considered in patients with abnormal rest ECG or patients who are unable to exercise. After reviewing this article, the reader should develop an understanding of the following: (1 the magnitude of the cardiac preoperative morbidity and mortality, (2 how to select a patient for further preoperative testing, (3 currently available noninvasive cardiac testing for the detection of coronary artery disease and assessment of left ventricular function, and (4 an approach to select the most appropriate noninvasive cardiac test, if needed.

  17. EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS

    Institute of Scientific and Technical Information of China (English)

    Li Changgen; Peng Xiaoyun; Xu Mingyu; Wang Zhongcheng

    2001-01-01

    Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods:33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n = 11), acupoint-skin electrical stimulation combined with epidural anesthesia (B) group (n= 11 ) and simple epidural anesthesia (C) group (n= 11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2~3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before,NE of group A and B lowered in comparison with pre-operation, particularly group A (P <0.01), while in group C,plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre-operation (P levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint-skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effec t has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. C_onclusion:Acupuncture or acupoint-surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.

  18. Anesthesia for subglottic stenosis in pediatrics

    Directory of Open Access Journals (Sweden)

    Eid Essam

    2009-01-01

    Full Text Available Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon′s comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofl uraneor propofol-based total intravenous anesthesia.

  19. Anesthesia for subglottic stenosis in pediatrics.

    Science.gov (United States)

    Eid, Essam A

    2009-07-01

    Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon's comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofluraneor propofol-based total intravenous anesthesia.

  20. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  1. Anesthesia for thoracoscopic surgery

    OpenAIRE

    Conacher I

    2007-01-01

    Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therape...

  2. Anesthesia for the homeless.

    Science.gov (United States)

    Benedict, S; Fehder, W P

    1993-06-01

    Healthcare for the homeless is often crisis-oriented and fragmented. Homelessness may be associated with ongoing healthcare problems such as tuberculosis, human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), and substance abuse. The purpose of this study was to identify the anesthesia services required by homeless individuals from an urban area. The anesthesia records of all individuals (N = 40) identified as being homeless and receiving care at one New York City medical center during a 12-month period were reviewed. Approximately one-half (47.5%) of the 40 patients in the study did not require general anesthesia but intubation only. Most of these intubations were for cardiac/respiratory arrests of unknown cause, drug/alcohol overdose, or multiple trauma. Of the 21 patients requiring surgery, 15 had emergency procedures such as splenectomy, appendectomy, exploratory laparotomy, incarcerated hernia repair, and reduction of fractures. The findings of this study support previous research which indicates that most homeless people enter into care for emergency rather than elective services.

  3. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

    Science.gov (United States)

    Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

    2004-12-01

    Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

  4. A psychological preoperative program: effects on anxiety and cooperative behaviors.

    Science.gov (United States)

    Cuzzocrea, Francesca; Gugliandolo, Maria C; Larcan, Rosalba; Romeo, Carmelo; Turiaco, Nunzio; Dominici, Tiziana

    2013-02-01

    To evaluate the effectiveness of a psychological preoperative program in reducing preoperative anxiety and in promoting compliance of pediatric participants with surgical procedures. Fifty children and their mothers were subjected to two conditions of treatment to investigate whether psychological preparation activities and psychologist's support during all phases of the operatory iter (group 1) were as efficient in reducing mothers' and child's anxiety and in increasing the child's compliance as distraction activities (group 2). The observed child anxiety was assessed using mYPAS; compliant behaviors with Induction Compliance Checklist; and mothers' anxiety with Amsterdam Pre-operative Anxiety and Information Scale. Children of the first group were less anxious and more cooperative in the preoperative period and during anesthesia induction than in the other condition. The psychological program was also more efficient in reducing mothers' anxiety. Finally, the mothers of group 1 showed a significantly higher satisfaction and judged as significantly more effective the program proposed to prepare their children than the mothers of group 2. Preparing children through playful dramatization of the operative procedure, manipulation of medical instruments and psychologist's support may be useful in pediatric surgery structures. © 2013 Blackwell Publishing Ltd.

  5. Safe Anesthesia For Every Tot

    DEFF Research Database (Denmark)

    Weiss, Markus; Vutskits, Laszlo; Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus...... on the safe conduct of pediatric anesthesia. This initiative aims to provide guidance on markers of quality anesthesia care. The introduction and implementation of national regulations of 'who, where, when and how' are required and will result in an improved perioperative outcome in vulnerable children....... The improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps...

  6. Sharing Expertise: Consulting

    Science.gov (United States)

    Graves, Bill

    2011-01-01

    A special breed of superintendents who have developed expertise in a particular area find ways of sharing it in other venues as outside consultants. They pull extra duty to put their special skills into practice, to give back to their communities, to stay current and grounded in the field, or to enhance their professional reputations. They teach…

  7. Management of intra-operative acute pulmonary embolism during general anesthesia: a case report.

    Science.gov (United States)

    Mao, Yuanyuan; Wen, Shuai; Chen, Gezi; Zhang, Wei; Ai, Yanqiu; Yuan, Jingjing

    2017-05-26

    Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in PETCO2 and increase in PaCO2 combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient's family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in PETCO2 and increase in PaCO2 might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis.

  8. [Technical Tips for Spinal Anesthesia].

    Science.gov (United States)

    Shima, Takeshi

    2015-09-01

    Spinal anesthesia is a standard technique for all anesthesiologists and surgeons. This review deals with basic knowledge and tips for spinal anesthesia in an empirical manner. It is important to understand practical knowledge about specific character of each local anesthetic, spread patterns of the anesthetics in the subarachnoid space and relation between anesthesia level and puncture site. This review also introduces tips for subarachnoid puncture and divided administration method of isobaric local anesthetic solution based on the literature. Anesthesiologists and surgeons have to recognize that it is necessary to take enough time to perform precious and optimal spinal anesthesia.

  9. Anesthesia of the geriatric equine

    Directory of Open Access Journals (Sweden)

    Doherty TJ

    2012-08-01

    Full Text Available Reza Seddighi, Thomas J DohertyDepartment of Large Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, University of Tennessee, Knoxville, TN, USAAbstract: Advancements in veterinary medicine have resulted in an increased number of geriatric horses being presented for medical or surgical procedures that require general anesthesia. Due to the physiological changes associated with aging and the likelihood of concurrent disease conditions, the geriatric equine is at an increased risk during anesthesia. The main physiological changes associated with aging, and their impact on anesthesia, are discussed in this review.Keywords: geriatric, equine, anesthesia

  10. Acute Paraplegia After General Anesthesia

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  11. PREDICTORS OF ATTITUDE OF PARTURIENTS SELECTED FOR CESAREAN SECTION TOWARD SPINAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    M.R. Afhami

    2004-11-01

    Full Text Available There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. Statistical programs used were Student’s t test and Chi square for demographic characteristics. The most important factors which influenced patients’ attitude were nausea and vomiting (27%, fear of pain (34%, fear of needle puncture (15% and discomfort during return of sensory and motor functions (6%. Being awake during surgery and witnessing birth of neonate were the most pleasant stages of anesthesia (19%. It seems that providing enough and appropriate information about the procedure at preoperative visit can increase acceptance of this regional anesthetic technique.

  12. Anesthesia - what to ask your doctor - adult

    Science.gov (United States)

    ... the procedure that I am having? General anesthesia Spinal or epidural anesthesia Conscious sedation When do I need to stop ... be sick to my stomach? If I have spinal or epidural anesthesia, will I have a headache afterwards? What if ...

  13. Anesthesia - what to ask your doctor - child

    Science.gov (United States)

    ... procedure that my child is having? General anesthesia Spinal or epidural anesthesia Conscious sedation When does my child need to ... have an upset stomach? If my child had spinal or epidural anesthesia, will my child have a headache afterwards? What ...

  14. Delayed emergence after anesthesia.

    Science.gov (United States)

    Tzabazis, Alexander; Miller, Christopher; Dobrow, Marc F; Zheng, Karl; Brock-Utne, John G

    2015-06-01

    In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  15. [Anesthesia and bodybuilding].

    Science.gov (United States)

    Hokema, Frank; Pietsch, Uta-Carolin; Führer, Dagmar; Kaisers, Udo

    2008-05-01

    A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

  16. Anesthesia for Heart Transplantation.

    Science.gov (United States)

    Ramsingh, Davinder; Harvey, Reed; Runyon, Alec; Benggon, Michael

    2017-09-01

    This article seeks to evaluate current practices in heart transplantation. The goals of this article were to review current practices for heart transplantation and its anesthesia management. The article reviews current demographics and discusses the current criteria for candidacy for heart transplantation. The process for donor and receipt selection is reviewed. This is followed by a review of mechanical circulatory support devices as they pertain to heart transplantation. The preanesthesia and intraoperative considerations are also discussed. Finally, management after transplantation is also reviewed. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  18. Anesthesia for geriatric patients.

    Science.gov (United States)

    Deiner, S; Silverstein, J H

    2011-02-01

    The number of elderly surgical patients will be increasing in Italy. Slowly, anesthesiologists are developing the expertise to care for these patients. The information available to apply to these cases is now the topic of a number of anesthesia textbooks dedicated to the elderly. In this article, we review some of the more recent findings and provide some tips to help guide the care of elderly patients. It is hoped that practitioners will use this information to improve the care of these patients and conduct additional research to further improve care in the future.

  19. Nurse anesthesia and multiculturalism.

    Science.gov (United States)

    Horton, B J; Waugaman, W R

    1996-01-01

    Program directors from 90 accredited nurse anesthesia programs in the United States and Puerto Rico were surveyed concerning multicultural issues. This article summarizes the identified needs of clients and student nurse anesthetists from culturally diverse backgrounds. Noteworthy findings include the perception that clients were more disadvantaged than students because of differences in socioeconomic status; the fact that about half of the programs provided students with instruction on cultural differences; and the observation that specific units of instruction within courses were the most frequent way of giving instruction in this subject area.

  20. Transient neurological symptoms after spinal anesthesia

    National Research Council Canada - National Science Library

    Muhammet Gozdemir; Bunyamin Muslu; Huseyin Sert; Burhanettin Usta; Ruveyda Irem Demircioglu; Hulya Kasikara

    2016-01-01

    ...) after spinal anesthesia with levobupivacaine, bupivacaine, articaine or lidocaine. The patients (n=400) were randomly assigned to receive spinal anesthesia with levobupivacaine, bupivacaine, articaine or isobaric lidocaine...

  1. Mentoring for new consultants.

    Science.gov (United States)

    Ackroyd, R; Adamson, K A

    2015-01-01

    There is increasing evidence of the benefits of having a mentor during the early years as a consultant. Mentoring encourages and provides support to an individual in their professional development. Although there are different forms of mentoring there is recognition that developing a formal mentoring scheme can provide a consistent approach and support within a framework. The Royal College of Physicians of Edinburgh has introduced a mentoring scheme for new consultants that provides a forum for supporting them in their ongoing professional wellbeing. There is potential that the process of mentoring can improve an individual's development, and motivate and encourage them to develop the skills needed to achieve their goals, thus having an impact on ultimately improving their ability to deliver an effective patient-centred service.

  2. Health Consultation in China

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    ONE Sunday morning, I noticed some people gathered at a clearing outside a school in which my family had an apartment. Feeling curious, I joined them to find that some young dentists, wearing their white coats, were offering free consultations for people. They were selling toothbrushes and dental floss at the same time. One of my teeth was bothering me. It always felt odd when I bit something cold. I consulted with a young dentist, who was wearing a pair of glasses. He asked me many questions like when had it begun to hurt, if I felt the pain, how long it had been since I had it filled the previous time. He asked me to open my mouth and checked the tooth carefully. "You should have your

  3. The Process of Psychological Consultation

    Science.gov (United States)

    Nolan, Anna; Moreland, Neil

    2014-01-01

    Consultation is a key means of service delivery in many psychological services. However, the "process" of consultation is little explored in Educational Psychology literature, particularly in the United Kingdom (UK). This paper focuses on a small-scale qualitative research study of psychological consultation provided by educational…

  4. Management Consulting: Planning, Entry, Performance.

    Science.gov (United States)

    Cosier, Richard A.; Dalton, Dan R.

    1993-01-01

    Contends that counseling has much in common with organizational consulting. Provides overview of consulting practices that counselors might find useful should they decide to investigate organizational consulting. Includes aspects of market research, gauging competition, and target markets. Considers promotion, networking, and elements of…

  5. Anesthetic management of minimally invasive intervention in children's oncohematology: preoperative patient management protocol

    Directory of Open Access Journals (Sweden)

    V. V. Shchukin

    2013-01-01

    Full Text Available Preoperative patient management protocol in the complex anesthetic support of minimally invasive interventions in pediatric oncology is described. Choice of general anesthesia method was determined by the specific clinical situation by analyzing all of the following factors: airway management, necessity and anticipated duration of unconsciousness, the need for analgesia, necessity and duration of immobilization, prevention of hypothermia, the presence and severity of disturbances in the hemostatic system, comfort for the child and his representatives (parents. Basic techniques of child preoperative examination, as well as the methodology for predicting the risk of perioperative adverse events are described.

  6. Anesthetic management of minimally invasive intervention in children's oncohematology: preoperative patient management protocol

    Directory of Open Access Journals (Sweden)

    V. V. Shchukin

    2014-07-01

    Full Text Available Preoperative patient management protocol in the complex anesthetic support of minimally invasive interventions in pediatric oncology is described. Choice of general anesthesia method was determined by the specific clinical situation by analyzing all of the following factors: airway management, necessity and anticipated duration of unconsciousness, the need for analgesia, necessity and duration of immobilization, prevention of hypothermia, the presence and severity of disturbances in the hemostatic system, comfort for the child and his representatives (parents. Basic techniques of child preoperative examination, as well as the methodology for predicting the risk of perioperative adverse events are described.

  7. Anesthesia and cor triatriatum

    Directory of Open Access Journals (Sweden)

    Federica Scavonetto

    2014-01-01

    Full Text Available Aims and Objectives: Cor triatriatum sinistrum (CTS and cor triatriatum dextrum (CTD are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative course of patients with CT. Materials and Methods: A computerized search of a medical record database was conducted to identify patients with a clinical diagnosis of uncorrected CTD and CTS undergoing surgical procedures. Descriptive statistics were used. Results: We identified 12 adult patients with asymptomatic CTS (n = 7 and CTD (n = 5 who underwent 23 anesthetics. There were no perioperative complications which could be attributed directly to the anatomy of CT. Conclusions: Our observation and review of the literature suggest that patients with asymptomatic CT typically tolerate anesthesia and surgical procedures well.

  8. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10: individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10: individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20: not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

  9. A SURVEY OF ELECTIVE SURGICAL PATIENTS' ATTITUDES TOWARD ANESTHESIA IN PUMC HOSPITAL

    Institute of Scientific and Technical Information of China (English)

    黄宇光; 杨克勤; 任洪智; 罗爱伦

    2002-01-01

    Objective.To assess patients' knowledge,attitudes,and concerns regarding anesthetic management.Method.A survey of 55 items was developed and administered preoperatively to 500 patients including 190 men and 310 women in our hospital.Patients were interviewed on their knowledge of the role of anesthesiologists,their preferences regarding anesthetic management,and also their concern about potential anesthetic complications.Results.Patients' perceptions of anesthesiologists' training and role have reached a certain level.Most significant preoperative concerns regarding the anesthesiologists focused on experience,qualifications,and presence or absence during the anesthesia.Patients' concerns also included the possibility of not being waken up following anesthesia,experiencing postoperative pain,and becoming paralyzed.The variations of concerns depended partially on patients' sex,type of anesthesia,and proposed surgical procedure,partially on their education and living environments.Conclusion.It is suggested that anesthesiologists address significant patient concerns during the preoperative visit to enhance their effectiveness in patient care.Efforts to educate the public on the anesthesiologists' role in preoperative care would improve patients' confidence.

  10. Preoperative alcoholism and postoperative morbidity

    DEFF Research Database (Denmark)

    Tonnesen, H; Kehlet, H

    1999-01-01

    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  11. Congenital supravalvular aortic stenosis and sudden death associated with anesthesia: what's the mystery?

    Science.gov (United States)

    Burch, Thomas M; McGowan, Francis X; Kussman, Barry D; Powell, Andrew J; DiNardo, James A

    2008-12-01

    Patients with congenital supravalvular aortic stenosis and associated peripheral pulmonary artery stenoses, the majority of whom have Williams-Beuren syndrome, are inherently at risk for development of myocardial ischemia. This is particularly true in the setting of procedural sedation and anesthesia. The biventricular hypertrophy that accompanies these lesions increases myocardial oxygen consumption and compromises oxygen delivery. In addition, these patients often have direct, multifactorial compromise of coronary blood flow. In this article, we review both the pathophysiology of congenital supravalvular aortic stenosis and the literature regarding sudden death in association with sedation and anesthesia. Recommendations as to preoperative assessment and management of these patients are made based on the best available evidence.

  12. [Progress in ambulatory anesthesia applied to gynecological surgery].

    Science.gov (United States)

    Rascol, N; Schneider, E; Gindre, G; Schoeffler, P

    2006-05-01

    Ambulatory gynecological surgery enables fast recovery of vital functions, ambulation and a relational life of quality. Patients whose disease is well-controlled at the anesthesia consultation can benefit from ambulatory procedures. Improved material and surgical practices broaden potential indications, limiting the risk of postoperative pain which can be controlled with simple analgesic protocols. The choice of the anesthesic techniques or the agents used during the intervention ensures fast recovery of higher functions. Nausea and vomiting, which may develop after returning home and compromise oral drug intake, must be prevented. More ambulatory gynecological procedures can be expected in the near future, pointing out the importance of developing more adapted medical structures.

  13. Consulting in Electronic Commerce

    Directory of Open Access Journals (Sweden)

    Florentina Loredana Tache

    2010-10-01

    Full Text Available Economic development of electronic services provide advice and many agents of existingreferral systems to recommend and provide products, information and customized views of thecommunity through a personalized interaction in real time. Distributed systems of autonomous agentsare becoming increasingly important in electronic comet because the basic decisions of agents adviceon trust and reputation are taken in a similar way human society. If these decisions will be as a realconsumer protection, when new aspects of online consumer legislation will become usefulinformation in advice and consulting of electronic commerce.

  14. [Non-verbal communication of patients submitted to heart surgery: from awaking after anesthesia to extubation].

    Science.gov (United States)

    Werlang, Sueli da Cruz; Azzolin, Karina; Moraes, Maria Antonieta; de Souza, Emiliane Nogueira

    2008-12-01

    Preoperative orientation is an essential tool for patient's communication after surgery. This study had the objective of evaluating non-verbal communication of patients submitted to cardiac surgery from the time of awaking from anesthesia until extubation, after having received preoperative orientation by nurses. A quantitative cross-sectional study was developed in a reference hospital of the state of Rio Grande do Sul, Brazil, from March to July 2006. Data were collected in the pre and post operative periods. A questionnaire to evaluate non-verbal communication on awaking from sedation was applied to a sample of 100 patients. Statistical analysis included Student, Wilcoxon, and Mann Whittney tests. Most of the patients responded satisfactorily to non-verbal communication strategies as instructed on the preoperative orientation. Thus, non-verbal communication based on preoperative orientation was helpful during the awaking period.

  15. Pre-use anesthesia machine check; certified anesthesia technician based quality improvement audit

    Science.gov (United States)

    Al Suhaibani, Mazen; Al Malki, Assaf; Al Dosary, Saad; Al Barmawi, Hanan; Pogoku, Mahdhav

    2014-01-01

    Context: Quality assurance of providing a work ready machine in multiple theatre operating rooms in a tertiary modern medical center in Riyadh. Aims: The aim of the following study is to keep high quality environment for workers and patients in surgical operating rooms. Settings and Design: Technicians based audit by using key performance indicators to assure inspection, passing test of machine worthiness for use daily and in between cases and in case of unexpected failure to provide quick replacement by ready to use another anesthetic machine. Materials and Methods: The anesthetic machines in all operating rooms are daily and continuously inspected and passed as ready by technicians and verified by anesthesiologist consultant or assistant consultant. The daily records of each machines were collected then inspected for data analysis by quality improvement committee department for descriptive analysis and report the degree of staff compliance to daily inspection as “met” items. Replaced machine during use and overall compliance. Statistical Analysis Used: Distractive statistic using Microsoft Excel 2003 tables and graphs of sums and percentages of item studied in this audit. Results: Audit obtained highest compliance percentage and low rate of replacement of machine which indicate unexpected machine state of use and quick machine switch. Conclusions: The authors are able to conclude that following regular inspection and running self-check recommended by the manufacturers can contribute to abort any possibility of hazard of anesthesia machine failure during operation. Furthermore in case of unexpected reason to replace the anesthesia machine in quick maneuver contributes to high assured operative utilization of man machine inter-phase in modern surgical operating rooms. PMID:25886335

  16. Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults

    Directory of Open Access Journals (Sweden)

    Charles M. Giattino

    2017-05-01

    Full Text Available Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD. Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD. Delirium and POCD risk are increased in patients with lower preoperative cognitive function, yet preoperative cognitive function is not routinely assessed, and no intraoperative physiological predictors have been found that correlate with lower preoperative cognitive function. Since general anesthesia causes alpha-band (8–12 Hz electroencephalogram (EEG power to decrease occipitally and increase frontally (known as “anteriorization”, and anesthetic-induced frontal alpha power is reduced in older adults, we hypothesized that lower intraoperative frontal alpha power might correlate with lower preoperative cognitive function. Here, we provide evidence that such a correlation exists, suggesting that lower intraoperative frontal alpha power could be used as a physiological marker to identify older adults with lower preoperative cognitive function. Lower intraoperative frontal alpha power could thus be used to target these at-risk patients for possible therapeutic interventions to help prevent postoperative delirium and POCD, or for increased postoperative monitoring and follow-up. More generally, these results suggest that understanding interindividual differences in how the brain responds to anesthetic drugs can be used as a probe of neurocognitive function (and dysfunction, and might be a useful measure of neurocognitive function in older adults.

  17. 임상연구 : 수술과 마취의 정보를 알고 싶어 하는 욕구는 Amsterdam preoperative Anxiety Information Scale에 의한 환자의 기질분류에 따라 차이가 있는가?

    National Research Council Canada - National Science Library

    김영선; Young Sun Kim; 신우종; Woo Jong Shin; 신중천; Joong Cheon Shin; 심재항; Jae Hang Shim; 전우재; Woo Jae Jeon; 조상윤; Sang Yoon Cho; 염종훈; Jong Hoon Yeom; 김경헌; Kyoung Hun Kim

    2007-01-01

    .... This study examined whether or not patients` desire for information related to anesthesia and surgery differ according to their coping style classified by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Methods...

  18. Propofol Anesthesia-Induced Seizures

    OpenAIRE

    J Gordon Millichap

    1994-01-01

    A case of a healthy young man who developed seizures and generalized paroxysmal fast activity in the EEG following use of propofol for anesthesia in minor surgery is reported from the Department of Neurology, University of South Alabama, Mobile, AL.

  19. [Regional anesthesia and cancer immunology].

    Science.gov (United States)

    Igarashi, Toru; Mori, Katsuya; Inoue, Kei; Suzuki, Takeshi; Morisaki, Hiroshi

    2013-09-01

    Regional anesthesia has been widely applied as an excellent method for perioperative analgesia. Recent studies suggested that regional anesthesia is a promising approach to minimize the risk of surgical site infection and postoperative cancer recurrence, subsequently providing the benefits to the long-term outcome. In particular, it is of great interest that regional anesthesia might be able to reduce cancer recurrence. In cancer patients, innate immunity against cancer could be depressed, resulting in the predisposition to evoke metastasis. Besides, during the perioperative periods, tumor immunity is significantly depressed due to surgical pain, activation of sympathetic nervous system, inflammatory responses, and others. In this review article, we discuss the tumor immunity during the perioperative period, with focus on the alterations of tumor immunity and regional anesthesia.

  20. Transverse myelitis following spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Jha Sanjeev

    2006-01-01

    Full Text Available Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.

  1. THE TRAINING AND UTILIZATION OF CHILD BEHAVIOR CONSULTANTS IN THE SCHOOLS. FINAL REPORT.

    Science.gov (United States)

    Erie County Board of Cooperative Educational Services, Buffalo, NY.

    THE PURPOSE OF THIS REPORT IS TO EVALUATE THE OBJECTIVES AND PRE-OPERATIONAL TRAINING OF A PROGRAM DESIGNED TO PROVIDE CHILD BEHAVIOR CONSULTANTS (CBCS) FOR SCHOOLS. THE EVALUATION IS BASED ON QUESTIONNAIRE DATA, CASE STUDIES, AND INTERVIEWS WITH TEACHERS AND STUDENTS. WHETHER THERE WERE ACTUAL PERSONALITY DIFFERENCES BETWEEN STUDENTS WHO WERE…

  2. Anesthesia and thyroid surgery: The never ending challenges

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2013-01-01

    Full Text Available Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease.

  3. Anesthesia and thyroid surgery: The never ending challenges

    Science.gov (United States)

    Bajwa, Sukhminder Jit Singh; Sehgal, Vishal

    2013-01-01

    Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease. PMID:23776893

  4. Psychological aspects of pediatric anesthesia

    OpenAIRE

    Drašković Biljana; Simin Jovana M.; Kvrgić Ivana M.

    2015-01-01

    Surgery and anesthesia cause a significant emotional stress in both parents and children. Since the consequences of this stress develop immediately after surgery and can last even when the hospital treatment is over, the role of the anesthesiologist is to ensure psychological as well as physiological well-being of the patient. In order to reduce emotional stress induced by anesthesia and operation, the anesthesiologist has to understand certain developmenta...

  5. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles.......The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  6. Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study.

    Science.gov (United States)

    Sitilci, T; Demirgan, S; Akcay, C; Kahraman, N; Koseoglu, B G; Erdem, M A; Cankaya, A B

    2017-04-01

    We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following categories: Demographic features, American Society of Anesthesiologists (ASA) classification, Mallampati score, type of anesthetic drug used during the operation, type of intubation used, any difficulties with tracheal intubation, presence of systemic diseases, and recovery times after ending general anesthesia. A total of 348 patients were selected from the Department of Maxillofacial Surgery and the Department of Pedodontics who underwent surgery with general anesthesia. Medical histories of all patients were taken, and their electrocardiography, chest X-rays, complete blood count, and blood clotting tests were checked during a preoperative assessment. Mallampati evaluations were also performed. Patients were grouped into ASA I, II, or III according to the ASA classification and were treated under general anesthesia. There was no significant difference between normal and intellectually disabled patients in terms of gender, Mallampati scores, intubation difficulties, mean anesthetic period, time to discharge, or postoperative nausea and vomiting. Epilepsy and genetic diseases in intellectually disabled patients were significantly more common than in non-ID (NID) patients. However, the frequency of diabetes and chronic obstructive pulmonary disease in NID patients was significantly higher than in the intellectually disabled patients. Dental treatment of intellectually disabled patients under general anesthesia can be performed just as safely as that with NID patients.

  7. Medical diagnoses of pediatric dental patients treated under general anesthesia: a 19 year review.

    Science.gov (United States)

    Roberts, Michael W; Milano, Michael; Lee, Jessica Y

    2009-01-01

    The objective of this study was to examine the records of pediatric dental patients treated under general anesthesia to determine if there had been any significant change in preoperative diagnoses between 1990-99 and 2000-08. The records of 3298 pediatric dental patients treated in the operating room under general anesthesia at the University of North Carolina (UNC) Children's Hospital were examined and medical diagnoses recorded. The number of cases treated by calendar year was obtained. The results of this study did not find any significant differences in percentage frequency of medical diagnoses between the years of 1990-99 and 2000-08. There has been a steady increase in the number of cases treated under general anesthesia over the period of the study. 1. Dental care under general anesthesia remains an important treatment option. 2. The medical diagnoses of children provided dental treatment under general anesthesia has not changed significantly over the past nineteen years at the UNC Children's Hospital. 3. The demand to provide dental care for children under general anesthesia has continued to increase.

  8. Comparing the organisational structure of the preoperative assessment clinic at eight university hospitals.

    Science.gov (United States)

    Edward, G M; Biervliet, J D; Hollmann, M W; Schlack, W S; Preckel, B

    2008-01-01

    The preoperative assessment clinic (PAC) has been implemented in most major hospitals. However, there is no uniformity in the way PACs are organised. We compared the organisational structure of the PACs from all eight university hospitals in The Netherlands, looking at the following variables: number of patients visiting the PAC, staffing of the PAC, opening hours, scheduling, and additional preoperative diagnostic testing. The number of patients seen yearly varies from 7.000 to 13.500. In all clinics, the preoperative assessment was performed by anaesthetists and residents. In five PACs, preoperative assessment was also performed by physician assistants or nurse practitioners. Opening hours varied. Consultations are by appointment, 'walk-in', or a combination of these two. In four clinics additional testing is performed at the PAC itself. This study shows that the organisational structure of the PAC at similar university hospitals varies greatly; this can have important implications when designing a benchmarking process.

  9. Epistemics in audiological consultations

    DEFF Research Database (Denmark)

    Egbert, Maria

    ' subjective descriptions of hearing experiences in different environments. In these consultations, the institutional conceptualization of hearing (and thus of hearing loss) is that of an objectively measurable functioning of the ear, categorized in an audiogram by decibels and hertz. In contrast, persons......, broad, and metaphorical. Compared to visual impairment, describing hearing seems to be more difficult, and frequently, persons with hearing impairment resort to visual metaphors. A CA examination of conversational order in the areas of turn-taking, sequence, repair, topic, multimodality, and linguistic...... at the micro-level of direct healthcare encounters to the macro-level and globel problems of the impact of untreated hearing loss. The social repercussions are stigmatization, miscommunication, loss of work, social isolation, depression, and suicide (Carmen 2001). The financial loss per person dropping out...

  10. Consciousness fluctuation during general anesthesia: a theoretical approach to anesthesia awareness and memory modulation.

    Science.gov (United States)

    Cascella, Marco; Schiavone, Vincenzo; Muzio, Maria Rosaria; Cuomo, Arturo

    2016-08-01

    With anesthesia awareness as a model of study we debate the both fascinating and dangerous phenomenon called consciousness fluctuation that takes place during surgical anesthesia. In accordance with current scientific knowledge this paradox is the consequence of our limits in both precise knowledge of anesthesia mechanisms and our inability to accurately assess the level of anesthesia with brain monitoring. We also focus on the relationships between memory and anesthesia, as well as the possibility of interfering with memory during general anesthesia.

  11. [Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal].

    Science.gov (United States)

    Lobo, Mercês; Mourão, Joana; Afonso, Graça

    2015-01-01

    Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results. Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality) in a tertiary center in Portugal and review the literature. Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation. A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregianal anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding perioperative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference. We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  12. Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal.

    Science.gov (United States)

    Lobo, Mercês; Mourão, Joana; Afonso, Graça

    2015-01-01

    Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results. Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality) in a tertiary center in Portugal and review the literature. Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation. A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference. We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal

    Directory of Open Access Journals (Sweden)

    Mercês Lobo

    2015-08-01

    Full Text Available BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality in a tertiary center in Portugal and review the literature.METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

  14. The Effect of the Kampo Medicine Yokukansan on Preoperative Anxiety and Sedation Levels

    Directory of Open Access Journals (Sweden)

    Young-Chang Arai

    2014-01-01

    Full Text Available Background. Preoperative anxiety can lead to unfavorable physiological response such as tachycardia and hypertension. Prevention of preoperative anxiety improves surgical outcome and decreases inpatient stay. Yokukansan is one of prescriptions in Kampo, traditional Japanese herbal medicine, and is known to exert anxiolytic effects. The aim of the present study was to compare the effects of diazepam and Yokukansan on preoperative anxiety, salivary amylase activity, and sedation levels. Methods. Seventy American Society of Anesthesiologists physical status I or II patients presenting for hemicolectomy under general anesthesia combined with epidural anesthesia were enrolled. The Diazepam group received diazepam 5 mg orally and the Yokukansan group received Yokukansan 2.5 g orally. Results. Although levels of anxiety and salivary amylase activity were not different between the two groups, the modified Observer’s Assessment of Alertness/Sedation Scale of the Yokukansan group was significantly higher compared to that of the Diazepam group. Conclusion. Yokukansan alleviated preoperative anxiety without undesirable sedation, when compared with diazepam.

  15. The effect of a preoperative education programme on perioperative anxiety in children: an observational study.

    Science.gov (United States)

    Rice, Mariam; Glasper, Alan; Keeton, Diana; Spargo, Paul

    2008-05-01

    The distress of children at the induction of anesthesia (DAI) is unpleasant for all involved and potentially harmful. Many strategies such as premedication or parental presence at induction have been described to minimize it. A preoperative education programme [the 'Saturday Morning Club' or (SMC)] has been in existence in our institution for a number of years and an observational study of children undergoing day case surgery was undertaken to assess the influence of attendance at the SMC on DAI. Ninety-four children aged between 2 and 16 years of age were included in the study; 21 attended the SMC and 73 did not. Patient anxiety using the modified Yale Preoperative Anxiety Scale was measured by blinded observers on the day ward, in the preoperative waiting room and at induction of anesthesia. Parental anxiety at the same locations was self reported using a visual analogue scale. Attendance at the SMC had a favorable effect on patient anxiety levels in all three locations but only reached statistical significance in the waiting room (P = 0.007, Mann-Whitney U-test). At present there is little evidence to support the use of preoperative education programmes in the UK and further studies are required to determine their benefit.

  16. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2014-01-01

    : Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS: The review authors......BACKGROUND: Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES: The objectives of this review...... are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA...

  17. Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Christopher C .C. Hudson

    2014-01-01

    Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

  18. Responsive Systems Consultation: A Model for Conjoint Consultation Preliminary Results.

    Science.gov (United States)

    Prasad-Gaur, Archna; And Others

    Responsive Systems Consultation (RSC) is an approach for enhancing children's developmental outcomes and involves a psychological or educational consultant working jointly with a child's parents and teachers. The impact of the RSC on parent and teacher consultees' attitudes toward home-school collaboration and their evaluation of the consultation…

  19. Educating Consultants for Multicultural Practice of Consultee-Centered Consultation

    Science.gov (United States)

    Ingraham, Colette L.

    2017-01-01

    Literature about educating consultants with knowledge, skills, and dispositions to work effectively within culturally and linguistically diverse schools is scarce. Research suggests that additional attention is needed on the preparation of consultants to practice with multicultural competence. This article reviews theories and research and…

  20. Preoperative staging of rectal cancer.

    Science.gov (United States)

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  1. Prolonged muscle weakness following general anesthesia in a parturient on combined antiretroviral therapy--a case report.

    Science.gov (United States)

    Mathew, Jotish; Maddali, Madan Mohan; Fahr, Jutta

    2007-10-01

    We report a case of an otherwise healthy; ambulatory 32 year old parturient on combined antiretroviral therapy that developed prolonged muscle weakness needing postoperative artificial ventilation. Despite no preoperative indication of muscle weakness, she developed respiratory insufficiency following general anesthesia with drugs that are deemed safe for her condition. After ruling out all the likely causes for her respiratory insufficiency that needed 12 hrs of artificial ventilation, we address the issue of undiagnosed preoperative muscle weakness as a likely cause for her problem. The role of a preoperative neurological evaluation to caution the anesthesiologist of the likelihood of a possible need for prolonged artificial ventilation following general anesthesia in this subgroup of patients, emphasized.

  2. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases.

    Science.gov (United States)

    Hung, Ming-Hui; Chan, Kuang-Cheng; Liu, Ying-Ju; Hsu, Hsao-Hsun; Chen, Ke-Cheng; Cheng, Ya-Jung; Chen, Jin-Shing

    2015-04-01

    Intubated general anesthesia with single-lung ventilation has been considered mandatory for thoracoscopic lobectomy for nonsmall cell lung cancer. Few reports of thoracoscopic lobectomy without tracheal intubation are published, using either thoracic epidural anesthesia (TEA) or intercostal blockade. The comparisons of perioperative outcomes of nonintubated thoracoscopic lobectomy using epidural anesthesia and intercostal blockade are not reported previously. From September 2009 to August 2014, a total of 238 patients with lung cancer who underwent nonintubated thoracoscopic lobectomy were recruited from our prospectively maintained database of all patients undergoing nonintubated thoracoscopic surgery using TEA or intercostal blockade. A multiple regression analysis, adjusting for preoperative variables, was performed to compare the perioperative outcomes of the 2 anesthesia methods. Overall, 130 patients underwent nonintubated thoracoscopic lobectomy using epidural anesthesia whereas 108 had intercostal blockade. The 2 groups were similar in demographic data, except for sex, preoperative lung function, physical status classification, and history of smoking. After adjustment for the preoperative variables, nonintubated thoracoscopic lobectomy using intercostal blockade was associated with shorter durations of anesthetic induction and surgery (P intercostal blockade group had a shorter average duration of chest tube drainage (P = 0.064) but a similar average length of hospital stay (P = 0.569). Conversion to tracheal intubation was required in 13 patients (5.5%), and no in-hospital mortality occurred in either group. Nonintubated thoracoscopic lobectomy using either epidural anesthesia or intercostal blockade is feasible and safe. Intercostal blockade is a simpler alternative to epidural anesthesia for nonintubated thoracoscopic lobectomy in selected patients with lung cancer.

  3. Incidence and outcomes of intraoperative vascular surgery consultations.

    Science.gov (United States)

    Danczyk, Rachel C; Coleman, Jake; Allensworth, Jordan; Azarbal, Amir F; Mitchell, Erica L; Liem, Timothy K; Landry, Gregory J; Moneta, Gregory L

    2015-07-01

    Vascular surgeons may aid in primarily nonvascular procedures. Such activity has not been quantified, and hospital administrators may be unaware of the importance of vascular surgeons to support other hospital-based surgical programs. This study reviewed intraoperative consultations by vascular surgeons to support other surgical services. Intraoperative vascular consultations were reviewed from January 2006 to January 2014 for consulting service, indication, and whether consultation occurred with advanced notice. Patient demographics, operative times, estimated blood loss, length of stay, and relative value units (RVUs) assigned for each consultation were also assessed. Consultations for trauma and iatrogenic injuries occurring outside the operating theater were excluded. Vascular surgeons performed 225 intraoperative consultations in support of procedures by nonvascular surgeons. Requesting services were surgical oncology (46%), orthopedics (17%), urology (11%), otolaryngology (7%), and others (19%). Reasons for consultation overlapped and included vascular reconstruction (53%), control of hemorrhage (39%), and assistance with difficult dissections (43%). Seventy-four percent were for intra-abdominal procedures, and venous (53%) and arterial (50%) problems were encountered equally with some overlap. Most patients were male (59%), overweight (56%; body mass index ≥25 kg/m(2)), had previous surgery (72%) and were undergoing elective procedures (89%). Mean total procedural anesthesia time was 9.4 hours, mean procedural operating time was 7.9 hours, and mean total and vascular-related estimated blood loss was 1702 mL and 327 mL, respectively. Mean length of stay was 14.7 days, mean intensive care unit stay was 2.9 days, and 30-day mortality was 6.2%. Mean nonvascular RVUs per operation were 46.0, and mean vascular RVUs per operation were 30.9. Unexpected intraoperative need for vascular surgical expertise occurs often enough that vascular surgeons should be regarded

  4. Validity and Reliability of the Czech Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

    Science.gov (United States)

    Zeleníková, Renáta; Homzová, Pavlína; Homza, Miroslav; Bužgová, Radka

    2017-10-01

    The purpose of this study was to validate the Czech version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in adult patients undergoing elective surgery. A cross-sectional study. Data were collected from July 2012 to January 2013. For reliability and validity testing, two instruments measuring preoperative anxiety were administered to the participants on the same occasion, (APAIS and the Spielberg State Anxiety Inventory (STAI-S)). The sample consisted of 344 patients undergoing elective surgery. Reliability of APAIS anxiety subscale measured by Cronbach's alpha was 0.91. Reliability of APAIS information subscale measured by Cronbach's alpha was 0.78. The APAIS anxiety subscale correlated significantly with the STAI-S (0.69). Women scored significantly higher on anxiety scales than men. APAIS may be a useful tool to measure preoperative anxiety in Czech patients undergoing elective surgery. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  5. National survey of pediatric anesthesia practice in Thailand.

    Science.gov (United States)

    Suraseranivongse, Suwannee; Attachoo, Anchalee; Leelanukrom, Ruenreong; Chareonsawan, Usa; Horatanaruang, Duenpen

    2011-04-01

    To assess current pediatric anesthesia practice for further education from Royal College of Anesthesiologists of Thailand. A questionnaire was sent to 500 anesthetists in public hospitals in January 2010 to investigate preoperative data, intraoperative data, postoperative pain management, ambulatory anesthesia, and pediatric anesthesia training requirement. Response rate was 30.6%. Preoperative fasting and infective endocarditis (IE) prophylaxis were appropriate except that half the anesthesiologists preferred giving antibiotics in non-cyanotic heart diseases and ordering complete blood count as a routine investigation in healthy patients undergoing minor surgery. Premedication was preferred in children and adolescents. Parental presence during induction was most often selected in children (74.5%). Modified Ayre T-piece was the most popular breathing circuit used during induction while circle circuit was more likely used during maintenance period. Manual ventilation was preferred in neonates. Scavenging system was rarely used Intraoperative fluid was given based on Holliday & Segar Law (> 90%). Isotonic fluid without glucose was preferred for replacement of third space loss and hypotonic fluid with glucose was preferred for maintenance fluid. Transfusion trigger was inversely correlated with age. Postoperative pain scales were more often used in children and adolescents. Fentanyl was more popular in younger age group. Intermittent intravenous administration was the most preferred route. Age group of infants and older were predominantly accepted to be anaesthetized on an ambulatory basis. Pediatric advanced life support was seldom performed. Intermittent training was more popular than certified fellowship training. Routine investigation in healthy patients, IE prophylaxis in non-cyanotic patients, intraoperative fluid replacement, and pediatric advanced life support and postoperative pain management were the issues recommended for further education.

  6. Adenotomy under general anesthesia.

    Science.gov (United States)

    Vokurka, J; Jakoubková, S; Vít, Z; Drahokoupilová, M

    1989-01-01

    Experience obtained from adenotomy (AT) under general anesthesia using Ketamin hydrochloride (Ketalar, Narkamon) in children are presented in this paper. The authors had used intramuscular premedication with Prothazin, Dolsin and Atropin at the first stage, then they shifted to oral administration of a combination of Diazepam, Theadryl and Atropin. Ketamin may be applied intravenously in the dosage of 1.0 to 1.5 mg/kg of body weight in most children. Where it is not possible, a triple dose into the muscle is used. A total of 2,266 AT were performed. About 70% of patients were calm during the operation, once a suspected aspiration was considered but it was not confirmed. The main contribution of the method is 100% amnesia of the surgery made. The procedure is a compromise between a requirement for minimal traumatization of the child's psyche by the intervention and the resources available, particularly the need of personnel at the majority of otorhinolaryngo-logical departments nowadays.

  7. [What preoperative information do the parents of children undergoing surgery want?].

    Science.gov (United States)

    Sartori, Josefina; Espinoza, Pilar; Díaz, María Soledad; Ferdinand, Constanza; Lacassie, Héctor J; González, Alejandro

    2015-01-01

    Parents feel fear and anxiety before surgery is performed on their child, and those feelings could obstruct their preparation for the surgery. Preoperative information could relieve those feelings. To determine the preoperative information needs of parents of children undergoing elective surgery. A study was conducted on the parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used. Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anaesthesia, surgery, preoperative fasting, drugs and anaesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalisation room, recovery room, and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours. Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Ambulatory Anesthesia in an Adult Patient with Corrected Hypoplastic Left Heart Syndrome

    Directory of Open Access Journals (Sweden)

    Jennifer Knautz

    2012-01-01

    congenital heart defects are surviving into adulthood and presenting for noncardiac surgeries. We describe one such example of a 26-year-old patient with corrected hypoplastic left heart syndrome presenting for knee arthroscopy and performed under general anesthesia with preoperative ultrasound guided saphenous nerve block. In this case, we review the anesthetic implications of corrected single ventricle physiology, anesthetic implications, as well as discuss the technique and role of saphenous nerve block in patients undergoing knee arthroscopy.

  9. 全麻查眼底患儿家属术前焦虑状态及护理需求的调查%Investigation on family members' pre-operative anxiety and nursing demands before eye-ground examination under general anesthesia in sick-children

    Institute of Scientific and Technical Information of China (English)

    闫建辉; 李岩; 庞冬

    2011-01-01

    目的 了解全麻查眼底患儿家属的焦虑状况及对护理工作的需求,分析与焦虑有关的因素.方法 采用状态-特质焦虑量表和自行设计的调查问卷,对82例已诊或拟诊视网膜母细胞瘤的患儿家属在术前1d进行调查.结果 患儿家属状态焦虑、特质焦虑得分均高于常模(男性:t=7.826,P<0.01;女性:t=15.278,P<0.01),其状态焦虑主要与患儿家属的性别、手术时与患儿的暂时性分离、担心此次入院疗效不佳等因素有关(P<0.05);特质焦虑主要与患儿的化疗史、全麻查眼底手术史以及手术时与患儿的暂时性分离有关(P<0.05).家长对护理工作的需求中减轻患儿恐惧占72.0%、护理技术过硬占70.7%、态度和蔼占64.6%、普及疾病知识占48.8%等.结论 患者家属的焦虑情况与多种因素有关,应该针对患儿及其家属的特点进行护理,根据其对护理工作的需求为其及患儿提供相应的护理措施,降低患儿家属的焦虑程度,确保患儿在最佳状态下进行手术.%Objective To investigate family members' anxiety status and nursing demands and analyze the related factors.Methods Anxiety level and nursing demands of 82 family members were investigated by nurses with self-designed Strate-Trait Anxiety Inventory and the questionnaires one day before eye-ground examination for children with retinoblastoma.Results State anxiety and trait anxiety scores of family members were higher than those of general population model (Male:t=7.826,P<0.01; Female:t=15.278,P<0.01). The state anxiety was related to family member gender, temporal separation from RB children during the operation and worrying about this time's therapy outcome (P<0.05); while the trait anxiety was mainly related to chemotherapy history, temporal separation from RB children during the operation and history of eye-ground examination under general anesthesia (P<0.05). Nursing demands included RB children terror alleviation (72.0%), good

  10. Mafutsuto-Ron: The First Anesthesia Textbook in the World. Bibliographic Review and English Translation.

    Science.gov (United States)

    Dote, Kentaro; Ikemune, Keizo; Desaki, Yoko; Yorozuya, Tosihiro; Makino, Hiroshi

    2015-10-01

    On October 13, 1804, Seishu Hanaoka performed a mastectomy on Kan Aiya in Hirayama, Kii Province Japan, in what is considered to be the first operation under general anesthesia. She was anesthetized with a mixture of herbs known as Mafutsuto. Although Seishu did not record his anesthetic practices, his student, Gendai Kamada, documented the use of Mafutsuto in Mafutsuto-Ron. Written in 1839, Mafutsuto-Ron is 10 pages and covers six topics, including preoperative management, dosing and administering Mafutsuto, induction of general anesthesia, common errors, and postoperative precautions. Mafutsuto-Ron, therefore, meets the requirements to be considered the first extant anesthesia textbook. We present a complete English translation of Mafutsuto-Ron.

  11. [Anesthesia in thymectomy. Experience with 115 cases].

    Science.gov (United States)

    Villani, A; Primieri, P; Adducci, G; Mennella, M; Lattanzi, A; De Cosmo, G

    1993-03-01

    The authors have conducted a retrospective study on 115 patients with myasthenia gravis undergoing transsternal or transcervical thymectomy at the Policlinico A. Gemelli of Rome in the period June 1984- to June 1991. A prolonged postoperative mechanical ventilation immediately and a few days following surgery was required respectively in 7 and 3 patients, while atelectasia and broncopneumonia have developed in 10 patients. No relationship could be established between the incidence of respiratory complications and factors such as preoperative symptomatology and treatment anesthetic agents, the surgical approach to the thymus and thymic pathology. However a significantly greater postoperative morbidity has been observed in the group of patients receiving suxametonium as compared to the patients receiving non-depolarizing muscle relaxants. Vecuronium and atracurium very frequently allowed ad adequate resumption of spontaneous respiration after anesthesia and made possible a safe early extubation of patients before leaving the operating room. The authors also stressed that all patients, irrespective of their clinical conditions, must be transferred after thymectomy. Oto the surgical ICU where anticholinesterase therapy can be safely restarted and cardiorespiratory status carefully monitored.

  12. Advanced training of tax consultants

    Directory of Open Access Journals (Sweden)

    Adigamova Farida F.

    2016-01-01

    Full Text Available The purpose of the research is to review and analyze the data on the necessity to provide an educational environment for training and advanced training of tax consultants in Russia. The article considers the types of tax consulting, the historical background of training financiers in Russia, as well as identifies conditions determining the significance of tax consulting. The research establishes the connection between the negative attitude to tax payment and tax evasion. The advanced training of tax consultants should be a continuous process as they need to take into account both external and internal taxpayers risks associated with the development of law and law-enforcement practice. Obviously, the training of tax consultants should take into account the experience of developed foreign countries, such as Germany, Austria, Czech Republic, Slovakia and other European countries as well. In Russia, it is necessary to open educational institutions, which will not only be involved in the certification of tax consultants, but also provide training courses. These courses should contribute to constant increase of tax consultants knowledge, consider the tax treatment of economic activities, as well changes in the legislation, economics, finance, accounting, manufacturing processes, which will improve the quality of services provided by tax consultants.

  13. The transition to hospital consultant

    DEFF Research Database (Denmark)

    Westerman, Michiel; Teunissen, Pim W.; Jorgensen, Rasmus Lundhus

    2013-01-01

    Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic comp...... competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored....

  14. Reduced fasting time improves comfort and satisfaction of elderly patients undergoing anesthesia for hip fracture

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Patient's satisfaction is a standard indicator of care quality. The aim of this study was to evaluate whether a preoperative oral ingestion of 200 mL of a carbohydrate drink can improve comfort and satisfaction with anesthesia in elderly patients with hip fracture. METHOD: Prospective randomized clinical trial conducted in a Brazilian public hospital, with patients ASA I-III undergoing surgery for hip fracture. The control group (NPO received nothing by mouth after 9:00 p.m. the night before, while patients in the experimental group (CHO received 200 mL of a carbohydrate drink 2-4 h before the operation. Patients' characteristics, subjective perceptions, thirst and hunger and satisfaction were determined in four steps. Mann-Whitney U-test and Fisher exact test were used for comparison of control and experimental groups. A p-value <0.05 was considered significant. RESULTS: A total of 100 patients were included in one of the two regimens of preoperative fasting. Fasting time decreased significantly in the study group. Patients drank 200 mL 2:59 h before surgery and showed no hunger (p < 0.00 and thirst on arrival to OR (p < 0.00, resulting in increased satisfaction with the perioperative anesthesia care (p < 0.00. CONCLUSIONS: The satisfaction questionnaire for surgical patient could become a useful tool in assessing the quality of care. In conclusion, CHO significantly reduces preoperative discomfort and increases satisfaction with anesthesia care.

  15. Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia.

    Science.gov (United States)

    Wang, Jinguo; Li, Hongqin; Ma, Haichun; Wang, Na

    2016-01-01

    Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

  16. CURBSIDE CONSULTATION IN KNEE ARTHROPLASTY: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Craig J. Della Vale

    2008-12-01

    Full Text Available A user- friendly reference for decision making in complicated cases of knee arthroplasty desingned in a question and answers format composed of articles containing current concepts and preferences of experts in total knee replacement surgery, enhanced by several images, diagrams and references and written in the form of a casual advice by Craig J. Della Vale, MD. and his collaborators. PURPOSE By this practical reference of knee arthroplasty, the editor and the contributors have aimed providing straightforward and brief answers, evidence-based advices, their preference and opinions containing current concepts for unanswered questions about complicated cases in total knee replacement surgery which are often controversial and not addressed clearly in traditional knee arthroplasty references. FEATURES There are 49 subjects each written by a different expert designed in 4 sections in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected including indications, unicompartmental osteoarthritis of the knee, patient with vascular problems, donating blood, bilateral arthroplasty, patellar resurfacing, range of motion, bearing surface, contraindications, teaching class for patients prior surgery. The second section is about intraoperative questions including skin incision, patella femoral maltracking, femoral component rotation, tibial component rotation, lateral release, femoral component sizing, flexion instability, varus deformity, and valgus deformity, tightness in extension, iatrogenic MCL injury, antibiotic-loaded cement, and perioperative pain. The third section subjects postoperative questions including wound drainage, preventing tromboembolic events, vascular complications, foot drop, manipulation under anesthesia, patella fractures, supracondylar femur fractures, acute extensor mechanism disruptions. In the fourth

  17. Stabilizing membrane domains antagonizes anesthesia

    CERN Document Server

    Machta, Benjamin B; Nouri, Mariam; McCarthy, Nicola L C; Gray, Erin M; Miller, Ann L; Brooks, Nicholas J; Veatch, Sarah L

    2016-01-01

    Diverse molecules induce general anesthesia with potency strongly correlated both with their hydrophobicity and their effects on certain ion channels. We recently observed that several anesthetics inhibit heterogeneity in plasma membrane derived vesicles by lowering the critical temperature ($T_c$) for phase separation. Here we exploit conditions that stabilize membrane heterogeneity to test the correlation between the anesthetic potency of n-alcohols and effects on $T_c$. First we show that hexadecanol acts oppositely to anesthetics on membrane mixing and antagonizes ethanol induced anesthesia in a tadpole behavioral assay. Second, we show that two previously described `intoxication reversers' raise $T_c$ in vesicles and counter ethanol's effects in vesicles, mimicking the findings of previous electrophysiological measurements. Third, we find that hydrostatic pressure, long known to reverse anesthesia, also raises $T_c$ in vesicles with a magnitude that counters the effect of an anesthetic at relevant concen...

  18. EEG entropy measures in anesthesia

    Directory of Open Access Journals (Sweden)

    Zhenhu eLiang

    2015-02-01

    Full Text Available Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs’ effect is lacking. In this study, we compare the capability of twelve entropy indices for monitoring depth of anesthesia (DoA and detecting the burst suppression pattern (BSP, in anesthesia induced by GA-BAergic agents.Methods: Twelve indices were investigated, namely Response Entropy (RE and State entropy (SE, three wavelet entropy (WE measures (Shannon WE (SWE, Tsallis WE (TWE and Renyi WE (RWE, Hilbert-Huang spectral entropy (HHSE, approximate entropy (ApEn, sample entropy (SampEn, Fuzzy entropy, and three permutation entropy (PE measures (Shannon PE (SPE, Tsallis PE (TPE and Renyi PE (RPE. Two EEG data sets from sevoflurane-induced and isoflu-rane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, phar-macokinetic / pharmacodynamic (PK/PD modeling and prediction probability analysis were applied. The multifractal detrended fluctuation analysis (MDFA as a non-entropy measure was compared.Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline vari-ability, higher coefficient of determination and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an ad-vantage in computation efficiency compared with MDFA.Conclusion: Each entropy index has its advantages and disadvantages in estimating DoA. Overall, it is suggested that the RPE index was a superior measure.Significance: Investigating the advantages and disadvantages of these entropy indices could help improve current clinical indices for monitoring DoA.

  19. Double balloon enteroscopy examinations in general anesthesia

    Institute of Scientific and Technical Information of China (English)

    Laszlo; Zubek; Lena; Szabo; Peter; Laszlo; Lakatos; Janos; Papp; Janos; Gal; Gabor; Elo

    2010-01-01

    AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the differen...

  20. The thermodynamics of general anesthesia

    CERN Document Server

    Heimburg, T; Heimburg, Thomas; Jackson, Andrew D.

    2006-01-01

    It is known that the action of general anesthetics is proportional to their partition coefficient in lipid membranes (Meyer-Overton rule). This solubility is, however, directly related to the depression of the temperature of the melting transition found close to body temperature in biomembranes. We propose a thermodynamic extension of the Meyer-Overton rule which is based on free energy changes in the system and thus automatically incorporates the effects of melting point depression. This model provides a quantitative explanation of the pressure reversal of anesthesia. Further, it explains why inflammation and the addition of divalent cations reduce the effectiveness of anesthesia.

  1. Levels of consciousness during regional anesthesia and monitored anesthesia care: patient expectations and experiences.

    Science.gov (United States)

    Esaki, Roy K; Mashour, George A

    2009-05-01

    Complaints of "intraoperative awareness" after regional anesthesia and monitored anesthesia care have been reported. We hypothesized that this may be due to either unmet expectations regarding levels of consciousness or states of consciousness resembling general anesthesia. A structured interview assessing expected and experienced levels of consciousness was given to 117 patients who underwent regional anesthesia or monitored anesthesia care. Complete unconsciousness was the state most often expected and subjectively experienced. Furthermore, only 58% of patients had expectations set by the anesthesia provider. These data indicate that, from the patient's perspective, the boundary between general and nongeneral anesthesia is obscured.

  2. Assessing preoperative anxiety using a questionnaire and clinical rating: a prospective observational study.

    Science.gov (United States)

    Laufenberg-Feldmann, Rita; Kappis, Bernd

    2013-12-01

    Preoperative anxiety and need for information can be detected during preoperative consultation via structured and standardised screening by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. To identify the prevalence of preoperative anxiety and need for information, with regard to influencing factors such as age, sex, previous operation and grade of surgery, and to examine the level of agreement between patients' self-rating and physicians' ratings. Prospective observational study. Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany. Two hundred seventeen patients scheduled for elective surgery. The patients completed questionnaires prior to the interaction with the anaesthesiologist. Physicians were blinded to the patients' ratings and provided their subjective ratings about patients' anxiety and need for information immediately after seeing the patient. Degree of anxiety and need for information, agreement of patients' self-reports and physician's rating. 18.9% of patients were classified as 'anxiety cases' (31.8% in women and 10.6% in men). The grade of the intended surgery but no other investigated factor was related to patients' anxiety. Age (older patients) was correlated with information requirement (r = 0.21, P = 0.002). Analysis of agreement showed only weak correlations between patients' self-reports and physicians' ratings, demonstrated in low weighted Kappa-coefficients (0.12 to 0.32). The APAIS is a useful instrument to assess the level of patients' preoperative anxiety and the need for information. Given the relationship between preoperative anxiety and postoperative outcome, it seems justified to incorporate this approach into the preoperative consultation. German Clinical Trials Register DRKS00003084.

  3. Awake Craniotomy Anesthesia: A Comparison of the Monitored Anesthesia Care and Asleep-Awake-Asleep Techniques.

    Science.gov (United States)

    Eseonu, Chikezie I; ReFaey, Karim; Garcia, Oscar; John, Amballur; Quiñones-Hinojosa, Alfredo; Tripathi, Punita

    2017-08-01

    Commonly used sedation techniques for an awake craniotomy include monitored anesthesia care (MAC), using an unprotected airway, and the asleep-awake-asleep (AAA) technique, using a partially or totally protected airway. We present a comparative analysis of the MAC and AAA techniques, evaluating anesthetic management, perioperative outcomes, and complications in a consecutive series of patients undergoing the removal of an eloquent brain lesion. Eighty-one patients underwent awake craniotomy for an intracranial lesion over a 9-year period performed by a single-surgeon and a team of anesthesiologists. Fifty patients were treated using the MAC technique, and 31 were treated using the AAA technique. A retrospective analysis evaluated anesthetic management, intraoperative complications, postoperative outcomes, pain management, and complications. The MAC and AAA groups had similar preoperative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P = 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P = 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P = 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P = 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P = 0.833). Both the MAC and AAA sedation techniques provide an efficacious and safe method for managing awake craniotomy cases and produce similar perioperative outcomes, with the MAC technique associated with shorter operative time. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, N.; Møller, Ann Merete;

    2010-01-01

    Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text......; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) and RR 1.41 (95% CI 1.22 to 1.63, five trials) respectively. Four trials evaluating the effect on long-term smoking cessation found a significant effect; pooled RR 1.61 (95% CI 1.12 to 2.33). However, when pooling intensive...

  5. [Preoperative fasting 2008: medical behaviour between empiricism and science].

    Science.gov (United States)

    Weiss, G; Jacob, M

    2008-09-01

    Preoperative fasting aims at minimizing the risk of pulmonary aspiration. However, perioperative safety does not directly increase with the duration of total abstinence from food and liquids. The traditional principle "nil per os from midnight on", is based on insufficient data, overinterpretation and expert opinion. In fact, the total perioperative risk of a clinically relevant regurgitation of gastric content is low. Clear liquids are not stored within the stomach for a long time and in the healthy, a fasting period of 6 h allows the total passage of solid food. Identifying those patients with an increased risk of perioperative aspiration is still difficult. In particular, the impact of pregnancy, adipositas and diabetes, trauma, smoking, opioids and renal insufficiency has not been clarified. This lack of knowledge is reflected by national and international guidelines concerning preoperative fasting, which mention the "patient at risk" without defining it exactly. Abstention from clear liquids 2 h before and of solids 6 h before induction of anesthesia, is becoming increasingly more accepted. Feeding babies with breast milk appears to be tolerated 4 h before anesthesiological procedures.

  6. Analgesic Effect of Preoperative Pentazocine for Laparoscopic Cholecystectomy

    Science.gov (United States)

    Wang, Na; Wang, Lei; Gao, Yang; Zhou, Honglan

    2016-01-01

    Objective: To assess whether preoperative pentazocine can reduce intraoperative hemodynamic changes and postoperative pain. Methods: Fifty patients undergoing laparoscopic cholecystectomy were randomized into two groups. Group P received intravenous 0.5 mg/kg pentazocine 10 min before surgery, and Group C received normal saline as a placebo. A standardized general anesthesia was conducted in all patients. Mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) scores at various time points were recorded. The tramadol consumption during the study period was recorded. Results: Group P had lower VAS scores at two, four, and eight hours postoperatively compared with Group C. MBP and HR rose significantly because of pneumoperitoneum within Group C, and no significant changes were detected in MBP and HR within Group P. Tramadol doses given were statistically fewer in Group P. Conclusion: Preoperative intravenous pentazocine can decrease intraoperative hemodynamic changes and postoperative pain. PMID:28168126

  7. Simulated consultations: a sociolinguistic perspective

    National Research Council Canada - National Science Library

    Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha

    2016-01-01

    .... Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language...

  8. Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section under Either General Or Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Suman Chattopadhyay

    2014-01-01

    Full Text Available This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5% patients underwent spinal anesthesia (SA and 27 (15.5% patients had general anesthesia (GA. Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P<0.001. Patients receiving GA had a higher mortality (25.9% versus 1.4%; P<0.001. The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P<0.01 and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P<0.05. To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.

  9. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  10. Anesthesia and the developing brain

    DEFF Research Database (Denmark)

    Davidson, Andrew J; Becke, Karin; de Graaff, Jurgen

    2015-01-01

    It is now well established that many general anesthetics have a variety of effects on the developing brain in animal models. In contrast, human cohort studies show mixed evidence for any association between neurobehavioural outcome and anesthesia exposure in early childhood. In spite of large...

  11. Intestinal circulation during inhalation anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Tverskoy, M.; Gelman, S.; Fowler, K.C.; Bradley, E.L.

    1985-04-01

    This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of /sub 86/Rb and 9-microns spheres labeled with /sup 141/Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO/sub 2/) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines.

  12. Comparative Effectiveness of Two Ultrasound-Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair.

    Science.gov (United States)

    Steffel, Lauren; Kim, T Edward; Howard, Steven K; Ly, Daphne P; Kou, Alex; King, Robert; Mariano, Edward R

    2016-01-01

    Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks ("double TAP" technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia.

  13. Do psychological interventions reduce preoperative anxiety?

    Science.gov (United States)

    Renouf, Tessa; Leary, Alison; Wiseman, Theresa

    The systematic review investigates whether, during preoperative assessments, nurse-delivered psychological interventions reduce anxiety levels preoperatively for patients undergoing elective surgery. Seventeen studies met the inclusion criteria for data extraction and in-depth critiquing. Of these, two were discarded due to lack of validity, while the remaining studies were organised thematically in a narrative synthesis, generating two principal results: patients' preoperative anxieties were lowered by nurse-delivered general preoperative psychological interventions; and patients valued individualised preoperative interventions delivered by nurses. However, the single oncology study in the review showed an elevation in preoperative anxiety, regardless of intervention, and highlights the need for more research in this under-reviewed area. In the meantime, the authors believe that service improvements should be implemented to ensure that, where possible, psychological preoperative interventions are individualised.

  14. Influence of intraoperative magnetic resonance imaging used in neurosurgery on anesthesia

    Directory of Open Access Journals (Sweden)

    Mao-wei GONG

    2011-09-01

    Full Text Available Objective To observe the influcences of intraoperative magnetic resonance imaging(iMRI used in neurosurgery on anesthesia.Methods Sixty patients with glioma were randomly divided into two groups(30 each,the patients in iMRI group underwent craniotomy and glioma ablation under the guidance of iMRI and functional neuro-navigation,and in N group with the functional neuro-navigation only.The patients’ general status and concerning parameters were observed and recorded,including anesthesia duration,preparation time for surgery,duration of surgery,blood loss,volume of fluid administration,number of patients who needed blood transfusion,preoperative and postoperative hemoglobin,postoperative body temperature,dosage of muscle relaxant,and the unforeseen incidents related to iMRI and anesthesia.Results No significant differences existed between the two groups(P > 0.05 in patients’ general status,anesthesia duration,blood loss,volume of fluid administration,numbers of patients who needed blood transfusion,preoperative and postoperative hemoglobin,and body temperature.However,the preparation time for and duration of surgery were longer,the dosage of muscle relaxant was larger in iMRI group than in N group(P < 0.05.No inadvertent incident related to iMRI and anesthesia occurred in both groups.Conclusions The application of iMRI in neurosurgery may improve the accuracy in operative manipulation and make the tumor resection more thorough,but it may prolong duration of surgery.Other perimoperative care related to iMRI surgery is similar to that of traditional functional neuro-navigation surgery.Besides the basic rules of neurosurgery anesthetic management for neurosurgery,anesthetist should focus on anesthetic adjustment for a long operation.

  15. [Simplified topical anesthesia protocol for ambulatory cataract surgery: safety and patient and surgeon satisfaction].

    Science.gov (United States)

    Batta, B; Fuchs-Buder, T; Tréchot, F; Angioi, K

    2014-09-01

    The purpose of our study was to assess safety and efficacy of cataract surgery (CS) under topical anesthesia alone, i.e. without pre-anesthetic evaluation and without direct presence of an anesthesiologist. To this end we assessed the incidence of patients' preoperative anxiety, perioperative adverse events and patients' and surgeons' satisfaction. Patients undergoing CS under topical anesthesia over a one-month period were included. An anesthesiologist and nurse anesthetist were present in the area and could intervene in case of an adverse event. Patients' anxiety was scored using the Amsterdam Preoperative Anxiety & Information Scale (APAIS), and their satisfaction with the Iowa Satisfaction with Anesthesia Scale (ISAS). Surgeons' satisfaction was scored with a VAS from 0 to 10 (0: surgery not possible & 10: excellent surgical conditions). One hundred and twenty-four consecutive patients were included; mean age was 71 (±9.4) years. Mean APAIS I was 6.4/20 (±3.7). Mean APAIS II was 3.1 (±1.8). Mean ISAS score was 5.5/6 (±0.6), indicating high patient satisfaction. Surgeon satisfaction score was 8.9/10 (±1.7). Twenty-three adverse events occurred of which 16 required interventions by the anaesthesiologist or surgeon: 5 supplemental local or regional anaesthesia, 6 iv-analgesia, 5 management of hypertension. These preliminary data suggest that a simplified topical anesthesia protocol for ambulatory CS appears to be feasible and safe, as long as an anesthesia team is present in the area to intervene if needed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Academic Development for Careers in Management Consulting

    Science.gov (United States)

    Adams, Susan M.; Zanzi, Alberto

    2004-01-01

    Explores the extent to which academic offerings are serving the consulting industry and identifies ways that academia can help. The numbers of management consulting courses, field experiences in consulting and consulting concentrations by graduate business schools were tracked over a three-year period to assess the current state of offerings. A…

  17. Communication Consulting as Persuasion: Issues and Implications.

    Science.gov (United States)

    Ross, Roseanna G.

    Focusing on the issue of the training and preparation of the communication specialist in communication consulting, an investigation of the persuasive elements in the client-consulting relationship suggests that more direct focus on consulting as persuasion can lead to more responsible and effective enactment of the role of both consultant and…

  18. Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia

    Directory of Open Access Journals (Sweden)

    Ivan Veličković

    2017-08-01

    Full Text Available The widespread use of continuous spinal anesthesia (CSA in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques.

  19. Myocardial protection during off pump coronary artery bypass surgery: A comparison of inhalational anesthesia with sevoflurane or desflurane and total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Sharadaprasad Suryaprakash

    2013-01-01

    Full Text Available Aims and Objectives: The objective of the study was to evaluate the myocardial protective effect of volatile agents-sevoflurane and desflurane versus total intravenous anesthesia (TIVA with propofol in offpump coronary artery bypass surgery (OPCAB by measuring cardiac troponin-T (cTnT as a marker of myocardial cell death. Materials and Methods: The study was conducted on 139 patients scheduled to undergo elective OPCAB surgery. The patients were randomly allocated to receive anesthesia with sevoflurane, desflurane or TIVA with propofol. The cTnT levels were measured preoperatively, at arrival in postoperative intensive care unit, at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels at all time intervals were comparable in the three groups. Conclusion: The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.

  20. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

    DEFF Research Database (Denmark)

    Bøtker, M T; Vang, M L; Grøfte, T;

    2014-01-01

    with focused ultrasonography in patients undergoing urgent surgical procedures. Methods We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology...... was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. Results A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society....... Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥ 3. Conclusion Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical...

  1. Preoperative localization in primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sanson; Kitamura, Hiroyuki; Takagita, Shin-ichi; Maetani, Toshiki; Iwahashi, Yuka; Miyazaki, Masakazu; Yamamoto, Norio [Tenri Hospital, Nara (Japan)

    1998-04-01

    Between 1992 and 1996, 31 cases (8 men and 23 women) with primary hyperparathyroidism (PHPT) were treated in our department. In this study, we compared which of the preoperative localization methods was most useful in the detection of PHPT. The sensitivity for detection of abnormal parathyroid glands was 88.6% on ultrasonography (US), 76.9% on magnetic resonance imaging (MRI), 74.3% on Tl-Tc subtraction scintigraphy and 68.8% on computed tomography. We concluded that US should be performed first, with MRI as a supplementary method, for the detection of abnormal parathyroid glands and the evaluation of invasion within the body. (author)

  2. Preoperative Evaluation for Noncardiac Surgery.

    Science.gov (United States)

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  3. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    National Research Council Canada - National Science Library

    Davidson, Anew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony

    2015-01-01

    ...) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA...

  4. Preoperative fasting time in children.

    LENUS (Irish Health Repository)

    Adeel, S

    2012-02-01

    The aim of preoperative fasting is to prevent regurgitation and pulmonary aspiration while limiting potential problems of thirst, dehydration and hypoglycaemia. The American Society of Anaesthesiologists (ASA) has suggested guidelines for preoperative fasting for children undergoing elective surgery. We did a postal survey to determine the current practice regarding these guidelines amongst all specialist registrars in anaesthesia in Ireland. A questionnaire was sent to all specialist registrars in anaesthesia (90 in total), 60 (67%) were returned and analysed. The question asked was how long children should be kept fasting before elective surgery. The results of our survey suggest that most of the respondents are following the ASA guidelines for clear fluids and solids however there were differing opinion regarding the duration of fasting for formula milk and breast milk. In conclusion, we would recommend greater awareness and collaboration between anaesthetists, nurses and surgeons to ensure that fasting instructions are consistent with the ASA guidelines and that patient and their parents understand these directives as well.

  5. Does obesity prolong anesthesia in children undergoing common ENT surgery?

    Science.gov (United States)

    Lee, Jennifer J; Sun, Lena S; Gu, Brian; Kim, Minjae; Wang, Shuang; Han, Sena

    2014-10-01

    To report the epidemiology of obesity in a pediatric surgical population and determine whether obesity is a risk factor for longer anesthesia duration. Childhood obesity is a significant public health problem in the United States. Epidemiologic studies on pediatric surgical populations have been limited to states with very high prevalence of adult obesity (Michigan, Texas). Data from other states and more recent data since 2006 are unavailable. We examined anesthesia records for surgical patients age 2-18 years at Columbia University Medical Center from January 2009 to December 2010. Patients undergoing bariatric surgery or those with records missing preoperative height or weight data were excluded. Body mass index (BMI) was calculated as weight (kg)/height (m(2) ). BMI ≥95th percentile according to national growth charts were considered obese. We reviewed 9522 patients of which 1639 were obese (17.2%). The sex-age category interaction on obesity was not significant using logistic regression (P = 0.11). Among surgical groups, the otolaryngology (ENT) cohort had the highest obesity rate (21.7%, 360/1656). Obese children who had tonsillectomy, adenoidectomy, or both did not have a prolonged anesthetic (P = 0.33) or surgical duration (P = 0.61) compared with nonobese children, adjusting for surgeon, season, surgical procedure code, and ASA status. Children presenting for surgery, particularly the ENT cohort, have a high prevalence of obesity. Obese and nonobese children who had tonsillectomy, adenoidectomy, or both had comparable durations of anesthesia. Therefore, obesity did not lead to longer anesthetic duration. © 2014 John Wiley & Sons Ltd.

  6. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  7. [A Systematic Review and Meta-Analysis of the Pros and Cons of Consuming Liquids Preoperatively].

    Science.gov (United States)

    Lin, Fang-Tzu; Lin, Tsai-Rung; Liao, Chia-Wei; Chen, Shu-Hui

    2017-08-01

    Preoperative anesthesia long time fasting, may increase patient hemodynamic instability during surgery and may affect the patient's post-surgery electrolyte balance. No meta-analysis has been conducted to explore the effects of preoperative liquid intake amount on gastric fluid PH, gastric fluid volume, surgery inhalation of pulmonary complications, and patient self-perceptions quality of care systematic review and meta-analysis of the literature. To assess the pros and cons of preoperative liquid intake using a systematic review of the literature. The authors searched ten databases including NRC (Nursing Reference Center), CINAHL (Cumulative Index to Nursing and Allied Health Literature), WOS (Web of Science), PubMed, The Cochrane Library, UpToDate, DynaMed, NGC (National Guideline Clearinghouse), Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan, to identify relevant articles that were published from 2003 to January 2017. Nine qualified articles were included in the analysis from the 30 articles that were selected using an initial keyword search. The Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence was used as the evidence grade and the CASP (Critical Appraisal Skills Program) was used to evaluate the quality of the selected articles. The quantitative results were analyzed using Review Manager, Version 5.1. The quality of the literature was medium to high. A small to moderate dose of fluid consumed at 2 hours prior to surgery did not significantly increase gastric fluid volume during anesthesia, with a combined effect of 2.37 (95% CI [-5.12, 9.85], p = .54), and had no effect on gastric fluid PH, with a combined effect of 0.10 (95% CI [0.00, 0.20], p = .05). The results indicate that consuming a small to moderate dose of liquid at 2 hours prior to the provision of anesthesia does not significantly increase the gastric fluid volume or gastric fluid PH of patients during anesthesia. Moreover, the positive benefits

  8. The elderly and general anesthesia

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2010-01-01

    Due to the aging population, the number of elderly patients taking advantage of healthcare services is increasing. A general physical decline of all organ systems and a high frequency of chronic disease accompanying aging.Comorbidity and polypharmacy are therefore common in the elderly. Hence, th......, the administration of general anesthesia to the elderly can be a very challenging task. This paper aims to highlight some of the important issues presented to the elderly undergoing surgery and to suggest some strategies for management....

  9. [Emergencies evolving from local anesthesia].

    Science.gov (United States)

    Kaufman, E; Garfunkel, A; Findler, M; Elad, S; Zusman, S P; Malamed, S F; Galili, D

    2002-01-01

    Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.

  10. [A case of trismus at anesthesia induction possibly attributable to traumatic cervical syndrome].

    Science.gov (United States)

    Hashimoto, Kazuyoshi; Ban, Masayuki; Sekine, Masahiro

    2013-08-01

    We recently had a 41-year-old male who developed trisms at anesthesia induction, probably due to traumatic cervical syndrome. Preoperatively, this patient had been able to open his mouth sufficiently to an extent of at least three finger breadths in width. However, when anesthesia was induced, his mouth could be manually opened only to an extent of about one finger breadth in width. As a result, intubation was difficult. As the trismus did not respond to a muscle relaxant, we were forced to use the Airwayscope for intubation. When the patient awoke from anesthesia, he was again capable of spontaneously opening his mouth to the three-finger breadth extent recorded before surgery. MRI revealed no abnormalities and the patient was diagnosed as having temporomandibular arthrosis based on clinical signs. Regarding the relationship between traumatic cervical syndrome and trismus due to temporomandibular arthrosis, while reports began to be published overseas in the 1990s, few such reports are yet available in Japan. Under the recent trend of increased day surgery, assessments made before surgery tend to be confined to routinely adopted items. Considering that even mild trauma after a car accident triggers temporomandibular arthrosis, the author proposes that preoperative examinations should include checking for a history of traumatic cervical syndrome within one year. Furthermore, the anesthetist should keep in mind the possibility of difficulty with intubation and be prepared to take appropriate measures immediately.

  11. [Anesthesia in ophthalmology (author's transl)].

    Science.gov (United States)

    Gemperlé, M

    1977-02-01

    General anesthesia in ophthalmological surgery has become a great fashion. However there are still many problems especially in intraocular surgery. The eye with normal intraocular pressure generally needs no special technique. Most of the usual anesthesia produce a slight hypotonia with the exception of Succinylcholine, whose effect is contrary. Unfortunately this is not the case in eyes with pathologically increased intraocular pressure as in the different forms of glaucoma. Eye surgeons and anesthesists therefore look for solutions to this problem which in principle consist in the application of medicaments, which not seldom are rather agressive. The controlled hypotension by ganglion blockers, the curarisation in the state of being awake, the rapid perfusion of solutions with high osmotique effect (isolated or associated) represent such measures. The one has the disadvantage to be applied during so-called subvigile anesthesias where the security that the patient is asleep is rather doubtful; the other has the disadvantage that it requires a rapid perfusion of solutions with highly osmotic effect. It goes without saying that these conditions represent risks especially if one considers that the candidates for this type of intervention very often are senile persons with prearious cardiovascular equilibrium, with insufficient renal function and with insufficient arterial cerebral circulation. These are some of the problems which are to be discussed.

  12. Preoperative information management system using wireless PDAs.

    Science.gov (United States)

    Sawa, Tomohiro; Okahara, Masaharu; Santo, Masayuki; Schmidt, Ulrich; Nakata, Yoshinori; Morita, Shigeho; Ohno-Machado, Lucila

    2003-01-01

    Personal Digital Assistant (PDA) and wireless communication are currently available in clinical settings. We developed wireless PDA software that assists anesthesiologists in pre-operative patient assessment. The device communicates with the hospital information system through a wireless LAN and is equipped with pre-programmed data entry templates for pre-operative assessment. As a preliminary test of the device, we randomly assigned residents in preoperative assessment to an intervention and a control arm and compared the results.

  13. Technology Diffusion of Anesthesia Information Management Systems into Academic Anesthesia Departments in the United States

    National Research Council Canada - National Science Library

    Stol, Ilana S; Ehrenfeld, Jesse M; Epstein, Richard H

    2014-01-01

    BACKGROUND:Anesthesia information management systems (AIMS) are electronic health records that automatically import vital signs from patient monitors and allow for computer-assisted creation of the anesthesia record...

  14. SPLIT SKIN GRAFT HARVESTING UNDER LOCAL ANESTHESIA INFILTRATION VERSUS TOPICAL LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Shahi

    2014-04-01

    Full Text Available OBJECTIVE: To compare the effectiveness of topical local anesthesia using PRILOX cream versus local anesthesia infiltration using lignocaine and adrenaline in harvesting split skin graft. METHODS: A prospective study of 58 patients requiring split skin graft was carried. One group comprising 29 patients underwent harvesting of split skin graft under topical local anesthesia using PRILOX cream while the other group had local anesthesia infiltration using lignocaine and adrenaline. RESULTS: There were no significant differences between the 2 groups in terms of operating time, per operative pain, post-operative pain and post-operative requirement of analgesia. There was significant difference in time and pain during administration of local anesthesia and patient’s acceptability/ satisfaction with method of anesthesia. CONCLUSION: Topical local anesthesia using PRILOX cream can be used effectively for harvesting of split skin graft and is good alternative to local anesthesia infiltration.

  15. Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity.

    Science.gov (United States)

    Hernández-Palazón, Joaquín; Fuentes-García, Diego; Falcón-Araña, Luis; Roca-Calvo, María José; Burguillos-López, Sebastián; Doménech-Asensi, Paloma; Jara-Rubio, Rubén

    2017-04-26

    The aim of this study was to measure the level of preoperative anxiety in patients scheduled for cardiac surgery, identify any influencing clinical factors, and assess the relationship between anxiety and postoperative morbidity. A prospective and consecutive study. A single university hospital. The study comprised 200 patients scheduled for cardiac surgery. Each patient was asked to grade his or her preoperative anxiety level using the Visual Analogue Scale for Anxiety, Amsterdam Preoperative Anxiety and Information Scale, and set of specific anxiety-related questions. Demographic data (age, sex, body mass index) and anesthetic and surgical data (American Society of Anesthesiologists physical status, EuroSCORE surgical risk, preoperative length of stay, and previous anesthetic experience) were registered. Also, postoperative morbidity was assessed. Twenty-eight percent of the patients developed high preoperative anxiety. The mean Amsterdam Preoperative Anxiety and Information Scale score was 11.4 ± 4.3, and the mean Visual Analogue Scale for Anxiety score was 48 ± 21. Patients scheduled for coronary artery bypass surgery, who had no previous anesthetic experience, and who were hospitalized before surgery, had higher anxiety scores. Coronary bypass surgery (odds ratio 3.026; 1.509-6.067; p = 0.002) was associated independently with preoperative high-level anxiety. Anxiety most commonly was caused by waiting for surgery, not knowing what is happening, fearing not being able to awaken from anesthesia, and being at the mercy of staff. Anxiety did not modify the postoperative course. In patients waiting to undergo cardiac surgery, both fear of the unknown and lack of information, especially related to the surgery, are crucial factors in high levels of preoperative anxiety in cardiac surgery. Coronary bypass surgery is a determining factor for preoperative anxiety. The anxiety level did not modify the postoperative course in these patients. Copyright © 2017 Elsevier

  16. Treatment of status migrainosus by general anesthesia: a case report.

    Science.gov (United States)

    Udelsmann, Artur; Saccomani, Priscila; Dreyer, Elisabeth; da Costa, Alberto Luiz Cunha

    2015-01-01

    The status migrainosus is a complication of migraine characterized by severe headache for more than 72h that did not respond to treatment, with risk of stroke and suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goal is to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia. Female patient, aged 50 years, with status migrainosus, in the last five days with visits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual Numeric Scale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuronium and maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed. Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  17. [Treatment of status migrainosus by general anesthesia: a case report].

    Science.gov (United States)

    Udelsmann, Artur; Saccomani, Priscila; Dreyer, Elisabeth; Costa, Alberto Luiz Cunha da

    2015-01-01

    The status migrainosus is a complication of migraine characterizedby severe headache for more than 72 h that did not respond to treatment, with risk of strokeand suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goalis to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia. Female patient, aged 50 years, with status migrainosus, in the last five days withvisits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual NumericScale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuroniumand maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed. Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. [Infracondylar abscess formation: a rare complication of local anesthesia].

    Science.gov (United States)

    Dojcinovic, I; Hugentobler, M; Richter, M

    2006-11-01

    Ninety percent of oro-facial infections arise from a dental origin. The remaining 10% are the consequence of oro-pharyngeal, cutaneous or iatrogenic problems, such as in the present case. A 24-year-old patient consulted the emergency room because of a left mandibular swelling, accompagnied by trismus. Four days earlier, extraction of the 38 was performed under inferior alveolar nerve block anesthesia. A first drainage by vestibular approach was performed under general anesthesia. Because of the absence of improvement, a CT-scan was performed and an abscess localized at the base of the condyle, surrounding the posterior margin of the mandible, very high above the lingula. Outcome was favourable after a second surgery. Formation of an abscess very high above the lingula, around the condylar neck is rarely reported in the literature. In this patient it was certainly a complication resulting from the injection of local anesthesic with a vasoconstrictor. CT-scan should be performed to guide diagnosis in the event of an unusual course after the first surgical procedure and an adequate antibiotic regimen.

  19. Perceived incivility during emergency department phone consultations.

    Science.gov (United States)

    Shetty, Amith L; Vaghasiya, Milan; Boddy, Rachel; Byth, Karen; Unwin, Danielle

    2016-06-01

    Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P  4 (9.1% vs 3.8%, P incivility during ED phone consultations. Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. Narrative and Structure in Consultation

    Science.gov (United States)

    Hadley, David

    2012-01-01

    This article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…

  1. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.

    2014-01-01

    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can re

  2. [Remote medical consultations in gerontology].

    Science.gov (United States)

    Mathieu-Fritz, Alexandre; Esterle, Laurence; Espinoza, Pierre

    2012-01-01

    Experimental teleconsultations have been set up between a university hospital and a public geriatric hospital in Paris in order to facilitate elderly patients' access to specialist consultations. Caregivers have had to accept major changes to their professional practices (delegation of tasks, sharing of knowledge, etc.). This new telemedecine scheme represents huge progress in patient care.

  3. Tianjin Architects & Consulting Engineers

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Tianjin Architects& Consulting Engineers (TACE), established in 1952,is the largest integrated architectural design institutein Tianjian. TACE has five A-Class certificates issued by the Ministry of Construction in areas such as engineering design, and it is rated as one of the top 100 exploration and design companies in China.

  4. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.

    2014-01-01

    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can re

  5. Comparative study of implicit memory during bispectral index guided total intravenous anesthesia versus sevoflurane inhalation anesthesia

    OpenAIRE

    Ahmed M. Elbadawy; Ahmed M. Khidr; Alia Adel Saleh

    2015-01-01

    Background: Several studies that investigate the implicit memory under general anesthesia revealed conflicting results. Limitations may be due to failure to control depth of anesthesia. This prospective randomized study was designed to compare the implicit memory during total intravenous versus inhalational anesthesia. Method: Fourty patients ASA I and II undergoing orthopedic procedures under BIS-guided (40–60) general anesthesia were tested for implicit memory of previously introduced au...

  6. CAN FRACTIONATED SPINAL ANESTHESIA BE AN ECONOMICAL ALTERNATIVE TECHNIQUE TO COMBINED SPINAL - EPIDURAL ANESTHESIA??

    OpenAIRE

    Sunitha; Mohammed Naveed

    2015-01-01

    NTRODUCTION : Central neuraxial blockade holds a very good place in anesthesia for surgical procedures on abdomen and lower limbs 1 . We have spinal anesthesia with rapid onset of action with precipitous hypotension , on the other hand we have epidural anesthesia with gradual onset of action with graded fall in BP and ability to prolong anesthesia for required duration and to provide post - operative analgesia. Combination of these two techniques can be of ...

  7. Preoperative evaluation of oesophageal adenocarcinoma.

    Science.gov (United States)

    Khanna, Lauren G; Gress, Frank G

    2015-02-01

    The preoperative evaluation of oesophageal adenocarcinoma involves endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET). With routine Barrett's oesophagus surveillance, superficial cancers are often identified. EUS, CT and PET have a limited role in the staging of superficial tumours. Standard EUS has limited accuracy, but high frequency ultrasound miniprobes are valuable for assessing tumour stage in superficial tumours. However, the best method for determining depth of invasion, and thereby stage of disease, is endoscopic mucosal resection. In contrast, in advanced oesophageal cancers, a multi-modality approach is crucial. Accurate tumour staging is very important since the treatment of advanced cancers involves a combination of chemotherapy, radiation, and surgery. EUS is very useful for staging of the tumour and nodes. High frequency ultrasound miniprobes provide the ability to perform staging when the lesion is obstructing the oesophageal lumen. CT and PET provide valuable information regarding node and metastasis staging.

  8. Preoperative preparation of patients with pituitary gland disorders.

    Science.gov (United States)

    Malenković, Vesna; Gvozdenović, Ljiljana; Milaković, Branko; Sabljak, Vera; Ladjević, Nebojsa; Zivaljević, Vladan

    2011-01-01

    This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients. Pituitary function manages almost the entire endocrine system using the negative feedback mechanism that is impaired by these diseases. The cause of acromegaly is a pituitary adenoma, which produces growth hormone in adults. Primary therapy of acromegaly is surgical, with or without associated radiotherapy. If a patient with acromegaly as comorbidity prepares for non-elective neurosurgical operation, then it requires consultation with brain surgeons for possible delays of that operation and primary surgical treatment of pituitary gland. If operative treatment of pituitary gland is carried out, the preoperative preparation (for other surgical interventions) should consider the need for perioperative glucocorticoid supplementation. Panhypopituitarism consequences are different in children and adults and the first step in diagnosis is to assess the function of target organs. Change of electrolytes and water occurs in the case of pituitary lesions in the form of central or nephrogenic diabetes insipidus as a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Preoperative preparation of patients with pituitary dysfunction should be multidisciplinary, whether it is a neurosurgical or some other surgical intervention. The aim is to evaluate the result of insufficient production of pituitary hormones (hypopituitarism), excessive production of adenohypophysis hormones (acromegaly, Cushing's disease and hyperprolactinemia) and the influence of pituitary tumours in surrounding structures (compression syndrome) and to determine the level of perioperative risk. Pharmacological suppressive therapy of the hyperfunctional pituitary disorders can have significant interactions with drugs used in the perioperative period.

  9. Anaesthesiologists H attitude towards preoperative patients education needs in 2005

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    R. Esmaeeli

    2006-01-01

    Full Text Available Background and purpose: lack of information about anaesthisia and fear of post operation contiousness, pain, nausea and vomiting increases the patientsH anxiety. There are various reports about patiensH desire for preoperation information in Iran and other countries. However, there is no study related to anaesthesiologistsH view about patientsH needs before anaesthesia and operation in the literature.Materials and Methods: This descriptive (cross- sectional study was done in 2005 on 110 anaesthesiologists working in hospitals of Mazandaran province. Questionnaire containing 4 questions about demographic and 18 questions related to anaesthesia was prepared. Attitude of the anaesthesiologists was divided into 5 categories based on Likert rating scale as follows: completely agreed, agreed, partially agreed, not agreed, completely not agreed. Chi-square test was used for the statistical analysis of the data.Results: Results of this study showed that the most positive attitude of anaesthesiologists about patient teaching was related to the proper explanation about duration of N.P.O before operation (%97.3. %52.7 of anaes the siologists were against giving explanation of the duration of N.P.O and post operation possible problems. In this regard no significant difference was observed between educational and non educational hospitals (P<0.018. No significant difference in terms of attitude was observed between anaesthesiologists at different level of education (P<0.07.Conclusion: Considering the positive attitude of the anaesthesiologists towards education and preoperation of the patients, it is recommended that such education be implemented and the patients be charged for preoperation consultation in order to give explanation about anaesthesia at proper time, when needed.

  10. Subclinical neuropathy in diabetic patients: a risk factor for bilateral lower limb neurological deficit following spinal anesthesia?

    Science.gov (United States)

    Angadi, Darshan S; Garde, Ajit

    2012-02-01

    Total knee arthroplasty performed under spinal or general anesthesia is a common successful orthopedic procedure. Nonetheless, in patients with diabetes mellitus this procedure can present unique challenges to orthopedic surgeon and anesthesiologist alike. We describe a case of an elderly male diabetic patient who developed bilaterally symmetrical lower limb neurological deficit following an uneventful total knee arthroplasty performed under spinal anesthesia. Postoperative nerve conduction study with electromyography confirmed symmetrical extensive denervation of lower limb muscles, including low-voltage fibrillation potentials and positive sharp waves. These findings were consistent with a preexisting neuropathy, thereby suggesting a subclinical neuropathy as a potential risk factor for this neurological complication. Our case highlights the fact that patients with longstanding comorbidities, namely peripheral vascular disease and diabetes mellitus, may be at an increased risk of neurological injury following regional anesthesia. Hence, we believe that preoperative evaluation of diabetic patients should include neurophysiological studies to identify subclinical neuropathy and minimize the risk of neurological injury.

  11. Recognition and management of preoperative risk.

    Science.gov (United States)

    Nierman, E; Zakrzewski, K

    1999-08-01

    Internists are frequently asked to do preoperative consultations and to manage perioperative complications. Realistic goals are to identify patient factors that increase the risk of surgery, to quantify this risk in order to make decisions about the appropriateness of and timing of the surgery, to provide recommendations on how to minimize the risk, to identify and manage coexisting medical conditions and their associated medication requirements, to monitor the patient for perioperative problems, and to make recommendations to deal with these problems when they occur. With few exceptions, nonselective imaging and laboratory screening tests have repeatedly been shown to be of little value when the history and physical do not suggest a problem. The risk associated with the planned surgery can be estimated, with the most common serious complications being cardiac events. Updated versions of Goldman's risk indices are particularly helpful for this. Clinical variables are optimally combined with selective stress testing to discern which patients will benefit from preoperative revascularization. This has been studied best in the setting of vascular surgery. A critical guiding principle is that the value of revascularization must be judged in terms of long term gains rather than just immediate perioperative benefit. Other interventions include the selective use of beta blockers, adequate analgesia for all, control of hypertension, and appropriate volume management, especially in the settings of preexisting CHF or valvular disease. It must also be recognized that perioperative ischemia and CHF often present atypically. An approach that combines aspects of both the ACC/AHA and the ACP guidelines seems optimal. A variety of noncardiac issues must also be addressed. Postoperative pulmonary complications are common, especially with preexisting pulmonary disease, thoracic and upper abdominal surgery, and obesity. PFTs and ABGs are indicated in selected patients. Stopping

  12. How to choose an anesthesia ventilator?

    Science.gov (United States)

    Coisel, Y; Millot, A; Carr, J; Castagnoli, A; Pouzeratte, Y; Verzilli, D; Futier, E; Jaber, S

    2014-01-01

    During the past few years, many manufacturers have developed a new generation anesthesia ventilators or anesthesia workstations with innovative technology and introduced so-called new ventilatory modes in the operating room. The aim of this article is to briefly explain how an anesthesia ventilator works, to describe the main differences between the technologies used, to describe the main criteria for evaluating technical and pneumatic performances and to list key elements not to be forgotten during the process of acquiring an anesthesia ventilator. Copyright © 2014. Published by Elsevier SAS.

  13. Fully Automated Anesthesia, Analgesia and Fluid Management

    Science.gov (United States)

    2016-09-05

    General Anesthetic Drug Overdose; Adverse Effect of Intravenous Anesthetics, Sequela; Complication of Anesthesia; Drug Delivery System Malfunction; Hemodynamic Instability; Underdosing of Other General Anesthetics

  14. Mobile anesthesia: Ready, set, pack, and go.

    Science.gov (United States)

    Khayata, Issam; Bourque, Jesse

    2012-04-01

    Although we get into the habit of thinking that anesthesia cannot be safely delivered without the availability of all equipments available in a state of the art Operating room, we find ourselves faced with situations where the availability and mobility of all this equipment is limited ; this results in the impetus to start a thought process of how we can perform mobile anesthesia with less technology. Disaster situations, such as earthquakes, floods, or armed conflicts, might happen in areas where access of a regular operating room might be hours away or not available at all. Delivering mobile Anesthesia during the golden hour can be a totally different experience from customary anesthesia practices in a regular operating room.It requires setting up a field/forward surgical teams with its organization and structure. Total Intravenous anesthesia gained popularity in crisis and combat situations and has been documented as a safe method in crisis situations.Anesthesia configured medic bag: Is a modified medic bag that can be utilized to contain the most commonly used Anesthesia supply material in a portable way. In reviewing the knowledge of how to provide anesthesia in crisis and disaster situations we conclude that there is evidence that anesthesia can be safely and efficiently delivered in a remote areas with limited tools and technology.

  15. Articaine and lidocaine for maxillary infiltration anesthesia.

    Science.gov (United States)

    Vähätalo, K.; Antila, H.; Lehtinen, R.

    1993-01-01

    This study was undertaken to compare the anesthetic properties of articaine hydrochloride with 1:200,000 epinephrine (Ultracain DS) and lidocaine with 1:80,000 epinephrine (Xylocain-Adrenalin) for maxillary infiltration anesthesia. Twenty healthy dental student volunteers were included in this double-blind study. Each subject received 0.6 mL of each test solution at different times. Infiltration anesthesia was performed on the upper lateral incisor. The onset and duration of anesthesia were monitored using an electric pulp tester. No statistically significant differences were seen in the onset and duration of anesthesia between the articaine and lidocaine solutions. PMID:7943919

  16. Motivation and parental presence during induction of anesthesia: an examination of the role of ethnicity and language.

    Science.gov (United States)

    Fortier, Michelle A; Gomez, Sulay H; Kain, Alexandra

    2012-11-01

    To examine the role of ethnicity and language in parental desire and motivation to be present for children's anesthesia induction. To compare motivation for parental presence at induction of anesthesia (PPIA) between English- and Spanish-speaking White and Hispanic parents of children undergoing outpatient surgery. The effectiveness of PPIA may depend, in part, on parental motivation and desire to be present at children's anesthesia induction; however, cultural variables such as ethnicity and language have not previously been explored in this relationship. Participants included 258 parents of children undergoing outpatient surgery and general anesthesia. Parents were grouped by self-reported ethnicity and primary language spoken into English-speaking White (ESW, n = 55), English-speaking Hispanic (ESH, n = 108), and Spanish-speaking Hispanic (SPH, n = 95) groups. Measures included the Motivation for Parental Presence during Induction of Anesthesia (MPPIA) and a 4-item measure of preference for PPIA. The majority of parents (73%) expressed a preference for PPIA. Analyses controlling for group differences in socioeconomic status and demographic variables revealed that English-(P = 0.03) and Spanish-speaking (P = 0.06) Hispanic parents reported significantly greater levels of desire to be present for their child's anesthesia induction compared to English-speaking White parents. English-speaking Hispanic parents also reported greater levels of beliefs about the impact of anxiety on children's anesthesia induction compared to English-speaking White parents (P = 0.07). Parental ethnicity and language may impact desire and motivation for PPIA, which may subsequently impact the effectiveness of PPIA and child anxiety at anesthesia induction. Future research should examine the impact of parental characteristics, including cultural variables, on children's preoperative anxiety. © 2012 Blackwell Publishing Ltd.

  17. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery.

    Science.gov (United States)

    Siriphuwanun, Visith; Punjasawadwong, Yodying; Lapisatepun, Worawut; Charuluxananan, Somrat; Uerpairojkit, Ketchada

    2014-01-01

    To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR) and 95% confidence intervals (CI) were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03-2.08, P=0.036), ASA physical status classification of 3-4 (RR =5.84, CI =4.20-8.12, Psurgery (upper intra-abdominal, RR =2.67, CI =2.14-3.33, Pcardiac, RR =3.61, CI =2.60-4.99, Pcardiac arrest within 24 hours of anesthesia for emergency surgery was high and associated with multiple factors such as young age (≤2 years old), cardiovascular and respiratory comorbidities, increasing ASA physical status classification, preoperative shock, and surgery site. Perioperative care providers, including surgeons, anesthesiologists, and nurses, should be prepared to manage promptly this high risk group of surgical patients.

  18. Regional anesthesia for an upper extremity amputation for palliative care in a patient with end-stage osteosarcoma complicated by a large anterior mediastinal mass.

    Science.gov (United States)

    Hakim, Mumin; Burrier, Candice; Bhalla, Tarun; Raman, Vidya T; Martin, David P; Dairo, Olamide; Mayerson, Joel L; Tobias, Joseph D

    2015-01-01

    Tumor progression during end-of-life care can lead to significant pain, which at times may be refractory to routine analgesic techniques. Although regional anesthesia is commonly used for postoperative pain care, there is limited experience with its use during home hospice care. We present a 24-year-old male with end-stage metastatic osteosarcoma who required anesthetic care for a right-sided above-the-elbow amputation. The anesthetic management was complicated by the presence of a large mediastinal mass, limited pulmonary reserve, and severe chronic pain with a high preoperative opioid requirement. Intraoperative anesthesia and postoperative pain management were provided by regional anesthesia using an interscalene catheter. He was discharged home with the interscalene catheter in place with a continuous local anesthetic infusion that allowed weaning of his chronic opioid medications and the provision of effective pain control. The perioperative applications of regional anesthesia in palliative and home hospice care are discussed.

  19. US-guided preoperative hook-wire localization of nonpalpable breast lesions

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    Shin, Tae Beom; Lee, Sang Kwon; Kim, Hye Jung; Ryeom, Hun Kyu; Kim, Tae Hun; Kim, Yong Ju; Kang, Duk Sik; Lee, Young Ha; Park, Ho Yong [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)

    2000-12-15

    To evaluate the feasibility and efficacy of US-guided preoperative wire localization of nonpalpable breast lesions. US-guided preoperative wire localization was performed upon 45 nonpalpable breast lesions including 14 nonpalpable masses, 11 nonpalpable masses with microcalcifications, 11 ductal lesions, 9 with microcalcifications. No local anesthesia was performed during the localization procedure. Under the US-guidance, the needle with the hook-wire was inserted into the lesion until the hook of the wire reached 1 cm beyond the posterior margin of the lesion. Precise wire positioning was confirmed by mammography. Specimen radiography or specimen ultrasonography was performed in all cases. US-guided preoperative wire localization was successfully achieved in all cases. The time required for US-guided wire localization was less than five minutes. All lesions were successfully removed by surgical excision. Successful removal was confirmed by specimen radiography or specimen ultrasonography, gross findings of the specimen and consistency between radiographic and pathologic findings. The histologic diagnosis of 45 lesions were 7 ductal carcinoma in situ, 8 invasive ductal carcinoma, 6 fibroadenoma, 8 intraductal papilloma, 2 atypical ductal hyperplasia, and 14 fibrocystic changes. No complications were occurred during and after the procedure. US-guided preoperative wire localization for excisional biopsy is simple, safe, and accurate method in the histologic diagnosis of nonpalpable breast lesions detectable with ultrasonography.

  20. Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting?

    Science.gov (United States)

    Van den Bosch, Jolanda E; Moons, Karel G; Bonsel, Gouke J; Kalkman, Cor J

    2005-05-01

    Preoperative anxiety has been suggested as a predictor of postoperative nausea and vomiting (PONV), but supporting data are lacking. We quantified the added predictive value of preoperative anxiety to established predictors of PONV in 1389 surgical inpatients undergoing various procedures, by using multivariate logistic regression analysis. Investigated predictors were a history of PONV or motion sickness, smoking, sex, age, ethnicity, body mass index, ASA physical status, surgery type, duration of anesthesia, anesthetic technique, and postoperative opioid analgesia. Anxiety was measured by the Spielberger State-Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. The outcome was the occurrence of PONV in the first 24 h after surgery. The area under the receiver operating characteristic curve of a multivariate (logistic regression) model including sex, age, smoking, history of PONV or motion sickness, surgery type, and anesthetic technique was 0.72 (95% confidence interval, 0.70-0.74). There was a weak but significant association of anxiety with PONV, but the addition of anxiety to the model did not further increase the area under the receiver operating characteristic curve. Therefore, routine preoperative measurement of anxiety does not seem warranted, provided that the other predictors are already considered.

  1. Safe spinal anesthesia in a woman with chronic renal failure and placenta previa

    Directory of Open Access Journals (Sweden)

    Beyazit Zencirci

    2010-05-01

    Full Text Available Beyazit ZencirciKahramanmaras, TurkeyBackground: Chronic renal failure is strongly associated with poor pregnancy outcome. Women dependent on hemodialysis before conception rarely achieve a successful live birth.Case presentation: A 31-year-old multiparous Turkish woman was scheduled for cesarean section under spinal anesthesia at 37 weeks and five days’ gestation because of hemorrhage due to secondary placenta previa. Spinal anesthesia with 8 mg of hyperbaric bupivacaine was successfully performed. Invasive blood pressure, central venous pressure, and heart rate were stable during the surgery. The mother returned to regular hemodialysis on the first postoperative day.Conclusion: Pregnancy is uncommon in women with chronic renal failure requiring chronic dialysis. Rates of maternal hypertension, pre-eclampsia, anemia, and infection in the pregnant chronic dialysis patient are high. However, our findings suggest that with careful, close, and effective monitoring preoperatively and intraoperatively, spinal anesthesia can be safely performed for cesarean section in patients undergoing hemodialysis.Keywords: chronic renal failure, pregnancy, spinal anesthesia, hemodialysis, placenta previa

  2. Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation

    Science.gov (United States)

    Thornberg, Robert

    2014-01-01

    The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

  3. Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation

    Science.gov (United States)

    Thornberg, Robert

    2014-01-01

    The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

  4. [Teledermatology versus consultations--a comparative study of 120 consultations].

    Science.gov (United States)

    Herrmann, F E; Sönnichsen, K; Blum, A

    2005-10-01

    Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.

  5. An evaluation of factors influencing the assessment time in a nurse practitioner-led anaesthetic pre-operative assessment clinic.

    Science.gov (United States)

    Hawes, R H; Andrzejowski, J C; Goodhart, I M; Berthoud, M C; Wiles, M D

    2016-03-01

    Elective patients undergoing anaesthetic pre-operative assessment are usually allocated the same period of time with a nurse practitioner, leading to potential inefficiencies in patient flow through the clinic. We prospectively collected data on 8519 patients attending a pre-operative assessment clinic. The data set were split into derivation and validation cohorts. Standard multiple regressions were used to construct a model in the derivation cohort, which was then tested in the validation cohort. Due to missing data, 2457 patients were not studied, leaving 5892 for analysis (3870 in the derivation cohort and 2022 in the validation cohort). The mean (SD) pre-operative assessment time was 46 (12) min. Age, ASA physical status, nurse practitioner and surgical specialty all influenced the time spent in pre-operative assessment. The predictive equations calculated using the derivation cohort, based on age and ASA physical status, correctly estimated duration of consultation to within 20% of the maximum predicted time in 74.2% of the validation cohort. We conclude that if age and ASA physical status are known before the pre-operative assessment consultation, it could allow appointment times to be allocated more accurately.

  6. [Anesthesia for geriatric patients. Part 1: age, organ function and typical diseases].

    Science.gov (United States)

    Herminghaus, A; Löser, S; Wilhelm, W

    2012-02-01

    Due to demographic changes in the population of industrial nations the number of elderly patients undergoing elective or emergency procedures will rise significantly in the coming years. Anesthesia for geriatric patients is challenging for the anesthesiologist in many ways: with increasing age numerous physiological changes occur which all lead to a subsequent reduction of physical performance and compensatory capacity of the organism, in many cases additionally aggravated by chronic illness. Subsequently, these age-dependent changes (with or without chronic illness) increase the risk for admission to intensive care units, perioperative death, treatment costs and a prolonged length of hospital stay. Therefore, subtle preoperative assessment and tailored anesthetic management are essential in elderly patients. Part 1 of this continuous education article covers the influence of age on organ functions and describes typical comorbidities which are of high relevance for the perioperative care of geriatric patients. The special features of anesthetic agents and anesthesia management in the elderly will be presented in part 2.

  7. Anesthetic and airway management of general anesthesia in a patient with Meckel-Gruber syndrome.

    Science.gov (United States)

    Miyazu, Mitsunori; Sobue, Kazuya; Ito, Hiroaki; Azami, Takafumi; Ito, Shoji; Takeuchi, Akinori; Sasano, Hiroshi; Tsuda, Takako; Katsuya, Hirotada

    2005-01-01

    Meckel-Gruber syndrome, characterized by occipital encephalocele, microcephaly, polydactyly, cleft lip or palate, mandibular micrognathism, and anatomical abnormality of the larynx and tongue, along with other associated malformations, is in the list of diseases associated with difficult airway. However, there has been no report on the management of general anesthesia and airway management for such patients. A 2-year-old girl with Meckel-Gruber syndrome was scheduled for cardioplasty and gastrostomy for gastroesophageal reflux under general anesthesia. Preoperative examination revealed obesity, microgenia, dysspondylism, proteinuria, hypoplastic kidneys, and stenosis of the anal canal. Although we anticipated some difficulty with the intubation and prepared several alternative methods for intubation, such as a bronchofiberscope and a laryngeal mask airway, tracheal intubation was completed without difficulty using conventional laryngoscopy after inhalational induction with sevoflurane. Because most patients with this syndrome die before and shortly after delivery, those who survive to some age might have less severe deformities.

  8. Anesthesia for major general surgery in neonates with complex cardiac defects.

    Science.gov (United States)

    Walker, Amy; Stokes, Monica; Moriarty, Anthony

    2009-02-01

    Centers with large cardiac workloads may be presented with neonates who need major general surgery before correction or palliation of a serious cardiac defect. This is still a rare situation with only three short case reports available in the medical literature (1-3). We have reviewed the anesthetic and analgesic regimens of 18 such neonates who presented to the Birmingham Children's Hospital in the 4-year period 2004-2007. These children require meticulous preoperative evaluation and although it might be anticipated that they would pose a serious challenge to anesthetists, in reality with thorough investigation, preparation, and careful management, they tolerate general anesthesia well. These children may be transferred to centers of specialist pediatric cardiac anesthesia to be benefited from experience obtained there.

  9. [Anesthesia for electroconvulsive therapy: propofol versus thiopental].

    Science.gov (United States)

    Harti, A; Hmamouchi, B; Idali, H; Barrou, L

    2001-01-01

    The anesthesia for sismotherapy is characterized by its briefness and repetitiveness, resulting in several imperatives: anesthesia of short duration, deep narcosis with muscular relaxation and ambulatory character. Thus anesthesic drugs should have a fast onset of action, in order to obtain a rapid and as alert as possible post anesthesia awakening. The objective of this study is to compare two anesthesic drugs: propofol versus thiopentone. We included in this study patients referred to our unit by the psychiatric service for sismotherapy, which was carried on under general anesthesia in the awakening room of the anesthesia department of Ibn Rochd University hospital. 7 of our patients received sismotherapy for schizophrenia, 2 for acute mania and 1 for suicidal depression. A total of 40 sessions of sismotherapy were analyzed, distributed in two groups: group I (n = 20): benefitted of a general anesthesia by thiopentone, the dose was 2 to 3 mg/kg; group II (n = 20): benefitted of general anesthesia by propofol, the dose was 1 to 1.5 mg/kg. Sismotherapy was carried out only once narcosis was considered as deep. To monitor our patients we used electrocardioscope and pulpe oxymeter. We evaluated the quality and especially the time of onset of anesthesia, its duration, the quality of narcosis, the degree of muscular relaxation, respiratory and cardiovascular parameters as well as side effect linked to anesthesia drugs and sismotherapy. Analysis of the results showed that the quality of anesthesia was excellent for both groups. The necessary dose for narcosis was 202 mg for thiopentone and 167 mg for propofol, time of onset of narcosis was 30 seconds for propofol and 45 seconds for thiopentone, anesthesia and the quality of muscular relaxation were considered deep for the two groups. Many authors showed that propofol is the most efficient agent in anesthesia for sismotherapy due to its brief delay of action and faster reversibility. As for thiopentone despite its

  10. Preoperative Smoking Status and Postoperative Complications

    DEFF Research Database (Denmark)

    Grønkjær, Marie; Eliasen, Marie; Skov-Ettrup, Lise Skrubbeltrang;

    2014-01-01

    To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.......To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type....

  11. ARTHROSCOPIC MENISCUS REPAIR WITH BIOABSORBABLE ARROWS IN LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Vladimir Senekovič

    2004-11-01

    Full Text Available Background. The menisci have important function in the knee joint. Because of this it is universally accepted that we have to preserve them as much as possible. After open and partially arthroscopic suture techniques new methods of all-inside meniscus repair with bioabsorbable arrows have been developed in the last decade. The meniscus repair using these arrows represents an easy task for a skilled surgeon. In addition, it can be performed in local anesthesia. We have evaluated the results of the first group of patients who were treated by this method.Methods. From February 2001 to August 2002 15 patients with torn meniscuses have been treated at the Clinical Department for Traumatology, University Medical centre, Ljubljana. We repaired their torn menisci arthroscopically with bioabsorbable arrows in local anesthesia. We divided patients in three groups: a group with isolated meniscus injury, a group with meniscus injury and anterior cruciate ligament injury and a group with associated pathology. Four patients had incarcerated meniscuses. Preoperative Lysholm score in the first group was 38, in the second 42 and in the third group 48. We repaired 12 medial and 3 lateral meniscuses. On average we need 45 minutes for therapeutic arthroscopy. Torn meniscus was fixated with minimum of 1 and maximum of 5 bioabsorbable arrows. All patients except one had the affected knee immobilized with cylinder plaster for 15 days on average.Results. At least three months after the arthroscopic fixation of the torn meniscus in local anesthesia another clinical evaluation was made. In all groups significant improvement was observed regarding the range of motions and absence of pain. Postoperative Lysholm score in the first group was 89, in the second 75 and in the third 71. Average deficit of flexion was 3 degrees while extension was full. One patient complained about the same pain in the joint, he underwent another arthroscopy which showed that the meniscus was

  12. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.|info:eu-repo/dai/nl/249966271; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick

    2015-01-01

    Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  13. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony

    2015-01-01

    BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  14. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick

    2015-01-01

    Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  15. Dexmedetomidine: Expanding role in anesthesia

    Directory of Open Access Journals (Sweden)

    Jyotsna S Paranjpe

    2013-01-01

    Full Text Available The potential uses of dexmedetomidine (DEX, a highly selective α2 - adrenoceptor agonist are very diverse. DEX appears to mimic many of the actions of mythical ′ideal′ sedative/analgesic agent. Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable, hence it has found place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to managing morbidly obese patients and patients with a compromised airway; without causing any cardio-respiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Its value as a primary sedative and analgesic is becoming more accepted and evident in critically ill patients; in adult and paediatric intensive care units. Besides use in locoregional anesthesia, it is also used as an opioid substitute, for treatment of substance withdrawal, as an anti-shivering agent, for treatment of delirium and as an end of life medication. Availability of an antidote (Atipamezole with similar elimination half life is taking the drug into new frontiers. However, use of DEX is contraindicated in patients with hepatic failure, hypovolemic shock, advanced heart block or ventricular dysfunction.

  16. Presbycusis: reversible with anesthesia drugs?

    Science.gov (United States)

    Kocher, Carl A

    2009-02-01

    Age-related hearing impairment, or presbycusis, is a degenerative condition not currently treatable by medication. It is therefore significant that the author, as a patient, experienced a reversal of high-frequency hearing loss during a 2-day period following abdominal surgery with general anesthesia. This report documents the surgery and the subsequent restoration of hearing, which was bilateral and is estimated to have exceeded 50dB at 4kHz. A possible role is noted for anesthetic agents such as lidocaine, propofol, or fentanyl. This experience may hold a clue for research toward the development of medical treatments for presbycusis.

  17. [Carotid endarterectomy under local anesthesia].

    Science.gov (United States)

    Kuz'min, A L; Belov, Iu V

    2001-01-01

    Results of carotid endarterectomy (CEAE) in 193 patients with different degree of cerebrovascular insufficiency were analyzed. All the patients were men with carotid atherosclerosis (age from 39 to 68 years, mean age 53.6 +/- 0.4). A total of 253 CEAEs were performed under local anesthesia (60 patients underwent consecutive bilateral operations). In early postoperative period 3 patients died, one of them--of ischemic stroke due to thrombosis of internal carotid artery on the side of the operation. Non-fatal stroke was in 1 patient. There were no intraoperative cerebral complications. This testifies to reliability of cerebral circulation control through direct contact with patient.

  18. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    OpenAIRE

    Sporer, Scott M.; Bernard R. Bach, Jr

    2009-01-01

    DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Sc...

  19. Optimal Technique in Cardiac Anesthesia Recovery

    NARCIS (Netherlands)

    Svircevic, V.

    2014-01-01

    The aim of this thesis is to evaluate fast-track cardiac anesthesia techniques and investigate their impact on postoperative mortality, morbidity and quality of life. The following topics will be discussed in the thesis. (1.) Is fast track cardiac anesthesia a safe technique for cardiac surgery?

  20. [Technical features of intraligamental intraseptal anesthesia].

    Science.gov (United States)

    Kuzin, A V; Voronkov, V V; Stafeeva, M V; Abramova, E S

    2016-01-01

    Based on personal clinical experience the authors provide clinical guidelines for periodontal anesthesia. The by-step protocol for intraligamentary and intraseptal anesthesia is presented. The basic mistakes in technique and possible complications are described. Recommendations for a local anesthetic choice and dosage for different groups of teeth are given.

  1. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... Asked Questions Español Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “general”, “local”, or “topical” ...

  2. Partial intravenous anesthesia in cats and dogs.

    Science.gov (United States)

    Duke, Tanya

    2013-03-01

    The partial intravenous anesthesia technique (PIVA) is used to lower the inspired concentration of an inhalational anesthetic by concurrent use of injectable drugs. This technique reduces the incidence of undesirable side-effects and provides superior quality of anesthesia and analgesia. Drugs commonly used for PIVA include opioids, alpha-2 adrenergic agonists, injectable anesthetic agents, and lidocaine. Most are administered by intravenous infusion.

  3. Core Competencies for Training Effective School Consultants

    Science.gov (United States)

    Burkhouse, Katie Lynn Sutton

    2012-01-01

    The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

  4. Core Competencies for Training Effective School Consultants

    Science.gov (United States)

    Burkhouse, Katie Lynn Sutton

    2012-01-01

    The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

  5. Special Education Teacher Consultant: Idealism versus Realism.

    Science.gov (United States)

    Haight, Sherrel Lee

    1984-01-01

    A review of literature on topics of teacher consultant roles, cross-categorical services, approval criteria, and caseloads suggests the position of teacher consultant as it is being implemented may be untenable. There is a critical lack of role definition at state and local levels and a dearth of professional preparation in consultation skills.…

  6. Observed Consultation: Confidence and Accuracy of Assessors

    Science.gov (United States)

    Tweed, Mike; Ingham, Christopher

    2010-01-01

    Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…

  7. Observed Consultation: Confidence and Accuracy of Assessors

    Science.gov (United States)

    Tweed, Mike; Ingham, Christopher

    2010-01-01

    Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…

  8. Anesthesia Management of a 20-Month-Old Patient with Giant Unilateral Wilms Tumor

    Directory of Open Access Journals (Sweden)

    Nune Matinyan

    2015-01-01

    Full Text Available Wilms tumour (WT (or nephroblastoma is one of the most common malignant kidney tumors in children. On subsequent stages clinically it is often characterized by abdominal hypertension syndrome, which, in turn, leads to development of respiratory insufficiency. Other symptoms comprise renal deficiency, hypertension, and abnormalities of hemostasis and hemogram. Treatment includes rounds of preoperative chemotherapy and subsequent surgery. We report a case of perioperative management for nephrectomy in 20-month-old patient with a giant unilateral WT. The complexity of anesthesia was determined by the size of tumor, increased intra-abdominal pressure, respiratory deficiency, and hypercoagulation.

  9. Anesthesia for a patient with Fanconi anemia for developmental dislocation of the hip: a case report

    Directory of Open Access Journals (Sweden)

    Zafer Dogan

    2014-06-01

    Full Text Available Fanconi anemia is a rare autosomal recessive inherited bone marrow failure syndrome with congenital and hematological abnormalities. Literature regarding the anesthetic management in these patients is limited. A management of a developmental dislocation of the hip was described in a patient with fanconi anemia. Because of the heterogeneous nature, a patient with fanconi anemia should be established thorough preoperative evaluation in order to diagnose on clinical features. In conclusion, we preferred caudal anesthesia in this patient with fanconi anemia without thrombocytopenia, because of avoiding from N2O, reducing amount of anesthetic, existing microcephaly, hypothyroidism and elevated liver enzymes, providing postoperative analgesia, and reducing amount of analgesic used postoperatively.

  10. Spinal morphine anesthesia and urinary retention.

    Science.gov (United States)

    Mahan, K T; Wang, J

    1993-11-01

    Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.

  11. [Minor sequelae of ambulatory anesthesia].

    Science.gov (United States)

    Melloni, C; Fusari, M; Ortelli, L; Belelli, G; Di Marco, M G; De Eccher, L; Rainaldi, P; Cuconati, N

    1987-12-01

    Voluntary abortions in day hospitals fulfill the need for shorter hospital stays and minimal interference with patient activities; on the other hand, it makes it more difficult to evaluate the possible complications of anesthesia. 1820 patients who received general anesthesia for voluntary abortion were given a questionnaire before they were discharged; items queried included drowsiness, headache, dizziness, nausea or vomiting, sore throat or mouth, abdominal cramps, pain at IV site, backache or muscular cramps, inability to perform daily activities. Only 465 patients returned the questionnaire. The most frequent complaint was sleepiness or drowsiness (19.8%), headache (7.1%), dizziness (15.1%), nausea or vomiting (8.2%), abdominal cramps (24.7%), and backache (16.7%). There seems to be less nausea or vomiting with the use of pentothal rather than alothane. Ketamine was never used on its own. The findings seen to suggest that the simplest combinations of drugs result in fewer and less severe complications than the use of several drugs.

  12. Prophylactic digitalization preoperatively of patients with arteriosclerotic heart disease.

    Science.gov (United States)

    Bille-Brahe, N E; Engell, H C; Sørensen, M B

    1981-02-01

    This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.

  13. Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

    Science.gov (United States)

    Lavand'homme, Patricia; Ambrosoli, Andrea Luigi; Cappelleri, Gianluca; Saccani Jotti, Gloria MR; Fanelli, Guido; Allegri, Massimo

    2016-01-01

    Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome. PMID:27051077

  14. Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

    Directory of Open Access Journals (Sweden)

    Dario Bugada

    2016-01-01

    Full Text Available Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP. The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR, proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient’s profile (comorbidities, preoperative inflammation, and hypertension, and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome.

  15. Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair.

    Science.gov (United States)

    Bugada, Dario; Lavand'homme, Patricia; Ambrosoli, Andrea Luigi; Cappelleri, Gianluca; Saccani Jotti, Gloria Mr; Meschi, Tiziana; Fanelli, Guido; Allegri, Massimo

    2016-01-01

    Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome.

  16. [Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis].

    Science.gov (United States)

    Fernández-Ordóñez, M; Tenías, J M; Picazo-Yeste, J

    2014-05-01

    To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001). Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  17. Tips for telephone and electronic medical consultation.

    Science.gov (United States)

    Gupta, Sailesh G

    2013-11-01

    The world is gradually shrinking in terms of time, and communications, while expanding in terms of population and distances. Patients demand and expect telephone and e-mail consultations and medical professionals are only too happy to oblige. However, a telephone consult is never so satisfying for the patients and well as the doctor as a face consult. Besides much essential information, cues and clues to diagnosis may be missed only with an audio input from patients. A telephone consult should be offered only to know the patient, and only after a prior face consult. It should be ensured that the patient can definitely understand, and follow the directions, and manage the disorder at home. While a telephone consultation may be considered convenient and short, there may be several disadvantages of such consultation, a wrong diagnosis and an inappropriate prescription being just two of them. Telephone etiquette should be followed by the staff and the physician. A triage system may be set up to filter calls that need to be necessarily answered by the physician himself. Telephone consults should be charged, and should be followed by a face consult as soon as possible. E-mail consultations are governed essentially by the same principles that govern telephone consultations. There is a slight advantage of e-mail consultation in that reports can be submitted online, including radiological reports. However, confidentiality is an important and uncertain issue in cyber space. A memorandum of understanding maybe signed between the patient and the physician. The information provided on e-mail should be of a general nature and a face consult should precede e-mail consultation. Patients may be referred to web resources for information. Telemedicine is a useful tool to obtain a medical diagnosis and to provide medical advice, and is likely to be used vastly in the near future.

  18. Cerebral oximetry in cardiac anesthesia

    Science.gov (United States)

    Vretzakis, George; Georgopoulou, Stauroula; Stamoulis, Konstantinos; Stamatiou, Georgia; Tsakiridis, Kosmas; Katsikogianis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Mpakas, Andreas; Beleveslis, Thomas; Koletas, Alexander; Siminelakis, Stavros N.; Zarogoulidis, Konstantinos

    2014-01-01

    Cerebral oximetry based on near-infrared spectroscopy (NIRS) is increasingly used during the perioperative period of cardiovascular operations. It is a noninvasive technology that can monitor the regional oxygen saturation of the frontal cortex. Current literature indicates that it can stratify patients preoperatively according their risk. Intraoperatively, it provides continuous information about brain oxygenation and allows the use of brain as sentinel organ indexing overall organ perfusion and injury. This review focuses on the clinical validity and applicability of this monitor for cardiac surgical patients. PMID:24672700

  19. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study.

    Science.gov (United States)

    Wilder-Smith, Oliver Hamilton; Schreyer, Tobias; Scheffer, Gert Jan; Arendt-Nielsen, Lars

    2010-06-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative persistence and spread of skin and deep tissue hyperalgesia (change in electric/pressure pain tolerance thresholds; ePTT/pPTT) up to 6 months postoperatively. In 20 patients undergoing elective major abdominal surgery under standardized anesthesia, we determined ePTT/pPTT (close to [abdomen] and distant from [leg] incision), eDNIC/pDNIC (change in ePTT/pPTT with cold pressor pain task; only preoperatively), and a 100 mm long pain visual analogue scale (VAS) (0 mm = no pain, 100 mm = worst pain imaginable), both at rest and on movement preoperatively, and 1 day and 1, 3, and 6 months postoperatively. Patients reporting chronic pain 6 months postoperatively had more abdominal and leg skin hyperalgesia over the postoperative period. More inhibitory preoperative eDNIC was associated with less late postoperative pain, without affecting skin hyperalgesia. More inhibitory pDNIC was linked to less postoperative leg deep tissue hyperalgesia, without affecting pain VAS. This pilot study for the first time links chronic pain after surgery, poorer preoperative inhibitory pain modulation (DNIC), and greater postoperative degree, persistence, and spread of hyperalgesia. If confirmed, these results support the potential clinical utility of perioperative pain processing testing.

  20. Development and validation of a perioperative satisfaction questionnaire in regional anesthesia.

    Science.gov (United States)

    Maurice-Szamburski, Axel; Bruder, Nicolas; Loundou, Anderson; Capdevila, Xavier; Auquier, Pascal

    2013-01-01

    Evaluating patient-reported outcomes is complex. These difficulties may explain weaknesses with some existing tools: mainly, they rely on expert instead of patient views or are not metrically sound. The purpose of this study was to develop and validate a multidimensional self-reported questionnaire, specifically assessing the satisfaction of patients undergoing regional anesthesia, Evaluation du Vécu de l'Anesthésie LocoRégionale (EVAN-LR). Patients included underwent various surgical procedures under regional anesthesia. The questionnaire structure was identified by principal component factor analyses and interitem, item-dimension, and interdimension correlations. The authors assessed external validity by studying the relationships between potential dimensions of EVAN-LR and validated instruments such as Amsterdam Preoperative Anxiety and Information Scale, State Trait Anxiety Inventory, and specific visual analog scales. Internal consistency reliability was assessed by Cronbach α. We included 390 patients for the validation phase. The EVAN-LR comprises 19 items, structured in a global index and five dimensions: Attention, Information, Discomfort, Waiting, and Pain. The consequences of staying alert during regional anesthesia were specifically addressed by two items. Female sex was associated with significantly lower Information score. Patients with American Society of Anesthesiologists physical status below 2 had a significantly lower Attention score. Patients older than 55 years showed higher satisfaction scores for most dimensions. EVAN-LR poorly correlated with premedication. The authors have validated a new measuring tool assessing patient satisfaction within the perioperative period surrounding regional anesthesia. The multidimensional structure of EVAN-LR allows it to be used as a clinical tool for improving anesthesia management.

  1. Use of simple clinical predictors on preoperative diagnosis of difficult endotracheal intubation in obese patients.

    Science.gov (United States)

    Magalhães, Edno; Oliveira Marques, Felipe; Sousa Govêia, Cátia; Araújo Ladeira, Luis Cláudio; Lagares, Jader

    2013-01-01

    Although the incidence of difficult laryngoscopy is similar in obese and non-obese patients, there are more reports of difficult intubation in obese individuals. Alternatives for the diagnosis and prediction of difficult intubation in the preoperative period may help reduce anesthetic complications in obese patients. The aim of this study was to identify predictors for the diagnosis of difficult airway in obese patients, correlating with the clinical methods of pre-anesthetic evaluation and polysomnography. We also compared the incidence of difficult facemask ventilation and difficult laryngoscopy between obese and non-obese patients, identifying the most prevalent predictors. Observational, prospective and comparative study, with 88 adult patients undergoing general anesthesia. In the preoperative period, we evaluated a questionnaire on the clinical predictors of the obstructive sleep apnea syndrome (OSAS) and anatomical parameters. During anesthesia, we evaluated difficult facemask ventilation and laryngoscopy. Descriptive statistics and correlation test were used for analysis. Patients were allocated into two groups: obese group (n=43) and non-obese group (n=45). Physical status, prevalence of snoring, hypertension, diabetes mellitus, neck circumference, and Mallampati index were higher in the obese group. Obese patients had a higher incidence of difficult facemask ventilation and laryngoscopy. There was no correlation between anatomical or clinical variable and difficult facemask ventilation in both groups. In obese patients, the diagnosis of OSAS showed strong correlation with difficult laryngoscopy. The clinical and polysomnographic diagnosis of OSA proved useful in the preoperative diagnosis of difficult laryngoscopy. Obese patients are more prone to difficult facemask ventilation and laryngoscopy. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  2. Recent advances in topical anesthesia

    Science.gov (United States)

    2016-01-01

    Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain. PMID:28879311

  3. Mortality in anesthesia: a systematic review

    Directory of Open Access Journals (Sweden)

    Leandro Gobbo Braz

    2009-01-01

    Full Text Available This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s, study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

  4. A fresh look at preoperative body washing

    Science.gov (United States)

    Tanner, Judith; Gould, Dinah; Jenkins, Philip; Hilliam, Rachel; Mistry, Neetesh; Walsh, Susannah

    2012-01-01

    National guidelines do not support preoperative body washing to reduce surgical site infections, instead recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon which guidelines are based, are dated and proposes a new investigation of preoperative body washing using modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in reducing CFUs in the groin. PMID:22448182

  5. Preoperative steroid in abdominal wall reconstruction

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo

    2016-01-01

    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  6. Preoperative alcohol cessation prior to elective surgery

    DEFF Research Database (Denmark)

    Oppedal, Kristian; Møller, Ann Merete; Pedersen, Bolette

    2012-01-01

    Hazardous drinking has been associated with an increased postoperative complication rate after surgery. Common complications include postoperative infections, cardiopulmonary complications, and bleeding episodes. Preoperative abstinence may to some degree reverse alcohol-induced pathophysiological...

  7. Preoperative steroid in abdominal wall reconstruction

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo;

    2016-01-01

    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  8. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study...... was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

  9. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study...... was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

  10. Preoperative education for lumbar surgery for radiculopathy

    OpenAIRE

    Louw, A; Louw, Q; L. Crous

    2009-01-01

    To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptive...

  11. Alzheimer’s disease and anesthesia

    Directory of Open Access Journals (Sweden)

    Marie-Amélie ePapon

    2011-01-01

    Full Text Available Cognitive disorders such as post-operative cognitive dysfunction, confusion, and delirium, are common following anesthesia in the elderly, with symptoms persisting for months or years in some patients. Alzheimer's disease (AD patients appear to be particularly at risk of cognitive deterioration following anesthesia, and some studies suggest that exposure to anesthetics may increase the risk of AD. Here, we review the literature linking anesthesia to AD, with a focus on the biochemical consequences of anesthetic exposure on AD pathogenic pathways.

  12. Supplemental pulpal anesthesia for mandibular teeth

    Directory of Open Access Journals (Sweden)

    Thangavel Boopathi

    2013-01-01

    Full Text Available Clinical pulpal anesthesia is dependent on the interaction of three major factors. (1 the dentist (2 the patient and (3 local anesthesia. Many patients fear endodontic treatment due to a concern about pain. Although pain treatment is well managed in many endodontic patients, there exists a group of patients who do not receive adequate local anesthesia. The purpose of this review article is to discuss the possible reasons for pulpal anesthetic failures and also to focus on the measures for developing effective approaches for the same.

  13. Anesthesia and Databases: Pediatric Cardiac Disease as a Role Model.

    Science.gov (United States)

    Vener, David F; Pasquali, Sara K; Mossad, Emad B

    2017-02-01

    Large data sets have now become ubiquitous in clinical medicine; they are particularly useful in high-acuity, low-volume conditions such as congenital heart disease where data must be collected from many centers. These data fall into 2 categories: administrative data arising from hospital admissions and charges and clinical data relating to specific diseases or procedures. In congenital cardiac diseases, there are now over a dozen of these data sets or registries focusing on various elements of patient care. Using probabilistic statistic matching, it is possible to marry administrative and clinical data post hoc using common elements to determine valuable information about care patterns, outcomes, and costs. These data sets can also be used in a collaborative fashion between institutions to drive quality improvement (QI). Because these data may include protected health information (PHI), care must be taken to adhere to federal guidelines on their use. A fundamental principle of large data management is the use of a common language and definition (nomenclature) to be effective. In addition, research derived from these information sources must be appropriately balanced to ensure that risk adjustments for preoperative and surgical factors are taken into consideration during the analysis. Care of patients with cardiac disease both in the United States and abroad consistently shows wide variability in mortality, morbidity, and costs, and there has been a tremendous amount of discussion about the benefits of regionalization of care based on center volume and outcome measurements. In the absence of regionalization, collaborative learning techniques have consistently been shown to minimize this variability and improve care at all centers, but before changes can be made it is necessary to accurately measure accurately current patient outcomes. Outcomes measurement generally falls under hospital-based QI initiatives, but more detailed analysis and research require

  14. Safety of oral glutamine in the abbreviation of preoperative fasting: a double-blind, controlled, randomized clinical trial Seguridad de la glutamina oral en la abreviación del ayuno preoperatorio: un ensayo clínico doble ciego, controlado, aleatorizado

    OpenAIRE

    D. Borges Dock-Nascimento; J. E. D Aguilar-Nascimento; C. Caporossi; M. Sepulveda Magalhães Faria; R. Bragagnolo; F. S. Caporossi; D. Linetzky Waitzberg

    2011-01-01

    Introduction: No study so far has tested a beverage containing glutamine 2 h before anesthesia in patients undergoing surgery. Objectives: The aim of the study was to investigate: 1) the safety of the abbreviation of preoperative fasting to 2 h with a carbohydrate-L-glutamine-rich drink; and 2) the residual gastric volume (RGV) measured after the induction of anesthesia for laparoscopic cholecystectomies. Methods: Randomized controlled trial with 56 women (42 (17-65) years-old) submitted to e...

  15. Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use.

    NARCIS (Netherlands)

    Katz, J.; Schmid, R.L.; Snijdelaar, D.G.; Coderre, T.J.; McCartney, C.J.; Wowk, A.

    2004-01-01

    The aim of the study was to evaluate post-operative pain and analgesic use after pre-operative or post-incisional i.v. fentanyl plus low dose i.v. ketamine vs. a standard treatment receiving i.v. fentanyl but not ketamine. Men undergoing radical prostatectomy under general anesthesia were randomly a

  16. Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Sadeghi A

    2017-02-01

    Full Text Available Afsaneh Sadeghi, Ahmad Khaleghnejad Tabari, Alireza Mahdavi, Sara Salarian, Seyed Sajjad Razavi Department of Anesthesiology, Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Introduction: Anesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient’s physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction.Patients and methods: A total of 96 pediatric patients undergoing elective minor surgery (ASA 1–2 were randomly divided into two groups. Both groups received oral midazolam (0.5 mg/kg at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS] and parents (as measured by the State and Trait Anxiety Inventory [STAI], the Induction Compliance Checklist (ICC, and parental satisfaction (as measured by visual analog scale were assessed. Results: There was no significant difference in the mean anxiety scores (mYPAS of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05. However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P<0.001. The ICC scores showed that perfect score was

  17. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  18. A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery.

    Science.gov (United States)

    Lee, G A; Wyatt, S; Topliss, D; Walker, K Z; Stoney, R

    2014-01-01

    Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p cardiac surgery.

  19. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Science.gov (United States)

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  20. Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists.

    Science.gov (United States)

    Townsend, Janice A; Hagan, Joseph L; Smiley, Megann

    2014-01-01

    The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

  1. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

    Directory of Open Access Journals (Sweden)

    Gaonkar V

    2004-01-01

    Full Text Available In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25 or peri-incisional infiltration (n=25 pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively. We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

  2. XENON ANESTHESIA IN CHILDREN: BIS-MONITORING

    Directory of Open Access Journals (Sweden)

    V. G. Bagaev

    2013-01-01

    Full Text Available We conducted 60 low-flow xenon anesthesias in children of 1-18 years of age. We measured the sedation level using bispectral (BIS index and clinically on the stage of induction, xenon anesthesia maintenance and during recovery. The trial showed that, according to the clinical and BIS-monitoring data, sevoflurane inhalational induction in children of 1-5 years of age and propofol intravenous induction in children of 6-18 years of age provides children with the required sedation level. BIS index objectively reflects intensity of the sedative component of an anesthesia both in the junior and the senior age groups on the stages of xenon anesthesia maintenance and during recovery.

  3. Anesthesia: What to Expect (For Parents)

    Science.gov (United States)

    ... a wide variety of modern medicines and monitoring technology to make sure that kids are stable and as comfortable as possible before, during, and after their ... Parents MORE ON THIS TOPIC Anesthesia Basics Types of ...

  4. Anesthesia in a Baird's tapir (Tapirus bairdii).

    Science.gov (United States)

    Trim, C M; Lamberski, N; Kissel, D I; Quandt, J E

    1998-06-01

    A Baird's tapir (Tapirus bairdii) was satisfactorily immobilized on two occasions with i.m. detomidine (0.065-0.13 mg/kg) and butorphanol (0.13-0.2 mg/kg). On the second occasion, anesthesia was induced by i.v. administration of ketamine (2.2 mg/kg). Twenty minutes later, endotracheal intubation was performed after an additional i.v. injection of ketamine (1.5 mg/kg). Anesthesia was maintained with isoflurane, which provided excellent conditions for radiology and surgery. Anesthesia was associated with hypoxemia when the tapir was allowed to breathe air and with hypoventilation. Mean arterial pressure remained satisfactory. No antagonist drugs were administered, and recovery from anesthesia was rapid and smooth.

  5. [The choice of a pediatric anesthesia ventilator].

    Science.gov (United States)

    Kern, D; Larcher, C; Cottron, N; Ait Aissa, D; Fesseau, R; Alacoque, X; Delort, F; Masquère, P; Agnès, E; Visnadi, G; Fourcade, O

    2013-12-01

    The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  6. [Seeing more : Technical innovations in regional anesthesia].

    Science.gov (United States)

    Wiesmann, T; Steinfeldt, T; Volk, T; Schwemmer, U; Kessler, P; Wulf, H

    2014-11-01

    Visualization and verification are key factors since the implementation of ultrasound-guided regional anesthesia. This article reviews and discusses newer technical innovations in regional anesthesia with regard to optimization of needle guidance, improvements in needle visibility, technical improvements in ultrasound techniques and innovative technologies in regional anesthesia. Clinically available applications are presented as well as experimental tools and techniques with a potential for clinical implementation in the future. Mechanical needle guides are used to improve alignment of needle axis and ultrasound beam axis. Compound imaging technology improves needle visibility in steep needle insertion angles and is already implemented in daily clinical practice. Sonoelastography improves tissue discrimination and detection of small amounts of fluids. Benefits of 3D and 4D ultrasound in regional anesthesia are discussed as well as experimental tools for tissue discrimination, such as optical reflection spectrophotometry.

  7. Anesthesia for the acute abdomen patient.

    Science.gov (United States)

    Hofmeister, Erik H

    2003-02-01

    Patients with acute abdomen often have marked physiologic and pathologic changes, making anesthesia both challenging and potentially hazardous for the patient. A thorough understanding of the pathophysiologic mechanisms of cardiovascular function under anesthesia and selection of appropriate anesthetic protocols are critical to a successful anesthetic outcome. The goal is to produce anesthesia while minimizing depression of the cardiovascular system. Monitoring and management of acid-base and cardiovascular function serve to ensure appropriate oxygen delivery to the tissues during anesthesia. Postoperative management can significantly influence patient outcome following anesthesic recovery, and must therefore be considered in the anesthetic plan. Finally, pain management in all patients is an important aspect of case management, and should not be overlooked. This article serves to educate the clinician in the above-described areas in regard to the acute abdomen patient.

  8. Anesthesia for the parturient with cardiovascular disease

    African Journals Online (AJOL)

    QuickSilver

    The most basic principles of obstetric anesthesia management must always apply8: 1. ... Pregnancy normally results in dramatic changes in the cardiovascu- lar system. .... ered systemic vascular resistance results in increased cardiac output.

  9. Factors associated with mothers selecting general anesthesia for lower segment caesarean section.

    Science.gov (United States)

    Holdcroft, A; Parshall, A M; Knowles, M G; Waite, K E; Morgan, B M

    1995-09-01

    The objective of the study was to investigate the sociodemographic and psychological factors which are associated with choice or refusal of regional anesthesia for lower segment Caesarean section. A semi-structured questionnaire was administered preoperatively to consecutive women presenting for elective operation at two hospital sites in the same health authority. The questionnaires were administered to 39 pregnant women by two anesthetists, one at each site. Sociodemographic and past and present obstetric and anesthetic details were obtained. The Hospital Anxiety and Depression scale and the FEAR questionnaire were used with an additional visual analog scale to assess fearfulness associated with the proposed operation. A 'panic checklist' of ten items was also constructed to identify procedures associated with feelings of panic. Ten women requested general anesthesia. These women had a similar level of anxiety to the others, but were significantly more depressed, had had more pregnancies overall and more without live babies. There were also more aspects of the procedure at which they thought they might panic. Women who have suffered the loss of a conception with its associated grief and often obstetric intervention are more reluctant to be conscious during an operative delivery for a subsequent baby. Preventive measures should be considered at the time of fetal loss to avoid this. However, preoperatively a simple visual analog scale for fearfulness would identify these women so that any unresolved fears could receive full psychological assessment.

  10. Dental trauma related to general anesthesia: should the anesthesiologist perform a preanesthetic dental evaluation?

    Science.gov (United States)

    Idrees, Saeed Riad; Fujimura, Kazuma; Bessho, Kazuhisa

    2014-06-01

    Perioperative dental damage is one of the most common anesthesia-related adverse events and is responsible for the greatest number of malpractice claims against anesthesiologists; therefore, several dental considerations are warranted. A thorough evaluation may necessitate a dentist's help, requires that anesthesiologists receive more formal training regarding oral and dental anatomy, and enables performing the treatments necessary to minimize the risks of dental injuries. Nevertheless, this preanesthetic assessment is frequently overlooked by surgeons and anesthesiologists. The present study aimed to investigate, for both dentists and anesthesiologists, how often and under what circumstances dental trauma occurs during general anesthesia as well as isolate possible anatomical, dental, and anesthesiological risk factors, based on which suggestions for preventive measures could be made. Anesthesiologists must perform a thorough preoperative oral evaluation to help identify the dentition at risk; the evaluation should include the patient's dental history, oral/dental examination, and a specific discussion with the patient about any existing dentures or crowns. The dental examination should especially include an assessment of the patient's upper incisors--the teeth most likely to be injured during the perioperative period--for pre-existing damage. Preoperative notes should record any damages or missing teeth. In addition, anesthesiologists must take adequate intraprocedure precautions to prevent/minimize iatrogenic dental injury.

  11. Formocresol blood levels in children receiving dental treatment under general anesthesia.

    Science.gov (United States)

    Kahl, Jeffrey; Easton, Jillian; Johnson, Gillian; Zuk, Jeannie; Wilson, Stephen; Galinkin, Jeffrey

    2008-01-01

    The purpose of this study was to determine the presence of formocresol in the plasma of children undergoing oral rehabilitation involving pulp therapy under general anesthesia. Thirty 2- to 6-year-old preschool children were enrolled in the study. Preoperative, intra-operative, and postoperative peripheral venous samples were collected from each child. All samples were analyzed for formaldehyde and cresol levels using gas chromatography with mass spectrometry detection. Eighty-five pulpotomies were performed ranging from 1 to 5 per child. Three hundred twelve blood samples were collected. Analysis revealed that formaldehyde was undetectable above baseline plasma concentration and cresol was undetectable in all samples. Benzyl alcohol (a byproduct of cresol metabolism) was present in all samples except the baseline preoperative samples. Benzyl alcohol concentrations ranged from 0 to 1 mg/ml. Formaldehyde was undetectable above baseline plasma concentration, and cresol was undetectable in subjects receiving pulpotomy treatment under general anesthesia. Benzyl alcohol was detected in the plasma of all subjects receiving pulpotomy treatment. The levels present were far below the Food and Drug Administration's recommended daily allowance. It is unlikely that formocresol, when used in the doses typically employed for a vital pulpotomy procedure, poses any risk to children.

  12. Management of comorbidities in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  13. Anesthesia for Pediatric Deep Brain Stimulation

    Directory of Open Access Journals (Sweden)

    Joseph Sebeo

    2010-01-01

    Full Text Available In patients refractory to medical therapy, deep brain stimulations (DBSs have emerged as the treatment of movement disorders particularly Parkinson's disease. Their use has also been extended in pediatric and adult patients to treat epileptogenic foci. We here performed a retrospective chart review of anesthesia records from 28 pediatric cases of patients who underwent DBS implantation for dystonia using combinations of dexmedetomidine and propofol-based anesthesia. Complications with anesthetic techniques including airway and cardiovascular difficulties were analyzed.

  14. Mobile anesthesia: Ready, set, pack, and go

    OpenAIRE

    Khayata, Issam; Bourque, Jesse

    2012-01-01

    Introduction: Although we get into the habit of thinking that anesthesia cannot be safely delivered without the availability of all equipments available in a state of the art Operating room, we find ourselves faced with situations where the availability and mobility of all this equipment is limited ; this results in the impetus to start a thought process of how we can perform mobile anesthesia with less technology. Disaster situations, such as earthquakes, floods, or armed conflicts, might ha...

  15. About Forum of Anesthesia and Monitoring

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Forum of Anesthesia and Monitoring is one of the leading publications for the specialties of Anesthesia,Intensive Care and Pain in China, sponsored by Beijing Committee of Anesthesiologists of Chinese Medical Association and Medical Information Limited. Published since 1993, it is widely regarded as the popular scientific journal in the specialty. This is evidenced not just by its circulation, but by its influences to the young anesthetists in China.

  16. About Forum of Anesthesia and Monitoring

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Forum of Anesthesia and Monitoring is one of the leading publications for the specialties of Anesthesia.Intensive Care and Pain in China. sponsored by Beijing Committee of Anesthesiologists of Chinese Medical Association and Medical Information Limited. Published since 1993, it is widely regarded as the popular scientific journal in the specialty. This is evidenced not just by its circulation, but by its influences to the.young anesthetists in China.

  17. Xenon-based anesthesia: theory and practice

    OpenAIRE

    Jan-Hinrich Baumert

    2009-01-01

    Jan-Hinrich BaumertDept of Anaesthesiology, UMC St Radboud, Nijmegen, NetherlandsAbstract: Xenon has been in use as an anesthetic for more than 50 years. Although it exhibits some of the properties of an ideal anesthetic, the technical complexity of xenon equipment and the high cost of the gas have prevented widespread use of xenon anesthesia. The main beneficial features of xenon anesthesia are fast induction and emergence because of low solubility in blood and tissues, along with remarkably...

  18. Advances in local anesthesia in dentistry.

    Science.gov (United States)

    Ogle, Orrett E; Mahjoubi, Ghazal

    2011-07-01

    Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.

  19. Single-lung ventilation in pediatric anesthesia.

    Science.gov (United States)

    Choudhry, Dinesh K

    2005-12-01

    Single-lung ventilation is requested for an increasing spectrum of surgical procedures in infants and children. A clear understanding of the physiology of single-lung ventilation, the techniques of lung separation, and the technical skill necessary to apply these techniques are essential for an anesthesiologist practicing thoracic anesthesia. This article focuses on various devices available for single-lung ventilation in the pediatric age group, the relevant respiratory physiology, and the strategies that optimize oxygenation during one-lung anesthesia.

  20. Mobile anesthesia: Ready, set, pack, and go

    OpenAIRE

    Khayata, Issam; Bourque, Jesse

    2012-01-01

    Introduction: Although we get into the habit of thinking that anesthesia cannot be safely delivered without the availability of all equipments available in a state of the art Operating room, we find ourselves faced with situations where the availability and mobility of all this equipment is limited ; this results in the impetus to start a thought process of how we can perform mobile anesthesia with less technology. Disaster situations, such as earthquakes, floods, or armed conflicts, might ha...

  1. Investigations Regarding Anesthesia during Hypovolemic Conditions.

    Science.gov (United States)

    1983-09-25

    supplier (J.G. Boswell Co.) artificially inseminates all swine, thus breeding is exactly controlled, and genetic make-up known and reproducible. Their...the facility is not required thus eliminating unproductive quarantine time and diminishing housing costs. Since our supplier artificially insem...this .ouiu be beneficial % hen iniucing anesthesia during . hypovole.iia. I.en used tor induction of anesthesia ouring hypovolemia, ketamine incrcases

  2. Anesthesia and analgesia for geriatric veterinary patients.

    Science.gov (United States)

    Baetge, Courtney L; Matthews, Nora S

    2012-07-01

    The number of geriatric veterinary patients presented for anesthesia appears to be increasing. This article summarizes physiologic changes that occur in geriatric patients that are relevant to anesthesia. Proper patient preparation and vigilant monitoring are the best defense against anesthetic problems in the geriatric animal. The authors also discuss particular anesthetic problems as they relate to geriatric patients and seek to present solutions to these problems.

  3. Anesthesia related Complications in Pediatric GI Endoscopy

    Directory of Open Access Journals (Sweden)

    A Sabzevari

    2014-04-01

    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  4. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  5. Integrating corpus consultation in language studies

    OpenAIRE

    Angela Chambers

    2005-01-01

    peer-reviewed Alongside developments in language research, the potential of corpora as a resource in language learning and teaching has been evident to researchers and teachers since the late 1960s. Despite publications which emphasise the benefits of corpus consultation for language learners (Bernardini, 2002; Kennedy & Miceli, 2001), there is little evidence to suggest that direct corpus consultation is coming to be seen as a complement or alternative to consultation of a dictionary, cou...

  6. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  7. Potential anesthesia protocols for space exploration missions.

    Science.gov (United States)

    Komorowski, Matthieu; Watkins, Sharmila D; Lebuffe, Gilles; Clark, Jonathan B

    2013-03-01

    In spaceflight beyond low Earth's orbit, medical conditions requiring surgery are of a high level of concern because of their potential impact on crew health and mission success. Whereas surgical techniques have been thoroughly studied in spaceflight analogues, the research focusing on anesthesia is limited. To provide safe anesthesia during an exploration mission will be a highly challenging task. The research objective is thus to describe specific anesthesia procedures enabling treatment of pre-identified surgical conditions. Among the medical conditions considered by the NASA Human Research Program Exploration Medical Capability element, those potentially necessitating anesthesia techniques have been identified. The most appropriate procedure for each condition is thoroughly discussed. The substantial cost of training time necessary to implement regional anesthesia is pointed out. Within general anesthetics, ketamine combines the unique advantages of preservation of cardiovascular stability, the protective airway reflexes, and spontaneous ventilation. Ketamine side effects have for decades tempered enthusiasm for its use, but recent developments in mitigation means broadened its indications. The extensive experience gathered in remote environments, with minimal equipment and occasionally by insufficiently trained care providers, confirms its high degree of safety. Two ketamine-based anesthesia protocols are described with their corresponding indications. They have been designed taking into account the physiological changes occurring in microgravity and the specific constraints of exploration missions. This investigation could not only improve surgical care during long-duration spaceflights, but may find a number of terrestrial applications in isolated or austere environments.

  8. [Systematic recording of perioperative events associated with anesthesia as quality indicator in ambulatory anesthesia].

    Science.gov (United States)

    García-Aguado, R; Vivó Benlloch, M; Arcusa Mon, M J; Peiró Alós, C; Zaragoza Fernández, C; Castaño Conesa, S; Grau Real, F

    2000-03-01

    To analyze the quality of several anesthetic techniques used for major outpatient surgery in our hospital, by quantifying for each the relative risk (RR) of adverse events during anesthesia and in the postoperative period. One thousand seventeen patients who underwent surgery between 18 May 1998 and 23 October 1998 were studied retrospectively. The mean age of the patients was 52.27 +/- 24.65 yr; 44.18% were ASA I, 40.56% were ASA II, 14.56% ASA III and 0.67% ASA IV. Mean time of surgery was 33 +/- 16.49 min and mean recovery time until discharge was 77.3 +/- 93.4 min. Admission was necessary for 0.6% of the patients and re-admission for 0.3%. General anesthesia was used with 19%, anesthetic monitoring with 17%, regional anesthesia (including peribulbar) with 46% and local anesthesia plus sedation with 16.6%. In 95% of the cases, no adverse events occurred during anesthesia; in 94.8% no such events occurred during the early recovery period. During surgery and postoperative recovery, intradural anesthesia was associated with significantly greater RR of adverse events in comparison with general anesthesia (6.6 and 2.2 respectively) and in comparison with monitored anesthesia (7.2 and 3.3). No differences in RR were found between general anesthesia and monitored anesthesia. Problems were slight to moderate in severity and mainly related to nausea and vomiting (2%). Recording perioperative events permits evaluation of the quality of anesthesic procedures. Intradural anesthesia is associated with more complications.

  9. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive

  10. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J; Absalom, Anthony

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive

  11. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J; Absalom, Anthony

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  12. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  13. Perspectives on ambulatory anesthesia: the patient’s point of view

    Directory of Open Access Journals (Sweden)

    Sehmbi H

    2014-12-01

    Full Text Available Herman Sehmbi, Jean Wong, David T WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaAbstract: Recent advances in anesthetic and surgical techniques have led to tremendous growth of ambulatory surgery. With patients with many co-morbid conditions undergoing complex procedures in an ambulatory setting, the challenges in providing ambulatory surgery and anesthesia are immense. In recent years, the paradigm has shifted from a health-care provider focus involving process compliance and clinical outcomes, to a patient-centered strategy that includes patients’ perspectives of desired outcomes. Improving preoperative patient education while reducing unnecessary testing, improving postoperative pain management, and reducing postoperative nausea and vomiting may help enhance patient satisfaction. The functional status of most patients is reduced postoperatively, and thus the pattern of recovery is an area of ongoing research. Standardized and validated psychometric questionnaires such as Quality of Recovery-40 and Postoperative Quality of Recovery Scale are potential tools to assess this. Patient satisfaction has been identified as an important outcome measure and dedicated tools to assess this in various clinical settings are needed. Identification of key aspects of ambulatory surgery deemed important from patients’ perspectives, and implementation of validated outcome questionnaires, are important in improving patient centered care and patient satisfaction.Keywords: ambulatory, patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  14. Outpatient transesophageal echocardiography with intravenous propofol anesthesia in children and adolescents.

    Science.gov (United States)

    Marcus, B; Steward, D J; Khan, N R; Scott, E B; Scott, G M; Gardner, A J; Wong, P C

    1993-01-01

    Outpatient transesophageal echocardiography (TEE) was performed in 10 children and adolescents (aged 3 to 19.5 years, mean 13.5 years; weight 12 to 91 kg, mean 49 kg), including two with Down's syndrome and one with autism, for diagnostic evaluation of issues unresolved by transthoracic echo examination (TTE). Issues for TEE: evaluation for atrial septal defect (two patients); anatomy of left ventricular outflow tract obstruction (one patient); aortic valve anatomy before valvuloplasty for insufficiency (one patient); evaluation for cause of cyanosis after Fontan operation (one patient); determination of source of high-velocity intracardiac turbulence after atrioventricular septal defect repair (one patient); rule out cardiac embolic source in patient with stroke (one patient); evaluate prosthetic valve function and rule out thrombus (one patient); determination of anatomic relationship of mitral valve to a ventricular septal defect before surgery for complex cyanotic heart disease (one patient); and evaluation for aortic dissection in Marfan's syndrome (one patient). Intravenous propofol anesthesia administered without endotracheal intubation by an anesthesiologist allowed successful outpatient TEE in nine patients; midazolam-conscious sedation was used in one. Outpatient TEE resolved diagnostic issues in all patients without complication, thereby avoiding cardiac catheterization in six patients and supplementing catheterization for preoperative planning in four patients. TEE can be performed safely and effectively with propofol anesthesia in the outpatient setting in carefully selected children and adolescents to provide vital diagnostic information. However, given the invasive nature of the procedure and the use of anesthesia, outpatient pediatric TEE should be used judiciously.

  15. Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy.

    Science.gov (United States)

    Tsujikawa, Shogo; Okutani, Ryu; Oda, Yutaka

    2012-04-01

    Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.

  16. Visual evoked potentials for intraoperative neurophysiologic monitoring using total intravenous anesthesia.

    Science.gov (United States)

    Wiedemayer, Helmut; Fauser, Barbara; Armbruster, W; Gasser, Thomas; Stolke, Dietmar

    2003-01-01

    Conflicting reports on the usefulness of intraoperative monitoring of visual function by means of visual evoked potentials (VEPs) initiated this study. In 32 patients without visual problems, VEPs were recorded to evaluate the reliability for intraoperative monitoring with total intravenous anesthesia. All patients underwent noncranial surgery. Using a standard technique, VEPs were recorded preoperatively in the awake patients and after induction of anesthesia during surgery. A total of 1436 intraoperative traces were recorded and analyzed. A minor prolongation of the P100 latency of 8% and a more pronounced attenuation of the P100-N145 amplitude of 60% were observed in the anesthetized patients. In most of the anesthetized patients, a stable recording of VEPs was not obtainable. In 4 patients (12.5%), clearly identifiable VEP peaks were detected in more than 90% of the traces recorded intraoperatively. In 88% of the patients, reproducible VEPs were obtained in less than 75% of the intraoperative traces only. We concluded that with standard recording techniques and total intravenous anesthesia, intraoperative VEP monitoring in surgically anesthetized patients is not reliable.

  17. Anesthesia treatment in cases of infant epiglottis cyst emergency extirpation operations.

    Science.gov (United States)

    Xu, Q; Xu, J P; Wang, L Z

    2014-06-17

    Congenital epiglottic cyst is a rare embryonic disease. As a congenital laryngeal mucocele, its clinical manifestations include repeated sudden dyspneic respiration and even suffocation accompanied by laryngeal stridor after birth. During food intake, bucking and vomiting is a key feature. Delay in diagnosis and treatment of the disease affects growth and the development of neonatorum leading to suffocation and death. This study was designed to investigate the safety of anesthesia in infants with congenital epiglottic cyst during operation to reduce the occurrence of its complications. The treatment of operations on 12 infants with congenital epiglottic cysts were retrospectively analyzed. Twelve cases of infants with epiglottic cysts received emergency enucleation. Owing to adequate preanesthetic preparation, cystectomies were successfully performed with microwave cauterization under suspension laryngoscopy. None of the 12 patients showed apparent suffocation during anesthesia, the surgical results were good, and after 6 months to 1 year of follow-up, the disease had not recurred. Because of the acute onset of the disease and its severe symptoms and complications, attention should be paid to improve preoperative preparation. Careful selection of proper anesthesia is the key to achieving a successful operation.

  18. Preoperative education for lumbar surgery for radiculopathy

    Directory of Open Access Journals (Sweden)

    A. Louw

    2009-02-01

    Full Text Available To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptiveand inferential statistical tests. Results showed that 100% of the patients and 99% of therapists view preoperative education to be an important component for lumbar surgery for radiculopathy. The most important factors identifiedfor inclusion in preoperative educational programs were reason for surgery, risks associated with surgery, limitations following surgery and more education regarding pain. The preferred method of education delivery was verbal one-on-one education. This study demonstrates that there is a demand for preoperative education for patients who had lumbar surgery.

  19. [Preoperative assessment of lung disease patients.].

    Science.gov (United States)

    Ramos, Gilson; Ramos Filho, José; Pereira, Edísio; Junqueira, Marcos; Assis, Carlos Henrique C

    2003-02-01

    Lung complications are the most frequent causes of postoperative morbidity-mortality, especially in lung disease patients. So, those patients should be preoperatively carefully evaluated and prepared, both clinically and laboratorially. This review aimed at determining surgical risk and at establishing preoperative procedures to minimize peri and postoperative morbidity-mortality in lung disease patients. Major anesthetic-surgical repercussions in lung function have already been described. Similarly, we tried to select higher-risk patients, submitted or not to lung resection. To that end, clinical and laboratorial propedeutics were used. Finally, a proposal of a preoperative algorithm was presented for procedures with lung resection. Lung disease patients, especially those with chronic evolution, need to be preoperatively thoroughly evaluated. ASA physical status and Goldmans cardiac index are important risk forecasting factors for lung disease patients not candidates for lung resection. Adding to these criteria, estimated postoperative max VO2, FEV1 and diffusion capacity are mandatory for some patients submitted to lung resection. beta2-agonists and steroids should be considered in the preoperative period of these patients.

  20. Consulting--Part 2. The art and science of using consultants.

    Science.gov (United States)

    Lister, E D; Pirrotta, S

    1996-11-01

    Part I of this series described a research project--a survey of more than 300 physician executives. Asked to share their personal experiences of unsuccessful consultations, our correspondents painted a clear picture of what can go wrong when organizational consultants enter health care systems, and described the lasting destructive sequelae to failed consultations. The two issues responsible for most failed consultations were the intrusion of internal politics into the process and the failure to clearly establish and maintain consensual goals. In Part 2, the consultation process is explored from a very different perspective. What are the issues that often trigger requests for consultation services, as well as the dynamics that can foreshadow success or failure before consultants are even engaged? What are the pitfalls and pointers for the successful use of consultation services?

  1. Current understanding of patients' attitudes toward and preparation for anesthesia: a review.

    Science.gov (United States)

    Klafta, J M; Roizen, M F

    1996-12-01

    A number of issues relating to patient education in anesthesia have been addressed in this review and, based upon the available data, some questions can be answered clearly. It is apparent both that a large minority of the American, British, and Australian public is under the misconception that anesthesiologists are not physicians and that the role of the anesthesiologist, both in and out of the operating room, is not fully understood. Many surgical patients, particularly younger ones, have fears about the anesthetic that are distinct from their fears about the surgery, the most common of them relating to waking up prematurely or not at all. Traditional attire for anesthesiologists is preferred by patients but does not appear to significantly influence patient satisfaction. While there are numerous putative advantages to improving patient rapport, good communication as judged by the patient is associated with a lower incidence of malpractice litigation. Preoperative instruction has been demonstrated to have benefit with regard to patient anxiety, postoperative pain, and length of hospitalization. It is also clear that patients' coping behavior varies considerably and strongly influences the usefulness of providing detailed preoperative information. Preoperative teaching should therefore be tailored accordingly. An issue that is less clear concerns the optimal methods for educating patients and the general public. Preliminary evaluation of videotape instruction has yielded somewhat encouraging results, but whether the preoperative visit, supplemented by videotape or in-hospital, on-demand television programming, or computer networks, such as the World Wide Web or home television, are the most effective and practical means for this education remains to be seen. How best to identify in a cost-effective way patients who would most likely benefit from more information is an important question that remains relatively unaddressed. Advances in surgical diagnosis and

  2. [Application of Non-intubated Anesthesia in VATS].

    Science.gov (United States)

    Dai, Xiaotan; Song, Pingping; Zhang, Baijiang

    2016-05-20

    Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery (VATS) because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a "minimally invasive" surgery (including micro anesthesia) has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology of non-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS. The anesthesia method not only reduces the anesthesia injury of tracheal intubation, but also conforms to the idea of rapid rehabilitation surgery. Based on non-intubated anesthesia in VATS in the brief history of development, the anesthesia selection, operation advantages and risks are reviewed in this paper.

  3. Patient-, treatment-, and facility-level structural characteristics associated with the receipt of preoperative lower extremity amputation rehabilitation.

    Science.gov (United States)

    Bates, Barbara E; Hallenbeck, Richard; Ferrario, Toni; Kwong, Pui L; Kurichi, Jibby E; Stineman, Margaret G; Xie, Dawei

    2013-01-01

    To determine patient, treatment, or facility characteristics that influence decisions to initiate a rehabilitation assessment before transtibial or transfemoral amputation within the Veterans Affairs (VA) health care system. Retrospective database study. VA medical centers. A total of 4226 veterans with lower extremity amputations discharged from a VA medical center between October 1, 2002, and September 30, 2004. Evidence of a preoperative rehabilitation assessment after the index surgical stay admission but before the surgical date. Evidence was found that 343 of 4226 veterans (8.12%) with lower extremity amputations received preoperative rehabilitation assessments. Veterans receiving preoperative rehabilitation were more likely to be older, admitted from home, or transferred from another hospital. Patients who underwent surgical amputation at smaller-sized hospitals or in the South Central or Mountain Pacific regions were more likely to receive preoperative rehabilitation compared with patients in mid-sized hospitals or in the Northeast, Southeast, or Midwest regions. Patients with evidence of paralysis, patients treated in facilities with programs accredited by the Commission on Accreditation of Rehabilitation Facilities (P facility-level structural characteristics, we found that older patients were more likely to receive preoperative rehabilitation services (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01-1.02). Patients with a contributing amputation etiology of a previous amputation complication were more likely to receive preoperative consultation rehabilitation services (OR 1.50, 95% CI 1.02-2.19) compared with patients who did not have this etiology. Compared with patients treated in the Southeast region of the United States, those treated in the South Central region (OR 2.52, 95% CI 1.82-3.48) or Mountain Pacific region (OR 1.62, 95% CI 1.11-2.37) were more likely to receive preoperative consultation rehabilitation services. Patients with

  4. The Application of Topical Anesthesia Combined with Subconjunctival Anesthesia for Glaucoma Surgery

    Institute of Scientific and Technical Information of China (English)

    Shengsong Huang; Minbin Yu; Jie Lian; Min Fan; Changyu Qiu

    2003-01-01

    Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5% Alcaine eye drops combined with subconjunctival anesthesia with 2% Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes(85.2%) were painless (Grade I ), 50 eyes (14.0%) were slight painful (Grade Ⅱ ), and 3 eyes (0.8%) were more painful (Grade Ⅲ ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow visual fields and poor visual ability.Conclusion: Topical anesthesia combined with subconjunctival anesthesia is effective,safe and simple anesthesia alternative in routine anti-glaucomatous surgery, especially for the glaucoma patients at the late stage with narrow visual fields and poor visual ability. It is worthy of being applied widely.

  5. CAN FRACTIONATED SPINAL ANESTHESIA BE AN ECONOMICAL ALTERNATIVE TECHNIQUE TO COMBINED SPINAL - EPIDURAL ANESTHESIA??

    Directory of Open Access Journals (Sweden)

    Sunitha

    2015-01-01

    Full Text Available NTRODUCTION : Central neuraxial blockade holds a very good place in anesthesia for surgical procedures on abdomen and lower limbs 1 . We have spinal anesthesia with rapid onset of action with precipitous hypotension , on the other hand we have epidural anesthesia with gradual onset of action with graded fall in BP and ability to prolong anesthesia for required duration and to provide post - operative analgesia. Combination of these two techniques can be of benefit in the form of rapid onset of action by spinal anesthesia and prolonging the duration of anesthesia by epidural. 2 , 3 This combined technique appears to be demanding higher cost when compared to either of them 4 , 5 and also associated with technical difficulties a nd catheter related problems. Fractionated spinal anesthesia (FSA 6 , 7 where local anesthetic is injected into subarachnoid space in fractions with time gap along with opioids like morphine 5 , 8 , 9 will not only reduce the degree of hypotension 10 , 11 but al so provides prolonged duration of anesthesia. 12 , 13 Addition of morphine will take care of postoperative analgesia and this technique is devoid of complications related to the catheters like kinking , infections , difficulty in insertion , blockade etc

  6. The effect of parallel consulting on the quality of consultations in regional general practice.

    Science.gov (United States)

    Tran, Peter Duy; Laurence, Jerome Martin; Weston, Kathryn M; McLennan, Peter L

    2012-05-01

    The sustainability of community-based medical education relies on maintaining consultation quality as perceived by patients. This study aims to investigate the effect of an alternative model (parallel consultation) of teaching on patients' views of consultation quality as compared to the conventional consultation model in a general practice setting. A cross-sectional questionnaire study. Patients attending a regional general practice in the Southern Highlands of New South Wales between February and May 2010, who consented to student involvement in their consultation. Instruments to measure 'empathy' (CARE score) and 'enablement' (PEI score) as markers for consultation quality were administered after patient consultations. There was no difference in consultation length between the two groups. There was a small increase in the level of empathy experienced by patients attending parallel consultations compared to conventional consultations (Pconsultation group (Pconsultation quality, as experienced by the patient, when using the parallel consulting model. Parallel consulting does not change the length of time a patient spends with their doctor, and patients have a positive perception of the students involved in this model of clinical teaching.

  7. Competency-Based Behavior Consultation Training: An Evaluation of Consultant Outcomes, Treatment Effects, and Consumer Satisfaction

    Science.gov (United States)

    Lepage, Kathy; Kratochwill, Thomas R.; Elliott, Stephen N.

    2004-01-01

    Assessments of consultants, clients, and consumer satisfaction were used to examine the effects of a competency-based consultation training program conducted over 4 years. Using a multiple-baseline framework to assess training effects on consultants and single-case study designs to evaluate changes in client behavior, a number of significant…

  8. [Transdermal nitroglycerin before induction of anesthesia prevents redistribution hypothermia in patients under general anesthesia].

    Science.gov (United States)

    Morioka, N; Ozaki, M; Matsukawa, T; Suzuki, H

    1998-12-01

    Initial anesthesic-induced hypothermia results largely from core-to-peripheral redistribution of heat. Administration of transdermal nitroglycerin induces vasodilation. Such vasodilation, induced well before induction of anesthesia, might redistribute heat to peripheral tissues. Minimal redistribution hypothermia might accompany subsequent induction of anesthesia. We studied 32 patients undergoing gastrointestinal surgery. Thirty minutes before induction of anesthesia, they were randomly assigned to: 1. transdermal nitroglycerin 10 mg; 2. transdermal nitroglycerin 5 mg; and, 3. control. Core temperature during the first hour of anesthesia decreased significantly more in the control patients than in those given either dose of nitroglycerin. Vasodilation induced by transdermal nitroglycerin before induction of anesthesia significantly decreased subsequent redistribution hypothermia. Drug-induced modulation of vascular tone thus produces clinically important alterations in intraoperative core temperature.

  9. Different Aspects of General Anesthesia in Pediatric Dentistry: A Review.

    Science.gov (United States)

    Ramazani, Nahid

    2016-04-01

    Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Besides criteria for case selection of dental GA, some degree of dental practitioner's judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.

  10. Teaching CONSULT: Consultation with Novel methods & Simulation for UME Longitudinal Training.

    Directory of Open Access Journals (Sweden)

    Keme Carter

    2015-10-01

    Full Text Available Introduction: An important area of communication in healthcare is the consultation. Existing literature suggests that formal training in consultation communication is lacking. We aimed to conduct a targeted needs assessment of third-year students on their experience calling consultations, and based on these results, develop, pilot, and evaluate the effectiveness of a consultation curriculum for different learner levels that can be implemented as a longitudinal curriculum. Methods: Baseline needs assessment data were gathered using a survey completed by third-year students at the conclusion of the clinical clerkships. The survey assessed students’ knowledge of the standardized consultation, experience and comfort calling consultations, and previous instruction received on consultation communication. Implementation of the consultation curriculum began the following academic year. Second-year students were introduced to Kessler’s 5 Cs consultation model through a didactic session consisting of a lecture, viewing of “trigger” videos illustrating standardized and informal consults, followed by reflection and discussion. Curriculum effectiveness was assessed through pre- and post- curriculum surveys that assessed knowledge of and comfort with the consultation process. Fourth-year students participated in a consultation curriculum that provided instruction on the 5 Cs model and allowed for continued practice of consultation skills through simulation during the Emergency Medicine clerkship. Proficiency in consult communication in this cohort was assessed using two assessment tools, the Global Rating Scale and the 5 Cs Checklist. Results: The targeted needs assessment of third-year students indicated that 93% of students have called a consultation during their clerkships, but only 24% received feedback. Post-curriculum, second-year students identified more components of the 5 Cs model (4.04 vs. 4.81, p<0.001 and reported greater comfort with the

  11. Linking Knowledge and Action: PRI's Community Consultant.

    Science.gov (United States)

    Spencer, Gregory P.

    Within the Partnership for Rural Improvement (PRI), community consultants operate within three complex sets of relationships: client groups, the organizational structure of PRI, and the local operational base. Community consultants are responsible for developing and facilitating rural development and for providing assistance in community and…

  12. Consulting Careers: A Profile of Three Occupations

    Science.gov (United States)

    Mullins, John

    2011-01-01

    Choosing an industry in which to work is often as important as choosing an occupation. And over the next several years, the best advice for some workers may be to choose an industry that sells advice: consulting. The management, scientific, and technical consulting services industry comprises businesses that offer specialized advice to other…

  13. The Consulting Challenge: A Case Competition

    Science.gov (United States)

    Sachau, Daniel A.; Naas, Patricia A.

    2010-01-01

    The Consulting Challenge is a yearly case competition in which teams of graduate students respond to a request for proposals (RFP) for consulting services. The case and RFP are based on a problem that a host organization has experienced. Over 3 days, students meet with representatives of the host organization, analyze data, prepare a proposal for…

  14. Capturing the Competence of Management Consulting Work

    Science.gov (United States)

    Visscher, Klaasjan

    2006-01-01

    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. Design/methodology/approach: A survey was conducted among Dutch management…

  15. Linking Knowledge and Action: PRI's Community Consultant.

    Science.gov (United States)

    Spencer, Gregory P.

    Within the Partnership for Rural Improvement (PRI), community consultants operate within three complex sets of relationships: client groups, the organizational structure of PRI, and the local operational base. Community consultants are responsible for developing and facilitating rural development and for providing assistance in community and…

  16. How to Hire a Search Consultant.

    Science.gov (United States)

    Lester, Virginia L.

    1993-01-01

    Increasingly, colleges and universities are using consultants to help search committees find the right president for the institution. Search consultants bring experience, historical and national perspectives, objectivity, personal knowledge of candidates, and a professional approach. Energy, enthusiasm, and style are important consultant…

  17. Patient expectations from consultation with family physician.

    NARCIS (Netherlands)

    Tähepöld, H.; Brink-Muinen, A. van den; Maaroos, H.I.

    2006-01-01

    Aim: To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. Method: We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped

  18. ARL/OMS Consultant Training Program.

    Science.gov (United States)

    Euster, Joanne R.

    1982-01-01

    Describes Academic Library Consultant Training Program begun in 1979, sponsored by Office of Management Studies (OMS) and designed to provide 80 consultants to aid academic libraries in improving performance. Viewpoints are included from OMS Director and participants concerning program objectives, trainee selection, workshops, internships, and the…

  19. Capturing the competence of management consulting work

    NARCIS (Netherlands)

    Visscher, Klaasjan

    2006-01-01

    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. - Design/methodology/approach: A su

  20. Pre-operative fasting guidelines: an update

    DEFF Research Database (Denmark)

    Søreide, E; Eriksson, L I; Hirlekar, G

    2005-01-01

    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children......Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  1. Postoperative Management of the Physiological Effects of Spinal Anesthesia.

    Science.gov (United States)

    O'Neill, Jennifer; Helwig, Elizabeth

    2016-08-01

    Spinal anesthesia is a common regional anesthesia used in ambulatory and hospital settings. Spinal anesthesia has been shown to reduce postoperative pain and morbidity in certain populations. Understanding the physiological changes during spinal anesthesia can help predict and manage side effects including hypotension, bradycardia, decreased expiration, nausea, vomiting, and urinary retention. This article describes the physiological effects of spinal anesthesia in a body systems approach, describes how to assess the spinal level, and presents common side effects seen postoperatively and how to successfully manage and treat these patients. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  2. Multidrug intravenous anesthesia for children undergoing MRI: a comparison with general anesthesia.

    Science.gov (United States)

    Shorrab, Ahmed A; Demian, Atef D; Atallah, Mohamed M

    2007-12-01

    We used a multidrug intravenous anesthesia regimen with midazolam, ketamine, and propofol to provide anesthesia for children during magnetic resonance imaging (MRI). This regimen was compared with general anesthesia in a randomized comparative study. Outcome measures were safety, side effects and recovery variables in addition to adverse events in relation to age strata. The children received either general anesthesia with propofol, vecuronium and isoflurane [general endotracheal anesthesia (GET) group; n=313] or intravenous anesthesia with midazolam, ketamine, and propofol [intravenous anesthesia (MKP) group; n=342]. Treatment assignment was randomized based on the date of the MRI. Physiological parameters were monitored during anesthesia and recovery. Desaturation (SpO2<93%), airway problems, and the need to repeat the scan were recorded. The discharge criteria were stable vital signs, return to baseline consciousness, absence of any side effects, and ability to ambulate. With the exception of two children (0.6%) in the MKP group, all enrolled children completed the scan. A significantly greater number (2.3%) required a repeat scan in the MKP group (P<0.05) and were sedated with a bolus dose of propofol. The total incidence of side effects was comparable between the MKP (7.7%) and GET groups (7.0%). Infants below the age of 1 year showed a significantly higher incidence of adverse events compared with the other age strata within each group. Within the MKP group, risk ratio was 0.40 and 0.26 when comparing infants aged below 1 year with the two older age strata, respectively. Recovery characteristics were comparable between both groups. Intravenous midazolam, ketamine and propofol provides safe and adequate anesthesia, comparable with that obtained from general endotracheal anesthesia, for most children during MRI.

  3. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

    Science.gov (United States)

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

  4. Timer: a new objective measure of consultation content and its application to computer assisted consultations.

    Science.gov (United States)

    Pringle, M; Robins, S; Brown, G

    1986-01-01

    As part of the research into the effect in the consultation of the use of a computer to prompt opportunistic preventive care a valid, objective, and practical measure of the consultation process was required. After a review of the alternative methods the Time Interval Medical Event Recorder (Timer) was developed, its reliability tested, and applied to 93 control consultations and 49 computer assisted consultations. Timer records, every five seconds, four consultation events: the problems being dealt with, the physical activity, the verbal activity, and the secondary tasks being attempted. Timer showed that control consultations lasted an average of 6 minutes 58 seconds. The doctors spent 35% of their time on administration, and patients and doctors were both conversational for just 33% of the consultation. Giving information was the most common verbal activity (48% of the duration of the consultation) with silence accounting for 21% of the time. When the computer was used the average consultation was longer, at 7 minutes and 46 seconds. The doctor's contribution to the consultation appeared to have increased. Patient centred speech fell from 36% in controls to 28% of the duration of the consultation when the computer was used, while doctor centred speech rose from 30% to 34.5%. Secondary tasks (exploring patient concepts, education, management sharing, and prevention) were attempted during 28% of the control consultations and 40% of the computer consultations. This was accounted for by the increase in prevention (p less than 0.001). Timer is a reliable and practical tool for researching the consultation, and though it has shown validity in detecting differences between consultations that use a computer and those that do not, further applications are required to establish its full value. PMID:3089391

  5. [Characteristics of anesthesia in patients with MELAS syndrome: Case report of anesthesia in video-assisted thoracoscopy].

    Science.gov (United States)

    Haas, A; Wappler, F

    2015-10-01

    The mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome is a disease triggered by a disorder in energy production within mitochondria. The cause of this syndrome is a mutation in the mitochondrial DNA where in 80% of cases an A-to-G mutation is present at nucleotide 3243 and with a prevalence of 18.4/100,000 in the population. Predominantly affected are organ systems with a high energy metabolism, such as the heart, brain and musculature. During the premedication visit a thorough patient history and examination with respect to neurological impairments must be carried out. Epilepsy and the appropriate permanent medication lead to possible alterations in effectiveness of anesthetics and muscle relaxants which are difficult to predict. An extensive patient cardiac history and a preoperative electrocardiogram (ECG) for an appraisal of possible disorders in the cardiac conduction system and when necessary extended cardiac diagnostics, are recommended. The monitoring must be adapted depending on the functional limitations and the forthcoming intervention and when necessary a postoperative surveillance in an intensive care unit should be initiated. Knowledge of the special features of MELAS syndrome in association with a consideration of the characteristics of anesthesia in MELAS patients and an individually adapted intensified perioperative surveillance, can contribute to a reduction in perioperative morbidity in patients suffering from MELAS syndrome.

  6. Awareness during anesthesia: a closed claims analysis.

    Science.gov (United States)

    Domino, K B; Posner, K L; Caplan, R A; Cheney, F W

    1999-04-01

    Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia

  7. Internet-Based Resources Frequently Provide Inaccurate and Out-of-Date Recommendations on Preoperative Fasting: A Systematic Review.

    Science.gov (United States)

    Roughead, Taren; Sewell, Darreul; Ryerson, Christopher J; Fisher, Jolene H; Flexman, Alana M

    2016-12-01

    Preoperative fasting is important to avoid morbidity and surgery delays, yet recommendations available on the Internet may be inaccurate. Our objectives were to describe the characteristics and recommendations of Internet resources on preoperative fasting and assess the quality and readability of these websites. We searched the Internet for common search terms on preoperative fasting using Google® search engines from 4 English-speaking countries (Canada, the United States, Australia, and the United Kingdom). We screened the first 30 websites from each search and extracted data from unique websites that provided recommendations on preoperative fasting. Website quality was assessed using validated tools (JAMA Benchmark criteria, DISCERN score, and Health on the Net Foundation code [HONcode] certification). Readability was scored using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. A total of 87 websites were included in the analysis. A total of 48 websites (55%) provided at least 1 recommendation that contradicted established guidelines. Websites from health care institutions were most likely to make inaccurate recommendations (61%). Only 17% of websites encouraged preoperative hydration. Quality and readability were poor, with a median JAMA Benchmark score of 1 (interquartile range 0-3), mean DISCERN score 39.8 (SD 12.5), mean reading ease score 49 (SD 15), and mean grade level of 10.6 (SD 2.7). HONcode certification was infrequent (10%). Anesthesia society websites and scientific articles had higher DISCERN scores but worse readability compared with websites from health care institutions. Online fasting recommendations are frequently inconsistent with current guidelines, particularly among health care institution websites. The poor quality and readability of Internet resources on preoperative fasting may confuse patients.

  8. Consulting by Business College Academics: Lessons for Business Communication Courses

    Science.gov (United States)

    Dave, Anish

    2009-01-01

    Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

  9. Consulting by Business College Academics: Lessons for Business Communication Courses

    Science.gov (United States)

    Dave, Anish

    2009-01-01

    Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

  10. Awareness and recall in outpatient anesthesia.

    Science.gov (United States)

    Wennervirta, Johanna; Ranta, Seppo O-V; Hynynen, Markku

    2002-07-01

    We studied the incidence of awareness and explicit recall during general anesthesia in outpatients versus inpatients undergoing surgery. During a 14.5-mo period, we structurally interviewed 1500 outpatients and 2343 inpatients. Among outpatients, there were five cases of awareness and recall (one with clear intraoperative recollections and four with doubtful intraoperative recollections). Of the inpatients, six reported awareness and recall (three with clear and three with doubtful intraoperative recollections). The incidence of clear intraoperative recollections was 0.07% in outpatients and 0.13% in inpatients. The difference in the incidence was not significant. Among outpatients, those with awareness and recall were given smaller doses of sevoflurane than those without awareness and recall (P awareness and recall are rare complications of general anesthesia, and outpatients are not at increased risk for this event compared with inpatients undergoing general anesthesia. Rapid recovery from general anesthesia is a crucial element of outpatient surgery. However, this practice may predispose a patient to receive less anesthetic, with increased risk for awareness and recall. We have shown that outpatients undergoing an operation using general anesthesia are not at increased risk for awareness compared with inpatients.

  11. Survey of international regional anesthesia fellowship directors

    Directory of Open Access Journals (Sweden)

    Lansdown AK

    2013-07-01

    Full Text Available Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship directors across the world were asked to complete a comprehensive survey that detailed the range of educational and practical experience and attitudes as well as assessment procedures offered in their programs. Results: The survey response rate was 66% (45/68. Overall, the range of activities and the time and resources committed to education during fellowships is encouraging. A wide range of nerve block experience is reported with most programs also offering acute pain management, research, and teaching opportunities. Only two-thirds of fellowships provide formal feedback. This feedback is typically a formative assessment. Conclusion: This is the first survey of regional anesthesia fellowship directors, and it illustrates the international scope and continuing expansion of education and training in the field. The results should be of interest to program directors seeking to benchmark and improve their educational programs and to faculty involved in further curriculum development. Keywords: anesthesia, regional, fellowship, education

  12. CONSULTATION ON UPDATED METHODOLOGY FOR ...

    Science.gov (United States)

    The National Academy of Sciences (NAS) expects to publish the Biological Effects of Ionizing Radiation (BEIR) committee's report (BEIR VII) on risks from ionizing radiation exposures in calendar year 2005. The committee is expected to have analyzed the most recent epidemiology from the important exposed cohorts and to have factored in any changes resulting from the updated analysis of dosimetry for the Japanese atomic bomb survivors. To the extent practical, the Committee will also consider any relevant radiobiological data, including those from the Department of Energy's low dose effects research program. Based on their evaluation of relevant information, the Committee is then expected to propose a set of models for estimating risks from low-dose ionizing radiation. ORIA will review the BEIR VII report and consider revisions to the Agency's methodology for estimating cancer risks from exposure to ionizing radiation in light of this report and other relevant information. This will be the subject of the Consultation. This project supports a major risk management initiative to improve the basis on which radiation risk decisions are made. This project, funded by several Federal Agencies, reflects an attempt to characterize risks where there are substantial uncertainties. The outcome will improve our ability to assess risks well into the future and will strengthen EPAs overall capability for assessing and managing radiation risks. the BEIR VII report is funde

  13. The Consultation of the Puericulture.

    Directory of Open Access Journals (Sweden)

    Rotardo Rafael Navarro Ruíz

    2010-06-01

    Full Text Available He/she was carried out a bibliographical revision related with the topic Puericulture with the objective of deepening in the knowledge related with the topic, keeping in mind that it is the consultation, par excellence, of the Primary Attention that takes charge of the care and the minor cultivation from a lot before the conception. The visit of the children and young to their doctor, without problems of health mediate they allow to evaluate the integral operation of these and to guide the parents on as acting before possible situations that are presented we Also insist in the different subespecialitys that compose the Puericulture like they are: Puericulture Preconcepcional, Intra-uterine Puericulture and or Prenatal, Puericulture Neonatal, Puericulture of the Infant, Puericulture of the Naive one, Puericulture of the Scholar, the adolescent's Puericulture and that of the boy handicapped. We stand out that this realized activity with quality guarantees the full health of the children, through the clinical exam and other observations we can identify and to diagnose some situation of health that can arise precociously and to diminish future problems.

  14. From Solution Shop to Boutique Consulting? Capturing Recent Developments on the German Consulting Marke

    Directory of Open Access Journals (Sweden)

    Jörg Jasper DÖTSCH

    2016-12-01

    Full Text Available Digitalization, globalization, new technologies and shorter product life cycles are only a few keywords underlining the fact that companies are under increasing pressure for faster adaptation, innovation and hence applying a higher knowledge intensity. We assume that these conditions require an increasingly important role of consulting companies, because they seem to be the intermediaries needed to bridge the faster growing gaps between existing business models, organizational structures and accelerating market change. Market pressure is growing on the market for consultant companies as well. New technologies and digitalization should influence both the structure of the consultancy market and the business models of consultancies. Christensen suggested a trend from Dzsolution shop” to Dzboutique consulting.” To track current developments, we concentrate on the German consulting market as one of the most important consultant markets worldwide and explore changes of the last two years based on various studies. Processes of change seem to be both substantially driven by digitalization and to reflect change on the non-consultancy markets. A high willingness to switch among providers documents a high pressure on performance. The impact of digitalisation seem• to be observable in structural and qualitative change. With regard to the German consulting market and the latest available data we cannot validate a tendency from a dominance of “solution shop” consultancies to “boutique” consultancy services.

  15. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

    Science.gov (United States)

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved.

  16. PREOPERATIVE ENDOSCOPIC MARKING OF UNPALPABLE COLONIC TUMORS

    Directory of Open Access Journals (Sweden)

    A. L. Goncharov

    2013-01-01

    Full Text Available The identification of small colon lesions is one of the major problems in laparoscopic colonic resection.Research objective: to develop a technique of visualization of small tumors of a colon by preoperative endoscopic marking of a tumor.Materials and methods. In one day prior to operation to the patient after bowel preparation the colonoscopy is carried out. In the planned point near tumor on antimesentery edge the submucous infiltration of marking solution (Micky Sharpz blue tattoo pigment, UK is made. The volume of entered solution of 1–3 ml. In only 5 months of use of a technique preoperative marking to 14 patients with small (the size of 1–3 cm malignant tumors of the left colon is performed.Results. The tattoo mark was well visualized by during operation at 13 of 14 patients. In all cases we recorded no complications. Time of operation with preoperative marking averaged 108 min, that is significantly less in comparison with average time of operation with an intra-operative colonoscopy – 155 min (р < 0.001.Conclusions. The first experience of preoperative endoscopic marking of non palpable small tumors of a colon is encouraging. Performance of a technique wasn't accompanied by complications and allowed to reduce significantly time of operation and to simplify conditions of performance of operation.

  17. Preoperative exercise training to improve postoperative outcomes

    NARCIS (Netherlands)

    Valkenet, K.

    2017-01-01

    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing majo

  18. Preoperational test report, primary ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  19. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from

  20. Pre-operative fasting guidelines: an update

    DEFF Research Database (Denmark)

    Søreide, E; Eriksson, L I; Hirlekar, G

    2005-01-01

    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  1. Preoperational test report, vent building ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  2. Preoperational test, vent building ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T., Westinghouse Hanford

    1996-08-20

    Preoperational Test Procedure for Vent Building Ventilation System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The Vent Building ventilation system provides ventilation, heating, cooling, and zone confinement control for the W-030 Project Vent Building. The tests verify correct System operation and correct indications displayed by the central Monitor and Control system.

  3. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from preo

  4. [Changes in psychological features in patients for anesthesia and operation during perioperative period].

    Science.gov (United States)

    Kunihiro, M; Somura, H; Matsumoto, M; Sakabe, T

    1998-09-01

    The purpose of this study was to assess perioperative changes in psychological features of patients receiving anesthesia and operation. Anxiety level and desire for obtaining information were evaluated in 37 patients using the Amsterdam preoperative anxiety and information scale (APAIS) at three points: before and after the preanesthetic examination, and 3 to 5 days after the operation. Anxiety scale (4-20) and information scale (2-10) scores decreased postoperatively from 9.8 +/- 3.8 to 7.3 +/- 3.4 and from 6.1 +/- 2.1 to 4.1 +/- 1.9, respectively. There was a significant but weak correlation (rs = 0.35) between the anxiety scale and information scale before the preanesthetic examination. The postoperative information scale score correlated well with preoperative anxiety scale score (rs = 0.61), and this correlation was higher than with preoperative information scale score (rs = 0.37). When patients were divided into two subgroups, namely patients with (U, n = 12) or without (non-U, n = 25) an increase in postoperative information scale score, anxiety scale score before the preanesthetic examination tended to be higher and the postoperative anxiety scale score was significantly higher in the U group than in the non-U group. We conclude that we should provide more information to the patients who have higher anxiety scale score before the preanesthetic examination regardless of their degree of desire for information.

  5. Transient Neurological Symptoms after Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Zehra Hatipoglu

    2013-02-01

    Full Text Available Lidocaine has been used for more than 50 years for spinal anesthesia and has a remarkable safety record. In 1993, a new adverse effect, transient neurologic toxicity was described in patients recovering from spinal anesthesia with lidocaine. Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h. The incidence of transient neurological symptoms reported in prospective, randomized trials varies from 4% to 37%. The etiology of transient neurological symptoms remains unkonwn. Despite the transient nature of this syndrome, it has proven to be difficult to treat effectively. Drug or some interventional therapy may be necessary. [Archives Medical Review Journal 2013; 22(1.000: 33-44

  6. Regional anesthesia in faciomaxillary and oral surgery

    Directory of Open Access Journals (Sweden)

    Manimaran Kanakaraj

    2012-01-01

    Full Text Available Faciomaxillary and oral surgical procedures are frequently done under local anesthesia. Only few techniques are used widely in these areas in spite of the numerous blocks available. Knowledge about these techniques could encourage use of these techniques for the benefit of patients and operators′ comfort. Leaving aside the commonly used intraoral anesthetic technique by faciomaxillary and dental surgeons, focus is given on regional blocks of extraoral route, like maxillary block, mandibular block, superficial cervical plexus block, forehead and scalp block, trigeminal nerve block, sphenopalatine nerve block, and they are discussed with their indications and technical details involved in administering them. Advantages of using the regional blocks over general anesthesia and multiple pricks include reduced dosage and number of needle pricks. Pediatric considerations like prolonged duration of anesthesia and wider area of action for regional blocks warrant that they should be used with caution.

  7. Discrimination of auditory stimuli during isoflurane anesthesia.

    Science.gov (United States)

    Rojas, Manuel J; Navas, Jinna A; Greene, Stephen A; Rector, David M

    2008-10-01

    Deep isoflurane anesthesia initiates a burst suppression pattern in which high-amplitude bursts are preceded by periods of nearly silent electroencephalogram. The burst suppression ratio (BSR) is the percentage of suppression (silent electroencephalogram) during the burst suppression pattern and is one parameter used to assess anesthesia depth. We investigated cortical burst activity in rats in response to different auditory stimuli presented during the burst suppression state. We noted a rapid appearance of bursts and a significant decrease in the BSR during stimulation. The BSR changes were distinctive for the different stimuli applied, and the BSR decreased significantly more when stimulated with a voice familiar to the rat as compared with an unfamiliar voice. These results show that the cortex can show differential sensory responses during deep isoflurane anesthesia.

  8. Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates

    Directory of Open Access Journals (Sweden)

    Dilek Kalayci

    2014-07-01

    Full Text Available OBJECTIVE: This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. MATERIALS AND METHODS: Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. INTERVENTIONS: Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF and low flow (Group LF. MEASUREMENTS: Blood samples were drawn at the beginning (t 0 and end (t 1 of the operation and after 24 h (t 2. Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. RESULTS: There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t 1 and t 2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t 1 and t 2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t 2. No correlation was found between the IL-10 and nitric oxide levels. CONCLUSION: Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t 1 and t 2 compared with preoperative concentrations; however, at 24 h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels.

  9. [Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates].

    Science.gov (United States)

    Kalayci, Dilek; Dikmen, Bayazit; Kaçmaz, Murat; Taşpınar, Vildan; Ornek, Dilşen; Turan, Ozlem

    2014-01-01

    This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF) and low flow (Group LF). Blood samples were drawn at the beginning (t0) and end (t1) of the operation and after 24h (t2). Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t1 and t2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t2. No correlation was found between the IL-10 and nitric oxide levels. Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations; however, at 24h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates.

    Science.gov (United States)

    Kalaycı, Dilek; Dikmen, Bayazit; Kaçmaz, Murat; Taşpınar, Vildan; Ornek, Dilşen; Turan, Ozlem

    2014-01-01

    This study investigated interleukin-10 and nitric oxide plasma levels following surgery to determine whether there is a correlation between these two variables and if different desflurane anesthesia flow rates influence nitric oxide and interleukin-10 concentrations in circulation. Forty patients between 18 and 70 years and ASA I-II physical status who were scheduled to undergo thyroidectomy were enrolled in the study. Patients were allocated into two groups to receive two different desflurane anesthesia flow rates: high flow (Group HF) and low flow (Group LF). Blood samples were drawn at the beginning (t0) and end (t1) of the operation and after 24h (t2). Plasma interleukin-10 and nitric oxide levels were measured using an enzyme-linked-immunosorbent assay and a Griess reagents kit, respectively. Hemodynamic and respiratory parameters were assessed. There was no statistically significant difference between the two groups with regard to interleukin-10 levels at the times of measurement. Interleukin-10 levels were increased equally in both groups at times t1 and t2 compared with preoperative concentrations. For both groups, nitric oxide circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations. However, the nitric oxide value was lower for Group HF compared to Group LF at t2. No correlation was found between the IL-10 and nitric oxide levels. Clinical usage of two different flow anesthesia forms with desflurane may increase interleukin-10 levels both in Group HF and Group LF; nitric oxide levels circulating concentrations were significantly reduced at times t1 and t2 compared with preoperative concentrations; however, at 24h postoperatively they were higher in Group LF compared to Group HF. No correlation was detected between interleukin-10 and nitric oxide levels. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  11. Practical guidance for charting ethics consultations.

    Science.gov (United States)

    Bruce, Courtenay R; Smith, Martin L; Tawose, Olubukunola Mary; Sharp, Richard R

    2014-03-01

    It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients' medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation.

  12. INTEGRATING CORPUS CONSULTATION IN LANGUAGE STUDIES

    Directory of Open Access Journals (Sweden)

    Angela Chambers

    2005-05-01

    Full Text Available Alongside developments in language research, the potential of corpora as a resource in language learning and teaching has been evident to researchers and teachers since the late 1960s. Despite publications which emphasise the benefits of corpus consultation for language learners (Bernardini, 2002; Kennedy & Miceli, 2001, there is little evidence to suggest that direct corpus consultation is coming to be seen as a complement or alternative to consultation of a dictionary, course book, or grammar by the majority of learners. There is thus a need for research to underpin the integration of corpora and concordancing in the language-learning environment.This study begins with an account of published research relating to course design and structure in the area of corpus consultation by language learners. The focus then narrows to the initial training of learners in corpus consultation, using as an example a course involving undergraduate students on several language degree programmes. The results of the students' consultation of the corpora are examined, including choice of search word(s, analytical skills, the problems encountered, and their evaluation of the activity. The results reveal how corpus consultation can complement traditional language-learning resources, while also raising questions concerning its integration in the language-learning environment.

  13. Longer-term impact of cardiology e-consults.

    Science.gov (United States)

    Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G

    2016-03-01

    Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. [Anesthesia for cesarean section in patients with fetal anomaly].

    Science.gov (United States)

    Nakano, S; Tashiro, C; Nishimura, M; Ueyama, H; Uchiyama, A; Kubota, A; Suehara, N

    1991-05-01

    Twenty-two cases of Cesarean section due to fetal anomaly diagnosed prenatally were reviewed in terms of the anesthetic managements. In 6 cases, diazepam 0.3 mg.kg-1, which provides fetal anesthesia for surgery scheduled immediately after birth, was administered intravenously to the mothers with/without fentanyl (2 general anesthesia and 4 regional anesthesia). The diagnosis of their fetuses was congenital diaphragmatic hernia, congenital cystic adenomatoid malformation of the lung, gastroschisis or omphalocele. No fetal anesthesia was performed in the other 16 cases (15 spinal anesthesia and 1 general anesthesia). Seven of their fetuses were diagnosed as hydrops. Since the general condition of the diseased newborn is known to be deteriorated after receiving various stress and aerophagia, fetal anesthesia in Cesarean delivery has the advantage of stress reduction and prevention of aerophagia. When the newborn is considered to need immediate neonatal resuscitation or intensive care including surgery, fetal anesthesia may be a choice of anesthetic technique.

  15. Before Anesthesia: The Patient's Active Role Makes a Difference

    Science.gov (United States)

    ... anesthesia, a candidate must have a four-year bachelor of science degree in nursing or other appropriate ... can—and should—take an active role in these preparations by communicating and cooperating with your anesthesia ...

  16. Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure.

    Science.gov (United States)

    Vaz, Filinto Aníbal Alagia; Abreu, Rone Antônio Alves; Soárez, Patrícia Coelho de; Speranzini, Manlio Basílio; Fernandes, Luís Cesar; Matos, Delcio

    2010-01-01

    Studies in the area of health economics are still poorly explored and it is known that the cost savings in this area is becoming more necessary, provided that strict criteria. To perform a cost-effectiveness analysis of spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure. This was a randomized clinical trial with 50 patients undergoing loop colostomy closure either under spinal anesthesia (n = 25) or under local anesthesia plus sedation (n = 25). The duration of the operation, time spent in the post-anesthesia recovery room, pain, postoperative complications, length of hospital stay, laboratory and imaging examinations and need for rehospitalization and reoperation were analyzed. The direct medical costs were analyzed. A decision tree model was constructed. The outcome measures were mean cost and cost per local and systemic postoperative complications avoided. Incremental cost-effectiveness ratios were presented. Duration of operation: 146 +/- 111.5 min. vs 105 +/- 23.6 min. (P = 0.012); mean time spent in post-anesthesia recovery room: 145 +/- 110.8 min. vs 36.8 +/- 34.6 min. (Pplus sedation (Pplus sedation (P = 0.209). Hospitalization + rehospitalization: 4.5 +/- 4.1 days vs 2.9 +/- 2.2 days (Pcost-effectiveness ratio: R$ -474.78, indicating that the strategy with local anesthesia plus sedation is cost saving. In the present investigation, loop colostomy closure under local anesthesia plus sedation was effective and appeared to be a dominant strategy, compared with the same surgical procedure under spinal anesthesia.

  17. Postpartum consultation: Occurrence, requirements and expectations

    Directory of Open Access Journals (Sweden)

    Carlgren Ingrid

    2008-07-01

    Full Text Available Abstract Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84 had a postpartum consultation of which 61.9% (n = 52 had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.

  18. Pharmacokinetics of levobupivacaine following infant spinal anesthesia.

    Science.gov (United States)

    Frawley, Geoff; Hallett, Ben; Velkov, Tony; Bjorksten, Andrew

    2016-06-01

    Infant spinal anesthesia with levobupivacaine has been promoted as a technique to reduce both the risk of postoperative apnea and exposure to volatile anesthesia. There is, however, no pharmacokinetic data to support the currently recommended doses. Our aim was to determine whether infant levobupivacaine spinal anesthesia is associated with plasma concentrations consistent with a low risk of local anesthetic systemic toxicity. This was an open-label pharmacokinetic safety and tolerability study of levobupivacaine spinal anesthesia in infants spinal anesthetic with levobupivacaine 1 mg·kg(-1) in the left lateral position. Spinal anesthesia was successful in 25 (86.2%) of 29 infants (postmenstrual age 36-52 weeks; weight 2.2-4.7 kg). The median (IQR) total venous levobupivacaine plasma concentrations was 0.33 (0.25-0.42) μg·ml(-1) and unbound venous levobupivacaine was 19.5 (14.5-38) ng·ml(-1) . Median protein binding was 93.5 (91.4-96%). Alpha-1 acid glycoprotein concentrations were 0.25 (0.17-0.37) g·l(-1) and albumin concentrations were 29 (24-32) g·l(-1) . Total plasma concentrations and unbound (free) concentration of levobupivacaine were consistently lower than concentrations reported in cases of pediatric local anesthetic toxicity. In a small number of infants requiring a repeat spinal of 1 mg·kg(-1) was also associated with acceptable total and free concentrations. We conclude that levobupivacaine at 1 mg·kg(-1) is associated with no systemic side effects in infants receiving awake spinal anesthesia. © 2016 John Wiley & Sons Ltd.

  19. Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine

    Directory of Open Access Journals (Sweden)

    S.M.R. Rabani

    2010-01-01

    Full Text Available Introduction & Objective: The efficacy of Percutaneous Nephrolithotomy (PCNL in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon , the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. Materials & Methods: In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine , from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48, at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics , sedatives or both., if needed. The rest of the procedure was done as routine.Results: Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220, 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones .Blood transfusion was needed only in one patient. No significant complication was observed in this study.Conclusion: PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.

  20. [Structured electronic consultation letter for shoulder disorders].

    Science.gov (United States)

    Paloneva, Juha; Oikari, Marjo; Ylinen, Jari; Ingalsuo, Minna; Ilkka, Kunnamo; Ilkka, Kiviranta

    2012-01-01

    Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. Expectations considering the purpose, contents, and timing of the referral of the consulting physician and the consultant do not always meet. A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.

  1. PERIPHERAL BLOCK ANESTHESIA OF UPPER EXTREMITY AND ITS COMPLICATIONS

    OpenAIRE

    Tapar, Hakan; SÜREN, Mustafa; Kaya, Ziya; Arıcı, Semih; Karaman, Serkan; Kahveci, Mürsel

    2012-01-01

    Successful peripheral blocks and selection of appropriate technique according to surgery is possible with a good knowledge of anatomy. Regional peripheral block anesthesia of upper extremity which applied by single injection to plexus brachialis is the most recommended method of anesthesia in daily surgical procedures. The most important advantages of peripheral nerve blocks which are type of regional anesthesia according to general anesthesia and central blocks are less effect to...

  2. Phrenic nerve blocage with spinal anesthesia for laparoscopic Nissen fundoplication

    Directory of Open Access Journals (Sweden)

    Murat Dursun

    2015-06-01

    Full Text Available In this case, we describe a patient having laparoscopic Nissen fundoplication (LNF under spinal anesthesia with phrenic nerve blockade. It’s emphasized that in this type of operations, spinal anesthesia may be an alternative method rather the general anesthesia and the resulting shoulder pain in laparoscopic surgery performed under spinal anesthesia can be prevented by phrenic nerve blockade. J Clin Exp Invest 2015; 6 (2: 186-188

  3. Implementation of an Anesthesia Information Management System (AIMS)

    OpenAIRE

    Douglas, James R.; Ritter, Melody J.

    2011-01-01

    During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applicati...

  4. Inguinal hernioraphy under local anesthesia in the elderly patients

    OpenAIRE

    2012-01-01

    Objectives: The incidence of inguinal hernia and the frequencyof comorbidity increase in the elderly. Therefore,in operations of these patients, anesthesia methods areimportant. The aim of our study was to investigate the feasibilityof local anesthesia in the operation of the elderly.Materials and methods: The patients operated for inguinalhernia were analyzed retrospectively. They weredivided into two groups: the elderly (>60 years) and theyounger. Anesthesia methods, additional anesthesia r...

  5. Implementation of an Anesthesia Information Management System (AIMS)

    OpenAIRE

    Douglas, James R.; Ritter, Melody J.

    2011-01-01

    During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applicati...

  6. Awareness and recall during general anesthesia.

    Science.gov (United States)

    Chung, Hyun Sik

    2014-05-01

    Anesthesia awareness is defined as both consciousness and recall of surgical events. New research has been conducted out to test this phenomenon. However, testing methods have not proven reliable, including those using devices based on electroencephalographic techniques to detect and prevent intraoperative awareness. The limitations of a standard intraoperative brain monitor reflect our insufficient understanding of consciousness. Moreover, patients who experience an intraoperative awareness can develop serious post-traumatic stress disorders that should not be overlooked. In this review, we introduce the incidence of intraoperative awareness during general anesthesia and discuss the mechanisms of consciousness, as well as risk factors, various monitoring methods, outcome and prevention of intraoperative awareness.

  7. Anesthesia care for the professional singer.

    Science.gov (United States)

    Meacham, Ryan K; Schindler, Joshua

    2015-06-01

    The professional singer comes to the day of surgery with a measure of anxiety about the effects of anesthesia or surgery on his or her voice. A detailed informed consent should be obtained to discuss and document risks, as well as set realistic expectations for recovery. The smallest endotracheal tube possible should be used to intubate in the least traumatic way. Movement of the tube should be minimized, both during anesthesia, as well as in emergence. Postoperative care may be coordinated with an otolaryngologist and speech language pathologist as the singer plans a return to performance.

  8. How accurate is preoperative evaluation of pelvic organ prolapse in women undergoing vaginal reconstruction surgery?

    Directory of Open Access Journals (Sweden)

    Haim Krissi

    Full Text Available OBJECTIVE: To evaluate the differences between the in-office and intraoperative techniques used to evaluate pelvic organ prolapse. MATERIALS AND METHODS: A prospective study included 25 women undergoing vaginal reconstruction surgery including vaginal hysterectomy for pelvic organ prolapse. The outpatient pelvic and site-specific vaginal examination was performed in the lithotomy position with the Valsalva maneuver. Repeated intraoperative examination was performed under general anesthesia with standard mild cervical traction. The Pelvic Organ Prolapse Quantification system (POPQ was used for both measurements and staging. The values found under the two conditions were compared. RESULTS: The intraoperative POPQ-measurements values were significantly higher than the outpatient values for apical wall prolapse in 17/25 (68% women and for anterior wall prolapse in 8/25 (32% women. There was not a significant difference in the posterior wall where increase in staging was shown in 3/25 (12% patients. CONCLUSIONS: Clinicians and patients should be alert to the possibility that pelvic organ measurements performed under general anesthesia with mild traction may be different from preoperative evaluation.

  9. Evaluation of PO2 and PCO2 changes during surgical removal of third molars utilizing enflurane anesthesia.

    Science.gov (United States)

    Kraut, R A; Rubal, B; Bush, B

    1985-01-01

    This study investigated the changes in partial pressure of oxygen during surgical removal of wisdom teeth utilizing a spontaneous ventilation general anesthesia technique with enflurane. Simultaneous transcutaneous and arterial blood gas determination confirmed the presence of two oxygen patterns. Normal preoperative pulmonary function tests, coupled with the stability of the Paco(2) between surgery and extubation, indicates that the 23±10 mmHg increase in transcutaneous oxygen (Ptco(2)) reported in 14 of 27 patients evaluated, was due to ventilation perfusion defects, since 13 of the 27 patients showed a 149±22 mmHg increase in Ptco(2) during the same time period.

  10. [Loss of anesthesia records during network failure of anesthesia management information system: a case of malfunction of backup system].

    Science.gov (United States)

    Fujii, Seishi; Moriwaki, Katsuyuki; Sanuki, Mikako; Tajima, Minoru; Kurita, Shigeaki; Shiroyama, Kazuhisa; Hashimoto, Ken

    2014-05-01

    We report a case of an accidental loss of anesthesia records through network failure of an anesthesia information management system (AIMS). The backup data were not kept in the anesthesia workstations or the server during the failure. Accordingly, anesthesia records of five patients were lost for one hour. Our AIMS has a network redundancy where the server keeps anesthesia monitoring data via two pathways: one via the monitoring server to the AIMS server and the other via anesthesia workstation to the server. Despite the redundant pathways, transient power failures of network switches caused interruptions in both pathways. Our case indicates that, to improve the robustness of the AIMS as electronic medical records, every network apparatus of AIMS, should be supplied with an uninterrupted power supply. Furthermore, each anesthesia workstation should function independently as an anesthesia record keeping client when network failure occurs.

  11. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger;

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to inve...

  12. Nurse Anesthetists' Perceptions Regarding Utilization of Anesthesia Support Personnel

    Science.gov (United States)

    Ford, Mary Bryant

    2010-01-01

    Anesthesia support personnel (ASP) provide direct support to health care providers administering anesthesia (Certified Registered Nurse Anesthetists [CRNAs] and anesthesiologists). Because these anesthesia providers are caring for a patient whom they cannot legally or ethically leave unattended, ASP are employed to bring them extra supplies or…

  13. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to...

  14. Inguinal hernioraphy under local anesthesia in the elderly patients

    Directory of Open Access Journals (Sweden)

    Nurettin Kahramansoy

    2012-12-01

    Full Text Available Objectives: The incidence of inguinal hernia and the frequencyof comorbidity increase in the elderly. Therefore,in operations of these patients, anesthesia methods areimportant. The aim of our study was to investigate the feasibilityof local anesthesia in the operation of the elderly.Materials and methods: The patients operated for inguinalhernia were analyzed retrospectively. They weredivided into two groups: the elderly (>60 years and theyounger. Anesthesia methods, additional anesthesia requirementand complications were compared.Results: Of totally 177 patients, 30.5% were elderly.Operation type, anesthesia method and score of operationalrisk differed between groups. The percentage of comorbidity (55.6% in the elderly was significantly high (p<0.001. Among elderly, the frequency of co morbidity wasslightly higher in patients who had local anesthesia comparedto spinal and general anesthesia. Patients in youngand middle ages preferred to be operated less under localanesthesia (34.1% compared to elderly (70.4%. Therewas one case (2.6% converted to general anesthesiaas an additional anesthesia in the elderly group. Postoperativecomplications were slight more frequent in elderly.These cases were five in number (31.3% and were operatedunder spinal or general anesthesia (p=0.002.Conclusions: The frequency of co morbidity and riskscore of operation (ASA category rise in the elderly.However, inguinal hernioraphy can be performed underlocal anesthesia without complication and conversion togeneral anesthesia.Key words: Inguinal hernia; aged; comorbidity; local anesthesia

  15. Quantification of respiratory depression during pre-operative administration of midazolam using a non-invasive respiratory volume monitor

    Science.gov (United States)

    Gonzalez Castro, Luis N.; Mehta, Jaideep H.; Brayanov, Jordan B.; Mullen, Gary J.

    2017-01-01

    Background Pre-operative administration of benzodiazepines can cause hypoventilation—a decrease in minute ventilation (MV)—commonly referred to as “respiratory compromise or respiratory depression.” Respiratory depression can lead to hypercarbia and / or hypoxemia, and may heighten the risk of other respiratory complications. Current anesthesia practice often places patients at risk for respiratory complications even before surgery, as respiratory monitoring is generally postponed until the patient is in the operating room. In the present study we examined and quantified the onset of respiratory depression following the administration of a single dose of midazolam in pre-operative patients, using a non-invasive respiratory volume monitor that reports MV, tidal volume (TV), and respiratory rate (RR). Methods Impedance-based Respiratory Volume Monitor (RVM) data were collected and analyzed from 30 patients prior to undergoing orthopedic or general surgical procedures. All patients received 2.0 mg of midazolam intravenously at least 20 minutes prior to the induction of anesthesia and the effects of midazolam on the patient's respiratory function were analyzed. Results Within 15 minutes of midazolam administration, we noted a significant decrease in both MV (average decrease of 14.3% ± 5.9%, pbenzodiazepines affect primarily TV rather than RR. Such respiratory monitoring data provide the opportunity for individualizing dosing and adjustment of clinical interventions, especially important in elderly patients. With additional respiratory data, clinicians may be able to better identify and quantify respiratory depression, reduce adverse effects, and improve overall patient safety. PMID:28235069

  16. Hypoventilation after inhaled anesthesia results in reanesthetization.

    Science.gov (United States)

    Leeson, Stanley; Roberson, Russell S; Philip, James H

    2014-10-01

    During emergence from volatile anesthesia, hypoventilation may result from many causes. In this study, we examined the effect of hypoventilation after initial emergence from volatile anesthesia and the potential for reanesthetization. The uptake and excretion of desflurane (Des), sevoflurane, and isoflurane were studied using the Gas Man® computer simulation program for a 70-kg simulated patient. The vaporizer setting was adjusted so that a VRG (vessel-rich tissue group, including brain) level of 0.75 minimum alveolar concentration (MAC), 1.0 MAC, and 1.5 MAC was rapidly achieved and maintained within tight limits for a 1-, 2-, 4-, and 6-hour period of anesthesia.At the end of the simulated period of anesthesia, the vaporizer was set to 0 and fresh gas flow was set to 8 L/min. Ventilation (VA) was continued at 4 L/min until the anesthetic level in the VRG reached MAC awake, equal to 0.33 MAC for each drug. Then, the VA was adjusted to 0.1 L/min to simulate near-apnea and 0.0 L/min to simulate true apnea. Severe reanesthetization was said to occur if the VRG level increased to or above 0.5 MAC. Mild reanesthetization was said to occur if VRG increased from its value of 0.33 MAC but did not reach 0.5 MAC. The minimum VA required to avoid severe reanesthetization was studied by trials of decreased VA beginning at the time the VRG reached 0.33 MAC. After emergence from 1 hour of anesthesia, all simulated patients were protected against mild and severe reanesthetization if anesthesia was at 0.75 or 1.0 MAC. After 4 or 6 hours of anesthesia, severe reanesthetization occurred with all drugs with near or true apnea if anesthesia was at 1.0 or 1.5 MAC. The minimum alveolar VA to protect against severe reanesthetization after 6 hours of anesthesia was no more than 0.5 L/min for all drugs at 0.75 MAC, no more than 0.5 L/min at 1.0 MAC, and no more than 1.2 L/min at 1.5 MAC. In all simulated cases, the source of anesthetic drug that allowed reanesthetization was muscle (MUS

  17. 24 CFR 91.100 - Consultation; local governments.

    Science.gov (United States)

    2010-04-01

    ... Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS Citizen Participation and Consultation § 91.100 Consultation; local governments. (a) General. (1) When preparing...

  18. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

    Science.gov (United States)

    2012-01-01

    Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with

  19. Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

    Science.gov (United States)

    Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

    2012-06-09

    Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative

  20. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF to identify factors that influence physicians’ decisions to order pre-operative tests

    Directory of Open Access Journals (Sweden)

    Patey Andrea M

    2012-06-01

    Full Text Available Abstract Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity; inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences; and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources. Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences. There were also conflicting comments about the potential

  1. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition......Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature......, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed since the last consultation 4 years previously. Where...

  2. Consulting Informs Best Practice in Academia

    Directory of Open Access Journals (Sweden)

    Risa Blair

    2015-10-01

    Full Text Available The Conversational Plenary Session began with a clear agenda of describing the process and challenge of developing eLearning and eTraining. After a brief discussion of the benefits and challenges of the modality, the conversation quickly segued to a highly spirited conversation related to consulting and the negative implications when one calls oneself a consultant. In fact, this became an integral theme of multiple discussions throughout the rest of the conference. This author strives to identify a selection of literature which supports the viewpoint that consulting does indeed inform best practices in academia. Those professors with up-to-the-minute consultancies in their fields offer an enriched experience for their students.

  3. Three Obstacles to Improving Academic Consultation.

    Science.gov (United States)

    Kremer, John F.

    1980-01-01

    Notes three obstacles to improving academic consultation to students: (1) lack of knowledge of techniques to improve student performance; (2) reduction of barriers between students and professors; and (3) needed reinforcements for professors. Suggests strategies for overcoming those problems. (CK)

  4. [A nurse consultation in victimology for minors].

    Science.gov (United States)

    Soudan, Corinne

    2014-10-01

    The nurse consultation is an integral part of the treatment of children and adolescents experiencing psychological distress following traumatic events. Specific support is therefore offered to young patients, in particular through the intervention of a clinical nurse specialist.

  5. Ethics consultation: a dangerous, antidemocratic charlatanry?

    Science.gov (United States)

    Lilje, Christian

    1993-01-01

    Giles Scofield's argument indicates ethics consultants may need to better clarify what in fact they are and what they are not doing, claiming, and striving for. But we must not step back too far. We must neither engage in putting in envious professional claims for exclusive rights in the area of difficult and momentous decisions in healthcare nor get stuck in discussing normative ethics at the level of metaphysics, ontology, and dogmatics (as has happened in Germany for decades). We must not do so especially in view of the achievements of ethics consultation and the growing demand for it by all parties involved, conceded even by sceptics. Ethics consultation, according to Scofield, appears to be dangerous....Let us look more closely at the logic of the argument by discussing the presumed "antidemocratic" nature. The "new tyranny" of thoughts, and the "proper" role of bioethics consultation. Some considerations about the possibility of ethics expertise shall be left for the end.

  6. 265 Statistical Consulting and the African Universities

    African Journals Online (AJOL)

    User

    2011-07-21

    Jul 21, 2011 ... Indexed African Journals Online. An International Multidisciplinary Journal, Ethiopia ... engineering, medicine, public health, psychology, marketing, ..... method and the role of statistics; Statistical Consulting Environments (Life ... intelligible reports, makes presentations using PowerPoint and persuasive.

  7. ACF 2012 Reponse to Tribal Consultation Testimony

    Data.gov (United States)

    U.S. Department of Health & Human Services — On March 5 and 6, 2012, the Administration for Children and Families (ACF) held its annual tribal consultation session in Washington, D.C. This session marked the...

  8. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    cytology and cystoscopy are recommended if clinically indicated. Treatment progresses from conservative management through various oral and intravesical therapies, with most surgical therapies reserved for unresponsive cases. Pain management is critical throughout the treatment process. The consultation...

  9. Preoperative staging of perforated diverticulitis by computed tomography scanning

    NARCIS (Netherlands)

    M.P.M. Gielens; I.M. Mulder (Irene); E. van der Harst (Erwin); M.P. Gosselink (Martijn Pieter); K.J. Kraal; H.T. Teng; J.F. Lange (Johan); J. Vermeulen (Jefrey)

    2012-01-01

    textabstractBackground: Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning. Methods: All patie

  10. The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

    National Research Council Canada - National Science Library

    Moerman, N; Dam, van, F.S.A.M; Muller, M.J; Oosting, H

    1996-01-01

    ... phase.During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS...

  11. Supporting Group Communication Among UX Consultants

    OpenAIRE

    Feldt, Tommy

    2015-01-01

    Professional User Experience (UX) practitioners have an inherent need for effective group communication practices. If they work as external consultants, the need is arguably even greater. Enterprise Social Media (ESM) technologies have affordances that make them seem promising for this domain. The aim of this thesis is thus to identify the domain-specific communicative needs of UX consultants, and discuss how these might be supported using ESM. A case study was conducted, examining how the ES...

  12. Using Language Consultants in Communicative Language Teaching

    OpenAIRE

    Hiroki, Yamamoto; Makoto, Izumisawa; Graduate School, Meiji University

    2016-01-01

    The purpose of the present study is to introduce a teaching technique using language consultants in communicative language teaching. Language consultant is a role in which a student pays attention to a group member's language use during activities, and provides him/her with corrective and positive feedback after the activities, referring to dictionaries. Its effectiveness in terms of second language (L2) learning and motivation was investigated by using it with 42 English learners at a Japane...

  13. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general ane

  14. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general ane

  15. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general

  16. An evaluation of new circle system of anesthesia. Quantitative anesthesia with isoflurane in new zealand rabbits

    OpenAIRE

    Fonseca,Neuber M.; Saul Goldenberg; Duvaldo Eurides; Novo, Neil F; Cirilo A. P. Lima

    1997-01-01

    A small circuit system of anesthesia was developed by Fonseca and Goldenberg in 1993. The authors used in this study New Zealand White (NZW) rabbits under closed system anesthetic regiment by insoflurane. Twenty male adult New Zealand rabbits were distributed in two groups of ten animals. No premedicant drugs were given. Endotraqueal intubation was made after intravenous administration of propofol (10mg/kg). Insoflurane was used to anesthesia management, administred by lowflow closed system t...

  17. Patient satisfaction in anesthesia: A modified Iowa Satisfaction in Anesthesia Scale

    OpenAIRE

    Baroudi, Dina N.; Nofal, Walid H.; Ahmad, Nauman A.

    2010-01-01

    Objectives: To set up and validate a patient satisfaction questionnaire based on Iowa Satisfaction in Anesthesia Scale (ISAS) for evaluating the degree of patient satisfaction in anesthesia. Materials and Methods: We established and validated a survey questionnaire of 13 questions measuring the following dimensions adequacy of patient information; participation in decision making, nurse patient relation, accessibility of communication with the anesthesiologist, patient fear and anxiety and th...

  18. Place of the Post-Anesthesia Care Unit in Patient Care after Anesthesia

    OpenAIRE

    Güvenç Doğan; Çakır E2 , Kılıç I; Akdur F; Ornek D; Selçuk Akçaboy ZN; Nermin G

    2017-01-01

    Aim: The aim of this study is to emphasize that the post-anesthesia care unit provides good quality service and is an important place for treatment of patients at high risk of postoperative complications. Material And Methods: Patients admitted to the post-anesthesia care unit with ASA II, III, IV, and V risk group during the postoperative period between 1 March 2013 and 30 September 2013 in Ankara Numune Training and Research Hospital were retrospectively evaluated for data relating to age, ...

  19. Anesthesia Providers’ Perspectives Regarding Parental Presence During Anesthesia Induction: A Pilot Study

    Science.gov (United States)

    1997-05-01

    was to ascertain anesthesia providers’ perspectives regarding parental presence during anesthesia induction. The work of Dr. John Bowlby (1973) laid...their parental surrogates. Bowlby looked at how orphans bonded with nurses and staff members. He found that children of all ages formed strong...during episodes of extreme stress only amplifies that stress ( Bowlby , 1973). Bowlby studied post World War II orphans in England and observed the

  20. [Preoperative assessment of patients with diabetes mellitus].

    Science.gov (United States)

    Takeda, Kiyoshi

    2010-07-01

    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  1. Preoperatively diagnosed mucocele of the appendix.

    Science.gov (United States)

    Rojnoveanu, Gh; Ghidirim, Gh; Mishin, I; Vozian, M; Mishina, A

    2014-01-01

    Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele. Celsius.

  2. Prevention of awareness during general anesthesia

    OpenAIRE

    Avidan, Michael S.; Mashour, George A.; Glick, David B

    2009-01-01

    Awareness during general anesthesia with subsequent explicit recall is a serious and frequently preventable problem that is gaining attention from clinicians and patients alike. Cost-effective interventions that increase vigilance should be implemented to decrease the likelihood of this complication.

  3. Awareness and recall during general anesthesia

    OpenAIRE

    Chung, Hyun Sik

    2014-01-01

    Anesthesia awareness is defined as both consciousness and recall of surgical events. New research has been conducted out to test this phenomenon. However, testing methods have not proven reliable, including those using devices based on electroencephalographic techniques to detect and prevent intraoperative awareness. The limitations of a standard intraoperative brain monitor reflect our insufficient understanding of consciousness. Moreover, patients who experience an intraoperative awareness ...

  4. Testing haptic sensations for spinal anesthesia.

    LENUS (Irish Health Repository)

    2011-01-01

    Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts\\' perceptions of the equivalent clinical events.

  5. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  6. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding...

  7. The Biochemical Impact of Surgery and Anesthesia

    NARCIS (Netherlands)

    J.W. Hol (Jaap Willem)

    2014-01-01

    markdownabstract__Abstract__ General anesthesia has been considered by some medical historians as one of the most important contributions to modern medicine second to perhaps the concept of antiseptic medicine and hygiene. The first historical mention of a deep unnatural sleep so that surgery can t

  8. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding...

  9. [Clinical utility of thoracoscopy under local anesthesia].

    Science.gov (United States)

    Ishii, Yoshiki

    2007-07-01

    Thoracoscopy has been recently established as an indispensable technique for diagnosis and treatment of respiratory diseases. Although, thoracoscopy is usually applied under general anesthesia by a surgeon, it can also be applied by a chest physician under local anesthesia if the target is limited to pleural diseases. The main objective of medical thoracoscopy under local anesthesia is to establish a diagnosis of pleural effusions by means of observation and biopsy in the thoracic cavity. Our main target diseases are the pleuritis carcinomatosa, malignant mesothelioma and tuberculous pleuritis. These 3 diseases are the diseases with which medical thoracoscopy is most useful because they can be reliably diagnosed by biopsies and because early diagnosis and early treatment are essential. In case of the pneumothorax, treatment with bulla looping or cauterization may be possible, but we do not treat pneumothorax with medical thoracoscopy because it is impossible to approach and find air leaks of lesions located in or near blind spots such as the apex or mediastinal part In case of acute emphysema, it is important to release adhesions and perform effective drainage using thoracoscopy as soon as possible since deposition of fibrin tends to form quickly compartments that make drainage difficult. Scince medical thoracoscopy under local anesthesia is rapid, easy, safe, and well-tolerated procedure with an excellent diagnostic yield, it is recommended as a diagnostic procedure for cases with pleural diseases.

  10. Awareness during general anesthesia: An Indian viewpoint

    Directory of Open Access Journals (Sweden)

    Reshma P Ambulkar

    2016-01-01

    Conclusion: Awareness under anesthesia is a distressing complication with a potential for long-term psychological consequences, and every effort should be undertaken to prevent it. It is reassuring though that our data in Indian cancer patients at high risk for intra-operative awareness suggests that it is an uncommon occurrence.

  11. Low dose spinal anesthesia for knee arthroscopy

    Directory of Open Access Journals (Sweden)

    Lakhin R.E.

    2015-06-01

    Full Text Available Objective: to evaluate the nature of unilateral spinal anesthesia using various modes of administration of low doses of hyperbaric bupivacaine. Materials and Methods. Prospectively, the randomized study included 56 patients undergoing knee arthroscopy. In the control group bupivacaine of 5mg was administered simultaneously, in the main group — fractionally by 2.5 mg. The development of thermal and pain blocks from different sides was investigated. The data were statistically processed. Results. In the control group, the positioning of the patient usually began after the entire dose of anesthetic had been administered. In the case of temperature paresthesia in the area of the sacral segments of the full anesthesia throughout underlying limb was not always achieved. In 6 cases of block was not sufficient. In the main group patient positioning was performed after the administration of 2.5 mg of anesthetic and evaluate temperature paresthesia and in 2 cases the total dose was increased to 7.5 mg. The successful development of sensory block at fractional administration was significantly higher than in the single-step introduction. Conclusion. Temperature paresthesia occurs within the first minute and is an early predictor of developing spinal anesthesia. The area of arising paresthesia shows preferential distribution of the anesthetic. In the application of low dose local anesthetic the desired upper level of anesthesia via the patient positioning and dose adjustment may be achieved.

  12. Outpatient varicocelectomy performed under local anesthesia

    Institute of Scientific and Technical Information of China (English)

    Geng-Long Hsu; Pei-Ying Ling; Cheng-Hsing Hsieh; Chii-Jye Wang; Cheng-Wen Chen; Hsien-Sheng Wen; Hsiu-Mei Huang; E. Ferdinand Einhorn; Guo-Fang Tseng

    2005-01-01

    Aim: To report a series of varicocelectomy performed under pure local anesthesia. Methods: From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale (VAS)was used to assess whether the pain level was acceptable. Results: The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % (567/575) of men could go back to work by the end of the first post-operative week and only 8 (1.4 %) men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of (18.5 ± 11.3) mm that was regarded as tolerable. Conclusion: This study has shown varicocelectomy under local anesthesia to be possible,simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

  13. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  14. Preoperative Alcohol Consumption and Postoperative Complications

    DEFF Research Database (Denmark)

    Eliasen, Marie; Grønkjær, Marie; Skov-Ettrup, Lise Skrubbeltrang

    2013-01-01

    .30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol...... complications, prolonged stay at the hospital, and admission to intensive care unit....

  15. [Predisposition to latex allergy undetected on preoperative evaluation: a case report].

    Science.gov (United States)

    Kimura, Yuriko; Okamura, Makoto; Harioka, Tokuya; Hara, Tadashi; Kamiya, Kiyoshi; Matsukawa, Takashi

    2013-12-01

    A 70-year-old man was scheduled to undergo laparoscopic total gastrectomy for stomach cancer. He had no history of atopy, fruit allergies, or frequent exposure to natural rubber. Preoperative latex-specific IgE antibodies were negative. Anesthesia was induced, and the surgery was started uneventfully. Soon after the surgeon had begun to manipulate the intestine, the blood pressure suddenly dropped to 27/21 mmHg. Facial flushing was also observed. Anaphylactic shock caused by latex was strongly suspected, and surgery was immediately halted. The surgical gloves were changed to latex-free ones, and adrenaline was administered. The blood pressure was gradually normalized within 30 min, and the facial flushing mostly disappeared. Postoperative laboratory examination revealed that serum tryptase had increased to 34.4 microg l-1, 40 minutes after the onset of anaphylaxis, and decreased to 19.4 microg l-1, 24 hours than later. Latex-specific IgE antibodies and a prick test with latex were both positive. Consequently, the diagnosis of latex-induced anaphylactic reaction was confirmed. Because even detailed questioning and examination does not always identify such a predisposition, avoiding contactwith latex products is more rational exhaustively checking every preoperative patient for latex allergy

  16. Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation.

    Science.gov (United States)

    Kalil, David M; Silvestro, Loraine S; Austin, Paul N

    2014-06-01

    Postoperative sore throat (POST) is usually self-limiting but was rated by patients as one of the top 10 most undesirable anesthetic outcomes. Pharmacologic interventions that have been suggested to decrease the incidence of POST include application of local anesthetics and corticosteroids to the cuff of the endotracheal tube. These interventions often require extra steps during induction of general anesthesia. We sought evidence for using nonsteroidal, nonlocal anesthetic, topical pharmacologic interventions conveniently implemented preoperatively to decrease the incidence of POST. One hundred seventeen potential evidence sources were located, with 11 randomized controlled trials meeting inclusion criteria. The evidence examined ketamine, aspirin, and azulene gargle; benzydamine gargle or oral spray; dexpanthenol pastilles; and lozenges containing amyl-m-cresol or magnesium. Although there were methodologic concerns with the studies, the evidence suggested that all the treatment medications decreased the incidence of POST at early and late intervals. The severity of POST was also typically reduced. Preoperative ketamine and aspirin gargle are probably the most promising for providers practicing in the United States. However, before these agents are recommended for general use, large multicenter trials should be done exploring not only efficacy but also dose-response relationships and side effects.

  17. Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara

    Science.gov (United States)

    Erkilic, Ezgi; Kesimci, Elvin; Soykut, Cem; Doger, Cihan; Gumus, Tülin; Kanbak, Orhan

    2017-01-01

    Background Preoperative anxiety and stress are undoubtedly a difficult experience in patients undergoing elective surgery. These unpleasant sensations depend on several factors. The objective of this study was to evaluate the preoperative anxiety levels in a sample of Turkish population, as well as the underlying causes using the Spielberger State-Trait Anxiety Inventory (STAI anxiety) scale. Methods The study was conducted according to the Declaration of Helsinki and was approved by the local ethical committee. All participants gave written informed consent upon having received detailed information on the study. Upon entry in the study, state and trait anxiety questionnaires were completed by 186 patients scheduled for elective surgery. The influencing factors in regard to age, sex, educational status and others were also reported. Results There was a statistically significant positive correlation between state and trait anxiety scores in this Turkish population. While the most important predictive factors that affected state-STAI scores were age, sex and duration of sleep the night before surgery; educational status and age were the best predictors for determining the variation in trait-STAI scores. Conclusion The factors affecting anxiety levels in different populations might vary among different countries. Interestingly, in this sample of Turkish population, the trait anxiety levels were found to be higher from state-anxiety levels, especially in women and less educated people. Thus, doubts about operation and anesthesia are overlooked. This could be attributed to the low to intermediate life standards of people admitted to our hospital. PMID:28280304

  18. The analgesic effect of preoperative pregabalin in radical cystectomy for cancer bladder patients

    Institute of Scientific and Technical Information of China (English)

    Ayman A. Ghoneim; Mohammed M. Hegazy

    2013-01-01

    Objective: After the pregabalin has been approved for the treatment of neuropathic pain, preliminary clinical studies suggested a possible role in the perioperative period. To our knowledge, It has never been studied the perioperative analgesic effect of pregabalin in patients with cancer bladder. In this study, we hypothesized that cancer bladder patients undergoing radical cystectomy and received oral pregabalin 75 mg twice daily for ten days preoperatively would get their postoperative pain reduced. Methods: Sixty patients scheduled for elective radical cystectomy were randomly assigned to one of 2 groups (control group or pregabalin group). Patients in the pregabalin group received 75 mg pregabalin twice daily for ten days before surgery. Standard anesthesia protocol was applied to all patients. Pain intensity, opioid consumption, level of sedation and other side effects were regularly assessed for 48 h postoperative. Results: Mean time for the first request of analgesia was statistically longer in pregabalin group. Meanwhile, mean morphine consumption, VAS scores at rest (in the first 32 h postoperatively), VAS scores during movement (in the first 20 h postoperatively) were statistically significant lower in the pregabalin group than those in the control group. Patients in the pregabalin group were statistically more sedated in the first four hours postoperative than the control group. Conclusion: Preoperative pregabalin 75 mg twice daily for ten days resulted in 60% reduction in 24 h postoperative morphine requirements in patients undergoing radical cystectomy.

  19. [Horner syndrome following combined spinal-epidural anesthesia].

    Science.gov (United States)

    Karaca, Ömer; Kumaş Solak, Sezen; Demirgan, Serdar; Bademci, Mehmet

    2016-07-01

    Horner syndrome is rarely observed in connection with epidural anesthesia. It is characterized by ptosis, enophthalmos, miosis, anisocoria, and conjunctival hyperemia in the affected eye, as well as anhydrosis and flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anesthesia; stellate ganglion, cervical or brachial plexus blocks; thoracic, lumbar or caudal epidural anesthesia, and intrapleural analgesia are the main causes for Horner syndrome related to anesthesia. Among other causes of Horner syndrome are head and neck surgery, trauma, and puncture of internal jugular vein. The present case of unilateral Horner syndrome appeared in the aortobifemoral bypass after lumbar spinal- epidural anesthesia.

  20. Comparison of Anesthesia Quality for Arthroscopic Knee Surgery: Combined Sciatic Femoral Block and Unilateral Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Sinem Sarı

    2015-08-01

    Full Text Available Objective: We aimed to evaluate the quality of anesthesia of combined sciatic and femoral 3-in-1 nerve blocks (CSFB and unilateral spinal anesthesia technique with low-dose levobupivacaine in outpatients undergoing knee arthroscopy surgery. Materials and Methods: Forty American Society of Anesthesiologists (ASA physical status I-II patients were randomly allocated into two groups and unilateral spinal anesthesia with low-dose levobupivacaine (group S, n=20 or CSFB (group B, n=20 was performed. Besides the quality of anesthesia, anesthetic effectiveness, hemodynamic values, duration of the technique application, maximum motor and sensorial block levels and durations, the first analgesics need, and total analgesic consumptions during postoperative 24 hours and determined complications were compared between the two groups. Results: The quality of anesthesia was better in group S, no patient received either sedation or analgesic intraoperatively while first analgesic need and number of patient was higher (p=0.014, p<0.001, p=0.032 respectively. The duration of technical application was shorter while maximum motor and sensorial block levels were higher in group S (p<0.0001, p=0.008, p<0.001 respectively. Motor block duration was significantly longer in group B (p<0.0001. Conclusion: We concluded that CSFB practice is an effective anesthetic alternative for unilateral spinal anesthesia. Introduction