Home About us Contact
|
Home About us Contact | ||
|
|
||
Elective Surgery (elective + surgery)
Kinds of Elective Surgery Selected AbstractsDo Private Patients have Shorter Waiting Times for Elective Surgery?ECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 2 2010Evidence from New South Wales Public Hospitals I11; D63 The Productivity Commission (2008) identified waiting times for elective surgery as a measure of governments' success in providing accessible health care. At the 2007 COAG meeting, the Prime Minister identified reduction of elective surgery waiting times in public hospitals as a major policy priority. To date, the analysis of waiting time data has been limited to summary statistics by medical procedure, doctor specialty and state. In this paper, we look behind the summary statistics and analyse the extent to which private patients are prioritised over comparable public patients in public hospitals. Our empirical evidence is based on waiting list and admission data from public hospitals in NSW for 2004,2005. We find that private patients have substantially shorter waiting times, and tend to be admitted ahead of their listing rank, especially for procedures that have low urgency levels. We also explore the benefits and costs of this preferential treatment on waiting times. [source] Initial experience of abdominal aortic aneurysm repairs in BorneoANZ JOURNAL OF SURGERY, Issue 10 2003Ming Kon Yii Background: Abdominal aortic aneurysms (AAA) repairs are routineoperations with low mortality in the developed world. There arefew studies on the operative management of AAA in the Asian population. This study reports the initial results from a unit with no previousexperience in this surgery by a single surgeon on completion oftraining. Methods: All patients with AAA repair from a prospective databasebetween 1996 and 1999 in the south-east Asian state of Sarawak inBorneo Island were analyzed. Three groups were identified on presentationaccording to clinical urgency of surgery. Elective surgery was offeredto all good risk patients with AAA of , 5 cm. All symptomatic patients were offered surgery unless contraindicatedmedically. Results: AAA repairs were performed in 69 patients: 32 (46%)had elective repairs of asymptomatic AAA; 20 (29%) hadurgent surgery for symptomatic non-ruptured AAA; and 17 (25%)had surgery for ruptured AAA. The mortality rate for elective surgery was6%; the two deaths occurred early in the series with thesubsequent 25 repairs recorded no further mortality. The mortalityrates for the urgent, symptomatic non-ruptured AAA repair and rupturedAAA repair were 20% and 35%, respectively. Cardiacand respiratory complications were the main morbidities. Sixty-three patients seen during this period had no surgery; threepresented and died of ruptured AAA, 34 had AAA of , 5 cmin diameter, and 26 with AAA of , 5 cmdiameter had either no consent for surgery or serious medical contraindications. Conclusion: This study showed that AAA can be repaired safely byhighly motivated and adequately trained surgeons in a hospital withlittle previous experience. [source] Hospital Disaster Preparedness in Los Angeles CountyACADEMIC EMERGENCY MEDICINE, Issue 11 2006Amy H. Kaji MD Background There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." Objectives To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. Methods This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. Results Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services,compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. Conclusions Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies. [source] Predictors of Survival 1 Hour After Implantation of an Intra-aortic Balloon Pump in Cardiac SurgeryJOURNAL OF CARDIAC SURGERY, Issue 1 2001Harald Hausmann M.D. From July 1996 to March 2000, 391 patients with intraoperative cardiac lowoutput syndrome who underwent surgery with heart-lung bypass and had an intre-aortic balloon pump (IABP) Implanted were analyzed in a prospective study. Of these 391 patients, 153 (39%) were operated on in an emergency situation, and 238 (61%) patients had elective surgeries. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 ,g/kg/min, a left mrial pressure higher then 15 mmHg, output of less than 100 mL/hour, and mixed venous saturation (SvO2) of less then 60% had poor outcomes. Using this data, we developed an IABP score to predict survival early after IABP implantation in cardiac surgery. We conclude that the success or failure of perioperative IABP support can be predicted early after implantation of the balloon pump. In patients with low-output syndrome despite IABP support, implantation of a vantricular assist system should be considered. [source] Effect of age on the incidence of venous thromboembolism after major surgeryJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2004R. H. White Summary.,Background:,Most guidelines for administration of thromboprophylaxis after major surgery use age as a major predictor of postoperative venous thromboembolism (VTE). We sought to quantify the effect of age on the risk of symptomatic VTE after a spectrum of surgical procedures. Methods:,Using the California Patient Discharge Data Set and specific ICD-9-CM surgical procedure codes, we retrospectively determined the incidence of VTE diagnosed within 91 days after 40 different urgent or elective surgeries performed in the hospital between 1992 and 1996. Logistic regression was used to quantify the effect of age on the incidence of postoperative VTE and to adjust for other risk factors. Results:,1 464 452 cases underwent one of 40 different procedures (mean cases per procedure = 35 718, range 4500,145 500). There was a significant interaction between age and the type of surgery performed (P<0.0001). Qualitative analysis of the effect of age on the incidence of VTE stratified by the presence or absence of malignancy revealed three general patterns: a steady increase in the incidence of VTE with age, exemplified by appendectomy or cholecystectomy; an increase in VTE up to approximately age 65 with no increase thereafter, exemplified by total hip arthroplasty; and no effect of age on the incidence of VTE, exemplified by vascular surgery. Conclusions:,The relationship between age and the risk of VTE after surgery is complex and depends on the nature of the surgery and the underlying pathologic process. Advancing age was a significant predictor for VTE following surgeries performed for conditions not inherently associated with significant comorbidity. Conversely, advancing age was not associated with a higher incidence of VTE after surgeries performed for conditions strongly associated with serious underlying comorbidity, such as a malignancy or severe peripheral vascular disease. [source] DPP-IV inhibition enhances the antilipolytic action of NPY in human adipose tissueDIABETES OBESITY & METABOLISM, Issue 4 2009K. Kos Context:, Dipeptidyl peptidase IV (DPP-IV) inactivates the incretin hormone glucagon-like peptide. It can also affect the orexigenic hormone neuropeptide Y (NPY1,36) which is truncated by DPP-IV to NPY3,36, as a consequence NPY's affinity changes from receptor Y1, which mediates the antilipolytic function of NPY, to other NPY receptors. Little is known whether DPP-IV inhibitors for the treatment of type 2 diabetic (T2DM) patients could influence these pathways. Aims:, To investigate the in vitro effects of NPY with DPP-IV inhibition in isolated abdominal subcutaneous (AbdSc) adipocytes on fat metabolism, and assessment of NPY receptor and DPP-IV expression in adipose tissue (AT). Methods:,Ex vivo human AT was taken from women undergoing elective surgery (body mass index: 27.5 (mean ± s.d.) ± 5 kg/m2, age: 43.7 ± 10 years, n = 36). Isolated AbdSc adipocytes were treated with human recombinant (rh)NPY (1,100 nM) with and without DPP-IV inhibitor (1 M); glycerol release and tissue distribution of DPP-IV, Y1 and Y5 messenger RNA (mRNA) were measured and compared between lean and obese subjects. Results and conclusion:, rhNPY reduced glycerol release, an effect that was further enhanced by co-incubation with a DPP-IV inhibitor [control: 224 (mean ± s.e.) ± 37 ,mol/l; NPY, 100 nM: 161 ± 27 ,mol/l**; NPY 100 nM/DPP-IV inhibitor, 1 M: 127 ± 14 ,mol/l**; **p < 0.01, n = 14]. DPP-IV was expressed in AbdSc AT and omental AT with relative DPP-IV mRNA expression lower in AbdSc AT taken from obese [77 ± 6 signal units (SU)] vs. lean subjects (186 ± 29 SU*, n = 10). Y1 was predominantly expressed in fat and present in all fat depots but higher in obese subjects, particularly the AbdSc AT-depot (obese: 1944 ± 111 SU vs. lean: 711 ± 112 SU**, n = 10). NPY appears to be regulated by AT-derived DPP-IV. DPP-IV inhibitors augment the antilipolytic effect of NPY in AT. Further studies are required to show whether this explains the lack of weight loss in T2DM patients treated with DPP-IV inhibitors. [source] Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgeryDRUG AND ALCOHOL REVIEW, Issue 2 2007SWATI SHOURIE Abstract Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation. [source] ORIGINAL INVESTIGATIONS: Different Clinical Features of Aortic Intramural Hematoma Versus Dissection Involving the Descending Thoracic AortaECHOCARDIOGRAPHY, Issue 8 2005Mariano Falconi M.D. Objective: The objective of this study is to test the hypothesis that the absence of flow communication in aortic intramural hematoma (IMH) involving the descending aorta may have a different clinical course compared with aortic dissection (AD). Methods: We prospectively evaluated clinical and echocardiographic data in AD (76 patients) and IMH (27 patients) of the descending thoracic aorta. Results: Patients did not differ with regard to age, gender, or clinical presentation. IMH and AD had the same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Surgical treatment was more frequently selected in AD (39% vs. 22%, P < 0.01) and AD patients who underwent surgical treatment had higher mortality than those with IMH (36% vs. 17%, P < 0.01). There was no difference in mortality with medical treatment (14% in AD vs. 19% in IMH, P = 0.7). During follow-up, of 23 patients with IMH, 11 (47%) showed complete resolution or regression, 6 (26%) increased the diameter of the descending aorta, and typical AD developed in 3 patients (13%). No changes occurred in 14% of the group. Three-year survival rate did not show significant differences between both groups (82 ± 6% in IMH vs. 75 ± 7% in AD, P = 0.37). Conclusion: IMH of the descending thoracic aorta has a relatively frequent rate of complications at follow-up, including dissection and aneurysm formation. Medical treatment with very frequent imaging and timed elective surgery in cases with complications allows a better patient management. [source] Do Private Patients have Shorter Waiting Times for Elective Surgery?ECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 2 2010Evidence from New South Wales Public Hospitals I11; D63 The Productivity Commission (2008) identified waiting times for elective surgery as a measure of governments' success in providing accessible health care. At the 2007 COAG meeting, the Prime Minister identified reduction of elective surgery waiting times in public hospitals as a major policy priority. To date, the analysis of waiting time data has been limited to summary statistics by medical procedure, doctor specialty and state. In this paper, we look behind the summary statistics and analyse the extent to which private patients are prioritised over comparable public patients in public hospitals. Our empirical evidence is based on waiting list and admission data from public hospitals in NSW for 2004,2005. We find that private patients have substantially shorter waiting times, and tend to be admitted ahead of their listing rank, especially for procedures that have low urgency levels. We also explore the benefits and costs of this preferential treatment on waiting times. [source] Comparison of cardiovascular function and quality of recovery in isoflurane-anaesthetised horses administered a constant rate infusion of lidocaine or lidocaine and medetomidine during elective surgeryEQUINE VETERINARY JOURNAL, Issue 3 2010A. VALVERDE Summary Reasons for performing study: The effects of lidocaine combined with medetomidine or lidocaine alone on cardiovascular function during anaesthesia and their effects on recovery have not been thoroughly investigated in isoflurane-anaesthetised horses. Objectives: To determine the effects of an intraoperative i.v. constant rate infusion of lidocaine combined with medetomidine (Group 1) or lidocaine (Group 2) alone on cardiovascular function and on the quality of recovery in 12 isoflurane-anaesthetised horses undergoing arthroscopy. Hypothesis: The combination would depress cardiovascular function but improve the quality of recovery when compared to lidocaine alone in isoflurane-anaesthetised horses. Methods: Lidocaine (2 mg/kg bwt i.v. bolus followed by 50 µg/kg bwt/min i.v.) or lidocaine (same dose) and medetomidine (5 µg/kg bwt/h i.v.) was started 30 min after induction of anaesthesia. Lidocaine administration was discontinued 30 min before the end of surgery in both groups, whereas medetomidine administration was continued until the end of surgery. Cardiovascular function and quality of recovery were assessed. Results: Horses in Group 1 had longer recoveries, which were of better quality due to better strength and overall attitude during the recovery phase than those in Group 2. Arterial blood pressure was significantly higher in Group 1 than in Group 2 and this effect was associated with medetomidine. No significant differences in cardiac output, arterial blood gases, electrolytes and acid-base status were detected between the 2 groups. Conclusions and potential relevance: The combination of an intraoperative constant rate infusion of lidocaine and medetomidine did not adversely affect cardiovascular function in isoflurane-anaesthetised horses and improved the quality of recovery when compared to an intraoperative infusion of lidocaine alone. [source] Continuous factor VIII infusion therapy in patients with haemophilia A undergoing surgical procedures with plasma-derived or recombinant factor VIII concentratesHAEMOPHILIA, Issue 5 2002D. Dingli Summary., We describe the experience of a single medical centre with continuous factor VIII (FVIII) infusion therapy in a cohort of patients undergoing elective surgery. Twenty-eight patients had a total of 45 procedures. Intraoperative haemostasis was considered excellent in all 45 cases. FVIII levels were maintained between 46% and 191% of normal (median, 103%) for 2,7 days. Bleeding occurred after five procedures (11%) at times when factor VIII levels were within haemostatic range. No patient required reoperation to control bleeding. There were no cases of sepsis related to continuous infusion of factor VIII. We conclude that continuous infusion: (1) is a safe and effective means of replacement therapy in patients with haemophilia undergoing surgery; (2) provides easier monitoring and more constant coagulation factor levels; and (3) has the potential to decrease the cost of replacement therapy by reducing overall usage of product. [source] The distribution of lymph node metastases in supraglottic squamous cell carcinoma: Therapeutic implicationsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2002Luca O. Redaelli de Zinis MD Abstract Background. The treatment of the neck in cancer of the upper aerodigestive tract is still a matter of controversy, even though nowadays there is a trend in the literature toward elective surgery in the N0 neck when the probability of occult lymph node metastasis is greater than 20%. In the elective setup, every effort is made for preservation of uninvolved nonlymphatic structures in positive neck. The aim of this study is to analyze in a large cohort of patients treated for supraglottic carcinoma the prevalence of lymph node metastases and their distribution through various neck levels to redefine our policy of neck treatment. Methods. A retrospective review of 402 consecutive patients, who underwent surgery in the Department of Otolaryngology of the University of Brescia (Italy) for supraglottic squamous cell carcinoma in a 14-year period, has been performed. The prevalence of neck metastases was assessed by pT category and site (marginal vs vestibular) of the primary tumor. The side(s) of neck disease was related to the side of the primary tumor, whether lateral or central. The distribution of involved lymph nodes through the neck levels was determined. Results. Overall lymph node metastases accounted for 40%; their prevalence rate increased with pT category from 10% to 57% (p = .0001). Occult metastases were found in 26% of N0 patients from 0% in pT1 to 40% in pT4 (p = .02). There was no difference in metastases rate between marginal vs vestibular, and central vs lateral neoplasms, whereas bilateral metastases were more frequent in central tumors (20% vs 5%; p < .0001). Level IV was involved only in association with level II and/or level III. Levels I and V were rarely involved when overt metastases were present and never by occult metastases. Conclusions. Elective lateral neck dissection (levels II,IV) is recommended in T2,T4 N0 supraglottic cancers; clearance of both sides of the neck is indicated whenever the lesion is not strictly lateral. We still perform a selective neck dissection including levels II,V whenever there is clinical, radiologic, or intraoperative evidence of metastases at any level. © 2002 Wiley Periodicals, Inc. Head Neck 24: 000,000, 2002 [source] The effect of practice budgets on patient waiting times: allowing for selection biasHEALTH ECONOMICS, Issue 10 2004Mark Dusheiko Abstract Under the UK fundholding scheme, general practices could elect to hold a budget to meet the costs of some types of elective surgery (chargeable admissions) for their patients. It was alleged that patients of fundholding practices had shorter waits for elective surgery than the patients of non-fundholders. Comparison of waiting times between fundholding and non-fundholding practices are potentially confounded by selection bias as fundholding was voluntary. We estimate the effect of a practice's fundholding status on the waiting times of its patients using both cross-sectional methods (OLS, propensity score, instrumental variables, Heckman selection correction and Heckman heterogenous effects estimators) and difference in differences methodologies to correct for selection bias. The estimated effect of fundholding status was to significantly reduce the waiting times for chargeable admissions of the patients of fundholders by 4.1,6.6% (or 4,7 days) with the instrumental variables and Heckman selection correction estimators yielding the highest estimates. We also find that patients of fundholding practices had shorter waits (by 3.7% or 2 days) for non-chargeable elective admissions, suggesting that fundholders were able to obtain shorter waits for all types of elective admissions. Copyright © 2004 John Wiley & Sons, Ltd. [source] Larger tidal volume increases sevoflurane uptake in blood: a randomized clinical studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010B. ENEKVIST Background: The rate of uptake of volatile anesthetics is dependent on alveolar concentration and ventilation, blood solubility and cardiac output. We wanted to determine whether increased tidal volume (VT), with unchanged end-tidal carbon dioxide partial pressure (PETCO2), could affect the arterial concentration of sevoflurane. Methods: Prospective, randomized, clinical study. ASA physical status 2 and II patients scheduled for elective surgery of the lower abdomen were randomly assigned to one of the two groups with 10 patients in each: one group with normal VT (NVT) and one group with increased VT (IVT) achieved by increasing the inspired plateau pressure 0.04 cmH2O/kg above the initial plateau pressure. A corrugated tube added extra apparatus dead space to maintain PETCO2 at 4.5 kPa. The respiratory rate was set at 15 min,1, and sevoflurane was delivered to the fresh gas by a vaporizer set at 3%. Arterial sevoflurane tensions (Pasevo), Fisevo, PETsevo, PETCO2, PaCO2, VT and airway pressure were measured. Results: The two groups of patients were similar with regard to gender, age, weight, height and body mass index. The mean PETsevo did not differ between the groups. Throughout the observation time, arterial sevoflurane tension (mean±SE) was significantly higher in the IVT group compared with the NVT group, e.g. 1.9±0.23 vs. 1.6±0.25 kPa after 60 min of anesthesia (P<0.05). Conclusion: Ventilation with larger tidal volumes with isocapnia maintained with added dead-space volume increases the tension of sevoflurane in arterial blood. [source] Cuffed endotracheal tubes in children reduce sevoflurane and medical gas consumption and related costsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. ESCHERTZHUBER Background: This study aims to evaluate sevoflurane and anaesthetic gas consumption using uncuffed vs. cuffed endotracheal tubes (ETT) in paediatric surgical patients. Methods: Uncuffed or cuffed ETT were used in paediatric patients (newborn to 5 years) undergoing elective surgery in a randomized order. Duration of assessment, lowest possible fresh gas flow (minimal allowed FGF: 0.5 l/min) and sevoflurane concentrations used were recorded. Consumption and costs for sevoflurane and medical gases were calculated. Results: Seventy children (35 uncuffed ETT/35 cuffed ETT), aged 1.73 (0.01,4.80) years, were enrolled. No significant differences in patient characteristics, study period and sevoflurane concentrations used were found between the two groups. Lowest possible FGF was significantly lower in the cuffed ETT group [1.0 (0.5,1.0) l/min] than in the uncuffed ETT group [2.0 (0.5,4.3) l/min], P<0.001. Sevoflurane consumption per patient was 16.1 (6.4,82.8) ml in the uncuffed ETT group and 6.2 (1.1,14.9) ml in the cuffed ETT group, P=0.003. Medical gas consumption was 129 (53,552) l in the uncuffed ETT group vs. 46 (9,149) l in the cuffed ETT group, P<0.001. The total costs for sevoflurane and medical gases were 13.4 (6.0,67.3),/patient in the uncuffed ETT group and 5.2 (1.0,12.5),/patient in the cuffed ETT group, P<0.001. Conclusions: The use of cuffed ETT in children significantly reduced the costs of sevoflurane and medical gas consumption during anaesthesia. Increased costs for cuffed compared with uncuffed ETT were completely compensated by a reduction in sevoflurane and medical gas consumption. [source] Pharmacokinetics after an intravenous single dose of the opioid ketobemidone in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010S. LUNDEBERG Background: Ketobemidone is often used as an alternative to morphine in children in the Scandinavian countries. The aim of this clinical trial was to explore the pharmacokinetics of ketobemidone in children because these properties have not been reported previously. Methods: Thirty children, newborn to 10 years, scheduled for elective surgery were included in the trial. Ketobemidone hydrochloride was administered as a single intravenous bolus dose and ketobemidone and norketobemidone concentrations were measured by LC-MS over 8 h. Pharmacokinetic parameters were determined using compartmental methods. Results: Six children were excluded from pharmacokinetic analysis because of incomplete blood sampling. The values of ketobemidone clearance (l/h/kg) given as median (range) were 0.84 (0.29,3.0) in Group A (0,90 days), 0.89 (0.55,1.35) in Group B (1,2.5 years) and 0.74 (0.50,0.99) in Group C (7,10 years). The corresponding values for apparent volume of distribution (l/kg) were 4.4 (3.7,6.9) (Group A), 2.6 (2.0,5.6) (Group B) and 3.9 (2.7,5.0 (Group C), and for elimination half-life (h) 3.0 (1.4,8.9) (Group A), 2.0 (1.2,4.7) (Group B) and 3.7 (2.4,6.9) (Group C), respectively. In the two neonates the elimination half-life was almost 9 h. The metabolite norketobemidone did not reach levels above the limit of quantification (0.07 ng/ml) in any of the patients. Conclusion: The pharmacokinetic parameters of ketobemidone in children older than 1 month appear to be similar to those in adults. Because of the large interindividual variability of the pharmacokinetics in neonates, further studies especially in this age group are warranted. [source] Pre-operative fasting: a nationwide survey of German anaesthesia departmentsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010J.-P. BREUER Background: Shorter pre-operative fasting improves clinical outcome without an increased risk. Since October 2004, German Anaesthesiology Societies have officially recommended a fast of 2 h for clear fluids and 6 h for solid food before elective surgery. We conducted a nationwide survey to evaluate the current clinical practice in Germany. Methods: Between July 2006 and January 2007, standardized questionnaires were mailed to 3751 Anaesthesiology Society members in leading positions requesting anonymous response. Results: The overall response rate was 66% (n=2418). Of those, 2148 (92%) claimed familiarity with the new guidelines. About a third (n=806, 34%) reported full adherence to the new recommendations, whereas 1043 (45%) reported an eased fasting practice. Traditional Nil per os after midnight was still recommended by 157 (7%). Commonest reasons reported for adopting the new guidelines were: ,improved pre-operative comfort' (84%), and ,increased patient satisfaction' (83%); reasons against were: ,low flexibility in operation room management' (19%), and ,increased risk of aspiration' (13%). Conclusion: Despite the apparent understanding of the benefits from reduced pre-operative fasting, full implementation of the guidelines remains poor in German anaesthesiology departments. [source] Effectiveness of cutaneous warming systems on temperature control: meta-analysisJOURNAL OF ADVANCED NURSING, Issue 6 2010Cristina Maria Galvăo galvăo c.m., liang y. & clark a.m. (2010) Effectiveness of cutaneous warming systems on temperature control: meta-analysis. Journal of Advanced Nursing,66(6), 1196,1206. Abstract Title.,Effectiveness of cutaneous warming systems on temperature control: meta-analysis. Aim., This paper is a report of a meta-analysis to identify the effectiveness of different types of cutaneous warming systems in temperature control for patients undergoing elective surgery. Background., Hypothermia is a common and serious complication of surgery. Different cutaneous warming systems are used to prevent hypothermia during surgery but there have been no previous meta-analyses of the effectiveness of different warming systems in controlling temperature. Data sources., We conducted a search of the CINAHL (2000 to April 2009), Medline (2000 to April 2009), Embase (2000 to April 2009) and the Cochrane Register of Controlled Trials (2000 to April 2009) databases for randomized controlled trials published in English, Spanish and Portuguese. The primary outcome measure of interest was core body temperature. Methods., A systematic review incorporating meta-analysis was carried out. Results., From 329 papers, 23 trials compared warming systems. Forced-air warming systems had a strong tendency towards superior temperature control over passive insulation via cotton blankets (mean difference: 0·29°C; 95% confidence interval: ,0·02 to 0·59, three trials 292 patients) and radiant warming systems (mean difference: 0·16°C; 95% confidence interval: ,0·01 to 0·33, three trials, 161 patients). However, circulating water garments tended to be more effective than forced-air warming systems (mean difference: ,0·73°C; 95% confidence interval: ,1·51 to 0·05, I2 = 97%; four trials, 198 patients). Pooled results approached statistical significance and indicated clinically meaningful differences in temperature control. Conclusion., Current evidence suggests that circulating water garments offer better temperature control than forced-air warming systems, and both are more effective than passive warming devices. [source] Endotracheal tube size and sore throat following surgery: a randomized-controlled studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010M. JAENSSON Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia. Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1,2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h. Results: After 1,2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P=0.006. This difference between the groups was also evident, P=0.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P=0.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size. Conclusion: Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit. [source] Relaxing music as pre-medication before surgery: a randomised controlled trialACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009H. BRINGMAN Introduction: Patients who await surgery often suffer from fear and anxiety, which can be prevented by anxiolytic drugs. Relaxing music may be an alternative treatment with fewer adverse effects. This randomised clinical trial compared pre-operative midazolam with relaxing music. Method: Three hundred and seventy-two patients scheduled for elective surgery were randomised to receive pre-operative prevention of anxiety by 0.05,0.1 mg/kg of midazolam orally or by relaxing music. The main outcome measure was the State Trait Anxiety Inventory (STAI X-1), which was completed by the patients just before and after the intervention. Results: Of the 177 patients who completed the music protocol, the mean and (standard deviation) STAI-state anxiety scores were 34 (8) before and 30 (7) after the intervention. The corresponding scores for the 150 patients in the midazolam group were 36 (8) before and 34 (7) after the intervention. The decline in the STAI-state anxiety score was significantly greater in the music group compared with the midazolam group (P<0.001, 95% confidence interval range ,3.8 to ,1.8). Conclusion: Relaxing music decreases the level of anxiety in a pre-operative setting to a greater extent than orally administrated midazolam. Higher effectiveness and absence of apparent adverse effects makes pre-operative relaxing music a useful alternative to midazolam for pre-medication. [source] Day surgery in Finland: a prospective cohort study of 14 day-surgery unitsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009K. MATTILA Background: Day surgery is an established practice for elective operative care, and is considered safe and cost-effective in several procedures and for several patients. At present, day-surgery accounts for approximately 50% of elective surgery in Finland. The aim of this study was to prospectively describe the present situation at Finnish day-surgery units, focusing on the quality of care. Methods: Fourteen large- to medium-sized day surgery and short-stay units were recruited, and all patient cases performed during a 2-month study period were registered and analyzed. Quality of care was assessed by analyzing the rates and reasons for overnight admission, readmission, reoperation, and cancellations. Satisfaction of care was inquired from day- surgery patients during a 2-week period. Head anesthesiologists were interviewed about functional policies. Results: Of 7915 reported cases, 84% were day surgery. Typically, several specialties were represented at the units, with orthopedics accounting for nearly 30% of all day-surgery procedures. Patient selection criteria were in line with the present-day recommendations, although the proportion of older patients and the ASA physical status 3 patients were still relatively low. The rate of unplanned overnight admissions was 5.9%. Return hospital visits were reported in 3.7% and readmissions in 0.7% of patients 1,28 days post-operatively. Patient satisfaction was high. Conclusion: Along with the growing demand for day surgery, Finnish public hospitals have succeeded in providing good-quality care, and there still seems to be potential to increase the share of day surgery. Easily accessible benchmarking tools are needed for quality control and learning from peers. [source] Catheter Closure of Coronary Artery FistulasJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2001SHAKEEL A. QURESHI F.R.C.P. Coronary artery fistulas are rare and vary widely in their morphological appearance and presentation. This paper presents experience of catheter closure of coronary artery fistulas in 40 patients. Catheter closure was performed with a variety of techniques, including detachable balloons, stainless steel coils, controlled-release coils, controlled-release patent ductus arteriosus (PDA) coils, and Amplatzer PDA plug. The vast majority of the fistulas were occluded with coils and in particular, controlled-release coils. Successful occlusion of the fistula was achieved in 39 (97%) of 40 patients. In one patient, the detachable balloon deflated prematurely and the patient underwent elective surgery. One 4-month-old infant died approximately 6 hours after the procedure. Immediate occlusion of the coronary artery fistula occurred in 33 (82%) of patients and late occlusion in 4 patients. Thus overall, total occlusion was achieved in 37 (97%) of 39 patients. The main complication was embolization of the occlusion device, which occurred in 6 (17%) of cases. In one of these cases, a detachable balloon deflated prematurely, and in five patients, coils embolized and were retrieved. In one of the patients, all six coils embolized 24 hours after the procedure but were retrieved, and further coils were implanted successfully. Controlled-release coils have made an important contribution to the technique of catheter closure of coronary artery fistulas. Catheter closure of these fistulas is an acceptable alternative to the standard surgical treatment. [source] Mask induction of anaesthesia with isoflurane or sevoflurane in premedicated catsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 1 2002P. Lerche A comparison was made of the time to and quality of induction of anaesthesia when sevoflurane (n=14) or isoflurane (n=14) was delivered by mask in premedicated healthy adult cats presented for elective surgery. Times to induction and intubation were significantly shorter with sevoflurane (210 ±57 seconds and 236 ±60 seconds, respectively) than with isoflurane (264 ±75 seconds and 292 ±73 seconds). The quality of induction was similar for both agents. Two cats in each group developed opisthotonus of less than 45 seconds'duration. Both sevoflurane and isoflurane produced mask induction of anaesthesia of a similar quality in this species. Sevoflurane provided more rapid induction of anaesthesia and establishment of a controlled airway than isoflurane. [source] Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists?JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2010A. STEIB See also Douketis JD, Spyropoulos AC. Vitamin K to reverse the anticoagulant effect of vitamin K antagonists: can you teach an old dog new tricks? This issue, pp 496,8. Summary.,Background: After a vitamin K antagonist (VKA) overdose, 1,2 mg of oral vitamin K can lower the International Normalized Ratio (INR) to the therapeutic range. Objective: To establish whether oral vitamin K can substitute for heparin bridging and decrease the INR to , 1.5 before elective surgery. Methods: Patients on long-term VKAs were randomized either to heparin bridging after the last VKA dose on day , 5 before surgery (group H) or to VKA treatment until day , 2, followed by 1 mg of oral vitamin K on the day before surgery (group K). Blood clotting variables were assessed on days ,5/,2, 1 and 0, and postoperatively. If the target INR was not achieved 2 h before incision, surgery was deferred or performed after injection of prothrombin complex concentrate (PCC). Results: In 30 of 94 included patients, baseline INR was outside the chosen range (18, INR < 2; 12, INR > 3.5), leaving 34 eligible patients in group H and 30 in group K. The groups were balanced in terms of body mass index, VKA treatment duration and indication, scheduled surgery, preoperative and postoperative hemoglobin, and blood loss. The INR was significantly higher in group K on days , 1 and 0 than in group H. An INR , 1.5 was not achieved in 20 group K patients (66%). Surgery was postponed or performed after PCC injection in 12 of these 20 patients. Conclusions: Oral vitamin K (1 mg) cannot substitute for heparin bridging before surgery. In addition, one-third of patients on VKAs were exposed to a risk of bleeding (overdose) or thrombosis (underdose), thus highlighting the need for new oral anticoagulants. [source] Platelet activation, myocardial ischemic events and postoperative non-response to aspirin in patients undergoing major vascular surgeryJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 10 2007S. RAJAGOPALAN Summary.,Objectives:,Myocardial ischemia is the leading cause of postoperative mortality and morbidity in patients undergoing major vascular surgery. Platelets have been implicated in the pathogenesis of acute thrombotic events. We hypothesized that platelet activity is increased following major vascular surgery and that this may predispose patients to myocardial ischemia.Methods:,Platelet function in 136 patients undergoing elective surgery for subcritical limb ischemia or infrarenal abdominal aortic aneurysm repair was assessed by P-selectin expression and fibrinogen binding with and without adenosine diphosphate (ADP) stimulation, and aggregation mediated by thrombin receptor-activating peptide and arachidonic acid (AA). Cardiac troponin-I (cTnI) was performed.Results:,P-selectin expression increased from days 1 to 3 after surgery [median increase from baseline on day 3: 53% (range: ,28% to 212%, P < 0.01) for unstimulated and 12% (range: ,9% to 45%, P < 0.01) for stimulated]. Fibrinogen binding increased in the immediate postoperative period [median increase from baseline: 34% (range: ,46% to 155%, P < 0.05)] and decreased on postoperative day 3 (P < 0.05). ADP-stimulated fibrinogen binding increased on day1 (P < 0.05) and thereafter decreased. Platelet aggregation increased on days 1,5 (P < 0.05). Twenty-eight (21%) patients had a postoperative elevation (> 0.1 ng mL,1) of cTnI. They had significantly increased AA-stimulated platelet aggregation in the immediate postoperative period and on day 2 (P < 0.05), and non-response to aspirin (48% vs. 26%, P = 0.036).Conclusions:,This study has shown increased platelet activity and the existence of non-response to aspirin following major vascular surgery. Patients with elevated postoperative cTnI had significantly increased AA-mediated platelet aggregation and a higher incidence of non-response to aspirin compared with patients who did not. [source] Comparison of recovery properties of desflurane and sevoflurane according to gender differencesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2005E. Tercan Background:, The aim of this study was to investigate the recovery properties of desflurane and sevoflurane in patients undergoing elective surgery, according to the gender differences. Methods:, In the study, 160 ASA class I,II patients aged between 20 and 60 years were included. The patients were assigned into two groups according to their gender, and these groups were randomly divided into two groups according to a selected volatile anaesthetic agent. Intraoperative bispectral index, time of postoperative achievement for end-tidal concentrations of volatile agents to decline 50% (ET-AA%50), time for extubation, time for eye opening and orientation, and time for bispectral index values to reach control values were recorded. Aldrete scores and error points of a delayed memory recall test were determined. Results:, Desflurane groups had a shorter ET-AA%50 time, extubation and eye-opening time in male and female patients compared to the sevoflurane groups, and these results were statistically significant (P < 0.05). In both the desflurane and sevoflurane groups, ET-AA%50 time, extubation and eye-opening time were shorter in male patients than in female patients, and these results were also statistically significant (P < 0.05). There were no significant differences among the groups in terms of Aldrete scores and error points of delayed memory recall test (P > 0.05). Conclusion:, In conclusion, early recovery time was shorter in male patients compared to female patients in both the desflurane and sevoflurane groups. Additionally, in the desflurane groups it was shorter in the sevoflurane groups for both genders. [source] A small dose of droperidol decreases postoperative nausea and vomiting in adults but cannot improve an already excellent patient satisfactionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2001A. Hechler Background: We evaluated whether or not 1) a routine prophylaxis with 20 ,g ,· ,kg,1 body weight of droperidol would efficiently prevent postoperative nausea and vomiting (PONV) after elective surgery in adults and 2) an efficient prophylaxis would improve patient satisfaction. Methods: With approval of the local ethics committe and after having obtained informed written consent, 1334 patients in a randomised, single-blinded fashion either received droperidol (group 1, n=665) or saline intravenously (group 2, n=669) 20 min before the end of a standard O2/N2O/fentanyl/isoflurane anaesthesia of at least 30 min duration. End points: incidence of PONV during the first 24 h; individual episodes of nausea or vomiting, overall patient satisfaction with the procedure. Results: Compared to saline, intravenous injection of droperidol substantially and significantly reduced the incidence of PONV from 30% to 20% (P<0.0001). Women suffered three times more frequently from PONV (10.5% vs. 30%, P<0.0001). Droperidol significantly reduced the incidence of PONV from 35.4% to 24.4% in women (relative risk reduction: 31%, P=0.0002), but not in men (13.1% vs. 8.2%, relative risk reduction: 37%, P=0.159) , without impact on overall patient satisfaction (98.8% vs. 97.1%, P=0.439). Distribution of surgical procedures, sex, age, height, weight and anaesthetic duration were not different between groups. To prevent one woman from suffering PONV, nine had to be treated prophylactically at an individual drug cost (German prices) of about 0.80 per woman. Conclusion: Routine PONV prophylaxis with 20 ,g ,· ,kg,1 body weight of droperidol is cost-efficient and appropriate in women but not in men. [source] Second-hand smoking and carboxyhemoglobin levels in children: a prospective observational studyPEDIATRIC ANESTHESIA, Issue 1 2010BRANDEN E. YEE MD Summary Aim:, To establish baseline noninvasive carboxyhemoglobin (COHb) levels in children and determine the influence of exposure to environmental sources of carbon monoxide (CO), especially environmental tobacco smoke, on such levels. Background:, Second-hand smoking may be a risk factor for adverse outcomes following anesthesia and surgery in children (1) and may potentially be preventable. Patients and Methods:, Parents and their children between the ages of 1,12 were enrolled on the day of elective surgery. The preoperative COHb levels of the children were assessed noninvasively using a CO-Oximeter (Radical-7 Rainbow SET Pulse CO-Oximeter; Masimo, Irvine, CA, USA). The parents were asked to complete an environmental air-quality questionnaire. The COHb levels were tabulated and correlated with responses to the survey in aggregate analysis. Statistical analyses were performed using the nonparametric Mann,Whitney and Kruskal,Wallis tests. P < 0.05 was statistically significant. Results:, Two hundred children with their parents were enrolled. Children exposed to parental smoking had higher COHb levels than the children of nonsmoking controls. Higher COHb values were seen in the youngest children, ages 1,2, exposed to parental cigarette smoke. However, these trends did not reach statistical significance, and confidence intervals were wide. Conclusions:, This study revealed interesting trends of COHb levels in children presenting for anesthesia and surgery. However, the COHb levels measured in our patients were close to the error margin of the device used in our study. An expected improvement in measurement technology may allow screening children for potential pulmonary perioperative risk factors in the future. [source] A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the Pediatric airway , a randomized clinical trialPEDIATRIC ANESTHESIA, Issue 11 2009ARNIM VLATTEN MD Summary Introduction:, Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sight to the glottic opening, the viewing angle has been measured at 15°. The STORZ DCI video laryngoscope (Karl Storz, Tuttlingen, Germany) incorporates a fiberoptic camera in the light source of a standard laryngoscope of variable sizes. The image is displayed on a screen with a viewing angle of 80°. We studied the effectiveness of the STORZ DCI as an airway tool compared to standard direct laryngoscopy in children with normal airway. Methods:, In this prospective, randomized study, 56 children (ages 4 years or younger) undergoing elective surgery with the need for endotracheal intubation were divided into two groups: children who underwent standard direct laryngoscopy using a Miller 1 or Macintosh 2 blade (DL) and children who underwent video laryngoscopy using the STORZ DCI video laryngoscope with a Miller 1 blade (VL). Time to best view (TTBV), time to intubate (TTI), Cormack,Lehane (CL), and percentage of glottis opening seen (POGO) score were recorded. Results:, TTBV in DL was 5.5 (4,8) s and 7 (4.2,9) s in VL. TTI in DL was 21 (17,29) s and in VL 27 (22,37) s (P = 0.006). The view as assessed by POGO score was 97.5% (60,100%) in DL and 100% (100,100%) in the VL (P = 0.003). Data are presented as median and interquartile range and analyzed using t -test. Discussion:, This study demonstrates that the STORZ DCI video laryngoscope provides an improved view to the glottis in children with normal airway anatomy, but requires a longer time for intubation. [source] Influence of anesthesia on immune responses and its effect on vaccination in children: review of evidencePEDIATRIC ANESTHESIA, Issue 5 2007J.N. SIEBERT MD Summary Anesthesia and surgery exert immunomodulatory effects and some authors argue that they may exert additive or synergistic influences on vaccine efficacy and safety. Alternatively, inflammatory responses and fever elicited by vaccines may interfere with the postoperative course. There is a lack of consensus approach among anesthesiologists to the theoretical risk of anesthesia and vaccination. Few studies have assessed the influence of anesthesia and surgery on pediatric vaccine responses. We have undertaken an extensive review of articles published in English between 1970 and 2006 meeting the criteria: measurement of immune parameters following general anesthesia in children. By searching the major medical databases (OVID Medline, PubMed, ISI Web of Science) and references cited in the articles themselves, among 277 articles obtained none examined directly the influence of anesthesia/surgery on vaccine responses. Only 16 original reports assessed the influence of several anesthetic agents on various markers of immunity including lymphocyte numbers and functions. These results are reinterpreted here in view of our current understanding of the immune mechanisms underlying vaccine efficacy and adverse events. We conclude that the immunomodulatory influence of anesthesia during elective surgery is both minor and transient (around 48 h) and that the current evidence does not provide any contraindication to the immunization of healthy children scheduled for elective surgery. However, respecting a minimal delay of 2 days (inactivated vaccines) or 14,21 days (live attenuated viral vaccines) between immunization and anesthesia may be useful to avoid the risk of misinterpretation of vaccine-driven adverse events as postoperative complications. [source] | |||||||||||||||||||||||||||||||