RESUMO
Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.
Assuntos
Anestesia , Anestesiologia , Anestesia/efeitos adversos , Humanos , Segurança do PacienteRESUMO
: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.
Assuntos
Analgesia/normas , Anestesia/normas , Anestesiologia/normas , Competência Clínica/normas , Erros Médicos/prevenção & controle , Segurança do Paciente/normas , Assistência Perioperatória/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Analgesia/efeitos adversos , Anestesia/efeitos adversos , Prova Pericial , Declaração de Helsinki , Humanos , Período Perioperatório , Guias de Prática Clínica como AssuntoRESUMO
Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis.
Assuntos
Neoplasias Brônquicas/secundário , Neoplasias Brônquicas/cirurgia , Circulação Extracorpórea , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Osteossarcoma/secundário , Osteossarcoma/cirurgia , Pneumonectomia/métodos , Adulto , Antineoplásicos/uso terapêutico , Braço , Neoplasias Brônquicas/diagnóstico por imagem , Quimioterapia Adjuvante , Terapia Combinada , Neoplasias Femorais/tratamento farmacológico , Neoplasias Femorais/patologia , Neoplasias Femorais/cirurgia , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/tratamento farmacológico , Pericardiectomia/métodos , Pericárdio/patologia , Pericárdio/cirurgia , Pleura/patologia , Pleura/cirurgia , Veias Pulmonares/patologia , Veias Pulmonares/cirurgia , Sarcoma/patologia , Sarcoma/radioterapia , Sarcoma/cirurgia , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: There is increasing interest in the use of the thoracic paravertebral block (TPVB) in association with general anesthesia for lung-resection surgery. The aim of the study was to evaluate the hemodynamic effects of a 5-mg/kg lidocaine bolus injected in the thoracic paravertebral space during one-lung ventilation (OLV) in noncardiac patients undergoing thoracic surgery. DESIGN: Prospective, observational study. SETTING: Tertiary care university hospital. PARTICIPANT: Twenty patients undergoing thoracotomy for lung resection. INTERVENTIONS: In addition to standard monitoring, cardiac output, preload parameters (global diastolic volume, total intrathoracic blood volume, and systolic volume variation), and myocardial contractility (dP(max) and cardiac function index) were measured with an aortic transpulmonary thermodilution technique. MEASUREMENTS AND MAIN RESULTS: After OLV initiation, a paravertebral lidocaine bolus of 5 mg/kg (2%) caused decreases in the dP(max) and cardiac function index that lasted up to 30 minutes. Accompanying minor reductions in heart rate and systolic blood pressure required no vasoactive drugs and were self-limiting. None of the other hemodynamic parameters studied was significantly altered. CONCLUSIONS: In noncardiac patients, TPVB is associated with good hemodynamic stability, despite a small and transient decrease in myocardial contractility that could be related to the drug's systemic effects after its absorption.