RESUMO
BACKGROUND: With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients. METHODS: A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol. RESULTS: The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 and 83.312 was estimated. CONCLUSIONS: Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Testes Diagnósticos de Rotina , Fidelidade a Diretrizes/estatística & dados numéricos , Cuidados Pré-Operatórios , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: A new supraglottic device, the LMA-Supreme™, has recently become available for clinical use. Information on anaesthetic and co-adjuvant requirements for insertion of the LMA-Supreme™ is limited. The present study aimed to evaluate the optimal effect-site concentration of propofol in 50 % (EC50) of adults necessary for successful insertion of the LMA-Supreme™ and to examine remifentanil's effect on propofol requirements. METHODS: Fifty-eight elective patients (aged 18-60 years; ASA (American Society Anaesthesiologists) physical status classification I and II) scheduled for day surgery were randomly assigned to one of two groups: propofol with saline or propofol with remifentanil. Anaesthesia was induced by target-controlled infusion according to predetermined effect-site concentrations of propofol and remifentanil (5 ng.mL(-1)). The EC50 was calculated using Dixon's up-and-down method. Ten minutes following drug administration, LMA-Supreme™ insertion was attempted without the use of muscle relaxant drugs. RESULTS: In the propofol + saline group, the EC50 of propofol required for LMA-Supreme™ insertion was 6.32 ± 0.67 µg.mL(-1) (95 % CI, 5.69-6.94 µg.mL(-1)). With the addition of remifentanil at an effect-site concentration of 5 ng.mL(-1), the EC50 of propofol required for LMA-Supreme™ insertion was 2.50 ± 0.80 µg.mL(-1) (95 % CI, 1.82-3.17 µg.mL(-1); p < 0.0001). CONCLUSIONS: The propofol requirement for smooth insertion of the LMA-Supreme™ was 60 % less when remifentanil (5 ng.mL(-1)) was co-administered. CLINICAL TRIAL REGISTRATION: Identified as NCT01974648 at www.clinicaltrials.gov .
Assuntos
Anestésicos Intravenosos/administração & dosagem , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Piperidinas/administração & dosagem , Propofol/administração & dosagem , Adulto , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RemifentanilRESUMO
CONTEXT: The single-use Laryngeal Mask Airway (LMA) Supreme is a new supraglottic airway device. It has been reported to be reliable and easy-to-use in clinical practice; however, the anaesthetic techniques for its insertion are not standardised. OBJECTIVES: The purpose of this study was to determine the ED50 of end-tidal sevoflurane concentration for successful LMA Supreme insertion without the use of neuromuscular blockade. DESIGN: A prospective observational study. SETTING: A single tertiary care surgical centre. PATIENTS: Thirty-one consecutive elective patients scheduled for minor elective surgery under general anaesthesia. INTERVENTION: Patients were preoxygenated with 100% oxygen and anaesthetised using normal tidal volume inhalation of sevoflurane. The target sevoflurane concentration was determined using a modified Dixon's 'up-and-down' method (starting at 2.5% with 0.5% as the step size). After the predetermined end-tidal concentration had been established and maintained for 10 min, LMA Supreme insertion was attempted. MAIN OUTCOME MEASURE: The main outcome measure was the patient's response to LMA Supreme insertion, classified as either 'movement' or 'no movement'. The mean of the concentrations of seven cross-overs from 'movement' to 'no movement' was used to estimate the ED50. RESULTS: The estimated sevoflurane concentration for successful LMA Supreme insertion in 50% of adults was 3.03 ± 0.75% (95% confidence interval 2.3 to 3.7%). The values of the ET50 and ET95 obtained by logistic regression were 2.83 and 5.30%, respectively. CONCLUSION: Sevoflurane alone can provide acceptable conditions for insertion of the LMA Supreme in adults, at an estimated minimum alveolar anaesthetic concentration of 3% with minimal adverse effects.