RESUMO
BACKGROUND: Postoperative delirium increases the morbidity and mortality in elderly patients. The present study was carried out to evaluate whether the difference of anesthetics has influence on the incidence of postoperative delirium, retrospectively. METHODS: Among the patients undergoing surgical procedure aged above 75 years, in seventy one patients anesthesia was maintained with sevoflurane (group S), and 38 with propofol (group P). The incidence of delirium postoperatively was obtained retrospectively from their medical chart. The delirium was diagnosed with the confusion assessment method diagnostic algorithm. RESULTS: The incidence of postoperative delirium of group P (15.8%) was significantly lower than that of group S (38.0%, P=0.02). CONCLUSIONS: Propofol anesthesia decreases postoperative delirium in elderly patients compared with sevoflurane anesthesia.
Assuntos
Anestésicos Gerais , Delírio/epidemiologia , Éteres Metílicos , Complicações Pós-Operatórias/epidemiologia , Propofol , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Delírio/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/prevenção & controle , SevofluranoRESUMO
STUDY OBJECTIVE: Postoperative delirium (POD) is a common complication of anesthesia. The incidence of POD in elderly patients ranges from 37% to 53%, and POD increases the morbidity and mortality of elderly patients. However, the effects of anesthetics on POD are not well known. The present study aimed to compare the incidence of POD resulting from propofol and sevoflurane anesthesia. DESIGN: Double-blind prospective study. SETTING: Operating room and postoperative recovery area. PATIENTS: Thirty patients in the sevoflurane anesthesia group and 29 in the propofol anesthesia group. MEASUREMENTS: Statistical analyses were performed using Microsoft Excel 2010 for Windows 7 (Microsoft Corporation, Redmond, Wash). Statistical analysis was performed using Fisher exact test and Student t test. MAIN RESULTS: The incidence of POD in the propofol anesthesia (6.9%) was significantly less than that observed in the sevoflurane anesthesia (26.7%; 038). CONCLUSION: In comparison with sevoflurane anesthesia, propofol anesthesia is associated with a lower incidence of POD in elderly patients.
Assuntos
Anestesia Intravenosa/métodos , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Delírio/induzido quimicamente , Delírio/epidemiologia , Éteres Metílicos/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/epidemiologia , Propofol/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Período de Recuperação da Anestesia , Delírio/psicologia , Método Duplo-Cego , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , SevofluranoRESUMO
Number of cases performed or total anesthesia time is usually used to evaluate workload anesthesiologists. However, each case is different in intensity of anesthetic management and these makes the evaluation difficult. We devised a total workload in anesthesia formula to account for technical, tactical, and physical factors in each case, as well as for number of cases and total anesthesia time. The present study evaluated reasonableness of this formula. We compared number of cases, hours of work, medical treatment fee and the total workload in anesthesia among anesthesiologists who had worked in our hospital in 2001. Each anesthesiologist answered questionnaires regarding number of cases, total anesthesia time, and total workload during 2001. Among anesthesiologists, we found significant differences in number of cases and total anesthesia time and medical treatment fee but no difference in total workload in anesthesia. The anesthesiologists indicated the same trend in their questionnaire responses. Evaluating only number of cases or total anesthetic time or medical treatment fee provides insufficient information to compare anesthesia workload. Our formula is a more appropriate index to quantify workload.
Assuntos
Anestesia/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Médicos/psicologia , Carga de Trabalho/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado , Humanos , Estresse Fisiológico , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
To determine the effect of oral clonidine premedication on postoperative sore throat and hoarseness, we evaluated the incidence and severity of each of these complications in patients who underwent elective surgery in the supine position. The subjects were 82 patients, American Society of Anesthiologists (ASA) status I-III, aged 15-82 years. They were premedicated with either 150 microg oral clonidine and 20 mg raftidine (clonidine group; n = 41) or with 20 mg raftidine only (control group; n = 41) 2 h before anesthesia induction. General anesthesia was maintained with propofol, ketamine, fentanyl, and vecuronium, with or without epidural anesthesia. Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery. The incidences of sore throat and hoarseness tended to be higher in the clonidine group than in the control group; however, the difference did not reach statistical significance. There were no significant differences in the severity of these symptoms between the two groups. In conclusion, oral premedication with 150 microg clonidine did not prevent postoperative sore throat or hoarseness, and may have exacerbated these symptoms.
Assuntos
Agonistas alfa-Adrenérgicos/uso terapêutico , Clonidina/uso terapêutico , Rouquidão/terapia , Intubação Intratraqueal/efeitos adversos , Faringite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Adjuvantes Anestésicos , Adolescente , Agonistas alfa-Adrenérgicos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Anestesia Intravenosa , Clonidina/efeitos adversos , Feminino , Rouquidão/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Faringite/etiologia , Pré-Medicação , Estudos ProspectivosRESUMO
PURPOSE: To determine the effect of laryngotracheal application of different doses of lidocaine spray on postoperative sore throat and hoarseness, we evaluated the incidence and severity of these complications in 168 ASA I-III patients aged 15-92 years in a placebo-controlled study. METHODS: After induction of anesthesia with propofol, ketamine, fentanyl, and vecuronium, the laryngotracheal area was sprayed immediately before intubation with lidocaine spray either 5 times (L5 group, n = 47) or 10 times (L10 group, n = 48) or with normal saline 1 ml (placebo group, n = 51). Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery. RESULTS: The incidence of sore throat was significantly higher in the L10 group than in the placebo group on both the day of and the day after surgery. The severity of sore throat was significantly higher in the L5 and L10 groups than in the placebo group on the day of surgery. On the day after surgery, the severity of sore throat remained significantly higher in the L10 group than in the placebo group. Although the incidence and severity of sore throat increased in a dose-dependent manner, these were not significantly different between the L5 and L10 groups. In addition, the incidence and severity of hoarseness did not differ at all among the three groups. CONCLUSION: We recommend that applications of lidocaine spray to the laryngotracheal area should be avoided to help eliminate unnecessary postoperative sore throat, thereby leading to improvement in patient satisfaction.