Asunto(s)
Anestesia Raquidea/métodos , Inmunodeficiencia Variable Común/complicaciones , Fijación Intramedular de Fracturas , Fracturas de Cadera/cirugía , Profilaxis Antibiótica , Pérdida de Sangre Quirúrgica , Susceptibilidad a Enfermedades , Transfusión de Eritrocitos , Femenino , Fracturas de Cadera/complicaciones , Humanos , Persona de Mediana Edad , Espacio Subaracnoideo , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
OBJECTIVE: To evaluate the level of compliance with antibiotic prophylaxis during surgery in a university referral hospital. PATIENTS AND METHODS: A descriptive study of 257 patients undergoing clean or clean-contaminated elective surgery was carried out in 2001. Data were gathered prospectively by three anesthesiologists in the operating room. Prophylaxis was considered to have been administered correctly if the first dose was given before the skin incision, if a second dose was given during operations lasting longer than 240 minutes, and if the antibiotic prescribed was of a wide enough spectrum to cover the type of surgical procedure performed. RESULTS: Prophylaxis was administered incorrectly to 132 patients (51.4%). The causes were administration after incision in 21.8%, long-duration surgery without a second dose in 15.6%, administration after incision plus long-duration surgery without a second dose in 3.1%, inadequate-spectrum antibiotic in 4.7%, administration after incision plus inadequate dose in 2.7%, inadequate dose in 1.9%, inadequate-spectrum antibiotic plus administration after incision in 0.8%, late second dose in 0.4%, long-duration surgery without a second dose plus inadequate dose in 0.4%. DISCUSSION: The rates of late administration of an antibiotic or failure to administer a second dose during long-duration surgery is high. CONCLUSION: To improve the low level of compliance and avoid late administration of antibiotics, we propose that the anesthetist be responsible for giving antibiotic prophylaxis and for directly monitoring compliance errors in the operating room.
Asunto(s)
Profilaxis Antibiótica , Infecciones Bacterianas/prevención & control , Procedimientos Quirúrgicos Electivos , Errores de Medicación , Complicaciones Posoperatorias/prevención & control , Premedicación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Profilaxis Antibiótica/estadística & datos numéricos , Infecciones Bacterianas/epidemiología , Esquema de Medicación , Femenino , Adhesión a Directriz/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Cuidados Intraoperatorios , Periodo Intraoperatorio , Masculino , Errores de Medicación/prevención & control , Errores de Medicación/estadística & datos numéricos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , España/epidemiologíaRESUMEN
We report the case of a woman scheduled for surgical fixation of an ankle fracture who developed a pulmonary embolism during application of an Esmarch compression bandage for exsanguination of the limb. Tracheal intubation and mechanical ventilation were needed to reanimate the patient and surgery had to be postponed 15 days. Orthopedic surgery, pneumatic tourniquets for providing a bloodless field and other risk factors contribute to the development of pulmonary embolism, which is often fatal. Accurate diagnosis by plasma D-dimer determination and imaging (perfusion scintigraphy, vascular Doppler ultrasound, echocardiography and pulmonary angiography) is discussed, along with therapeutic approaches to consider when managing pulmonary embolism.