ABSTRACT
A program of quality improvement of blood transfusion safety was carried out in St Camille Hospital after a call for tenders had been jointly issued by the French Ministry of Health and the French Agency for Medical Evaluation (ANDEM). The blood transfusion process was analysed and a diagnosis of the situation was performed. Improvement actions were then undertaken to control the blood transfusion process. They consisted in education programs, elaboration of procedures and documents such as a transfusion record and a transfusion manual. The effectiveness of the actions was measured using indicators. Such a quality improvement approach revealed to be a good method to manage the blood transfusion process and to improve safety. However, it requires people's involvement in the project, and rigorous project management.
Subject(s)
Blood Transfusion/standards , Quality Assurance, Health Care , Education, Continuing , Forms and Records Control , France , Hospitals , HumansABSTRACT
In our institution, plexus nerves blocks have been performed in seventy patients after lower limb surgery. The technique is considered as simple and reliable. The administration of a 0.375 per cent bupivacaine epinephrine containing solution allows to obtain analgesia longer than 15 hours in 45 p. 100 of the patients, devoided of side effects. Lower limb plexus nerves blocks appear as an efficient technique for postoperative analgesia following orthopaedic surgery.
Subject(s)
Nerve Block/methods , Orthopedics , Pain, Postoperative/therapy , Adult , Aged , Analgesia/methods , Bupivacaine/administration & dosage , Female , Femoral Nerve , Humans , Male , Middle Aged , Sciatic NerveABSTRACT
Plexus nerve blocks of the lower limb have been described for many years but were seldom used until recently. Postoperative analgesia is one of the main indications of these blocks. The blockade of both lumbar and sciatic plexuses is required for most of the surgical procedures performed on the proximal part of the lower limb. Nerve stimulators account for less difficulties to perform such blocks and results are more reliable. Several pharmacokinetic studies have documented that toxic thresholds of plasma concentrations of local anaesthetics are not reached with the doses commonly injected. Many different techniques and landmarks have been described providing several alternatives to perform these blocks according to the type and the localisation of the surgical procedure. Extensive indications are reported for day case surgery or patients at risk.
Subject(s)
Leg , Nerve Block/methods , Ankle/innervation , Femoral Nerve , Humans , Lumbosacral Plexus , Sciatic NerveABSTRACT
Nitrous oxide (N2O) is far from inert in terms of its cerebral effects. It can increase the cerebral blood flow (CBF) and the cerebral metabolic rate for oxygen in animals and in man. In poor risks patients, the N2O may increase the intracranial pressure (ICP) but these effects are blocked by hyperventilation, benzodiazepines, barbiturates and narcotics. N2O is not epileptogenic but modifies evoked potentials. Because of its greater solubility than Nitrogen it can increase ICP, in case of pneumoencephalus and the size and consequences of gazous embolism. In neurosurgical patients, nitrous oxide should be used cautiously in regards of its neurological effects.
Subject(s)
Anesthesia, Inhalation , Neurosurgery , Nitrous Oxide , Animals , Brain/metabolism , Cerebrovascular Circulation/drug effects , Humans , Intracranial Pressure/drug effects , Nervous System Diseases/surgery , Oxygen Consumption/drug effectsABSTRACT
This study is a retrospective analysis of 303 consecutive spinal anaesthesia performed in orthopaedic patients of a University Hospital between January and December 1990. Failure of spinal anaesthesia was defined as the requirement for general anaesthesia to perform surgery. The parameters studied as possible risk factors of failure were patients demographics, local anaesthetic agents and solutions and techniques of spinal anaesthesia (single injection versus continuous spinal anaesthesia). Failures were related to inadequate or incomplete extension of sensory blockade or to difficulties to perform spinal injection. Continuous spinal anaesthesia was performed in 209 patients mostly with 0.5% isobaric bupivacaine, while 94 patients received a single injection of either hyperbaric 0.5% tetracaine with adrenaline or 0.5% bupivacaine or 5% lidocaine. Failures occurred in 6.3% of the cases but were significantly less frequent with continuous spinal anaesthesia (4.8%) than with the conventional technique (9.6%). The incidence of failure was higher with hyperbaric tetracaine (11.1%) confirming its poor reliability. Inadequate extension of the anaesthetic block was the main cause of failure whatever the spinal anaesthetic technique. These results point out the reliability of continuous spinal anaesthesia but problems may occasionally occur due to spinal catheter misplacement.
Subject(s)
Anesthesia, Spinal/methods , Practice Management, Medical , Academic Medical Centers , Aged , Anesthesia, Spinal/adverse effects , Bupivacaine , Female , Humans , Lidocaine , Male , Middle Aged , Orthopedics , Retrospective Studies , TetracaineABSTRACT
The efficacy of oxacillin as a prophylaxis for infection was analyzed in a 27-month randomized double-blind study of 400 patients who had undergone clean neurosurgical interventions lasting longer than 2 hours. Four neurosurgeons took part in the study and 356 patients were eligible for final analysis. Among the 171 patients treated with oxacillin, there was one case of infection (0.6%), compared to nine (4.9%) of the 185 patients given a placebo. The difference between the two groups was statistically significant (p = 0.0398). This study, together with others (randomized or not), clearly demonstrates the efficacy of antibiotic prophylaxis in prolonged clean neurosurgery.
Subject(s)
Infection Control , Neurosurgery/methods , Oxacillin/therapeutic use , Postoperative Complications/prevention & control , Adolescent , Adult , Aged , Chi-Square Distribution , Double-Blind Method , Female , Humans , Male , Middle Aged , Oxacillin/administration & dosage , Randomized Controlled Trials as Topic , Time FactorsABSTRACT
Subarachnoid hemorrhage induces a lot of extracerebral disturbances such as: systemic hypertension, electrocardiographic abnormalities both morphological, rhythmic and subendocardial damages; those events have been interpreted as overactivity of the sympathetic nervous system. In biochemical changes, hyponatremia early recognized was referred during a long time to a syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia is now referred to a cerebral salt-wasting. Hypovolemia often observed supports the use of volemic expansion in the prevention and treatment of ischemic complications associated with ruptured intracranial aneurysms. The hypothalamus which lies in close anatomical proximity to the circle of Willis may be directly influenced by the rupture of a cerebral aneurysm. So, hypothalamic dysfunction may affect pituitary adrenal function sympathetic and parasympathetic activities. The knowledge of all these disturbances, and their mechanisms supports the current strategies for the management of aneurysmal subarachnoid hemorrhage.
Subject(s)
Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/physiopathology , Arrhythmias, Cardiac/etiology , Hemodynamics , Humans , Hyponatremia/physiopathology , Hypothalamus/physiopathology , Prognosis , Pulmonary Edema/physiopathology , Rupture, Spontaneous , Subarachnoid Hemorrhage/etiology , Sympathetic Nervous System/physiopathologyABSTRACT
Calcium entry blockers are usually used to control cerebral vasospasm in patients with subarachnoid haemorrhage due to aneurysm rupture. In this study, it's appeared that the dose of sodium nitroprusside required to decrease blood pressure is higher when calcium entry blockers are used.
Subject(s)
Ferricyanides , Hypotension, Controlled/methods , Intracranial Aneurysm/surgery , Nicardipine/therapeutic use , Nitroprusside , Premedication , Adult , Anesthesia, General/methods , Female , Humans , Male , Middle Aged , Nicardipine/administration & dosage , Preoperative CareABSTRACT
For one case of thrombosis of sinus sagittalis superior joint haemorrhagic cerebral softening necessitates surgical draining of haemorrhagic focus grown to a true intracranial haematoma; for the another case direct low molecular weight heparin treatment obtained a mere evolution. Authors are of the opinion that early low molecular weight heparin treatment is able to avoid massive haemorrhage.