RÉSUMÉ
BACKGROUND: The World Health Organization (WHO) surgical safety checklist (SSC) was introduced to improve the safety of surgical procedures. This systematic review evaluated current evidence regarding the effectiveness of this checklist in reducing postoperative complications. METHODS: The Cochrane Library, MEDLINE, Embase and CINAHL were searched using predefined inclusion criteria. The systematic review included all original articles reporting a quantitative measure of the effect of the WHO SSC on postoperative complications. Data were extracted for postoperative complications reported in at least two studies. A meta-analysis was conducted to quantify the effect of the WHO SSC on any complication, surgical-site infection (SSI) and mortality. Yule's Q contingency coefficient was used as a measure of the association between effectiveness and adherence with the checklist. RESULTS: Seven of 723 studies identified met the inclusion criteria. There was marked methodological heterogeneity among studies. The impact on six clinical outcomes was reported in at least two studies. A meta-analysis was performed for three main outcomes (any complication, mortality and SSI). Risk ratios for any complication, mortality and SSI were 0·59 (95 per cent confidence interval 0·47 to 0·74), 0·77 (0·60 to 0·98) and 0·57 (0·41 to 0·79) respectively. There was a strong correlation between a significant decrease in postoperative complications and adherence to aspects of care embedded in the checklist (Q = 0·82; P = 0·042). CONCLUSION: The evidence is highly suggestive of a reduction in postoperative complications and mortality following implementation of the WHO SSC, but cannot be regarded as definitive in the absence of higher-quality studies.
Sujet(s)
Liste de contrôle , Complications postopératoires/prévention et contrôle , Humains , Sécurité des patients , Complications postopératoires/mortalité , Pratique professionnelle/normes , Réintervention/statistiques et données numériques , Facteurs de risque , Organisation mondiale de la santéRÉSUMÉ
A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.
Sujet(s)
Anesthésiques par inhalation/usage thérapeutique , Anesthésiques intraveineux/usage thérapeutique , Cardiotoniques/usage thérapeutique , Pontage aortocoronarien/méthodes , Lésion de reperfusion myocardique/prévention et contrôle , Sujet âgé , Pontage cardiopulmonaire , Desflurane , Femelle , Humains , Préconditionnement ischémique myocardique/méthodes , Isoflurane/analogues et dérivés , Isoflurane/usage thérapeutique , Durée du séjour , Mâle , Éthers méthyliques/usage thérapeutique , Adulte d'âge moyen , Lésion de reperfusion myocardique/sang , Complications postopératoires/prévention et contrôle , Facteurs de risque , Sévoflurane , Analyse de survie , Troponine T/sangRÉSUMÉ
Dexamethasone and methylprednisolone have been proven effective in the prevention of nausea after chemotherapy. Dexamethasone has been proven effective in the prophylaxis of late PONV. Literature about methylprednisolone in PONV prophylaxis is rare. We randomized 118 patients in a double blind way to receive either dexamethasone 8 mg, methylprednisolone 40 mg or placebo as prophylactic agent. Duration of anaesthesia was significantly longer and significantly more sufentanil was used in the methylprednisolone group. Despite these 2 risk factors, methylprednisolone was significantly better than placebo in the prevention of late nausea, retching and PONV. There was a beneficial clinical effect of dexamethasone in this population, although not significant. A possible explanation lies in the fact that monotherapy is mostly insufficient in a population at risk like ours. This study confirms that steroids are mostly effective in the prevention of late PONV, less effective in early PONV.
Sujet(s)
Antiémétiques/usage thérapeutique , Dexaméthasone/usage thérapeutique , Méthylprednisolone/usage thérapeutique , Vomissements et nausées postopératoires/prévention et contrôle , Adulte , Sujet âgé , Méthode en double aveugle , Femelle , Humains , Adulte d'âge moyen , Études prospectivesRÉSUMÉ
The aim of the prospective randomised study is to compare the cost effectiveness of three general anaesthesia techniques for total hip replacement surgery and the cost minimisation by use of anaesthetics. For induction propofol was used in the three techniques. For maintenance, we used desflurane, or sevoflurane, or propofol. There was no significant difference in consumption of drugs for pain treatment, treatment of nausea and vomiting or cost of hospital stay or total cost for pharmacy. In terms of cost-effectiveness we can consider that the three techniques are similar. The cost of an i.v. technique was always higher than inhaled anaesthetics. The major cost in anaesthesia is the fee for the anaesthesiologist. But all in, the cost of anaesthesia was only 15.1% of the total cost of the procedure. Cost of inhaled or i.v. anaesthetics was 0.55% to 1.0% of the total cost. There was a discrepancy between the measured consumption of inhaled anaesthetics and the consumption (and cost) on the invoice. Cost minimisation based on anaesthetic medication is ridiculously by small considering the total cost of the procedure.
Sujet(s)
Anesthésie générale/économie , Anesthésiques généraux/économie , Arthroplastie prothétique de hanche/économie , Sujet âgé , Anesthésiologie/économie , Anesthésiques par inhalation/administration et posologie , Anesthésiques par inhalation/économie , Anesthésiques intraveineux/administration et posologie , Anesthésiques intraveineux/économie , Belgique , Maîtrise des coûts , Analyse coût-bénéfice , Desflurane , Coûts des médicaments , Femelle , Humains , Injections veineuses/économie , Isoflurane/administration et posologie , Isoflurane/analogues et dérivés , Isoflurane/économie , Durée du séjour/économie , Mâle , Éthers méthyliques/administration et posologie , Éthers méthyliques/économie , Douleur postopératoire/économie , Pharmacie d'hôpital/économie , Vomissements et nausées postopératoires/économie , Propofol/administration et posologie , Propofol/économie , Études prospectives , Sévoflurane , Facteurs sexuelsRÉSUMÉ
Today, quality is part of our practice. Anaesthetists are involved in a medical science and want to be excellent at it. Anaesthetists are also involved in departmental organisation and are providers of care, a service to the patients. Quality is a method to obtain efficiency (efficacy and economical advantages). We consider our patients no longer as such, but as health-customers. Anaesthetists are health providers. The patients-customers have their own expectations and they compare the service between the different hospitals. On the other hand, health care is a public matter and in most countries depends on a governmental financing. Quality means efficacy, ethics and economics, including medico-legal aspects. But how can we use a quality and management concept (QMDA) in our daily practice? This is the subject of the paper.
Sujet(s)
Anesthésiologie/normes , Assurance de la qualité des soins de santé/organisation et administration , Anesthésie/normes , Anesthésiologie/enseignement et éducation , Audit médical , Pratique professionnelle , Terminologie comme sujetSujet(s)
Anesthésiologie/tendances , Anesthésie , Anesthésiologie/enseignement et éducation , Anesthésiologie/statistiques et données numériques , Attitude du personnel soignant , Belgique , Collecte de données , Hôpitaux , Internat et résidence , Infirmières anesthésistes , Soins périopératoires , Assistants médecins , Enquêtes et questionnairesSujet(s)
Perte sanguine peropératoire/prévention et contrôle , Procédures de chirurgie cardiaque/méthodes , Facteur VIII/usage thérapeutique , Hémophilie A/chirurgie , Hémorragie postopératoire/prévention et contrôle , Anticoagulants/usage thérapeutique , Antifibrinolytiques/usage thérapeutique , Pontage aortocoronarien/méthodes , Érythrocytes , Facteur VIII/administration et posologie , Implantation de valve prothétique cardiaque/méthodes , Hématocrite/méthodes , Hémophilie A/sang , Héparine/usage thérapeutique , Antagonistes de l'héparine/usage thérapeutique , Humains , Perfusions veineuses/méthodes , Mâle , Adulte d'âge moyen , Valve atrioventriculaire gauche/chirurgie , Plasma sanguin , Numération des plaquettes/méthodes , Protamine/usage thérapeutique , Facteurs temps , Acide tranéxamique/usage thérapeutiqueSujet(s)
Anesthésiques par inhalation/pharmacologie , Mécanique respiratoire/effets des médicaments et des substances chimiques , Analgésiques morphiniques/pharmacologie , Bronchoconstriction/effets des médicaments et des substances chimiques , Interactions médicamenteuses , Fentanyl/pharmacologie , HumainsRÉSUMÉ
BACKGROUND AND OBJECTIVE: The study evaluated the manpower requirements in anaesthesia in Belgium until 2020. The basic intent was to estimate the need for anaesthesiologists in different hospitals because the number of medical students will be reduced to 700 in 2004 and to 600 in 2007 (numerus clausus), and the number of trainees in anaesthesia from 110 to 42 (best scenario) or to 21 (worst scenario). Simultaneous anaesthesia (more than one patient at the same time) is not allowed by our professional safety rules or by the Belgian Ministry of Public Health. The questions are: will we have enough anaesthesiologists in the next 20 years, and is there a need for nurses to administer anaesthesia? This professional title of nurse anaesthetist does not presently exist in Belgium. METHODS: Every registered anaesthesiologist in Belgium received a questionnaire about the manpower requirements in his or her institution expected over the next 20 years. The workload in the specialty was also considered. RESULTS: We received 154 replies from 186 different hospitals. The workload is definitely high: 10 h per day was devoted to clinical work and 4.6 h per week to administration. Belgium will need 51 anaesthesiologists each year after 2004, and 58 each year from 2010 to 2020. CONCLUSIONS: Will anaesthesiologists accept their present high workload for the next 20 years? If not, the consequences will be serious. Three-quarters (75.4%) of the replies identified a need for more anaesthesiologists and considered that an anaesthesiologist supervising anaesthesia nurses for a number of patients simultaneously was a possible solution.
Sujet(s)
Anesthésiologie , Infirmières anesthésistes/ressources et distribution , Belgique , Humains , Enquêtes et questionnaires , Effectif , Charge de travailRÉSUMÉ
An original question. Following a recent questionnaire of the Ministry of Public Health we are often stressed, tried, we work to hard. We arrive before the surgeons, remain the defender of patient during the OR stay. Outside of the OR we are fighters against "Pain". We do protect the organism of the patient against the consequences of the surgical aggression. The physiology in a totality and the maintenance of the vital function of the patient is our major concern. The Anaesthetist reanimator will focus on the essential. The author also discusses the "qualification" and activities of a Emergency room or Intensive Care specialty. This evolution will limit our activity. The value of team work is stressed the anaesthesist focus on the essential, the patient, his life ... He is a "Doctor"
Sujet(s)
Anesthésiologie , Relations médecin-patient , Anesthésiologie/enseignement et éducation , Soins de réanimation , Services des urgences médicales , Humains , Soins peropératoires , Douleur postopératoire/prévention et contrôle , Équipe soignante , Procédures de chirurgie opératoireRÉSUMÉ
We report a case of intoxication with paraquat. On admission three days after intoxication the patient had high paraquat levels. The treatment consisted of hypoxic ventilation with 14% oxygen and 86% nitrogen, hemodialysis, and forced diuresis. The patient never exhibited either clinical or radiological signs of pulmonary complications. The toxicology of paraquat and the use of hypoxic ventilation are discussed.