RESUMO
BACKGROUND AND OBJECTIVES: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. METHODS: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. CONCLUSION: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.
Assuntos
Anestesia por Condução , Consenso , Técnica Delphi , Documentação , HumanosRESUMO
This article presents an overview of how to set up an ambulatory regional anesthesia program for orthopedic surgery. This information is valuable to anesthesiologists who want to expand their regional anesthesia practice and provides a greater understanding of relevant issues and strategies to maximize success.
Assuntos
Assistência Ambulatorial/organização & administração , Procedimentos Cirúrgicos Ambulatórios , Anestesia por Condução/métodos , Ortopedia/organização & administração , Anestesia por Condução/efeitos adversos , Humanos , Complicações Pós-Operatórias/terapiaAssuntos
Antieméticos/efeitos adversos , Droperidol/efeitos adversos , Aprovação de Drogas , Rotulagem de Medicamentos , Sistema de Condução Cardíaco/efeitos dos fármacos , Náusea e Vômito Pós-Operatórios/prevenção & controle , Terminologia como Assunto , Qualidade de Produtos para o Consumidor , Relação Dose-Resposta a Droga , Uso de Medicamentos , Medicina Baseada em Evidências , Humanos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/fisiopatologia , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/fisiopatologia , Estados Unidos , United States Food and Drug AdministrationRESUMO
OBJECTIVES: To present the clinical presentation, workup, surgical approach, and pathological findings of the first case report of a patient with adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. STUDY DESIGN: Retrospective review of the records of a case of adenocarcinoma ex-pleomorphic adenoma of the lacrimal sac and nasolacrimal duct. METHODS: The clinical presentation, workup, surgical approach, and pathological findings were reviewed. RESULTS: A 51-year-old man presented with a 10-year history of recurrent epiphora of the right eye. At dacryocystorhinostomy a small lesion was visualized within the lumen of the lacrimal sac. A biopsy specimen was consistent with adenocarcinoma. En bloc resection was accomplished using a lateral rhinotomy and medial maxillectomy. The final specimen showed adenocarcinoma ex-pleomorphic adenoma. The patient was given postoperative radiation therapy. He was free of disease 16 months after treatment. CONCLUSIONS: Lacrimal sac tumors should be considered in the differential diagnosis of chronic epiphora. Management of nasolacrimal adenocarcinoma requires complete surgical resection. Radiation treatment in and of itself is not curative but may be useful as adjuvant therapy. Carcinoma ex-pleomorphic adenoma can develop in the lacrimal sac and nasolacrimal duct.