The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study.

BACKGROUND: Surgical checklists (SCs) have been developed to enhance teamwork and facilitate handovers, thereby improving the safety of surgical patients in health care organisations. The aim of this study was to determine whether the implementation of a 39-item SC reduced mortality and surgical adverse events (AEs) in patients undergoing inpatient surgery. METHODS: A retrospective pre- and post-intervention study of two cohorts of surgical patients was conducted (n = 1602) in a tertiary teaching hospital. The patients' homogeneity was confirmed by studying 40 comorbidities, 13 analytical determinations and 14 patient- and intervention-related variables. A 39-item SC adapted from one by the World Health Organization was used. The primary endpoint was the occurrence of any AE, including death, within 30 days of the operation. Twenty-three types of AEs were analysed. RESULTS: Following implementation of the checklist, the rate of AEs per 100 patients decreased from 31.5% to 26.5% (P = 0.39), the rate of infectious AEs decreased from 13.9 to 9.6 (P = 0.037) and non-infectious AEs decreased from 17.5 to 16.8 (P = 0.82). For non-elective patients, total AEs decreased from 60.4 to 37.0 (P = 0.017). The proportion of patients with one or more AE decreased from 18.1% to 16.2% (P = 0.35), and the death rate at 30 days decreased from 1.5% to 0.9% (P = 0.35). CONCLUSION: The overall AE rate did not decrease significantly between the two periods. However, the rate of infectious AEs and overall AEs in patients with non-elective admissions had statistically significant reductions. Further research is needed to determine how and in which patients SC introduction can work successfully.

[Anesthetic management in a patient previously diagnosed with takotsubo cardiomyopathy]. / Manejo anestésico en una paciente previamente diagnosticada de síndrome de takotsubo.

Takotsubo cardiomyopathy (transient apical ballooning of the left ventricle) is a recently described and often underdiagnosed entity. The syndrome is observed predominately in postmenopausal women and the clinical signs are similar to those of an acute anterior myocardial infarction. In most of the reported cases an emotional or physical stress event has been identified as a trigger, and perioperative stress has been suggested as the trigger in some of these cases. Outcome is favorable with the right treatment, though recurrences are possible. We report the anesthetic management of a 79-year-old woman with a previously diagnosed episode of Takotsubo cardiomyopathy, who was admitted to our hospital for total hip replacement. Care was taken to provide proper preoperative sedation before provision of hyperbaric spinal anesthesia, followed by sedation with intravenous propofol. Surgery and the early postoperative period were uneventful. We believe that minimizing perioperative anxiety should be a priority in these patients due to the possibility that a catecholamine discharge might trigger an episode of Takotsubo cardiomyopathy.

Manejo anestésico en una paciente previamente diagnosticadade síndrome de takotsubo / Anesthetic management in a patient previously diagnosed with Takotsubo cardiomyopathy

El síndrome de takotsubo (disquinesia apical transitoriadel ventrículo izquierdo) es una entidad descritarecientemente y a menudo infradiagnosticada. Se observapredominantemente en mujeres postmenopáusicas ysu presentación clínica es muy similar a la de un infartoagudo de miocardio anterior. En la mayoría de loscasos descritos se identifica como desencadenante unevento de estrés que puede ser emocional o físico, y elestrés perioperatorio se ha postulado como responsablede algunos de ellos. Con el tratamiento adecuado el pronósticoes favorable, si bien son posibles las recurrencias.Describimos el manejo anestésico de una pacientede 79 años diagnosticada previamente de un episodio desíndrome de takotsubo que ingresó en nuestro hospitalpara colocación de prótesis total de cadera. Tras unapremedicación ansiolítica cuidadosa se practicó anestesiaraquídea hiperbárica, seguida de sedación intravenosacon propofol. El procedimiento quirúrgico y elpostoperatorio inmediato transcurrieron sin incidencias.Consideramos prioritario minimizar la ansiedadperioperatoria en estos pacientes, dado el posible papelde una descarga catecolamínica como desencadenantede un episodio de síndrome de takotsubo (AU)

Takotsubo cardiomyopathy (transient apicalballooning of the left ventricle) is a recently described andoften underdiagnosed entity. The syndrome is observedpredominately in postmenopausal women and the clinicalsigns are similar to those of an acute anterior myocardialinfarction. In most of the reported cases an emotional orphysical stress event has been identified as a trigger, andperioperative stress has been suggested as the trigger insome of these cases. Outcome is favorable with the righttreatment, though recurrences are possible. We reportthe anesthetic management of a 79-year-old womanwith a previously diagnosed episode of Takotsubocardiomyopathy, who was admitted to our hospital fortotal hip replacement. Care was taken to provide properpreoperative sedation before provision of hyperbaricspinal anesthesia, followed by sedation with intravenouspropofol. Surgery and the early postoperative period wereuneventful. We believe that minimizing perioperativeanxiety should be a priority in these patients due to thepossibility that a catecholamine discharge might triggeran episode of Takotsubo cardiomyopathy (AU)

Implicaciones anestésicas del síndrome de Swyer-James / Anesthetic implications of Swyer-James syndrome

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