Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients.

OBJECTIVES: The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed. OBJECTIVES: To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4year period. PATIENTS/METHODS: All hospitalised patients at a single institution during the first semesters of 2005-2009 (n=32280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected. RESULTS: E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29-0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22-0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30million. CONCLUSIONS: E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.

Premedicación con ketamina-midazolam oral en pacientes no colaboradores en cirugía mayor ambulatoria / Oral ketamine-midazolam premedication of uncooperative patients in major outpatient surgery

INTRODUCCIÓN: La ketamina es un fármaco con una baja utilización actualmente como anestésico. Sus características clínicas y mecanismo de acción dependen en gran parte de su efecto antagonista en el receptor del Nmetil- D-aspartato. OBJETIVO: Valorar la idoneidad de la ketamina vía oral como agente preanestésico para la atenuación del estrés quirúrgico en pacientes discapacitados psíquicos. MATERIAL Y MÉTODOS: Estudio retrospectivo y observacional de 112 pacientes discapacitados psíquicos intervenidos de cirugía odontológica en régimen de cirugía mayor ambulatoria. Se incluyeron dos grupos, la premedicación con midazolam e ibuprofeno vía oral (grupo control), y la adicción a los anteriores de ketamina oral a dosis de 6 mg/kg (grupo de estudio). Se recogieron datos demográficos, anestésicos, quirúrgicos, variables fisiológicas, escala de Glasgow, tiempo de inicio de ansiolisis, así como el tiempo de estancia en la sala de recuperación e incidentes. RESULTADOS: En el 66,3% de los pacientes se realizó tratamiento odontológico conservador. Setenta y un pacientes (64,4%) correspondieron al grupo control y 41 pacientes (36,6%) al grupo de estudio. Los cambios hemodinámicos, respiratorios y neurológicos fueron mínimos, sin diferencias estadísticamente significativas entre los grupos. Entre ambos grupos e intragrupo en el grado de sedación a los 15 y 30 minutos en el grupo de estudio (p=0,0001) hubo diferencias estadísticamente significativas. El tiempo medio de la cirugía fue de 72,6±29,7 minutos. La permanencia de los pacientes en las salas de Reanimación postquirúrgica y de readaptación al medio fue de 140,9±52,1 minutos (135,8±54,89 minutos en el grupo de estudio y de 144,2±50,5 minutos en el grupo control). No existieron diferencias estadísticamente significativas en la aparición de efectos adversos. CONCLUSIONES: La ketamina vía oral es eficaz en la premedicación en cirugía mayor ambulatoria sin conllevar un aumento de efectos adversos(AU)

BACKGROUND: Currently, ketamine is not often used as an anesthetic. Its clinical characteristics and mechanism of action largely depend on antagonism of the N-methyl-D-aspartate receptor. Objective: To evaluate the utility of oral ketamine as a preanesthetic agent to lower surgical stress for patients with mental disability. MATERIAL AND METHODS: Observational, retrospective study of 112 mentally disabled patients undergoing major dental surgery on an outpatient basis. The study group received oral midazolam, ibuprofen, and 6 mg/kg of ketamine; the control group received only midazolam and ibuprofen. We recorded data concerning demographics, anesthesia, surgery, physiologic variables, Glasgow score, time of onset of anxiolysis, duration of stay in the recovery ward, and adverse events. RESULTS: Conservative odontologic treatment was provided in 66.3% of the cases. Seventy-one patients (64.4%) were in the control group and 41 patients (36.6%) in the study group. Hemodynamic, respiratory, and neurologic changes were minimal and there were no significant between-group differences. Level of sedation differed significantly between groups (P=.001) at 15 and 30 minutes; differences were also observed within the study group. Mean (SD) duration of surgery was 72.6 (29.7) minutes. Mean duration of stay in the postoperative recovery ward was 140.9 (52.1) minutes (135.8 [54.89] minutes in the study group and 144.2 [50.5] minutes in the control group). The incidence of adverse events did not differ significantly between groups. CONCLUSIONS: Oral ketamine is an effective premedication for major ambulatory surgery and does not increase the incidence of side effects(AU)

Utilización de fentanilo oral como premedicación en pacientes pediátricos / No disponible

No disponible

Utilización de fentanilo oral como premedicación en pacientes pediátricos. Respuesta de los autores / No disponible

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New concepts in acute pain therapy: preemptive analgesia.

Pain, which is often inadequately treated, accompanies the more than 23 million surgical procedures performed each year and may persist long after tissue heals. Preemptive analgesia, an evolving clinical concept, involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain. Surgery offers the most promising setting for preemptive analgesia because the timing of noxious stimuli is known. When adequate drug doses are administered to appropriately selected patients before surgery, intravenous opiates, local anesthetic infiltration, nerve block, subarachnoid block and epidural block offer benefits that can be observed as long as one year after surgery. The most effective preemptive analgesic regimens are those that are capable of limiting sensitization of the nervous system throughout the entire perioperative period.