[Advantages of starting outpatient preoperative evaluation system].

BACKGROUND: We started an outpatient preoperative evaluation system in September, 2006, and reviewed whether preoperative examination of outpatients contributed to efficiency of duties of anesthesiologists. METHODS: A questionnaire paper was delivered to each anesthesiologist before and after starting the outpatient preoperative evaluation system. Items investigated are patient background (age, sex, ASA-PS classification, planned anesthesia methods), time required, the factor that took time, the end time of preoperative examination. RESULTS: The number investigated were 245 and 240 cases before and after starting the outpatient preoperative evaluation system, individually. Most reasons why we needed time in the wards were "absence of the patient" (7.3%). We visited an average of 1.15 times to the patient in the wards. The ratio that we finished the preoperative examination after five o'clock in the evening was 29.4% before starting our system. On the other hand, we finished the preoperative examination by approximately five o'clock in the evening and time for one case was shortened from 35.5 +/- 10.9 to 29.5 +/- 8.9 minutes after starting our system. CONCLUSIONS: Outpatient preoperative evaluation raises the efficiency of duties of anesthesiologists to finish preoperative examination before hospitalization.

[Fire caused by a spark of electric scalpel igniting alcoholic antiseptic containing chlorhexidine].

Fire accident is one of the most severe complications that can occur in the perioperative period. We report a case of an episode of electrosurgical burn. An 80-year-old woman was scheduled for ascending colectomy due to ascending colon carcinoma. The skin of the surgical site was sterilized with alcoholic antiseptic containing chlorhexidine before the operation. On coagulating the bleeding point of the subcutaneous fatty tissue, a spark of the electric scalpel ignited the alcoholic antiseptic. She had burn on her right thorax, lower abdomen and femoral region. Two-degree burn occupied 2% of the body surface and three-degree burn 3%. She underwent dermatoplasty 14 days later. Postoperative course was uneventful and she left the hospital on the 58th postoperative day. An alcoholic antiseptic is the most useful and has an immediate effect for preoperative disinfection of the skin according to the CDC guideline. However, electric scalpel and alcoholic use are always accompanied with the risk of ignition and sufficient caution is required.

[Anesthetic management with ATP for endovascular thoracic aortic repair].

A 78-year-old man with thoracic aortic aneurysm was scheduled for endovascular stent-graft surgery without cardiopulmonary bypass. He had a history of myocardial infarction five months before and echocardiography revealed ejection fraction of 37%. Deployment of the stent-graft was performed during third degree atrioventricular (A-V) block of 32 seconds produced by adenosine 5'-triphosphate (ATP) 30 mg. There were no complications during this procedure. ATP is a convenient and suitable agent to produce transient A-V block for the precise deployment of the stent-graft in these patients with severe cardiopulmonary complications.