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At least 811 records · Page 45Linked to original sources
PubMed1996

Automatic record keeping in anaesthesia--a nine-year Italian experience.

In 1986, in Buccheri La Ferla Hospital, Palermo, an anaesthesia information management project was started. Its aim was to develop a computerized anaesthesia workstation. Today, the system is in daily clinical use and has reached most of its original goals: Automatic collection of physiological signals and patient monitor trends is possible by means of analog-digital conversion or by using serial data transfer. A centralized display is included in the system to allow easy control of the progress of the anaesthetic procedures in the hospital. Available in the workstation, there is an on-line help function to assist pharmacological calculations and administration of anaesthesia drugs. Mail messages can be sent to different anaesthesia workstations and data can be shared between them. Information collected during preoperative visits is automatically transferred from a portable personal computer to the system. There is a nine-year patient data-base with both preoperative and perioperative anaesthesia information which can be accessed from each of the workstations. Today, the system is in daily routine use and comprises eight anaesthesia workstations and two portable personal computers used for preoperative visits. The operation schedule with anaesthetists' notes is printed both for surgical wards and for O.R., using information stored from preoperative visits to the system. For automated data collection a trend resolution of one minute has been used. The postoperative orders are printed from the system in the recovery room and given to the wards with the patient. The feedback from the seventeen anaesthetists and twenty-four nurses who use the system routinely is positive. Today, 16,000 patient records are available in the database. This number increases by 3,300 every year. With increasing computer utilization in patient treatment there have been no legal or administrative controversies. Based on nine years' experience, it is clear that the use of computers in anaesthesia practice improves quality of patient care.

Analog-Digital Conversion↗
PubMed1982

Postoperative care and review of complications.

This chapter is an overview of the management of a patient who has undergone a surgical procedure in an outpatient setting. It addresses the complications that are most common in this setting and their management. Without attempting a thorough discussion of every conceivable complication, this discussion seeks nonetheless to be reasonably comprehensive. Perhaps the most straightforward means of presenting this information is to follow chronologically the patient's experience from the moment the procedure has been concluded, through his recovery room care, and finally look at the patient's needs and experiences after leaving the ambulatory care facility.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Retrospective cost analysis comparing Essure hysteroscopic sterilization and laparoscopic bilateral tubal coagulation.

STUDY OBJECTIVE: To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Midwestern academic medical center. PATIENTS: Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied. INTERVENTIONS: Placement of the Essure inserts according to the manufacturer's instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy. MEASUREMENTS AND MAIN RESULTS: Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was 180 dollars (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p <.0001), but this was offset by higher charges for operating room costs, which included the recovery room (p <.0001) and pharmacy costs (p <.0001) in the patients in the laparoscopy group. CONCLUSION: In our setting, the Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study.

Adult↗
PubMed1989

Comparison of oral transmucosal fentanyl citrate and an oral solution of meperidine, diazepam, and atropine for premedication in children.

The safety and efficacy of premedication with oral transmucosal fentanyl citrate (OTFC) was compared with that of an orally administered solution of meperidine, diazepam, and atropine and no premedication in 59 children about to undergo elective operations. The patients were randomly assigned to receive no premedication (n = 19); 0.25 ml/kg of the oral solution (containing meperidine, 1.5 mg/kg, diazepam, 0.2 mg/kg, and atropine, 0.02 mg/kg, n = 20); or OTFC (15-20 micrograms/kg, n = 20). Children had activity (sedation) and anxiety scores, vital signs (including systolic and diastolic arterial blood pressures and heart and respiratory rates) and pulse oximetry determined oxygen saturation measured before and at 10-min intervals after premedication until they were taken to the operating room. Quality of induction and recovery was evaluated using scoring schedules; recovery times were measured and side effects noted. OTFC was readily accepted and provided significant reductions in preoperative activity (sedation) and anxiety starting after 30 min. After OTFC, sedation and anxiolysis were significantly greater than in children having no premedication but similar to children having the oral solution for premedication. Vital signs and oxygen saturations remained unchanged preoperatively in all groups. Induction and recovery evaluations and recovery times were similar in the three groups, although children having OTFC had the lowest requirements for narcotics in the recovery room. OTFC caused an 80% incidence of mild preoperative facial pruritus and a higher overall incidence of postoperative vomiting (37%) than premedication with the oral solution (5%) or no premedication (18%).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2001

The TURP syndrome: importance of expiratory ethanol measurement and high serum levels of glycine.

OBJECTIVE: In a prospective study it was our intention to evaluate the reliability and the predictive value of expiratory ethanol for the early detection of the occurrence of TURP syndrome and emphasize the role of the serum levels of glycine in clinical manifestation. METHODS: We studied 30 patients scheduled for elective traditional transuretral resection of the prostate performed with subarachnoid anesthesia. Serum sodium and glycine concentrations, serum osmolality and end-expiratory ethanol levels were monitored at scheduled intervals. Continuous heart rate and blood pressure monitoring was performed during the perioperative period in the operativing room and, later, in the recovery room. Occurrence of cardiocirculatory, respiratory and neurologic symptoms were recorded. Statistics included Bonferroni's t-test and Fisher's exact test. A decision level plot for end-expiratory ethanol level was performed for the choice of predictivity criterion. RESULTS: In our population we identified three groups of patients: Group I (15 patients) in which no symptom was recorded; Group II (6 patients) in which non-specific anesthesia-related symptoms occurred; Group III (9 patients) in which TURP syndrome of various degree of severity was observed. In this group of patients changes in serum sodium and glycine concentrations, serum osmolality and end-expiratory ethanol levels were significantly different compared with the other two groups. In regard to end-expiratory ethanol levels, we identified a cut-off point at 0.05 mg/ml. In Group III two patients developed transient blindness. These patients had the highest serum glycine concentrations (> 4000 mumol/ml). Mortality was nil. CONCLUSIONS: Our data show the reliability and accuracy of end-expiratory ethanol levels as a predictive test of the occurrence of TURP syndrome. Further, we emphasize the role of serum glycine concentration in the occurrence of neurologic symptoms related to the transurethral resection of the prostate.

Aged↗
PubMed1995

A prospective cost analysis of laparoscopic cholecystectomy.

BACKGROUND: In order to improve the value of laparoscopic cholecystectomy (LC), we completed a prospective micro-cost analysis at a large, multispecialty referral hospital. METHODS: After a line-item cost database had been established, the following cost data were retrieved over a 1-year period (May 1993 through May 1994): operating room (OR), radiology, pharmacy, anesthesia supplies, recovery room, and hospital room. OR cost data was further divided into costs for room-staff, room setup, radiology, plus disposable and nondisposable equipment. Sixty uncomplicated LC cases were collected (30 cases each for 2 surgeons to examine the surgeon variable). RESULTS: Sixty percent of the hospital costs occurred in the OR. Disposable laparoscopic equipment accounted for 17% of the total hospital costs and 28% of the OR costs. Staff charges in the OR (cost estimated by the hospital using minutes in the LC room) represented 24% and 41%, respectively, of the above costs to the hospital. CONCLUSIONS: The areas in which hospitals and surgeons can improve the surgical value package (ie, decrease costs while maintaining quality) are in disposable equipment and efficient minimization of in-the-room time.

Cholangiography↗
PubMed1995

Lumbar spine arthrodesis. A comparison of hospital costs between 1986 and 1993.

The purpose of this project was to evaluate the hospital costs of one- and two-level spinal arthrodesis and to determine areas where costs may be effectively reduced. The hospital bills of 40 patients (20 each in 1986 and 1993) who had undergone single-level and double-level lumbar arthrodesis were reviewed. Each patients's bill was examined and the specific charge items were assigned to one of seven "service centers." To effectively compare costs in the two different years, dollar values on 1986 bills were converted to inflation-adjusted 1993 amounts (the consumer price index over this interval was about 35%). The hospital cost (mean) for single- and double-level spinal arthrodesis increased from $7,457 (1986) to $19,712 (1993). In inflation-adjusted 1993 dollars the actual increase was 97%. All but two service centers demonstrated increased costs. The most dramatically increased in price was implant cost ($300 in 1986 vs $2,967 in 1993, a 638% increase with inflation adjustment). When adjusted for inflation, surgeons' fees actually decreased by 18% at our institution ($7,503 in 1986 vs $8,338 in 1993). The other service center that showed a decrease was the hospital room (-15%). The anesthesia charge, recovery-room fee, operating-room charge, and the "other" charges increased between 36% and 288%. As a percentage of the total hospital bill, implant cost accounted for approximately 4% of the 1986 charges, whereas in 1993 it accounted for more than 15% of the total bill. None of the other service centers showed such a drastic increase. Increasingly sophisticated technology has dramatically raised hospital charges. Strategies to reduce the overall cost of spinal surgery should concentrate on controlling the cost of spinal implants.

Cost Control↗
PubMed2000

Pethidine reverses morphine-induced delirium.

A young patient had unexpected and prolonged postoperative delirium apparently associated with morphine-induced biliary colic. Naloxone had no therapeutic effect, but a small dose of pethidine produced a dramatic return to lucidity. Unrecognized biliary spasm should be considered as a cause of agitation in the recovery room in postoperative patients who have received morphine.

Adolescent↗
PubMed1995

Postoperative hypoxaemia during transport and in the recovery area.

This study was undertaken to ascertain the incidence of postoperative hypoxaemia in the recovery area and during transfer to the recovery area while adhering to the current practice of anaesthesia and recovery room care. Attempts were also made to determine some of the risk factors for the development of hypoxaemia. There were 546 patients who had general or regional anaesthesia observed in the recovery area and of these, 534 patients were also observed during transfer using Critikon Oxyshuttle pulse oximeters. The incidence of hypoxaemia (SpO2 < or = 90%) and severe hypoxaemia (SpO2 < or = 85%) during transfer were 10.11% and 2.06% respectively. The incidence of hypoxaemia and severe hypoxaemia in the recovery area were 8.42% and 2.2% respectively. No oxygen was given to patients during transfer. In the recovery area, 322 patients (58.97%) had oxygen therapy and 224 patients (41.03%) did not. The occurrence of hypoxaemia during transfer was significantly related to the duration of surgery. In the recovery area, age and weight were found to be statistically significant risk factors. The incidence of hypoxaemia in this study is much lower than that reported in other studies.

Abdomen↗
PubMed1997

The impact of choice of muscle relaxant on postoperative recovery time: a retrospective study.

UNLABELLED: To test the hypothesis that the use of long-acting muscle relaxants is associated with prolonged postoperative recovery when compared with the use of shorter-acting relaxants, we undertook a retrospective study of 270 patients with induced paralysis recovering from general anesthesia. We calculated the mean recovery time associated with each muscle relaxant used. Regression analyses were performed to control for potential confounding of the results by length and type of surgery, as well as age and sex. Taking these into account, the adjusted difference in mean recovery time between patients receiving short- and intermediate-acting relaxants (mivacurium, atracurium, and vecuronium) versus those receiving long-acting relaxants (d-tubocurarine, pancuronium, and pancuronium and d-tubocurarine combination) was 30 min (95% confidence interval [CI] 8-53). The adjusted difference in mean recovery time between patients receiving vecuronium and those receiving pancuronium (i.e., the single most frequently used drug in each category) was 33 min (95% CI 1-66). Shortened recovery time accounted for an estimated average $37.95 decrease in recovery room charge per patient when vecuronium was used instead of pancuronium, versus a $22.84 increase in drug cost. Our data and analyses support the hypothesis that the use of long-acting muscle relaxants is associated with prolonged recovery after surgery and provide preliminary evidence that restricting the use of the more expensive, shorter-acting muscle relaxants may represent a false economy. IMPLICATIONS: In this retrospective study, the use of old-fashioned, inexpensive, long-acting paralyzing drugs was found to be associated with prolonged postoperative recovery. This has implications when deciding whether, as an economic measure, to restrict the use of the more expensive, shorter-acting paralyzing drugs, because prolonged recovery also has a price.

Adolescent↗
PubMed1994

[Structure and organization of ambulatory and day treatment in a non-university facility].

Though German hospitals are normally not built for day case surgery, this became a new challenge based on changed legal regulations. A stepwise adaptation of the present facilities to the altered necessities seems to be a relatively simple way to realise day case surgery also in hospitals. Preoperatively surgeons and anaesthetists offer office hours during the same time to avoid patients having to wait. On the day of surgery patients are admitted to the hospital and treated like inpatients with regular transport to the operating room for anaesthesia and surgery, followed by recovery room stay and transmission to the normal ward. At a fixed time in the afternoon patients are visited by the surgeon and the anaesthetist to clear the conditions for dismission. While anaesthesia, surgery and recovery take the same time as for inpatients, the pre- and postoperative procedures are more time consuming. With a rising number of outpatients a separate department for outpatient surgery with its own administration, operating theaters and day case ward should be developed.

Ambulatory Surgical Procedures↗
PubMed1998

Patients prefer sedation for fibreoptic bronchoscopy.

This study was carried out in order to determine if intravenous (i.v.) sedation with diazepam, at the time of procedure, made fibreoptic bronchoscopy more tolerable and if these perceptions persisted on later questioning. Methodology consisted of a sequential, parallel group design comparing sedation with no sedation for bronchoscopy in a tertiary referral hospital. Patient comfort and sedation desired for hypothetical repeat bronchoscopy were assessed both immediately and after at least 1 month. Patients who received sedation rated bronchoscopy as more comfortable (P = 0.01). Those who received sedation were also more likely to want no change in sedation if the bronchoscopy were repeated (P < 0.01). These differences were more evident at later questioning. Sedation was not associated with an increased complication rate but was associated with a prolonged recovery room stay (no sedation, 19.2 min (SEM 3.8) compared with sedation, 76.1 min (5.4), P < 0.001). In contrast to previous studies, our patients found bronchoscopy more comfortable with i.v. diazepam sedation. This was supported by patients who received sedation being less likely to want any change in future sedation if a repeat bronchoscopy were required. The benefit seen with sedation was more marked at later questioning supporting a previously postulated amnesic effect. However, sedation was associated with a prolonged room stay and potentially greater attendant cost.

Bronchoscopy↗
PubMed2001

Structured preoperative patient education for patient-controlled analgesia.

STUDY OBJECTIVE: To investigate the effectiveness of a structured preoperative education program in patients receiving patient-controlled analgesia (PCA). DESIGN: Randomized controlled trial. SETTING: University-affiliated hospital. PATIENTS: 60 ASA physical status I and II women undergoing major gynecologic surgery. INTERVENTIONS: Patients were randomly allocated to receive either standard information given during routine preanesthetic assessment (n = 30) or additional structured preoperative education on the use of PCA (n = 30). MEASUREMENTS: All patients received standard anesthesia and PCA was provided for postoperative analgesia. Patients were reviewed bid by an independent team of pain specialists and nurses. Patient satisfaction, severity of postoperative pain, nausea, dizziness, and morphine consumption were measured at discharge from recovery room, 24, and 48 hours after operation. Recovery characteristics of patients were also measured. MAIN RESULTS: Pain scores and morphine consumption decreased over time (p < 0.01), but there was no significant difference between groups. The overall analgesic efficacy, side effects, and recovery times was not affected by the education program. Patient satisfaction in the education group was better than control during early recovery (p= 0.03), but there was no additional benefit in the remaining postoperative period. CONCLUSIONS: Structured preoperative PCA education did not affect patient outcome. The early improvement in patient satisfaction was minimized by continued education and pain team supervision during the rest of the postoperative period.

Adult↗
PubMed1994

[Clinical evaluation of diazepam suppository for premedication in children].

Anesthesiologists need a safe and effective premedication before general anesthesia and want to help decrease anxiety and minimize psychologic trauma to children. Therefore, we evaluated diazepam suppository (0.5 mg.kg-1 body weight) administered to 21 children before minor surgery under general anesthesia. We evaluated the sedative effect of the diazepam suppository (tablet) on the arrival at the operating room, during anesthesia induction and in the recovery room. On the arrival at operating room, 86% of children were sedated, and 65% of children could be induced smoothly under mask. There was no delayed emergence. Plasma diazepam level at induction was 376.5 +/- 28.4 ng.ml-1, which is the level needed for sedation. We conclude that diazepam suppository is a useful drug for premedication in children.

Anesthesia, General↗
PubMed1984

A post-anaesthetic scoring system.

A post-anaesthetic scoring system is described. The scoring system scores five parameters that may be quickly assessed by the recovery room staff at five-minute intervals. The system was usefully employed for a month's trial and has now been adopted on a full-time basis at this hospital.

Anesthesia, General↗
PubMedDate not supplied

Establishing a protocol for parental presence in recovery.

This study aimed to contribute to providing a quality service that is sensitive to the needs of children undergoing surgery and their parents. An action research approach, focusing on parents' perceptions of coming into recovery, was used. A retrospective survey design was utilized to establish parents' views. A response rate of 71% (n = 100) was achieved. A short prospective study carried out concurrently achieved a 50% (n = 50) response from questionnaires handed out in recovery. Almost all the parents (98%) from both studies felt that they and their child had benefited from the parents' presence in recovery. When given the choice, 100% of parents came to recovery. The structural location and information given to parents preoperatively helped to ensure that parents were easy to find when the time was right to come to recovery. Communication between recovery staff, children and parents before surgery was recognized as a significant factor. A protocol for allowing parents into the recovery room has been produced. Staff who had preconceived ideas about parents' presence now identified the practice as good and considered that it contributed to the quality of the service.

Adolescent↗