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At least 19 recordsLinked to original sources
PubMed2006

[Muscle relaxants in Germany 2005: a comparison of application customs in hospitals and private practices].

Aim of this study was to evaluate application customs of muscles relaxants in hospitals compared to their use in private practice. Of the 3,260 questionnaires sent-out, 66.9% could be analyzed. Of these 54% were from anesthetists in private practice, 41% from heads of hospital anesthesia departments and 5% from heads of level one hospital anesthesia departments. The first difference between private practices and hospitals was the number of available muscle relaxants: 87% of private practices use 1-3 relaxants, whereas 79% of hospitals use 3-5. Another apparent difference was the relationship between general anesthesia and the number of intubations: 60% of private practices have over 80% of general anesthesia cases, but only 50% of these patients are intubated. On the contrary, two thirds of the hospitals have 50-80% general anesthesia cases and 60-70% of patients are intubated. The main wish for an ideal muscle relaxant was independent of private practice or hospital, short onset time, followed by fast recovery. In accordance 74% of anesthetists in hospitals and 72% of anesthetists in private practice voiced the wish for a non-depolarizing succinylcholine substitute. The results of this nationwide survey suggest that time pressure in combination with an increased specialization of anesthetists in private practice are the main factors for availability and use of muscle relaxants in routine anesthesia.

Anesthesia↗
PubMed1998

[Costs of sevoflurane in the perioperative setting].

The total costs for a department of anaesthesia amount to a fraction of the total hospital budget that is proportional to the overall number of hospital departments; this means anaesthetic departments are in general not cost drivers. In the analysis of perioperative costs, anaesthesia accounts for about 10-15% of the total costs for the complete hospital stay, the exact proportion depending on the type of surgery. In the analysis of costs for the intraoperative period alone anaesthesia personnel contributes about 20%, and material costs about 10% of the total costs, while inhalational agents account for less than 1%. Aggregating the cost for inhalational agents, about 5% of the total budget of an anaesthesia department are accounted for by volatile agents, which take a 20% share of all drug costs in an anaesthesia department. When the costs of one MAC-hour of anaesthesia are compared, halothane, enflurane and isoflurane remain the cheapest agents. Sevoflurane is less expensive than desflurane at current market prices. However, at low fresh gas flows the price difference for one MAC-hour is marginal for these volatile anaesthetics. Total intravenous anaesthesia using propofol is even more expensive, more than 2- to 6-fold the costs of inhalational anaesthesia, depending on the dosage of the intravenous agent, the type of inhalational agent, the fresh gas flow, etc. In our hospital, overall costs for inhalational agents could be reduced over a three year period by increasing use of the low-flow technique, despite sevoflurane becoming the agent of choice for pediatric and ambulatory patients and for operations of short duration. An overall cost-effectiveness analysis must balance the costs of the various agents and the pharmacodynamic advantages of the new agents, e.g. rapid recovery from anaesthesia. Furthermore, indirect costs for side effects have to be taken into account, e.g., nausea and vomiting. The question of whether these effects and side effects translate into cost differences between agents depends largely on local factors, e.g., patient case mix, staffing, policy of discharge from the postanaesthetic care unit, and many others. We conclude that volatile anaesthetics account for only a minor portion of the budgets in the anaesthesia department and the hospital overall. The higher market price for the new agents that result in higher costs per MAC-hour may be compensated for by the economic impact of the fewer side effects and the shorter postanaesthesia stay in the hospital.

Anesthesia Department, Hospital↗
PubMed1995

Use of esophageal or precordial stethoscopes by anesthesia providers: are we listening to our patients?

STUDY OBJECTIVE: To ascertain current anesthesia utilization of esophageal and precordial stethoscopes in U.S. anesthesia training programs. DESIGN: Prospective, single-blind, incidence study. SETTING: Operating rooms of three tertiary care hospitals with major academic anesthesiology departments. SUBJECTS: Anesthesia faculty [MD and certified registered nurse-anesthetist (CRNA) staff] and anesthesia trainees (anesthesiology residents and student nurse-anesthetists). INTERVENTIONS: observe and record the placement (stethoscope device appropriately positioned) and utilization (stethoscope in place and connected to the ear piece of the anesthesia provider) of the esophageal or precordial stethoscope during general, regional, and monitored anesthesia care. MEASUREMENTS AND MAIN RESULTS: During 520 anesthetics, an esophageal stethoscope was inserted in 68% of subjects, a precordial stethoscope was positioned in 16%, and an anesthetic stethoscope was absent in 16% of cases. Utilization (stethoscope connected to earpiece) ranged from a low of 11% of cases to a high of 45%, depending on the institution. Overall, providers were listening via an anesthetic stethoscope in only 28% of anesthetics. CONCLUSIONS: Our data suggest infrequent utilization of esophageal and precordial stethoscopes in anesthesia training institutions. Thus, current anesthesia training may be fostering an environment where providers overlook a valuable minimally invasive, and cost-effective continuous monitor of patients' dynamic vital organ function.

Anesthesia Department, Hospital↗
PubMed1998

[Clinical experience at Uppsala University].

The author had a chance to study at the Department of Cardiothoracic Anesthesia at Uppsala University Hospital, Uppsala, Sweden. About 12 hundred cases of open heart surgery and thoracic surgery are done by cardiothoracic anesthesiologists every year. Most of the cardiac anesthesia was performed with low flow anesthesia using mixture of oxygen-air-isoflurane, from economical and environmental view points. Early extubation is common at Uppsala University. The patients were extubated at the intensive care unit on the day of surgery. The author also visited the central surgery suite. More than 12 thousand surgeries per year, including hepatic and renal transplantation, are performed. General intensive care unit, emergency medicine were managed and organized mainly by anesthesiologists. The role of anesthesiologists are well appreciated and they are respected in Sweden.

Anesthesia Department, Hospital↗
PubMed1998

A method for assessment of standards of care of anesthesia services in departments with different levels of resources.

In developing countries the standards of anesthesia care vary greatly between hospitals. In order to identify the urgent needs of disadvantaged hospitals, we compared three index hospitals in the greater Cairo area, one of which has excellent (category I), on intermediate (category II), and one with severely restricted resources (category III). Standards of care published by the American Society of Anesthesiologists (ASA) were used to develop a spreadsheet for documenting features of pre-, intra- and post-anesthetic care in patients undergoing tonsillectomies, a procedure commonly performed in all three hospitals. The spreadsheet enabled us to document all equipment, supplies and personnel engaged from pre-anesthetic evaluation to discharge. Analysis of the data revealed that the service provided by the category I hospital approached the ASA standards. In the category II hospital the patients did not go through a pre-anesthetic evaluation; instead they were seen for the first time in the operating room. No premedication was given. Intravenous access was established with the help of a needle (rather than a catheter). Monitoring consisted occasionally of a finger on the pulse. Sterilization was accomplished by boiling. Air-conditioning was not available. No records were kept and no recovery room was available. The same deficiencies existed in the category III hospital, which did not even have oropharyngeal airways, antiarrhythmic or inotropic medications, and sterile techniques were completely ignored. Despite these stark differences in care, the patients or their parents in all three hospitals appeared satisfied with the level of care they received. Much has to be done to improve anesthesia care in less fortunate departments in developing nations. Urgent help does not mean the need for sophisticated monitors or equipment only, but the establishment of practice standards first. Applying the priciples of modern management, we need to evaluate the structure, processes and outcome of anesthetic practice in developing countries in order to reengineer the way we provide help to anesthetic departments in developing nations. In this modest study we are presenting a means to evaluate the features and processes of the anesthesia services in developing countries.

Anesthesia Department, Hospital↗
PubMed1989

Possible decrease in mortality associated with anaesthesia. A comparison of two time periods in Massachusetts, USA. Closed Claims Study Committee.

This paper compares mortality associated with anaesthesia in Massachusetts USA, during two periods of time separated by 13 years. The denominators in the calculation of the mortality rates are not precisely comparable but there appears to be approximately a thirteenfold decrease in the death rate after general anaesthesia and a tenfold decrease after spinal anaesthesia.

Anesthesia↗
PubMed1985

Deaths during general anesthesia: technology-related, due to human error, or unavoidable? An ECRI technology assessment.

More than 2,000 healthy Americans die each year during general anesthesia, and at least half of these deaths may be preventable. Anesthetists and equipment manufacturers have made considerable progress in improving anesthesia safety. However, much more needs to be done, especially in "human-factors" areas such as improved training, consistent use of preanesthesia checklists, and anesthetists' willingness to enhance their vigilance by using appropriate monitoring equipment. While defective equipment and supplies are the direct cause of relatively few deaths, inexpensive oxygen analyzers and disconnect alarms could, if available in more ORs, warn anesthetists in time to convert many deaths to near misses. Some anesthetists are using other monitoring technologies that are more costly, but can detect a wider range of problems. The anesthesia community could expand its anesthesia-safety leadership and guidance, by improving technology-related training and by developing practice standards for anesthetists and safety standards for equipment. The Joint Commission on Accreditation of Hospitals could impose specific safety requirements on hospitals; malpractice insurance carriers could require anesthetists and hospitals to use monitors and alarms during all procedures; and the Food and Drug Administration could actively stimulate and oversee these efforts and perhaps provide seed money for some of them. The necessary equipment costs would likely be offset by long-term savings in malpractice premiums, as anesthesia incidents are the most costly of all types of malpractice claims. Concerted efforts such as these could greatly reduce the number of avoidable anesthesia-related deaths.

Anesthesia Department, Hospital↗