Pre-oxygenation: Is it a waste of ‘anaesthetic time’ in elective patients?

Opiate premedication may cause significant respiratory depression, particularly when other sedative agents such as scopolamine or benzodiazepines are added. This can cause hypoxaemia with potential for worsening myocardial ischaemia in cardiac surgery patients. The aim of this study was to investigate the incidence of hypoxaemia (SpO2 <90%) in elective patients undergoing cardiac surgery and to assess the efficacy of supplemental oxygen in preventing it. One hundred elective patients without significant respiratory disease or cardiac failure, who received both an opiate and a sedative premedication, were prospectively randomized to receive either oxygen via a facemask at 4 l/min or no oxygen. Continuous arterial oxygen saturation was recorded using a pulse oximeter from the time of premedication until the patient arrived in theatre. An SpO2 <90% was recorded as a significant event and oxygen was administered to the patients. Six patients were excluded because of equipment failure or protocol violations. The patient groups were comparable with respect to patient demographics, premedication type and dose or the duration of monitoring. In patients receiving oxygen (n=48) there were no episodes of hypoxaemia (0%). In patients not receiving oxygen (n=46) there were 14 episodes of hypoxaemia (30%, P<0.0001). We conclude that there is a significantly high incidence of hypoxaemia in cardiac surgery patients following combined opiate and sedative premedication and that it can be reduced by the routine administration of supplemental oxygen.

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TCTAP A-011 Incidence of Sub-Acute Stent Thrombosis in Patients with ST-Segment Elevation Myocardial Infarction: Comparison with Elective Patients and Impact of Two-Stent Procedure

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.03.058 ◽

2015 ◽

Vol 65 (17) ◽

pp. S6-S7

Author(s):

Hidewo Amano ◽

Kazushige Kadota ◽

Yu Izawa ◽

Takenori Kanazawa ◽

Tahei Ichinohe ◽

...

Keyword(s):

Myocardial Infarction ◽

Stent Thrombosis ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Acute Stent Thrombosis ◽

Elective Patients

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The Effect of the Covid-19 Free Operation Path Protocol on the Incidence of Lung Complications in Postoperative Elective Patients at dr. Moewardi Hospital Surakarta

BioScientia Medicina ◽

10.32539/bsm.v5i11.369 ◽

2021 ◽

Vol 5 (11) ◽

pp. 1030-1036

Author(s):

Galih Aktama ◽

Henky Agung Nugroho ◽

Muhammad David Perdana Putra

Keyword(s):

Cancer Patients ◽

Elective Surgery ◽

Pulmonary Complications ◽

P Value ◽

Chi Square ◽

Elective Surgical Procedures ◽

Significant Difference ◽

Before And After ◽

Chi Square Test ◽

Elective Patients

The pandemic that began in late 2019, COVID-19, affects all patients, including cancer patients. Patients with cancer that continues to spread and there is no other effective alternative treatment must undergo surgery so that cancer does not get worse. Given this problem, many health care centers have developed a protocol system in the form of a COVID-19-free surgical route. This study is a retrospective cohort study comparing the incidence of pulmonary complications in patients undergoing elective cancer surgery at dr. Moewardi Surakarta before and during the COVID-19 pandemic. The study sample was adult patients aged ≥ 18 years which underwent elective surgical procedures with the aim of curative cancer starting before COVID-19 (March 2019-February 2020) until the time the COVID-19 pandemic emerged (March 2020 - February 2021). The data obtained were 768 patients. Of these patients, 384 were classified as having a COVID19-free operation route during the pandemic, and 384 others underwent elective surgery in the pre-pandemic period. Based on the Chi-Square test, a p-value of 0.850 was obtained (P>0.05) which shows that there is significant difference between cases of pulmonary complications in surgical patients before and after the pandemic who were carried out through the COVID-19-free protocol route. In conclusion, there is no significant change in effect of the covid-19 free operation path protocol on the incidence of lung complications in postoperative elective patients at dr. Moewardi Hospital Surakarta, although this patented and mandatory protocol can reduce cancer patients’ morbidity and mortality who undergoing elective surgery during a pandemic.

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123P Are we Starving our Elective Patients for too long? A Clinical Audit

Annals of Oncology ◽

10.1016/s0923-7534(19)65762-5 ◽

2012 ◽

Vol 23 ◽

pp. ii48

Author(s):

J.M. Fussey ◽

A. Parvaiz ◽

A. Allan ◽

J. Mohammed ◽

B. Isgar

Keyword(s):

Clinical Audit ◽

Elective Patients

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The effect of COVID-19 on the trauma burden, theatre efficiency and training opportunities in a district general hospital

Bone & Joint Open ◽

10.1302/2633-1462.18.bjo-2020-0074.r1 ◽

2020 ◽

Vol 1 (8) ◽

pp. 494-499

Author(s):

Monil Karia ◽

Vatsal Gupta ◽

Wajiha Zahra ◽

Joeseph Dixon ◽

Edward Tayton

Keyword(s):

Hip Fracture ◽

General Hospital ◽

District General Hospital ◽

Turnaround Time ◽

Service Planning ◽

Surgical Time ◽

Significant Difference ◽

Training Opportunities ◽

And Training ◽

Anaesthetic Time

Aims The aim of this study is to determine the effects of the UK lockdown during the COVID-19 pandemic on the orthopaedic admissions, operations, training opportunities, and theatre efficiency in a large district general hospital. Methods The number of patients referred to the orthopaedic team between 1 April 2020 and 30 April 2020 were collected. Other data collected included patient demographics, number of admissions, number and type of operations performed, and seniority of primary surgeon. Theatre time was collected consisting of anaesthetic time, surgical time, time to leave theatre, and turnaround time. Data were compared to the same period in 2019. Results There was a significant increase in median age of admitted patients during lockdown (70.5 (interquartile range (IQR) 46.25 to 84) vs 57 (IQR 27 to 79.75); p = 0.017) with a 26% decrease in referrals from 303 to 224 patients and 37% decrease in admissions from 177 to 112 patients, with a significantly higher proportion of hip fracture admissions (33% (n = 37) vs 19% (n = 34); p = 0.011). Paediatric admissions decreased by 72% from 32 to nine patients making up 8% of admissions during lockdown compared to 18.1% the preceding year (p = 0.002) with 66.7% reduction in paediatric operations, from 18 to 6. There was a significant increase in median turnaround time (13 minutes (IQR 12 to 33) vs 60 minutes (IQR 41 to 71); p < 0.001) although there was no significant difference in the anaesthetic time or surgical time. There was a 38% (61 vs 38) decrease in trainee-led operations. Discussion The lockdown resulted in large decreases in referrals and admissions. Despite this, hip fracture admissions were unaffected and should remain a priority for trauma service planning in future lockdowns. As plans to resume normal elective and trauma services begin, hospitals should focus on minimising theatre turnaround time to maximize theatre efficiency while prioritizing training opportunities. Clinical relevance Lockdown has resulted in decreases in the trauma burden although hip fractures remain unaffected requiring priority Theatre turnaround times and training opportunities are affected and should be optimised prior to the resumption of normal services. Cite this article: Bone Joint Open 2020;1-8:494–499.

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