scholarly journals Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

2019 ◽  
Vol 32 (1) ◽  
pp. 53
Author(s):  
Luís Guilherme Casimiro ◽  
Sara Marisa Pereira ◽  
Sofia Cardoso Pires ◽  
Joana Mourão
Keyword(s):  
Informed Consent ◽  
Elective Surgery ◽  
University Hospital ◽  
Anesthetic Technique ◽  
Patient Relationship ◽  
Active Process ◽  
Legal Principles ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

scholarly journals Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Cyrus Motamed ◽  
Migena Demiri ◽  
Nora Colegrave
Keyword(s):  
Neuromuscular Blockade ◽  
Lower Limit ◽  
Elective Surgery ◽  
Orotracheal Intubation ◽  
Neuromuscular Blocking ◽  
Physical Status Classification ◽  
Train Of Four ◽  
Surgery First ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

scholarly journals Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shin-Yan Chen ◽  
Feng-Lin Liu ◽  
Yih-Giun Cherng ◽  
Shou-Zen Fan ◽  
Barbara L. Leighton ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
University Hospital ◽  
Control Regimen ◽  
Background Infusion ◽  
Continuous Background ◽  
American Society ◽  
Group B ◽  
Double Blinded ◽  
American Society Of Anesthesiologists

Purpose.The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study.Methods.We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion.Results.There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups.Conclusion.Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

Informed Consent: Framing the Questions

2001 ◽  
Author(s):  
Jessica W. Berg ◽  
Paul S. Appelbaum ◽  
Charles W. Lidz ◽  
Lisa S. Parker
Keyword(s):  
Informed Consent ◽  
Interpersonal Process ◽  
Patient Relationship ◽  
Policy Issues ◽  
Legal Principles ◽  
Legal Rules ◽  
Reasonable Approach ◽  
The Many ◽  
Society Today ◽  
Right Of Self Determination

What is informed consent? The answer may seem self-evident only to those who have yet to explore the many meanings of the term. Informed consent refers to legal rules that prescribe behaviors for physicians and other healthcare professionals in their interactions with patients and provide for penalties, under given circumstances, if physicians deviate from those expectations; to an ethical doctrine, rooted in our society’s cherished value of autonomy, that promotes patients’ right of self-determination regarding medical treatment; and to an interpersonal process whereby these parties interact with each other to select an appropriate course of medical care. Informed consent is each of these things, yet none of them alone. As a theory based on ethical principles, given effect by legal rulings and implemented by clinicians, it has been haunted by its complex lineage. When legal principles and ethical values conflict, which should take precedence? When clinical interests appear to be served by neither legal nor ethical concerns, which interests should be compromised and to what degree? The vast literature on informed consent, found in journals and books of medicine, law, bioethics, philosophy, and public policy, has been stimulated by the need to create a workable doctrine that can accommodate values that to many observers are in an irremediable state of conflict. The conflicts in theory and the need to resolve them in practice are the subjects of this book. Theory is the focus of the first half of the volume; practice is the topic of the second. Seeking to understand the fascinating theoretical problems requires us to grapple with some of the most difficult ethical and policy issues facing our society today. But let us state at the outset our belief that the clinician on the front lines need not be paralyzed by differences of opinion among legal and ethical theorists. Through the vaguely translucent wall of expertise behind which the discussion about the proper shape of the informed consent doctrine has taken place, a reasonable approach to informed consent in the clinician-patient relationship can be discerned. Our most important and challenging task in this book is to make that approach evident.

Effect of Different Cost Drivers on Cost per Anesthesia Minute in Different Anesthesia Subspecialties

2004 ◽  
Vol 101 (6) ◽  
pp. 1435-1443 ◽  
Author(s):  
Martin Schuster ◽  
Thomas Standl ◽  
Joachim A. Wagner ◽  
Jürgen Berger ◽  
Hajo Reißmann ◽  
...  
Keyword(s):  
Multiple Regression Model ◽  
University Hospital ◽  
Cost Drivers ◽  
Personnel Costs ◽  
Facial Surgery ◽  
American Society ◽  
The Cost ◽  
American Society Of Anesthesiologists ◽  
Cost Differences ◽  
Nose And Throat

Background Little is known about differences in costs to provide anesthesia care for different surgical subspecialties and which factors influence the subspecialty-specific costs. Methods In this retrospective study, the authors determined main cost components (preoperative visit, intraoperative personnel costs, material and pharmaceutical costs, and others) for 10,843 consecutive anesthesia cases from a 6-month period in the 10 largest anesthesia subspecialties in their university hospital: ophthalmology; general surgery; obstetrics and gynecology; ear, nose, and throat surgery; oral and facial surgery; neurosurgery; orthopedics; cardiovascular surgery; traumatology; and urology. Using regression analysis, the effect of five presumed cost drivers (anesthesia duration, emergency status, American Society of Anesthesiologists physical status of III or higher, patient age younger 6 yr, and placement of invasive monitoring) on subspecialty-specific costs per anesthesia minute were analyzed. Results Both personnel costs for anesthesiologists and total costs calculated per anesthesia minute were inversely correlated with the duration of anesthesia (adjusted R2 = 0.75 and 0.69, respectively), i.e., they were higher for subspecialties with short cases and lower for subspecialties with longer cases. The multiple regression model showed that differences in anesthesia duration alone accounted for the majority of the cost differences, whereas the other presumed cost drivers added only little to explain subspecialty-specific cost differences. Conclusions Different anesthesia subspecialties show significant and financially important differences regarding their specific costs. Personnel costs and total costs are highest for subspecialties with the shortest cases. Other analyzed cost drivers had little effect on subspecialty-specific costs. In the light of these cost differences, a detailed cost analysis seems necessary before the profitability of an anesthesia subspecialty can be assessed.

scholarly journals Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

2012 ◽  
Vol 97 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Stephan Engelberger ◽  
Manuel Zürcher ◽  
Jochen Schuld ◽  
Carsten Thomas Viehl ◽  
Christoph Kettelhack
Keyword(s):  
Postoperative Delirium ◽  
Statistical Significance ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Colorectal Origin ◽  
American Society ◽  
Emergency Colorectal Surgery ◽  
American Society Of Anesthesiologists ◽  
The University

Abstract Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P  =  0.279 and P  =  0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score‚ or short ‚cr-POSSUM’) and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

The Combitube in Elective Surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Luis A. Gaitini ◽  
Sonia J. Vaida ◽  
Somri Mostafa ◽  
Boris Yanovski ◽  
Milian Croitoru ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Airway Device ◽  
Spontaneous Ventilation ◽  
Mechanically Ventilated ◽  
Entire Duration ◽  
Duration Of Surgery ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

scholarly journals A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

2021 ◽  
Author(s):  
Wirat Wasinwong ◽  
Sarocha Termthong ◽  
Prae Plansangkate ◽  
Jutarat Tanasansuttiporn ◽  
Riam Kosem ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Elective Surgery ◽  
Controlled Study ◽  
Injection Pain ◽  
Syringe Pump ◽  
Intravenous Catheter ◽  
Randomized Controlled ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Median Pain

Abstract Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

Anesthetic Techniques

2018 ◽  
Author(s):  
Dennis Grech ◽  
Laurence M. Hausman
Keyword(s):  
Blood Pressure Monitoring ◽  
Radiology Department ◽  
Anesthetic Technique ◽  
Postanesthesia Care Unit ◽  
Anesthetic Techniques ◽  
American Society ◽  
Safety Considerations ◽  
End Tidal ◽  
Monitoring Protocols ◽  
American Society Of Anesthesiologists

Anesthetic techniques for procedures performed outside the traditional operating room are varied. General anesthesia, sedation, and regional anesthesia can all be delivered in this venue. The choice of technique is based on safety considerations and patient comorbidities. Perioperative monitoring such as pulse oximetry, end-tidal carbon dioxide monitoring, and electrocardiography and blood pressure monitoring protocols must be consistent with American Society of Anesthesiologists guidelines. Common procedures include elective office-based anesthetics, emergency room sedations, endoscopic retrograde cholangiopancreatographies in the gastroenterology suite, and minimally invasive interventions in the radiology department. Because most of these locations have limited postanesthesia care unit capabilities, the patient’s rapid return to baseline functioning and the ability to be discharged quickly, safely, and comfortably are important goals. Thus, anesthetic technique and the pharmacokinetics and pharmacodynamics of the anesthetics, analgesics, antiemetics, and local anesthetics are of utmost importance.

scholarly journals Analysis of factors affecting reversal of Hartmann’s procedure and post-reversal complications

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jae Hyun Kang ◽  
Byung Mo Kang ◽  
Sang Nam Yoon ◽  
Jeong Yeon Kim ◽  
Jun Ho Park ◽  
...  
Keyword(s):  
Medical Records ◽  
Elective Surgery ◽  
Multivariable Analysis ◽  
Colorectal Disease ◽  
Hartmann’S Procedure ◽  
Class Iii ◽  
Factors Affecting ◽  
Hartmann's Procedure ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Although Hartmann’s procedure (HP) is commonly used as emergency treatment for colorectal disease, the reversal of HP (HR) is infrequently performed. The aims were to evaluate the rate of HR and determine the factors predictive of achieving HR. We retrospectively reviewed the medical records of patients who underwent HP between January 2007 and June 2019 at six Hallym University-affiliated hospitals. Multivariable analysis was performed to identify which factors were independently associated with HR. In the study period, 437 patients underwent HP, and 127 (29.0%) subsequently underwent HR. Of these, 46 (35.9%) patients experienced post-HR complications. In multivariable analysis, an interval between HP and HR of > 6 months was associated with the only lower rate of post-HR complications. Multivariate analysis showed that HR was less likely in patients aged > 70 years, those with American Society of Anesthesiologists (ASA) class III or IV, elective surgery, those experiencing more than two HP-related complications, and those with a malignancy (an indication for HP). One-third of the patients underwent HR. Age > 70 years, ASA class III or IV, elective surgery, more than two HP-related complications, and malignancy were associated with a non-HR rate.

Effects of Clonidine on Propofol-Based Anesthesia

2002 ◽  
Vol 19 (2) ◽  
pp. 87-89 ◽  
Author(s):  
Edward B. Lack ◽  
John D. Rachel ◽  
Oana Patrascu
Keyword(s):  
Elective Surgery ◽  
Control Group ◽  
Intravenous Sedation ◽  
Hemodynamic Stability ◽  
Beneficial Effects ◽  
Dosage Rate ◽  
Grade Ii ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Higher Doses

Introduction: Propofol-based anesthesia is a safe and effective method to provide intravenous sedation in office-based elective surgery. Clonidine is a drug that can provide anxiolytic sedation and hemodynamic stability, thus reducing the propofol consumption rate. This study reports the effect of 0.1 mg of clonidine administered orally and preoperatively on the dosage rate of propofol. The authors also describe the hemodynamic effects on patients undergoing elective liposculpture surgery. Materials and Methods: In a retrospective review, 20 American Society of Anesthesiologists grade I and grade II patients undergoing elective liposculpture surgery under monitored anesthesia care were studied. Ten patients received premedication (0.1 mg clonidine) 30–45 minutes before the induction of anesthesia. A control group receiving no premedication underwent the same procedures conducted by the same surgeon. Propofol dosage rate, heart rate, and blood pressure of both groups were monitored preoperatively, intraoperatively, and in the recovery room. Results: The average propofol dosage rate was 3.21 mg/ kg/h for the treatment group and 2.78 mg/kg/h for the control group. Hemodynamic stability was obtained for both groups during and after the treatment periods. Neither group had episodes of hypotension or changes in expectable recovery time. Discussion: Clonidine premedication of 0.1 mg orally did not reduce the requirements for propofol dosage rates. In contrast to previous studies using higher doses, this clonidine dose did not provide the beneficial effects of lowering the anesthetic requirement for propofol. However, hemodynamic stability was achieved, and no adverse effects were observed.

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