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.

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.

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.

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 Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients

2021 ◽  
Vol 5 (2) ◽  
pp. 849-853
Author(s):  
Besnik Faskaj ◽  
Monika Belba
Keyword(s):  
Relative Risk ◽  
Statistical Significance ◽  
Burn Injuries ◽  
University Hospital ◽  
Burn Shock ◽  
Ringer Lactate ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Observational Prospective Cohort Study ◽  
The University

Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h. This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids.  Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours. Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL. Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.

scholarly journals Morbidity and Mortality in Adolescents at the University Hospital of Brazzaville

2021 ◽  
Vol 11 (02) ◽  
pp. 243-253
Author(s):  
Engoba Moyen ◽  
Vérinal Ouemeyi-Enani ◽  
Annie Rachelle Okoko ◽  
Ben Borgea Nianga ◽  
Verlem Bomelefa-Bomel ◽  
...  
Keyword(s):  
Morbidity And Mortality ◽  
University Hospital ◽  
The University

scholarly journals Morbidity and Mortality of Inpatients in the Department of Infectious Diseases of the University Hospital of Bobo-Dioulasso, Burkina Faso

2019 ◽  
Vol 09 (03) ◽  
pp. 171-182
Author(s):  
Armel Poda ◽  
Jacques Zoungrana ◽  
Arsène Héma ◽  
Ziemlé Clément Méda ◽  
Alexandre Boena ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Burkina Faso ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Bobo Dioulasso ◽  
The University

scholarly journals Time to Endoscopy and Outcomes in Upper Gastrointestinal Bleeding

2009 ◽  
Vol 23 (7) ◽  
pp. 489-493 ◽  
Author(s):  
Nitin Sarin ◽  
Neerav Monga ◽  
Paul C Adams
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Large Teaching Hospital ◽  
Early Endoscopy ◽  
Transfusion Requirements ◽  
London Health ◽  
The University ◽  
Upper Gastrointestinal

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common problem associated with significant morbidity and mortality. Previous studies show that immediate endoscopies do not affect outcomes in patients; however, endoscopic interventions have evolved. The present retrospective review of endoscopies performed at a large teaching hospital assessed the timing of endoscopy with respect to the morbidity and mortality of UGIB.METHODS: Diagnostic billing codes were used to assess all inpatients of gastroenterologists at the University Hospital of the London Health Sciences Centre, London, Ontario, from July 2004 to June 2006, using a centralized data recording system. Time to endoscopy (within 6 h, 6 h to 24 h and beyond 24 h) were compared for the outcomes of mortality, need for surgery and transfusion requirements.RESULTS: From July 2004 to June 2006, there were 502 upper endoscopies performed for the indication of suspected UGIB and 375 for overt acute nonvariceal UGIB. Approximately 10% of cases revealed variceal bleeding. When comparing endoscopy within 6 h with endoscopy at 6 h to 24 h, there were no significant differences in mortality, need for surgery (OR 3.6 and 2.8, respectively, compared with endoscopy beyond 24 h) or transfusion requirements. Even when assessing the group that received endoscopic hemostasis, time to endoscopy was not associated with better outcomes. Multivariate analysis did not demonstrate any advantages for early endoscopy (less than 6 h) compared with endoscopy within 24 h.CONCLUSIONS: Most patients with acute gastrointestinal bleeding can be effectively managed with endoscopy within 24 h.

Morbidity and mortality associated with anesthetic management in small animal veterinary practice in Ontario

1998 ◽  
Vol 34 (4) ◽  
pp. 325-335 ◽  
Author(s):  
DH Dyson ◽  
MG Maxie ◽  
D Schnurr
Keyword(s):  
Cardiac Arrest ◽  
Management Practices ◽  
Anesthetic Management ◽  
Small Animal ◽  
Morbidity And Mortality ◽  
Logistic Regression Models ◽  
Significant Odds Ratio ◽  
American Society ◽  
A Prospective Study ◽  
American Society Of Anesthesiologists

During 1993, 66 small animal practices participated in a prospective study to evaluate the incidence and details of anesthetic-related morbidity and mortality. Considering a total of 8,087 dogs and 8,702 cats undergoing anesthesia, the incidences of complications were 2.1% and 1.3%, respectively. Death occurred in 0.11% and 0.1% of cases, respectively. Logistic regression models were developed and showed that a significant odds ratio (OR) of complications in dogs was associated with xylazine (OR, 91.5); heart rate monitoring (OR, 3.2); American Society of Anesthesiologists (ASA) 3, 4, or 5 classification (OR, 2.5); isoflurane (OR, 2.4); butorphanol (OR, 0.35); technician presence (OR, 0.26); acepromazine (OR, 0.24); ketamine (OR, 0.21); and mask induction (OR, 0.2). Complications in cats were associated with ASA 3, 4, or 5 classification (OR, 5.3); diazepam (OR, 4.1); intubation (OR, 1.7); butorphanol (OR, 0.45); and ketamine (OR, 0.17). Cardiac arrest in dogs was associated with xylazine (OR, 43.6) and ASA 3, 4, or 5 classification (OR, 7.1). Cardiac arrest in cats was associated with ASA 3, 4, or 5 classification (OR, 21.6) and technician presence (OR, 0.19). This paper reports the incidences of complications and cardiac arrest in small animal practice and identifies common complications and factors that may influence anesthetic morbidity and mortality. This information may be useful in comparing anesthetic management practices.

scholarly journals Evolution of ASA Physical status scoring system

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Mehreen Malik ◽  
Sana Urooj ◽  
Aftab Imtiaz ◽  
Arif Muhammad Arif
Keyword(s):  
Scoring System ◽  
Risk Index ◽  
Preoperative Evaluation ◽  
Morbidity And Mortality ◽  
Physical Status ◽  
Operative Morbidity ◽  
Hospital Administrators ◽  
Operative Outcomes ◽  
American Society ◽  
American Society Of Anesthesiologists

Anesthesia Preoperative evaluation holds a prime importance in improving overall patient outcomes and decreases hospital expenditure. The American Society of Anesthesiologists Physical Status scoring system ASA-PS was introduced 70 years back in clinical practice and it still holds the lime light for stratifying patient population and considering the risk index and mortality outcomes to warn the surgeon. How has it evolved since the passing years? We will see how over centuries it has evolved. ASA PS has been a significant predictor in depicting morbidity and mortality and evaluating peri-operative risks in patients going for surgery for clinicians, researchers, hospital administrators and government. Further addition of examples of modifying ASA PS status is necessary to make it more comprehensive and easier to use even for non-anesthetists to improve overall peri-operative morbidity and mortality. Key words: ASA PS (American Society of Anesthesiology Physical Status); Peri-operative outcomes Citation: Malik M, Urooj S, Imtiaz A, Arif AM. Evolution of ASA Physical status scoring system. Anaesth. pain intensive care 2021;25(2):225-232. DOI: 10.35975/apic.v25i2.1476 Received: , Reviewed: , Accepted:

scholarly journals Lack of Evidence for an Association between Previous HEV Genotype-3 Exposure and Glomerulonephritis in General

Pathogens ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Sven Pischke ◽  
Sarah Tamanaei ◽  
Maria Mader ◽  
Julian Schulze zur Wiesch ◽  
Christine Petersen-Benz ◽  
...  
Keyword(s):  
Blood Donors ◽  
Statistical Significance ◽  
University Hospital ◽  
Genotype 3 ◽  
Seropositivity Rate ◽  
Future Studies ◽  
Age Related ◽  
Immune Mediated ◽  
The University ◽  
Age And Sex

Among numerous other immune-mediated diseases, glomerulonephritis has also been suspected to be an extrahepatic manifestation of HEV infection. In this prospective study, we tested 108 patients with glomerulonephritis and 108 age- and sex-matched healthy controls at the University Hospital Hamburg Eppendorf, Hamburg, Germany, for anti-HEV IgG (Wantai test) as a marker for previous HEV exposure. A total of 24 patients (22%) tested positive for anti-HEV IgG. Males tended to be more frequently anti-HEV IgG positive (29%) in comparison to females (16%). However, this does not reach statistical significance (p = 0.07). Anti-HEV IgG positive patients were older in comparison to negative patients (mean 53 vs. 45 years, p = 0.05). The kidney function seems to be slightly decreased in anti-HEV IgG positive patients in comparison to and anti-HEV IgG negative patients basing on creatinine (p = 0.04) and glomerular filtration rate (GFR) (p = 0.05). Slightly higher values of bilirubin could be found in IgG positive patients (p = 0.04). Anti-HEV-IgG seropositivity rate (22%) in glomerulonephritis patients, did not differ significantly in comparison to an age- and sex-matched control cohort of healthy blood donors (31/108 positive, 29%). A total of 2/2 patients with membranoproliferative glomerulonephritis (MPGN) tested anti-HEV IgG positive (p = 0.002 in comparison to glomerulonephritis patients with other subtypes).In conclusion, our findings indicate that previous HEV exposure in a region where GT3 is endemic is not associated with glomerulonephritis in general. However, the subgroup of MPGN patients should be investigated in future studies. Furthermore, future studies are needed to investigate whether the observed association between anti-HEV IgG positivity and reduced GFR in glomerulonephritis patients is HEV associated or is an age-related effect.

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