sábado, 31 de mayo de 2014

Un formulario de evaluación preanestésica en UCI reduce información clave perdida

An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information.
Chuy K, Yan Z, Fleisher L, Liu R.
J Anesth Clin Res. 2012 Sep 28;3(9). pii: 1000242.
BACKGROUND: A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. METHODS: The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. RESULTS: Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). CONCLUSIONS: A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety.
KEYWORDS: Anesthesia, Intensive care unit, Operating room, Patients

Pruebas de embarazo preoperatorias

Preoperative pregnancy testing.
Maher JL, Mahabir RC.
Can J Plast Surg. 2012 Fall;20(3):e32-4.
BACKGROUND: In up to 2% of all pregnancies, the need for general anesthesia in a nonobstetrical surgery arises. Surgery on a pregnant woman may have significant implications for the fetus, patient, physician and hospital. On review of the plastic surgery literature, the authors were unable to find current guidelines or recommendations for preoperative pregnancy testing in the plastic surgery patient population. METHODS: Literature regarding maternal and fetal risk during anesthesia and surgery, as well as preoperative pregnancy testing was identified by performing a PubMed, OVID and MEDLINE key word search. The current literature was subsequently reviewed and summarized. RESULTS: A report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation allows physicians and hospitals to implement their own policies and practices with regard to preoperative pregnancy testing. The overall frequency of an incidentally found positive preoperative pregnancy test ranges from 0.34% to 2.4%. DISCUSSION: Various studies have reported increased rates of spontaneous abortions, congenital anomalies, such as neural tube defects, and low and very low birth weight infants born to mothers exposed to anesthesia and surgery during pregnancy. Because the accepted practice is to postpone elective surgery during pregnancy, identifying these patients before surgery is critical. CONCLUSIONS: Based on the current evidence, the authors' best practice recommendation for preoperative pregnancy testing is provided.
KEYWORDS: Anesthesia, Pregnancy testing, Preoperative assessment, Surgery during pregnancy


Evaluación preoperatoria y preparación para anestesia y cirugía

Preoperative evaluation and preparation for anesthesia and surgery.
Hippokratia. 2007 Jan;11(1):13-21.
Zambouri A.
The ultimate goals of preoperative medical assessment are to reduce the patient's surgical and anesthetic perioperative morbidity or mortality, and to return him to desirable functioning as quickly as possible. It is imperative to realize that "perioperative" risk is multifactorial and a function of the preoperative medical condition of the patient, the invasiveness of the surgical procedure and the type of anesthetic administered. A history and physical examination, focusing on risk factors for cardiac and pulmonary complications and a determination of the patient's functional capacity, are essential to any preoperative evaluation. Laboratory investigations should be ordered only when indicated by the patient's medical status, drug therapy, or the nature of the proposed procedure and not on a routine basis. Persons without concomitant medical problems may need little more than a quick medical review. Those with comorbidity should be optimized for the procedure. Proper consultations with appropriate medical services should be obtained to improve the patient's health. These consultations should ideally not be done in a "last second" fashion. The preoperative preparation involves procedures that are implemented based on the nature of the expected operation as well as the findings of the diagnostic workup and the preoperative evaluation.
KEYWORDS: anesthetic risk, perioperative risk, preoperative assessment, preoperative preparation


Anestesiología y Medicina del Dolor

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