Visual loss after shoulder surgery under general anesthesia diagnosed as caused by ocular compression with electroretinography testing: case report and review of the literature

Ophthalmic complications after nonocular surgery are well documented in the ophthalmic, surgical, and anesthesia literature. A case of unilateral visual loss after shoulder surgery under general anesthesia is presented in which electroretinography (ERG) confirms ocular compression as the etiology of the visual loss. Compression is a preventable risk factor for perioperative visual loss, and its diagnosis has serious medico-legal implications. The importance of performing ERG testing in all unexplained cases of visual loss after nonocular surgical procedures is supported by this case to rule out ocular compression perioperatively. The abnormal decreased scotopic ERG B-wave amplitude in the affected eye compared with the normal eye confirms ocular compression, which can be prevented by proper positioning of the head and adequate headrest during general anesthesia.     

A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure

BACKGROUND: Anal fissure in children usually is treated by sitz baths, stool softeners, and analgesic ointments. However, some cases are intractable to the treatment. In recent years, it has been reported that nitric oxide donors such as local glyceryl-trinitrate (GTN) ointment causes a reversible chemical sphincterotomy. Although the GTN ointment can be an alternative therapy for adult cases, it has not yet been studied in the children who suffer from anal fissure. METHODS: Sixty-five children with anal fissure were divided randomly into 3 groups. Each group received double-blinded a topical ointment that contained either 0.2% GTN, 10% lidocaine, or placebo. These ointments were applied to the lowest part of the anal canal twice daily. Patients were periodically reviewed, and the study was ended after 8 weeks. RESULTS: Complete healing of the fissure occurred in 26 of 31 (83.9%) patients treated with GTN, 7 of 14 (50%) patients treated with lidocaine, and 6 of 17 (35.2%) treated with placebo. In 29 of 31 (93.5%) GTN-treated patients, a total relief of symptoms was observed, whereas this occurred in 7 of 14 (50%) treated with lidocaine and 6 of 11 (35.3%) in the placebo group. The differences between the study group and control groups were highly statistically significant (P < .001). CONCLUSION: The majority of children suffering from anal fissure will be cured and have relief of symptoms after topical application of GTN ointment to the anal canal.     

重组人表皮生长因子软膏对烧伤创面修复的促进作用

目的　探讨重组人表皮生长因子 (rh EGF)软膏治疗烧伤的有效浓度 ,并观察对创面愈合的促进作用。方法　将 12 0例烧伤患者分为两部分 ,第一部分选择 15例浅 °烧伤患者 ,采用开放实验 ,分三组每组 5例 ,进行三种不同浓度 rh EGF软膏 (0 .5 μg/ g,10 μg/ g,5 0 μg/ g)的疗效比较 ,确定临床使用浓度。第二部分 ,选择浅 °和深 °烧伤患者10 5例为试验对象 ,在第一部分研究的基础上选取最适药浓度 ,进行多中心随机双盲实验 ,所有患者均采用自身对照。以创面愈合为指标 ,判断创面愈合时间 ,并观察创面动态愈合率及不良反应。结果　第一部分患者 10 μg/ g和 5 0 μg/ g组的创面愈合时间差异不显著但较 0 .5 μg/ g组明显缩短 ,有统计学意义 (P<0 .0 1)。第二部分选用 10 μg/ g浓度的 rh EGF软膏与水溶性软膏基质进行随机双盲研究。浅 °创面用药组愈合时间为 (8.39± 2 .2 5 )天 ,空白对照组为 (9.5 2± 2 .5 6 )天 ,组间比较具有统计学意义 (P<0 .0 1) ;用药组不同时间内的愈合率较对照组明显提高 ;深 °创面愈合时间用药组、对照组分别为 (16 .80± 2 .99)天 ,(18.2 7± 3.17)天 ,组间比较有统计学意义 (P<0 .0 1)。结论　rh EGF软膏对烧伤创面有明显的促进修复作用 ,且 10 μg/ g的浓度较为理想     

Tissue Distribution of Oxacillin and Ampicillin in the Isolated Perfused Bovine Udder

In vivo, tissue distribution of intramammarily administered antibiotics is mostly only assessed by sampling milk and blood. Therefore, the described study analysed whether measurement of tissue concentrations makes sense in vitro instead. Isolated bovine udders were perfused with gassed and warmed Tyrode solution. To four front and rear quarters each, 1000 mg oxacillin in 7.5 ml vehicle was administered intracisternally, completely formulated as sodium monohydrate in two lactation ointments (with or without sodium dodecylsulphate) or 80 % as benzathine salt in a dry‐off ointment. Over 3 h, perfusate and glandular tissue from different locations were sampled and analysed by high pressure liquid chromatography. With increasing vertical distance to the teat base, the tissue concentration of antibiotics decreased. With the lactation ointment containing sodium dodecylsulphate, lower oxacillin concentrations were reached in glandular tissue and lymph nodes compared to those without. The ointments led to a higher recovery of oxacillin in glandular tissue than in perfusate. Aluminium monostearate in the dry‐off ointment caused an even poorer absorption of oxacillin into perfusate. The isolated perfused bovine udder is suitable to study the tissue distribution of antibiotics, since the results were mainly comparable with the few existing in vivo studies and show the influence of different formulations.     

The effect of some ointment bases on the systemic absorption of tobramycin from various wound surfaces of burned patients

Three kinds of 0·2 per cent tobramycin ointment were prepared with tobramycin and 3 ointment bases (cream, polyethylene glycol and hydrophilic petrolatum), and applied to the various wound surfaces of 5 burned patients. The systemic absorptions of tobramycin were compared with the values of the tentative AUC (area under the curve of tobramycin blood level, μg.h/ml.g) until 12 hours after the applications, by determining tobramycin level in blood. Similar values of AUC from the cream and polyethylene glycol ointments were obtained, while that of hydrophilic petrolatum ointment was very low. The systemic absorption of tobramycin from the polyethylene glycol ointment was studied when the ointment was applied to the wound surfaces of 7 patients with partial-thickness bum, 9 patients with full-thickness burn and 6 patients with burn ulcer. The mean values of the tentative AUC of patients with partial-thickness burn, full-thickness burn and burn ulcer were found to be 0·06, 0·03 and 0·15, respectively. These results showed that cream and polyethylene glycol bases should be used carefully as a vehicle of tobramycin ointments because of the rapid systemic absorption of tobramycin from human burn wounds, especially burn ulcer.     

Upper eyelid gold weight implants in patients with facial nerve palsy. Surgical technique

Facial nerve injuries produce lagophthalmos and consequent ocular disease caused by corneal exposure. The management of the affected eye in patients with facial palsy has been improved. Previously ointment, eye drops, taping, partial or complete tarsorrhaphy was the primary treatment of the inability to close the eyelid. Other mechanical techniques for reanimating lid closure, including palpebral springs, encircling the upper and lower eyelids with silicone or fascia lata, and temporalis muscle transfer. The most popular and widely used static procedure in facial nerve palsy is the upper eyelid gold weight implant. This procedure is the goal of the treatment for the restoration of function and cosmesis to the paralyzed eyelids. The surgical technique used for lid load insertion are described below.     

Characterization of a novel standardized human three‐dimensional skin wound healing model using non‐sequential fractional ultrapulsed CO2 laser treatments

Background and Objective

At present, there is no standardized in vitro human skin model for wound healing. Therefore, our aim was to establish and characterize an in vitro/ex vivo three‐dimensional (3D) wound healing model, which we employed to analyze the effects of dexpanthenol on wound healing and gene regulation.

Materials and Methods

The novel human 3D skin wound healing model using scaffold and collagen 3D organotypic skin equivalents was irradiated with a non‐sequential fractional ultrapulsed CO₂ laser. These standardized injured full‐thickness skin equivalents enable qRT–PCR, microarray, and histological studies analyzing the effect of topically or systemically applied compounds on skin wound healing.

Results

These human laser‐irradiated skin models were found to be appropriate for in vitro wound healing analysis. Topical treatment of skin wounds with a 5% dexpanthenol water‐in‐oil emulsion or two different 5% dexpanthenol oil‐in‐water emulsions clearly enhanced wound closure compared to laser‐irradiated untreated control models. To find out whether this positive effect is caused by the active substance dexpanthenol, laser‐irradiated skin models were cultured in calciumpantothenate containing medium (20 μg/ml) compared to skin equivalents cultured without calciumpantothenate. 3D models cultured in calciumpantothenate revealed considerably faster wound closure compared to the control models. Quantitative RT–PCR studies showed enhanced mRNA expression of MMP3, IL1α, keratin‐associated protein 4–12 (KRTAP4–12), and decreased expression of S100A7 in laser‐irradiated skin models cultured in medium containing calciumpantothenate.

Conclusion

This novel standardized human 3D skin wound healing model proves useful for topical pharmacological studies on wound healing and reveals new insights into molecular mechanisms of dexpanthenol‐mediated effects on wound healing. In addition, these novel 3D model systems can be used to monitor ex vivo effects of various laser systems on gene expression and morphology of human skin. Lasers Surg. Med. 47:257–265, 2015. © 2015 Wiley Periodicals, Inc.     

Canaliculectomy in the treatment of keratitis sicca

In patients with keratitis sicca (exposure keratopathy) in whom treatment with topical tear solutions and ointments is not effective, closure of the lacrimal puncta is performed with insertion of plugs or by cautery, hypercation, or laser. If punctal occlusion fails with these modalities, surgical excision of the canaliculi is recommended. Canaliculectomy successfully relieved ocular irritation and keratopathy in three patients with keratitis sicca, with no complications (follow-up, 10 to 26 months).     

手术室术前舒适护理干预对≥60岁腹股沟疝患者心理状态及应激反应的影响

目的探讨手术室术前舒适护理干预对≥60岁腹股沟疝患者心理状态及应激反应的影响。 方法选取2017年11月至2019年8月,安徽医科大学第一附属医院64例择期在硬膜外麻醉或全麻下行腹股沟疝无张力修补术患者,按照入院顺序随机分为观察组（32例）和对照组（32例）,其中对照组实施麻醉前常规手术室护理,观察组在对照组基础上实施舒适护理。观察比较2组患者入手术室时及麻醉前的焦虑自评量表（SAS）评分、视觉模拟评分（VAS）、血压、心率、生理舒适度及心理舒适度变化情况。 结果入手术室时,观察组患者SAS与VAS评分与对照组比较,差异无统计学意义（P>0.05）。对照组麻醉前SAS与VAS评分与对照组入手术室评分比较,差异有统计学意义（P<0.05）。观察组麻醉前SAS与VAS评分与麻醉前对照组比较,差异有统计学意义（P<0.05）。入手术室时,观察组患者心率、收缩压及舒张压与对照组比较,差异无统计学意义（P>0.05）。麻醉前,观察组心率、收缩压及舒张压与对照组比较,差异有统计学意义（P<0.05）。观察组麻醉前与入手术室时心率、收缩压及舒张压比较,差异有统计学意义（P<0.05）。入手术室时,观察组患者生理舒适度与心理舒适度评分与对照组比较,差异无统计学意义（P>0.05）;麻醉前,观察组患者生理舒适度与心理舒适度评分与对照组比较,差异有统计学意义（P<0.05）。 结论手术室术前舒适护理有助于显著改善患者负面情绪和应激反应,提高患者围手术期舒适度,令患者临床获益。     

Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study.

BACKGROUND: Transnasal fiberoptic laryngoscopy (TFL) is frequently performed by otolaryngologists, speech language pathologists, and various other health care providers. Historically, topical sprays have been administered to patients to decongest and anesthetize the nasal mucosa, thus minimizing the discomfort of the procedure. Recently, it was reported that patients undergoing TFL with topical anesthesia experienced no improvement in comfort compared with those who received oxymetazoline or saline. This observation is in direct opposition to our clinical experience that patients tolerate the procedure better with topical anesthesia. PURPOSE: We sought to compare patient comfort levels during TFL after the administration of cocaine, oxymetazoline, or saline. METHODS: Fifteen subjects undergoing TFL were prospectively evaluated. Each had TFL performed on 3 separate occasions. Before TFL, each patient received either 4% cocaine, 0.05% oxymetazoline, or saline topically administered via an atomizer to both nasal cavities (1 spray of 2-second duration). By the conclusion of the study, each patient had undergone TFL with each of the test agents. The subjects rated the discomfort they experienced on a scale ranging from 1 (minimal discomfort) to 5 (severe discomfort). Both patient and examiner were blinded to the test agent used. RESULTS: The mean nasal discomfort score for saline was 2.8 +/- 1.1. The scores for oxymetazoline and cocaine were 3.4 +/- 0.9 and 2.0 +/- 0.9, respectively. Compared with saline and oxymetazoline independently, TFL with topical cocaine appeared to provide more comfort (P < 0.05 and P < 0.005). CONCLUSION: The continued routine use of topical anesthetics such as cocaine before the performance of TFL is justified because it significantly decreases the patient's discomfort.     

Intra-operative natural sound decreases salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia

Background: The perioperative period is psychologically as well as physically stressful for patients. Although music and sound are known to reduce patients' psychological stress, a few previous studies showed an objective outcome of music. The aim of the present study was to evaluate the relaxing effect of music during epidural anesthesia, using patients' salivary amylase activity.
Methods: Thirty-two American Society of Anesthesiologists (ASA) I or II patients presenting for inguinal hernia repair under epidural anesthesia were randomly assigned to listen to sounds of a soft wind and a twitter (S group) or to have no sounds (N group). Patients' salivary amylase activity was evaluated on arrival to the operating room and at wound closure.
Results: Intra-operative music significantly decreased salivary amylase activity at wound closure in the S group and the activity at wound closure of the S group was significantly smaller than that of the N group.
Conclusion: Intra-operative natural sound significantly decreased salivary amylase activity of patients undergoing inguinal hernia repair under epidural anesthesia.     

Sedation and anesthesia care for ophthalmologic surgery during local/regional anesthesia

Anesthesia care for the patients undergoing ophthalmologic surgical procedures during local/regional anesthesia balances goals of patient comfort with safety and an optimal outcome in a highly cost-conscious environment. This article discusses current practices and trends in anesthesia care with respect to sedation for eye surgery during local/regional anesthesia. Although there is no evidence that one local/regional anesthesia technique or sedation analgesia regimen is superior to the others, this review highlights important differences between these varied approaches. The type of block used for the ophthalmologic surgery alters the sedation requirements. Changes in surgical techniques have increased the popularity of topical anesthesia, which reduces the need for sedation analgesia and may lessen the need for an anesthesia practitioner. The involvement of an anesthesia practitioner in eye surgery varies from facility to facility based on costs, anesthesiologist availability, and local standards. Anesthesia care choices are often made based on surgeon skill and anesthesiologist comfort, as well as the expectations and needs of the patient.     

Awareness during general anesthesia for head and neck surgery--a case report

We report a second case of awareness during general anesthesia with sevoflurane supplemented with fentanyl. A 58-year-old man, weighing 61 kg, underwent an 8.8-hour operation for a malignant tumor of the right mandible. His right eye was guarded with ointment but kept open for observation of facial movement following muscle stimulation by the surgeon. The intraoperative course and emergence from anesthesia were otherwise uneventful. The patient became agitated in the recovery room and could recall his visual memory during the operation. We speculated contribution of visual input through the open eye and/or the effects of cranial bone oscillation during the surgery to his intraoperative awareness.     

Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy

BACKGROUND: Patch angioplasty during carotid endarterectomy (CEA) may reduce the risk for perioperative or late carotid artery recurrent stenosis and subsequent ischemic stroke. We performed a systematic review of randomized controlled trials to assess the effect of routine or selective carotid patch angioplasty compared with CEA with primary closure, and the effect of different materials used for carotid patch angioplasty. METHODS: Randomized trials were included if they compared carotid patch angioplasty with primary closure in any patients undergoing CEA or use of one type of carotid patch with another. RESULTS: Thirteen eligible randomized trials were identified. Seven trials involving 1281 operations compared primary closure with routine patch closure, and 8 trials with 1480 operations compared different patch materials (2 studies compared both). Patch angioplasty was associated with a reduction in risk for stroke of any type (P = .004), ipsilateral stroke (P = .001), and stroke or death during both the perioperative period (P = .007) and long-term follow-up (P = .004). Patching was also associated with reduced risk for perioperative arterial occlusion (P = .0001) and decreased recurrent stenosis during long-term follow-up (P < .0001). Seven trials that compared different patch types showed no difference in the risk for stroke, death, or arterial recurrent stenosis either perioperatively or at 1-year follow-up. One study of 180 patients (200 arteries) compared collagen-impregnated Dacron (Hemashield) patches with polytetrafluoroethylene patches. There was a significant increase in risk for stroke (P = .02), combined stroke and transient ischemic attack (P = .03), and recurrent stenosis (P = .01) at 30 days, and an increased risk for late recurrent stenosis greater than 50% (P < .001) associated with Dacron compared with polytetrafluoroethylene. CONCLUSIONS: Carotid patch angioplasty decreases the risk for perioperative death or stroke, and long-term risk for ipsilateral ischemic stroke. More data are required to establish differences between various patch materials.     

Comparison of saphenous vein patch, polytetrafluoroethylene patch, and direct arteriotomy closure after carotid endarterectomy. Part I. Perioperative results

To evaluate the perioperative outcomes and the immediate increases in size after patch closure, 140 carotid endarterectomies were randomized into one of three groups: direct no-patch closure, saphenous vein patch closure, and polytetrafluoroethylene patch closure. Seven patients (4.4%) experienced signs of cerebral ischemia in the immediate postoperative period. In three cases this was transient and reversible. In the other four reexploration was undertaken and carotid thrombosis was corrected by thrombectomy. The condition of one of these patients deteriorated to a permanent stroke, whereas the other patients made a complete recovery. Neurologic complications were more frequent in the no-patch group, but the differences between the groups were not significant. The incidence of perioperative internal carotid stenosis, aneurysmal dilatation, and other morphologic abnormalities was assessed in 131 intravenous digital subtraction angiograms taken before the patient was discharged from the hospital. Eight (17.0%) of the endarterectomies in the no-patch group were narrowed by 30% to 50% diameter stenosis, whereas none of the patched arteries had more than 30% stenosis. In contrast, dilatation of the common or internal carotid artery to more than twice the measured diameter was absent in non-patched arteries but was present in seven (17.0%) saphenous patch closures and four (9.23%) polytetrafluoroethylene patch closures. We conclude that patch closure after carotid endarterectomy is less likely to cause stenosis in the perioperative period. Poly-tetrafluoroethylene patches resist dilatation better than do saphenous vein patches and are less likely to become aneurysmal.     

Preoperative anterior thigh temperature does not correlate with perioperative temporal hypothermia during cesarean delivery with spinal anesthesia: Secondary analysis of a randomized control trial

BackgroundCore-to-peripheral redistribution of heat, secondary to sympathetic-mediated vasodilation, is the major mechanism leading to early perioperative hypothermia after neuraxial anesthesia. The study aim was to determine if preoperative anterior thigh (peripheral lower extremity) temperature predicted perioperative temporal (core) temperature decrease during cesarean delivery with spinal anesthesia.MethodsSecondary analysis of data derived from a prospective, randomized study of 46 healthy women undergoing scheduled cesarean delivery with spinal anesthesia was performed. Anterior thigh temperature was measured preoperatively prior to spinal anesthesia. The primary outcome was maximum perioperative temporal temperature decrease. Secondary outcomes included incidence of temporal hypothermia (temperature <36°C), shivering, and thermal comfort scores. This study ran concurrently with a previously published trial comparing no active intraoperative warming with active warming.ResultsThere was no correlation between preoperative anterior thigh temperature and maximum perioperative temporal temperature decrease (r=−0.049, P=0.751). The mean ± standard deviation preoperative anterior thigh temperature of women who developed temporal hypothermia compared to those who did not was 32.4 ± 0.8°C versus 32.4 ± 0.70°C respectively (P=0.995). Preoperative anterior thigh temperature did not correlate with the incidence of shivering (r=0.267, P=0.080) or thermal comfort scores (r=0.233, P=0.129).ConclusionPreoperative anterior thigh temperature does not correlate with the degree of perioperative temporal temperature decrease, likelihood of developing hypothermia, shivering, or thermal comfort during cesarean delivery with spinal anesthesia. Although core-to-peripheral redistribution of heat after neuraxial anesthesia is a major mechanism of perioperative heat loss, a lower extremity temperature prediction hypothesis was not confirmed in this population.     

Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: propofol-based vs. sevoflurane-based anesthesia

BACKGROUND: Post-operative mental dysfunction may be an important problem in elderly patients. This study was designed to compare the effects of propofol and sevoflurane anesthesia on recovery characteristics and the incidence of post-operative delirium (POD) in long-duration laparoscopic surgery for elderly patients. METHODS: Fifty ASA physical status I-II patients over the age of 65 scheduled for laparoscopic surgery lasting 3 h or more randomly received propofol (group P, n = 25) or sevoflurane (group S, n = 25) for both induction and maintenance of general anesthesia. Both groups were combined with continuous perioperative epidural analgesia. The level of primary anesthetics was adjusted to maintain changes in mean arterial pressure within 20% of the pre-anesthetic values. The emergence times from anesthesia (eye opening, extubation, response to command, and orientation) were recorded, and the occurrence of POD was assessed by the delirium rating scale (DRS) during the first 3 days after surgery. All patients received oxygen and continuous epidural analgesia postoperatively. RESULTS: Immediate emergence, i.e. eye opening and extubation was significantly faster after sevoflurane (P < 0.05). There was no significant difference between the incidences of POD in the two groups during the first 3 days after surgery. The scores for DRS on day 2 and 3 after surgery, however, were significantly higher in group P than in group S (P < 0.01). CONCLUSION: Sevoflurane may be preferable to propofol for general anesthesia in combination with epidural analgesia with respect to less effect on mental function during the early postoperative period for long-duration laparoscopic surgery in elderly patients.     

加压包扎联合冰敷护理在局麻眼袋切除术后的效果

目的 探讨加压包扎联合冰敷护理在局麻眼袋切除术后的应用效果。方法 选取2020年5月-2023年 5月我院收治的30例局麻眼袋切除术患者为研究对象,根据随机数字表法分为参照组和研究组,各15例。 参照组予以常规护理,研究组予以加压包扎联合冰敷护理,比较两组眼部水肿程度、眼部疼痛程度、护 理满意度及护理优良率。结果 研究组护理后眼部水肿评分、眼部疼痛评分低于参照组（P＜0.05）;研究 组护理满意度为100.00%,高于参照组的66.67%（P ＜0.05）;研究组护理优良率为100.00%,高于参照组的 73.33%（P＜0.05）。结论 对接受局麻眼袋切除术治疗的患者采用加压包扎联合冰敷护理能够减轻其眼部 疼痛,加快水肿消退,提升舒适度,且护理效果更佳。     

Perioperative management issues in pediatric patients

Recent developments in perioperative practice, emphasizing issues that are of greatest concern in pediatric patients, are reviewed in this article. Many areas bear further evaluation in the evolving field of perioperative medicine: Effective techniques of psychologic preparation for children and their parents in an era in which the family rarely encounters the hospital environment before the day of surgery Application of newer intraoperative anesthetics, such as new narcotics and muscle relaxants, to shorten PACU and pediatric ICU stay while maintaining safety and comfort Critical evaluation of current methods of pain management to optimize comfort, while minimizing cost of such management in an increasingly cost-conscious health care environment The recent advent of a process for credentialing pediatric anesthesia fellowship programs, which requires a research component, bodes well for the prospect of finding answers to some of these questions.     

Perioperatives Patientenmanagement

BACKGROUND: The aim of this investigation was to assess the extent of stress and demands in patients during preparation for general anesthesia for elective surgical procedures. PATIENTS AND METHODS: A total of 52 female patients scheduled for elective gynecological surgery under general anesthesia were included in this prospective study. The extent and time course of actual demands describing perceived emotional stress was assessed at close intervals using the German version of the Questionnaire for Actual Demands (KAB). Pre-operative and postoperative anxiety was assessed using part one of Spielberger's state-trait-anxiety inventory (STAI-X1). This was compared to hemodynamic (heart rate und blood pressure) and endocrinal stress parameters [cortisol concentration in serum and saliva, prolactin and dehydroepiandrosteronesulfate (DHEA-S) in serum]. Postoperatively, all patients were asked to rate the quality of care during preparation for general anesthesia. RESULTS: The extent of patients' demands and stress during preparation for general anesthesia could be quantified by the short questionnaire for the actual demands (KAB). So-called objective stress parameters like hemodynamic and endocrinal data alone did not correlate with perceived stress. However, the subjective information correlated with the nature of the underlying diagnosis. The postoperative assessment of quality of care during preparation for general anesthesia did not correlate with the course of actual demands and stress. CONCLUSION: In future studies assessing the perioperative management of patients and quality of care, standardized testing questionnaires should be preferred, instead of vegetative parameters alone, to reliably evaluate perioperative demands and stress in surgical patients.