Evaluation of preoperative admission and anesthesia consultation in surgery

Preoperative consultation with patients on their imminent hospitalisation for surgery and on aspects of necessary anaesthesia was introduced at the Lübben District Hospital for planned operations in 1977. Five categories of diseases which required general surgery have now been evaluated, in this context. That consultation, based on outpatient practice, has proved helpful in reducing the time of hospitalisation, disability, and pre-admission waiting periods. Surgical and bed capacities were more effectively utilised, and duplicated examinations were avoided. Patients were given a say in surgical timing.     

Anesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety

PURPOSE: Preoperative anxiety in relation to anesthesia remains for many patients a major subject of concern. The aim of the present study was to compare the level of preoperative anxiety in patients assessed in an outpatient consultation clinic with the anxiety level of those having been assessed by the anesthesiologist after entering the hospital. METHOD: We studied two groups of 20 patients who underwent elective transurethral prostate or bladder resection: group A having the anesthetic assessment between one-two weeks before hospitalisation, group B having this assessment the evening before surgery, after entering the hospital. Two different methods to assess anxiety were used: the Multiple-Affect-Adjective-Check-List (MAACL) and the visual analogue scale of anxiety (VAS). RESULTS: Both anxiety provided scores, assessed by two different methods, were lower in group A, than in group B(P<0.01). CONCLUSION: The results of this study confirm that an anesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety, when compared with an assessment on the evening before surgery.     

麻醉科医师术前受邀会诊与老年患者髋部手术后早期并发症的相关性

目的 探讨麻醉科医师术前受邀会诊与老年患者髋部手术后早期并发症的相关性。
方法 采用倾向性评分匹配（PSM）法回顾性分析2019年1—12月行髋部手术患者100例,男36例,女64例,年龄≥65岁,ASA Ⅲ或Ⅳ级。根据术前是否接受由外科医师提交会诊申请并由麻醉科高年资主治医师执行的正式会诊,将患者分为两组：受邀会诊组（会诊组）和非受邀会诊组（对照组）,每组50例。收集性别、年龄、BMI、ASA分级、年龄校正的Charlson合并症指数（aCCI）、麻醉方法、手术时间、麻醉时间、手术出血量、术前等待时间、术前住院时间、术后住院时间、总住院时间、术后1个月并发症等数据。比较两组一般情况、术中情况、住院时间和术后并发症等。
结果 两组性别、年龄、BMI、ASA分级和aCCI差异无统计学意义。会诊组椎管内麻醉比例明显高于对照组,术前等待时间、术前住院时间明显长于对照组,术后住院时间明显短于对照组（P<0.05）。两组手术时间、麻醉时间、出血量和总住院时间差异无统计学意义。会诊组术后并发症发生率明显低于对照组（P<0.05）。
结论 麻醉科医师术前受邀会诊与缩短老年患者髋部手术后住院时间及减少术后早期并发症相关。     

Survey of observer variation in transesophageal echocardiography: comparison of anesthesiology and cardiology literature

OBJECTIVE: Transesophageal echocardiographic examination tends to be somewhat observer and experience dependent, and observer bias can arise easily when data are calculated and interpreted by unskilled, nonblinded, or single observers. The study plan was to see whether authors have adequately described how observer bias is minimized in their studies. Thus, a study was conducted systematically reviewing methods reported in transesophageal echocardio graphy articles in peer-reviewed anesthesiology journals versus those reported in peer-reviewed cardiology journals. INTERVENTIONS: After MEDLINE searches of the literature published from 1997 through 1999, the authors investigated 56 anesthesiology reports and 56 randomly selected, year-matched cardiology reports. An 8-item questionnaire was developed that examined several factors: the number of observers and their experience levels, whether observers were blind to clinical data, whether low-quality images were excluded, the use of on-line or off-line analysis, and observer variability. MAIN RESULTS: The analysis revealed inadequacies in reporting of important information that relates to bias and quality in 91.1% of anesthesiology and 98.2% of cardiology articles. Observer variability was not reported in 50.0% of the anesthesiology reports and 67.9% of the cardiology reports; however, difference between the 2 bodies of literature was not significant. The journal impact factor was significantly higher for the cardiology literature than for the anesthesiology literature (2.42 [0.386-10.893] v 1.07 [0.664-3.439]; median [range], p < 0.001). CONCLUSION: Articles reviewed had at least some inadequacies in reporting the methods to minimize observer bias in both the anesthesiology and cardiology literature. Reporting methodology standards in TEE examinations remain to be established.     

Survey of smoking status among preoperative patients and characteristics of smokers

Smoking is an independent risk factor for both pulmonary and nonpulmonary perioperative complications. For safer anesthetic management, it is important to encourage and support the cessation of smoking in the preoperative period. As a first step to design a preoperative smoking cessation program, we conducted a survey of preoperative patients about smoking status and characteristics of smokers at an outpatient clinic for an anesthesiology department. The percentages of male and female smokers were 42% and 19%, respectively. Percentages of preoperative smokers considered to be in the preparation stage of smoking stage were 26% in male and 19% in female, as compared to 3% in male and 5% in female in general smokers. Twenty four % of both male and female patients were strongly committed to achieving smoking cessation. These trends in smoking characteristics indicate that preoperative smokers are more likely to quit smoking without heavy support and encouragement than general smokers. In designing a preoperative smoking cessation program, these results must be taken into consideration.     

Combined epidural-spinal anesthesia for radical hysterectomy in a patient complicated with bronchiectasis diagnosed on preoperative anesthetic consultation

A radical hysterectomy was performed in a patient complicated with bronchiectasis, under combined spinal-epidural anesthesia. The patient was asymptomatic and preoperatively diagnosed with bronchiectasis on an anesthetic consultation with an anesthesiologist. An epidural catheter was inserted between T12 and L1, and spinal anesthesia was subsequently performed with 0.5% bupivacaine 2.8 ml and fentanyl 10 microg. It was necessary to administer a supplemental epidural dose of 0.375% ropivacaine fifty minutes after the start of the operation. Postoperative epidural analgesia was effective and no perioperative complications were observed.     

The effect of alterations in a preoperative assessment clinic on reducing the number and improving the yield of cardiology consultations

Although preoperative assessment testing clinics (PATCs) can produce efficiency in the evaluation of surgical candidates, their effect on the use of consultants has not been studied. We hypothesized that changes in PATC procedures, education, and staffing could affect the use and yield of cardiology consultations. All PATC anesthesiologist-requested cardiology consultations for patients undergoing elective noncardiac surgery from 1993 to 1999 were reviewed. This period corresponded to 3 yr before and after a change in the PATC leadership, which resulted in more stringent consultation algorithms, a cardiac assessment and electrocardiogram interpretation educational program, and altered staffing of anesthesiologists and ancillary personnel. A single senior cardiologist completed all consultations. Data including age, sex, reason for consultation, resultant testing, consultant conclusions, cancellations, and surgical procedure and outcomes were collected. In the PRE and POST groups, respectively, 917 and 279 consultations (1.46% versus 0.49% [P = 0.0001] of noncardiovascular surgeries) were ordered despite an increase in the surgical case-mix acuity. In the POST group, significantly fewer consultations were ordered and significantly more required further testing to assess cardiac status. We conclude that changes in PATC consultation algorithms, education, and staffing can significantly decrease the use and yield of preoperative cardiology consultations. IMPLICATIONS: Alterations in preoperative assessment testing clinic consultation algorithms, education, and staffing can significantly reduce the use of preoperative cardiology consultations while improving their overall yield.