术前麻醉评估中心在胸科手术中的效果评价

目的:评价术前麻醉评估中心在胸科手术中的效果,为提高围手术期患者麻醉安全质量提供保障。方法:选取2020年7月1日—2021年2月1日进行胸科手术的患者1 600例,按随机数字表法分为常规访视组（对照组）和术前麻醉评估中心组（观察组）,每组800例。对照组患者于手术前1 d由麻醉医师去病房进行访视和风险评估;观察组于手...     

Protocol for preoperative chest X-rays in elective surgery

BACKGROUND: To evaluate the effects of a protocol designed to optimize the use of preoperative chest X-rays (CXRs) in the evaluation of patients undergoing anesthesia for elective surgery. DESIGN: Observational prospective study. SETTING: General 350 bedded hospital, with main surgical branches. METHODS: a) Protocol: routine CXRs can be avoided in patients aged less than 60 years, nonsmokers, without acute-chronic respiratory, cardiovascular symptoms, free from neoplastic diseases, not candidates to major vascular, abdominal or thoracic surgery, not treated with immunosuppressive therapy, nor immigrants from areas of endemic TB. b) All out patient subjects admitted to anesthesiology service for evaluation prior to elective surgery. RESULTS: Out of 5198 patients, 3795 were enrolled in the protocol; in 152 cases, preoperative CXRs were performed, 3456 patients (57.2% ASA 1; 42% ASA 2; 0.8% ASA 3) underwent surgery without CXRs. Thirty-four percent of patients had general anesthesia, 54.5% regional anesthesia, 20.6% regional-peripheral anesthesia with/without MAC. No critical events nor major complications were observed in the perioperative period in these subjects. Preoperative CXRs (performed in 152 cases) yelded useful informations with effect on the clinical management in 20 instances. CONCLUSIONS: In a context of adequate preoperative anesthesiologic evaluation, this protocol proved to be effective in reducing the number of routine preoperative CXRs in patients undergoing elective surgery. This resulted in a substantial reduction of radiation exposure both to the subject and to the general population, and costs saving, without evident negative side-effects.     

Indications for electrocardiogram in the preoperative assessment for programmed surgery

OBJECTIVES: To establish indications for ordering a screening electrocardiogram (ECG) before scheduled surgery. To study the prevalence of abnormalities found in routine ECGs and the impact of routine ECGs on anesthetic and surgical management and on preventing perioperative complications. MATERIAL AND METHODS: A prospective study of 413 patients undergoing scheduled non-cardiac surgery over a two-year period. ECG anomalies were defined as major or minor in function of their association with perioperative morbimortality. ECG results were considered expected or unexpected in function of agreement with a patient's history. RESULTS: An ECG was done for all patients before surgery. Anomalies were observed in 41.9% of the ECGs, 28.6% of which were considered major. The prevalence of anomalies was greater among men over 40 years of age, with heart or respiratory disease and these classified as ASA III-V. The anomalies were unexpected in 8.9% and did not cause postponement or cancellation of scheduled procedures. Anomalies found led to changes in preoperative approach in 0.5% of the cases. Intraoperative complications were seen in 7.9% and postoperative complications in 24.6%. CONCLUSIONS: Preoperative ECGs should be obtained only in patients over 40 years of age who present cardiac or respiratory signs or symptoms and who are diagnosed of some heart or respiratory disease.     

Indications for needle catheter jejunostomy in elective abdominal surgery

Needle catheter jejunostomy for postoperative nutritional support is now employed worldwide. However, there is a large discrepancy regarding indications for this technique which this study attempts to rectify. The need for nutritional support after elective abdominal procedures in 464 patients was analyzed and compared with the experience with needle catheter jejunostomy in 42 patients. The results show that needle catheter jejunostomy is indicated after extensive operations of the upper gastrointestinal tract, for example, esophagectomy, total gastrectomy, and the Whipple procedure. With minor upper gastrointestinal operations, or procedures of the lower gastrointestinal tract, needle catheter jejunostomy should be performed only in patients with poor nutritional status or in the presence of postoperative chemotherapy or radiotherapy. In an unclear situation, liberal insertion of the needle catheter jejunostomy and a postponed decision on enteral feeding is recommended, as there is no significant catheter-related morbidity.     

Indications and long-term outcome after elective surgery for hepatocellular adenoma

The management of hepatocellular adenoma (HA) is dependent on several parameters, which are influencing the decision for further management. The aim of this study was to evaluate the clinical presentation, indications, and long-term outcome of surgical treatment in a single-institution analysis. Forty-nine patients underwent elective hepatectomy for HA between 1990 and 2007. Analysis parameters included demographic data, lesion number and size, diagnostic method, mode of surgery, and postoperative outcome. Mean follow-up was 108 months. Thirty-six patients underwent hormone therapy and four patients had a history of cancer before surgical treatment. The mean tumor diameter was 9.8 cm. Mild or moderate postoperative complications were recorded in 16 patients. There was no perioperative mortality. Symptoms were relieved in 95 per cent of the patients. Intratumoral hemorrhage was detected in 21 specimens (43%); malignant transformation was detected in zero specimens. Among patients with HA with clinical symptoms, tumor diameter greater than 5 cm and in male patients the indication for surgery should be given because of the high risk of tumor-related complications. Elective liver resection for HA is a safe procedure and results in a good long-term outcome.     

Anesthetic evaluation and management of a patient with thoracic endometriosis syndrome presenting for elective surgery

Thoracic endometriosis syndrome is a relatively uncommon disorder characterized by recurrent pneumothoraces, hemothorax, chest pain, dyspnea, and hemoptysis within 48 to 72 hours of menstruation. A 34 year old, ASA physical status 2 woman with recurrent catamenial pneumothoraces due to thoracic endometriosis syndrome is presented. After treatment with video-assisted thoracoscopic surgery, she underwent successful elective diagnostic abdominal laparoscopy without incident. The presence of parenchymal injury and damage predisposes these patients to ventilator-induced lung injury. Postponement of surgery until the intermenstrual period, with lung protective ventilation, allows patients with this disease to successfully undergo general anesthesia and surgery.     

Preoperative evaluation for thoracic surgery

The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung ventilation leads to a significant derangement of gas exchange, and hypoxemia can develop due to increased intrapulmonary shunting. Recent advances in anesthetic management, monitoring devices, improved lung isolation techniques, and improved critical care management have increased the number of patients who were previously considered inoperable. In addition, there is a growing tendency to offer surgery to patients with significant lung function impairment; hence a higher incidence of intraoperative gas-exchange abnormalities can be expected. The anesthesiologist must also consider the risks of denying or postponing a potentially curative operation in patients with lung cancer. Detailed consideration of the information provided by preoperative testing is essential to successful outcomes following thoracic surgery.     

Utilization of preoperative autologous blood donation in elective surgery

Background: The aim of the present paper was to review the pattern of collection and transfusion of autologous red cells for elective surgical procedures Methods: Data on requests for preoperative autologous donation of blood were obtained from the Australian Red Cross Blood Service, Victoria and the Royal Melbourne Hospital for the calendar year 1998. The following information was collected: patient age, sex, surgery type, number of autologous units requested and collected and, if relevant, reasons for not achieving the requested collection. Transfusion of autologous units and any additional homologous units was confirmed from records at the blood banks of the Royal Melbourne Hospital and Melbourne Pathology (the pathology provider performing cross‐matching for the majority of autologous units collected by Australian Red Cross Blood Service, Victoria). Results: Over 12 months, 2803 units of autologous blood were requested and 2282 units collected from 1301 patients. The most common reason for failure to collect the number of units requested was insufficient time between referral and surgery. Of the autologous units collected, 73% were transfused giving a collection to transfusion ratio of 1.4. Sixty‐eight per cent of patients received their autologous units only, 10% received both autologous and homologous units, while 22% were not transfused. For the majority of procedures, patients using preoperative autologous donation of blood had higher transfusion rates than those who did not use this. Conclusions: Ninety per cent of patients undergoing preoperative autologous donation of blood successfully avoided homologous blood exposure. However, preoperative autologous donation of blood is both wasteful and increases the incidence of transfusion in surgical procedures.     

Emergency intensive care admission following elective thoracic surgery

AIM: The aim of this study was to analyse the outcomes of patients admitted to the intensive care unit (ICU) following initial recovery after elective thoracic surgery. METHODS: The case notes of all patients who underwent elective thoracic surgery over a one-year period were reviewed. Patients who were admitted to ICU following an initial recovery on the ward were identified and their postoperative course analysed. The clinical and demographic characteristics of these patients were recorded and their outcomes analysed. RESULTS: A total of 20 patients were admitted to ICU of whom 13 (65%) were admitted for respiratory complication, 5 with sepsis and 2 with cardiovascular instability. Sixteen (80%) patients required CPAP or BIPAP, of whom only 7 (35%) required mechanical ventilation. Renal support was required in 7 patients, with 2 (10%) requiring haemofiltration. ICU survival was 15 patients (75%), whilst overall three-month survival post ICU admission was 65%. Requirement for renal support was the only predictor of mortality on univariate and multivariate analysis. CONCLUSIONS: Salvage ICU admission following elective thoracic surgery is associated with significant mortality, however the outcome is far from hopeless. The majority of patients can be managed without recourse to mechanical ventilation or haemofiltration. The need for renal support is, however, a significant adverse prognostic indicator.     

选择性结直肠手术中机械性肠道准备的必要性

目的 分析机械性肠道准备在选择性结直肠外科手术中的必要性.方法 将77例行选择性结直肠手术的患者分为进行机械性肠道准备组(MBP组,42例)与未进行机械性肠道准备组(非MBP组,35例),分析两组术后吻合口瘘、感染等并发症发生的差异.结果 两组在术后吻合口瘘、切口感染、切口裂开等并发症发生方面无统计学差异(P＞0.05).结论 术前的MBP对降低选择性结直肠手术术后并发症方面没有显著的优势,术前MBP可能并非必要.     

Management of patients with coronary stents in elective thoracic surgery

Purpose  

Interruption of oral antiplatelet agents for noncardiac surgery places patients who have received coronary stent implantation at high risk of coronary events, including stent thrombosis. We investigated retrospectively perioperative management for patients with coronary stents undergoing thoracic surgery.     

胃肠道肿瘤择期手术患者术前营养支持的研究进展

对胃肠道肿瘤手术患者术前营养支持的5个方面即营养状况评估、营养支持适应证、营养支持途径、持续时间及营养制剂的研究现状进行综述,旨在提高临床工作者对术前营养支持的重视程度,更好地为患者实施营养支持,促进患者康复。     

Intraoperative autotransfusion during emergency thoracic and elective open-heart surgery

Massive intraoperative autotransfusion (average 7,200 ml.) was carried out in 5 patients with major thoracic trauma. All patients survived, but 3 required reoperation for postoperative bleeding associated with thrombocytopenia and low serum fibrinogen.Three patients underwent repair of complex congenital cardiac anomalies utilizing cardiopulmonary bypass. Excessive bleeding from cloth conduits, suture lines, and bronchial mediastinal collaterals precluded decannulation. Autotransfusion was begun as a preliminary to protamine administration; within 30 minutes autotransfusion was discontinued concurrent with hemostasis. All 3 patients survived.It is concluded that if the problems attendant upon autotransfusion are understood, the procedure can be a valuable, lifesaving adjunct in the management of major thoracic bleeding.