ABSTRACT
L'objectif de l'étude est d'évaluer la pratique anesthésique au cours des adénomectomies hypophysaires par voie endo nasale à Abidjan. Méthode : Il s'agissait d'une étude rétrospective à visée analytique et descriptive, menée entre le 01 janvier 2010 et le 31 décembre 2020 et portant sur les patients admis au bloc opératoire pour une adénomectomie hypophysaire. Les caractéristiques sociodémographiques, cliniques, anesthésiques, évolutives et pronostiques ont été étudiées. Résultats : Nous avons recensé 102 patients. L'âge moyen était de 44,72±12,14 ans. Le sex ratio était de 1. Le délai de diagnostic était d'un an pour 46% (n = 47) des patients. L'hypertension artérielle était l'antécédent le plus retrouvé. Les principaux motifs de consultation étaient les céphalées et les troubles de l'acuité visuelle. Le syndrome d'hypertension intracrânien a été observé chez 67,6% (n= 69) des patients. Tous les patients ont bénéficié d'une consultation pré anesthésique. Cinquante-huit pourcent (n=59) des patients ont été classés ASA I selon la société américaine d'anesthésie. L'anesthésie générale était le seul schéma anesthésique. La durée de l'anesthésie était de plus de trois heures chez 57% (n=58) des patients et le réveil sur table a concerné 88,2% (n=90) des patients. La mortalité était de 3,9%. La durée de l'anesthésie supérieure à 6 heures (p= 0,0012 ; OR= 55,8 [4,88-637,33]) et la perte sanguine supérieure à 1000 ml (p = 0,0228 ; OR=18,6 2,152- 160,747]) ont constitué des facteurs de mauvais pronostic (p<0,05). Conclusion: La réduction de la létalité au cours de l'anesthésie pour adénomes hypophysaires passe par la lutte contre les facteurs de mauvais pronostics
Subject(s)
Humans , Pituitary Diseases , Anesthesia , Prognosis , Preoperative Care , PseudohypoaldosteronismABSTRACT
Preoperative anxiety potentially results in perioperative anaesthetic complications. This study aimed to determine the prevalence of preoperative anxiety in adult patients scheduled to undergo elective orthopaedic surgery at an academic hospital in South Africa and identify contributory factors. Methods: This cross-sectional study included all patients scheduled for elective orthopaedic surgery the following day from 25 July to 3 November 2021. An adapted version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used. Four questions determined the patients' anxiety and two questions their desire for more information about their forthcoming anaesthesia and surgery. A 5-point Likert scale was used to capture the patients' responses to the APAIS questions. Data on other possible contributory factors to preoperative anxiety were collected using a questionnaire. Results: Of the 88 patients, 82 (93.2%) were included in the study. A total of 40 (48.8%) patients had an APAIS score of ≥ 11, indicating anxiety. A high need-for-information score (≥ 8) was found in 31 (37.8%) patients. A significant association between patients with a higher anxiety score and a higher need-for-information score (p = 0.0063) was identified. Other non-significant factors associated with a higher anxiety score included a lower level of education and no postoperative home support. Conclusion: Patients with a high need for information tended to be more anxious on the day before surgery. The APAIS could be introduced in preoperative ward admissions to identify these patients and provide an appropriate level of counselling about their planned procedure. Counselling might reduce their preoperative anxiety, but further research needs to confirm this assertion. Larger studies are recommended to determine the influence of other factors contributing to preoperative anxiety
Subject(s)
Humans , General Surgery , Preoperative Care , Adult , Patients , Perioperative Nursing , Cross-Sectional Studies , Intraoperative ComplicationsABSTRACT
charge d'une intervention. L'objectif de l'étude était d'évaluer la qualité de la tenue des fiches d'anesthésie à partir des indicateurs pour l'améliora-tion de la qualité et de la sécurité des soins « tenue de dossier d'anesthésie » (IPAQSS / TDA) proposés par la Haute Autorité de Santé (HAS ; France). Matériels et Méthodes : Une étude rétrospective, descriptive des fiches d'anesthésie des patients allant bénéficier d'une intervention pro-grammée au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (Antananarivo, Madagascar) a été réalisée sur une période de deux ans (2016 - 2017). Celles des patients transférés en Réanimation Chirurgicale n'ont pas été incluses. Les critères portant sur l'identification du médecin anesthésiste, celle du patient, le traitement habituel de ce dernier, les caractéristiques des voies aériennes et leur technique d'abord, le type d'anesthésie prévue, la visite préanesthésique, les incidents per anesthésiques, l'autorisation de sortie de la salle de soins post interventionnelle ont été étudiés. Lorsque les critères proposés par l'IPAQSS / TDA de la HAS n'étaient pas applicables, ceux-ci n'ont pas été considérés. Les résultats sont exprimés en moyenne avec écartype et en fréquence. Résultats : Durant cette période 2504 fiches d'anesthésie ont été analysées. Le nombre de critères remplis par patient étaient de 6,9±1,3. Le taux de remplissage des critères pré anesthésiques était de 68,44%, per anesthésiques de 32,04% et post anesthésiques (en salle de soins post interventionnelle) de 5,67%. Le score individuel était de 0,69±0,13 ; le score global était de 68,82%. Con¬clusion : A des fins d'optimisation de la sécurité des patients et de la qualité des soins, l'évaluation de la tenue des dossiers doit être régulière. Cette évaluation
Subject(s)
Academic Medical Centers , Anesthesia and Analgesia , Madagascar , Office Visits , Preoperative CareABSTRACT
Background. Abnormal preoperative serum sodium measurements have been shown to be associated with increased postoperative mortality in US and European surgical populations. It is possible that such measurements are also associated with increased postoperative mortality in a South African (SA) setting, but this is yet to be confirmed. Establishing whether preoperative serum sodium measurements are associated with postoperative mortality could have implications for perioperative risk stratification in SA settings.Objectives. To determine whether preoperative serum sodium measurements are associated with postoperative mortality in SA surgical patients.Methods. This was an unmatched case-control study of patient data (demographics, comorbidities, procedure-related variables, and preoperative serum sodium measurements) collected during the South African Surgical Outcomes Study. Data were analysed using recommended statistical methods for unmatched case-control studies.Results. The study population comprised 103 patients and 410 controls. Cases were defined as patients who suffered postoperative inpatient mortality, while controls were defined as patients who did not suffer postoperative inpatient mortality. Preoperative hypernatraemia (i.e. a preoperative serum sodium measurement >144 mEq/L) was independently associated with a four-fold higher risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement of 135 - 144 mEq/L (odds ratio (OR) 4.21, 95% confidence interval (CI) 1.19 - 14.83, p=0.025). Preoperative hyponatraemia (i.e. a preoperative serum sodium measurement <135 mEq/L) was not independently associated with a higher or lower risk of postoperative inpatient mortality compared with a normal preoperative serum sodium measurement (OR 1.39, 95% CI 0.70 - 2.76, p=0.346).Conclusions. Preoperative hypernatraemia, but not preoperative hyponatraemia, is a risk factor for postoperative inpatient mortality in SA surgical patients
Subject(s)
Hypernatremia , Inpatients , Preoperative Care , Sodium , South Africa , Surgical Procedures, OperativeABSTRACT
Emergency caesarean section poses obstetric, anesthetic and surgical risks to the mother and the unborn baby and exacerbates anxiety which is deleterious. Preoperative nursing care rendered during this period greatly influence patient's care perception, a concept underpinned in this study. Patients' pre-and postoperative anxiety levels and demographics informed by literature reviewed were evaluated. Demographics included age, the level of education, mode of hospital bill payment, history of major illness, previous surgeries, current medication, smoking and the condition of the newborn. A descriptive cross-sectional survey was conducted in a private and a public hospital among patients undergoing emergency caesarean section. Sixty participants were purposively and systematically sampled from the postnatal ward admission registers using inclusion criteria. A structured questionnaire was used to assess participants' demographics and care satisfaction. Anxiety levels were evaluated using Form Y-6. Ethical approval was obtained from the respective ethical review boards. Multivariate nonparametric statistical analyses using Statistical Package for Social Sciences (SPSS) version 17 computer software was used to analyze data Alongside descriptive statistics. Significant finding observed regarding demographics were on the level of education and mode of hospital hill payment. The highest level of education attained was tertiary 22(73.3%) in private compared to secondary level 14 (46.7%) in the public hospital. The mode of hospital bill payment was through companies' medical schemes 24(80%) in private hospital and through National Health Insurance Fund (NHIF) 22(73.3%) in public. Mann-Whitney U test showed statistically significant differences in only two out of the six anxiety defining statements assessed postoperatively. Participants at the public hospital felt calmer (z=-2.071, p=0.038<0.05) and more relaxed (z=-2.85, p=0.004<0.05) than those at the private hospital. Wilcoxon rank test yielded significant results for only one out of the six care satisfaction defining statements. Participants at the public hospital were more satisfied with the information given by the nurse about what is expected before and after surgery (z=-2.61, p=0.009<0.05) compared to private. This study evidences nurses' ability to render satisfactory care to patients in emergency situations regardless of socio-patients' demographic profile and type of hospital. There is need to initiate and sustain such care surveillance for quality auditing
Subject(s)
Anxiety , Cesarean Section , Emergencies , Hospitals, Private , Hospitals, Public , Kenya , Patient Satisfaction , Postoperative Care , Preoperative CareABSTRACT
BACKGROUND:Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.OBJECTIVE:To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). METHODS:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.RESULTS:Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital; with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection; attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59; 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64; 95% CI 0.57 - 0.71; petlt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59; 95% CI 0.21 - 1.70; p=0.33; cardiac complications RR 0.74; 95% CI 0.28 - 1.95; p=0.54; infectious complications RR 0.61; 95% CI 0.29 - 1.27; p=0.18; and perioperative bleeding RR 0.36; 95% CI 0.23 - 0.56; petlt;0.00001.CONCLUSIONS:There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However; randomised evidence of the efficacy of the SSC at rural hospital level is absent
Subject(s)
Checklist , Preoperative Care , Surgical Procedures, OperativeABSTRACT
Background: Pre-anaesthetic evaluation is a basic component of safe anaesthetic practice and ends with the establishment of an anaesthetic plan of action for individual patients. Objectives: The aim of the present study was to assess the difficulties encountered by the anaesthetist during such visits and suggest ways they can be overcome Subjects and Methods: The `activity book' of anaesthetic resident doctors in the hospital was reviewed retrospectively for documented problems they encountered during the pre-operative visit. The problems listed were then subjected to analysis using the SPSS 17. Result: The commonest problem was the unavailability of the patient for review 73.1followed by very busy schedule (7.4) and unfit patients (6.9) Conclusion: Anaesthetists still do encounter problems during the pre-operative visit. Exposing such problems creates the necessary awareness for improvement of patient care
Subject(s)
Anesthesia , Hospitals , Nigeria , Preoperative Care , TeachingABSTRACT
Objectives: This study aimed to investigate if the frequently observed low preoperative values of the plasma electrolytes Na+; K+; and Ca+2 in our surgical patients; in Khartoum; is a reflection of their levels in the population at large or it is a genuine finding in patients.Methods: 90 male and female subjects were included in this study. 60 healthy; young and elderly individuals were selected randomly from amongst medical students and employees of the University of Khartoum. 30 elective orthopedic and general surgical patients were randomly selected from Khartoum teaching hospital. Plasma Na+ and K+ were measured using a digital flammometer; and plasma Ca+2 was measured using a spectrophotometer. Results were compared to international data using the Z test. Comparison between the groups in the study was done using the student t-test. Results: Plasma Na+; K+; and Ca+2of the healthy subjects and the surgical patients were found to be low compared to the international reference values. Plasma K+ is higher and Ca+2is lower in the older subjects when compared to young ones. Conclusion: a larger study is needed to set the normal values for plasma electrolytes in the Sudan. The high environmental temperature and nature of our diets could be the reason for the observed differences between our subjects and international reference values
Subject(s)
Elective Surgical Procedures , Electrolytes/analysis , Hospitals, Teaching , Plasma/microbiology , Potassium , Preoperative Care , Sodium , SudanABSTRACT
Background: In our hospital pre-operative chest x-ray (CXR) are routinely requested without prior establishment of any medical indication for patients of 70 or more years of age who are undergoing elective surgery. The aim of this study was to determine if routine preoperative chest x-rays are justifiably indicated for elderly patients undergoing elective surgery in the University of Nigeria Teaching Hospital; Enugu. Method: One hundred and twenty consecutive patients aged 70 or more years were studied between January 2003 and December 2005. As part of our routine preoperative evaluation; detailed history and thorough physical examination were carried out with a view to eliciting symptoms and signs that would normally indicate chest X-ray. Pre-operative ECG were also examined for presence or absence of abnormalities that could indicate chest X-ray. preoperative chest X-rays of the 120 patients were also studied and radiological findings noted. Results: Ninety (75) out of 120 patients had medical indications for chest X-ray. The remaining 30 (25) were considered to lack medical indication for chest X-ray. Overall; 105 out of the 120 (84) patients had abnormal findings on chest X-ray. Conclusion: Routine preoperative chest X-rays in the elderly patients are worthwhile even without medical indication
Subject(s)
Aged , Hospitals , Mass Chest X-Ray , Preoperative Care , Surgical Procedures, Operative , TeachingABSTRACT
Aims: This study is aimed at assessing the perception and attitude of health workers in Guinness Eye Hospital; Onitsha; towards preoperative HIV screening of patients. Metho- dology: Semi-structured questionnaire designed to collect information on HIV and its transmission; the perception and attitude to the preoperative HIV screening were adminis- tered to the subjects. Data analysis was manual and use of electronic calculator; simple percentage and contingency c2 test. Results: Eighty seven questionnaires were distributed; 78(89.7) were retrieved and analyzed. Sixteen (20.5) of the subjects were males and 62 (79.5) females. All the subjects were aware of HIV infection. Seventy seven (98.7) of the respondents knew that preoperative HIV screening is done in Guinness Eye Centre; Onitsha. Seventy three subjects (93.6) were in favour of preoperative HIV screening in the hospital; 4(5.1) were against and 1(1.3) had no opinion. All clinical staff supported preoperative HIV screening in the hos Conclusion: Preoperative screening is recommended for all patients undergoing surgery. Seminars should be organized for all hospital workers and public to improve knowledge of the HIV/AIDS pandemic.) were retrieved and analyzed. Sixteen (20.5) of the subjects were males and 62 (79.5) females. All the subjects were aware of HIV infection. Seventy seven (98.7) of the respondents knew that preoperative HIV screening is done in Guinness Eye Centre; Onitsha. Seventy three subjects (93.6) were in favour of preoperative HIV screening in the hospital; 4(5.1) were against and 1(1.3) had no opinion. All clinical staff supported preoperative HIV screening in the hospital. Conclusion: Preoperative screening is recommended for all patients undergoing surgery. Seminars should be organized for all hospital workers and public to improve knowledge of the HIV/AIDS pandemic
Subject(s)
Attitude of Health Personnel , HIV Infections , Health Personnel , Perception , Preoperative CareABSTRACT
Objective To evaluate the impact of preoperative accelerated hyperfractionated radiotherapy in the management of bladder carcinoma in Egyptian patients. Patients and Methods Between December 1996 and February 2000; 104 Egyptian patients with pathologically proven infiltrative bladder carcinoma were enrolled in this prospective study. Patients with all pathological subtypes; non-metastatic disease; clinical stage T2-T4; and medically operable were eligible for this study. A total preoperative dose of 45 Gy was given in an overall time of 3 weeks; 1.5 Gy/fraction; 2 fractions/day with an interval of 6 hours in between; 5 days/week. Three weeks later; this was followed by radical cystectomy with pelvic node dissection. The clinical radiation response of the tumor was evaluated by C.T. scan done before irradiation and just before surgery. Only 56 patients completed this treatment program. The median follow-up was 26 months; ranging from 9 to 32 months. Results The actuarial 2-year disease-free survival (DFS) of the 56 patients was 63.9; with 50of failures due to pelvic recurrences. The univariate analysis revealed that only lymph node infiltration and pathological staging correlated significantly with DFS. There was a marginal insignificant improvement of DFS among patients who showed an increased tumor regression after radiotherapy. The multivariate analysis using the Cox model showed that lymph node affection is the only significant predictor for DFS. Other factors including age; sex; cell type; bilharzial infestation and clinical radiation response did not show a significant importance regarding the DFS. Minimal acute radiation toxicity with no late tissue reaction was observed among the whole group of patients. No increased operative difficulty related to irradiation nor an increased postoperative morbidity was found. Conclusion The potential biological advantage of this preoperative radiation schedule (in terms of a shorter overall duration of treatment; a shorter preoperative treatment period; a lower dose per fraction and an overall dose equivalent to conventional fractionation); aiming at an increased tumor regression and a decrease of late normal tissue reaction with its impact on DFS; remains to be further investigated with a larger number of patients and a longer follow-up
Subject(s)
Preoperative Care , Urinary Bladder NeoplasmsABSTRACT
Haematological investigations for 225 paediatric patients aged between zero to 15 years who presented for elective surgery were studied retrospectively over a five-month period. In addition to the Haemoglobin (Hb); the Sickling test and the haemoglobin electrophoresis where applicable were done. Thirty per cent (30 per cent) of the patients had Hb of 10g/dl and below. The lower Hb was found more commonly in the age group zero to 5 years. Eleven (4.9 per cent) patients did not have the Sickling test done. Twenty-three (23) out of 29 patients with Sickling positive had electrophoresis done. The results were 21 AS; 1 SS; and 1 SC. Blood film for malaria parasites yielded positive results in 33 out of 175 (18.9 per cent) patients. There were no immediate anaesthetic complications in any of the patients. The need for minimum test of Hb; Sickling and blood film for malaria parasites are discussed