ABSTRACT
Introducción: evaluar el riesgo anestésico-quirúrgico en un paciente que será intervenido quirúrgicamente no es tarea fácil para el anestesiólogo. Objetivo: hacer una puesta al día sobre los diferentes elementos predictores en la evaluación del riesgo anestésico por el anestesiólogo. Desarrollo: la evaluación preanestésica implica tener en consideración múltiples elementes entre ellos los inherentes al paciente. Existen varios índices multifactoriales, que combinan y asignan una importancia relativa a muchos parámetros clínicos y son más útiles que cualquier factor aislado para determinar el riesgo; sin embargo, tienen limitaciones. Conclusiones: se debe considerar diferentes elementos en la estimación del riego anestésico quirúrgico y partir de un grupo de estos factores de riesgo previamente seleccionados, para realizar estudios y determinar cuáles de ellos son los predictores de mortalidad y de complicaciones mayores.
Background: the evaluation of the surgical and anesthetic risk for a patient that will undergo surgery is not an easy task for the anesthesiologist. Objective: to make an update on the different prediction elements for the evaluation of the anesthetic risk made by the anesthesiologist. Development: pre-anesthetic evaluation involves taking into consideration multiple elements, among them, the ones that are inherent to the patient. There are several multifactor indexes that combine and assign a relative importance to many clinical parameters and are more useful than any isolated factor to determine the risk; however, they have limitations. Conclusions: Different elements should be considered in estimating the surgical and anesthetic risk and, from a group of previously selected risk factors, studies should be developed to determine which of them are considered predictors for mortality and major complications.
ABSTRACT
Background: Currently, there is a considerable variation concerning the provision of preanesthetic-risk information, especially potential detrimental adverse outcomes. Objective: Determine the effects of printed anesthetic-risk information before surgery including patients’ anxiety, refusal of surgery, knowledge perception of adverse events and factors affecting anxiety. Methods: Patients in a university hospital, a tertiary care hospital, a secondary care hospital, and a neurological institute in Thailand, undergoing low-to-moderate risk surgery were randomly allocated to control group (C) and study group (S), where group C received printed general information in anesthesia, and group S received printed incidences of five anesthetic adverse events as sore throat, nausea/vomiting, tooth loss, not waking up after surgery, cardiac arrest. Spielberger State-Trait Anxiety Inventory Scale (STAIS, STAIT) for anxiety and Visual Analog Scale (VAS) for knowledge perception were recorded before and after information, and after surgery. Numbers of patients who refused surgery and needed anesthetic-risk information in the next surgery were also recorded. STAIS >45 were considered “high anxiety”. Results: Eight-hundred and twenty-four patients were analyzed (group C: 414, group S: 410). There was no difference in age, sex, ASA physical status, salary, education level, habitat, anesthetic experience and operative risk between groups. STAIS and STAIT, proportion of patients with high anxiety, proportion of patients who refused surgery were not different between groups. Patients in control group needed anesthetic-risk information in the next surgery more than study group (p<0.001). VAS for knowledge about five adverse events in study group were significantly higher than control group (p <0.001). Risk factors by the multivariate analysis included patients with high baseline trait anxiety and low income of less than 10,000 Baht/month. Conclusion: Printed anesthetic-risk nformation did not increase anxiety, but increased knowledge perception of the patients.
ABSTRACT
A medida que la población envejece, más pacientes geriátricos deben someterse a cirugías, bien sea electivas o urgentes. Dado que el envejecimiento es una experiencia única y personal, cada paciente que va ser sometido a cirugía debe abordarse de manera individual. La valoración de la reserva funcional ha llegado a ser la piedra angular en el plan anestésico y es marcador pronóstico integral. Se dan pautas para su valoración, así como de la capacidad funcional, con el fin de minimizar los riesgos de la anestesia y la cirugía. En la presente revisión se discuten los cambios de los órganos con la edad, el papel de las enfermedades intercurrentes como factores determinantes del riesgo, otros factores que incrementan el riesgo de complicaciones y los problemas perioperatorios que se pueden presentar, entre otros, los relacionados con el estado cognitivo.
As the population ages, more geriatric patients should undergo Esther elective or urgent surgery. Given that ageing is a unique and individual experience, each patient that goes to surgery, must be addressed on an individual basis. The assessment of the functional reserve has become the cornerstone in the anesthetic plan and is the fore-casting integral marker. Guidelines for its assessment are given, as well as its functional capacity, in order to minimize the risks of anesthesia and surgery. In this review, changes in organs with age, the role of intercurrent diseases, and other factors that increase the risk of complications, perioperative problems that may arise, including those related to cognitive stes are discussed.
Subject(s)
HumansABSTRACT
BACKGROUND: As the problems of medical malpractices become a very serious social issue, it is necessary to increasingly relate law to medical practice and evaluate medical services. However, it is not easy to legally call someone to account, as medical services are highly specific, especially anesthetic management. Anesthesiologist can expect to be involved in legal action alleging malpractice, either as a defendant or expert witness. METHODS: The anesthetic informed consent form was examined at 42 general hospitals in the Republic of Korea. The chief physician of the department of anesthesiology and pain medicine was asked for the anesthetic informed consent form they used in clinical anesthetic practice, and then what constitutes adequate informed consent analyzed. RESULTS: All of the hospitals were using informed consent forms, but 42.9% of the hospital used a specific form to describe the complications or risks associated with anesthetic management. In 71.4% of hospitals, the anesthesiologists or anesthetic residents explained the anesthetic risk, but 28.6% of hospitals the anesthetic complications were explained by nurses or surgeons. In 76.2% of hospitals, the anesthetic risks were explained to both the patients and parents, but in 23.8% these were explained to parents only. CONCLUSIONS: We propose a new anesthetic informed consent form for adequate explanation and agreement to legal requirements.