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Introduction: The preanesthetic evaluation, documenting it and maintaining the record is the responsibility of anesthetist. Better documentation practices can improve the patient's outcome. It has the pivotal role in medicolegal aspects. However, the documentation is one of the challenges when it comes to quality of care. The objective of the study was to assess the practice of documentation at preanesthetic evaluation and completeness of Preanesthetic evaluation tools. The descriptive study was conducted in tertiary care hospital. Modied global quality index (GQI) isMethod: used to prepare the Predefined twenty-two indicators. The data analysis is done using SPSS version-20. A total ofResult: 300 pre-anesthetic evaluation tools (PAETs) were reviewed. There was different trend in terms of completion rate for elective and emergency cases. However, there was no PAETs found complete. Indicators with high completion rate (>90%) were signed a consent, past medical history (PMH), history of medication, allergy, surgical procedure, cardiovascular examination, airway examination and respiratory examination. Anesthetic plan, premedication, vital signs, a name, per-oral status and age were found with below average (<50%) completion rate. andConclusion recommendations: Documentation during the preanesthetic visit observed below the standard. Which need to be standardized for uniformity. Use of electronic system with prefilled formats and training of personnel involved in the process is the way forward
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Enhanced Recovery After Surgery (ERAS) has been well-accepted and popularized in many surgeries but not in the field of trauma orthopaedics except in senile hip fractures for which relatively fast progress has been made in ERAS.Senile hip fractures have been regarded as important as stroke and myocardial infarction in discussion of emergency management due to tremendously changed understanding of the injury in the elderly,indicating the importance of ERAS for this population.The key point to ERAS for senile hip fractures is to optimizing peri-operative management so as to reduce surgical risks,improve surgical safety and enhance patients' satisfaction.The optimal peri-operative management involves proper surgical timing,nutritional support,management of pain and sleep,prevention of infection and venous thromboembolism,optimal application of drainage tubes and urinary catheters,and functional rehabilitation as well.This article reviews the literature concerning peri-operative management of senile hip fractures in the light of ERAS,and summarizes the strategies for the peri-operative management for the elderly patients.
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Congenital diaphragmatic hernia occurs 1 in 2500 births, when the abdominal contents protrude through the patent pleura-peritoneal canals in the diaphragm, leading to maldevelopment of the alveoli and pulmonary vessels. CDH is associated with high mortality, and the probability of survival was found to be low in the presence of any other associated congenital abnormality, worse with cardiac defects. We successfully managed a 2-day-old neonate born in our facility with left congenital diaphragmatic hernia presenting with immediate postnatal respiratory distress, and delayed repair of the defect was carried out - through an open trans-abdominal approach with good outcome; the neonate survived to hospital discharge without any complication.
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Objective To retrospectively analyse the clinical data of off-pump coronary artery bypass grafting surgery(OPCAB)in our department and summarize the clinical experience of peri-operative management.Methods From January 2007 to May 2008,253 patients underwent OPCAB.Seventy-six cases with left main disease(including 18 cases of single left main lesion and 58 cases of complex lesion);13 cases had single vessel disease;32 cases had double vessels disease and 190 cases had triple vessels disease.Eighteen cases received emergency OPCAB.All vessel anastomosis were performed with coronary artery stablizer and shunt through median sternotomy.Resuits Three cases died after operation(1.2%).Intra-aortic balloon pump was used in 11 cases.Mechanical ventilation time was 3-168 h[(24.1±22.3)h],and ICU stay time was 1-14 day[(2.8±2.0)d].Postoperative hospital stay time was 8-42 days[(15.6±6.3)d].Conclusion OPCAB is reliable for most bypass cases.With appropilate peri-operative management,a satisfied result will be acceptable.
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Objective To study the protective effects of ulinastatin and tumor necrosis factor-?(TNF-?) antibody on ischemia and reperfusion injury of liver in rats. Methods One hundred and twenty male SD rats were randomly divided into four groups: the normal control group, ischemia and reperfusion group, TNF-? antibody group and ulinastatin plus TNF-? antibody group. And the animals were killed after 60 minutes ischemia of liver followed by reperfusion for 1,3,6 and 12 hours. Serum alanine aminotransferase(ALT) and malondialdehyde(MDA) were detected, and liver histopathologic lesions were observed. Results After ischemia and reperfusion, the serum level of ALT and MDA remarkedly increased, and the hepatic congestion was prominent. Treatment of ulinastatin and TNF-? antibody could decrease the serum level of ALT and MDA significantly, and relieve hepatic congestion. Conclusions Ulinastatin and TNF-? antibody can suppress the inflammatory reaction induced by hepatic ischemia and reperfusion, and has protective effects on rat hepatic ischemia and reperfusion injury.