ABSTRACT
In a retrospective study, all patients having anaesthetic procedures within a 3-month period were identified and followed up to establish if they had further procedures within a calendar year. The procedures undertaken on these patients were then identified to establish if a relationship existed between the procedures and what that relationship was. 11% of all patients returned for further procedures, 80% of which were within the same surgery specialty. In the overwhelming majority, the subsequent procedures were related to the first either as planned courses of treatment or by complications of the surgery or the disease process. The relationship between the procedures and their time intervals is discussed.
Subject(s)
Postoperative Complications/surgery , Reoperation/statistics & numerical data , England , Female , Gynecologic Surgical Procedures/statistics & numerical data , Humans , Obstetric Surgical Procedures/statistics & numerical data , Postoperative Period , Retrospective Studies , Specialties, Surgical/statistics & numerical data , Urologic Surgical Procedures/statistics & numerical dataABSTRACT
We have described a method for control of end-tidal carbon dioxide tension during intermittent positive pressure ventilation in a model lung and in 19 adults during general anaesthesia supplemented by central or peripheral neural blockade. The inspiratory and expiratory limbs of an open or a circle anaesthesia system were interconnected and ventilated simultaneously in a variable manner during inspiration. The flow of mixed-expired gas, normally one-way, became to-and-fro (variable functional apparatus deadspace, or "virtual' deadspace). At minute volume ventilation > or = 100 ml.kg-1.min-1 (patients), the value of end-tidal carbon dioxide tension was varied reproducibly within the range 4.1-6.5 (SD 0.1)kPa independently of fresh gas flow or other prescribed patterns of ventilation. At a steady state, stable nominated values of end-tidal carbon dioxide tension within the range were attained. By how much any given intra-operative value of end-tidal carbon dioxide tension may be said to affect peri-operative outcome is debatable, but during surgery any change in a nominated value may usefully indicate a change in the steady state.
Subject(s)
Carbon Dioxide , Intermittent Positive-Pressure Ventilation , Tidal Volume , Adult , Anesthesia, General , Anesthesiology/instrumentation , Humans , Respiratory Dead SpaceABSTRACT
The predicted outcome of anaesthesia and surgery was compared with the immediate outcome in 508 patients by means of two 100 mm linear analogue scales. The results were used to obtain a statistically based rule by which the anaesthetist may consistently select three groups of patients for audit: group 1, patients in whom immediate outcome of anaesthesia and surgery is worse than predicted; group 2, patients whose outcome is better than predicted; and group 3, the remaining patients. The rule, which is simply adapted to departmental audit, does not necessarily need a computer but is suited to the computer as it is numerically based.
