ABSTRACT
OBJECTIVE: To assess the quality of the preadmission anaesthetic consultation prior to cardiovascular and thoracic surgery with a satisfaction inquiry. STUDY DESIGN: Prospective study with a questionnaire, extended over a period of two months. PERSONS: Patients and anaesthetists of the cardiothoracic surgical service. METHODS: The inquiry, which took place after completion of the consultation was achieved by a person non member of the staff. Anaesthetists were questioned on the medical content, its exhaustive character and its value for the patient's perioperative care. RESULTS: Out of the 273 patients included in the study, 121 agreed to answer the questionnaire. Participation in the study was more significant in older patients (58 +/- 20 vs 51 +/- 24 years) and following shorter waiting time (WT) [15 +/- 13 (0-60) vs 25 +/- 18 (0-66) min]. The duration of the consultation (DC) was not different between the two groups [29 +/- 12 (8-70) vs 31 +/- 14 (6-75) min]. However patients' participation increased when the DC exceeded by 0.6 the sum of DC and WT [DC > 0.6 (DC + WT)]. The analogic score (AS) assessing reduction in preoperative anxiety was 8.4 +/- 1.5 (2-10). Finally, 108 patients out of 121 considered to have been well informed about the anaesthetic [AS = 8.7 +/- 1.2 (4-10)], 113 considered the preadmission consultation as a useful procedure [AS = 8.6 +/- 1.5 (2-10)]) and for 41 a personalized follow-up by the same anaesthetist was valuable. Only three operations had to be postponed the day before surgery. One third of the anaesthetists considered that the consultation improved the clinical and therapeutic management of the patients. CONCLUSION: This inquiry showed that the preadmission anaesthesia consultation was considered as benefitful by patients and anaesthetists. However the participation of patients in this study was poor. Subsequently to the inquiry information forms have been produced and handed to the patient prior to the consultation.
Subject(s)
Anesthesiology , Attitude of Health Personnel , Cardiovascular Surgical Procedures , Patient Satisfaction , Referral and Consultation , Thoracic Surgical Procedures , Adolescent , Adult , Age Factors , Aged , Anxiety/prevention & control , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Care Planning , Patient Education as Topic , Physician-Patient Relations , Preoperative Care , Prospective Studies , Quality of Health Care , Surveys and Questionnaires , Time FactorsABSTRACT
OBJECTIVE: Whether intraoperative fluid infusion should contain glucose during pediatric cardiac surgery remains controversial. This study was performed to compare the effects of glucose and glucose-free solutions on blood glucose and blood insulin levels during total repair of congenital heart diseases. DESIGN: Prospective randomized and blinded study. SETTING: Cardiovascular university center. PARTICIPANTS: Forty nondiabetic children, weight ranging from 4 to 10 kg, scheduled for cardiac surgical procedures requiring cardiopulmonary bypass (CPB) without total circulatory arrest. INTERVENTIONS: Group R (n = 20) was administered lactated Ringer's solution intraoperatively, and group G (n = 20) received 5% glucose. Fluids were infused at a rate of 3 mL/kg/h in the two groups from the induction of anesthesia to the end of the surgical procedure. Blood glucose and insulin were sampled before infusion (Tzero), before CPB (T1), 10 minutes after initiation of CPB (T2), 10 minutes after initiation of rewarming (T2), and at the end of the procedures (T4). Postoperatively, blood glucose was measured at the first, 12th, and 24th hours. MEASUREMENTS AND RESULTS: During the prabypass period, three children in group R had severe hypoglycemia (blood glucose < 40 mg/dL). After initiation of CPB, blood glucose increased in both groups, with a small difference at the end of the procedure. No infants in the two groups had blood glucose higher than 239 mg/dL. CONCLUSIONS: Glucose withdrawal during pediatric cardiac surgery induces threatening hypoglycemia during the prabypass period, and moderate intraoperative glucose administration (2.5 mg/kg/min) is not responsible for major hyperglycemia.
