Informed consent for anesthesia: survey of current practices in Japan.

Anesthesia requires informed consent because it is an invasive procedure with certain risks. However, the state of informed consent for anesthesia in Japan remains unclear. The purpose of this survey was to examine the state of informed consent for anesthesia in Japan. A questionnaire was sent to all hospitals certified by the Japanese Society of Anesthesiologists (n = 854). The questionnaire consisted of four sections: explanation of the anesthesia, method of documentation, consent for anesthesia, and other information such as the hospital's size. A total of 504 (59.0%) questionnaires were completed and returned. At 96.7% of hospitals, an anesthesiologist would explain the scheduled anesthesia. Most departments provide an explanation of dental damage, malignant hyperthermia, and nausea/vomiting. Explanation of anesthesia was standardized at 59.0% of hospitals. A written description was handed out to patients routinely at 61.3% of hospitals. Although consent for anesthesia was obtained at more than 90% of departments, only 59.9% of departments would keep records of having obtained consent. This survey found that the explanation of anesthesia varied among hospitals and was not standardized in Japan. Further attention is needed on how to improve the documentation of informed consent.

[Methodology of retrospective chart review to detect adverse events: the reliability of physician judgment].

PURPOSE: To establish a scientific basis for promoting patient safety, basic information related to the incidence of adverse events (AEs) is needed. In studies in several other countries, trained nurses screened for potential AEs using explicit criteria in the first stage, and physicians reviewed selected charts in the second stage. To assure the accuracy of retrospective chart review, it is important to verify the reliability of AE judgments by physician reviewers. The purpose of this study was to test this reliability of judgment of AEs (their presence, causation of healthcare management and preventability) by three physician reviewers. METHODS: This study used 100 selected charts of non-psychiatric inpatients in an acute care hospital. Three physicians independently assessed AEs and discussed their judgments with the physician who created the manual for judging AEs. We considered judgments of the AEs agreed on by the four physicians to be final AE judgments and compared the reliability of each measure related to AE judgments among the physician reviewers using the kappa statistic. RESULTS: The number of AE cases each physician reviewer judged ranged from 18 to 27. Agreement on the presence of an AE ranged from 83.0% to 90.0% (kappa=0.52-0.70). Ultimately, AEs were judged to have occurred in 16 cases while 7 cases were deferred. The agreement on the presence of an AE between the physician's and the final judgment ranged from 86.0% to 96.8% (kappa = 0.56-0.88). However, agreement on the causation of healthcare management and preventability between the physician's and the final judgment was not in the acceptable range. CONCLUSION: The reliability of each physician's judgments regarding the presence of an AE was satisfactory. However, the reliability of judgments related to the causation of health care management and preventability was not necessarily satisfactory. Therefore, it is considered important to judge causation and preventability based on discussion with clinical experts in the relevant field.

Effect of smoking on intraoperative sputum and postoperative pulmonary complication in minor surgical patients.

The effect of smoking for postoperative pulmonary complications (PPCs) in minor surgical patients who have an early recovery has not been evaluated. Smoking may also affect intraoperative sputum volume. We thus evaluated whether smoking had a relation to intraoperative sputum volume or PPCs in minor surgical patients. Smoking status was determined through the interviewer-assisted questionnaires. Intraoperative sputum volume was judged using the number of trials to suck up sputum from the trachea. Current and Ex-smokers were significantly more likely to have an increased intraoperative sputum volume when compared with Non-smokers (18.3% and 17.9% vs. 9.4%) although the relationship between smoking and PPCs was not demonstrated. In the multivariate models, Current and Ex-Smokers was identified as an independent risk factor of an increased intraoperative sputum volume (odds ratio, 2.7; 95% confidence interval, 1.6-4.6). The patients with < 2 months smoking cessation were more likely to have an increased intraoperative sputum volume. In conclusion, smoking is the risk factor of an increased intraoperative sputum volume, and preoperative smoking cessation > or = 2 months is recommended to reduce the risk of an increased intraoperative sputum volume, although the relationship between smoking and PPCs was not elucidated in minor surgical patients.

Preoperative droperidol improved postoperative pain relief in patients undergoing rotator-cuff repair during general anesthesia using intravenous morphine.

STUDY OBJECTIVE: To demonstrate the effect of preoperative and intraoperative, small-dose intravenous (IV) droperidol on postoperative pain relief in orthopedic patients given general anesthesia with morphine. DESIGN: Randomized, double-blind, prospective study. SETTING: University-affiliated hospital. PATIENTS: 84 ASA physical status I and II patients undergoing shoulder rotator-cuff repair with general anesthesia. INTERVENTIONS: Patients were randomly assigned to one of three groups: Group P (n = 27) wee given droperidol 10 microg/kg IV before skin incision; Group A (n = 30) received droperidol 10 microg/kg IV after skin incision; and Group C (n = 27) served as controls. General anesthesia consisted of sevoflurane and nitrous oxide in oxygen and IV morphine 0.2 mg/kg, which was given before skin incision. MEASUREMENTS: The degree of postoperative pain as assessed by postoperative pain scores and the number of supplemental analgesics given, and the frequency of postoperative nausea and vomiting, nightmares, and respiratory depression were compared among the three groups. A p-value < 0.05 was considered statistically significant. MAIN RESULTS: The postoperative pain score distribution was significantly greater in smaller values in Groups P and A than in Group C (p < 0.01). The number of supplemental analgesics given in the first 18 hours postoperatively was significantly smaller in Group P than in Groups A or C (p < 0.05). CONCLUSIONS: Preoperative IV droperidol resulted in improved postoperative pain relief inpatients undergoing shoulder rotator cuff surgery with general anesthesia using IV morphine.