ABSTRACT
The prevention of post-operative risk of venous thrombo-embolism (VTE) is of fundamental importance, but preventive methods have progressed with the introduction of direct oral anticoagulants (DOAC), the development of ambulatory surgery and enhanced recovery programs (ERP) after surgery. Surgery is, inherently a trigger for venous thrombo-embolic disease, as is prolonged immobilization. However, the risk of VTE is very low following ambulatory surgery, especially in this selected population. ERP, consists of a set of measures to optimize the patient's peri-operative management while reducing length of stay, costs and morbidity and mortality; one measure is the encouragement of early ambulation. This will undoubtedly have an impact on the incidence of VTE and lessen the need for prolonged thrombo-prophylaxis.
Subject(s)
Anticoagulants/therapeutic use , Early Ambulation/methods , Patient Safety , Postoperative Complications/prevention & control , Venous Thromboembolism/prevention & control , Adult , Ambulatory Surgical Procedures/standards , Ambulatory Surgical Procedures/trends , Female , Humans , Length of Stay , Male , Middle Aged , Operative Time , Postoperative Care/methods , Pulmonary Embolism/prevention & control , Risk Assessment , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the risk of over-inflation of endotracheal tube cuffs (ETC) when used with nitrous oxide (N(2)O); to assess the rate of under and over-inflation of ETC when they are inflated without a manometer; to survey anesthesiologists about how they prevent these risks. METHODS: Nine types of endotracheal tube were studied on bench using various N(2)O concentrations; airway pressure levels and two sizes of trachea. Then, the rate and magnitude of over and under inflation pressure of ETC was assessed in our clinical practice. Finally, a national survey assessed how anesthesiologists prevented misuse of endotracheal tube with N(2)O. RESULTS: Pressure in ETC rose sharply using N(2)O, up to more than 40 cmH(2)O in six over nine tube types. Only two tube types (Mallinckrodt Hi-Lo Brandt and Lanz) were immune regarding N(2)O. Pratice study showed that ETC over inflation (>30 cmH(2)O) and under inflation (<20 cmH(2)O) was observed in 50 and 31 % of patients, respectively when cuff was inflated without a manometer. In France, a minority of anesthesiologists inflated ETC with a manometer (41 %) because in 61 % of theatres only manometers were available. CONCLUSION: There are risks induced by the use of N(2)O with tracheal tubes. This study provides data to sensitize users to these risks.
