[Documentation problems in anesthesiology and gynecology?]. / Dokumentationsproblem i anaestesiologi og gynaekologi?

INTRODUCTION: The number of beds in surgical wards is declining. Whether the reason is more outpatient surgery or quicker recovery, owing to better perioperative care is unknown. MATERIALS AND METHODS: A questionnaire was sent to all gynaecological and anaesthetic departments in Denmark concerning the treatment of women who had had a hysterectomy for non-malignant disease. The following questions were asked: What were the numbers of patients operated on in 1998, the methods of operation, duration of admission, the surgeon in charge, information about admission and postoperative management of patients, choice of anaesthesia and treatment of postoperative pain. RESULTS: The chief surgical method was abdominal hysterectomy. There were relatively few vaginal or laparoscopically assisted hysterectomies. The duration of admission varied considerably. Patients mostly were given written information about admission and the postoperative course. Postoperative follow-up was relatively uncommon. The duration of admission was not influenced by the anaesthetic method. Seventeen of 31 anaesthetic departments knew the number of patients anaesthetised for hysterectomy in 1998 and the anaesthetic methods. DISCUSSION: This study cannot answer the question: How does the method of operation, choice of anaesthesia, postoperative analgesia, and information to the patient affect the duration of admission? Data allowing a discussion of the quality of the treatment were not available. There is a serious lack of registration.

Effect of felodipine on renal function and vasoactive hormones in infrarenal aortic surgery.

We have examined the possible renoprotective effect of felodipine 5 mg orally, given daily for 5 days before operation, in 29 patients undergoing elective infrarenal aortic surgery in a randomized, blinded and placebo-controlled study. Effective renal plasma flow (ERPF), glomerular filtration rate (GFR), urine output, fractional sodium clearance and plasma concentrations of angiotensin II, aldosterone, arginine vasopressin and atrial natriuretic peptide did not differ between the felodipine and placebo groups. ERPF and GFR were not reduced after operation in the placebo group. In the felodipine group, GFR was higher 24 h after operation compared with before operation. We conclude that increased GFR in the felodipine group, measured 24 h after operation, may indicate a beneficial effect of felodipine but in the present context this was not clinically important. Felodipine had no significant effect on vasoactive hormones.

A randomised, clinical study of the effect of low-dose dopamine on central and renal haemodynamics in infrarenal aortic surgery.

OBJECTIVE: To determine whether dopamine prevents deterioration of central haemodynamics and renal function in aortoiliac surgery. DESIGN: Prospective, randomised and placebo-controlled. SETTING: University hospital. MATERIALS: Thirty patients for elective vascular surgery with implantation of an aortobifemoral or an aortobiiliac graft due to aortoiliac arteriosclerosis had infusion of dopamine 3 micrograms/kg/min or placebo during the operation and 24 h postoperatively. Thoracic epidural analgesia and general anaesthesia were used. CHIEF OUTCOME MEASURES: Central haemodynamic measurements were registered. The effective renal plasma flow (ERPF), the glomerular filtration rate (GFR), angiotensin II, aldosterone, arginine vasopressin (AVP), atrial natriuretic peptide (ANP), endothelin and excretion of water and electrolytes were measured preoperatively, 1 h postoperatively and 24 h postoperatively. MAIN RESULTS: During the operation the dopamine group had higher cardiac index and heart rate together with lower pulmonary artery wedge blood pressure. ERPF and GFR did not differ between the groups. In the dopamine group ERPF was increased in all patients at the first postoperative clearance. The fractional excretion of sodium, the per- and postoperative diuresis and AVP were increased in the dopamine group as compared to the placebo group. Postoperatively, ANP in the placebo group was raised as compared to the preoperative level. CONCLUSIONS: Peroperatively, dopamine counteracted depression of left ventricular function. The increased ERPF at the first postoperative clearance in the dopamine group indicates either improved peroperative haemodynamics or a synergistic effect between dopamine and epidural sympathetic blockade. Dopamine also improved diuresis and natriuresis.