[Anesthesiology consulting unit in perioperative medicine]. / Anestezjologiczna poradnia konsultacyjna w medycynie okolooperacyjnej.

There is a demand, caused by increase of one-day surgery, surgery of high risk patients with coexisting diseases, and growing need for patient education, for such improvement of preoperative preparation, which will enable an optimalization in patient care. That became a special task of Preanesthetic Evaluation Clinic. The aim of the paper was to analyze activity of local Preanesthetic Evaluation Clinic in years 1993-2000. Special emphasize was put on: assessment of Clinic functioning, with regard to variety of consultations, perioperative patient education, use of perioperative risk scales, processing of guidelines of laboratory tests in particular groups of patients, assessment of perioperative fear factors. Analyze of consultations was conducted using custom design computer program, operated in the "Clinic since" 1997. Discussing own experiences, a necessity of patient education was emphasized as a significant factor lowering perioperative fear. There was also a presentation of perioperative risk assessment methods as well as guidelines of laboratory tests improving clinical effectiveness. Information for patients, prepared in the Clinic "What should you know about anesthesia" was described. As conclusions perspectives of further development of the Clinic were shown. Growing significance of an anesthetic nurse in perioperative patient preparation was foreseen. A demand for improving electronic patient records as well as use of new technologies was proven.

[Perioperative sedation and analgesia for complications from arthroscopy and arthrotomy of the knee joint]. / Sedacja i analgezja okolooperacyjna do zabiegów artroskopii i artrotomii stawu kolanowego.

Estimation of the quality of the epidural anaesthesia of the patients sedated with Alprazolam and Midazolam in premedication before arthroscopy or arthrotomy of the knee was the goal of our study. Forty six (34 men and 12 women) ASA physical status 1-2 patients were divided into groups depending on the drugs orally applied in premedication (Alprazolam 0.5 mg, n = 29 or Midazolam 15 mg, n = 17) and of the kind of analgesia. The patients subjected to arthroscopy were treated with a single-shot epidural analgesia (n = 38), while those subjected to arthrotomy--with a continuous epidural analgesia (n = 8). 2% Lignocain with addition of Epinephrine and Fentanyl was used in the perioperative analgesia, while 0.25% Bupivacain with addition of Morphine was used in the postoperative period when continuous epidural analgesia was applied. The ISAS, VAS and Ramsey scales were used and the data were analysed with the Kormogolov test. The perioperative sedation in arthroscopy and arthrotomy of the knee is good without any significant differences associated with a kind of the drugs applied. The single-shot epidural anaesthesia is inadequate only during a prolonged arthroscopy of the knee. The postoperative continuous epidural analgesia, expressed in the VAS scale, was inadequate. A level of general satisfaction of the patients of the sedation and analgesia, expressed in the points of the ISAS scale, was satisfactorily good.