[Patient dissatisfaction with anesthetic care].

BACKGROUND: The evaluation of services by patients is an essential component of quality improvement in anesthesiology. Therefore, it is important to identify the factors for patient dissatisfaction. METHODS: We retrospectively studied 9974 consecutive patients who had received spinal or general anesthesia for elective surgery between 1999 and 2002. Pre-anesthetic, intra-anesthetic and post-anesthetic variables were recorded and patient satisfaction was assessed using direct interviews at the post-anesthetic clinic. Qualitative data on dissatisfaction were obtained by asking patients' reasons for dissatisfaction. RESULTS: 348 of the 8843 respondents (3.9%) had dissatisfaction with anesthesia. The rates of dissatisfaction were higher in women than in men and in spinal anesthesia than in general anesthesia, and were observed mostly in the patients aged from 20 to 39 years. Qualitative data show that the common reasons for dissatisfaction with anesthesia were spinal anesthesia as the most dissatisfactory factor, followed by epidural anesthesia, postoperative pain, vomiting/nausea and memory of tracheal extubation. However, other various factors were associated with dissatisfaction. CONCLUSIONS: It is difficult for anesthesiologists to satisfy all patients, because patients' senses of values were varied. However, we conclude that anesthesiologists can improve the quality of anesthesia by enlightenment of the patient about anesthesia, and moreover, by better peri-anesthetic management for dissatisfactory factors with anesthesia.

[Evaluation of the different doses of olprinone for continuous infusion after cardiopulmonary bypass for coronary artery bypass surgery].

BACKGROUND: We evaluated the hemodynamic efficacy of combined cathecholamine and three different continuous infusion doses of olprinone (0.05, 0.1, 0.3 microgram.kg-1.min-1) in 24 cases (0.05 group: 8 cases, 0.1 group: 8 cases, 0.3 group: 8 cases) undergoing coronary artery bypass grafting (CABG). METHODS: Olprinone was administered as a single dose (0.1 mg.kg-1) into the venous reservoir of the CPB circuit 15 min prior to the end of emergence from CPB, followed by continuous infusion. Hemodynamics were measured at the time of preCPB (M 0), just after the end of CPB (M 1), pre chest closure (M 2) and after chest closure (M 3). Cathecholamines were used to maintain mean arterial pressure (> 65 mmHg) and cardiac index (> 3.0 l.min-1.m-2). Hemodynamics (at M 0, M 1, M 2 and M 3) and the number of cases requiring combined cathecholamine were compared among the 3 doses. RESULTS: Three doses showed no significant difference on hemodynamics. In the number of cases requiring combined cathecholamine, group 0.3 were significantly lower than group 0.05 at dobutamine, and group 0.05 were significantly higher than group 0.1 and 0.3 at norepinephrine. CONCLUSIONS: The higher continuous infusion dose of olprinone (0.3 > 0.1 > 0.05 microgram.kg-1.min-1) can diminish the number of cases requiring combined cathecholamine administration during coronary artery bypass grafting.