RESUMEN
OBJECTIVE: To assess the duration and total number of anesthetic exposures required for the treatment of urolithiasis during pregnancy, specifically comparing temporizing measures with active treatment because urolithiasis and its management may pose potential theoretical risks for the mother and fetus. MATERIALS AND METHODS: We retrospectively reviewed patients with a confirmed diagnosis of urolithiasis during pregnancy who underwent surgical intervention from 1997 to 2012 at our institution. The number and duration of anesthetic exposures were assessed. RESULTS: We identified 26 women with urolithiasis during pregnancy, of which 15 (58%) were treated with temporizing stents and 11 (42%) with ureteroscopic stone extraction. In the ureteroscopy group, the median number of anesthetic exposures was 1.18 (interquartile range [IQR], 1-2), and the median total anesthetic time was 80 minutes (IQR, 37-126 minutes). In the stent group, 6 (40%) required multiple stent exchanges for a median of 1.47 (IQR, 1-3) anesthetic events and a median total anesthetic time of 70 minutes (IQR, 29-208 minutes). In the ureteral stent group, 7 women (47%) were induced before spontaneous labor due to inability to tolerate the stent. There was no difference in the number of anesthetic events (P = .208) or anesthesia time (P = .503) between stenting and ureteroscopy. CONCLUSION: Women undergoing ureteroscopic surgical intervention during pregnancy were at no greater risk in the number or cumulative duration of anesthesia exposure than women managed with temporizing ureteral stent placement and subsequent exchanges.
Asunto(s)
Anestesia/métodos , Anestésicos/administración & dosificación , Complicaciones del Embarazo/cirugía , Resultado del Embarazo , Ureteroscopía/métodos , Cálculos Urinarios/cirugía , Adulto , Análisis de Varianza , Anestesia/efectos adversos , Anestésicos/efectos adversos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Embarazo , Complicaciones del Embarazo/diagnóstico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Stents , Factores de Tiempo , Resultado del Tratamiento , Cálculos Urinarios/diagnósticoRESUMEN
The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.