RESUMEN

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a common emergency. Currently, there are no agreed guidelines on the level of anaesthetic support required in patients undergoing acute esophago-gastro-duodendoscopy (EGD). METHODS: An online questionnaire comprising 19 questions was distributed to all members of the Danish Association of Anaesthesiology and Intensive Care (n = 1,418) and the Danish Society of Anaesthesiologists in Training (n = 566). The questions concerned clinical practice for anaesthesia care to patients undergoing EGD for suspected UGIB and availability of local guidelines. RESULTS: A total of 521 anaesthetists who had, on average, concluded medical school 14 years earlier (range: 9-27 years) answered the questionnaire. Of the responders, 65.5% (167/255; 95% confidence interval (CI): 59.7-71.3) had provided anaesthesia to five or more patients with suspected UGIB during the previous six months. 32.9% (110/333; 95% CI: 27.9-38.0) had a local guideline for this procedure. Rapid sequence induction was part of the guideline for 71.8% (79/110; 95% CI: 63.4-80.2) in case of general anaesthesia (GA). The preferred choice of anaesthesia was GA with endotracheal intubation (56.2%; 187/333; 95% CI: 50.9-61.5). CONCLUSIONS: We found considerable variation in daily clinical practice of anaesthesia for patients undergoing EGD for suspected UGIB. The fact that anaesthesia for UGIB is a complex emergency procedure may underline the need for development of an international or at least a national guideline. FUNDING: The study received financial support from Karner's Foundation, Denmark. TRIAL REGISTRATION: not relevant.

Asunto(s)

Anestesia/normas , Cuidados Críticos/normas , Endoscopía del Sistema Digestivo/normas , Hemorragia Gastrointestinal/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anestesiología/normas , Cuidados Críticos/métodos , Dinamarca , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Femenino , Humanos , Intubación Intratraqueal/normas , Masculino , Persona de Mediana Edad

RESUMEN

INTRODUCTION: The aim of this study was to investigate whether there was a difference in opioid usage during admission for hip fracture patients with continuous femoral nerve block (cFNB) when compared to patients nonfemoral nerve block (nFNB). METHODS AND MATERIALS: Patients were identified from the local database on all hip fracture patients admitted to Bispebjerg University Hospital, Denmark. Four hundred fifty-six hip fracture patients were included during the period September 2008 to October 2010. RESULTS: Three hundred sixty-six hip fracture patients had cFNB. The mean time with cFNB was 3.4 days. There were no significant differences in gender, length of stay, time to surgery, mortality rate, in-hospital falls, or resurgery rates during admission between the 2 groups. The nFNB group had an insignificant higher use of morphine as needed during the first 5 days of admission (nFNB: 53.1 mg, 95% confidence interval [CI]: 34.4-71.7; cFNB: 47.7 mg, 95% CI: 40.7-64.3; P = .54) and during the whole admission (cFNB: 34.3 mg, 95% CI: 23.2-45.5; cFNB: 30.3 mg, 95% CI: 26.6-33.0; P = .4). Some 8.47% of the total morphine consumption during admission was morphine as needed for the nFNB group and 9.89% for the cFNB group. CONCLUSION: Patients with cFNB did only have a marginally lower opioid usage during admission when compared to patients without the block, with no significance between the 2 groups. This could indicate that the cFNB is an ineffective analgesic strategy, especially in the postoperative period, but larger randomized studies are needed in order to clarify this.