RESUMEN
BACKGROUND: Failed intubation remains one cause of anaesthesia-related morbidity and mortality. In a recent survey in Denmark, 20% of respondents reported preventable mishaps in airway management. METHODS: Assessment of the airway, and its documentation, as well as the availability of various equipment to manage a difficult airway, and the existence of a failed intubation plan were surveyed by mailing a questionnaire to the clinical directors of all 69 anaesthesia departments in Denmark. RESULTS: Fifty-six departments (81%) returned the questionnaire. Pre-operative airway evaluation is performed in 90% of the departments. The tests included the mouth-opening test (77%), Mallampati score (48%), lower jaw protrusion (34%), neck mobility (63%), the measurement of the thyromental (11%) and sternomental distance (4%). The result of the tests are documented by 38% of the departments in the anaesthetic chart (96%), in the record (54%), on a card given to the patient (23%), in a letter sent to the patient's general practitioner (2%) or in a database (13%). The patients are personally informed in 82% of the departments. Only 54% of the departments have a failed intubation plan readily available. CONCLUSION: The preoperative assessment of the airways and its documentation is still unsatisfactory, as is communicating with the patient after a case of a difficult/impossible intubation. The adoption of internationally recognized recommendations might improve airway management and teaching to the best standard possible in the already well-equipped Danish anaesthetic departments.
Asunto(s)
Anestesia , Intubación Intratraqueal , Respiración , Algoritmos , Servicio de Anestesia en Hospital , Dinamarca , Tecnología de Fibra Óptica , Humanos , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Máscaras Laríngeas , Laringoscopios , Mandíbula/fisiología , Registros Médicos , Movimiento , Cuello/anatomía & histología , Cuello/fisiología , Evaluación de Necesidades , Planificación de Atención al PacienteRESUMEN
To assess the use of sedatives, analgesics and neuromuscular blocking agents in patients requiring mechanical ventilation in Danish ICUs, questionnaires were mailed to all Departments of Anaesthesiology in Denmark. Forty-nine out of 53 hospitals responded (92.5%). All ICUs surveyed used both sedatives and analgesics for patients undergoing mechanical ventilation. Opioids, benzodiazepines and propofol were employed most commonly, in particular by continuous infusion. Neuromuscular blocking agents were used at 65% of the ICUs surveyed, but only rarely. Ninety-eight percent of the ICUs reported side effects, but for less than 20% of the patients, secondary to the sedative treatment. Most frequent side effects were delayed emergence and gastrointestinal disorders.
Asunto(s)
Analgésicos/administración & dosificación , Utilización de Medicamentos , Hipnóticos y Sedantes/administración & dosificación , Unidades de Cuidados Intensivos/estadística & datos numéricos , Bloqueantes Neuromusculares/administración & dosificación , Analgésicos/efectos adversos , Servicio de Anestesia en Hospital/estadística & datos numéricos , Dinamarca , Humanos , Hipnóticos y Sedantes/efectos adversos , Bloqueantes Neuromusculares/efectos adversos , Pautas de la Práctica en Medicina , Respiración Artificial , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To assess the use of sedatives, analgesics and neuromuscular blocking agents (NMBAs) in patients requiring mechanical ventilation in Danish Intensive Care Units (ICUs). DESIGN: Questionnaires were mailed in December 1996 to all Departments of Anaesthesiology listed in the Annual Directory of Danish Hospitals. The questionnaires asked about the use of sedatives, analgesics and NMBAs in patients on mechanical ventilation in the ICU. RESULTS: Forty-nine questionnaires were received from a possible 53 ICUs with ventilators (response rate 92.5%). Sedatives and analgesics were given to patients on mechanical ventilation at virtually all the ICUs surveyed (60% used the combination routinely). The frequency of use was influenced by both the level of ventilatory support and the type of underlying disease. Opioids, benzodiazepines and propofol were employed most commonly, in particular by continuous infusion. NMBAs were used in 65% of the ICUs surveyed in less than 20% of the total number of patients in the respective ICU. Overall 98% of the ICUs reported the occurrence of some kind of side effect secondary to the sedative treatment, but in most ICUs they were reported to occur in less than 20% of the patients. CONCLUSION: Sedatives and analgesics are widely used in patients requiring mechanical ventilation in Danish ICUs. NMBAs are only used in a few patients. The frequency of use is correlated to the level of ventilatory support required and to the kind of respiratory disease.
Asunto(s)
Analgésicos/administración & dosificación , Utilización de Medicamentos/estadística & datos numéricos , Hipnóticos y Sedantes/administración & dosificación , Unidades de Cuidados Intensivos/estadística & datos numéricos , Bloqueantes Neuromusculares/administración & dosificación , Sedación Consciente/estadística & datos numéricos , Dinamarca , Humanos , Respiración Artificial , Encuestas y CuestionariosRESUMEN
BACKGROUND: Recently, clinical reports have suggested a relationship between the occurrence of hyperalgesia, allodynia and/or myoclonus and treatment with high doses of morphine in humans. Although few clinical descriptions of these phenomena are available, experimental work supports the notion that high doses of morphine may play a pathogenetic role in the observed behavioural syndrome. METHODS: Six patients, four with malignant and two with chronic, non-malignant pain conditions, treated with moderate to high doses of oral, continuous intravenous infusion or intrathecal morphine developed hyperalgesia, allodynia and/or myoclonus. When the side-effects occurred, blood or CSF samples were taken and analyzed for contents of morphine, morphine-6-glucuronide (M-6-G) and morphine-3-glucuronide (M-3-G). RESULTS: When comparing the plasma and CSF concentrations from these patients with data from available literature obtained from patients not suffering from these side-effects, it was demonstrated that the values deviated in five patients. In all six patients, the side-effects disappeared after substituting morphine with other opioid agonists or after lowering the daily dose of morphine. CONCLUSION: These results may indicate that elevated concentrations of M-3-G in plasma as well as the plasma and CSF M-3-G/M-6-G ratios may play a pathogenetic role in the development of hyperalgesia, allodynia and myoclonus.
Asunto(s)
Analgésicos Opioides/metabolismo , Hiperalgesia/inducido químicamente , Derivados de la Morfina/toxicidad , Morfina/metabolismo , Mioclonía/inducido químicamente , Anciano , Femenino , Glucuronosiltransferasa/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Morfina/efectos adversosRESUMEN
A double-blind trial was undertaken to assess the effect of oxytocin on the duration of intestinal atony after cholecystectomy. Eleven pairs of patients were either given injections of oxytocin or placebo at regular intervals during the first and second postoperative day. Sequential analysis showed placebo as being more effective, regarding the time until flatus was passed.
Asunto(s)
Colecistectomía/efectos adversos , Motilidad Gastrointestinal/efectos de los fármacos , Oxitocina/farmacología , Adulto , Anciano , Método Doble Ciego , Femenino , Flatulencia/tratamiento farmacológico , Flatulencia/etiología , Humanos , Masculino , Persona de Mediana Edad , Oxitocina/administración & dosificación , Estudios ProspectivosRESUMEN
A case of primary aortoduodenal fistula of unknown origin in a 72 year old female is presented. The fistula was successfully treated by excision from the duodenum and direct suture of the aortic wall.
Asunto(s)
Aorta Abdominal/cirugía , Enfermedades Duodenales/cirugía , Fístula Intestinal/cirugía , Anciano , Femenino , HumanosRESUMEN
A case of primary retroperitoneal cyst in a woman aged 21 years is presented. The cyst, which contained 6.5 litres, was treated by total excision. The diagnosis, treatment and classification are briefly described.