PubMed Health⌕ Search

Biomedical subjects

M G Barneschi

Publications and source records attributed to M G Barneschi.

10 recordsLinked to original sources
PubMed2002

Informing patients about risks and complications of anaesthesia.

BACKGROUND: This study examines the quality of patients' informed consent in patients undergoing minor surgical procedure. Information provided on risks and complications inherent in anaesthesia-care and patients' awareness of specific risks involved in anaesthesia were recorded, and the influence of a questionnaire-form was evaluated. METHODS: This is a prospective controlled study. In the first part (Group I: n=71) social and demographic data, complications and risks communicated to the patient in the preanaesthetic evaluation, as well as patients' satisfaction with the information obtained, were noted. In the second part of the study (Group II: n=201) patients were also asked to answer a questionnaire form concerning their own state of health and their knowledge of risks in anaesthesia. The statistical analysis was conducted using Pearson's Chi square test or t test, and by fitting suitable logistic models. RESULTS: The frequency of the communication of at least one of the risks and complications of anaesthesia has been 43.7% in GI and 59,7% in GII, p=0.019. Patients in class ASA III were informed more (77%, c.i. 59-90) as compared to those in class ASA I-II (52%, c.i. 45-59) (p=0.008); 37% in class ASA I-II and 65% in class ASA III desire the presence of one of their relatives during the preassessment (p=0.016). CONCLUSIONS: Our results indicate that most patients are glad to be informed, even if they are unaware of the risks and complications of anaesthesia. The questionnaire form seems to be an important tool for patient education. Ethical questions are proposed.

Anesthesia↗
PubMed2001

[Sevoflurane in stop-flow interventions. Hemodynamics study].

BACKGROUND: The so called stop-flow operation is based on locoregional perfusion with an antiblastic hypoxic solution of the region invaded by malignant tissue. Cardiocirculatory complications are common, mainly consisting of reduction of cardiac index, increase of arterial pulmonary pressure, systemic vascular resistance and heart rate. Sevoflurane has been used for its stable hemodynamic profile to reduce cardiocirculatory troubles. METHODS: Six patients were submitted to stop-flow operation. General anaesthesia was performed with Sevoflurane 1 MAC in Air/O2. The following parameters were recorded: nitroglycerin infusion m order to maintain the position of the balloon of the catheters, arterial oxygen saturation, end-tidal carbon dioxide, mean arterial pressure, central venous pressure, arterial pulmonary pressure, heart rate and mixed oxygen venous saturation; recordings were performed before stop-flow (T1), during stop-flow (T2) and 10' after reperfusion (T3). RESULTS: Before stop-flow (T1) all the parameters were normal. At T2 heart rate, cardiac index and pulmonary capillary wedge pressure increased whilst mean arterial pressure, systemic vascular resistance and pulmonary vascular resistance decreased. Ten minutes after the end of perfusion (T3) absence of variations in systemic vascular resistance, in pulmonary vascular resistance, in pulmonary capillary wedge pressure, in cardiac index and in mixed oxygen venous saturation were noticed. Heart rate and central venous pressure showed a tendency to decrease. CONCLUSIONS: The hemodynamic profile during stop-flow appears to be stable with general anaesthesia with Sevoflurane.

Aged↗
PubMed1999

Informed consent and patient participation in the medical encounter: a list of questions for an informed choice about the type of anaesthesia.

The present study was undertaken to evaluate the impact of a new procedure for eliciting informed consent by patients undergoing minor surgical procedures, in which the choice between general anaesthesia (GA) and regional anaesthesia (RA) was possible. In this prospective study, two randomly selected groups of patients were compared: study group (SG), 52 patients, received from the nurse before the preoperative interview, a list of seven questions, which they were invited to ask the anaesthetist; while the control group (CG), 73 patients, did not receive any suggested questions. There were two end points: the proportion that chose RA and the number of questions actually addressed to the doctor at the preanaesthetic interview. Psychological aspects were taken into account by collecting the Hospital Anxiety and Depression (HAD) scale before the preanaesthetic interview. Satisfaction with the interview was recorded using a telephone questionnaire 2 weeks after the operation. The results from the two groups were compared by calculating the odds ratio according to Mantel-Haenszel and by logistic analysis. Altogether, 71.2% of the patients chose RA without any difference between the groups. The average number of questions asked by each SG patient was higher than for the CG (1.67 vs. 0.96). The satisfaction level was similar in the two groups. Our list of questions was designed to facilitate patient autonomy. It offered an aid to those requesting more information and assisted communication. The method did not change the proportion who chose a specific kind of anaesthesia, but does seem to improve patient participation in the decision-making process.

Adult↗
PubMed1995

Peri-operative assessment of glomerular permeability.

Surgical trauma may provoke an increase in glomerular permeability. Microalbuminuria is a subclinical increase in urinary albumin ranging from 20 to 300 mg..-1. This cannot be measured with routine laboratory tests and is estimated by radioimmunoassay. It has been proposed that microalbuminuria, an expression of increased glomerular permeability, serves to reflect a generalised increase in systemic vascular permeability. In this study the degree of microalbuminuria (expressed as microalbuminuria/creatinine ratio to correct for dilutional changes) has been measured in two groups of patients undergoing either videolaparoscopic surgery (group A) or conventional, open, abdominal surgery (group B). The anaesthetic technique was standardised and the duration of surgery similar in the two groups. A significant increase (p < 0.01) in the microalbuminuria/urinary creatinine ratio occurred in patients undergoing open abdominal surgery (group B). This alteration appeared 2 h after surgery but had disappeared 24 h after the end of the operation. During surgery, there was a direct relationship between glomerular permeability and the severity of the surgical insult.

Abdomen↗
PubMed1994

[Effect of dopexamine in splanchnic perfusion during surgery of the abdominal aorta].

Abdominal aortic surgery has significant effects on cardiac and splanchnic perfusion. The purpose of this study was to examine the effects of dopexamine, an inodilator drug, on hemodynamic and splanchnic perfusion with measurement of gastric intramucosal pH, by the method of gastric tonometry, during abdominal aneurysm resection. Twenty-five patients undergoing excision of an aortic abdominal aneurysm were randomly divided into two groups. During aortic cross-clamping Group II patients received dopexamine infusion, at a dose of 1 microgram/kg/m, and at a dose of 0.5 micrograms/kg/m from declamping to the end of the surgery. Whereas Group I patients did not receive a dopexamine infusion. During aortic cross-clamping the intramucosal pH value decreased in Group I patients, but did not change in Group II patients. Heart rate, cardiac index, and mixed venous oxygen saturation increased significantly during dopexamine infusion, whereas systemic vascular resistance was reduced. During aortic cross-clamping dopexamine was a useful agent in improving splanchnic blood flow, cardiac index venous saturation. Also, since the drug produces dose related hemodynamic changes of rapid onset and reversibility, it is possible to interrupt the infusion before aortic declamping to avoid the decrease in the intramucosal pH value.

Aged↗
PubMedDate not supplied

[The desire for information and informed consent in general anesthesia].

BACKGROUND: In the last years the interest for Informed Consent (IC) in anaesthesia has been growing and it has been debated on the adequate explanations in order to obtain a consent. The purpose of the present study was to assess patients' desire for information about anaesthesia. METHODS: In this prospective study a form has been given to consecutive patients waiting for surgical operation in general surgery or ear nose throat surgery and able to read and write, to inform them about the necessity of General Anaesthesia (GA); they were asked to complete a questionnaire concerning their desire for information about the following six items concerning anaesthesia: "the duration of anaesthesia"; "what type of pain will I have when I come round, and what pain-killers will I be given"; "details on the various types of anaesthesia, how and where will I be anaesthetized"; "what are the most common complications of general anaesthesia"; "where and how will I come round from general anaesthesia"; "what is artificial respiration in general anaesthesia". RESULTS: 107 patients participated in the study, 24 of whom were undergoing surgery for malignant cancer and 83 for benign non-oncological diseases. More than two-thirds of patients expressed their wish to receive information, and the trend of desire to know was inversely related to age (p < 0.05). There was no significant statistical difference in the desire to know according either to sex or to the kind of disease (benign or malignant). The demand for information about pain was particularly high (85%), also in the older group of patients. The results and the difficulties for obtaining IC are debated. CONCLUSIONS: The growth of patients' desire for information about anaesthesia is an aspect of the evolving doctor-patient relationship in Italy. Efforts should be directed at improving reciprocal communication.

Anesthesia↗