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S Fasting

Publications and source records attributed to S Fasting.

9 recordsLinked to original sources
PubMed2002

Equipment problems during anaesthesia--are they a quality problem?

BACKGROUND: Anaesthesia equipment problems may contribute to anaesthetic morbidity and mortality. The magnitude and pattern of these problems are not established. We wanted to analyse the frequency, type and severity of equipment-related problems in our department, and if additional efforts to improve safety were needed. METHODS: The study is based on a system in which anaesthesia-related data are recorded from all anaesthetic cases on a routine basis. The data include intraoperative problems and their severity. When a problem occurs, the anaesthetist responsible for the case writes a short description of the event on the anaesthetic chart. From all recorded cases of general and regional anaesthesia, we selected cases recorded with anaesthetic 'equipment/technical problems'. These charts were retrieved from departmental archives for analysis. RESULTS: From 83 154 anaesthetics, we found the frequency of anaesthetic equipment problems to be 0.05% during regional anaesthesia, and 0.23% during general anaesthesia. One-third of problems involved the anaesthesia machine, and in a quarter, human error was involved. No patient died and none suffered any lasting morbidity. CONCLUSION: The rate of equipment problems was low, and most often of low severity. Aside from improvements in routines for preoperative equipment checks, no specific strategies for problem reduction could be suggested. The incidence of equipment problems is not a good quality indicator because of the low rate of occurrence. However, recorded equipment problems may be useful for improving quality, by analysing causative factors, and suggesting preventative strategies.

Anesthesia↗
PubMed2000

Adverse drug errors in anesthesia, and the impact of coloured syringe labels.

PURPOSE: To describe the frequency and pattern of drug errors in clinical anesthesia, and to evaluate whether a change to colour coded syringe labels, along with education, could reduce the problem of drug errors. METHODS: We prospectively recorded anesthesia-related information from all anesthetic cases for 36 mo, totally 55,426 procedures. Intraoperative problems, including drug errors, were recorded. After eighteen months we changed to colour coded syringe labels, and the effect of this change and education on drug errors was assessed. Errors were divided into four groups: syringe swap, ampoule swap, other 'wrong drug' errors, and wrong dose errors. The problems were graded into four levels, according to severity. RESULTS: A drug error was recorded in 63 cases (0.11%). There were 28 syringe swaps, and muscle relaxants were erroneously given in 15. There were nine ampoule swaps. There were eight 'other wrong drug' cases, and 18 cases where a wrong dose of the correct drug was given. Three of the drug errors were classified as serious, and 27 were of moderate severity. We found no differences between the two periods except for decreased number of ampoule swaps (P = 0.04). CONCLUSION: Drug errors are uncommon, and represent a small part of anesthesia problems but still have the potential for serious morbidity. Syringe swaps occurred most often between syringes of equal size, and were not eliminated by colour coding of labels. As muscle relaxant drugs are most commonly involved, and can cause lasting morbidity, special preventive measures should be taken for this group of drugs.

Adult↗
PubMed1999

[Ultrasound guidance for placement of central venous catheters].

Central venous cannulation is associated with a number of serious complications like arterial punction and pneumothorax and with discomfort for the awake patient when repeated attempts are made. Ultrasound guidance during cannulation has been shown to reduce complications, increase the success rate and thus reduce the need for multiple catheter placement attempts. We describe two methods using ultrasound for central venous cannulation and we recommend the use of ultrasound guidance, particularly in high-risk patients.

Carotid Artery, Internal↗
PubMed1998

Changing preoperative fasting policies. Impact of a national consensus.

BACKGROUND: Liberalisation of preoperative fasting rules has been discussed and recommended in the anaesthesia literature in recent years. In Norway, a national consensus on this issue was reached in 1993. The aim of the present study was to investigate whether a national consensus on fasting recommendations led to a change in fasting policies in Norwegian anaesthesia departments. METHODS: A questionnaire on preoperative fasting routines was sent to all Norwegian anaesthesia departments in 1993 and repeated in 1996. RESULTS: Written local guidelines for preoperative fasting were present in 85% of the institutions in both surveys. Of the hospitals, 69% had changed their local guidelines after the national consensus. In 1996 more hospitals allowed less than 6 h fasting for clear liquids in children (93% versus 71% in 1993; P < 0.005). A similar tendency was noted in adults (79% versus 63% in 1993; P = 0.1). In contradiction to the national guidelines, 31% of the departments reported that they allowed less than 6 h fasting after a light breakfast in the morning of surgery in 1996. The corresponding number for 1993 was 21% (ns). CONCLUSION: The new, consensus-based national fasting guidelines have been associated with a change towards more liberal fasting policies in Norwegian departments of anaesthesia. However, as not all local changes were supported by the national consensus, other sources of information were used when local policies were decided.

Adult↗
PubMed1996

Data recording of problems during anaesthesia: presentation of a well-functioning and simple system.

BACKGROUND: As quality assurance, risk analysis and documentation become more important, rapid access to accurate information of departmental activity is needed. In this paper we describe a system for routine data recording of anaesthesia-related information, and we give examples of how this information can be used. METHODS: For each anaesthesia procedure we record 20 variables in a database. The variables are related to the patient, the procedure, and the anaesthesia. Both the type and severity of intraoperative problems are recorded. All information is routinely written on the standard anaesthetic chart, and later entered into a database. All charts are quality checked before data entry. RESULTS: With small modifications, we have used this system for 10 years, and it is well integrated as part of our departmental routine. From 1985 to 1995 we have recorded an increased incidence of 'minor' intraoperative problems, while the increase in 'severe' problems has been small. During the period 1993-95 the total problem incidence has been stable at around 14%. We have found the incidence of problems related to technical equipment to be 0.14%, and of 'minor' severity, and therefore equipment failure has not warranted extensive quality assurance efforts. We also investigated the impact of our routines for gastric emptying of non-fasting patients, and found an incidence of pulmonary aspiration of 0.03%. Our results made us conclude that our recommendations concerning anaesthetic technique and gastric emptying are safe. The system has proven to be simple enough to be practicable, and yet detailed enough to be informative for educational, quality assurance, research and administrative purposes. CONCLUSION: A simple database for information related to anaesthetic care and problems can be a useful tool for anaesthesiology departments. We have used the system for a variety of quality assurance efforts, for educational and administrative purposes and in research. To get reliable data it is important to keep the system simple, with the information recorded kept to a minimum. The software chosen must make it possible for people within the department to write and modify reports. A constant focus on data quality is important, and motivated nurses and doctors as well as leadership enthusiasm are necessary to make the system work properly. The atmosphere of problem recording should be one of 'openness and confidence', rather than 'inspection and control'.

Anesthesia↗
PubMed1996

Routine preoperative gastric emptying is seldom indicated. A study of 85,594 anaesthetics with special focus on aspiration pneumonia.

BACKGROUND: The aim of this study was to determine the incidence and severity of pulmonary aspiration of gastric contents during anaesthesia, to determine the short- and long-term morbidity, and to evaluate present routines for preoperative gastric emptying. During the study period, preoperative gastric emptying was done only when intestinal obstruction was suspected. METHODS: We routinely record prospectively all problems during and after anaesthesia by means of a database. All data for the 5 years from 1989 to 1993, a total of 85594 anaesthetic procedures, were analyzed. The hospital charts were also reviewed for those patients where aspiration to the lungs had occurred. RESULTS: Pulmonary aspiration of gastric contents was detected in 25 cases; all occurred in patients receiving general anaesthesia. The incidence was 4.1 times higher in emergency procedures than in electives. There were no aspirations in 30199 patients receiving regional anaesthesia. The complication occurred in all phases of anaesthesia, but clinical morbidity was low in most cases. Three cases showed serious morbidity immediately after the event, but recovered. Two cases showed serious long-term morbidity, but also recovered completely. No patients died. No cases, except possibly one, might have been prevented by stricter routines for preoperative gastric emptying. CONCLUSION: We found a low incidence of pulmonary aspiration. When it occurs, it carries a low risk for serious morbidity. Emergency cases for general anaesthesia are most at risk. Regional anaesthesia is considered safe. There is no evidence that preoperative gastric emptying should be routinely done in emergency cases, except in patients with suspected ileus/ subileus.

Anesthesia↗
PubMed1991

Serious complications with dextran-70 despite hapten prophylaxis. Is it best avoided prior to delivery?

Dextran is used clinically for plasma volume expansion, improvement of blood flow and thromboprophylaxis, but has been associated with untoward side effects. Immunoprophylaxis with dextran I (hapten), before the infusion of dextran-70, has reduced the incidence of serious dextran-induced anaphylactoid reactions. We report three cases of severe reactions occurring during anaesthesia in spite of immunoprophylaxis. One patient given dextran-70 before Caesarean section had a mild reaction but gave birth to a child with serious brain damage. One patient with an extremely high titre of dextran-reactive antibodies died from myocardial infarction and another patient recovered without sequelae. From our experience we conclude that dextran-induced anaphylactoid reactions are still a serious problem despite immunoprophylaxis. Dextran-70 should be avoided during pregnancy and should not be given during Caesarean section before delivery of the child. Even in the presence of immunological prophylaxis, vigilant observation of the patient is essential and resuscitation equipment must be available when starting a dextran infusion.

Adult↗