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48 records · Page 3Linked to original sources
PubMed1990

[Criteria for selection and contra-indications of ambulatory surgery].

Ambulatory surgery means to us the scheduled surgery and investigations carried out under various modes of anaesthesia in patients who are admitted in the morning and discharged in the evening. Now the strictness and guarantees required and the essential conditions of safety and efficiency can only be achieved if a number of selection criteria and contraindications are complied with. The authors first study the lesions for which ambulatory treatment is possible, as well as the criteria regarding both the patient and the attending physician responsible for the follow-up at home. Since a close co-operation between the anaesthesist and the surgeon proves to be essential, the criteria of anaesthesia must also be dealt with. The contraindications are connected to the type of surgery, to the type of anaesthesia, to the patient, to the patient's circle, to the medical team, and finally to the equipment and organization of the unit in which ambulatory surgery is performed. These many aspects of the problem are analyzed and discussed.

Ambulatory Surgical Procedures↗
PubMed1995

[Ambulatory surgery in the hospital--analysis of a 1978-1994 patient sample].

In the outpatient department of the University hospital of the Technology University Dresden ambulatory surgery has been performed since 1965. The patients of 16 years were analyzed. From 1978 till VI/1994 we have carried out 13948 elective operations. The personal wish of a cooperative patient without risk factors and an orderly social surrounding are the prerequisites for carrying out outpatient operations. Applied anaesthetic techniques were: general anaesthesia 9.2%, spinal anaesthesia 7.1%, sacral anaesthesia 14.8%, nerveblock of the upper extremity 11.1 and infiltration anaesthesia 57.8%. On the day of operation 61 patients had to be admitted to the hospital because of intraoperative events, expansion of the operation and complications of anaesthesia. Between the first to eight postoperative day 23 patients were hospitalised due to bleeding and 1 patient due to a wound infection. After aseptic elective operations 33 patients (0.35%) and after proctology operations with primary wound closure 10% of the patients developed wound infections. The cooperation of the general practitioner must be ensured in the post-operative days. Outpatient operations lower the financial burden of the health insurance companies, medical care services can be reduced.

Adolescent↗
PubMed1993

[Evaluation of the anesthetic risk in patients with coronary disease prior to non-cardiac surgery].

Evaluation of operative risk in coronary artery disease patients before non-cardiac surgery is a frequent problem concerning 100,000 patients each year in France. Perioperative cardiac morbidity is the first cause of death associated with non-cardiac surgery, with infarction rates of the order of 1 to 2% in coronary disease patients. These infarcts are followed by the death of the patient in 25 to 50% of cases. Evaluation of anesthetic risk is based upon three points: type of surgery, clinical findings and results of investigations. The risk is markedly increased in emergency surgery, and in thoracic, intraperitoneal and above all vascular surgery, in particular when clamping of the aorta is involved. From a clinical standpoint, only a history of infarction and signs of peripheral cardiac failure are independent predictive factors of postoperative complications. Other criteria, e.g. age, uncontrolled hypertension, diabetes and above all the severity of angina are also associated with the onset of perioperative-complications. This evaluation can be refined by electrocardiogram (Q wave, ST segment anomalies, ventricular hypertrophy and left bundle branch block) and chest X-ray. The usefulness and predictive value of exercise tests, when possible in a preoperative context, are particularly precious when the result is positive at low work-load. Many publications have studied the value of myocardial isotope scan, in particular before vascular surgery. They report the excellent negative predictive value (95 to 100%) of this investigation. Furthermore, the predictive value of isotope scan is all the greater when the clinical risk factors seen in the patients and the number of areas with ischemia are taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1993

An introduction to the automatic implantable cardioverter-defibrillator and its anesthetic implications.

This paper presents a description of the automatic implantable cardioverter-defibrillator (AICD), as well as information pertaining to indications for its use, patient selection criteria, surgical implantation techniques, and anesthetic implications. A brief historical overview of the development of the AICD is included. Complications, indications, and contraindications associated with the device are discussed.

Anesthesia↗
PubMed1997

Direct listing for adult tonsillectomy.

Health care economic efficiency is important. Adult tonsillectomy is a common operation. The decision to operate is made at an out-patient consultation and is based on information in the general practitioner's (GP) referral letter. This study aims to define what proportion of adult tonsillectomies are suitable for listing with an out-patient consultation (direct listing). GPs were informed of the indications (six episodes of tonsillitis in the last year) and contraindications (tonsillectomy for another reason and general ill health) for direct listing. All referrals for 1 year were screened by an otolaryngologist and suitable patients were listed directly. Patients were then reviewed in the anaesthetic pre-admission clinic and inappropriate listings were cancelled and reasons noted. Of all patients, 50% were suitable for direct listing. Of these 3% were later deemed inappropriate. None of the cancellations were due to a flaw in the direct listing process. This would result in savings to the NHS of 2 million pounds per annum.

Adult↗
PubMedDate not supplied

[Anesthesia in laparoscopic surgery].

The use of laparoscopic techniques in general surgery is increasing in popularity. The anesthesiologist's goals during laparoscopic surgery are hemodynamic and respiratory stability, appropriate muscle relaxation, control of diaphragmatic excursion, intraoperative and postoperative patient analgesia. The implications are that the anesthesiologist must use a technique that not only allows for optimal surgical conditions but also provides intraoperative patient comfort and safety and a rapid postoperative anesthetic recovery. Laparoscopy is not a benign procedure. It is associated with major and minor surgical and non surgical complications, including death. Therefore, it is imperative that the anesthesiologist and surgeon thoroughly understand the physiopathology and immediate treatment of these potential complications and communicate effectively about their management.

Anesthesia↗
PubMedDate not supplied

Extracorporeal shock wave lithotripsy: a comprehensive review.

Extracorporeal shock wave lithotripsy (ESWL) has revolutionized treatment of urolithiasis since its introduction in the 1980s. The great majority of renal and ureteral stones can be successfully treated with ESWL. Complications can be minimized with maximal efficacy if patient selection is optimum.

Anesthesia↗
PubMed1998

[The prognosis of surgery on the elderly. Proposal for a parametric evaluation].

BACKGROUND AND AIMS: To data there are no preoperative systems of evaluating surgical risk specifically in geriatric patients. Given that it was thought useful to formulate a score-based prognostic system for these patients based on surgical risk, the authors collected a wide range of preoperative data with the aim of identifying the easily determined variables. METHODS: While data from other hospital centres are in the process of being collected, the authors report the data for 122 over 65-year-old patients who underwent elective surgery up until 30-1-1996 out of a total of 329 hospitalized patients. In addition to a wide series of objective, laboratory and instrumental data, the study also took into account the pathology requiring to surgery, any associated morbid conditions, psychic and social conditions, the type of surgery and local and/or general postoperative complications. RESULTS: Hernia of the abdominal wall were found to be the most frequent cause of surgery (41 cases), followed by 27 neoplasias of various organs and biliary lithiasis (20 cases). Cardiovascular diseases were the most common associated pathologies (85 patients). A total of 13 major and 80 medium operations were performed, including 16 cholecystectomies. Among the general complications, an altered acid-base balance was found in 7 patients. Two deaths were recorded within 30 days of surgery. When the data collection is complete, the results will be analysed statistically in order to obtain a numerical calculation of the coefficients of risk correlated to the individual variables. CONCLUSIONS: This will enable the criteria of operability to be broadened, thereby allowing surgery to be performed in those patients who are currently excluded merely on the basis of the personal judgement of the surgeon and anesthetist.

Aged↗