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[PMID]:28701156
[Au] Autor:Stubenrouch FE; Mus EMK; Lut JW; Hesselink EM; Ubbink DT
[Ad] Endereço:Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. f.e.stubenrouch@amc.nl.
[Ti] Título:The current level of shared decision-making in anesthesiology: an exploratory study.
[So] Source:BMC Anesthesiol;17(1):95, 2017 Jul 12.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Shared decision-making (SDM) seeks to involve both patients and clinicians in decision-making about possible health management strategies, using patients' preferences and best available evidence. SDM seems readily applicable in anesthesiology. We aimed to determine the current level of SDM among preoperative patients and anesthesiology clinicians. METHODS: We invited 115 consecutive preoperative patients, visiting the pre-assessment outpatient clinic of the department of Anesthesiology at the Academic Medical Center of Amsterdam. Inclusion criteria were patients who needed surgery in the arms, lower abdomen or legs, and in whom three anesthesia techniques were feasible. The SDM-level of the consultation was scored objectively by independent observers who judged audio-recordings of the consultation using the OPTION -scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and CollaboRATE questionnaires) and clinicians (SDM-Q-Doc questionnaire). Objective and subjective SDM-levels were assessed on five-point and six-point Likert scales, respectively. Both scores were expressed as percentages. RESULTS: Data of 80 patients could be analysed. Objective SDM-scores were low (30.5%). Subjective scores of the SDM-Q-9 and CollaboRATE were high among patients (91.7% and 96.3%, respectively) and among clinicians (SDM-Q-Doc; 84.3%). Apparently, they appreciated satisfaction rather than SDM, being poorly aware of what SDM entails. CONCLUSION: The level of SDM in an outpatient anesthesiology clinic where preoperative patients receive information about various possible anesthesia options, was found to be low. Thus, there is room for improving the level of SDM. Some suggestions are given how this can be achieved.
[Mh] Termos MeSH primário: Anestesiologia
Tomada de Decisões
Participação do Paciente
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Países Baixos
Educação de Pacientes como Assunto
Cuidados Pré-Operatórios
Liberação de Cirurgia
Procedimentos Cirúrgicos Operatórios
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0386-3


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[PMID]:28640783
[Au] Autor:Shillcutt SK; Walsh DP; Thomas WR; Lyden E; Brakke TR; Ellis SJ; Lisco SJ; Markin NW
[Ad] Endereço:From the Departments of *Anesthesiology and †Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska.
[Ti] Título:The Implementation of a Preoperative Transthoracic Echocardiography Consult Service by Anesthesiologists.
[So] Source:Anesth Analg;125(5):1479-1481, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We describe a preoperative transthoracic echocardiography consult service led by anesthesiologists. The implementation process and the patient cohort are described. Preoperative transthoracic echocardiographic examinations were mostly performed in patients undergoing intermediate- or high-risk noncardiac surgery and in patients with a higher calculated mortality risk. All transthoracic echocardiographic examinations were interpreted by anesthesiologists.
[Mh] Termos MeSH primário: Anestesiologistas
Ecocardiografia
Cardiopatias/diagnóstico por imagem
Cuidados Pré-Operatórios
Encaminhamento e Consulta
Procedimentos Cirúrgicos Operatórios
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Tomada de Decisão Clínica
Estudos de Viabilidade
Feminino
Cardiopatias/complicações
Cardiopatias/mortalidade
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/mortalidade
Valor Preditivo dos Testes
Avaliação de Programas e Projetos de Saúde
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Liberação de Cirurgia
Procedimentos Cirúrgicos Operatórios/efeitos adversos
Procedimentos Cirúrgicos Operatórios/mortalidade
Fluxo de Trabalho
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002156


  3 / 11 MEDLINE  
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[PMID]:28260449
[Au] Autor:Al-Rabadi K; Almardini RI; Hajeer M; Hendawi M; Hadad A
[Ad] Endereço:Royal Medical Services; and King Hussein Cancer Center, Amman, Jordan.
[Ti] Título:Living Kidney Donor Cancellation at King Hussein Medical Center.
[So] Source:Exp Clin Transplant;15(Suppl 1):116-120, 2017 Feb.
[Is] ISSN:2146-8427
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Living-related kidney donation is the main source of renal grafts in Jordan, since kidneys from deceased donors are scarce. Although the Jordanian community accepts the idea of kidney donation to family members, not all potential donors manage to complete the required psychologic and medical evaluations. We review the causes of kidney-donation cancellation and suggest options to increase the number of available organs. MATERIALS AND METHODS: We performed a retrospective chart review of all potential living-related kidney donors at King Hussein Medical Center between January 2008 and June 2016. RESULTS: Of 642 potential donors, 366 (57%) were male and 276 (43%) were female, ranging in age from 18 to 66 years with a mean age of 37 years. A total of 384 (59.8%) eventually donated a kidney. A donor issue was the cause of cancellation in 143 (22.3%), whereas 47 (32.9%) had a risk for renal impairment after donation (eg, hematuria, proteinuria, stones, multiple renal cysts, scarred kidney, congenital malformation, recurrent urinary tract infection), and 30 (21%) had blood group or immunologic incompatibilities. Fifteen (10.5%) withdrew during the evaluation process, 13 (9%) had hypertension, 10 (7%) had a high body mass index, 8 (5.6%) were diabetic or prediabetic, 7 (4.9%) were surgically unsuitable, 4 (2.8%) had hepatitis B virus infection, 4 (2.8%) were pregnant, 3 (2.1%) had significant cardiovascular disease, 1 (0.7%) had splenomegaly with lymph node enlargement, and 1 (0.7%) had thyroiditis. CONCLUSIONS: Cancellation of kidney donation in Jordan is mainly for medical reasons, the most common being renal issues. Paired donation between blood group and immunologically incompatible duos may increase the number of organs available, as may good psychologic assessment and counseling of those likely to change their mind. Support should be provided for donors who drop out of donation for any cause, especially for renal and vascular issues.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos
Seleção do Doador
Transplante de Rim/métodos
Doadores Vivos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Comorbidade
Feminino
Nível de Saúde
Indicadores Básicos de Saúde
Histocompatibilidade
Seres Humanos
Jordânia
Transplante de Rim/efeitos adversos
Doadores Vivos/psicologia
Doadores Vivos/provisão & distribuição
Masculino
Meia-Idade
Valor Preditivo dos Testes
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Liberação de Cirurgia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE


  4 / 11 MEDLINE  
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[PMID]:28257309
[Au] Autor:Enneking FK; Radhakrishnan NS; Berg K; Patel S; Wishin JM; Vasilopoulos T
[Ad] Endereço:From the *Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida; †Division of Hospital Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida; and ‡University of Florida College of Medicine, Gainesville, Florida.
[Ti] Título:Patient-Centered Anesthesia Triage System Predicts ASA Physical Status.
[So] Source:Anesth Analg;124(6):1957-1962, 2017 Jun.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The purpose of this study was to validate a patient-centered anesthesia triage system (PCATS) by examining its association with, and predictive value of, ASA physical status (PS) classification. ASA PS classification is a widely used indicator of health status and the predictor of risk of perioperative complications. Thus, ASA PS is a good triage point such that healthy surgical patients (ASA PS I and II) undergoing low-complexity surgery are assessed by telephone, whereas less-healthy patients (ASA PS III and IV) or those patients undergoing highly complex surgery are seen in person at a presurgical clinic. However, ASA PS is not commonly available in electronic health records or easily determined by nonanesthesiologists. PCATS criteria, including the number of prescription medications used daily, body mass index (BMI), age, and surgical complexity, are readily available in electronic health records. Nonclinical scheduling personnel can use PCATS to make appropriate preassessment appointments for elective surgical patients before surgery. METHODS: After getting approval from the University of Florida IRB for an exempt study, 300 consecutive patients scheduled in the presurgical clinic over a 1-week span were retrospectively enrolled. Each of the records was reviewed and collated for study identification number, number of prescription medications, BMI, and ASA PS classification assigned on the day of surgery. In addition, a surgical complexity score was assigned to each procedure (high, moderate, minimal).The association between PCATS and individual PCATS criteria and ASA PS was assessed by χ test. The utility of PCATS to discriminate between ASA PS classifications was assessed using receiver operating characteristic (ROC) curves as well as other indicators of clinical validity: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive clinical utility index ([CIU+] = sensitivity × PPV) and negative CIU ([CIU-] = specificity × PPV). RESULTS: BMI (P = .002), age (P = .01), surgical complexity (P < .0001), and number of prescriptions (P < .001) were significantly associated with ASA PS. Definitions included as PCATS criteria were BMI > 35, age > 80 years, 5 or more prescriptions, and high surgical complexity. Eighty-seven percent of patients with any PCATS criterion were ASA PS classification III or IV. From ROC curve analysis, PCATS emerged as a significant, and moderately good, predictor of ASA PS class (area under the curve = 0.75, 95% confidence interval [CI], 0.69-0.83). PCATS was highly sensitive (0.88, 95% CI, 0.84-0.92) and specific (0.74; 95% CI, 0.61-0.86), and had excellent utility in confirmation/case finding (CUI+ = 0.83, 95% CI, 0.82-0.84) and moderate utility in screening out cases (CUI- = 0.43, 95% CI, 0.41-0.44). CONCLUSIONS: PCATS serves as a useful, and valid, predictor of ASA PS classification. Thus, it may also serve as a tool to triage patients to an appropriate venue for preoperative assessment that can be utilized by nonclinical schedulers. Using a simple tool such as PCATS may help streamline the presurgical patient experience and improve clinic staff utilization.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica
Técnicas de Apoio para a Decisão
Indicadores Básicos de Saúde
Nível de Saúde
Assistência Centrada no Paciente/métodos
Triagem/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Área Sob a Curva
Índice de Massa Corporal
Distribuição de Qui-Quadrado
Criança
Pré-Escolar
Procedimentos Cirúrgicos Eletivos
Feminino
Florida
Seres Humanos
Lactente
Masculino
Meia-Idade
Seleção de Pacientes
Polimedicação
Valor Preditivo dos Testes
Curva ROC
Reprodutibilidade dos Testes
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Liberação de Cirurgia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170304
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001712


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[PMID]:27905060
[Au] Autor:Bernstein DN; Keswani A; Ring D
[Ad] Endereço:University of Rochester School of Medicine & Dentistry, Rochester, NY, USA.
[Ti] Título:Perioperative Risk Adjustment for Total Shoulder Arthroplasty: Are Simple Clinically Driven Models Sufficient?
[So] Source:Clin Orthop Relat Res;475(12):2867-2874, 2017 Dec.
[Is] ISSN:1528-1132
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure. Comparing clinically driven with statistically derived risk models of total shoulder arthroplasty (TSA) offers insight into potential gaps between common practice and evidence-based medicine. QUESTIONS/PURPOSES: (1) Does a statistically driven model better explain the variation in unplanned readmission within 30 days of discharge when compared with an a priori five-variable model selected based on expert orthopaedic surgeon opinion? (2) Does a statistically driven model better explain the variation in adverse events within 30 days of discharge when compared with an a priori five-variable model selected based on expert orthopaedic surgeon opinion? METHODS: Current Procedural Terminology codes were used to identify 4030 individuals older than 17 years of age who had TSA in which osteoarthritis was the primary etiology. A logistic regression model for adverse event and unplanned readmission within 30 days was constructed using (1) five variables chosen a priori based on clinic expertise (age, American Society of Anesthesiologists classification ≥ 3, body mass index, smoking status, and diabetes mellitus); and (2) by entering all variables with p < 0.10 in bivariate analysis. We then excluded 870 patients (22%) based on preoperative factors felt to make large discretionary surgery unwise to focus our research on appropriate procedures. Infirm patients have more pressing needs than alleviation of shoulder pain and stiffness. Among the remaining 3160 patients, logistic regression models for adverse event and unplanned readmission within 30 days were constructed in a similar manner to the complete models. The five a priori risk factors used in each model based on clinical expertise were selected by consensus of an expert orthopaedic surgeon panel. RESULTS: When patients unfit for discretionary surgery were excluded, the clinically driven model found no risk factors and accounted for 1.4% of the variation in unplanned readmission. In contrast, the statistically driven model explained 4.6% of the variation and found operating time (hours) (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.04-1.53) and hypertension requiring medications (OR, 1.95; 95% CI, 1.01-3.76) were associated with unplanned readmission accounting for all other factors. However, neither the clinically driven model (pseudo R , 1.4%) nor statistically driven model (pseudo R , 4.6%) provided much explanatory power. When patients unfit for discretionary surgery were excluded, no factors in the clinically driven model were significant and the model accounted for 0.95% of the variation in adverse events. In the statistically driven model, age (OR, 1.03; 95% CI, 1.01-1.06), men (OR, 1.64; 95% CI, 1.05-2.57), operating time (hours) (OR, 1.27; 95% CI, 1.07-1.52), and high BUN (OR, 3.12; 95% CI, 1.35-7.21) were associated with adverse events when accounting for all other factors, explaining 3.3% of the variation. However, neither the clinically driven model (pseudo R , 0.95%) nor the statistically driven model (pseudo R , 3.3%) provided much explanatory power. CONCLUSIONS: The observation that a statistically derived risk model performs better than a clinically driven model affirms the value of research based on large databases, although the models derived need to be tested prospectively. CLINICAL RELEVANCE: Clinicians can utilize our results to understand that clinician intuition may not always offer the best risk adjustment and that factors impacting TSA unplanned readmission and adverse events may be best derived from large data sets. However, because current analyses explain limited variation in outcomes, future studies might look to better define what factors drive the variation in unplanned readmission and adverse events.
[Mh] Termos MeSH primário: Artroplastia do Ombro/efeitos adversos
Técnicas de Apoio para a Decisão
Readmissão do Paciente
Avaliação de Processos (Cuidados de Saúde)
Articulação do Ombro/cirurgia
[Mh] Termos MeSH secundário: Idoso
Tomada de Decisão Clínica
Mineração de Dados
Bases de Dados Factuais
Medicina Baseada em Evidências
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Período Perioperatório
Valor Preditivo dos Testes
Lacunas da Prática Profissional
Medição de Risco
Fatores de Risco
Articulação do Ombro/diagnóstico por imagem
Articulação do Ombro/fisiopatologia
Liberação de Cirurgia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171117
[Lr] Data última revisão:
171117
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161202
[St] Status:MEDLINE
[do] DOI:10.1007/s11999-016-5147-y


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[PMID]:27890838
[Au] Autor:Coscas R; Wagner S; Vilaine E; Sartorius A; Javerliat I; Alvarez JC; Goeau-Brissonniere O; Coggia M; Massy Z
[Ad] Endereço:Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France. Electronic address: rcoscas@gmail.com.
[Ti] Título:Preoperative Evaluation of the Renal Function before the Treatment of Abdominal Aortic Aneurysms.
[So] Source:Ann Vasc Surg;40:162-169, 2017 Apr.
[Is] ISSN:1615-5947
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Chronic impaired renal function constitutes a major risk factor of morbi-mortality during the treatment of an abdominal aortic aneurism (AAA). The inflammatory state due to the AAA could result in a reduction in the muscular mass and an overestimation of the glomerular filtration rate (GFR) with the usual formulas. The objective of this study was to determine if the formulas used to evaluate the estimated GFR were adapted in patients with AAA. MATERIALS AND METHODS: Between August 2013 and November 2014, we conducted an exploratory study to evaluate the renal function before surgery for AAA in 28 patients. The renal function was evaluated by (1) the dosage of plasmatic creatinine, (2) the GFR estimated with the Cockroft-Gault, Modification of Diet in Renal Disease (MDRD), and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas, (3) the creatinine clearance (CC), and (4) the direct measurement of the GFR with a reference method (iohexol clearance). Statistical analysis was carried out to compare and correlate the GFR estimated by the various formulas with the GFR measured by the reference technique. RESULTS: The study included 21 men (75%) and 7 women (25%), with a median age of 76 years (58-89). The measured GFR was correlated with the GFR estimated from the CKD-EPI (rho = 0.78, P < 0.0001), the MDRD (rho = 0.78, P < 0.0001), the Cockroft-Gault (rho = 0.65, P = 0.0002), and CC (rho = 0.86, P < 0.0001). However, there were important individual variations between estimated and measured GFR. As regards the detection of the patients presenting a GFR <60 mL/min/1.73 m , the sensitivities of the CKD-EPI, MDRD, Cockroft-Gault formulas and CC were 64%, 64%, 71%, and 70%, respectively. Specificities were 71%, 79%, 57%, and 100%, respectively. The estimation of the GFR by the CKD-EPI formula had the lowest bias (-3.0). Bland-Altman plots indicated that the estimation of the GFR by the CKD-EPI formula had the best performance in comparison with the other methods. CONCLUSIONS: This study found a statistical correlation between the measurement of the GFR and the various formulas available to estimation the GFR among AAA patients. The CKD-EPI formula is most appropriate. However, there were important individual variations between the measurement and the estimations of the GFR. A larger scale study is necessary to determine the profile of the patients with a risk of error in the estimation of the GFR. The French recommendations on the evaluation of the renal function before AAA treatment remain based on serum creatinine and should be revalued.
[Mh] Termos MeSH primário: Aneurisma da Aorta Abdominal/cirurgia
Taxa de Filtração Glomerular
Rim/fisiopatologia
Modelos Biológicos
Modelos Estatísticos
Insuficiência Renal Crônica/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aneurisma da Aorta Abdominal/complicações
Aneurisma da Aorta Abdominal/diagnóstico
Biomarcadores/sangue
Meios de Contraste/administração & dosagem
Creatinina/sangue
Feminino
Seres Humanos
Iohexol/administração & dosagem
Masculino
Meia-Idade
Valor Preditivo dos Testes
Cuidados Pré-Operatórios
Estudos Prospectivos
Insuficiência Renal Crônica/sangue
Insuficiência Renal Crônica/complicações
Insuficiência Renal Crônica/diagnóstico
Reprodutibilidade dos Testes
Liberação de Cirurgia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Contrast Media); 4419T9MX03 (Iohexol); AYI8EX34EU (Creatinine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161129
[St] Status:MEDLINE


  7 / 11 MEDLINE  
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[PMID]:28100967
[Au] Autor:Deng Y; Naeini PS; Razavi M; Collard CD; Tolpin DA; Anton JM
[Ti] Título:Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia.
[So] Source:Tex Heart Inst J;43(6):496-502, 2016 Dec.
[Is] ISSN:1526-6702
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.
[Mh] Termos MeSH primário: Anestesia/métodos
Ablação por Cateter
Taquicardia Ventricular/cirurgia
[Mh] Termos MeSH secundário: Anestesia/efeitos adversos
Ablação por Cateter/efeitos adversos
Eletrocardiografia
Técnicas Eletrofisiológicas Cardíacas
Seres Humanos
Monitorização Intraoperatória
Segurança do Paciente
Seleção de Pacientes
Valor Preditivo dos Testes
Medição de Risco
Fatores de Risco
Liberação de Cirurgia
Taquicardia Ventricular/diagnóstico
Taquicardia Ventricular/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170120
[St] Status:MEDLINE
[do] DOI:10.14503/THIJ-15-5688


  8 / 11 MEDLINE  
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[PMID]:27861445
[Au] Autor:Chow VW; Hepner DL; Bader AM
[Ad] Endereço:From the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
[Ti] Título:Electronic Care Coordination From the Preoperative Clinic.
[So] Source:Anesth Analg;123(6):1458-1462, 2016 Dec.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fragmented and variable perioperative care exposes patients to unnecessary risks and handoff errors. The perioperative surgical home aims to optimize quality, value-based care. We performed a retrospective evaluation of how a preoperative assessment center could coordinate care through e-mails sent to a patient's healthcare team that initiate discussion on critical clinical information. During 100 clinic days on which 8122 patients were evaluated, 606 triggered e-mails, with a potential impact on 19 elements across the perioperative care spectrum. Four cases were canceled, and 42 cases were rescheduled. By fostering information exchange, these communications could advance patient-centered, value-enhanced quality and safety outcomes.
[Mh] Termos MeSH primário: Anestesia
Prestação Integrada de Cuidados de Saúde/organização & administração
Correio Eletrônico/organização & administração
Ambulatório Hospitalar/organização & administração
Equipe de Assistência ao Paciente/organização & administração
Assistência Centrada no Paciente/organização & administração
Cuidados Pré-Operatórios
Procedimentos Cirúrgicos Operatórios
[Mh] Termos MeSH secundário: Idoso
Anestesia/efeitos adversos
Comportamento Cooperativo
Feminino
Seres Humanos
Comunicação Interdisciplinar
Masculino
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Liberação de Cirurgia
Procedimentos Cirúrgicos Operatórios/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161119
[St] Status:MEDLINE


  9 / 11 MEDLINE  
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[PMID]:27529323
[Au] Autor:Vetter TR; Boudreaux AM; Ponce BA; Barman J; Crump SJ
[Ad] Endereço:From the Departments of *Anesthesiology and Perioperative Medicine and †Surgery, Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
[Ti] Título:Development of a Preoperative Patient Clearance and Consultation Screening Questionnaire.
[So] Source:Anesth Analg;123(6):1453-1457, 2016 Dec.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The optimal timing of the preanesthesia evaluation varies with the patient's comorbidities. As anesthesiologists assume a broader role in perioperative care, there may be opportunities to provide additional patient management beyond historical routine anesthesia services. This study was thus undertaken to survey our institutional perioperative clinicians regarding their perceptions of patient medical conditions that (a) need additional time for preoperative clearance by anesthesiology before actually scheduling the date of surgery and (b) warrant additional preoperative evaluation and management services by an anesthesiologist. These data were used to create a pilot version of a Preoperative Patient Clearance and Consultation Screening Questionnaire.
[Mh] Termos MeSH primário: Anestesia
Técnicas de Apoio para a Decisão
Seleção de Pacientes
Cuidados Pré-Operatórios/métodos
Encaminhamento e Consulta
Liberação de Cirurgia/métodos
Procedimentos Cirúrgicos Operatórios
Inquéritos e Questionários
[Mh] Termos MeSH secundário: Anestesia/efeitos adversos
Seres Humanos
Projetos Piloto
Valor Preditivo dos Testes
Medição de Risco
Fatores de Risco
Procedimentos Cirúrgicos Operatórios/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160817
[St] Status:MEDLINE


  10 / 11 MEDLINE  
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[PMID]:26165267
[Au] Autor:Stitgen A; Poludnianyk K; Dulaney-Cripe E; Markert R; Prayson M
[Ad] Endereço:Department of Orthopaedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH.
[Ti] Título:Adherence to Preoperative Cardiac Clearance Guidelines in Hip Fracture Patients.
[So] Source:J Orthop Trauma;29(11):500-3, 2015 Nov.
[Is] ISSN:1531-2291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To identify if preoperative cardiac consultations are made in accordance with the American College of Cardiology (ACC) Foundation and American Heart Association (AHA) guidelines and the delays in care after unnecessary consults. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: A retrospective review of 315 patients with hip fractures admitted over a 2-year period was conducted. After excluding patients younger than 65 years and those admitted by the general surgery trauma service, 266 patients were included. INTERVENTION: Criteria meeting the ACC/AHA guidelines for preoperative cardiac consultations. MAIN OUTCOME MEASUREMENTS: Time to surgical intervention and total hospital length of stay. RESULTS: Of the 266 patients reviewed, 55 patients (21%) received preoperative cardiac consultations, whereas 211 patients did not. Only 16 of the 55 patients (29%) with cardiac consults met the ACC/AHA guidelines, whereas 39 patients received unnecessary cardiac consults. Of the 247 patients (39 with consults and 208 without consults) who did not meet the guidelines, those who received a preoperative cardiac consult had a significantly longer average time to surgery (43.9 vs. 23.1 hours) (P = 0.005) and hospital length of stay (7.9 vs. 5.3 days) (P = 0.010). There were no significant differences in postoperative complications or disposition. CONCLUSIONS: Preoperative cardiac consults are frequently overused and lead to delays to surgical intervention and longer hospital length of stay while not revealing any further need for cardiac intervention or changing the rate of adverse events. Stricter adherence to the ACC/AHA guidelines will help decrease surgical delay and hospital length of stay.
[Mh] Termos MeSH primário: Fidelidade a Diretrizes
Cardiopatias/diagnóstico
Fraturas do Quadril/cirurgia
Liberação de Cirurgia/normas
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Cardiopatias/complicações
Fraturas do Quadril/complicações
Seres Humanos
Masculino
Encaminhamento e Consulta/normas
Estudos Retrospectivos
Medição de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1609
[Cu] Atualização por classe:151022
[Lr] Data última revisão:
151022
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150714
[St] Status:MEDLINE
[do] DOI:10.1097/BOT.0000000000000381



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