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Veterinary Anaesthesia and Analgesia May 2022The provision of general anesthesia is common in veterinary hospitals and procedures include some level of risk, up to and including mortality. A quality initiative was... (Observational Study)
Observational Study
OBJECTIVE
The provision of general anesthesia is common in veterinary hospitals and procedures include some level of risk, up to and including mortality. A quality initiative was introduced with a focus on reducing canine and feline anesthesia mortality. This paper describes the development and implementation of risk-based medical quality standards (MQS) and resultant impacts on anesthesia mortality.
STUDY DESIGN
This was a qualitative observational study. MQS focused on the provision of anesthesia were researched, developed and implemented. Anesthesia mortality rates, captured via an automated process based on the electronic medical record, were recorded before and after implementation. Compliance to standards was determined via hospital auditing.
ANIMALS
Client-owned dogs and cats presenting to Banfield Pet Hospital (a national network of primary care hospitals) for elective and nonelective general anesthesia procedures. Over the course of the study, 2,038,318 dogs and 350,410 cats had a general anesthesia event.
METHODS
Literature reviews and analysis of veterinary patient medical records identified risk factors associated with anesthesia mortality. Risk factors informed the development of MQS. Evidence-based standards focused on the provision of general anesthesia were written, reviewed, evaluated and edited. Implementation occurred over 6 months via a robust communication plan. Anesthesia mortality rates were continuously monitored before, during and after the introduction of standards. Compliance with all quality standards was assessed via hospital-based auditing performed on an annual basis.
RESULTS
Prior to quality standards implementation, anesthesia mortality rates for dogs and cats combined was 7.4 deaths/10,000 procedures. At 6 months after implementation, the mortality rate was 6.24 deaths/10,000 procedures, representing a 16% decrease. Compliance with standards improved over time with continued focus and education.
CONCLUSIONS AND CLINICAL RELEVANCE
Development, implementation and continued focus on MQS can improve anesthetic safety and reduce anesthesia mortality in primary care veterinary hospitals.
Topics: Anesthesia; Anesthesiology; Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Primary Health Care
PubMed: 35314123
DOI: 10.1016/j.vaa.2022.01.009 -
British Journal of Anaesthesia Apr 2021
Topics: Ambulatory Surgical Procedures; Anesthesia, Conduction; Humans; Nerve Block; Pain; Peripheral Nerves
PubMed: 33551124
DOI: 10.1016/j.bja.2020.12.034 -
Anaesthesia Feb 2022
Topics: Anesthesia; Blood Pressure; Humans; Hypotension; Intraoperative Complications; Monitoring, Intraoperative
PubMed: 34542906
DOI: 10.1111/anae.15584 -
Anaesthesia Jan 2022
Topics: Aged, 80 and over; Anesthesia; Brain; Frail Elderly; Geriatric Assessment; Humans; Patient Care Team; Risk Factors
PubMed: 35001379
DOI: 10.1111/anae.15636 -
International Journal of Molecular... Apr 2024Apart from being a significant line of defense in the host defense system, neutrophils have many immunological functions. Although there are not many publications that... (Review)
Review
Apart from being a significant line of defense in the host defense system, neutrophils have many immunological functions. Although there are not many publications that accurately present the functions of neutrophils in relation to oncological pathology, their activity and implications have been studied a lot recently. This review aims to extensively describe neutrophils functions'; their clinical implications, especially in tumor pathology; the value of clinical markers related to neutrophils; and the implications of neutrophils in onco-anesthesia. This review also aims to describe current evidence on the influence of anesthetic drugs on neutrophils' functions and their potential influence on perioperative outcomes.
Topics: Neutrophils; Anesthetics; Anesthesia; Medical Oncology
PubMed: 38612841
DOI: 10.3390/ijms25074033 -
Anaesthesia Mar 2023
Topics: Humans; Anesthesia; Anesthesiology
PubMed: 35944281
DOI: 10.1111/anae.15830 -
Minerva Anestesiologica Jan 2021Regional anesthesia has a very interesting long history, initially preferred over general anesthesia because of safety concerns, then for a period general anesthesia...
Regional anesthesia has a very interesting long history, initially preferred over general anesthesia because of safety concerns, then for a period general anesthesia became safer and was preferred. The use of innovative technologies such as ultrasound technology has made the blocks safer and successful by directly visualizing targeted nerves and the location of local anesthetics. With the wide use of ultrasound in the regional anesthesia field success rate of peripheral nerve blocks increased and novel blocks techniques developed. Moreover, new extended-release local anesthetic agents have begun to be promising time-efficient and longer duration of analgesia with a single injection. In this article, we attempt to summarize some of the novel block techniques, pharmacological agents, and new technologies in the field of regional anesthesia.
Topics: Analgesia; Anesthesia, Conduction; Anesthesia, Local; Anesthetics, Local; Humans; Nerve Block
PubMed: 32959636
DOI: 10.23736/S0375-9393.20.14791-6 -
Handchirurgie, Mikrochirurgie,... Aug 2021Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the...
BACKGROUND
Liposuctions are among the most frequently performed operations in plastic surgery worldwide. They are offered as inpatient as well as outpatient procedures. In the outpatient setting, tumescent anaesthesia is used in various forms. There is ambiguity about the amount of lipoaspirate that can be removed safely in an outpatient setting, and also about the monitoring of parameters and the duration of postoperative care.
MATERIAL AND METHODS
A systematic literature review was conducted with the help of the MEDLINE data base of the U. S. National Library of Medicine (NLM) and the bibliographic search engine Google Scholar (https://scholar.google.com) of Google LLC. The key words "Liposuction Anesthesia" and "Liposuction Guidelines" were used. All items resulting from the search were checked for thematic concordance and further analysed by their level of evidence, significance and availability.
RESULTS
After the literature review, a total of 197 items were identified for further analysis. The analysis of the international and German literature yielded a systematic overview of recommendations.
CONCLUSIONS
Tumescence anaesthesia in an outpatient setting has various advantages, e. g. cost reduction for provider and patient as well as avoidance of the risk profile of general anaesthesia. Also patients can change their position autonomously, which can be beneficial for surgery. However, there are limitations in terms of the lipoaspirate volume that can be removed safely. With increasing lipoaspirate volumes, more local anaesthetic is needed, which also increases the postoperative monitoring time. In the authors view, tumescent anaesthesia should only be used for small-volume and localised liposuctions. Liposuction in general anaesthesia offers more advantages, especially with increasing lipoaspirate volumes.
Topics: Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Humans; Lipectomy; United States
PubMed: 33525036
DOI: 10.1055/a-1333-2696 -
Radiology and Oncology Mar 2024Oncological patients make up a large proportion of all surgical patients. Through its influence on the patient's inflammatory and immune system, the choice of... (Review)
Review
BACKGROUND
Oncological patients make up a large proportion of all surgical patients. Through its influence on the patient's inflammatory and immune system, the choice of anaesthetic technique has an indirect impact on the health of the individual patient and on public health. Both the specific and the non-specific immune system have a major influence on the recurrence of carcinomas. The pathophysiological basis for growth and metastasis after surgery is the physiological response to stress. Inflammation is the organism's universal response to stress. Anaesthetics and adjuvants influence perioperative inflammation in different ways and have an indirect effect on tumour growth and metastasis. studies have shown how individual anaesthetics influence the growth and spread of cancer, but clinical studies have not confirmed these results. Nevertheless, it is advisable to use an anaesthetic that has shown lesser effect on the growth of cancer cells .
CONCLUSIONS
In this review, we focus on the area of the effects of anaesthesia on tumour growth. The field is still relatively unexplored, there are only few clinical prospective studies and their results are controversial. Based on the review of new research findings we report on recommendations about anaesthetics and anaesthetic techniques that might be preferable for oncological surgical procedures.
Topics: Humans; Prospective Studies; Anesthesia; Neoplasms; Anesthetics; Inflammation
PubMed: 38378027
DOI: 10.2478/raon-2024-0012 -
Anaesthesia Aug 2022
Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Female; Humans; Pregnancy
PubMed: 35587999
DOI: 10.1111/anae.15759