Features the addition of key new drugs and the removal of obsolete drugs. New to this edition. A complete revision of all the featured drugs, the addition of key new drugs and the removal of obsolete drugs In everyday practice anaesthetists can make use of a wide range of drug treatments and require readily available and accessible information on the appropriate drugs to use in any given situation.
Drugs in Anaesthesia and Intensive Care has quickly established itself as an essential reference text for all anaesthetists, both trainees and consultants. The fourth edition of this book includes information on many new drugs, with information on many others revised. The book describes the pharmacokinetics and pharmodynamics of all the drugs commonly used by anaesthetists, all organized so as to allow rapid access to specific information on the properties and characteristics of almost drugs. Drugs in Anaesthesia and Intensive Care fourth edition successfully provides a comprehensive, up-to-date reference for anaesthetists in training, consultant anaesthetists, intensive care nurses and anaesthetic assistants.
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You must be logged in to access this feature. Since our original report was published in , there have been a number of articles and editorials exploring the topic of anesthesia-related cardiac arrest. Another report found an overall frequency of perioperative cardiac arrests of 4. Cardiac arrests primarily attributable to anesthesia were estimated to be approximately 0.
Mortality attributable to anesthesia was approximately 1 in , anesthetics. Beginning in , there were additional publications on this topic.
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In , a study looked at predictors of survival from perioperative cardiopulmonary arrests. The authors used a national in-hospital resuscitation registry to identify patients 18 yr or older who had a cardiac arrest in the operating room or within 24 h postoperatively. Out of a total of 2, perioperative cardiac arrests reported from hospitals, they found 1, intraoperative cardiac arrests and that occurred in the postanesthesia care unit PACU. The remainder occurred in telemetry, critical care areas, or general inpatient areas.
Those arrests in the operating room and PACU had better survival compared with the survival in other perioperative locations. To address this lack of information about anesthesia-related cardiac arrests, we asked an independent study commission, comprised of three anesthesiologists, an internist and critical care specialist, and a surgeon, to review all of the cases of cardiac arrest occurring within the h perioperative period at our institution, to determine the incidence and outcome of anesthesia-attributable and anesthesia-contributory cardiac arrests.
After obtaining approval from the University of Nebraska Medical Center Institutional Review Board, Omaha, Nebraska, we identified all cardiac arrests that occurred within 24 h after anesthesia that were reported to our anesthesia database at The Nebraska Medical Center from August 15, to December 31, We used the same methodology as in our first report in that after we identified all cases of cardiac arrest from our anesthesia database, we prepared an abstract of each case from anesthesia and medical records.
See appendix 1 for details extracted from the records to prepare the abstract. We then submitted the abstracts to an independent study commission representing anesthesiology, internal medicine, and surgery. The use of an independent study commission for review of deaths related to anesthesia in the perioperative period was proposed by Henry S. Ruth, M. It was thought that there would be an insufficient number of deaths in Philadelphia to warrant the use of a commission.
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The independent study commission we created was asked to determine which cases were anesthesia-attributable and which cases were anesthesia-contributory to the cardiac arrest. Cardiac arrests were identified from the anesthesia database that was developed from a quality assurance QA form included as mandatory documentation with each anesthetic record.get link
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The anesthesiology faculty member, anesthesiology resident, or nurse anesthetist providing the anesthetic completed the QA form. Required data on the QA form contained patient demographics, anesthesia provider information, date, location, ASA physical status classification, and a item checklist of airway, cardiovascular, respiratory, neurologic, regional, and miscellaneous events.
Providers were encouraged to describe the event, treatment, and outcome, and make any comments as to the cause or causes. Cardiac arrest was defined as an event requiring cardiopulmonary resuscitation, which may include closed or open-chest cardiac compressions. All QA forms were collected daily with a copy of the anesthesia record and reviewed for completeness by one of the authors M.
During the study period, a weekly mortality and morbidity conference was held as part of our quality improvement process in which challenging cases or perioperative complications were discussed. Providers were expected to complete a h follow-up of all cases. For outpatients, a designated nurse called the patient within 24 h to determine whether the patient had any concerns. Any problems identified in the postoperative period were added to the database. During the study period, all anesthetic records were kept in files maintained by the Department of Anesthesiology.
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Two cases randomly filed by billing personnel immediately preceding the cardiac arrest case and two immediately after the cardiac arrest case were identified as controls. For each study case and each control case, data were obtained on patient demographics including age and sex , ASA physical status, operative status emergency or elective , surgical procedure performed, time of day, and outcome. A copy of this data collection form is provided in appendix 2. A case was considered an emergency if it was designated as such by the ASA physical status classification.
Additional pertinent information related to preoperative assessment, intraoperative course, and anesthetic management was recorded.
The medical and anesthesia records of each patient who had a cardiac arrest during anesthesia or in the h perioperative period were reviewed by at least one of the authors S. Abstracts were prepared without assigning responsibility for the cardiac arrest. Each abstract was assigned a three-digit code and submitted anonymously to an independent study commission formed for this analysis. Commission members from outside the institution may provide a more unbiased evaluation of these cases than if we used faculty exclusively within our institution.
Commission members were asked to review abstracts of all cases of cardiac arrest and were asked on their initial review to provide their assessment of the primary cause of cardiac arrest or death as due to 1 anesthesia, 2 surgery, 3 patient disease or condition, 4 other, for example, serendipity, electrical malfunction, fall, catastrophic failure of equipment, or 5 unable to decide from information provided.
Commission members were also asked to determine which of the following, anesthesia, surgery, patient disease or condition, or other contributing cause, appeared to be a contributing cause of cardiac arrest or death. Consensus was determined when at least three of the five commission members agreed on a cause of the cardiac arrest or death. The cases identified as anesthesia-attributable or anesthesia-contributory on the first review were resubmitted to the commission for a second, more restrictive review. The commission members were asked to make a choice of the role of anesthesia in these cases using the following scale, briefly summarized from our previous publication:.
After the second review by the commission, cases were assigned as anesthesia-attributable if the majority of the members judged them to have anesthesia as the primary cause 1 or 2 on the review scale or anesthesia-contributory if the majority of the members judged them to have anesthesia as an important contributing cause numbers 3 and 4 on the review scale of the cardiac arrest.
The incidence, cause, and mortality of anesthesia-related cardiac arrests were summarized. Matching of cases and controls was based on the anesthesia time and location.
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The characteristics of case and control groups were summarized using means and SDs for continuous variables, and frequencies and percentages for categorical variables. A P value of less than 0. There were , anesthetics administered during the slightly more than yr period of this study, from August 15, to December 31, A total of cardiac arrests within the h perioperative period were identified from an anesthesia QA database. The incidence of cardiac arrest from all causes was 1 per , or 7.
To provide a comparison group, cases experiencing cardiac arrest were matched with four other cases that underwent anesthesia on the same day and in the same location by a proximal convenience method.
The characteristics of the cases that had a cardiac arrest and the controls are reported in table 1. Table 1.
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