Canadian journal of anaesthesia = Journal canadien d'anesthésie
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There have been many recent advances in the understanding and therapy of respiratory diseases. This review has attempted to cover some of the relevant new information about those disorders most likely to be encountered by anaesthetists. RéSUMé: Il y a de nombreux progrès récents dans la compréhension et la thérapie des maladies respiratoires. Cette revue a tenté de revoir l'information nouvelle et pertinente concernant les maladies les plus susceptibles d'être rencontrées par les anesthésistes.
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Perioperative myocardial ischaemia is common in patients who have or are at risk of coronary artery disease, occurring frequently in the pre-, intra- and postoperative periods. The majority of perioperative ischaemic episodes are silent, being unaccompanied by any symptoms of angina. ⋯ Maintenance of haemodynamic stability is important to reduce the incidence of myocardial ischemia, but ischaemia may occur in the absence of adverse haemodynamic changes. Although our efforts have largely been devoted to the prevention and treatment of intraoperative ischaemia, it is hoped that similar efforts outside the operating room in the postoperative period will further improve patient care and outcome.
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Multicenter Study Clinical Trial
The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care?
Since anaesthesia, unlike medical or surgical specialties, does not constitute treatment, this study sought to determine if methods used to assess medical or surgical outcomes (that is the determination of adverse outcome) are applicable to anaesthesia. Anaesthetists collected information on patient, surgical and anaesthetic factors while data on recovery room and postoperative events were evaluated by research nurses. Data on 27,184 inpatients were collected and the analysis of outcomes determined for the intraoperative, post-anaesthetic care unit and postoperative time periods. ⋯ Possible reasons to account for these variations in outcome include compliance in recording events, inadequate case-mix adjustment, differences in interpretation of the variables (despite guidelines) and institutional differences in monitoring, charting and observation protocols. The authors conclude that measuring quality of care in anaesthesia by comparing major outcomes is unsatisfactory since the contribution of anaesthesia to perioperative outcomes is uncertain and that variations may be explained by institutional differences which are beyond the control of the anaesthetist. It is suggested that minor adverse events, particularly those of concern to the patient, should be the next focus for quality improvement in anaesthesia.