Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1978
The influence of staff and personnel on the safety of the patient during anesthesia.
The safety of the patient under anesthesia is directly correlated to the quality of the service delivered by the anesthetic department. A good organised work, supposes a staff, which accords to numerical and qualitative requirements. ⋯ The quality required for the persons who administer anesthesia, depends upon the intrinsic danger of the procedure. As the nature of anesthesia is still linked with the acute control of vital functions of the patient, the qualifications of the person who administer the narcosis should be of the highest level.
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Acta Anaesthesiol Belg · Jan 1978
Cardiovascular monitoring with special emphasis on mixed venous oxygen measurements.
With the advent of complicated surgical procedures the need for invasive hemodynamic monitoring has taken a prominent place in the management of patients. This has resulted in improved morbidity and mortality in overall patient care. ⋯ This paper describes the usefulness of Swan-Ganz catheter (SG catheter) during intensive care. The purposes of the study is to determine the relationship between mixed venous oxygen saturation measurement, peripheral skin temperature and volume replacement in the immediate postoperative period, as well as the need for prolonged mechanical ventilation in shocked patients.
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Most of the articles on safety in anesthesia take the mortality as the criterion. This is fallacious. The anesthetist's area of responsibility must be clearly defined before his contribution to any given mortality can be assessed. ⋯ Outdated attitudes must be resolutely abandoned, particularly with regard to monitoring. The use of a coding system for anesthetic complications helps towards an objective assessment of the degree of safety achieved. The results obtained by this means in the Institute of Anesthesiology in Utrecht are reported.
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Malignant hyperthermia is now recognized as a distinct entity in anesthetic practice and can be considered as a pharmacogenetic disease of obscure etiology occuring in man and pigs with a dominant inheritance. A close association with myopathy has been noted. Commonly used muscle relaxants or anesthetic drugs can act as triggering agents in genetically susceptible patients, who develop a real hypermetabolic state, characterized by a rapid rise in body temperature, muscular rigidity, tachycardia and tachypnoea, cyanosis and severe respiratory and metabolic acidosis, the lethality being about 60%. ⋯ A regime of treatment is suggested, based on current concepts of the pathogenesis. It consists in establishing effective and rapid cooling, reversal of tissue hypoxia and correction of respiratory and metabolic acidosis and hyperkalemia. Specific therapy with dantrolene sodium may prove to be an answer to this serious problem.