Content deleted Content added
m Open access bot: doi added to citation with #oabot. |
Citation bot (talk | contribs) Add: doi-access. | Use this bot. Report bugs. | Suggested by Headbomb | Linked from Wikipedia:WikiProject_Academic_Journals/Journals_cited_by_Wikipedia/Sandbox3 | #UCB_webform_linked 769/1975 |
||
Line 44:
== Preoperative evaluation ==
Prior to a planned procedure, the anesthesiologist reviews medical records, interviews the patient, and conducts a physical examination to obtain information regarding their medical history and current physical state, and to determine an appropriate anesthetic plan, including what combination of drugs and dosages will likely be needed for the patient's comfort and safety during the procedure. A variety of non-invasive and invasive monitoring devices may be necessary to ensure a safe and effective procedure. Key factors in this evaluation are the patient's age, gender, [[body mass index]], medical and surgical history, current medications, exercise capacity, and fasting time.<ref>{{cite journal | vauthors = Lederman D, Easwar J, Feldman J, Shapiro V | title = Anesthetic considerations for lung resection: preoperative assessment, intraoperative challenges and postoperative analgesia | journal = Annals of Translational Medicine | volume = 7 | issue = 15 | pages = 356 | date = August 2019 | pmid = 31516902 | pmc = 6712248 | doi = 10.21037/atm.2019.03.67 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Izumo W, Higuchi R, Yazawa T, Uemura S, Shiihara M, Yamamoto M | title = Evaluation of preoperative risk factors for postpancreatectomy hemorrhage | journal = Langenbeck's Archives of Surgery | volume = 404 | issue = 8 | pages = 967–974 | date = December 2019 | pmid = 31650216 | pmc = 6935390 | doi = 10.1007/s00423-019-01830-w | doi-access = free }}</ref> Thorough and accurate preoperative evaluation is crucial for the effective safety of the anesthetic plan. For example, a patient who consumes significant quantities of [[Alcoholic beverage|alcohol]] or [[Recreational drug use|illicit drugs]] could be undermedicated during the procedure if they fail to disclose this fact, and this could lead to [[anesthesia awareness|anaesthesia awareness]] or intraoperative [[hypertension]].<ref>{{cite journal | vauthors = Budworth L, Prestwich A, Lawton R, Kotzé A, Kellar I | title = Preoperative Interventions for Alcohol and Other Recreational Substance Use: A Systematic Review and Meta-Analysis | journal = Frontiers in Psychology | volume = 10 | pages = 34 | date = 2019-02-04 | pmid = 30778307 | pmc = 6369879 | doi = 10.3389/fpsyg.2019.00034 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Siriphuwanun V, Punjasawadwong Y, Saengyo S, Rerkasem K | title = Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia | journal = Risk Management and Healthcare Policy | volume = 11 | pages = 177–187 | date = 2018-10-18 | pmid = 30425598 | pmc = 6201994 | doi = 10.2147/rmhp.s178950 | doi-access = free }}</ref> Commonly used medications can also interact with anaesthetics, and failure to disclose such usage can increase the risk during the operation. Inaccurate timing of last meal can also increase the risk for aspiration of food, and lead to serious complications.<ref name=":11">{{Cite book |title=Miller's anesthesia |date=2020 |publisher=Elsevier |editor=Michael A. Gropper |isbn=978-0-323-61264-7 |edition=Ninth |location=Philadelphia, PA |oclc=1124935549}}</ref>
An important aspect of pre-anaesthetic evaluation is an assessment of the patient's [[Respiratory tract|airway]], involving inspection of the mouth opening and visualisation of the soft tissues of the [[Human pharynx|pharynx]].<ref>{{cite journal | vauthors = Mushambi MC, Jaladi S | title = Airway management and training in obstetric anaesthesia | journal = Current Opinion in Anesthesiology | volume = 29 | issue = 3 | pages = 261–267 | date = June 2016 | pmid = 26844863 | doi = 10.1097/ACO.0000000000000309 | s2cid = 27527932 }}</ref> The condition of teeth and location of [[Crown (dentistry)|dental crowns]] are checked, and neck flexibility and head extension are observed.<ref>{{cite journal | vauthors = Rehak A, Watterson LM | title = Institutional preparedness to prevent and manage anaesthesia-related 'can't intubate, can't oxygenate' events in Australian and New Zealand teaching hospitals | journal = Anaesthesia | volume = 75 | issue = 6 | pages = 767–774 | date = June 2020 | pmid = 31709522 | doi = 10.1111/anae.14909 | s2cid = 207944753 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Schieren M, Kleinschmidt J, Schmutz A, Loop T, Staat M, Gatzweiler KH, Wappler F, Defosse J | display-authors = 6 | title = Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: a blinded manikin study | journal = Anaesthesia | volume = 74 | issue = 12 | pages = 1563–1571 | date = December 2019 | pmid = 31448404 | doi = 10.1111/anae.14815 | doi-access = free }}</ref> The most commonly performed airway assessment is the Mallampati classification, which evaluates the airway base on the ability to view airway structures with the mouth open and the tongue protruding. Mallampati tests alone have limited accuracy, and other evaluations are routinely performed addition to the Mallampati test including mouth opening, thyromental distance, neck range of motion, and mandibular protrusion. In a patient with suspected distorted airway anatomy, endoscopy or ultrasound is sometimes used to evaluate the airway before planning for the airway management.<ref>{{Cite journal |last1=Roth |first1=Dominik |last2=Pace |first2=Nathan L. |last3=Lee |first3=Anna |last4=Hovhannisyan |first4=Karen |last5=Warenits |first5=Alexandra-Maria |last6=Arrich |first6=Jasmin |last7=Herkner |first7=Harald |date=2018-05-15 |title=Airway physical examination tests for detection of difficult airway management in apparently normal adult patients |journal=The Cochrane Database of Systematic Reviews |volume=5 |issue=5 |pages=CD008874 |doi=10.1002/14651858.CD008874.pub2 |issn=1469-493X |pmc=6404686 |pmid=29761867}}</ref>
Line 53:
One commonly used premedication is [[clonidine]], an [[Alpha-adrenergic agonist#α2 agonists|alpha-2 adrenergic agonist]].<ref>{{cite journal | vauthors = Bergendahl H, Lönnqvist PA, Eksborg S | title = Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedication | journal = Acta Anaesthesiologica Scandinavica | volume = 50 | issue = 2 | pages = 135–143 | date = February 2006 | pmid = 16430532 | doi = 10.1111/j.1399-6576.2006.00940.x | url = http://www3.interscience.wiley.com/cgi-bin/fulltext/118557949/HTMLSTART | s2cid = 25797363 | archive-url = https://archive.today/20121216135407/http://www3.interscience.wiley.com/cgi-bin/fulltext/118557949/HTMLSTART | archive-date = 2012-12-16 }}</ref><ref>{{cite journal | vauthors = Dahmani S, Brasher C, Stany I, Golmard J, Skhiri A, Bruneau B, Nivoche Y, Constant I, Murat I | display-authors = 6 | title = Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies | journal = Acta Anaesthesiologica Scandinavica | volume = 54 | issue = 4 | pages = 397–402 | date = April 2010 | pmid = 20085541 | doi = 10.1111/j.1399-6576.2009.02207.x | s2cid = 205430269 | doi-access = free }}</ref> It reduces postoperative shivering, [[postoperative nausea and vomiting]], and emergence [[delirium]].<ref name=":11" /> However, a randomized controlled trial from 2021 demonstrated that clonidine is less effective at providing anxiolysis and more sedative in children of preschool age. Oral clonidine can take up to 45 minutes to take full effect,<ref>{{Cite journal |last1=Bromfalk |first1=Åsa |last2=Myrberg |first2=Tomi |last3=Walldén |first3=Jakob |last4=Engström |first4=Åsa |last5=Hultin |first5=Magnus |date=November 2021 |editor-last=Cravero |editor-first=Joseph |title=Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine |journal=Pediatric Anesthesia |language=en |volume=31 |issue=11 |pages=1225–1233 |doi=10.1111/pan.14279 |pmid=34403548 |s2cid=237197251 |issn=1155-5645|doi-access=free }}</ref> The drawbacks of clonidine include [[hypotension]] and [[bradycardia]], but these can be advantageous in patients with hypertension and tachycardia.<ref>{{cite journal | vauthors = Henry RG, Raybould TP, Romond K, Kouzoukas DE, Challman SD | title = Clonidine as a preoperative sedative | journal = Special Care in Dentistry | volume = 38 | issue = 2 | pages = 80–88 | date = March 2018 | pmid = 29364538 | doi = 10.1111/scd.12269 | s2cid = 3875130 }}</ref> Another commonly used alpha-2 adrenergic agonist is dexmedetomidine, which is commonly used to provide a short term sedative effect (<24 hours). [[Dexmedetomidine]] and certain [[atypical antipsychotic]] agents may be also used in uncooperative children.<ref>{{Cite journal |last1=Manning |first1=Alexander N. |last2=Bezzo |first2=Leah K. |last3=Hobson |first3=Jamie K. |last4=Zoeller |first4=Justine E. |last5=Brown |first5=Courtney A. |last6=Henderson |first6=Kristin J. |date=October 2020 |title=Dexmedetomidine Dosing to Prevent Pediatric Emergence Delirium |url=https://pubmed.ncbi.nlm.nih.gov/32990204 |journal=AANA Journal |volume=88 |issue=5 |pages=359–364 |issn=2162-5239 |pmid=32990204}}</ref>
Benzodiazepines are the most commonly used class of drugs for premedication. The most commonly utilized benzodiazepine is [[Midazolam]], which is characterized by a rapid onset and short duration. Midazolam is effective in reducing [[Preoperational anxiety|preoperative anxiety]], including [[Separation anxiety disorder|separation anxiety]] in children.<ref>{{Cite journal |last=El Batawi |first=Hisham Yehia |date=2015 |title=Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia |journal=Journal of International Society of Preventive & Community Dentistry |volume=5 |issue=2 |pages=88–94 |doi=10.4103/2231-0762.155728 |issn=2231-0762 |pmc=4415335 |pmid=25992332 |doi-access=free }}</ref> It also provides mild sedation, sympathicolysis, and anterograde amnesia.<ref name=":11" />
[[Melatonin]] has been found to be effective as an anaesthetic premedication in both adults and children because of its [[hypnotic]], [[anxiolytic]], [[Sedation|sedative]], [[Nociception|analgesic]], and [[anticonvulsant]] properties. Recovery is more rapid after premedication with melatonin than with midazolam, and there is also a reduced incidence of post-operative [[Psychomotor agitation|agitation]] and delirium.<ref name="Naguib2007">{{cite journal | vauthors = Naguib M, Gottumukkala V, Goldstein PA | title = Melatonin and anesthesia: a clinical perspective | journal = Journal of Pineal Research | volume = 42 | issue = 1 | pages = 12–21 | date = January 2007 | pmid = 17198534 | doi = 10.1111/j.1600-079X.2006.00384.x | doi-access = free }}</ref> Melatonin has been shown to have a similar effect in reducing perioperative anxiety in adult patients compared to benzodiazepine.<ref>{{cite journal | vauthors = Madsen BK, Zetner D, Møller AM, Rosenberg J | title = Melatonin for preoperative and postoperative anxiety in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD009861 | date = December 2020 | issue = 12 | pmid = 33319916 | pmc = 8092422 | doi = 10.1002/14651858.CD009861.pub3 }}</ref>
Line 161:
== Perioperative mortality ==
{{Main|Perioperative mortality}}
Most [[perioperative mortality]] is attributable to [[Complication (medicine)|complications]] from the operation, such as [[Bleeding|haemorrhage]], [[sepsis]], and failure of vital organs. Over the last several decades, the overall anesthesia related mortality rate improved significantly for anesthetics administered. Advancements in monitoring equipment, anesthetic agents, and increased focus on perioperative safety are some reasons for the decrease in perioperative mortality. In the United States, the current estimated anesthesia-related mortality is about 1.1 per million population per year. The highest death rates were found in the geriatric population, especially those 85 and older.<ref>{{Cite journal |last1=Li |first1=Guohua |last2=Warner |first2=Margaret |last3=Lang |first3=Barbara H. |last4=Huang |first4=Lin |last5=Sun |first5=Lena S. |date=April 2009 |title=Epidemiology of Anesthesia-related Mortality in the United States, 1999–2005 |journal=Anesthesiology |volume=110 |issue=4 |pages=759–765 |doi=10.1097/aln.0b013e31819b5bdc |issn=0003-3022 |pmc=2697561 |pmid=19322941}}</ref> A review from 2018 examined perioperative anesthesia interventions and their impact on anesthesia-related mortality. Interventions found to reduce mortality include pharmacotherapy, ventilation, transfusion, nutrition, glucose control, dialysis and medical device.<ref>{{Cite journal |last1=Boet |first1=Sylvain |last2=Etherington |first2=Cole |last3=Nicola |first3=David |last4=Beck |first4=Andrew |last5=Bragg |first5=Susan |last6=Carrigan |first6=Ian D. |last7=Larrigan |first7=Sarah |last8=Mendonca |first8=Cassandra T. |last9=Miao |first9=Isaac |last10=Postonogova |first10=Tatyana |last11=Walker |first11=Benjamin |last12=De Wit |first12=José |last13=Mohamed |first13=Karim |last14=Balaa |first14=Nadia |last15=Lalu |first15=Manoj Mathew |date=2018-11-30 |title=Anesthesia interventions that alter perioperative mortality: a scoping review |journal=Systematic Reviews |volume=7 |issue=1 |pages=218 |doi=10.1186/s13643-018-0863-x |issn=2046-4053 |pmc=6267894 |pmid=30497505 |doi-access=free }}</ref> Interestingly, a randomized controlled trial from 2022 demonstrated that there is no significant difference in mortality between patient receiving handover from one clinician to another compared to the control group.<ref>{{Cite journal |last1=Meersch |first1=Melanie |last2=Weiss |first2=Raphael |last3=Küllmar |first3=Mira |last4=Bergmann |first4=Lars |last5=Thompson |first5=Astrid |last6=Griep |first6=Leonore |last7=Kusmierz |first7=Desiree |last8=Buchholz |first8=Annika |last9=Wolf |first9=Alexander |last10=Nowak |first10=Hartmuth |last11=Rahmel |first11=Tim |last12=Adamzik |first12=Michael |last13=Haaker |first13=Jan Gerrit |last14=Goettker |first14=Carina |last15=Gruendel |first15=Matthias |date=2022-06-28 |title=Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults: The HandiCAP Randomized Clinical Trial |journal=JAMA |volume=327 |issue=24 |pages=2403–2412 |doi=10.1001/jama.2022.9451 |issn=1538-3598 |pmc=9167439 |pmid=35665794}}</ref>
Mortality directly related to anaesthetic management is very uncommon but may be caused by [[pulmonary aspiration]] of gastric contents,<ref>{{cite journal | vauthors = Engelhardt T, Webster NR | title = Pulmonary aspiration of gastric contents in anaesthesia | journal = British Journal of Anaesthesia | volume = 83 | issue = 3 | pages = 453–460 | date = September 1999 | pmid = 10655918 | doi = 10.1093/bja/83.3.453 | doi-access = free }}</ref> [[asphyxia]]tion,<ref>{{cite journal | vauthors = Parker RB | title = Maternal death from aspiration asphyxia | journal = British Medical Journal | volume = 2 | issue = 4983 | pages = 16–19 | date = July 1956 | pmid = 13329366 | pmc = 2034767 | doi = 10.1136/bmj.2.4983.16 }}</ref> or [[anaphylaxis]].<ref>{{cite journal | vauthors = Dewachter P, Mouton-Faivre C, Emala CW | title = Anaphylaxis and anesthesia: controversies and new insights | journal = Anesthesiology | volume = 111 | issue = 5 | pages = 1141–1150 | date = November 2009 | pmid = 19858877 | doi = 10.1097/ALN.0b013e3181bbd443 | doi-access = free }}</ref> These in turn may result from malfunction of [[Anaesthetic equipment|anaesthesia-related equipment]] or, more commonly, [[Human reliability|human error]]. In 1984, after a television programme highlighting anaesthesia mishaps aired in the United States, American anaesthesiologist [[Ellison C. Pierce]] appointed the Anesthesia Patient Safety and Risk Management Committee within the [[American Society of Anesthesiologists]].<ref name=Guadagnino2000>{{Cite web|title=Improving anesthesia safety|author=Guadagnino C|publisher=Physician's News Digest, Inc.|location=Narberth, Pennsylvania|year=2000|url=http://physiciansnews.com/spotlight/200wp.html|access-date=8 September 2010|archive-url=https://web.archive.org/web/20100815080827/http://physiciansnews.com/spotlight/200wp.html|archive-date=15 August 2010}}</ref> This committee was tasked with determining and reducing the causes of anaesthesia-related [[Disease#Morbidity|morbidity]] and mortality.<ref name=Guadagnino2000/> An outgrowth of this committee, the Anesthesia Patient Safety Foundation, was created in 1985 as an independent, nonprofit corporation with the goal "that no patient shall be harmed by anesthesia".<ref>{{Cite web|title=Foundation History|author=Stoelting RK|publisher=Anesthesia Patient Safety Foundation|location=Indianapolis, IN|year=2010|url=http://www.apsf.org/about_history.php|access-date=8 September 2010}}</ref>
| |||