OBJECTIVE: To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. METHODS: This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. RESULTS: Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm ²) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm ²). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. CONCLUSION Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.
Female ; Humans ; Male ; Anesthesia ; Anesthesiologists/statistics & numerical data* ; Disinfection/standards* ; Hand Hygiene/statistics & numerical data* ; Staphylococcal Infections ; Operating Rooms/statistics & numerical data* ; Staphylococcus aureus/isolation & purification*

Active involvement of anesthesiologists in perioperative management is important to ensure the patients' safety. This study aimed to investigate the state of anesthetic services in Korea by identifying anesthetic service providers. From the insurance claims data of National Health Insurance for 3 yr, the Korean state of anesthetic services was analyzed. The claims for anesthesia from the medical institutions which hire their own anesthesiologist or with an anesthesiologist invitation fee are assumed to be the anesthesia performed by anesthesiologists. The annual anesthetic data were similar during the study period. In 2013, total counts of 2,129,871 were composed with general anesthesia (55%), regional anesthesia (36%) and procedural sedation with intravenous anesthetics (9%). About 80% of total cases of general anesthesia were performed in general hospitals, while more than 60% of the regional anesthesia and sedation were performed in the clinics and hospitals under 100 beds. Non-anesthesiologists performed 273,006 cases of anesthesia (13% of total) including 36,008 of general anesthesia, 143,134 of regional anesthesia, and 93,864 of sedation, mainly in the clinics and hospitals under 100 beds. All procedural sedations in the institutions without direct employed anesthesiologist were performed by non-anesthesiologists. Significant numbers of anesthesia are performed by non-anesthesiologist in Korea. To promote anesthetic services that prioritize the safety of patients, the standard to qualify anesthetic service is required. Surgeons and patients need to enhance their perception of anesthesia, and the payment system should be revised in a way that advocates anesthesiologist-performed anesthetic services.
Adult ; Aged ; Anesthesia/*statistics & numerical data ; Databases, Factual ; Female ; Humans ; Middle Aged ; National Health Programs ; Republic of Korea ; Surveys and Questionnaires

INTRODUCTIONPerioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.

METHODSThis was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.

RESULTSA total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).

CONCLUSIONThe current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.

Adult ; Anesthesia, Local ; methods ; Anesthesiologists ; statistics & numerical data ; Blood Glucose ; analysis ; Cataract Extraction ; Cross-Sectional Studies ; Diabetes Mellitus ; blood ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Ophthalmologists ; statistics & numerical data ; Perioperative Care ; methods ; Singapore ; epidemiology ; Surveys and Questionnaires

Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after surgery. An identification of risk factors associated with PONV would make it easier to select specific patients for effective antiemetic therapy. We designed a case-controlled study to identify the risk factors for PONV in 5,272 surgical patients. At postoperative 2 and 24 hr, patients were visited and interviewed on the presence and severity of PONV. Thirty nine percent of patients experienced one or more episodes of nausea or vomiting. Five risk factors were highly predictive of PONV: 1) female, 2) history of previous PONV or motion sickness, 3) duration of anesthesia more than 1 hour, 4) non-smoking status, and 5) use of opioid in the form of patient controlled analgesia (PCA), in the order of relevance. The formula to calculate the probability of PONV using the multiple regression analysis was as follows: P (probability of PONV)=1/1+e(-Z), Z=-1.885+0.894 (gender)+0.661 (history)+0.584 (duration of anesthesia)+0.196 (smoking status) +0.186 (use of PCA-based opioid) where gender: female=1, male=0; history of previous PONV or motion sickness: yes=1, no=0; duration of anesthesia: more than 1 hr=1, less than or 1 hr=0; smoking status: no=1, yes=0; use of PCA-based opioid: yes=1, no=0.
Anesthesia/*statistics and numerical data ; Case-Control Studies ; Female ; Humans ; Korea/epidemiology ; Male ; Outcome Assessment (Health Care)/*methods ; Postoperative Nausea and Vomiting/*epidemiology ; Prevalence ; Prognosis ; *Proportional Hazards Models ; Reproducibility of Results ; Research Support, Non-U.S. Gov't ; Risk Assessment/*methods ; Risk Factors ; Sensitivity and Specificity

Objective To investigate the independent risk factors and the prognosis of reintubation following surgeries under general anesthesia in post-anesthesia care unit (PACU). Methods 　We retrospectively analyzed the clinical data of 14 407 patients undergoing elective surgeries from October 2013 to October 2014 in the China-Japanese Friendship Hospital. Patients were divided into reintubation group and control group according to the application of reintubation (or not) in PACU. Multivariate Logistic analysis was performed for factors showing significant difference between these two groups to screen for risk factors and analyze the prognosis. Results 　Sixteen patients (0.11%) were reintubated in PACU.The Logistic regression analysis showed that the independent risk factors for reintubation were as following:preoperative chronic obstructive pulmonary disease (COPD)(OR=17.55,95%CI :3.08-59.84,P=0.001) or preoperative coronary artery disease (OR=5.98,95%CI :1.67-21.42,P=0.006),intraoperative blood loss greater than 12 ml·kg-1 (OR=27.83,95%CI :10.75-54.62,P <0.001),and thoracic surgery (OR=22.96,95%CI :12.66-48.19,P=0.004). Conclusion s　Preoperative COPD or coronary artery disease,intraoperative blood loss greater than 12 ml·kg-1,and thoracic surgery are the independent risk factors for postoperative PACU reintubation of patients undergoing surgeries with general anesthesia.Although the mortality rate is relative high,most patients have a good prognosis.
Anesthesia, General ; adverse effects ; Blood Loss, Surgical ; China ; Coronary Artery Disease ; complications ; Humans ; Intubation, Intratracheal ; statistics & numerical data ; Postoperative Period ; Prognosis ; Pulmonary Disease, Chronic Obstructive ; complications ; Retrospective Studies ; Risk Factors ; Thoracic Surgical Procedures

INTRODUCTIONThis study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore.

METHODSData pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter.

RESULTSA total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children.

CONCLUSIONCritical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

Adolescent ; Adult ; Anesthesia ; adverse effects ; methods ; Anesthesiology ; methods ; Child ; Child, Preschool ; Hospitals, Teaching ; Humans ; Infant ; Infant, Newborn ; Medical Errors ; prevention & control ; statistics & numerical data ; Pediatrics ; methods ; Quality Assurance, Health Care ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult