Central to the question of anesthetic risk is the definition of an anesthetic death. This has yet to be defined within any reasonable limits. A number of factual and philosophical considerations have complicated attempts to derive a precise definition. Anesthetic risk is largely confused with surgical risk, involving a second set of persons and procedures. Only events between induction of anesthesia and onset of operation clearly relate the risk of anesthesia to patient diseases and the causes of deaths during and after operation are usually speculative. Among those factors which relate to anesthetic risk; age, physical status, surgical area, anesthetic method, selection of anesthetic agent, inadequate preoperative preparation, improper decision and skill of anesthesiologist himself, and elective vs emergency operations are most important in minimizing the anesthetic risk. Furthermore, elective vs emergency operations relate more to anesthetic mortality than to other factors. Many emergency operations were practiced in our hospital, more than in other institutions. Thus, our anesthesiologists are faced with a higher incidence of anesthetic risks. Evaluated results were as follows; 1) The percentage of emergency operations was 57.4% of the total performed operations. 2) The mortality rate is significantly higher in emergency surgical procedures than in elective surgical procedures, 3) Frequent changing of the operation schedule may cause confusion in the anesthesiologist's decision on preparation and selection of the anesthetic agent and technique, and may also cause an increased workload.
Anesthesia ; Appointments and Schedules* ; Cause of Death ; Elective Surgical Procedures ; Emergencies ; Humans ; Incidence ; Methods ; Mortality

In the past several years of 21 century, there are many updates of concepts on the diagnosis and treatment of colorectal cancer, which indicates the era of experience-based medicine has been gradually replaced by that of evidence-based medicine. Despite emerging evidence from randomized controlled trials(RCT) and meta-analyses questioning its use, concurrent suggestion on the indication of preoperative bowel preparation has not been reached. The authors agree with the opinion of The Huang Jia-si Textbook of Surgery(7th Edition). Preoperative bowel preparation should be emphasized before the consensus is confirmed, though there are so many trials showing that bowel preparation before elective colorectal surgery was unnecessary. In the authors' consideration, compared with the Westerner, the Chinese prefer to the food style of low fat and high cellulose, which would make more food residue. So whether the oversea finding of the preoperative bowel preparation is fit for the colorectal patients in China is questioned. Therefore large-sample, multi-centre, prospective RCT is expected to be carried out by the national academic organization, by which high-ranking evidence suitable for the Chinese could be obtained.
Colorectal Surgery ; Elective Surgical Procedures ; Enema ; adverse effects ; methods ; Humans ; Preoperative Care

Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, P<0.05], successful endotracheal intubation [(39.8±9.5) s vs. (24.1±8.2) s, P<0.05], and device removal [(18.2±5.1) s vs. (14.7±3.7) s, P<0.05]. There were no differences in fiberoptic grade of view between these devices, and the percentage of glottis seen was 80.0% (Air-Q group) vs. 86.7% (Aura-i group). The leak pressure was (20.5±4.8) cmHO in the Air-Q group and (22.2±5.0) cmHO in the Aura-i group (P<0.05), and the cuff pressure was (22.9±11.5)cmHO in the Air-Q group and (33.9±15.9) cmHO in the Aura-i group (P<0.05). Hemodynamic changes were not significantly different between two group. The incidence rate of sore throat two hours after operation was 6.5% (n=4) in the Air-Q group and 5% (n=3) in the Aura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.
Anesthesia, General ; Child ; Device Removal ; Elective Surgical Procedures ; Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; methods ; Laryngeal Masks ; Pressure ; Prospective Studies

Animals ; Aortic Aneurysm, Abdominal ; mortality ; surgery ; Elective Surgical Procedures ; economics ; methods ; Female ; Health Care Costs ; Male ; Survival Rate

BACKGROUNDAirway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis.

METHODSA total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III-IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test.

RESULTSThe success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P< 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034).

CONCLUSIONSSOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway.

TRIAL REGISTRATIONChinese Clinical Trial Registry, ChiCTR-IOR-16007821; http://www.chictr.org.cn/showproj.aspx?proj=13203.

Adult ; Blood Pressure ; physiology ; Elective Surgical Procedures ; methods ; Female ; Heart Rate ; physiology ; Humans ; Intubation, Intratracheal ; methods ; Laryngoscopes ; Laryngoscopy ; methods ; Male ; Middle Aged ; Spondylosis ; surgery ; Treatment Outcome

For elective surgery of colorectal cancer, current evidence supports preoperative mechanical bowel preparation combined with oral antibiotics. Meanwhile, for patients with varied degrees of intestinal stenosis, individualized protocol is required to avoid adverse events. We hereby summarize recent high-quality evidences and updates of guidelines and consensus, and recommend stratified bowel preparation based on the clinical practice of our institute as follows. (1) For patients with unimpaired oral intake, whose tumor can be passed by colonoscopy, mechanical bowel preparation and oral antibiotics are given. (2) For patients without symptoms of bowel obstruction but with impaired oral intake or incomplete colonoscopy due to tumor-related stenosis, small-dosage laxative is given for several days before surgery, and oral antibiotics the day before surgery. (3) For patients with bowel obstruction, mechanical bowel preparation or enema is not indicated. We proposed this evidence-based, individualized protocol for preoperative bowel preparation for the reference of our colleagues, in the hope of improving perioperative outcomes and reducing adverse events.
Anti-Bacterial Agents/therapeutic use* ; Colorectal Neoplasms/drug therapy* ; Constriction, Pathologic/etiology* ; Elective Surgical Procedures/adverse effects* ; Humans ; Preoperative Care/methods* ; Surgical Wound Infection/etiology*

Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.
Elective Surgical Procedures/adverse effects/*methods ; Humans ; Incidental Findings ; Kidney Neoplasms/*surgery ; Length of Stay ; Nephrectomy/adverse effects/*methods ; Postoperative Complications/prevention & control ; Treatment Outcome

Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.
Elective Surgical Procedures/adverse effects/*methods ; Humans ; Incidental Findings ; Kidney Neoplasms/*surgery ; Length of Stay ; Nephrectomy/adverse effects/*methods ; Postoperative Complications/prevention & control ; Treatment Outcome

INTRODUCTIONProduction pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore.

METHODSA random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure.

RESULTSDemographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively.

CONCLUSIONProduction pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.

Anesthesia ; methods ; Anesthesiologists ; Anesthesiology ; methods ; Elective Surgical Procedures ; Humans ; Operating Rooms ; Patient Safety ; Prevalence ; Singapore ; Stress, Physiological ; Surveys and Questionnaires ; Tertiary Care Centers ; Treatment Outcome ; Workload

BACKGROUNDAlthough tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and "watchful waiting" remains controversial for patients with early stage N0 oral tongue carcinoma.

METHODSOn the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value (EV) was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed.

RESULTSThe results showed that the decision model favored elective neck dissection (EV = 0.87), over "watchful waiting" (EV = 0.77). One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the "watchful waiting" group, and a salvage rate threshold value 0.73 for the "watchful waiting" group.

CONCLUSIONSThese results suggested that elective neck dissection strategy of the neck should be applied for early stage N0 oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, "watchful waiting" strategy would be preferable.

Carcinoma, Squamous Cell ; pathology ; surgery ; Decision Support Techniques ; Elective Surgical Procedures ; Humans ; Neck Dissection ; methods ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Tongue Neoplasms ; pathology ; surgery