[Experience of an interdisciplinary anesthesiology and nursing team for providing anesthesia outside the operating room]

Management of iron deficiency anaemia by the preanaesthesia nurse with respect to perioperative transfusion rates

OBJECTIVE

To describe the prevalence of perioperative blood transfusion (BT) for patients with preoperative iron deficiency anaemia and undergoing major elective surgery, included in an intravenous iron protocol (IV Fe) led by the pre-anaesthesia nurse.

METHOD

Observational, descriptive, longitudinal and retrospective study in a population of patients undergoing major elective surgery, seen in anaesthesia nursing consultation in a tertiary hospital between April 2014 and January 2017. The patients with iron deficiency anaemia, included in the study, were included in a protocol of treatment with preoperative IV Fe.

RESULTS

Fifty patients were studied. Twelve percent required a BT. A statistically significant association was observed between the need for intraoperative BT and the number of days between the first administration of IV Fe and date of surgery (P<.01) and also the number of days between the last administration of IV Fe and the surgical intervention (P=.04). The increase in haemoglobin was greater in patients who received more than one dose compared to those who received only one dose of 1,000mg (P<.01).

CONCLUSIONS

In our study, we estimated an increase in haemoglobin greater than in other studies and a low administration rate of BT (12%). The role of the nurse is fundamental for the preselection of these patients.

[An established anesthesia team-care model: over 12000 cases in a digestive endoscopy unit]

BACKGROUND AND OBJECTIVE

The growing demand for digestive and other endoscopic procedures outside the operating room, both in terms of type of endoscopy and number of patients, requires reorganization of the anesthesiology department's workload. We describe 2 years of our hospital digestive endoscopy unit's experience with a now well-established care model involving both anesthesiologists and nurse anesthetists.

MATERIAL AND METHODS

After previously reviewing the medical records of outpatients and conducting a telephone interview about state of health, nurse anesthetists administered a combination of propofol and remifentanil through a target-controlled infusion system under an anesthesiologist's direct supervision.

RESULTS

The ratio of anesthesiologists to nurses ranged from 1:2 to 1:3 according to the complexity of the examination procedure. Over 12000 endoscopies (simple to advanced) in a total of 11853 patients were performed under anesthesia during the study period. Airway management maneuvers were required by 4.9% of the patients; 0.18% required bag ventilation for respiratory depression, and 0.084% required bolus doses of a vasopressor to treat hypotension or atropine to treat bradycardia. The procedure had to be halted early in 9 patients (0.07%). No patient required orotracheal intubation and none died. Nor were any complications related to sedation recorded.

CONCLUSION

The results suggest that this care model can safely accommodate a large caseload in anesthesia at an optimum level of quality.