Preoperative tests recommendations in adult patients for ambulatory surgery

Anesthetic assessment traditionally included a series of laboratory tests intended to detect undiagnosed diseases, and to ensure that the patient undergoes surgery following safety criteria. These tests, without a specific clinical indication, are expensive, of questionable diagnostic value and often useless. In the context of outpatient surgery, recent evidence suggests that patients of any age without significant comorbidity, ASA physical status gradei and grade ii, do not need additional preoperative tests routinely. The aim of the present recommendations is to determine the general indications in which these tests should be performed in ASA gradei and grade ii patients undergoing ambulatory surgery.

[Jehovah's Witnesses refusal of blood: religious, legal and ethical aspects and considerations for anesthetic management]

The refusal of Jehovah's Witnesses to agree to blood or blood product transfusion based on religious beliefs is one of the most challenging conflictive issues health care givers have to face today. Such conflict is a by product of the ideological and religious diversity in society today. The perioperative care of such patients constitutes a genuine challenge for anesthesiologists and surgeons from technical, scientific, ethical, and legal perspectives. We review the reasons why Jehovah's Witnesses refuse transfusion and discuss the ethical, legal, and anesthetic aspects of their care. The literature up to August 2005 was reviewed by MEDLINE search. The following search terms were used: Jehovah's Witnesses, anesthesia (and anaesthesia), legislation and jurisprudence, ethics, blood transfusion, alternatives, anemia (and anaemia), erythropoietin, trigger, and critical care. To further cover ethical and legal aspects, we reviewed current laws in Spain and similar practice settings.

Multimediale Patientenaufkl�rung in der Klinik

Due to heavy workloads and shortage of staff, doctors often find it difficult to explain operations to their patients with the legally required detail and timing (in Germany, 24 h preop). This is however mandatory for obtaining informed consent. We developed a computer program that generates films explaining 24 common orthopedic operations and blood transfusion. They explain the operation, early postoperative phase, and benefits and risks to the patient. At our clinic, this program is used in daily routine and precedes the actual doctor-patient conversation for informed consent. We asked 300 patients about their satisfaction with the newly developed program. The multimedia presentation gives the patient more time, enough detail and clarity, and the chance to repeat parts of the film. For the doctor, it saves time. The time gap required in Germany between explanation and operation is thus easily adhered to. In case of legal problems, the film can be used for evidence. The use of this multimedia presentation to help in getting informed consent is improving workflow considerably.

What are the benefits and the pitfalls of preoperative fasting?

Preoperative fasting has been a traditional practice for many years to reduce the risk of aspiration while the patient is under general anaesthetic and to eliminate the risk of postoperative nausea and vomiting. Although it is generally accepted that fasting is beneficial, the fasting regimens that patients undergo are not dependent on the individual patient or the timing of their operation.

Legal aspects of consent 4: duty to inform patients of risks

Fred has suffered for many years with a hernia and has been placed on the waiting list for surgery. He is finally admitted, but is extremely frightened, never having had any contact with hospitals before. He keeps asking what will happen to him. Nurses discover that his mother died when he was only 8 years old following an operation for the removal of gall stones. He is afraid that the same thing will happen to him.

Preoperative hair removal: a case report with implications for nursing

Preoperative hair removal has been a practice since the beginning of this century. Research in the 1970s and 1980s provide support for the contention that the procedure is unnecessary for wound asepsis and may increase the rate of surgical site infections (Seropian & Reynolds, 1971; Hamilton et al., 1977; Cruse & Foord, 1980; Court-Brown, 1981; Alexander et al., 1983; Winfield, 1986; Fairclough et al., 1987). However, some hospitals have continued routine preoperative hair removal long after dissemination of recommendations against it. This begs the question, 'Why is it that so often research findings are not applied in practice'. In Stroud v. General Hospital Corp. and Pollett (1993), a man died of sepsis resulting from cuts he gave himself after he was asked by a nurse, in complete violation of the hospital's preoperative skin preparation protocol, to clip hair from his abdomen. The court held the hospital liable for the nurse's negligent breach of its protocol. The case clearly supports findings in the literature that preoperative hair removal is potentially dangerous. It reinforces the importance of strict adherence to hospital protocols which have been put in place to protect patients' safety.