| Sažetak | Uvod. Anestezija je postupak izazivanja neosjetljivosti. Riječ anestezija dolazi od grčkih riječi an – bez i estos – osjećaja, a skovao ju je američki liječnik, pjesnik i pisac Oliver Wendell Holmes 1848. godine. Izvođenje anestezije nekoć je bilo opasno i neizvjesno, smrtnost je bila velika, danas je smrtnost niska. Rizici anestezije i komplikacije anestezije svedeni su na nisku razinu zahvaljujući otkriću i uporabi sigurnijih anestetika, boljim strojevima i monitorima kojima se prati tijek anestezije, te boljom edukacijom anesteziologa i njihovih pomoćnika. U pokušaju da se objektivizira prije – operacijski rizik, pedesetih godina prošlog stoljeća u upotrebu se uvodi ASA – klasifikacija (eng. American Society of Anesthesiology). Prema procjeni postoji li u bolesnika sustavna bolest i prate li ju funkcionalna ograničenja, sve bolesnike možemo svrstati u 5 skupina s odgovarajućom stopom smrtnosti. Bolesnici koji se operiraju u hitnoći imaju povećani prije – operacijski rizik u odnosu prema pripadajućoj skupini i obično se uz brojku ASA – skupine kojoj pripadaju dodaje oznaka E (emergency). Cilj mog istraživanja u ovom radu je bio utvrditi korelaciju prije – operacijskog rizika anestezije s njenim komplikacijama u hitnim i programski operiranih bolesnika. Hipoteza. Pretpostavljam da će veća učestalost komplikacija biti izražena kod hitno operiranih bolesnika, uz višu ocjenu pre-anesteziološkog rizika, veću dužinu trajanja operacije, određenu vrstu anestezije te stariju životnu dob.
Metode istraživanja. Retrospektivno istraživanje sam provela unutar godine dana u sklopu Opće bolnice Dubrovnik, a nakon odobrenja Etičkog povjerenstva. Podaci su prikupljani pravilnim nizom iz arhiviranih kopija anestezioloških lista abdominalne, torakalne i vaskularne sale. Pregledom je obuhvaćeno ukupno 417 bolesnika od kojih je 334 činilo kontrolnu (planirane operacije), a 83 bolesnika ispitivanu skupinu (hitno operirani bolesnici). U ocjeni anesteziološkog rizika korištena je ASA klasifikacija, dokumentirana na listi anesteziološkog pregleda bolesnika prije operacije. Svi bolesnici prikazani su prema demografskim karakteristikama. Komplikacije anestezije razvrstane su prema općenitim i specifičnim da bi u konačnosti bile istaknute samo one koje su bile zabilježene u ispitivanom periodu. Statistička obrada je učinjena uz Interactive Statistic Calculating Pages.
Rezultati. Od ukupno 417 bolesnika, samo jedna komplikacija anestezije ili istovremeno više njih je zabilježeno kod 32 bolesnika (7,7%), od toga kod 10 planirano (2,4%) i 22 (5,3%) hitno operiranih bolesnika. Učestalost komplikacija je kod bolesnika s ocjenjenim niskim
2
anesteziološkim rizikom iznosila po 0,7% (ASA 1, 2 i EASA 1), a kod bolesnika s povećanim rizikom anestezije 1,2% za ASA 3 i 0,2% za ASA 4. Kod hitnih bolesnika istog ocjenjenog rizika anestezije je pojavnost komplikacija bila značajnije češća 1,2% za EASA 2 (0,7% ASA 2), 2,4% za EASA 3 (1,2% ASA 3) i 0,7% za EASA 4 (0,2% ASA 4). Kod hitnih operacija je, u usporedbi s planiranim, bila veća učestalost samo komplikacija koje proizlaze iz uzroka bolesti i/ili vrste operacije (13% i 1%) i komplikacija koje traže specifičnu terapijsku nadoknadu (16% i 1%). Značajno manji omjer broja komplikacija bio je kod regionalnih anestezija i kod elektivnih, i kod hitnih bolesnika kroz sve stupnjeve ASA ocjenjenog rizika. Dob bolesnika i dužina trajanja anestezije iako su bili vezani uz više ocjene rizika anestezije (ASA 3 i ASA 4) u našoj grupi ispitanika nisu ukazivali na povezanost s pojavom učestalijih komplikacija.
Zaključak. Utvrđena je povezanost između prije- operacijskog ASA statusa bolesnika i komplikacija tijekom kirurškog zahvata. Znatan doprinos prije – operacijskom riziku anestezije donosi i sam kirurški postupak. Što je ASA status bolesnika viši trajanje operacijskog zahvata je duže i više je komplikacija anestezije. |
| Sažetak (engleski) | Introduction. Anesthesia is a process of causing insensitivity. The word anesthesia comes from Greek words an- without and estos – feelings, and it was made by the American doctor, poet and writer Oliver Wendell Holmes in 1848. Performing anesthesia was once dangerous and uncertain, death was great as for today we have low death rate. Risk od anesthesia and anestetic complikations have been reduceed to a low level thanks to the doscovery and use of safer anesthetics, better machines and monitors to monitor anesthesia, and improved training of anesthesilologists and their assistants. In the attempt to objectify the preoperative risk, the ASA – classifikation (American Society of Ansthesiology) was introducet in the patient and whether functional limitacions are in place, all patients can be classified into 5 groups with an appropriate mortality rate. Emergency patiens have incrased preoperative risk in relation to the associated group and usually with the number of ASAs we add the E (emergency) tag. The aim of my research in the paper was to determine correlation of preoperative risk of anesthesia with its complications will be expressed in emergency and program – operated patients. Hypothesis. The premis was that a greater incidence of complications will be expressed in emergency patients with a higher pre-anesthesiological risk assessment, longer duration of surgery, a certain type of anesthesia, and an older ahe.
Method of research. Retrospective study I have spent year within the General Hospital od Dubrovnik, and after the approval of the Etics Committee. The data were collected in a regular aequence from the archived copies of te anesthetic list of abdominal, thoracic and vascular hall. A total of 417 patients were included, 334 of witch were controlled (planned), and 83 were examined (emergency patients). In anesthesia ris assessment, ASA classification was used, documented on the list of anesthesiologic examinations of patients prior to surgery. All patients are predented according to demographic characteristics. Complikations of anesthesia are classified according to the general and spacific ones so that only those observed in the study period are highlighted. Statistical processing was done with Interactive Statistic Calculating Pages.
The results. Our of a total of 417 patients, only one complication of anesthesia or more was observed in 32 patients (7,7 %), of whom 10 were planned (2,4 %) and 22 (5,3 %) of urgently operated patients. The frequency of complications in patients with a low risk of anesthesia was 0,7 % (ASA 1 1,2 and EASA 1) and in patients with increased risk of anesthesia 1,2 % for ASA
4
3 and 0,2 % for ASA 4. By patients with the same estimated risk of anesthesia, the incidence of complications was significantly higher by 1,2 % for EASA 2 (0,7 % ASA 2), 2,4 % EASA 3 (1,2% ASA 3) and 0,7% for EASA 4 (0,2% ASA 4). In the case of emergency operations, compared to the plannes, there was a greater incidence of only complications due to the cause of the disease and/ or type of surgery (13% ana 1%) and complications requiring specific therapeutic remission (16% and 1%). Significantly smaller ratio of complications was observed in regional anesthesia and in elektive and in emergency patients through all grades of ASA rated risk. The age of the patients and the duration of the anesthesia although related to a higer assessment of anesthesia risk (ASA 3 and ASA 4) in gropu did not indicate association with the occurrent of more frequent complications.
Conclusion. The correlation between the preopertive ASA status of the patient and complications during the surgical procedur was established. Significant contribution to the peroperative risk of anesthesia is also the surgical procedure itself. When the ASA status of patient is higher the duration of surgery is longer and there are more anestethic complications. |
