臨床麻酔学ジャーナル: オープンアクセス

Perioperative embolism increases the risk of morbidity and mortality in surgical patients. Pulmonary Embolism (PE), Fat Embolism Syndrome (FES), and Vascular Air Embolism (VAE) are a relatively common embolic phenomenon in the perioperative period. Surgical intervention causes tissue injury, hypercoagulability, and venous stasis. The incidence of pulmonary embolism varies with the type of surgical interventions, and hip hemi-arthroplasty has a higher incidence, whereas the laparoscopic surgeries have a lower incidence of pulmonary embolism. Various risk predispose to a perioperative pulmonary embolism. CTPA (Computerized Tomographic Pulmonary Angiography) has high sensitivity and specificity for the diagnosis of pulmonary embolism. Unfractionated Heparin (UFH) should be started as soon as pulmonary embolism is suspected. FES is the organ dysfunction caused by fat emboli. FES can be diagnosed by using a combination of clinical criteria and imaging studies. Supportive care is the mainstay of treatment for FES while heparin, steroid, and dextran are not recommended. VAE is frequent in obstetric, laparoscopic, and neurosurgical surgeries. VAE is increasingly occurring in divers, aviators, and astronauts due to the dysbarism. VAE commonly manifests by respiratory, cardiogenic, and neurological manifestations. Treatment includes hyperbaric oxygen therapy, UFH, and lignocaine. The incidence of pulmonary embolism in ICU patients with COVID-19 range between (14-43)%, most of them on anticoagulants. The diagnosis is challenging. The raised D-Dimer is an indication to do CTPA (Computerized Tomographic Pulmonary Angiography).

Establishing a block room or dedicated space outside the operating theatres for performing regional anesthesia techniques is reported to improve patients' clinical care, satisfaction, enhance teaching and education and cost effect regarding saving operating room hours. In this article, the author represents two trials for establishing a successful block room at a tertiary care facility. By demonstration, the Plan-Do-Study-Act model for quality improvement, the essential components, and necessary actions were recognized and done over two years' timeframe. The number of patients receiving regional anesthesia in the block room increased significantly from 85 to around 200 after one year of operation. Then, it reached stability towards the end of the study period. The total no of patients who received regional anesthesia increased in 2018 compared to 2017 from 1800 (9%) to 2324 (11.6%), and in 2019 to 3132 (15.7%) of the total patients operated annually.

The annual cases for fellows increased significantly from 52 ± 28 cases to 164 ± 42 cases annually (p<0.05). The total daily working hours added nine daily hours to ORs to recruit more patients during the daytime.

In conclusion, establishing a successful block room helps improve patient's clinical care and decrease the cost of OR utilization by adding more hours to busy operating theatres and improving teaching and education.