Whoever thinks a faultless piece to see, thinks what ne'er was, nor is, nor e'er shall be. A. Poe, An Assay on Criticism

LUIGI S. BRANDI
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GENERAL ANESTHESIA


REGIONAL ANESTHESIA


LOCAL ANESTHESIA


LABOR ANALGESIA


SURGERY and PAIN


MALIGNANT HYPERTHERMIA


ANESTHESIA and HERBS


ANESTHESIA SIDE EFFECTS


REFERENCED in:
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DICA 33 MOTORE DI RICERCA



DETSKY AND GOLDMAN CALCULATORS

 J Gen Int Med (1986) 1:211;   Arch Intern Med (1986) 146:2131;  N.Engl.J.Med. (1977) 297:845

This calculator allows an easy calculation of scores to evaluate mortality and morbidity after surgical procedures. Its only purpose is the calculation of the scores, irrespectively of any judgement on their relevance or usefulness.


The calculation of a risk assigned to a measured score is an epidemiologic tool, and never should be used as a single patient prevision tool. Moreover, it should be underlined that in different patient populations and health system realities, these scores could not work.


Please refer to : Lemeshow S, Le Gall JR. Modeling the severity of illness of ICU patients. A systems update. JAMA. 1994;272:1049-55



 Clinical History
Goldman
Detsky
  Age > 70 yr
5
5

  Myocardial Infarction:

< 6 months

> 6 months

 never

10,0
10,5

Pulmonary edema

 ever

recent

never

NA
5,10

 Angina*
Goldman
Detsky
 Class III
10,20
NA
 Class IV
NA
10,20
 Neither
NA
10,20
Unstable Angina within 3 months
NA
10

Cardiac Exam
Goldman
Detsky
Signs of congestive heart failure (S3 or Jugular Distension)
11
NA
Significant aortic stenosis / suspected critical aortic stenosis
20
3

 Electrocardiogram
Goldman
Detsky
Arrhythmia other than sinus or premature atrial contractions
7 5
5 or more PVCs per minute any time before surgery
7 5

Goldman
Detsky
Medical Conditions (any of these:)
PO2 < 60mmHg (8kPa); PCO2 > 50mmHg (6.7kPa); K < 3mmol/l; HCO3 < 20mmol/l; urea >18mmol/l (BUN > 50mg/dl); Creatinine > 260umol/l (3mg/dl); elevated SGOT; chronic liver disease; bedridden from non-cardiac cause
5
3

 Operation
Goldman
Detsky
  Emergency
4
10

 Intraperitoneal or intrathoracic

3
 Vascular - aortic
3
 Vascular - carotid

NA

 Vascular - peripheral
 Orthopaedic
 Head & neck
 Minor surgery
 None of the above

Goldman

Equates to a risk of

complications (ie cardiac death, documented intra- or postoperative MI, pulmonary oedema or nonfatal ventricular tachycardia)

Score :

Detsky

Equates to a risk of

severe complications (ie cardiac death, MI, alveolar pulmonary oedema)

Equates to a risk of

serious complications (ie as above plus coronary insufficiency and new or worsened congestive cardiac failure without alveolar pulmonary oedema)

Score :


*Canadian Heart Association angina classification:

Class I
Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous, rapid or prolonged exertion at work or recreation.
Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in the cold, in wind or when under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and at normal conditions.
Class II
Class III Marked limitation of ordinary physical activity. Walking one to two blocks on the level and climbing more than one flight in normal conditions.
Inability to carry on any physical activity without discomfort - anginal syndrome may be present at rest.
Class IV


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Last Update 12-08-2008

on line since January. 22, 2003


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