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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INFORMATION
Before your surgery, you will meet an important physician specialist, your anesthesiologist....


GENERAL ANESTHESIA
General Anesthesia is a technique during which the patient is rendered unconscious....


REGIONAL ANESTHESIA
Regional Anesthesia involves blocking sensations to one part of the body....


LOCAL ANESTHESIA
Local anesthesia refers to temporarily numbing a small area by injecting local anesthetic....


LABOR ANALGESIA
In most hospital labor suites today, the most common form of pain control for the woman.....


SURGERY and PAIN
The site of the surgery has a profound effect upon the degree of postoperative pain....


MALIGNANT HYPERTHERMIA
MH is a chain reaction event (a syndrome) "triggered" in susceptible individuals....


ANESTHESIA and HERBS
Herbal products are also known as dietary supplements, alternative therapies....


ANESTHESIA SIDE EFFECTS
Some operations and anaesthetic and pain-relieving....


REFERENCED in:
PAGINEMEDICHE

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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