Chapter

Principles of patient management

Barrie Fischer

in Principles and Practice of Regional Anaesthesia

Fourth edition

Published on behalf of Oxford University Press

Published in print November 2012 | ISBN: 9780199586691
Published online November 2012 | e-ISBN: 9780191755507 | DOI: http://dx.doi.org/10.1093/med/9780199586691.003.0011

Series: Oxford Textbooks in Anaesthesia

Principles of patient management

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Regional anaesthesia offers considerable potential benefit to high-risk patients undergoing major surgery but, perversely, these patients are also more likely to suffer serious adverse events from its use. In a major prospective study, central neuraxial complications (especially epidural) were reported more commonly in the subgroup of elderly patients undergoing major abdominal surgery for cancer than other subgroups (Cook et al. 2009a). A large retrospective study of the adverse events associated with central neuraxial block found an increased risk of epidural haematoma in elderly females undergoing major orthopaedic procedures, compared to other subsets of patients and procedures (Moen et al. 2004). There are four important aspects of providing safe and successful regional anaesthesia. 1. Patient assessment and preoperative preparation; 2. Selection of the most appropriate block for the intended surgical procedure; 3. Performance of that block; and 4. Management of the patient thereafter. While the patient and the anaesthetist are the main individuals involved, best practice in regional anaesthesia can only be achieved if all the staff involved with the patient’s care (surgical team, anaesthesia and recovery staff, ward nurses, acute pain team, and rehabilitation staff) are fully engaged with the process. Staff training and education are important components of safe patient care, and these require significant time and resources to establish and maintain.

Chapter.  11719 words.  Illustrated.

Subjects: Anaesthetics ; Communication Skills

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