Anaesthesia procedures are carried out by 10 specialists in Anaesthesiology and Reanimation, 5 on the morning shift (08.00 hours to 15.00 hours) and 5 on the evening shift (15.oo to 22.00 hours). The unit is supervised by 2 anaesthesiologists, one on the morning shift and the other on the evening shift. After 22.00 hours, the anaesthesiologist on duty is responsible for the unit and for providing anaesthesia coverage during the night shift.
The duties of the anaesthesiologists ascribed to this Unit are to attend all surgical procedures, both programmed surgery as well as emergency surgery, performed in the central operating theatres. Patient postoperative monitoring at the Recovery & Intensive Care Unit (ICU) is also part of the responsibilities of anaesthesiologists.
Approximately 6000 surgical anaesthesia procedures were attended in this unit in 2005, with the highest number corresponding to Traumatology and Orthopaedic Surgery, Gynaecology, Plastic Surgery, General Surgery and Paediatric Surgery, respectively. Special mention must be made to limb-lengthening procedures in achodronplastic patients, in which our orthopaedic team is pioneer. Also worth mentioning is paediatric surgery where any type of surgery is performed, including newborns, favoured by the existence at the Institute of a highly specialised Neonatology Service.
Although with a lower incidence, Urology, Otorhynolaryngology, Thoracic Surgery, Vascular Surgery and Neurosurgery, also hold an important stake within the healthcare activity conducted by the Surgical Unit.
The anaesthetic techniques employed were 25% locoregional procedures with or without sedation and 75% general anaesthesia procedures, combined in approximately 15% of cases with locoregional anaesthesia (epidural or peripheral block).
Balanced-type techniques are used in general anaesthesia (inhalation - intravenous) with endotracheal intubation or laryngeal mask, depending on the individual case. Standard monitoring includes pulsoxymetry, capnography, ECG, and an bloodless measurement of blood pressure.
Moreover, general anaesthesia in aggressive major surgery systematically includes invasive monitoring of blood pressure and central venous pressure, muscle relaxation and BISs (bispectral index scores).
Double lumen endotracheal tubes are used in thoracic surgery, with verification of their correct positioning by means of auscultation and/or fibroscopy. In corrective surgery of severe scoliosis, postoperative electroneurographic measurements are obtained to preserve the integrity of lumbosacral nerve function.
Locoregional anaesthesia is mainly used in Traumatology and Orthopaedic surgery; being peripheral blocks the most widely used technique to the detriment of epidural anaesthesia.
This obeys to the steadily increasing use of heparin and/or antiaggregant drugs in this type of patients, thus increasing the risk for spinal haematoma in case of concomitant epidural anaesthesia.
The method of neurostimulation is used in all blocks; being the axillary, femoral, interscalenic and the sciatic the most frequently used blocks. Continuous techniques via a catheter are used on many occasions to control postoperative pain.
Combined techniques can be used in cases of aggressive major surgery (oncological surgery, thoracic surgery, hip/knee replacement, etc.) and/or in patients with significant cardiorespiratory pathology. In paediatric patients, general anaesthesia is often given in combination with caudal anaesthesia when the procedure and/or the patient´s condition make it advisable.
In cases of IVF, an anaesthesiologist gives the anaesthesia required to perform the punctures between 08.00 to 17.00 hours.
With regard to patient volume, approximately 1,400 ultrasound-guided punctures under anaesthesia were performed in 2005. The anaesthesia technique used in most cases is intravenous general anaesthesia and assisted respiration via a facial mask or a laryngeal mask (this latter method is exceptional), also known as unconscious sedation. This technique enables the patient to recover quickly from the effects of anaesthesia and to leave the hospital on the same day of the procedure. In specific cases (patient´s wishes and/or patient´s condition), the puncture is performed under spinal anaesthesia (epidural or intradural).
