Münst Laura, Schläpfer Martin, Biro Peter
Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland.
Institute of Physiology and Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
Turk J Anaesthesiol Reanim. 2018 Sep;46(5):348-353. doi: 10.5152/TJAR.2018.00236. Epub 2018 Sep 4.
Various drugs are available for general anaesthesia, and the anaesthesiologist in charge may choose the one that is considered as the most appropriate for each specific case. When selecting an anaesthetic drug, its specific pharmacokinetic and pharmacodynamics as well as certain non-pharmacological properties have to be considered. This may lead to decisions that may be justified or unjustified according to scientific evidence and local standards.
In a prospective, single-centre, non-randomised and non-interventional study, 30 attending anaesthetists were interviewed about their drug prescription for general anaesthesia cases scheduled for the next day. The stated reasons for their choices from available alternatives were recorded and analysed for being justified or unjustified.
We found 69% of all decisions as justified, while 31% were incorrect, unjustified or random. Female anaesthetists made 83%±15% justified decisions, whereas males achieved a lower performance with 69%±17% justified decisions (p=0.046).
To a large proportion, convenience, habit and personal preferences influence the decision-making in choosing the anaesthetic medication. A change of paradigm in the postgraduate education and training seems to be necessary.
有多种药物可用于全身麻醉,负责的麻醉医生可选择被认为最适合每个具体病例的药物。选择麻醉药物时,必须考虑其特定的药代动力学和药效学以及某些非药理学特性。根据科学证据和当地标准,这可能导致合理或不合理的决策。
在一项前瞻性、单中心、非随机且非干预性的研究中,对30名主治麻醉医生就其为次日安排的全身麻醉病例所开的药物处方进行了访谈。记录并分析他们从可用备选药物中做出选择的既定理由,判断其合理与否。
我们发现所有决策中有69%是合理的,而31%是错误、不合理或随机的。女性麻醉医生做出合理决策的比例为83%±15%,而男性的表现较低,合理决策比例为69%±17%(p=0.046)。
在很大程度上,便利性、习惯和个人偏好会影响麻醉药物选择的决策。研究生教育和培训似乎有必要进行模式转变。