46 results on '"Anesthesiology methods"'
Search Results
2. The impact of hindsight bias on the diagnosis of perioperative events by anesthesia providers: A multicenter randomized crossover study.
- Author
-
Millan PD, Kleiman AM, Friedman JF, Dunn LK, Gui JL, Bechtel AJ, Collins SR, Huffmyer JL, Dwivedi P, Wolpaw JT, Nemergut EC, Tsang S, and Forkin KT
- Subjects
- Humans, Female, Male, Adult, Anesthesiologists, Anesthesiology methods, Anesthesiology standards, Intraoperative Complications diagnosis, Intraoperative Complications etiology, Intraoperative Complications prevention & control, Middle Aged, Bias, Retrospective Studies, Cross-Over Studies, Hypotension diagnosis, Hypotension etiology, Hypoxia etiology, Hypoxia diagnosis, Hypoxia prevention & control
- Abstract
Study Objective: Hindsight bias is the tendency to overestimate the predictability of an event after it has already occurred. We aimed to evaluate whether hindsight bias influences the retrospective interpretation of clinical scenarios in the field of anesthesiology, which relies on clinicians making rapid decisions in the setting of perioperative adverse events., Design: Two clinical scenarios were developed (intraoperative hypotension and intraoperative hypoxia) with 3 potential diagnoses for each. Participants completed a crossover study reviewing one case without being informed of the supposed ultimate diagnosis (i.e., no 'anchor' diagnosis), referred to as their foresight case, and the other as a hindsight case wherein they were informed in the leading sentence of the scenario that 1 of the 3 conditions provided was the ultimate diagnosis (i.e., the diagnosis the participant might 'anchor' to if given this information at the start). Participants were randomly assigned to (1) which scenario (hypotension or hypoxia) was presented as the initial foresight case and (2) which of the 3 potential diagnoses for the second case (the hindsight case, which defaulted to whichever case the participant was not assigned for the first case) was presented as the ultimate diagnosis in the leading sentence in a 2 (scenario order) x 3 (hindsight case anchor) between-subjects factorial design (6 possible randomization assignments)., Setting: Two academic medical centers., Participants: Faculty, fellow, and resident anesthesiologists and certified nurse anesthetists (CRNAs)., Interventions: None., Measurements: After reading each clinical scenario, participants were asked to rate the probability (%) of each of three potential diagnoses to have caused the hypotension or hypoxia. Compositional data analysis (CoDA) was used to compare whether diagnosis probabilities differ between the hindsight and the foresight case., Main Results: 113 participants completed the study. 59 participants (52%) were resident anesthesiologists. Participants randomized to the hypotension scenario as a hindsight case were 2.82 times more likely to assign higher probability to the pulmonary embolus diagnosis if provided as an anchor (95% CI, 1.35-5.90; P = 0.006) and twice as likely to assign higher probability to the myocardial infarction diagnosis if provided as an anchor (95% CI, 1.12-3.58; P = 0.020). Participants randomized to the hypoxia scenario as a hindsight case were 1.78 times more likely to assign higher probability to the mainstem bronchus intubation diagnosis if provided in the anchor statement (95% CI, 1.00-3.14; P = 0.048) and 3.72 times more likely to assign higher probability to the pulmonary edema diagnosis if provided as an anchor (95% CI, 1.88-7.35; P < 0.001)., Conclusions: Hindsight bias influences the clinical diagnosis probabilities assigned by anesthesia providers. Clinicians should be educated on hindsight bias in perioperative medicine and be cognizant of the effect of hindsight bias when interpreting clinical outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
3. Optimizing ergonomics in the operating room: A vital factor for anesthesia care.
- Author
-
Espinosa-Leon JP, Alvarez GG, and Azocar RJ
- Subjects
- Humans, Anesthesiology methods, Anesthesiology instrumentation, Ergonomics, Operating Rooms organization & administration, Anesthesia methods
- Abstract
Competing Interests: Declaration of competing interest Gabriel G. Alvarez reports a relationship with Angel Medical Devices that includes: board membership.
- Published
- 2024
- Full Text
- View/download PDF
4. Protection of anesthesia providers from silent carriers of COVID-19 while minimizing disposable PPE utilization.
- Author
-
Ringenberg KR, Fremming BA, Lisco SJ, and Schulte TE
- Subjects
- Anesthesia methods, COVID-19, Humans, Anesthesiology methods, Coronavirus Infections prevention & control, Pandemics prevention & control, Personal Protective Equipment, Pneumonia, Viral prevention & control
- Abstract
Competing Interests: Declaration of competing interest All authors listed have participated in the preparation of this manuscript. They have all participated in the production of the Intubation Team, that this article is written about. Every author has no financial conflicts of interest with anything mentioned in this manuscript. Due to social distancing, please accept each of this electronic signatures as authentic. The senior author has published multiple times with this prestigious Journal of Clinical Anesthesia, so accepts these as truth.
- Published
- 2020
- Full Text
- View/download PDF
5. Novel method of performing brachial plexus block using an aerosol box during COVID-19 pandemic.
- Author
-
Kulkarni RR, Stephen M, Shashank A, and Mandhal LN
- Subjects
- Aerosols, Anesthesiologists organization & administration, Anesthesiology instrumentation, COVID-19, Humans, Male, Middle Aged, Anesthesiology methods, Brachial Plexus Block methods, Coronavirus Infections prevention & control, Pandemics prevention & control, Pneumonia, Viral prevention & control
- Abstract
Competing Interests: Declaration of competing interest The authors declare no competing interests.
- Published
- 2020
- Full Text
- View/download PDF
6. SARS-CoV-2 infection control measures for the anesthesiology department: experience from the Sichuan Provincial People's Hospital, China.
- Author
-
Xie M, Huang JX, Chen PP, Wei XC, Li XK, Zhang P, Yang LN, and Zhou Q
- Subjects
- Anesthesia Department, Hospital methods, COVID-19, China, Coronavirus Infections epidemiology, Humans, Pneumonia, Viral epidemiology, Anesthesiology methods, Coronavirus Infections prevention & control, Infection Control methods, Pandemics prevention & control, Pneumonia, Viral prevention & control
- Published
- 2020
- Full Text
- View/download PDF
7. Retained surgical items: Implications for anesthesiology practice.
- Author
-
Gluncic V, Lukić A, and Candido K
- Subjects
- Anesthesiology standards, Humans, Patient Safety, Anesthesiology methods, Foreign Bodies prevention & control, Perioperative Care standards
- Published
- 2019
- Full Text
- View/download PDF
8. Selected highlights from clinical anesthesia and pain management.
- Author
-
Kendall MC, Pisano DV, Cohen AD, Gorgone M, McCormick ZL, and Malgieri CJ
- Subjects
- Airway Management instrumentation, Airway Management methods, Anesthesia methods, Anesthesiology instrumentation, Anesthesiology methods, Humans, Pain Management methods, Pain, Postoperative etiology, Pain, Postoperative therapy, Surgical Procedures, Operative adverse effects, Airway Management trends, Anesthesia trends, Anesthesiology trends, Pain Management trends
- Abstract
Study Objective: To review research highlights of manuscripts published in 2017 that pertain to all aspects of the clinical practice of anesthesiology., Design: Narrative review., Setting: N/A., Materials: The major themes addressed in this review include recent studies examining airway management, obstetrical and gynecological anesthesia, pediatric anesthesia, cardiac anesthesia, regional analgesia and pain management., Interventions: N/A., Main Results: N/A., Conclusions: This review will highlight and inform anesthesiologists of the developing trends in clinical anesthesia and will also pose new challenges for further studies., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
9. Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI).
- Author
-
Alvarez-Nebreda ML, Bentov N, Urman RD, Setia S, Huang JC, Pfeifer K, Bennett K, Ong TD, Richman D, Gollapudi D, Alec Rooke G, and Javedan H
- Subjects
- Aged, Anesthesiology standards, Evidence-Based Medicine methods, Evidence-Based Medicine standards, Female, Frail Elderly, Humans, Male, Perioperative Care standards, Postoperative Complications etiology, Postoperative Complications prevention & control, Prognosis, Risk Assessment methods, Risk Assessment standards, Sex Factors, Anesthesiology methods, Elective Surgical Procedures adverse effects, Frailty diagnosis, Perioperative Care methods, Quality Improvement
- Abstract
Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery. These recommendations summarize evidence-based principles of measuring and screening for frailty, as well as basic interventions that can help improve patient outcomes., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
10. ASA physical status classification of obstructive sleep apnoea disease.
- Author
-
Bamgbade OA
- Subjects
- Anesthesiologists statistics & numerical data, Anesthesiology statistics & numerical data, Health Status Indicators, Humans, Observer Variation, Preoperative Care statistics & numerical data, United Kingdom, Anesthesiology methods, Health Care Surveys statistics & numerical data, Health Status, Preoperative Care methods, Sleep Apnea, Obstructive diagnosis
- Published
- 2018
- Full Text
- View/download PDF
11. Selected highlights in clinical anesthesia research.
- Author
-
Kendall MC, Robbins ZM, Cohen A, Minn M, Benzuly SE, Triebwasser AS, McCormick ZL, and Gorgone M
- Subjects
- Airway Management instrumentation, Airway Management trends, Anesthesia adverse effects, Anesthesiology instrumentation, Anesthesiology trends, Humans, Patient Positioning, Surgical Procedures, Operative methods, Airway Management methods, Anesthesia methods, Anesthesiology methods, Biomedical Research trends, Surgical Procedures, Operative adverse effects
- Abstract
Study Objective: To review research highlights of manuscripts published in 2016 that pertain to all aspects of the clinical practice of anesthesiology., Design: Narrative review., Setting: N/A., Materials: The major themes address broad categories of general anesthesia including airway management, abdominal surgery, and obstetrical and gynaecological anesthesia. In addition, recent advancements in specialties of anesthesiology including regional anesthesia are reviewed., Interventions: N/A., Main Results: N/A., Conclusions: This recent body of evidence will both help inform anesthesiologists of the developing trends in anesthesiology and will also pose new challenges for further studies., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
12. The effects of dynamic airway photographs on preoperative airway planning among a panel of anesthetists.
- Author
-
Hanifi MT, Pimentel MP, Motzkus C, Gosnell J, and Aglio LS
- Subjects
- Adult, Aged, Anesthesiology methods, Female, Humans, Laryngoscopy methods, Male, Middle Aged, Physical Examination methods, Pilot Projects, Risk Assessment methods, Surveys and Questionnaires, Airway Management methods, Patient Care Planning, Photography methods, Preoperative Care methods
- Abstract
Study Objective: To determine whether having preoperative airway photographs will change the preanesthetic airway plan., Design: Questionnaire., Setting: American academic medical center (Brigham and Women's Hospital, Boston MA)., Subjects: Twenty-five test subjects (American Society of Anesthesiologists 1-4) were enrolled to have their preoperative airway photographs taken as well as to have a customary preoperative history and physical examination. In addition, 15 anesthetists were enrolled to review the subjects' preoperative history, physical examination, and preoperative airway photographs., Measurements: All 15 anesthetists were asked to fill out a survey for airway management for each test subject., Main Results: All 15 anesthetists completed the survey. Across all providers, plans were changed a median of 24% (95% confidence interval [CI], 12.7-38.6). Among attending anesthesiologists, airway management plans were changed 30% of the time (95% CI, 12.4-40.0), whereas among nonattending level providers, plans changed 24% of the time (95% CI, 12.0-38.8). χ
2 Tests found no difference between the percent change of airway plans between attending and nonattending level providers (P=.306)., Conclusions: Our findings suggest that the addition of dynamic airway photographs to preoperative airway reports affects airway management plans among a variety of anesthesia care providers. In general, dynamic airway photographs can aid preoperative airway management planning., (Copyright © 2016 Elsevier Inc. All rights reserved.)- Published
- 2017
- Full Text
- View/download PDF
13. Use of cuffed tracheal tubes in neonates, infants and children: A practice survey of members of the Society of Pediatric Anesthesia.
- Author
-
Sathyamoorthy M, Lerman J, Okhomina VI, and Penman AD
- Subjects
- Age Factors, Airway Extubation adverse effects, Anesthesiology education, Child, Child, Preschool, Elective Surgical Procedures statistics & numerical data, Emergency Medical Services, Equipment Design, Humans, Infant, Infant, Newborn, Internship and Residency, Intubation, Intratracheal statistics & numerical data, Monitoring, Intraoperative, Respiratory Sounds etiology, Societies, Medical, Surveys and Questionnaires, Anesthesiology methods, Intubation, Intratracheal instrumentation
- Abstract
Study Objective: This study aimed to characterize the current practice patterns with cuffed tracheal tubes (CTT) in neonates, infants, and children among members of the Society of Pediatric Anesthesia (SPA)., Design and Setting: An electronic mail survey was distributed using Survey Monkey to members of SPA between December 2013 and February 2014. Each member was permitted one response., Patients/intervention/measurements: Not applicable as this is a practice survey study., Main Results: A total of 805 (28%) of the 2901 members of the SPA responded. Of the respondents, 88% were from the US, 83% were fellowship trained, 82% practiced pediatric anesthesia >50% of the time, and 65% practiced in academic centers. Eighty-five percent used CTT >50% of the time in children >2 years and 60% used CTT in full-term neonates >50% of the time. Twenty-nine percent reported always using CTT whereas 5% reported never using CTT. Those in practice <5 years, who were fellowship trained or in academic practice used CTT more often in neonates compared with those in practice >20 years, not fellowship trained or in private practice (P< .0001, P= .0003 and P= .0005, respectively). The most common reason for avoiding CTT was concern about post-extubation stridor (39%). Almost 70% of respondents accept the TT if it passes the subglottis without resistance and has a leak at 15 to 20 cmH2O. More than 60% of respondents do not monitor cuff pressures in CTT., Conclusion: A majority of SPA members routinely use CTT in neonates, infants and children., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
14. Patient preference for the pre-anesthesia evaluation: Telephone versus in-office assessment.
- Author
-
Lozada MJ, Nguyen JT, Abouleish A, Prough D, and Przkora R
- Subjects
- Female, Humans, Male, Medical History Taking statistics & numerical data, Middle Aged, Prospective Studies, Ambulatory Care, Anesthesiology methods, Interviews as Topic methods, Medical History Taking methods, Patient Preference statistics & numerical data, Telephone
- Abstract
Study Objective: Pre-anesthesia evaluation (PAE) is designed to reduce patient and family anxiety, identify pre-existing health issues, avoid surgical delays, minimize costs, and tailor an anesthetic plan. If PAE requires a clinic visit, patients must take time off work and may incur travel and childcare costs. A telephone-based Preoperative Assessment Clinic can minimize patient inconvenience, while maintaining high-quality patient care and improving efficiency. We assessed patient satisfaction with a telephone PAE and determined whether patients preferred a telephone PAE or a conventional clinic visit., Design: Prospective, institutional review board-approved study., Setting: University hospital., Patients: We conducted an IRB-approved telephone survey of 75 adult, post-operative patients., Interventions: Telephone survey., Measurements: Patients were asked about their preference for a telephone PAE over an in-person evaluation. Survey questions included assessment of patient satisfaction with their anesthesia evaluation, operation, and anesthetic delivered. Delays and day of surgery cancellations were reviewed., Main Results: The majority (97%) of patients stated they preferred a telephone PAE. Patient satisfaction was unaffected by driving distance (30±54 mi), ASA physical status or duration of surgery (169±159 min). Even patients who were not satisfied with their anesthetic (N=5) still preferred the telephone-based PAE. No increase in surgical delays or cancellation was noted., Conclusion: The majority of patients in this survey preferred a telephone PAE. Given the large catchment area of our hospital of nine counties, telephone-based interviews add to patient convenience and likely increase compliance with the PAE. Even patients who live in close proximity to our hospital (<5 mi) preferred a telephone assessment. A telephone-based PAE provides high patient satisfaction over a traditional office visit while increasing patient convenience. Larger studies are necessary to ensure that telephone PAEs compare well with in-person examinations., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
15. Accuracy in obtaining 100 μg from 10 mg of morphine for spinal anesthesia.
- Author
-
Benkhadra M, Rivory JC, Wessels C, Guerard P, Vadot L, Astruc K, Dumas M, and Girard C
- Subjects
- Analgesics, Opioid chemistry, Anesthesiology methods, Chromatography, High Pressure Liquid methods, Hospitals, University, Humans, Injections, Spinal, Morphine chemistry, Syringes, Analgesics, Opioid administration & dosage, Anesthesia, Spinal methods, Drug Compounding methods, Morphine administration & dosage
- Abstract
Study Objective: Dilution is often required to obtain appropriate concentrations of intrathecal morphine for analgesia. We compared techniques of diluting by measuring the quantity of morphine actually obtained in the final solution., Design: This is an experimental study by 3 experienced anesthesiologists., Setting: The setting is at a university teaching hospital., Patients: There are no patients., Interventions: There are no interventions., Measurements: Five techniques for obtaining 100 μg from 10 mg/mL were compared: technique 1 (T1) = extraction up to 0.1 graduation on a 1-mL syringe, followed by simple dilution (SD). Technique 2 (T2) = As for T1 but syringe was shaken to mix solution. Technique 3 (T3): SD with 10-mL syringe. Technique 4 (T4): Double dilution with 10-mL syringe. Technique 5 (T5): Extraction up to the 0.1 graduation of a 1-mL syringe, then SD, then shake solution by hand. Three tests using high-performance liquid chromatography with ultraviolet were performed on each syringe prepared 3 consecutive times, namely, at the first (beginning, B), fifth (middle, M) and last (end, E) milliliter or 0.1 mL (depending on syringe type)., Main Results: Average overall concentrations were 208 ±19, 199 ±24, 120 ±13, 136 ±9, and 119 ±16 μg/0.1 mL, T1-T5, respectively. By Kruskal-Wallis test, we classified the techniques according to the magnitude of the difference between the observed concentration of morphine and the desired (theoretical) concentration of 100 μg/0.1 mL. In ascending order, techniques ranked as follows: T5 (smallest difference), T3, T4, T2, and T1 (greatest difference) (P = .0001)., Conclusions: There is significant variability in the concentration of morphine actually contained in final solutions after dilution. Morphine presented in different premixed concentrations increases the risk of error. We advocate technique 5 as described above, whereas technique 1 should be prohibited., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
16. Delayed emergence after anesthesia.
- Author
-
Tzabazis A, Miller C, Dobrow MF, Zheng K, and Brock-Utne JG
- Subjects
- Anesthesiology methods, Humans, Risk Factors, Time Factors, Anesthesia methods, Anesthesia Recovery Period, Delayed Emergence from Anesthesia etiology
- Abstract
In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
17. Leak in Perseus workstation after complete check sequences.
- Author
-
Kinoshita H, Hatakeyama N, Fujita Y, and Fujiwara Y
- Subjects
- Anesthesiology methods, Equipment Failure, Humans, Male, Young Adult, Anesthesia methods, Anesthesiology instrumentation, Anesthetics administration & dosage
- Published
- 2015
- Full Text
- View/download PDF
18. The versatility of intraosseous vascular access in perioperative medicine: a case series.
- Author
-
Anson JA, Sinz EH, and Swick JT
- Subjects
- Adult, Aged, Cardiopulmonary Resuscitation methods, Female, Humans, Infusions, Intraosseous, Male, Middle Aged, Young Adult, Anesthesiology methods, Perioperative Care methods, Vascular Access Devices
- Abstract
Intraosseous vascular access is a time-tested procedure that is reemerging in popularity. This is primarily a result of the emphasis on intraosseous access in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Advanced Cardiac Life Support. Modern intraosseous insertion devices are easy to learn and use, suggesting the possibility of use beyond the resuscitation setting. We present a case series of recent intraosseous insertions for a variety of indications by anesthesiologists at our institution to demonstrate the potential utility of this alternative access technique., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
19. Health literacy and anesthesia: patients' knowledge of anesthesiologist roles and information desired in the preoperative visit.
- Author
-
Garcia-Marcinkiewicz AG, Long TR, Danielson DR, and Rose SH
- Subjects
- Aged, Educational Status, Elective Surgical Procedures methods, Female, Humans, Male, Middle Aged, Patient Education as Topic methods, Preoperative Care methods, Anesthesia methods, Anesthesiology methods, Health Knowledge, Attitudes, Practice, Health Literacy statistics & numerical data
- Abstract
Study Objective: To assess patients' knowledge of the role of the anesthesiologist and to identify information patients desire during the preoperative visit., Design: Self-administered structured survey evaluation., Setting: Preoperative Evaluation Clinic at Mayo Clinic, Rochester, Minnesota., Patients: 502 adult surgical patients scheduled for elective surgery., Measurements: A survey was designed and administered to patients in the preoperative clinic to assess their knowledge of the job descriptions and roles of anesthesiologists. The survey also included questions about information that patients desire before anesthesia and surgery., Main Results: The survey was distributed to 502 patients, 500 of whom (99%) completed the survey. Seventy-four percent (346/466) of respondents were educated at or above the college level. The majority (377/460; 82%) of patients in this study had adequate or high health literacy levels. Four hundred sixteen of 486 (86%) respondents knew that an anesthesiologist was a doctor specializing in anesthesia. However, the roles of anesthesiologists throughout the hospital system were not well known. Ninety-six of 475 (20%) patients knew that anesthesiologists may work in pain management clinics, 80 of 470 (17%) patients knew that anesthesiologists may work in intensive care units, but only 59 of 472 (13%) patients knew that anesthesiologists may transfuse blood during surgery if needed., Conclusion: Despite the high level of education and health literacy in this group of patients, many were uninformed about the roles of anesthesiologists. Patients expressed interest in receiving a broad range of information during the preoperative visit. An educational booklet was the preferred method to provide this information., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
20. Unrecognized barriers to perioperative limitations on potentially life-sustaining medical treatment.
- Author
-
Waisel DB
- Subjects
- Anesthesiology standards, Humans, Perioperative Care methods, Resuscitation methods, Resuscitation Orders, Anesthesiology methods, Life Support Care methods, Practice Guidelines as Topic
- Published
- 2014
- Full Text
- View/download PDF
21. Unexpected cause of leak in a modern anesthesia workstation.
- Author
-
Singh M, Chaudhary K, and Uppal R
- Subjects
- Anesthesiology instrumentation, Equipment Failure, Equipment Failure Analysis, Humans, Anesthesia methods, Anesthesiology methods
- Published
- 2014
- Full Text
- View/download PDF
22. Considerations for the use of short-acting opioids in general anesthesia.
- Author
-
Mandel JE
- Subjects
- Analgesics, Opioid adverse effects, Analgesics, Opioid therapeutic use, Anesthesia, General adverse effects, Anesthetics, General administration & dosage, Anesthetics, General adverse effects, Anesthetics, General therapeutic use, Humans, Hypnotics and Sedatives administration & dosage, Hypnotics and Sedatives adverse effects, Hypnotics and Sedatives therapeutic use, Piperidines administration & dosage, Piperidines adverse effects, Piperidines therapeutic use, Remifentanil, Time Factors, Analgesics, Opioid administration & dosage, Anesthesia, General methods, Anesthesiology methods
- Abstract
Anesthesiologists play a critical role in facilitating a positive perioperative experience and early recovery for patients. Depending on the kind of procedure or surgery, a wide variety of agents and techniques are currently available to anesthesiologists to administer safe and efficacious anesthesia. Notably, the fast-track or ambulatory surgery environment requires the use of agents that enable rapid induction, maintenance, and emergence combined with minimal adverse effects. Short-acting opioids demonstrate a safe and rapid onset/offset of effect; that short effect is both predictable and precise. It also ensures easier titration and reduced or rapidly reversed side effects. Due to their distinct pharmacokinetic and pharmacodynamic properties, and, in one case, rapid extra-hepatic clearance of remifentanil, these agents have several applications in general anesthesia., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
23. Anesthesia for liver transplantation in United States academic centers: intraoperative practice.
- Author
-
Schumann R, Mandell MS, Mercaldo N, Michaels D, Robertson A, Banerjee A, Pai R, Klinck J, Pandharipande P, and Walia A
- Subjects
- Academic Medical Centers statistics & numerical data, Evidence-Based Medicine, Health Care Surveys, Humans, Internet, Intraoperative Care methods, United States, Anesthesia methods, Anesthesiology methods, Liver Transplantation methods, Monitoring, Intraoperative methods, Perioperative Care methods
- Abstract
Study Objective: To determine current practice patterns for patients receiving liver transplantation., Design: International, web-based survey instrument., Setting: Academic medical centers., Measurements: Survey database responses to questions about liver transplant anesthesiology programs and current intraoperative anesthetic care and resource utilization were assessed. Descriptive statistics of intraoperative practices and resource utilization according to the size of the transplant program were recorded., Main Results: Anesthetic management practices for liver transplantation varied across the academic centers. The use of cell salvage (Cell Saver®), transesophageal echocardiography, thrombelastography, and ultrasound guidance for catheter placement varies among institutions., Conclusion: Effective practices and more evidence-based intraoperative management have not yet been applied in many programs. Many facets of perioperative liver transplantation anesthesia care remain underexplored., (© 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
24. A unique case of electrical hazard during anesthesia.
- Author
-
Subramanian S and Sethi D
- Subjects
- Aged, 80 and over, Anesthesia methods, Anesthesiology methods, Electricity adverse effects, Female, Humans, Occupational Injuries etiology, Accidents, Occupational, Electric Injuries etiology, Electrocardiography
- Published
- 2013
- Full Text
- View/download PDF
25. Methodologies of anesthesia information management system development.
- Author
-
Sinclair DR
- Subjects
- Anesthesia standards, Anesthesiology standards, Health Information Management methods, Humans, Patient Care standards, Quality Assurance, Health Care, Anesthesia methods, Anesthesiology methods, Management Information Systems
- Published
- 2013
- Full Text
- View/download PDF
26. Drug shortages: implications on pediatric anesthesia practice and management resources.
- Author
-
Moffett BS and Mossad EB
- Subjects
- Child, Humans, Patient Care methods, Pediatrics methods, Anesthesia methods, Anesthesiology methods, Anesthetics supply & distribution
- Published
- 2012
- Full Text
- View/download PDF
27. A novel way to repurpose waste to improve operating room hygiene.
- Author
-
Egan BJ and Cheng S
- Subjects
- Anesthesiology methods, Anesthesiology standards, Decontamination methods, Equipment Contamination, Humans, Hygiene, Waste Products, Computer Peripherals, Operating Rooms standards, Recycling methods
- Published
- 2012
- Full Text
- View/download PDF
28. Discounted cash flow of anesthesia information management systems.
- Author
-
Sinclair DR
- Subjects
- Anesthesia economics, Anesthesiology economics, Hospital Information Systems, Humans, Operating Rooms economics, Reimbursement Mechanisms, Anesthesia methods, Anesthesiology methods, Operating Room Information Systems
- Published
- 2012
- Full Text
- View/download PDF
29. Perioperative cardiac evaluation of simulated patients by practicing anesthesiologists is not consistent with 2007 ACC/AHA guidelines.
- Author
-
Vigoda MM, Behrens V, Miljkovic N, Arheart KL, Lubarsky DA, and Dutton RP
- Subjects
- Academic Medical Centers, Anesthesiology standards, Anesthesiology statistics & numerical data, Health Care Surveys, Humans, Perioperative Care standards, Perioperative Care statistics & numerical data, Societies, Medical, Time Factors, United States, Anesthesiology methods, Guideline Adherence, Perioperative Care methods, Practice Guidelines as Topic
- Abstract
Study Objective: To determine if practicing anesthesiologists recommend preoperative evaluations consistent with the 2007 ACC/AHA guidelines on perioperative care., Design: Survey instrument., Setting: Academic medical center., Subjects: ASA membership., Measurements: In this Web-based survey, participants were presented with 6 clinical scenarios characterized by surgical procedure and the patient's clinical condition (ie, clinical risk factors and functional capacity). Scenarios and possible recommendations were presented randomly. Participants were asked to select the recommendation they considered to be most consistent with the Guidelines. The percentage of participants selecting the recommendation most consistent with the 2007 Guidelines was recorded., Main Results: Of the 22,504 actively practicing members of the ASA who were sent a survey, 1,595 actively practicing self-selected anesthesiologists responded. For one of 6 scenarios, patients with an active cardiac condition, the upper 95% confidence bound for the percent selecting a recommendation consistent with the Guidelines was 82%. For the remaining 5 scenarios, the upper 95% confidence bound for the percent of anesthesiologists with an appropriate recommendation did not exceed 40%. With the exception of the scenario describing a patient with an active cardiac condition, respondents were more likely to provide recommendations consistent with the Guidelines if they had been in practice less than 5 years or worked in a teaching environment., Conclusion: When evaluating simulated patients, practicing anesthesiologists who are ASA members did not recommend preoperative evaluations that were consistent with the 2007 ACC/AHA Guidelines., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
30. Factors influencing unexpected disposition after orthopedic ambulatory surgery.
- Author
-
Memtsoudis SG, Ma Y, Swamidoss CP, Edwards AM, Mazumdar M, and Liguori GA
- Subjects
- Adolescent, Adult, Aged, Ambulatory Surgical Procedures methods, Anesthesia methods, Anesthesiology methods, Anesthesiology statistics & numerical data, Databases, Factual, Female, Humans, Knee Joint surgery, Male, Middle Aged, Orthopedic Procedures methods, Patient Discharge statistics & numerical data, Retrospective Studies, Risk Factors, Shoulder Joint surgery, United States, Young Adult, Ambulatory Care Facilities statistics & numerical data, Ambulatory Surgical Procedures statistics & numerical data, Orthopedic Procedures statistics & numerical data, Outcome Assessment, Health Care
- Abstract
Study Objective: To analyze whether patient characteristics, ambulatory facility type, anesthesia provider and technique, procedure type, and temporal factors impact the outcome of unexpected disposition after ambulatory knee and shoulder surgery., Design: Retrospective analysis of a national database., Setting: Freestanding and hospital-based ambulatory surgery facilities., Measurements: Ambulatory knee and shoulder surgery cases from 1996 and 2006 were identified through the National Survey of Ambulatory Surgery. The incidence of unexpected disposition status was determined and risk factors for such outcome were analyzed., Main Results: Factors independently increasing the risk for unexpected disposition included procedures performed in hospital-based versus freestanding facilities [odds ratio (OR) 6.83 (95% confidence interval [CI] 4.34; 10.75)], shoulder versus knee procedures [OR 3.84 (CI 2.55; 5.77)], anesthesia provided by nonanesthesiology professionals and certified registered nurse-anesthetists versus anesthesiologists [OR 7.33 (CI 4.18; 12.84) and OR 1.80 (CI 1.09; 2.99), respectively]. Decreased risk for unexpected disposition was for procedures performed in 2006 versus 1996 [OR 0.15 (CI 0.10; 0.24)] and the use of anesthesia other than regional or general [OR 0.34 (CI 0.18; 0.68)]., Conclusions: The decreased risk for unexpected disposition associated with more recent data and with freestanding versus hospital-based facilities may represent improvements in efficiency, while the decreased odds for such disposition status associated with the use of other than general or regional anesthesia may be related to a lower invasiveness of cases. We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. No difference in this outcome was noted when an anesthesia care team provided care., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
31. Anesthetic management of a patient who swallowed a knife.
- Author
-
Hsu GC, Manabat ER, Alent MG, and Witkowski TA
- Subjects
- Adult, Anesthesiology methods, Cooking and Eating Utensils, Esophagus, Foreign Bodies diagnostic imaging, Humans, Male, Radiography, Surgical Instruments, Esophagoscopes, Foreign Bodies surgery, Laryngoscopy methods
- Published
- 2011
- Full Text
- View/download PDF
32. Perioperative management of von Willebrand disease: a review for the anesthesiologist.
- Author
-
Mazzeffi MA and Stone ME
- Subjects
- Anesthesiology methods, Humans, Perioperative Care methods, Prevalence, Surgical Procedures, Operative adverse effects, von Willebrand Diseases epidemiology, von Willebrand Diseases physiopathology, Blood Loss, Surgical prevention & control, Surgical Procedures, Operative methods, von Willebrand Diseases complications
- Abstract
von Willebrand disease (VWD) is the most common hereditary bleeding disorder in humans, with an estimated prevalence of 0.5% to 1%. Patients with VWD are at increased risk of perioperative bleeding complications. This review provides an evidence-based overview of VWD and its management during the perioperative period., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
33. Anesthesia care in a medium-developed country: a nationwide survey of Mongolia.
- Author
-
Jochberger S, Bataar O, Mendsaikhan N, Grander W, Tsenddorj G, Lundeg G, and Dünser MW
- Subjects
- Anesthesia adverse effects, Anesthesia statistics & numerical data, Anesthesiology statistics & numerical data, Anesthetics adverse effects, Health Care Surveys, Hospitals statistics & numerical data, Humans, Mongolia, Monitoring, Intraoperative methods, Perioperative Care statistics & numerical data, Surgical Procedures, Operative methods, Surveys and Questionnaires, Anesthesia methods, Anesthesiology methods, Anesthetics administration & dosage
- Abstract
Study Objective: To evaluate the current status of anesthesia and its allied disciplines in Mongolia., Design: Nationwide questionnaire survey., Setting: Two university hospitals., Measurements: A total of 44 hospitals that include a department of surgery and that were registered at the Mongolian Ministry of Health were queried. The questionnaire included 44 questions in two sections. The first section consisted of 6 general questions about the hospital, and the second section included 40 questions on anesthesia and perioperative patient care. The Mann-Whitney U-test, Chi²-tests, and a bivariate correlation analysis were used for statistical analysis., Main Results: 44 (100%) questionnaires were returned. Twenty-two (50%) hospitals were located in the capital city of Ulaanbaatar. Nine hundred (median; interquartile range: 413-1,468) surgical interventions were performed annually in the study hospitals. Physician anesthesiologists delivered anesthesia in all hospitals. Techniques for general anesthesia included endotracheal intubation (95.5%), laryngeal mask ventilation (13.6%), mask ventilation (27.3%), dissociative ketamine anesthesia (84.1%), and combined general/regional anesthesia (63.6%). Regional anesthetic techniques included spinal (97.7%), epidural (43.2%), axillary plexus (40.9%), peripheral nerve (13.6%), and local anesthesia (15.9%). The most frequently used hypnotics were ketamine (86.4%) and thiopental sodium (70.5%). Halothane was available in all hospitals. Oxygen was available during anesthesia in 95.5% of hospitals. The most widely available intraoperative monitoring equipment were a stethoscope (84.1%), oximeter (81.8%), and sphygmomanometer (84.1%). A recovery room was available in 22 (50%) hospitals., Conclusions: Anesthesia is an underdeveloped and under-resourced medical specialty in Mongolia., (Copyright © 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
34. Anesthesiologists' preferences for preoperative cardiac evaluation before vascular surgery: results of a mail survey.
- Author
-
Ellis JE, Tung A, Lee H, Lee H, and Kasza K
- Subjects
- Adult, Aged, Aged, 80 and over, Cardiovascular Diseases complications, Cardiovascular Diseases diagnosis, Data Collection, Echocardiography methods, Evidence-Based Medicine, Exercise Test methods, Female, Guideline Adherence, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Postoperative Complications prevention & control, Practice Guidelines as Topic, Risk Factors, United States, Vascular Surgical Procedures adverse effects, Anesthesiology methods, Practice Patterns, Physicians' statistics & numerical data, Preoperative Care methods, Vascular Surgical Procedures methods
- Abstract
Study Objective: To investigate whether anesthesiologists' decisions to request preoperative cardiac evaluation (cardiologist consultation, echocardiography, and cardiac stress testing) before vascular surgery were influenced by patient comorbidity and magnitude of surgery; and to explore whether factors unrelated to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines influence these decisions., Design: Survey instrument., Setting: University medical center., Subjects: 2,000 U.S. anesthesiologists who were mailed a survey., Measurements: Six factors in a hypothetical patient presenting for vascular surgery [gender, race (white vs. black), age (65 yrs vs. 85 yrs), comorbidities (sick vs. healthy), functional status, and magnitude of surgical stress] were evaluated. Respondents were asked about their demographics, practice patterns, and how they would manage the hypothetical patient., Main Results: Of 2,000 mailed surveys, 439 U.S. anesthesiologists responded (22%). Multivariate ordinal logistic regression analysis showed that anesthesiologists were more likely to recommend preoperative cardiology consultation for patients with more comorbidities [odds ratio = 5.53; 95% confidence interval (CI) = 3.76, 8.15], for those with poorer functional status (odds ratio = 1.45; 95% CI = 1.02, 2.07), for those undergoing a more significant surgery (odds ratio = 1.61; 95% CI = 1.13, 2.30), as the clinicians' estimated risk of perioperative myocardial infarction increased (P < 0.001), or if they only infrequently anesthetized patients such as the one described in the scenario (P = 0.05). They also would request a preoperative echocardiogram for patients with more comorbidities (odds ratio = 2.58; 95% CI = 1.80, 3.68) and for those undergoing a more significant surgery (odds ratio = 1.59; 95% CI = 1.12, 2.25). A preoperative stress test was recommended for patients with more comorbidities (odds ratio = 3.01; 95% CI = 2.06, 4.38) and for those with a more significant surgery (odds ratio = 1.74; 95% CI = 1.15, 2.63). Other factors associated with request for a preoperative stress test were female gender of the anesthesiologist (odds ratio = 1.79; 95% CI = 1.11, 2.87), those with less experience with such patients (P = 0.05), and those from New England (odds ratio = 2.16; 95% CI = 1.01, 4.62)., Conclusions: Anesthesiologists' preferences for preoperative cardiac evaluation are generally consistent with evidence-based and expert-based AHA/ACC guidelines. However, other physician factors (ie, gender, years in practice, and familiarity with the surgical procedure) also influenced these decisions., (Copyright © 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
35. The application of fiberoptic intubation in difficult airway patients.
- Author
-
Liang YX, Gu MN, Wang SD, and Chu HC
- Subjects
- Anesthesiology methods, Fiber Optic Technology, Humans, Wakefulness, Intubation, Intratracheal methods, Laryngoscopy methods, Obesity physiopathology
- Published
- 2010
- Full Text
- View/download PDF
36. The role of surgery in postoperative nerve injuries following total hip replacement.
- Author
-
Uskova AA, Plakseychuk A, and Chelly JE
- Subjects
- Anesthesiology methods, Humans, Peripheral Nervous System Diseases etiology, Risk Factors, Arthroplasty, Replacement, Hip adverse effects, Peripheral Nerve Injuries, Postoperative Complications etiology
- Abstract
Although postoperative nerve injury is infrequent in patients undergoing joint replacement, it is extremely distressing for the patient, surgeon, and anesthesiologist. The nature of nerve injury is often closely related to the type of surgery; this review details the potential surgical causes of nerve injuries following total hip arthroplasty. The current orthopedic literature (1943-2008) was reviewed to help anesthesiologists better understand the pathophysiology of surgery-related postoperative nerve injuries, including the relationship with hip joint anatomy and the surgical techniques., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
37. Complications associated with 2-octyl cyanoacrylate (Dermabond): considerations for the anesthesiologist.
- Author
-
Jagannathan N and Hallman M
- Subjects
- Cheek, Cyanoacrylates administration & dosage, Female, Granuloma, Pyogenic surgery, Hemangioma surgery, Humans, Infant, Mouth, Tissue Adhesives administration & dosage, Anesthesiology methods, Cyanoacrylates adverse effects, Tissue Adhesives adverse effects
- Published
- 2010
- Full Text
- View/download PDF
38. Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurement.
- Author
-
Kaneko M, Yamaguchi S, Hamaguchi S, Egawa H, Fujii K, Ishikawa K, Kitajima T, and Minami J
- Subjects
- Adult, Anesthesiology methods, Blood Pressure drug effects, Double-Blind Method, Female, Heart physiology, Humans, Intubation, Intratracheal, Male, Medical Records Systems, Computerized, Middle Aged, Treatment Outcome, Urea pharmacology, Young Adult, Adrenergic beta-Antagonists pharmacology, Anesthesia methods, Anesthesiology instrumentation, Electrocardiography drug effects, Heart drug effects, Morpholines pharmacology, Urea analogs & derivatives
- Abstract
Study Objective: To examine the effects of landiolol on the QT interval, rate-corrected QT (QTc) interval, QT dispersion (QTD), and rate-corrected QTD (QTcD) during tracheal intubation using computerized measurement., Design: Randomized, double-blinded study., Setting: Dokkyo Medical University Hospital operating room., Patients: 30 ASA physical status I patients scheduled for elective surgery., Inventions: Patients were randomized to receive either normal saline (saline group) or landiolol (landiolol group; one-min loading infusion of 0.125 mg/kg followed by 0.04 mg/kg/min infusion). Immediately after the start of administration of saline or landiolol, anesthesia was induced with intravenous (IV) fentanyl two microg/kg, propofol 1.5 mg/kg, and vecuronium 0.1 mg/kg. Six minutes after administration of saline or landiolol, tracheal intubation was performed within 20 seconds., Measurements: Mean arterial pressure (MAP), RR interval, QT interval, QTc interval, QTD, and QTcD were consecutively recorded during the induction., Main Results: There was no significant difference in MAP between groups during the study. RR interval in the landiolol group was significantly longer than in the saline group from two minutes after the start of the landiolol infusion to the end of the study. The QT interval in the landiolol group was significantly shorter than in the saline group from start of the infusion to 4 minutes after tracheal intubation. The QTc interval, QTD, and QTcD in the landiolol group were significantly shorter than those in the saline group from immediately after tracheal intubation to the end of study., Conclusion: A bolus of landiolol 0.125 mg/kg followed by an infusion of landiolol 0.04 mg/kg/min may reduce the risk of cardiac arrhythmias during induction of anesthesia.
- Published
- 2009
- Full Text
- View/download PDF
39. Comparison of the two different auditory evoked potentials index monitors in propofol-fentanyl-nitrous oxide anesthesia.
- Author
-
Nishiyama T
- Subjects
- Adult, Aged, Anesthesiology methods, Anesthetics, Inhalation, Cautery, Female, Fentanyl, Humans, Laryngeal Masks, Mastectomy, Middle Aged, Monitoring, Intraoperative methods, Nitrous Oxide, Propofol, Prospective Studies, Anesthesia, Inhalation methods, Anesthesiology instrumentation, Electroencephalography drug effects, Electroencephalography methods, Evoked Potentials, Auditory drug effects, Monitoring, Intraoperative instrumentation
- Abstract
Study Objective: To determine the difference in performance of two different auditory evoked potentials (AEP) monitors, the A-Line AEP (AAI) and the aepEX, and their indices, during general anesthesia., Design: Prospective study., Setting: Operating room at a private hospital., Patients: 40 ASA physical status I and II women, aged 30 to 70 years, scheduled for partial mastectomy., Interventions: Anesthesia was induced with propofol and fentanyl, and a Laryngeal Mask Airway (LMA) was inserted. Anesthesia was maintained with propofol, fentanyl, and nitrous oxide., Measurements and Main Results: The AAI or the aepEX was continuously monitored and their performance was compared at the start of monitoring, at LMA insertion, after disturbance by electric cautery, and during anesthesia. Eighteen of 20 patients had low enough impedance to extract good electroencephalogram signals at the first electrode application with the A-Line AEP, and 14 of 20 patients, with the aepEX. The time to return to good signals after signal disturbance by electric cautery was 14 +/- 3 seconds (SD) with the AAI and 19 +/- 4 seconds (SD) with the aepEX (P = 0.035). Both AAI and aepEX decreased after anesthesia induction, with significantly lower values seen in AAI than the aepEX., Conclusions: The A-Line AEP (AAI) is better detects the response to painful stimuli and during recovering from noise of electric cautery than the aepEX. The aepEX shows higher values than the AAI during propofol-fentanyl-nitrous oxide anesthesia.
- Published
- 2009
- Full Text
- View/download PDF
40. Introduction of new safety technologies into central venous access.
- Author
-
Gerstein NS, Martin HB, Toma G, Sibbitt RR, and Sibbitt WL Jr
- Subjects
- Adult, Anesthesiology methods, Catheterization, Central Venous adverse effects, Catheterization, Central Venous methods, Equipment Design, Equipment Safety, Humans, Anesthesiology instrumentation, Catheterization, Central Venous instrumentation, Quality Assurance, Health Care
- Abstract
The American Society of Anesthesiologists, the Anesthesia Patient Safety Foundation, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), and the Patient Safety and Quality Improvement Act of 2005 encourage anesthesiology departments to institute systematic improvements in patient safety, including but not limited to integration of new safety technologies. The evaluation and method of use of the reciprocating procedure device in central venous access is presented.
- Published
- 2009
- Full Text
- View/download PDF
41. The anesthesia preoperative assessment: an opportunity for smoking cessation intervention.
- Author
-
Quraishi SA, Orkin FK, and Roizen MF
- Subjects
- Health Promotion methods, Humans, Intraoperative Complications prevention & control, Smoking adverse effects, Anesthesia, Anesthesiology methods, Preoperative Care methods, Smoking Cessation methods
- Abstract
Smoking is the single most cause of preventable disease and premature death in the United States. We discuss potential hazards that the anesthesiologist should be aware of when caring for patients who abuse tobacco. A review of recent preoperative smoking cessation initiatives is also provided in addition to recommendations on how anesthesiologists may use the preoperative visit as an opportunity to play a more active role in reducing the burden of tobacco-related disease.
- Published
- 2006
- Full Text
- View/download PDF
42. The Airway Approach Algorithm: a decision tree for organizing preoperative airway information.
- Author
-
Rosenblatt WH
- Subjects
- Airway Obstruction prevention & control, Anesthesiology methods, Decision Making, Humans, Practice Guidelines as Topic, Preoperative Care, Respiratory Physiological Phenomena
- Abstract
Anticipatory decision-making in airway management requires the integration of both history and physical examination findings. Though all airways can be managed along some branch of the American Society of Anesthesiologists' (ASA) Difficult Airway Algorithm, by predicting specific difficulties and integrating this information into an airway approach strategy, emergency branches of the ASA algorithm may be avoided. The Airway Approach Algorithm (AAA) consists of five clinical questions, with "yes" or "no" answers, to be addressed prior to the management of the airway. A positive answer to any question leads the clinician to the next, whereas a negative answer directs the operator to a root point of the ASA algorithm. The AAA is introduced with the anticipation that trainees in Anesthesiology, as well as others, will find it helpful in organizing preoperative information concerning the airway.
- Published
- 2004
- Full Text
- View/download PDF
43. Instruction of airway management skills during anesthesiology residency training.
- Author
-
Hagberg CA, Greger J, Chelly JE, and Saad-Eddin HE
- Subjects
- Anesthesiology methods, Curriculum, Data Collection, Humans, Teaching methods, United States, Anesthesiology education, Internship and Residency, Intubation, Intratracheal
- Abstract
Background: Difficult airway management is a critical aspect of anesthesiology training and practice. A survey was conducted of American anesthesia residency programs to determine the prevalence of a specific airway rotation and its curriculum., Methods: A questionnaire was sent by both e-mail and fax to all 132 directors of American anesthesiology residency programs., Results: Of the 132 programs surveyed, 79 (60%) responded. Of the responders, 26 programs (33%) have a difficult airway rotation. The rotation was offered throughout the years of clinical training in 13 (49%) of the programs and was of 1-week duration in 16 (61%) of these programs who had a rotation. Formal instruction was administered before the rotation in 18 (69%) of the programs. Instruction was usually performed on surgical patients in 22 (85%) of the program, ASA status I and II patients in 20 (77%) of the programs, and taught by selected faculty in 20 (78%) of the programs. There was a 2- to 5-minute time limitation or a number of maximum attempts when using any of these devices in 16 (62%) programs. There was a case number requirement regarding the use of the devices in 5 (19%) of the programs. Residents were evaluated by both skills testing and written evaluation in 63% of these programs., Discussion: Of the programs with an airway rotation, the flexible fiberoptic bronchoscope and the laryngeal mask airway represent the most frequently used devices, excluding the standard laryngoscopes. There is minimum emphasis on more invasive techniques. Traditional methods of instruction continue to be utilized more frequently than nontraditional methods.
- Published
- 2003
- Full Text
- View/download PDF
44. A modification of the Yodfat laryngeal mask airway insertion technique.
- Author
-
Jaffe RA and Brock-Utne JG
- Subjects
- Female, Humans, Middle Aged, Anesthesiology methods, Laryngeal Masks
- Abstract
We present here a case of a common problem for the anesthesiologist, i.e., difficulty in placing a Laryngeal Mask Airway (LMA). One solution is the use of the Yodfat technique to facilitate placement of the LMA.
- Published
- 2002
- Full Text
- View/download PDF
45. Failed emergency transtracheal ventilation through a 14-gauge intravenous catheter.
- Author
-
Metz S, Parmet JL, and Levitt JD
- Subjects
- Aged, Coronary Artery Bypass, Emergencies, Fiber Optic Technology, Humans, Inhalation, Kidney Transplantation, Male, Middle Aged, Pancreas Transplantation, Anesthesiology methods, Intraoperative Complications therapy, Respiration, Artificial, Trachea surgery
- Abstract
We encountered two patients who could be neither ventilated nor intubated after induction of anesthesia. In both cases, transtracheal ventilation failed after emergent cricothyroid membrane puncture with a 14-gauge intravenous (i.v.) catheter. In the first case, two catheters placed in rapid succession kinked, preventing gas exchange. In the second case, absence of a plunger on the needle-over-catheter assembly prevented confirmation of intratracheal placement. Both patients required emergent tracheal access by the surgeon. We suggest that transtracheal ventilation via standard i.v. catheters as a primary emergent rescue technique be reassessed.
- Published
- 1996
- Full Text
- View/download PDF
46. A more successful method for laryngeal mask airway insertion?
- Author
-
Brimacombe JR
- Subjects
- Anesthesiology methods, Humans, Laryngeal Masks
- Published
- 1996
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.