188 results on '"Anesthesiology methods"'
Search Results
2. Regional anesthesia with single shot blocks and current outcome measures: in and out of the anesthesiological radar.
- Author
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Volk T and Kubulus C
- Subjects
- Humans, Outcome Assessment, Health Care, Anesthetics, Local administration & dosage, Anesthesiology methods, Anesthesia, Conduction methods, Nerve Block methods
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thomas Volk reports a relationship with European Society of Regional Anaesthesia and Pain Therapy that includes: board membership. Associate Editor: Journal of Clinical Anesthesia If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Published
- 2024
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3. Performance of ChatGPT on a free-response anaesthesia primary examination.
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Cai SC, Tung AMS, and Eslick AT
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- Humans, Educational Measurement methods, Anesthesia methods, Clinical Competence, Anesthesiology methods
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- 2024
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4. The impact of hindsight bias on the diagnosis of perioperative events by anesthesia providers: A multicenter randomized crossover study.
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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.)
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- 2024
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5. Optimizing ergonomics in the operating room: A vital factor for anesthesia care.
- Author
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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
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6. From Brobdingnag to Lilliput: Gulliver's travels in airway management guidelines.
- Author
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Massimiliano S and Daniele T
- Subjects
- Child, Infant, Newborn, Humans, Airway Management methods, Critical Care methods, Advisory Committees, Intubation, Intratracheal methods, Anesthesia, Anesthesiology methods
- Abstract
Neonatal airway management comes with exclusive anatomical, physiological, and environmental complexities, and probably higher incidences of accidents and complications. No dedicated airway management guidelines were available until the recently published first joint guideline released by a task force supported by the European Society of Anaesthesiology and Intensive Care and the British Journal of Anaesthesia and focused on airway management in children under 1 yr of age. The guideline offers a series of recommendations based on meticulous methodology including multiple Delphi rounds to complement the sparse and scarce available evidence. Getting back from Brobdingnag, the land of giants with many guidelines available, this guideline represents a foundational cornerstone in the land of Lilliput., (Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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7. Impact of female sex on anaesthetic awareness, depth, and emergence: a systematic review and meta-analysis.
- Author
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Braithwaite HE, Payne T, Duce N, Lim J, McCulloch T, Loadsman J, Leslie K, Webster AC, Gaskell A, and Sanders RD
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- Female, Humans, Male, Prospective Studies, Anesthesia, General, Anesthetics, Anesthesiology methods
- Abstract
Background: Suggested anaesthetic dose ranges do not differ by sex, likely because of limited studies comparing sexes. Our objective was to systematically synthesise studies with outcomes of unintended anaesthesia awareness under anaesthesia, intraoperative connected consciousness, time to emergence from anaesthesia, and dosing to achieve adequate depth of anaesthesia, and to compare between females and males., Methods: Studies were identified from MEDLINE, Embase, and the Cochrane library databases until August 2, 2022. Controlled clinical trials (randomised/non-randomised) and prospective cohort studies that reported outcomes by sex were included. Results were synthesised by random effects meta-analysis where possible, or narrative form., Results: Of the 19 749 studies identified, 64 (98 243 participants; 53 143 females and 45 100 males) were eligible for inclusion, and 44 citations contributed to meta-analysis. Females had a higher incidence of awareness with postoperative recall (33 studies, odds ratio 1.38, 95% confidence interval [CI] 1.09-1.75) and connected consciousness during anaesthesia (three studies, OR 2.09, 95% CI 1.04-4.23) than males. Time to emergence was faster in females, including time to eye-opening (10 studies, mean difference -2.28 min, 95% CI -3.58 to -0.98), and time to response to command (six studies, mean difference -2.84 min, 95% CI -4.07 to -1.62). Data on depth of anaesthesia were heterogenous, limiting synthesis to a qualitative review which did not identify sex differences., Conclusions: Female sex was associated with a greater incidence of awareness under general anaesthesia, and faster emergence from anaesthesia. These data suggest reappraisal of anaesthetic care, including whether similar drug dosing for females and males represents best care., Systematic Review Registration: PROSPERO CRD42022336087., (Copyright © 2023 British Journal of Anaesthesia. All rights reserved.)
- Published
- 2023
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8. Undiagnosed attention-deficit/hyperactivity disorder may be a risk factor for requiring anaesthesia.
- Author
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Conway Morris A and Conway Morris A
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- Anesthesiology methods, Child, Humans, Risk Factors, Anesthesia adverse effects, Attention Deficit Disorder with Hyperactivity etiology
- Abstract
Competing Interests: Declarations of interest The authors declare that they have no conflicts of interest.
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- 2022
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9. Medication errors, critical incidents, adverse drug events, and more: a review examining patient safety-related terminology in anaesthesia.
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Biro J, Rucks M, Neyens DM, Coppola S, Abernathy JH 3rd, and Catchpole KR
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- Anesthesiology methods, Animals, Humans, Patient Safety, Risk Management methods, Anesthesia adverse effects, Drug-Related Side Effects and Adverse Reactions prevention & control, Medication Errors prevention & control
- Abstract
Literature focused on quantifying or reducing patient harm in anaesthesia uses a variety of labels and definitions to represent patient safety-related events, such as 'medication errors', 'adverse events', and 'critical incidents'. This review extracts and compares definitions of patient safety-related terminology in anaesthesia to examine the scope of this variability and inconsistencies. A structured review was performed in which 36 of the 769 articles reviewed met the inclusion criteria. Similar terms were grouped into six categories by similarities in keyword choice (Adverse Event, Critical Incident, Medication Error, Error, Near Miss, and Harm) and their definitions were broken down into three base components to allow for comparison. Our analysis found that the Medication Error category, which encompasses the greatest number of terms, had widely variant definitions which represent fundamentally different concepts. Definitions of terms within the other categories consistently represented relatively similar concepts, though key variations in wording remain. This inconsistency in terminology can lead to problems with synthesising, interpreting, and overall sensemaking in relation to anaesthesia medication safety. Guidance towards how 'medication errors' should be defined is provided, yet a definition will have little impact on the future of patient safety without organisations and journals taking the lead to promote, publish, and standardise definitions., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
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- 2022
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10. Adverse event and complication tracking in anaesthesiology: dependence on self-reporting despite implementation of electronic health records.
- Author
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Tewfik G, Naftalovich R, Kaushal N, and Zhang K
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- Adverse Drug Reaction Reporting Systems statistics & numerical data, Anesthesiology standards, Electronic Health Records, Humans, Quality Improvement, Self Report, Anesthesia adverse effects, Anesthesiology methods, Anesthetics adverse effects
- Abstract
Competing Interests: Declarations of interest The authors declare no conflicts of interest.
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- 2022
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11. Animal products in anaesthesia: navigating complex requests.
- Author
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O'Sullivan R and Kearsley R
- Subjects
- Animals, Humans, Religion and Medicine, Vegans, Anesthesia methods, Anesthesiology methods, Anesthetics chemistry
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- 2022
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12. Associations of form and function of speaking up in anaesthesia: a prospective observational study.
- Author
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Lemke R, Burtscher MJ, Seelandt JC, Grande B, and Kolbe M
- Subjects
- Adult, Female, Humans, Male, Prospective Studies, Surveys and Questionnaires, Switzerland, Anesthesiology methods, Attitude of Health Personnel, Communication, Organizational Culture, Patient Safety statistics & numerical data
- Abstract
Background: Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up., Methods: Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding., Results: Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018)., Conclusion: Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2021
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13. The Routine posTsuRgical Anesthesia visit to improve patient outComE (TRACE) study: lessons learned.
- Author
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Hollmann MW, de Korte-de Boer D, Boer C, and Buhre WFFA
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- Anesthesia adverse effects, Humans, Patient Outcome Assessment, Anesthesia methods, Anesthesiology methods, Postoperative Care methods
- Published
- 2021
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14. Bias and ethical considerations in machine learning and the automation of perioperative risk assessment.
- Author
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O'Reilly-Shah VN, Gentry KR, Walters AM, Zivot J, Anderson CT, and Tighe PJ
- Subjects
- Bias, Humans, Risk Assessment, Anesthesiology methods, Automation methods, Machine Learning ethics, Machine Learning statistics & numerical data, Perioperative Care methods
- Published
- 2020
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15. Determining competence in performing obstetric combined spinal-epidural procedures in junior anesthesiology residents: results from a cumulative sum analysis.
- Author
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Lew E, Allen JC Jr, Goy RWL, Ithnin F, and Sng BL
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- Adult, Anesthesia, Epidural methods, Anesthesia, Obstetrical methods, Anesthesia, Spinal methods, Anesthesiology methods, Female, Humans, Internship and Residency methods, Male, Prospective Studies, Anesthesia, Epidural standards, Anesthesia, Obstetrical standards, Anesthesia, Spinal standards, Anesthesiology standards, Clinical Competence statistics & numerical data, Internship and Residency statistics & numerical data
- Abstract
Background: The epidural anesthesia technique is a challenging skill to master. The Accreditation Council for Graduate Medical Education (ACGME) stipulates that anesthesiology residents must complete 40 epidural procedures by the end of junior residency. The rationale is unknown. The aim of this prospective study was to determine the minimum case experience required to demonstrate competence in performing obstetric combined spinal-epidural procedures among junior residents, using an objective statistical tool, the cumulative sum (CUSUM) analysis., Methods: Twenty-four residents, with no prior experience performing epidurals, sequentially recorded all obstetric combined spinal-epidural procedures as a 'success' or 'failure', based on study criteria. Individual CUSUM graphs were plotted, with acceptable and unacceptable failure rates set at 20% and 35%, respectively. The number of procedural attempts necessary to demonstrate competence was determined., Results: Twenty-four residents (mean (SD) age 29 (2) years) participated in the study. Median (IQR) number of procedures was 78 (66-85), with a median (IQR) success rate of 86% (82-89%). Nineteen of 24 residents required a median (IQR) of 40 (33-50) attempts to demonstrate competence. Five did not achieve procedural competence in the training period. The CUSUM graphs highlighted performance trends that required intervention., Conclusion: Competence was achieved by 19/24 residents after the ACGME-required case experience of 40 combined spinal-epidural procedures, based on a predefined acceptable failure rate of 20%. In our experience, CUSUM analysis is useful in monitoring technical performance over time and should be included as an adjunct assessment method for determining procedural competence., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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16. Protection of anesthesia providers from silent carriers of COVID-19 while minimizing disposable PPE utilization.
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Ringenberg KR, Fremming BA, Lisco SJ, and Schulte TE
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- 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.
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- 2020
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17. The value of anaesthesiologists in the COVID-19 pandemic: a model for our future practice?
- Author
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van Klei WA, Hollmann MW, and Sneyd JR
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- COVID-19, Humans, Pandemics, SARS-CoV-2, Anesthesiologists, Anesthesiology methods, Betacoronavirus, Coronavirus Infections therapy, Critical Care methods, Pneumonia, Viral therapy
- Abstract
Competing Interests: Declarations of interest The authors declare that they have no conflicts of interest.
- Published
- 2020
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18. Novel method of performing brachial plexus block using an aerosol box during COVID-19 pandemic.
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Kulkarni RR, Stephen M, Shashank A, and Mandhal LN
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- 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
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19. SARS-CoV-2 infection control measures for the anesthesiology department: experience from the Sichuan Provincial People's Hospital, China.
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Xie M, Huang JX, Chen PP, Wei XC, Li XK, Zhang P, Yang LN, and Zhou Q
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- 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
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20. Healthcare at the time of COVID-19: A review of the current situation with emphasis on anesthesia providers.
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Rekatsina M, Paladini A, Moka E, Yeam CT, Urits I, Viswanath O, Kaye AD, Morgan JA, and Varrassi G
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- COVID-19, Humans, Personal Protective Equipment, SARS-CoV-2, Anesthesiology methods, Betacoronavirus, Coronavirus Infections prevention & control, Health Personnel, Pandemics prevention & control, Pneumonia, Viral prevention & control
- Abstract
Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, healthcare workers, health systems, as well as economies. While, healthcare systems are globally operating at maximum capacity, healthcare workers and especially anesthesia providers are facing extreme pressures, something that is also leading to declining availability and increasing stress. In this regard, it is extremely concerning the fact that some regions worldwide have reported up to 20% of their cases to be healthcare workers. When considering that the global case fatality rate may be as much as 5.4%, these numbers are concerning and unacceptable. As this pandemic accelerates, access to personal protective equipment for health workers is a key concern since at present, healthcare workers are every country's most valuable resource in the fight against COVID-19. Governments and heath organizations should take care of their staff and support them in any way possible. This review aims to describe the current situation anesthesia providers are facing in the setting of COVID-19 and provide solutions and evidence on important concerns, including which guidance to follow, the level of equipment that is adequate, and the level of protection they need for every patient being administered an anesthetic., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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21. Navigating the complexities of treating COVID-19 during the pandemic and a multimodal approach to chronic pain.
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Viswanath O and Kaye AD
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- COVID-19, Coronavirus Infections epidemiology, Humans, Pandemics, Pneumonia, Viral epidemiology, Anesthesiology methods, Chronic Pain therapy, Coronavirus Infections therapy, Pneumonia, Viral therapy
- Abstract
Competing Interests: Declaration of competing interest None to declare.
- Published
- 2020
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22. The Airway Lead: opportunities to improve institutional and personal preparedness for airway management.
- Author
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McNarry AF, M Cook T, Baker PA, and O'Sullivan EP
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- Humans, Airway Management methods, Anesthesiology methods, Anesthesiology organization & administration, Clinical Competence, Leadership
- Published
- 2020
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23. Perioperative considerations for transgender women undergoing routine surgery: a narrative review.
- Author
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Lennie Y, Leareng K, and Evered L
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- Female, Humans, Male, Anesthesiology methods, Perioperative Care methods, Sex Reassignment Procedures methods, Surgical Procedures, Operative methods, Transgender Persons
- Abstract
A transgender woman is a person assigned male sex at birth who identifies as a woman. With the numbers of transgender identity on the rise, encountering a transgender woman requiring routine surgery is becoming more common in anaesthetic practice. The perioperative period can be challenging for transgender women, but these challenges can be mitigated by a skilled and sensitive perioperative team. Engagement with patients and their primary physicians is important. Whilst there are anaesthetic issues relevant to both transgender women and men, there are many issues unique to transgender women. This article focuses only on considerations for the perioperative care of the transgender woman. This narrative review provides an overview of the factors influencing the safe care of the transgender woman presenting for routine surgery, including the potential social and pharmacological factors to consider, and anatomical changes to be aware of from previous gender confirming or feminisation surgeries that can influence clinical decision-making., (Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
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24. Smartphone otoscope: an alternative technique for intubation in rabbits.
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Freitag FAV, Muehlbauer E, Martini R, Froes TR, and Duque JCM
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- Anesthesia methods, Anesthesiology instrumentation, Anesthesiology methods, Animals, Intubation, Intratracheal instrumentation, Intubation, Intratracheal methods, Anesthesia veterinary, Intubation, Intratracheal veterinary, Otoscopes, Rabbits, Smartphone
- Published
- 2020
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25. Reporting of interventions used in anesthesiology trials: analysis using the Template for Intervention Description and Replication (TIDieR) checklist.
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Jellison S, Nolan J, Vo N, Thai M, Puljak L, and Vassar M
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- Anesthesiology standards, Humans, Randomized Controlled Trials as Topic methods, Randomized Controlled Trials as Topic standards, Research Design standards, Research Report standards, Anesthesiology methods, Checklist, Publications standards
- Published
- 2020
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26. Point of care ultrasound for the clinical anesthesiologist.
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Novitch M, Prabhakar A, Siddaiah H, Sudbury AJ, Kaye RJ, Wilson KE, Haroldson A, Fiza B, Armstead-Williams CM, Cornett EM, Urman RD, and Kaye AD
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- Anesthesiology trends, Humans, Perioperative Care trends, Ultrasonography, Interventional trends, Anesthesiologists trends, Anesthesiology methods, Perioperative Care methods, Point-of-Care Systems trends, Ultrasonography, Interventional methods
- Abstract
Diagnostic ultrasonography was first utilized in the 1940s. The past 70+ years have seen an explosion in both ultrasound technology and availability of ultrasound technology to more and more clinicians. As ultrasound technology and availability have grown, the utility of ultrasound technology in the clinical setting as only been limited by clinicians' imagination. Due to its lack of radiation, non-invasive nature, and gentle learning curve, medical ultrasonography is now a tremendously useful Point of Care technology in the clinical arena. What follows is a discussion of Point of Care Ultrasound (PoCUS) and how it can be incorporated in the daily practice of any regional anesthesiology. While most regional anesthesiologists usually focus on the interventional aspects of ultrasonography (i.e. nerve blocks), our discussion will center on the diagnostic value of ultrasonography-especially concerning assessment of cardiac physiology and pathophysiology, gastric anatomy, airway anatomy, and intracranial pathophysiology. After reading and reviewing this chapter, the learner will have the knowledge to start training themselves in a variety of PoCUS exams that will allow rapid diagnosis of normal and abnormal patient conditions. Once an accurate diagnosis is established, the anesthesiologist and his/her team can then confidently optimize an anesthetic pain, prevent harm, and/or treat a patient condition. In this day and age, the ability to rapidly establish an accurate diagnosis cannot be overstated-especially in a critical situation. It is the authors' sincerest hope that the following discussion will help regional anesthesiologist to become even better and well-rounded clinical leaders., (Published by Elsevier Ltd.)
- Published
- 2019
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27. Humanistic medicine in anaesthesiology: development and assessment of a curriculum in humanism for postgraduate anaesthesiology trainees.
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Canales C, Strom S, Anderson CT, Fortier MA, Cannesson M, Rinehart JB, Kain ZN, and Perret D
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- Adolescent, Adult, Aged, Aged, 80 and over, Anesthesiology methods, Attitude of Health Personnel, Empathy, Female, Humans, Male, Middle Aged, Students, Medical psychology, Young Adult, Anesthesiology education, Clinical Competence statistics & numerical data, Curriculum, Humanism, Internship and Residency, Patient Satisfaction statistics & numerical data
- Abstract
Background: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training., Methods: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre- and post-curriculum assessments in first-year postgraduate trainee doctors (residents)., Results: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P=0.013). After training, patients rated the residents as more empathetic (31 [4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7-12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9-16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10-18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P=0.001; 95% CI: 0.8-2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P=0.010; 95% CI: 0.4-2.8)., Conclusions: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care., (Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2019
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28. Retained surgical items: Implications for anesthesiology practice.
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Gluncic V, Lukić A, and Candido K
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- Anesthesiology standards, Humans, Patient Safety, Anesthesiology methods, Foreign Bodies prevention & control, Perioperative Care standards
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- 2019
- Full Text
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29. Anaesthesiology in China: present and future.
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Yang Q, Xie K, and Xiong L
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- Anesthesiology trends, China, Health Policy, Humans, Societies, Medical, Anesthesiology methods
- Published
- 2019
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30. Streamlined guidelines for antibiotic therapies are required for greater efficacy.
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Roger PM, Michélangeli C, Girard D, Etienne P, Borredon G, Dautezac V, Keita-Perse O, and Del Giudice P
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- Anesthesiology methods, Anesthesiology organization & administration, Anesthesiology standards, Antimicrobial Stewardship methods, Critical Care methods, Critical Care organization & administration, Critical Care standards, France epidemiology, Humans, Hygiene standards, Infectious Disease Medicine methods, Infectious Disease Medicine organization & administration, Infectious Disease Medicine standards, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' statistics & numerical data, Respiratory Tract Infections drug therapy, Respiratory Tract Infections epidemiology, Societies, Medical organization & administration, Societies, Medical standards, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship standards, Practice Guidelines as Topic
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- 2019
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31. Selected highlights from clinical anesthesia and pain management.
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Kendall MC, Pisano DV, Cohen AD, Gorgone M, McCormick ZL, and Malgieri CJ
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- 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
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32. Agreement among anesthesiologists regarding postoperative pain assessment in dogs.
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Hofmeister EH, Barletta M, Shepard M, Brainard BM, Trim CM, and Quandt J
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- Anesthesiology methods, Anesthesiology standards, Animals, Dogs, Observer Variation, Pain Measurement methods, Pain Measurement standards, Pain, Postoperative diagnosis, Reproducibility of Results, Dog Diseases diagnosis, Pain Measurement veterinary, Pain, Postoperative veterinary
- Abstract
Objective: To establish evidence for the validity and reliability of three commonly used pain scales in dogs when assessed by video by specialists in anesthesia., Study Design: Mixed-method test-retest observational study., Subjects: A group of six American College of Veterinary Anesthesia and Analgesia board-certified specialists and 31 postoperative dogs., Methods: The evaluators scored 31 dogs using a visual analogue scale (VAS), numeric rating scale (NRS), and Glasgow pain scale (GPS). The evaluators individually scored the dogs using all three scales together and subsequently, at 3 month intervals, using each of the scales apart. Then, all evaluators in one room reviewed 23 of the videos. A camera was positioned for video and audio recording of discussion about the videos. Intra- and interobserver reliability was determined using a two-way random model intra-class correlation coefficient (ICC)., Results: Linear regression indicated a strong correlation among all scales when assigned together (VAS versus NRS, p < 0.0001, R
2 = 0.93; VAS versus GPS, p < 0.0001, R2 = 0.59; and NRS versus GPS, p < 0.0001, R2 = 0.61) and apart (VAS versus NRS, p < 0.0001, R2 = 0.68; VAS versus GPS, p < 0.0001, R2 = 0.40; and NRS versus GPS, p < 0.0001, R2 = 0.47). Posture, appearance, vocalization, stiffness, interaction between the animal and a person and response to palpation were identified as important variables for assessing pain. Intra-observer reliability produced average ICC values of 0.90 for VAS, 0.89 for NRS and 0.85 for GPS. Interobserver reliability produced average ICC values when scores were assigned together (VAS: 0.93, NRS: 0.93 and GPS: 0.93) and when done separately (VAS: 0.91, NRS: 0.93 and GPS: 0.95)., Conclusions and Clinical Relevance: The preferred use of the VAS and NRS over the use of the GPS should be cautiously considered for research applications when experts are observers. Revisions of the GPS to clarify descriptors and remove or modify items that may not be associated with pain in dogs should be considered., (Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)- Published
- 2018
- Full Text
- View/download PDF
33. Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI).
- Author
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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
34. Update on nitrous oxide and its use in anesthesia practice.
- Author
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Zafirova Z, Sheehan C, and Hosseinian L
- Subjects
- Anesthesia trends, Anesthesiology methods, Anesthesiology trends, Female, Humans, Labor Pain diagnosis, Labor Pain drug therapy, Pregnancy, Randomized Controlled Trials as Topic methods, Anesthesia methods, Anesthetics, Inhalation administration & dosage, Nitrous Oxide administration & dosage
- Abstract
Nitrous oxide (N
2 O) is an anesthetic and analgesic gas with a long history of medical applications. It acts on multiple supraspinal and spinal targets and has utility in a wide range of clinical situations. The relative safety, low incidence, and acuity of adverse effects of N2 O, along with the ability to be administered by trained medical providers with varying clinical backgrounds, as well as self-administered by patients, assure its persistent and expanding role in clinical practice., (Copyright © 2018 Elsevier Ltd. All rights reserved.)- Published
- 2018
- Full Text
- View/download PDF
35. How to prevent medication errors in the operating room? Take away the human factor.
- Author
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Litman RS
- Subjects
- Humans, Anesthesia adverse effects, Anesthesiology methods, Ergonomics, Medication Errors prevention & control, Operating Rooms, Patient Safety
- Published
- 2018
- Full Text
- View/download PDF
36. ASA physical status classification of obstructive sleep apnoea disease.
- Author
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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
37. Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation.
- Author
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Roback MG, Green SM, Andolfatto G, Leroy PL, and Mason KP
- Subjects
- Advisory Committees, Checklist, Consensus, Humans, Patient-Centered Care, Quality Improvement, Reference Standards, Research, Terminology as Topic, Anesthesiology methods, Conscious Sedation standards
- Abstract
Many hospitals, and medical and dental clinics and offices, routinely monitor their procedural-sedation practices-tracking adverse events, outcomes, and efficacy in order to optimize the sedation delivery and practice. Currently, there exist substantial differences between settings in the content, collection, definition, and interpretation of such sedation outcomes, with resulting widespread reporting variation. With the objective of reducing such disparities, the International Committee for the Advancement of Procedural Sedation has herein developed a multidisciplinary, consensus-based, standardized tool intended to be applicable for all types of sedation providers in all locations worldwide. This tool is amenable for inclusion in either a paper or an electronic medical record. An additional, parallel research tool is presented to promote consistency and standardized data collection for procedural-sedation investigations., (Copyright © 2017. Published by Elsevier Ltd.)
- Published
- 2018
- Full Text
- View/download PDF
38. Managing anaesthetic provision for global disasters.
- Author
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Craven RM
- Subjects
- Emergencies, Global Health, Humans, Anesthesiology methods, Anesthetics, Disasters, Internationality
- Abstract
The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the affected country is least able to respond. For this reason an international disaster response is often required. For many years this disaster response was not coordinated. The response consisted of what was available not what was needed and standards of care varied widely producing a healthcare lottery for the affected population. In recent years the World Health organisation has initiated the Emergency Medical Team programme to coordinate the response to disasters and set minimum standards for responding teams. Anaesthetists have a key role to play in Level 2 Surgical Field Hospitals. The disaster context produces a number of logistical challenges that directly impact on the anaesthetist requiring adaptation of anaesthetic techniques from their everyday practice. The context in which they will be working and the wider scope of practice that will be expected from them in the field mandates that deploying anaesthetists should be trained for disaster response. There have been significant improvements in recent years in the speed of response, equipment availability, coordination and training for disasters. Future challenges include increasing local disaster response capacity, agreeing international standards for training and improving data collection to allow for future research and improvement in disaster response. The goal of this review article is to provide an understanding of the disaster context and what logistical challenges it provides. There has been a move during the last decade from a globally uncoordinated, unregulated response, with no consensus on standards, to a globally coordinated response through the World Health Organisation (WHO). A classification system for responding Emergency Medical Teams (EMTs) and a set of agreed minimum standards has been defined. This review outlines the scope of the role of the anaesthetist in a Level 2 field hospital and some of the challenges that this scope and context present. It focuses mainly on natural disasters, but also outline some of the differences encountered in responding to other global disasters such as conflict and infectious outbreaks, and concludes with some of the challenges for the future., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
39. Selected highlights in clinical anesthesia research.
- Author
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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
40. Abdominal aortic aneurysm repair in the United Kingdom: an exemplar for the role of anaesthetists in perioperative medicine.
- Author
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Howell SJ
- Subjects
- Anesthetists, Humans, Length of Stay, United Kingdom, Anesthesiology methods, Aortic Aneurysm, Abdominal surgery, Endovascular Procedures methods, Perioperative Care methods
- Abstract
The past two decades have seen an increasing recognition that the delivery of safe surgery with low complication rates and good long-term outcomes is a team endeavour embracing the whole patient care pathway. The key role of the anaesthetist in managing the patient through the surgical process is widely understood and has driven the emergence of perioperative medicine. In parallel with these developments there has been a sea change in the organisation of the care of patients presenting for elective abdominal aortic aneurysm (AAA) repair. Data from the 2008 report of the VASCUNET vascular registry suggested that the UK had the highest mortality for elective open AAA repair in Europe (7.9%). In response, a national quality improvement programme (AAAQIP) spanning the disciplines of surgery, anaesthesia, radiology and nursing was put in place. This led to significant changes in all aspects of AAA repair including the role of the anaesthetist. Preoperative assessment by an anaesthetist with a vascular practice was mandated and the role of the anaesthetist in the vascular multidisciplinary team meeting (MDT) established. Anaesthetic data were included in the national data collection system for vascular surgery, the National Vascular Registry. These changes paralleled and in some cases led the wider evolution of the role of the anaesthetist in perioperative medicine. The mortality from infrarenal AAA repair in the UK decreased to 2.4% by 2012. This improvement reflects changes in perioperative care supported and in some cases led by anaesthetists., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
41. Thiopental to desflurane - an anaesthetic journey. Where are we going next?
- Author
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Sneyd JR
- Subjects
- Humans, Hypnotics and Sedatives, Anesthesiology methods, Anesthetics, Inhalation, Anesthetics, Intravenous, Desflurane, Thiopental
- Abstract
Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects. Recently, questions around neonatal neurotoxicity, delirium and postoperative cognitive dysfunction have stimulated research to characterise these phenomena and explain them in mechanistic terms. Emergent basic science from these enquiries together with exploration of possible effects of anaesthetic drug choice on patient outcomes from cancer surgery may yield new targets for drug discovery., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
42. The evolution of robotic surgery: surgical and anaesthetic aspects.
- Author
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Ashrafian H, Clancy O, Grover V, and Darzi A
- Subjects
- Humans, Surgery, Computer-Assisted, Anesthesiology methods, Robotic Surgical Procedures methods
- Abstract
Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems. We examine the challenges, obstacles and limitations of robotic surgery and its future potential including integrated real-time anatomical and immune-histological imaging and data assimilation with improved visualisation, haptic feedback and robot-surgeon interactivity. We consider current evidence, cost-effectiveness and the learning curve in relation to the surgical and anaesthetic journey, and what is required to continue to realise improvements in surgical operative care. The innovative impact of this technology holds the potential to achieve transformative clinical improvements. However, despite over 30 yr of incremental advances it remains formative in its innovative disruption., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
43. Global lessons: developing military trauma care and lessons for civilian practice.
- Author
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Woolley T, Round JA, and Ingram M
- Subjects
- Critical Care methods, Humans, Military Personnel, Wounds and Injuries rehabilitation, Anesthesiology methods, Internationality, Military Medicine methods, Wounds and Injuries therapy
- Abstract
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role. Pre-deployment training includes additional skill training, team training and finally whole hospital collective training. This pathway ensures ongoing and continuing competence on an individual basis, and assurance that hospital management systems and clinical staff can function effectively as a deploying unit., (© Crown copyright 2017.)
- Published
- 2017
- Full Text
- View/download PDF
44. SmartPilot® view-guided anaesthesia improves postoperative outcomes in hip fracture surgery: a randomized blinded controlled study.
- Author
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Leblanc D, Conté M, Masson G, Richard F, Jeanneteau A, Bouhours G, Chrétien JM, Rony L, Rineau E, and Lasocki S
- Subjects
- Aged, Aged, 80 and over, Drug Therapy, Computer-Assisted instrumentation, Female, Humans, Length of Stay statistics & numerical data, Male, Prospective Studies, Single-Blind Method, Anesthesia, General methods, Anesthesiology methods, Drug Therapy, Computer-Assisted methods, Hip Fractures surgery, Intraoperative Complications prevention & control, Postoperative Complications prevention & control
- Abstract
Background: Both under-dosage and over-dosage of general anaesthetics can harm frail patients. We hypothesised that computer-assisted anaesthesia using pharmacokinetic/pharmacodynamic models guided by SmartPilot® View (SPV) software could optimise depth of anaesthesia and improve outcomes in patients undergoing hip fracture surgery., Methods: This prospective, randomized, single-centre, blinded trial included patients undergoing hip fracture surgery under general anaesthesia. In the intervention group, anaesthesia was guided using SPV with predefined targets. In the control group, anaesthesia was delivered by usual practice using the same agents (propofol, sufentanil and desflurane). The primary endpoint was the time spent in the "appropriate anaesthesia zone" defined as bispectral index (BIS) (blinded to the anaesthetist during surgery) of 45-60 and systolic arterial pressure of 80-140 mm Hg. Postoperative complications were recorded for one month in a blinded manner., Results: Of 100 subjects randomised, 97 were analysed (n=47 in SPV and 50 in control group). Anaesthetic drug consumption was reduced in the SPV group (for propofol and desflurane). Intraoperative duration of low BIS (<45) was similar, but cumulative time of low systolic arterial pressure (<80 mm Hg) was significantly shorter in the SPV group (median (Q1-Q3); 3 (0-40) vs 5 (0-116) min, P=0.013). SPV subjects experienced fewer moderate or major postoperative complications at 30-days (8 (17)% vs 18 (36)%, P=0.035) and shorter length of hospitalisation (8 (2-20) vs 8 (2-60) days, P=0.017)., Conclusions: SmartPilot® View-guided anaesthesia reduces intraoperative hypotension duration, occurrence of postoperative complications and length of stay in hip fracture surgery patients., Clinical Trial Registration: NCT 02556658., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)
- Published
- 2017
- Full Text
- View/download PDF
45. Heterogeneity of studies in anesthesiology systematic reviews: a meta-epidemiological review and proposal for evidence mapping.
- Author
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Umberham B, Hedin R, Detweiler B, Kollmorgen L, Hicks C, and Vassar M
- Subjects
- Epidemiologic Studies, Humans, Periodicals as Topic, Research Design, Anesthesiology methods, Anesthesiology statistics & numerical data, Data Interpretation, Statistical, Systematic Reviews as Topic
- Abstract
Heterogeneity among the primary studies included in a systematic review (SR) is one of the most challenging considerations for systematic reviewers. Current practices in anaesthesiology SRs have not been evaluated, but traditional methods may not provide sufficient information to evaluate the true nature of these differences. We address these issues by examining the practices for evaluating heterogeneity in anesthesiology reviews. Also, we propose a mapping method for presenting heterogeneous aspects of the primary studies in SRs.We evaluated heterogeneity practices reported in SRs published in highly ranked anesthesiology journals and Cochrane reviews. Elements extracted from the SRs included heterogeneity tests, models used, analyses conducted, plots used, and I2 values. Additionally, we selected a SR to develop an evidence map in order to display clinical heterogeneity.Our statistical analysis showed 150/207 SRs reporting a test for statistical heterogeneity. Plots were used in 138 reviews to display heterogeneity. Subgroup analyses were the most commonly reported analysis (54%). Meta-regression and sensitivity analyses were used sparingly (25%; 23% respectively). A random effects model was most commonly reported (33%). Heterogeneity statistics across meta-analyses suggested that, in our sample, the majority (55%) did not present sufficient heterogeneity to be of great concern. Cochrane reviews (n=58) were also analysed. Plots were used in 88% of Cochrane reviews. Subgroup analysis was used in 59% Cochrane reviews, while sensitivity analysis was used in 62%.Many reviews did not provide sufficient detail regarding heterogeneity. We are calling for improvement to reporting practices., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
46. Use of an anaesthesia workstation barrier device to decrease contamination in a simulated operating room.
- Author
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Hunter S, Katz D, Goldberg A, Lin HM, Pasricha R, Benesh G, Le Grand B, and DeMaria S
- Subjects
- Anesthesiology methods, Fluorescent Dyes, Humans, Infection Control, Simulation Training, Anesthesia, Equipment Contamination prevention & control, Operating Rooms organization & administration
- Abstract
Background.: Strategies to achieve reductions in perioperative infections have focused on hand hygiene among anaesthestists but have been of limited efficacy. We performed a study in a simulated operating room to determine whether a barrier covering the anaesthesia workstation during induction and intubation might reduce the risk of contamination of the area and possibly, by extension, the patient., Methods.: Forty-two attending and resident anaesthetists unaware of the study design were enrolled in individual simulation sessions in which they were asked to induce and intubate a human simulator that had been prepared with fluorescent marker in its oropharynx as a marker of potentially pathogenic bacteria. Twenty-one participants were assigned to a control group, whereas the other 21 performed the simulation with a barrier device covering the anaesthesia workstation. After the simulation, an investigator examined 14 target sites with an ultraviolet light to assess spread of the fluorescent marker of contamination to those sites., Results.: The difference in rates of contamination between the control group and the barrier group was highly significant, with 44.8% (2.5%) of sites contaminated in the control group vs 19.4% (2.6%) of sites in the barrier group ( P <0.001). Several key clinical sites showed significant differences in addition to this overall decrement., Conclusions.: The results of this study suggest that application of a barrier device to the anaesthesia workstation during induction and intubation might reduce contamination of the intraoperative environment., (© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com)
- Published
- 2017
- Full Text
- View/download PDF
47. Preanesthetic evaluation of the patient with end-stage heart failure.
- Author
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Sumler M and Vadlamudi R
- Subjects
- Anesthesiology standards, Heart Transplantation methods, Heart Transplantation standards, Heart-Assist Devices standards, Humans, Preoperative Care standards, Anesthesiology methods, Heart Failure diagnosis, Heart Failure therapy, Patient Selection, Preoperative Care methods
- Abstract
Heart failure (HF) currently affects more than 5 million patients in the United States [1]. Advanced HF is associated with high mortality and poor quality of life. It is estimated that between 5% and 10% of all patients with HF have an advanced form of the disease [1]. Orthotopic heart transplantation (OHT) is an accepted therapy for stage D HF [3] (Fig. 1). Unfortunately, the number of patients with the disease exceeds the number of available organs. This makes appropriate patient selection vital in the field of heart transplantation. Anesthetic evaluation of the patient presenting for OHT or mechanical circulatory support (MCS) implantation is a vital component of the patient's perioperative course. Patients often have had extensive diagnostic testing and assessment prior to being listed for OHT or considered for MCS implantation. Because of the often urgent nature of these procedures, the cardiac anesthesiologist must conduct a focused review of the relevant information and perform a focused patient interview and physical exam., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
48. A different use of visual analytic techniques in anaesthetics.
- Author
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Rice R and Rice I
- Subjects
- Databases, Factual, Humans, Machine Learning, Anesthesiology methods, Anesthetics, Big Data, Data Mining methods
- Published
- 2017
- Full Text
- View/download PDF
49. Remote ischaemic preconditioning: an intervention for anaesthetists?
- Author
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Mouton R and Soar J
- Subjects
- Anesthetists, Humans, Anesthesiology methods, Ischemic Preconditioning, Myocardial methods
- Published
- 2017
- Full Text
- View/download PDF
50. Meta-analyses of Bland-Altman-style cardiac output validation studies: good, but do they provide answers to all our questions?
- Author
-
Critchley LAH
- Subjects
- Humans, Reproducibility of Results, Anesthesiology methods, Cardiac Output, Monitoring, Intraoperative methods
- Published
- 2017
- Full Text
- View/download PDF
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