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Your search keyword '"Agarwala, A. V."' showing total 2 results
Start Over Author "Agarwala, A. V." Topic lung diseases
2 results on '"Agarwala, A. V."'

1. Implementation of a new strategy to improve the peri-operative management of neuromuscular blockade and its effects on postoperative pulmonary complications.

Author

Rudolph MI, Chitilian HV, Ng PY, Timm FP, Agarwala AV, Doney AB, Ramachandran SK, Houle TT, and Eikermann M

Subjects
Adult, Aged, Cholinesterase Inhibitors adverse effects, Cholinesterase Inhibitors pharmacology, Dose-Response Relationship, Drug, Female, Hospital Costs statistics & numerical data, Humans, Length of Stay statistics & numerical data, Lung Diseases chemically induced, Lung Diseases epidemiology, Male, Massachusetts epidemiology, Middle Aged, Neostigmine adverse effects, Neostigmine pharmacology, Neuromuscular Blockade economics, Neuromuscular Junction drug effects, Perioperative Care methods, Postoperative Complications chemically induced, Postoperative Complications epidemiology, Prospective Studies, Quality Improvement organization & administration, Young Adult, Cholinesterase Inhibitors administration & dosage, Lung Diseases prevention & control, Neostigmine administration & dosage, Neuromuscular Blockade methods, Postoperative Complications prevention & control
Abstract

Inappropriate dosing of neostigmine for antagonism of neuromuscular blockade has been associated with postoperative pulmonary complications. We evaluated the effects of a quality improvement initiative tailored to optimise the use of neostigmine in antagonising neuromuscular blockade on postoperative pulmonary complications, costs and duration of hospital stay. The quality improvement initiative consisted of: a reduction in available neostigmine aliquot sizes; a cognitive aid; an educational component; and a financial incentive for the intra-operative documentation of train-of-four measurement before administration of neostigmine. We conducted a pre-specified analysis of data obtained in our quality improvement study. Additional analyses were conducted in a propensity-matched cohort. An interrupted time series design was used to discriminate between the intervention and a counterfactual scenario. We analysed 12,025 consecutive surgical cases performed in 2015. Postoperative pulmonary complications occurred in 220 (7.5%) of 2937 cases pre-intervention and 568 (6.3%) of 9088 cases post-intervention. Adjusted regression analyses showed significantly a lower risk of postoperative pulmonary complications (OR 0.73 (95%CI 0.61-0.88); p = 0.001), lower costs (incidence rate ratio 0.95 (95%CI 0.93-0.97); p < 0.001) and shorter duration of hospital stay (incidence rate ratio 0.91 (95%CI 0.87-0.94); p < 0.001) after implementation of the quality improvement initiative. Analyses in a propensity-matched sample (n = 2936 per group) and interrupted time series analysis (n = 27,202 cases) confirmed the findings. Our data show that a local, multifaceted quality improvement initiative can enhance the quality of intra-operative neuromuscular blocking agent utilisation, thereby reducing the incidence of postoperative pulmonary complications., (© 2018 Association of Anaesthetists.)

Published
2018
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2. International multicenter observational study on assessment of ventilatory management during general anaesthesia for robotic surgery and its effects on postoperative pulmonary complication (AVATaR): study protocol and statistical analysis plan

Author

Queiroz, Veronica Neves Fialho, Da Costa, Luiz Guilherme Villares, Barbosa, Rogerio Póvoa, Takaoka, Flávio, De Baerdemaeker, Luc, Cesar, Daniel Souza, D'Orto, Ulisses Cardoso, Galdi, José Roberto, Gottumukkala, Vijaya, Cata, Juan P, Hemmes, Sabrine N T, Hollman, Markus W, Kalmar, Alain, De Moura, Lucas A B, Mariano, Renato M, Matot, Idit, Mazzinari, Guido, Mills, Gary H, Posso, Irimar De Paula, Teruya, Alexandre, Vidal Melo, Marcos Francisco, Sprung, Juraj, Weingarten, Toby N, Treschan, Tanja A, Koopman, Seppe, Eidelman, Leonid, Chen, Lee-Lynn, Lee, Jae-Woo, Ariño Irujo, Jose J, Tena, Beatriz, Groeben, Harald, Pelosi, Paolo, De Abreu, Marcelo Gama, Schultz, Marcus J, Neto, Ary Serpa, Catala, Juan, Bravo, Mauro, De Freitas, Renato Carneir, Felipe, Chaves, Bruno, Rothman, Arantes, Schuind, Hatanaka, Dina Mie, Beltran, Joan, Monsalve, Concepción, Droger, Sijgje Mari, Deljou, Atousa, Sabov, Moldovan, Rabbu, Yosef Sale, Del Barrio De Bonis, Marina, Babian, Renate, Rabenalt, Robert, Köhne, Wiebke, Ronen, Ariel, Agarwala, Aalok V., Granell, Manuel, Anesthesiology, Intensive Care Medicine, Graduate School, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation

Subjects
Lung Diseases, Laparoscopic surgery, medicine.medical_specialty, PROSTATECTOMY, medicine.medical_treatment, Trendelenburg position, LAPAROSCOPIC SURGERY, Anesthesia, General, mechanical ventilation, general anesthesia, postoperative pulmonary complications, robotic surgery, Medicine (all), Anaesthesia, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Robotic Surgical Procedures, 030202 anesthesiology, Protocol, medicine, Medicine and Health Sciences, Humans, Multicenter Studies as Topic, Robotic surgery, General anaesthesia, 030212 general & internal medicine, Mechanical ventilation, Prostatectomy, business.industry, General surgery, General Medicine, Institutional review board, Respiration, Artificial, body regions, Observational Studies as Topic, Observational study, business
Abstract

IntroductionRobotic-assisted surgery (RAS) has emerged as an alternative minimally invasive surgical option. Despite its growing applicability, the frequent need for pneumoperitoneum and Trendelenburg position could significantly affect respiratory mechanics during RAS. AVATaR is an international multicenter observational study aiming to assess the incidence of postoperative pulmonary complications (PPC), to characterise current practices of mechanical ventilation (MV) and to evaluate a possible association between ventilatory parameters and PPC in patients undergoing RAS.Methods and analysisAVATaR is an observational study of surgical patients undergoing MV for general anaesthesia for RAS. The primary outcome is the incidence of PPC during the first five postoperative days. Secondary outcomes include practice of MV, effect of surgical positioning on MV, effect of MV on clinical outcome and intraoperative complications.Ethics and disseminationThis study was approved by the Institutional Review Board of the Hospital Israelita Albert Einstein. The study results will be published in peer-reviewed journals and disseminated at international conferences.Trial registration numberNCT02989415; Pre-results.

Published
2018

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