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Reversal of neuromuscular blockade is an important anesthesia quality measure, and anesthesiologists should strive to improve both documentation and practice of this measure. We hypothesized that the use of an electronic quality database to give individualized resident anesthesiologist feedback would increase the percentage of cases that residents successfully documented quantitative depth of neuromuscular blockade before extubation. The mean baseline success rate among anesthesiology residents was 80% (95% confidence interval [CI], 78-81) and increased by 14% (95% CI, 11-17; P < .001) after the residents were given their individualized quality data. Practice patterns improved quickly but were not sustained over 6 months.

Amniotic fluid embolism (AFE) is a rare but devastating condition with mortality rates as high as 60%-80%., We report a case of AFE complicating the labor of a parturient with no reported risk factors. She received general anesthesia for emergent cesarean delivery (CD), after which she developed a pulseless electrical activity (PEA) event requiring resuscitation, disseminated intravascular coagulation, and postpartum hemorrhage with undetectable fibrinogen activity by ROTEM FIBTEM assay. Extracorporeal membrane oxygenation (ECMO) therapy was successfully initiated, and she was discharged home without neurologic sequelae. ECMO therapy can be considered for the treatment of AFE even in the absence of fibrinogen activity.

Aim of review: Perioperative stroke is a rare, but potentially devastating complication. This review is performed to draw attention of perioperative care providers to this complication and improve their understanding on the risk factors for perioperative stroke so that better management of patients with risk factors can be achieved.Method: Literature was searched and reviewed to identify articles on risk factors of perioperative stroke and management of these risk factors. Recent findings: Stroke rates are as high as 6% after cardiac, neurosurgical, and vascular surgery, and are lower (

Perioperative lung-protective ventilation (LPV) can reduce perioperative pulmonary morbidity. We hypothesized that modifying default anesthesia machine ventilator settings would increase the use of intraoperative LPV. Default tidal volume settings on our anesthesia machines were decreased from 600 to 400 mL, and default positive end-expiratory pressure was increased from 0 to 5 cm H2O. This modification increased mean positive end-expiratory pressure from 3.1 to 5.0 cm H2O and decreased mean tidal volume from 8.2 to 6.7 mL/kg predicted body weight. Notably, increased adherence to LPV from 1.6% to 23.0% occurred quickly with the rate of increase more than doubling from 1.8% to 3.9% per year.