Use of a pressure sensing sheath: comparison with standard means of blood pressure monitoring in catheterization procedures

Does communication between neurosurgeons and anesthesiologists improve preoperative efficiency?

BACKGROUND

Suboptimal communication can lead to preventable preoperative delays. In our study, we aimed to identify factors delaying surgery in the immediate preoperative period. Our outcomes of interest were the anesthesia release to incision time (RIT) and preoperative expectations of neurosurgery and anesthesia providers. Additionally, we introduced new communication goals prior to induction, to examine the impact on preoperative efficiency.

METHODS

The study is a prospective cohort analysis evaluating communication in the immediate preoperative period. In 42 consecutive cranial neurosurgical cases, a questionnaire was given to neurosurgical and anesthesia providers, and their responses were recorded. Halfway through this study, a formal pre-induction checklist was implemented that included expected duration of surgery, expected blood loss, surgical positioning, and intraoperative medication requirements.

RESULTS

Comparing the cohorts before and after implementing the checklist, no difference in release to incision time was observed. However, the difference in estimated procedure time was significantly decreased after implementation of the formal pre-induction checklist. Further, there was a trend towards better agreement in estimated blood loss, although results did not achieve statistical significance. These delays all demonstrated a statistically significant decrease after the new communication goals were executed.

CONCLUSION

While no statistically significant change in release to incision time was uncovered during our study, there was evidence that communication between teams improved after implementation of the checklist. Additionally, we observed less discrepancy in estimated case length and blood loss, suggesting focused communication goals aligned expectations of the neurosurgical and anesthesia teams.

Comparison of a pressure-sensing sheath and radial arterial line for intraoperative blood pressure monitoring in neurointerventional procedures

Purpose

The efficiency of neuroendovascular procedures may partly depend on the time devoted to placement of a radial arterial line (RAL) for intraoperative blood pressure monitoring. An alternative approach is to use a pressure-sensing sheath (PSS) that serves to provide invasive blood pressure monitoring without requiring a separate procedure for placement. We compared the use of a RAL versus PSS and assessed procedure time, anesthetist and patient satisfaction, and cost.

Methods

We performed a single-center, prospective, blockwise, comparative trial of procedure start time using traditional RAL placement versus the EndoPhys PSS for invasive blood pressure monitoring. Endpoints included time from room arrival to groin puncture, patient and anesthetist satisfaction ratings, and costs associated with RAL placement.

Results

Twenty patients were enrolled in the PSS+RAL arm and 20 in the PSS-alone arm. Mean time from arrival in the room until groin puncture was 61.9±14.0 min in the RAL group and 51.2±10.8 min in the PSS-alone group (P=0.01; difference=10.7 min). Patients in the PSS-alone group reported less pain than those in the RAL group. Furthermore, anesthetists reported accurate blood pressure in the PSS group. The average cost estimate of RAL placement was US$774.70, with a range of US$743 to US$1171.

Conclusions

Placement of a RAL at the start of the neuroendovascular procedures resulted in increased delays to procedure start time and more patient-reported pain compared with the PSS, which may offer a more efficient means of blood pressure monitoring for neurointerventional procedures.

Clinical trial registration

NCT03239847.