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Daly Guris RJ, George P, Gurnaney HG. Simulation in pediatric anesthesiology: current state and visions for the future. Curr Opin Anaesthesiol 2024; 37:266-270. [PMID: 38573191 DOI: 10.1097/aco.0000000000001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Simulation is a well established practice in medicine. This review reflects upon the role of simulation in pediatric anesthesiology in three parts: training anesthesiologists to care for pediatric patients safely and effectively; evaluating and improving systems of care for children; and visions for the future. RECENT FINDINGS Simulation continues to prove a useful modality to educate both novice and experienced clinicians in the perioperative care of infants and children. It is also a powerful tool to help analyze and improve upon how care is provided to infants and children. Advances in technology and computational power now allow for a greater than ever degree of innovation, accessibility, and focused reflection and debriefing, with an exciting outlook for promising advances in the near future. SUMMARY Simulation plays a key role in developing and achieving peak performance in the perioperative care of infants and children. Although simulation already has a great impact, its full potential is yet to be harnessed.
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Affiliation(s)
- Rodrigo J Daly Guris
- Children's Hospital of Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia
| | - Preeta George
- Division of Pediatric Anesthesiology, Department of Anesthesiology, St. Louis Children's Hospital, Washington University, Missouri, USA
| | - Harshad G Gurnaney
- Children's Hospital of Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia
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Nwokolo O. Anesthesia unveiled: navigating challenges posed by medical diseases. Curr Opin Anaesthesiol 2024; 37:277-278. [PMID: 38654545 DOI: 10.1097/aco.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Omonele Nwokolo
- Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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3
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Shilling AM. Orthopedic Anesthesia: Changes, Challenges, and Choices. Anesthesiol Clin 2024; 42:xv-xvi. [PMID: 38705683 DOI: 10.1016/j.anclin.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Ashley M Shilling
- University of Virginia Health System, Department of Anesthesiology, University of Virginia, PO Box 800710, Charlottesville, VA 22908, USA.
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Dundaru-Bandi D, Antel R, Ingelmo P. Advances in pediatric perioperative care using artificial intelligence. Curr Opin Anaesthesiol 2024; 37:251-258. [PMID: 38441085 DOI: 10.1097/aco.0000000000001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF THIS REVIEW This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. RECENT FINDINGS The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. SUMMARY The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.
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Affiliation(s)
| | - Ryan Antel
- Department of Anesthesia, McGill University
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University
- Division of Pediatric Anesthesia
- Edwards Family Interdisciplinary Center for Complex Pain. Montreal Children's Hospital
- Research Institute, McGill University Health Center
- Alan Edwards for Research on Pain. McGill University, Montreal, Quebec, Canada
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Maffucci P, Park CH, Shirur M, Hyers B, Levine AI, Katz D, Burnett GW, Laitman JT. Human dissection for anesthesiology resident training augments anatomical knowledge and clinical skills. Anat Sci Educ 2024; 17:413-421. [PMID: 38124364 DOI: 10.1002/ase.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Anatomy is an essential component of clinical anesthesiology. The use of simulated patients and alternative materials, including embalmed human bodies, have become increasingly common during resident physician training due to the deemphasis on anatomical education during undergraduate medical training. In this report, the need for a more extensive review of relevant anatomy for the practice of anesthesiology was addressed by the design, evaluation, and dissemination of a human dissection course for procedural training of anesthesiology residents. The course utilized "freedom art" embalmed human bodies that allowed trainees to perform ultrasound-based regional and neuraxial techniques followed by detailed dissections of critical anatomy. One hundred and four residents participated in workshops and small group discussions and were evaluated using pre- and post-course assessments. A variety of clinical techniques were performed on the bodies, including regional blocks and neuraxial catheter placement. Insertion of peripheral/neuraxial catheters was successful, with dissections demonstrating the expected placement. Assessment scores improved following the course (pre-course mean 52.7%, standard deviation (σ) 13.1%; post-course mean 72.2%, σ 11.6%; t-test p < 0.0001) and feedback highlighted the usefulness and clinical relevance of course content. The ability to correlate ultrasound imaging with subsequent dissections of the "blocked" area and visualization of dye staining was extremely relevant for spatial understanding of the anatomy relevant for the clinical practice of these techniques. This manuscript demonstrates successful implementation of a comprehensive course for anesthesiology resident physicians to address gaps in undergraduate anatomical education and suggests that broader adoption of dissection courses may be beneficial for training anesthesiologists.
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Affiliation(s)
- Patrick Maffucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chang H Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mo Shirur
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Hyers
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam I Levine
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey T Laitman
- Center for Anatomy and Functional Morphology, Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Chinn GA, Gray AT, Larson MD. Overcoming Obstacles: The Legacy of Fidel Pagés, Founder of the Epidural, 100 Years After His Passing. Anesth Analg 2024; 138:475-479. [PMID: 38048631 PMCID: PMC10840793 DOI: 10.1213/ane.0000000000006706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Fidel Pagés, a Spanish surgeon, tragically died in 1923 at the age of 37, just 2 years after his publication "Anestesia Metamérica," the first description of human thoracolumbar epidural anesthesia. In the intervening 100 years, epidural anesthesia has faced countless obstacles, starting with the dissemination of his initial report, which was not widely read nor appreciated at the time. However, the merits of the technique have fueled innovations to meet these challenges over the years. Even today, while epidural anesthesia is widely embraced, particularly in obstetric and chronic pain medicine, the pressures of the operating room for efficiency and a low tolerance for failure, pose modern-day challenges. Here, we revisit Pagés' original report and highlight the key innovations that have allowed for the evolution of this essential anesthesia technique.
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Affiliation(s)
- Gregory A. Chinn
- University of California, San Francisco. Department of Anesthesia and Perioperative Care
| | - Andrew T. Gray
- University of California, San Francisco. Department of Anesthesia and Perioperative Care
| | - Merlin D. Larson
- University of California, San Francisco. Department of Anesthesia and Perioperative Care
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Lima LC, Cumino DDO, Vieira AM, Silva CHRD, Neville MFL, Marques FO, Quintão VC, Carlos RV, Fujita ACG, Barros HÍM, Garcia DB, Ferreira CBT, Barros GAMD, Módolo NSP. Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in pediatric care. Braz J Anesthesiol 2024; 74:744478. [PMID: 38147975 PMCID: PMC10877349 DOI: 10.1016/j.bjane.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics.
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Affiliation(s)
- Luciana Cavalcanti Lima
- Instituto Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Faculdade Pernambucana de Saúde, Recife, PE, Brazil
| | - Débora de Oliveira Cumino
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Serviço de Anestesiologia Pediátrica/SAPE, Brazil; Hospital Municipal Menino Jesus, São Paulo, SP, Brazil
| | | | | | - Mariana Fontes Lima Neville
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil; Serviço de Anestesiologia Pediátrica/SAPE, Brazil
| | | | - Vinicius Caldeira Quintão
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil
| | - Ricardo Vieira Carlos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Ana Carla Giosa Fujita
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Serviço de Anestesiologia Pediátrica/SAPE, Brazil; Hospital Municipal Menino Jesus, São Paulo, SP, Brazil
| | - Hugo Ítalo Melo Barros
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Serviço de Anestesiologia Pediátrica/SAPE, Brazil; Hospital Municipal Menino Jesus, São Paulo, SP, Brazil
| | | | | | - Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil
| | - Norma Sueli Pinheiro Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
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Martins MP, Ortenzi AV, Perin D, Quintas GCS, Malito ML, Carvalho VH. Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in adults. Braz J Anesthesiol 2024; 74:744477. [PMID: 38135152 PMCID: PMC10877351 DOI: 10.1016/j.bjane.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.
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Affiliation(s)
| | - Antonio V Ortenzi
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brazil
| | - Daniel Perin
- Universidade de São Paulo (USP), Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil
| | - Guilherme C S Quintas
- Hospital da Restauração, Hospital Universitário Oswaldo Cruz, CET Hospital Getúlio Vargas, Recife, PE, Brazil
| | | | - Vanessa H Carvalho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Anestesiologia, Oncologia e Radiologia, Campinas, SP, Brazil
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Massimiliano S, Daniele T. From Brobdingnag to Lilliput: Gulliver's travels in airway management guidelines. Br J Anaesth 2024; 132:21-24. [PMID: 38036322 DOI: 10.1016/j.bja.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
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.
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Affiliation(s)
- Sorbello Massimiliano
- Head of Anesthesia and Intensive Care, Department of Anaesthesia "Giovanni Paolo II" Hospital, Ragusa, Italy.
| | - Trevisanuto Daniele
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
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10
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Savoldelli GL, Burlacu CL, Lazarovici M, Matos FM, Østergaard D. Integration of simulation-based education in anaesthesiology specialist training: Synthesis of results from an Utstein Meeting. Eur J Anaesthesiol 2024; 41:43-54. [PMID: 37872824 PMCID: PMC10720798 DOI: 10.1097/eja.0000000000001913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Despite its importance in education and patient safety, simulation-based education and training (SBET) is only partially or poorly implemented in many countries, including most European countries. The provision of a roadmap may contribute to the development of SBET for the training of anaesthesiologists. OBJECTIVE To develop a global agenda for the integration of simulation into anaesthesiology specialist training; identify the learning domains and objectives that are best achieved through SBET; and to provide examples of simulation modalities and evaluation methods for these learning objectives. DESIGN Utstein-style meeting where an expert consensus was reached after a series of short plenary presentations followed by small group workshops, underpinned by Kern's six-step theoretical approach to curriculum development. SETTING Utstein-style collaborative meeting. PARTICIPANTS Twenty-five participants from 22 countries, including 23 international experts in simulation and two anaesthesia trainees. RESULTS We identified the following ten domains of expertise for which SBET should be used to achieve the desired training outcomes: boot camp/initial training, airway management, regional anaesthesia, point of care ultrasound, obstetrics anaesthesia, paediatric anaesthesia, trauma, intensive care, critical events in our specialty, and professionalism and difficult conversations. For each domain, we developed a course template that defines the learning objectives, instructional strategies (including simulation modalities and simulator types), and assessment methods. Aspects related to the practical implementation, barriers and facilitators of this program were also identified and discussed. CONCLUSIONS We successfully developed a comprehensive agenda to facilitate the integration of SBET into anaesthesiology specialist training. The combination of the six-step approach with the Utstein-style process proved to be extremely valuable in supporting content validity and representativeness. These results may facilitate the implementation and use of SBET in several countries. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Georges L Savoldelli
- From the Division of Anaesthesia, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine. Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland (GLS), University College Dublin, School of Medicine, Surgery and Surgical Specialties and Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland (CLB), Institute for Emergency Medicine and Management in Medicine, Ludwig Maximilians University Hospital, Munich, Germany (ML), Anaesthesiology Department, Centro Hospitalar e Universitário de Coimbra, CHUC, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, FMUC, Coimbra, Portugal and Clinic Academic Center of Coimbra, CACC, Coimbra, Portugal (FMM), Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and Faculty of Medicine, University of Copenhagen (DO), European Society of Anaesthesiology and Intensive Care (ESAIC) Simulation Committee, https://www.esaic.org/about/committees/simulation-committee/ (GLS, CLB, FMM, DO), Society for Simulation in Europe (SESAM) Executive Committee, https://www.sesam-web.org (ML, FMM), World Federation of Societies of Anaesthesiologists (WFSA) Education Committee, https://wfsahq.org/about/people/committees/education-committee/ (DO), See attached list for the affiliations of the investigators of the Utstein Simulation Study Group (USSG)
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11
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Waters P, Rucker B, Love M, Vassar M. Lowering the statistical significance threshold of randomized controlled trials in three major general anesthesiology journals. Can J Anaesth 2023; 70:1441-1448. [PMID: 37561351 DOI: 10.1007/s12630-023-02529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE The primary objective of our study was to determine how lowering a P value threshold from 0.05 to 0.005 would affect the statistical significance of previously published randomized controlled trials (RCTs) in major anesthesiology journals. METHODS We searched the PubMed database for studies electronically published in 2020 within three major general anesthesiology journals as indexed by both Google Metrics and Scimago Journal & Country Rank. Studies included were RCTs published in 2020 in Anesthesiology, Anesthesia & Analgesia, and the British Journal of Anaesthesia; had a primary endpoint, and used a P value threshold to determine the effect of the intervention. We performed screening and data extraction in a masked duplicate fashion. RESULTS Ninety-one RCTs met inclusion criteria. The most frequently studied type of intervention was drugs (44/91, 48%). From the 91 trials, 99 primary endpoints, and thus P values, were obtained. Fifty-eight (59%) endpoints had a P value < 0.05 and 41 (41%) had a P value ≥ 0.05. Of the 58 primary endpoints previously considered statistically significant, 21 (36%) P values would maintain statistical significance at P < 0.005, and 37 (64%) would be reclassified as "suggestive." CONCLUSIONS Lowering a P value threshold of 0.05 to 0.005 would have altered one third of significance interpretations of RCTs in the surveyed anesthesiology literature. Thus, it is important for readers to consider post hoc probabilities when evaluating clinical trial results. Although the present study focused on the anesthesiology literature, we suggest that our results warrant further research within other fields of medicine to help avoid clinical misinterpretation of RCT findings and improve quality of care.
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Affiliation(s)
- Philo Waters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - Brayden Rucker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Mitchell Love
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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12
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Braithwaite HE, Payne T, Duce N, Lim J, McCulloch T, Loadsman J, Leslie K, Webster AC, Gaskell A, Sanders RD. Impact of female sex on anaesthetic awareness, depth, and emergence: a systematic review and meta-analysis. Br J Anaesth 2023; 131:510-522. [PMID: 37453840 DOI: 10.1016/j.bja.2023.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
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.
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Affiliation(s)
- Hannah E Braithwaite
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia.
| | - Thomas Payne
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas Duce
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Jessica Lim
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Tim McCulloch
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - John Loadsman
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Kate Leslie
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Angela C Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amy Gaskell
- Department of Anaesthesiology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Robert D Sanders
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Bradley CA, Ma C, Hollon MM. Perioperative Point of Care Ultrasound for Hemodynamic Assessment: A Narrative Review. Semin Cardiothorac Vasc Anesth 2023; 27:208-223. [PMID: 36943777 DOI: 10.1177/10892532231165088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
While transesophageal echocardiography (TEE) has traditionally been used in perioperative care, there is growing evidence supporting point of care ultrasound (POCUS) for the anesthesiologist in guiding patient care. It is a quick way to non-invasively evaluate hemodynamically unstable patients and ascertain their state of shock, determine volume status, and guide resuscitation in cardiac arrest. In addition, through use of POCUS, the anesthesiologist is able to identify signs of chronic heart disease to provide a more tailored and safer approach to perioperative care.
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Affiliation(s)
- Caitlin A Bradley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Chris Ma
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - McKenzie M Hollon
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
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Heinz ER, Keneally R, d'Empaire PP, Vincent A. Current status of point of care ultrasonography for the perioperative care of trauma patients. Curr Opin Anaesthesiol 2023; 36:168-175. [PMID: 36550092 DOI: 10.1097/aco.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The incorporation of point of care ultrasound into the field of anesthesiology and perioperative medicine is growing at rapid pace. The benefits of this modality align with the acuity of patient care and decision-making in anesthetic care of a trauma patient. RECENT FINDINGS Cardiac ultrasound can be used to diagnose cardiac tamponade or investigate the inferior vena cava to assess volume status in patients who may suffer from hemorrhagic shock. Thoracic ultrasound may be used to rapidly identify pneumothorax or hemothorax in a patient suffering chest wall trauma. In addition, investigators are exploring the utility of ultrasonography in traumatic airway management and elevated intracranial pressure. In addition, the utility of gastric ultrasound on trauma patients is briefly discussed. SUMMARY Incorporation of point of care ultrasound techniques into the practice of trauma anesthesiology is important for noninvasive, mobile and expeditious assessment of trauma patients. In addition, further large-scale studies are needed to investigate how point of care ultrasound impacts outcomes in trauma patients.
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Affiliation(s)
- Eric R Heinz
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
| | - Ryan Keneally
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
| | - Pablo Perez d'Empaire
- Department of Anesthesiology and Pain Medicine, Department of Anesthesia, Sunnybrook Health Sciences Centre University of Toronto, Toronto, Canada
| | - Anita Vincent
- Department of Anesthesiology and Critical Care Medicine. George Washington University, Washington, District of Columbia, USA
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Giraldo-Gutiérrez DS, Ruíz-Villa JO, Rincón-Valenzuela DA, Feliciano-Alfonso JE. Multivariable prediction models for difficult direct laryngoscopy: Systematic review and literature metasynthesis. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:88-101. [PMID: 35210196 DOI: 10.1016/j.redare.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/09/2020] [Indexed: 06/14/2023]
Abstract
CONTEXT The difficult airway is an important scenario in anaesthesia due to the impact of its potential complications, and the difficulty in predicting its presence in current clinical practice. METHODS Systematic review of articles in English and Spanish retrieved from MEDLINE (Ovid), LILACS and EMBASE up to March 2018. The search strategy was defined by the authors. The reviewers uploaded the studies to specially designed tables in order to qualitatively analyse the results of each paper. RESULTS A total of 3602 studies were identified. Thirty-four of these were included in the qualitative review. The most commonly used definition of difficulty was the Cormack-Lehane 3 or 4 classification, with a weighted mean incidence of 7.23%. The most relevant finding was the methodological weaknesses in obtaining these scales. CONCLUSIONS Available prediction models show limited discrimination, and weaknesses were detected in the methodology used to develop these prediction rules.
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Affiliation(s)
- D S Giraldo-Gutiérrez
- Especialista en Anestesiología y Reanimación, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - J O Ruíz-Villa
- Especialista en Anestesiología y Reanimación, Universidad Nacional de Colombia, Bogotá, Colombia
| | - D A Rincón-Valenzuela
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Departamento de Salas de Cirugía, Clínica Universitaria Colombia (Clínica Colsanitas, Keralty), Bogotá, Colombia
| | - J E Feliciano-Alfonso
- Departamento de Medicina Interna, Universidad Nacional de Colombia, Bogotá, Colombia
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Bouwhuis A, van den Brom CE, Loer SA, Bulte CSE. Frailty as a growing challenge for anesthesiologists - results of a Dutch national survey. BMC Anesthesiol 2021; 21:307. [PMID: 34872523 PMCID: PMC8647406 DOI: 10.1186/s12871-021-01528-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Frailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery. Anesthesiologists can reduce adverse outcomes when risk factors are recognized early and dedicated care pathways are operational. As the frail elderly population is growing, we investigated the perspective on the aging population, familiarity with the frailty syndrome and current organization of perioperative care for elderly patients among Dutch anesthesiologists. METHODS A fifteen-item survey was distributed among anesthesiologists and residents during the annual meeting of the Dutch Society of Anesthesiology. The first section included questions on self-reported competence on identification of frailty, acquaintance with local protocols and attitude towards the increasing amounts of elderly patients presenting for surgery. The second part included questions on demographic features of the participant such as job position, experience and type of hospital. Answers are presented as percentages, using the total number of replies for the question per group as a denominator. RESULTS A sample of 132 surveys was obtained. The increasing number of elderly patients was primarily perceived as challenging by 76% of respondents. Ninety-nine percent agreed that frailty should influence anesthetic management, while 85% of respondents claimed to feel competent to recognize frailty. Thirty-four percent of respondents reported the use of a dedicated pathway in the preoperative approach of frail elderly patients. However, only 30% of respondents reported to know where to find the frailty screening in the patient file and appointed that frailty is not consistently documented. Interestingly, only 43% of respondents reported adequate collaboration with geriatricians. This could include for example a standardized preoperative multidisciplinary approach or dedicated pathway for the elderly patient. CONCLUSIONS This survey demonstrated that the increasing number of frail elderly patients is perceived as important and relevant for anesthetic management. Opportunities lie in improving the organization and effectuation of perioperative care by more consistent involvement of anesthesiologists.
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Affiliation(s)
- A Bouwhuis
- Departments of Anesthesiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
- Departments of Intensive Care, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - C E van den Brom
- Departments of Anesthesiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - S A Loer
- Departments of Anesthesiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - C S E Bulte
- Departments of Anesthesiology Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
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17
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Affiliation(s)
- Andrea Girnius
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH
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18
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Lalonde S, Truchetti G, Otis C, Beauchamp G, Troncy E. Management of veterinary anaesthesia and analgesia in small animals: A survey of English-speaking practitioners in Canada. PLoS One 2021; 16:e0257448. [PMID: 34582482 PMCID: PMC8478190 DOI: 10.1371/journal.pone.0257448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe how small animal anaesthesia and analgesia is performed in English-speaking Canada, document any variation among practices especially in relation to practice type and veterinarian's experience and compare results to published guidelines. DESIGN Observational study, electronic survey. SAMPLE 126 respondents. PROCEDURE A questionnaire was designed to assess current small animal anaesthesia and analgesia practices in English-speaking Canadian provinces, mainly in Ontario, Alberta and British Columbia. The questionnaire was available through SurveyMonkey® and included four parts: demographic information about the veterinarians surveyed, evaluation and management of anaesthetic risk, anaesthesia procedure, monitoring and safety. Year of graduation and type of practice were evaluated as potential risk factors. Exact chi-square tests were used to study the association between risk factors and the association between risk factors and survey responses. For ordinal data, the Mantel-Haenszel test was used instead. RESULTS Response rate over a period of 3 months was 12.4% (126 respondents out of 1 016 invitations). Current anaesthesia and analgesia management failed to meet international guidelines for a sizable number of participants, notably regarding patient evaluation and preparation, safety and monitoring. Nearly one third of the participants still consider analgesia as optional for routine surgeries. Referral centres tend to follow guidelines more accurately and are better equipped than general practices. CONCLUSIONS AND CLINICAL RELEVANCE A proportion of surveyed Canadian English-speaking general practitioners do not follow current small animal anaesthesia and analgesia guidelines, but practitioners working in referral centres are closer to meet these recommendations.
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Affiliation(s)
| | - Geoffrey Truchetti
- Centre Vétérinaire Rive-Sud, Brossard, Québec, Canada
- Centre Vétérinaire Laval, Laval, Québec, Canada
| | - Colombe Otis
- Faculty of Veterinary Medicine, Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Guy Beauchamp
- Faculty of Veterinary Medicine, Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Eric Troncy
- Faculty of Veterinary Medicine, Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ), Université de Montréal, Saint-Hyacinthe, Québec, Canada
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Hollmann MW, de Korte-de Boer D, Boer C, Buhre WFFA. The Routine posTsuRgical Anesthesia visit to improve patient outComE (TRACE) study: lessons learned. Br J Anaesth 2021; 127:e140-e142. [PMID: 34426010 DOI: 10.1016/j.bja.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/22/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dianne de Korte-de Boer
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Christa Boer
- Department of Anesthesiology, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands.
| | - Wolfgang F F A Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Yánez Benítez C, Ribeiro MAF, Alexandrino H, Koleda P, Baptista SF, Azfar M, Di Saverio S, Ponchietti L, Güemes A, Blas JL, Mesquita C. International cooperation group of emergency surgery during the COVID-19 pandemic. Eur J Trauma Emerg Surg 2021; 47:621-629. [PMID: 33047158 PMCID: PMC7550249 DOI: 10.1007/s00068-020-01521-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/26/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams' adoption of recommendations during the pandemic. METHODS Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. RESULTS One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. CONCLUSION Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.
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Affiliation(s)
- Carlos Yánez Benítez
- General and GI Surgery Department, Royo Villanova Hospital, SALUD, Av. de San Gregorio s/n. 50015, Zaragoza, Spain
| | - Marcelo A. F. Ribeiro
- Department of General Surgery and Trauma Surgery, Catholic University of São Paulo PUC-Sorocaba and Hospital Moriah, Avenida Victor Civita, Sao Paulo, 235 Brazil
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045 Coimbra, Portugal
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Mohammad Azfar
- Department of General Surgery, Al Rahba Hospital, Abu Dhabi, UAE
| | - Salomone Di Saverio
- Department of General Surgery, Varese University Hospital, ASST Sette Laghi, University of Insubria, Regione Lombardia, Varese, Italy
| | - Luca Ponchietti
- Department of General Surgery, San Jorge University Hospital, Av. Martínez de Velasco, 36, 22004 Huesca, Spain
| | - Antonio Güemes
- Department of General Surgery, Lozano Blesa University Hospital, Av. San Juan Bosco, 15, 50009 Zaragoza, Spain
| | - Juan L. Blas
- General and GI Surgery Department, Royo Villanova Hospital, SALUD, Av. de San Gregorio s/n. 50015, Zaragoza, Spain
| | - Carlos Mesquita
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045 Coimbra, Portugal
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21
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Romare C, Enlöf P, Anderberg P, Jildenstål P, Sanmartin Berglund J, Skär L. Nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care: A qualitative study. PLoS One 2021; 16:e0250122. [PMID: 33882100 PMCID: PMC8059852 DOI: 10.1371/journal.pone.0250122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To describe nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care. METHODS Data was collected through individual semi-structured interviews with seven nurse anesthetists who had used smart glasses, with a customized application for monitoring vital signs, during clinical anesthesia care. Data was analyzed using thematic content analysis. RESULTS An overarching theme became evident during analysis; Facing and embracing responsibility. Being a nurse anesthetist entails a great responsibility, and the participants demonstrated that they shouldered this responsibility with pride. The theme was divided in two sub-themes. The first of these, A new way of working, comprised the categories Adoption and Utility. This involved incorporating smart glasses into existing routines in order to provide safe anesthesia care. The second sub-theme, Encountering side effects, consisted of the categories Obstacles and Personal affect. This sub-theme concerned the possibility to use smart glasses as intended, as well as the affect on nurse anesthetists as users. CONCLUSION Smart glasses improved access to vital signs and enabled continuous monitoring regardless of location. Continued development and improvement, both in terms of the application software and the hardware, are necessary for smart glasses to meet nurse anesthetists' needs in clinical practice.
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Affiliation(s)
- Charlotte Romare
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Intensive Care Unit, Department of Anesthesiology, Region Blekinge, Karlskrona, Sweden
| | - Per Enlöf
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska academy, Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Department of Health Sciences, University of Skövde, Skövde, Sweden
| | - Pether Jildenstål
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska academy, Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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22
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Kiefer JJ, Rock P, Augoustides JG, Mazzeffi MA. Critical Care During the Coronavirus Crisis-Reflections on the Roles of Anesthesiologists in Meeting the Challenges of the Pandemic. J Cardiothorac Vasc Anesth 2020; 34:3186-3188. [PMID: 32507459 PMCID: PMC7205704 DOI: 10.1053/j.jvca.2020.04.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jessie J Kiefer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Peter Rock
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Mazzeffi
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD
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Abstract
IMPORTANCE Many patients are admitted to the intensive care unit following surgery, and some of them will experience incomplete recovery. For patients in this situation, preoperative discussions regarding patient values and preferences may direct care decisions. Existing literature shows that it is uncommon for surgeons to have these conversations preoperatively; it is unclear whether anesthesia professionals engage with patients on this topic prior to surgery. OBJECTIVE To review the literature on communication between patients and anesthesia professionals, with a focus on discussions related to postoperative critical care. EVIDENCE REVIEW MEDLINE and Web of Science were searched using specific search criteria from January 1980 to April 2020. Studies describing encounters between patients and anesthesia professionals were selected, and data regarding study objectives, study design, methodology, measures, outcomes, patient characteristics, and clinical setting were extracted and collated. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. FINDINGS A total of 12 studies including 1284 individual patient encounters were eligible for inclusion in the review. These studies demonstrated that communication between patients and anesthesia professionals related to postoperative care is rare: only 2 studies reported communication regarding adverse postoperative events, and this communication behavior was reported in only 46 of 1284 consultations (3.6%) across all studies. Additional findings were that communication during these encounters is dominated by anesthetic planning and perioperative logistics, with variable discussion of perioperative risks vs benefits and infrequent elicitation of patient values and preferences. Some data suggest that patients wish to be involved in perioperative decision-making but are often limited by an incomplete understanding of risks and benefits. CONCLUSIONS AND RELEVANCE This systematic review found that communication in anesthesia is dominated by anesthetic planning and discussion of preoperative logistics, whereas postoperative critical care is rarely discussed. Most patients who are admitted to an intensive care unit after a major operation will not have had a discussion regarding goals of care specific to protracted recovery or prolonged intensive care with their anesthesiologist.
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Affiliation(s)
- Michael J. Tylee
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Gordon D. Rubenfeld
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Duminda Wijeysundera
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael C. Sklar
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sajid Hussain
- Department of Intensive Care Medicine, King AbdulAziz Medical City, Riyadh, Saudi Arabia
| | - Neill K. J. Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
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Xie M, Huang JX, Chen PP, Wei XC, Li XK, Zhang P, Yang LN, Zhou Q. SARS-CoV-2 infection control measures for the anesthesiology department: experience from the Sichuan Provincial People's Hospital, China. J Clin Anesth 2020; 64:109846. [PMID: 32353808 PMCID: PMC7174192 DOI: 10.1016/j.jclinane.2020.109846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/15/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Min Xie
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
| | - Jian Xin Huang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
| | - Pan Pan Chen
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Xin Chuan Wei
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
| | - Xiang Kui Li
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
| | - Ping Zhang
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
| | - Li Na Yang
- Center of Anesthesia and Operation, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
| | - Qin Zhou
- Department of Anesthesiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People' Hospital, Chengdu 610072, China
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25
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Rekatsina M, Paladini A, Moka E, Yeam CT, Urits I, Viswanath O, Kaye AD, Morgan JA, Varrassi G. Healthcare at the time of COVID-19: A review of the current situation with emphasis on anesthesia providers. Best Pract Res Clin Anaesthesiol 2020; 34:539-551. [PMID: 33004165 PMCID: PMC7366073 DOI: 10.1016/j.bpa.2020.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 12/14/2022]
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.
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Affiliation(s)
| | | | - Eleni Moka
- Creta Interclinic Hospital, Heraklion, Creta, Greece
| | - Cheng Teng Yeam
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Ivan Urits
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Omar Viswanath
- LSUHSC School of Medicine, Department of Anesthesiology, Shreveport, LA, USA; Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA; Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA; Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Alan D Kaye
- LSUHSC School of Medicine, Department of Anesthesiology, Shreveport, LA, USA
| | - John A Morgan
- LSUHSC School of Medicine, Department of Obstetrics and Gynecology, Shreveport, LA, USA
| | - Giustino Varrassi
- Paolo Procacci Foundation, Via Tacito 7, Roma, Italy; World Institute of Pain, USA.
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Augoustides JG. Critical Care During the Coronavirus Crisis: Challenges and Considerations for the Cardiothoracic and Vascular Anesthesia Community. J Cardiothorac Vasc Anesth 2020; 34:2299-2302. [PMID: 32387015 PMCID: PMC7165080 DOI: 10.1053/j.jvca.2020.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 01/02/2023]
Affiliation(s)
- John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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27
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Aoyama K, Pinto R, Ray JG, Hill A, Scales DC, Fowler RA. Determining Associations and Estimating Effects with Regression Models in Clinical Anesthesia. Anesthesiology 2020; 133:500-509. [PMID: 32788557 DOI: 10.1097/aln.0000000000003425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are an increasing number of "big data" studies in anesthesia that seek to answer clinical questions by observing the care and outcomes of many patients across a variety of care settings. This Readers' Toolbox will explain how to estimate the influence of patient factors on clinical outcome, addressing bias and confounding. One approach to limit the influence of confounding is to perform a clinical trial. When such a trial is infeasible, observational studies using robust regression techniques may be able to advance knowledge. Logistic regression is used when the outcome is binary (e.g., intracranial hemorrhage: yes or no), by modeling the natural log for the odds of an outcome. Because outcomes are influenced by many factors, we commonly use multivariable logistic regression to estimate the unique influence of each factor. From this tutorial, one should acquire a clearer understanding of how to perform and assess multivariable logistic regression.
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Affiliation(s)
- Kazuyoshi Aoyama
- From the Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada (K.A.) the Program in Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada (K.A.) the Department of Critical Care Medicine (R.P., A.H., D.C.S., R.A.F.) the Sunnybrook Research Institute (K.A., R.P., A.H., D.C.S., R.A.F.), Sunnybrook Health Science Center, Toronto, Ontario, Canada the Keenan Research Centre of the Li Ka Shing Knowledge Institute (J.G.R.) the Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada (J.G.R.) the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (K.A., J.G.R., D.C.S., R.A.F.)
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Viswanath O, Kaye AD. Navigating the complexities of treating COVID-19 during the pandemic and a multimodal approach to chronic pain. Best Pract Res Clin Anaesthesiol 2020; 34:353-354. [PMID: 33004152 PMCID: PMC7415221 DOI: 10.1016/j.bpa.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Omar Viswanath
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA.
| | - Alan D Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
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van Klei WA, Hollmann MW, Sneyd JR. The value of anaesthesiologists in the COVID-19 pandemic: a model for our future practice? Br J Anaesth 2020; 125:652-655. [PMID: 32896431 PMCID: PMC7440078 DOI: 10.1016/j.bja.2020.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Markus W Hollmann
- Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Robert Sneyd
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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Abstract
Children and adults with congenital heart disease undergoing noncardiac surgery are at higher risk of perioperative adverse events. Patients have significant comorbidities and syndromic associations that increase perioperative risk further. The complexity of congenital heart disease requires a thorough understanding of lesion-specific pathophysiology in order to provide safe care. Comprehensive multidisciplinary planning and the use of skilled and experienced teams achieve the best outcomes. The anesthesiologist is a perioperative physician charged with providing safe anesthesia care, instituting appropriate hemodynamic monitoring, and determining appropriate postoperative disposition on an individual basis.
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Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Houston, TX 77030, USA.
| | - Aruna T Nathan
- Department of Anesthesia, Stanford University Medical Center, 300 Pasteur Drive, Room H3580, MC 5640, Stanford, CA 94304, USA
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31
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Friedrich J, Itano EM, Lynn RR. Management of Cardiac Implantable Electrical Devices in Patients Undergoing Radiofrequency Ablation for Spine Pain: Physician Survey and Review of Guidelines. Pain Physician 2020; 23:E335-E342. [PMID: 32709179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN Web-based provider survey and narrative review. SETTING Multispecialty pain clinic, academic medical center. METHODS A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.
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Affiliation(s)
- Jason Friedrich
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Elise M Itano
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO
| | - Rachael Rzasa Lynn
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO
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Matava CT, Kovatsis PG, Summers JL, Castro P, Denning S, Yu J, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg 2020; 131:61-73. [PMID: 32287142 PMCID: PMC7173403 DOI: 10.1213/ane.0000000000004872] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.
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Affiliation(s)
- Clyde T. Matava
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pete G. Kovatsis
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Jennifer Lee Summers
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Pilar Castro
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
| | - Simon Denning
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Yu
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Stefano Sabato
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
| | - Lisa K. Lee
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Ihab Ayad
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Sam Mireles
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - David Lardner
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Simon Whyte
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judit Szolnoki
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | | | - Nicole Thompson
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
| | - Mary Lyn Stein
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Dalesio
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John McCloskey
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James Peyton
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology, Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Faye Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Bishr Haydar
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Paul Reynolds
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Franklin Chiao
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Brad Taicher
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Thomas Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
| | - Vidya T. Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
| | | | - Jorge Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan Tan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed Rehman
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christy Crockett
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patrick Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
| | - Peter Szmuk
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Chris Glover
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Maria Matuszczak
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
| | - Ignacio Galvez
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - David Polaner
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Cheryl Gooden
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Grace Hsu
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harshad Gumaney
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Edgar E. Kiss
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
| | - Mary C. Theroux
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lau
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Saeedah Asaf
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
| | - Pablo Ingelmo
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Engelhardt
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Mónica Hervías
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - Eric Greenwood
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luv Javia
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicola Disma
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Myron Yaster
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - John E. Fiadjoe
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
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Kamath D, McIntyre S, Byerly S, Agarwal N, Kamath P, Peskin E, Gupta R, Roy S, Schwartz R, Kaye AD, Viswanath O, Urits I, Horn DB. Descriptive Analysis of Federal and State Interventional Pain Malpractice Litigation in the United States: A Pilot Investigation. Pain Physician 2020; 23:413-422. [PMID: 32709176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The aim of this study was to examine and appreciate characteristics of malpractice lawsuits brought against interventional pain specialists. OBJECTIVES To examine and appreciate characteristics of malpractice lawsuits brought against interventional pain specialists. STUDY DESIGN Retrospective review. SETTING Jury verdicts and settlement reports of state and federal malpractice cases involving interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from the Westlaw online legal database. METHODS Jury verdicts and settlement reports of state and federal malpractice cases involving interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from the Westlaw online legal database. Data collected for each case included year, state, patient age, patient gender, defendant specialty, legal outcome, award amount, alleged cause of malpractice, and factors in plaintiff's decision to file. After elimination of duplicates and applying inclusion/exclusion criteria to our initial search yielding over 1,500 cases, a total of 82 cases were included in this study. RESULTS A total of 57.3% of cases resulted in a jury verdict in favor of the defendant, whereas 41.5% favored the plaintiff. When comparing cases that were performed in the operating room to cases performed outside the operating room, we found the jury verdicts to favor the plaintiff 83.3% of the time for operating room procedures (P = 0.003). In other words, interventional pain practitioners were more likely to be found at fault for complications from procedures performed in the operating room. To eliminate confounders, a logistical regression was performed and confirmed operating room procedures were an independent predictor of a verdict awarded to the plaintiff (P = 0.008). The median amount awarded to the plaintiff for all cases was $333,000, and the single highest award amount was $36,636,288. The median payout for operating room procedures was $450,000 (P = 0.010), which was significantly different from the median payout for nonoperating room procedures. Procedure categorization demonstrated a statistically significant difference in jury verdicts (P = 0.01411) and procedural error was the leading reason for pursuing litigation, followed by lack of informed consent and unnecessary procedure performed. LIMITATIONS There is more than one database that captures medicolegal claims brought against practitioners. Westlaw, which has been previously utilized by other studies, is only one of them and the extent to which overlap exists in unclear. For each, data input are not necessarily consistent and data capture are not complete. As a result, there could exist a skew toward more severe complications and the details of individual cases likely vary. During data extraction, we found that all details of the procedure were not always included. For example, not all cases specified the type of injectate utilized for epidural injection (i.e., local anesthetic, steroid, mixture, and others) or route of injection (i.e., transforaminal vs. interlaminar). Moreover, as previously mentioned, cases that are settled out of court or finalized prior to trial are not necessarily reported by the Westlaw database, and therefore were not always included in our data search. CONCLUSIONS Overall, interventional pain medicine physicians were favored by jury verdicts for malpractice claims. However, when filtering by procedure or setting, jury verdicts favored the plaintiff in some cases. KEY WORDS Interventional pain, medical, malpractice, anesthesiology.
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Affiliation(s)
| | | | | | - Nitin Agarwal
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Raghav Gupta
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Souvik Roy
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL
| | | | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ; Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Sharma D, Rasmussen M, Han R, Whalin MK, Davis M, Kofke WA, Venkatraghvan L, Raychev R, Fraser JF. Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC): Endorsed by Society of Vascular & Interventional Neurology (SVIN), Society of NeuroInterventional Surgery (SNIS), Neurocritical Care Society (NCS), European Society of Minimally Invasive Neurological Therapy (ESMINT) and American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) Cerebrovascular Section. J Neurosurg Anesthesiol 2020; 32:193-201. [PMID: 32282614 PMCID: PMC7236841 DOI: 10.1097/ana.0000000000000688] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.
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Affiliation(s)
- Deepak Sharma
- Departments of Anesthesiology & Pain Medicine
- Neurological Surgery, University of Washington, Seattle, WA
| | - Mads Rasmussen
- Department of Anesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Matthew K. Whalin
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Melinda Davis
- Department of Anesthesiology, Pain and Perioperative Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - W. Andrew Kofke
- Departments of Anesthesiology and Critical Care
- Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | | | - Radoslav Raychev
- Department of Neurology, University of California Los Angeles, Los Angeles, CA
| | - Justin F. Fraser
- Departments of Neurological Surgery
- Neurology
- Radiology
- Anatomy & Neurobiology, University of Kentucky, Lexington, KY
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Abstract
It is necessary to discuss the sometimes competing goals of sufficient critical care capacity, maintenance of regular patient care, protection of medical staff, interruption of infectious chains within the general public and individual aspects of patient care in anesthesia and the operating room in times of the SARS CoV-2 pandemic, given the uncertainty of many data on which decisions need to be based. Basic hygiene remains the cornerstone of infection prevention especially when resources are sparse and SARS-CoV-2 specific additional measures need to be taken according to a risk analysis taking the dynamic of the pandemic as well as local factors into account.
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Affiliation(s)
- Sebastian Schulz-Stübner
- Korrespondenzadresse PD Dr. med. Sebastian Schulz-Stübner BZH GmbH – Deutsches Beratungszentrum für HygieneSchnewlinstraße 479098 Freiburg im BreisgauDeutschland
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Thampi S, Yap A, Fan L, Ong J. Special considerations for the management of COVID-19 pediatric patients in the operating room and pediatric intensive care unit in a tertiary hospital in Singapore. Paediatr Anaesth 2020; 30:642-646. [PMID: 32267047 PMCID: PMC7262206 DOI: 10.1111/pan.13863] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022]
Abstract
COVID-19 was first identified in Wuhan, China and is caused by the novel coronavirus SARS-CoV 2. It has now spread rapidly to over 190 countries and territories around the world and has been declared a global pandemic by the World Health Organization. The virus is spread through droplet transmission and currently has a mortality rate of over 4% globally. The pediatric population has been found to be less susceptible to the disease with the majority of children having milder symptoms and only one pediatric death being reported globally so far. Despite this, strategies need to be put in place to prevent further spread of the virus. We present a summary of the general measures implemented at a large adult and pediatric tertiary hospital in Singapore (National University Hospital) as well as the specific strategies in place for the operating room and pediatric intensive care unit.
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Affiliation(s)
- Swapna Thampi
- Department of AnesthesiaNational University HospitalSingaporeSingapore
- Department of AnesthesiaYong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
| | - Andrea Yap
- Department of AnesthesiaNational University HospitalSingaporeSingapore
- Department of AnesthesiaYong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
| | - Lijia Fan
- Khoo Teck Puat‐ National University Children’s Medical InstituteNational University HospitalSingaporeSingapore
- Department of PediatricsYong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
| | - Jacqueline Ong
- Khoo Teck Puat‐ National University Children’s Medical InstituteNational University HospitalSingaporeSingapore
- Department of PediatricsYong Loo Lin School of MedicineNational University SingaporeSingaporeSingapore
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He H, Zhao S, Han L, Wang Q, Xia H, Huang X, Yao S, Huang J, Chen X. Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome COVID-19 Infection. J Cardiothorac Vasc Anesth 2020; 34:1402-1405. [PMID: 32220557 PMCID: PMC7102517 DOI: 10.1053/j.jvca.2020.03.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 01/02/2023]
Abstract
Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors' team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.
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Affiliation(s)
- Hao He
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Linlin Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qi Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Haifa Xia
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, KY
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Lipton G, Stewart M, McDermid R, Docking R, Urquhart C, Morrison M, Montgomery J. Multispecialty tracheostomy experience. Ann R Coll Surg Engl 2020; 102:343-347. [PMID: 32233651 PMCID: PMC7374792 DOI: 10.1308/rcsann.2019.0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tracheostomy is a common surgical procedure used to create a secure airway in patients, now performed by a variety of specialties, with a notable rise in critical care environments. It is unclear whether this rise is seen in units with large head and neck surgery departments, and how practice in such units compares with the rest of the UK. METHODS A three-year retrospective audit was carried out between anaesthetic, surgical and critical care departments. All tracheostomy procedures were recorded anonymously. RESULTS A total of 523 tracheostomies were performed, 66% of which were in men. The mean patient age was 60 years. The majority (83%) were elective, performed for various indications, while the remaining 17% were emergency tracheostomies performed for pending airway obstruction. A fifth of the tracheostomies were percutaneous procedures. Most emergency tracheostomies (78%) were performed by otolaryngology. Three cricothyroidotomies were performed within critical care and theatres. Complications related to tracheostomy occurred in 47 cases (9%), most commonly lower respiratory tract infection. The mean time to decannulation was 12.8 days. CONCLUSIONS This paper discusses the findings of a comprehensive, multispecialty audit of tracheostomy experience in a large health board, with over 150 tracheostomies performed annually. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies. Around a quarter of those requiring tracheostomy ultimately died, mostly as a result of advanced cancer.
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Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth 2020; 67:885-892. [PMID: 32212103 PMCID: PMC7095295 DOI: 10.1007/s12630-020-01637-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on 11 March 2020 because of its rapid worldwide spread. In the operating room, as part of hospital outbreak response measures, anesthesiologists are required to have heightened precautions and tailor anesthetic practices to individual patients. In particular, by minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission. This article explores the practical considerations and recommended measures for performing regional anesthesia in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, equipment protection, and infection prevention. By doing so, we hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, with particular relevance to this new era of emerging infectious diseases and novel pathogens. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the first, and certainly will not be the last novel virus that will lead to worldwide outbreaks. Having a well thought out regional anesthesia plan to manage these patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.
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Affiliation(s)
- Sui An Lie
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Sook Wai Wong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Loong Tat Wong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Theodore Gar Ling Wong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Shin Yuet Chong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Neville MFL, Vanzillotta PP, Quintão VC. [The paradox of COVID-19 and pediatric anesthesiology: opinion of the Pediatric Anesthesia Committee of the Brazilian Society of Anesthesiology]. Rev Bras Anestesiol 2020; 70:187-188. [PMID: 32405100 PMCID: PMC7219370 DOI: 10.1016/j.bjan.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mariana Fontes Lima Neville
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brasil; Comitê de Anestesia em Pediatria, Sociedade Brasileira de Anestesiologia, São Paulo, SP, Brasil
| | - Pedro Paulo Vanzillotta
- Comitê de Anestesia em Pediatria, Sociedade Brasileira de Anestesiologia, São Paulo, SP, Brasil; Hospital Municipal Jesus, Rio de Janeiro, RJ, Brasil
| | - Vinícius Caldeira Quintão
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, São Paulo, SP, Brasil; Comitê de Anestesia em Pediatria, Sociedade Brasileira de Anestesiologia, São Paulo, SP, Brasil; Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brasil.
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Hendrickx JFA, Van Zundert T, De Wolf AM. End of year summary 2019: anaesthesia and airway management. J Clin Monit Comput 2020; 34:1-5. [PMID: 31898149 DOI: 10.1007/s10877-019-00453-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
This end of the year summary reviews anesthesia related manuscripts that have been published in the Journal of Clinical Monitoring and Computing in 2019. Anesthesia is currently defined as being composed of unconsciousness, immobility, and autonomic nervous system (ANS) control (Br J Anaesth;122:e127-e135135, Egan 2019). Pain is a postoperative issue, because by definition unconsciousness implies pain cannot be experienced. We first review work related to these aspect of the profession: unconsciousness (EEG, target control), immobility (muscle relaxants), and ANS control. Regaining consciousness has to be accompanied by pain control, and it is important to ensure that the patient regains baseline cognitive function. Anesthesia machine equipment, drug administration, and airway related topics make up the rest of published manuscripts.
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Affiliation(s)
| | - Tom Van Zundert
- Department of Anesthesiology/CCM, OLV Hospital, Aalst, Belgium
| | - Andre M De Wolf
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Abstract
BACKGROUND The novice anaesthesiology trainee must rapidly assimilate the cognitive, technical and non-technical skills necessary to competently respond to critical events in their new role. Providing trainees with the safe and controlled environment of high-fidelity patient simulation is one method to compensate for gaps in trainee experience, offering the potential for effective training. An anaesthesiology boot camp was set up to increase the knowledge, clinical, technical and non-technical competencies of the novice trainee, creating a framework for their future learning and practice. Anaesthetic nurses also attended to incorporated teamwork and collaboration into the boot camp. METHODS Seven novice anaesthesiology trainees and 3 anaesthetic nurses attended 3 4-h boot camp sessions. The boot camp consisted of the following: (1) interactive didactic lectures; (2) task-trainer technical skills teaching; and, (3) high-fidelity simulations. Pre- and post-course evaluation forms including a multiple-choice-questions (MCQ) assessing knowledge were completed. RESULTS Nine participants fully completed the boot camp. There was a significant increase in post-MCQ score (p = 0.001). Feedback from participants included "well organised", "helpful" and "structured approach" with all participants agreeing or strongly agreeing that it was relevant training for their practice. DISCUSSION We have created the first Irish anaesthesiology boot camp, demonstrating the important role that simulation has in enhancing medical education. Our results showed both knowledge attainment and participant satisfaction in this method of learning. Anaesthesiology boot camps are the ideal method to provide novice trainees with a framework for their initial introduction into anaesthesia.
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Affiliation(s)
- Caoimhe C Duffy
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland.
- College of Anaesthesiologists Simulation Training Programme (CAST), College of Anaesthesiology of Ireland, Merrion Square North, Dublin 2, Ireland.
| | - Zeenat Nawoor-Quinn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
- College of Anaesthesiologists Simulation Training Programme (CAST), College of Anaesthesiology of Ireland, Merrion Square North, Dublin 2, Ireland
| | - Crina L Burlacu
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
- College of Anaesthesiologists Simulation Training Programme (CAST), College of Anaesthesiology of Ireland, Merrion Square North, Dublin 2, Ireland
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Cladis FP, Lockman JL, Lupa MC, Chatterjee D, Lim D, Hernandez M, Yanofsky S, Waldrop WB. Pediatric Anesthesiology Fellowship Positions: Is There a Mismatch? Anesth Analg 2019; 129:1784-1786. [PMID: 31743202 DOI: 10.1213/ane.0000000000004431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Franklyn P Cladis
- From the Department of Anesthesiology and Perioperative Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Concetta Lupa
- Department of Anesthesiology, University of North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado/University of Colorado, Aurora, Colorado
| | - Doyle Lim
- Department of Anesthesiology, Thomas Jefferson University, Nemours AI Dupont Children's Hospital, Wilmington, Delaware
| | - Michael Hernandez
- Department of Anesthesiology, Critical Care and Pain Medicine, The Children's Hospital Boston, Boston, Massachusetts
| | - Samuel Yanofsky
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California
| | - William B Waldrop
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Fisler N, Sweitzer BJ, Wurz J, Kleiman AM, Stueber F, Luedi MM. Achieving Gender Parity in Acute Care Medicine Requires a Multidimensional Perspective and a Committed Plan of Action. Anesth Analg 2019; 129:1778-1783. [PMID: 31743201 DOI: 10.1213/ane.0000000000004451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nadja Fisler
- From the Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jeannie Wurz
- From the Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Amanda M Kleiman
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Frank Stueber
- From the Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- From the Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Clinical practice parameters have been published with greater frequency by professional societies and groups of experts. These publications run the gamut of practice standards, practice guidelines, consensus statements or practice advisories, position statements, and practice alerts. The definitions of these terms have been clarified in an accompanying article. In this article, we present the criteria for high-quality clinical practice parameters and outline a process for developing them, specifically the Delphi method, which is increasingly being used to build consensus among content experts and stakeholders. Several tools for grading the level of evidence and strength of recommendation are offered and compared. The speciousness of categorizing guidelines as evidence-based or consensus-based will be explained. We examine the recommended checklist for reporting and appraise the tools for evaluating a practice guideline. This article is geared toward developers and reviewers of clinical practice guidelines and consensus statements.
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Affiliation(s)
- Honorio T Benzon
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Girish P Joshi
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, University of Texas, Austin, Texas
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Abstract
The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness.
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Affiliation(s)
- Kyan C. Safavi
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - William Driscoll
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeanine P. Wiener-Kronish
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Price MJ, Blake HA, Kenyon S, White IR, Jackson D, Kirkham JJ, Neilson JP, Deeks JJ, Riley RD. Empirical comparison of univariate and multivariate meta-analyses in Cochrane Pregnancy and Childbirth reviews with multiple binary outcomes. Res Synth Methods 2019; 10:440-451. [PMID: 31058440 PMCID: PMC6771837 DOI: 10.1002/jrsm.1353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 04/04/2019] [Accepted: 04/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multivariate meta-analysis (MVMA) jointly synthesizes effects for multiple correlated outcomes. The MVMA model is potentially more difficult and time-consuming to apply than univariate models, so if its use makes little difference to parameter estimates, it could be argued that it is redundant. METHODS We assessed the applicability and impact of MVMA in Cochrane Pregnancy and Childbirth (CPCB) systematic reviews. We applied MVMA to CPCB reviews published between 2011 and 2013 with two or more binary outcomes with at least three studies and compared findings with results of univariate meta-analyses. Univariate random effects meta-analysis models were fitted using restricted maximum likelihood estimation (REML). RESULTS Eighty CPCB reviews were published. MVMA could not be applied in 70 of these reviews. MVMA was not feasible in three of the remaining 10 reviews because the appropriate models failed to converge. Estimates from MVMA agreed with those of univariate analyses in most of the other seven reviews. Statistical significance changed in two reviews: In one, this was due to a very small change in P value; in the other, the MVMA result for one outcome suggested that previous univariate results may be vulnerable to small-study effects and that the certainty of clinical conclusions needs consideration. CONCLUSIONS MVMA methods can be applied only in a minority of reviews of interventions in pregnancy and childbirth and can be difficult to apply because of missing correlations or lack of convergence. Nevertheless, clinical and/or statistical conclusions from MVMA may occasionally differ from those from univariate analyses.
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Affiliation(s)
- Malcolm J. Price
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
| | - Helen A. Blake
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sara Kenyon
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ian R. White
- MRC Clinical Trials UnitUniversity College LondonLondonUK
| | - Dan Jackson
- Statistical Innovation GroupAstraZenecaCambridgeUK
| | | | - James P. Neilson
- Cochrane Pregnancy & Childbirth Group, Centre for Women's Health ResearchUniversity of LiverpoolLiverpoolUK
| | - Jonathan J. Deeks
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
| | - Richard D. Riley
- Centre for Prognosis ResearchResearch Institute for Primary Care & Health SciencesKeele UniversityUK
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Ogata H, Nakamoto S, Miyawaki H, Ueki R, Kariya N, Tatara T, Hirose M. Association between intraoperative nociception and postoperative complications in patients undergoing laparoscopic gastrointestinal surgery. J Clin Monit Comput 2019; 34:575-581. [PMID: 31264131 DOI: 10.1007/s10877-019-00347-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023]
Abstract
A higher degree of surgical invasiveness, which increases intraoperative nociception, might induce postoperative complications. Although several nociceptive indices for use during surgery are available in clinical practice, association between intraoperative nociception and postoperative complications has not been reported. An index representing intraoperative nociception, which is the averaged value of Nociceptive Response throughout the surgery (mean NR) was applied to examine the association in the present study. The retrospective study evaluated consecutive adult patients undergoing laparoscopic gastrointestinal surgery, American Society of Anesthesiologists-physical status (ASA-PS) I or II, whose preoperative C-reactive protein level was < 0.3 mg dL-1. We first used ordinal logistic analysis to examine the association between preoperative and intraoperative risk factors and complications graded by the Clavien-Dindo classification. Next, we performed propensity score matched analysis to evaluate the effects of mean NR throughout surgery on postoperative complications. Ordinal logistic analysis (n = 158) revealed that duration of surgery (P < 0.001), mean NR during surgery (P = 0.002), and ASA-PS (P = 0.016) were risk factors for postoperative complications. Then all patients were divided into two propensity score matched groups, based on a mean NR of < 0.85 and ≥ 0.85, with matching for age, ASA-PS, body mass index and duration of surgery. The severity of postoperative complications was significantly higher in the high NR group than in the low NR group (P = 0.005). In conclusion, there was likely an association between intraoperative nociception and postoperative complications in patients without serious preoperative conditions and comorbidities.
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Affiliation(s)
- Hiroki Ogata
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shiroh Nakamoto
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroki Miyawaki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tsuneo Tatara
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, Hyogo, Japan.
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Black S, Lerman J, Banks SE, Noghrehkar D, Curia L, Mai CL, Schwengel D, Nelson CK, Foster JMT, Breneman S, Arheart KL. Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors. Anesth Analg 2019; 128:1292-1299. [PMID: 31094802 DOI: 10.1213/ane.0000000000004013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P < .001). The frequency of large errors (100-fold greater or less than the correct answer) by residents was twice that of faculty. Error rates varied among institutions ranged from 12% to 22% (P = .021). CONCLUSIONS Anesthesiology residents and faculty erred frequently on a computational test, with junior residents and faculty with more experience committing errors more frequently. Residents committed more serious errors twice as frequently as faculty.
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Affiliation(s)
- Shira Black
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Jerrold Lerman
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Shawn E Banks
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami-Miller School of Medicine, Miami, Florida
| | - Dena Noghrehkar
- Department of Anesthesiology, John R. Oishei Children's Hospital, Buffalo, New York
| | - Luciana Curia
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah Schwengel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Corey K Nelson
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California
| | - James M T Foster
- Department of Anesthesiology, State University of New York Upstate, Syracuse, New York
| | - Stephen Breneman
- From the Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Kris L Arheart
- Department of Public Health Sciences, Division of Biostatistics, University of Miami School of Medicine, Miami, Florida
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Bailey CR, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A, Montgomery J, Russon K, Potparic O, Stocker M. Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia 2019; 74:778-792. [PMID: 30963557 DOI: 10.1111/anae.14639] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 12/18/2022]
Abstract
Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.
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Affiliation(s)
- C R Bailey
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, Chair of Working Party, Association of Anaesthetists, London, UK
| | - M Ahuja
- Department of Anaesthesia, Royal Wolverhampton Hospitals NHS Trust, Elected Member, British Association of Day Surgery, Wolverhampton, UK
| | - K Bartholomew
- Department of Anaesthesia, Calderdale and Huddersfield NHS Foundation Trust, Elected Member, Association of Paediatric Anaesthetists of Great Britain and Ireland, Huddersfield, UK
| | - S Bew
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Elected Member, Association of Paediatric Anaesthetists of Great Britain and Ireland, Leeds, UK
| | - L Forbes
- Department of Anaesthesia, Ninewells Hospital, Elected Member Trainee Committee, Association of Anaesthetists, Dundee, Scotland
| | - A Lipp
- Department of Anaesthesia, Norfolk and Norwich University Hospital, Elected Member, British Association of Day Surgery, Norwich, UK
| | - J Montgomery
- Department of Anaesthesia, Torbay and South Devon NHS Foundation Trust, Elected Member, British Association of Day Surgery, Torbay, UK
| | - K Russon
- Department of Anaesthesia, Rotherham NHS Foundation Trust, Elected Member, British Association of Day Surgery, Rotherham, UK
| | - O Potparic
- Department of Anaesthesia, Chelsea and Westminster NHS Foundation Trust, SAS Committee, Association of Anaesthetists, London, UK
| | - M Stocker
- Department of Anaesthesia, Torbay and South Devon, NHS Foundation Trust, President, British Association of Day Surgery, Torbay, UK
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