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Anesthesiology Clinics

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https://www.readbyqxmd.com/read/29101963/anesthesia-outside-the-operating-room
#1
EDITORIAL
Mark S Weiss, Wendy L Gross
No abstract text is available yet for this article.
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101962/anesthesia-outside-of-the-operating-room-the-wild-west-or-the-new-frontier
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101961/value-based-care-and-strategic-priorities
#3
REVIEW
Wendy L Gross, Lebron Cooper, Steven Boggs, Barbara Gold
The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101960/market-evaluation-finances-bundled-payments-and-accountable-care-organizations
#4
REVIEW
Shazia Mehmood Siddique, Shivan J Mehta
To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101959/pediatric-anesthesia-considerations-for-interventional-radiology
#5
REVIEW
Olivia Nelson, Philip D Bailey
Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101958/interventional-pulmonology
#6
REVIEW
David M DiBardino, Andrew R Haas, Richard C Month
Bronchoscopy presents a unique challenge and need for collaboration between anesthesia providers and bronchoscopists. The approach to topical anesthesia, analgesia, and sedation must be customized based on complexity, duration, and setting. The bronchoscopy team must work together in each phase of the procedure to ensure patient safety and allow completion of a quality bronchoscopy. Airway access may change depending on the type of procedure planned and must be discussed before each case. Intraprocedural difficulties with ventilation, airway pressure, and sedation may arise that must be addressed together...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101957/anesthesia-for-colonoscopy-and-lower-endoscopic-procedures
#7
REVIEW
John Michael Trummel, Vinay Chandrasekhara, Michael L Kochman
Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. No sedation for routine colonoscopy works well for selected patients and eliminates sedation-related risks...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101956/anesthesia-for-routine-and-advanced-upper-gastrointestinal-endoscopic-procedures
#8
REVIEW
Christopher D Sharp, Ezekiel Tayler, Gregory G Ginsberg
This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. It additionally will address the nuances of endoscopic retrograde cholangiopancreatography and new natural orifice transluminal endoscopic surgery procedures including endoscopic cystgastrostomy and the per-oral endoscopic myotomy procedure...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101955/cardioversions-and-transthoracic-echocardiography
#9
REVIEW
Ronak Shah, Elizabeth Zhou
Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Appropriate anesthetics must be chosen based on the preoperative evaluation. Additionally, because most of these cases are done without a secured airway, emergency medications and airway equipment must be readily available...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101954/anesthesia-in-the-electrophysiology-laboratory
#10
REVIEW
Jeff E Mandel, William G Stevenson, David S Frankel
The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101953/catheterization-laboratory-structural-heart-disease-devices-and-transcatheter-aortic-valve-replacement
#11
REVIEW
Paul N Fiorilli, Saif Anwaruddin, Elizabeth Zhou, Ronak Shah
The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101952/a-radiologist-s-view-of-tumor-ablation-in-the-radiology-suite
#12
REVIEW
Sharath K Bhagavatula, Jason Lane, Paul Shyn
Image-guided percutaneous, minimally invasive ablation techniques offer a wide variety of new modalities to treat tumors in some of the most medically complicated patients coming to our hospitals. The use of computed tomography, PET, ultrasound imaging, and MRI to guide radiofrequency ablation, microwave ablation, and cryoablation techniques now makes it possible to treat patients on a short stay or outpatient basis with very good immediate outcomes. This rapid expansion of new tumor ablation techniques often presents challenges for the non-operating room anesthesia team...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101951/an-anesthesiologist-s-view-of-tumor-ablation-in-the-radiology-suite
#13
REVIEW
Annie Amin, Jason Lane, Thomas Cutter
The advent of radiology image-guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. What traditionally was done in an operating room via large open incisions, with multiple days in the hospital recovering, is now becoming an outpatient procedure via these new techniques. Anesthesiologists play a critical role in optimizing outcome in these patients...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101950/use-of-anesthesiology-services-in-radiology
#14
REVIEW
Hansol Kim, Jason Lane, Rolf Schlichter, Michael S Stecker, Richard Taus
In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non-operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101949/monitoring-for-nonoperating-room-anesthesia
#15
REVIEW
Stylianos Voulgarelis, John P Scott
Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Body temperature should also be measured in appropriate scenarios. High-risk anesthetics require advanced preparation and monitoring...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101948/implementation-and-use-of-anesthesia-information-management-systems-for-non-operating-room-locations
#16
REVIEW
Jason T Bouhenguel, David A Preiss, Richard D Urman
Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101947/safety-of-non-operating-room-anesthesia-a-closed-claims-update
#17
REVIEW
Zachary G Woodward, Richard D Urman, Karen B Domino
Malpractice claims for non-operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Fewer malpractice claims for NORA occurred than for OR anesthesia as assessed by the relative numbers of in NORA versus OR procedures. The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101946/building-and-maintaining-organizational-infrastructure-to-attain-clinical-excellence
#18
REVIEW
Kelly Lebak, Jason Lane, Richard Taus, Hansol Kim, Michael S Stecker, Michael Hall, Meghan B Lane-Fall, Mark S Weiss
Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101945/demands-of-integrated-care-delivery-in-interventional-medicine-and-anesthesiology-interdisciplinary-teamwork-and-strategy
#19
REVIEW
Wendy L Gross, Lebron Cooper, Steven Boggs
Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested.
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28784227/organ-transplantation-a-systematic-review
#20
EDITORIAL
Aman Mahajan, Christopher Wray
No abstract text is available yet for this article.
September 2017: Anesthesiology Clinics
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