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Anesthesia in remote locations

Vittorio Scaravilli, Alberto Zanella, Valentina Ciceri, Mariagrazia Bosatra, Claudia Flandoli, Alessia La Bruna, Simone Sosio, Rossella Parini, Serena Gasperini, Antonio Pesenti, Alessandra Moretto
BACKGROUND: Complications are common during anesthesia for patients with mucopolysaccharidoses. San Gerardo Hospital (Italy) is a reference center for mucopolysaccharidoses with a dedicated pediatric anesthesia service. AIMS: This study aims to evaluate the safety of anesthesia for mucopolysaccharidoses patients, describe their anesthetic management at our institution, and assess risk factors for complications. METHODS: The anesthetic charts of mucopolysaccharidoses patients admitted from January 1999 to December 2014 were retrospectively analyzed...
May 2018: Paediatric Anaesthesia
T R Grant, E H Ellinas, A O Kula, M Y Muravyeva
BACKGROUND: Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. METHODS: Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta. RESULTS: Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%)...
May 2018: International Journal of Obstetric Anesthesia
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
Yuan-Yuan Hou, Yun Li, Shu-Fang He, Jie Song, De-Xin Yu, Gordon T C Wong, Ye Zhang
STUDY OBJECTIVE: There are two windows of protection for remote ischemic preconditioning (RIPC), an early (ERIPC) and a late-phase (LRIPC). While ERIPC has been well studied, works on LRIPC are relatively scarce, especially for the kidneys. We aimed to compare the effects of early-phase versus late-phase RIPC in patients with laparoscopic partial nephrectomy (LPN). DESIGN: A randomized controlled study SETTING: The Second Affiliated Hospital of Anhui Medical University, 1 May 2012 to 30 October 2013 PATIENTS: Sixty-five ASA 1 to 2 patients scheduled for LPN were located randomly to ERIPC group, LRIPC group and CON group (control)...
September 2017: Journal of Clinical Anesthesia
Rachel R Wang, Amanda H Kumar, Pedro Tanaka, Alex Macario
Anesthesia providers are frequently exposed to radiation during routine patient care in the operating room and remote anesthetizing locations. Eighty-two percent of anesthesiology residents (n = 57 responders) at our institution had a "high" or "very high" concern about the level of ionizing radiation exposure, and 94% indicated interest in educational materials about radiation safety. This article highlights key learning points related to basic physical principles, effects of ionizing radiation, radiation exposure measurement, occupational dose limits, considerations during pregnancy, sources of exposure, factors affecting occupational exposure such as positioning and shielding, and monitoring...
June 2017: Seminars in Cardiothoracic and Vascular Anesthesia
Sekar Bhavani
The term, non-operating room anesthesia, describes a location remote from the main operating suites and closer to the patient, including areas that offer specialized procedures, like endoscopy suites, cardiac catheterization laboratories, bronchoscopy suites, and invasive radiology suites. There has been an exponential growth in such procedures and they present challenges in both organizational aspects and administration of anesthesia. This article explores the requirements for the location, preoperative evaluation and patient selection, monitoring, anesthesia technique, and postoperative management at these sites...
July 2016: Gastrointestinal Endoscopy Clinics of North America
Yoshihiro Yonekawa, Wei-Chi Wu, Shunji Kusaka, Joshua Robinson, Daishi Tsujioka, Kai B Kang, Michael J Shapiro, Tapas R Padhi, Lubhani Jain, Jonathan E Sears, Ajay E Kuriyan, Audina M Berrocal, Polly A Quiram, Amanda E Gerber, R V Paul Chan, Karyn E Jonas, Sui Chien Wong, C K Patel, Ashkan M Abbey, Rand Spencer, Michael P Blair, Emmanuel Y Chang, Thanos D Papakostas, Demetrios G Vavvas, Robert A Sisk, Philip J Ferrone, Robert H Henderson, Karl R Olsen, M Elizabeth Hartnett, Felix Y Chau, Shizuo Mukai, Timothy G Murray, Benjamin J Thomas, P Anthony Meza, Kimberly A Drenser, Michael T Trese, Antonio Capone
PURPOSE: To determine the feasibility and safety of bilateral simultaneous vitreoretinal surgery in pediatric patients. DESIGN: International, multicenter, interventional, retrospective case series. PARTICIPANTS: Patients 17 years of age or younger from 24 centers worldwide who underwent immediate sequential bilateral vitreoretinal surgery (ISBVS)-defined as vitrectomy, scleral buckle, or lensectomy using the vitreous cutter-performed in both eyes sequentially during the same anesthesia session...
August 2016: Ophthalmology
Laura E Schleelein, Ariel M Vincent, Abbas F Jawad, Eric Y Pruitt, Genna D Kreher, Mohamed A Rehman, Theodora K Goebel, David E Cohen, Scott D Cook-Sather
BACKGROUND: Perioperative pediatric adverse events have been challenging to study within and across institutions due to varying definitions, low event rates, and incomplete capture. AIM: The aim of this study was to determine perioperative adverse event prevalence and to evaluate associated case characteristics and potential contributing factors at an academic pediatric quaternary-care center. METHODS: At the Children's Hospital of Philadelphia (CHOP), perioperative adverse events requiring rapid response assistance are termed Anesthesia Now (AN!) events...
July 2016: Paediatric Anaesthesia
C S Elser, W B Murray, A Schneider, K Underberg, J Henry, P Foster, S Vaduva, J C Venable, M Shindel
Patient simulators are useful tools for training residents and all levels of medical personnel. Simulator usefulness, in small group sessions, is limited by the costs of training large numbers of people. We present an interrupted methodology designed to involve a large group at a location remote from the simulator. The goal was to enable the remote participants to take part in decision making while under time pressure. Two volunteers were chosen as hands-on participants while eighteen remaining anesthesiology residents observed from a lecture room via a closed circuit audio/video feed...
July 2001: Journal of Education in Perioperative Medicine: JEPM
Richard H Epstein, Franklin Dexter, David M Gratch, Michael Perino, Jerry Magrann
BACKGROUND: Accurate accounting of controlled drug transactions by inpatient hospital pharmacies is a requirement in the United States under the Controlled Substances Act. At many hospitals, manual distribution of controlled substances from pharmacies is being replaced by automated dispensing cabinets (ADCs) at the point of care. Despite the promise of improved accountability, a high prevalence (15%) of controlled substance discrepancies between ADC records and anesthesia information management systems (AIMS) has been published, with a similar incidence (15...
June 2016: Anesthesia and Analgesia
Dollyane Muret, Sébastien Daligault, Hubert R Dinse, Claude Delpuech, Jérémie Mattout, Karen T Reilly, Alessandro Farnè
It is well established that permanent or transient reduction of somatosensory inputs, following hand deafferentation or anesthesia, induces plastic changes across the hand-face border, supposedly responsible for some altered perceptual phenomena such as tactile sensations being referred from the face to the phantom hand. It is also known that transient increase of hand somatosensory inputs, via repetitive somatosensory stimulation (RSS) at a fingertip, induces local somatosensory discriminative improvement accompanied by cortical representational changes in the primary somatosensory cortex (SI)...
April 2016: Journal of Neurophysiology
D A Burckett-St Laurent, M S Cunningham, S Abbas, V W Chan, A Okrainec, A U Niazi
BACKGROUND: Ultrasound-guided regional anesthesia (UGRA) requires acquisition of new skills. Learning requires one-on-one teaching, and can be limited by time and mentor availability. We investigate whether the skills required for UGRA can be developed and subsequently assessed remotely using a novel online teaching platform. This platform was developed at the University of Toronto to teach laparoscopic surgery remotely and has been termed Telesimulation. METHODS: Anesthesia Site Chiefs at 10 hospitals across Ontario were sent a letter inviting their anesthesia teams to participate in an UGRA remote training program...
August 2016: Acta Anaesthesiologica Scandinavica
Sebastian Heinrich, Andreas Ackermann, Johannes Prottengeier, Ixchel Castellanos, Joachim Schmidt, Jürgen Schüttler
OBJECTIVES: Former analyses reported an increased rate of poor direct laryngoscopy view in cardiac surgery patients; however, these findings frequently could be attributed to confounding patient characteristics. In most of the reported cardiac surgery cohorts, the rate of well-known risk factors for poor direct laryngoscopy view such as male sex, obesity, or older age, were increased compared with the control groups. Especially in the ongoing debate on anesthesia staff qualification for cardiac interventions outside the operating room a detailed and stratified risk analysis seems necessary...
December 2015: Journal of Cardiothoracic and Vascular Anesthesia
Anuradha Patel, Scott R Clark, Moshe Schiffmiller, Catherine Schoenberg, George Tewfik
BACKGROUND: Laryngeal mask is frequently the airway device of choice in routine general anesthesia for many procedures in children. Several studies have described the use of laryngeal masks in unconventional situations. This survey was undertaken to assess how laryngeal masks are being used by pediatric anesthesiologists. METHOD: The 40-question electronic survey using SurveyMonkey™ was sent to 2740 members of the Society for Pediatric Anesthesia (SPA). This survey assessed the age, work environment, types of practice, and training levels, as well as clinical situations in which the practitioners use laryngeal masks across different pediatric age groups...
November 2015: Paediatric Anaesthesia
Carlos E Navarro
BACKGROUND: The author presents a 20-year experience leading cleft lip and palate surgical volunteer missions in Peru for CIRPLAST, a nonprofit volunteer plastic surgery goodwill program that has provided free surgery for patients with cleft lip and palate deformities in remote areas of Peru. Surgical procedures were performed by the author, together with a group of experienced plastic surgeons, under the auspices of the Peruvian Plastic Surgery Society, and local health authorities. METHODS: CIRPLAST missions are scheduled annually in different locations around Peru...
June 2015: Journal of Craniofacial Surgery
Ulrika A Bergvall, Petter Kjellander, Per Ahlqvist, Örjan Johansson, Kent Sköld, Jon M Arnemo
We evaluated impact of the needle length, sex, and body condition on chemical immobilization induction time in 50 (29 males and 21 females) free-ranging fallow deer (Dama dama) in Sweden, 2006-11. Induction time is probably the single most important factor when immobilizing free-ranging wildlife with the use of a remote drug-delivery system. Induction times should be short to minimize stress and risk of injury, and to ensure that immobilized animals can be found and clinically monitored as soon as possible...
April 2015: Journal of Wildlife Diseases
Dale F Szpisjak, Cheryl M Starrett-Keller
Field anesthesia machine ventilators powered by compressed gas are designed for remote locations that may lack a pipeline supply of O2. This study determined the O2 consumption of the compPAC ventilator powered by E cylinders when ventilating the Vent Aid Training Test Lung model of high (HC) and low (LC) pulmonary compliance. Consumed O2 was calculated after measuring the mass of O2 depleted from the E cylinder. Three tidal volumes (V(T)) were tested (500, 750, and 1000 mL). The HC and LC settings were 0.100 and 0...
December 2014: Military Medicine
A Hamid
Anesthesiologist's involvement for the purpose of diagnostic and interventional procedures in cardiac catheterization laboratory has been evolving particularly since last two decades. Catheterization laboratory environment poses certain challenges for the anesthesiologist including unfamiliar remote location, exposure to radiation, limited help from colleagues and communication with cardiologists. Anesthesiologists working in catheterization laboratory are required to have adequate knowledge of the environment, personnel, fluoroscope, echocardiography and type of radio contrast dye during the procedure...
2014: Heart, Lung and Vessels
J Devin Roberts
The cardiac catheterization laboratory (CCL) and electrophysiology laboratory (EPL) environments present unique clinical challenges. These challenges include unfamiliar work areas and staff, limited space with physical barriers separating the patient from the care provider, remote locations, and procedures with rare but potentially catastrophic clinical complications. Ambulatory anesthesiologists must familiarize themselves with these new surroundings and practice vigilant preoperative planning and continual communication with the proceduralist and team...
June 2014: Anesthesiology Clinics
Franklin Dexter, Ruth E Wachtel
PURPOSE OF REVIEW: Providing general anesthesia at locations away from the operating room, called remote locations, poses many medical and scheduling challenges. This review discusses how to schedule procedures at remote locations to maximize anesthesia productivity (see Video, Supplemental Digital Content 1). RECENT FINDINGS: Anesthesia labour productivity can be maximized by assigning one or more 8-h or 10-h periods of allocated time every 2 weeks dedicated specifically to each remote specialty that has enough cases to fill those periods...
August 2014: Current Opinion in Anaesthesiology
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