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Perioperative anesthesiology

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https://www.readbyqxmd.com/read/29690755/perioperative-surgical-home-a-new-scope-for-future-anesthesiology
#1
Min A Kwon
The health care system is changing from 'pay for volume' to 'pay for value.' These changes are turning health care delivery into a more cost-effective and coordinated care setup that drives hospitals to lower costs and greater quality gains. The present perioperative care service in Korea has proven to be costly, fragmented, and neither evidence-based nor patient- centered. Recently, a new concept of a perioperative care model termed perioperative surgical home (PSH) has been proposed. The PSH is a patient-centered, team-based, and coordinated perioperative care setup, composed of the head anesthesiologist-perioperativist in tandem with dedicated nurse practitioners and other PSH team doctors...
April 25, 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29672400/enhanced-recovery-after-surgery-eras-pathway-in-esophagectomy-is-a-reasonable-prediction-of-hospital-stay-possible
#2
Paolo Parise, Carlo Ferrari, Andrea Cossu, Francesco Puccetti, Ugo Elmore, Stefano De Pascale, Leonardo Garutti, Uberto Romario Fumagalli, Mariaclelia Stefania Di Serio, Riccardo Rosati
OBJECTIVE: To assess whether perioperative variables or deviation from enhanced recovery after surgery (ERAS) items could be associated with delayed discharge after esophagectomy, and to convert them into a scoring system to predict it. SUMMARY BACKGROUND DATA: ERAS perioperative pathways have been recently applied to esophageal resections. However, low adherence to ERAS items and high rates of protocol deviations are often reported. METHODS: All patients who underwent esophagectomy between April 2012 and March 2017 were managed with a standardized perioperative pathway according to ERAS principles...
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29661153/improved-analgesia-and-reduced-post-operative-nausea-and-vomiting-after-implementation-of-an-enhanced-recovery-after-surgery-eras-pathway-for-total-mastectomy
#3
Catherine Chiu, Pedram Aleshi, Laura J Esserman, Christina Inglis-Arkell, Edward Yap, Elizabeth L Whitlock, Monica W Harbell
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways have been shown in multiple surgical disciplines to improve outcomes, including reduced opioid consumption, length of stay, and post-operative nausea and vomiting (PONV). However, very few studies describe the application of ERAS to breast surgery and even fewer describe ERAS for outpatient surgery. We describe the implementation and efficacy of an Enhanced Recovery After Surgery (ERAS) pathway for total skin-sparing mastectomy with immediate reconstruction in an outpatient setting...
April 16, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29649026/evidence-review-conducted-for-the-agency-for-healthcare-research-and-quality-safety-program-for-improving-surgical-care-and-recovery-focus-on-anesthesiology-for-colorectal-surgery
#4
Kristen A Ban, Melinda M Gibbons, Clifford Y Ko, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Michael C Grant, Christopher L Wu
The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), which is a national effort to disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. The program will integrate evidence-based processes central to enhanced recovery and prevention of surgical site infection, venous thromboembolic events, catheter-associated urinary tract infections with socioadaptive interventions to improve surgical outcomes, patient experience, and perioperative safety culture...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29642696/periprocedural-and-perioperatory-management-of-patients-with-tricuspid-valve-disease
#5
Fabrizio Monaco, Ambra L DI Prima, Monica DE Luca, Gaia Barucco, Alberto Zangrillo
Tricuspid regurgitation (TR) is a common valvular lesion which may affect morbidity and mortality. It can be related to an intrinsic abnormality of the tricuspid valve leaflets (organic) or secondary to annular dilatation (functional). Often organic and functional TR coexist in the same patient. A long standing TR is associated with ascites, congestive hepatopathy, peripheral edema, renal failure, and abdominal fullness which significantly affect the outcome. In particular, the perioperative course may be complicated due to both the presence of comorbidities and the development of a severe postoperative right ventricle (RV) dysfunction...
April 11, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29628572/impact-of-targeted-preoperative-optimization-on-clinical-outcome-in-emergency-abdominal-surgeries-a-prospective-randomized-trial
#6
Ashish Sethi, Miltan Debbarma, Neeraj Narang, Anudeep Saxena, Mamta Mahobia, Gaurav Singh Tomar
Background: Perforation peritonitis continues to be one of the most common surgical emergencies that need a surgical intervention most of the times. Anesthesiologists are invariably involved in managing such cases efficiently in perioperative period. Aims: The assessment and evaluation of Acute Physiology and Chronic Health Evaluation II (APACHE II) score at presentation and 24 h after goal-directed optimization, administration of empirical broad-spectrum antibiotics, and definitive source control postoperatively...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29623382/-the-heart-catheter-table-is-not-the-operating-table-intraindividual-comparison-of-pulmonary-artery-pressures
#7
M U Ziegler, H Reinelt
BACKGROUND: Patients undergoing cardiac surgery need extensive and invasive monitoring, which needs to be individually adapted for each patient and requires a diligent risk-benefit analysis. The use of a pulmonary artery catheter (PAC) seems to be justifiable in certain cases; therefore, the preoperative diagnosis of pulmonary hypertension represents an indication for perioperative monitoring with PAC in the S3 guidelines of the German Society for Anesthesiology and Intensive Care Medicine (DGAI)...
April 5, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29600254/anesthesiology-residency-curriculum-and-implementation-of-a-perioperative-surgical-home-curriculum-a-survey-study
#8
Joseph Rinehart, Jenny Seong, Navid Alem, Roberta Andreatta, Jason Derhovanesian, Christina Smith, Zeev Kain
Background: The perioperative surgical home (PSH) is a physician-led, interdisciplinary, and patient-centered model of perioperative care that focuses on patient outcomes and comprehensive care management. Many studies to date have looked at the clinical implementation of varied PSH models with promising results discussed. There are no studies directly examining concrete plans for the various Accreditation Council for Graduate Medical Education (ACGME) anesthesiology residency programs to implement augmented PSH training into curricula...
July 2017: Journal of Education in Perioperative Medicine: JEPM
https://www.readbyqxmd.com/read/29581087/improving-health-related-quality-of-life-of-patients-with-an-ostomy-using-a-novel-digital-wearable-device-protocol-for-a-pilot-study
#9
Dara Rouholiman, Jamison G Gamble, Sylvie D Dobrota, Ellen M Encisco, Ashish G Shah, Francisco J Grajales Iii, Larry F Chu
BACKGROUND: Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients. OBJECTIVE: In the present study, we plan to assess the quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth-linked biosensor that facilitates easier ostomy bag output measurements...
March 26, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29572858/red-blood-cell-transfusion-in-perioperative-pediatric-anesthesia-a-survey-of-current-practice-in-germany
#10
Eva Wittenmeier, Claudius Troeber, Ulrike Zier, Irene Schmidtmann, Nina Pirlich, Karin Becke, Tim Piepho
BACKGROUND: Little is known about the current practice of the perioperative transfusion of red blood cells (RBCs) in pediatric patients. This study was performed to evaluate the practice of RBC transfusion in German pediatric anesthesia. STUDY DESIGN AND METHODS: An online survey was conducted among members of the German Society of Anesthesiology and Intensive Care. Participants were asked to indicate the hemoglobin (Hb) thresholds for starting RBC transfusion in six cases of different bleeding situations in pediatric anesthesia...
March 23, 2018: Transfusion
https://www.readbyqxmd.com/read/29570150/cost-effectiveness-research-in-anesthesiology
#11
Bijan J Teja, Tori N Sutherland, Sheila R Barnett, Daniel S Talmor
Perioperative interventions aimed at decreasing costs and improving outcomes have become increasingly popular in recent years. Anesthesiologists are often faced with a choice among different treatment strategies with little data available on the comparative cost-effectiveness. We performed a systematic review of the English language literature between 1980 and 2014 to identify cost-effectiveness analyses of anesthesiology and perioperative medicine interventions. We excluded interventions related to critical care or pediatric anesthesiology, and articles on interventions not normally ordered or performed by anesthesiologists...
March 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29550619/recommendations-for-preoperative-management-of-frailty-from-the-society-for-perioperative-assessment-and-quality-improvement-spaqi
#12
Maria Loreto Alvarez-Nebreda, Nathalie Bentov, Richard D Urman, Sabeena Setia, Joe Chin-Sun Huang, Kurt Pfeifer, Katherine Bennett, Thuan D Ong, Deborah Richman, Divya Gollapudi, G Alec Rooke, Houman Javedan
Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery...
March 15, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29505959/wrong-site-nerve-blocks-a-systematic-literature-review-to-guide-principles-for-prevention
#13
REVIEW
Ellen S Deutsch, Robert A Yonash, Donald E Martin, Joshua H Atkins, Theresa V Arnold, Christina M Hunt
STUDY OBJECTIVE: Wrong-site nerve blocks (WSBs) are a significant, though rare, source of perioperative morbidity. WSBs constitute the most common type of perioperative wrong-site procedure reported to the Pennsylvania Patient Safety Authority. This systematic literature review aggregates information about the incidence, patient consequences, and conditions that contribute to WSBs, as well as evidence-based methods to prevent them. DESIGN: A systematic search of English-language publications was performed, using the PRISMA process...
March 2, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29491752/preliminary-indications-for-the-use-of-sugammadex-after-its-addition-to-a-formulary-at-a-tertiary-care-children-s-hospital
#14
N'Diris Barry, Joshua C Uffman, Dmitry Tumin, Joseph D Tobias
OBJECTIVES: Neuromuscular blocking agents (NMBAs) are administered to facilitate endotracheal intubation and provide skeletal muscle relaxation in surgical procedures. Sugammadex (Bridion) recently received approval by the United States Food and Drug Administration for reversal of rocuronium and vecuronium-induced neuromuscular blockade thereby providing an alternative to acetylcholinesterase inhibitors such as neostigmine. This quality improvement analysis sought to investigate the clinical reasons and common clinical perceptions for choosing sugammadex over neostigmine to reverse NMBAs...
January 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/29481430/analgesic-effects-of-oxycodone-relative-to-those-of-sufentanil-in-the-presence-of-midazolam-during-endoscopic-injection-sclerotherapy-for-patients-with-cirrhosis-and-esophageal-varices
#15
Zhefeng Quan, Chao Luo, Ping Chi, Lujie Wang, Haili He
BACKGROUND: We evaluated the efficacy and gastroenterologist/patient satisfaction of midazolam combined with oxycodone, relative to that of midazolam combined with sufentanil, for anesthesia during endoscopic injection sclerotherapy (EIS) in patients with cirrhosis and esophageal varices. METHODS: Patients with cirrhosis (20-69 years of age), body mass index, 18-25 kg/m, American Society of Anesthesiology patient classification physical status I-II who underwent elective EIS were randomly assigned to 1 of 2 groups...
February 23, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29445309/the-role-of-pairing-an-anesthesiology-rotation-with-the-general-surgery-clerkship-positive-impact-on-surgical-and-perioperative-education
#16
Gaurav P Patel
Background: The use of an anesthesiology rotation in the realm of surgical education is not very well studied. Several studies show the importance of an anesthesiology rotation in the grand scheme of undergraduate medical education. However, its importance in perioperative medicine and surgical education is not very well understood. This study attempts to look at this relationship and determine whether or not a temporal relationship between this anesthesiology rotation and a surgical rotation is important...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/29441169/perioperative-stroke-pathophysiology-and-management
#17
REVIEW
Sang-Bae Ko
Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping)...
February 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29416871/anesthesiology-control-tower-feasibility-assessment-to-support-translation-act-fast-a-feasibility-study-protocol
#18
Teresa M Murray-Torres, Frances Wallace, Mara Bollini, Michael S Avidan, Mary C Politi
Background: Major postoperative morbidity and mortality remain common despite efforts to improve patient outcomes. Health information technologies have the potential to actualize advances in perioperative patient care, but failure to evaluate the usability of these technologies may hinder their implementation and acceptance. This protocol describes the usability testing of an innovative telemedicine-based intra-operative clinical support system, the Anesthesiology Control Tower, in which a team led by an attending anesthesiologist will use a combination of established and novel information technologies to provide evidence-based support to their colleagues in the operating room...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29401078/teaching-medical-students-clinical-anesthesia
#19
Saundra E Curry
There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia...
February 2, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29388810/knowledge-gaps-in-the-perioperative-management-of-adults-with-obstructive-sleep-apnea-and-obesity-hypoventilation-syndrome-an-official-american-thoracic-society-workshop-report
#20
Najib T Ayas, Cheryl R Laratta, John M Coleman, Anthony G Doufas, Matthias Eikermann, Peter C Gay, Daniel J Gottlieb, Indira Gurubhagavatula, David R Hillman, Roop Kaw, Atul Malhotra, Babak Mokhlesi, Timothy I Morgenthaler, Sairam Parthasarathy, Satya Krishna Ramachandran, Kingman P Strohl, Patrick J Strollo, Michael J Twery, Phyllis C Zee, Frances F Chung
The purpose of this workshop was to identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). A single-day meeting was held at the American Thoracic Society Conference in May, 2016, with representation from many specialties, including anesthesiology, perioperative medicine, sleep, and respiratory medicine. Further research is urgently needed as we look to improve health outcomes for these patients and reduce health care costs. There is currently insufficient evidence to guide screening and optimization of OSA and OHS in the perioperative setting to achieve these objectives...
February 2018: Annals of the American Thoracic Society
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