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https://www.readbyqxmd.com/read/28372650/asa-physical-status-assignment-by-non-anesthesia-providers-do-surgeons-consistently-downgrade-the-asa-score-preoperatively
#1
Christopher Curatolo, Andrew Goldberg, David Maerz, Hung-Mo Lin, Hardikkumar Shah, Muoi Trinh
OBJECTIVE: The American Society of Anesthesiologists physical status (ASA-PS) is associated with increased morbidity and mortality in the perioperative period. When surgeries are scheduled by surgeons and their staff at our large institution a presumed ASA-PS is chosen. This is because our institution (and, anecdotally, others in our hospital system and elsewhere), recognizing the relationship between higher ASA-PS and poorer postoperative outcomes, requires all patients with higher ASA-PS levels (≥3) to undergo enhanced preoperative workup...
May 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28290956/multidisciplinary-in-situ-simulation-based-training-as-a-postpartum-hemorrhage-quality-improvement-project
#2
Monica A Lutgendorf, Carmen Spalding, Elizabeth Drake, Dennis Spence, Jason O Heaton, Kristina V Morocco
BACKGROUND: Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28236859/regulation-of-hypnosis-in-propofol-anesthesia-administration-based-on-non-linear-control-strategy
#3
Muhammad Ilyas, Ali Khaqan, Jamshed Iqbal, Raja Ali Riaz
Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia...
March 2017: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/28223056/transcatheter-aortic-valve-in-valve-implantation-using-lotus-valve-for-failed%C3%A2-surgical-bioprostheses
#4
Fausto Castriota, Roberto Nerla, Antonio Micari, Caterina Cavazza, Francesco Bedogni, Luca Testa, Matteo Montorfano, Mauro Del Giglio, Alberto Cremonesi
BACKGROUND: Patients with failed bioprostheses are an increasing population at high risk for redo surgery. Valve-in-valve transcatheter aortic valve implantation is a promising alternative but a limited number of first-generation devices have proven efficacy in all cases. METHODS: Patients with degenerated bioprostheses at high risk for redo surgery were included in the registry after being assigned to valve-in-valve intervention by a local heart team. Main basal and follow-up data (at 1 month and 6 months) of patients undergoing valve-in-valve transcatheter aortic valve implantation with the Lotus valve system (Boston Scientific, Natick, MA) in three high-volume Italian centers were entered in the registry...
February 18, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28106793/hybrid-intelligent-system-to-perform-fault-detection-on-bis-sensor-during-surgeries
#5
José-Luis Casteleiro-Roca, José Luis Calvo-Rolle, Juan Albino Méndez Pérez, Nieves Roqueñí Gutiérrez, Francisco Javier de Cos Juez
This paper presents a new fault detection system in hypnotic sensors used for general anesthesia during surgery. Drug infusion during surgery is based on information received from patient monitoring devices; accordingly, faults in sensor devices can put patient safety at risk. Our research offers a solution to cope with these undesirable scenarios. We focus on the anesthesia process using intravenous propofol as the hypnotic drug and employing a Bispectral Index (BIS(TM)) monitor to estimate the patient's unconsciousness level...
January 18, 2017: Sensors
https://www.readbyqxmd.com/read/28079566/retesting-the-hypothesis-of-a-clinical-randomized-controlled-trial-in-a-simulation-environment-to-validate-anesthesia-simulation-in-error-research-the-vaser-study
#6
Alan F Merry, Jacqueline A Hannam, Craig S Webster, Kylie-Ellen Edwards, Jane Torrie, Chris Frampton, Daniel W Wheeler, Arun K Gupta, Ravi P Mahajan, Rachel Evley, Jennifer M Weller
BACKGROUND: Simulation has been used to investigate clinical questions in anesthesia, surgery, and related disciplines, but there are few data demonstrating that results apply to clinical settings. We asked "would results of a simulation-based study justify the same principal conclusions as those of a larger clinical study?" METHODS: We compared results from a randomized controlled trial in a simulated environment involving 80 cases at three centers with those from a randomized controlled trial in a clinical environment involving 1,075 cases...
March 2017: Anesthesiology
https://www.readbyqxmd.com/read/28067709/factors-associated-with-risk-of-neurologic-complications-after-peripheral-nerve-blocks-a-systematic-review
#7
Rakesh V Sondekoppam, Ban C H Tsui
The onset of neurologic complications after regional anesthesia is a complex process and may result from an interaction of host, agent, and environmental risk factors. The purpose of this systematic review was examine the qualitative evidence relating to various risk factors implicated in neurologic dysfunction after peripheral nerve block (PNB). The MEDLINE, OVID, and EMBASE databases were primary sources for literature. Cochrane, LILACS, DARE, IndMed, ERIC, NHS, and HTA via Centre for Reviews and Dissemination (CRD; York University) databases were searched for additional unique results...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28040234/-regulation-of-hypnosis-in-propofol-anesthesia-administration-based-on-non-linear-control-strategy
#8
Muhammad Ilyas, Ali Khaqan, Jamshed Iqbal, Raja Ali Riaz
Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia...
March 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/27871514/cost-impact-of-unexpected-disposition-after-orthopedic-ambulatory-surgery-associated-with-category-of-anesthesia-provider
#9
Robert L Ohsfeldt, Thomas R Miller, John E Schneider, Cara M Scheibling
STUDY OBJECTIVE: To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. DESIGN: A projection model was used to apply estimates of costs and health outcomes associated with the excess risk of unexpected disposition for NAs reported in a recent study. SETTING: Ambulatory and inpatient surgery. PATIENTS: Base-case model parameters were based on estimates taken from peer-reviewed publications when available, or from other sources including data for all hospital stays in the United States in 2013 from the Healthcare Cost and Utilization Project Web site...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27429085/contact-lens-related-keratoschisis-an-unusual-case-of-corneal-stroma-lamellar-trauma
#10
Adam Meeney, Mathew Raynor, Matthew Edwards, Hardeep Singh Mudhar
PURPOSE: To describe the clinical, imaging, and histopathological features of a highly unusual, postcontact lens removal scenario in a 29-year-old woman. Most documented cases recover good vision but differ significantly from our case. METHODS: A 29-year-old woman presented to the Eye Casualty Department as she was unable to remove her right soft contact lens after having inadvertently slept wearing soft contact lenses. During removal, extensive axial corneal epithelial sloughing occurred...
October 2016: Cornea
https://www.readbyqxmd.com/read/27311343/multiflap-closure-of-scalp-defects-revisiting-the-orticochea-flap-for-scalp-reconstruction
#11
Arvind Badhey, Sameep Kadakia, Manoj T Abraham, J K Rasamny, Augustine Moscatello
Reconstruction of the scalp following oncologic resection is a challenging undertaking owing to the variable elasticity of the soft tissue overlying the calvarium and the limited amount of tissue available for recruitment. Defect size, location, and skin characteristics heavily influence the reconstructive options available to the surgeon. Reconstruction options for scalp defects range from simple direct closure, to skin grafting, to adjacent tissue transfer with local flaps, and ultimately to free tissue transfer...
September 2016: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/27290957/air-q-laryngeal-airway-for-rescue-and-tracheal-intubation
#12
Ayman Ads, Frederic Auerbach, Kelly Ryan, Abdel R El-Ganzouri
We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report...
August 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27276774/airway-visualization-eyes-see-what-mind-knows
#13
REVIEW
Massimiliano Sorbello, Giulio Frova, Ivana Zdravković
Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. New technology has made available an opportunity to move the physician's eye inside patient airways thanks to video laryngoscopy and video assisted airway management technique. Undoubtedly, we have entered a new era of high resolution airway visualization and different approach in airway instrumentation...
March 2016: Acta Clinica Croatica
https://www.readbyqxmd.com/read/27172145/the-risks-to-patient-privacy-from-publishing-data-from-clinical-anesthesia-studies
#14
Liam O'Neill, Franklin Dexter, Nan Zhang
In this article, we consider the privacy implications of posting data from small, randomized trials, observational studies, or case series in anesthesia from a few (e.g., 1-3) hospitals. Prior to publishing such data as supplemental digital content, the authors remove attributes that could be used to re-identify individuals, a process known as "anonymization." Posting health information that has been properly "de-identified" is assumed to pose no risks to patient privacy. Yet, computer scientists have demonstrated that this assumption is flawed...
June 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27082606/difficult-airway-due-to-an-undiagnosed-subglottic-tumor-a-case-report
#15
Kohji Uzawa, Joho Tokumine, Alan Kawarai Lefor, Toshiyuki Takagi, Kunitaro Watanabe, Tomoko Yorozu
The "cannot ventilate, cannot intubate" scenario during anesthesia induction can be lethal. We present a patient with an undiagnosed subglottic tumor who developed the "cannot ventilate, cannot intubate" situation after induction of general anesthesia, due to the presence of an undiagnosed subglottic tumor. A 93-year-old woman was brought to the operating room for repair of a femoral neck fracture. Both ventilation and intubation could not be accomplished, and the patient was awakened without complications after trials of maintaining the airway...
April 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27006957/intraoperative-tension-pneumothorax-in-a-patient-with-remote-trauma-and-previous-tracheostomy
#16
Ana Mavarez-Martinez, Suren Soghomonyan, Gurneet Sandhu, Demicha Rankin
Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma...
January 2016: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/26796607/comparison-of-2-resident-learning-tools-interactive-screen-based-simulated-case-scenarios-versus-problem-based-learning-discussions-a-prospective-quasi-crossover-cohort-study
#17
COMPARATIVE STUDY
Shobana Rajan, Ashish Khanna, Maged Argalious, Stephen J Kimatian, Edward J Mascha, Natalya Makarova, Eman M Nada, Hesham Elsharkawy, Farhad Firoozbakhsh, Rafi Avitsian
STUDY OBJECTIVE: Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. DESIGN: Prospective, nonblinded quasi-crossover study...
February 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/26768939/profile-of-drug-administration-errors-in-anesthesia-among-anesthesiologists-from-santa-catarina
#18
Thomas Rolf Erdmann, Jorge Hamilton Soares Garcia, Marcos Lázaro Loureiro, Marcelo Petruccelli Monteiro, Guilherme Muriano Brunharo
INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors...
January 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/26686867/impact-of-advanced-monitoring-variables-on-intraoperative-clinical-decision-making-an-international-survey
#19
Alexandre Joosten, Olivier Desebbe, Koichi Suehiro, Mfonobong Essiet, Brenton Alexander, Cameron Ricks, Joseph Rinehart, David Faraoni, Maurizio Cecconi, Philippe Van der Linden, Maxime Cannesson
To assess the relationship between the addition of advanced monitoring variables and changes in clinical decision-making. A 15-questions survey was anonymously emailed to international experts and physician members of five anesthesia societies which focused on assessing treatment decisions of clinicians during three realistic clinical scenarios measured at two distinct time points. The first is when typical case information and basic monitoring (T1) were provided, and then once again after the addition of advanced monitoring variables (T2)...
February 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/26606173/case-scenario-perioperative-management-of-a-young-woman-with-fontan-repair-for-major-gynecologic-surgery
#20
Antonio Maria Dell'Anna, Domenico Luca Grieco, Andrea Russo, Elisabetta Marana, Massimo Antonelli
Effective treatment for many congenital heart diseases diagnosed before birth has become available since the last three decades. Continuous improvements in surgical knowledge and techniques have allowed patients born with severe heart defects to survive through adulthood. However, palliative surgery often implies profound modifications of classical circulatory physiology, which must be taken into account particularly when general anesthesia is needed for major noncardiac surgery. Among the palliative surgeries, Fontan repair is an intervention aiming at excluding the right heart chambers with a total cavopulmonary conduit, which directs blood flow from both inferior and superior vena cavae directly to the right pulmonary artery...
February 2016: Anesthesiology
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