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https://www.readbyqxmd.com/read/28414657/death-by-propofol
#1
James H Diaz, Alan David Kaye
Since its introduction in 1986, propofol ( two, 6-diisopropylphenol) , an intravenous sedative-hypnotic agent, has been utilized for the induction and maintenance of general anesthesia and conscious sedation in over 80 percent of cases; largely replacing thiopental ( sodium pentothal) over a decade ago. Unrestricted as a controlled substance, propofol's abuse potential emerged quickly and was highlighted by the death of pop singer, Michael Jackson, in 2009. In order to assess the epidemiological features of fatal propofol abuse, a descriptive analysis of the scientific literature was conducted using Internet search engines...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28372645/anesthesiologists-perceptions-of-minimum-acceptable-work-habits-of-nurse-anesthetists
#2
Ilana I Logvinov, Franklin Dexter, Bradley J Hindman, Sorin J Brull
STUDY OBJECTIVE: Work habits are non-technical skills that are an important part of job performance. Although non-technical skills are usually evaluated on a relative basis (i.e., "grading on a curve"), validity of evaluation on an absolute basis (i.e., "minimum passing score") needs to be determined. DESIGN: Survey and observational study. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS: The theme of "work habits" was assessed using a modification of Dannefer et al...
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
#3
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/28098571/operating-room-anesthesia-subspecialization-is-not-associated-with-significantly-greater-quality-of-supervision-of-anesthesia-residents-and-nurse-anesthetists
#4
Franklin Dexter, Johannes Ledolter, Richard H Epstein, Bradley J Hindman
BACKGROUND: Supervision of anesthesia residents and nurse anesthetists is a major responsibility of faculty anesthesiologists. The quality of their supervision can be assessed quantitatively by the anesthesia residents and nurse anesthetists. Supervision scores are an independent measure of the contribution of the anesthesiologist to patient care. We evaluated the association between quality of supervision and level of specialization of anesthesiologists. METHODS: We used two 6-month periods, one with no feedback to anesthesiologists of the residents' and nurse anesthetists' evaluations, and the other with feedback...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27871514/cost-impact-of-unexpected-disposition-after-orthopedic-ambulatory-surgery-associated-with-category-of-anesthesia-provider
#5
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/27705012/how-patient-controlled-sedation-is-adopted-in-clinical-practice-of-sedation-for-endoscopic-retrograde-cholangiopancreatography-a-prospective-study-of-1196-cases
#6
Jarno Jokelainen, Marianne Udd, Leena Kylänpää, Harri Mustonen, Jorma Halttunen, Outi Lindström, Reino Pöyhiä
OBJECTIVE: Patient-controlled sedation (PCS) has been shown to be a valid choice for sedation during endoscopic retrograde cholangiopancreatography (ERCP) in randomized studies. However, large-scale studies are lacking. MATERIAL AND METHODS: A single center, prospective observational study to determine how sedation for ERCP is administered in clinical setting. All 956 patients undergoing 1196 ERCPs in the endoscopy unit of Helsinki University Central Hospital 2012-2013, methods of sedation and adverse events associated with different sedations were recorded...
February 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/27687466/assessing-electronic-interruptions-experienced-by-an-anesthesiology-clinical-director
#7
Thomas E Schulte, Ellen K Roberts, Kristina Birch, Steven J Lisco
STUDY OBJECTIVE: The purpose of this study was to assess the workflow interruptions on an anesthesiology clinical director (CD). By assessing the interruptions on the CD, we hypothesize that these frequent interruptions would prohibit the CD from medical direction of residents or certified nurse anesthetists in operating rooms. DESIGN: Cellular phone data were obtained from Verizon Wireless statements over 10 months, August 2012 through May 2013. These data were from a single cellular phone carried by the anesthesia CD and subsequent overnight anesthesiologist 24 hours a day...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27542098/precautionary-practices-for-administering-anesthetic-gases-a-survey-of-physician-anesthesiologists-nurse-anesthetists-and-anesthesiologist-assistants
#8
James M Boiano, Andrea L Steege
Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants...
October 2, 2016: Journal of Occupational and Environmental Hygiene
https://www.readbyqxmd.com/read/27372772/endoscopist-directed-propofol
#9
REVIEW
Douglas K Rex
Endoscopist-directed propofol (EDP) refers to delivery of propofol for endoscopic sedation under the direction of an endoscopist without any involvement of an anesthesia specialist (anesthesiologist or nurse anesthetist). EDP has been proven to be safe and is also cost-effective compared with the anesthetist delivered sedation for endoscopy. EDP has been endorsed by US gastroenterology societies as an appropriate paradigm for clinical practice. EDP has proliferated in Switzerland and Germany, but its expansion in the United States has been limited by financial disincentives, concerns about medical-legal risk for endoscopists, and regulatory obstacles...
July 2016: Gastrointestinal Endoscopy Clinics of North America
https://www.readbyqxmd.com/read/27301058/growth-in-an-anesthesiologist-and-nurse-anesthetist-supervised-sedation-nurse-program-using-propofol-and-dexmedetomidine
#10
Joss Thomas, Franklin Dexter, Ruth E Wachtel, Michael M Todd
In 2007, the Department of Anesthesia at the University of Iowa established an anesthesiologist-supervised nurse-managed sedation program. In 2008, the use of propofol and dexmedetomidine by nurses was approved in Iowa. We reviewed 11,038 elective sedation cases done between January 1, 2007, and June 30, 2014. Caseload increased from 170 to 470 cases/quarter. Propofol use increased from 0% to approximately equal to 70% of cases and dexmedetomidine from 0% to approximately equal to 25% of cases. There were no safety issues...
June 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27235960/analysis-of-cricoid-pressure-force-and-technique-among-anesthesiologists-nurse-anesthetists-and-registered-nurses
#11
Melissa Lefave, Brad Harrell, Molly Wright
PURPOSE: The purpose of this project was to assess the ability of anesthesiologists, nurse anesthetists, and registered nurses to correctly identify anatomic landmarks of cricoid pressure and apply the correct amount of force. DESIGN: The project included an educational intervention with one group pretest-post-test design. METHODS: Participants demonstrated cricoid pressure on a laryngotracheal model. After an educational intervention video, participants were asked to repeat cricoid pressure on the model...
June 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/27213547/scope-of-practice-laws-and-anesthesia-complications-no-measurable-impact-of-certified-registered-nurse-anesthetist-expanded-scope-of-practice-on-anesthesia-related-complications
#12
Brighita Negrusa, Paul F Hogan, John T Warner, Caryl H Schroeder, Bo Pang
BACKGROUND: Scope of practice (SOP) laws governing Certified Registered Nurse Anesthetists (CRNAs) vary by state and drive CRNA practice and reimbursement. OBJECTIVE: To test whether the odds of an anesthesia complication vary by SOP and delivery model (CRNA only, anesthesiologist only, or mixed anesthesiologist and CRNAs team). METHODS: Anesthesia claims and related complications were identified in a large commercial payor database, including inpatient and ambulatory settings...
October 2016: Medical Care
https://www.readbyqxmd.com/read/27158297/cme-article-perceptions-of-acupuncture-and-acupressure-by-anesthesia-providers-a-quantitative-descriptive-study
#13
Amanda C Faircloth, Arkadiy Dubovoy, Chuck Biddle, Diane Dodd-McCue, John F Butterworth
Background: Randomized controlled trials show that acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements, and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness but have not yet diffused into mainstream anesthesia practice. To determine why, this study assessed U.S. anesthesia provider's perceptions of acupuncture and acupressure. Methods: After institutional review board approval, 96 anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children's hospitals, and veterans affairs hospitals) were selected for participation in an anonymous, pretested, online survey...
April 1, 2016: Medical Acupuncture
https://www.readbyqxmd.com/read/27007433/-nursing-care-in-the-anesthetic-procedure-an-integrative-review
#14
REVIEW
Cassiane de Santana Lemos, Aparecida de Cassia Giani Peniche
OBJECTIVE: To search for the scientific evidence available on nursing professional actions during the anesthetic procedure. METHOD: An integrative review of articles in Portuguese, English and Spanish, indexed in MEDLINE/PubMed, CINAHL, LILACS, National Cochrane, SciELO databases and the VHL portal. RESULTS: Seven studies were analyzed, showing nurse anesthetists' work in countries such as the United States and parts of Europe, with the formulation of a plan for anesthesia and patient care regarding the verification of materials and intraoperative controls...
February 2016: Revista da Escola de Enfermagem da U S P
https://www.readbyqxmd.com/read/27003489/are-anesthesia-providers-ready-for-hypnosis-anesthesia-providers-attitudes-toward-hypnotherapy
#15
Alexander B Stone, Rosanne Sheinberg, Amanda Bertram, Anastasia Rowland Seymour
This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists...
April 2016: American Journal of Clinical Hypnosis
https://www.readbyqxmd.com/read/26995356/effect-of-anesthesia-staffing-ratio-on-first-case-surgical-start-time
#16
York Chen, Rodney A Gabriel, Bhavani S Kodali, Richard D Urman
On time start of the first case of the day is an important operating room (OR) efficiency metric, in which delays can have effects throughout the day. Although previous studies have identified various causes of first case start delays, none have attempted to evaluate the effect anesthesia staffing ratios have on first case start times. We performed a single-center retrospective analysis at an academic teaching hospital. Data was collected and analyzed over a period of 4 years and on more than 8,700 cases. We examined whether staffing ratios of attending only (solo staffing ratio), attending working with 1 resident/certified registered nurse anesthetist (CRNA) (1 to 1), or attending covering 2 residents/CRNAs (1 to 2) had a significant effect on first patient in room time (FPIR) and first case on time start (FCOTS)...
May 2016: Journal of Medical Systems
https://www.readbyqxmd.com/read/26947712/pulmonary-artery-catheter-use-during-cardiac-surgery-in-the-united-states-2010-to-2014
#17
Ethan Y Brovman, Rodney A Gabriel, Richard P Dutton, Richard D Urman
OBJECTIVES: To examine patterns of use of pulmonary artery catheters in a large cohort of patients undergoing cardiac surgery. DESIGN: A retrospective study with univariate and multivariate logistic regression to identify independent predictors for the utilization of pulmonary artery catheters. SETTING: University, small, medium and large community hospitals participating in the National Anesthesia Clinical Outcomes Registry. PARTICIPANTS: A total of 116,333 patients undergoing pulmonary artery catheter placement during cardiac surgery in the National Anesthesia Clinical Outcomes Registry from the Anesthesia Quality Institute...
June 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/26895523/in-the-united-states-opt-out-states-show-no-increase-in-access-to-anesthesia-services-for-medicare-beneficiaries-compared-with-non-opt-out-states
#18
COMPARATIVE STUDY
Eric C Sun, Thomas R Miller, Nicholas M Halzack
In the United States, anesthesia care can be provided by anesthesiologists or nurse anesthetists. Since 2001, 17 states have exercised their right to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist, with the majority citing increased access to anesthesia care as the rationale for their decision. By using Medicare data, we found that most (4 of 5) cohorts of "opt-out" states likely experienced smaller growth in anesthesia utilization rates compared with non-"opt-out" states, suggesting that opt-out was not associated with an increase in access to anesthesia care...
May 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/26891395/decreasing-the-hours-that-anesthesiologists-and-nurse-anesthetists-work-late-by-making-decisions-to-reduce-the-hours-of-over-utilized-operating-room-time
#19
REVIEW
Franklin Dexter, Ruth E Wachtel, Richard H Epstein
In this special article, we evaluate how to reduce the number of hours that anesthesiologists and nurse anesthetists work beyond the end of their scheduled shifts. We limit consideration to surgical suites where the hours of cases in each operating room (OR) average 8 hours or more per day. Let "allocated hours" refer to the hours into which cases are scheduled, calculated months in advance for each combination of service and day of the week. Over-Utilized time is the OR workload exceeding allocated time. Reducing Over-Utilized time is the key to reducing the hours that anesthesia providers work late...
March 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26625579/geographical-imbalance-of-anesthesia-providers-and-its-impact-on-the-uninsured-and-vulnerable-populations
#20
C Jason Liao, Jihan A Quraishi, Lorraine M Jordan
The purpose of this study was to determine if there is a relationship between socioeconomic factors related to geography and insurance type and the distribution of anesthesia provider type. Using the 2012 Area Resource File, the correlation analyses illustrates county median income is a key factor in distinguishing anesthesia provider distribution. Certified registered nurse anesthetists (CRNAs) correlated with lower-income populations where anesthesiologists correlated with higher-income populations. Furthermore, CRNAs correlated more with vulnerable populations such as the Medicaid-eligible population, uninsured population, and the unemployed...
September 2015: Nursing Economic$
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