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https://www.readbyqxmd.com/read/29613935/the-use-of-emergency-physicians-to-deliver-anesthesia-for-orthopaedic-surgery-in-austere-environments-the-expansion-of-the-emergency-physician-s-general-anesthesia-syllabus-to-orthopaedic-surgery
#1
Ogedad Pierre, John F Lovejoy, Robert Stanton, Richard Skupski, Harold Previl, Jerry Bernard, Lia Losonczy, Mark Walsh
BACKGROUND: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions...
April 4, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29580599/anesthetists-and-surgeons-predict-postoperative-pain
#2
Selena A Hunter, Rachel Martin, Mark Weatherall, Duncan Galletly
PURPOSE: Nurses, surgeons and anesthetists are responsible for the management of postoperative pain. This study aimed to investigate surgeons', surgical residents', anesthesiologists', and anesthetic residents' predictions of patients' postoperative pain and satisfaction with pain management, compared to patients' postoperative ratings. DESIGN: The bias and limits of agreement between physician and patient ratings of postoperative pain were compared. METHODS: Doctors and patients completed a pain questionnaire (Numeric Rating Scale 11-point) regarding patients' overall pain, worst pain, and dissatisfaction with pain management during the first three days postoperatively...
April 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29548712/dynamic-configuration-scheduling-problem-for-stochastic-medical-resources
#3
Wen-Tso Huang, Ping-Shun Chen, John J Liu, Yi-Ru Chen, Yen-Hsin Chen
Scheduling approaches for conventional surgery operating rooms in a hospital treat surgeons as bottleneck resources directly, but do not deal with stochastic medical resources, leading to an uneven human resource distribution in optimizing medical resource scheduling. Thus, this research focuses on the dynamic configuration scheduling problem for stochastic medical resources. In this paper, the surgical operating room is limited, and the arriving calls (i.e., number of patients) are dynamic. When a patient arrives, the nurse anesthetist and anesthesiologist are limited, but the medical service duration per patient is random...
March 13, 2018: Journal of Biomedical Informatics
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
#4
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/29274837/dedicated-operating-room-teams-and-clinical-outcomes-in-an-enhanced-recovery-after-surgery-pathway-for-colorectal-surgery
#5
Michael C Grant, Andrew Hanna, Andrew Benson, Deborah Hobson, Christopher L Wu, Christina T Yuan, Michael Rosen, Elizabeth C Wick
BACKGROUND: Our aim was to determine whether the establishment of a dedicated operating room team leads to improved process measure compliance and clinical outcomes in an Enhanced Recovery after Surgery (ERAS) program. Enhanced Recovery after Surgery programs involve the application of bundled best practices to improve the value of perioperative care. Successful implementation and sustainment of ERAS programs has been linked to compliance with protocol elements. STUDY DESIGN: Development of dedicated teams of anesthesia providers was a component of ERAS implementation...
March 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29157768/identifying-nurse-anesthetists-professional-identity
#6
Karin Aagaard, Erik Elgaard Sørensen, Bodil Steen Rasmussen, Birgitte Schantz Laursen
PURPOSE: To explore professional identity of registered nurse anesthetists (RNAs) and RNAs' expectations of their professional self and the expectations RNAs meet from interdisciplinary team members when preparing patients for general anesthesia. DESIGN: Focused ethnography was used for data collection. METHODS: Participant observations and interviews were conducted with patients scheduled for surgery and with RNAs in charge of the patients during the anesthetic procedures...
December 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29148326/understanding-professional-jurisdiction-changes-in-the-field-of-anesthesiology
#7
Scott Feyereisen, Joseph P Broschak, Beth Goodrick
We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists' (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs...
January 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29035894/prevalence-of-potentially-distracting-noncare-activities-and-their-effects-on-vigilance-workload-and-nonroutine-events-during-anesthesia-care
#8
Jason M Slagle, Eric S Porterfield, Amanda N Lorinc, David Afshartous, Matthew S Shotwell, Matthew B Weinger
BACKGROUND: When workload is low, anesthesia providers may perform non-patient care activities of a clinical, educational, or personal nature. Data are limited on the incidence or impact of distractions on actual care. We examined the prevalence of self-initiated nonclinical distractions and their effects on anesthesia workload, vigilance, and the occurrence of nonroutine events. METHODS: In 319 qualifying cases in an academic medical center using a Web-based electronic medical chart, a trained observer recorded video and performed behavioral task analysis...
January 2018: Anesthesiology
https://www.readbyqxmd.com/read/28789748/measuring-certified-registered-nurse-anesthetist-organizational-climate-instrument-adaptation
#9
Donald Boyd, Lusine Poghosyan
BACKGROUND AND PURPOSE: No tool exists measuring certified registered nurse anesthetist (CRNA) organizational climate. The study's purpose is to adapt a validated tool to measure CRNA organizational climate. METHODS: Content validity of the Certified Registered Nurse Anesthetist Organizational Climate Questionnaire (CRNA-OCQ) was established. Pilot testing was conducted to determine internal reliability consistency of the subscales. RESULTS: Experts rated the tool as content valid...
August 1, 2017: Journal of Nursing Measurement
https://www.readbyqxmd.com/read/28746222/the-use-of-tenoxicam-to-prevent-symptoms-of-discomfort-induced-by-vagotonia-during-uterus-manipulation-in-cesarean-sections
#10
RANDOMIZED CONTROLLED TRIAL
Shih-Hong Chen, Shiou-Sheng Chen, Ching-Tao Chang, Chi-Hsiang Huang, Shou-Zen Fan, Li-Kuei Chen
PURPOSE: Symptoms such as nausea, vomiting, tightness of the chest, bradycardia, and shoulder or abdominal discomfort, caused by vagotonia occurring during uterus manipulation, have concerned healthcare professionals for some time. Patients sometimes report these symptoms when undergoing spinal anesthesia for cesarean sections (CSs). We designed a prospective, double-blind study to investigate the effectiveness of tenoxicam in preventing these symptoms of discomfort. METHODS: A total of 105 American Society of Anesthesiologists (ASA) class I-II nulliparous pregnant women, who were scheduled for a CS, were enrolled into this prospective, double-blind study...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28688211/reducing-sedation-time-for-thyroplasty-with-arytenoid-adduction-with-sequential-anesthetic-technique
#11
Charles K Saadeh, Eric B Rosero, Girish P Joshi, Esra Ozayar, Ted Mau
OBJECTIVE: To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. STUDY DESIGN: Case-control study. METHODS: A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA...
December 2017: Laryngoscope
https://www.readbyqxmd.com/read/28625457/erratum-to-anesthesiologists-perceptions-of-minimum-acceptable-work-habits-of-nurse-anesthetists-j-clin-anesth-38-2017-107-110
#12
Ilana I Logvinov, Franklin Dexter, Bradley J Hindman, Sorin J Brull
No abstract text is available yet for this article.
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28625430/sensorimotor-and-executive-function-slowing-in-anesthesiology-residents-after-overnight-shifts
#13
George W Williams, Bairavi Shankar, Eliana M Klier, Alice Z Chuang, Salma El Marjiya-Villarreal, Omonele O Nwokolo, Aanchal Sharma, Anne B Sereno
STUDY OBJECTIVE: Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures. DESIGN: A prospective, observational, longitudinal, comparison study was conducted...
August 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28414657/death-by-propofol
#14
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
#15
COMPARATIVE STUDY
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/28322646/operating-room-personnel-viewpoints-about-certified-registered-nurse-anesthetists
#16
Desiree Hensel, Rachel Cooper, Neil Craney
The purpose of this project was to explore what attitudes physicians, nurses, and operating room technicians had about working with Certified Registered Nurse Anesthetists (CRNAs) to better understand practice barriers and facilitators. This Q methodology study used a purposive sample of operating room personnel from four institutions in the Midwestern United States. Participants completed a -4 to +4 rank-ordering of their level of agreement with 34 attitude statements representing a wide range of beliefs about nurse anesthetists...
February 2018: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28306580/comment-on-growth-in-an-anesthesiologist-and-nurse-anesthetist-supervised-sedation-nurse-program-using-propofol-and-dexmedetomidine
#17
Joseph P Cravero, Randall P Flick, Shobha V Malviya
No abstract text is available yet for this article.
June 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28290956/multidisciplinary-in-situ-simulation-based-training-as-a-postpartum-hemorrhage-quality-improvement-project
#18
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/28235524/awake-tracheal-intubation-in-anticipated-difficult-airways-lma-fastrach-vs-flexible-bronchoscope-a-pilot-study
#19
COMPARATIVE STUDY
Sherine F Hanna, Marianne Mikat-Stevens, James Loo, Raj Uppal, W Scott Jellish, Matthew Adams
STUDY OBJECTIVE: To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways. DESIGN: Randomized prospective study. SETTING: Large academic medical center. PATIENTS: Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination. INTERVENTIONS: After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21...
February 2017: Journal of Clinical Anesthesia
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
#20
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
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