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Effect of Apneic Oxygenation on Tracheal Oxygen Levels, Tracheal Pressure, and Carbon Dioxide Accumulation: A Randomized, Controlled Trial of Buccal Oxygen Administration | BACKGROUND: Apneic oxygenation via the oral route using a buccal device extends the safe apnea time in most but not all obese patients. Apneic oxygenation techniques are most effective when tracheal oxygen concentrations are maintained >90%. It remains unclear whether buccal oxygen administration consistently achiev... |
Pediatric anesthesiology fellows' perception of quality of attending supervision and medical errors | Background: Appropriate supervision has been shown to reduce medical errors in anesthesiology residents and other trainees across various specialties. Nonetheless, supervision of pediatric anesthesiology fellows has yet to be evaluated. The main objective of this survey investigation was to evaluate supervision of pedi... |
Regional anesthesia for vascular access surgery | BACKGROUND: Approximately 25% of initial arteriovenous fistula (AVF) placementswill fail as a result of thrombosis or failure to develop adequate vessel size andblood flow. Fistula maturation is impacted by patient characteristics and surgicaltechnique, but both increased vein diameter and high fistula blood flow rates... |
Effect of a Rapid Response Team on the Incidence of In-Hospital Mortality | BACKGROUND: Approximately half of the life-limiting events, such as cardiopulmonary arrests or cardiac arrhythmias occurring in hospitals, are considered preventable. These critical events are usually preceded by clinical deterioration. Rapid response teams (RRTs) were introduced to intervene early in the course of cli... |
Research, education, and nonclinical service productivity of new junior anesthesia faculty during a 2-year faculty development program | BACKGROUND: As a specialty, anesthesiology has relatively low research productivity. Prior studies indicate that junior faculty development programs favorably affect academic performance. We therefore initiated a junior faculty development program and hypothesized that most (>50%) new junior faculty would take <50 nonc... |
National pediatric anesthesia safety quality improvement program in the United States | BACKGROUND: As pediatric anesthesia has become safer over the years, it is difficult to quantify these safety advances at any 1 institution. Safety analytics (SA) and quality improvement (QI) are used to study and achieve high levels of safety in nonhealth care industries. We describe the development of a multiinstitut... |
Understanding the Economic Impact of an Essential Service: Applying Time-Driven Activity-Based Costing to the Hospital Airway Response Team | BACKGROUND: As the United States moves toward value-based care metrics, it will become essential for anesthesia groups nationwide to understand the costs of their services. Time-driven activity-based costing (TDABC) estimates the amount of time it takes to perform a clinical activity by dividing complex tasks into proc... |
Trainability of Cricoid Pressure Force Application: A Simulation-Based Study | BACKGROUND: Aspiration of gastric contents is a leading cause of airway management–related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousne... |
Fluid challenge during anesthesia: A systematic review and meta-analysis | BACKGROUND: Assessing the volemic status of patients undergoing surgery is part of the routine management for the anesthesiologist. This assessment is commonly performed by means of dynamic indexes based on the cardiopulmonary interaction during mechanical ventilation (if available) or by administering a fluid challeng... |
Reliability and validity of the anesthesiologist supervision instrument when certified registered nurse anesthetists provide scores | BACKGROUND: At many facilities in the United States, supervision of Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of anesthesiologists. We use the term "supervision" to include clinical oversight functions directed toward assuring the quality of clinical care whenever the anesthesiolog... |
Lack of sensitivity of staffing for 8-hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues | BACKGROUND: At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeo... |
Changes in utilization of intraoperative laboratory testing associated with the introduction of point-of-care testing devices in an academic department | BACKGROUND: Availability of point-of-care testing (POCT) technology may lead to unnecessary testing and expense without improving outcomes. We tested the hypothesis that frequency of intraoperative blood testing (IBT) would increase in association with installation of POCT devices in our surgical suites. METHODS: We pe... |
Head-elevated patient positioning decreases complications of emergent tracheal intubation in the ward and intensive care unit | BACKGROUND: Based on the data from elective surgical patients, positioning patients in a back-up head-elevated position for preoxygenation and tracheal intubation can improve patient safety. However, data specific to the emergent setting are lacking. We hypothesized that back-up head-elevated positioning would be assoc... |
Analysis of production, impact, and scientific collaboration on difficult airway through the web of science and scopus (1981-2013) | BACKGROUND: Bibliometrics, the statistical analysis of written publications, is an increasingly popular approach to the assessment of scientific activity. Bibliometrics allows researchers to assess the impact of a field, or research area, and has been used to make decisions regarding research funding. Through bibliomet... |
Newborn resuscitation skills in health care providers at a zambian tertiary center, and comparison to world health organization standards | BACKGROUND: Birth asphyxia is a leading cause of early neonatal death. In 2013, 32% of neonatal deaths in Zambia were attributable to birth asphyxia and trauma. Basic, timely interventions are key to improving outcomes. However, data from the World Health Organization suggest that resuscitation is often not initiated, ... |
Open Reimplementation of the BIS Algorithms for Depth of Anesthesia | BACKGROUND: BIS (a brand of processed electroencephalogram [EEG] depth-of-anesthesia monitor) scores have become interwoven into clinical anesthesia care and research. Yet, the algorithms used by such monitors remain proprietary. We do not actually know what we are measuring. If we knew, we could better understand the ... |
Do technical skills correlate with non-technical skills in crisis resource management: A simulation study | Background: Both technical skills (TS) and non-technical skills (NTS) are key to ensuring patient safety in acute care practice and effective crisis management. These skills are often taught and assessed separately. We hypothesized that TS and NTS are not independent of each other, and we aimed to evaluate the relation... |
A survey evaluating burnout, health status, depression, reported alcohol and substance use, and social support of anesthesiologists | BACKGROUND: Burnout affects all medical specialists, and concern about it has become common in today's health care environment. The gold standard of burnout measurement in health care professionals is the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which measures emotional exhaustion, depersonalization (... |
Defining excellence in anaesthesia: the role of personal qualities and practice environment | Background: Calls for reform to postgraduate medical training structures in the UK have included suggestions that training should foster excellence and not simply ensure competence. Methods: We conducted a modified Delphi-type survey starting with an e-mail request to specialist anaesthetists involved in education, ask... |
Trends in central venous catheter insertions by Anesthesia providers: An analysis of the medicare physician supplier procedure summary from 2007 to 2016 | BACKGROUND: Central line insertion is a core skill for anesthesiologists. Although recent technical advances have increased the safety of central line insertion and reduced the risk of central line-associated infection, noninvasive hemodynamic monitoring and improved intravenous access techniques have also reduced the ... |
South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients | Background: Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-in... |
Discrepancies between randomized controlled trial registry entries and content of corresponding manuscripts reported in anesthesiology journals | BACKGROUND: Clinical trial registries have been created to reduce reporting bias. Study registration enables the examination of discrepancies between the original study design and the final results reported in the literature. The main objective of the current investigation is to compare the original clinical trial regi... |
Closed-loop fluid administration compared to anesthesiologist management for hemodynamic optimization and resuscitation during surgery: An in vivo study | BACKGROUND: Closed-loop systems have been designed to assist practitioners in maintaining stability of various physiologic variables in the clinical setting. In this context, we recently performed in silico testing of a novel closed-loop fluid management system that is designed for cardiac output and pulse pressure var... |
The Current State of Combined Pediatric Anesthesiology-Critical Care Practice: A Survey of Dual-Trained Practitioners in the United States | Background: Combined practice in pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM) was historically common but has declined markedly with time. The reasons for this temporal shift are unclear, but existing evidence suggests that length of training is a barrier to contemporary trainees. Among cur... |
Defining competence in obstetric epidural anaesthesia for inexperienced trainees | Background: Cumulative sum (CUSUM) analysis has been used for assessing competence of trainees learning new technical skills. One of its disadvantages is the required definition of acceptable and unacceptable success rates. We therefore monitored the development of competence amongst trainees new to obstetric epidural ... |
A Comparison of Measurements of Change in Respiratory Status in Spontaneously Breathing Volunteers by the ExSpiron Noninvasive Respiratory Volume Monitor Versus the Capnostream Capnometer | BACKGROUND: Current respiratory monitoring technologies such as pulse oximetry and capnography have been insufficient to identify early signs of respiratory compromise in nonintubated patients. Pulse oximetry, when used appropriately, will alert the caregiver to an episode of dangerous hypoxemia. However, desaturation ... |
Development of education and research in anesthesia and intensive care medicine at the university teaching hospital in Lusaka, Zambia: A descriptive observational study | BACKGROUND: Data from 2006 show that the practice of anesthesia at the University Teaching Hospital in Lusaka, Zambia was underdeveloped by international standards. Not only was there inadequate provision of resources related to environment, equipment, and drugs, but also a severe shortage of staff, with no local capab... |
An international survey of airway management education in 61 countries† | Background: Deficiencies in airway management skills and judgement contribute to poor outcomes. Airway management practice guidelines emphasise the importance of education. Little is known about the global uptake of guidelines, availability of equipment, provision of training, assessment of skills, and confidence with ... |
Enhancing Feedback on Professionalism and Communication Skills in Anesthesia Residency Programs | BACKGROUND: Despite its importance, training faculty to provide feedback to residents remains challenging. We hypothesized that, overall, at 4 institutions, a faculty development program on providing feedback on professionalism and communication skills would lead to (1) an improvement in the quantity, quality, and util... |
Do You Really Mean It? Assessing the Strength, Frequency, and Reliability of Applicant Commitment Statements during the Anesthesiology Residency Match | BACKGROUND: Despite the critical nature of the residency interview process, few metrics have been shown to adequately predict applicant success in matching to a given program. While evaluating and ranking potential candidates, bias can occur when applicants make commitment statements to a program. Survey data show that... |
Nationwide Clinical Practice Patterns of Anesthesiology Critical Care Physicians: A Survey to Members of the Society of Critical Care Anesthesiologists | BACKGROUND: Despite the growing contributions of critical care anesthesiologists to clinical practice, research, and administrative leadership of intensive care units (ICUs), relatively little is known about the subspecialty-specific clinical practice environment. An understanding of contemporary clinical practice is e... |
A Contemporary Analysis of Medicolegal Issues in Obstetric Anesthesia between 2005 and 2015 | BACKGROUND: Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among cont... |
Developing a Real-Time Electroencephalogram-Guided Anesthesia-Management Curriculum for Educating Residents: A Single-Center Randomized Controlled Trial | BACKGROUND: Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time series data and the corresponding spectral information for intraoperative anesthetic titration, or what effect this might have on outcomes. MET... |
Distraction and interruption in anaesthetic practice | Background: Distractions are a potential threat to patient safety. Previous research has focused on parts of the anaesthetic process but not on entire cases, and has focused on hazards rather than existing defences against error. Methods: We observed anaesthetists at work in the operating theatre and quantified and cla... |
Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions | BACKGROUND: Drug diversion in the operating room (OR) by anesthesia providers is a recognized problem with significant morbidity and mortality. Use of anesthesia drug dispensing systems in ORs, coupled with the presence of anesthesia or OR information management systems, may allow detection through database queries scr... |
Evaluating the requirements of electroencephalograph instruction for anesthesiology residents | BACKGROUND: During a 1-mo neurosurgical intensive care unit rotation, anesthesiology residents interpret electroencephalograms (EEGs) performed throughout the institution, including intraoperative EEGs. The curriculum goal is to increase familiarity with EEG use and interpretation with 20 EEG interpretations with a cli... |
Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation? | BACKGROUND: During mechanical ventilation of infants and neonates, small changes in tidal volume may lead to hypo- or hyperventilation, barotrauma, or volutrauma. Partly because breathing circuit compliance and fresh gas flow affect tidal volume delivery by traditional anesthesia ventilators in volume-controlled ventil... |
Training novice anaesthesiology trainees to speak up for patient safety | Background: Effectively communicating patient safety concerns in the operating theatre is crucial, but novice trainees often struggle to develop effective speaking up behaviour. Our primary objective was to test whether repeated simulation-based practice helps trainees speak up about patient management concerns. We als... |
Evaluation of a mandatory quality assurance data capture in anesthesia: A secure electronic system to capture quality assurance information linked to an automated anesthesia record | BACKGROUND: Efforts to assure high-quality, safe, clinical care depend upon capturing information about near-miss and adverse outcome events. Inconsistent or unreliable information capture, especially for infrequent events, compromises attempts to analyze events in quantitative terms, understand their implications, and... |
The reliability and accuracy of a noncontact electrocardiograph system for screening purposes | BACKGROUND: Electrocardiography (ECG) requires the application of electrodes to the skin and often necessitates undressing. Capacitively coupled electrodes embedded in a normal chair would be a rational alternative for ECG screening. We evaluated the reliability and accuracy of ECG electrodes imbedded in a chair cushio... |
Practical training of anesthesia clinicians in electroencephalogram-based determination of hypnotic depth of general anesthesia | BACKGROUND: Electroencephalographic (EEG) brain monitoring during general anesthesia provides information on hypnotic depth. We hypothesized that anesthesia clinicians could be trained rapidly to recognize typical EEG waveforms occurring with volatile-based general anesthesia. METHODS: This was a substudy of a trial te... |
The success of emergency endotracheal intubation in trauma patients: A 10-year experience at a major adult trauma referral center | BACKGROUND: Emergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission. METHODS: We examined Trauma Registry, quality management, and billing system rec... |
Trends in perioperative practice and resource utilization in patients with obstructive sleep apnea undergoing joint arthroplasty | BACKGROUND: Emerging evidence associating obstructive sleep apnea (OSA) with adverse perioperative outcomes has recently heightened the level of awareness among perioperative physicians. In particular, estimates projecting the high prevalence of this condition in the surgical population highlight the necessity of the d... |
The Dynamics of Enterococcus Transmission from Bacterial Reservoirs Commonly Encountered by Anesthesia Providers | BACKGROUND: Enterococci, the second leading cause of health care-associated infections, have evolved from commensal and harmless organisms to multidrug-resistant bacteria associated with a significant increase in patient morbidity and mortality. Prevention of ongoing spread of this organism within and between hospitals... |
Agreement between trainees and supervisors on first-year entrustable professional activities for anaesthesia training | Background: Entrustable professional activities (EPAs) are commonly developed by senior clinicians and education experts. However, if postgraduate training is conceptualised as an educational alliance, the perspective of trainees should be included. This raises the question as to whether the views of trainees and super... |
A randomized trial comparing the effect of fiberoptic selection and guidance versus random selection, blind insertion, and direct laryngoscopy, on the incidence and severity of epistaxis after nasotracheal intubation | BACKGROUND: Epistaxis, or nasal bleeding, is a common complication after nasotracheal intubation (NTI). Because such bleeding is likely related to trauma during intubation, use of fiberoptic visualization and guidance rather than direct laryngoscopy may affect the incidence and severity of epistaxis. We compared the in... |
Adherence to the European Society of Cardiology/European Society of Anaesthesiology recommendations on preoperative cardiac testing and association with positive results and cardiac events: a cohort study | Background: European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines inform cardiac workup before noncardiac surgery based on an algorithm. Our primary hypotheses were that there would be associations between (i) the groups stratified according to the algorithms and major adverse cardiac ... |
A comparison of plaintiff and defense expert witness qualifications in malpractice litigation in anesthesiology | BACKGROUND: Expert witnesses serve a crucial role in the medicolegal system, interpreting evidence so that it can be understood by jurors. Guidelines have been established by both the legal community and professional medical societies detailing the expectations of expert witnesses. The primary objective of this analysi... |
Anesthesia residents' global (Departmental) evaluation of faculty anesthesiologists' supervision can be less than their average evaluations of individual anesthesiologists | BACKGROUND: Faculty anesthesiologists' supervision of anesthesiology residents is required for both postgraduate medical education and billing compliance. Previously, using the de Oliveira Filho et al. supervision question set, De Oliveira et al. found that residents who reported mean department-wide supervision scores... |
Risk factors associated with fast-track ineligibility after monitored anesthesia care in ambulatory surgery patients | BACKGROUND: Fast-tracking after ambulatory anesthesia has been advocated as a pathway to improve efficiency and maximize resources without compromising patient safety and satisfaction. Studies reporting successful fast-tracking focus primarily on anesthesia techniques and not on specific patient factors, surgical proce... |
A bibliometric analysis of global clinical research by anesthesia departments | BACKGROUND: Few studies have investigated the diversity in research conducted by anesthesia-based researchers. We examined global clinical research attributed to anesthesia departments using Medline® and Ovid® databases. We also investigated the impact of economic development on national academic productivity. METHODS:... |
Use of survey and delphi process to understand trauma anesthesia care practices | BACKGROUND: Few trauma guidelines evaluate and recommend anesthesiology practices and there are no trauma anesthesia-specific guidelines. There is no information on how anesthesiologists perceive clinical practice patterns. Our objective was to understand the perceptions of anesthesiologists regarding trauma anesthesia... |
Determination of Geolocations for Anesthesia Specialty Coverage and Standby Call Allowing Return to the Hospital Within a Specified Amount of Time | BACKGROUND: For emergent procedures, in-house teams are required for immediate patient care. However, for many procedures, there is time to bring in a call team from home without increasing patient morbidity. Anesthesia providers taking subspecialty or backup call from home are required to return to the hospital within... |
Modeling procedure and surgical times for current procedural terminology-anesthesia-surgeon combinations and evaluation in terms of case-duration prediction and operating room efficiency: A multicenter study | BACKGROUND: Gains in operating room (OR) scheduling may be obtained by using accurate statistical models to predict surgical and procedure times. The 3 main contributions of this article are the following: (i) the validation of Strum's results on the statistical distribution of case durations, including surgeon effects... |
Status of Women in Academic Anesthesiology: A 10-Year Update | BACKGROUND: Gender inequity is still prevalent in today’s medical workforce. Previous studies have investigated the status of women in academic anesthesiology. The objective of this study is to provide a current update on the status of women in academic anesthesiology. We hypothesized that while the number of women in ... |
Preclinical Proficiency-Based Model of Ultrasound Training | BACKGROUND: Graduate medical education is being transformed from a time-based training model to a competency-based training model. While the application of ultrasound in the perioperative arena has become an expected skill set for anesthesiologists, clinical exposure during training is intermittent and nongraduated wit... |
Transmission Dynamics of Gram-Negative Bacterial Pathogens in the Anesthesia Work Area | BACKGROUND: Gram-negative organisms are a major health care concern with increasing prevalence of infection and community spread. Our primary aim was to characterize the transmission dynamics of frequently encountered gram-negative bacteria in the anesthesia work area environment (AWE). Our secondary aim was to examine... |
Monitoring with head-mounted displays: Performance and safety in a full-scale simulator and part-task trainer | BACKGROUND: Head-mounted displays (HMDs) can help anesthesiologists with intraoperative monitoring by keeping patients' vital signs within view at all times, even while the anesthesiologist is busy performing procedures or unable to see the monitor. The anesthesia literature suggests that there are advantages of HMD us... |
Staffing With Disease-Based Epidemiologic Indices May Reduce Shortage of Intensive Care Unit Staff During the COVID-19 Pandemic | BACKGROUND: Health care worker (HCW) safety is of pivotal importance during a pandemic such as coronavirus disease 2019 (COVID-19), and employee health and well-being ensure functionality of health care institutions. This is particularly true for an intensive care unit (ICU), where highly specialized staff cannot be re... |
Hand Hygiene Knowledge and Perceptions among Anesthesia Providers | BACKGROUND: Health care worker compliance with hand hygiene guidelines is an important measure for health care-associated infection prevention, yet overall compliance across all health care arenas remains low. A correct answer to 4 of 4 structured questions pertaining to indications for hand decontamination (according ... |
Health Numeracy and Relative Risk Comprehension in Perioperative Patients and Physicians | BACKGROUND: Helping patients to understand relative risks is challenging. In discussions with patients, physicians often use numbers to describe hazards, make comparisons, and establish relevance. Patients with a poor understanding of numbers-poor "health numeracy"-also have difficulty making decisions and coping with ... |
Using Machine Learning to Evaluate Attending Feedback on Resident Performance | BACKGROUND: High-quality and high-utility feedback allows for the development of improvement plans for trainees. The current manual assessment of the quality of this feedback is time consuming and subjective. We propose the use of machine learning to rapidly distinguish the quality of attending feedback on resident per... |
Association between anesthesiology volumes and early and late outcomes after cystectomy for bladder cancer: A population-based study | BACKGROUND: Hospital and surgeon volume are related to postoperative complications and long-term survival after radical cystectomy. Here, we describe the relationships between these provider characteristics and anesthesiologist volumes on early and late outcomes after radical cystectomy for bladder cancer. METHODS: Rec... |
Implications of resolved hypoxemia on the utility of desaturation alerts sent from an anesthesia decision support system to supervising anesthesiologists | Background: Hypoxemia (oxygen saturation <90%) lasting 2 or more minutes occurs in 6.8% of adult patients undergoing noncardiac anesthesia in operating room settings. Alarm management functionality can be added to decision support systems (DSS) to send text alerts about vital signs outside specified thresholds, usin... |
Anesthesiologist staffing considerations consequent to the temporal distribution of hypoxemic episodes in the Postanesthesia care unit | BACKGROUND: Hypoxemia, as measured by pulse oximetry (Spo2), is common in postanesthesia care unit (PACU) patients. The temporal distribution of desaturation has managerial implications because treatment may necessitate the presence of an anesthesiologist.METHODS: We retrieved Spo2 values recorded electronically every ... |
The role of the anesthesiologist in fast-track surgery: From multimodal analgesia to perioperative medical care | BACKGROUND: Improving perioperative efficiency and throughput has become increasingly important in the modern practice of anesthesiology. Fast-track surgery represents a multidisciplinary approach to improving perioperative efficiency by facilitating recovery after both minor (i.e., outpatient) and major (inpatient) su... |
Progressive Increase in Scholarly Productivity of New American Board of Anesthesiology Diplomates From 2006 to 2016: A Bibliometric Analysis | BACKGROUND: Improving research productivity is a common goal in academic anesthesiology. Initiatives to enhance scholarly productivity in anesthesiology were proposed more than a decade ago as a result of emphasis on clinical work. We hypothesized that American Board of Anesthesiology diplomates certified from 2006 to ... |
Academic anesthesiology career development: A mixed-methods evaluation of the role of foundation for anesthesiology education and research funding | BACKGROUND: In 1986, the American Society of Anesthesiologists created the Foundation for Anesthesiology Education and Research (FAER) to fund young anesthesiology investigators toward the goal of helping launch their academic careers. Determining the impact of the FAER grant program has been of importance. METHODS: Th... |
Advanced auditory displays and head-mounted displays: Advantages and disadvantages for monitoring by the distracted anesthesiologist | BACKGROUND: In a full-scale anesthesia simulator study we examined the relative effectiveness of advanced auditory displays for respiratory and blood pressure monitoring and of head-mounted displays (HMDs) as supplements to standard intraoperative monitoring. METHODS: Participants were 16 residents and attendings. Whil... |
Validation of the Lusaka Formula: A Novel Formula for Weight Estimation in Children Presenting for Surgery in Zambia | BACKGROUND: In children, the use of actual weight or predicted weight from various estimation methods is essential to reduce harm associated with dosing errors. This study aimed to validate the new locally derived Lusaka formula on an independent cohort of children undergoing surgery at the University Teaching Hospital... |
An Analysis of Substandard Propofol Detected in Use in Zambian Anesthesia | BACKGROUND: In early 2015, clinicians throughout Zambia noted a range of unpredictable adverse events after the administration of propofol, including urticaria, bronchospasm, profound hypotension, and most predictably an inadequate depth of anesthesia. Suspecting that the propofol itself may have been substandard, samp... |
Association between Participation and Performance in MOCA Minute and Actions Against the Medical Licenses of Anesthesiologists | BACKGROUND: In January 2016, as part of the Maintenance of Certification in Anesthesiology (MOCA) program, the American Board of Anesthesiology launched MOCA Minute, a web-based longitudinal assessment, to supplant the former cognitive examination. We investigated the association between participation and performance i... |
Work Habits Are Valid Components of Evaluations of Anesthesia Residents Based on Faculty Anesthesiologists' Daily Written Comments about Residents | Background: In our department, faculty anesthesiologists routinely evaluate the resident physicians with whom they worked in an operative setting the day before, providing numerical scores to questions. The faculty can also enter a written comment if so desired. Because residents' work habits are important to anesthesi... |
Characteristics of emergency pages using a computer-based anesthesiology paging system in children and adults undergoing procedures at a tertiary care medical center | BACKGROUND: In our large academic supervisory practice, attending anesthesiologists concomitantly care for multiple patients. To manage communications within the procedural environment, we use a proprietary electronic computer-based anesthesiology visual paging system. This system can send an emergency page that instan... |
Anesthesiologists' Overconfidence in Their Perceived Knowledge of Neuromuscular Monitoring and Its Relevance to All Aspects of Medical Practice: An International Survey | BACKGROUND: In patients who receive a nondepolarizing neuromuscular blocking drug (NMBD) during anesthesia, undetected postoperative residual neuromuscular block is a common occurrence that carries a risk of potentially serious adverse events, particularly postoperative pulmonary complications. There is abundant eviden... |
Desire paths for workplace assessment in postgraduate anaesthesia training: analysing informal processes to inform assessment redesign | Background: In postgraduate specialist training, workplace assessments are expected to provide the information required for decisions on trainee progression. Research suggests that meeting this expectation can be difficult in practice, which has led to the development of informal processes, or ‘shadow systems’ of asses... |
Automated responsiveness monitor to titrate propofol sedation | BACKGROUND: In previous studies, we showed that failure to respond to automated responsiveness monitor (ARM) precedes potentially serious sedationrelated adversities associated with loss of responsiveness, and that the ARM was not susceptible to false-positive responses. It remains unknown, however, whether loss and re... |
Decreased parasympathetic activity of heart rate variability during anticipation of night duty in anesthesiology residents | BACKGROUND: In residency programs, it is well known that autonomic regulation is influenced by night duty due to workload stress and sleep deprivation. A less investigated question is the impact on the autonomic nervous system of residents before or when anticipating a night duty shift. In this study, heart rate variab... |
Emergency Department Airway Management Responsibilities in the United States | BACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room. METHODS: A survey was sent via the Eastern Assoc... |
Nighttime extubation does not increase risk of reintubation, length of stay, or mortality: Experience of a large, urban, teaching hospital | BACKGROUND: In the intensive care unit (ICU), extubation failure has been associated with greater resource utilization and worsened clinical outcomes. Most recently, nighttime extubation (NTE) has been reported as a risk factor for increased ICU and hospital mortality. We hypothesized that, in a large, urban, universit... |
Five-year follow-up on the work force and finances of United States anesthesiology training programs: 2000 to 2005 | BACKGROUND: In the middle 1990s, there was a decrease in anesthesiology residency class sizes, which contributed to a nationwide shortage of anesthesiologists, resulting in a competitive market with increased salary demands. In 1999, a nationwide survey of the financial status of United States anesthesiology training p... |
Default drug doses in anesthesia information management systems | BACKGROUND: In the United States, anesthesia information management systems (AIMS) are well established, especially within academic practices. Many hospitals are replacing their stand-alone AIMS during migration to an enterprise-wide electronic health record. This presents an opportunity to review choices made during t... |
Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block | Background: In this study, we performed the infraclavicular block with combined ultrasound guidance and neurostimulation to selectively target cords to compare the success rates of placing a single injection of local anesthetic either in a central or peripheral location. Methods: Two hundred eighteen patients were enro... |
Multicenter study validating accuracy of a continuous respiratory rate measurement derived from pulse oximetry: A comparison with capnography | Background: Intermittent measurement of respiratory rate via observation is routine in many patient care settings. This approach has several inherent limitations that diminish the clinical utility of these measurements because it is intermittent, susceptible to human error, and requires clinical resources. As an altern... |
A novel skin-traction method is effective for real-time ultrasound-guided internal jugular vein catheterization in infants and neonates weighing less than 5 kilograms | BACKGROUND: Internal jugular vein (IJV) catheterization in pediatric patients is sometimes difficult because of the small sizes of veins and their collapse during catheterization. To facilitate IJV catheterization, we developed a novel skin-traction method (STM), in which the point of puncture of the skin over the IJV ... |
Assessment of Anesthesia Capacity in Public Surgical Hospitals in Guatemala | BACKGROUND: International standards for safe anesthetic care have been developed by the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO). Whether these standards are met is unknown in many nations, including Guatemala, a country with universal health coverage. We aimed ... |
Effect of Hypotension Prediction Index-guided intraoperative haemodynamic care on depth and duration of postoperative hypotension: a sub-study of the Hypotension Prediction trial | Background: Intraoperative and postoperative hypotension are associated with morbidity and mortality. The Hypotension Prediction (HYPE) trial showed that the Hypotension Prediction Index (HPI) reduced the depth and duration of intraoperative hypotension (IOH), without excess use of intravenous fluid, vasopressor, and/o... |
Management of anesthesia equipment failure: A simulation-based resident skill assessment | BACKGROUND: Intraoperative anesthesia equipment failures are a cause of anesthetic morbidity. Our purpose in this study was 1) to design a set of simulated scenarios that measure skill in managing intraoperative equipment-related errors and 2) to evaluate the reliability and validity of the measures from this multiple ... |
A novel classification instrument for intraoperative awareness events | Background: Intraoperative awareness with explicit recall occurs in approximately 1-2 cases per 1000. Given the rarity of the event, a better understanding of awareness and its sequelae will likely require the compilation of data from numerous studies. As such, a standard description and expression of awareness events ... |
A randomized trial of continuous noninvasive blood pressure monitoring during noncardiac surgery | BACKGROUND: Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraope... |
Development and Evaluation of a Risk-Adjusted Measure of Intraoperative Hypotension in Patients Having Nonemergent, Noncardiac Surgery | BACKGROUND: Intraoperative hypotension is common and associated with organ injury and death, although randomized data showing a causal relationship remain sparse. A risk-adjusted measure of intraoperative hypotension may therefore contribute to quality improvement efforts. METHODS: The measure we developed defines hypo... |
Multiple reservoirs contribute to intraoperative bacterial transmission | Background: Intraoperative stopcock contamination is a frequent event associated with increased patient mortality. In the current study we examined the relative contributions of anesthesia provider hands, the patient, and the patient environment to stopcock contamination. Our secondary aims were to identify risk factor... |
Nasogastric tube insertion using different techniques in anesthetized patients: A prospective, randomized study | BACKGROUND: It is often difficult to correctly place nasogastric (NG) tubes under anesthesia. We hypothesized that simple modifications in technique of NG tube insertion will improve the success rate. METHODS: Two hundred patients were enrolled into the study. The patients were randomized into four groups: control, gui... |
Clinical performance scores are independently associated with the American board of anesthesiology certification examination scores | BACKGROUND: It is unknown whether clinical performance during residency is related to the American Board of Anesthesiology (ABA) oral examination scores. We hypothesized that resident clinical performance would be independently associated with oral examination performance because the oral examination is designed to tes... |
The association between timing of routine preoperative blood testing and a composite of 30-day postoperative morbidity and mortality | BACKGROUND: Laboratory testing is a common component of preanesthesia evaluation and is designed to identify medical abnormalities that might otherwise remain undetected. While blood testing might optimally be performed shortly before surgery, it is often done earlier for practical reasons. We tested the hypothesis tha... |
Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings | BACKGROUND: Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST)... |
Availability of lipid emulsion in united states obstetric units | BACKGROUND: Lipid emulsion is recommended in the guidelines for the management of local anesthetic systemic toxicity. In this study, we sought to identify the current level of lipid emulsion availability in U.S. obstetric units. METHODS:: A survey was developed addressing lipid emulsion availability and sent to U.S. ob... |
The Epidemiology of Staphylococcus aureus Transmission in the Anesthesia Work Area | BACKGROUND: Little is known regarding the epidemiology of intraoperative Staphylococcus aureus transmission. The primary aim of this study was to examine the mode of transmission, reservoir of origin, transmission locations, and antibiotic susceptibility for frequently encountered S aureus strains (phenotypes) in the a... |
A Comparison of Web-Based with Traditional Classroom-Based Training of Lung Ultrasound for the Exclusion of Pneumothorax | BACKGROUND: Lung ultrasound (LUS) is a well-established method that can exclude pneumothorax by demonstration of pleural sliding and the associated ultrasound artifacts. The positive diagnosis of pneumothorax is more difficult to obtain and relies on detection of the edge of a pneumothorax, called the "lung point." Yet... |
Comparison of a novel cadaver model (Fix for Life) with the formalin-fixed cadaver and manikin model for suitability and realism in airway management training | BACKGROUND: Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facema... |
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