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A system for anesthesia drug administration using barcode technology: The codonics safe label system and smart anesthesia manager™ | BACKGROUND: Many anesthetic drug errors result from vial or syringe swaps. Scanning the barcodes on vials before drug preparation, creating syringe labels that include barcodes, and scanning the syringe label barcodes before drug administration may help to prevent errors. In contrast, making syringe labels by hand that... |
Development and pilot testing of a context-relevant safe anesthesia checklist for cesarean delivery in East Africa | BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive... |
Supervising Anesthesiologists Cannot Be Effectively Compared According to Their Patients' Postanesthesia Care Unit Admission Pain Scores | BACKGROUND: Measurement of postoperative pain scores on arrival to the postanesthesia care unit (PACU) is a potential quality metric for supervising anesthesiologists. Our goal in this study was to determine whether rank-ordering by initial PACU numeric rating scale (NRS) pain score, as collected by nurses in a nonrese... |
Controlling Anesthesia Hardware With Simple Hand Gestures: Thumbs Up or Thumbs Down? | BACKGROUND: Modern consumer electronic devices and automobiles are often controlled by interfaces that sense physical gestures and spoken commands. In contrast, patient monitors and anesthesia devices are typically equipped with panel-mounted buttons, dials, and keyboards. The increased use of noncontact gesture-based ... |
Development and Pilot Testing of Entrustable Professional Activities for US Anesthesiology Residency Training | BACKGROUND: Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable profe... |
Is There Evidence for Systematic Upcoding of ASA Physical Status Coincident with Payer Incentives? A Regression Discontinuity Analysis of the National Anesthesia Clinical Outcomes Registry | BACKGROUND: Modifications in physician billing patterns have been shown to occur in response to payer incentives, but the phenomenon remains largely unexplored in billing for anesthesia services. Within the field of anesthesiology, Medicare's policy not to provide additional reimbursement for higher ASA physical status... |
Anesthesia Infrastructure and Resources in Bangladesh | BACKGROUND: Monitoring improvements in nationwide anesthesia capacity over time is critical to ensuring that population anesthesia needs are being met and identifying areas for targeted health systems interventions. Anesthesia resources in Bangladesh were previously measured using a cross-sectional nationwide hospital-... |
Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients | BACKGROUND: Morbid obesity (MO), obstructive sleep apnea (OSA), and neck circumference (NC) are widely believed to be independent risk factors for difficult tracheal intubation. In this study, we sought to determine whether these factors were associated with increased risk of difficult intubation in patients undergoing... |
Numbers of simultaneous turnovers calculated from anesthesia or operating room information management system data | BACKGROUND: More personnel are needed to turn over operating rooms (ORs) promptly when there are more simultaneous turnovers. Anesthesia and/or OR information management system data can be analyzed statistically to quantify simultaneous turnovers to evaluate whether to add an additional turnover team. METHODS: Data col... |
A case series of the anesthetic management of parturients with surgically repaired tetralogy of fallot | BACKGROUND: Most case reports of pregnancies after surgical repair of tetralogy of Fallot have focused on cardiovascular and obstetric concerns, with relatively few authors focusing on specific intrapartum and postpartum anesthetic management strategies. METHODS: The Mayo Clinic Congenital Heart Disease Clinic and the ... |
Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests | BACKGROUND: Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing an... |
Assessment Scores of a Mock Objective Structured Clinical Examination Administered to 99 Anesthesiology Residents at 8 Institutions | BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are used in a variety of high-stakes examinations. The primary goal of this study was to examine factors influencing the variability of assessment scores for mock OSCEs administered to senior anesthesiology residents. METHODS: Using the American Board of An... |
Obstetric anesthesia workforce survey: A 30-year update | BACKGROUND: Obstetric Anesthesia Workforce Surveys were conducted in 1981, 1992, and 2001, and the 10-year update was conducted in 2012. Anesthesia providers from US hospitals were surveyed to identify the methods used to provide obstetric anesthesia. Our primary hypothesis was that the provision of obstetric anesthesi... |
A systemic review of obstructive sleep apnea and its implications for anesthesiologists | BACKGROUND: Obstructive sleep apnea (OSA) is present in a significant proportion of the population, but the majority of patients remain undiagnosed. It is crucial that anesthesiologists and surgeons recognize the increased perioperative risks associated with undiagnosed OSA. We present a systematic review of the litera... |
Anesthesiology residents' and nurse anesthetists' perceptions of effective clinical faculty supervision by anesthesiologists | Background: Often anesthesia care is provided by nonfaculty anesthesia providers (e.g., anesthesiology residents and certified registered nurse anesthetists [CRNAs]) under the guidance of faculty anesthesiologists. Performance appraisal of faculty anesthesiologists should therefore include evaluation of this guidance. ... |
An organized, comprehensive, and security-enabled strategic response to the haiti earthquake: A description of pre-deployment readiness preparation and preliminary experience from an academic anesthesiology department with no preexisting international disaster response program | Background: On Tuesday, January 12, 2010 at 16:53 local time, a magnitude 7.0 Mw earthquake struck Haiti. The global humanitarian attempt to respond was swift, but poor infrastructure and emergency preparedness limited many efforts. Rapid, successful deployment of emergency medical care teams was accomplished by organi... |
The impact of anesthesiologists on coronary artery bypass graft surgery outcomes | BACKGROUND: One of every 150 hospitalized patients experiences a lethal adverse event; nearly half of these events involves surgical patients. Although variations in surgeon performance and quality have been reported in the literature, less is known about the influence of anesthesiologists on outcomes after major surge... |
Success of commonly used operating room management tools in reducing tardiness of first case of the day starts: Evidence from German hospitals | Background: One of the declared objectives of surgical suite management in Germany is to increase operating room (OR) efficiency by reducing tardiness of first case of the day starts. We analyzed whether the introduction of OR management tools by German hospitals in response to increasing economic pressure was successf... |
Preanesthesia clinics, information management, and operating room delays: Results of a survey of practicing anesthesiologists | BACKGROUND: One purpose of preanesthesia evaluation clinics (PECs) is to decrease the incidence of day-of-surgery delays and cancellations by ensuring that patients are medically ready for surgery. In several single-center studies, PECs have been shown to have a positive impact. However, limited information is availabl... |
Attempted Development of a Tool to Predict Anesthesia Preparation Time from Patient-Related and Procedure-Related Characteristics | BACKGROUND: Operating room (OR) utilization generally ranges from 50% to 75%. Inefficiencies can arise from various factors, including prolonged anesthesia preparation time, defined as the period from induction of anesthesia until patients are considered ready for surgery. Our goal was to use patient-related and proced... |
Intraoperative noise increases perceived task load and fatigue in anesthesiology residents: A simulation-based study | BACKGROUND: Operating rooms are identified as being one of the noisiest of clinical environments, and intraoperative noise is associated with adverse effects on staff and patient safety. Simulation-based experiments would offer controllable and safe venues for investigating this noise problem. However, realistic simula... |
A survey of anesthesiologists' views of operating room recycling | BACKGROUND: Operating rooms contribute significantly to the increasing volumes and costs of hospital waste. Little is known, however, about doctors' views of hospital waste recycling despite their potential influence in improving recycling programs. We surveyed the waste recycling views held by anesthesiologists in Aus... |
Obstetric Anesthesia Procedure-Based Workload and Facility Utilization of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Designated Institutions | BACKGROUND: Optimal workload and staffing for obstetric anesthesia services have yet to be determined. We surveyed Society of Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence (COE) for Obstetric Anesthesia Care institutions to evaluate procedure-based obstetric anesthesia workload and facility use. ME... |
Double Gloves: A Randomized Trial to Evaluate a Simple Strategy to Reduce Contamination in the Operating Room | BACKGROUND: Oral flora, blood-borne pathogens, and bacterial contamination pose a direct risk of infection to patients and health care workers. We conducted a study in a simulated operating room using a newly validated technology to determine whether the use of 2 sets of gloves, with the outer set removed immediately a... |
Validity and reliability of metrics for translation of regional anaesthesia performance from cadavers to patients | Background: Our goal is to develop metrics that quantify the translation of performance from cadavers to patients. Our primary objective was to develop steps and error checklists from a Delphi questionnaire. Our second objective was to show that our test scores were valid and reliable. Methods: Sixteen UK experts ident... |
Teaching aseptic technique for central venous access under ultrasound guidance: A randomized trial comparing didactic training alone to didactic plus simulation-based training | BACKGROUND: Our goal was to determine whether simulation combined with didactic training improves sterile technique during ultrasound (US)-guided central venous catheter (CVC) insertion compared with didactic training alone among novices. We hypothesized that novices who receive combined didactic and simulation-based t... |
The relative exposure of the operating room staff to sevoflurane during intracerebral surgery | BACKGROUND: Our primary aim in this study was to investigate whether escape of the volatile anesthetic sevoflurane from the surgical site during craniotomy for tumor resection increases the exposure of the neurosurgeon to the anesthetic when compared with the anesthesiologist. METHODS: Initially, the release of sevoflu... |
Challenges of Pediatric Anesthesia Services and Training Infrastructure in Tertiary Care Teaching Institutions in Pakistan: A Perspective from the Province of Sindh | BACKGROUND: Pakistan is a lower middle-income country located in South Asia with a population of nearly 208 million. Sindh is its second largest province. The aim of this survey was to identify the current setup of pediatric services, staffing, equipment, and training infrastructure in the teaching hospitals of Sindh. ... |
Radiation Safety Perceptions and Practices among Pediatric Anesthesiologists: A Survey of the Physician Membership of the Society for Pediatric Anesthesia | BACKGROUND: Pediatric anesthesiologists are exposed to ionizing radiation from x-rays on an almost daily basis. Our goal was to determine the culture of safety in which they work and how they adhere to preventative strategies that minimize exposure risk in their daily practice. METHODS: After Institutional Review Board... |
A clinical profile of a cohort of patients referred to an anesthesiology-based pediatric chronic pain medicine program | BACKGROUND: Pediatric chronic pain is very common and results in significant health care costs. Pediatric chronic pain is both an individual and a public health concern. The primary objective of this study was to generate a descriptive clinical profile of the patients referred to an anesthesiology-based pediatric chron... |
Development and Multidisciplinary Preliminary Validation of a 3-Dimensional-Printed Pediatric Airway Model for Emergency Airway Front-of-Neck Access Procedures | BACKGROUND: Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway ... |
Rescuing the obese or burned airway: are conventional training manikins adequate? A simulation study | Background: Percutaneous tracheal access is required in more than 40% of major airway emergencies, and rates of failure are high among anaesthetists. Supraglottic airway management is more likely to fail in patients with obesity or neck pathology. Commercially available manikins may aid training. In this study, we modi... |
Hospital Volumes of Inpatient Pediatric Surgery in the United States | BACKGROUND: Perioperative outcomes of children depend on the skill and expertise in managing pediatric patients, as well as integration of surgical, anesthesiology, and medical teams. We compared the types of pediatric patients and inpatient surgical procedures performed in low- versus higher-volume hospitals throughou... |
Pilot Findings of Pharmacogenomics in Perioperative Care: Initial Results From the First Phase of the ImPreSS Trial | BACKGROUND: Pharmacogenomics, which offers a potential means by which to inform prescribing and avoid adverse drug reactions, has gained increasing consideration in other medical settings but has not been broadly evaluated during perioperative care. METHODS: The Implementation of Pharmacogenomic Decision Support in Sur... |
Resident Competency and Proficiency in Combined Spinal-Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial | BACKGROUND: Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e... |
The association between frequency of self-reported medical errors and anesthesia trainee supervision: A survey of United States anesthesiology residents-in-training | BACKGROUND: Poor supervision of physician trainees can be detrimental not only to resident education but also to patient care and safety. Inadequate supervision has been associated with more frequent deaths of patients under the care of junior residents. We hypothesized that residents reporting more medical errors woul... |
Midazolam Premedication Immediately before Surgery Is Not Associated with Early Postoperative Delirium | BACKGROUND: Postoperative delirium is common among older surgical patients and may be associated with anesthetic management during the perioperative period. The aim of this study is to assess whether intravenous midazolam, a short-Acting benzodiazepine used frequently as premedication, increased the incidence of postop... |
Intraoperative prediction of postanaesthesia care unit hypotension | Background: Postoperative hypotension is associated with adverse outcomes, but intraoperative prediction of postanaesthesia care unit (PACU) hypotension is not routine in anaesthesiology workflow. Although machine learning models may support clinician prediction of PACU hypotension, clinician acceptance of prediction m... |
Deep-learning model for predicting 30-day postoperative mortality | Background: Postoperative mortality occurs in 1–2% of patients undergoing major inpatient surgery. The currently available prediction tools using summaries of intraoperative data are limited by their inability to reflect shifting risk associated with intraoperative physiological perturbations. We sought to compare simi... |
Efficacy of an Online Curriculum for Perioperative Goals of Care and Code Status Discussions: A Randomized Controlled Trial | BACKGROUND: Preoperative goals of care (GOC) and code status (CS) discussions are important in achieving an in-depth understanding of the patient's care goals in the setting of a serious illness, enabling the clinician to ensure patient autonomy and shared decision making. Past studies have shown that anesthesiologists... |
Women anaesthesiologists' attitudes and reported barriers to career advancement in anaesthesia: a survey of the European Society of Anaesthesiology | Background: Previous studies have confirmed gender imbalance in anaesthesia leadership. Whether women anaesthesiologists aspire to career advancement has not been reported. This European Society of Anaesthesiology (ESA) survey explored anaesthesiologists' motivation to advance their careers into leadership positions, a... |
Automated Assessment of Existing Patient's Revised Cardiac Risk Index Using Algorithmic Software | BACKGROUND: Previous work in the field of medical informatics has shown that rules-based algorithms can be created to identify patients with various medical conditions; however, these techniques have not been compared to actual clinician notes nor has the ability to predict complications been tested. We hypothesize tha... |
The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort | BACKGROUND: Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. METHODS: From January 2013 to April 201... |
Reporting and methodology of multivariable analyses in prognostic observational studies published in 4 anesthesiology journals: A methodological descriptive review | BACKGROUND: Prognostic research studies in anesthesiology aim to identify risk factors for an outcome (explanatory studies) or calculate the risk of this outcome on the basis of patients' risk factors (predictive studies). Multivariable models express the relationship between predictors and an outcome and are used in b... |
A mobile application to facilitate implementation of programmatic assessment in anaesthesia training | Background: Programmatic assessment is a concept to support learning through continuously providing information about learner progress to trainees and supervisors. Central to the concept are multiple low-stakes workplace-based assessments and meaningful feedback opportunities. Mobile technology may facilitate frequent ... |
Publication misrepresentation among anesthesiology residency applicants | Background: Publication misrepresentation has been documented among applicants for residency positions in several specialties. However, these data are not available for anesthesiology applicants. Our purpose in this study was to document the prevalence of publication misrepresentation among applicants to a single anest... |
Comparison of Registered and Reported Outcomes in Randomized Clinical Trials Published in Anesthesiology Journals | BACKGROUND: Randomized clinical trials (RCTs) provide high-quality evidence for clinical decision-making. Trial registration is one of the many tools used to improve the reporting of RCTs by reducing publication bias and selective outcome reporting bias. The purpose of our study is to examine whether RCTs published in ... |
Gender differences in professional social media use among anaesthesia researchers | Background: Recent studies suggest that female researchers are less visible on social media. The objective of this observational work was to compare the use of professional social networks between male and female anaesthesia researchers. Methods: Among four anaesthesia journals, we analysed the first/last authors (FA/L... |
Minimum false-positive risk of primary outcomes and impact of reducing nominal P-value threshold from 0.05 to 0.005 in anaesthesiology randomised clinical trials: a cross-sectional study | Background: Reproducibility of research is poor; this may be because many articles report statistically significant findings that are false positives. Two potential solutions are to lower the P-value for statistical significance testing from 0.05 to 0.005 and to report the minimum false-positive risk (minFPR). This stu... |
Impact of Caffeine Ingestion on the Driving Performance of Anesthesiology Residents After 6 Consecutive Overnight Work Shifts | BACKGROUND: Residency training in anesthesiology involves care of hospitalized patients and necessitates overnight work, resulting in altered sleep patterns and sleep deprivation. Caffeine consumption is commonly used to improve alertness when fatigued after overnight work, in preparation for the commute home. METHODS:... |
An update on pediatric anesthesia liability: A closed claims analysis | BACKGROUND: Respiratory complications were associated with half of pediatric malpractice claims from the 1970s to 1980s in the ASA Closed Claims Database. Advances in pediatric anesthesia practice have occurred in the 1980s and 1990s and may be reflected in liability trends. METHODS: We reviewed 532 pediatric (age ≤16 ... |
The WFSA Global Anesthesia Workforce Survey | BACKGROUND: Safe anesthesia and surgical care are not available when needed for 5 billion of the world's 7 billion people. There are major deficiencies in the specialist surgical workforce in many parts of the world, and specific data on the anesthesia workforce are lacking. METHODS: The World Federation of Societies o... |
The cost of resident scholarly activity and its effect on resident clinical experience | BACKGROUND: Scholarly activity is an important aspect of the academic training of future anesthesiologists. However, residents' scholarly activity may reduce training caseloads and increase departmental costs. METHODS: We conducted this study within a large academic anesthesiology residency program with data from the 4... |
Auditory event-related potentials, Bispectral Index, and entropy for the discrimination of different levels of sedation in intensive care unit patients | BACKGROUND: Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, p... |
Liability related to peripheral venous and arterial catheterization: A closed claims analysis | BACKGROUND: Serious complications after peripheral IV and arterial vascular cannulations have been reported. To assess liability associated with these peripheral vascular catheters for anesthesiologists, we reviewed claims in the American Society of Anesthesiologists Closed Claims database. METHODS: Claims related to p... |
Evaluation of clinical practice in perioperative patient blood management | Background: Several guidelines have been published to facilitate implementation of patient blood management (PBM). This study was performed to evaluate clinical practices in PBM. Methods: An online survey based on the guidelines for the management of severe perioperative bleeding from the European Society of Anaesthesi... |
Presenting research risks and benefits to parents: Does format matter? | BACKGROUND: Several studies suggest that many parents and research participants have poor understanding of the elements of consent, particularly the risks and benefits. However, some data suggest that the format and framing of research risks and benefits may be an important determinant of subject understanding. We exam... |
Promoting anaesthetisia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting | Background: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-re... |
Efficacy of a new dual channel laryngeal mask airway, the LMA®Gastro™ Airway, for upper gastrointestinal endoscopy: a prospective observational study | Background: Significant cardiorespiratory events are frequent in patients undergoing gastrointestinal endoscopy. Central to the occurrence of respiratory events is an unsecured airway. This study sought to determine the efficacy of a new laryngeal mask airway, the LMA®GastroTM Airway (Teleflex Medical, Athlone, Ireland... |
Knowledge retention after simulated crisis: importance of independent practice and simulated mortality | Background: Simulation is an important component of postgraduate medical education, but optimal parameters for simulation are not known. Managing simulations independently and allowing simulated morbidity and mortality have been shown to improve follow-up performance in simulation. We hypothesised that allowing simulat... |
Impact of sleep deprivation on anaesthesia residents' non-technical skills: A pilot simulation-based prospective randomized trial | Background: Sleep deprivation is common in anaesthesia residents, but its impact on performance remains uncertain. Non-technical skills (team working, situation awareness, decision making, and task management) are key components of quality of care in anaesthesia, particularly in crisis situations occurring in the opera... |
Identification of Sleep Medicine and Anesthesia Core Topics for Anesthesia Residency: A Modified Delphi Technique Survey | BACKGROUND: Sleep disorders affect up to 25% of the general population and are associated with increased risk of adverse perioperative events. The key sleep medicine topics that are most important for the practice of anesthesiology have not been well-defined. The objective of this study was to determine the high-priori... |
Associations of form and function of speaking up in anaesthesia: a prospective observational study | Background: Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and re... |
Understanding conflict management styles in anesthesiology residents | BACKGROUND: Successful conflict resolution is vital for effective teamwork and is critical for safe patient care in the operating room. Being able to appreciate the differences in training backgrounds, individual knowledge and opinions, and task interdependency necessitates skilled conflict management styles when addre... |
Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction | BACKGROUND: Sugammadex binds progesterone with high affinity and may interfere with hormonal contraceptive effectiveness. The clinical, economical, and ethical implications of unintended pregnancy should prompt anesthesiologists to actively consider and manage this pharmacologic interaction. We surveyed anesthesiology ... |
Reliability and validity of assessing subspecialty level of faculty anesthesiologists' supervision of anesthesiology residents | BACKGROUND: Supervision of anesthesiology residents is a major responsibility of faculty (academic) anesthesiologists. Supervision can be evaluated daily for individual anesthesiologists using a 9-question instrument. Faculty anesthesiologists with lesser individual scores contribute to lesser departmental (global) sco... |
Intraoperative Mortality in Malawi | BACKGROUND: Surgical care is essential to improving population health, but metrics to monitor and evaluate the continuum of surgical care delivery have rarely been applied in low-resource settings, and improved efforts at benchmarking progress are needed. The objective of this study was to measure the intraoperative mo... |
Closed-loop fluid resuscitation: Robustness against weight and cardiac contractility variations | BACKGROUND: Surgical patients present with a wide variety of body sizes and blood volumes, have large differences in baseline volume status, and may exhibit significant differences in cardiac function. Any closed-loop fluid administration system must be robust against these differences. In the current study, we tested ... |
Methodological and Reporting Quality of Systematic Reviews Published in the Highest Ranking Journals in the Field of Pain | BACKGROUND: Systematic reviews (SRs) are important for making clinical recommendations and guidelines. We analyzed methodological and reporting quality of pain-related SRs published in the top-ranking anesthesiology journals. METHODS: This was a cross-sectional meta-epidemiological study. SRs published from 2005 to 201... |
Publication Bias and Nonreporting Found in Majority of Systematic Reviews and Meta-analyses in Anesthesiology Journals | BACKGROUND: Systematic reviews and meta-analyses are used by clinicians to derive treatment guidelines and make resource allocation decisions in anesthesiology. One cause for concern with such reviews is the possibility that results from unpublished trials are not represented in the review findings or data synthesis. T... |
Communication latencies of apple push notification messages relevant for delivery of time-critical information to anesthesia providers | BACKGROUND: Tablet computers and smart phones have gained popularity in anesthesia departments for educational and patient care purposes. VigiVU is an iOS application developed at Vanderbilt University for remote viewing of perioperative information, including text message notifications delivered via the Apple Push Not... |
Teaching and evaluating group competency in systems-based practice in anesthesiology | BACKGROUND: Teaching and assessment of the systems-based practice competency has been problematic in hospital-based specialties such as anesthesiology. We developed a method to teach systems-based practice with collaborative team projects. The outcome was assessed with a tool that focused on group attributes. METHODS: ... |
Acute pain management efficiency improves with point-of-care handheld electronic billing system | BACKGROUND: Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service. METHODS: Using a handheld personal digital assistant (... |
Performance of emergency surgical front of neck airway access by head and neck surgeons, general surgeons, or anaesthetists: an in situ simulation study | Background: The ‘cannot intubate cannot oxygenate’ (CICO) emergency requires urgent front of neck airway (FONA) access to prevent death. In cases reported to the 4th National Audit Project, the most successful FONA was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines ado... |
2007 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on perioperative cardiac evaluation are usually incorrectly applied by anesthesiology residents evaluating simulated patients | Background: The 2007 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the accepted standard for perioperative cardiac evaluation. Anesthesiology training programs are required to teach these algorithms. We estimated the... |
A historical perspective on resident evaluation, the accreditation council for graduate medical education outcome project and accreditation council for graduate medical education duty hour requirement | BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, endorsed at the 1999 ACGME annual meeting, was intended to shift the focus of residency program requirements and accreditation from processoriented assessment to an assessment of outcomes. The Outcome Project established six g... |
Decision support tool improves real and perceived anesthesiology resident relief equity | BACKGROUND: The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of ... |
Perioperative use of focused transthoracic cardiac ultrasound: A survey of current practice and opinion | BACKGROUND: The advent of portable ultrasound machines in recent years has led to greater availability of focused cardiac ultrasound (FoCUS) in the perioperative and critical care setting. To our knowledge, its use in the perioperative setting among anesthesiologists remains undefined. We sought to assess the use of Fo... |
Utility of the SmartPilot® View advisory screen to improve anaesthetic drug titration and postoperative outcomes in clinical practice: a two-centre prospective observational trial | Background: The advisory system SmartPilot® View (Drägerwerk AG, Lübeck, Germany) provides real-time, demographically adjusted pharmacodynamic information throughout anaesthesia, including time course of effect-site concentrations of administered drugs and a measure of potency of the combined drug effect termed the “‘N... |
Construct Validation of the American Board of Anesthesiology's APPLIED Examination for Initial Certification | BACKGROUND: The American Board of Anesthesiology administers the APPLIED Examination as a part of initial certification, which as of 2018 includes 2 components-the Standardized Oral Examination (SOE) and the Objective Structured Clinical Examination (OSCE). The goal of this study is to investigate the measurement const... |
Body temperature change during anesthesia for electroconvulsive therapy: Implications for quality incentives in anesthesiology | BACKGROUND: The American Society of Anesthesiologists has announced that perioperative normothermia is a "Quality Incentive in Anesthesiology." We examined whether we could meet this quality incentive in a simple population: patients undergoing anesthesia for electroconvulsive therapy (ECT). METHODS: We compared infrar... |
One Size Does Not Fit All: A Perspective on the American Society of Anesthesiologists Physical Status Classification for Pediatric Patients | BACKGROUND: The American Society of Anesthesiologists physical status (ASA-PS) classification system is used worldwide to classify patients based on comorbid conditions before general anesthesia. Despite its popularity, the ASA-PS classification system has been shown to have poor interrater reliability due to its subje... |
Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity and Mortality in a Tertiary Care Center in a Low- and Middle-Income Country: A 25-Year Audit | Background: The analysis of adverse events, including morbidity and mortality (M&M), helps to identify subgroups of children at risk and to modify clinical practice. There are scant data available from low- and middle-income countries. Our aim was to estimate the proportion of pediatric patients with various severe adv... |
A Forensic Disassembly of the BIS Monitor | BACKGROUND: The bispectral index (BIS) monitor has been available for clinical use for >20 years and has had an immense impact on academic activity in Anesthesiology, with >3000 articles referencing the bispectral index. Despite attempts to infer its algorithms by external observation, its operation has nevertheless re... |
Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database | BACKGROUND: The caudal block is the most commonly performed regional anesthesia technique in pediatric patients undergoing surgical procedures, but safety concerns raised by previous reports remain to be addressed. Our main objective in current investigation was to estimate the overall and specific incidence of complic... |
Performance of the cerebral state index during increasing levels of propofol anesthesia: A comparison with the bispectral index | BACKGROUND: The cerebral state monitor is a new device to measure depth of anesthesia. In this study we compared the cerebral state monitor with the bispectral index (BIS) monitor during propofol anesthesia. METHODS: Fifteen healthy patients received a continuous infusion of propofol (300 mL/h). The cerebral state inde... |
Chinese anesthesiologists have high burnout and low job satisfaction: A cross-sectional survey | BACKGROUND: The Chinese health care system must meet the needs of 19% of the world’s population. Despite recent economic growth, health care resources are unevenly distributed. This creates the potential for job stress and burnout. We therefore conducted a survey among anesthesiologists in the Beijing–Tianjin–Hebei reg... |
Changes in Pain Medicine Training Programs Associated with COVID-19: Survey Results | BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. Th... |
Racial, Ethnic, and Gender Diversity in Pediatric Anesthesiology Fellowship and Anesthesiology Residency Programs in the United States: Small Reservoir, Leaky Pipeline | BACKGROUND: The critical question of racial and gender diversity in pediatric anesthesia training programs has not been previously explored. The primary objective of this study was to evaluate trends by race/ethnicity and gender in pediatric anesthesiology fellowship training programs in the United States for the years... |
A Novel Method of Evaluating Key Factors for Success in a Multifaceted Critical Care Fellowship Using Data Envelopment Analysis | BACKGROUND: The current system of summative multi-rater evaluations and standardized tests to determine readiness to graduate from critical care fellowships has limitations. We sought to pilot the use of data envelopment analysis (DEA) to assess what aspects of the fellowship program contribute the most to an individua... |
Effect of mental rotation skills training on ultrasound-guided regional anaesthesia task performance by novice operators: a rater-blinded, randomised, controlled study | Background: The effect of mental rotation training on ultrasound-guided regional anaesthesia (UGRA) skill acquisition is currently unknown. In this study we aimed to examine whether mental rotation skill training can improve UGRA task performance by novice operators. Methods: We enrolled 94 volunteers with no prior exp... |
Promoting a restrictive intraoperative transfusion strategy: The influence of a transfusion guideline and a novel software tool | Background: The effect of neither transfusion guidelines nor decision support tools on intraoperative transfusion has been previously evaluated. The University of Michigan introduced a transfusion guideline in 2009, and in 2011, the Department of Anesthesiology developed a transfusion decision support tool. The primary... |
The effectiveness of a simple novel approach on electroencephalograph instruction for anesthesiology residents | BACKGROUND: The electroencephalogram (EEG) measures cerebral activity and, because of its use as an intraoperative monitor, the Accreditation Council for Graduate Medical Education requires EEG monitoring experience during anesthesiology residency. To improve the anesthesiology residents' education at the University of... |
Active research fields in anesthesia: A document co-citation analysis of the anesthetic literature | BACKGROUND: The expansion of science has resulted in an increased information flow and in an exponentially growing number of connections between knowledge in different research fields. In this study, we used methods of scientometric analysis to obtain a conceptual network that forms the structure of active scientific r... |
The geographic distribution of pediatric anesthesiologists relative to the US Pediatric Population | BACKGROUND: The geographic relationship between pediatric anesthesiologists and the pediatric population has potentially important clinical and policy implications. In the current study, we describe the geographic distribution of pediatric anesthesiologists relative to the US pediatric population (0-17 years) and a sub... |
A prospective observational study of technical difficulty with GlideScope-guided tracheal intubation in children | BACKGROUND: The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and in... |
An observational assessment of anesthesia capacity in madagascar as a prerequisite to the development of a national surgical plan | BACKGROUND: The global lack of anesthesia capacity is well described, but country-specific data are needed to provide country-specific solutions. We aimed to assess anesthesia capacity in Madagascar as part of the development of a Ministry of Health national surgical plan. METHODS: As part of a nationwide surgical safe... |
Systematic reviews of anesthesiologic interventions reported as statistically significant: Problems with power, precision, and type 1 error protection | BACKGROUND: The GRADE Working Group assessment of the quality of evidence is being used increasingly to inform clinical decisions and guidelines. The assessment involves explicit consideration of all sources of uncertainty. One of these sources is imprecision or random error. Many published meta-analyses are underpower... |
Preparing Anesthesiology Residents for Operating Room Communication Challenges: A New Approach for Conflict Resolution Training | BACKGROUND: The hierarchical culture in high-stake areas such as operating rooms (ORs) may create volatile communication challenges. This unfunded exploratory study sought to establish whether a conflict resolution course was effective in preparing anesthesiology residents to handle and deescalate disagreements that ma... |
A national survey of american pediatric anesthesiologists: Patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management | Background: The influence of patient characteristics, institutional demographics, and published practice guidelines on the provision of IV opioid analgesia, particularly as delivered through a patient-controlled analgesia (PCA) delivery device, to pediatric patients is unknown. Methods: We sent a national, web-based, d... |
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