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Defining complexity in anaesthesia: description and validation of the Oxford Anaesthetic Complexity (OxAnCo) score | Increasing demand for surgery and anaesthesia has created an imperative to manage anaesthetic workforce and caseload. This may include changes to distribution of cases amongst anaesthetists of different grades, including non-physician anaesthetists. To achieve this safely, an assessment of case complexity is essential.... |
Mandragora: Anesthetic of the ancients | Initial attempts at surgical anesthesia began many centuries ago, with the plants of antiquity. The mandragora, or mandrake, was used as a sedative and to induce pain relief for surgical procedures. It has been depicted in tablets and friezes since the 16th century before the common era (BCE) and used for its sedative ... |
Calculating institutional support that benefits both the anesthesia group and hospital | Institutional support to anesthesia groups for clinical care is very common, particularly when compensation for certified registered nurse anesthetists and anesthesiology residents is considered. Poor contracts can reduce incentives for good operating room (OR) management. We show that two types of agreements for insti... |
Task analysis of the preincision surgical period: An independent observer-based study of 1558 cases | Intense production pressure has focused on the preincision period (from patient-on-table to incision) as an important component of overall operating room efficiency. We conducted a prospective study in which trained independent observers measured the performance of anesthesiologists, surgeons, and nursing staff to dete... |
Interruptions and blood transfusion checks: Lessons from the simulated operating room | Interruptions occur frequently in the operating room with both positive and negative consequences. Interruptions can distract anesthesiologists from safety-critical tasks, such as the pretransfusion blood check. In a simulated operating room, 12 anesthesiologists requested blood as part of a "bleeding patient" scenario... |
Control chart monitoring of the numbers of cases waiting when anesthesiologists do not bring in members of call team | INTRODUCTION: An anesthesia group staffing agreement with a hospital often specifies the minimum number of operating rooms (ORs) to be covered during evening or weekend hours. Frequently, 1 anesthesiologist works in-house and others take call from home, coming in if multiple cases are waiting to be done. The anesthesio... |
A consensus checklist to help clinicians interpret clinical trial results analysed by Bayesian methods | Introduction: In the context of an increasing number of publications of trial data analysed by Bayesian methods, clinicians need support to better understand Bayesian statistical methods. The existing checklists are intended for people who already know these methods. We aimed to establish and validate a checklist that ... |
Application of a similarity index to state discharge abstract data to identify opportunities for growth of surgical and anesthesia practices | INTRODUCTION: Most surgical and anesthesia groups are interested in expanding their practices and recruiting more patients. Methods have been developed to help hospitals identify surgical specialties with the potential for growth by determining whether the hospital is performing fewer of certain types of procedures tha... |
A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients | INTRODUCTION: Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process m... |
Determinants of tidal volumes with adaptive support ventilation: A multicenter observational study | INTRODUCTION:: In the present study, we investigated the behavior of adaptive support ventilation (ASV) in patients after cardiothoracic surgery. We determined tidal volumes (Vt) and factors that influence Vt with this mode of microprocessor-controlled mechanical ventilation (MV). METHODS:: This was a prospective, mult... |
Clinicians consistently exceed a typical person's short-term memory during preoperative teaching | INTRODUCTION:: Patient education is a critical part of preparation for surgery. Little research on provider-to-patient teaching has been conducted with systematic focus on the quantity of information provided to patients. This is important to assess because short-term memory capacity for information such as preoperativ... |
A mission-based productivity compensation model for an academic anesthesiology department | INTRODUCTION:: We replaced a nearly fixed-salary academic physician compensation model with a mission-based productivity model with the goal of improving attending anesthesiologist productivity. METHODS:: The base salary system was stratified according to rank and clinical experience. The supplemental pay structure was... |
Passage of pathogenic microorganisms through breathing system filters used in anaesthesia and intensive care | Invasive ventilation poses a risk of respiratory infection that can be drug-resistant. One means of reducing transmission of infection is the use of a breathing system filter. Filters are intended to be used with dry gas. Current international standards do not require that filters prevent bacterial transfer when wet. I... |
Ethical considerations in anaesthesia journals | It has been shown that instructions to authors in nonanaesthesia biomedical journals often fail to require authors to state that the study was approved by an ethics committee and informed consent obtained from participants; articles also often omit mentioning these points. We examined 11 English-language journals, whic... |
A survey of the use of ultrasound guidance in internal jugular venous cannulation | It has been that suggested the use of two dimensional (2D) ultrasound to facilitate placement of central venous cannulae in the internal jugular vein improves patient safety and reduces complications. Since the introduction of the National Institute for Clinical Excellence Technology Appraisal Guideline Number 49 in 20... |
A simulation design for research evaluating safety innovations in anaesthesia | It is notoriously difficult to obtain evidence from clinical randomised controlled trials for safety innovations in healthcare. We have developed a research design using simulation for the evaluation of safety initiatives in anaesthesia. We used a standard and a modified scenario in a human-patient simulator, involving... |
Institutional preparedness to prevent and manage anaesthesia-related ‘can't intubate, can't oxygenate’ events in Australian and New Zealand teaching hospitals | It is unclear how the recent local and international focus on systems issues and human factors in ‘can't intubate, can't oxygenate’ events has impacted institutional preparedness in Australia and New Zealand. This study attempts to capture a snapshot of current practices in Australian and New Zealand teaching hospitals... |
The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery | It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery ... |
Clinical anaesthetic knowledge amongst surgical house staff | Knowledge of common anaesthetic drugs, techniques and complications amongst junior surgical staff at a typical district general hospital is assessed. The implications for patient care are discussed and suggestions made for improved education. Copyright © 1985, Wiley Blackwell. All rights reserved |
The effects of needle bevel orientation during epidural catheter insertion in laboring parturients | Lateral needle bevel orientation during identification of the epidural space has been recommended to reduce the risk of postdural puncture headache (PDPH). Rotation to cephalad or caudad orientation before catheter insertion is assumed necessary for analgesic success. We prospectively compared the effects of catheter i... |
Latex allergy: A strategy for management | Latex is a ubiquitous part of life today. It is a constituent of many household products and medical devices, although not always obvious on examination. The increase in incidence of potentially life-threatening allergic reactions to latex has been a cause for mounting concern over recent years. Although there have bee... |
Special article: Laurette McMechan (1878-1970): "mother of anesthetists". | Laurette van Varseveld McMechan (1878-1970) was married to Francis Hoeffer McMechan (1879-1939), who organized the International Anesthesia Research Society and was the editor of the first journal for physician and dentist anesthetists. Although she was not a physician, she made vital contributions to the development o... |
Correspondence by charles T. Jackson containing the earliest known illustrations of a morton ether inhaler | letter, dated December 1, 1846, from Charles T. Jackson, MD, to Josiah D. Whitney contains a previously unreported description of a Morton ether inhaler and the only known contemporaneous hand-drawn illustrations of this type of ether inhaler. This letter and 2 other known letters on ether anesthesia were probably carr... |
Unexpectedly extensive conduction blocks in obstetric epidural analgesia | Life‐threatening extensions of conduction block during obstetric epidural analgesia can be classified according to the risk to the mother. High blocks that occur in the presence of the anaesthetist should present a readily treatable problem. Reports of total spinal anaesthesia that occur with no anaesthetist in attenda... |
Elton romeo smilie, the not-quite discoverer of ether anesthesia | Like William T.G. Morton, Elton Romeo Smilie (1819-1889) was raised in Massachusetts, attended medical school in New England, practiced dentistry there, strove for clinical invention, and moved to Boston. In October 1846, both announced that inhaled ethereal preparations achieved reversible insensibility in surgical pa... |
A national survey of the effects of fatigue on trainees in anaesthesia in the UK | Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Wor... |
Fatigue risk management: The impact of anesthesiology residents' work schedules on job performance and a review of potential countermeasures | Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night... |
Percutaneous nonangiographic insertion of Hickman catheters in marrow transplant recipients by anesthesiologists and intensivists | Long-term central venous lines for chronic hemoaccess are usually inserted in the operating theater under local or general anesthesia or in interventional radiology suites using fluoroscopic technique. In a prospective study we determined the feasibility of percutaneous insertion of Hickman catheters without fluoroscop... |
Provision of long-term venous access procedures by UK anaesthetists: A postal survey | Long-term venous access is widely used in hospital and in the community for cancer chemotherapy, total parenteral nutrition and long-term administration of antibiotics. There is a large variety of catheters, ports and other devices designed to facilitate these treatments. A postal survey of anaesthetic departments in E... |
Another Selectatec switch malfunction | Malfunction of a Selectatec‐3 switch mechanism is reported which caused isolation of the selected vaporizer. This resulted in a delivery of unsupplemented fresh gas to the patient. Copyright © 1990, Wiley Blackwell. All rights reserved |
Postoperative nausea and vomiting: A comparative survey of the attitudes, perceptions, and practice of Swiss anesthesiologists and surgeons | Managing postoperative nausea and vomiting (PONV) depends on awareness of the problem, the therapeutic measures available, and effective implementation control systems. We mailed 616 PONV questionnaires to all 129 Swiss hospitals with anesthesiological and surgical departments. The responses [192 (31%) completed questi... |
The resident application process and its correlation to future performance as a resident | Many authors have attempted to determine predictors for success within a residency program. There is very little agreement about what is useful. We hypothesized that our residency selection process is effective in determining which resident applicants would be most likely to excel in our program. To test this hypothesi... |
Tracking and Reporting Outcomes Of Procedural Sedation (TROOPS): Standardized Quality Improvement and Research Tools from the International Committee for the Advancement of Procedural Sedation | Many hospitals, and medical and dental clinics and offices, routinely monitor their procedural-sedation practices—tracking adverse events, outcomes, and efficacy in order to optimize the sedation delivery and practice. Currently, there exist substantial differences between settings in the content, collection, definitio... |
Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training | Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education cou... |
Anesthesia for Maternal-Fetal Interventions: A Consensus Statement from the American Society of Anesthesiologists Committees on Obstetric and Pediatric Anesthesiology and the North American Fetal Therapy Network | Maternal-fetal surgery is a rapidly evolving specialty, and significant progress has been made over the last 3 decades. A wide range of maternal-fetal interventions are being performed at different stages of pregnancy across multiple fetal therapy centers worldwide, and the anesthetic technique has evolved over the yea... |
Curriculum and cases for pain medicine crisis resource management education | Medical crises that may occur in the setting of a pain medicine service are rare events that require skillful action and teamwork to ensure safe patient outcome. A simulated environment is an ideal venue for both acquisition and reinforcement of this knowledge and skill set. Here, we present an educational curriculum i... |
Work hours of residents in seven anesthesiology training programs | Medical educators and credentialing organizations recently have called attention to the long hours that some house staff are required to spend in the hospital during training. To determine the average duration of in- hospital work hours of anesthesiology residents, 148 residents at seven, university-affiliated training... |
Radiation exposure to anaesthetists during endovascular procedures | Medical radiation exposure increases the likelihood of cataract formation. A personal dosimeter was attached to the left temple of 77 anaesthetists during 45 endovascular aortic aneurysm repairs and 32 interventional neuroradiology procedures. Compared with interventional neuroradiology, the median (IQR [range]) total ... |
The effect of additional teaching on medical students' drug administration skills in a simulated emergency scenario | Medical students have difficulty calculating drug doses correctly, but better teaching improves their performance in written tests. We conducted a blinded, randomised, controlled trial to assess the benefit of online teaching on students' ability to administer drugs in a simulated critical incident scenario, during whi... |
Excipients in Anesthesia Medications | Medications used in anesthesiology contain both pharmacologically active compounds and additional additives that are usually regarded as being pharmacologically inactive. These additives, called excipients, serve diverse functions. Despite being labeled inert, excipients are not necessarily benign substances. Anesthesi... |
Rainy days for the society for pediatric anesthesia | Members of the Society for Pediatric Anesthesia (SPA) perceive the 47% rain rate has burdened its national meetings more than would be expected. We compared weather conditions on the first day of each national SPA meeting since 1987 with historical data using the day, month, and location of each meeting. Using a genera... |
Quality assessment of meta-analyses published in leading anesthesiology journals from 2005 to 2014 | Meta-analysis, when preceded by a systematic review, is considered the "gold standard" in data aggregation; however, the quality of meta-analyses is often questionable, leading to uncertainty about the accuracy of results. In this study, we evaluate the quality of meta-analyses published in 5 leading anesthesiology jou... |
A European consensus statement on the use of four-factor prothrombin complex concentrate for cardiac and non-cardiac surgical patients | Modern four-factor prothrombin complex concentrate was designed originally for rapid targeted replacement of the coagulation factors II, VII, IX and X. Dosing strategies for the approved indication of vitamin K antagonist-related bleeding vary greatly. They include INR and bodyweight-related protocols as well as fixed ... |
Temperature monitoring practices during regional anesthesia | Monitoring and maintaining body temperature during the perioperative period has a significant impact on the risk of myocardial ischemia, cardiac morbidity, wound infection, surgical bleeding, and patient discomfort. To test the hypothesis that body temperature is inadequately monitored during regional anesthesia (RA), ... |
The influence of first author sex on acceptance rates of submissions to Anaesthesia Cases | More than 50% of medical students and 45% of practising doctors are female in the UK. In the specialty of anaesthesia, 32% of consultants are female. However, compared with males, females are under-represented as authors of articles published in high-impact journals. We investigated the proportion of female first autho... |
Life after death: The aftermath of perioperative catastrophes | Most anesthesiologists will experience the perioperative death of a patient or a major perioperative catastrophe in the course of their careers. Anesthesia training, however, does not prepare individuals to handle the aftermath of such a stressful event. Multiple surveys have shown that the death of a patient has a maj... |
Communication in critical care environments: Mobile telephones improve patient care | Most hospital policies prohibiting the use of wireless devices cite reports of disruption of medical equipment by cellular telephones. There have been no studies to determine whether mobile telephones may have a beneficial impact on safety. At the 2003 meeting of the American Society of Anesthesiologists 7878 surveys w... |
Sedation and anesthesia protocols used for magnetic resonance imaging studies in infants: Provider and pharmacologic considerations | Most studies report the efficacy of only a single drug to achieve sedation in a broad age range of children. In clinical practice, a variety of sedative and anesthetic regimes are monitored by nurses and physicians. In this study we report the efficacy of a tiered approach to monitoring and sedation in infants. Two-hun... |
The effect of music on anaesthetists' psychomotor performance | Music is frequently played in operating theatres, but may prove distracting to anaesthetists. We undertook a laboratory-based study of the effects of music on the psychomotor performance of 12 anaesthetic trainees. Using part of the computer-based PsychE psychomotor evaluation programme, we were unable to demonstrate a... |
Narrative Medicine: Perioperative Opportunities and Applicable Health Services Research Methods | Narrative medicine is a humanities-based discipline that posits that attention to the patient narrative and the collaborative formation of a narrative between the patient and provider is essential for the provision of health care. In this Special Article, we review the basic theoretical constructs of the narrative medi... |
Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates | National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases ... |
Multiple-choice examinations: Adopting an evidence-based approach to exam technique | Negatively marked multiple-choice questions (MCQs) are part of the assessment process in both the Primary and Final examinations for the fellowship of the Royal College of Anaesthetists. It is said that candidates who guess will lose marks in the MCQ paper. We studied candidates attending a pre-examination revision cou... |
The use of high-fidelity human patient simulation and the introduction of new anesthesia delivery systems | New anesthesia delivery systems are becoming increasingly complex. Although equipment is involved in a large proportion of intraoperative anesthesia problems (most also involving human error), the current methods of introducing new equipment into clinical practice have not been well studied. We designed a randomized, c... |
Autotriggering during pressure support ventilation due to cardiogenic oscillations | Newer generation anesthesia machines are equipped with a pressure support mode of ventilation, which can be used to support spontaneous ventilation in anesthetized patients. The Drager Apollo anesthesia machine uses an inspiratory limb hot-wire flow sensor to measure inspiratory flow rates. Detected flow rates that exc... |
Bedford Square: A connexion with mesmerism | Nine Bedford Square has now been established as a Centre for Anaesthesia. It is a town house of considerable merit in the first square to have been planned on the London estate of the fifth Duke of Bedford. Built between 1775 and 1780, it is now the last complete Georgian square in Bloomsbury. This brief note on the hi... |
Faulty Superset plastic catheter mounts: A cautionary tale applicable to other mass‐produced disposable products | Nine Superset (Intersurgical Ltd) single‐use corrugated plastic catheter mounts were found to be faulty in a boxed batch of 75. The manufacturer's meticulous system of batch coding enabled the source of the problem to be traced quickly. Sporadic faults must be expected to occur in mass‐produced disposable equipment and... |
Litigation related to drug errors in anaesthesia: An analysis of claims against the NHS in England 1995-2007 | Ninety-three claims (total cost £4 915 450) filed under 'anaesthesia' in the NHS Litigation Authority database between 1995 and 2007, alleging patient harm directly by drug administration error or by an allergic reaction, were analysed. Alleged errors were categorised using systems employed by the National Coordinating... |
Nitrous oxide content in the operating suite | Nitrous oxide (N2O) concentrations in the ambient atmosphere were measured by gas chromatography during surgical anesthesia. Levels in the recovery room were affected not only by the N2O content in the expiratory air of postanesthetic patients and personnel but also by N2O levels in the operating rooms. With the onset ... |
Personality characteristics of a sample of anaesthetists | No published information on the personality characteristics of a significant proportion of any specialty of the medical profession has been available to date. The author presents the results from the application of a personality questionnaire (Cattell's 16 PF Form C) to a sample of anaesthetists (n = 231). These show t... |
Development of workplace-based assessments of non-technical skills in anaesthesia | Non-technical skills are recognised as crucial to good anaesthetic practice. We designed and evaluated a specialty-specific tool to assess non-technical aspects of trainee performance in theatre, based on a system previously found reliable in a recruitment setting. We compared inter-rater agreement (multir-ater kappa) ... |
Serum methionine and hepatic enzyme activity in anaesthetists exposed to nitrous oxide | Normal serum concentrations of methionine, leucine, isoleucine and valine have been found in 10 anaesthetists using nitrous oxide under their regular working conditions without scavenging of patients' exhaled gas. Mean inhaled concentrations of nitrous oxide ranged from 150 to 400 p.p.m. The results indicate either tha... |
Pre-operative screening: Criteria for referring to anaesthetists | Nurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questio... |
Propensity score methods: Theory and practice for anesthesia research | Observational data are often readily available or less costly to obtain than conducting a randomized controlled trial. With observational data, investigators may statistically evaluate the relationship between a treatment or therapy and outcomes. However, inherent in observational data is the potential for confounding ... |
Epidural anesthesia for elective cesarean delivery with intraoperative arterial occlusion balloon catheter placement | Obstetric hemorrhage is a leading cause of maternal mortality. We describe the anesthetic management of elective cesarean delivery in patients at high risk for hemorrhage. The utility and limitations of intraarterial balloon catheter placement and epidural anesthesia are described. Supported internally by the Stanford ... |
Anesthetic practice in haiti after the 2010 earthquake | On January 12, 2010, a 7.0 ML earthquake devastated Haiti, the most impoverished nation in the Western hemisphere with extremely limited health care resources. We traveled to Milot, Haiti situated north of Port-au-Prince, to care for injured patients at Hôpital Sacré Coeur, an undamaged hospital with 74 beds and 2 oper... |
Freeman Allen: Boston's pioneering physician anesthetist | On October 16, 1846 dentist William T. G. Morton successfully demonstrated at the Massachusetts General Hospital that ether could prevent the pain of surgery. For decades afterwards, the administration of anesthesia in the United States was generally relegated to dentists, medical students, junior surgical trainees, or... |
The pre‐operative anaesthetic visit: Its value to the patient and the anaesthetist | One hundred and thirty‐two patients staying in hospital more than 24 h were visited pre‐ and postoperatively. Patients were asked a standard set of questions, and 39% could not remember accurately what they were asked. This has important medicolegal implications. In 15% of patients, information that significantly alter... |
Teaching fibreoptic intubation in anaesthetised patients | One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior e... |
The Malawi anaesthetic machine: Experience with a new type of anaesthetic apparatus for developing countries | One year's experience with a new type of oxygen concentrator and anaesthetic machine, designed for anaesthesia in developing countries, is presented. The apparatus, its performance and problems are described and the author's suggested modijications to improve the original design are outlined. The apparatus, with these ... |
Early proponents of cardiac massage | Open‐chest cardiac massage in humans to treat chloroform syncope was first performed by Niehans in Berne and Langenbuch in Berlin in the late 1880s. Closed‐chest cardiac massage in humans was advocated by Koenig and Maass in Göttingen in the last two decades of the 19th century. The closed technique was used in Central... |
A serious anesthetic hazard during orthognathic surgery | Oral surgical procedures for the correction of maxillomandibular deformities present unique anesthetic problems, which, though reported in oral surgical journals, have not received sufficient attention in the anesthesiology literature. One of these unique problems relates to the fact that this type of surgery requires ... |
An analysis of the academic capacity of anaesthesia in the UK by publication trends and academic units | Over a decade ago, bibliometric analysis predicted the disappearance of UK publishing in anaesthesia by 2020. We repeated this analysis to assess if this had turned out to be the case, searching PubMed for papers associated with UK consultant anaesthetists for 2017–2019 across 15 journals. Although the rate of decline ... |
Estimating the duration of common elective operations: Implications for operating list management | Over-running operating lists are known to be a common cause of cancellation of operations on the day of surgery. We investigated whether lists were overbooked because surgeons were optimistic in their estimates of the time that operations would take to complete. We used a questionnaire to assess the estimates of total ... |
Challenges in paediatric procedural sedation: Political, economic, and clinical aspects | Paediatric sedation has expanded in volume and demand over the past decade. In parallel with the increasing demand for and delivery of sedation by multi-specialty providers, conflicting political agendas have surfaced. With a limited selection of sedatives and few new sedatives to market over the past decade, some prov... |
The qualifications of pain physicians in Ohio | Pain physicians in Ohio come from many medical backgrounds and use different medical boards to claim board certification in the field of pain medicine. Our goal was to explore the number, demographics, and qualifications of pain physicians in Ohio. The names of Ohio physicians designating themselves as pain physicians ... |
The Use of a Novel Technology to Study Dynamics of Pathogen Transmission in the Operating Room | Pathogenic organisms have been found in the intraoperative environment, potentially posing a risk of infection that could cause morbidity and mortality. In an effort to understand how a patient's bacteria can be spread throughout the operating room with the anesthesia provider as a vector, we conducted a study using re... |
Concepts for the Development of Anesthesia-Related Patient Decision Aids | Patient decision aids are educational tools used by health care providers to assist patients in choosing their treatment and care. The use of anesthesia-related patient decision aids can help practitioners provide patient-centered care by facilitating shared decision-making. The benefits of these aids have been well do... |
Anesthesia Patient Safety: Next Steps to Improve Worldwide Perioperative Safety by 2030 | Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically redu... |
Falls from the O.R. or Procedure Table | Patient safety secured by constant vigilance remains a primary responsibility of every anesthesia professional. Although significant attention has been focused on patient falls occurring before and after surgery, a potentially catastrophic complication is when patients fall off an operating room or procedure table duri... |
Cross‐sectional study of complications of inhalational anaesthesia in 16995 patients | Patients undergoing anaesthesia in which halothane, enflurane or isoflurane were used, were surveyed with reference to 16 unwanted effects selected by the nominal group method. A simple record card was completed at the time of anaesthetic administration. The overall incidence of complications was 13.9%. One complicatio... |
Prospective survey of the use of the laryngeal mask airway in 2359 patients | Patients undergoing anaesthesia in which the laryngeal mask airway was used were prospectively audited over a 6‐month period. A simple record sheet was completed at the time of anaesthetic administration and 2359 completed forms were analysed to assess problems encountered with its use. It was used successfully in 2350... |
The impact of a consultant anaesthetist led pre-operative assessment clinic on patients undergoing major vascular surgery | Patients undergoing major vascular surgery are at high risk of peri-operative morbidity and mortality owing to a combination of advanced age, significant co-morbidity and the nature of the surgery. A consultant-led pre-operative assessment clinic provides an opportunity to stratify these patients on the basis of risk i... |
Expectations and experiences of anaesthesia in a District General Hospital | Patients were asked about their pre‐anaesthetic assessment, expectations and experiences of anaesthesia, during the first postoperative day. Of the 100 patients interviewed, 95 were visitedpre‐operatively by an anaesthetist, 46 patients denied being anxious, and nine said they were very anxious. Middle‐aged patients se... |
Palliative Care and End-of-Life Considerations for the Frail Patient | Patients with frailty experience substantial physical and emotional distress related to their condition and face increased morbidity and mortality compared with their nonfrail peers. Palliative care is an interdisciplinary medical specialty focused on improving quality of life for patients with serious illness, includi... |
Consensus Statement by the Congenital Cardiac Anesthesia Society: Milestones for the Pediatric Cardiac Anesthesia Fellowship | Pediatric cardiac anesthesiology has evolved as a subspecialty of both pediatric and cardiac anesthesiology and is devoted to caring for individuals with congenital heart disease ranging in age from neonates to adults. Training in pediatric cardiac anesthesia is a second-year fellowship with variability in both trainin... |
The prevalence and characteristics of incentive plans for clinical productivity among academic anesthesiology programs | Performance-based compensation is encouraged in medical schools to improve faculty productivity. Medical specialties other than anesthesiology have used financial incentives for clinical work. The goal of this study was to determine the prevalence and the types of clinical incentive plans among academic anesthesiology ... |
Pro-Con Debate: 1-vs 2-Hour Fast for Clear Liquids before Anesthesia in Children | Perioperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastrointestinal contents. The current recommendations from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology and Intensive Care (ESAIC) are for a minimum 2-hour fast after ingestion o... |
A Guide to Understanding "State-of-the-Art" Basic Research Techniques in Anesthesiology | Perioperative medicine is changing from a "protocol-based"approach to a progressively personalized care model. New molecular techniques and comprehensive perioperative medical records allow for detection of patient-specific phenotypes that may better explain, or even predict, a patient's response to perioperative stres... |
Chronic Hiccups: An Underestimated Problem | Persistent singultus, hiccupping that lasts for longer than 48 hours, can have a tremendous impact on a patient's quality of life. Although involved neurologic structures have been identified, the function of hiccups remains unclear - they have been controversially interpreted as a primitive reflex preventing extent sw... |
Describing oneself: What anesthesiology residency applicants write in their personal statements | Personal statements in ERAS residency applications contain abundant personal information and interesting stories in which students describe themselves and their perceptions of the specialty. The writing quality varies greatly, enjoyable when good and tolerable when bad. The content helps us understand our specialty. To... |
Neopterin as a marker of immunostimulation: An investigation in anaesthetic workplaces | Personnel working in operating theatres and recovery rooms are exposed to a variety of noxious substances. The results of studies of the effects of occupational exposure on immune parameters are conflicting. Neopterin is an acknowledged marker of immunostimulation. Urinary neopterin levels of 58 anaesthetists and anaes... |
Investigation of phthalate release from tracheal tubes | Phthalates are chemicals used extensively in the manufacture of plastics for their desirable physical characteristics. In addition to enhancing the performance of plastics, phthalates have a number of undesirable effects, principally endocrine disruptor effects, that may have adverse effects on reproductive development... |
Creation and Execution of a Novel Anesthesia Perioperative Care Service at a Veterans Affairs Hospital | Physician-led perioperative surgical home models are developing as a method for improving the American health care system. These models are novel, team-based approaches that help to provide continuity of care throughout the perioperative period. Another avenue for improving care for surgical patients is the use of enha... |
Team planning discussion and clinical performance: a prospective, randomised, controlled simulation trial | Planning held before emergency management of a critical situation might be an invaluable asset for optimising team preparation. The purpose of this study was to investigate whether a brief planning discussion improved team performance in a simulated critical care situation. Forty-four pairs of trainees in anaesthesia a... |
Low pressure leakage in anaesthetic machines evaluation by positive and negative pressure tests | Positive and negative pressure tests for checking the low pressure section of 36 anaesthetic machines in order to detect gas leaks were prospectively compared. The low pressure section was checked by the soap bubble test as a 'gold standard'. The leakage rate was 86.1%. The sensitivity and specificity of the positive p... |
Use of operating room information system data to predict the impact of reducing turnover times on staffing costs | Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each su... |
Power spectral analysis of heart rate variability after spinal anaesthesia | Power spectral analysis of heart rate (HR) variability is a useful tool with which to assess cardiac autonomic activity. The low frequency bands have been considered as both sympathetically and parasympathetically mediated components, while the high frequency bands have been assumed to be the parasympathetically mediat... |
AAGBI: Safer pre-hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland | Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only ... |
Predatory open-access publishing in anesthesiology | Predatory publishing is an exploitative fraudulent open-access publishing model that applies charges under the pretense of legitimate publishing operations without actually providing the editorial services associated with legitimate journals. The aim of this study was to analyze this phenomenon in the field of anesthes... |
A program for computing the prediction probability and the related receiver operating characteristic graph | Prediction probability (PK) and the area under the receiver operating characteristic curve (AUC) are statistical measures to assess the performance of anesthetic depth indicators, to more precisely quantify the correlation between observed anesthetic depth and corresponding values of a monitor or indicator. In contrast... |
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