Anesthesia Equipment Research Articles

Adaptations in pediatric anesthesia care and airway management in the resource‐poor setting

The need for safe and quality pediatric anesthesia care in low- and middle-income countries (LMICs) is huge. An estimated 1.7billion children do not have access to surgical care, and the majority are in LMICs. In addition, most LMICs do not have the requisite surgical workforce including anesthesia providers. Surgery is usually performed at three levels of facilities: district, provincial, and national referral hospitals. Unfortunately, the manpower, equipment, and other resources available to provide surgical care for children vary greatly at the different level facilities. The majority of district level hospitals are staffed solely by non-physician anesthesia providers with variable training and little support to manage complicated pediatric patients. Airway and respiratory complications are known to account for a large portion of pediatric perioperative complications. Management of the difficult pediatric airway pathology is a challenge for anesthesia providers regardless of setting. However, in the low-resource setting poor infrastructure, lack of transportation systems, and crippled referral systems lead to late presentation. There is often a lack of pediatric-sized anesthesia equipment and resources, making management of the local pathology even more challenging. Efforts are being made to offer these providers additional training in pediatric anesthesia skills that incorporate low-fidelity simulation. Out of necessity, anesthesia providers in this setting learn to be resourceful in order to manage complex pathologies with fewer, less ideal resources while still providing a safe anesthetic.

Major Bacteria Species Surface Contaminants in Hospitals of Littoral Region, Cameroon

Globally, the levels of healthcare-associated infections (nosocomial infections) are important high, and especially those due to bacterial are significant and costly. Healthcare environments provide a worrying reservoir for spreading infections. According to the World Health Organization (WHO) Low and Middle-Income Countries may be particularly at risk, hence, the need to perform a timely assessment of surface contamination of bacterial origin in the major units of four different hospitals of the Littoral Region, Cameroon. A cross-sectional and descriptive study was conducted from December 2018 to May 2019. A simple random sampling was used to swap 10 selected equipment (treatment tables, operating tables, delivery tables, office tables, anesthesia equipment, surgical aspirators, oxygen concentrators, wheelchairs, patients and office chairs) and 10 materials (fans, patient bedside tables, patient bed rails, trolleys, door handles, negastoscopes, baby scales, air conditioners, Antiseptic container boxes, and covers) in the mornings after disinfection but before the start of work in each unit. After inoculation in four agar media consecutively (Eosine Methylene blue, Cled, Mannitol salt agar and the blood agar in segmented) and incubated in appropriate conditions, identification and confirmation were based on morphological characteristics of bacteria colonies, microscopy, and biochemical methods using API staph, strep, and 20ETM gallery Biomerieux. Of a total of 236 samples collected, 119 (50.4%) showed bacterial growth, 33 different species of which 62/119 (52.10%) were Gram-positive cocci, 57/119 (47.90%) Gram-negative bacilli. S. aureus, 45/119 (37.81%), E. coli 6/119 (5.04%), and Acinetobacter spp 4/119 (3.36%) were the most common contaminants. Patients’ bedside tables, office chairs, and patients’ bed rails were the highest contaminants respectively 14/119 (11.76%), 13/119 (10.92%) and 12/119 (10.08%). The Emergency units were the mainly contaminated area for Gram-positive cocci, 12/62 (19.35%) majority S. aureus 9/62 (14.51%) as most as Gram-negative non-Enterobacteriaceae 11/31 (35, 48%) with a predominance of C. meningoseptica and M. heamolytica both 2/31 (6.45%). Therefore for the Gram-negative bacilli Enterobacteriaceae family, the highest level of bacterial isolates was recovered in laboratory 7/26 (26.92%), in which E. coli was predominantly reported 4/26 (15.38%). However, S. aureus was the only species found in all hospitals and units. This high level of contamination in various key units in these hospitals is a serious risk of infections with leading to complicated and cost healthcare. This work will help clinical care and decision making to take appropriate actions to improve sanitation and ensure control measures to limit the spread of hospital-acquired infections.

Challenges and associated factors of anesthesia practice in Ethiopia

BackgroundAnesthesia is mainly needed in surgical services, for diagnostic services in almost all fields of specialty in medicine. When anesthesia services are inadequate, difficulties are experienced. There are multifactorial reasons for the inadequacy of anesthesia services in sub-Saharan countries. The aim of this study is to assess the challenges and problems of anesthesia practice in Ethiopia. MethodologyAn observational survey carried out in 60 hospitals of the Nine regional states and two city administrative states of Ethiopia in 2018. A structured questionnaire sent to each hospital, the questionnaire consisted of eight sections to assess the availability of basic Anesthesia equipment, Drugs, and Professional Anesthetists. The head of anesthetists represented in each Hospital. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0, the results are presented in appropriate statistical tools, and the findings discussed. ResultsThis study shows that 81% of the anesthetists do have challenges and problems, which weigh down the provision of Safe anesthesia service. Eighty-three percent (83%) of anesthetists working alone without assistant. 83.2% of Anesthetists have main difficulties to perform pre-anesthetic evaluation. Around 55% of hospitals/anesthetists/have no minimum standard of monitoring devices. The availability of Anesthetic drugs in the Operation room is inadequate, for instance, 89.6%, 97.9%, and 45.8% Operation rooms/Anesthetists/have no Isoflurane, Etomidate, and Propofol respectively. Due to lack of Analgesics, only 22.9% of Anesthetists administer Analgesics Intraoperatively. 67% of Anesthetists have no emergency drug kit and 81.2% of Anesthetists have no Cricothyrodtomy set to Manage difficult airway. The overall Challenges stated by Anesthetists include Shortage of workforce, drugs & equipment, Lack of skills & Knowledge in some specialized procedures, less payment in comparison with Work overload, risks & stress, and Lack of insurance to the Anesthetists. ConclusionSince the Anesthesia service is least addressed, Major focus in terms of Anesthesia working force, Anesthesia drugs, and equipment is required to bring up to date and improve the safety of anesthesia for patients in Ethiopia.

Unusual cause of airway obstruction after nasal intubation with a preformed endotracheal tube.

Unusual cause of airway obstruction after nasal intubation with a preformed endotracheal tube.

Bundled Payment Plans Are Associated With Notable Cost Savings for Ambulatory Outpatient Total Shoulder Arthroplasty.

Bundling of services, typically into a 90-day episode of care, is intended to facilitate cost reduction. The purpose of this study was to determine the impact of a private insurance bundling program on the costs of outpatient total shoulder arthroplasty (TSA) at a freestanding ambulatory surgery center. A cost minimization analysis was done of patients who had anatomic TSA by a single surgeon at a single freestanding ambulatory surgery center, including line-by-line comparisons of demographic and comorbidity factors for all patients treated within the 90-day episode of care. Seventy-six primary anatomic TSAs were included, 39 in the bundled group and 37 outside of the program. The bundled group was on average older (58 years) than the unbundled group (54 years, P = 0.021), but the groups were otherwise similar in demographics. The average total implant charges were significantly less for the bundled group ($24,822.43 versus $28,405.51, P = 0.014). Average total surgery supply charges and anesthesia supply charges were similar (P > 0.05). Mean total outpatient surgical day charges (implants, surgical, and anesthesia equipment) were significantly less for the bundled group ($29,782.43 versus $33,238.68, P = 0.022), as were average operating room staffing costs ($135.37 versus $162.55, P = 0.015). During the 90-day postoperative period, charges were similar. Primary anatomic TSA using a bundled care program in an outpatient setting coincides with markedly lower charges. The primary driver of this reduction is implant pricing, which is negotiated as part of the bundle. Surgeons must carefully analyze their unique practices in the changing economic health care environment when creating an outpatient TSA and/or bundling program. Level III economic analysis.

The Nagin Parbhoo History of Anaesthesia Museum – Part 1

This paper provides a brief history of the Nagin Parbhoo History of Anaesthesia Museum housed in the University of Cape Town Department of Anaesthesia and Perioperative Medicine and introduces readers to the contents of the museum. Artifacts are contextualised and demonstrate the vast changes that have taken place in the specialty from the early days of ‘rag and bottle’ anaesthesia in the 1840s to the present. The role of a medical museum in preserving the history of the specialty, encouraging research and in using artifacts to teach physical principles relating to anaesthetic equipment is discussed. A follow-up paper will document the history of the museum.

The Nagin Parbhoo History of Anaesthesia Museum – Part 1

This paper provides a brief history of the Nagin Parbhoo History of Anaesthesia Museum housed in the University of Cape Town Department of Anaesthesia and Perioperative Medicine and introduces readers to the contents of the museum. Artifacts are contextualised and demonstrate the vast changes that have taken place in the specialty from the early days of ‘rag and bottle’ anaesthesia in the 1840s to the present. The role of a medical museum in preserving the history of the specialty, encouraging research and in using artifacts to teach physical principles relating to anaesthetic equipment is discussed. A follow-up paper will document the history of the museum.

Benefit of systematic selection of pairs of cases matched by surgical specialty for surveillance of bacterial transmission in operating rooms

Bacterial transmission within and between successive surgical cases occurs in operating rooms (ORs), often includes anesthesia equipment as a reservoir, and can be monitored by collecting samples and identifying bacteria by genetic testing. We evaluated how tochoose cases for active surveillance to quantify the effectiveness of interventions in 2groups ofORs (eg, rooms with germicidal lighting vs those without). Data were from a 7 OR single-specialty gastrointestinal endoscopy suite and from atypical 8OR multispecialty surgical suite. At the multispecialty hospital, 40.3% (SE 1.2%) of the total number of cases could be used for surveillance (ie, followed by another case of the same specialty and matched with a corresponding pair of cases from the other OR group). Random selection obtained fewer matched pairs than deliberate selection: mean ratio of random/deliberate = 0.64 (0.01) for the single-specialty and 0.51 (0.02) for the multispecialty suite (P<.001). The efficiency of sampling to obtain pairs of successive surgical cases of the same specialty isimpaired markedly by randomly selecting pairs ofcases (or using convenience sampling) as compared to choosing pairs deliberately. This is important because the number ofcases that can be suitably used for surveillance of bacterial transmission will typically be less than one-half the total case number.

Frequency of post-operative complications of thyroidectomy.

Objectives: The objective of this study is to determine the frequency of post-operative complications of thyroidectomy. Study Design: Observational study. Setting: LUMHS Jamshoro at the Surgery Department. Period: January 2016 to December 2017. Material and Method: During these two years all the patients visiting surgery department with thyroid swelling were assessed. Assessment of thyroid swelling was done by detailed history and clinical examination. For further assessment of the swelling thyroid function tests (serum T3, T4, TSH level), ultrasound, isotope scanning and FNAC was performed. Assessed post-operative complications of thyroidectomy. Results: After assessment thyroidectomy was performed in 143 patients. Among them there were 37 males and 106 females. The ages of patients were in the range of 15-55 years and mean age was found to be 38 years. All of these patients have visited us due to complain of thyroid swelling. After complete assessment it was found that most commonly diagnosed thyroid swelling was multinodular goitre (51.04%). On ultrasound findings 60% of patients showed solid consistency whereas cystic and mixed were found in less patients. Post-operative complications were found in 61 patients (42.6%). Hypocalcaemia was the most frequent complication found in 14.68% of patients. Conclusion: Thyroidectomy is a commonly performed procedure in endocrine surgery with low morbidity and mortality. Despite improvements in surgical techniques and anaesthetic equipment, the rate of complications in thyroidectomy is constant. Post-operative measurement of calcium levels in susceptible patients can prevent tetany and emergency room admissions.

Integrating the 2-tuple linguistic representation and soft set to solve supplier selection problems with incomplete information

With the advent of the information age, choosing suitable suppliers has become an important issue in supply chain management. Selection of the optimal supplier will ensure the competitiveness and customer satisfaction of the overall supply chain. However, assessment attribute values are sometimes missing or nonexistent in supplier selection. Moreover, experts often fail to confirm the rating values of assessment attributes, hesitating between linguistic term sets. Conversely, because experts have disparate expertise, experience, and backgrounds, they will use different linguistic term sets to evaluate the rating values of assessment attributes. These issues complicate supplier selection. To overcome these hurdles, this paper integrates the 2-tuple linguistic representation and soft set to solve supplier selection problems with incomplete information. To illustrate the application of the proposed approach, a real-life example of the selection of key anesthetic equipment is adopted. This paper also compares the results of this simulation with those of the arithmetic average, fuzzy VIKOR, and interval 2-tuple linguistic VIKOR methods. The proposed approach is more suitable and more accurate in solving supplier selection problems with uncertain and incomplete information.

Radiotherapy in Children without Anesthesia: A Feasibility Approach Using Distraction

Abstract Context: Radiotherapy is an important component of treatment of children with cancer. However, delivery of radiotherapy to children is challenging because of the requirement of sedation or anesthesia for immobilization. The present study attempts to highlight our experience of successful delivery of radiotherapy to children with cancer without the use of sedation or anesthesia. Subjects and Methods: The study included pediatric patients &lt;12 years who were treated with radiotherapy at our center between January 2015 and June 2017. Retrospective analysis of patient case records was performed to obtain the treatment details. Results: During the study, 50 children received radiotherapy, among them, 44 (88%) were treated without sedation or anesthesia. The most common diagnosis was acute lymphoblastic leukemia (25%) followed by Ewing’s sarcoma (16%) and rhabdomyosarcoma (14%). About 56% of the children belonged to the age group of 1–5 years and 44% belonged to 6–12 years. The latter age group were cooperative and completed the treatment without anxiety. Although the children belonging to 1–5 years age group had anxiety in the commencement of treatment, they completed it without anesthesia, using distraction techniques. There were no treatment delays or physical trauma sustained due to nonusage of sedation or anesthesia. Conclusions: The study shows that with adequate counseling and use of distraction techniques it is possible to deliver radiotherapy to children without the requirement of anesthesia. This practice will be useful for settings were the availability of staff and equipment for anesthesia is limited.

Anestezi ve Solunum Ekipmanlarının Sterilizasyonu ve Dezenfeksiyonu

Anestezi ve Solunum Ekipmanlarının Sterilizasyonu ve Dezenfeksiyonu

A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients.

Accidental dural puncture and post-dural puncture headache are well-known complications of neuraxial anesthesia in parturients. The primary goal of this study was to identify the rate of post-dural puncture headache and epidural blood patch in all parturients who received a neuraxial anesthetic during a ten-year period at an academic tertiary-care medical centre. A secondary goal was to identify any delay in hospital discharge due to a post-dural puncture headache. We conducted a retrospective analysis of all patients who received a neuraxial anesthetic on the labour and delivery unit at Stony Brook Medical Center from 1 January, 2006 to 31 December, 2015. Standardized neuraxial anesthesia equipment was used throughout this period. Chart reviews were conducted on all patients who received a neuraxial anesthetic and had an accidental dural puncture and/or developed a post-dural puncture headache. Of the 32,655 neuraxial anesthetics performed, 298 (0.9%) patients experienced a post- dural puncture headache. Analysis of all patients who developed a post-dural puncture headache showed that 150 (50.3%) patients received one or more epidural blood patches. Overall, 19 (0.06%) patients had a delay in hospital discharge due to a post-dural puncture headache. We showed a relatively low incidence (< 1%) of post-dural puncture headache following neuraxial anesthesia in parturients at an academic tertiary-care medical centre. Patients that rated their post-dural puncture headache as very severe were more likely to undergo at least one epidural blood patch procedure. Post-dural puncture headache is a well-known complication of neuraxial anesthesia, and may lead to a delay in hospital discharge.

Medical equipment donation in low-resource settings: a review of the literature and guidelines for surgery and anaesthesia in low-income and middle-income countries

BackgroundMedical equipment donation to low-resource settings is a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation. Challenges such as infrastructure gaps,...

Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis.

Background:The objective of this study was to compare the costs of performing metacarpal fracture fixation in minor surgery (MS) versus the main operating room (OR) at a tertiary care center in Calgary, Alberta, from the institutional perspective.Methods:Data were extracted from the Operating Room Information System and the Business Advisory System by a financial analyst. All data were based on actual expenses from the 2016–2017 fiscal year (US$). Direct costs included: staffing, supply, day (outpatient) surgery unit, post-anesthesia care unit (PACU), and anesthesia (anesthesiologist and equipment) costs. Surgeon and hardware costs were deemed neutral and excluded from the analysis.Results:The total cost of metacarpal fixation in MS was $250, compared to $2,226 in the OR, after surgeon and hardware costs were excluded. Staffing costs are a major contributing factor to cost by location ($75 in MS versus $233 in OR), largely attributable to 0.5 nursing staff per room in MS compared to 3 nursing staff per room in the OR. Supply costs (minor tray, $94 versus case cart, $247) are also greater for OR cases. The combined costs for DSU ($465), PACU ($435), and anesthesia ($247) totaled $1,147 and are only incurred for OR cases.Conclusions:Repair of metacarpal fractures in MS represents a substantial cost-minimization strategy from the institutional perspective. Staffing and supply costs by location and the additional combined costs of DS, PACU, and anesthesia are all contributing factors.

Perioperative cardio-pulmonary resuscitation

The article presents the project of guidelines in perioperative cardio-pulmonary resuscitation by international expert group and analyzes of situation on this subject in Ukraine. According to the annual reports of the anesthetic service of the 20 regions of Ukraine in 2017, 116 cases of cardiorespiratory arrest were recorded in the operating room and during the first postoperative day. 38168 cases of complications were registered in the intraoperative period and during the first day after surgery, 96 (0.25%) of them were fatal. The total number of performed anesthesia during 2017 is 858331. The incidence of intraoperative cardiorespiratory arrest was 1: 7400 anaesthesia, mortality 1: 8940 anaesthesia. Such low incidence are likely to be due to lack of registration and does not reflect a real situation. In Ukraine, the supply of minimum monitoring is 0.46 per 1 operating table. Disastrously missing modern anesthetic equipment, advanced monitoring and equipment for difficult airways. Conducting inhalation anesthesia in the mode of small / minimum flow without a gas analyzer has become, unfortunately, a common practice in Ukraine. Nearly absolutely no monitoring of neuromuscular conduction, depth of anaesthetia.

Improving Anesthesia Safety in Low-resource Settings

(Anesth Analg. 2018;126(4):1312–1320) Over the last century, anesthesia safety has improved significantly in high-income countries (HICs) of the world but has not done the same in low-income countries (LICs), due to characteristics like poor infrastructure and shortages of anesthesia providers, essential drugs, equipment and supplies. In the present article, the authors argued that further disregard of this global anesthesia crisis could result in failure to achieve the full potential of LIC populations. In order to address this issue, the authors provided a high-level overview of some of the relevant challenges and discussed current and potential initiatives at global, regional, national, and local levels. The authors believe that understanding how such systems work is essential to achieving sustainable, widespread improvement globally for safety in anesthesia.

Anesthetic Care of Children With Gene Therapy for the Treatment of Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency

AADC deficiency is a rare autosomal recessive disease that may lead to movement disorder and/or autonomic dysfunction. The prognosis of AADC deficiency patients is poor, and most die in childhood. Gene therapy is the only method currently available to help alleviate related symptoms. Gene therapy involves the injection of adeno-associated viral (AV) vector into the basal ganglia of patients, helping transfer the AADC gene and leading to improved AADC production and higher numbers of neurotransmitters in the brain. Moreover, as patients are unable to produce catecholamine, they may also suffer from a disorder affecting the regulatory control of the autonomic nervous system, resulting in hypoglycemia, which often causes imbalances in thermoregulation and hemodynamic and functional adjustments during surgery. Furthermore, the use of analgesics and inhalational anesthetics increase the risks of hypotension and bradycardia. Thus, in addition to assessing cardiac and respiratory system functions, it is important to evaluate the patient's airway before administering anesthesia, as structural anomalies or other situations may be present that lead to difficulties in tracheal intubation. Various airway tools, anesthesia equipment, and alternative plans should thus be prepared to protect the airway and maintain vital signs. All of the abovementioned issues increase the risks of AADC deficiency patients undergoing general anesthesia. The development of gene transfection for genetic diseases is a future trend. This paper identifies possible problems and related responses in perioperative patient care during gene therapy. The authors hope that these experiences provide references for the administration of AADC and similar gene therapies in the future.

МЕЖДУНАРОДНЫЕ СТАНДАРТЫ БЕЗОПАСНОЙ АНЕСТЕЗИИ: ОБЗОР РЕКОМЕНДАЦИЙ ВСЕМИРНОЙ ОРГАНИЗАЦИИ ЗДРАВООХРАНЕНИЯ И ВСЕМИРНОЙ ФЕДЕРАЦИИ ОБЩЕСТВ АНЕСТЕЗИОЛОГОВ

Background. At present, the problem of ensuring the highest possible safety of anesthesia is of current importance. To this end, the World Health Organization and the World Federation of Societies of Anesthesiologists have developed a guideline, the implementation of which enables to minimize the risks associated with the conduction of anesthesia.Objective. To provide Russian-speaking readers with an overview of the current version of safe anesthesia standards.Material and methods. A Russian translation and review of the original guideline by the World Health Organization and the World Federation of Societies of Anesthesiologists of 2018 has been done.Results. The article provides an overview of the guideline by the World Health Organization and the World Federation of Societies of Anesthesiologists concerning safe anesthesia practice in hospitals at various levels. The issues of specialists training, staff policy, organization of labor, medicinal support, modern requirements towards monitoring and anesthesia equipment, perioperative management of patients are considered.Conclusions. The implementation and compliance with these standards contributes to improving the quality of medical care, the prestige of the anesthesiology profession, reducing the number of complications of anesthesia and the cost of treatment of the patient.

The path to safe and accessible anaesthesia care

The increasing focus on and importance of surgical care in achieving universal health coverage requires the development of safe and accessible anaesthesia services. Increasing access to care by supporting the necessary inputs to the anaesthesia system, including medications, equipment and personnel, must be accompanied by processes that support high-quality care, including support for education, and guidelines for standards, and training. As safe, high-quality care requires an integrated approach, each element must be supported together, i.e., in an integrated manner to ensure that anaesthesia care reaches those who need it, and in the safest possible manner. Several important efforts have been undertaken globally to address and foster these elements, and resources to guide these processes exist for low- and middle-income countries to improve them. This review highlights both the needs and resources for safe and high-quality care that patients deserve.