Anaesthetic Practice Research Articles

Big data in anaesthesia: a narrative, nonsystematic review

Data generation is growing with the use of ‘anaesthesia information management systems’ (AIMS), but the appropriate use of data for scientific purposes is often wasted by a lack of integration. This narrative review aims to describe the use of routinely collected data and its potential usefulness to improve the quality of care, first by defining the six levels of integration of electronic health records as proposed by the National Health Service (NHS) illustrated by examples in anaesthesia practice. Secondly, by explaining what measures can be taken to profit from those data on the micro-system level (for the patient), the meso-system (for the department and the hospital institution) and the macro-system (for healthcare and public health). We will next describe a homemade AIMS solution and the opportunities which result from his integration on the different levels and the research prospects implied. Opportunities outside of high-income countries will also be presented. All lead to the conclusion that a core dataset for peri-operative global research may facilitate a framework for the integration of large volumes of data from electronic health records. It will allow a constant re-evaluation of our practice as anaesthesiologists to offer the best care for patients. In this regard, the training of some anaesthesiologists in data science and artificial intelligence is of paramount importance. We must also take into account the ecological footprint of data centres as these are energy-consuming. It is essential to prepare for these changes and turn the speciality of anaesthesia, collaborating with data scientists, into a more prominent role of peri-operative medicine.

Оценка адекватности спинального блока

This research presents a literature analysis of methods for evaluating the effec-tiveness of spinal anesthesia. The purpose of this analysis is to draw the attention of anesthesiologists to the issue of assessing the adequacy of neuraxial blockade and, in particular, spinal anesthesia, as the most commonly performed anesthetic management of surgical interventions. The adequacy of spinal anesthesia implies a pronounced motor block, which allows achieving complete relaxation of the muscles of the lower extremities and, if necessary, the muscles of the anterior abdominal wall, as well as the loss of pain, temperature and, as the most optimal level, this is the loss of tactile sensitivity. Considered methods for assessing motor, sensory and sympathetic blockade are P.R. Bromage scale to assess motor block, assessment of temperature and pain sensitivity (test with an ice tube, so-called Cold-test, test for pain sensitivity of the skin pin-prick). Until recently, in anesthesia practice, insufficient attention was paid to assessing the level of sympathetic blockade. The research describes an alternative method for assessing this type of blockade: laser doppler flowmetry. The quality and adequacy of spinal anesthesia will depend on the level and severity of these types of blockades.

Recent advances in cardiac anaesthesia.

The speciality of cardiac anaesthesia has rapidly evolved over the past few decades with advances in technology, including artificial intelligence (AI), newer devices, techniques, imaging, pain relief and a better understanding of the pathophysiology of disease states. Incorporation of the same has led to improved patient outcomes in terms of morbidity and mortality benefits. With the advent of minimally invasive surgical methods, minimising the dose of opioids and ultrasound-guided regional anaesthesia for pain relief, enhanced recovery after cardiac surgery has been made possible. Perioperative imaging including 3D transoesophageal echocardiography, newer devices and drugs and AI algorithms will play a significant role in cardiac anaesthesia. This review briefly addresses some of the recent advances that the authors believe can impact the practice of cardiac anaesthesia.

Impact of a standardized multidisciplinary protocol for placenta accreta spectrum on blood bank services

To assess the impact of a standardized multidisciplinary protocol for managing patients with placenta accreta spectrum (PAS) on the utilization of blood bank services. We performed a retrospective cohort study of all pregnant women managed at our center between January 2013 and October 2019 for confirmed or suspected PAS disorders. We compared the demographic and clinical characteristics of the patients and the utilization of blood bank services, including dispensed, transfused, and wasted blood components products, before (T1) and after (T2) the implementation of a standardized multidisciplinary protocol. This protocol focused on increased surveillance and readiness for patients at risk for PAS, standardization of surgery, anesthesia and transfusion practices, selective embolization of pelvic arteries in patients with abnormally invasive placenta, intraoperative blood salvage, and robust treatment of anemia antenatally. Univariate analysis was performed using unpaired t, Mann-Whitney, chi-square, and Fisher's exact tests as appropriate. The patients' characteristics in T1 and T2 were comparable (Table1). In T2, 79% of the patients were managed according to the protocol. The number of blood products dispensed from the blood bank, particularly RBCs, increased during T2. (Table 2). In contrast, fewer RBCs and FFPs were transfused in T2. There was no significant difference in dispensed or transfused platelet and cryoprecipitate units. The number of wasted blood products was small and did not significantly change. The decreased transfusion of RBC and FFP was the result of a decline in peripartum blood loss (median, 800 vs.1550 ml, p< . 001) and the risk for massive blood loss (RR: 0.16, 95% CI: 0.03 to 0.92, p=.04) and stage 3 postpartum hemorrhage (RR: 0.37, 95% CI: 0.17 to 0.75, p=.009). The standardized multidisciplinary protocol for PAS increased the workload of our blood bank due to greater dispensation of blood products but resulted in fewer RBC and FFP transfusions parallel to a decline in catastrophic hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Recent advancements in regional anaesthesia.

Patient safety, improved quality of care, and better patient satisfaction and functional outcomes are currently the topmost priorities in regional anaesthesia (RA) and all advancements in RA move in this direction. Ultrasonography-guided central neuraxial and peripheral nerve blocks, intracluster and intratruncal injections, fascial plane blocks, diaphragm-sparing blocks, use of continuous nerve block techniques, and continuous local anaesthetic wound infiltration catheters are now topics of popular clinical interest. The safety and efficacy of nerve blocks can be improved with the help of injection pressure monitoring and the incorporation of advanced technology in the ultrasound machine and needles. Novel procedure-specific and motor-sparing nerve blocks have come up. The anaesthesiologist of the current era, with a good understanding of the sonoanatomy of the target area and the microarchitecture of nerves, along with the backup of advanced technology, can be very successful in performing RA techniques. RA is rapidly evolving and revolutionising the practice of anaesthesia.

Guidelines to the Practice of Anesthesia: Revised Edition 2023.

The Guidelines to the Practice of Anesthesia Revised Edition 2023 (the Guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. The Guidelines are subject to revision and updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2023 supersede all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the CAS cannot guarantee any specific patient outcome. Anesthesiologists should exercise their own professional judgment in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.

The Advent of Artificial Intelligence in Anesthesiology and Pain Management: A Review Article

Background: Artificial intelligence (AI) has brought about advancements in several areas, including anesthesiology. A description of the current state of the literature regarding the use of AI in relation to anesthesiology is needed to analyze whether AI is implemented in clinical anesthetic practice. AI and machine learning (ML) have been proven to be useful in developing effective healthcare strategies. Although AI has been employed to automate anesthetic delivery, it is not yet that common in anesthesiology and pain management. Methods: Various studies on the diverse uses of AI in the areas related to anesthesiology were compiled from several databases such as the Cochrane Library, Google Scholar, Medline (Ovid), and PubMed from 2003 to 2023. The obtained data were then classified, condensed, and juxtaposed finally. The study included diverse permutations of AI, ML, pain, and anesthesiology. Results: Postoperative pain has been one of the major concerns of anesthesiologists, and poor management in this regard can be associated with adverse events. In recent years, remarkable advances have been made in pain management strategies. One of them, which has attracted increasing attention, is the use of AI in anesthesiology and pain management. However, despite its great popularity, it has not been without challenges. Conclusion: In general, most of the studies explored in this review article have envisaged a bright future for the use of AI in anesthesiology and pain management. Some studies, however, have reported mixed results. Accordingly, further investigations with larger sample sizes are required to validate these findings.

Global Anesthesiology and Intraoperative Neuromonitoring: Report from a Sustainable Collaboration

Committee News| January 2023 Global Anesthesiology and Intraoperative Neuromonitoring: Report from a Sustainable Collaboration Julio C. Montejano, MD; Julio C. Montejano, MD Search for other works by this author on: This Site PubMed Google Scholar Betty Nantongo, MBChB, MMed; Betty Nantongo, MBChB, MMed Search for other works by this author on: This Site PubMed Google Scholar Teguo Daniel Djoyum, MPH, CNIM, R.EEG.T; Teguo Daniel Djoyum, MPH, CNIM, R.EEG.T Search for other works by this author on: This Site PubMed Google Scholar Colby G. Simmons, DO, MBA Colby G. Simmons, DO, MBA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 32–33. https://doi.org/10.1097/01.ASM.0000911812.56399.8f Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Julio C. Montejano, Betty Nantongo, Teguo Daniel Djoyum, Colby G. Simmons; Global Anesthesiology and Intraoperative Neuromonitoring: Report from a Sustainable Collaboration. ASA Monitor 2023; 87:32–33 doi: https://doi.org/10.1097/01.ASM.0000911812.56399.8f Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: intraoperative neurophysiological monitoring, uganda, neurosurgical procedures The stated mission of the ASA Committee on Global Health is to enhance, support, educate, represent and collaborate for safe anesthesia practice worldwide. As an ASA Committee on Global Health scholarship recipient, Dr. Simmons traveled to CURE Uganda in 2017 and fully felt the pull of that mission. It was during this trip, and subsequent visits thereafter, that the framework was set for the creation of an educational and clinical program that would significantly improve surgical and anesthesia care, support economic development with job creation, and improve career satisfaction of clinicians via the implementation of the first intraoperative neuromonitoring (IONM) program in Uganda. At the University of Colorado Hospital, where Drs. Simmons and Montejano practice, the Section of Neuroanesthesia supervises and directs the IONM program. Utilizing these unique skills and recognizing the need for this technology and its ability to enhance patient outcomes, work began toward training and educating both... You do not currently have access to this content.

Making Regional Anaesthesia Safe

The complexity of current practice in anaesthesiology and perioperative medicine has resulted in employing complex regional anaesthesia techniques to improve patient outcomes in terms of better postoperative pain control and thus facilitate early mobilization and recuperation of patients. However, ensuring patient safety while performing these complex procedures is of paramount importance and all efforts need to be undertaken to minimise the possibility of harm to the patient. Quality improvement and patient safety go hand in hand. Ensuring safe practices in regional anaesthesia is not just an individual task but a collective responsibility of the perioperative team. It thus involves both technical skills as well as non-technical skills and human factors. This article provides a brief discussion of the various measures involving technical and non-technical factors to improve patient safety in modern day regional anaesthesia practice. Keywords: Regional Anaesthesia, Patient safety, Non-technical skills, Human factors

Allaying Pediatric Preoperative Anxiety, Where are we Now? - A Nationwide Survey.

Preoperative anxiety (PA) in children is a common phenomenon associated with various negative patient outcomes. Allaying PA is accepted as a standard of care, but its use is not universal and often overlooked. This survey is designed to evaluate the nationwide current practice patterns and attitudes of anesthesiologists toward the practice of allaying PA in children. A questionnaire of 25 questions, including information on methods of relieving PA in children, reasons for noncompliance, and associated complications, was framed. It was circulated among members of the Indian Society of Anaesthesiologists through an online survey of Google Forms and manually. Four hundred and fifty anesthesiologists were surveyed. Responses were predominantly from anesthesiologists practicing in medical colleges across the country. Although 97% of the surveyed respondents practiced anxiety-relieving strategies, only 37% used it consistently. Seventy-three percent of anesthesiologists practiced both pharmacological and nonpharmacological techniques. The most common reason for avoiding premedication was an anticipated difficult airway (88%). Inadequate sedation was a commonly reported problem. Ninety-five percent of participants felt that PA-relieving strategies should be integral to pediatric anesthesia practice. The most common reason for not following these practices was an inadequate hospital infrastructure (67%). Ninety-seven percent of the participants believed that more awareness is required on this crucial perioperative issue. Only 37% of the surveyed anesthesiologists consistently used some form of PA-relieving strategy and the practice varied widely. Further improvement and team approach involving anesthesiologists, surgeons, and nurses is required to ensure the quality of pediatric PA-relieving services and establish it as a standard of care.

IS SURGICAL TREATMENT OF VELOPHARYNGEAL INSUFFICIENCY BY MYOMUCOSAL POSTERIOR PHARYNGEAL FLAP A CONTRAINDICATION FOR NASAL INTUBATION? A NARRATIVE REVIEW.

Velopharyngeal insufficiency is a disorder where the soft palate directs the air through the nose. It is often present in patients with previous cleft or short palate, but also in many other conditions. Symptoms are primarily to be found in speech, with very distinct nasal sound. After clinical evaluation and nasal endoscopy, surgery is considered. Several surgical techniques are in use, with posterior pharyngeal flap pharyngoplasty being most widely used. This method leaves the base of the posterior pharyngeal flap attached to the posterior pharyngeal wall, with two lateral ports on each side of the flap. Permanent nasopharyngeal obstruction is a very challenging pathology for anesthesiologists in case of mandatory nasal intubation since it is a relative contraindication for nasal intubation. Patients with previous palatoplasty will regularly appear in our routine anesthetic practice, in all surgical segments. The high risk of damage to the flap with possible bleeding can put the anesthesiologist in a very unpleasant situation if not aware of the permanent effect of this surgery. During preanesthetic assessment, if there is information on a previous pharyngoplasty, one should consider alternative options for nasotracheal intubation. All nasal insertion procedures must be either avoided or carried out with great caution, under fiberoptic visual control.

Anaesthetic challenges in apert syndrome : A case series.

Apert syndrome is an autosomal dominant inherited condition characterised by craniosynostosis, syndactyly, mid face hypoplasia, organ malformations, and mental retardation. As it is rarely encountered, so there is little knowledge of the anaesthesia practice in the literature for this syndrome, we present our experience of two cases undergoing bilateral syndactyly release under general anaesthesia.

Regional anaesthesia practices: insights from a European survey

BACKGROUND The use of regional anaesthesia has increased and evolved over the past two decades but to what extent is unclear. Moreover, there is no clear standardisation of best practice in the current European landscape, which could result in inconsistencies in regional anaesthesia in practice. OBJECTIVES The objective of this survey was to explore regional anaesthesia practices across Europe, including the differences in procedures, use of ultrasound, reporting of complications, guidelines, training and patient safety implementation. DESIGN A Faculty of European regional anaesthesia experts developed a survey of 27 questions focused on respondent and institution profile, anaesthesia services, patient and safety management, training, use of guidelines, and the implementation of NRFitTM [neuraxial device connectors that meet the International Organisation for Standardisation (ISO) requirements]. SETTINGS The survey was disseminated across several European countries via professional networks. PARTICIPANTS There were 794 respondents from 36 European countries. RESULTS The survey demonstrated that use of regional anaesthesia is growing in Europe and is supported by new technologies. Although some results are consistent with expected trends and applications (e.g. procedures predominantly performed by anaesthesiologists), there are inconsistencies in practice across European countries, especially in the specific regional anaesthesia procedures utilised for different clinical applications and the recording and reporting of regional anaesthesia complications. These inconsistencies also extended to which guidelines are primarily followed and how training is implemented. There were also variations in the general awareness and uptake of the ISO standard for NRFit. CONCLUSION The survey results highlight a clear need for standardisation and consistency in the use and management of regional anaesthesia across Europe. The faculty put forth several calls to action that could provide major steps in the right direction towards meeting that goal, including the establishment of European best practices, development of a complication reporting system and implementation of educational programmes to highlight the importance of NRFit.

Plan A blocks

With the increase in ultrasound use, regional anesthesia practices have gained popularity and many novel techniques are being described. However, the rapidly increasing number of new block techniques also led to confusion. Therefore, seven basic regional anesthesia techniques that are effective in most of the surgeries have been listed as 'Plan A Blocks.' The purpose of this review is to introduce the basic sono-anatomy and indications of Plan A blocks.

Low Dose Combined Spinal-Epidural (CSE) Anaesthesia with Blocks for Management of A High-Risk Geriatric Patient with Dilated Cardiomyopathy Posted for TURBT

Introduction: Transurethral resection of bladder tumors (TURBT) is the first-line method and mainstay for endoscopic diagnosis, staging, and treatment of urinary bladder tumours. Hypotonic fluid absorption, electrolyte imbalance from irrigation, haemorrhage, and obturator jerk episodes are just a few of the procedure’s intrinsic risks. Cardiovascular issues were more likely to arise in elderly patients undergoing this surgery. A high risk of pulmonary oedema, arrhythmia, and bleeding problems exists in individuals with coronary artery disease (CAD), dilated cardiomyopathy (DCMP), multiple comorbidities, and anticoagulant medication. Case Presentation: Here, we provide a challenging situation of A 74-year-old man was scheduled to have TURBT (Transurethral Resection of Bladder Tissue) for a bladder mass with hematuria and many comorbidities, including Hypertension (HTN), Chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), post percutaneous transluminal coronary angioplasty (PTCA), cerebrovascular accident (CVA), dilated cardiomyopathy (DCMP), ejection fraction (EF) 25%, and Severe MR necessitating obturator nerve block (ONB), spinal anaesthesia (SA), and epidural anaesthesia (EA) for perioperative and postoperative anaesthetic as well as analgesia, which was effectively handled without any difficulties. Conclusion: Elderly patient with ischemic cardiomyopathy are at higher risk of major cardiovascular events perioperatively. Low dose spinal anaesthesia combined with epidural anaesthesia provides better hemodynamic stability, prevents myocardial depression, provide perioperative analgesia and early ambulation. Keywords: Obturator nerve block, Spinal anaesthesia, General anaesthesia practice, Transurethral Resection of Bladder Tissue (TURBT), Cerebrovascular accident (CVA), Chronic obstructive pulmonary disease (COPD)

Comparison of Intraoperative Effects of Intratesticular Lidocaine and Procaine on Hemodynamic Responses in Male Cats Undergoing Routine Castration

This study was aimed to compare the effects of intratesticularly administered lidocaine and procaine on perioperative nocifensive responses in cats undergoing elective castration. Sixteen male cats (weighing between 2.3 and 6.7 kg, and 8 mounths to 3 years of age) were received for planned castration and suitable for inclusion. Cats were incidentally divided to 2: the lidocaine (group 1) and the procaine (group 2) groups. In group 1, lidocaine (1 mg/kg) was slowly injected to the right testis of the cats with a hypodermic syringe. In group 2, 1 mg/kg procaine was slowly injected to the right testis with the same technique. Besides to objective follow-up clinical monitoring, heart rate, electrocardiogram, respiration frequency, pulse oximetry, rectal temperature and blood pressure were traced during surgery with a bedside monitor. Respiration frequency values were significantly higher than before surgey at the first prescrotal incision and the clamping of the left testicular pediclein group 1 (p &amp;lt; 0.05). BP diastolic values significantly increased from before surgeryat the clamping of right testicular pedicle in the procaine group (p &amp;lt; 0.05). These findings suggested that intratesticular procaine is a beneficial analgesic technique in cats undergo planned castration and should be considered as an adjunct to standard anesthetic practice with lidocaine.

Practice of Pediatric Anesthesia in an Adult Operating Theater in Sub-Saharan Africa: Experience of the Essos Hospital Center in Yaounde (Cameroon)

Background: The aim of this study was to evaluate the practice of pediatric anesthesia in an adult operating theater in sub-Saharan Africa. Patients and Methods: This was an observational, prospective descriptive study that took place over a period of 12 months in the anesthesiology department of the Essos hospital center in Yaounde (Cameroon). Children &lt;15 years old, seen in anesthesia consultation and operated on for scheduled surgery during the above- mentioned period were included in the study. The variables studied were the variables studied were: the characteristics of the study population, the anesthetic and surgical data, as well as the patient's postoperative itinerary. Results: During the study period, 162 patients were included out of a total of 1205 patients operated on during the same period. The median age was 5 years, the sex ratio 1.8. ASA class 1 was the most represented (98.1%). The combination midazolam and atropine was the premedication of choice (87.1%). General anesthesia was the most practiced technique (96.3%). Induction of general anesthesia was inhalation in 69% of cases, sevoflurane was the hypnotic used in this indication. General anesthesia was performed by a senior anesthesiologist in 67.3% of children. The majority of surgical procedures belonged to otolaryngology surgery (57%). The electrocardiogram (ECG), blood pressure, SpO2 and heart rate constituted the main part of the intraoperative monitoring. Conclusion: In low-income countries, pediatric anesthesia is still performed by personnel who are not specialized in pediatric anesthesia. In order to improve the safety of children in the operating room, health policies must encourage training and specialization in this highly delicate area, which will make it possible to reduce perioperative infant morbidity and mortality.

Continuous spinal anaesthesia, an underutilised neuraxial technique in current anaesthesia practice: a timely reminder

Continuous spinal anaesthesia (CSA) is a cardio-stable technique used in high-risk patients undergoing surgery. However, this technique appeared to decline over the last decades due concerns of complications that arise from using this technique, such as post-dural puncture headaches and neurological deficits. We report two cases of elderly patients, one at high cardiac risk and one with dementia and multiple comorbidities, under CSA for orthopaedic surgery with no reported complications. CSA is an adequeate anaesthetic technique with a low failure rate and complications. Proper technique should be taken into consideration to increase the success rate for this procedure.

Pediatric anesthesia practices during the COVID-19 pandemic: A retrospective cohort study.

The onset of the coronavirus 2019 (COVID-19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID-19. Using the Premier Health Database, we retrospectively analyzed pediatric patients undergoing a surgical intervention for fractures or ligament repair before and during COVID-19. We sought to determine if there were differences in anesthesia use among this cohort during the two time periods. Fracture groups included shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankles, and foot and toes. Ligament procedures included surgical intervention for the anterior cruciate ligament and ulnar collateral ligament repair. We identified a total of 5935 patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID-19. After exclusion for unknown anesthesia use, 2,807 patients were included in our cohort with 81.5% (n = 2288) of patients undergoing a procedure under general anesthesia, 6.4% (n = 181) under regional anesthesia, and 12.0% (n = 338) under combined general-regional anesthesia. There did not appear to be a significant difference in the type of anesthesia used before and during COVID-19 (p = 0.052). Our study did not identify a difference in anesthesia use before and during COVID-19 among pediatric patients undergoing a surgical procedure. Further studies should estimate the change in anesthesia used during the time period when elective procedures were resumed.

A Rare Case of Transesophageal Echocardiography Probe-Induced Tongue Ulcer

AbstractTransesophageal echocardiography (TEE) is a commonly used diagnostic and monitoring modality in anesthetic practice. It is used in neurosurgery for monitoring cardiac function and detecting venous air embolism. TEE is a semi-invasive procedure and is considered to be reasonably safe with a few complications. During neurosurgical cases, access to the head end is limited and TEE can cause injury due to prolonged contact. These injuries can be noticed only at the conclusion of the surgery. We report a rare case of tongue ulcer caused due to the use of TEE in a sitting neurosurgical procedure with a complete resolution.