Anaesthetic Assessment Research Articles

Assessing the Rates and Reasons of Elective Surgical Cancellations on the Day of Surgery: A Multicentre Study from Urban Indian Hospitals

BackgroundCancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC). This study investigates the rate and causes of cancellations of elective surgeries on the DOS in various surgical departments across ten hospitals in India.MethodsA research consortium ‘IndSurg’ led by World Health Organisation Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs, India conducted this multicentre retrospective cross-sectional study to analyse the cancellations of elective/planned surgical operations on DOS across urban secondary and tertiary level hospitals. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations.ResultsWe analysed records from the participating hospitals, with an overall cancellation rate of 9.7% (508/5231) on the DOS for elective surgical operations. Of these, 74% were avoidable cancellations. A majority (30%) of these 508 cancellations were attributed to insufficient resources, 28% due to patient's refusal or failure to show-up, and 22% due to change in patient's medical status.ConclusionWe saw a preponderance of avoidable reasons for elective surgery cancellations. A multidisciplinary approach with adequate preoperative patient counselling, timely communication between the patients and caregivers, adequate preoperative anaesthetic assessment, and planning by the surgical team may help reduce the cancellation rate.

Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review

The pre-operative phase in planning a pelvic exenteration or extended resections is critical to optimising patient outcomes. This review summarises the key components of preoperative assessment and planning in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LLRC) being considered for potential curative resection. The preoperative period can be considered in 5 key phases: 1) Multidisciplinary meeting (MDT) review and recommendation for neoadjuvant therapy and surgery, 2) Anaesthetic preoperative assessment of fitness for surgery and quantification of risk, 3) Shared decision making with the patient and the process of informed consent, 4) Prehabilitation and physiological optimisation 5) Technical aspects of surgical planning. This review will focus on patients who have been recommended for surgery by the MDT and have completed neoadjuvant therapy. Other important considerations beyond the scope of this review are the various neoadjuvant strategies employed which in this patient group include Total Neo-adjuvant Therapy and reirradiation. Critical to improving perioperative outcomes is the dual aim of achieving a negative resection margin in a patient fit enough for extended surgery. Advanced, realistic communication is required pre-operatively and should be maintained throughout recovery. Optimising patient's physiological and psychological reserve with a preoperative prehabilitation programme is important, with physiotherapy, psychological and nutritional input. From a surgical perspective, image based technical preoperative planning is important to identify risk points and ensure correct surgical strategy. Careful attention to the entire patient journey through these 5 preoperative phases can optimise outcomes with the accumulation of marginal gains at multiple timepoints.

TP6.2.13 A PEG insertion pathway for Motor Neurone Disease patients improves efficiency and patient outcomes

Abstract Aims Patients with Motor Neurone Disease (MND) often require a Percutaneous Endoscopic Gastrostomy (PEG) as a palliative procedure during the later stages of their illness, due to swallowing difficulties. More recently these are being inserted earlier before the inevitable decrease in nutritional intake and subsequent fall in albumin levels. This allows patients to eat food they enjoy rather than concentrating on maintaining intake. Insertion has traditionally been done with local anaesthetic and OGD, which can be difficult and traumatic. We propose a method of insertion using TIVA (Totally Intravenous Anaesthetic) in theatre with no intubation, performed by the surgical team, with a pathway including pre-operative anaesthetic assessment. Methods Data was collected from all PEG insertions performed in theatre from 1/1/2011 to 1/9/2019. MND patients following our pathway were compared to all other indications for PEG insertions. Length of stay (LOS), 30-day re-admission rates, 30-day, 90-day and 1-year mortality were analysed. Results 98 patients were identified. Median LOS was 3 days (mean 12.2) with a 3% 30-day mortality, 12.2% 90-day mortality and 34.7% 1-year mortality. In the MND group there were 27 patients. Median LOS was 2 days (mean 8.6) with a 7.4% (2 patients) 30-day mortality, which remained 7.4% at 90 days. There were 13 re-admissions (13.3%) overall compared to 0% in the MND group (p = 0.04 (Chi-squaredtest)). Conclusions PEG insertion under TIVA for MND patients is safe. A set pathway for admission and pre/post-insertion care increases efficiency with reduced length of stay and improves patient outcomes with no re-admissions.

Penanganan Trigeminocardiac Reflex (TCR) selama Anestesi untuk Bedah Saraf

Trigeminocardiac reflex (TCR) is a unique brain stem reflex that manifests as negative cardio-respiratory perturbations. The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. This reflex is largely reported in skull base surgeries/interventions; however, in recent times, it has been also linked with many neurosurgical, neurointerventional procedures, non-neurosurgical and non-surgical conditions. This reflex presents with many cardiovascular changes that can create catastrophic complications, worse outcome as well as diagnostic dilemmas. Although, there is an abundant literature with reports of incidences and risk factors of the TCR; the physiological significance and function of this brainstem reflex has not yet been fully elucidated. In addition, there are complexities within the TCR that requires examination and clarification. If a CTR occurs, it can risk factor identification and modification, depth of anesthesia assessment, prophylactic treatment with either vagolytic agents or peripheral nerve block in case of peripheral manipulations of the nerve, careful cardiovascular monitoring during anesthesia, especially in those with a risk factor for TCR, treatment of the condition when it occurs: cessation of the manipulation, and administration of vagolytic agents and adrenaline. Therefore, this narrative review intends to elaborate on its mechanisms, definition, pathophysiology, manifestations, diagnosis and management.

Perioperative Risk Stratification: A Need for an Improved Assessment in Surgery and Anesthesia-A Pilot Study.

Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score–P-POSSUM (p < 0.01, r = 0.465); ASA score–SAS, (p < 0.01, r = −0.446); ASA score–APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient’s progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes.

Is ASA Classification Useful in Risk Stratification for EBUS-TBNA?

The efficiency and safety of American Society of Anesthesiologists (ASA) in predicting peri-bronchoscopic morbidity and mortality is an increasing concern as endobronchial ultrasound (EBUS) gains popularity. The purpose of this study is to investigate whether the ASA classification is useful in risk stratification for EBUS. The patients who underwent EBUS and had anesthesia assessment before the procedure, were enrolled. Data about the age, gender, comorbidity, ASA score, and complications were collected retrospectively from their medical files. A total of 221 patients with ASA class documentation in anesthesia assessment before EBUS, were enrolled in the study. The study population comprised 125 (56.6%) male and 96 (43.4%) female patients with a mean age of 59.08 ± 11.15 years. Comorbidity was present in 161 patients (72.9%), of which hypertension (64%) was the most common. There was no significant difference between the pre-bronchoscopic and post-bronchoscopic values of oxygen saturation (SpO2), systolic and diastolic blood pressure, and heart rate (respectively P = .83, P = .12, P = .15, P = .89). The most frequent complication during EBUS was desaturation that happened in 109 (49.3%) patients. There was no correlation between ASA score and complications (P > .999). There was no statistically significant difference in ASA scores with respect to complications (P = .14). The sensitivity and the specificity of pre-bronchoscopic evaluation in predicting the post-anesthesia care unit (PACU)/intensive care unit (ICU) requirement, were 83.3% and 61%, respectively. The significant deciding factors for post-bronchoscopic follow-up sites were found to be as ASA and age (respectively, P = .025, P < .001). There was no correlation between ASA and complications. To organize PACU/ICU beds more efficiently, a better scoring system is required.

S592 COVID-19 and Its Effect on Endoscopic Peri-Procedural Times Based on the American Society of Anesthesiologists Physical Status Classification: A Single Center Experience

Introduction: Endoscopy centers have had to adjust common practices during the COVID-19 pandemic in order to mitigate the risk of transmission while optimizing layout to maintain efficiency. Pre-procedural testing, changes in endoscopy structure and staff, downtime for cleaning, and a limited number of negative pressure rooms have presented new challenges. The purpose of our study is to compare outpatient peri-procedure times before and during COVID-19, to determine if any significant differences would be present. Methods: Our study is a retrospective, single center analysis utilizing endoPRO software to extract individual patient data during the months of October in 2019 and 2020. These two months were chosen since they reflect a pre-COVID-19 and COVID-19 time period. The study included patients that underwent various endoscopic procedures in an outpatient setting. A total of 1769 procedures were classified into two groups, either American Society of Anesthesiologists Physical Status (ASA-PS) 1 and 2 (n=1087), or ASA-PS 3 and 4 (n=679), as determined by pre-procedure anesthesia assessment. Patients were further divided into year 2019 and year 2020 subgroups. Table 1 shows the outcomes of interest that were analyzed, which was performed using a two-sample t-test with Python programming language. Results: The analysis is presented in Table 1. Comparing outpatient procedures across all ASA-PS, those in 2020 had statistically significant longer time intervals for many of the outcomes of interest, as shown in Table 1 (p < 0.05). Stratifying by ASA-PS 1 and 2 in each year, procedures in 2020 also had longer outcomes of interest. Selecting for colonoscopies only, our data also demonstrates longer time intervals in multiple subcategories when comparing 2020 to 2019. Conclusion: Our single center retrospective analysis establishes that outpatient peri-procedure times in October of 2020 were considerably longer compared to those in October of 2019. Grouping the data further by similar ASA-PS and type of procedure still showed longer endoscopy suite preparation and post-procedural times in 2020. This period represents a time when COVID-19 has caused substantial disruption to regular endoscopy workflow and efficiency. One notable difference was that the procedure time for a colonoscopy in October of 2020 was 23.2 minutes, compared to 19.6 minutes in 2019. We hypothesize that there were likely fewer screening colonoscopies being performed in 2020 versus 2019, which may be accounting for some of the difference.Table 1.: Study Analysis

Electroencephalographic assessment of infant spinal anesthesia: A pilot prospective observational study.

Spinal anesthesia is utilized as an alternative to general anesthesia in infants for some surgeries. After spinal anesthesia, infants often become less conscious without administration of sedative medications. The aim of this study was to assess electroencephalographic (EEG) correlates after spinal anesthesia in a cohort of infants. This pilot study included 12 infants who underwent spinal anesthesia. Unprocessed electroencephalography was recorded. The electroencephalogram was interpreted by four neurologists. Processed analyses compared electroencephalogram changes 30min after spinal anesthesia to baseline. Following spinal anesthesia, all 12 infants became sedated. Electroencephalography in all 12 demonstrated Stage 2 sleep with the appearance of sleep spindles (12-14Hz) in the frontal and central leads in 8/12 (67%) of subjects. The median time to onset of sleep spindles was 24.7 interquartile range (21.2, 29.9)min. The duration of sleep spindles was 25.1 interquartile range (5.8, 99.8)min. Voltage attenuation and background slowing were the most common initial changes. Compared to baseline, the electroencephalogram 30min after spinal anesthesia showed significantly increased absolute delta power (p=0.02) and gamma power (p<0.0001); decreases in beta (p=0.0006) and higher beta (p<0.0001) were also observed. The Fast Fourier Transform power ratio difference for delta/beta was increased (p=0.03). Increased coherence was noted in the delta (p=0.02) and theta (p=0.04) bandwidths. Spinal anesthesia in infants is associated with increased electroencephalographic slow wave activity and decreased beta activity compared to the awake state, with appearance of sleep spindles suggestive of normal sleep. The etiology and significance of the observed voltage attenuation and background slowing remains unclear. The EEG signature of infant spinal anesthesia is distinct from that seen with general anesthesia and is consistent with normal sleep. Further investigation is required to better understand the etiology of these findings. Our preliminary findings contribute to the understanding of the brain effects of spinal anesthesia in early development.

Safety Assessment of Dental Local and Regional Anesthesia after COVID-19 Vaccination

Backgrounds and objectives: Recently, a particular importance has been attributed to the receive of the Covid-19 vaccine in order to hope minimizing the spread of the pandemic and to reduce the very high mortality rate especially lately with the appearance of the Delta variant, however, a very large part of the population still hesitate for fear of the probable side effects falsely reported by the social media, among these risks, the contraindication of local or regional dental anesthesia after Covid-19 vaccination because of potentially fatal complications, until proven otherwise, this rumor remains false but threatens however a good progression of the vaccination, the objective of this research is to evaluate the safety of the realization of a dental local or regional anesthesia after the Covid-19 vaccination. Methods: This study was conducted on 288 patients, the control of 140 patients was done by a complete medical examination while the health status of 148 patients was assessed by a telephonic interview, the participating patients must present their vaccination’s proof with a date of vaccination that does not exceed one week before their dental care or surgical procedures requiring local anesthesia, 252 of these studied patients consulted having their first dose of the vaccine while only 36 patients who received the second dose, pregnant women are excluded from the study, only complications of local or regional anesthesia related to the three vaccines Sinovac, Sputnik V and AstraZeneca were studied because they are the only three vaccines available in Algeria, this research excludes the study of possible complications of general anesthesia in relation to the vaccines Covid-19, complications and side effects were sought within one week of the administration of local or regional anesthesia, beyond one week, the participant was excluded because of the possibility that other origins might distort the study. Results: No deaths, no particular complications .......

COMPARISON OF ENDOTRACHEAL INTUBATION VERSUS SUPRAGLOTTIC AIRWAY DEVICE IN PATIENTS UNDERGOING CORNEAL TRANSPLANTATION UNDER GENERAL ANAESTHESIA

Objective: To compare endotracheal intubation versus Suraglottic airway device in patients undergoing penetrating keratoplasty under general anaesthesia.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan 2018 to Mar 2020.&#x0D; Methodology: Total 28 patients enrolled with a mean age of 42.82 ± 7.86 years and age-range of 18-55 belonging to American Society of Anesthesiology I, II &amp; III undergoing penetrating keratoplasty under general anaesthesia. The airway was secured with I–Gel and Endotracheal tube in group A (n=14) and group B (n=14) respectively. Pre anaesthesia assessment along with informed written consent performed. General Anesthesia is given and patients monitored as per standard protocols. Postextubation incidence of cough, sore throat, bronchospasm, stridor and blood on device recorded in addition to surgery and recovery duration.&#x0D; Results: Twenty-eight patients were enrolled in the study with a mean age of 42.82 ± 7.86 years. There were 9 (32.1%) females and 19 (67.9%) males in the study group. The recovery time was significantly lower for group A as compared to group B (72.64 ± 5.06 vs 80.43 ± 3.75, p&lt;0.001). Similarly, a significantly lesser number of patients experienced post-extubation complications i.e. cough, among group A as compared to Group B [1 (7.1%) vs 8 (57.1%) p0.005].&#x0D; Conclusion: I-Gel provides smooth recovery with reduced mean recovery time and decreased potential of raised intraocular pressure, when compared with endotracheal intubation in patients undergoing penetrating keratoplasty under general anaesthesia.

Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury

Advances in shoulder magnetic resonance imaging (MRI) and arthrography (MRA) have revolutionised musculoskeletal diagnosis and surgical planning. Despite this, the overall accuracy of MRI, with or without intra-articular contrast, can be variable. In this prospective non-randomised analysis, 200 participants (74.5% males) with suspected shoulder injuries underwent MRI (41.0%) or MRA followed by arthroscopy. A study specific proforma was developed to ensure consistency of reporting by radiologists and surgeons. The reports were compared to assess the predictive power of MRI/MRA. Specific assessment of rotator cuff tendon appearance, long head of biceps (LHB) tendon appearance, position and anchor, subacromial space, glenoid labrum and humeral cartilage grade were included. Shoulder MRA demonstrated a higher agreement with arthroscopy than MRI for supraspinatus, infraspinatus and subscapularis tendon appearance (κ=0.77 vs. κ=0.61, κ=0.55 vs. κ=0.53 and κ=0.58 vs. κ=0.46 respectively). There were also superior agreement rates with MRA compared to MRI for LHB tendon appearance (κ=0.70 vs. κ =0.54) and position (κ=0.89 vs. κ=0.72). As an overall assessor of shoulder pathology we found significantly higher total agreement scores when MRA was used (p=0.002). Whilst magnetic resonance imaging with arthrography is an extremely useful tool to assess underlying pathological shoulder states it does not confer 100% accuracy. In cases whereby this modality is inconclusive, an examination under anaesthesia and diagnostic arthroscopic assessment for the detection of intra-articular shoulder pathology may be considered.

Providing sealants at the general anaesthetic assessment visit for children requiring caries-related dental extractions under general anaesthetic: a pilot randomised controlled trial.

Introduction Children experiencing a caries-related dental general anaesthetic (GA) are at high risk of developing new caries. It is thus important to maximise opportunities for prevention.Aim To undertake a pilot randomised controlled clinical trial (RCT) to assess the feasibility of delivering and evaluating the effectiveness of sealing sound permanent molars at the pre-GA assessment appointment in children needing caries-related extractions under GA.Methods Children (5-15 years) scheduled for GA extractions at Birmingham Dental Hospital were randomised to control or sealant groups. At the pre-GA assessment appointment, sound permanent molars were sealed. Participants were followed up at two years.Results In total, 132 children were assessed for eligibility and 100 randomised (50 control, 50 sealant). Forty-nine children in the intervention group had sealants applied. At two years, 82 children returned for follow-up (43 control, 39 sealant). Sealants were retained on 93.5% (244/261) of surfaces sealed at baseline. Overall, 42% (n = 18) of control group participants had dentine caries in at least one permanent molar that was sound at baseline compared with none in the sealant group.Conclusion Following caries-related extractions under GA, children are at high risk of developing new caries in permanent molars that were sound at the time of the GA. Sealant placement during the pre-GA assessment visit is feasible and may reduce caries incidence in this vulnerable group. High-risk families were found to be reliable study participants.

General Versus Regional Anaesthesia for Lower Limb Arthroplasty and Associated Patient Satisfaction Levels: A Prospective Service Evaluation in the Oxford University Hospitals.

IntroductionLower limb arthroplasty is performed under general anaesthesia (GA) or regional anaesthesia (RA). There is increasing evidence of the surgical and anaesthetic benefits of RA. National Institute for Health and Care Excellence (NICE) guidelines advise using either but highlight a lack of data comparing outcomes of RA and GA for these procedures. We conducted a service evaluation, prospectively analysing elective orthopaedic cases performed at the Nuffield Orthopaedic Centre, Oxford, UK from 19/11/2018 to 03/04/2019. We aimed to compare data on anaesthetic assessment, intra-operative parameters and patient satisfaction for RA and GA cases.MethodsWe selected elective patients, aged above 18, undergoing total hip, total knee or unilateral knee arthroplasties. Prospective quantitative and qualitative data were collected using two forms. Firstly, anaesthetists completed a case report recording demographic data, intra-operative details and reason for anaesthetic choice. Secondly a questionnaire gathered patient satisfaction data. This was analysed using descriptive statistics and presented in tables.ResultsData for 132 patients were collected over the service evaluation period. After exclusion, 99 patients were included for final analysis; 59 underwent GA and 40 had RA. GA was used predominantly due to patient preference (74.6%). RA was used primarily due to anaesthetic preference (75%); most commonly due to speed of list and duration of operation. Overall patients had low pain scores (0.3/10) and high pre-operative anxiety levels (4.6/10) regardless of anaesthetic.ConclusionOur results show high patient satisfaction with GA and RA for lower limb arthroplasty; however, pre-operative anxiety was common for both. Patient preference and comfort influenced choice of anaesthesia, highlighting the importance of pre-operative counselling and education to facilitate shared decision making, leading to favourable post-operative outcomes.

May thermal imaging be useful in the assessment of dental anaesthesia? Preliminary study

The main goal of this study was to find out if thermal imaging may be useful in the evaluation of two types of anaesthetic injections—with and without a vasoconstrictor. There were 20 patients (13 women and 7 men) involved in the study. The group was divided into two subgroups. Patients from the first subgroup received infiltration anaesthesia (so-called: IA) of lidocaine (2 mL) and the second group included patients, who received infiltration anaesthesia (so-called: IAN) of lidocaine with 2% noradrenaline (2 mL). The obtained results showed a significant increase in the average temperature 10 min after the injection. In the IA group, the temperature increase was nearly 1.0 °C what was 0.3 °C higher than in the IAN group. Moreover, temperature changes showed a wide plateau between 10 and 25 min after anesthesia administration. The effect of temperature rise was also observed on the contralateral cheek where there was no intervention renders by a contralateral reflex.

Pre anesthetic assessment: study on the influence of preoperative approach on patient satisfaction during the covid-19 pandemic

Anesthesiology provides absence of or relief from pain and other sensations to patients who need to undergo medical procedures. Those who specialize in this area have been expanding their fields of action not only intraoperatively, but also pre- and postoperatively. Recently, going to pre-anesthetic office was implemented as mandatory for anyone who undergo surgery. However, the COVID-19 pandemic made attending to such meetings difficult, so many of them were done online. This research evaluated the degree of satisfaction with anesthesia office of a sample of the population who underwent surgical procedures during the aforementioned pandemic, verifying the importance of the anesthesiologist and the trust of the community after their contact with this professional, focusing on their opinion regarding the elucidation of doubts and reduction of anxiety symptoms. Pre-anesthetic evaluation has been shown to reduce anxiety and clear doubts about anesthetics procedures. Moreover, this prior contact was considered relevant by the patients.

Non-Fellowship regional anesthesia training and assessment: an international Delphi study on a consensus curriculum

Background and objectivesWhile there are several published recommendations and guidelines for trainees undertaking subspecialty Fellowships in regional anesthesia, a similar document describing a core regional anesthesia curriculum for non-fellowship trainees...

Accuracy of STOP-Bang Questionnaire in Predicting Difficult Mask Ventilation: An Observational Study.

IntroductionDifficulty with bag-mask ventilation after the induction of general anesthesia and muscle relaxation places the patient at risk for a prolonged period of apnea and hypoxia and thus, at an increased risk of morbidity and mortality. This study was designed to assess the accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation (DMV) in patients receiving general anesthesia for elective surgical procedures.MethodsIt was a prospective cross-sectional, observational study conducted at a university teaching hospital. A total of 530 patients undergoing surgery under general anesthesia with endotracheal intubation were enrolled. STOP-Bang questionnaire was filled at pre-operative anesthesia assessment. Ease or difficulty of mask ventilation was assessed and documented by a senior resident responsible for intraoperative anesthetic management.ResultsOut of 530 patients, 139 (26.22%) had a STOP-Bang score of ≥ 3, of whom 55 (39.5%) were found to have DMV. Out of 391 patients with a STOP-Bang score of < 3, only 29 patients (7.5%) had DMV (P ≤0.001). Snoring, high blood pressure, BMI more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender were significantly associated with DMV. The accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation was 78.68% (95% CI 74.99-81.95) with a negative predictive value of 92.58%. The sensitivity and specificity were found to be 65.48% and 81.17% respectively.ConclusionSTOP-Bang score has a high negative predictive value and can be very useful in ruling out the possibility of difficult mask ventilation.

Decision aid and preference assessment of topical anesthesia for otolaryngology procedures.

ObjectivesTo determine preference patterns for topical anesthesia in patients undergoing endoscopy pre‐coronavirus (2019 coronavirus disease [COVID‐19]) pandemic and analyze outcomes based on preference, using a decision aid format.MethodsA decision aid was developed with expert and patient input. New patients presenting to subspecialty clinics over a 2‐month pre‐COVID‐19 period completed a pre‐procedure survey about their priorities, then were asked to choose between topical oxymetazoline/lidocaine spray or none. A post‐procedure outcome survey followed.ResultsOf 151 patients, 90.1% patients elected to have topical anesthesia. Top patient priorities were “I want the scope to be easy for the doctor” and “I want to be as comfortable as possible.” Patients who strongly wanted to avoid medication (P = .002) and bad taste (P = .003) were more likely to select no spray, whereas those who wanted to avoid pain received anesthetic (P = .011). According to the post‐procedure assessment, 95.4% of patients were satisfied or strongly satisfied their choice, and this did not correlate with anesthetic vs none.ConclusionsPatient preferences are easily elicited and correlate with treatment choices. Most patients chose to have topical anesthetic and were willing to tolerate side effects; however, both patients with and without topical anesthetic were satisfied with their choices. This decision aid can be used to optimize shared decision making in the otolaryngology clinic. Given the aerosolizing potential of both spray and no spray conditions, this insight may be consequential when devising office protocols for post‐COVID‐19 practice.Level of evidenceII.

Integrating ECG Monitoring and Classification via IoT and Deep Neural Networks.

Anesthesia assessment is most important during surgery. Anesthesiologists use electrocardiogram (ECG) signals to assess the patient’s condition and give appropriate medications. However, it is not easy to interpret the ECG signals. Even physicians with more than 10 years of clinical experience may still misjudge. Therefore, this study uses convolutional neural networks to classify ECG image types to assist in anesthesia assessment. The research uses Internet of Things (IoT) technology to develop ECG signal measurement prototypes. At the same time, it classifies signal types through deep neural networks, divided into QRS widening, sinus rhythm, ST depression, and ST elevation. Three models, ResNet, AlexNet, and SqueezeNet, are developed with 50% of the training set and test set. Finally, the accuracy and kappa statistics of ResNet, AlexNet, and SqueezeNet in ECG waveform classification were (0.97, 0.96), (0.96, 0.95), and (0.75, 0.67), respectively. This research shows that it is feasible to measure ECG in real time through IoT and then distinguish four types through deep neural network models. In the future, more types of ECG images will be added, which can improve the real-time classification practicality of the deep model.

P.25 Improving antenatal anaesthetic assessment and dissemination of information to parturients with a high body mass index

Introduction: Parturients with a body mass index (BMI) greater than 40 kg/m2 should be referred to the anaesthetic clinic for antenatal assessment. [1] OAA/AAGBI Guidelines for Obstetric Anaesthetic Services 2013.https://www.oaa-anaes.ac.uk/assets/_managed/cms/files/Clinical%20Guidelines/obstetric_anaesthetic_services_2013.pdf. Google Scholar We assessed parturients’ understanding of high BMI and the additional risks posed to them in order to improve their anaesthetic assessment. This has particular importance due to COVID-19 when most assessments have taken place over the telephone.