Anesthetic Issues Research Articles

Patient safety issues in office-based surgery and anaesthesia in Switzerland: a qualitative study

ObjectivesTo identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. MethodsPurposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings “structure”, “process”, and “outcome”. ResultsExperts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. ConclusionThere is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland.

Specific issues in anesthesia of obese patients

Specific issues in anesthesia of obese patients

The FDA Warning on Anesthesia Drugs.

The FDA Warning on Anesthesia Drugs.

Medication Errors among Physician-Assistants Anaesthesia

Background. Safety issues in anaesthesia are currently being discussed widely. Anaesthetists have a unique cross-specialty opportunity to influence the safety and quality of patient care. Anaesthetists administer very potent drugs, in rapid succession, during the course of one anaesthesia event. Methodology. The study was done in April 2013 at the annual refresher course of the Physician-Assistants Anaesthesia using a questionnaire which was completed by the participants on the course. The data was analysed using IBM SPSS Statistics software version 20. Results. There were 164 completed questionnaires, with 92 (62.2%) males and 56 (37.8%) females with a mean age of 32.3 years. The majority of them (66.5%) work in government hospitals. One hundred and seven (65.3%) have had an episode of medication error with 101 (94.4%) experiencing it between 1 and 5 times. The incident occurred in the afternoon or at night in 73 (71.7%) cases. The commonest type of incident was the administration of wrong drug which occurred on 64 (71.9%) occasions resulting in 3 deaths. The contributing factors included distraction, tiredness, and overreliance on vial/ampoule colour. Conclusion. Medication errors among Physician-Assistants Anaesthesia are not uncommon leading to harm and even death of patients. The rate of medication errors can be minimised by addressing some of the contributory factors raised by the respondents.

Anesthesia Issues in Central Nervous System Disorders.

Every year, millions of people affected by disorders of the central nervous system (CNS) undergo various diagnostic, therapeutic and surgical procedures requiring administration of anesthetic agents. Anesthetics exert their anesthetic, amnesic and analgesic effects by acting on multiple neuronal membrane proteins in the CNS. While some of the causal anesthetic targets have been identified, a large number of anesthetic targets remain unknown. The consequent longterm effect of anesthetic agents on expression of these various molecular targets has been implicated in mediating potentially long-lasting adverse effects. Recent work suggested that the effects of general anesthetics may not be entirely reversible, with animal studies demonstrating persistent changes in CNS protein expression post recovery from anesthesia. Age-associated or disease-induced alterations in the CNS can profoundly alter multiple aspects of brain structure, biochemistry, and function. Such maladaptive changes in the brain can render it increasingly vulnerable to the effects of various anesthetics. The selection of appropriate anesthesia drugs and protocol is mandatory, especially in individuals with pre-existing CNS disorders, so as to maximize anesthesia efficiency, avoid occurrence of adverse events, and ensure patient safety. This review aims to summarize and consider the effects and potential risks of commonly used anesthetic agents in patients with compromised CNS function. We provide a comprehensive review of the established as well as the implicated effects of anesthetic agents on the elderly as well as on the pathology and progression of common neurological conditions.

Ophthalmic regional blocks: management, challenges, and solutions.

In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon’s block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma.

Anesthesia for Pediatric Ocular Surgery

Ophthalmic pathology in infants and children undergoing eye surgery ranges from the rare and atypical to the commonplace. These pathologies include nasolacrimal duct obstruction, strabismus, congenital or traumatically induced cataracts, penetrating eye injuries, glaucoma, retinopathy of prematurity, intraorbital tumors, and more. Nasolacrimal duct stenosis, cataracts, and traumatic eye injuries often occur in otherwise healthy pediatric patients; however, many ophthalmopathies can be associated with other congenital disorders that may have important anesthesia implications. In this article, we will review pertinent anesthesia issues within the context of various ophthalmic diseases.

Transition to Office-based Obstetric and Gynecologic Procedures

Office-based surgery is increasingly desired by patients and providers due to ease of access, overall efficiency, reimbursement, and satisfaction. The adoption of office-based surgery requires careful consideration of safety, efficacy, cost, and feasibility within a providers practice. This article reviews the currently available data regarding patient and provider satisfaction as well as practical considerations of staffing, equipment, and supplies. To aid the practitioner, issues of office-based anesthesia and safety with references to currently available national guidelines and protocols are provided. Included is a brief review of billing, coding, and reimbursement. Technical procedural aspects with information and recommendations are summarized.

Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): development.

As a result of cost-containment efforts, preparation programs for outpatient surgery are currently not available to the majority of children and parents. The recent dramatic growth in the Internet presents a unique opportunity to transform how children and their parents are prepared for surgery. In this article, we describe the development of a Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS). A multidisciplinary taskforce agreed that a Web-based tailored intervention consisting of intake, matrix, and output modules was the preferred approach. Next, the content of the various intake variables, the matrix logic, and the output content was developed. The output product has a parent component and a child component and is described in http://surgerywebtips.com/about.php. The child component makes use of preparation strategies such as information provision, modeling, play, and coping skills training. The parent component of WebTIPS includes strategies such as information provision, coping skills training, and relaxation and distraction techniques. A reputable animation and Web design company developed a secured Web-based product based on the above description. In this article, we describe the development of a Web-based tailored preoperative preparation program that can be accessed by children and parents multiple times before and after surgery. A follow-up article in this issue of Anesthesia & Analgesia describes formative evaluation and preliminary efficacy testing of this Web-based tailored preoperative preparation program.

Anesthetic issues for robotic cardiac surgery.

As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.

The importance of Anesthesia Progress to dental anesthesiology.

The importance of Anesthesia Progress to dental anesthesiology.

Predicting Patients at Risk of Early Postoperative Adverse Events

Adverse events after surgery are common. Identification of markers of at-risk patients may facilitate efficient and effective perioperative resource allocation. This pilot study aimed to identify simple preoperative factors associated with postoperative adverse events. In 1291 surgical patients, the relationship between patient and surgical factors and adverse events in the post-anaesthesia care unit was examined using binomial logistic regression analysis. Adverse events in the postoperative care unit were common, including desaturation (13.6%), hypotension (5.8%) and apnoea (5.5%), with 19.9% of cases requiring attendance by an anaesthetist to manage unexpected complications. Average length of stay in the post-anaesthesia care unit was 120 minutes and prolonged stay for medical reasons was common. A number of patient and surgical factors, including surgical complexity, preoperative arrhythmia, previous anaesthetic issues and heart failure were strongly associated with these adverse events. Areas under receiver operating characteristic curves ranged from 0.63 to 0.80. Patients with adverse events in the post-anaesthesia care unit appeared to have a higher risk of intervention in postoperative wards from a medical emergency or intensive care unit team. Our preliminary findings suggest that preoperative identification of key factors may have utility in determining risk of early postoperative problems and hence, aid perioperative planning.

Anaesthetic issues in Brugada electrocardiogram/syndrome undergoing laproscopic common bile duct exploration and laproscopic primary common bile duct closure

Here we report a rare case of Brugada Syndrome in a young Nepalese male undergoing laparoscopic common bile ductexploration and laparoscopic primary common bile duct closure. Recognition of the disease, preparedness to tacklethe developing arrhythmias, avoidance of precipitating drugs, adopting policy of anaesthetic interventions to balancethe autonomic system, maintenance of normothermia and electrolyte balance, avoidance of hypoxia, hypercarbia andacidosis are the key to management of this disease in anaesthetic pursuit.DOI: http://dx.doi.org/10.3126/jkmc.v2i1.10555Journal of Kathmandu Medical College, Vol. 2, No. 1, Issue 3, Jan.-Mar., 2013, Page: 36-39

Anaesthesia for orphan disease

Anaesthesia for orphan disease

Cognitive Outcome of Surgery

Once upon a time, being “in a home” was a pejorative. Now, thanks largely to the government’s uncontrolled experiment in health care reform, everyone seems to want in. At least physicians do. “Homes” are popping up everywhere. One type currently under construction and described by several articles in this month’s issue of Anesthesia & Analgesia is the “perioperative surgical home.” The perioperative surgical home concept is simple enough: better care, better service, and lower costs through standardization of the continuum of surgical care. 1 It’s a nice idea but there are at least 2 problems. One is that the ability of such health care redesign to achieve these goals is unproven. The second is that most of the cost variability in surgery comes from what happens after hospital discharge and some of the clinical conditions driving these costs are poorly understood and not readily modifiable. Cognitive outcome is a case in point. Delirium and postoperative cognitive dysfunction (POCD) are extremely common in geriatric surgical patients, 2,3 a group the government pays for because they are enrolled in Medicare. After elective major joint replacement or other types of major surgery, about 5% to 15% of elders develop delirium and 25% to 40% and 12% to 15% develop, respectively, early or late POCD. 2,4,5 This may not seem like much but it far exceeds the rate of other complications we spend a lot of time talking about and managing. Delirium and POCD are associated with prolonged length of stay, discharge to a place other than home (i.e., the physical place they actually live, not a virtual administrative home), and higher 1-year mortality (e.g., persistent delirium is associated with a 2.9-fold increase [95% confidence interval, 1.9–4.4] in mortality at 1 year). 5–8 In addition, delirium is associated with an acceler

Preventing Delirium After Cardiothoracic Surgery

Preventing Delirium After Cardiothoracic Surgery

Anaesthetic issues related to incidental unruptured intracranial aneurysm

Anaesthetic issues related to incidental unruptured intracranial aneurysm

The “Other Tube” in the Airway

The “Other Tube” in the Airway

Anesthesia Scholarship, Research, and Publication

Anesthesia Scholarship, Research, and Publication

Issues in geriatric orthopedic anesthesia.

Issues in geriatric orthopedic anesthesia.