High-quality Anesthesia Research Articles

Overcoming Obstacles: The Legacy of Fidel Pagés, Founder of the Epidural, 100 Years After His Passing

(Anesth Analg. 2024;138(2):475–479. doi: 10.1213/ANE.0000000000006706) Fidel Pagés, a pioneer in segmental anesthesia, revolutionized the field by accessing the epidural space over a century ago, laying the groundwork for modern neuraxial techniques. This year commemorates the centennial of his premature death. Despite his early passing and subsequent challenges, the high-quality anesthesia he introduced propelled epidural anesthesia into routine clinical practice.

Patient Safety in Anesthesiology: Progress, Challenges, and Prospects.

Anesthesiology is considered a complex medical specialty. Its history has been marked by radical advances and profound transformations, owing to technical and pharmacological developments and innovations in the field, enabling us over the years to improve patient outcomes and perform longer, more complex surgical procedures on more fragile patients. However, anesthesiology has never been safe and free of challenges. Despite the advances made, it still faces risks associated with the practice of anesthesia, for both patients and healthcare professionals, and with some of the specific challenges encountered in low and middle-income countries. In this context, certain actions and initiatives must be carried out collaboratively. In addition, recent technologies and innovations such as simulation, genomics, artificial intelligence, and robotics hold promise for further improving patient safety in anesthesiology and overcoming existing challenges, making it possible to offer safer, more effective, and personalized anesthesia. However, this requires rigorous monitoring of ethical aspects and the reliability of the studies to reap the full benefits of the new technology. This literature review presents the evolution of anesthesiology over time, its current challenges, and its promising future. It underlines the importance of the new technologies and the need to pursue efforts and strengthen research in anesthesiology to overcome the persistent challenges and benefit from the advantages of the latest technology to guarantee safe, high-quality anesthesia with universal access.

Anesthetic considerations in robotic surgery: a comprehensive review.

Recent advancements have led to a rise, in the demand for surgical methods with robot-assisted procedures becoming increasingly popular for addressing the limitations of traditional laparoscopy. However, incorporating surgery involves making changes in the way patients are positioned and logistical planning, which can challenge conventional approaches to providing anesthesia care. Despite these obstacles robotic technology shows potential for bringing about improvements in therapy. Anesthesiologists play a role in ensuring safety and delivering high quality anesthesia care during robotic surgery. Having an understanding of the elements of robotic surgical systems is essential for adjusting anesthesia practices effectively. Keeping up to date with the developments in surgery is key to achieving optimal outcomes for patients. Effective collaboration between teams and anesthesiologists is essential for managing the complexities of anesthesia during surgery. By promoting communication and cooperation across disciplines healthcare professionals can enhance safety and results. In summary while the introduction of surgery presents challenges in anesthesia care it also offers opportunities for innovation and advancement. Anesthesiologists need to embrace these advancements adapt their practices accordingly and engage in education and collaboration to ensure the safe and successful integration of robotic technology, into surgical procedures ultimately improving patient care.

Management of Anesthesia in Patient with Osteogenesis Imperfecta Type IV and Fractures on Tibia and Fibula: A Case Report

Background: Osteogenesis imperfecta (OI), known as brittle bone disease, is a rare inherited and genetic skeletal disorder characterized by a significantly heightened risk of fragility fractures. About 1 in 15 to 20.000 births are affected with OI. these defects may moreover be combined with an airway that's troublesome to oversee, platelet dysfunctions, and other issues. The perioperative administration of anesthesia speaks to a significant challenge. Subsequently, it is critical to be able to anticipate the dangers during the perioperative period and to define and actualize particular high-quality anesthesia administration plans for such patients when they involve injury.
 Case presentation: We present a case of a female patient 26 years old with known OI type IV who underwent Osteotomy and Open Reduction Internal Fixation with plate and screw (ORIF PS) on her left Tibia and Fibula. In this case, we present the anesthesia technique with general anesthesia using a metal wire-enforced endotracheal tube to prevent partial obstruction due to kyphoscoliosis.
 Conclusion: It is crucial to assess the severity of the disease, identify risk factors in advance, and optimize the preoperative health status of individuals with OI.

Anatomical and topographic substantiation of mandibular anesthesia in sheep

This study presents an anatomical and topographic justification for performing mandibular anesthesia in sheep. The study was conducted on the basis of the Department of Anatomy and Histology of Animals named after Professor A. F. Klimov of the Moscow State Academy of Veterinary Medicine and Biotechnology – MBA named after K. I. Scriabin. The object of the study was sheep of the Romanov breed (n=20) aged 1-2 years without pronounced signs of pathology of the dental apparatus. The material for the study was the lower jaws (n=20) and survey radiographs of the head area (n=20). To achieve this goal, a comprehensive methodological approach was used, including: anatomical dissection and macromorphometry with the determination of skeletotopic and linear parameters of the mandible. Mandibular anesthesia is one of the most common manipulations in animal dentistry. For high-quality anesthesia of the mandibular branch of the trigeminal nerve, it is important to take into account the topical landmarks of the structures forming the mandibular canal. Based on the results of macromorphometry and rengenogrammetry, skeletotopic landmarks of the holes forming the mandibular canal are presented, which are important to take into account when performing anesthesia of the lower alveolar nerve. Comparative analysis of morphometric and rengenogrammetric parameters of the upper and lower jaws did not reveal significant differences in their linear parameters, which indicates the high informative value of the X-ray diagnostic method in assessing the morphofunctional state of the jaw bones and the channels located on them. The results obtained can be used in the development of new approaches to the mandibular branch of the trigeminal nerve during local anesthesia in veterinary and experimental dentistry.

A Brief History of Anesthesia in Somaliland.

A Brief History of Anesthesia in Somaliland.

Каудальная анестезия в педиатрической практике

Caudal anesthesia has been used for more than a hundred years. Caudal epidural blockade is the most commonly used regional technique in children and is considered the safest access to the epidural space. This method of anesthesia is used in combination with general anesthesia. With the correct implementation of this anesthetic manual, the risk of complications is small. The technique is used for peri- and postoperative analgesia in children of different ages. The main advantage of the method is high-quality anesthesia during caudal blockade, it is provided in 95–98 % of cases. The level of anesthesia depends on the amount of anesthetic administered; in some cases it may reach the level of the chest. The same advantage is the rapid onset of adequate analgesia and its long-term effect. For successful regional anesthesia in a pediatric patient, it is necessary for the anesthesiologist to know the anatomical and physiological structures of the body, the pharmacology of local anesthetics and the availability of the necessary medical equipment. The research presents a method of using caudal anesthesia as a component of anesthetic support for surgical interventions performed in children. We present the advantages and disadvantages of such anesthesia, indications and contraindications to its use, analyze possible complications, the implementation method.

Knowledge and awareness on neurolept anesthesia among dental students.

N20 omission or addition to the combination of an opioid and neuroleptic is referred to as neuroleptanalgesia and neuroleptanesthesia, respectively. Conscious sedation is the result of this evolution. The requirement for high-quality anesthesia that is also related with speedier recovery, improved comfort, and lower costs all support the concept of neuroleptanesthesia. A set of eight questions was formulated and circulated among the undergraduate and postgraduate students of Saveetha Dental College. Responses were collected and the data were entered into MS Excel sheet and transferred to SPSS for the analysis. Results were made into graphs and interpreted. In the present study, among the students who took part in the study, 36.3% of the students were postgraduates and 63.7% of them were undergraduates. About 45.2% of the students were not aware and 54.8% of the students were aware that neuroleptanalgesia refers to the combination of a potent sedative analgesic agent and a tranquillizer. Many of the students were not aware of what neuroleptic esthetic is and how it evolved. The current study showed that most students did not have enough knowledge about neurolept anesthesia. However, dentists should make efforts to improve knowledge, awareness of neurolept anesthesia for further advancement, and the need for high-quality anesthesia.

X-ray and anatomical features of the lower jaw alveolar cortical layer in children

Introductionthe world studies showed the interest in measurement of the buccal or anterior cortical plate thickness. Data indicate a significant superiority of the spongy substance over the compact one in the distal part of the jaw, which makes it possible to think about a higher effectiveness of transcortical injections. The empirical “rule of 10″ provides for the choice of a method of anesthesia in children for primary teeth but demonstrates difficulties with high-quality anesthesia accompanied for permanent teeth. Therefore, the importance of clinical examination and anatomical investigation of the jaw cortical plate in children for competent planning of transcortical interventions has been determined. AimTo study the features of the clinical and X-ray anatomy of the cortical layer in distal alveolar part of the mandible in children. Material and methodsThe assessment of the X-ray anatomical characteristics of the mandible was carried out according to 150 anonymized cone-beam computed tomograms of patients aged 6–12 years, performed for the treatment of major diseases. Qualitative assessment and examination of the cortical plate of the distal alveolar part of the mandible were carried out on the skeletonized certified preparations of aged 6–12 in the amount of 50. ResultsThe age characteristics of the cortical plate in the area of the chewing group of teeth in the mandible were determined according to macro anatomical studies, which confirms with the X-ray results. Therefore, the obtained images serve as actual confirmation of X-ray studies, which are ranked by age. The thickness of the cortical plate in the second primary molar of the mandible in subgroups 6, 7 and 8 years has a proportional increase from the cervical region to the apical projection. The average thickness of the cortical plate is 1.57 mm at 6 years, 1.52 mm at 7 years, 1.6 mm at 8 years and 1.84 at 9 years. The cortical plate thickness in the first primary molar of the mandible in subgroups 6 and 7 years has a proportional decrease from the cervical region to the apical projection as well as an inverse proportion to age. The average thickness of the cortical plate is 1.33 mm. In the first molar of the mandible at the age limit of 6–12 years the attention is drawn to the linear increase in tissue volume from the cervical region to the apical projection up to 8 years. At 6–8 years the average thickness of the cortical plate in this age group is 1.74 ± 0.2 mm, at 9 years - 2.03 mm, at 10 - average value in the cervical region it is 1.53 ± 0.23 mm, in the root middle it is 2.19 ± 0.13 mm and in the apical projection it is 1.98 ± 0.16 mm, at 11–2.22 mm and at 12–2.35 mm. For the second primary molar the average thickness of the buccal cortical plate of the second primary molar is 1.4 mm in cervical part, 1.68 mm in the root middle and 1.81 mm in the apical projection. Finally, thickness of the buccal cortical plate in the cervical region of the first permanent molar is 2 mm in groups. ConclusionThe study makes it possible to determinate with noninvasive way the age limit for the least pronounced zone of the buccal cortical plate.

The Anesthetic Strategy for Patients with Mucopolysaccharidoses: A Retrospective Cohort Study.

Anesthesia for patients with mucopolysaccharidoses (MPS) is quite challenging due to vital systemic dysfunction following progressive accumulation of lysosomal glycosaminoglycans. Previous studies focused on perioperative difficult airway management under general anesthesia but rarely depicted the concern of choosing the size of the endotracheal tube (ETT) as well as neuraxial anesthesia. This study aimed to analyze the overall anesthetic management and related complications for a thorough anesthetic strategy. Within the study period from 2002 to 2021, each record of the anesthetic and perioperative quality assurance/improvement system for patients with a diagnosis of MPS at MacKay Memorial Hospital was retrospectively reviewed. A total of 51 individuals with 151 anesthesia for 163 interventions were cohort studied, and there were 136 general anesthesia and 15 neuraxial anesthesia. We found that the most common interventions for MPS patients were otolaryngological surgeries (49.6%). Additionally, a secured airway played a marked preference for the most general anesthesia (87.1%). The incidence of difficult intubation was 12.5%. In view of ETT size, a smaller than estimated size was used in MPS type II, III, IV, and VI patients and also in patients who received intubation with multiple attempts. However, a larger than estimated size of ETT was adopted whilst choosing cuffed ones. For neuraxial anesthesia, two failed spinal anesthesia procedures were converted to general anesthesia and 73 percent of the patients received perioperative sedation. In conclusion, through the individualized anesthetic strategy and build-up of an experienced team for airway management, high-quality anesthesia can be ensured in each patient.

Establishing a sustainable training programme in anaesthesia in Ethiopia.

BackgroundLack of qualified staff is a major hindrance for quality and safety improvements in anaesthesia and critical care in many low‐income countries. Support in specialist training may enhance perioperative treatment and have a positive downstream impact on other hospital services, which may improve the overall standard of care.MethodsBetween 2011 and 2019, consultant anaesthetists from Haukeland University Hospital in Norway supported a postgraduate anaesthesia‐training programme at Addis Ababa University/Tikur Anbessa Specialised Hospital in Ethiopia. The aim of the programme was to build a self‐sustainable work force of anaesthetists across the country who could perform high quality anaesthesia within the confinement of limited local resources. Over the course of 10 years, an almost continuous rotation of experienced anaesthetists and intensivists assisted training of Ethiopian residents in anaesthesia and critical care. Local specialists organised the programme; however, external support was necessary during this period to establish a sustainable training programme.ResultsSince the programme's commencement at Addis Ababa University in 2011, 159 residents have entered the programme and 71 have graduated. As the number of qualified anaesthetists increased, Ethiopian specialists gradually obtained responsibility for the programme. Candidates are recruited from various regions and from neighbouring countries. Five other Ethiopian training sites have been established. To date (May 2022), 112 residents have completed their training in Ethiopia, and 195 residents expect to graduate within 3 years.ConclusionNearly 11 years after establishment of the programme, locally trained highly qualified anaesthetists work in Ethiopia's major hospitals throughout the country.

Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care.

Placenta accreta spectrum (PAS) disorder is a potentially life-threatening condition that can occur during pregnancy. PAS puts pregnant individuals at a very high risk of major blood loss, hysterectomy, and intensive care unit admission. These patients should receive care in a center with multidisciplinary experience and expertise in managing PAS disorder. Obstetric anesthesiologists play vital roles in the peripartum care of pregnant patients with suspected PAS. As well as providing high-quality anesthesia care, obstetric anesthesiologists coordinate peridelivery care, drive transfusion-related decision making, and oversee postpartum analgesia. However, there are a number of key knowledge gaps related to the anesthesia care of these patients. For example, limited data are available describing optimal anesthesia staffing models for scheduled and unscheduled delivery. Evidence and consensus are lacking on the ideal surgical location for delivery; primary mode of anesthesia for cesarean delivery; preoperative blood ordering; use of pharmacological adjuncts for hemorrhage management, such as tranexamic acid and fibrinogen concentrate; neuraxial blocks and abdominal wall blocks for postoperative analgesia; and the preferred location for postpartum care. It is also unclear how anesthesia-related decision making and interventions impact physical and mental health outcomes. High-quality international multicenter studies are needed to fill these knowledge gaps and advance the anesthesia care of patients with PAS.

Периоперационное ведение больных с переломами проксимального отдела бедренной кости

Abstract. We analyze the perioperative management results among patients with proximal femur fractures after surgical treatment in the Traumatology Department of the Kotovsk City Clinical Hospital in 2021. An increase in the proportion of the elderly and senile population (60–90 years old) inevitably leads to an increase in the number of proximal femur fractures, which obliges the traumatology departments in hospitals to allocate more forces and funds to assist this category of patients, to introduce and apply not only modern surgical and anesthesiological techniques, but also new approaches to the perioperative management of patients and especially patients over 60 years old, who, as a rule, have several concomitant diseases complicating the course of the underlying disease. The use of a multidisciplinary approach, a full-fledged laboratory and instrumental examination, detection of concomitant pathology and its correction, performing surgical interventions no later than 48 hours from the moment of admission to the hospital, adequate high-quality anesthesia, early initiation of mobilization measures no later than 24 hours, correct calculation of the permissible load on the operated limb allow achieving good results in the surgical treatment of patients with proximal femur fractures. This contributes to improving the quality of life among patients after surgery and their return to an active full-fledged life, despite their age.

Applications and Limitations of Neuro-Monitoring in Paediatric Anaesthesia and Intravenous Anaesthesia: A Narrative Review.

Safe management of anaesthesia in children has been one of the top areas of research over the last decade. After the large volume of articles which focused on the putative neurotoxic effect of anaesthetic agents on the developing brain, the attention and research efforts shifted toward prevention and treatment of critical events and the importance of peri-anaesthetic haemodynamic stability to prevent negative neurological outcomes. Safetots.org is an international initiative aiming at raising the attention on the relevance of a high-quality anaesthesia in children undergoing surgical and non-surgical procedures to guarantee a favourable outcome. Children might experience hemodynamic instability for many reasons, and how the range of normality within brain autoregulation is maintained is still unknown. Neuro-monitoring can guide anaesthesia providers in delivering optimal anaesthetic drugs dosages and also correcting underling conditions that can negatively affect the neurological outcome. In particular, it is referred to EEG-based monitoring and monitoring for brain oxygenation.

Peer Mentorship: Implementation of a Resident Registered Nurse Anesthetist Mentorship Program

Abstract Nurse anesthesia residents experience high levels of stress while being enrolled in a post-baccalaureate nurse anesthesia program. Elevated levels of stress have been proven to limit one’s ability to learn and commit new material to memory, all while inhibiting their academic and clinical performance. This study represents a quality improvement project that implements a Peer Mentorship Program (PMP) into a major University in the New England area of the United States. The study utilizes descriptive statistics to determine if implementation of a peer mentorship program can help to decrease nurse anesthesia resident’s stress, while simultaneously increasing academic and clinical performance. Data gathered by the investigators of this study was composed of a Critical Action Point Checklist (CAPC); a set of objectives that were meant to be completed by the participants in order to help run a successful mentorship program. Additional data was collected using a Peer Mentorship Reflection Questionnaire at the end of the study to receive feedback about the Peer Mentorship Program. 56% of participants agreed that the Peer Mentorship Program helped to decrease stress during the study and 83.4% of participants agreed that they would like to see the Peer Mentorship Program continue for future cohorts at their nurse anesthesia program. The findings of this study suggest that more Nurse Anesthesia Programs should work to incorporate a Peer Mentorship Program for their nurse anesthesia residents to help develop safe, high-quality anesthesia providers for the future.

Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta-analysis.

Spinal anaesthesia has been implicated as one of the possible causes of neurological complications following surgical procedures. This painful condition, occurringduring the immediate postoperative period, is termed transient neurological symptoms (TNS) and is typically observed after the use of spinal lidocaine. Alternatives to lidocaine that can provide high-quality anaesthesia without TNS development are needed. This review was originally published in 2005, and last updated in 2009. To determine the frequency of TNS after spinal anaesthesia with lidocaine and compare it with other types of local anaesthetics by performing a meta-analysis for all pair-wise comparisons, and conducting network meta-analysis (NMA) to rank interventions. We searched CENTRAL, MEDLINE, Elsevier Embase, and LILACS on 25 November 2018. We searched clinical trial registries and handsearched the reference lists of trials and review articles. We included randomized and quasi-randomized controlled trials comparing the frequency of TNS after spinal anaesthesia with lidocaine to other local anaesthetics. Studies had to have two or more armsthat used distinct local anaesthetics (irrespective of the concentration and baricity of the solution) for spinal anaesthesia in preparation for surgery. We included adults who received spinal anaesthesia and considered all pregnant participants as a subgroup. The follow-up period for TNS was at least 24 hours. Four review authors independently assessed studies for inclusion. Three review authors independently evaluated the quality of the relevant studies and extracted the data from the included studies. We performed meta-analysis for all pair-wise comparisons of local anaesthetics, as well as NMA. We used an inverse variance weighting for summary statistics and a random-effects model as we expected methodological and clinical heterogeneity across the included studies resulting in varying effect sizes between studies of pair-wise comparisons. The NMA used all included studies based on a graph theoretical approach within a frequentist framework. Finally, we ranked the competing treatments by P scores. The analysis included 24 trials reporting on 2226 participants of whom 239 developed TNS. Two studies are awaiting classification and one is ongoing. Included studies mostly had unclear to high risk of bias. The NMA included 24 studies and eight different local anaesthetics; the number of pair-wise comparisons was 32 and the number of different pair-wise comparisons was 11. This analysis showed that, compared to lidocaine, the risk ratio (RR)of TNS waslower for bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine with RRs in the range of 0.10 to 0.23 while 2-chloroprocaine and mepivacaine did not differ in terms of RR of TNS development compared to lidocaine. Pair-wise meta-analysis showed that compared with lidocaine, most local anaesthetics were associated with a reduced risk of TNS development (except 2-chloroprocaine and mepivacaine) (bupivacaine: RR 0.16, 95% confidence interval (CI) 0.09 to 0.28; 12 studies; moderate-quality evidence; 2-chloroprocaine: RR 0.09, 95% CI 0.01 to 1.51; 2 studies; low-quality evidence; levobupivacaine: RR 0.13, 95% CI 0.02 to 0.69; 2 studies; low-quality evidence; mepivacaine: RR 1.01, 95% CI 0.18 to 5.82; 4 studies; very low-quality evidence; prilocaine: RR 0.18, 95% CI 0.07 to 0.49; 4 studies; moderate-quality evidence; procaine: RR 0.14, 95% CI 0.04 to 0.52; 2 studies; moderate-quality evidence; ropivacaine: RR 0.10, 95% CI 0.01 to 0.78; 2 studies; low-quality evidence). We were unable to perform any of our planned subgroup analyses due to the low numberof TNS events. Results from both NMA and pair-wise meta-analysis indicate that the risk of developing TNS after spinal anaesthesia is lower when bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine are used compared tolidocaine. The use of 2-chloroprocaine and mepivacaine had a similar risk to lidocaine in terms of TNS development after spinal anaesthesia. Patients should be informed of TNS as a possible adverse effect of local anaesthesia with lidocaine and the choice of anaesthetic agent should be based on the specific clinical context and parameters such as the expected duration of the procedure and the quality of anaesthesia. Due to the very low- to moderate-quality evidence (GRADE), future research efforts in this field are required to assess alternatives to lidocaine that would be able to provide high-quality anaesthesia without TNS development. The two studies awaiting classification and one ongoing study may alter the conclusions of the review once assessed.

Combined Extended High Spinal Anesthesia and Endotracheal Narcosis: a Clinical Case

Background. In recent years, various methods of combined anesthesia during abdominal surgery have been introduced into clinical practice.Aim. To demonstrate the possibilities of a combination of high prolonged spinal anesthesia and endotracheal anesthesia during abdominal surgery.Materials and methods. A clinical case of combined use of high prolonged spinal anesthesia and endotracheal anesthesia in a 48-year-old patient with a tumor in the right half of the ascending part of the right half of the colon is presented.Results. The patient received a puncture of the spinal space at a standard point and was installed a spinal catheter in the cranial direction for 3 cm. An isobaric solution of marcaine in the initial dose of 20 mg was injected into the catheter. The regulation of the development of the block was regulated by the inclination of the head end of the table by 60°. After that endotracheal anesthesia was performed on the basis of fentanyl and propofol. This combination allowed to expand the scope of surgical intervention, provided adequate pain relief intraoperatively and in the postoperative period, without the use of narcotic analgesics. With the appearance of signs of recovery of pain sensitivity, intraoperatively or in the postoperative period, re-introduction of the anesthetic into the spinal catheter was performed in half of the initial dose with liquor barbotage. In the early postoperative period, the patient was on strict bed rest with a head end of the bed raised at 30–45°. The method provides complete segmental blockade and muscle relaxation in the area of operation, stability of central hemodynamics during surgery and in the postoperative period.Conclusion. This type of anesthesia is more easily tolerated by patients, accompanied by early awakening and extubation, characterized by stability of central hemodynamics, reduced risk of complications, the possibility of prolonging anesthesia with lower doses of narcotic analgesics in the intraoperative period, providing high-quality anesthesia in the postoperative period without resorting to the use of narcotic analgesics.

Characteristics of a High-quality Anesthesia Practice

Characteristics of a High-quality Anesthesia Practice

Measuring the quality of anaesthesia from a patient’s perspective: development, validation, and implementation of a short questionnaire

The primary aim of this study was to develop and validate a short psychometric instrument to assess the patient's perception of the quality of anaesthesia. In Part 1, the Perception of Quality in Anaesthesia (PQA) questionnaire was developed, pilot tested, and validated. Attributes of high-quality anaesthesia were identified using a process that restricted input to patients and members of the public. In Part 2, patient cohorts completed the PQA before, and after, a 6 month period where anaesthetists were given individualized performance data using questions from the PQA. In Part 1, items in the PQA were identified and ranked by 120 patients and members of the public. Validity and reliability of the PQA was assessed by 714 patients. Principal component analysis showed that the PQA comprised five factors: attention/gentleness; pain management; information/confidence; postoperative nausea or vomiting (PONV); and concerns addressed. In Part 2, there were 2046 patient participants in the pre-feedback cohort, 4251 in the feedback cohort, and 1421 in the post-feedback cohort. Unsatisfactory experience in at least one PQA factor was described by 45.2% [95% confidence interval (CI) 43.1-47.4%] during the pre-feedback period, and 35.0% (95% CI 32.6-37.6%) during the post-feedback period. We developed and validated a patient-derived questionnaire to measure the patient's perception of anaesthesia quality. PONV, postoperative pain management, and communication with the anaesthetist are the most important features of the patient's experience. Feedback of PQA performance scores to anaesthetists can lead to improved patient experience.

Self-Reported Information Needs of Anesthesia Residency Applicants and Analysis of Applicant-Related Web Sites Resources at 131 United States Training Programs

Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs). We used an anonymous web-based program (SurveyMonkey, Portland, OR) to distribute a survey investigating the information needs and perceived usefulness of ARPWs to all 572 Stanford anesthesia residency program applicants. A quantitative scoring system was then created to assess the quality of ARPWs in meeting the information needs of these applicants. Two researchers independently analyzed all 131 ARPWs in the United States to determine whether the ARPWs met the needs of applicants based on the scoring system. Finally, a qualitative assessment of the overall user experience of ARPWs was developed to account for the subjective elements of the Web site's presentation. Ninety-eight percent of respondents reported having used ARPWs during the application process. Fifty-six percent reported first visiting the Stanford ARPW when deciding whether to apply to Stanford's anesthesia residency program. Multimedia and Web 2.0 technologies were "very" or "most" useful in "learning intangible aspects of a program, like how happy people are" (42% multimedia and Web 2.0 versus 14% text and photos). ARPWs, on average, contained only 46% of the content items identified as important by applicants. The average (SD) quality scores among all ARPWs was 2.06 (0.59) of 4.0 maximum points. The mean overall qualitative score for all 131 ARPWs was 4.97 (1.92) of 10 points. Only 2% of applicants indicated that the majority (75%-100%) of Web sites they visited provided a complete experience. Anesthesia residency applicants rely heavily on ARPWs to research programs, prepare for interviews, and formulate a rank list. Anesthesia departments can improve their ARPWs by including information such as total hours worked and work hours by rotation (missing in 96% and 97% of ARPWs) and providing a valid web address on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) (missing in 28% of ARPWs).