Anesthesia Patient Safety Research Articles

Navigating postextubation bronchospasm in pediatric patients with intraoperative inhalation agents: A comprehensive review

Post-extubation bronchospasm poses a considerable challenge in pediatric anesthesia, necessitating effective management strategies to mitigate its potential complications. This review provides an overview of post-extubation bronchospasm, including its etiology, risk factors, and clinical presentation in pediatric patients. We emphasize the critical role of intraoperative inhalation agents in managing bronchospasm, discussing their mechanisms of action and comparative efficacy. Through a comprehensive analysis of existing literature and clinical evidence, we highlight best practices for administering and monitoring inhalation agents during pediatric anesthesia. Furthermore, we present case studies and clinical outcomes to illustrate the practical implications of utilizing these agents in bronchospasm management. Our review underscores the importance of optimizing intraoperative inhalation agents to improve patient outcomes and safety in pediatric anesthesia, emphasizing the need for evidence-based approaches and tailored interventions in clinical practice.

Perspectives on Anesthesia and Perioperative Patient Safety: Past, Present, and Future.

During the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event prevention relies on better staffing, education, and basic standards. In Safety-1, used by hospitals, harm events arise from individual and/or system failures. Safety is improved through analytics, workplace culture, high reliability principles, technology, and quality improvement. Safety-2 emphasizes clinicians' adaptability to prevent harm events in an everchanging environment, using resilience engineering principles. Safety-3, used by aviation, adds system design and control elements to Safety-1 and Safety-2, deploying human factors, design-thinking, and operational control or feedback to prevent and respond to harm events. Safety-3 represents a potential way for anesthesia and perioperative care to become safer.

"Safety Monitoring" Behavior and Technology: Reflections From the Anesthesia Patient Safety Foundation 2023 E. C. Pierce, MD, Memorial Lecture.

"Safety Monitoring" Behavior and Technology: Reflections From the Anesthesia Patient Safety Foundation 2023 E. C. Pierce, MD, Memorial Lecture.

Depth of anesthesia monitoring: an argument for its use for patient safety.

There have been significant advancements in depth of anesthesia (DoA) technology. The Anesthesia Patient Safety Foundation recently published recommendations to use a DoA monitor in specific patient populations receiving general anesthesia. However, the universal use of DoA monitoring is not yet accepted. This review explores the current state of DoA monitors and their potential impact on patient safety. We reviewed the current evidence for using a DoA monitor and its potential role in preventing awareness and preserving brain health by decreasing the incidence of postoperative delirium and postoperative cognitive dysfunction or decline (POCD). We also explored the evidence for use of DoA monitors in improving postoperative clinical indicators such as organ dysfunction, mortality and length of stay. We discuss the use of DoA monitoring in the pediatric population, as well as highlight the current limitations of DoA monitoring and the path forward. There is evidence that DoA monitoring may decrease the incidence of awareness, postoperative delirium, POCD and improve several postoperative outcomes. In children, DoA monitoring may decrease the incidence of awareness and emergence delirium, but long-term effects are unknown. While there are key limitations to DoA monitoring technology, we argue that DoA monitoring shows great promise in improving patient safety in most, if not all anesthetic populations.

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation. Call for an Additional Monitor.

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation. Call for an Additional Monitor.

The silent threat: Fatigue, burnout, and patient safety in anaesthesia

The silent threat: Fatigue, burnout, and patient safety in anaesthesia

Drug Errors in Obstetric Anesthesia: A Narrative Review

The subspecialty of obstetric anaesthesiology is different from other subspecialties in anaesthesiology in that, at any point of time, two lives are at stake, making drug errors particularly critical. This narrative review explores the incidence, contributing factors, and preventive strategies for medication errors in Obstetric Anaesthesia. Key contributors of medication errors include distractions, fatigue, look-alike/sound-alike drugs, lack of standardized protocols, poor communication strategies, inadequate training and education. Effective strategies for reducing errors include double-check procedures, bar-coded medication administration systems, implementing “Tall Man lettering for look-alike/sound-alike drugs, structured communication tools, continuous education and training. The review also introduces the mnemonic "SAFE-LABEL CHECK" to encapsulate best practices for minimizing drug errors. Future directions suggest integrating advanced technologies and fostering a multidisciplinary approach to enhance patient safety in obstetric anaesthesia.

The Anesthesia Patient Safety Officer: Why Every Institution Needs One

The Anesthesia Patient Safety Officer: Why Every Institution Needs One

Perioperative Patients With Hemodynamic Instability: Consensus Recommendations of the Anesthesia Patient Safety Foundation.

In November of 2022, the Anesthesia Patient Safety Foundation held a Consensus Conference on Hemodynamic Instability with invited experts. The objective was to review the science and use expert consensus to produce best practice recommendations to address the issue of perioperative hemodynamic instability. After expert presentations, a modified Delphi process using discussions, voting, and feedback resulted in 17 recommendations regarding advancing the perioperative care of the patient at risk of, or with, hemodynamic instability. There were 17 high-level recommendations. These recommendations related to the following 7 domains: Current Knowledge (5 statements); Preventing Hemodynamic Instability-Related Harm During All Phases of Care (4 statements); Data-Driven Quality Improvement (3 statements); Informing Patients (2 statements); The Importance of Technology (1 statement); Launch a National Campaign (1 statement); and Advancing the Science (1 statement). A summary of the recommendations is presented in Table 1 .

A Comprehensive Analysis and Review of Artificial Intelligence in Anaesthesia.

In the field of anaesthesia, artificial intelligence (AI) has become a game-changing technology. Applications of AI include keeping records, monitoring patients, calculating and administering drugs, and carrying out mechanical procedures. This article explores the current uses, challenges, and prospective applications of AI in anaesthesia practices. This review discusses AI-supported systems like anaesthesia information management systems (AIMS), mechanical robots for carrying out procedures, and pharmacological models for drug delivery. AIMS has helped in automated record-keeping, predicting bad events, and monitoring the vital signs of the patient. Their application has a vital role in improving the efficacy of anaesthesia management and patient safety. The application of AI in anaesthesia comes with its own unique difficulties. Noteworthy obstacles include issues with data quantity and quality, technical limitations, and moral and legal dilemmas. The key to overcoming these barriers is to set guidelines for the ethical use of AI in healthcare, improve the reliability and comprehension of AI systems, and certify the health data precision and security. AI has very bright potential. Exciting future directions include developments in AI and machine learning thus development of new applications, and the possible enhancement in training and education. Potential research areas include the application of AI to chronic disease management, pain management, and the reinforcement of anaesthesiologists' education. AI could be used to design authentic lifelike training simulations and individualized student feedback systems, hence transforming anaesthesia education and training methodology. For this review, we conducted a PubMed, Google Scholar, and Cochrane Database search in 2022-2023 and retrieved articles on AI and its uses in anaesthesia. Recommendations for future research and development include strengthening the safety and reliability of health data, building a better understanding of AI systems, and looking into new areas of use. The power of AI can be used to innovate anaesthesia practices by concentrating on these areas.

More Than a Perioperative Surgical Home: An Opportunity for Anesthesiologists to Advance Public Health.

Public health and the medical specialty of anesthesiology have been closely intertwined throughout history, dating back to the 1800s when Dr. John Snow used contact tracing methods to identify the Broad Street Pump as the source of a cholera outbreak in London. During the COVID-19 pandemic, leaders in anesthesiology and anesthesia patient safety came forward to develop swift recommendations in the face of rapidly changing evidence to help protect patients and healthcare workers. While these high-profile examples may seem like uncommon events, there are many common modern-day public health issues that regularly intersect with anesthesiology and surgery. These include, but are not limited to, smoking; chronic opioid use and opioid use disorder; and obstructive sleep apnea. As an evolving medical specialty that encompasses pre- and postoperative care and acute and chronic pain management, anesthesiologists are uniquely positioned to improve patient care and outcomes and promote long-lasting behavioral changes to improve overall health. In this article, we make the case for advancing the role of the anesthesiologist beyond the original perioperative surgical home model into promoting public health initiatives within the perioperative period.

Anesthesia Risk Alert Program: A Proactive Safety Initiative.

Analyzing adverse events data collected over a three-year period on all anesthetic cases, North American Partners in Anesthesia (NAPA), a nationwide anesthesia practice, found a correlation between certain high-risk clinical factors and a number of critical events. Seeking to reduce the incidence of critical adverse events associated with these high-risk factors, the quality team of the NAPA Anesthesia Patient Safety Institute (NAPSI) developed the Anesthesia Risk Alert (ARA) program, which guides clinicians in proactively applying targeted risk mitigation interventions in five specific clinical scenarios. NAPSI is NAPA's Patient Safety Organization (PSO). ARA promotes a proactive (Safety II) approach to patient safety. The protocol incorporates innovative collaboration techniques to improve clinical decision-making, along with recommendations by professional medical societies. ARA risk mitigation strategies also adapt decision tools from other industries, such as red team/blue team methodology. Following implementation training to approximately 6,000 NAPA clinicians, ongoing compliance is tracked for the program's two components: screening patients for the five high-risk clinical scenarios and performing the associated mitigation strategy when one or more risk factor is identified. Since launching the ARA program in 2019, clinician compliance consistently exceeds 95%. Simultaneously, available data indicate that the incidence of selected adverse events has decreased. ARA, developed as a process improvement initiative to reduce patient harm in several vulnerable perioperative patient populations, demonstrates how proactive safety strategies can improve clinical outcomes and create better perioperative cultures. At various sites, NAPA anesthesia clinicians reported that ARA's collaboration strategies were transformative behaviors that extended beyond the operating room. Other health care providers may customize the lessons learned from ARA with a Safety II approach.

Proceedings of the Third American Association of Oral and Maxillofacial Surgeons Anesthesia Patient Safety Conference

The 3rd Anesthesia Patient Safety Conference of the American Association of Oral and Maxillofacial Surgeons was held at the Daniel M Laskin Institute for Oral and Maxillofacial Surgery Education and Innovation at American Association of Oral and Maxillofacial Surgeons headquarters in Rosemont, Illinois on June 6, 2022. The conference provided a platform to scrutinize collective errors, explore optimal practices, comprehend the concepts and principles of human complacency, assessing the system's capacity to handle deviations from the norm, and contemplate ideas and initiatives to enhance our practice model. These safety conferences are designed to foster collaborative, proactive conversations and understand best practices in safe delivery of anesthetic care to our patients.

The Cappuccini Test: an audit of anesthesia supervision

Background & Objective: Cappuccini test was launched on 22th May 2019, at Royal College of Anesthetists 2019 conference. This is an audit tool to improve the patient safety in anesthesia, based on lessons learned from Frankie Cappuccini’s death. It has been incorporated into standards set by Royal College of Anesthetists and into their hospital accreditation process as a quality improvement tool. We conducted this audit to explore the current status of supervision of trainees in anesthesia in our hospital and to suggest potential improvement of training standards.
 Methodology: This prospective audit was conducted in Shaukat Khanum Memorial Cancer Hospital & research Centre, Lahore, Pakistan. It was conducted for 6 weeks from June 20, 2021 to July 31, 2021. We used the tool kit provided by Royal College of Anesthetists and compared our practicing standards against Royal College of Anesthetists' newly set standard for safety of patients and healthcare staff.
 Results: We collected twenty-one operation lists during the audit time period. All these lists had trainees under supervision by a consultant grade anesthetist (100%). In response to questions (1−3 and 6) related to trainees’ knowledge about who was the supervising consultant, how she/he could be contacted if needed, being able to contact and supervisor able to attend if required, were all 100%.
 The two questions (4 and 5) were related to supervising consultants, about their awareness of the operating list being supervised by them (90.5%) and accurate description of the nature of the work being supervised by them (81%).
 Conclusion: The Cappuccini test is a simple safety and quality improvement tool. It provides assurance that the trainee is working in a safe environment and has full access to contact the supervising consultant. It is a useful indicator of supervision and potential improvement of training standards.
 Abbreviations: AAGBI- Association of Anesthetists in Great Britain and Ireland RcoA-Royal College of Anesthetists UK; NCEPOD-National Confidential Enquiry into Patient Outcome and Death
 Key words: Cappuccini test; Patient safety; Safer surgery; Supervision
 Citation: Saleem H, Iqbal A, Bukhari S, Durrani RS. The Cappuccini Test: an audit of anesthesia supervision. Anaesth. pain intensive care 2023;27(4):490−495; DOI: 10.35975/apic.v27i4.2257
 Received: November 27, 2022; Reviewed: June 04, 2023; Accepted: June 07, 2023

Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: A Meeting Report From the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation.

Beard, John MD*; Methangkool, Emily MD, MPH†; Angus, Shane CAA, MSA‡; Urman, Richard D. MD, MBA§; Cole, Daniel J. MD† Author Information

Quality of Life After Critical Illness.

1 Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA. 2 Harvard Medical School, Boston, MA. 3 Ariadne Labs, Boston, MA. *See also p. 632. The views expressed in this article are those of the authors and do not necessarily represent the views of others. Support was provided solely from institutional sources. Dr. Arriaga is the recipient of: 1) a mentored research training grant from the Anesthesia Patient Safety Foundation (APSF) and the Foundation for Anesthesia Education and Research (FAER) and 2) a Career Development Award from the Center for Diversity and Inclusion of the Brigham and Women’s Hospital. He is also a member of the Patient Safety Editorial Board for the American Society of Anesthesiologists and Question Editor/Examiner for the American Board of Anesthesiology, where he receives a stipend for work that is otherwise done in a volunteer capacity. He received funding from the American Society of Anesthesiologists Patient Safety Editorial Board, the American Board of Anesthesiology, the Minority Faculty Career Development Award from the Center for Diversity and Inclusion of the Brigham and Women’s Hospital, the APSF, and the FAER. Dr. Allen has disclosed that he does not have any potential conflicts of interest.

Addressing anesthesia medication errors for improved quality care

Medication errors in anesthesia can have serious consequences for patients, including morbidity and mortality. These errors can occur at any stage of the medication administration process, from prescribing and preparation to administration and monitoring. Learning from medication errors is essential to improving patient safety in anesthesia. To address medication errors in anesthesia, various strategies have been developed, including the use of checklists, protocols, and simulation training. The implementation of technology, such as barcode scanning and automated dispensing systems, has also been effective in reducing medication errors. Learning from medication errors involves identifying the root causes of the error, analyzing the factors that contributed to the error, and implementing strategies to prevent similar errors from occurring in the future. A culture of safety that encourages reporting and analysis of errors is crucial for learning from medication errors. Improving patient safety in anesthesia requires a collaborative effort among healthcare professionals, including anesthesiologists, nurses, and pharmacists, as well as a commitment to continuous improvement through learning from errors.

Low-Flow Anesthesia...100 Years Later

Anesthesia Patient Safety Foundation| March 2023 Low-Flow Anesthesia...100 Years Later Jeffrey M. Feldman, MD, MSE; Jeffrey M. Feldman, MD, MSE Search for other works by this author on: This Site PubMed Google Scholar Samsun (Sem) Lampotang, PhD, FSSH, FAIMBE Samsun (Sem) Lampotang, PhD, FSSH, FAIMBE Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor March 2023, Vol. 87, 36. https://doi.org/10.1097/01.ASM.0000922056.23891.43 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 Jeffrey M. Feldman, Samsun (Sem) Lampotang; Low-Flow Anesthesia...100 Years Later. ASA Monitor 2023; 87:36 doi: https://doi.org/10.1097/01.ASM.0000922056.23891.43 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: fluid flow “The signs of oxygen want and plane of anesthesia as shown by color, muscular phenomena, etc. must be watched constantly...” Ralph Waters, MD, Anesthesia & Analgesia, 1926 One hundred years ago, Dr. Ralph Waters introduced carbon dioxide absorbents to facilitate rebreathing of exhaled anesthetics, and reduce the need for adding fresh gas and anesthetic to the breathing circuit. Advantages included reduced use (cost) of inhaled anesthetics, reduced exposure of the surgical team to anesthetics, since scavenging systems were not used, and better preservation of the patient's temperature and airway humidity. As the quote above from his 1926 article indicates, Dr. Waters was concerned about the safety implications of reducing fresh gas flow, specifically inadequate oxygen and inadequate anesthetic depth (Anesth Analg 1926;5:160-2). With careful clinical observation, Dr. Waters was able to safely practice low-flow anesthesia using a bag-mask type device with an integrated CO2 absorbent. In... You do not currently have access to this content.

Improving patient safety: Did we learn from the story of Jean-Pierre Adams?

The safety of surgery and anesthesia has seen many advances over the last several decades; however, the frequency of complications experienced by patients undergoing surgical operations remains high. Most of these complications are avoidable, with a considerable portion of surgical patient injuries originating from human factors. Telling stories and assessing what went wrong and why for lessons to be learned are proven methods used to improve patient safety in anesthesia. In this narrative, we revisited a case of an anesthesia mishap that occurred in 1982, leaving the victim in a coma for nearly four decades until his death in September 2021. The patient reported for his operation, but a number of the hospital's staff were on strike. His operation, however, went ahead and the reduction in anesthesia care team members and its consequential increase in workload resulted in a series of avoidable errors. Decades after this event, many of the issues identified still remain a challenge in anesthesia care; there are still lessons to learn. We identified and discussed three major issues of concern: the non-cancellation of his procedure amid a strike action, giving a delicate anesthetic duty to a trainee without active supervision, and poor coordination and teamwork among team members in the operating room.

A Brief Assessment of Patient Safety Culture in Anesthesia and Intensive Care Departments.

Due to the nature of their activity, anesthesia and critical care have generally well-developed patient safety cultures, which are linked to a greater level of incident awareness and reporting during clinical activity. In order to determine the status quo and identify and adopt, where appropriate, techniques and instruments for further improving patient safety, it is necessary to evaluate the culture and barriers in these departments. The main objective of our study was to assess patient safety culture in Romanian anesthesia and intensive care departments (AICDs), to pinpoint the areas that may need improvement, and to examine the correlation between the prevalence of adverse event reporting, as well as the level of self-reported patient safety culture. To determine how anesthesia and intensive care department staff perceived patient safety, the Hospital Survey on Patient Safety Culture (HSOPSC) was used in a translated Romanian version. In total, 1200 employees from 36 anesthesiology and intensive care departments across 32 hospitals in Romania received the questionnaire, representing 42.66% of all anesthesia and intensive care departments in the country. In 7 of the 12 examined dimensions, significant differences between tertiary and secondary hospitals were observed. Among all dimensions, the highest positive score was for "organizational learning and continuous development". In general, our study revealed a positive view on patient safety in anesthesia and intensive care departments. Further studies are required to determine a threshold of the level of culture development.