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European Review For Medical and... Mar 2019Childhood obstructive sleep disordered breathing (SDB) is a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation;... (Review)
Review
OBJECTIVE
Childhood obstructive sleep disordered breathing (SDB) is a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation; obstructive sleep apnea syndrome (OSAS) is one of the most common causes of SDB in children. The aim of this review is to evaluate the role of the anesthesiologist in pediatric OSAS.
MATERIALS AND METHODS
A literature review has been performed on the following topics: clinical aspects of pediatric OSAS, preoperative investigations including questionnaires, clinical parameters, laboratory polysomnography and home sleep apnea testing, anesthesiologic preoperative management, anesthesiologic perioperative management, anesthesiologic postoperative management including postoperative analgesia, postoperative nausea and vomiting (PONV), and post-tonsillectomy bleeding.
RESULTS
OSAS in children is a distinct disorder from the condition that occurs in adults; adenoidectomy and tonsillectomy are the first line of therapy in these patients. Even if these surgical procedures are frequently performed, they represent a great challenge for surgeons and anesthesiologists and are associated with a substantially increased risk of morbidity and mortality.
CONCLUSIONS
The role of the anesthesiologist is pediatric OSAS is crucial before, during and after surgery, as pediatric patients are at higher risk of preoperative, perioperative and postoperative adverse events including airway obstruction, PONV, and bleeding.
Topics: Anesthesiologists; Humans; Pediatrics; Physician's Role; Sleep Apnea, Obstructive
PubMed: 30920637
DOI: 10.26355/eurrev_201903_17343 -
British Journal of Anaesthesia Jun 2020
Topics: Airway Management; Anesthesiologists; Anesthesiology; COVID-19; Cardiopulmonary Resuscitation; China; Coronavirus Infections; Critical Care; Disease Outbreaks; Humans; Pandemics; Patient Care Team; Physician's Role; Pneumonia, Viral
PubMed: 32307116
DOI: 10.1016/j.bja.2020.03.022 -
British Journal of Anaesthesia Mar 2020
Topics: Anesthesiologists; Apgar Score; History, 20th Century
PubMed: 31948680
DOI: 10.1016/j.bja.2019.12.017 -
Die Anaesthesiologie Feb 2023This article is intended to provide clinically working anesthesiologists with a practice-oriented overview of selected important current guidelines and recommendations... (Review)
Review
This article is intended to provide clinically working anesthesiologists with a practice-oriented overview of selected important current guidelines and recommendations pertaining to intraoperative prevention of infection. The contents of this article are based on the guidelines or recommendation of the World Health Organization (WHO) and the Association of the Scientific Medical Societies in Germany (AWMF) as well as the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI). The authors' objective is to foster and support the standard of infection prevention and control in the operating theater by optimizing the standard of hygiene in daily practice to reduce the number of perioperative infections.
Topics: Humans; Anesthesiologists; Operating Rooms; Hospitals; Germany; Hygiene
PubMed: 36449055
DOI: 10.1007/s00101-022-01239-z -
Advances in Anesthesia Dec 2018
Review
Topics: Anesthesiologists; Civil Defense; Disaster Planning; Emergency Medical Services; Humans; Mass Casualty Incidents; Physician's Role
PubMed: 30414641
DOI: 10.1016/j.aan.2018.07.002 -
British Journal of Anaesthesia Aug 2021
Topics: Airway Management; Anesthesiologists; COVID-19; Humans; Laryngoscopy; Video-Assisted Surgery
PubMed: 34092382
DOI: 10.1016/j.bja.2021.05.004 -
JAMA Network Open Dec 2023Surgery within 24 hours after a hip fracture improves patient morbidity and mortality, which has led some hospitals to launch quality improvement programs (eg, targeted...
IMPORTANCE
Surgery within 24 hours after a hip fracture improves patient morbidity and mortality, which has led some hospitals to launch quality improvement programs (eg, targeted resource management, documented protocols) to address delays. However, these programs have had mixed results in terms of decreased time to surgery (TTS), identifying an opportunity to improve the effectiveness of interventions.
OBJECTIVE
To identify the contextual determinants (site-specific barriers and facilitators) of TTS for patients with hip fracture across diverse hospitals.
DESIGN, SETTING, AND PARTICIPANTS
This qualitative mixed-methods study used an exploratory sequential design that comprised 2 phases. In phase 1, qualitative semistructured interviews were conducted with stakeholders involved in hip fracture care (orthopedic surgeons or residents, emergency medicine physicians, hospitalists, anesthesiologists, nurses, and clinical or support staff) at 4 hospitals with differing financial, operational, and educational structures. Interviews were completed between May and July 2021. In phase 2, a quantitative survey assessing contextual determinants of TTS within 24 hours for adult patients with hip fracture was completed by orthopedic surgeon leaders representing 23 diverse hospitals across the US between May and July 2022. Data analysis was performed in August 2022.
MAIN OUTCOMES AND MEASURES
Thematic analysis of the interviews identified themes of contextual determinants of TTS within 24 hours for patients with hip fracture. The emergent contextual determinants were then measured across multiple hospitals, and frequency and distribution were used to assess associations between determinants and various hospital characteristics (eg, setting, number of beds).
RESULTS
A total of 34 stakeholders were interviewed in phase 1, and 23 surveys were completed in phase 2. More than half of respondents in both phases were men (19 [56%] and 18 [78%], respectively). The following 4 themes of contextual determinants of TTS within 24 hours were identified: availability, care coordination, improvement climate, and incentive structure. Within these themes, the most commonly identified determinants across the various hospitals involved operating room availability, a formal comanagement system between orthopedics and medicine or geriatrics, the presence of a physician champion focused on timely surgery, and a program that facilitates improvement work.
CONCLUSIONS AND RELEVANCE
In this study, contextual determinants of TTS within 24 hours for patients with hip fracture varied across hospital sites and could not be generalized across various hospital contexts because no 2 sites had identical profiles. As such, these findings suggest that guidance on strategies for improving TTS should be based on the contextual determinants unique to each hospital.
Topics: Adult; Male; Humans; Female; Hip Fractures; Hospitals; Anesthesiologists; Climate; Emergency Medicine
PubMed: 38100104
DOI: 10.1001/jamanetworkopen.2023.47834 -
Journal of Clinical Anesthesia Feb 2021
Topics: Anesthesiologists; Burnout, Professional; COVID-19; Humans; Mental Health
PubMed: 33038719
DOI: 10.1016/j.jclinane.2020.110084 -
International Journal of Pediatric... Sep 2020There has been a rapid global spread of a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which originated in Wuhan China in late...
There has been a rapid global spread of a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which originated in Wuhan China in late 2019. A serious threat of nosocomial spread exists and as such, there is a critical necessity for well-planned and rehearsed processes during the care of the COVID-19 positive and suspected patient to minimize transmission and risk to healthcare providers and other patients. Because of the aerosolization inherent in airway management, the pediatric otolaryngologist and anesthesiologist should be intimately familiar with strategies to mitigate the high-risk periods of viral contamination that are posed to the environment and healthcare personnel during tracheal intubation and extubation procedures. Since both the pediatric otolaryngologist and anesthesiologist are directly involved in emergency airway interventions, both specialties impact the safety of caring for COVID-19 patients and are a part of overall hospital pandemic preparedness. We describe our institutional approach to COVID-19 perioperative pandemic planning at a large quaternary pediatric hospital including operating room management and remote airway management. We outline our processes for the safe and effective care of these patients with emphasis on simulation and pathways necessary to protect healthcare workers and other personnel from exposure while still providing safe, effective, and rapid care.
Topics: Airway Management; Anesthesiologists; Betacoronavirus; COVID-19; Child; Coronavirus Infections; Humans; Otolaryngologists; Otolaryngology; Pandemics; Pneumonia, Viral; Quaternary Prevention; SARS-CoV-2
PubMed: 32563080
DOI: 10.1016/j.ijporl.2020.110174 -
Advances in Anesthesia Dec 2021
Review
Topics: Anesthesiologists; Burnout, Professional; COVID-19; Humans; Mental Health; Resilience, Psychological
PubMed: 34715972
DOI: 10.1016/j.aan.2021.07.009