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Nature Biomedical Engineering Oct 2018Although anaesthesiologists strive to avoid hypoxemia during surgery, reliably predicting future intraoperative hypoxemia is not currently possible. Here, we report the...
Although anaesthesiologists strive to avoid hypoxemia during surgery, reliably predicting future intraoperative hypoxemia is not currently possible. Here, we report the development and testing of a machine-learning-based system that, in real time during general anaesthesia, predicts the risk of hypoxemia and provides explanations of the risk factors. The system, which was trained on minute-by-minute data from the electronic medical records of over fifty thousand surgeries, improved the performance of anaesthesiologists when providing interpretable hypoxemia risks and contributing factors. The explanations for the predictions are broadly consistent with the literature and with prior knowledge from anaesthesiologists. Our results suggest that if anaesthesiologists currently anticipate 15% of hypoxemia events, with this system's assistance they would anticipate 30% of them, a large portion of which may benefit from early intervention because they are associated with modifiable factors. The system can help improve the clinical understanding of hypoxemia risk during anaesthesia care by providing general insights into the exact changes in risk induced by certain patient or procedure characteristics.
Topics: Adult; Aged; Aged, 80 and over; Anesthesia, General; Anesthesiologists; Area Under Curve; Electronic Health Records; Female; Humans; Hypoxia; Machine Learning; Male; Middle Aged; ROC Curve; Risk Factors; Surgical Procedures, Operative
PubMed: 31001455
DOI: 10.1038/s41551-018-0304-0 -
Anesthesia and Analgesia May 2022The American Society of Anesthesiologists' (ASA) Task Force on Management of the Difficult Airway has developed a decision tree tool that uses inductive assessments to...
The American Society of Anesthesiologists' (ASA) Task Force on Management of the Difficult Airway has developed a decision tree tool that uses inductive assessments to guide the anesthesiologist's choice of pathway in the ASA's Difficult Airway Algorithm. The tool prompts the anesthesiologist to consider the risk of difficulty with laryngoscopy (direct or indirect) and tracheal intubation, facemask or supraglottic ventilation, gastric contents aspiration, and rapid oxyhemoglobin desaturation. For every airway management event, the approach integrates the anesthesiologist's unique combination of experience, expertise, patient anatomy and disease, equipment availability, and other contextual conditions into the decision process. Entry into the awake intubation pathway is encouraged when the patient is judged at risk of difficult tracheal intubation and one or more of the following: difficult ventilation, significant aspiration risk, and/or rapid oxyhemoglobin desaturation. The decision tree tool is anticipated to improve communication between anesthesiologists and others by clearly identifying those factors of concern and how decision-making is affected by those concerns.
Topics: Airway Management; Algorithms; Anesthesiologists; Decision Trees; Humans; Intubation, Intratracheal; Laryngoscopy; Oxyhemoglobins
PubMed: 35171880
DOI: 10.1213/ANE.0000000000005930 -
CMAJ : Canadian Medical Association... Oct 2020
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Canada; Humans; Nurse Anesthetists
PubMed: 33051318
DOI: 10.1503/cmaj.76505 -
British Journal of Anaesthesia Dec 2022Reproductive health is an active area of practice and research for anaesthetists, intensivists, and pain medicine specialists. The purpose of the British Journal of...
Reproductive health is an active area of practice and research for anaesthetists, intensivists, and pain medicine specialists. The purpose of the British Journal of Anaesthesia is to promote the health, welfare, and safety of all persons by disseminating knowledge to further our understanding of anaesthetic principles and improve practice and skills. This includes supporting safe abortion care as an integral part of safe reproductive health.
Topics: Humans; Pregnancy; Female; Maternal Mortality; Abortion, Induced; Anesthetists; Anesthesiologists; Anesthesiology
PubMed: 36184295
DOI: 10.1016/j.bja.2022.08.020 -
Anesthesiology Clinics Jun 2020With a shift in the cultural, political, and social climate surrounding gender and gender identity, an increase in the acceptance and visibility of transgender... (Review)
Review
With a shift in the cultural, political, and social climate surrounding gender and gender identity, an increase in the acceptance and visibility of transgender individuals is expected. Anesthesiologists are thus more likely to encounter transgender and gender nonconforming patients in the perioperative setting. Anesthesiologists need to acquire an in-depth understanding of the transgender patient's medical and psychosocial needs. A thoughtful approach throughout the entirety of the perioperative period is key to the successful management of the transgender patient. This review provides anesthesiologists with a culturally relevant and evidence-based approach to transgender patients during the preoperative, intraoperative, and postoperative periods.
Topics: Anesthesiologists; Female; Gender Identity; Humans; Intraoperative Care; Male; Perioperative Care; Physical Examination; Postoperative Care; Risk Assessment; Transgender Persons
PubMed: 32336386
DOI: 10.1016/j.anclin.2020.01.009 -
Anesthesiology May 2021
Topics: Anesthesiologists; Burnout, Professional; Humans; Pandemics; Surveys and Questionnaires
PubMed: 33667300
DOI: 10.1097/ALN.0000000000003711 -
Anesthesiology Jan 2020
Topics: Advisory Committees; Anesthesiologists; Catheterization, Central Venous; Humans; Societies, Medical; United States
PubMed: 31821240
DOI: 10.1097/ALN.0000000000002864 -
Canadian Journal of Anaesthesia =... Mar 2022
Topics: Anesthesia, Obstetrical; Anesthesiologists; Cesarean Section; Female; Humans; Peripartum Period; Pregnancy
PubMed: 34939140
DOI: 10.1007/s12630-021-02159-z -
Anesthesiology Sep 2020
Review
Topics: Anesthesiologists; Anesthesiology; Enhanced Recovery After Surgery; Humans; Patient Compliance; Preoperative Care
PubMed: 32358253
DOI: 10.1097/ALN.0000000000003331 -
British Journal of Anaesthesia Mar 2020Despite an increase in the proportion of women anaesthesiologists over time, women remain under-represented in academic and leadership positions, honour awards, and... (Review)
Review
Despite an increase in the proportion of women anaesthesiologists over time, women remain under-represented in academic and leadership positions, honour awards, and academic promotion. Current literature has identified several reasons for the observed gender disparity in anaesthesiology leadership and faculty positions, including unsupportive work environments, lack of mentorship, personal choices, childcare responsibilities, and active discrimination against women. A scoping review design was selected to examine the nature and extent of available research. Our review provides an overview of the literature that explores gender issues in anaesthesiology, identifies gaps in the literature, and appraises effective strategies to improve gender equity in anaesthesiology. We searched PubMed, MEDLINE, and EMBASE up to July 2019, and included 30 studies for analysis. Most reports used retrospective or survey methodologies. The review shows that women anaesthesiologists face gender biases in the work environment, are under-represented in various positions of leadership or influence, and as authors. Work-life demands may impose a challenge. Motivation and interest in career advancement of women anaesthesiologists have not been well studied. Several strategies have been proposed, ranging from an individual to administrative level, which may help anaesthesiologists achieve equal representation of women in the field.
Topics: Anesthesiologists; Authorship; Awards and Prizes; Female; Humans; Leadership; Physicians, Women; Sexism
PubMed: 31983412
DOI: 10.1016/j.bja.2019.12.021