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British Journal of Anaesthesia Apr 2024Anaesthesiologists overwhelmingly favour pulse wave analysis techniques as their primary method to monitor cardiac output during high-risk noncardiac surgery. In...
Anaesthesiologists overwhelmingly favour pulse wave analysis techniques as their primary method to monitor cardiac output during high-risk noncardiac surgery. In patients with a radial arterial catheter in place, pulse wave analysis techniques have the advantage of instantly providing non-operator-dependent and continuous haemodynamic monitoring information. Green pulse wave analysis techniques working with any standard pressure transducer are as reliable as techniques requiring dedicated pressure transducers. They have the advantage of minimising plastic waste and related carbon dioxide emissions, and also significantly reducing hospital costs. The future integration of pulse wave analysis algorithms into multivariable bedside monitors, obviating the need for standalone haemodynamic monitors, could lead to wider use of haemodynamic monitoring solutions by further reducing their cost and carbon footprint.
PubMed: 38752841
DOI: 10.1016/j.bja.2024.03.008 -
BMC Medical Education Aug 2023Cricothyrotomy is a procedure performed to establish an airway in critical airway events. It is performed only rarely and anesthesiologists are often unprepared when...
BACKGROUND
Cricothyrotomy is a procedure performed to establish an airway in critical airway events. It is performed only rarely and anesthesiologists are often unprepared when called upon to perform it. This study aimed to simulate cricothyrotomy using pig larynx and trachea models to help anesthesiologists master cricothyrotomy and improve the ability to establish cricothyrotomy quickly.
METHODS
The porcine larynx and trachea were dissected and covered with pigskin to simulate the structure of the anterior neck of a human patient. An animal model of cricothyrotomy was established. Forty anesthesiologists were randomly divided into four groups. Each physician performed three rounds of cricothyrotomy, and recorded the time to accomplish each successful operation. After training the cricothyrotomy procedure, a questionnaire survey was conducted for the participating residents using a Likert scale. The participants were asked to score the utility of the training course on a scale of 1 ((minimum) to 5 ((maximum).
RESULTS
Through repeated practice, compared with the time spent in the first round of the operation (67 ± 29 s), the time spent in the second round of the operation (47 ± 21 s) and the time spent in the third round of the operation (36 ± 11 s) were significantly shortened (P < 0.05). Results of the survey after training were quite satisfied, reflecting increased the ability of proficiency in locating the cricothyroid membrane and performing a surgical cricothyrotomy.
CONCLUSION
The porcine larynx and trachea model is an excellent animal model for simulating and practicing cricothyrotomy, helping anesthesiologists to master cricothyrotomy and to perform it proficiently when required.
Topics: Animals; Humans; Swine; Trachea; Airway Management
PubMed: 37550664
DOI: 10.1186/s12909-023-04558-w -
Seminars in Cardiothoracic and Vascular... Dec 2023
Topics: Humans; Anesthesiologists; Perioperative Medicine; Hypertension, Pulmonary; Heart Defects, Congenital
PubMed: 37909211
DOI: 10.1177/10892532231212593 -
Journal of Cardiothoracic and Vascular... Jan 2024
Commentary on Anesthetic Management of an Infant with Dilated Cardiomyopathy and Congestive Heart Failure Undergoing Open Aortic Abdominal Aneurysm Repair: The Critical Role of a Dual-Trained Pediatric and Adult Cardiothoracic Anesthesiologist.
Topics: Adult; Infant; Humans; Child; Cardiomyopathy, Dilated; Anesthesiologists; Aortic Aneurysm, Abdominal; Heart Failure; Anesthetics
PubMed: 37968197
DOI: 10.1053/j.jvca.2023.10.016 -
Journal of Cardiothoracic and Vascular... Jan 2024
Commentary on Anesthetic Management of an Infant with Dilated Cardiomyopathy and Congestive Heart Failure Undergoing Open Aortic Abdominal Aneurysm Repair: The Critical Role of a Dual-Trained Pediatric and Adult Cardiothoracic Anesthesiologist.
Topics: Adult; Infant; Humans; Child; Cardiomyopathy, Dilated; Anesthesiologists; Aortic Aneurysm, Abdominal; Heart Failure; Anesthetics
PubMed: 37953176
DOI: 10.1053/j.jvca.2023.10.017 -
BJA Open Dec 2023The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia... (Review)
Review
The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.
PubMed: 37942056
DOI: 10.1016/j.bjao.2023.100234 -
Brazilian Journal of Anesthesiology... 2023Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering,... (Review)
Review
Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.
Topics: Humans; Anesthesiologists; Prescription Drug Diversion; Substance-Related Disorders; Health Personnel; Pain
PubMed: 37517585
DOI: 10.1016/j.bjane.2023.07.008 -
Current Opinion in Organ Transplantation Feb 2024The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation. (Review)
Review
PURPOSE OF REVIEW
The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation.
RECENT FINDINGS
Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise.
SUMMARY
The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.
Topics: Humans; Hemodynamic Monitoring; Liver Transplantation; Hemodynamics; Cardiac Output; Monitoring, Physiologic
PubMed: 38032246
DOI: 10.1097/MOT.0000000000001125 -
Seminars in Cardiothoracic and Vascular... Dec 2023Public health and the medical specialty of anesthesiology have been closely intertwined throughout history, dating back to the 1800s when Dr. John Snow used contact... (Review)
Review
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.
Topics: Humans; Anesthesiologists; Public Health; Pandemics; Anesthesiology; Opioid-Related Disorders
PubMed: 37679298
DOI: 10.1177/10892532231200620 -
Canadian Journal of Anaesthesia =... May 2024Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly... (Review)
Review
PURPOSE
Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly expanded over the last two decades as a sensitive marker of myocardial dysfunction with important diagnostic and prognostic values. Strain analysis has the potential to become a routine part of the perioperative echocardiographic examination for most anesthesiologist-echocardiographers but its exact role in the perioperative setting is still being defined.
CLINICAL FEATURES
This clinical report reviews the principles underlying strain analysis and describes its main clinical uses pertinent to the field of anesthesiology and perioperative medicine. Strain for assessment of left and right ventricular function as well as atrial strain is described. We also discuss the potential role of strain to aid in perioperative risk stratification, surgical patient selection in cardiac surgery, and guidance of anesthetic monitor choice and clinical decision-making in the perioperative period.
CONCLUSION
Echocardiographic strain analysis is a powerful tool that allows seeing what conventional 2D imaging sometimes fails to reveal. It often provides pathophysiologic insight into various cardiac diseases at an early stage. Strain analysis is readily feasible and reproducible thanks to the use of highly automated software platforms. This technique shows promising potential to become a valuable tool in the arsenal of the anesthesiologist-echocardiographer and aid in perioperative risk-stratification and clinical decision-making.
Topics: Humans; Anesthesiologists; Echocardiography; Cardiac Surgical Procedures; Prognosis
PubMed: 38600285
DOI: 10.1007/s12630-024-02713-5