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Medical Gas Research 2024Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of adding magnesium sulfate, dexmedetomidine and ondansetron to lidocaine for gargling before laryngoscopy and endotracheal intubation to prevent sore throat: a randomized clinical trial.
Postoperative sore throat is one well-recognized complication, occurring most frequently following tracheal intubation. Effective prevention of postoperative sore throat has been recognized as a top priority, bringing pleasant feelings and satisfaction to patients. This study aimed to assess the efficacy of magnesium sulfate, dexmedetomidine and ondansetron gargle with lidocaine administrated prior to laryngoscopy and tracheal intubation for postoperative sore throat prevention alongside hemodynamic management. This double-blind randomized clinical trial enrolled 105 general anesthesia-administered patients who had undergone laryngoscopy and endotracheal intubation, and they were equally randomized into three groups: magnesium sulfate, dexmedetomidine, and ondansetron groups. No significant intergroup difference was seen in oxygen saturation, non-invasive blood pressure, heart rate, duration of surgery, postoperative complications, analgesic consumption, and incidence of cough and hoarseness. The results showed statistically significant intergroup differences in pain scores and average pain intensity in the dexmedetomidine group was significantly lower than the other groups. Results suggest that dexmedetomidine gargle with lidocaine before general anesthesia induction could be recommended as an option depending on the patient's general condition and the anesthesiologist's discretion.
Topics: Humans; Lidocaine; Magnesium Sulfate; Dexmedetomidine; Ondansetron; Laryngoscopy; Pain; Pharyngitis; Intubation, Intratracheal
PubMed: 37929508
DOI: 10.4103/2045-9912.372664 -
Current Opinion in Anaesthesiology Dec 2023This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making. (Review)
Review
PURPOSE OF REVIEW
This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making.
RECENT FINDINGS
Naturalistic decision-making, a rich research field that aims to understand how cognitive work is accomplished in complex environments, provides insight into anesthesiologists' decision processes. Due to the complexity of clinical work and limits of human decision-making (e.g. fatigue, distraction, and cognitive biases), attention on the role of artificial intelligence to support anesthesiologists' decision-making has grown. Artificial intelligence, a computer's ability to perform human-like cognitive functions, is increasingly used in anesthesiology. Examples include aiding in the prediction of intraoperative hypotension and postoperative complications, as well as enhancing structure localization for regional and neuraxial anesthesia through artificial intelligence integration with ultrasound.
SUMMARY
To fully realize the benefits of artificial intelligence in anesthesiology, several important considerations must be addressed, including its usability and workflow integration, appropriate level of trust placed on artificial intelligence, its impact on decision-making, the potential de-skilling of practitioners, and issues of accountability. Further research is needed to enhance anesthesiologists' clinical decision-making in collaboration with artificial intelligence.
Topics: Humans; Artificial Intelligence; Anesthesiology; Intraoperative Care; Anesthesia; Anesthesiologists
PubMed: 37865848
DOI: 10.1097/ACO.0000000000001318 -
Anesthesia and Analgesia Nov 2023
Topics: Capnography; Monitoring, Physiologic
PubMed: 37862391
DOI: 10.1213/ANE.0000000000006690 -
JMIR Perioperative Medicine Sep 2023Anesthesiologists require an understanding of their patients' outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had...
BACKGROUND
Anesthesiologists require an understanding of their patients' outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had limited information about their surgical outpatients' outcomes due to minimal contact post discharge. Leveraging digital health innovations for analyzing personal and population outcomes may improve perioperative care. BC Children's Hospital's postoperative follow-up registry for outpatient surgeries collects short-term outcomes such as pain, nausea, and vomiting. Yet, these data were previously not available to anesthesiologists.
OBJECTIVE
This quality improvement study aimed to visualize postoperative outcome data to allow anesthesiologists to reflect on their care and compare their performance with their peers.
METHODS
The postoperative follow-up registry contains nurse-reported postoperative outcomes, including opioid and antiemetic administration in the postanesthetic care unit (PACU), and family-reported outcomes, including pain, nausea, and vomiting, within 24 hours post discharge. Dashboards were iteratively co-designed with 5 anesthesiologists, and a department-wide usability survey gathered anesthesiologists' feedback on the dashboards, allowing further design improvements. A final dashboard version has been deployed, with data updated weekly.
RESULTS
The dashboard contains three sections: (1) 24-hour outcomes, (2) PACU outcomes, and (3) a practice profile containing individual anesthesiologist's case mix, grouped by age groups, sex, and surgical service. At the time of evaluation, the dashboard included 24-hour data from 7877 cases collected from September 2020 to February 2023 and PACU data from 8716 cases collected from April 2021 to February 2023. The co-design process and usability evaluation indicated that anesthesiologists preferred simpler designs for data summaries but also required the ability to explore details of specific outcomes and cases if needed. Anesthesiologists considered security and confidentiality to be key features of the design and most deemed the dashboard information useful and potentially beneficial for their practice.
CONCLUSIONS
We designed and deployed a dynamic, personalized dashboard for anesthesiologists to review their outpatients' short-term postoperative outcomes. This dashboard facilitates personal reflection on individual practice in the context of peer and departmental performance and, hence, the opportunity to evaluate iterative practice changes. Further work is required to establish their effect on improving individual and department performance and patient outcomes.
PubMed: 37725426
DOI: 10.2196/47398 -
Cureus Aug 2023Despite improvements in anesthesia practice, there is still a lack of public awareness of the field, the range of an anesthesiologist's duties, and the crucial role they...
BACKGROUND
Despite improvements in anesthesia practice, there is still a lack of public awareness of the field, the range of an anesthesiologist's duties, and the crucial role they play in the healthcare delivery system. Thus, this study aimed to assess Saudi citizens' perceptions of anesthesiologists' training, expertise, role, and responsibilities, as well as their knowledge and concerns about anesthesia.
METHOD
A cross-sectional study was conducted between December 2022 and April 2023, with a 42-question survey administered to 406 adult Saudi citizens of both genders residing in Saudi Arabia, excluding healthcare students and employees.
RESULTS
Most participants were female (82.8%), aged over 40 (67.6%), held a bachelor's degree (74.6%), and reported very good health (38.7%). A majority (67.2%) had at least undergone one or more surgeries. Knowledge scores averaged 8.14 ± 2.35/14, distributed as 20% poor, 67.7% moderate, and 12.3% good. Perception scores averaged 3.25 ± 1.59/7, with 55.2% poor, 38.2% moderate, and 6.7% good. A significant positive correlation between perception and knowledge scores was found. Higher perception scores were associated with having a chronic medical condition, while higher knowledge scores were associated with being female and having undergone more surgeries. Anesthesiologists were recognized as specially trained doctors by 79.8% of participants, and 63.8% trusted physicians for care. However, 22.4% refused care. Notably, the most common anesthesia concern was fear of dying during anesthesia (very concerned: 26.6%).
CONCLUSION
This study reveals knowledge gaps and misconceptions about an anesthesiologist's role and responsibilities, highlighting the need for public education to address concerns, improve patient satisfaction, and inform future research.
PubMed: 37772216
DOI: 10.7759/cureus.44265 -
Anesthesiology Aug 2023Conflicting evidence exists regarding the risks and benefits of inotropic therapies during cardiac surgery, and the extent of variation in clinical practice remains... (Observational Study)
Observational Study
BACKGROUND
Conflicting evidence exists regarding the risks and benefits of inotropic therapies during cardiac surgery, and the extent of variation in clinical practice remains understudied. Therefore, the authors sought to quantify patient-, anesthesiologist-, and hospital-related contributions to variation in inotrope use.
METHODS
In this observational study, nonemergent adult cardiac surgeries using cardiopulmonary bypass were reviewed across a multicenter cohort of academic and community hospitals from 2014 to 2019. Patients who were moribund, receiving mechanical circulatory support, or receiving preoperative or home inotropes were excluded. The primary outcome was an inotrope infusion (epinephrine, dobutamine, milrinone, dopamine) administered for greater than 60 consecutive min intraoperatively or ongoing upon transport from the operating room. Institution-, clinician-, and patient-level variance components were studied.
RESULTS
Among 51,085 cases across 611 attending anesthesiologists and 29 hospitals, 27,033 (52.9%) cases received at least one intraoperative inotrope, including 21,796 (42.7%) epinephrine, 6,360 (12.4%) milrinone, 2,000 (3.9%) dobutamine, and 602 (1.2%) dopamine (non-mutually exclusive). Variation in inotrope use was 22.6% attributable to the institution, 6.8% attributable to the primary attending anesthesiologist, and 70.6% attributable to the patient. The adjusted median odds ratio for the same patient receiving inotropes was 1.73 between 2 randomly selected clinicians and 3.55 between 2 randomly selected institutions. Factors most strongly associated with increased likelihood of inotrope use were institutional medical school affiliation (adjusted odds ratio, 6.2; 95% CI, 1.39 to 27.8), heart failure (adjusted odds ratio, 2.60; 95% CI, 2.46 to 2.76), pulmonary circulation disorder (adjusted odds ratio, 1.72; 95% CI, 1.58 to 1.87), loop diuretic home medication (adjusted odds ratio, 1.55; 95% CI, 1.42 to 1.69), Black race (adjusted odds ratio, 1.49; 95% CI, 1.32 to 1.68), and digoxin home medication (adjusted odds ratio, 1.48; 95% CI, 1.18 to 1.86).
CONCLUSIONS
Variation in inotrope use during cardiac surgery is attributable to the institution and to the clinician, in addition to the patient. Variation across institutions and clinicians suggests a need for future quantitative and qualitative research to understand variation in inotrope use affecting outcomes and develop evidence-based, patient-centered inotrope therapies.
Topics: Humans; Male; Female; Adolescent; Adult; Middle Aged; Aged; Aged, 80 and over; Myocardial Contraction; Cardiotonic Agents; Cardiac Surgical Procedures; Epinephrine; Dopamine; Dobutamine; Milrinone; Intraoperative Care
PubMed: 37094103
DOI: 10.1097/ALN.0000000000004593 -
Current Opinion in Anaesthesiology Oct 2023The goal of this review is to summarize the perioperative management of noncardiac implanted electrical devices (NCIEDs) and update the anesthesiologist on current... (Review)
Review
PURPOSE OF REVIEW
The goal of this review is to summarize the perioperative management of noncardiac implanted electrical devices (NCIEDs) and update the anesthesiologist on current recommendations for management when a NCIED is encountered during a nonneurosurgical procedure.
RECENT FINDINGS
Indications for NCIEDs continue to expand, and increasing numbers of patients with NCIEDs are presenting for nonneurosurgical procedures. Recent case reports demonstrate that NCIEDs may meaningfully affect perioperative management including use of electrocautery and neuromonitoring. This review highlights the importance of evaluating NCIED function (including lead impedance) prior to surgery, provides an update on the MRI compatibility and safety of these devices, and reviews the management of patients with altered respiratory drive because of vagal nerve stimulators.
SUMMARY
As the prevalence of NCIEDs in patients presenting for surgery increases, anesthesiologists will likely encounter these devices more frequently. To provide a well tolerated anesthetic, anesthesiologists should recognize the concerns associated with NCIEDs and how best to address them perioperatively.
Topics: Humans; Anesthetics; Anesthesiologists
PubMed: 37552004
DOI: 10.1097/ACO.0000000000001296 -
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 Neurosurgical Anesthesiology Oct 2023
Topics: Humans; Anesthesiologists; Thrombectomy; Stroke
PubMed: 37490773
DOI: 10.1097/ANA.0000000000000930