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Optimizing Patient Outcomes in Spinal Surgery: An Investigation Into Anesthesiologists' Case Volume.Cureus Nov 2023Introduction Nearly one million patients in the United States undergo spine surgical procedures annually to seek relief from chronic back and neck pain. A...
Introduction Nearly one million patients in the United States undergo spine surgical procedures annually to seek relief from chronic back and neck pain. A multidisciplinary approach is key to ensuring the efficiency and safety of the surgical process, with the anesthesia team, nursing, surgeon, and healthcare facilities all playing a role. The purpose of this study is to capture potential associations between the anesthesiologists' case volume and patient postoperative outcomes in the early recovery period. Methods A retrospective review of anterior cervical discectomy and fusion (ACDF), lumbar decompression (LD), and lumbar fusion (LF) patients from July 2019 to June 2023 was performed. Anesthesiologists were categorized into low, medium, and high volumes of spine surgical cases. Univariate analysis was performed on patient demographics, intraoperative measures, post-anesthesia care unit (PACU) measures, and postoperative measures by anesthesiologist volume. Results This study included 545 ACDF, 815 LD, and 1,144 LF patients. There were no differences between groups in ACDF patients by anesthesiologist volume. When examining patients undergoing LD, there was a difference in patients with an American Society of Anesthesiologists (ASA) physical status classification of three or greater (low volume: 41.7% vs. medium volume: 53.7% vs. high volume: 45.0%; p=0.029). When examining patients undergoing LF, there were differences in patients with low temperatures in PACU (low volume: 2.8% vs. medium volume: 7.3% vs. high volume: 4.2%; p=0.044) and the percentage of patients with a 90-day emergency department return (low volume: 7.7% vs. medium volume: 11.9% vs. high volume: 7.0%; p=0.024). Conclusion While this study found a minimal impact of anesthesiologist volume on postoperative outcomes, recent literature has emphasized the critical role of teamwork and specialized surgical teams to enhance efficiency and patient care. Further studies are warranted to identify other variables in anesthesia, nursing, and surgical team workflow that may impact postoperative outcomes in spinal surgeries.
PubMed: 38156156
DOI: 10.7759/cureus.49559 -
Journal of Cardiothoracic and Vascular... Oct 2023To estimate the current practice in the perioperative management of patients undergoing cardiac surgery due to infective endocarditis.
OBJECTIVES
To estimate the current practice in the perioperative management of patients undergoing cardiac surgery due to infective endocarditis.
DESIGN
A prospective, open, 24-item, web-based cross-sectional survey.
SETTING
Online survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC).
PARTICIPANTS
Members of the EACTAIC.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A total of 156 responses from 44 countries were received, with a completion rate of 99%. The response rate was 16.6%. Most respondents (76%) practiced cardiac anesthesia in European hospitals, and most respondents stated that a multidisciplinary endocarditis team was not established at their center, that cardiac anesthesiologists appeared to be involved infrequently in those teams (36%), and that they were not involved in decision-making on indication and timing of surgery (88%). In contrast, the cardiac anesthesiologist performed intraoperative antibiotic therapy (62%) and intraoperative transesophageal echocardiography (90%). Furthermore, there was a relative heterogeneity concerning perioperative monitoring, as well as for coagulation and transfusion management.
CONCLUSIONS
This international survey evaluated current practice among cardiac anesthesiologists in the perioperative management of patients with infective endocarditis and the anesthesiologist's role in multidisciplinary decision-making. Heterogeneity in treatment approaches was identified, indicating relevant knowledge gaps that should encourage further clinical research to optimize treatment and postoperative outcomes in this specific population.
Topics: Humans; Cross-Sectional Studies; Prospective Studies; Cardiac Surgical Procedures; Surveys and Questionnaires; Endocarditis
PubMed: 37438180
DOI: 10.1053/j.jvca.2023.06.019 -
Indian Journal of Anaesthesia Jan 2024There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like...
There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios. Trainees also learn non-technical skills such as communication, teamwork, and coordination. A wide range of airway simulators are available. However, texture surface characteristics vary from one type to another. The simulation-based airway management training requires availability, understanding, faculty development, and a structured curriculum for effective delivery. This article explored the available evidence on simulation-based airway management teaching and training.
PubMed: 38406347
DOI: 10.4103/ija.ija_1234_23 -
Stereotactic and Functional Neurosurgery 2024Magnetic resonance-guided focused ultrasound (MRgFUS) is an effective treatment option for essential tremor (ET) and tremor dominant Parkinson's disease (TDPD), which is...
INTRODUCTION
Magnetic resonance-guided focused ultrasound (MRgFUS) is an effective treatment option for essential tremor (ET) and tremor dominant Parkinson's disease (TDPD), which is often performed with sedation or in the presence of an anesthesiologist in an effort to minimize adverse events and maximize patient comfort. This study explores the safety, feasibility, and tolerability of performing MRgFUS without an anesthesiologist.
METHODS
This is a single academic center, retrospective review of 180 ET and TDPD patients who underwent MRgFUS treatment without anesthesiologist support. Patient demographics, intra-procedural treatment parameters, peri-procedural adverse events, and 3-month Clinical Rating Scale for Tremor Part B (CRST-B) scores were compared to MRgFUS studies that utilized varying degrees of anesthesia.
RESULTS
There were no anesthesia related adverse events or unsuccessful treatments. There were no early treatment terminations due to patient discomfort, regardless of skull density ratio. 94.6% of patients would repeat the procedure again. The most common side effects during treatment were facial/tongue paresthesia (26.3%), followed by nausea (22.3%), dysarthria (8.6%), and scalp pain (8.0%). No anxiolytic, pain, or antihypertensive medications were administered. The most common early adverse event after MRgFUS procedure was gait imbalance (58.3%). There was a significant reduction of 83.1% (83.4% ET and 80.5% TDPD) of the mean CRST-B scores of the treated hand when comparing 3-month and baseline scores (1.8 vs. 10.9, n = 109, p < 0.0001).
CONCLUSION
MRgFUS without intra-procedural anesthesiologist support is a safe, feasible, and well-tolerated option, without an increase in peri-procedural adverse events.
Topics: Humans; Male; Female; Middle Aged; Aged; Retrospective Studies; Parkinson Disease; Essential Tremor; Anesthesiologists; Treatment Outcome; Magnetic Resonance Imaging; Aged, 80 and over; High-Intensity Focused Ultrasound Ablation; Adult
PubMed: 38657586
DOI: 10.1159/000537695 -
Turkish Journal of Anaesthesiology and... Oct 2023Enhanced recovery after cardiac surgery (ERACS) is a multi-disciplinary approach to improve patient outcomes and reduce complications following cardiac surgery. The aim...
Enhanced recovery after cardiac surgery (ERACS) is a multi-disciplinary approach to improve patient outcomes and reduce complications following cardiac surgery. The aim of ERACS protocol is to optimize pre-operative preparation, reduce surgical trauma, and minimize post-operative stress.The protocol has been shown to improve patient outcomes, including shorter hospital stays, lower rates of complications, and faster return to normal activities. It is important to note that ERACS is a multi-disciplinary approach, and requires close collaboration between surgeons, anaesthesiologists, nurses, and other healthcare professionals to ensure successful implementation. Anaesthesiologists play a crucial role in the ERACS protocol, as they are responsible for the management of the patient's anaesthesia and pain management during and after surgery. In this paper provide an overview of the ERACS protocol from the perspective of an anaesthesiologist.
PubMed: 37876162
DOI: 10.4274/TJAR.2023.231238 -
Anesthesia and Analgesia Apr 2024Millions of individuals require anesthesia services each year. Although anesthesia-associated mortality rates have declined, anesthetic-related morbidity remains high,... (Review)
Review
Millions of individuals require anesthesia services each year. Although anesthesia-associated mortality rates have declined, anesthetic-related morbidity remains high, particularly among vulnerable populations. Disparities in perioperative screening, optimization, surveillance, and follow-up contribute to worse outcomes in these populations. Community-engaged collaborations may be the essential ingredient needed for anesthesiologists to improve disparities in anesthetic outcomes and prioritize the needs of patients and communities. This scoping review seeks to examine the available literature on community engagement among anesthesiologists to identify gaps and seek opportunities for future work. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). OVID MEDLINE, Scopus, and Web of Science Core Collection were searched to identify sources that used or recognized community-engaged strategies and involved the work of anesthesiologists. Sources were selected based on inclusion criteria and consistent data were extracted from each paper for compilation in a data chart. The initial search generated 1230 articles of which 16 met criteria for inclusion in the review. An updated search of the literature and reference scan of included sources resulted in 7 additional articles being included. The sources were grouped according to overarching themes and methods used and ultimately categorized according to the spectrum of public participation developed by the International Association for Public Participation (IAP2). This spectrum includes 5 levels: inform, consult, involve, collaborate, and empower. This review identified 5 sources at the inform level, 8 studies in consult, 0 in involve, 7 in collaborate, and 3 in empower. Results indicate that most initiatives representing deeper levels of community engagement, at the collaborate or empower level, occur internationally. Efforts that occur in the United States tend to emphasize engagement of individual patients rather than communities. There is a need to pursue deeper, more meaningful community-engaged efforts within the field of anesthesiology at a local and national level.
Topics: Humans; Anesthesiologists; Anesthesiology; Anesthesia; Referral and Consultation; Anesthetics
PubMed: 38009932
DOI: 10.1213/ANE.0000000000006740 -
Canadian Journal of Anaesthesia =... Sep 2023
Topics: Humans; Anesthesiologists; Canada; Physicians
PubMed: 37561352
DOI: 10.1007/s12630-023-02540-0 -
Current Opinion in Anaesthesiology Oct 2023To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients. (Review)
Review
PURPOSE OF REVIEW
To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients.
RECENT FINDINGS
Recent studies have been published on the anesthetic consideration for functional MRI, robotic-assisted stereoelectroencephalography, high-intensity focused ultrasound, and magnetoencephalography. These articles describe the anesthesia management, risks, and outcome for these procedures.
SUMMARY
The number of diagnostic and treatment options being used for the management of pediatric epilepsy has increased significantly. In the past few years, a handful of articles have been published, which describe the anesthetic considerations for these procedures. These studies are helpful to anesthesiologists who are planning an upcoming anesthetic or who are developing a 'best practice' model for their institution. Because unlike other diagnostic studies, failure to understand what effects anesthetics have on the brain, may negate the utility of the study. Although these new findings can be used to provide some anesthesia practice recommendations for epilepsy procedures in which the best management is still unclear, additional high-quality studies are needed.
Topics: Child; Humans; Anesthetics; Anesthesia; Epilepsy; Brain; Anesthesiologists
PubMed: 37552014
DOI: 10.1097/ACO.0000000000001303 -
Current Opinion in Anaesthesiology Jun 2024Simulation is a well established practice in medicine. This review reflects upon the role of simulation in pediatric anesthesiology in three parts: training... (Review)
Review
PURPOSE OF REVIEW
Simulation is a well established practice in medicine. This review reflects upon the role of simulation in pediatric anesthesiology in three parts: training anesthesiologists to care for pediatric patients safely and effectively; evaluating and improving systems of care for children; and visions for the future.
RECENT FINDINGS
Simulation continues to prove a useful modality to educate both novice and experienced clinicians in the perioperative care of infants and children. It is also a powerful tool to help analyze and improve upon how care is provided to infants and children. Advances in technology and computational power now allow for a greater than ever degree of innovation, accessibility, and focused reflection and debriefing, with an exciting outlook for promising advances in the near future.
SUMMARY
Simulation plays a key role in developing and achieving peak performance in the perioperative care of infants and children. Although simulation already has a great impact, its full potential is yet to be harnessed.
Topics: Humans; Anesthesiology; Child; Pediatrics; Simulation Training; Clinical Competence; Infant; Perioperative Care; Anesthesiologists; Computer Simulation
PubMed: 38573191
DOI: 10.1097/ACO.0000000000001375 -
Current Opinion in Anaesthesiology Aug 2023Magnetic resonance imaging (MRI) is an ever-expanding investigation modality in children. This review aims to present current strategies to perform MRI in pediatrics... (Review)
Review
PURPOSE OF REVIEW
Magnetic resonance imaging (MRI) is an ever-expanding investigation modality in children. This review aims to present current strategies to perform MRI in pediatrics efficiently and safely. The latest evidence on approaches, safety and costs of MRI with no sedation or with sedation provided by anesthesiologists and non-anesthesiologists are outlined and discussed.
RECENT FINDINGS
MRI under sedation provided by either anesthesiologists or non-anesthesiologists has a low incidence of minor adverse events and rarely severe complications. Propofol infusion with or without dexmedetomidine appears the ideal anesthetic, as it allows spontaneous breathing and fast turnover. Intranasal dexmedetomidine is safe and the most effective medication when a nonintravenous route is employed.New scanning techniques and patient's preparation methods can increase the chances to successfully perform MRI with no sedation by shortening sequences, reducing artifacts, and improving child's cooperation.
SUMMARY
MRI under sedation can be considered safe. Proper patient selection, clear decision-making and medico-legal pathways are particularly necessary for nurse-only sedated scans. Nonsedated MRIs are feasible and cost-effective but require optimal scanning techniques and patient's preparation to be successful. Further research should be focused on identifying the most effective modalities to perform MRI without sedation and clarify protocols for the nurse-only sedations.Anesthesia service will likely remain pivotal for complex and critically ill patients and to provide assistance in case of adverse events.
Topics: Child; Humans; Hypnotics and Sedatives; Dexmedetomidine; Magnetic Resonance Imaging; Anesthesia; Magnetic Resonance Spectroscopy
PubMed: 36994750
DOI: 10.1097/ACO.0000000000001267