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British Journal of Anaesthesia Oct 2022Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the...
Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the validity of this metric has recently been questioned. In this issue of the British Journal of Anaesthesia, Fowler and colleagues quantify, update, and put into perspective the looming suspicion that perioperative adverse events cast a 'long shadow' of increased mortality, far beyond the 30-day time frame. Their work not only raises important questions on how we should think about, analyse, and report 'perioperative' complications and mortality, but also stresses anaesthesiologist and surgeon roles as key stakeholders in patient long-term survival.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Humans; Outcome Assessment, Health Care; Postoperative Complications
PubMed: 35410788
DOI: 10.1016/j.bja.2022.03.014 -
Anesthesiology Jul 2021
Topics: Anesthesiology; Internship and Residency; Motivation
PubMed: 34046660
DOI: 10.1097/ALN.0000000000003809 -
International Anesthesiology Clinics 2020
Topics: Anesthesiology; Humans; Precision Medicine
PubMed: 32991333
DOI: 10.1097/AIA.0000000000000297 -
Journal of Cardiothoracic and Vascular... Aug 2023
Review
Topics: Humans; Anesthesiology; Critical Care; Forecasting
PubMed: 37164803
DOI: 10.1053/j.jvca.2023.04.013 -
Anesthesia and Analgesia Dec 2020The bispectral index (BIS) monitor has been available for clinical use for >20 years and has had an immense impact on academic activity in Anesthesiology, with >3000...
BACKGROUND
The bispectral index (BIS) monitor has been available for clinical use for >20 years and has had an immense impact on academic activity in Anesthesiology, with >3000 articles referencing the bispectral index. Despite attempts to infer its algorithms by external observation, its operation has nevertheless remained undescribed, in contrast to the algorithms of other less commercially successful monitors of electroencephalogram (EEG) activity under anesthesia. With the expiration of certain key patents, the time is therefore ripe to examine the operation of the monitor on its own terms through careful dismantling, followed by extraction and examination of its internal software.
METHODS
An A-2000 BIS Monitor (gunmetal blue case, amber monochrome display) was purchased on the secondary market. After identifying the major data processing and storage components, a set of free or inexpensive tools was used to retrieve and disassemble the monitor's onboard software. The software executes primarily on an ARMv7 microprocessor (Sharp/NXP LH77790B) and a digital signal processor (Texas Instruments TMS320C32). The device software can be retrieved directly from the monitor's hardware by using debugging interfaces that have remained in place from its original development.
RESULTS
Critical numerical parameters such as the spectral edge frequency (SEF), total power, and BIS values were retraced from external delivery at the device's serial port back to the point of their calculation in the extracted software. In doing so, the locations of the critical algorithms were determined. To demonstrate the validity of the technique, the algorithms for SEF and total power were disassembled, comprehensively annotated and compared to their theoretically ideal behaviors. A bug was identified in the device's implementation of the SEF algorithm, which can be provoked by a perfectly isoelectric EEG.
CONCLUSIONS
This article demonstrates that the electronic design of the A-2000 BIS Monitor does not pose any insuperable obstacles to retrieving its device software in hexadecimal machine code form directly from the motherboard. This software can be reverse engineered through disassembly and decompilation to reveal the methods by which the BIS monitor implements its algorithms, which ultimately must form the definitive statement of its function. Without further revealing any algorithms that might be considered trade secrets, the manufacturer of the BIS monitor should be encouraged to release the device software in its original format to place BIS-related academic literature on a firm theoretical foundation and to promote further academic development of EEG monitoring algorithms.
Topics: Anesthesiology; Biomedical Engineering; Consciousness Monitors; Electroencephalography; Equipment Design; Humans; Monitoring, Intraoperative
PubMed: 33093360
DOI: 10.1213/ANE.0000000000005220 -
Anesthesiology Nov 2021
Topics: Anesthesiologists; Anesthesiology; Humans
PubMed: 34520524
DOI: 10.1097/ALN.0000000000003956 -
Anesthesiology Nov 2021
Topics: Anesthesiologists; Anesthesiology; Humans
PubMed: 34520531
DOI: 10.1097/ALN.0000000000003955 -
Anesthesiology Feb 2022
Topics: Anesthesia; Anesthesiology
PubMed: 34816278
DOI: 10.1097/ALN.0000000000004077 -
Anesthesiology Feb 2022
Topics: Anesthesia; Anesthesiology
PubMed: 34816277
DOI: 10.1097/ALN.0000000000004076 -
British Journal of Anaesthesia May 2023Recently, fatigue has received more attention as a workplace hazard. This scoping review focuses on fatigue in anaesthesia providers. We explore the prevalence of... (Review)
Review
BACKGROUND
Recently, fatigue has received more attention as a workplace hazard. This scoping review focuses on fatigue in anaesthesia providers. We explore the prevalence of fatigue in anaesthesia providers, and we examine how fatigue impacts their performance.
METHODS
A literature search was independently conducted from December 2019 through March 2020. The following four databases were consulted: MEDLINE, CINAHL, EMBASE, and PubPsych. Only studies discussing fatigue in anaesthesia providers were eligible.
RESULTS
The initial database search identified a total of 118 studies, of which 30 studies were included in the review. Eight articles concerned the prevalence of fatigue in anaesthesia providers, whereas 22 explored the impact of fatigue on the performance of anaesthesia providers. Up to 60.8% of anaesthesia providers suffered from severe excessive daytime sleepiness, and fatigue was denoted as a common workplace problem in up to 73.1% of anaesthesia providers. Fatigue had a negative influence on medication errors and vigilance, and it decreased the performance of anaesthesia providers during laboratory psychomotor testing. There was a decrease in non-technical skills (notably communication and teamwork) and worsening mood when fatigued.
CONCLUSIONS
Based on this scoping review, fatigue is a prevalent a phenomenon that anaesthesia providers cannot ignore. A combination of deterioration in non-technical skills, increased medication errors, loss of sustained attention, and psychomotor decline can lead to poorer performance and cause patient harm. Concrete strategies to mitigate fatigue should be developed.
Topics: Humans; Anesthesia; Fatigue; Anesthesiology
PubMed: 36697276
DOI: 10.1016/j.bja.2022.12.011