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European Journal of Anaesthesiology Oct 2022
Topics: Anesthesiologists; Climate Change; Humans; Job Satisfaction; Surveys and Questionnaires
PubMed: 36101910
DOI: 10.1097/EJA.0000000000001734 -
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 -
Journal of Cardiothoracic and Vascular... Dec 2017
Review
Topics: Anesthesiologists; Cardiac Surgical Procedures; Databases, Factual; Heart Defects, Congenital; Humans; Societies, Medical; Surgeons; Thoracic Surgical Procedures; Treatment Outcome
PubMed: 29107588
DOI: 10.1053/j.jvca.2017.06.027 -
Journal of Anesthesia Apr 2023The COVID-19 pandemic is ongoing as of September 2022. Since January 2020 when the first case was reported in Japan, the medical community faced a variety of problems...
The COVID-19 pandemic is ongoing as of September 2022. Since January 2020 when the first case was reported in Japan, the medical community faced a variety of problems both domestically and internationally. It is meaningful to review the impact of COVID-19 from an anesthesiologist's perspective to clarify our policy for future infectious disease outbreaks. In this year's Journal of Anesthesia (JA) symposium, five experts who were deeply involved in the COVID-19 response reviewed the past 2.5 years and made recommendations for potential future pandemics. Anesthesiologists are specialists in airway management and their role in intubating patients with COVID-19 has received much attention. However, they have also played an important backup role in intensive care as critical care physicians and must be more involved in critical care in regular (non-pandemic) times to properly fulfill this role. It is especially important for the Japan Society of Anesthesiologists and JA to quickly disseminate accurate information on unknown infectious diseases to the medical community and wider society. Therefore, it is important to promptly publish papers that are quality-assured through peer review.
Topics: Humans; Anesthesiologists; COVID-19; Pandemics; Anesthesiology; Anesthesia
PubMed: 36402864
DOI: 10.1007/s00540-022-03137-5 -
Canadian Journal of Anaesthesia =... Jan 2018There is increased interest in the perioperative management of patients with sleep-disordered breathing (SDB). Anesthesiologists must distill information from clinical... (Review)
Review
There is increased interest in the perioperative management of patients with sleep-disordered breathing (SDB). Anesthesiologists must distill information from clinical reports to make key decisions for optimizing perioperative care. A patient with SDB may present with a sleep study report at the time of surgery. Knowledge of the essential components of such a report can help the anesthesiologist evaluate the patient and optimize the perioperative management. In this narrative review, we describe how level I (i.e., laboratory-based) polysomnography (PSG) data are collected and scored using the recommended scoring guidelines, as well as the basic information and salient features of a typical PSG report relevant to the anesthesiologist. In addition, we briefly review the indications for sleep studies, including the types of laboratory-based studies, as well as the role and limitations of portable monitors (level II-IV studies) and examples of PSG reports in the clinical context.
Topics: Anesthesiologists; Anesthesiology; Humans; Perioperative Care; Polysomnography; Sleep Apnea Syndromes
PubMed: 29086358
DOI: 10.1007/s12630-017-0988-8 -
Journal of Intensive Care Medicine Oct 2020The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to...
PURPOSE
The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to cause transient adrenal suppression. The clinical consequences of transient adrenal suppression are poorly understood. Anecdotally, some clinicians advocate strongly for etomidate, while others feel it can cause significant harm. To better understand the current clinical environment with respect to single-dose etomidate use in critically ill patients, Canadian anesthesiologists and Canadian emergency medicine (EM) physicians were questioned regarding their opinions, knowledge, and preferences about etomidate use as an induction agent.
METHODS
Invitations to participate with the electronic survey were sent to 100 Canadian EM physicians and 260 Canadian anesthesiologists. The survey had 4 general parts: demographics, familiarity with the current literature, choice of induction agent given various clinical scenarios, and opinions on the controversy. The Pearson γ test was used to detect whether significant differences exist between physician groups.
RESULTS
Ninety three anesthesiologists and 42 EM physicians responded for response rates of 36% and 42%. There were no self-reported differences in knowledge about etomidate properties between EM physicians and anesthesiologists. There were significant differences in etomidate use between EM physicians and anesthesiologists in general rapid sequence intubation, noncritically ill patients, and those with undifferentiated hypotension. Both EM physicians and anesthesiologists describe the current etomidate controversy as significant and not adequately resolved.
CONCLUSION
There is no significant difference in self-reported etomidate knowledge between anesthesiologists and EM physicians; however, significant practice pattern differences exist with EM physicians using etomidate more often. Broad agreement supports future research to investigate etomidate's impact in critically ill patients.
Topics: Adult; Anesthesiologists; Anesthetics, Intravenous; Canada; Emergency Medicine; Etomidate; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Intubation, Intratracheal; Male; Middle Aged; Physicians; Practice Patterns, Physicians'
PubMed: 30336713
DOI: 10.1177/0885066618804989 -
Anesthesia and Analgesia Sep 2017
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Anti-Bacterial Agents; Consensus; Humans
PubMed: 28753170
DOI: 10.1213/ANE.0000000000002315 -
Paediatric Anaesthesia Sep 2017
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Child; Humans; Radiography; Risk Assessment
PubMed: 28772016
DOI: 10.1111/pan.13184 -
CMAJ : Canadian Medical Association... Oct 2020
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Canada; Humans; Nurse Anesthetists
PubMed: 33051318
DOI: 10.1503/cmaj.76505 -
Journal of Cardiothoracic and Vascular... Jun 2020
Topics: Anesthesiologists; Electronics; Heart; Humans; Prostheses and Implants
PubMed: 32197804
DOI: 10.1053/j.jvca.2020.01.059