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Current Opinion in Anaesthesiology Aug 2019Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be... (Review)
Review
PURPOSE OF REVIEW
Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education.
RECENT FINDINGS
Topics for the future include, but are not limited to, new medications, artificial intelligence and big data, monitoring depth of hypnosis, translational innovation and collaboration, demographic changes, financial driving forces, destination hubs, medical tourism, and new approaches to education training and self-management.
SUMMARY
Implementing new medical technologies for anesthesia outside the operating room will help to successfully master this ever evolving subspecialty. Anesthesiologists require specific preparation for the diverse settings that they will encounter during their training. In this rapidly changing field, cognitive fitness must be factored into teaching and evaluation of residents. We describe the most important topics to consider when educating anesthesiology residents, and highlight research that addresses upcoming challenges.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Anesthetics; Biomedical Technology; Diffusion of Innovation; Forecasting; Humans; Internship and Residency
PubMed: 31021895
DOI: 10.1097/ACO.0000000000000743 -
Minerva Anestesiologica Nov 2015The recently introduced Navigator® (GE Healthcare, Helsinki, Finland) and SmartPilot® View (Dräger Medical, Lübeck, Germany) show the concentrations and predicted... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
The recently introduced Navigator® (GE Healthcare, Helsinki, Finland) and SmartPilot® View (Dräger Medical, Lübeck, Germany) show the concentrations and predicted effects of combined anesthetic drugs, and should facilitate more precisely their titration. Our aim was to evaluate if Navigator® or SmartPilot® View guided anesthesia was associated with a good quality of analgesia, depth of hypnosis and may reduce anesthetic requirements.
METHODS
We performed a prospective non-randomized study. Sixty ASA I-II patients undergoing balanced general anesthesia for abdominal and plastic surgery were enrolled. Patients were divided in 4 groups. Group 1 (N. 15) and group 3 (N. 15) were cases in whom anesthesia was performed with standard monitoring plus the aid of Navigator® (Nav) or SmartPilot® View (SPV) display. Group 2 (N. 15) and group 4 (N. 15) were controls in whom anesthesia was performed with standard monitoring (heart rate, NIBP, SpO2, end-tidal CO2, end-expired sevoflurane concentration, train of four, Bispectral Index [Aspect Medical Systems, Natick, MA, USA] or Entropy [GE Healthcare]). Patients' vital parameters and end-expired sevoflurane concentration were recorded during anesthesia.
RESULTS
All patients recovered uneventfully and showed hemodynamic stability. End-tidal sevoflurane concentrations values [median (min-max)], during maintenance of anesthesia, were significantly (P<0.05) lower in SPV [1.1% (0.8-1.5)] and Nav [1%(0.8-1.8)] groups compared to SPV-control group [1.5%(1-2.5)] and Nav-control group [1.5%(0.8-2)]. BIS and entropy values were respectively higher in the SPV group [53 (46-57)] compared to the control group [43 (37-51)] (P<0.05) and Nav group [53 (43-60)] compared to the control group [41 (35-51)] (P<0.05). No significant differences in Remifentanil dosing were observed in the four groups.
CONCLUSION
Navigator® and SmartPilot® View may be of clinical use in monitoring adequacy of anesthesia. Both displays can optimize the administration and monitoring of anesthetic drugs during general anesthesia and may reduce the consumption of volatile anesthetic agents.
Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthesiology; Anesthetics; Anesthetics, Inhalation; Anesthetics, Intravenous; Female; Humans; Male; Methyl Ethers; Middle Aged; Monitoring, Intraoperative; Piperidines; Prospective Studies; Remifentanil; Sevoflurane; Young Adult
PubMed: 25598294
DOI: No ID Found -
California Medicine Apr 1949Induction of anesthesia in infants and children presents many problems not present in procedures for adults. Anesthetists may better serve the patient by visiting with...
Induction of anesthesia in infants and children presents many problems not present in procedures for adults. Anesthetists may better serve the patient by visiting with him on the eve of operation, not only to establish friendly relations to avoid rebellion, but to form a basis for decision as to what anesthetic agent to use and by what method it should be given. As the kind of operation and the difficulties to be expected with each are large factors in the choice of agent and technique, a number of operative situations are reviewed from this standpoint.
Topics: Anesthesia; Anesthesiology; Anesthetics; Child; Humans; Infant; Male; Pediatrics
PubMed: 18116232
DOI: No ID Found -
EMBO Reports Nov 2014
Topics: Amino Acid Sequence; Anesthesiology; Anesthetics; Animals; Drug Discovery; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Molecular Sequence Data; Sodium Channel Blockers; Sodium Channels
PubMed: 25312808
DOI: 10.15252/embr.201439593 -
Medical Ultrasonography Jun 2013The four major categories of skill sets associated with proficiency in ultrasound guided regional anaesthesia are 1) understanding device operations, 2) image... (Review)
Review
The four major categories of skill sets associated with proficiency in ultrasound guided regional anaesthesia are 1) understanding device operations, 2) image optimization, 3) image interpretation and 4) visualization of needle insertion and injection of the local anesthetic solution. Of these, visualization of needle insertion and injection of local anaesthetic solution can be practiced using simulators and phantoms. This survey of existing simulators summarizes advantages and disadvantages of each. Current deficits pertain to the validation process.
Topics: Anesthesia, Conduction; Anesthesiology; Anesthetics, Local; Biomimetics; Computer-Assisted Instruction; Equipment Design; Equipment Failure Analysis; Humans; Injections; Ireland; Phantoms, Imaging; Ultrasonography, Interventional
PubMed: 23702502
DOI: 10.11152/mu.2013.2066.152.sfs1gs2 -
Singapore Medical Journal Mar 2019
Topics: Anesthesia; Anesthesiology; Anesthetics; Big Data; Equipment Design; Humans; Intubation, Intratracheal; Medicine
PubMed: 30997516
DOI: 10.11622/smedj.2019024 -
British Medical Journal (Clinical... Jun 1984
Topics: Anesthesia, Inhalation; Anesthesiology; Anesthetics; Developing Countries; Education, Medical; Humans; Ventilators, Mechanical
PubMed: 6428529
DOI: 10.1136/bmj.288.6432.1750 -
Journal of Clinical Anesthesia Nov 2020• Standards for perioperative supply and equipment precaution for COVID-19 have not been detailed. • Systematically introduces sufficiently preoperative and...
• Standards for perioperative supply and equipment precaution for COVID-19 have not been detailed. • Systematically introduces sufficiently preoperative and postoperative equipment precaution. • The sterilization of disassembled anesthesia machine according to high-temperature resistance. • The disinfection of the breathing systems of nondetachable anesthesia machines. • The decontamination of video laryngoscopes, fiberoptic bronchoscopes, and lighted stylets.
Topics: Anesthesiology; Anesthetics; COVID-19; Coronavirus Infections; Disinfection; Equipment Contamination; Humans; Pandemics; Pneumonia, Viral
PubMed: 32473502
DOI: 10.1016/j.jclinane.2020.109924 -
Anesthesia and Analgesia Jan 2022Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time series data and the corresponding spectral information for intraoperative anesthetic titration, or what effect this might have on outcomes.
METHODS
We developed an electronic learning curriculum (ELC) that covered EEG spectrogram interpretation and its use in anesthetic titration. Anesthesiology residents at a single academic center were randomized to receive this ELC and given spectrogram monitors for intraoperative use versus standard residency curriculum alone without intraoperative spectrogram monitors. We hypothesized that this intervention would result in lower inhaled anesthetic administration (measured by age-adjusted total minimal alveolar concentration [MAC] fraction and age-adjusted minimal alveolar concentration [aaMAC]) to patients ≥60 old during the postintervention period (the primary study outcome). To study this effect and to determine whether the 2 groups were administering similar anesthetic doses pre- versus postintervention, we compared aaMAC between control versus intervention group residents both before and after the intervention. To measure efficacy in the postintervention period, we included only those cases in the intervention group when the monitor was actually used. Multivariable linear mixed-effects modeling was performed for aaMAC fraction and hospital length of stay (LOS; a non-prespecified secondary outcome), with a random effect for individual resident. A multivariable linear mixed-effects model was also used in a sensitivity analysis to determine if there was a group (intervention versus control group) by time period (post- versus preintervention) interaction for aaMAC. Resident EEG knowledge difference (a prespecified secondary outcome) was compared with a 2-sided 2-group paired t test.
RESULTS
Postintervention, there was no significant aaMAC difference in patients cared for by the ELC group (n = 159 patients) versus control group (N = 325 patients; aaMAC difference = -0.03; 95% confidence interval [CI], -0.09 to 0.03; P =.32). In a multivariable mixed model, the interaction of time period (post- versus preintervention) and group (intervention versus control) led to a nonsignificant reduction of -0.05 aaMAC (95% CI, -0.11 to 0.01; P = .102). ELC group residents (N = 19) showed a greater increase in EEG knowledge test scores than control residents (N = 20) from before to after the ELC intervention (6-point increase; 95% CI, 3.50-8.88; P < .001). Patients cared for by the ELC group versus control group had a reduced hospital LOS (median, 2.48 vs 3.86 days, respectively; P = .024).
CONCLUSIONS
Although there was no effect on mean aaMAC, these results demonstrate that this EEG-ELC intervention increased resident knowledge and raise the possibility that it may reduce hospital LOS.
Topics: Aged; Aged, 80 and over; Algorithms; Anesthesia; Anesthesiology; Anesthetics; Curriculum; Electroencephalography; Electronic Health Records; Female; Humans; Internship and Residency; Length of Stay; Male; Middle Aged; Monitoring, Intraoperative; Multivariate Analysis; Prospective Studies; Reproducibility of Results; Sample Size; Software; Treatment Outcome
PubMed: 34709008
DOI: 10.1213/ANE.0000000000005677 -
Minerva Anestesiologica Mar 2020
Topics: Anesthesiologists; Anesthesiology; Anesthetics; Electroencephalography; Humans; Monitoring, Intraoperative
PubMed: 32191408
DOI: 10.23736/S0375-9393.20.14297-4