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BMJ Open Jun 2022The aim of this study was to explore the current status of the anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China. (Observational Study)
Observational Study
OBJECTIVE
The aim of this study was to explore the current status of the anaesthesia provision, infrastructure and resources in the Heilongjiang Province, China.
DESIGN
A cross-sectional observational study of hospitals, anaesthesiologists, assistant anaesthesiologists and anaesthetic nurses in the Heilongjiang Province.
SETTING
All hospitals in the Heilongjiang Province.
PARTICIPANTS
The hospitals, anaesthesiologists (attending physicians, associate chief physicians and chief physicians), assistant anaesthesiologists (licenced assistant physicians, resident physicians and other trainees) and anaesthetic nurses.
MAIN OUTCOME MEASURES
Standard descriptive statistics (percentages and numbers) were used to summarise the data.
RESULTS
The investigation involved 1123 hospitals, 405 of these hospitals had anaesthesiology departments (36.06%). There were 2406 anaesthesiologists, 175 assistant anaesthesiologists and 409 anaesthetic nurses. The proportion of anaesthesiologists was 56.60% in tertiary hospitals, 40.15% in secondary hospitals and 3.25% in primary hospitals and ungraded hospitals, respectively. Anaesthesiologists were present in 91.20% of public hospitals and 8.80% of private hospitals. Anaesthesiologists were present in 83.55% general hospitals and 16.45% of specialised hospitals. The Heilongjiang Province has a total of 2041 operating rooms and 543 beds in recovery rooms. The number of anaesthesia cases per capita per year was 326.86. The percentages of anaesthesiologists' age ≥46, 36-45, 25-35 and <25 are 24.03%, 41.80%, 33.91% and 0.27%, respectively. The proportions of resident physicians and attending physicians were 60.87%, and the proportions of associate chief physicians and chief physicians were 39.13%. The proportions of anaesthesiologists working >12 hours, 10 hours≤time≤12 hours, 8 hours≤time<10 hours and <8 hours were 0.55%, 22.04%, 64.30% and 13.11%, respectively.
CONCLUSIONS
The present study demonstrated for the first time that the proportion of anaesthesiologists in the Heilongjiang Province, China, is still insufficient. The structure of anaesthesiologists needs to be optimised.
Topics: Anesthesia; Anesthesiology; Anesthetics; China; Cross-Sectional Studies; Hospitals, Public; Humans
PubMed: 35725259
DOI: 10.1136/bmjopen-2021-051934 -
JAMA Network Open Aug 2023Accurate measurements of clinical workload are needed to inform health care policy. Existing methods for measuring clinical workload rely on surveys or time-motion...
IMPORTANCE
Accurate measurements of clinical workload are needed to inform health care policy. Existing methods for measuring clinical workload rely on surveys or time-motion studies, which are labor-intensive to collect and subject to biases.
OBJECTIVE
To compare anesthesia clinical workload estimated from electronic health record (EHR) audit log data vs billed relative value units.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study of anesthetic encounters occurring between August 26, 2019, and February 9, 2020, used data from 8 academic hospitals, community hospitals, and surgical centers across Missouri and Illinois. Clinicians who provided anesthetic services for at least 1 surgical encounter were included. Data were analyzed from January 2022 to January 2023.
EXPOSURE
Anesthetic encounters associated with a surgical procedure were included. Encounters associated with labor analgesia and endoscopy were excluded.
MAIN OUTCOMES AND MEASURES
For each encounter, EHR-derived clinical workload was estimated as the sum of all EHR actions recorded in the audit log by anesthesia clinicians who provided care. Billing-derived clinical workload was measured as the total number of units billed for the encounter. A linear mixed-effects model was used to estimate the relative contribution of patient complexity (American Society of Anesthesiology [ASA] physical status modifier), procedure complexity (ASA base unit value for the procedure), and anesthetic duration (time units) to EHR-derived and billing-derived workload. The resulting β coefficients were interpreted as the expected effect of a 1-unit change in each independent variable on the standardized workload outcome. The analysis plan was developed after the data were obtained.
RESULTS
A total of 405 clinicians who provided anesthesia for 31 688 encounters were included in the study. A total of 8 288 132 audit log actions corresponding to 39 131 hours of EHR use were used to measure EHR-derived workload. The contributions of patient complexity, procedural complexity, and anesthesia duration to EHR-derived workload differed significantly from their contributions to billing-derived workload. The contribution of patient complexity toward EHR-derived workload (β = 0.162; 95% CI, 0.153-0.171) was more than 50% greater than its contribution toward billing-derived workload (β = 0.106; 95% CI, 0.097-0.116; P < .001). In contrast, the contribution of procedure complexity toward EHR-derived workload (β = 0.033; 95% CI, 0.031-0.035) was approximately one-third its contribution toward billing-derived workload (β = 0.106; 95% CI, 0.104-0.108; P < .001).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of 8 hospitals, reimbursement for anesthesiology services overcompensated for procedural complexity and undercompensated for patient complexity. This method for measuring clinical workload could be used to improve reimbursement valuations for anesthesia and other specialties.
Topics: Humans; Anesthesiology; Workload; Electronic Health Records; Cross-Sectional Studies; Anesthesia; Documentation; Anesthetics
PubMed: 37566415
DOI: 10.1001/jamanetworkopen.2023.28514 -
Anaesthesia Aug 2018
Topics: Anesthesia; Anesthesiology; Anesthetics; Biomedical Research; Clinical Trials as Topic; Humans; Observational Studies as Topic; Terminology as Topic
PubMed: 29280142
DOI: 10.1111/anae.14200 -
The Cochrane Database of Systematic... Jun 2014The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may have certain advantages over clinical signs. This is the second update of a review originally published in 2007.
OBJECTIVES
The primary objective of this review focused on whether the incorporation of BIS into the standard practice for management of anaesthesia can reduce the risk of intraoperative awareness, consumption of anaesthetic agents, recovery time and total cost of anaesthesia in surgical patients undergoing general anaesthesia.
SEARCH METHODS
In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE (1990 to 31 January 2013), EMBASE (1990 to 31 January 2013) and reference lists of articles. Previously, we searched to May 2009.
SELECTION CRITERIA
We included randomized controlled trials comparing BIS with standard practice criteria for titration of anaesthetic agents.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details.
MAIN RESULTS
We included 36 trials. In studies using clinical signs as standard practice, the results demonstrated a significant effect of the BIS-guided anaesthesia in reducing the risk of intraoperative awareness among surgical patients at high risk for awareness (7761 participants; odds ratio (OR) 0.24, 95% confidence interval (CI) 0.12 to 0.48). This effect was not demonstrated in studies using end tidal anaesthetic gas (ETAG) monitoring as standard practice (26,530 participants; OR 1.13, 95% CI 0.56 to 2.26). BIS-guided anaesthesia reduced the requirement for propofol by 1.32 mg/kg/hr (672 participants; 95% CI -1.91 to -0.73) and for volatile anaesthetics (desflurane, sevoflurane, isoflurane) by 0.65 minimal alveolar concentration equivalents (MAC) (95% CI -1.01 to -0.28) in 985 participants. Irrespective of the anaesthetics used, BIS reduced the following recovery times: time for eye opening (2557 participants; by 1.93 min, 95% CI -2.70 to -1.16), response to verbal command (777 participants; by 2.73 min, 95% CI -3.92 to -1.54), time to extubation (1501 participants; by 2.62 min, 95% CI -3.46 to -1.78), and time to orientation (373 participants; by 3.06 min, 95% CI -3.63 to -2.50). BIS shortened the duration of postanaesthesia care unit stay by 6.75 min (1953 participants; 95% CI -11.20 to -2.31) but did not significantly reduce the time to home readiness (329 participants; -7.01 min, 95% CI -30.11 to 16.09).
AUTHORS' CONCLUSIONS
BIS-guided anaesthesia can reduce the risk of intraoperative awareness in surgical patients at high risk for awareness in comparison to using clinical signs as a guide for anaesthetic depth. BIS-guided anaesthesia and ETAG-guided anaesthesia may be equivalent in protection against intraoperative awareness but the evidence for this is inconclusive. In addition, anaesthesia guided by BIS kept within the recommended range improves anaesthetic delivery and postoperative recovery from relatively deep anaesthesia.
Topics: Anesthesia; Anesthesia Recovery Period; Anesthesiology; Anesthetics; Electroencephalography; Humans; Intraoperative Awareness; Monitoring, Intraoperative; Randomized Controlled Trials as Topic
PubMed: 24937564
DOI: 10.1002/14651858.CD003843.pub3 -
British Journal of Anaesthesia Jan 2013Our speciality commonly traces its origin to a demonstration of the inhalation of ether by a patient undergoing surgery in Boston in 1846. Less well known is the... (Review)
Review
Our speciality commonly traces its origin to a demonstration of the inhalation of ether by a patient undergoing surgery in Boston in 1846. Less well known is the demonstration of the i.v. injection of opium with alcohol into a dog in Oxford in 1656, leading to anaesthesia followed by full long-term recovery. After gaining i.v. access, a mixture of opium and alcohol was injected, resulting in a brief period of anaesthesia. After a period during which the dog was kept moving to assist recovery, a full recovery was made. Details from this momentous experiment allow us to compare the technique used with modern management. It is important to consider why there was a failure to translate the results into clinical practice and nearly 200 yr of potentially pain-free surgery. Possible factors include lack of equipment for i.v. access, lack of understanding of dose-response effects, and a climate of scientific discovery rather than clinical application. Given the current interest in total i.v. anaesthesia, it seems appropriate to identify its origins well before those of inhalation anaesthesia.
Topics: Analgesics, Opioid; Anesthesia Recovery Period; Anesthesia, Intravenous; Anesthesiology; Anesthetics, Intravenous; Animals; Central Nervous System Depressants; Dogs; Ethanol; History, 17th Century; Injections, Intravenous; Opium
PubMed: 23161361
DOI: 10.1093/bja/aes388 -
Medicina (Kaunas, Lithuania) Oct 2022The incidence and societal burden of cancer is increasing globally. Surgery is indicated in the majority of solid tumours, and recent research in the emerging field of... (Review)
Review
The incidence and societal burden of cancer is increasing globally. Surgery is indicated in the majority of solid tumours, and recent research in the emerging field of onco-anaesthesiology suggests that anaesthetic-analgesic interventions in the perioperative period could potentially influence long-term oncologic outcomes. While prospective, randomised controlled clinical trials are the only research method that can conclusively prove a causal relationship between anaesthetic technique and cancer recurrence, live animal (in vivo) experimental models may more realistically test the biological plausibility of these hypotheses and the mechanisms underpinning them, than limited in vitro modelling. This review outlines the advantages and limitations of available animal models of cancer and how they might be used in perioperative cancer metastasis modelling, including spontaneous or induced tumours, allograft, xenograft, and transgenic tumour models.
Topics: Animals; Humans; Anesthesiology; Prospective Studies; Anesthetics; Neoplasms; Analgesics; Models, Theoretical
PubMed: 36295541
DOI: 10.3390/medicina58101380 -
Anesthesia and Analgesia Oct 2022BIS (a brand of processed electroencephalogram [EEG] depth-of-anesthesia monitor) scores have become interwoven into clinical anesthesia care and research. Yet, the...
BACKGROUND
BIS (a brand of processed electroencephalogram [EEG] depth-of-anesthesia monitor) scores have become interwoven into clinical anesthesia care and research. Yet, the algorithms used by such monitors remain proprietary. We do not actually know what we are measuring. If we knew, we could better understand the clinical prognostic significance of deviations in the score and make greater research advances in closed-loop control or avoiding postoperative cognitive dysfunction or juvenile neurological injury. In previous work, an A-2000 BIS monitor was forensically disassembled and its algorithms (the BIS Engine) retrieved as machine code. Development of an emulator allowed BIS scores to be calculated from arbitrary EEG data for the first time. We now address the fundamental questions of how these algorithms function and what they represent physiologically.
METHODS
EEG data were obtained during induction, maintenance, and emergence from 12 patients receiving customary anesthetic management for orthopedic, general, vascular, and neurosurgical procedures. These data were used to trigger the closely monitored execution of the various parts of the BIS Engine, allowing it to be reimplemented in a high-level language as an algorithm entitled ibis. Ibis was then rewritten for concision and physiological clarity to produce a novel completely clear-box depth-of-anesthesia algorithm titled openibis .
RESULTS
The output of the ibis algorithm is functionally indistinguishable from the native BIS A-2000, with r = 0.9970 (0.9970-0.9971) and Bland-Altman mean difference between methods of -0.25 ± 2.6 on a unitless 0 to 100 depth-of-anesthesia scale. This precision exceeds the performance of any earlier attempt to reimplement the function of the BIS algorithms. The openibis algorithm also matches the output of the native algorithm very closely ( r = 0.9395 [0.9390-0.9400], Bland-Altman 2.62 ± 12.0) in only 64 lines of readable code whose function can be unambiguously related to observable features in the EEG signal. The operation of the openibis algorithm is described in an intuitive, graphical form.
CONCLUSIONS
The openibis algorithm finally provides definitive answers about the BIS: the reliance of the most important signal components on the low-gamma waveband and how these components are weighted against each other. Reverse engineering allows these conclusions to be reached with a clarity and precision that cannot be obtained by other means. These results contradict previous review articles that were believed to be authoritative: the BIS score does not appear to depend on a bispectral index at all. These results put clinical anesthesia research using depth-of-anesthesia scores on a firm footing by elucidating their physiological basis and enabling comparison to other animal models for mechanistic research.
Topics: Algorithms; Anesthesia; Anesthesiology; Anesthetics; Consciousness Monitors; Electroencephalography
PubMed: 35767469
DOI: 10.1213/ANE.0000000000006119 -
Anaesthesiology Intensive Therapy 2021The twenty-first century, with its transforming ideology and rising acceptance, is witnessing an increased number of transgender people applying for gender reassignment... (Review)
Review
The twenty-first century, with its transforming ideology and rising acceptance, is witnessing an increased number of transgender people applying for gender reassignment surgery (GRS). The procedure of GRS is a lengthy and complex one involving the active collaboration of multiple disciplines including psychology, psychiatry, family medicine, plastic surgery, endocrinology, otolaryngology, urology, gynaecology, maxillofacial surgery, and anaesthesiology. The considerable paucity of literature regarding the management of patients presenting for GRS places health care providers at a disadvantage. It is imperative to cautiously regard the specific medical, emotional, social, and economic concerns regarding these patients. Health care providers need to be trained well to deal empathetically with such patients. The present literature about GRS deals mainly with the surgeon's perspective, while the anaesthetist's approach remains hazy. This is because GRS imposes the need for anaesthesiologists to search for better and more efficient modes of anaesthesia so as to improve prognosis and minimize the associated morbidity. Anaesthetists should understand the associated psychological aspects and effects of hormone therapy while performing an extensive and informative pre-operative evaluation to formulate an effective strategy. Providing the optimal modes for anaesthesia and keeping a cautious watch for complications along with timely intervention in the advent of the same comprise the approach for high-quality anaesthetic care. This review aims to provide a detailed overview of significant considerations and competent peri-operative outcomes in patients presenting for GRS.
Topics: Anesthesia; Anesthesiology; Anesthetics; Humans; Sex Reassignment Surgery; Transgender Persons
PubMed: 34714015
DOI: 10.5114/ait.2021.109446 -
British Journal of Anaesthesia Jul 2009
Topics: Anesthesiology; Anesthetics; Humans; Pharmacology, Clinical
PubMed: 19546199
DOI: 10.1093/bja/aep168 -
British Journal of Anaesthesia Jan 1950
Topics: Anesthesia; Anesthesia, Local; Anesthesiology; Anesthetics, Local
PubMed: 15404761
DOI: 10.1093/bja/22.1.34