Team factors influence emotions and stress in a non-operating room anaesthetising location

Incidence of complications after nonoperating room anesthesia in children in a low- and middle-income country: A prospective and observational study

INTRODUCTION

Nonoperating room anesthesia is a growing field of medicine that can have an increased risk of complications, particularly in low- and middle-income countries.

AIMS

The aim of this study was to describe the incidence of complications after pediatric nonoperating room anesthesia and investigate its risk factors.

METHODS

In this prospective observational study, we included all children aged less than 5 years who were sedated or anesthetized in the radiology setting of a university hospital in a low- and middle-income country. Patients were divided into two groups: complications or no-complications groups. Then, we compared both groups, and univariable and multivariable logistic regression models were used to investigate the main risk factors for complications.

RESULTS

We included 256 children, and the incidence of complications was 8.6%. The main predictors of nonoperating room anesthesia-related morbidity were: critically-ill children (aOR = 2.490; 95% CI: 1.55-11.21), predicted difficult airway (aOR = 5.704; 95% CI: 1.017-31.98), and organization insufficiencies (aOR = 52.6; 95% CI:4.55-613). The preanesthetic consultation few days before NORA protected against complications (aOR = 0.263; 95%CI: 0.080-0.867).

CONCLUSIONS

The incidence of complications during NORA among children in our radiology setting remains high. Investigating predictors for morbidity allowed high-risk patient selection, which allowed taking precautions. Several improvement measures were taken to address the organization's insufficiencies.

Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration

BACKGROUND

An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.

METHODS

This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.

RESULTS

A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.

CONCLUSION

Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.

Systems, safety, and anaesthesia outside the operating room

An increasing number of patients are receiving sedation or anaesthesia in locations outside of the operating room. Compared with the operating room, anaesthesia providers working in a non-operating room anaesthesia (NORA) location report significantly lower perceived levels of safety, and higher levels of anxiety, stress, and workload. These results are likely to affect the well-being of staff in NORA locations and are clinically relevant in terms of patient safety.

Anaesthesia clinicians' perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room

BACKGROUND

Anaesthesia care outside of the standard operating room (OR) can be challenging. This prospective matched case-pair study describes the difference in anaesthesia clinicians' perception of safety, workload, anxiety, and stress in two settings by comparing similar neurosurgical procedures performed in either the OR or a remote hybrid room with intraoperative MRI (MRI-OR).

METHODS

A visual numeric scale for safety perception and validated instruments for workload, anxiety, and stress were administered to enrolled anaesthesia clinicians after induction of anaesthesia and at the end of eligible cases. The difference in outcomes reported by the same clinician for unique pairs of similar operations performed in both settings (OR vs MRI-OR) was compared using the Student t-test with the general bootstrap algorithm to address the presence of clusters.

RESULTS

Over 15 months, 37 clinicians provided data for 53 case pairs. Working in the remote MRI-OR vs OR was associated with lower perceived safety (7.3 [2.0] vs 8.8 [0.9]; P<0.001), higher scores in the workload subdomains effort and frustration (41.6 [24.1] vs 31.3 [21.6]; P=0.006 and 32.4 [22.9] vs 20.7 [17.2]; P=0.002, respectively), and higher anxiety (33.6 [10.1] vs 28.4 [9.2]; P=0.003) at the end of the case. Stress was rated higher in the MRI-OR after induction of anaesthesia (26.5 [15.5] vs 20.9 [13.4]; P=0.006). Effect sizes (Cohen's D) were moderate to good.

CONCLUSIONS

Anaesthesia clinicians reported lower perceived safety and higher workload, anxiety, and stress in a remote MRI-OR compared with a standard OR. Improving non-standard work settings should benefit clinician well-being and patient safety.

CLINICAL TRIAL REGISTRATION

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