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Schroeck H, Whitty MA, Martinez-Camblor P, Voicu S, Burian BK, Taenzer AH. Anaesthesia clinicians' perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room. Br J Anaesth 2023; 131:598-606. [PMID: 37202262 DOI: 10.1016/j.bja.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
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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Affiliation(s)
- Hedwig Schroeck
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Pablo Martinez-Camblor
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Stefana Voicu
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Mountain View, CA, USA
| | - Andreas H Taenzer
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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2
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Wang X, Liu X, Mi J. Perioperative management and drug selection for sedated/anesthetized patients undergoing MRI examination: A review. Medicine (Baltimore) 2023; 102:e33592. [PMID: 37083779 PMCID: PMC10118336 DOI: 10.1097/md.0000000000033592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
In recent years, magnetic resonance imaging (MRI) technology has become an indispensable imaging tool owing to significant improvements in MRI that have opened up new diagnostic perspectives. Due to the closed environment, long imaging time, and need to remain still during the examination process, the examiner may cannot cooperate with the completion of the examination of the procedure, which increases the need for deep sedation or anesthesia. Achieving this can sometimes be challenging, especially in the special nontraditional environment of MRI equipment (unfamiliar and narrow spaces, away from patients, strong magnetic fields) and in special populations requiring sedation/anesthesia during examinations, which pose certain challenges for the perioperative anesthesia management of MRI. A simple "checklist" is necessary because it allows the anesthesiologist to become familiar with the particular environment and human and material resources as quickly as possible. For the choice of sedative/anesthetic, the traditional drugs, such as midazolam and ketamine, are still used due to the ease of administration despite their low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, propofol, with high effectiveness and rapid recovery, and sevoflurane, which is mild and nonirritating, are preferred for sedation/anesthesia in children and adults undergoing MRI. Therefore, familiarity with the perioperative management of patient sedation and general anesthesia and drug selection in the MRI environment is critical for successful surgical completion and for the safe and rapid discharge of MRI patients receiving sedation/anesthesia.
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Affiliation(s)
- Xiaoyu Wang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - XueQuan Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Junqiao Mi
- Julius-Maximilians-Universität of Würzburg, Würzburg, Germany
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3
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Herman AD, Jaruzel CB, Lawton S, Tobin CD, Reves JG, Catchpole KR, Alfred MC. Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review. Br J Anaesth 2021; 127:729-744. [PMID: 34452733 DOI: 10.1016/j.bja.2021.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have increased significantly in the last 20 yr and are projected to account for half of all anaesthetics delivered in the next decade. In contrast to most other medication administration contexts, NORA is performed in high-volume fast-paced environments not optimised for anaesthesia care. These predisposing factors combined with increasing case volume, less provider experience, and higher-acuity patients increase the potential for preventable adverse events. Our narrative review examines morbidity and mortality in NORA settings compared with the OR and the systems factors impacting safety in NORA. A review of the literature from January 1, 1994 to March 5, 2021 was conducted using PubMed, CINAHL, Scopus, and ProQuest. After completing abstract screening and full-text review, 30 articles were selected for inclusion. These articles suggested higher rates of morbidity and mortality in NORA cases compared with OR cases. This included a higher proportion of death claims and complications attributable to inadequate oxygenation, and a higher likelihood that adverse events are preventable. Despite relatively few attempts to quantify safety concerns, it was possible to find a range of systems safety concerns repeated across multiple studies, including insufficient lighting, noise, cramped workspace, and restricted access to patients. Old and unfamiliar equipment, lack of team familiarity, and limited preoperative evaluation are also commonly noted challenges. Applying a systems view of safety, it is possible to suggest a range of methods to improve NORA safety and performance.
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Affiliation(s)
- Abigail D Herman
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Candace B Jaruzel
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Sam Lawton
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine D Tobin
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph G Reves
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth R Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Myrtede C Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Sirimontakan T, Artprom N, Anantasit N. Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room. Anesth Pain Med 2020; 10:e106493. [PMID: 33134153 PMCID: PMC7539052 DOI: 10.5812/aapm.106493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/25/2020] [Accepted: 08/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background The volume of pediatric Procedural Sedation and Analgesia (PSA) outside the operating room has been increasing. This high clinical demand leads non-anesthesiologists, especially pediatric intensivists, pediatricians, and emergency physicians, to take a role in performing procedural sedation. Our department has established the PSA service by pediatric intensivists since 2015. Objectives We aimed to assess the efficacy and safety of PSA outside the operating room conducted by pediatric intensivists and identify risk factors for severe adverse events. Methods This was a retrospective descriptive study conducted from January 2015 to July 2019. Children aged less than 20 years who underwent procedural sedation were included. We collected demographic data, sedative and analgesic medications, American Society of Anesthesiologists (ASA) Physical Status Classification, indications for sedation, the success of procedural sedation, and any adverse events. Results Altogether, 395 patients with 561 procedural sedation cases were included. The median age was 55 months (range: 15 to 119 months), and 58.5% (231/395) were male. The rate of successful procedures under PSA was 99.3%. Serious Adverse Events (SAE) occurred in 2.7%. Patients who received more than three sedative medications had higher SAE than patients who received fewer medications (adjusted for age, location of sedation, type of procedure, and ASA classification) (odds ratio: 8.043; 95% CI: 2.472 - 26.173, P = 0.001). Conclusions Our data suggest that children who undergo procedural sedation outside the operating room conducted by pediatric intensivists are safe and effectively treated. Receiving more than three sedative medications is the independent risk factor associated with serious adverse events.
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Affiliation(s)
- Thitima Sirimontakan
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand
| | - Ninuma Artprom
- Department of Nursing, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattachai Anantasit
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand
- Corresponding Author: Associate Professor, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand. Tel: +66-22012949,
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Stohl S, Klein MJ, Ross PA, vonBusse S, Menteer J. Impact of Anesthetic and Ventilation Strategies on Invasive Hemodynamic Measurements in Pediatric Heart Transplant Recipients. Pediatr Cardiol 2020; 41:962-971. [PMID: 32556487 DOI: 10.1007/s00246-020-02344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Care of pediatric heart transplant recipients relies upon serial invasive hemodynamic evaluation, generally performed under the artificial conditions created by anesthesia and supportive ventilation. OBJECTIVES This study aimed to evaluate the hemodynamic impacts of different anesthetic and ventilatory strategies. METHODS We compared retrospectively the cardiac index, right- and left-sided filling pressures, and pulmonary and systemic vascular resistances of all clinically well and rejection-free heart transplant recipients catheterized from 2005 through 2017. Effects of spontaneous versus positive pressure ventilation and of sedation versus general anesthesia were tested with generalized linear mixed models for repeated measures using robust sandwich estimators of the covariance matrices. Least squared means showed adjusted mean outcome values, controlled for appropriate confounders. RESULTS 720 catheterizations from 101 recipients met inclusion criteria. Adjusted cardiac index was 3.14 L/min/m2 (95% CI 3.01-3.67) among spontaneously breathing and 2.71 L/min/m2 (95% CI 2.56-2.86) among ventilated recipients (p < 0.0001). With spontaneous breathing, left filling pressures were lower (9.9 vs 11.0 mmHg, p = 0.030) and systemic vascular resistances were higher (24.0 vs 20.5 Woods units, p < 0.0001). After isolating sedated from anesthetized spontaneously breathing patients, the observed differences in filling pressures and resistances emerged as a function of sedation versus general anesthesia rather than of spontaneous versus positive pressure ventilation. CONCLUSION In pediatric heart transplant recipients, positive pressure ventilation reduces cardiac output but does not alter filling pressures or vascular resistances. Moderate sedation yields lower left filling pressures and higher systemic vascular resistances than does general anesthesia. Differences are quantitatively small.
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Affiliation(s)
- Sheldon Stohl
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. .,Department of Anesthesiology and Critical Care Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Patrick A Ross
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.,Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Sabine vonBusse
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.,Department of Anesthesiology and Critical Care Medicine, University of Southern California, Los Angeles, CA, USA
| | - JonDavid Menteer
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA.,Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
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Droghetti A, Fusco P, Marini M, Harizai F, Scimia P. Ultrasound‐guided serratus anterior plane block and parasternal block in cooperative sedation for S‐ICD implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1076-1078. [DOI: 10.1111/pace.13727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care UnitSan Salvatore Academic Hospital of L'Aquila L'Aquila Italy
| | | | - Fabiola Harizai
- Department of Anesthesia and Intensive Care UnitASST Cremona Cremona Italy
| | - Paolo Scimia
- Department of Anesthesia and Intensive Care UnitASST Cremona Cremona Italy
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Schroeck H, Welch TL, Rovner MS, Johnson HA, Schroeck FR. Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review. J Clin Anesth 2018; 54:89-101. [PMID: 30415150 DOI: 10.1016/j.jclinane.2018.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Hybrid operating room suites with intraoperative magnetic resonance imaging enable image guided surgery in a fully functional operating room environment. While this environment creates challenges to anesthetic care, the effects on anesthetic adverse events and outcomes are largely unknown. This systematic scoping review aims to map the existing knowledge about anesthetic care in advanced imaging hybrid operating rooms. METHODS A broad-based literature search was performed using the PubMed (Medline), Embase, Cochrane Library, Web of Science, and Google Scholar databases. References published in English between January 1994 and August 2017 were included. Quality of evidence was assessed using the GRADE guidelines. RESULTS Forty-seven manuscripts were eligible for data collection. Adverse events were heterogeneously defined across 17 manuscripts and occurred in 0 to 100% (quality of evidence mostly very low). Monitoring difficulty was reported in 4 manuscripts of very low data quality. Interference between the magnet and the electrocardiogram was investigated in 2 manuscripts (quality of evidence low and very low, respectively). None of the reported events appeared to result in long-term patient harm. Author recommendations or a narrative review of the literature were provided in 40 manuscripts. Common safety concerns included lower equipment reliability, inaccessibility of the patient and airway, and the relative isolation of the suite (in relationship to other anesthesia care areas). Most authors also emphasized the importance of safety checklists, protocols, and provider training. DISCUSSION While intraoperative magnetic resonance imaging hybrid operating rooms are increasingly utilized, the existing literature does not allow estimating adverse event rates in this location. Prospective studies quantifying the effect of the environment on anesthesia outcomes are lacking. Despite this, there is a broad consensus regarding the anesthetic and safety concerns. More research is needed to inform practice standards and training requirements for this challenging environment.
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Affiliation(s)
- Hedwig Schroeck
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, USA; Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Tasha L Welch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Michelle S Rovner
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 165 Ashley Avenue, Suite 525CH, Charleston, SC 29425, USA.
| | - Heather A Johnson
- Biomedical Libraries, Dartmouth College, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Florian R Schroeck
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover, NH 03755, USA; White River Junction VA Medical Center, 215 N Main Street, White River Junction, VT 05009, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, USA.
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8
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Stone AB, Brovman EY, Greenberg P, Urman RD. A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007–2016). J Clin Anesth 2018; 48:15-20. [DOI: 10.1016/j.jclinane.2018.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 11/26/2022]
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9
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Interventional Procedures Outside of the Operating Room: Results From the National Anesthesia Clinical Outcomes Registry. J Patient Saf 2018; 14:9-16. [DOI: 10.1097/pts.0000000000000156] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Malpractice claims for non-operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Fewer malpractice claims for NORA occurred than for OR anesthesia as assessed by the relative numbers of in NORA versus OR procedures. The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations. Although NORA is safe, adherence to safe clinical practice is important.
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Affiliation(s)
- Zachary G Woodward
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Karen B Domino
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356540, Seattle, WA 98195, USA
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11
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Hsu WC, Orr J, Lin SP, Yu L, Tsou MY, Westenskow DR, Ting CK. Efficiency of oxygen delivery through different oxygen entrainment devices during sedation under low oxygen flow rate: a bench study. J Clin Monit Comput 2017; 32:519-525. [DOI: 10.1007/s10877-017-0023-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Pieri M, Belletti A, Oriani A, Landoni G, Latib A, Mangieri A, Colombo A, Zangrillo A, Monaco F. Anesthetic Management of Cardioband Implantation: Data From a Preliminary Experience and New Insights. J Cardiothorac Vasc Anesth 2017; 31:482-488. [DOI: 10.1053/j.jvca.2016.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Indexed: 11/11/2022]
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Butz DR, Gill KK, Randle J, Kampf N, Few JW. Facial Aesthetic Surgery: The Safe Use of Oral Sedation in an Office-Based Facility. Aesthet Surg J 2016; 36:127-31. [PMID: 26446058 DOI: 10.1093/asj/sjv200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The desire for efficient and safe office-based facial plastic surgery procedures has continued to rise. Oral sedation is a safe and effective method to provide anesthesia for facial aesthetic surgery. OBJECTIVES This study reviewed private practice anesthesia-related outcomes using oral sedation combined with local anesthesia for office-based facial aesthetic surgery procedures. METHODS A retrospective chart review was performed on all patients who underwent office-based facial plastic surgery procedures from July 2008 to July 2014. Patient demographic data including age, gender, body mass index (BMI), past medical history, social history, surgical history, allergies, and medications were collected. Anesthesia-related data were also collected including: American Society of Anesthesia (ASA) class, type of procedure, medications administered, and major complications related to sedation were assessed. RESULTS There were 199 patients (23 males and 176 females) who underwent 283 facial aesthetic surgical procedures. Mean age was 49.8 years (range, 29 to 80 years). There were 195 patients in ASA class I and 4 patients were in ASA class II. Patients underwent 44 upper blepharoplasty procedures, 35 lower blepharoplasty procedures, 5 browlifts, 43 upper blepharoplasty-browpexy, 46 facelifts, 38 neck lifts/lower facelifts, 54 fat grafting, 3 tip rhinoplasties, and 15 minor revision cases. During the study period, there were no major complications and no sedation issues. CONCLUSIONS Facial aesthetic surgical procedures can be performed safely and comfortably in the office-based setting under oral sedation in appropriately selected patients. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Daniel R Butz
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Kiranjeet K Gill
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Jasmine Randle
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Natalie Kampf
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
| | - Julius W Few
- Dr Butz is a Resident and Next Generation Editor of Aesthetic Surgery Journal and Dr Few is a Clinical Professor of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Illinois; and Cosmetic Medicine Section Editor of Aesthetic Surgery Journal. Dr Gill is a plastic surgeon in private practice in Naples, Florida. Ms Randle and Ms Kampf are research assistants at a private plastic surgery practice in Chicago, Illinois
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14
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Youn AM, Ko YK, Kim YH. Anesthesia and sedation outside of the operating room. Korean J Anesthesiol 2015; 68:323-31. [PMID: 26257843 PMCID: PMC4524929 DOI: 10.4097/kjae.2015.68.4.323] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022] Open
Abstract
Due to rapid evolution and technological advancements, medical personnel now require special training outside of their safe zones. Anesthesiologists face challenges in practicing in locations beyond the operating room. New locations, inadequate monitoring devices, poor assisting staff, unfamiliarity of procedures, insufficient knowledge of basic standards, and lack of experience compromise the quality of patient care. Therefore, anesthesiologists must recognize possible risk factors during anesthesia in nonoperating rooms and familiarize themselves with standards to improve safe practice. This review article emphasizes the need for standardizing hospitals and facilities requiring nonoperating room anesthesia, and encourages anesthesiologists to take the lead in applying these practice guidelines to improve patient outcomes and reduce adverse events.
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Affiliation(s)
- Ann Misun Youn
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Young-Kwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
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15
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Kiekkas P. Anesthesia outside the operating room in adults: a matter of safety?: guest editorial. J Perianesth Nurs 2015; 30:82-4. [PMID: 25616893 DOI: 10.1016/j.jopan.2014.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/02/2014] [Indexed: 11/24/2022]
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Abstract
Pediatric patients in the neurointerventional radiology setting pose the dual challenges of caring for relatively sick patients in the outfield environment. For safe and successful practice, the anesthesiologist must not only understand the nuances of pediatric anesthesia and the physiologic demands of the cerebral lesions. They must also help maintain a team-based approach to safe, compassionate care of the child in this challenging setting. In this review article, we summarize key aspects of success for several of these topics.
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Affiliation(s)
- Mary Landrigan-Ossar
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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17
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McClain CD, Landrigan-Ossar M. Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiol Clin 2013; 32:83-100. [PMID: 24491651 DOI: 10.1016/j.anclin.2013.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article gives a review of 3 challenges in caring for children undergoing neurosurgical and neurointerventional procedures. Anesthesiologists may have experience with certain aspects of these situations but may not have extensive experience with each clinical setting. This review addresses issues with awake craniotomy, intraoperative magnetic resonance imaging, and neurointerventional procedures in children with neurologic disease. Familiarization with these complex clinical scenarios and their unique considerations allows the anesthesiologist to deliver optimal care and helps facilitate the best possible outcome for these patients.
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Affiliation(s)
- Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA.
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
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Nekhendzy V, Ramaiah VK. Prevention of perioperative and anesthesia-related complications in facial cosmetic surgery. Facial Plast Surg Clin North Am 2013; 21:559-77. [PMID: 24200375 DOI: 10.1016/j.fsc.2013.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although office-based anesthesia for facial cosmetic surgery remains remarkably safe, no anesthesia or sedation performed outside the operating room should be considered minor. Proper organization, preparation, and patient selection, close collaboration with the surgeon, and expert and effective anesthesia care will increase patient safety and improve perioperative outcomes and patient satisfaction. This article presents a comprehensive overview of anesthesia in terms of facial plastic surgery procedures, beginning with a broad review of essentials and pitfalls of anesthesia, followed by details of specific anesthetic agents, their administration, mechanism of action, and complications.
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Affiliation(s)
- Vladimir Nekhendzy
- Stanford Head and Neck Anesthesia, Advanced Airway Management Program, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Deep sedation without intubation for ERCP is appropriate in healthier, non-obese patients. Dig Dis Sci 2013; 58:3287-92. [PMID: 23877477 DOI: 10.1007/s10620-013-2783-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/28/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND Providing the appropriate anesthesia for endoscopic retrograde cholangiopancreatography (ERCP) cases is challenging. AIM The aim of our study was to prospectively assess the safety of anesthesia directed deep sedation (ADDS) in non-intubated patients compared to general endotracheal anesthesia (GET) during an ERCP. METHODS We conducted a prospective observational study in patients undergoing an ERCP. The choice of anesthetic-ADDS or GET-was made by the anesthesiologist. The pre-anesthesia assessment, intraoperative vital signs, and medications administered were collected. A standardized study instrument was used to record the number of procedure interruptions, intraprocedure and recovery room adverse events (AE). RESULTS A total of 393 (89.7 %) patients received ADDS (no intubation) and 45 (10.2 %) received a GET. Age and comorbidities were similar in ADDS and GET groups. BMI was higher in the GET (32.6 ± 9.5) versus in the ADDS (27.3 ± 6.1) group; p < 0.001. The number of ASA 2 patients was higher in the ADDS versus the GET group (38.7 versus 22.2 %; p < 0.04); the number of ASA 4 patients was 15.6 % of GET versus 6.6 % of the ADDS cases (p = 0.05). During the procedure 16 (3.7 %) ADDS patients were intubated and converted to a GET anesthetic; 4 (25 %) of the converted ADDS cases were ASA 4 versus 6.4 % of ADDS patients (p = 0.006). Intraprocedure events occurred in 35.6 % of GET and 25.7 % of ADDS cases, without significant complications. CONCLUSION Our data suggest that the administration of anesthesia without intubation for prone ERCP cases is feasible especially in non-obese, healthier patients.
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Jones-Haywood MM, Combs C, Pu M, Gandhi SK, Dhawan R, Tempe DK. Percutaneous Closure of Mitral Paravalvular Leak. J Cardiothorac Vasc Anesth 2013; 27:168-77. [DOI: 10.1053/j.jvca.2012.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 11/11/2022]
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Backman ES, Triant VA, Ehrenfeld JM, Lu Z, Arpino P, Losina E, Gandhi RT. Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy. HIV Med 2013; 14:379-84. [PMID: 23332038 DOI: 10.1111/hiv.12014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (iv) midazolam vs. iv diazepam, a second-line agent, during colonoscopy. METHODS We conducted a retrospective analysis of adult HIV-positive patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure (SBP), nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses. RESULTS We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (mean 48.0 vs. 45.7 minutes for the midazolam and diazepam groups, respectively; P = 0.68), nadir SBP (mean 97.0 vs. 101.6 mmHg; P = 0.06), nadir oxygen saturation (mean 94.6 vs. 94.8%; P = 0.72) or rate of abnormal cardiac rhythm (11.4 vs. 19.7%; P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91% vs. 74% in the diazepam group; P = 0.0075), but no patient required reversal of sedation or became unresponsive. CONCLUSIONS We did not find evidence that patients who received midazolam for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be confirmed in prospective studies or in a randomized controlled trial.
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Affiliation(s)
- E S Backman
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA 02114, USA.
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Steurer MP, Steurer MA, Baulig W, Piegeler T, Schläpfer M, Spahn DR, Falk V, Dreessen P, Theusinger OM, Schmid ER, Schwartz D, Neff TA, Beck-Schimmer B. Late pharmacologic conditioning with volatile anesthetics after cardiac surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R191. [PMID: 23062276 PMCID: PMC3682293 DOI: 10.1186/cc11676] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/14/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The aim of this randomized controlled trial was to investigate whether volatile anesthetics used for postoperative sedation have any beneficial effects on myocardial injury in cardiac surgery patients after on-pump valve replacement. METHODS Anesthesia was performed with propofol. After arrival in the intensive care unit (ICU), 117 patients were randomized to be sedated for at least 4 hours with either propofol or sevoflurane. Sevoflurane was administered by using the anesthetic-conserving device. Troponin T, creatine kinase, creatine kinase from heart muscle tissue, myoglobin, and oxygenation index were determined on arrival at the ICU, 4 hours after sedation, and in the morning of the first postoperative day (POD1). Primary end points were cardiac injury markers on POD1. As secondary end points oxygenation, postoperative pulmonary complications, and ICU and hospital stay were documented. RESULTS Fifty-six patients were analyzed in the propofol arm, and 46 patients in the sevoflurane arm. Treatment groups were comparable with regard to patient demographics and intraoperative characteristics. Concentration of troponin T as the most sensitive marker for myocardial injury at POD1 was significantly lower in the sevoflurane group compared with the propofol group (unadjusted difference, -0.4; 95% CI, -0.7 to -0.1; P < 0.01; adjusted difference, -0.2; 95% CI, -0.4 to -0.02; P = 0.03, respectively). CONCLUSIONS The data presented in this investigation indicate that late postconditioning with the volatile anesthetic sevoflurane might mediate cardiac protection, even with a late, brief, and low-dose application. TRIAL REGISTRATION ClinicalTrials.gov: NCT00924222.
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Greenberg SB. Rebalancing the risks of Computed Tomography and Magnetic Resonance imaging. Pediatr Radiol 2011; 41:951-2. [PMID: 21626107 DOI: 10.1007/s00247-011-2159-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/30/2011] [Accepted: 05/05/2011] [Indexed: 12/29/2022]
Affiliation(s)
- S Bruce Greenberg
- Department of Radiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR 72202, USA.
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Wide, Short Bore Magnetic Resonance at 1.5 T. Clin Neuroradiol 2011; 21:141-4. [DOI: 10.1007/s00062-011-0075-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE To review anesthesia practice patterns associated with electroconvulsive therapy (ECT) in the UK. METHODS A 12-item questionnaire survey on the practice of ECT anesthesia was sent to all units in the UK identified as providing ECT services. RESULTS One hundred thirty active ECT units were identified. Sixty-six (51%) responded. Forty-five percent of respondents worked in units located within acute hospital boundaries and 53% outside acute hospital boundaries. Forty-seven percent of respondents were associated with units providing consultant anesthetic cover for 75-100% of ECT sessions. Twenty-seven percent of the units did not use capnography, 17% did not use continuous electrocardiography, and 16% did not use noninvasive blood pressure monitoring. LIMITATIONS Results were entirely from respondents. No practices were directly observed. CONCLUSIONS Although there is apparent widespread recognition of ECT Accreditation Service guidelines, compliance with recommended standards is variable. Given the typically high comorbidity of ECT patients, and indications of elevated anesthetic risk from non-UK studies, this has important implications for the safety of ECT anesthesia in the UK.
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Delgado JA, Abad P, Angel GJ, Llano JF, Gómez FJ, Calvo VD. Uso de sedación profunda asistida por un anestesiólogo en resonancia magnética para población pediátrica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2010. [DOI: 10.1016/s0120-3347(10)84006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room. Curr Opin Anaesthesiol 2010; 23:494-9. [PMID: 20585246 DOI: 10.1097/aco.0b013e32833b9c9f] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recommendations for the safe and efficient conductance of sedation and anesthesia at remote locations; and to define safety standards, monitoring techniques, quality of care and procedural eligibility. RECENT FINDINGS Anesthesia outside of the operating room is rapidly increasing in numbers, which has seen a growth of older and sicker patients. These circumstances have created a need for guidelines, for both specialist anesthesia providers and nonanesthesia-trained practitioners, that define patient selection, minimum monitoring (hemodynamics and respiration), facility design and equipment, policy framework, recovery facilities and policies. The patient's safety throughout all stages of sedation and/or anesthesia is the most pertinent goal. Recent data emphasize the importance of monitoring pulse oximetry and end-tidal carbon dioxide for any sedating or anesthetic procedure. Substandard monitoring combined with oversedation and subsequent respiratory depression are implicated as the main reasons for catastrophic sedation and anesthetic outcomes at remote locations. SUMMARY Patient selection, procedure appropriateness and location appropriateness are the key elements defining the provision of safe anesthesia care outside the operating room. Titratable, short-acting intravenous drugs are preferred such as propofol and remifentanil.
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The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol 2009; 22:502-8. [PMID: 19506473 DOI: 10.1097/aco.0b013e32832dba50] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW A growing number of procedures are performed outside the operating room. In spite of their relatively noninvasive nature, serious adverse outcomes can occur. We analyzed claims from 1990 and later in the American Society of Anesthesiologists Closed Claims database to assess patterns of injury and liability associated with claims from anesthesia in remote locations (n = 87) compared with claims from operating room procedures (n = 3287). RECENT FINDINGS Compared with operating room claims, remote location claims involved older and sicker patients (P < 0.01), with 50% of remote location claims involving monitored anesthesia care. The proportion of claims for death was increased in remote location claims [54 vs. 29% (operating room claims), P < 0.001]. Respiratory damaging events were more common in remote location claims (44 vs. 20%, P < 0.001), with inadequate oxygenation/ventilation the most common specific event (21 vs. 3% in operating room claims, P < 0.001). Remote location claims were more often judged as being preventable by better monitoring (32 vs. 8% for operating room claims, P < 0.001). CONCLUSION Data from the American Society of Anesthesiologists, Closed Claims database suggest that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care. Similar anesthesia and monitoring standards and guidelines should be used in all anesthesia care areas.
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Calvo Vecino JM. [Anesthesia-analgesia vs. deep sedation for diagnostic or therapeutic procedures in pediatric patients: who should perform the technique?]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:203-205. [PMID: 19537258 DOI: 10.1016/s0034-9356(09)70372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
There is no need to reinvent the wheel to determine the need for vigilant monitoring in outside of the operating room (OOR) settings. Anesthesiologists have evolved a robust system of monitoring standards based on decades of experience in operating room environments. Every OOR location should be thoroughly evaluated and monitoring standards implemented. The standards should be periodically reviewed to avert morbidity.
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Affiliation(s)
- Samuel M Galvagno
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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