1
|
Rüggeberg A, Meybohm P, Nickel EA. Preoperative fasting and the risk of pulmonary aspiration-a narrative review of historical concepts, physiological effects, and new perspectives. BJA OPEN 2024; 10:100282. [PMID: 38741693 PMCID: PMC11089317 DOI: 10.1016/j.bjao.2024.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
In the early days of anaesthesia, the fasting period for liquids was kept short. By the mid-20th century 'nil by mouth after midnight' had become routine as the principles of the management of 'full stomach' emergencies were extended to include elective healthy patients. Back then, no distinction was made between the withholding of liquids and solids. Towards the end of the last century, recommendations of professional anaesthesiology bodies began to reduce the fasting time of clear liquids to 2 h. This reduction in fasting time was based on the understanding that gastric emptying of clear liquids is rapid, exponential, and proportional to the current filling state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration. Indeed, most instances of aspiration are caused by failure to identify aspiration risk factors and adjust the anaesthetic technique accordingly. In contrast, long periods of liquid withdrawal cause discomfort and may also lead to serious postoperative complications. Despite this, more than two decades after the introduction of the 2 h limit, patients still fast for a median of up to 12 h before anaesthesia, mainly because of organisational issues. Therefore, some hospitals have decided to allow patients to drink clear liquids within 2 h of induction of anaesthesia. Well-designed clinical trials should investigate whether these concepts are safe in patients scheduled for anaesthesia or procedural sedation, focusing on both aspiration risk and complications of prolonged fasting.
Collapse
Affiliation(s)
- Anne Rüggeberg
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Eike A. Nickel
- Department of Anaesthesiology and Pain Therapy, Helios Klinikum Emil von Behring, Berlin, Germany
| |
Collapse
|
2
|
Leister N, Löser J, Gostian AO, Gostian M, Rokohl AC, Fieber MA, Alkan D, Schumacher C, Löw V, Gordon E, Böttiger BW, Heindl LM. Postoperative Pain Following Eye Enucleation: A Prospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:614. [PMID: 38674260 PMCID: PMC11051797 DOI: 10.3390/medicina60040614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. Materials and Methods: This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT®). Patients received usual pain therapy in an unstandardized individual manner. Results: Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0-8), 3.29 ± 3.24 (range, 0-8) on the day of surgery, 4.67 ± 1.90 (range, 2-10) on day 1, 3.25 ± 1.39 (range, 1-6) on day 2, and 2.71 ± 1.30 (range, 1-6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0-10) preoperatively, 4.04 ± 3.78 (range, 0-10) on the day of surgery, 5.75 ± 2.01 (range, 2-10) on day 1, 4.25 ± 1.89 (range, 2-10) on day 2, and 3.88 ± 1.54 (range, 2-8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Conclusions: Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information.
Collapse
Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Johannes Löser
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
- Department of Palliative Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Antoniu-Oreste Gostian
- Department of Otolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Magdalena Gostian
- Department of Anesthesiology and Intensive Care Medicine, Malteser Waldkrankenhaus St. Marien, 91054 Erlangen, Germany;
| | - Alexander C. Rokohl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (A.C.R.); (E.G.); (L.M.H.)
| | - Marc A. Fieber
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Deniz Alkan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Christine Schumacher
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Vanessa Löw
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Erik Gordon
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (A.C.R.); (E.G.); (L.M.H.)
| | - Bernd W. Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.L.); (M.A.F.); (D.A.); (C.S.); (V.L.); (B.W.B.)
| | - Ludwig M. Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (A.C.R.); (E.G.); (L.M.H.)
| |
Collapse
|
3
|
Buhre W, Maas L. Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again). Curr Opin Anaesthesiol 2024; 37:150-154. [PMID: 38390961 DOI: 10.1097/aco.0000000000001358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW The landscape of healthcare is characterized by high demands and scarce human and financial resources. This calls for action in improving healthcare quality. This review shows how anaesthesiologists are the designated medical specialist to share their affinity and knowledge in quality and safety, throughout the hospital and across the care continuum. RECENT FINDINGS Recent studies show excellent frameworks and examples of anaesthesiologist leading the way in patient safety and quality of care. SUMMARY Anaesthesiologist are early adapters of patient safety. In the last decades anaesthesia has become linked with patient safety and the quality of care. With the recent transition from peroperative to perioperative care; new opportunities are emerging, expanding our professional scope. Unfortunately, the anaesthesiologist is not often positioned in a leading role in quality of care and patient safety. After a brief rise during the COVID-19 pandemic, in which anaesthesiologists were visible in the frontline in many countries, we have unfortunately disappeared from the spotlight. This review shows numerous ideas, examples, and a framework how a leading position can be realized.
Collapse
Affiliation(s)
- Wolfgang Buhre
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
4
|
Speer T, Mühlbradt T, Unger H, Fastner C, Schröder S. [Understanding complex processes better-A case study on increasing patient safety and efficiency in a central operating room]. DIE ANAESTHESIOLOGIE 2024; 73:232-243. [PMID: 38459378 DOI: 10.1007/s00101-024-01390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/21/2023] [Accepted: 02/01/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using modern medical technology (sociotechnical system) in a cost-effective manner. Ensuring perioperative patient safety is of particular importance. At the same time, the efficient use of the central operating room is essential for the economic success of a hospital. Preoperative preparation is a complex process with many substeps that are often difficult to manage. Historically, the focus has been on retrospective learning from errors and incidents. More recent approaches take a systemic view. A central idea is to consider the mostly positive course of treatment and the adjustments to daily work that are currently required by the people involved (Safety-II). By taking greater account of how the many components of the system interact, processes can be better understood and specific measures derived. This strengthens the system's ability to adapt to changes and disturbances, thus ensuring that goals are achieved. The functional resonance analysis method (FRAM) is an internationally recognized method for modelling work as done compared to work as imagined. This paper presents the application of FRAM to preoperative preparation in a major regional hospital. OBJECTIVE Is FRAM suitable for improving process understanding in preoperative preparation? MATERIAL AND METHODS An interdisciplinary project team identified relevant functions of preoperative preparation through document analysis and walkthroughs. Based on this, more than 30 guided interviews were conducted with functionaries. The results were presented graphically and specific information, such as safety-related statements or reasons for the variability of functions, were also presented textually. In the next phase, statements were evaluated and compared with the target model and the job descriptions. RESULTS The FRAM revealed the process as a complex network of relationships. During the modelling process, a varying degree of centrality and variability of certain functions became apparent. From the observations, the project team selected those with high relevance for patient safety and for the efficiency of the overall process in order to prioritize starting points for deriving measures to increase resilience. These starting points relate either to single functions, such as surgical site marking or to multiple functions that are variable in their execution, such as delays due to nonsynchronized duty times. CONCLUSION The FRAM conducted provides valuable new insights into the functioning of complex sociotechnical systems that go far beyond classical linear methods. The awareness of operational processes gained and the resulting dynamic view of interactions within the system enable specific measures to be derived that promote resilient behavior and reduce critical variability, thus contributing to increased patient safety and efficiency.
Collapse
Affiliation(s)
- Tillmann Speer
- Klinik für Anästhesiologie, Klinikum Itzehoe, Robert-Koch-Straße 2, 25524, Itzehoe, Deutschland.
| | | | - Helga Unger
- FOM Hochschule für Oekonomie & Management, Essen, Deutschland
| | - Christian Fastner
- I. Medizinische Klinik - Kardiologie, Angiologie, Pneumologie, internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
| | - Stefan Schröder
- Klinik für Anästhesiologie, Intensivmedizin, Schmerztherapie und Notfallmedizin, Artemed Krankenhaus Düren, Düren, Deutschland
- Aktionsbündnis Patientensicherheit (APS), Berlin, Deutschland
| |
Collapse
|
5
|
Gonzalez-Pizarro P, Brazzi L, Koch S, Trinks A, Muret J, Sperna Weiland N, Jovanovic G, Cortegiani A, Fernandes TD, Kranke P, Malisiova A, McConnell P, Misquita L, Romero CS, Bilotta F, De Robertis E, Buhre W. European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice. Eur J Anaesthesiol 2024; 41:260-277. [PMID: 38235604 DOI: 10.1097/eja.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China. Recognising the importance of urgent action, the European Society of Anaesthesiology and Intensive Care (ESAIC) adopted the Glasgow Declaration on Environmental Sustainability in June 2023. Building on this initiative, the ESAIC Sustainability Committee now presents a consensus document in perioperative sustainability. Acknowledging wider dimensions of sustainability, beyond the environmental one, the document recognizes healthcare professionals as cornerstones for sustainable care, and puts forward recommendations in four main areas: direct emissions, energy, supply chain and waste management, and psychological and self-care of healthcare professionals. Given the urgent need to cut global carbon emissions, and the scarcity of evidence-based literature on perioperative sustainability, our methodology is based on expert opinion recommendations. A total of 90 recommendations were drafted by 13 sustainability experts in anaesthesia in March 2023, then validated by 36 experts from 24 different countries in a two-step Delphi validation process in May and June 2023. To accommodate different possibilities for action in high- versus middle-income countries, an 80% agreement threshold was set to ease implementation of the recommendations Europe-wide. All recommendations surpassed the 80% agreement threshold in the first Delphi round, and 88 recommendations achieved an agreement >90% in the second round. Recommendations include the use of very low fresh gas flow, choice of anaesthetic drug, energy and water preserving measures, "5R" policies including choice of plastics and their disposal, and recommendations to keep a healthy work environment or on the importance of fatigue in clinical practice. Executive summaries of recommendations in areas 1, 2 and 3 are available as cognitive aids that can be made available for quick reference in the operating room.
Collapse
Affiliation(s)
- Patricio Gonzalez-Pizarro
- From the Department of Paediatric Anaesthesia and Critical Care. La Paz University Hospital, Madrid, Spain (PGP), the Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital, Department of Surgical Science, University of Turin, Turin, Italy (LB), the University of Southern Denmark (SDU) Odense, Department of Anesthesia, Hospital of Nykobing Falster, Denmark (SK), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (SK), the Department of Anaesthesiology. LMU University Hospital, LMU Munich, Germany (AT), the Department of Anaesthesia and Intensive Care. Institute Curie & PSL Research University, Paris, France (JM), the Department of Anaesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands (NSW), the Department of Anaesthesia and Perioperatve Medicine. Medical Faculty, University of Novi Sad, Novi Sad, Serbia (GJ), the Department of Surgical, Oncological and Oral Science, University of Palermo, Italy. Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy (AC), the Department of Anaesthesiology, Hospital Pedro Hispano, Matosinhos, Portugal (TDF), the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Germany (PK), the Department of Anaesthesiology and Pain. P&A Kyriakou Children's Hospital Athens Greece (AM), Royal Alexandra Hospital. Paisley, Scotland, United Kingdom (PM), Department of Neuro-anaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, England, United Kingdom (LM), the Department of Anesthesia, Critical care and Pain Unit, Hospital General Universitario de Valencia. Research Methods Department, European University of Valencia, Spain (CR), the "Sapienza" University of Rome, Department of Anesthesiology and Critical Care, Rome, Italy (FB), the Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery - University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy (EDR), the Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
Collapse
Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
7
|
Ryan AN, Robertson KL, Glass BD. Look-alike medications in the perioperative setting: scoping review of medication incidents and risk reduction interventions. Int J Clin Pharm 2024; 46:26-39. [PMID: 37688737 PMCID: PMC10830657 DOI: 10.1007/s11096-023-01629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/17/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Look-alike medications, where ampoules or vials of intravenous medications look similar, may increase the risk of medication errors in the perioperative setting. AIM This scoping review aimed to identify and explore the issues related to look-alike medication incidents in the perioperative setting and the reported risk reduction interventions. METHOD Eight databases were searched including: CINAHL Complete, Embase, OVID Emcare, Pubmed, Scopus, Informit, Cochrane and Prospero and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Key search terms included anaesthesia, adverse drug event, drug error or medication error, look alike sound alike, operating theatres and pharmacy. Title and abstracts were screened independently and findings were extracted using validated tools in collaboration and consensus with co-authors. RESULTS A total of 2567 records were identified to 4th July 2022; however only 18 publications met the inclusion criteria. Publication types consisted of case reports, letters to the editor, multimodal quality improvement activities or survey/audits, a controlled simulation study and one randomised clinical trial. Risk reduction intervention themes identified included regulation, procurement, standardisation of storage, labelling, environmental factors, teamwork factors and the safe administration. CONCLUSION This review highlighted challenges with look-alike medications in the perioperative setting and identified interventions for risk reduction. Key interventions did not involve technology-based solutions and further research is required to assess their effectiveness in preventing patient harm.
Collapse
Affiliation(s)
- Alexandra N Ryan
- Pharmacy Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4810, Australia.
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.
| | - Kelvin L Robertson
- Pharmacy Department, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4810, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley D Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| |
Collapse
|
8
|
Leister N, Yücetepe S, Ulrichs C, Menzel C, Dübbers M, Kribs A, Böttiger BW, Trieschmann U. Anesthesia in the separation of conjoined twins (omphalopagus)-Example of a practical approach. DIE ANAESTHESIOLOGIE 2024; 73:40-43. [PMID: 37566259 PMCID: PMC10791715 DOI: 10.1007/s00101-023-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Sirin Yücetepe
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christoph Ulrichs
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christoph Menzel
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Martin Dübbers
- Pediatric Surgery, Department of General, Visceral, Cancer and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Angela Kribs
- Department of Pediatrics, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| |
Collapse
|
9
|
García-Aroca MA, Fernández-de Miguel JM, Franceschi MAD, Fernández-Vaquero MA, Meléndez-Salinas DA, Piñero-Merino M, Álvarez-Avello JM. Inhalation anesthesia without any intravenous management for pediatric proton beam therapy. Paediatr Anaesth 2023; 33:946-954. [PMID: 37526245 DOI: 10.1111/pan.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols. METHODS We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway. RESULTS Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches. CONCLUSION Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.
Collapse
Affiliation(s)
- Miguel A García-Aroca
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | | | | | | | | | - María Piñero-Merino
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | - José M Álvarez-Avello
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| |
Collapse
|
10
|
Leister N, Trieschmann U, Yücetepe S, Ulrichs C, Muenke N, Wendt S, Menzel C, Heindl LM. Nalbuphine as analgesic in preschool children undergoing ophthalmic surgery and the occurrence of emergence delirium. Br J Ophthalmol 2023; 107:1522-1525. [PMID: 35817561 DOI: 10.1136/bjo-2022-321575] [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: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Perioperative pain in children is often inadequately treated, and emergence agitation is common. The purpose of this analysis was to determine whether nalbuphine is suitable for perioperative eye pain and to analyse if it influences the occurrence of emergence delirium/agitation (EDA) in children undergoing ophthalmic surgery in general anaesthesia. METHODS Retrospective cohort analysis of 50 children in preschool age undergoing general anaesthesia for ophthalmic surgery receiving nalbuphine as a postoperative analgesic in a German university hospital from June 2020 to February 2021.Scores and values for pain and EDA were routinely recorded after awakening and during the stay in the recovery room. Data were evaluated retrospectively from the medical records. RESULTS A total of 50 children (17 girls and 33 boys) underwent general anaesthesia for ophthalmic surgery. The median age of the children included was 20.5 months (range, 1-68 months), the median body weight was 12.25 kg (range, 2.9-29 kg). All patients received ibuprofen (10 mg/kg1) during induction of anaesthesia and nalbuphine (0.1 mg/kg) at the end of surgery. All patients had an Paediatric-Anaesthesia-Emergence-Delirium-I-score (PAED-ED-I Score) of less than 6 and acceptable Face-Legs-Activity-Cry-Consolability-scores (FLACC less than 3) on waking and on leaving the recovery room. CONCLUSION Nalbuphine shows a sufficient analgesic effect for pain therapy following ophthalmic surgery in preschool children. Nalbuphine seems to reduce the incidence of EDA in children undergoing ophthalmic surgery.
Collapse
Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sirin Yücetepe
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Ulrichs
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nikolas Muenke
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Menzel
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
| |
Collapse
|
11
|
Leister N, Bachmann B, Matthaei M, Trieschmann U, Schumacher C, Löw V, Böttiger BW, Schrittenlocher S, Heindl LM, Cursiefen C. Immediate postoperative topical lidocaine gel for the treatment of eye pain following corneal abrasion in descemet membrane endothelial keratoplasty (DMEK) under general anaesthesia: a pilot retrospective analysis. BMC Anesthesiol 2023; 23:305. [PMID: 37689627 PMCID: PMC10492328 DOI: 10.1186/s12871-023-02258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Patients undergoing corneal abrasion as part of Descemet membrane endothelial keratoplasty (DMEK) under general anesthesia suffer from early burning pain postoperatively. This pain appears to be poorly treatable with systemic analgesics. This study aims to evaluate postoperative pain management using topical lidocaine gel after DMEK with iatrogenic corneal abrasion. METHODS Retrospective analysis of 28 consecutive patients undergoing DMEK with corneal abrasion from October 19, 2021, to November 12, 2021, at a German university hospital. Patients during week 1 and 2 received peri-operative standard pain treatment (cohort S) and additional local lidocaine gel during week 3 and 4 immediately postoperatively (cohort L). RESULTS 13 patients were included in cohort S and 15 patients in cohort L. At awakening all patients (100%) in cohort S reported burning pain, and six of 15 patients (40%) in cohort L reported burning pain. Burning pain scores were significantly lower in cohort L (p < 0.001 at awakening, p < 0.001 at 10 min, p < 0.001 at 20 min, p < 0.001 at 30 min, p = 0.007 at 40 min after awakening, and p < 0.001 at leaving recovery room). No significant differences between cohort S and cohort L were detected concerning surgical outcome during 1-month-follow-up (p = 0.901 for best corrected visual acuity). CONCLUSION Patients undergoing DMEK with corneal abrasion suffer significant pain in the recovery room. A single dose of topic lidocaine gel reduces the early postoperative burning pain sufficiently and does not affect the surgical outcome.
Collapse
Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Björn Bachmann
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Mario Matthaei
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Christine Schumacher
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Vanessa Löw
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Silvia Schrittenlocher
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
12
|
Leister N, Commotio S, Menzel C, Yücetepe S, Ulrichs C, Wendt S, Dedden C, Trieschmann U, Hannes T. Human metapneumovirus infection in the cardiac paediatric ICU before and during COVID-19 pandemic: a retrospective cohort analysis. Cardiol Young 2023; 33:1517-1522. [PMID: 35920053 PMCID: PMC9379262 DOI: 10.1017/s1047951122002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study investigates the hygiene standards in the context of the COVID-19 pandemic and their impact on the perioperative incidence of human metapneumovirus as well as the typical symptom burden of human metapneumovirus-infected children with CHDs. MATERIALS AND METHODS Between March 2018 and July 2021, all patients of a cardiac paediatric ICU of a German university hospital were included in this retrospective cohort analysis. RESULTS A total of 589 patients with CHD were included in the analysis. Three hundred and fifty-two patients (148 females and 204 males) were admitted before the introduction of social distancing and face masks between March 2018 and 15 April 2020 (cohort A). Two hundred and thirty-seven patients (118 females and 119 males) were admitted after the introduction between April 16 and July 2021 (cohort B). In cohort A, human metapneumovirus was detected in 11 out of 352 patients (3.1%) during their stay at cardiac paediatric ICU. In cohort B, one patient out of 237 (0.4%) tested positive for human metapneumovirus. Patients who tested positive for human metapneumovirus stayed in cardiac paediatric ICU for a median of 17.5 days (range, 2-45 days). Patients without a detected human metapneumovirus infection stayed in the cardiac paediatric ICU for a median of 4 days (range, 0.5-114 days). Nine out of 12 (75%) human metapneumovirus-positive patients showed atelectasis. CONCLUSION Perioperative human metapneumovirus infections prolong cardiac paediatric ICU stay in children with CHD. In affected patients, pulmonary impairment with typical symptoms appears. Under certain circumstances, a complication-rich perioperative infection with human metapneumovirus could be prevented in paediatric cardiac high-risk patients by prophylactic hygiene intervention.
Collapse
Affiliation(s)
- Nicolas Leister
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Simone Commotio
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christoph Menzel
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Sirin Yücetepe
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christoph Ulrichs
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christoph Dedden
- Department of Paediatric Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Uwe Trieschmann
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Tobias Hannes
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
- Department of Paediatric Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
- Department of Neonatology and Paediatric Intensive Care Medicine, Asklepios Children’s Hospital St. Augustin, Sankt Augustin, Germany
| |
Collapse
|
13
|
Ojeda IM, Sánchez-Cuervo M, Candela-Toha Á, Serrano-López DR, Bermejo-Vicedo T, Alcaide-López-de-Lerma JM. Protocolization of Analgesia and Sedation Through Smart Technology in Intensive Care: Improving Patient Safety. Crit Care Nurse 2023; 43:30-38. [PMID: 37524366 DOI: 10.4037/ccn2023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND The risk of medication errors in intensive care units is high, primarily in the drug administration phase. LOCAL PROBLEM Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units. METHODS The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected. RESULTS Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions. CONCLUSIONS Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.
Collapse
Affiliation(s)
- Isabel Muñoz Ojeda
- Isabel Muñoz Ojeda is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marina Sánchez-Cuervo
- Marina Sánchez-Cuervo is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal
| | - Ángel Candela-Toha
- Ángel Candela-Toha is a physician, Anesthesia and Resuscitation Department, Hospital Universitario Ramón y Cajal
| | - Dolores R Serrano-López
- Dolores R. Serrano-López is a pharmacist, Pharmacology Department, School of Pharmacy, Universidad Complutense de Madrid, Madrid
| | - Teresa Bermejo-Vicedo
- Teresa Bermejo-Vicedo is a pharmacist, Pharmacy Department, Hospital Universitario Ramón y Cajal
| | - Juan Miguel Alcaide-López-de-Lerma
- Juan Miguel Alcaide-López-de-Lerma is a postanethesia care unit nurse manager, intensive care unit, Hospital Universitario Ramón y Cajal
| |
Collapse
|
14
|
Buhre W, De Robertis E, Gonzalez-Pizarro P. The Glasgow declaration on sustainability in Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2023; 40:461-464. [PMID: 37265337 DOI: 10.1097/eja.0000000000001862] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Wolfgang Buhre
- From the Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB), Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Italy (EDR) and Department of Paediatric Anaesthesia and Critical Care. La Paz University Children's Hospital, Madrid, IdiPaz Research Institute, Madrid, Spain (PG-P)
| | | | | |
Collapse
|
15
|
Bielka K, Kuchyn I, Frank M, Sirenko I, Yurovich A, Slipukha D, Lisnyy I, Soliaryk S, Posternak G. Critical incidents during anesthesia: prospective audit. BMC Anesthesiol 2023; 23:206. [PMID: 37316789 DOI: 10.1186/s12871-023-02171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/09/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Critical incident reporting and analysis is one of the key components of patient safety in anesthesiology. The aim of this study was to determine the frequency and characteristics of critical incidents during anesthesia, main causes and factors involved, influence on patient outcomes, prevalence of incident reporting and further analysis. METHODS A multicenter prospective audit was conducted at the clinical departments of the Bogomolets National Medical University during the period from 1 to 2021 to 1 December 2021. 13 hospitals from different Ukrainian regions took part in the study. Anesthesiologists voluntarily submitted critical incident reports into a Google form as they occurred during the working shifts, reporting the details of the incident, and the incident registration routine in their hospital. The study design was approved by the Bogomolets National Medical University (NMU) ethics committee, protocol #148, 07.09.2021. RESULTS The incidence of critical incidents was 9.35 cases per 1000 anesthetic procedures. Most common incidents were related to the respiratory system: difficult airway (26.8%), reintubation (6.4%), oxygen desaturation (13.8%); cardiovascular system: hypotension (14.9%), tachycardia (6.4%), bradycardia (11.7%), hypertension (5.3%), collapse (3.2%); massive hemorrhage (17%). Factors associated with critical incidents were elective surgery (OR 4.8 [3.1-7.5]), age from 45 to 75 years (OR 1.67 [1.1-2.5]), ASA II (OR 38 [13-106]}, III (OR 34 [12-98]) or IV (3.7 [1.2-11]) compared to ASA I; regional anesthesia (OR 0.67 95 CI 0.5-0.9) or general anesthesia (GA) and regional anesthesia combination (OR 0.55 95 CI 0.3-0.9] decreased the risk of incidents compared to GA alone. Procedural sedation was associated with increased risk of a critical incident, compared to GA (OR 0.55 95 CI 0.3-0.9). The incidents occurred most commonly during the maintenance phase (75/113, 40%, OR compared to extubation phase 20 95 CI 8-48) or the induction phases of anesthesia (70/118, 37%, OR compared to extubation phase 18 95 CI 7-43). Among common reasons that could lead to the incident, the physicians have identified: individual patient features (47%), surgical tactics (18%), anesthesia technique (16%) and human factor (12%). The most frequent failings contributing to the incident occurrence were: insufficient preoperative assessment (44%), incorrect interpretation of the patients' state (33%), faulty manipulation technique (14%), miscommunication with a surgical team (13%) and delay in emergency care (10%). Furthermore, 48% of cases, as judged by participating physicians, were preventable and the consequences of another 18% could be minimized. The consequences of the incidents were insignificant in over a half of the cases, but in 24.5% have led to prolonged hospital stay, in 16% patients required an urgent transfer to the ICU and 3% of patients died during their hospital stay. The majority of the critical incidents (84%) were reported through the hospital reporting system, using mostly paper forms (65%), oral reports (15%) and an electronic database (4%). CONCLUSION Critical incidents during anesthesia occur rather often, mainly during the induction or maintenance phases of anesthesia, and could lead to prolonged hospital stay, unplanned transfer to the ICU or death. Reporting and further analysis of the incident are crucial, so we should continue to develop the web-based reporting systems on both local and national levels. STUDY REGISTRATION NCT05435287, clinicaltrials.gov, 23/6/2022.
Collapse
Affiliation(s)
- K Bielka
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine.
| | - I Kuchyn
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine
| | - M Frank
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine
| | - I Sirenko
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine
| | - A Yurovich
- Mukachevo Central District Hospital (St. Martin Hospital), Mukachevo, Ukraine
| | - D Slipukha
- Medical center "Medion", Poltava, Ukraine
| | - I Lisnyy
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine
| | - S Soliaryk
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine
| | - G Posternak
- Bogomolets National Medical University, department of surgery, anesthesiology and intensive care of postgraduate education, Kyiv, Ukraine
| |
Collapse
|
16
|
Alegret N, Usart M, Valle A, De la Flor AR, Subirana L, Valero R. Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool. JOURNAL OF SURGICAL EDUCATION 2023; 80:706-713. [PMID: 36882339 DOI: 10.1016/j.jsurg.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. DESIGN Pre-and postintervention study. SETTING Acute-care teaching hospital in Sabadell, Barcelona (Spain). PARTICIPANTS Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. RESULTS Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. CONCLUSIONS Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.
Collapse
Affiliation(s)
- Núria Alegret
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain.
| | - Mireia Usart
- Education and Information Technology, University Rovira i Virgili, Tarragona, Spain
| | - Anna Valle
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | | | - Laura Subirana
- Service of Anesthesiology and Resuscitation, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Ricard Valero
- Service of Anesthesiology and Resuscitation, Hospital Clinic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Center for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain
| |
Collapse
|
17
|
Wacker J. Quality indicators for anesthesia and perioperative medicine. Curr Opin Anaesthesiol 2023; 36:208-215. [PMID: 36689392 PMCID: PMC9973445 DOI: 10.1097/aco.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Routine monitoring of care quality is fundamental considering the high reported rates of preventable perioperative morbidity and mortality. However, no set of valid and feasible quality indicators is available as the gold standard for comprehensive routine monitoring of the overall quality of perioperative care. The purpose of this review is to describe underlying difficulties, to summarize current trends and initiatives and to outline the perspectives in support of suitable perioperative quality indicators. RECENT FINDINGS Most perioperative quality indicators used in the clinical setting are based on low or no evidence. Evidence-based perioperative quality indicators validated for research purposes are not always applicable in routine care. Developing a core set of perioperative quality indicators for clinical practice may benefit from matching feasible routine indicators with evidence-based indicators validated for research, from evaluating additional new indicators, and from including patients' views. SUMMARY A core set of valid and feasible quality indicators is essential for monitoring perioperative care quality. The development of such a set may benefit from matching evidence-based indicators with feasible standard indicators and from including patients' views.
Collapse
Affiliation(s)
- Johannes Wacker
- Institute of Anaesthesia and Intensive Care, Hirslanden Clinic
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
| |
Collapse
|
18
|
Cieniewicz A, Trzebicki J. Malignant hyperthermia in Poland: A survey study. Medicine (Baltimore) 2023; 102:e33238. [PMID: 36897682 PMCID: PMC9997818 DOI: 10.1097/md.0000000000033238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Malignant hyperthermia (MH) is a life-threatening syndrome caused by sudden, uncontrolled skeletal muscle hypermetabolism in response to inhalation anesthetics and depolarizing relaxants. The estimated incidence of MH is between 1:10,000 and 1:250,000 anesthetic procedures. In Poland, due to lack of reporting, the incidence of MH is unknown. Dantrolene is imported as a life-saving drug (target import) and temporally authorized for sale. The aim of the study was to evaluate the prevalence of malignant hyperthermia in Poland and to assess the accessibility to dantrolene in Poland. A questionnaire was conducted among the chiefs of anesthesia and intensive care units in Poland. During the years 2014 to 2019, 10 episodes of MH have been reported in 238 surveyed polish anesthesia departments. The estimated prevalence is 1:350,000. Eight patients survived the MH crisis. Dantrolene is stocked in 48 (20%) anesthesiology departments. Among the surveyed hospitals, only in 38 (16%) it is possible to administer dantrolene within 5 minutes of suspecting a MH reaction. Less than half units (44%) have an algorithm for the management of MH episode in the operating theaters. The results of the study revealed, that the prevalence of MH in Poland is lower than the prevalence reported in other countries. Access to dantrolene in Poland is limited.
Collapse
Affiliation(s)
- Agnieszka Cieniewicz
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Trzebicki
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
19
|
Azilagbetor DM, Jawara M. Improving patient safety: Did we learn from the story of Jean-Pierre Adams? JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2023. [DOI: 10.1177/25160435231157235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The safety of surgery and anesthesia has seen many advances over the last several decades; however, the frequency of complications experienced by patients undergoing surgical operations remains high. Most of these complications are avoidable, with a considerable portion of surgical patient injuries originating from human factors. Telling stories and assessing what went wrong and why for lessons to be learned are proven methods used to improve patient safety in anesthesia. In this narrative, we revisited a case of an anesthesia mishap that occurred in 1982, leaving the victim in a coma for nearly four decades until his death in September 2021. The patient reported for his operation, but a number of the hospital's staff were on strike. His operation, however, went ahead and the reduction in anesthesia care team members and its consequential increase in workload resulted in a series of avoidable errors. Decades after this event, many of the issues identified still remain a challenge in anesthesia care; there are still lessons to learn. We identified and discussed three major issues of concern: the non-cancellation of his procedure amid a strike action, giving a delicate anesthetic duty to a trainee without active supervision, and poor coordination and teamwork among team members in the operating room.
Collapse
Affiliation(s)
| | - Maimuna Jawara
- Higher Institute of Health Sciences, Hassan 1st University, Settat, Morocco
| |
Collapse
|
20
|
A Brief Assessment of Patient Safety Culture in Anesthesia and Intensive Care Departments. Healthcare (Basel) 2023; 11:healthcare11030429. [PMID: 36767004 PMCID: PMC9914654 DOI: 10.3390/healthcare11030429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Due to the nature of their activity, anesthesia and critical care have generally well-developed patient safety cultures, which are linked to a greater level of incident awareness and reporting during clinical activity. In order to determine the status quo and identify and adopt, where appropriate, techniques and instruments for further improving patient safety, it is necessary to evaluate the culture and barriers in these departments. The main objective of our study was to assess patient safety culture in Romanian anesthesia and intensive care departments (AICDs), to pinpoint the areas that may need improvement, and to examine the correlation between the prevalence of adverse event reporting, as well as the level of self-reported patient safety culture. To determine how anesthesia and intensive care department staff perceived patient safety, the Hospital Survey on Patient Safety Culture (HSOPSC) was used in a translated Romanian version. In total, 1200 employees from 36 anesthesiology and intensive care departments across 32 hospitals in Romania received the questionnaire, representing 42.66% of all anesthesia and intensive care departments in the country. In 7 of the 12 examined dimensions, significant differences between tertiary and secondary hospitals were observed. Among all dimensions, the highest positive score was for "organizational learning and continuous development". In general, our study revealed a positive view on patient safety in anesthesia and intensive care departments. Further studies are required to determine a threshold of the level of culture development.
Collapse
|
21
|
Patient safety practices in European anaesthesiology: Expert evaluation and ranking. Eur J Anaesthesiol 2023; 40:113-120. [PMID: 36437746 DOI: 10.1097/eja.0000000000001779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient safety is a key concern of anaesthesiology practice. However, good practices are often not widely shared between departments and hospitals, whether within or between countries. OBJECTIVE We aimed to collect and analyse safety practices and tips from anaesthesiology departments around Europe in order to facilitate successful transfer of safety knowledge. DESIGN Review of previously collected safety practices; allocation of numerical scores in order to rank them on 0-5 scales in terms of anticipated impact, and speed, cost, and ease of implementation; free text comment on any possible difficulties or unintended harms which might arise from adopting any of the collected practices. SETTING Collaborative remote working of expert group. PARTICIPANTS Nineteen experts in patient safety in anaesthesiology from nine European countries. MAIN OUTCOME MEASURES Rankings of safety practices for anticipated practice impact, cost, speed, and ease of implementation. RESULTS We collected 117 practices. The highest-ranked items for potential beneficial impact were: standardising the layout of drug trolleys (4.82); involving all staff in new safety initiatives in the operating theatre (4.73); ensuring patients' medical records are available at the time of surgery (4.71); running regular simulation training sessions in departments of anaesthesia (4.67); and creating a difficult airway management trolley (4.65). A major theme to emerge from the qualitative analysis of the experts' free text comments was the risk that practices aimed at enhancing patient safety might not achieve the effect intended, as introducing new safety activities can cause more mistakes during the implementation phase. CONCLUSION Many useful practices to promote patient safety were identified, but as some practices appear to be context-dependent, we recommend that a proper, prospective risk assessment is carried out before they are introduced in a new setting. The full list of items is available online as Supplementary Digital Content, http://links.lww.com/EJA/A785 . TRIAL REGISTRATION Not applicable.
Collapse
|
22
|
Extension of patient safety initiatives to perioperative care. Curr Opin Anaesthesiol 2022; 35:717-722. [PMID: 36302210 DOI: 10.1097/aco.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE OF REVIEW Patient safety has significantly improved during the intraoperative period thanks to the anesthesiologists, surgeons, and nurses. Nowadays, it is within the perioperative period where most of the preventable harm happened to the surgical patient. We aim to highlight the main issues and efforts to improve perioperative patient safety focusing and the relation to intraoperative safety strategies. RECENT FINDINGS There is ongoing research on perioperative safety strategies aiming to initiate multidisciplinary interventions on early stages of the perioperative period as well as an increasing focus on preventing harm from postoperative complications. SUMMARY Any patient safety strategy to be implemented needs to be framed beyond the operating room and include in the intervention the whole perioperative period.
Collapse
|
23
|
Neuhaus C, Grawe P, Bergström J, St.Pierre M. The impact of " To Err Is Human" on patient safety in anesthesiology. A bibliometric analysis of 20 years of research. Front Med (Lausanne) 2022; 9:980684. [PMID: 36465924 PMCID: PMC9709126 DOI: 10.3389/fmed.2022.980684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/31/2022] [Indexed: 09/19/2023] Open
Abstract
Background Patient safety gained public notoriety following the 1999 report of the Institute of Medicine: To Err is Human - Building a Safer Health System which summarized a culminated decades' worth of research that had so far been largely ignored. The aim of this study was to analyze the report's impact on patient safety research in anesthesiology. Methods A bibliometric analysis was performed on all anesthesiologic publications from 2000 to 2019 that referenced To Err Is Human. In bibliometric literature, references are understood to represent an author's conscious decision to express a relationship between his own manuscript and the cited document. Results The anesthesiologic data base contained 1.036 publications. The journal with the most references to the IOM report is Anesthesia & Analgesia. By analyzing author keywords and patterns of collaboration, changes in the patient safety debate and its core themes in anesthesiology over time could be visualized. The generic notion of "error," while initially a central topic in the scientific discourse, was subsequently replaced by terms representing a more granular, team-oriented, and educational approach. Patient safety research in anesthesia, while profiting from a certain intellectual and conceptual head start, showed a discursive shift toward more managerial, quality-management related topics as observed in the health care system as a whole. Conclusions Over the last 20 years, the research context expanded from the initial focus set forth by the IOM report, which ultimately led to an underrepresentation of research on critical incident reporting and systemic approaches to safety. Important collaborations with safety researchers from outside of health care dating back to the 1990's were gradually reduced, while previous research within anesthesiology was aligned with a broader, more managerial patient safety agenda.
Collapse
Affiliation(s)
- Christopher Neuhaus
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Grawe
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Johan Bergström
- Division of Risk Management and Societal Safety, Lund University, Lund, Sweden
| | - Michael St.Pierre
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
24
|
Gawronski O, Thekkan KR, Genna C, Egman S, Sansone V, Erba I, Vittori A, Varano C, Dall’Oglio I, Tiozzo E, Chiusolo F. Instruments to evaluate non-technical skills during high fidelity simulation: A systematic review. Front Med (Lausanne) 2022; 9:986296. [PMID: 36405618 PMCID: PMC9669714 DOI: 10.3389/fmed.2022.986296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/11/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers' (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom (n = 13; 50%), North America/Australia (n = 12; 46%) and Thailand (n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence. CONCLUSION Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS.
Collapse
Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Kiara R. Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Sabrina Egman
- Clinical Risk, Innovation and Integration of Care Services, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Ilaria Erba
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Carmelita Varano
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| |
Collapse
|
25
|
Rosboch GL, Cortese G, Neitzert L, Brazzi L. Towards a universal, holistic, evidence-based consensus on difficult airway management: the new American Society of Anesthesiologists guidelines. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1182. [PMID: 36467366 PMCID: PMC9708469 DOI: 10.21037/atm-22-4271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023]
Affiliation(s)
- Giulio Luca Rosboch
- Department of Anesthesia and Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Gerardo Cortese
- Department of Anesthesia and Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Luca Neitzert
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia and Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
26
|
Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 247] [Impact Index Per Article: 123.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
27
|
Abstract
PURPOSE OF REVIEW Ambulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation. RECENT FINDINGS Identifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams. SUMMARY The increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW The penalization of error in the health field continues to be one of the main barriers in the notification, analysis and proposals for measures to improve adverse events. Strategies should be established in order to develop a nonpunitive culture with the sole purpose of learning from mistakes and improving patient safety. RECENT FINDINGS Strategies are established for the development of a nonpunitive culture, such as promoting confidentiality and data protection in the notification and analysis of adverse events. SUMMARY Despite education, improvements in quality and safety in healthcare, mistakes will undoubtedly occur. The creation of a protected, blame-free environment that promotes systematic reporting of adverse events will provide valuable information for preventive work and the desired improvement in patient and health team safety.
Collapse
|
29
|
Guasch E, Brogly N, Gilsanz F. Clinical practice and organizational standards in obstetric analgesia and anesthesia (EUROMISTOBAN): A European document. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:449-453. [PMID: 36085143 DOI: 10.1016/j.redare.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/17/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Guasch
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - N Brogly
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - F Gilsanz
- Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma de Madrid, Honorary Member ESAIC, Madrid, Spain
| |
Collapse
|
30
|
Leister N, Yücetepe S, Ulrichs C, Pietsch S, Schink U, Kilian J, Menzel C, Trieschmann U. Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis. Paediatr Anaesth 2022; 32:907-915. [PMID: 35434867 DOI: 10.1111/pan.14461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many different sedation concepts for magnetic resonance imaging have been described for prematurely and term-born infants, ranging from "no sedation" to general anesthesia. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate older children, because the anesthesiologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards. AIMS The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for prematurely and term-born infants less than 60 weeks postconceptional age undergoing diagnostic procedures. METHODS We performed a retrospective monocentric analysis of n = 39 prematurely and term-born infants (<60 weeks postconceptional age or a body weight <5 kg) who were sedated with dexmedetomidine for an MRI at a German university hospital from August 2016 to November 2018. RESULTS Successful imaging was achieved in all cases. The median initial bolus of dexmedetomidine administered over 10 min was 1.39 μg kg-1 body weight (range 0.34-3.64 μg kg-1 ), followed with a continuous infusion at a median rate of 1.00 μg kg-1 h-1 (range 0.5-3.5 μg kg-1 h-1 ); however, 3 patients (7%) needed some additional sedation (ketamine or propofol). All patients, including 10 infants who had previously required respiratory support, underwent the procedure without any relevant desaturation or apnea. Bradycardia was observed in up to 15 out of 39 cases (38.5%), but only four (10.3% in total and 26.7% of bradycardia) required atropine. CONCLUSIONS These results indicate that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of prematurely and term-born infants less than 60 weeks postconceptional age. Apnea during procedural sedation and subsequent stay in the recovery room is avoided, but bradycardia remains a relevant risk that may require treatment.
Collapse
Affiliation(s)
- Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sirin Yücetepe
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Ulrichs
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Steffi Pietsch
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ullrich Schink
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Janine Kilian
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Emergency Medicine, Rhineland Clinic, Hospital Dormagen, Dormagen, Germany
| | - Christoph Menzel
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Uwe Trieschmann
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
31
|
Liu LL, Larson MD. Patient Safety During Anesthesia: 100 Years of Progress Documented in Anesthesia & Analgesia. Anesth Analg 2022; 135:S37-S47. [PMID: 35839832 DOI: 10.1213/ane.0000000000005906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthesiology has evolved to be a leader in addressing patient safety. Our specialty has overcome serious morbidities including explosions, fires, organ toxicity, fatal arrhythmias, and hypoxic brain damage. Anesthesia safety has been significantly improved due to modern drug development, technical advances, and a strong leadership willing to apply human factors and systems' research strategies, but patient safety concerns remain at the forefront as we strive to improve patient care even further. This year marks the centennial year since the publication of the first issue of Anesthesia & Analgesia. Today, the International Anesthesia Research Society (IARS) and Anesthesia & Analgesia continue to advance the boundaries of patient safety by disseminating practice standards, serving as a forum for novel ideas, and supporting research advancements. This review will discuss several topics published in Anesthesia & Analgesia that exemplify steady changes leading to the safe practices that we rely on currently as well as other IARS activities that have advocated and elevated patient safety within the specialty.
Collapse
Affiliation(s)
- Linda L Liu
- From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | | |
Collapse
|
32
|
Warner MA, Arnal D, Cole DJ, Hammoud R, Haylock-Loor C, Ibarra P, Joshi M, Khan FA, Lebedinskii KM, Mellin-Olsen J, Miyasaka K, Morriss WW, Onajin-Obembe B, Toukoune R, Yazbeck P. Anesthesia Patient Safety: Next Steps to Improve Worldwide Perioperative Safety by 2030. Anesth Analg 2022; 135:6-19. [PMID: 35389378 DOI: 10.1213/ane.0000000000006028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.
Collapse
Affiliation(s)
- Mark A Warner
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Arnal
- Department of Anesthesiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Daniel J Cole
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California
| | - Rola Hammoud
- Department of Anesthesiology, Clemenceau Medical Center, Dubai, United Arab Emirates
| | - Carolina Haylock-Loor
- Department of Anesthesiology, Critical Care, and Pain Medicine, Hospital del Valle, San Pedro Sula, Honduras
| | - Pedro Ibarra
- Department of Anesthesiology and Perioperative Medicine, Clínica Reina Sofía, Bogota, Colombia
| | | | - Fauzia A Khan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Konstantin M Lebedinskii
- Department of Anaesthesiology and Reanimatology, North-Western State Medical University, St Petersburg, Russia.,Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | | | - Katsuyuki Miyasaka
- Department of Anesthesiology, St Luke's International University, Tokyo, Japan
| | - Wayne W Morriss
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Bisola Onajin-Obembe
- Department of Anaesthesiology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
| | - Robinson Toukoune
- Department of Anaesthesia, Vila Central Hospital, Port Vila, Vanuatu
| | - Patricia Yazbeck
- Department of Anesthesiology and Critical Care, Saint Joseph's University; Beirut, Lebanon
| |
Collapse
|
33
|
Bielka K, Kuchyn I, Semenko N, Kashchii U, Pliuta I. Patient safety during anesthesia in Ukraine: national audit results. BMC Anesthesiol 2022; 22:164. [PMID: 35624436 PMCID: PMC9137063 DOI: 10.1186/s12871-022-01704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although anesthesiologists are one of the leaders in patient safety, anesthesia in low and low-middle income countries still need improvement in safety mesures with evidence-based practice application. The study aim was to audit the safety principles implementation in the Ukrainian anesthesiologist`s practice. Methods The study was held in March 2021-Februrary 2022 by filling out an online questionnarie. The link to the survey was distributed through Ukrainian Anesthesiologists Association (UAA) members emails and also published on UAA webpage and facebook page. The email was sent to 1000 UAA members. Results Summary 210 respondents took part in the study. Among the respondents, 79.1% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology, but only 40,3% declared that the principles of this Declaration had been implemented in their medical institutions. Even though most of the respondents declared that the quality of the work has improved with the application of the Helsinki Declaration, 16% stated, that there is no positive impact. Most of the medical institutions include mandatory perioperative monitoring, while 17% of hospitals have no access to pulse oximetry for all patients in the operating room and intensive care unit. Concerning using clinical protocols, the one on the treatment of massive bleeding is used in 60.3% of cases, on infection control in 60.5%. In relation to checklists, 28.2% of respondents have never heard about the WHO Safe Surgery checklist. Checklists for equipment inspection are used in only 27.8% of medical institutions. 72.8% hospitals keep records of anaesthesia complications. Conclusion The study showed that significant positive steps are being taken to improve patient safety in Ukraine, where most hospitals comply with the minimum standarts of monitoring during anesthesia. Although there are many challenges for improvement, more hospitals need to implement WHO Safe Surgery and equipment checklists, protocols etc. These areas are a priority for further development in Ukraine. Trial registration Clinicaltrials.gov NCT05175976 on 04/01/2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01704-7.
Collapse
Affiliation(s)
- Kateryna Bielka
- Postgraduate Department of Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, 13 T. Shevchenko Boulevard, 01601, Kyiv, Ukraine.
| | - Iurii Kuchyn
- Postgraduate Department of Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, 13 T. Shevchenko Boulevard, 01601, Kyiv, Ukraine
| | - Nataliia Semenko
- Postgraduate Department of Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, 13 T. Shevchenko Boulevard, 01601, Kyiv, Ukraine
| | - Uliana Kashchii
- Postgraduate Department of Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, 13 T. Shevchenko Boulevard, 01601, Kyiv, Ukraine
| | - Iryna Pliuta
- Postgraduate Department of Surgery, Anesthesiology and Intensive Care, Bogomolets National Medical University, 13 T. Shevchenko Boulevard, 01601, Kyiv, Ukraine
| |
Collapse
|
34
|
Charoenkoop P, Luetrakool P, Puttapornpattana T, Sangdee N. Anesthesiology trainees performing flexible scope intubation in spontaneously breathing patients in the left lateral position and the supine position: a prospective randomized trial. BMC Anesthesiol 2022; 22:93. [PMID: 35366811 PMCID: PMC8976386 DOI: 10.1186/s12871-022-01636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Flexible scope intubation is an important airway management skill that requires hands-on training in a real airway. We compared flexible scope intubation by trainees between patients in the left lateral and supine positions. Methods Forty patients aged 20 to 80 years with American Society of Anesthesiologists physical status class I to III were scheduled for elective surgery under general endotracheal anesthesia in Ramathibodi Hospital from February 2020 to June 2020. Patients were randomly assigned to be intubated in one of two positions: supine (Group S) or left lateral (Group L). Trainees performed flexible scope intubation in sedated patients under the supervision of an attending anesthesiologist. Intubation success, time to successful intubation, number of attempts, airway adjustment maneuvers, and hemodynamic changes were compared between groups. Results Patient characteristics did not differ between groups except for Mallampati airway classification. The rate of successful intubation on the first attempt and intubation time did not significantly differ between groups. The proportion of patients who required a jaw thrust during intubation was significantly lower in Group L (10.5% vs. 85%; P < 0.01). Blood pressure and oxygen saturation declined in both groups after intubation. The relative risk of desaturation in patients in the left lateral position compared with the supine position was 0.44 (0.1649–1.1978). Conclusion The rate of successful flexible scope intubation on the first attempt and intubation time did not differ between the groups. The proportion of patients who required a jaw thrust maneuver was significantly lower in patients in the left lateral position. Trial registration https://www.thaiclinicaltrials.org/ (TCTR20200208001) on 08/02/2020.
Collapse
|
35
|
Pizarro Calderón AG, Pazó Sayos L, Lema Tomé M. Always on the alert: Medication errors. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:187-188. [PMID: 35305948 DOI: 10.1016/j.redare.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/03/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A G Pizarro Calderón
- Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, Spain.
| | - L Pazó Sayos
- Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, Spain
| | - M Lema Tomé
- Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, Spain
| |
Collapse
|
36
|
EL-Molla A. Airway security and safety: Is it a priority in the prone position during upper endoscopic procedures under general anesthesia? Saudi J Anaesth 2022; 16:520-521. [DOI: 10.4103/sja.sja_296_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/04/2022] Open
|
37
|
Eismann H, Breuer G, Flentje M. Further development of crew resource management training : Needs assessment by means of teamwork-context analysis in anesthesia and intensive care teams. DIE ANAESTHESIOLOGIE 2022; 71:180-189. [PMID: 35925183 PMCID: PMC9266080 DOI: 10.1007/s00101-022-01170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Teams in anesthesia and intensive care work as high responsibility teams (HRT). Success in this environment partly depends on the use of nontechnical skills which can be learned through simulation-based training. A teamwork context analysis could help to identify training requirements for crew resource management training. MATERIAL AND METHODS We used a multicentric observational cross-sectional study design utilizing survey methodology to evaluate the teamwork context of different work environments, using the 62-item TAKAI inventory. We surveyed anesthesia and intensive care staff from nine hospitals in Germany which provide varying levels of care. RESULTS In total, 128 people (44.5% male, 53.9% female) from 9 German hospitals participated in the study. The topics "interconnectedness: departments", "interconnectedness: information flow", "dynamics", "polytely", "velocity of the team's movement", "velocity of system changes", "hierarchy" and "hierarchy: leadership", "shared task mental model", "shared team mental model" and all aspects of the scale "adaptive behaviors" were identified as focal aspects to be implemented into Crew-Resource-Management (CRM) training for the evaluated work environments. CONCLUSION The TAKAI scales meet quality criteria (Cronbach's alpha > 0.6) and are appropriate for use in the analysis of the teamwork environment. The results indicate many similarities between the work contexts surveyed but also slight differences. TAKAI can be an additional method to design an appropriate simulation training program for HRT in anesthesia and intensive care medicine as there does not seem to be a one-size-fits-all simulation concept. For a special focus on the needs of a work context, the easy to perform TAKAI analysis in the needs analysis step is worthwhile.
Collapse
Affiliation(s)
- Hendrik Eismann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Georg Breuer
- REGIOMED Kliniken, Ketschendorfer Straße 33, 96450 Coburg, Germany
| | - Markus Flentje
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| |
Collapse
|
38
|
Pharmacologic Behavior Management (Sedation – General Anesthesia). Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
39
|
Koppenberg J, Stoevesandt D, Watzke S, Schwappach D, Bucher M. Analysis of 30 anaesthesia-related deaths in Germany between 2006 and 2015: An analysis of a closed claims database. Eur J Anaesthesiol 2022; 39:33-41. [PMID: 34397508 DOI: 10.1097/eja.0000000000001586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anaesthesiology is one of the safest fields in medicine today in relation to mortality. Deaths directly because of anaesthesia have fortunately now become rare exceptions. Nevertheless, important findings can still be drawn from the rare deaths that still occur. OBJECTIVE The aim of this study was to identify and analyse the causes of deaths related to anaesthesia alone over a 10-year period. DESIGN Retrospective structured analysis of a database of medical liability claims. SETTING Hospitals at all levels of care in Germany. PATIENTS The database of a large insurance broker included data for 81 413 completed liability claims over the 10-year period from 2006 to 2015. Among 1914 cases associated with anaesthetic procedures, 56 deaths were identified. Of these, 30 clearly involved anaesthesia (Edwards category 1) and were included in the evaluation. INTERVENTIONS None (retrospective database analysis). MAIN OUTCOME MEASURES Causes of anaesthesia-related death identified from medical records, court records, expert opinions and autopsy reports. RESULTS The 30 deaths were analysed in detail at the case and document level. They included high proportions of 'potentially avoidable' deaths, at 86.6%, and what are termed 'never events', at 66.7%. Problems with the airway were the cause in 40% and problems with correct monitoring in 20%. In addition, communication problems were identified as a 'human factor' in 50% of the cases. CONCLUSION The majority of the anaesthesia-related deaths investigated could very probably have been avoided with simple anaesthesiological measures if routine guidelines had been followed and current standards observed. Actions to be taken are inferred from these results, and recommendations are made. In future, greater care must be taken to ensure that the level of safety already achieved in anaesthesiology can be maintained despite demographic developments and increasing economic pressures.
Collapse
Affiliation(s)
- Joachim Koppenberg
- Department of Anaesthesiology, Pain Therapy and Emergency Medicine, Lower Engadine Hospital and Health Centre, Scuol, Switzerland (JK), Dorothea Erxleben Lernzentrum Halle, Medical Faculty of Martin Luther University of Halle-Wittenberg, Halle, Germany (DS), Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Halle (Saale), Germany (SW), Stiftung Patientensicherheit Schweiz, Zurich, Switzerland (DS), Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland (DS) and Department of Anaesthesiology and Surgical Intensive Care Medicine, University Hospital of Halle (Saale), Germany (MB)
| | | | | | | | | |
Collapse
|
40
|
Misamer M, Flentje M, Stötefalke A, Eismann H. Usage of power by different types of trainers in the education of paramedics - evaluation by means of a validated questionnaire. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc105. [PMID: 34651063 PMCID: PMC8493839 DOI: 10.3205/zma001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Objective: Emergency medical services are characterized by a high pressure to act. Dealing with trainees is a challenge. It is known, that the use of power in education subsists: power can be applied in a participative and restrictive way. We investigated the transferability of existing scales to the education system of Emergency medical service trainees. We hypothesized: a restrictive (a) and participative (b) use of power, can be demonstrated in Emergency medical service training, (c) the use of power by educators, who are responsible for theoretical learning, and instructors, who accompany trainees in real-life emergencies, are different and (d) the assessed participatory and restrictive use of power by trainers is negatively correlated. Methods: In a cross-sectional study, 206 trainees of Emergency medical service schools completed a questionnaire. The survey consists of 35 power related items regarding medical educators and practical instructors. Differences in the dimensions of power application were tested. The effect size and the correlation between power dimension were calculated. Results: The reliability of the scales was .92 (practical instructor) and .89 (medical educator) by removing one item. All subscales showed values with higher Cronbach's alpha than .68. Application of participative power differs (p<.00) between practical instructors (mean 64.7; SD 20.3) and medical educators (mean 55.3; SD 17.8). The participatory and the restrictive use of power correlated for medical educators significant negatively (r=-.48; p<.01). Conclusion: In both educator and instructor groups the use of participative power had a greater agreement that the use of restrictive techniques. The practical instructors used participative power slightly more often that did educators due to the dependency on the trainee as a team member. The context of the scales partially overlaps with other descriptions such as leadership and instructor quality.
Collapse
Affiliation(s)
- Melanie Misamer
- Hochschule für Angewandte Wissenschaft und Kunst, Göttingen, Germany
| | - Markus Flentje
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| | | | - Hendrik Eismann
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany
| |
Collapse
|
41
|
Pirlich N, Dutz M, Wittenmeier E, Kriege M, Didion N, Ott T, Piepho T. Current practice of German anesthesiologists in airway management : Results of a national online survey. Anaesthesist 2021; 71:190-197. [PMID: 34453552 DOI: 10.1007/s00101-021-01025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a worldwide consensus among experts that guidelines and algorithms on airway management contribute to improved patient safety in anesthesia. The present study aimed to determine the current practice of airway management of German anesthesiologists and assess the safety gap, defined as the difference between observed and recommended practice, amongst these practitioners. OBJECTIVE To determine the effect of implementing the guidelines on airway management practice in Germany amongst anesthesiologists and identify potential safety gaps. METHODS A survey was conducted in September 2019 by contacting all registered members of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) via email. The participants were asked about their personal and institutional background, adherence to recommendations of the current German S1 guidelines and availability of airway devices. RESULTS A total of 1862 DGAI members completed the questionnaire (response rate 17%). The main outcome was that anesthesiologists mostly adhered to the guidelines, yet certain recommendations, particularly pertaining to specifics of preoxygenation and training, showed a safety gap. More than 90% of participants had a video laryngoscope and half had performed more than 25 awake intubations using a flexible endoscope; however, only 81% had a video laryngoscope with a hyperangulated blade. An estimated 16% of all intubations were performed with a video laryngoscope, and 1 in 4 participants had performed awake intubation with it. Nearly all participants had cared for patients with suspected difficult airways. Half of the participants had already faced a "cannot intubate, cannot oxygenate" (CICO) situation and one in five had to perform an emergency front of neck access (eFONA) at least once. In this case, almost two thirds used puncture-based techniques and one third scalpel-based techniques. CONCLUSION Current practice of airway management showed overall adherence to the current German guidelines on airway management, yet certain areas need to be improved.
Collapse
Affiliation(s)
- Nina Pirlich
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Matthias Dutz
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Eva Wittenmeier
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Nicole Didion
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Ott
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Tim Piepho
- Department of Anaesthesiology and Intensive Care, Brothers of Mercy Hospital, Trier, Germany
| |
Collapse
|
42
|
Imach S, Wafaisade A, Lefering R, Böhmer A, Schieren M, Suárez V, Fröhlich M. The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU®. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:277. [PMID: 34348782 PMCID: PMC8336395 DOI: 10.1186/s13054-021-03701-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022]
Abstract
Background Outcome data about the use of tranexamic acid (TXA) in civilian patients in mature trauma systems are scarce. The aim of this study was to determine how severely injured patients are affected by the widespread prehospital use of TXA in Germany. Methods The international TraumaRegister DGU® was retrospectively analyzed for severely injured patients with risk of bleeding (2015 until 2019) treated with at least one dose of TXA in the prehospital phase (TXA group). These were matched with patients who had not received prehospital TXA (control group), applying propensity score-based matching. Adult patients (≥ 16) admitted to a trauma center in Germany with an Injury Severity Score (ISS) ≥ 9 points were included. Results The matching yielded two comparable cohorts (n = 2275 in each group), and the mean ISS was 32.4 ± 14.7 in TXA group vs. 32.0 ± 14.5 in control group (p = 0.378). Around a third in both groups received one dose of TXA after hospital admission. TXA patients were significantly more transfused (p = 0.022), but needed significantly less packed red blood cells (p ≤ 0.001) and fresh frozen plasma (p = 0.023), when transfused. Massive transfusion rate was significantly lower in the TXA group (5.5% versus 7.2%, p = 0.015). Mortality was similar except for early mortality after 6 h (p = 0.004) and 12 h (p = 0.045). Among non-survivors hemorrhage as leading cause of death was less in the TXA group (3.0% vs. 4.3%, p = 0.021). Thromboembolic events were not significantly different between both groups (TXA 6.1%, control 4.9%, p = 0.080). Conclusion This is the largest civilian study in which the effect of prehospital TXA use in a mature trauma system has been examined. TXA use in severely injured patients was associated with a significantly lower risk of massive transfusion and lower mortality in the early in-hospital treatment period. Due to repetitive administration, a dose-dependent effect of TXA must be discussed.
Collapse
Affiliation(s)
- Sebastian Imach
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany.
| | - Arasch Wafaisade
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Andreas Böhmer
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Victor Suárez
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matthias Fröhlich
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | | |
Collapse
|
43
|
Soncrant C, Neily J, Sum-Ping SJT, Wallace AW, Mariano ER, Leissner KB, Mills PD, Mazzia L, Paull DE. Sharing Lessons Learned to Prevent Adverse Events in Anesthesiology Nationwide. J Patient Saf 2021; 17:e343-e349. [PMID: 31135598 DOI: 10.1097/pts.0000000000000616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Veterans Health Administration (VHA) lessons learned process for Anesthesia adverse events was developed to alert the field to the occurrences and prevention of actual adverse events. This article details this quality improvement project and perceived impact. METHODS As part of ongoing quality improvement, root cause analysis related to anesthesiology care are routinely reported to the VHA National Center for Patient Safety. Since May 2012, the National Anesthesia Service subject matter experts, in collaboration with National Center for Patient Safety, review actual adverse events in anesthesiology and detailed lessons learned are developed. A survey of anesthesiology chiefs to determine perceived usefulness and accessibility of the project was conducted in April 2018. RESULTS The distributed survey yielded a response rate of 69% (84/122). Most of those who have seen the lessons learned (85%, 71/84) found them valuable. Ninety percent of those aware of the lessons learned (64/71) shared them with staff and 75% (53/71) reported a changed or reinforced patient safety behavior in their facility. The lessons learned provided 72% (51/71) of chiefs with new knowledge about patient safety and 75% (53/71) gained new knowledge for preventing adverse events. CONCLUSIONS This nationwide VHA anesthesiology lessons learned project illustrates the tenets of a learning organization. implementing team and systems-based safeguards to mitigate risk of harm from inevitable human error. Sharing lessons learned provides opportunities for clinician peer-to-peer learning, communication, and proactive approaches to prevent future similar errors.
Collapse
Affiliation(s)
- Christina Soncrant
- From the Veterans' Health Administration, National Center for Patient Safety, Field Office, White River Junction, Vermont
| | - Julia Neily
- From the Veterans' Health Administration, National Center for Patient Safety, Field Office, White River Junction, Vermont
| | | | | | | | - Kay B Leissner
- Veterans Affairs Boston Healthcare System, Boston Massachusetts
| | | | - Lisa Mazzia
- Veterans' Health Administration, National Center for Patient Safety, Ann Arbor, Michigan
| | - Douglas E Paull
- Veterans' Health Administration, National Center for Patient Safety, Ann Arbor, Michigan
| |
Collapse
|
44
|
Goffin P, Lecoq J, Sermeus L. The practice of regional anesthesia in Belgium – a national survey. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : National surveys are useful to assess the state of regional anaesthesia (RA) practice in a particular country. Given that such information was lacking in Belgium, we conducted a survey to evaluate the Belgian practice of peripheral nerve blocks (PNBs) with a particular focus on its safety aspects.
Methods : A survey was sent by email to 1510 Belgian anesthesiologists. No identifying information was collected. Data were collected between September 2019 and October 2019.
Results : We collected 324 questionnaires (response rate 21%). Eighty five percent of respondents perform regularly PNB. 99% place a venous access before performing a block, and more than 90% monitor patients with minimum peripheral pulse oximetry.
The majority monitor patients for a minimum of 30 minutes after the injection of local anesthetic (LA). Ultrasound-guided technique for RA is used by 89% of respondents. Neurostimulation is totally abandoned by 20% of them. Monitoring of injection pressures is performed by 21% of respondents. More than 50% of respondents use sterile gloves, surgical drapes and a mask. With regards to the solution of LA used, 52% of respondents never mix LAs. An adjuvant is always used by 15% of the respondents while 10% of them never use them.
Conclusions : This survey suggests that the practice of PNBs in Belgium is in line with the current international guidelines. This survey can serve as a benchmark for future evaluation and comparison between RA techniques. These observations should be taken into account for the implementation of national guidelines and therefore for the improvement of safety in the practice of PNBs.
Collapse
|
45
|
Braz LG, Braz MG, Tiradentes TAA, Braz JRC. A correlation between anaesthesia-related cardiac arrest outcomes and country human development index: A narrative review. J Clin Anesth 2021; 72:110273. [PMID: 33957413 DOI: 10.1016/j.jclinane.2021.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Studies have demonstrated gaps between developed and developing countries in the quality of surgical and anaesthesia care. The aim of this review was to provide a critical overview of documented outcomes from the 2010s of anaesthesia-related cardiac arrest events in countries with largely differing Human Development Indexes (HDIs). The HDI ranges from 0 to 1, representing the lowest and highest levels of development, respectively. Most related studies conducted between 2011 and 2020 showed low rates (from 0 to 215 per million anaesthetics) of anaesthesia-related mortality up to the 30th postoperative day in very high-HDI countries (HDI ≥ 0.800) and higher rates (from 0 to 915.4 per million anaesthetics) in high-HDI countries (HDI: 0.700-0.799). Low-HDI countries (HDI < 0.550) showed higher anaesthesia-related mortality rates, which were greater than 1500 per million anaesthetics. The anaesthesia-related mortality rates per quartile demonstrated a gap in the anaesthesia-related safety between very high- and high-HDI countries, and especially between very high- and low-HDI countries. Anaesthesia-related cardiac arrest showed similarly high survival proportions in very high-HDI countries (45.9% to 100%) and high-HDI countries (62.9% to 100%), while in a low-HDI country, the anaesthesia-related cardiac arrest survival was lower (22.2%). Our review demonstrates large gaps among countries with largely differing HDIs regarding anaesthesia-related cardiac arrest outcomes in the last decade. This finding highlights the need to improve patient safety care in low-HDI countries. Anaesthesia patient safety has improved in high-HDI countries, but there is still a persistent gap in the health care systems of these countries and those of very high-HDI countries. Our review also found a consistent improvement in anaesthesia patient safety in very high-HDI countries.
Collapse
Affiliation(s)
- Leandro G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Mariana G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teófilo Augusto A Tiradentes
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - José Reinaldo C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| |
Collapse
|
46
|
The evolution of a national, advanced airway management simulation-based course for anaesthesia trainees. Eur J Anaesthesiol 2021; 38:138-145. [PMID: 32675701 DOI: 10.1097/eja.0000000000001268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Needs analyses involving patient complaints and anaesthesiologists' confidence levels in difficult airway management procedures in Denmark have shown a need for training in both technical and non-technical skills. OBJECTIVE To provide an example of how to design, implement and evaluate a national simulation-based course in advanced airway management for trainees within a compulsory, national specialist training programme. DESIGN AND RESULTS A national working group, established by the Danish Society for Anaesthesiology and Intensive Care Medicine, designed a standardised simulation course in advanced airway management for anaesthesiology trainees based on the six-step approach. Learning objectives are grounded in the curriculum and analyses-of-needs (in terms of knowledge, skills and attitudes, including non-technical skills, which encompass the cognitive skills and social skills, necessary for safe and effective performance). A total of 28 courses for 800 trainees have been conducted. Evaluation has been positive and pre and posttests have indicated a positive effect on learning. CONCLUSION The course was successfully designed and implemented within the national training programme for trainees. Important factors for success were involvement of all stakeholders, thorough planning, selection of the most important learning objectives, the use of interactive educational methods and training of the facilitators.
Collapse
|
47
|
European minimum standards for obstetric analgesia and anaesthesia departments: An experts' consensus. Eur J Anaesthesiol 2021; 37:1115-1125. [PMID: 33074944 DOI: 10.1097/eja.0000000000001362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: An important variability of anaesthetic standards of care was discovered in the obstetric departments of many European Union countries. After discussing this issue in various meetings of the European Society of Anaesthesiology (ESA) board and its obstetric subcommittee, European Board of Anaesthesiology of the European Union of Medical Specialists (EBA-UEMS) executive members, ESA obstetric subcommittee members and European experts in obstetric anaesthesiology have participated in the elaboration of this document. This experts' opinion is focused mainly on obstetric patients and safety concerns in terms of minimum standards of practice. An initial bibliographical search was performed in medical databases and general literature, searching for obstetric anaesthesiology standards to select the most important safety issues. After the initial presentation of the project during EBA-UEMS and ESA obstetric subcommittee meetings, participants were asked to review the document; several rounds of revisions were performed by the experts, to reach a common opinion concerning the topics considered central to patient safety in the obstetric setting. After three rounds of revision, a consensus was reached and is presented in this document, which includes the list of topics considered relevant by the involved areas, and the respective recommendations. These recommendations covered some EBA-UEMS strategic key areas, in addition to several clinical aspects of common obstetric practice.
Collapse
|
48
|
[An analysis of medication errors in patients admitted to surgery rooms and post-anesthetic recovery at a high-complexity hospital in Bogota, Colombia]. Salud Colect 2021; 17:e3155. [PMID: 34105334 DOI: 10.18294/sc.2021.3155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Medication errors represent one of the main causes of incidents and adverse events during the perioperative period. Therefore, this study analyzes errors before, during, and after the administration of general anesthesia for abdominal surgery at a high-complexity hospital in Bogota, Colombia. A descriptive cross-sectional study was conducted with 390 patients between January and September 2019. Of the 3,677 medication administrations, some type of error was made in 60% of cases, mostly in emergency surgeries. The pharmacological group with the most errors was general anesthetics, with 32%. All identified errors constituted situations with harm potential, indicating the need to promote the standardization of activities involving the use of medications and a culture of healthcare safety in order to avoid adverse events.
Collapse
|
49
|
Lonnée HA, Isern ER, Mellin-Olsen J. Pulse oximetry-To bleep or not to bleep? Acta Anaesthesiol Scand 2021; 65:566-567. [PMID: 33326596 DOI: 10.1111/aas.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Herman A Lonnée
- Department of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim, Norway
| | - Erik R Isern
- Department of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim, Norway
| | | |
Collapse
|
50
|
Preckel B. Safety and quality in perioperative anaesthesia care. Best Pract Res Clin Anaesthesiol 2021; 35:1-2. [PMID: 33742569 DOI: 10.1016/j.bpa.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Benedikt Preckel
- Department of Anesthesiology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| |
Collapse
|