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    672 results match your criteria Anesthesiology Clinics[Journal]

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    Integrating Academic and Private Practices: Challenges and Opportunities.
    Anesthesiol Clin 2018 Jun 9;36(2):321-332. Epub 2018 Apr 9.
    Department of Anesthesiology and Perioperative Medicine, UCLA Health, 757 Westwood Plaza, Suite 2331-L, Los Angeles, CA 90095-7403, USA. Electronic address:
    As health care reform shifts toward value over volume, academic medical centers, known for highly specialized, high-cost care, will suffer from erosion of their traditional funding sources. Academic medical centers have undertaken mergers and partnerships with community medical centers, to maintain a more diversified, cost-effective, and competitive presence in their markets. These consolidations have seen varying results. Read More

    Anesthesiology's Future with Specialists in Population Health.
    Anesthesiol Clin 2018 Jun 9;36(2):309-320. Epub 2018 Apr 9.
    Population Health, Premier Inc, PSH Learning Collaborative, Clearwater, FL, USA. Electronic address:
    In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments. Read More

    Comprehensive Acute Pain Management in the Perioperative Surgical Home.
    Anesthesiol Clin 2018 Jun 7;36(2):295-307. Epub 2018 Apr 7.
    Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA. Electronic address:
    The careful coordination of care throughout the perioperative continuum offered by the perioperative surgical home (PSH) is important in the treatment of postoperative pain. Physician anesthesiologists have expertise in acute pain management, pharmacology, and regional and neuraxial anesthetic techniques, making them ideal leaders for managing perioperative analgesia within the PSH. Severe postoperative pain is one of many patient- and surgery-specific factors in the development of chronic postsurgical pain. Read More

    Perioperative Surgical Home for the Patient with Chronic Pain.
    Anesthesiol Clin 2018 Jun 9;36(2):281-294. Epub 2018 Apr 9.
    Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA.
    The management of acute pain for the phenotypically different patient who suffers from chronic pain is challenging. The care of these patients is expensive and siloed. The physician-led, multidisciplinary, patient-centric, care coordination framework of the perioperative surgical home is an optimal vehicle for the management of these patients. Read More

    Comprehensive Preoperative Assessment and Global Optimization.
    Anesthesiol Clin 2018 Jun;36(2):259-280
    Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School, The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA. Electronic address:
    To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery. Read More

    Bundled Payments and Hidden Costs.
    Anesthesiol Clin 2018 Jun 9;36(2):241-258. Epub 2018 Apr 9.
    American Society of Anesthesiologists, Inc, 905 16th Street, Northwest, Suite 400, Washington, DC 20006, USA.
    In a fee-for-service environment, anesthesiologists are paid for the volume of services billed, with little relation to the cost of delivering the services. In bundled payments, anesthesiologists are paid a set fee for an episode of care inclusive of all the anesthesia, pain medicine, and related services for the surgical episode and a period of time after the initial procedure to cover complications and redo procedures. When calculating a bundled payment, all the services typically used by a patient must be counted when calculating both the costs and expected payment. Read More

    Value Proposition and Anesthesiology.
    Anesthesiol Clin 2018 Jun 9;36(2):227-239. Epub 2018 Apr 9.
    Chamberlin Health Care Consulting Group, 540 San Pedro Cove, San Rafael, CA 94901, USA.
    Health care in general and anesthesia in particular have seen dramatic changes in the economic landscape. It is vital if anesthesia groups wish to survive and prosper in this new environment to understand the changes occurring in health care and be flexible and proactive in taking on these challenges. More than ever anesthesia groups must be good corporate citizens and seek ways in which to enhance their value to the organization, whether in the operating room or out of operating room locations, and be a proactive partner with the hospital. Read More

    Quality and the Health System: Becoming a High Reliability Organization.
    Anesthesiol Clin 2018 Jun 7;36(2):217-226. Epub 2018 Apr 7.
    Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Institute for Patient Safety, 3500 Camp Bowie Boulevard, EAD 402, Fort Worth, TX 76107, USA.
    Since the publication of "To Err is Human" in 1999, substantial efforts have been made within the health care industry to improve quality and patient safety. Although improvements have been made, recent estimates continue to indicate the need for a marked change in approach. In this article, the authors discuss the concepts and characteristics of high reliability organizations, safety culture, and clinical microsystems. Read More

    Quality Reporting: Understanding National Priorities, Identifying Local Applicability.
    Anesthesiol Clin 2018 Jun;36(2):201-216
    American Society of Anesthesiologists, 905 16th Street Northwest, Suite 400, Washington, DC 20006, USA. Electronic address:
    Since the 1990s, the use of quality measures in healthcare has grown exponentially. Practices must maintain current knowledge of measures that affect their clinicians locally and understand how assessment of these medical professionals affects the priorities and quality activities of practices and facilities. Because quality measures are increasingly used by hospital administrators, health plans, and payers, practices are being asked to shoulder the additional burdens of collecting and reporting data to various entities. Read More

    Challenges in Outcome Reporting.
    Anesthesiol Clin 2018 Jun 9;36(2):191-199. Epub 2018 Apr 9.
    Department of Anesthesia and Critical Care, University of Chicago, 5841 South Maryland Avenue MC 4028, Chicago, IL 60637, USA. Electronic address:
    Although measuring outcomes is an integral part of medical quality improvement, large-scale outcome reporting efforts face several challenges. Among these are difficulties in establishing consensus definitions for outcome measurement; classifying gray outcomes, such as postoperative respiratory failure; and adequately adjusting for patient comorbidities and severity of illness. Unintended consequences of outcome reporting can also distort care in undesirable ways, and clinician reluctance to care for high-risk patients may occur with reporting programs. Read More

    Measuring Quality for Individual Anesthesia Clinicians.
    Anesthesiol Clin 2018 Jun 9;36(2):177-189. Epub 2018 Apr 9.
    Department of Anesthesiology and Peri-operative Medicine, Spectrum Healthcare Partners, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
    A robust quality management system (QMS) will provide value to patients, providers, and hospitals or systems by focusing on system performance. The QMS must remain independent of provider-specific measures used for privileging. Some outcome measures may be used to assess system performance; they must not be used to assess individual provider performance. Read More

    Overlapping Surgery: A Case Study in Operating Room Throughput and Efficiency.
    Anesthesiol Clin 2018 Jun;36(2):161-176
    Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA.
    A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. Read More

    Measuring Clinical Productivity.
    Anesthesiol Clin 2018 Jun 9;36(2):143-160. Epub 2018 Apr 9.
    Department of Anesthesiology, University of Pittsburgh Medical Center, Kaufman Medical Building, Suite 910, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
    Productivity measurements have been used to evaluate and compare physicians and physician practices. Anesthesiology is unique in that factors outside anesthesiologist control impact opportunity for revenue generation and make comparisons between providers and facilities challenging. This article uses data from the multicenter University of Pittsburgh Physicians Department of Anesthesiology to demonstrate factors influencing productivity opportunity by surgical facility, between department divisions and subspecialties within multispecialty divisions, and by individuals within divisions. Read More

    Rethinking Clinical Workflow.
    Anesthesiol Clin 2018 Mar;36(1):99-116
    VA Tennessee Valley Healthcare System, 1310 24th Avenue S, Nashville, TN 37212, USA.
    The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Read More

    Handovers in Perioperative Care.
    Anesthesiol Clin 2018 Mar;36(1):87-98
    Department of Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 3115, Nashville, TN 37232, USA.
    Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication. Read More

    Developing Multicenter Registries to Advance Quality Science.
    Anesthesiol Clin 2018 Mar;36(1):75-86
    Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Main Building, 9th Floor, Suite 9329, Philadelphia, PA 19104, USA.
    There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. Read More

    Use of Simulation in Performance Improvement.
    Anesthesiol Clin 2018 Mar;36(1):63-74
    Cooper Medical School of Rowan University, 401 South Broadway Camden, NJ 08103, USA.
    Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. Read More

    Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.
    Anesthesiol Clin 2018 Mar;36(1):45-62
    Department of Experimental Psychology, University of Oxford, Tinbergen Building, 9 South Parks Road, Oxford OX1 3UD, UK.
    How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care. Read More

    Quality Improvement in Anesthesiology - Leveraging Data and Analytics to Optimize Outcomes.
    Anesthesiol Clin 2018 Mar;36(1):31-44
    Department of Anesthesiology and Critical Care, The Perelman School of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
    Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Read More

    Human Factors Applied to Perioperative Process Improvement.
    Anesthesiol Clin 2018 Mar;36(1):17-29
    Department of Anesthesiology, Florida Hospital, Winter Park, FL, USA; US Anesthesia Partners-Florida, Fort Lauderdale, FL, USA; Florida Hospital, Orlando, FL, USA.
    This article discusses some of the major theories of the science of human factors/ergonomics (HF/E) in relation to perioperative medicine, with a focus on safety and errors within these systems. The discussion begins with human limitations based in cognition, decision making, stress, and fatigue. Given these limitations, the importance of measuring human performance is discussed. Read More

    Diffusing Innovation and Best Practice in Health Care.
    Anesthesiol Clin 2018 Mar;36(1):127-141
    Office of the Executive Vice President for Health System Affairs, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
    Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Read More

    Developing Capacity to Do Improvement Science Work.
    Anesthesiol Clin 2018 Mar;36(1):117-126
    Anesthesiology, Mount Sinai Health Centre, University of Toronto, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
    Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Read More

    Implementation Science in Perioperative Care.
    Anesthesiol Clin 2018 Mar;36(1):1-15
    Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 3015, Philadelphia, PA 19104, USA.
    There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. Read More

    Value-Based Care and Strategic Priorities.
    Anesthesiol Clin 2017 Dec;35(4):725-731
    Anesthesiology, Anesthesiology Administration, University of Minnesota Health, MMC 294 Mayo, 8294A (Campus Delivery Code), 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
    The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Read More

    Market Evaluation: Finances, Bundled Payments, and Accountable Care Organizations.
    Anesthesiol Clin 2017 Dec;35(4):715-724
    Division of Gastroenterology, Perelman School of Medicine, 3400 Civic Center Boulevard-14th Floor Innovation Center, Philadelphia, PA 19104, USA.
    To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act. Read More

    Pediatric Anesthesia Considerations for Interventional Radiology.
    Anesthesiol Clin 2017 Dec;35(4):701-714
    Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, The University of Pennsylvania, The Children's Hospital of Philadelphia, 9th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address:
    Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan. Read More

    Interventional Pulmonology.
    Anesthesiol Clin 2017 Dec;35(4):687-699
    Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, 7th Floor Ravdin Building, Philadelphia, PA 19104, USA.
    Bronchoscopy presents a unique challenge and need for collaboration between anesthesia providers and bronchoscopists. The approach to topical anesthesia, analgesia, and sedation must be customized based on complexity, duration, and setting. The bronchoscopy team must work together in each phase of the procedure to ensure patient safety and allow completion of a quality bronchoscopy. Read More

    Anesthesia for Colonoscopy and Lower Endoscopic Procedures.
    Anesthesiol Clin 2017 Dec;35(4):679-686
    Gastroenterology Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
    Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. Read More

    Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures.
    Anesthesiol Clin 2017 Dec;35(4):669-677
    Gastroenterology Division, University of Pennsylvania, Perelman School of Medicine, Penn Medicine, Abramson Cancer Center, Perelman Center for Advanced Medicine, South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address:
    This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. Read More

    Cardioversions and Transthoracic Echocardiography.
    Anesthesiol Clin 2017 Dec;35(4):655-667
    Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
    Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Read More

    Anesthesia in the Electrophysiology Laboratory.
    Anesthesiol Clin 2017 Dec;35(4):641-654
    Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
    The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. Read More

    Catheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement.
    Anesthesiol Clin 2017 Dec;35(4):627-639
    Adult Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address:
    The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. Read More

    A Radiologist's View of Tumor Ablation in the Radiology Suite.
    Anesthesiol Clin 2017 Dec;35(4):617-626
    Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
    Image-guided percutaneous, minimally invasive ablation techniques offer a wide variety of new modalities to treat tumors in some of the most medically complicated patients coming to our hospitals. The use of computed tomography, PET, ultrasound imaging, and MRI to guide radiofrequency ablation, microwave ablation, and cryoablation techniques now makes it possible to treat patients on a short stay or outpatient basis with very good immediate outcomes. This rapid expansion of new tumor ablation techniques often presents challenges for the non-operating room anesthesia team. Read More

    An Anesthesiologist's View of Tumor Ablation in the Radiology Suite.
    Anesthesiol Clin 2017 Dec;35(4):611-615
    Department of Anesthesiology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
    The advent of radiology image-guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. What traditionally was done in an operating room via large open incisions, with multiple days in the hospital recovering, is now becoming an outpatient procedure via these new techniques. Read More

    Use of Anesthesiology Services in Radiology.
    Anesthesiol Clin 2017 Dec;35(4):601-610
    Morton Hospital, Taunton, MA, USA.
    In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non-operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome. Read More

    Monitoring for Nonoperating Room Anesthesia.
    Anesthesiol Clin 2017 Dec;35(4):591-599
    Anesthesiology, Division of Pediatric Anesthesiology, Pediatric Intensive Care Unit, Children's Hospital of Wisconsin, MCW, Milwaukee, WI, USA; Pediatrics, Division of Pediatric Critical Care, Pediatric Intensive Care Unit, Children's Hospital of Wisconsin, MCW, Milwaukee, WI, USA. Electronic address:
    Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Read More

    Implementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.
    Anesthesiol Clin 2017 Dec;35(4):583-590
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Perioperative Research, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address:
    Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Read More

    Safety of Non-Operating Room Anesthesia: A Closed Claims Update.
    Anesthesiol Clin 2017 Dec;35(4):569-581
    Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356540, Seattle, WA 98195, USA.
    Malpractice claims for non-operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Read More

    Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence.
    Anesthesiol Clin 2017 Dec;35(4):559-568
    Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6th Floor Dulles Building, Philadelphia, PA 19104, USA. Electronic address:
    Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. Read More

    Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology: Interdisciplinary Teamwork and Strategy.
    Anesthesiol Clin 2017 Dec;35(4):555-558
    Department of Anesthesiology, University of Tennessee College of Medicine, UTHSC/Regional One Health, Chandler Building, Suite 600, 877 Jefferson Avenue, Memphis, TN 38103, USA.
    Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested. Read More

    Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery.
    Anesthesiol Clin 2017 Sep 5;35(3):539-553. Epub 2017 Jul 5.
    Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, IL 60611, USA.
    As solid organ transplantation increases and patient survival improves, it will become more common for these patients to present for nontransplant surgery. Recipients may present with medical problems unique to the transplant, and important considerations are necessary to keep the transplanted organ functioning. A comprehensive preoperative examination with specific focus on graft functioning is required, and the anesthesiologist needs pay close attention to considerations of immunosuppressive regimens, blood product administration, and the risk benefits of invasive monitoring in these immunosuppressed patients. Read More

    Anesthesia and Perioperative Care in Reconstructive Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):523-538. Epub 2017 Jul 5.
    Departments of Surgery, Ophthalmology and Bioengineering, US Air Force, Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Richard H. Dean Biomedical Building, 391 Technology Way, Winston Salem, NC 27101, USA. Electronic address:
    Reconstructive transplantation of vascularized composite allografts (VCAs), such as upper extremity, craniofacial, abdominal, lower extremity, or genitourinary transplants, has emerged as a cutting-edge specialty, with more than 50 programs in the United States and 30 programs across the world performing these procedures. Most VCAs involve complicated technical planning and preparation, protracted surgery, and complex immunosuppressive or immunomodulatory protocols, each associated with unique anesthesiology challenges. This article outlines key procedural, patient, and protocol-related aspects of VCA relevant to anesthesiology management with the goal of ensuring patient safety and optimizing surgical, immunologic, and functional outcomes. Read More

    Anesthesia for Intestinal Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):509-521. Epub 2017 Jul 5.
    Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
    The diagnosis of irreversible intestinal failure confers significant morbidity, mortality, and decreased quality of life. Patients with irreversible intestinal failure may be treated with intestinal transplantation. Intestinal transplantation may include intestine only, liver-intestine, or other visceral elements. Read More

    Anesthesia for Liver Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):491-508. Epub 2017 Jul 10.
    Department of Anesthesiology, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA. Electronic address:
    The provision of anesthesia for a liver transplant program requires a dedicated team of anesthesiologists. Liver transplant anesthesiologists must have an understanding of liver physiology and anatomy; the spectrum of clinical disease associated with liver dysfunction; the impact of warm and cold ischemia times, surgical techniques in liver transplantation, and the impact of ischemia-reperfusion syndrome; and optimal practices to protect the liver. The team must provide a 24-hour service, be actively involved in the selection committee process, and stay current with advances in the subspecialty. Read More

    Anesthesia for Lung Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):473-489. Epub 2017 Jul 5.
    Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine, University of California, 757 Westwood Boulevard, Suite 3325, Los Angeles, CA 90095, USA.
    Perioperative management of patients undergoing lung transplantation is challenging and requires constant communication among the surgical, anesthesia, perfusion, and nursing teams. Although all aspects of anesthetic management are important, certain intraoperative strategies (mechanical ventilation, fluid management, extracorporeal mechanical support deployment) have tremendous impact on the subsequent evolution of the lung transplant recipient, especially with respect to allograft function, and should be carefully considered. This review highlights some of the intraoperative anesthetic challenges and opportunities during lung transplantation. Read More

    Anesthesia for Heart Transplantation.
    Anesthesiol Clin 2017 Sep 5;35(3):453-471. Epub 2017 Jul 5.
    Department of Anesthesiology, Loma Linda Medical Center, 11234 Anderson Street, MC-2532-D, Loma Linda, CA 92354, USA.
    This article seeks to evaluate current practices in heart transplantation. The goals of this article were to review current practices for heart transplantation and its anesthesia management. The article reviews current demographics and discusses the current criteria for candidacy for heart transplantation. Read More

    Anesthesia for Kidney and Pancreas Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):439-452. Epub 2017 Jul 10.
    Department of Anesthesiology, Columbia University Medical Center, College of Physicians & Surgeons, Columbia University, PH 527-B, 630 West 168th Street, New York, NY 10032, USA. Electronic address:
    Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Read More

    Anesthetic Management of Pediatric Liver and Kidney Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):421-438. Epub 2017 Jul 10.
    Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, 225 East Chicago Avenue, Box 19, Chicago, IL 60611-2605, USA.
    Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Read More

    Transfusion Medicine and Coagulation Management in Organ Transplantation.
    Anesthesiol Clin 2017 Sep 10;35(3):407-420. Epub 2017 Jul 10.
    Department of Anesthesiology and Pain Management, William P. Clements University Hospital, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9202, Dallas, TX 75390, USA. Electronic address:
    Organ transplantation recipients present unusual challenges with regard to blood transfusion. Although this patient population requires a larger proportion of blood product resources, liberal transfusion of allogeneic blood products can lead to a plethora of complications. Recent trends suggest that efforts to minimize bleeding, conserve products, and target transfusion to specific deficits and needs are increasingly becoming the standard practice; these must all occur with optimization of graft function and preservation in mind. Read More

    Anesthesia Management of Organ Donors.
    Anesthesiol Clin 2017 Sep 5;35(3):395-406. Epub 2017 Jul 5.
    Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Anesthesiology, Greater Los Angeles VA Hospital, Los Angeles, CA, USA.
    The shortage of suitable organs is the biggest obstacle for transplants. At present, most organs for transplant in the United States are from donation after neurologic determination of death (brain death). Potential organs for transplant need to maintain their viability during a series of insults, including the original disease, physiologic derangements during the dying process, ischemia, and reperfusion. Read More

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