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    160 results match your criteria Perioperative Management of the Female Patient

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    In-Patient Code Stroke: A Quality Improvement Strategy to Overcome Knowledge-to-Action Gaps in Response Time.
    Stroke 2017 Aug 27;48(8):2176-2183. Epub 2017 Jun 27.
    From the Division of Neurology, Department of Medicine (C.D.K., J.D.W., K.S., P.K., D.S., G.S.) and Applied Health Research Centre, Li Ka Shing Knowledge Institute (R.N.), St. Michael's Hospital, Toronto, Ontario, Canada; Division of Neurology (C.D.K., D.S., G.S.) and Dalla Lana School of Public Health (R.N.), University of Toronto, Ontario, Canada; and Ryerson University, Toronto, Ontario, Canada (J.B.).
    Background And Purpose: Stroke is a relatively common and challenging condition in hospitalized patients. Previous studies have shown delays in recognition and assessment of inpatient strokes leading to poor outcomes. The goal of this quality improvement initiative was to evaluate an in-hospital code stroke algorithm and educational program aimed at reducing the response times for inpatient stroke. Read More

    Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry.
    Anesthesiology 2017 Sep;127(3):432-440
    From the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (N.E.B., N.J.); Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.N., J.E.F., K.N.P.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida (H.D.A.); Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio (V.T.R.); Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health System of Texas, Dallas, Texas (P.N.O.); and Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts (P.G.K.). Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health System of Texas, Dallas, Texas Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi Department of Anesthesiology, Duke University, Durham, North Carolina Department of Anesthesiology and Pain Management, Children's Hospital of Cleveland Clinic, Cleveland, Ohio Department of Anesthesia, Critical Care and Pain, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico Department of Anesthesiology, Weill Cornell Medical College, New York, New York Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Department of Anesthesiology, National Institute of Pediatrics, Mexico City, Mexico Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts.
    Background: The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. Read More

    Perioperative Surgical Home: Evaluation of a New Protocol Focused on a Multidisciplinary Approach to Manage Children Undergoing Posterior Spinal Fusion Operation.
    Anesth Analg 2017 Sep;125(3):812-819
    From the Department of Anesthesiology Critical Care Medicine-Pain Service, Children's Hospital Los Angeles, Los Angeles, California.
    Background: The concept of Perioperative Surgical Home has been gaining significant attention in surgical centers. This model is delivering and improving coordinated care in a cost-effective manner to patients undergoing surgical procedures. It starts with the decision for surgical intervention, continues to the intraoperative and postoperative periods, and follows into long-term recovery. Read More

    Costs and Length of Stay for the Acute Care of Patients with Motor-Complete Spinal Cord Injury Following Cervical Trauma: The Impact of Early Transfer to Specialized Acute SCI Center.
    Am J Phys Med Rehabil 2017 Jul;96(7):449-456
    From the Hôpital du Sacré-Coeur (AR-D, CT, J-MM-T); Faculty of Medicine, University of Montreal (AR-D, DEF, ÉB-M, J-MM-T); Hôpital Sainte-Justine (J-MM-T), Montréal; and Centre for Interdisciplinary Research in Rehabilitation, Québec (DEF), Québec, Canada.
    Objective: Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center. Read More

    Perioperative Low Arterial Oxygenation Is Associated With Increased Stroke Risk in Cardiac Surgery.
    Anesth Analg 2017 Jul;125(1):38-43
    From the Departments of *Surgery, †Neurology, ‡Anesthesiology, and §Cardiac Surgery, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
    Background: Both patient characteristics and intraoperative factors have been associated with a higher risk of stroke after cardiac surgery. We hypothesized that poor systemic oxygenation in the perioperative period is associated with increased risk of stroke following cardiopulmonary bypass.

    Methods: In this study of 251 adult patients who underwent cardiopulmonary bypass procedures at a single center from 2003 to 2006, cases (patients with a postoperative stroke at least 24 hours after surgery) were matched 1:2 to controls without stroke. Read More

    Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data.
    Anesth Analg 2017 Aug;125(2):507-513
    From the *Division of General Internal Medicine, School of Medicine, University of California, San Francisco, California; †Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California; ‡Department of Quality, Sepsis Program, University of California, San Francisco, California; and §Department of Anesthesia and Perioperative Care, School of Medicine, University of California, San Francisco, California.
    Background: Sepsis is a systemic response to infection that can lead to tissue damage, organ failure, and death. Efforts have been made to develop evidence-based intervention bundles to identify and manage sepsis early in the course of the disease to decrease sepsis-related morbidity and mortality. We evaluated the relationship between a minimally invasive sepsis intervention bundle and in-hospital mortality using robust methods for observational data. Read More

    Preoperative Low-Dose Aspirin Exposure and Outcomes After Emergency Neurosurgery for Traumatic Intracranial Hemorrhage in Elderly Patients.
    Anesth Analg 2017 Aug;125(2):514-520
    From the *Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; †Anesthesiology Division, VA Puget Sound Health System, Seattle, Washington; ‡College of Arts and Sciences, University of Washington, Seattle, Washington; §Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand; ‖Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington; ¶Department of Anesthesiology, University of Alabama, Birmingham, Alabama; #Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington; and **Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
    Background: Antiplatelet medications are usually discontinued before elective neurosurgery, but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients.

    Methods: We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center. Read More

    A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients.
    Anesth Analg 2017 Aug;125(2):477-482
    From the *Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; and †Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon.
    Introduction: Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process may reduce the rate of communication errors and perioperative complications. Read More

    The Emergency Surgery Score (ESS) accurately predicts the occurrence of postoperative complications in emergency surgery patients.
    J Trauma Acute Care Surg 2017 Jul;83(1):84-89
    From the Division of Trauma, Emergency Surgery and Surgical Critical Care (A.R.N., J.D.B., N.F.S., T.P., K.H., D.D.Y., J.L., M.D.M., G.C.V., D.C.C., H.M.A.K.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and Codman Center for Clinical Effectiveness in Surgery (D.C.C., H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts.
    Background: The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoperative complications in ES.

    Methods: The 2011-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was screened for all surgical operations classified as "emergent. Read More

    Case Report of a Patient With Idiopathic Hypersomnia and a Family History of Malignant Hyperthermia Undergoing General Anesthesia: An Overview of the Anesthetic Considerations.
    A A Case Rep 2017 May;8(9):238-241
    From the *Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; †Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ‡Toronto Sleep and Pulmonary Centre, Toronto, Ontario, Canada; and §Women's College Hospital, Toronto, Ontario, Canada.
    The pathophysiologic underpinnings of idiopathic hypersomnia and its interactions with anesthetic medications remain poorly understood. There is a scarcity of literature describing this patient population in the surgical setting. This case report outlines the anesthetic considerations and management plan for a 55-year-old female patient with a known history of idiopathic hypersomnia undergoing an elective shoulder arthroscopy in the ambulatory setting. Read More

    A Contemporary Medicolegal Analysis of Implanted Devices for Chronic Pain Management.
    Anesth Analg 2017 Apr;124(4):1304-1310
    From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and †CRICO Strategies, Boston, Massachusetts.
    Background: Analysis of closed malpractice claims allows the study of rare but serious complications and likely results in improved patient safety by raising awareness of such complications. Clinical studies and closed claims analyses have previously reported on the common complications associated with intrathecal drug delivery systems (IDDS) and spinal cord stimulators (SCS). This study provides a contemporary analysis of claims from within the past 10 years. Read More

    Process Improvement Initiative for the Perioperative Management of Patients With a Cardiovascular Implantable Electronic Device.
    Anesth Analg 2017 Jul;125(1):58-65
    From the *Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon; †Operative Care Division, Veterans Affairs Portland Healthcare System, Portland, Oregon; ‡STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts; §Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas; ‖Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon; and ¶Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
    Background: Economic, personnel, and procedural challenges often complicate and interfere with efficient and safe perioperative care of patients with cardiovascular implantable electronic devices (CIEDs). In the context of a process improvement initiative, we created and implemented a comprehensive anesthesiologist-run perioperative CIED service to respond to all routine requests for perioperative CIED consultations at a large academic medical center. This study was designed to determine whether this new care model was associated with improved operating room efficiency, reduced institutional cost, and adequate patient safety. Read More

    A Perioperative Smoking Cessation Intervention With Varenicline, Counseling, and Fax Referral to a Telephone Quitline Versus a Brief Intervention: A Randomized Controlled Trial.
    Anesth Analg 2017 Aug;125(2):571-579
    From the *Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada; †Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Ontario, Canada; ‡Department of Pharmacy, Mount Sinai Hospital, Toronto, Ontario, Canada; §Departments of Family and Community Medicine and Psychiatry, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; and ‖Addictions Program and Ontario Tobacco Research Unit, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada.
    Background: The effectiveness of perioperative interventions to quit smoking with varenicline has not been compared with brief interventions. Our objective was to determine the efficacy of a comprehensive smoking cessation program versus a brief intervention for smoking cessation.

    Methods: In this prospective, multicenter study, 296 patients were randomized to participate in a smoking cessation program (one 10- to 15-minute counseling session, pharmacotherapy with varenicline, an educational pamphlet, and a fax referral to a telephone quitline); or brief advice and self-referral to a telephone quitline. Read More

    Case Report of Serratus Plane Catheter for Pain Management in a Patient With Multiple Rib Fractures and an Inferior Scapular Fracture.
    A A Case Rep 2017 Mar;8(6):132-135
    From the *Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York; †Department of Anesthesiology, Divisions of Pain Medicine and Critical Care, Columbia University Medical Center, New York, New York; and ‡Staff Anesthesiologist at Kaiser Permanente in San Francisco, California; Clinical Instructor in Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, California.
    We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Read More

    Patient-Centered Anesthesia Triage System Predicts ASA Physical Status.
    Anesth Analg 2017 Jun;124(6):1957-1962
    From the *Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida; †Division of Hospital Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida; and ‡University of Florida College of Medicine, Gainesville, Florida.
    Background: The purpose of this study was to validate a patient-centered anesthesia triage system (PCATS) by examining its association with, and predictive value of, ASA physical status (PS) classification. ASA PS classification is a widely used indicator of health status and the predictor of risk of perioperative complications. Thus, ASA PS is a good triage point such that healthy surgical patients (ASA PS I and II) undergoing low-complexity surgery are assessed by telephone, whereas less-healthy patients (ASA PS III and IV) or those patients undergoing highly complex surgery are seen in person at a presurgical clinic. Read More

    Anesthetic Management of a Patient With Multiple Previous Episodes of Postanesthesia Care Unit Delirium: A Case Report.
    A A Case Rep 2017 Jun;8(12):311-315
    From the *Department of Anesthesiology, Emory University, Atlanta, Georgia; †Department of Anesthesiology & Perioperative Care, University of California, Irvine, California; and ‡Department of Anesthesiology, Atlanta VA Medical Center, Decatur, Georgia.
    We report the case of a 37-year-old female patient who required 22 surgeries following a pedestrian versus car accident. She was enrolled in a clinical study investigating emergence from anesthesia. In 10 of her 22 surgeries, we assessed her cognitive status in the postanesthesia care unit (PACU) using the Confusion Assessment Method. Read More

    Intermediate-Acting Nondepolarizing Neuromuscular Blocking Agents and Risk of Postoperative 30-Day Morbidity and Mortality, and Long-term Survival.
    Anesth Analg 2017 May;124(5):1476-1483
    From the *Adult and Child Consortium for Health Outcomes Research and Delivery Science; †Surgical Outcomes and Applied Research; ‡Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, Colorado; §Department of Anesthesiology and Perioperative Medicine, University of Missouri, Columbia, Missouri; ‖Department of Anesthesiology, Durham VA Medical Center, Durham, North Carolina; ¶Department of Surgery, University of Alabama Birmingham, Birmingham VA Medical Center, Birmingham, Alabama; #Department of Anesthesiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas; **Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, VA North Texas Health Care System, Dallas, Texas; ††Department of Anesthesiology, University of Pittsburgh School of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and ‡‡Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
    Background: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality. Read More

    Association Between Anesthesiology Volumes and Early and Late Outcomes After Cystectomy for Bladder Cancer: A Population-Based Study.
    Anesth Analg 2017 Jul;125(1):147-155
    From the Departments of *Anesthesiology and Perioperative Medicine; †Urology; ‡Oncology; §Division of Cancer Care and Epidemiology; and ‖Public Health Sciences, Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
    Background: Hospital and surgeon volume are related to postoperative complications and long-term survival after radical cystectomy. Here, we describe the relationships between these provider characteristics and anesthesiologist volumes on early and late outcomes after radical cystectomy for bladder cancer.

    Methods: Records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients with radical cystectomy in Ontario during 1994 to 2008. Read More

    Necrotizing Soft Tissue Infection or Sweet Syndrome: Surgery Versus No Surgery?: A Case Report.
    A A Case Rep 2017 Apr;8(7):182-185
    From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; ‡Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts; §Tufts University School of Medicine, Boston, Massachusetts; ‖Harvard Medical School, Boston, Massachusetts.
    The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle-findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Read More

    A Case Report: Establishing a Definitive Airway in a Trauma Patient With a King Laryngeal Tube In Situ in the Presence of a Closed Head Injury and Difficult Airway: "Between the Devil and the Deep Blue Sea".
    A A Case Rep 2017 Mar;8(6):139-141
    From the *Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada; and †Department of Otolaryngology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.
    Airway management in trauma is a crucial skill, because patients are at risk of aspiration, hypoxia, and hypoventilation, all of which may be fatal in the setting of increased intracranial pressure. The King Laryngeal Tube reusable supraglottic airway (King Systems, Noblesville, IN) allows for temporary management of a difficult airway but poses a challenge when an attempt is made to exchange the device for an endotracheal tube, often managed by emergency tracheostomy. We describe a novel fiberoptic, video laryngoscope-assisted approach to intubation in a difficult trauma airway with an in situ King Laryngeal Tube. Read More

    A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population.
    Anesthesiology 2017 Mar;126(3):431-440
    From the Departments of Anesthesiology, Surgery, Biomedical Informatics, Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (J.M.E.); Department of Surgery, Uniformed Services University of the Health Sciences, Vanderbilt University Hospital, Nashville, Tennessee (J.M.E.); Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee (J.P.W.); and Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee (M.T., B.S.R., W.S.S.).
    Background: Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring.

    Methods: With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose. Read More

    Implementation of a Needs-Based, Online Feedback Tool for Anesthesia Residents With Subsequent Mapping of the Feedback to the ACGME Milestones.
    Anesth Analg 2017 Feb;124(2):627-635
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; †Stanford University School of Medicine, Stanford, California; ‡Department of Anesthesia, New York Presbyterian Hospital, Weill-Cornell University, New York, New York; and §Department of Pediatrics and ‖Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
    Background: Optimizing feedback that residents receive from faculty is important for learning. The goals of this study were to (1) conduct focus groups of anesthesia residents to define what constitutes optimal feedback; (2) develop, test, and implement a web-based feedback tool; and (3) then map the contents of the written comments collected on the feedback tool to the Accreditation Council for Graduate Medical Education (ACGME) anesthesiology milestones.

    Methods: All 72 anesthesia residents in the program were invited to participate in 1 of 5 focus groups scheduled over a 2-month period. Read More

    Choice of Anesthesia for Cesarean Delivery: An Analysis of the National Anesthesia Clinical Outcomes Registry.
    Anesth Analg 2017 Jun;124(6):1914-1917
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; †Harvard Medical School, Boston, Massachusetts; ‡Department of Anesthesiology, University of California, San Diego; and §US Anesthesia Partners, Dallas, Texas.
    Neuraxial anesthesia use in cesarean deliveries (CDs) has been rising since the 1980s, whereas general anesthesia (GA) use has been declining. In this brief report we analyzed recent obstetric anesthesia practice patterns using National Anesthesiology Clinical Outcomes Registry data. Approximately 218,285 CD cases were identified between 2010 and 2015. Read More

    Anesthetic Management of a Patient With Antimuscle-Specific Kinase Antibody-Positive Myasthenia Gravis Undergoing an Open Cholecystectomy: A Case Report.
    A A Case Rep 2017 Mar;8(6):150-153
    From the *Department of Anesthesiology, Iwaki Kyoritsu Hospital, Fukushima, Japan; †Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima, Japan; ‡Department of Anesthesiology, Fukushima Medical University School of Medicine, Fukushima, Japan; and §Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan.
    Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. Read More

    Complications, Risk Factors, and Staffing Patterns for Noncardiac Surgery in Patients with Left Ventricular Assist Devices.
    Anesthesiology 2017 Mar;126(3):450-460
    From the Department of Anesthesiology (M.R.M., S.S., S.K., M.D.C., E.S.J., M.C.E.) and Department of Cardiac Surgery (F.D.P.), University of Michigan Health System, University of Michigan, Ann Arbor, Michigan.
    Background: Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns.

    Methods: The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015. Read More

    The Lipo-Body Lift: A New Circumferential Body-Contouring Technique Useful after Bariatric Surgery.
    Plast Reconstr Surg 2017 Jan;139(1):38e-49e
    Rennes, Toulouse, and Nancy, France From the Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1; INSERM U917, University of Rennes 1; SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital; STROMAlab, UMR5273 CNRS/UPS/EFS, INSERM U1031, and the Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital; and the Department of Maxillofacial, Plastic, Reconstructive and Cosmetic Surgery, Nancy University Hospital.
    Background: After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo-body lift method. The authors describe their experience with this novel, safe procedure. Read More

    Strategies to Prevent Periprosthetic Joint Infection After Total Knee Arthroplasty and Lessen the Risk of Readmission for the Patient.
    J Am Acad Orthop Surg 2017 Feb;25 Suppl 1:S13-S16
    From the New York University Langone Medical Center, New York, New York.
    There is yet to be a standardized total knee arthroplasty (TKA) surgical protocol that has been studied to a sufficient degree to offer evidence-based practices regarding infection and readmission prevention. Although high-level evidence is often sought to provide guidance concerning protocol- and process-level decisions, the literature is often confusing and nondefinitive in its conclusions and recommendations regarding periprosthetic joint infection and readmission prevention. Areas of study that require further investigation include the following: the role of patient optimization and preoperative mitigation of risk; perioperative antibiotics; operating room environment; blood management; operative techniques, implants, and infection prevention measures; wound care management; and post acute care. Read More

    A Randomized Controlled Trial of Music Use During Epidural Catheter Placement on Laboring Parturient Anxiety, Pain, and Satisfaction.
    Anesth Analg 2017 Feb;124(2):542-547
    From the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
    Background: Although music is frequently used to promote a relaxing environment during labor and delivery, the effect of its use during the placement of neuraxial techniques is unknown. Our study sought to determine the effects of music use on laboring parturients during epidural catheter placement, with the hypothesis that music use would result in lower anxiety, lower pain, and greater patient satisfaction.

    Methods: We conducted a prospective, randomized, controlled trial of laboring parturients undergoing epidural catheter placement with or without music. Read More

    Implications of Perioperative Team Setups for Operating Room Management Decisions.
    Anesth Analg 2017 Jan;124(1):262-269
    From the *Department of Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the Medical School Hannover, Vechta, Germany; †PrognosiX AG, Zurich, Switzerland, and the Institute of Applied Simulation, Zurich University of Applied Sciences ZHAW, Waedenswil, Switzerland; ‡Saint Mary's Hospital Vechta, Teaching Hospital of Hannover University, Vechta, Germany; and §Department of Anesthesiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland.
    Background: Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient.

    Methods: We analyzed 13,632 surgical cases at our hospital that involved 64 surgeons and 48 anesthesiologists. Read More

    Anesthetic Considerations for Patients With Congenital Central Hypoventilation Syndrome: A Systematic Review of the Literature.
    Anesth Analg 2017 Jan;124(1):169-178
    From the Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada.
    Congenital central hypoventilation syndrome (CCHS) is a form of sleep-disordered breathing characterized by a diminished drive to breathe during sleep, despite progressive hypercapnia and hypoxia. The condition results from mutations in the paired-like homeobox 2B (PHOX2B) gene. The aim of this review was to conduct a systematic search of the current data on CCHS as it relates to perioperative considerations and to discuss the classification, prevalence, pathophysiology, presentation, genetics, and management of the condition. Read More

    The Effect of Implementation of Preoperative and Postoperative Care Elements of a Perioperative Surgical Home Model on Outcomes in Patients Undergoing Hip Arthroplasty or Knee Arthroplasty.
    Anesth Analg 2017 May;124(5):1450-1458
    From the Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
    Background: The Perioperative Surgical Home (PSH) seeks to remedy the currently highly fragmented and expensive perioperative care in the United States. The 2 specific aims of this health services research study were to assess the association between the preoperative and postoperative elements of an initial PSH model and a set of (1) clinical, quality, and patient safety outcomes and (2) operational and financial outcomes, in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA).

    Methods: A 2-group before-and-after study design, with a nonrandomized preintervention PSH (PRE-PSH group, N = 1225) and postintervention PSH (POST-PSH group, N = 1363) data-collection strategy, was applied in this retrospective observational study. Read More

    Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery.
    Anesth Analg 2016 Dec;123(6):1582-1587
    From the Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
    Background: The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality.

    Methods: We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. Read More

    Electronic Care Coordination From the Preoperative Clinic.
    Anesth Analg 2016 Dec;123(6):1458-1462
    From the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
    Fragmented and variable perioperative care exposes patients to unnecessary risks and handoff errors. The perioperative surgical home aims to optimize quality, value-based care. We performed a retrospective evaluation of how a preoperative assessment center could coordinate care through e-mails sent to a patient's healthcare team that initiate discussion on critical clinical information. Read More

    Use of Methohexital and Dexmedetomidine for Maintenance of Anesthesia in a Patient With Mitochondrial Myopathy: A Case Report.
    A A Case Rep 2017 Jan;8(2):33-35
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and †Harvard Medical School, Boston, Massachusetts.
    Provision of anesthesia for patients with mitochondrial disorders is associated with a unique set of challenges. These disorders are rare, which complicates efforts to develop high quality, evidence-based guidelines to inform the perioperative management of those who suffer from them. Accordingly, case reports remain an important source of information regarding their care. Read More

    Left Ventricular Assist Device Insertion in a Patient With Biventricular Noncompaction Cardiomyopathy, Ebstein Anomaly, and a Left Atrial Mass: A Case Report.
    A A Case Rep 2016 Dec;7(12):251-255
    From the Department of Anesthesiology, Allegheny Health Network, Pittsburgh, Pennsylvania.
    In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation. Read More

    A Case Report of the Anesthetic Management for Liver Retransplantation in a Patient With a Bronchobiliary Fistula.
    A A Case Rep 2016 Nov;7(10):219-221
    From the Departments of *Anesthesia and Perioperative Medicine, †Surgery, and ‡Oncology, Western University, London, Ontario, Canada.
    A 64-year-old woman with a previous liver transplant developed graft failure with biliary complications including a bronchobiliary fistula, which did not respond to preoperative conservative therapy. Liver retransplantation provided definitive therapy for the liver failure and bronchobiliary fistula. We present anesthestic considerations for the intraoperative management of a liver retransplant with one-lung ventilation. Read More

    Total Hip and Knee Arthroplasty in Patients Older Than Age 80 Years.
    J Am Acad Orthop Surg 2016 Oct;24(10):683-90
    From the Warren Alpert Medical School of Brown University, Providence, RI.
    A rapidly aging population is currently reshaping the demographic profile of the United States. Among older patients, the cohort aged >80 years is not only living longer but also is electing to undergo more total hip and knee arthroplasties. To improve perioperative safety, orthopaedic surgeons should understand the risks and clinical outcomes of arthroplasty in patients of advanced age. Read More

    National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review.
    Anesth Analg 2017 Jan;124(1):216-232
    From the *Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel; †Departments of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California; ‡Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey; §Departments of Anesthesiology, Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; and ‖Department of Pathology, Stanford University School of Medicine, Stanford, California.
    In developed countries, rates of postpartum hemorrhage (PPH) requiring transfusion have been increasing. As a result, anesthesiologists are being increasingly called upon to assist with the management of patients with severe PPH. First responders, including anesthesiologists, may adopt Patient Blood Management (PBM) recommendations of national societies or other agencies. Read More

    Diagnosis of Intraabdominal Fluid Extravasation After Hip Arthroscopy With Point-of-Care Ultrasonography Can Identify Patients at an Increased Risk for Postoperative Pain.
    Anesth Analg 2017 Mar;124(3):791-799
    From the *Department of Anesthesiology, Hospital for Special Surgery, New York, New York; †Healthcare Research Institute, Hospital for Special Surgery, New York, New York; ‡Department of Anesthesiology, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, New York; and §Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
    Background: Intraabdominal fluid extravasation (IAFE) after hip arthroscopy has historically been diagnosed in catastrophic circumstances with abdominal compartment syndrome requiring diuresis or surgical decompression. A previous retrospective study found the prevalence of symptomatic IAFE requiring diuresis or decompression to be 0.16%, with risk factors including surgical procedure and high pump pressures. Read More

    Emergency Manual Uses During Actual Critical Events and Changes in Safety Culture From the Perspective of Anesthesia Residents: A Pilot Study.
    Anesth Analg 2016 Sep;123(3):641-9
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; †Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California; and ‡Department of Medicine, Stanford University School of Medicine, Stanford, California.
    Background: Emergency manuals (EMs), context-relevant sets of cognitive aids or crisis checklists, have been used in high-hazard industries for decades, although this is a nascent field in health care. In the fall of 2012, Stanford clinically implemented EMs, including hanging physical copies in all Stanford operating rooms (ORs) and training OR clinicians on the use of, and rationale for, EMs. Although simulation studies have shown the effectiveness of EMs and similar tools when used by OR teams during crises, there are little data on clinical implementations and uses. Read More

    Clonidine Does Not Reduce Pain or Opioid Consumption After Noncardiac Surgery.
    Anesth Analg 2016 Sep;123(3):749-57
    From the *Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; †Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; ‡Departments of Cardiology and Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; §Departments of Outcomes Research and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; ‖Department of Anesthesiology, Queen's University and Kingston Hospitals, Kingston, Ontario, Canada; ¶Departments of Anesthesiology and Biomedical and Molecular Sciences, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada; and #Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
    Background: Clonidine is an α2-adrenoceptor agonist, which has analgesic properties. However, the analgesic efficacy of perioperative clonidine remains unclear. We, therefore, tested the hypothesis that clonidine reduces both pain scores and cumulative opioid consumption during the initial 72 hours after noncardiac surgery. Read More

    Methodologic Considerations for Collecting Patient-reported Outcomes from Unselected Surgical Patients.
    Anesthesiology 2016 Sep;125(3):495-504
    From the Department of Anesthesiology, Institute of Quality Improvement, Research and Informatics (INQUIRI), Washington University School of Medicine, St. Louis, Missouri (D.L.H., A.B.A., M.S.A., T.S.W., S.M., M.B., P.C., A.S.); Department of Surgery, Washington University School of Medicine, St. Louis, Missouri (A.W.); and Wright State University and Premier Health Clinical Trials Research Alliance, Miami Valley Hospital, Dayton, Ohio (B.A.B.).
    Background: The impact of surgery on health is only appreciated long after hospital discharge. Furthermore, patients' perceptions of postoperative health are not routinely ascertained. The authors instituted the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) registry to evaluate patients' postoperative health based on patient-reported outcomes (PROs). Read More

    Low-Cost Simulation to Teach Anesthetists' Non-Technical Skills in Rwanda.
    Anesth Analg 2016 Aug;123(2):474-80
    From the *Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesia and Intensive Care, University of Rwanda, Huye (Butare), Rwanda; ‡Department of Anesthesia, Rwanda Military Hospital, Kigali, Rwanda; and §Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
    Background: Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS)-task management, team working, situation awareness, and decision making-are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in sub-Saharan Africa. Read More

    Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up.
    Anesth Analg 2016 Jul;123(1):51-62
    From the *Department of Anesthesiology and Perioperative Care, †Department of Orthopaedic Surgery, University of California Irvine, Irvine, California; and ‡Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
    Background: Previously, our group successfully established one of the nation's first Perioperative Surgical Homes (PSHs) aimed at coordinating services to patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). As we now focus on extending the PSH to other service lines within the hospital, the long-term sustainability of this practice model is an important factor to consider moving forward.

    Methods: We prospectively collected data from all patients who underwent elective primary TKA and THA at our institution between October 1, 2012, and September 30, 2014. Read More

    How Rescue Echocardiography Changed the Intraoperative Management of an Obese Patient with Refractory Hypotension?
    A A Case Rep 2016 Jun;6(12):391-3
    From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    The value of perioperative echocardiography as a rescue tool to complement the clinical assessment of patients who develop hemodynamic instability during noncardiac surgery is becoming increasingly recognized. Several studies have demonstrated the utility of echocardiography in establishing a diagnosis during clinical emergencies. We present the case of an obese patient with refractory hypotension during laparoscopic gynecologic surgery in which rescue transesophageal echocardiography was pivotal in elucidating a diagnosis and changing the course of management. Read More

    Adverse Drug Effects and Preoperative Medication Factors Related to Perioperative Low-Dose Ketamine Infusions.
    Reg Anesth Pain Med 2016 Jul-Aug;41(4):482-7
    From the *Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; †Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA; and ‡Department of Anesthesiology, University of Miami, Miami, FL.
    High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. Read More

    Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages?
    Reg Anesth Pain Med 2016 Jul-Aug;41(4):438-44
    From the *Department of Anesthesiology, Hospital for Special Surgery; †Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Medical Center; and ‡Department of Biostatistics, Hospital for Special Surgery, New York, NY; ¶Private practice.
    Background And Objectives: In this randomized double-blind prospective study in patients undergoing shoulder arthroscopy, we compared the effects of ultrasound-guided interscalene nerve block using 20 mL (intervention group) and 40 mL (control group) of a mepivacaine 1.5% and bupivacaine 0.5% mixture (1:1 volume) on ipsilateral handgrip strength and other postoperative end points. Read More

    Management of a Patient With Tetralogy of Fallot, Congenital Diaphragmatic Hernia, and Complete Left Lung Agenesis.
    A A Case Rep 2016 Jul;7(1):16-20
    From the *Pediatric Anesthesiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; and †Pediatric Anesthesiology and Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
    We describe the rare case of an infant with congenital diaphragmatic hernia, unilateral lung agenesis, and unpalliated single-ventricle physiology. Infants with congenital diaphragmatic hernia and parallel circulation are at risk for maldistribution of systemic and pulmonary blood flow. Optimal perioperative management should include an assessment of the ratio of pulmonary to systemic blood flow (Qp:Qs). Read More

    The Anesthetic Implications of Aqueous Drainage Devices and Glaucoma: A Report of a Patient Undergoing Urgent Prone Cervical Decompression and Fusion.
    A A Case Rep 2016 Aug;7(3):63-6
    From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California; †The Eye Institute of Utah and the University of Utah John A. Moran Eye Center, Salt Lake City, Utah; and ‡Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
    The pathophysiology of glaucoma and perioperative visual loss is similar. A patient with glaucoma may be at increased risk of perioperative visual loss. For both, goals of management include optimizing ocular perfusion pressure and oxygen delivery. Read More

    Intraoperative Autotriggered Pressure Support Ventilation Resistant to Increased Flow Trigger Threshold.
    A A Case Rep 2016 Jul;7(1):9-12
    From the Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami, Miami, Florida.
    Oscillations from cardiac pulsations are normally transmitted to mediastinal structures without any consequence. Autotriggering (AT) of mechanical ventilation occurs when an inspiratory trigger, typically negative inspiratory flow in anesthesia ventilators, is met in the absence of patient effort. AT can lead to respiratory alkalosis, opioid overdose, prolonged mechanical ventilation, and lung hyperinflation. Read More

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