Perceptions and goals of preoperative planning conversations between anesthesiology residents and attending physicians.

STUDY OBJECTIVE: To systematically evaluate anesthesiology resident and attending perceptions of preoperative planning conversations (POPCs) and to generate understanding for improving the educational and clinical value of this practice. DESIGN: cross-sectional study. SETTING: two large Northeastern US academic residency training programs. PARTICIPANTS: clinically practicing anesthesiology residents and attendings. INTERVENTIONS: An electronic survey was administered to 303 anesthesia attendings and 168 anesthesia residents across two academic institutions between June and July 2014. MEASUREMENTS: Survey questions addressing phone call frequency and duration, clinical value, educational value and intended purpose of POPC were administered to both groups. Chi-squared tests were used to evaluate differences in responses between groups, with p < 0.05 as statistically significant. MAIN RESULTS: Responses were collected from 93 attending physicians (31%) and 80 trainee physicians (48%) for an overall response rate of 37%. 99% of residents reported paging their attendings to engage in the POPC the evening prior to all operations and 95% of trainees reported almost always receiving a call back from the attending. Trainees overwhelmingly reported attendings would believe they were unprofessional or negligent if they did not initiate a POPC (73% vs 14%, chi-square = 60.9, p < 0.001). Attendings were much more likely to view the POPC as a very important tool to discuss perioperative events (60% vs 16%, chi-square = 37.3, p < 0.001) and necessary for the majority or every case (59% vs. 31%, chi-square = 13.5, p < 0.001). The majority of attendings and trainees did not find the POPC to be a very important educational tool in terms of assessing trainee knowledge base (14% vs. 6%, chi-square = 2.76, p = 0.097), discussing teaching opportunities (26% vs. 9%, chi-square = 8.5, p = 0.004), or establishing rapport (24% vs. 7% trainees, chi-square = 8.3, p = 0.004). CONCLUSIONS: Significant discrepancies exist between how anesthesia attendings and residents perceive the purpose of the POPC, with trainees less likely to view the POPC as having clinical value and neither group perceiving the conversation as a very useful educational tool. The results highlight the need to reexamine the value of the daily POPC as a deliberate educational practice to meet expectations of both trainees and attendings.

Successful Use of High-Flow Nasal Cannula for Concurrent Vocal Cord Electromyography and Tubeless Microlaryngeal Surgery in a Spontaneously Breathing Adult Patient: A Case Report.

Ventilation during microlaryngoscopy previously included jet ventilation, microlaryngeal endotracheal tubes, and extended apnea. Historically, apneic oxygenation provided a tubeless field but limited operative time. Increased utilization of high-flow nasal cannula in intensive care units and operating rooms has created new opportunities to expand tubeless microlaryngoscopy. Although few studies have described high-flow nasal cannula for microlaryngoscopy, there remains much to be explored. In this case report, we describe the unique setting of utilizing high-flow nasal cannula in a spontaneously breathing patient to create an optimal tubeless surgical field for both microlaryngoscopy and vocal cord electromyography.