Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists.

BACKGROUND: We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. METHODS: A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to nine ordinal scale) ratings of participant's technical and nontechnical performance. Raters also judged whether the performance was at a level expected of a board-certified anesthesiologist. RESULTS: Rater reliability for most measures was good. In 284 simulated emergencies, participants were rated as successfully completing 81% (interquartile range, 75 to 90%) of the critical performance elements. The median rating of both technical and nontechnical holistic performance was five, distributed across the nine-point scale. Approximately one-quarter of participants received low holistic ratings (i.e., three or less). Higher-rated performances were associated with younger age but not with previous simulation experience or other individual characteristics. Calling for help was associated with better individual and team performance. CONCLUSIONS: Standardized simulation-based assessment identified performance gaps informing opportunities for improvement. If a substantial proportion of experienced anesthesiologists struggle with managing medical emergencies, continuing medical education activities should be reevaluated.

Procedures for Evaluating the Adequacy of Anesthesia.

Assessing adequacy of anesthesia requires evaluation of its components: hypnosis, analgesia, and neuromuscular transmission. In order to do this, many methods have been developed that process signals representing different modalities. Assessment of hypnosis requires cortical measures of the central nervous system (CNS); methods that assess analgesia concentrate on subcortical and spinal levels of the CNS; and neuromuscular transmission is a peripheral phenomenon. This article presents an overview of the current state of methods available for measuring each of these components. We conclude that, whereas important gains have been made in the area of assessment of hypnosis, mainly owing to the advancement of methods using EEG and auditory evoked potentials, and whereas neuromuscular transmission can be objectively monitored using motor nerve stimulation, assessment of analgesia still contains many challenges.

Consideraciones básicas para el manejo del dolor en odontopediatría en la práctica diaria del cirujano dentista general y su relación de interconsulta con el anestesiólogo / Basic considerations for the management of pain in dentistry in the daily practice of the surgeon general dentist and their relationship with the anesthesiologist

El dolor es un fenómeno complejo y multidimensional mediado por procesos psicoquímicos en el sistema nervioso periférico y central, cuya percepción puede modificarse considerablemente a través de una serie de mecanismos que incluyen, entre otros, fármacos, estímulos ambientales, procesos cognoscitivos y emocionales, así como condiciones sociales y culturales. La gran parte de los agentes farmacológicos que se utiliza en odontología tiene por objeto controlar la angustia y el dolor. En términos generales, la eliminación de la sensación de dolor en el ámbito dental requiere el bloqueo de la percepción del dolor por vía periférica, mediante anestesia local o por vía central, con anestesia general (AU)

Pain is a complex and multidimensional event regulated by psycho-chemical processes in the peripheral and central nervous system; pain perception can be modified by different mechanisms that include, between others, drugs, environmental stimuli, cognoscitive and emotional processes, and cultural and social conditions. The drugs that are used in odontology try to control the pain. In general, it is necessary to stop the peripheral and central pain perception using local or general anesthesia, respectively (AU)

Anesthesia and the Lone Star State.

The field of anesthesiology has changed dramatically from its humble beginnings. Rags of ether and the art of monitoring blood color for oxygenation have been replaced with precise concentrations of inhaled anesthetic and continuous pulse oximetry. It is on the shoulders of our predecessors that we stand today as anesthesiologists. We must constantly evolve to adapt to an ever-changing medical profession. It is this spirit and mind-set that will allow the field of anesthesiology to continue to advance and improve the care of our patients.

Encuesta sobre la situación actual de la evaluación preoperatoria en los hospitales de España / A national survey on current practice of preanaesthetic assessment in elective surgery patients in Spain

Objetivo. Analizar la práctica común en las consultas externas preanestésicas de los pacientes sometidos a cirugía electiva en los hospitales públicos españoles. Material y métodos. Estudio observacional descriptivo transversal. Las variables principales de estudio fueron: características de los pacientes, tipo de evaluación preanestésica realizada, profesional evaluador y tipo de apoyo durante el proceso de evaluación. Como secundarias se contemplaron: número de quirófanos de cirugía programada y número de consultas preanestésicas. Se realizó análisis descriptivo uni y bivariante. Resultados. Fueron invitados a participar 214 hospitales del Sistema Nacional de Salud. Los 203 que finalmente participaron en la encuesta, disponían de consultas externas preanestésicas. En 183 de ellos (90%) pasan por dicha consulta todos los pacientes candidatos a intervención quirúrgica programada y en 202 (99,5%) la valoración preanestésica es realizada por un anestesiólogo del equipo. Reciben apoyo de una enfermera en 128 hospitales (63%), sola (49%) o junto a un auxiliar de enfermería (14%). En 68 de ellos (33%) es un auxiliar de enfermería el que ayuda en la consulta preoperatoria, mientras que en 7 centros (3%) no cuentan con ningún apoyo. En 14 de los centros (7%) las enfermeras realizan en la consulta valoraciones preanestésicas de forma autónoma tuteladas por un anestesiólogo. Centros con un mayor número de pacientes disponen de mayor número de consultas preanestésicas. Hospitales con un mayor número de quirófanos funcionantes reciben en mayor proporción el apoyo de una enfermera en la consulta preoperatoria. Conclusiones. La instauración de algún tipo de consulta externa preanestésica está asumida por la totalidad de los Servicios de Anestesiología de los hospitales públicos españoles. Aunque hay diferencias en el diseño y la organización(AU)

Objective. To analyse the preanaesthetic assessment prior to elective surgery in hospitals of the Spanish National Health Care System. Methods. A prospective cross-sectional descriptive observational survey was performed. Primary variables were patient characteristics, type of preanaesthetic evaluation and the evaluator, as well as type of support the evaluator received during patient assessment. Secondary variables included the number of operating rooms available for elective surgery, as well as preanaesthesia clinic facilities. Data were analysed by univariate and bivariate descriptive analysis. Results. A total of 214 hospitals of the Spanish Health Care System were invited to participate, and 203 centres responded, with all of them having a preanaesthesia assessment clinic. In 183 of them (90%), elective surgerypatients were interviewed prior to their surgical intervention, and in 202 hospitals (99.5%) a anaesthesiologist physician performed the interview. In 128 hospitals (63%), anaesthesiologists were helped during preoperative assessment by nurses alone (49%) or together with auxillary nurses (14%). In 68 of hospitals (33%) they were supported only by auxillary nurses and in 7 hospitals (3%) they obtained no help at all. In 14 centres (7%) anaesthesia nurses assessed patients directly (under supervision of an anaesthesiologist physician). Hospitals with a higher volume of patients performed more preanaesthesia interviews. Hospitals with more running operating rooms received more nurse support in the preanaesthesia assessment clinic. Conclusions. Some kind of preanaesthesia assessment clinic exists in all Anaesthesia Departments of public Spanish hospitals, although there are differences in design and organisation(AU)

Acolhimento e humanização na visão dos anestesiologistas / Receptiveness and humanization from the perspective of anesthesiologists / Acogida y humanización en la visión de los anestesiólogos

JUSTIFICATIVA E OBJETIVOS: O acolhimento é uma ferramenta que traz contribuições para a humanização do cuidado em saúde, especialmente no que diz respeito à prática do acolhimento no cenário da Anestesiologia. Objetivou-se no discurso dos anestesiologistas investigar a compreensão sobre o fenômeno do acolhimento entre estes profissionais. MÉTODOS: A pesquisa foi de natureza descritiva com abordagem qualitativa, realizada no Hospital Universitário Lauro Wanderley (HULW), na cidade de João Pessoa-PB. A amostra foi composta por dezesseis médicos anestesiologistas, sendo 25 por cento do sexo feminino e 75 por cento masculino. Os dados foram coletados através de entrevista, norteada por duas questões semiestruturadas, de setembro a outubro de 2010. A análise dos dados foi por meio da técnica do Discurso do Sujeito Coletivo (DSC). RESULTADOS: Como resultados, observou-se que os médicos anestesiologista em resposta à questão "O que você acha da prática do acolhimento como estratégia para humanizar a relação médico-paciente?" No DSC dos médicos observaram-se duas ideias centrais: uma abordagem holística do paciente, bem como uma estratégia que melhora a relação médico-paciente. Quando arguidos sobre as estratégias por eles adotadas para humanizar sua relação com o paciente no momento do acolhimento, suas narrativas organizaram-se a partir de três ideias centrais: observação dos direitos do paciente; comunicação terapêutica; e consulta pré-anestésica. Constata-se que os médicos envolvidos no estudo reconhecem o valor do acolhimento como estratégia para humanizar a relação médico paciente. CONCLUSÕES: O acolhimento ao paciente, no curso da anestesia, é muito importante, pois permite que o profissional produza escuta qualificada, aliada ao processo de cuidado humanizado, possibilitando melhora da interação entre o médico e o paciente.

BACKGROUND AND OBJECTIVES: Receptiveness is a tool that brings contributions for health care humanization, especially with regard to its practice in the field of Anesthesiology. The aim was to investigate through the report of anesthesiologists the understanding of the receptiveness phenomenon among these professionals. METHODS: This is a descriptive qualitative research held at the Hospital Universitário Lauro Wanderley (HULW), in the city of João Pessoa, PB. The sample consisted of 16 attending anesthesiologists, 25 percent female doctors and 75 percent male doctors. Data were collected through interviews guided by two semi-structured questions from September to October 2010. Data analysis was performed using the technique of Collective Subject Discourse (CSD). RESULTS: The anesthesiologists' answer to the following question was considered as this study's result: "What do you think about the practice of receptiveness as a strategy to humanize the doctor-patient relationship?" The doctors' CSD presented two central ideas: 1) a holistic approach to the patient; 2) a strategy that improves the doctor-patient relationship. When asked about the strategies adopted by them to humanize the relationship with the patient at the time of reception, their reports were organized based on three central ideas: 1) observation of patients' rights; 2) therapeutic communication; 3) preanesthetic visit. It was found that the physicians involved in the research recognized the value of receptiveness as a strategy to humanize the doctor-patient relationship. CONCLUSIONS: The receptivity to the patient in the course of anesthesia is very important because it allows the professional to perform a qualified hearing of the patient's history, together with the humanized care process, which enables the improvement of the interaction between doctor and patient.

JUSTIFICATIVA Y OBJETIVOS: La acogida es una herramienta que aporta a la humanización del cuidado en la Sanidad, especialmente en lo que se refiere a la práctica de la acogida en el escenario de la Anestesiología. Fue un objetivo en el discurso de los anestesiólogos investigar la comprensión sobre el fenómeno de la acogida entre esos profesionales. MÉTODOS: La investigación fue de naturaleza descriptiva con un abordaje cualitativo, realizado en el Hospital Universitario Lauro Wanderley (HULW), en la ciudad de João Pessoa-PB. La muestra estuvo compuesta por dieciséis médicos anestesiólogos, siendo 25 por ciento del sexo femenino y 75 por ciento masculino. Los datos fueron recolectados por medio de una entrevista, guiada por dos preguntas semiestructuradas, desde setiembre hasta octubre de 2010. El análisis de los datos fue por medio de la técnica del Discurso del Sujeto Colectivo (DSC). RESULTADOS: Como resultados, observamos que los médicos anestesiólogos, en respuesta a la pregunta "¿Cuál es su opinión sobre la práctica de la acogida como estrategia para humanizar la relación médico-paciente?", su DSC se centró en dos ideas centrales: un abordaje holístico del paciente, como también una estrategia que mejora la relación médico-paciente. Cuando se les preguntó sobre las estrategias adoptadas por ellos para humanizar su relación con el paciente al momento de la acogida, sus argumentos se organizaron a partir de las tres ideas centrales: observación de los derechos del paciente; comunicación terapéutica; y consulta preanestésica. Comprobamos entonces que los médicos involucrados en el estudio, reconocen el valor de la acogida como una estrategia para humanizar la relación médico paciente. CONCLUSIONES: La acogida al paciente durante la anestesia es muy importante, porque permite que el profesional obtenga una escucha activa, junto con el proceso de cuidado humanizado, posibilitando la mejoría del tiempo de ingreso entre el médico y el paciente.

Receptiveness and humanization from the perspective of anesthesiologists.

BACKGROUND AND OBJECTIVES: Receptiveness is a tool that brings contributions for health care humanization, especially with regard to its practice in the field of Anesthesiology. The aim was to investigate through the report of anesthesiologists the understanding of the receptiveness phenomenon among these professionals. METHODS: This is a descriptive qualitative research held at the Hospital Universitário Lauro Wanderley (HULW), in the city of João Pessoa, PB. The sample consisted of 16 attending anesthesiologists, 25% female doctors and 75% male doctors. Data were collected through interviews guided by two semi-structured questions from September to October 2010. Data analysis was performed using the technique of Collective Subject Discourse (CSD). RESULTS: The anesthesiologists' answer to the following question was considered as this study's result: "What do you think about the practice of receptiveness as a strategy to humanize the doctor-patient relationship?" The doctors' CSD presented two central ideas: 1) a holistic approach to the patient; 2) a strategy that improves the doctor-patient relationship. When asked about the strategies adopted by them to humanize the relationship with the patient at the time of reception, their reports were organized based on three central ideas: 1) observation of patients' rights; 2) therapeutic communication; 3) preanesthetic visit. It was found that the physicians involved in the research recognized the value of receptiveness as a strategy to humanize the doctor-patient relationship. CONCLUSIONS: The receptivity to the patient in the course of anesthesia is very important because it allows the professional to perform a qualified hearing of the patient's history, together with the humanized care process, which enables the improvement of the interaction between doctor and patient.

American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version.

In 2010, the American Society of Regional Anesthesia and Pain Medicine (ASRA) issued a practice advisory on local anesthetic systemic toxicity (LAST). The executive summary of this work contained a document that was intended to serve as a checklist for the management of LAST. Based on testing the checklist during a simulated episode of LAST, ASRA has issued an updated version that should replace the previous 2010 version. Electronic copies of the ASRA Checklist, suitable for lamination and inclusion in a local anesthetic toxicity kit, are available from the ASRA Web site (www.asra.com).