Identifying patient safety competences among anesthesiology residents: systematic review

Abstract Introduction and objective Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents. Methods A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence". Results and conclusions Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.

Identifying patient safety competences among anesthesiology residents: systematic review.

INTRODUCTION AND OBJECTIVE: Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents. METHODS: A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence". RESULTS AND CONCLUSIONS: Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.

[Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis]. / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) ­ Parte II: etiologia e diagnóstico.

This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) - Parte II: etiologia e diagnóstico

Abstract This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

Resumo Este segundo documento, escrito por especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória, tem por objetivo revisar os mecanismos fisiopatológicos, agentes desencadeantes (em adultos e crianças), assim como a abordagem diagnóstica durante e após o episódio. Por se tratar de uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados, e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.

[Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment]. / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) ­ Parte I: tratamento e orientação pós­crise.

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.

Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) - Parte I: tratamento e orientação pós-crise

Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.

Resumo Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.

Complicações pós-anestésicas em sala de recuperação de hospital pediátrico / Post-anesthetic complications in recovery room at a pediatric hospital

Introdução: De acordo com a literatura até 24% dos pacientes admitidos na sala de recuperação pós anestésica podem apresentar complicações identificadas neste período. Este estudo tem como objetivo avaliar retrospectivamente as complicações imediatas na sala de recuperação anestésicas em pacientes pediátricos submetidos à procedimento cirúrgico entre os meses de Setembro e Outubro de 2015. Métodos: Estudo descritivo, retrospectivo e observacional. Os dados coletados foram realizados na sala de recuperação pós-anestésica (SRPA) pela equipe de enfermagem através de um questionário padronizado. Os dados coletados foram idade do paciente, nível de consciência na admissão na SRPA, complicações como dor com ou sem bloqueio periférico, agitação, dessaturação, laringoespasmo, náuseas/ vômitos, broncoespasmo e sangramento. Resultados: Foram avaliados 783 pacientes sendo que 53,4% tinham entre 1 a 5 anos de idade. 84,2% dessas crianças foram admitidas na SRPA ainda sonolentas sendo monitorizadas com oximetria de pulso, sendo acrescentado oxigênio suplementar, quando necessário. Dos 783 pacientes avaliados 110 apresentaram complicações na SRPA o que corresponde a 14% dessa população. As complicações observadas por ordem de frequência foram dessaturação (5,2% / 41/783) agitação (5,2% / 41/783) dor (3,1% / 24/783) náuseas e vômitos (0,25% / 2/783) e laringoespasmo (0,25% / 2/783). Não houve casos de broncoespasmo e sangramento. Dos 24 casos de pacientes com dor ressalta-se que 16 foram submetidos à bloqueio periférico no intraoperatório. Conclusão: Os resultados apresentados refletem a importância em se ter uma equipe multidisciplinar na assistência da criança submetida à procedimento cirúrgico. (AU)

Introduction: During anesthesia recovery patients must be carefully assisted. Literature reports that up to 24% of patients admitted to postanesthesia recovery room can present complications identified in this period. This study aims to evaluate complication rates in pediatric patients during two months of observation at the recovery room. Methods: Descriptive, retrospective, observational study. The collected data were carried out in the post-anesthetic care unit (PACU) using a standardized questionnaire. Resultados: 783 pacients were avaluated, 53,4% were 1-5 years old, 84,2% were sleepily when arived at the immediate postoperative room, and was ofered oxigen suply when it was nedeed. We observed that 14% of the pacients presented complications at the immediate postoperative period. The pacients were divided in to 5 groups (group 1: <1 years old, group 2: 1 -5, group 3: 5 - 6, group 4: 6 - 10 and group 5: > 10 years old), the group associated with higher incidence of overal complications were group 2 ( 47%, p - value: 0.035), laryngospasm were observed only in group 1 ( 2 pacients, p- value: 0.019). Pacients who underwent general pediatic surgery had more overal complication rate (p-value: <0.001), including pain (p-value0,038), agitation (p-value: 0.005), desaturation (p-value: 0.004) when comparing with orthopedic, otorhinolaringology, oftalmology, oncologic surgeries. Conclusion: The results presented reflect the importance of having a multidisciplinary team in child care submitted to the surgical procedure. (AU)

Complicaçöes obstrutivas de vias aéras pós-extubaçäo / Obstructive complictions of the airway after extubation

A intubaçäo endotraqueal(IE) é procedimento frequentemente utilizado em Unidades de Terapia Intensiva. Mesmo, muitas vezes, sendo salvador de vidas, näo é destituído de complicaçöes. O presente estudo teve como objetivo avaliar as complicaçöes obstrutivas(CO) de vias aéras após extubaçäo quanto a sua prevalência, tipos de lesöes encontradas e fatores predidponentes. Foram analisados retrospectiva e prospectivamente 656 protocolos de pacientes submetidos à IE no período de agosto de 1988 a dezembro de 1994. Foram excluídos 157 oacientes, 150 que evoluíram para óbito e sete que foram traqueostomizados devido à doença de base. Das 408 crianças estudadas, 106(25 por cento) apresentaram CO. O achado laringoscópico mais frequente foi o de edema laríngeo, presente em 97 pacientes(91,5 por cento)...