Use of CPAP Machines in the Perioperative Setting in Ambulatory Surgical Centers.

INTRODUCTION: Obstructive sleep apnea is a common sleep-related breathing disorder that is associated with significant perioperative complications. In 2012 and 2017, Society of Ambulatory Anesthesia and Society of Anesthesia and Sleep Medicine published consensus statements for the selection of patients with OSA scheduled for ambulatory surgery. Despite these recommendations, the need for a CPAP device in the immediate postoperative period at ambulatory surgical centers remains controversial because these ambulatory patients are healthier and have fewer complications. This study aims to investigate the compliance rate with this recommendation among busy ASCs. METHODS: We created a survey to investigate if ASCs require patients to bring their CPAP devices to the facility. The survey measured compliance rates of ASCs to SAMBA's recommended guidelines of having CPAP machines available. RESULTS: The survey had a response rate of 60.9% encompassing 408,147 cases among 1946 providers. Of the facilities that responded, only 59.7% of them required their patients to bring their CPAP devices on the day of surgery. Out of the 67 facilities that responded, only 25.37% reported using a CPAP machine postoperatively within the past 2 years, with the highest CPAP usage at one facility being 20 times in that 2-year period. DISCUSSION: This would mean that 40.3% of ASCs that did respond do not have access to a CPAP device on-site and may possibly lack the proper equipment needed to handle these complications. The frequency and fatality rate associated with postoperative respiratory complications requiring a CPAP device are still inconclusive, making the need for CPAP devices during perioperative management controversial. Studies further in-depth are therefore necessary to assess postoperative complications that require the use of a CPAP device to determine the urgency of ASCs implementing SAMBA's recommendations.

Rapid Quantitative Pharmacodynamic Imaging with Bayesian Estimation.

We recently described rapid quantitative pharmacodynamic imaging, a novel method for estimating sensitivity of a biological system to a drug. We tested its accuracy in simulated biological signals with varying receptor sensitivity and varying levels of random noise, and presented initial proof-of-concept data from functional MRI (fMRI) studies in primate brain. However, the initial simulation testing used a simple iterative approach to estimate pharmacokinetic-pharmacodynamic (PKPD) parameters, an approach that was computationally efficient but returned parameters only from a small, discrete set of values chosen a priori. Here we revisit the simulation testing using a Bayesian method to estimate the PKPD parameters. This improved accuracy compared to our previous method, and noise without intentional signal was never interpreted as signal. We also reanalyze the fMRI proof-of-concept data. The success with the simulated data, and with the limited fMRI data, is a necessary first step toward further testing of rapid quantitative pharmacodynamic imaging.

VISIT-TS: A multimedia tool for population studies on tic disorders.

Population-based assessment of Tourette syndrome (TS) and other tic disorders produces a paradox. On one hand, ideally diagnosis of tic disorders requires expert observation. In fact, diagnostic criteria for TS explicitly require expert assessment of tics for a definite diagnosis. On the other hand, large-scale population surveys with expert assessment of every subject are impracticable. True, several published studies have successfully used expert assessment to find tic prevalence in a representative population (e.g. all students in a school district). However, extending these studies to larger populations is daunting. We created a multimedia tool to demonstrate tics to a lay audience, discuss their defining and common attributes, and address features that differentiate tics from other movements and vocalizations. A first version was modified to improve clarity and to include a more diverse group in terms of age and ethnicity. The result is a tool intended for epidemiological research. It may also provide additional benefits, such as more representative minority recruitment for other TS studies and increased community awareness of TS.