Drug-Induced Sleep Endoscopy Performed in the Endoscopy Suite: A Resource Utilization Analysis.

OBJECTIVES: To analyze the resource utilization of performing drug-induced sleep endoscopy (DISE) procedures in an endoscopy suite (ES) setting as compared with the operating room (OR). STUDY DESIGN: A retrospective review of DISE procedures performed by a single attending surgeon from 2016 to 2018. SETTING: Tertiary hospital. SUBJECTS AND METHODS: All patients undergoing sleep endoscopy without concurrent surgical procedures were included. No exclusion criteria were incorporated. Analysis assessed for differences in procedure-related expenditures, patient characteristics, anesthesia and surgeon time, and access to care. RESULTS: A total of 87 sleep endoscopies were included: 65 (74.7%) performed in the ES and 22 (25.3%) in the OR. Patient groups were similar in age and apnea-hypopnea index severity (P > .05). Patient body mass index was significantly higher for the ES group (P = .03). Total facility time, postoperative recovery time, anesthesia care time, and time in the surgical room were significantly decreased in the ES setting (P < .01). Surgical time was similar between the groups (P > .05). For ES procedures, total cost was reduced by 74% (P < .01). DISE in the ES resulted in a mean $5080 less in health system charges versus the OR group (P < .01). There were no treatment-related complications in either setting. CONCLUSION: The resource utilization profile of performing DISE can be significantly improved by transferring these procedures from the OR to the ES setting.

Efficiency and scheduling in the nonoperating room anesthesia suite: implications from patient satisfaction to increased revenue operating room: a common (Dollars and Sense) approach.

PURPOSE OF REVIEW: Although the NORA setting continues to outgrow the main operating room in cases, there are few studies addressing efficiency metrics, and even fewer studies addressing those of a single specialty outpatient gastroenterology facility. In order to capitalize on this growing trend, gastrointestinal endoscopies must be scheduled in a way that prevents lost potential revenue while maintaining patient convenience, comfort, safety, and satisfaction. By standardizing our scheduling for procedure block time among various endoscopists and converting our sedation practices from conscious sedation to solely Propofol sedation in a 4 : 1 CRNA to Anesthesiologist model, we increased revenue while maximizing physician efficiency and site utilization. RECENT FINDINGS: The commonly used main operating room efficiency benchmarks cannot effectively be applied in NORA as these two locations have widely different procedure times, turn-around-times, and recovery times. In fact, procedures in gastrointestinal endoscopy suites can be completed in less time than a typical operating room takes for turnover. SUMMARY: By adapting our sedation practices to solely Propofol sedation and by standardizing our procedural schedule times among all the endoscopists, we maximized the number of cases and revenue in our outpatient gastrointestinal endoscopy suite while increasing patient satisfaction through reduction in overall patient facility time and procedure to discharge time.

Sugammadex: cyclodextrins, development of selective binding agents, pharmacology, clinical development, and future directions.

Neuromuscular blocking agents are widely used in perioperative medicine to aid in endotracheal intubation, facilitate surgery, and in critical care/emergency medicine settings. Muscle relaxants have profound clinical uses in current surgical and intensive care and emergency medical therapy. This article reviews cyclodextrins, development of selective binding agents, clinical development, and future directions of sugammadex.

Retrograde intubation.

Airway management in the emergency department is a critical skill that must be mastered by emergency physicians. When rapid-sequence induction with oral-tracheal intubation performed by way of direct laryngoscopy is difficult or impossible due to a variety of circumstances, an alternative method or device must be used for a rescue airway. Retrograde intubation requires little equipment and has few contraindications. This technique is easy to learn and has a high level of skill retention. Familiarity with this technique is a valuable addition to the airway-management armamentarium of emergency physicians caring for ill or injured patients. Variations of the technique have been described, and their use depends on the individual circumstances.