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2.
Zhonghua Yi Xue Za Zhi ; 104(29): 2688-2700, 2024 Jul 30.
Artículo en Chino | MEDLINE | ID: mdl-39075990

RESUMEN

The incidence of perioperative adverse events in children aged 0 to 15 years was 5.2%. Preoperative scientific and accurate anesthesia assessment is a crucial step in ensuring the safety of pediatric surgery. Perioperative risk prediction is a digital quantitative evaluation of the level of perioperative risk, which classifies the degree of danger. In order to further standardize the methods of anesthesia assessment and identify risk factors, Chinese Society of Anesthesiology organized experts in anesthesiology from children's specialty hospitals and general hospitals, along with statisticians from public health colleges, to jointly draft the "Chinese expert consensus on pediatric anesthesia assessment and perioperative risk prediction (2024 edition)".The anesthesia assessment includes history collection, physical examination, laboratory examination, American Society of Anesthesiologists physical status, difficult airway assessment, and identification and assessment of critically sick children. Perioperative risk prediction includes preoperative anxiety, perioperative respiratory adverse events, regurgitation and aspiration, emergence delirium, postoperative nausea and vomiting, postoperative ICU admission, postoperative acute kidney injury, perioperative mortality, and risk prediction for in-hospital mortality in children with congenital heart disease undergoing non-cardiac surgery.This consensus has formulated a total of 16 recommendations, aiming to promote anesthesiologists' familiarity with the content of pediatric anesthesia assessment, identify risk factors for adverse events during the perioperative period, and take targeted measures to reduce the occurrence of adverse events and improve the safety of children during the perioperative period.


Asunto(s)
Anestesia , Periodo Perioperatorio , Humanos , Niño , Anestesia/efectos adversos , China , Factores de Riesgo , Lactante , Preescolar , Adolescente , Medición de Riesgo , Anestesiología , Consenso , Complicaciones Posoperatorias , Anestesia Pediátrica
3.
Vet Rec ; 195(1): e4147, 2024 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-38959210

RESUMEN

BACKGROUND: Patient safety is essential in small animal anaesthesia. This study aimed to assess anaesthesia-related deaths in cats worldwide, identify risk and protective factors and provide insights for clinical practice. METHODS: A prospective multicentre cohort study of 14,962 cats from 198 veterinary centres across different countries was conducted. Data on anaesthesia-related deaths, from premedication up to 48 hours postextubation, were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs. RESULTS: The anaesthesia-related mortality was 0.63%, with 74.5% of deaths occurring postoperatively. Cats with cachexia, a higher ASA status or who underwent abdominal, orthopaedic/neurosurgical or thoracic procedures exhibited elevated mortality. Mechanical ventilation use was associated with increased mortality. Mortality odds were reduced by the use of alpha2-agonist sedatives, pure opioids in premedication and locoregional techniques. LIMITATIONS: Limitations include non-randomised sampling, potential biases, unquantified response rates, subjective death cause classification and limited variable analysis. CONCLUSIONS: Anaesthetic mortality in cats is significant, predominantly postoperative. Risk factors include cachexia, higher ASA status, specific procedures and mechanical ventilation. Protective factors include alpha2-agonist sedatives, pure opioids and locoregional techniques. These findings can help improve anaesthesia safety and outcomes. However, further research is required to improve protocols, enhance data quality and minimise risks.


Asunto(s)
Anestesia , Gatos , Animales , Anestesia/veterinaria , Anestesia/efectos adversos , Anestesia/mortalidad , Estudios Prospectivos , Medición de Riesgo , Masculino , Femenino , Factores de Riesgo , Estudios de Cohortes , Anestésicos/efectos adversos , Salud Global/estadística & datos numéricos , Enfermedades de los Gatos/mortalidad
5.
Br J Anaesth ; 133(2): 371-379, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38866639

RESUMEN

BACKGROUND: Many serious adverse events in anaesthesia are retrospectively rated as preventable. Anonymous reporting of near misses to a critical incident reporting system (CIRS) can identify structural weaknesses and improve quality, but incidents are often underreported. METHODS: This prospective qualitative study aimed to identify conceptions of a CIRS and reasons for underreporting at a single Swiss centre. Anaesthesia cases were screened to identify critical airway-related incidents that qualified to be reported to the CIRS. Anaesthesia providers involved in these incidents were individually interviewed. Factors that prevented or encouraged reporting of critical incidents to the CIRS were evaluated. Interview data were analysed using the Framework method. RESULTS: Of 3668 screened airway management procedures, 101 cases (2.8%) involved a critical incident. Saturation was reached after interviewing 21 anaesthesia providers, who had been involved in 42/101 critical incidents (41.6%). Only one incident (1.0%) had been reported to the CIRS, demonstrating significant underreporting. Interviews revealed highly variable views on the aims of the CIRS with an overall high threshold for reporting a critical incident. Factors hindering reporting of cases included concerns regarding identifiability of the reported incident and involved healthcare providers. CONCLUSIONS: Methods to foster anonymity of reporting, such as by national rather than departmental critical incident reporting system databases, and a change in culture is required to enhance reporting of critical incidents. Institutions managing a critical incident reporting system need to ensure timely feedback to the team regarding lessons learned, consequences, and changes to standards of care owing to reported critical incidents. Consistent reporting and assessment of critical incidents is required to allow the full potential of a critical incident reporting system.


Asunto(s)
Anestesia , Investigación Cualitativa , Gestión de Riesgos , Humanos , Estudios Prospectivos , Gestión de Riesgos/métodos , Anestesia/efectos adversos , Anestesia/normas , Masculino , Femenino , Persona de Mediana Edad , Manejo de la Vía Aérea/métodos , Manejo de la Vía Aérea/normas , Adulto , Anciano , Errores Médicos/estadística & datos numéricos , Errores Médicos/prevención & control , Suiza , Potencial Evento Adverso/estadística & datos numéricos
6.
J Pediatr Gastroenterol Nutr ; 79(2): 382-393, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38873914

RESUMEN

OBJECTIVES: Data regarding the occurrence of complications specifically during pediatric anesthesia for endoscopic procedures is limited. By evaluating such data, factors could be identified to assure proper staffing and preparation to minimize adverse events and improve patient safety during flexible endoscopy. METHODS: This retrospective cohort study included children undergoing anesthesia for gastroscopy, colonoscopy, bronchoscopy, or combined endoscopic procedures over 10-year period. The primary study aim was to evaluate the incidence of complications and identify risk factors for adverse events. RESULTS: Overall, 2064 endoscopic procedures including 1356 gastroscopies (65.7%), 93 colonoscopies (4.5%), 235 bronchoscopies (11.4%), and 380 combined procedures (18.4%) were performed. Of the 1613 patients, 151 (7.3%) patients exhibited an adverse event, with respiratory complications being the most common (65 [3.1%]). Combination of gastrointestinal endoscopies did not lead to an increased adverse event rate (gastroscopy: 5.5%, colonoscopy: 3.2%). Diagnostic endoscopy as compared to interventional had a lower rate. If bronchoscopy was performed, the rate was similar to that of bronchoscopy alone (19.5% vs. 20.4%). Age < 5.8 years or body weight less than 20 kg, bronchoscopy, American Society of Anesthesiologists status ≥ 2 or pre-existing anesthesia-relevant diseases, and urgency of the procedure were independent risk factors for adverse events. For each risk factor, the risk for events increased 2.1-fold [1.8-2.4]. CONCLUSIONS: This study identifies multiple factors that increase the rate of adverse events associated anesthesia-based endoscopy. Combined gastrointestinal procedures did not increase the risk for adverse events while combination of bronchoscopy to gastrointestinal endoscopy showed a similar risk as bronchoscopy alone.


Asunto(s)
Broncoscopía , Colonoscopía , Humanos , Estudios Retrospectivos , Factores de Riesgo , Niño , Femenino , Masculino , Preescolar , Lactante , Broncoscopía/efectos adversos , Broncoscopía/métodos , Adolescente , Colonoscopía/efectos adversos , Colonoscopía/métodos , Colonoscopía/estadística & datos numéricos , Incidencia , Anestesia/efectos adversos , Anestesia/métodos , Gastroscopía/efectos adversos , Gastroscopía/métodos , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/métodos , Endoscopía Gastrointestinal/estadística & datos numéricos
7.
Br J Anaesth ; 133(3): 628-636, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38926028

RESUMEN

BACKGROUND: Previous studies suggested that surgeon sex is associated with differential patient outcomes. Whether this also applies to anaesthesia providers is unclear. We hypothesised that female sex of the primary anaesthesia provider is associated with lower risk of perioperative complications. METHODS: The first case for all adult patients undergoing anaesthesia care between 2008 and 2022 at two academic healthcare networks in the USA was included in this retrospective cohort study. The primary exposure was the sex of the anaesthesia provider who spent the most time in the operating theatre during the case. The primary outcome was intraoperative complications, defined as hypotension (mean arterial blood pressure <55 mm Hg for ≥5 cumulative minutes) or hypoxaemia (oxygen saturation <90% for >2 consecutive minutes). The co-primary outcome was 30-day adverse postoperative events (including complications, readmission, and mortality). Analyses were adjusted for a priori defined confounders. RESULTS: Among 364,429 included patients, 57,550 (15.8%) experienced intraoperative complications and 55,168 (15.1%) experienced adverse postoperative events. Care by female compared with male anaesthesia providers was associated with lower risk of intraoperative complications (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.94-0.97, P<0.001), which was magnified among non-trainees (aOR 0.84, 95% CI 0.82-0.87, P-for-interaction<0.001). Anaesthesia provider sex was not associated with the composite of adverse postoperative events (aOR 1.00, 95% CI 0.98-1.02, P=0.88). CONCLUSIONS: Care by a female anaesthesia provider was associated with a lower risk of intraoperative complications, which was magnified among non-trainees. Future studies should investigate underlying mechanisms.


Asunto(s)
Complicaciones Intraoperatorias , Complicaciones Posoperatorias , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Intraoperatorias/epidemiología , Anciano , Adulto , Factores Sexuales , Estudios de Cohortes , Anestesiólogos/estadística & datos numéricos , Anestesia/efectos adversos
9.
Curr Opin Anaesthesiol ; 37(4): 344-351, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38841907

RESUMEN

PURPOSE OF REVIEW: Remimazolam is a novel benzodiazepine anesthetic/sedative, designed as a rapidly metabolized carboxylic acid. Since its recent launch, the role of remimazolam in modern anesthesia and sedation practice is still evolving. This review aims to outline the clinical pharmacology and clinical utility of remimazolam to elucidate its potential advantages and limitations. RECENT FINDINGS: Remimazolam is "short-acting" but not ultra-short-acting compared with propofol based on context-sensitive decrement times. But compared to propofol, the availability of the benzodiazepine antagonist, flumazenil, is considered an advantage, particularly in certain emergency situations such as in patients with difficult airways. However, because flumazenil is shorter acting than remimazolam when remimazolam accumulates or is present in a high concentration, the reappearance of remimazolam sedation may occur after the initial reversal of anesthesia/sedation from flumazenil administration. Although it is beneficial that remimazolam causes less respiratory depression and hypotension than propofol, serious respiratory depression and hypotension can still occur. Remimazolam administration causes minimal or no pain on injection. Remimazolam is associated with less postoperative nausea and vomiting than inhaled anesthetics, but propofol is clearly superior in this regard. The anesthetic/sedative effects may be prolonged by severe hepatic impairment; remimazolam tolerance can occur in long-term benzodiazepine users. SUMMARY: Remimazolam may be beneficial to use in procedural sedation and general anesthesia for patients with difficult airways or hemodynamic instability. Further clinical studies with remimazolam are warranted to identify the potential benefits in other settings and patient populations.


Asunto(s)
Benzodiazepinas , Hipnóticos y Sedantes , Humanos , Benzodiazepinas/efectos adversos , Benzodiazepinas/farmacología , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/farmacología , Anestesia/métodos , Anestesia/efectos adversos , Flumazenil/farmacología , Propofol/efectos adversos , Propofol/administración & dosificación
10.
Curr Opin Anaesthesiol ; 37(4): 432-438, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38841922

RESUMEN

PURPOSE OF REVIEW: This review explores the intricacies of ethical anesthesia, exploring the necessity for precision anesthesia and its impact on patient-reported outcomes. The primary objective is to advocate for a defined aim, promoting the implementation of rules and feedback systems. The ultimate goal is to enhance precision anesthesia care, ensuring patient safety through the implementation of a teamwork and the integration of feedback mechanisms. RECENT FINDINGS: Recent strategies in the field of anesthesia have evolved from intraoperative monitorization to a wider perioperative patient-centered precision care. Nonetheless, implementing this approach encounters significant obstacles. The article explores the evidence supporting the need for a defined aim and applicable rules for precision anesthesia's effectiveness. The implementation of the safety culture is underlined. The review delves into the teamwork description with structured feedback systems. SUMMARY: Anesthesia is a multifaceted discipline that involves various stakeholders. The primary focus is delivering personalized precision care. This review underscores the importance of establishing clear aims, defined rules, and fostering effective and well tolerated teamwork with accurate feedback for improving patient-reported outcomes. The Safe Brain Initiative approach, emphasizing algorithmic monitoring and systematic follow-up, is crucial in implementing a fundamental and standardized reporting approach within patient-centered anesthesia care practice.


Asunto(s)
Anestesia , Atención Dirigida al Paciente , Humanos , Anestesia/métodos , Anestesia/normas , Anestesia/ética , Anestesia/efectos adversos , Atención Dirigida al Paciente/ética , Atención Dirigida al Paciente/normas , Anestesiología/ética , Anestesiología/normas , Seguridad del Paciente/normas , Medicina de Precisión/métodos , Medicina de Precisión/ética , Medicina de Precisión/normas , Grupo de Atención al Paciente/ética , Grupo de Atención al Paciente/normas , Grupo de Atención al Paciente/organización & administración , Medición de Resultados Informados por el Paciente , Monitoreo Intraoperatorio/métodos , Monitoreo Intraoperatorio/normas
11.
Curr Opin Anaesthesiol ; 37(4): 406-412, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38841978

RESUMEN

PURPOSE OF REVIEW: Given the rapid growth of nonoperating room anesthesia (NORA) in recent years, it is essential to review its unique challenges as well as strategies for patient selection and care optimization. RECENT FINDINGS: Recent investigations have uncovered an increasing prevalence of older and higher ASA physical status patients in NORA settings. Although closed claim data regarding patient injury demonstrate a lower proportion of NORA cases resulting in a claim than traditional operating room cases, NORA cases have an increased risk of claim for death. Challenges within NORA include site-specific differences, limitations in ergonomic design, and increased stress among anesthesia providers. Several authors have thus proposed strategies focusing on standardizing processes, site-specific protocols, and ergonomic improvements to mitigate risks. SUMMARY: Considering the unique challenges of NORA settings, meticulous patient selection, risk stratification, and preoperative optimization are crucial. Embracing data-driven strategies and leveraging technological innovations (such as artificial intelligence) is imperative to refine quality control methods in targeted areas. Collaborative efforts led by anesthesia providers will ensure personalized, well tolerated, and improved patient outcomes across all phases of NORA care.


Asunto(s)
Anestesia , Selección de Paciente , Humanos , Anestesia/métodos , Anestesia/efectos adversos , Anestesia/normas , Medición de Riesgo/métodos , Ergonomía/métodos
13.
Curr Opin Anaesthesiol ; 37(4): 413-420, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38934202

RESUMEN

PURPOSE OF REVIEW: The integration of artificial intelligence (AI) in nonoperating room anesthesia (NORA) represents a timely and significant advancement. As the demand for NORA services expands, the application of AI is poised to improve patient selection, perioperative care, and anesthesia delivery. This review examines AI's growing impact on NORA and how it can optimize our clinical practice in the near future. RECENT FINDINGS: AI has already improved various aspects of anesthesia, including preoperative assessment, intraoperative management, and postoperative care. Studies highlight AI's role in patient risk stratification, real-time decision support, and predictive modeling for patient outcomes. Notably, AI applications can be used to target patients at risk of complications, alert clinicians to the upcoming occurrence of an intraoperative adverse event such as hypotension or hypoxemia, or predict their tolerance of anesthesia after the procedure. Despite these advances, challenges persist, including ethical considerations, algorithmic bias, data security, and the need for transparent decision-making processes within AI systems. SUMMARY: The findings underscore the substantial benefits of AI in NORA, which include improved safety, efficiency, and personalized care. AI's predictive capabilities in assessing hypoxemia risk and other perioperative events, have demonstrated potential to exceed human prognostic accuracy. The implications of these findings advocate for a careful yet progressive adoption of AI in clinical practice, encouraging the development of robust ethical guidelines, continual professional training, and comprehensive data management strategies. Furthermore, AI's role in anesthesia underscores the need for multidisciplinary research to address the limitations and fully leverage AI's capabilities for patient-centered anesthesia care.


Asunto(s)
Anestesia , Inteligencia Artificial , Humanos , Anestesia/métodos , Anestesia/efectos adversos , Anestesia/normas , Medición de Riesgo/métodos , Atención Perioperativa/métodos , Atención Perioperativa/normas , Anestesiología/métodos , Selección de Paciente
16.
Sci Rep ; 14(1): 14060, 2024 06 18.
Artículo en Inglés | MEDLINE | ID: mdl-38890405

RESUMEN

Isoflurane anesthesia (IA) partially compensates NREM sleep (NREMS) and not REM sleep (REMS) requirement, eliciting post-anesthetic REMS rebound. Sleep deprivation triggers compensatory NREMS rebounds and REMS rebounds during recovery sleep as a result of the body's homeostatic mechanisms. A combination of sleep deprivation and isoflurane anesthesia is common in clinical settings, especially prior to surgeries. This study investigates the effects of pre-anesthetic sleep deprivation on post-anesthetic sleep-wake architecture. The effects of isoflurane exposure (90 min) alone were compared with the effects of isoflurane exposure preceded by experimental sleep deprivation (6 h, gentle handling) on recovery sleep in adult mice by studying the architecture of post-anesthetic sleep for 3 consecutive post-anesthetic days. Effects of isoflurane anesthesia on recovery sleep developed only during the first dark period after anesthesia, the active phase in mice. During this time, mice irrespective of preceding sleep pressure, showed NREMS and REMS rebound and decreased wakefulness during recovery sleep. Additionally, sleep deprivation prior to isoflurane treatment caused a persistent reduction of theta power during post-anesthetic REMS at least for 3 post-anesthetic days. We showed that isoflurane causes NREMS rebound during recovery sleep which suggests that isoflurane may not fully compensate for natural NREMS. The study also reveals that isoflurane exposure preceded by sleep deprivation caused a persistent disruption of REMS quality. We suggest that preoperative sleep deprivation may impair postoperative recovery through lasting disruption in sleep quality.


Asunto(s)
Anestésicos por Inhalación , Isoflurano , Privación de Sueño , Sueño REM , Vigilia , Isoflurano/efectos adversos , Isoflurano/farmacología , Animales , Privación de Sueño/fisiopatología , Ratones , Masculino , Anestésicos por Inhalación/efectos adversos , Sueño REM/efectos de los fármacos , Vigilia/efectos de los fármacos , Vigilia/fisiología , Ratones Endogámicos C57BL , Electroencefalografía , Sueño/efectos de los fármacos , Sueño/fisiología , Anestesia/efectos adversos
17.
Med Sci Monit ; 30: e944116, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38822518

RESUMEN

BACKGROUND Colonoscopy is the predominant invasive procedure for Crohn disease (CD) patients. Opioids and propofol carry risks of respiratory and cardiovascular complications. This study aimed to evaluate whether substituting fentanyl with ketamine or lidocaine could diminish propofol usage and minimize adverse events. MATERIAL AND METHODS In total, 146 patients with CD scheduled for elective colonoscopy were assigned to anesthesia with fentanyl (n=47), ketamine (n=47), or lidocaine (n=55). Propofol was administered to achieve sufficient anesthesia. Measured outcomes in each group included propofol consumption, hypotension and desaturation incidents, adverse event types, consciousness recovery time, abdominal pain intensity, Aldrete scale, and Post Anaesthetic Discharge Scoring System (PADSS). RESULTS Patients administered fentanyl needed significantly more propofol (P=0.017) than those on ketamine, with lidocaine showing no notable difference (P=0.28). Desaturation was significantly less common in the ketamine and lidocaine groups than fentanyl group (P<0.001). The ketamine group experienced milder reductions in mean arterial (P=0.018) and systolic blood pressure (P<0.001). Recovery metrics (Aldrete and PADSS scores) were lower for fentanyl (P<0.001), although satisfaction and pain levels were consistent across all groups (P=0.797). Dizziness occurred less frequently with lidocaine than fentanyl (17.2%, P=0.018) and ketamine (15.1%, P=0.019), while metallic taste incidents were more prevalent in the lidocaine group (13.5%, P=0.04) than fentanyl group. CONCLUSIONS Using ketamine or lidocaine instead of fentanyl in anesthesia for colonoscopy in patients with CD significantly lowers propofol use, reduces desaturation events, maintains blood pressure more effectively, without increasing hypotension risk, and accelerates recovery, without negatively impacting adverse events or patient satisfaction.


Asunto(s)
Colonoscopía , Enfermedad de Crohn , Fentanilo , Ketamina , Lidocaína , Propofol , Humanos , Ketamina/efectos adversos , Ketamina/administración & dosificación , Fentanilo/efectos adversos , Fentanilo/administración & dosificación , Propofol/efectos adversos , Propofol/administración & dosificación , Lidocaína/efectos adversos , Lidocaína/administración & dosificación , Masculino , Femenino , Colonoscopía/métodos , Adulto , Persona de Mediana Edad , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/administración & dosificación , Anestesia/métodos , Anestesia/efectos adversos
18.
Curr Opin Urol ; 34(5): 358-365, 2024 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-38898779

RESUMEN

PURPOSE OF REVIEW: The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice. RECENT FINDINGS: The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process. SUMMARY: Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.


Asunto(s)
Quirófanos , Humanos , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/administración & dosificación , Huella de Carbono , Eliminación de Residuos Sanitarios/métodos , Residuos Sanitarios/efectos adversos , Residuos Sanitarios/prevención & control , Ambiente , Anestesia/efectos adversos , Anestesia/métodos , Gases de Efecto Invernadero/efectos adversos
19.
Anaesth Crit Care Pain Med ; 43(4): 101390, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38718923

RESUMEN

BACKGROUND: Reporting and analysis of adverse events (AE) is associated with improved health system learning, quality outcomes, and patient safety. Manual text analysis is time-consuming, costly, and prone to human errors. We aimed to demonstrate the feasibility of novel machine learning and natural language processing (NLP) approaches for early predictions of adverse events and provide input to direct quality improvement and patient safety initiatives. METHODS: We used machine learning to analyze 9559 continuously reported AE by clinicians and healthcare systems to the French National Health accreditor (HAS) between January 1, 2009, and December 31, 2020 . We validated the labeling of 135,000 unique de-identified AE reports and determined the associations between different system's root causes and patient consequences. The model was validated by independent expert anesthesiologists. RESULTS: The machine learning (ML) and Artificial Intelligence (AI) model trained on 9559 AE datasets accurately categorized 8800 (88%) of reported AE. The three most frequent AE types were "difficult orotracheal intubation" (16.9% of AE reports), "medication error" (10.5%), and "post-induction hypotension" (6.9%). The accuracy of the AI model reached 70.9% sensitivity, 96.6% specificity for "difficult intubation", 43.2% sensitivity, and 98.9% specificity for "medication error." CONCLUSIONS: This unsupervised ML method provides an accurate, automated, AI-supported search algorithm that ranks and helps to understand complex risk patterns and has greater speed, precision, and clarity when compared to manual human data extraction. Machine learning and Natural language processing (NLP) models can effectively be used to process natural language AE reports and augment expert clinician input. This model can support clinical applications and methodological standards and used to better inform and enhance decision-making for improved risk management and patient safety. TRIAL REGISTRATION: The study was approved by the ethics committee of the French Society of Anesthesiology (IRB 00010254-2020-20) and the CNIL (CNIL: 118 58 95) and the study was registered with ClinicalTrials.gov (NCT: NCT05185479).


Asunto(s)
Algoritmos , Anestesia , Aprendizaje Automático , Procesamiento de Lenguaje Natural , Humanos , Anestesia/efectos adversos , Francia , Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Seguridad del Paciente , Mejoramiento de la Calidad , Errores de Medicación/estadística & datos numéricos , Errores de Medicación/prevención & control , Inteligencia Artificial
20.
Paediatr Anaesth ; 34(9): 958-969, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38808685

RESUMEN

Patient safety is the most important aspect of anesthetic care. For both healthcare professionals and patients, the ideal would be no significant morbidity or mortality under anesthesia. Lessons from harm during healthcare can be shared to reduce harm and to increase safety. Many nations and individual institutions have developed robust safety systems to improve the quality and safety of patient care. Large registries that collect rare events, analyze them, and share findings have been developed. The approach, the funding, the included population, support from institutions and government and the methods of each vary. Wake Up Safe (WUS) is a patient safety organization accredited by Agency for Healthcare Research and Quality. Wake Up Safe was established in the United States in 2008 by the Society for Pediatric Anesthesia. The initiative aims to gather data on adverse events, analyze these incidents to gain insights, and apply this knowledge to ultimately reduce their occurrence. The purpose of this review is to describe the patient safety approaches in the USA. Through a national patient safety database WUS. Similar approaches either through WUS international or independent safety approaches have been described in Australia-New Zealand, India, and Singapore. We examine the patient safety processes across the four countries, evaluating their incident review process and the distribution of acquired knowledge. Our focus is on assessing the potential benefits of a WUS collaboration, identifying existing barriers, and determining how such a collaboration would integrate with current incident review databases or systems.


Asunto(s)
Seguridad del Paciente , Humanos , Estados Unidos , Anestesia/métodos , Anestesia/efectos adversos , Errores Médicos/prevención & control , Anestesiología/métodos , Niño
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