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1.
Anaesthesia ; 75 Suppl 1: e18-e27, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31903566

RESUMO

Article 25 of the United Nations' Universal Declaration of Human Rights enshrines the right to health and well-being for every individual. However, universal access to high-quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri-operative care, where an estimated five billion individuals lack access to safe, affordable and timely surgical care. Delivery of surgery and anaesthesia in low-resource environments presents unique challenges that, when unaddressed, result in limited access to low-quality care. Current peri-operative research and clinical guidance often fail to acknowledge these system-level deficits and therefore have limited applicability in low-resource settings. In this manuscript, the authors priority-set the need for equitable access to high-quality peri-operative care and analyse the system-level contributors to excess peri-operative mortality rates, a key marker of quality of care. To provide examples of how research and investment may close the equity gap, a modified Delphi method was adopted to curate and appraise interventions which may, with subsequent research and evaluation, begin to address the barriers to high-quality peri-operative care in low- and middle-income countries.


Assuntos
Anestesiologia/métodos , Saúde Global , Assistência Perioperatória/métodos , Qualidade da Assistência à Saúde , Humanos
2.
Anaesthesia ; 75 Suppl 1: e34-e38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31903583

RESUMO

Safety of patients in the operating theatre relies on a cordial and efficient working relationship between all members of the theatre team. A team that communicates well, defines the roles of its members and is aware of their limitations will provide safe patient care. In this review, we will examine how human factors engineering - the science of how to design processes, equipment and environments to optimise the human contributions to performance - can be used to improve safety and efficiency of surgery. Although these are often dismissed as 'common sense', we will explain how these solutions emerge not from healthcare but from diverse disciplines such as psychology, design and engineering.


Assuntos
Anestesiologia/métodos , Ergonomia/métodos , Equipe de Assistência ao Paciente , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios , Humanos
3.
Br J Anaesth ; 123(6): 887-897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591019

RESUMO

BACKGROUND: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training. METHODS: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre- and post-curriculum assessments in first-year postgraduate trainee doctors (residents). RESULTS: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P=0.013). After training, patients rated the residents as more empathetic (31 [4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7-12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9-16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10-18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P=0.001; 95% CI: 0.8-2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P=0.010; 95% CI: 0.4-2.8). CONCLUSIONS: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Currículo , Humanismo , Internato e Residência , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Empatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina/psicologia , Adulto Jovem
5.
Scand J Trauma Resusc Emerg Med ; 27(1): 87, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533787

RESUMO

Children form a specific group of patients, as there are significant differences between children and adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient's death. There are few paediatric difficult-airway guidelines available in the current literature, and some of these have significant limitations. This position paper, intended for unanticipated difficult airway, was elaborated by the panel of specialists representing the Polish Society of Anaesthesiology and Intensive Care as well as the Polish Neonatal Society. It covers both elective intubation and emergency situations in children in all age groups. An integral part of the paper is an algorithm. The paper describes in detail all stages of the algorithm considering some modification in specific age groups, i.e. neonates.


Assuntos
Manuseio das Vias Aéreas/normas , Algoritmos , Anestesiologia/métodos , Cuidados Críticos/normas , Hipóxia/terapia , Sociedades Médicas , Criança , Humanos
6.
Anaesthesia ; 74(9): 1138-1146, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31155704

RESUMO

This prospective, observational study compared the proportion of cases with missing critical pre-induction items before and after the implementation of an aviation-style computerised pre-induction anaesthesia checklist. Trained observers recorded the availability of critical pre-induction items and evaluated the characteristics of the pre-induction anaesthesia checklist performance including provider participation and distraction level, resistance to the use of the checklist and the time required for completion. Surgical cases that met the criteria for inclusion in the National Surgical Quality Improvement Program at a single academic hospital were selected for observation. A total of 853 cases were observed before and 717 after implementation of the checklist. The proportion of cases with failure to perform all pre-induction steps decreased from 10.0% to 6.4% (p = 0.012). There was also a significant decrease in the proportion of cases with non-routine events from 1.2% cases before to none after checklist implementation (p = 0.003). In 17 cases, the checklist alerted the anaesthesia provider to correct a mistake in pre-induction preparation.


Assuntos
Serviço Hospitalar de Anestesia/métodos , Anestesiologia/métodos , Lista de Checagem/métodos , Segurança do Paciente/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Pain Physician ; 22(3): 201-207, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31151329

RESUMO

Many of the patients undergoing interventional procedures have daily regimens of medications including analgesics, muscle relaxants, and other drugs that can have significant additive/synergistic effects during the perioperative period. Further, many patients also present with comorbid states, including obesity, cardiovascular, and pulmonary disease. Consequently, in the perioperative period, a significant number of patients have suffered permanent neurologic injury, hypoxic brain injury, and even death as a result of over sedation, hypoventilation, and spinal cord injury. In addition, physicians are concerned about aspiration, subsequent complications, and as a result, they ask patients to fast for several hours prior to the procedures. Based on extensive literature and consensus, a minimum fasting period is established as 2 hours before a procedure for clear liquids and 4 hours before procedure for light meals, rather than having all patients fast for 8 hours or even fasting beginning at midnight the night before the procedure. Gastrointestinal stimulants, gastric acid secretion blockers, and antacids may be used, even though not routinely recommended. Due to the nature of chronic pain and anxiety, many patients undergoing interventional techniques may require mild to moderate sedation. Deep sedation and/or general anesthesia for most interventional procedures is considered as unsafe, since the patient cannot communicate acute changes in symptoms, thus, resulting in morbidity and mortality, as well as creating compliance issues. We are adapting the published standards of the American Society of Anesthesiologists for monitoring patients under sedation, regardless of the location of the procedure, either office-based, in a surgery center, or a hospital outpatient department. These standards include monitoring of blood pressure, cardiac rhythm, temperature, pulse oximetry, and continuous quantitative end tidal CO2 monitoring. Sedation must be provided either by qualified anesthesia or non-anesthesia providers, with appropriate understanding of the medications, drug interactions, and resuscitative protocols.KEY WORDS: Guidelines, sedation, fasting status, monitoring, neurological complications.


Assuntos
Anestesiologia/métodos , Sedação Consciente/métodos , Monitorização Intraoperatória/métodos , Manejo da Dor/métodos , Jejum , Humanos , Masculino
8.
Curr Pain Headache Rep ; 23(7): 48, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31147838

RESUMO

PURPOSE OF REVIEW: Total patient care is of extreme importance during the administration of anesthesia. Proper care of the eye is necessary during all anesthetic administrations, especially during the administration of general anesthesia or monitored anesthesia care. By paying attention to details, the likelihood of an occurrence of eye injuries is reduced. RECENT FINDINGS: Though perioperative eye injuries are rare during general anesthesia, they do account for 2-3% of claims against anesthesiologists. Ocular injuries may occur during general anesthesia even when tape has been utilized for eye closure. Corneal abrasions are the most common injuries that have been attributed to direct trauma to the eye, exposure keratopathy, or chemical injury. Using a hydrogel patch during general anesthesia is also associated with more frequent corneal injury than previously thought. Prevention of anesthesia-related eye injuries assumes a high priority since the eye is one of the major sense organs of the body. The eye can be damaged during anesthesia for both non-ophthalmic and ophthalmic surgeries.


Assuntos
Anestesia Geral , Lesões da Córnea/diagnóstico , Lesões da Córnea/terapia , Procedimentos Cirúrgicos Oftalmológicos , Complicações Pós-Operatórias/cirurgia , Anestesia Geral/efeitos adversos , Anestesiologia/métodos , Humanos , Período Pós-Operatório
9.
Obstet Gynecol Clin North Am ; 46(2): 329-337, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056134

RESUMO

The subspecialty of obstetric anesthesiology has embraced patient safety research, which has led to a reduction in obstetric anesthesia-related morbidity and mortality. Although there are innumerable individual improvements, this article highlights the following innovations: safer and more effective labor analgesia, safer treatments for hypotension associated with neuraxial blockade, advances in spinal and epidural techniques for operative deliveries, lower incidence of postdural puncture headache through improved technology, safer parental agents for labor analgesia, improved safety of general anesthesia in obstetrics, improved education and the use of simulation including team training, and reductions in operating room-related infections.


Assuntos
Anestesia Obstétrica , Segurança do Paciente , Analgesia , Anestesia Geral/efeitos adversos , Anestesia Geral/tendências , Anestesia Obstétrica/métodos , Anestesia Obstétrica/mortalidade , Anestesia Obstétrica/tendências , Anestesiologia/métodos , Anestesiologia/tendências , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto , Cefaleia Pós-Punção Dural/prevenção & controle , Gravidez
10.
Curr Opin Anaesthesiol ; 32(4): 517-522, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082826

RESUMO

PURPOSE OF REVIEW: To review the anesthestic and airway management for gastrointestinal procedures outside of the operating room. RECENT FINDINGS: The number of gastrointestinal endoscopic procedures performed is steadily increasing worldwide. As complexity, duration and invasiveness of procedures increase, there is ever greater requirement for deeper sedation or general anesthesia. A close relationship between anesthetic practitioners and endoscopists is required to ensure safe and successful outcomes. The American Society of Gastrointestinal endoscopy and the British Society of Gastroenterology have recently released guidelines for sedation and general anesthesia in gastrointestinal endoscopy, highlighting the need for careful monitoring for all cases, and anesthetic expertise in complex cases. The recent advances in high-flow nasal oxygenation in sedation may provide alternative options for oxygenation during gastrointestinal sedation, especially in deep sedation and this may reduce the need for general anesthesia. SUMMARY: The advances in gastrointestinal endoscopic intervention have increased the requirement for deep sedation and anesthetic involvement outside of the operating room. Careful titration of anesthetic intervention and close monitoring are required to ensure patient safety.


Assuntos
Anestesiologia/normas , Endoscopia Gastrointestinal/efeitos adversos , Dor Processual/prevenção & controle , Guias de Prática Clínica como Assunto , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Anestesiologia/métodos , Anestésicos/administração & dosagem , Sedação Consciente/métodos , Sedação Consciente/normas , Sedação Profunda/métodos , Sedação Profunda/normas , Endoscopia Gastrointestinal/normas , Gastroenterologia/normas , Humanos , Dor Processual/etiologia , Sociedades Médicas/normas , Reino Unido
11.
Anesth Analg ; 128(6): 1107-1117, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094775

RESUMO

Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway. A literature search was performed for each protocol component, and the highest levels of evidence available were selected for review. Anesthesiology components of care were identified and evaluated across the perioperative continuum. For the preoperative phase, the use of regional analgesia and nonopioid multimodal analgesic agents is suggested. For the intraoperative phase, a standardized anesthetic with postoperative nausea and vomiting prophylaxis is suggested. For the postoperative phase, a multimodal (primarily nonopioid) analgesic regimen is suggested. A summary of the best available evidence and recommendations for inclusion in ERAS protocols for HFx repair are provided.


Assuntos
Anestesiologia/métodos , Anestesiologia/normas , Artroplastia de Quadril/métodos , Fraturas do Quadril/cirurgia , Analgésicos/uso terapêutico , Anestésicos/efeitos adversos , Anestésicos/uso terapêutico , Medicina Baseada em Evidências , Humanos , Comunicação Interdisciplinar , Bloqueio Nervoso , Manejo da Dor , Segurança do Paciente , Assistência Centrada no Paciente , Assistência Perioperatória/métodos , Período Perioperatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos , United States Agency for Healthcare Research and Quality
12.
Anesth Analg ; 128(6): 1118-1126, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094776

RESUMO

BACKGROUND: In patients who receive a nondepolarizing neuromuscular blocking drug (NMBD) during anesthesia, undetected postoperative residual neuromuscular block is a common occurrence that carries a risk of potentially serious adverse events, particularly postoperative pulmonary complications. There is abundant evidence that residual block can be prevented when real-time (quantitative) neuromuscular monitoring with measurement of the train-of-four ratio is used to guide NMBD administration and reversal. Nevertheless, a significant percentage of anesthesiologists fail to use quantitative devices or even conventional peripheral nerve stimulators routinely. Our hypothesis was that a contributing factor to the nonutilization of neuromuscular monitoring was anesthesiologists' overconfidence in their knowledge and ability to manage the use of NMBDs without such guidance. METHODS: We conducted an Internet-based multilingual survey among anesthesiologists worldwide. We asked respondents to answer 9 true/false questions related to the use of neuromuscular blocking drugs. Participants were also asked to rate their confidence in the accuracy of each of their answers on a scale of 50% (pure guess) to 100% (certain of answer). RESULTS: Two thousand five hundred sixty persons accessed the website; of these, 1629 anesthesiologists from 80 countries completed the 9-question survey. The respondents correctly answered only 57% of the questions. In contrast, the mean confidence exhibited by the respondents was 84%, which was significantly greater than their accuracy. Of the 1629 respondents, 1496 (92%) were overconfident. CONCLUSIONS: The anesthesiologists surveyed expressed overconfidence in their knowledge and ability to manage the use of NMBDs. This overconfidence may be partially responsible for the failure to adopt routine perioperative neuromuscular monitoring. When clinicians are highly confident in their knowledge about a procedure, they are less likely to modify their clinical practice or seek further guidance on its use.


Assuntos
Anestesiologia/métodos , Competência Clínica , Recuperação Demorada da Anestesia/induzido quimicamente , Monitorização Intraoperatória/métodos , Bloqueio Neuromuscular/métodos , Monitoração Neuromuscular/métodos , Tomada de Decisões , Humanos , Internacionalidade , Internet , Pneumopatias/etiologia , Fármacos Neuromusculares , Complicações Pós-Operatórias , Psicometria , Reprodutibilidade dos Testes , Risco , Inquéritos e Questionários
13.
Anesth Analg ; 128(6): 1154-1159, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094782

RESUMO

BACKGROUND: Apneic oxygenation via the oral route using a buccal device extends the safe apnea time in most but not all obese patients. Apneic oxygenation techniques are most effective when tracheal oxygen concentrations are maintained >90%. It remains unclear whether buccal oxygen administration consistently achieves this goal and whether significant risks of hypercarbia or barotrauma exist. METHODS: We conducted a randomized trial of buccal or sham oxygenation in healthy, nonobese patients (n = 20), using prolonged laryngoscopy to maintain apnea with a patent airway until arterial oxygen saturation (SpO2) dropped <95% or 750 seconds elapsed. Tracheal oxygen concentration, tracheal pressure, and transcutaneous carbon dioxide (CO2) were measured throughout. The primary outcome was maintenance of a tracheal oxygen concentration >90% during apnea. RESULTS: Buccal patients were more likely to achieve the primary outcome (P < .0001), had higher tracheal oxygen concentrations throughout apnea (mean difference, 65.9%; 95% confidence interval [CI], 62.6%-69.3%; P < .0001), and had a prolonged median (interquartile range) apnea time with SpO2 >94%; 750 seconds (750-750 seconds) vs 447 seconds (405-525 seconds); P < .001. One patient desaturated to SpO2 <95% despite 100% tracheal oxygen. Mean tracheal pressures were low in the buccal (0.21 cm·H2O; SD = 0.39) and sham (0.56 cm·H2O; SD = 1.25) arms; mean difference, -0.35 cm·H2O; 95% CI, 1.22-0.53; P = .41. CO2 accumulation during early apnea before any study end points were reached was linear and marginally faster in the buccal arm (3.16 vs 2.82 mm Hg/min; mean difference, 0.34; 95% CI, 0.30-0.38; P < .001). Prolonged apnea in the buccal arm revealed nonlinear CO2 accumulation that declined over time and averaged 2.22 mm Hg/min (95% CI, 2.21-2.23). CONCLUSIONS: Buccal oxygen administration reliably maintains high tracheal oxygen concentrations, but early arterial desaturation can still occur through mechanisms other than device failure. Whereas the risk of hypercarbia is similar to that observed with other approaches, the risk of barotrauma is negligible. Continuous measurement of advanced physiological parameters is feasible in an apneic oxygenation trial and can assist with device evaluation.


Assuntos
Administração Bucal , Apneia/terapia , Dióxido de Carbono/análise , Oxigênio/uso terapêutico , Respiração Artificial/instrumentação , Adolescente , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Anestesiologia/métodos , Feminino , Humanos , Intubação Intratraqueal/métodos , Laringoscopia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Respiração Artificial/métodos , Traqueia , Adulto Jovem
14.
Anesth Analg ; 128(6): 1199-1207, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094788

RESUMO

BACKGROUND: Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice claims where obstetric anesthesiology was the principal defendant. METHODS: The Controlled Risk Insurance Company (CRICO) is the captive medical liability insurer of the Harvard Medical Institutions that, in collaboration with other insurance companies and health care entities, contributes to the Comparative Benchmark System database for research purposes. We reviewed all (N = 106) closed malpractice cases related to obstetric anesthesia between 2005 and 2015 and compared the following classes of injury: maternal death and brain injury, neonatal death and brain injury, maternal nerve injury, and maternal major and minor injury. In addition, settled claims were compared to the cases that did not receive payment. χ, analysis of variance, Student t test, and Kruskal-Wallis tests were used for comparison between the different classes of injury. RESULTS: The largest number of claims, 54.7%, involved maternal nerve injury; 77.6% of these claims did not receive any indemnity payment. Cases involving maternal death or brain injury comprised 15.1% of all cases and were more likely to receive payment, especially in the high range (P = .02). The most common causes of maternal death or brain injury were high neuraxial blocks, embolic events, and failed intubation. Claims for maternal major and minor injury were least likely to receive payment (P = .02) and were most commonly (34.8%) associated with only emotional injury. Compared to the dropped/denied/dismissed claims, settled claims more frequently involved general anesthesia (P = .03), were associated with delays in care (P = .005), and took longer to resolve (3.2 vs 1.3 years; P < .0001). CONCLUSIONS: Obstetric anesthesia remains an area of significant malpractice liability. Opportunities for practice improvement in the area of severe maternal injury include timely recognition of high neuraxial block, availability of adequate resuscitative resources, and the use of advanced airway management techniques. Anesthesiologists should avoid delays in maternal care, establish clear communication, and follow their institutional policy regarding neonatal resuscitation. Prevention of maternal neurological injury should be directed toward performing neuraxial techniques at the lowest lumbar spine level possible and prevention/recognition of retained neuraxial devices.


Assuntos
Anestesia Obstétrica/efeitos adversos , Anestesiologia/legislação & jurisprudência , Revisão da Utilização de Seguros , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Adulto , Anestesia por Condução , Anestesiologia/métodos , Lesões Encefálicas/etiologia , Bases de Dados Factuais , Feminino , Humanos , Morte Materna , Gravidez , Medição de Risco , Traumatismos da Medula Espinal/etiologia , Adulto Jovem
15.
Anesth Analg ; 128(6): 1242-1248, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094794

RESUMO

BACKGROUND: Pediatric anesthesiologists are exposed to ionizing radiation from x-rays on an almost daily basis. Our goal was to determine the culture of safety in which they work and how they adhere to preventative strategies that minimize exposure risk in their daily practice. METHODS: After Institutional Review Board waiver and approval of the Society for Pediatric Anesthesia's research and quality and safety committees, an electronic e-mail questionnaire was sent to the Society's physician, nontrainee members and consisted of questions specific to provider use of protective lead shielding, the routine use of dosimeters, and demographic information. Univariate analyses were performed using the Wilcoxon rank sum test for ordinal variables, the Fisher exact test for categorical variables, and the Spearman test to analyze correlation between 2 ordinal variables, while a proportional odds logistic regression was used for a multivariable ordinal outcome analysis. P values of <.05 were considered statistically significant. RESULTS: Twenty-one percent (674/3151) of the surveyed anesthesiologists completed the online questionnaire. Radiation exposure is ubiquitous (98.7%), and regardless of sex, most respondents were either concerned or very concerned about radiation exposure (76.8%); however, women were significantly more concerned than men (proportional odds ratio, 1.66 [95% confidence interval, 1.20-2.31]; P = .002). Despite this and independent of sex, level of concern was not associated with use of a radiation dosimeter (P = .85), lead glasses (odds ratio, 1.07 [95% confidence interval, 0.52-2.39]; P = 1.0), or a thyroid shield (P = .12). Dosimeters were rarely (13%) or never used (52%) and were mandated in only 28.5% of institutions. Virtually none of the respondents had ever taken a radiation safety course, received a personal radiation dose report, notification of their radiation exposure, or knew how many millirem/y was considered safe. Half of the respondents were female, and while pregnant, 73% (151/206) tried to avoid radiation exposure by requesting not to be assigned to cases requiring x-rays. These requests were honored 78% (160/206) of the time. DISCUSSION: Despite universal exposure to ionizing radiation from x-rays, pediatric anesthesiologists do not routinely adhere to strategies designed to limit the intensity of this exposure and rarely work in institutions in which a culture of radiation safety exists. Our study highlights the need to improve radiation safety education, the need to change the safety culture within the operating rooms and imaging suites, and the need to more fully investigate the utility of dosimeters, lead shielding, and eye safety measures in pediatric anesthesia practice.


Assuntos
Anestesia/métodos , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Exposição Ocupacional/prevenção & controle , Proteção Radiológica/métodos , Adulto , Anestesiologistas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Saúde do Trabalhador , Salas Cirúrgicas , Médicos , Radiação Ionizante , Radiometria , Análise de Regressão , Risco , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
16.
Anesth Analg ; 128(6): 1292-1299, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094802

RESUMO

BACKGROUND: Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS: With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS: A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P < .001). The frequency of large errors (100-fold greater or less than the correct answer) by residents was twice that of faculty. Error rates varied among institutions ranged from 12% to 22% (P = .021). CONCLUSIONS: Anesthesiology residents and faculty erred frequently on a computational test, with junior residents and faculty with more experience committing errors more frequently. Residents committed more serious errors twice as frequently as faculty.


Assuntos
Anestesiologia/educação , Anestesiologia/métodos , Anestésicos/administração & dosagem , Esquema de Medicação , Erros de Medicação/estatística & dados numéricos , Psicometria , Anestesia , Competência Clínica , Análise Fatorial , Docentes de Medicina , Humanos , Internato e Residência , Reprodutibilidade dos Testes , Risco , Inquéritos e Questionários , Estados Unidos
18.
GMS J Med Educ ; 36(2): Doc12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30993170

RESUMO

Introduction: The focus of public attention and health policy is increasingly being drawn to patient safety. According to studies, more than 30,000 patients die each year as a result of medical errors. To date, learning objectives such as patient safety have not played a role in the core curriculum for medical education in Germany. The National Competence-Based Catalogue of Learning Objectives for Undergraduate Medical Education contains a total of 13 learning objectives relating to this subject. Methods: In a descriptive study, learning content was implemented within the "Operative Medicine" study block offered by the Faculty of Medicine at Universität Hamburg. The definition and occurrence of errors as well as strategies for dealing with and avoiding errors were set as the learning objectives for an interactive lecture, problem-based learning (PBL) case as well as the bedside teaching on anaesthesiology. Students were able to evaluate the lecture directly. During the simulator session on anaesthesia, the safety-relevant information that students requested from patients was compared with the questions asked by a control group in the previous trimester. Results: The topic of patient safety could be integrated into the "Operative Medicine" curriculum through a number of minor changes to classes. The accounts of personal experiences and importance assigned to the subject were considered positive, while content perceived as redundant was criticised. In the simulator, the students appeared to request more comprehensive preoperative safety-relevant information than the control group. Conclusion: The subject's relevance, positive feedback and trend towards a change in behaviour in the simulator lead the authors to deem introduction of the topic of patient safety a success.


Assuntos
Anestesiologia/educação , Segurança do Paciente/normas , Anestesia/métodos , Anestesia/normas , Anestesiologia/métodos , Competência Clínica/normas , Currículo/normas , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Avaliação Educacional/métodos , Alemanha , Humanos , Erros Médicos/efeitos adversos , Erros Médicos/prevenção & controle , Inquéritos e Questionários
20.
J Grad Med Educ ; 11(2): 177-181, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024649

RESUMO

Background: Arterial line insertion is traditionally done by blind palpation. Residents may need multiple attempts for successful insertion, leading to longer procedure times and many failed attempts. Objective: We hypothesized that ultrasound guidance (USG) would be faster and more successful than traditional blind palpation (TBP) for radial artery line placement by residents. Methods: Patients undergoing elective surgery requiring a radial arterial line were randomized to either the USG or TBP groups. Exclusion criteria included a need for arterial line placement in an awake patient, emergent surgery, or American Society of Anesthesiologists (ASA) physical status class VI. After the induction of anesthesia, a postgraduate year 3 (PGY-3) or PGY-4 anesthesia resident placed an arterial line by either USG or TBP. Results: A total of 412 patients and 85 of 106 residents (80%) in the training program were included. The 2 groups were similar with respect to sex, weight, height, ASA class, baseline systolic blood pressure, and baseline heart rate. USG was faster than TBP (mean times 171.1 ± 16.7 seconds versus 243.6 ± 23.5 seconds, P = .012), required fewer attempts (mean 1.78 ± 0.11 versus 2.48 ± 0.15, P = .035), and had an improved success rate (96% versus 90%, P = .012). Conclusions: We found that residents using USG in an academic institution resulted in significantly faster placement of the arterial lines, fewer attempts, and fewer catheters used.


Assuntos
Cateterismo Periférico/métodos , Palpação/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Anestesiologia/educação , Anestesiologia/métodos , Feminino , Hospitais de Ensino , Humanos , Internato e Residência/métodos , Masculino , Estudos Prospectivos , Artéria Radial
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