Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.007
Filtrar
2.
Br J Anaesth ; 126(2): 423-432, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33413977

RESUMO

Delirium and postoperative neurocognitive disorder are the commonest perioperative complications in patients more than 65 yr of age. However, data suggest that we often fail to screen patients for preoperative cognitive impairment, to warn patients and families of risk, and to take preventive measures to reduce the incidence of perioperative neurocognitive disorders. As part of the American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative, an international group of experts was invited to review published best practice statements and guidelines. The expert group aimed to achieve consensus on a small number of practical recommendations that could be implemented by anaesthetists and their partners to reduce the incidence of perioperative neurocognitive disorders. Six statements were selected based not only on the strength of the evidence, but also on the potential for impact and the feasibility of widespread implementation. The actions focus on education, cognitive and delirium screening, non-pharmacologic interventions, pain control, and avoidance of antipsychotics. Strategies for effective implementation are discussed. Anaesthetists should be key members of multidisciplinary perioperative care teams to implement these recommendations.


Assuntos
Anestesiologia/normas , Anestesistas/normas , Encéfalo/fisiopatologia , Cognição , Delírio/prevenção & controle , Equipe de Assistência ao Paciente/normas , Assistência Perioperatória/normas , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Fatores Etários , Idoso , Antipsicóticos/efeitos adversos , Consenso , Delírio/fisiopatologia , Delírio/psicologia , Medicina Baseada em Evidências/normas , Humanos , Liderança , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias/fisiopatologia , Complicações Cognitivas Pós-Operatórias/psicologia , Medição de Risco , Fatores de Risco
3.
Anesth Analg ; 131(5): 1412-1418, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079864

RESUMO

In 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate an Objective Structured Clinical Examination (OSCE) into its initial certification examination system. Previously, the ABA's staged examination system consisted of 2 written examinations (the BASIC and ADVANCED examinations) and the Standardized Oral Examination (SOE). The OSCE and the existing SOE are now 2 separate components of the APPLIED Examination. This report presents the results of the first-year OSCE administration. A total of 1410 candidates took both the OSCE and the SOE in 2018. Candidate performance approximated a normal distribution for both the OSCE and the SOE, and was not associated with the timing of the examination, including day of the week, morning versus afternoon session, and order of the OSCE and the SOE. Practice-based Learning and Improvement was the most difficult station, while Application of Ultrasonography was the least difficult. The correlation coefficient between SOE and OSCE scores was 0.35 ([95% confidence interval {CI}, 0.30-0.39]; P < .001). Scores for the written ADVANCED Examination were modestly correlated with scores for the SOE (r = 0.29 [95% CI, 0.25-0.34]; P < .001) and the OSCE (r = 0.15 [95% CI, 0.10-0.20]; P < .001). Most of the candidates who failed the SOE passed the OSCE, and most of the candidates who failed the OSCE passed the SOE. Of the 1410 candidates, 77 (5.5%) failed the OSCE, 155 (11.0%) failed the SOE, and 25 (1.8%) failed both. Thus, 207 (14.7%) failed at least 1 component of the APPLIED Examination. Adding an OSCE to a board certification examination system is feasible. Preliminary evidence indicates that the OSCE measures aspects of candidate abilities distinct from those measured by other examinations used for initial board certification.


Assuntos
Anestesiologia/normas , Certificação/normas , Avaliação Educacional , Competência Clínica , Comunicação , Humanos , Internato e Residência , Aprendizagem , Papel Profissional , Melhoria de Qualidade , Conselhos de Especialidade Profissional , Ultrassonografia , Estados Unidos
4.
Curr Opin Anaesthesiol ; 33(5): 674-684, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32826622

RESUMO

PURPOSE OF REVIEW: Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years. RECENT FINDINGS: Twenty-two articles were identified, investigating nine out of the 13 top-ranked research topics in education and training in regional anaesthesia. Research topics addressed by these articles included prerotation simulation, deliberate practice combined with formative assessment tools, validation of assessment tools, three-dimensional-printed models, and knowledge translation from simulation to clinical practice. Emerging concepts investigated for their applications in regional anaesthesia included eye-tracking as a surrogate metric when evaluating proficiency, and elastography aiding visual salience to distinguish appropriate perineural and inappropriate intraneural injections. SUMMARY: Research into education and training in regional anaesthesia covered multiple and diverse topics. Methodological limitations were noted in several articles, reflecting the difficulties in designing and conducting medical education studies. Nonetheless, the evidence-base continues to mature and innovations provide exciting future possibilities.


Assuntos
Anestesia por Condução/normas , Anestesiologia/educação , Educação Médica , Ultrassonografia de Intervenção/normas , Anestesia por Condução/métodos , Anestesiologia/normas , Competência Clínica/normas , Humanos , Dor
5.
Medwave ; 20(6): e7950, 2020 Jul 02.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32759892

RESUMO

The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.


Assuntos
Anestesiologia/normas , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Doenças Profissionais/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Aerossóis , Anestesia por Condução/métodos , Anestesia Epidural/métodos , Anestesia Geral/métodos , Raquianestesia/métodos , Anestesiologia/organização & administração , Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Bloqueio Nervoso/métodos , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Respiração Artificial/métodos , Respiração Artificial/normas , Procedimentos Cirúrgicos Operatórios , Avaliação de Sintomas/métodos
6.
Br J Anaesth ; 125(5): 835-842, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32611528

RESUMO

INTRODUCTION: Reliable, high-quality research is essential to the field of anaesthesiology. Reproducibility and transparency have been investigated in the biomedical domain and in the social sciences, with both lacking to provide necessary information to reproduce the study findings. In this study, we investigated 14 indicators of reproducibility in anaesthesiology research. METHODS: We used the National Library of Medicine catalogue to search for all anaesthesiology journals that are MEDLINE indexed and provide English texts. PubMed was searched with the list of journals to identify all publications from January 1, 2014 to December 31, 2018. We randomly sampled 450 publications that fit the inclusion criteria for our analysis. Data extraction was then conducted in a blinded, duplicate fashion using a pilot-tested Google form. RESULTS: The PubMed search of these journals identified 171 441 publications, with 28 310 being within the time frame. From the 450 publications sampled, 444 full-text publications were accessible. The majority of publications analysed did not have a statement regarding availability of data (164/188), analysis scripts (187/188), or study materials (160/188). CONCLUSIONS: Anaesthesiology research needs to improve indicators of reproducibility and transparency. By making research publicly available and improving accessibility to detailed study components, primary research can be reproduced in subsequent studies and help contribute to the development of new practice guidelines.


Assuntos
Anestesiologia/normas , Pesquisa/normas , Animais , Estudos Transversais , Interpretação Estatística de Dados , Medicina Baseada em Evidências , Humanos , PubMed , Reprodutibilidade dos Testes
7.
Anesth Prog ; 67(2): 109-120, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32633770

RESUMO

Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.


Assuntos
Anestesia Dentária/normas , Anestesiologia/normas , Infecções por Coronavirus , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Betacoronavirus , Humanos
8.
Curr Opin Anaesthesiol ; 33(4): 520-526, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628399

RESUMO

PURPOSE OF REVIEW: Advances in early diagnosis and treatment of diseases using minimally invasive procedures has led to an increase in the number of cases in locations outside the operating room. This surge created the need for anesthesia services to expand to these areas to provide well tolerated and favorable procedural conditions. The present review describes nonoperating room anesthesia patterns in different parts of the world. RECENT FINDINGS: Nonoperating room anesthesia has grown exponentially over the last years. Patients scheduled in these areas are sicker and older compared to the operating room patients. Anesthesiologist-directed care has proven to be well tolerated, with less serious complications and improvement in patients and proceduralist satisfaction. SUMMARY: There are marked variations in how anesthesia services are delivered in out of operating room locations in different parts of the world. Although there are some data available from the United States, expansion of minimally invasive procedures across continents will likely lead to the emergence of various models of delivering anesthetic care.


Assuntos
Anestesia/tendências , Anestesiologia/tendências , Anestésicos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Anestesiologistas , Anestesiologia/normas , Ásia , Betacoronavirus , Europa (Continente) , Humanos , Salas Cirúrgicas , América do Sul , Estados Unidos
9.
Curr Opin Anaesthesiol ; 33(4): 539-547, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628401

RESUMO

PURPOSE OF REVIEW: This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. RECENT FINDINGS: Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation. SUMMARY: NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.


Assuntos
Anestesia/normas , Anestesiologia/normas , Anestesiologistas , Broncoscopia , Cateterismo , Endoscopia , Gastroenterologia/normas , Humanos , Pneumologia/normas , Radiologia Intervencionista/normas , Ultrassonografia
10.
Curr Opin Anaesthesiol ; 33(4): 554-560, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628402

RESUMO

PURPOSE OF REVIEW: With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the operating room to more unfamiliar environments. RECENT FINDINGS: Despite limited nonoperating room anaesthesia outcome data, analysis of malpractice claims, anaesthesia-related medical disputes and clinical outcome registries have suggested higher morbidity and mortality. Complications were often associated with suboptimal monitoring, nonadherence to recommended guidelines and sedationist or nonanaesthesiologist caregivers. More recently, clear monitoring guidelines, global patient safety initiatives and widespread implementation of cognitive aids may have contributed to nonoperating room anaesthesia (NORA) outcomes approaching that of traditional operating rooms. SUMMARY: As NORA caseloads increase, understanding structural and anaesthetic requirements is essential to patient safety. The severe acute respiratory syndrome coronavirus 2 pandemic has provided an opportunity for anaesthesiologists to implement lessons learned from previous analyses, share expertise as patient safety leaders and provide valuable input into protecting patients and caregivers.


Assuntos
Anestesia/normas , Anestesiologia/normas , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Anestesia/efeitos adversos , Betacoronavirus , Lista de Checagem , Cognição , Humanos , Salas Cirúrgicas , Segurança do Paciente
11.
Curr Opin Anaesthesiol ; 33(4): 584-588, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628407

RESUMO

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) cases performed in pediatric patients have increased over the past decade. It is imperative for the anesthesia provider to be familiar with the nuances of this environment and the myriad of cases to ensure delivery of safe and efficient care. RECENT FINDINGS: Though case volume has increased, sedative agents have largely remained unchanged. NORA sites must meet the same operating room standards and expectations of anesthesia established by the American Society of Anesthesiologists. Despite the increasing NORA volume and efforts to instill a similar culture of safety as the operating room complex, NORA cases present challenges with limited resources and access to the patient, highlighting the need for resident and fellow training to include NORA experiences. SUMMARY: Experience working in the NORA environment helps provide, maintain, and improve the cognitive fitness and resilience that an anesthesiologist needs to tackle the complexities from the variety of NORA cases and locations. Patient factors aside, procedural considerations can affect the anesthetic plan, so understanding the nuances of the procedure helps the anesthesia provider provide safe and efficient care.


Assuntos
Anestesia/normas , Anestesiologia/normas , Anestesiologistas , Anestésicos/administração & dosagem , Criança , Humanos , Salas Cirúrgicas , Pediatria/normas
12.
Curr Opin Anaesthesiol ; 33(4): 594-600, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628408

RESUMO

PURPOSE OF REVIEW: To provide aids to deal with increasing amount of several comorbidities in nonoperating room anesthesia (NORA). RECENT FINDINGS: New indexes for assessment of comorbidities are described and guidelines for the care of patients with obesity, obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), diabetes and COVID19 in NORA summarized. SUMMARY: In addition to ASA classification, such instruments as Charlson Comorbidity Index, Frailty Index, Surgical Complexity Score and Revised Cardiac Risk could supplement the prospective assessment of the risk of comorbidities. Using institutional protocols patients with significant obesity, obstructive sleep apnea, COPD, diabetes and COVID19 can be safely cared in NORA. However, the individual functioning and the severity are more important than only the number of diseases.


Assuntos
Anestesia/normas , Anestesiologia/normas , Comorbidade , Betacoronavirus , Infecções por Coronavirus , Diabetes Mellitus , Humanos , Obesidade , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica , Apneia Obstrutiva do Sono
13.
Pain Physician ; 23(4): 413-422, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709176

RESUMO

BACKGROUND: The aim of this study was to examine and appreciate characteristics of malpractice lawsuits brought against interventional pain specialists. OBJECTIVES: To examine and appreciate characteristics of malpractice lawsuits brought against interventional pain specialists. STUDY DESIGN: Retrospective review. SETTING: Jury verdicts and settlement reports of state and federal malpractice cases involving interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from the Westlaw online legal database. METHODS: Jury verdicts and settlement reports of state and federal malpractice cases involving interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from the Westlaw online legal database. Data collected for each case included year, state, patient age, patient gender, defendant specialty, legal outcome, award amount, alleged cause of malpractice, and factors in plaintiff's decision to file. After elimination of duplicates and applying inclusion/exclusion criteria to our initial search yielding over 1,500 cases, a total of 82 cases were included in this study. RESULTS: A total of 57.3% of cases resulted in a jury verdict in favor of the defendant, whereas 41.5% favored the plaintiff. When comparing cases that were performed in the operating room to cases performed outside the operating room, we found the jury verdicts to favor the plaintiff 83.3% of the time for operating room procedures (P = 0.003). In other words, interventional pain practitioners were more likely to be found at fault for complications from procedures performed in the operating room. To eliminate confounders, a logistical regression was performed and confirmed operating room procedures were an independent predictor of a verdict awarded to the plaintiff (P = 0.008). The median amount awarded to the plaintiff for all cases was $333,000, and the single highest award amount was $36,636,288. The median payout for operating room procedures was $450,000 (P = 0.010), which was significantly different from the median payout for nonoperating room procedures. Procedure categorization demonstrated a statistically significant difference in jury verdicts (P = 0.01411) and procedural error was the leading reason for pursuing litigation, followed by lack of informed consent and unnecessary procedure performed. LIMITATIONS: There is more than one database that captures medicolegal claims brought against practitioners. Westlaw, which has been previously utilized by other studies, is only one of them and the extent to which overlap exists in unclear. For each, data input are not necessarily consistent and data capture are not complete. As a result, there could exist a skew toward more severe complications and the details of individual cases likely vary. During data extraction, we found that all details of the procedure were not always included. For example, not all cases specified the type of injectate utilized for epidural injection (i.e., local anesthetic, steroid, mixture, and others) or route of injection (i.e., transforaminal vs. interlaminar). Moreover, as previously mentioned, cases that are settled out of court or finalized prior to trial are not necessarily reported by the Westlaw database, and therefore were not always included in our data search. CONCLUSIONS: Overall, interventional pain medicine physicians were favored by jury verdicts for malpractice claims. However, when filtering by procedure or setting, jury verdicts favored the plaintiff in some cases. KEY WORDS: Interventional pain, medical, malpractice, anesthesiology.


Assuntos
Anestesiologia/legislação & jurisprudência , Governo Federal , Imperícia/legislação & jurisprudência , Manejo da Dor/normas , Dor/epidemiologia , Governo Estadual , Adulto , Anestesiologia/métodos , Anestesiologia/normas , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bases de Dados Factuais/normas , Feminino , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/normas , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Projetos Piloto , Estudos Retrospectivos , Estados Unidos/epidemiologia
14.
Pain Physician ; 23(4): E335-E342, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709179

RESUMO

BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.


Assuntos
Dor nas Costas/cirurgia , Ablação por Cateter/normas , Desfibriladores Implantáveis/normas , Médicos/normas , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Anestesia por Condução/métodos , Anestesia por Condução/normas , Anestesiologia/métodos , Anestesiologia/normas , Ablação por Cateter/métodos , Dor Crônica/cirurgia , Humanos , Articulação Zigapofisária/cirurgia
15.
Medwave ; 20(6)31-07-2020.
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1119716

RESUMO

El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.


The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.


Assuntos
Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Betacoronavirus/genética , Anestesiologia/normas , Doenças Profissionais/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Respiração Artificial/métodos , Respiração Artificial/normas , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Eletivos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Aerossóis , Pandemias , Avaliação de Sintomas/métodos , Equipamento de Proteção Individual , Unidades de Terapia Intensiva , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Anestesia por Condução/métodos , Anestesia Epidural/métodos , Anestesia Geral/métodos , Raquianestesia/métodos , Anestesiologia/organização & administração , Bloqueio Nervoso/métodos
16.
Anesthesiology ; 133(2): 332-341, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32541549

RESUMO

BACKGROUND: While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this study was to demonstrate the use of systems theoretic process analysis in a healthcare organization to prospectively identify causal factors for medication errors in the operating room. METHODS: The authors completed a systems theoretic process analysis for the medication use process in the operating room at their institution. First, the authors defined medication-related accidents (adverse medication events) and hazards and created a hierarchical control structure (a schematic representation of the operating room medication use system). Then the authors analyzed this structure for unsafe control actions and causal scenarios that could lead to medication errors, incorporating input from surgeons, anesthesiologists, and pharmacists. The authors studied the entire medication use process, including requesting medications, dispensing, preparing, administering, documenting, and monitoring patients for the effects. Results were reported using descriptive statistics. RESULTS: The hierarchical control structure involved three tiers of controllers: perioperative leadership; management of patient care by the attending anesthesiologist, surgeon, and pharmacist; and execution of patient care by the anesthesia clinician in the operating room. The authors identified 66 unsafe control actions linked to 342 causal scenarios that could lead to medication errors. Eighty-two (24.0%) scenarios came from perioperative leadership, 103 (30.1%) from management of patient care, and 157 (45.9%) from execution of patient care. CONCLUSIONS: In this study, the authors demonstrated the use of systems theoretic process analysis to describe potential causes of errors in the medication use process in the operating room. Causal scenarios were linked to controllers ranging from the frontline providers up to the highest levels of perioperative management. Systems theoretic process analysis is uniquely able to analyze management and leadership impacts on the system, making it useful for guiding quality improvement initiatives.


Assuntos
Anestesiologia/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Erros de Medicação/prevenção & controle , Salas Cirúrgicas/normas , Melhoria de Qualidade/normas , Teoria de Sistemas , Anestesiologistas/normas , Humanos , Salas Cirúrgicas/métodos , Farmacêuticos/normas , Estudos Prospectivos , Cirurgiões/normas
18.
Otolaryngol Pol ; 74(3): 1-5, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32398383

RESUMO

Recommendations of the Main Board of the Polish Society of Otorhinolaryngologists, Head and Neck Surgeons for providing services during the COVID-19 pandemic constitute the guidance to outpatient and hospital practices in all cases where contact with a patient whose status of COVID-19 is unknown. They have been created based on world publications and recommendations due to the current state of the COVID-19 pandemic. Justification for suspension of planned provision of services in the first phase of a pandemic was presented. The indication of the best medical practices for the time of stabilization, but with the persistence of the risk of COVID-19 infection in the population are discussed. The possibility of providing services in the following months of the pandemic is important. We provide the rationale for launching medical activities and indicate optimal practices until the consolidation of SARS COV-2 prevention and treatment methods.


Assuntos
Anestesiologia/normas , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/normas , Otolaringologia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral , Assistência Ambulatorial/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Hospitalização , Humanos , Otorrinolaringopatias/terapia , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Polônia
19.
Anesth Analg ; 130(6): 1450-1460, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384334

RESUMO

Frailty is a multidimensional syndrome characterized by decreased reserve and diminished resistance to stressors. People with frailty are vulnerable to stressors, and exposure to the stress of surgery is associated with increased risk of adverse outcomes and higher levels of resource use. As Western populations age rapidly, older people with frailty are presenting for surgery with increasing frequency. This means that anesthesiologists and other perioperative clinicians need to be familiar with frailty, its assessment, manifestations, and strategies for optimization. We present a narrative review of frailty aimed at perioperative clinicians. The review will familiarize readers with the concept of frailty, will discuss common and feasible approaches to frailty assessment before surgery, and will describe the relative and absolute associations of frailty with commonly measured adverse outcomes, including morbidity and mortality, as well as patient-centered and reported outcomes related to function, disability, and quality of life. A proposed approach to optimization before surgery is presented, which includes frailty assessment followed by recommendations for identification of underlying physical disability, malnutrition, cognitive dysfunction, and mental health diagnoses. Overall, 30%-50% of older patients presenting for major surgery will be living with frailty, which results in a more than 2-fold increase in risk of morbidity, mortality, and development of new patient-reported disability. The Clinical Frailty Scale appears to be the most feasible frailty instrument for use before surgery; however, evidence suggests that predictive accuracy does not differ significantly between frailty instruments such as the Fried Phenotype, Edmonton Frail Scale, and Frailty Index. Identification of physical dysfunction may allow for optimization via exercise prehabilitation, while nutritional supplementation could be considered with a positive screen for malnutrition. The Hospital Elder Life Program shows promise for delirium prevention, while individuals with mental health and or other psychosocial stressors may derive particular benefit from multidisciplinary care and preadmission discharge planning. Robust trials are still required to provide definitive evidence supporting these interventions and minimal data are available to guide management during the intra- and postoperative phases. Improving the care and outcomes of older people with frailty represents a key opportunity for anesthesiologists and perioperative scientists.


Assuntos
Anestesiologia/métodos , Fragilidade/cirurgia , Período Perioperatório , Idoso , Envelhecimento , Anestesiologia/normas , Delírio/prevenção & controle , Fragilidade/complicações , Fragilidade/fisiopatologia , Fragilidade/psicologia , Humanos , Assistência Centrada no Paciente , Qualidade de Vida , Índice de Gravidade de Doença
20.
J Cardiothorac Vasc Anesth ; 34(9): 2315-2327, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32414544

RESUMO

The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.


Assuntos
Comitês Consultivos/normas , Manuseio das Vias Aéreas/normas , Anestesia em Procedimentos Cardíacos/normas , Betacoronavirus , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Guias de Prática Clínica como Assunto/normas , Manuseio das Vias Aéreas/métodos , Anestesia em Procedimentos Cardíacos/métodos , Anestesiologia/métodos , Anestesiologia/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...