Continuous monitoring and feedback of quality of recovery indicators for anaesthetists: a qualitative investigation of reported effects on professional behaviour
Conclusions: This study investigated the requirements for effective feedback on quality of anaesthetic care for anaesthetists, highlighting the mechanisms by which feedback may translate into improvements in practice at the individual and peer-group level. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Hypotension during induction of anaesthesia is neither a reliable nor a useful quality measure for comparison of anaesthetists ’ performance
Conclusions. The AUC65 of time-weighted pre-incision hypotension is not a suitable metric for comparing anaesthetists. There were few at-risk patients, half the anaesthetists were not evaluable because of their case-mix and caseload, and hypotension was widely distributed. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Somatic tissue oxygenation monitoring
Editor —Heringlake and Maurer1 rightly caution about factors that might affect the interpretation and use of muscle tissue oximetry (SmtO2) compared with the better-studied cerebral oximetry monitoring. Indeed, a recent systematic review of peripheral near-infrared spectrometry (NIRS) monitoring revealed modest associations with central haemodynamics, but highlighted the need for improvement of NIRS technology, methodology, and appropriate metrics.2 In questioning the applicability and variability of SmtO2 measurements for clinical assessment, the authors assert that such measurements represent uncalibrated, off-label us...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Lip, tooth, and pharyngeal injuries during tracheal intubation at a teaching hospital
Editor—A non-negligible number of patients suffer injury to the lips, teeth, or pharynx during tracheal intubation,12 but the incidence of such injuries at teaching hospitals has not been clarified. This prospective observational study surveyed the occurrence of lip, tooth, and pharyngeal injuries associated with tracheal intubation by trainee doctors at a teaching hospital (Osaka Medical College, Japan) to compare incidence rates during the early and late training stages. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
ISO (Infraclavicular –SubOmohyoid) block: a single-puncture technique for diaphragm- and opioid-sparing shoulder anaesthesia
Editor —The shoulder joint and its muscles are entirely supplied by the brachial plexus and can be anaesthetized simply using the interscalene block. However, this proximal placement of local anaesthetic results in spread to many crucial neural structures (especially the phrenic nerve). To bypass this co mplication, distal block of the shoulder innervation is recommended.1 Distally, the shoulder nerves are discrete, so multiple injections are usually required to achieve adequate analgesia. Blocking the axillary nerve and suprascapular nerve can provide adequate analgesia for minor shoulder surgery, but for major surgery ...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Rising sudden death among anaesthesiologists in China
Editor —Anaesthesiologists in China are currently suffering from work overload, and sudden death is increasing dramatically. A recent sudden death of a young anaesthesiologist in a local hospital followed an overnight of on-duty work; the second sudden death of a young anaesthesiologist this spring. In 2 014, a young anaesthesiologist had a cardiac arrest after working 70 hours per week before the incident. More than 10 anaesthesiologists aged 30–45 yr had a cardiac arrest due to a heavy workload in China from 2013 to 2014.1 Sadly, this number has been increasing in recent years.2 The occupational status of anaesth...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
The Goldilocks principle as it applies to perioperative blood pressure: what is too high, too low, or just right?
This article challenges us to perhaps be as concerned about low BP readings as we are about elevated BP in the preoperative as well as intraoperative periods. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Some light in the grey zone?
Treatment of shock is not a new concern in intensive care medicine. The highest priority in patients with shock is the restoration of oxygen delivery. Fluid resuscitation is the very first goal of increasing cardiac output and oxygen delivery in patients with acute circulatory insufficiency. First, based on the simple physiology of the Frank –Starling mechanism, fluid loading should increase cardiac output (CO) by increasing preload and subsequently increasing left ventricular (LV) stroke volume.1 However, fluid overload, especially in patients with pre-existing or developing cardiac failure, can end in only a fractional...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Methodology in systematic reviews of goal-directed therapy: improving but not perfect
There has been a recent tsunami of articles on goal-directed (fluid) therapy, haemodynamic optimization and validation of cardiovascular monitoring devices. This has been followed by a wave of systematic reviews, in particular over the last five years, trying to summarize and derive conclusions and recommendations from many of these studies.1–19 Terminology for systematic reviews and meta-analyses is frequently used incorrectly. A systematic review refers to a rigorous scientific process of reviewing relevant literature whereas meta-analysis refers to a statistical method of pooling data from multiple studies to derive a...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Intraoperative fraction of inspired oxygen: bringing back the focus on patient outcome
Over the last two decades, several randomized controlled trials (RCTs) have investigated the clinical impact of a higher fraction of inspired oxygen (FiO2) administered in the perioperative period. SettingFiO2 in the operating theatre and after surgery is one of the daily tasks of every anaesthetist, and in elective surgery in uncomplicated patients is often based on the clinician ’s habits, training, and local clinical practice, rather than on evidence-based guidelines. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Supplemental oxygen and surgical site infection: getting to the truth
Surgical site infection (SSI) remains one of the most serious and expensive postoperative complications.1 Infected patients are twice as likely to need admission to critical care and twice as likely to die.2 The primary defence against SSI is oxidative killing by neutrophils, and molecular oxygen is the substrate.3 Resistance to infection is thus a strong function of tissue oxygen partial pressure over the clinical range. One might thus expect that supplemental perioperative oxygen ( ∼80%) would reduce infection risk when compared with more traditional inspired oxygen concentrations (∼30%) during anaesthesia and surger...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Sleep deprived and unprepared
Recent UK government policy initiatives concerning 24/7 care have once again put the spotlight on work after hours. The unavoidable night shift confronts us on a regular basis with the physical, psychological, social, and emotional impacts of acute sleep deprivation and fatigue. Although the function of sleep is still not fully understood, it is undoubtedly vital for our good health and well-being. Regardless, on average we are sleeping less now than we ever did before. As a result, there is endless debate about the dangers of long working hoursvs the benefits of continuity of care. Intriguingly, very little is actually kn...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Quality metrics: hard to develop, hard to validate
In this issue of theBritish Journal of Anaesthesia, Epstein and colleagues1 report their findings surrounding the proposed use of intraoperative hypotension as a quality metric for comparison of anaesthetists. The authors analysed a retrospective data set derived from 10 yr of data from their anaesthesia information management system, focusing specifically on a cohort of patients undergoing surgery at an increased risk of postoperative myocardial injury. The availability of electronic health records has enabled big data approaches for quality improvement and outc omes research in anaesthesia.23 Anaesthetists performing ...
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery
British Journal of Anaesthesia, 119(1): 65 –77 (2017), DOI10.1093/bja/aex056 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 28, 2017 Category: Anesthesiology Source Type: research
Catheter-related right internal jugular vein thrombosis after chest surgery
Conclusions: Earlier catheter removal may reduce the risk of catheter-related thrombosis and avoid possibly fatal complications after catheter-related thrombosis. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 26, 2017 Category: Anesthesiology Source Type: research
