clinical forum

The evolving changes in the delivery of Healthcare in general and anesthsia in particular has created an emphasis on patient safety.  With the push for more cost effective delivery of healthcare, more procedures are being done on an outpatient basis on sicker patients.  Combining the new economics with the obesity epidemic in America has created […]

According to the CDC, nearly 2 million people get infections while in US hospitals annually and around 100,000 of those people die.  Hand washing is one of the most important and easy ways of reducing the transfer of pathogens from person to person. An Article by By Ruth LeTexier, RN, BSN, PHN (Preventing Infection Through […]

Living and working in a society where substance abuse is not uncommon places the Anesthetist in a position where they may administer anesthesia to a patient who either is high or has recently used illegal drugs.  Cocaine abuse has been associated with acute onset of hemodynamic changes and end organ dysfunction.  This scenario begs the question […]

Supraglottic  airway devices have proven to be an acceptable alternative to endotracheal intubation and easier to insert by the less experienced provider.  As a result, paramedics and other first line responders are using the laryngeal mask airway more frequently to ensure an open airway while en route to definitive care.  In addition to inserting the […]

Those who read the anesthesia literature know that post-operative nausea and vomiting is a common topic.  A colleague once said “if I have to read another puke article, I’m going to puke”.  To the anesthetist, post op nausea is a concern.  To the patient experiencing nausea along with post-op pain it is a terrible experience. […]

As anesthetists we face the challenge of providing a safe, comfortable and speedy recovery to our patients.  Narcotics improve analgesia at the expense of nausea and speed of recovery.  The use of non-opioid drugs to supplement and reduce the amout of narcotic administered should, in theory, provide a comfortable and speedy recovery.  In this study, the […]

As Anesthetists, we are known as airway experts.  Both Surgeons and patients trust our skills at maintaining an open airway to ensure patient safety.   At the end of the case, we wake our patients and take them to recovery with an open airway and then move on to the next patient.  In the midst of […]

Anesthetists in locations ranging from community hospitals to large Children’s hospitals are frequently given the opportunity to anesthtize children of all ages.  Three recent studies were recently reviewed by Karen Blum in Anesthesiology News (JANUARY 2013 | VOLUME: 39:1) looking at the effects of anesthesia on children. Researchers presenting studies at the 2012 International Assembly for Pediatric […]

As anesthetists we are on the front line of patient care.  We are trusted with the responsibility to promote wellness and “first, do no harm”.  Recently, we have been required to set aside our personal rights in order to enforce a greater good for our patient population and the question has emerged “should healthcare workers […]

Postoperative cognitive dysfunction (POCD) is a common complication after major surgery with general anaesthesia in the elderly.   Due to the increase of average life expectancy, an increasing number of elderly patients undergo surgery. Following surgery, elderly patients may exhibit  cognitive changes. Anesthesia researchers have speculated that single lung ventilation places an elderly patient at increased risk for reduced cerebral oxygenation […]

Clinical topic: The Preanesthetic Set-up

November 18, 2012

Ensuring that the necessary equipment is present and in working condition is foundational in providing safe anesthetic care to each patient and is a standard of care to which we are held.  Patients expect their anesthetist to be properly prepared for each and every case.  The following comes from the Anesthesia Patient Safety Foundaton: “While […]

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Clinical Topic: Fluid optimization improves outcome

October 29, 2012

The clinical anesthetist is frequently challenged with the critically ill patient presenting for non-cardiac surgery.  Often, they are in a weakened condition with very little physiologic reserve.  It is essential that fluid administration is goal directed to optimize outcome.  In this patient population, hypovolemia will lead to hypotension and related complications.  However, excessive fluid administration […]

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Clinical Topic: Bis and Postoperative Cognitive Dysfunction

October 26, 2012

As anesthetists, we pride ourselves in our vigilance and our ability to maintain hemodynamic stability during difficult surgical situations.  However, for the patient, the surgical experience is just one point in time in the continuum of life.  They recover, leave the hospital and continue with life.  The ability of an elderly patient to participate in […]

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Clinical Topic: Intraoperative Hypotension and Stroke

October 16, 2012

As guardians of patient safety during the surgical procedure, anesthetists are tasked with the prevention of adverse intraoperative events.  Of the many risks of surgery, death and stroke are two of the most devastating events that can occur.  Ischemic stroke occurs in 0.1-3% of patients undergoing general anesthesia.  Thus, maintenance of cerebral perfusion is essential […]

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Clinical Topic: Prewarming, Does it really matter?

September 27, 2012

Peri-operative hypothermia is a common problem related to the practice of anesthesia.  Numerous studies have documented the negative effects of hypothermia to the extent that SCIP has made patient temperature a marker of quality care.  In an attempt to reduce hypothermia, many anesthesia providers recommend patient pre-warming in the holding area prior to surgery. An […]

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Clinical Topic: Predicting Sleep Apnea, the STOP-BANG scale

September 23, 2012

A foundational skill required of all anesthetists is airway management.   With the obesity epidemic in our nation, obstructive sleep apnea (OSA) is becoming more common and presenting challenges to the anesthetist.  Predicting which patients are at increased risk for OSA is an important part of the preoperative assessment.  In a recent report published in the […]

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Clinical Topic: JCAHO Sentinal Event Regarding Opioids

September 18, 2012

Patient safety is a foundational responsibility of all health care workers.  The Joint Commission identifies “sentinel events” related to patient safety and distributes them to Hospitals.  During accreditation visits, JCAHO evaluates the Hospital’s effectiveness in addressing, reporting, and eliminating sentinel events. “A Sentinel Event is defined by The Joint Commission (TJC) as any unanticipated event […]

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Clinical Topic: What’s your favorite Anesthesia APP?

September 13, 2012

Controversy remains as to whether or not cell phones (hand held computers with audio capability) and iPads have a place in the operating room.  It is true that they can be a distraction for healthcare workers but they also put a wealth of information at your finger tips.   When used appropriately, they provide instant information […]

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Clinical Topic: Learning Ultrasound Guided Regional Anesthesia

September 9, 2012

Ultrasound guided regional anesthesia has quickly established itself as the preferred technique for placing blocks.  Several models of ultrasound devices are available and each vendor touts their product as the best.  Time for placement, success of the block and patient satisfaction all reinforce ultrasound guided placement as the method of choice for regional anesthesia. CME […]

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Clinical Topic: Ipad APP for Anesthesia Patient Teaching

September 2, 2012

Are you still trying to justify whether or not to break down and buy and iPad?  As the use of technology continues to grow and develop, devices such as the Ipad are becoming important tools for the anesthetist.  Writing for the on-line Barton Blog, author Ben Amirault describes a newly developed APP for the iPad […]

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Clinical Topic: CRNA liable for poor communication

August 27, 2012

Despite the requirement for all health care workers to have annual training related to fire safety, hospital fires continue to occur.  Operating rooms have an ample supply of each of the elements required to ignite a fire and the anesthetist must be vigilant to the threat of fire at all times. Ann Latner, JD, writing […]

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Clinical Topic: Intraoperative Hypothermia

August 24, 2012

Reducing or eliminating postoperative surgical site infection is an ongoing challenge to health care professionals.   Infection following surgery constitutes up to 38% of nocosomial infections.   Avoiding intraoperative hypothermia is thought to be an important to overall survival, especially in trauma patients.  To improve the quality of care, SCIP protocol mandates the recording of intraoperative temperature […]

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Clinical Topic: Ultrasound Guidance in Anesthesia

August 16, 2012

For nearly 60 years ultrasonography has been in use in clinical medicine.  Over the past few decades the use of ultrasonography in anesthesia has increased.  As imaging machines improve in technology and the use of ultrasonography becomes everyday practice, patients are benefiting in terms of safety, comfort and cost.  The number of hands on workshops […]

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Clinical Topic: Does Anesthetic Technique Make a Difference?

August 10, 2012

The belief that the choice of anesthetic technique has little effect on long term outcome is being challenged.  New evidence is being presented in the literature suggesting that anesthetic technique, in fact, may make a difference in long term outcome. A recent study by Kavanagh T, and Buggy DJ. (Curr Opin Anaesthesiol. 2012 Apr;25(2):185-98.) titled […]

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Clinical Topic: Control Infection with disposable ECG wires

July 27, 2012

Hospital acquired infection effects nearly 2 million patients annually and has become a marker for quality care.  The SCIP guidelines have specific requirements for antibiotic administration in the peri-operative period, however, antibiotics are only one piece of the infection control puzzle.  Sterile instruments and hand washing with every patient contact are also essential elements.  One […]

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