Current Opinion in Anesthesiology最新文献_第3页

Safety amid the scalpels: creating psychological safety in the operating room. 手术刀下的安全：在手术室创造心理安全。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-09-05 DOI: 10.1097/ACO.0000000000001431

Jonathan B Cohen, Jennifer A Feldman-Brillembourg, Jason Cheng, Govind Rangrass

{"title":"Safety amid the scalpels: creating psychological safety in the operating room.","authors":"Jonathan B Cohen, Jennifer A Feldman-Brillembourg, Jason Cheng, Govind Rangrass","doi":"10.1097/ACO.0000000000001431","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001431","url":null,"abstract":"Purpose of review: We briefly review the concept of psychological safety and discuss the actions that can create it in the anesthesiologist's work environment.Recent findings: The interest in psychological safety has grown in popularity since the publication of Amy Edmondson's book The Fearless Organization in 2018. While the concept and its benefits are described in the healthcare literature, the specific actions necessary to create it are often not.Summary: To ensure patient safety, we want members of the teams we lead to be comfortable sharing emerging problems that they see before we become aware of them. As educators, we want trainees to approach us when they do not understand something and openly participate and contribute without the fear of how others will perceive them. These scenarios require an environment of psychological safety - the ability to ask for help, admit mistakes, and be respectfully forthright with unpopular beliefs without the fear of being ostracized or ignored. Methods for creating an environment of psychological safety will be discussed.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Depth of anesthesia monitoring: an argument for its use for patient safety. 麻醉深度监测：为患者安全使用麻醉深度监测的论据。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-09-03 DOI: 10.1097/ACO.0000000000001430

Karolina Brook, Aalok V Agarwala, Fenghua Li, Patrick L Purdon

{"title":"Depth of anesthesia monitoring: an argument for its use for patient safety.","authors":"Karolina Brook, Aalok V Agarwala, Fenghua Li, Patrick L Purdon","doi":"10.1097/ACO.0000000000001430","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001430","url":null,"abstract":"Purpose of review: There have been significant advancements in depth of anesthesia (DoA) technology. The Anesthesia Patient Safety Foundation recently published recommendations to use a DoA monitor in specific patient populations receiving general anesthesia. However, the universal use of DoA monitoring is not yet accepted. This review explores the current state of DoA monitors and their potential impact on patient safety.Recent findings: We reviewed the current evidence for using a DoA monitor and its potential role in preventing awareness and preserving brain health by decreasing the incidence of postoperative delirium and postoperative cognitive dysfunction or decline (POCD). We also explored the evidence for use of DoA monitors in improving postoperative clinical indicators such as organ dysfunction, mortality and length of stay. We discuss the use of DoA monitoring in the pediatric population, as well as highlight the current limitations of DoA monitoring and the path forward.Summary: There is evidence that DoA monitoring may decrease the incidence of awareness, postoperative delirium, POCD and improve several postoperative outcomes. In children, DoA monitoring may decrease the incidence of awareness and emergence delirium, but long-term effects are unknown. While there are key limitations to DoA monitoring technology, we argue that DoA monitoring shows great promise in improving patient safety in most, if not all anesthetic populations.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The electronic health record: does it enhance or distract from patient safety? 电子病历：是加强了患者安全，还是分散了患者安全？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-09-03 DOI: 10.1097/ACO.0000000000001429

George Tewfik, Steven Rivoli, Emily Methangkool

引用次数: 0

Educating for success: ambulatory anesthesia training. 成功教育：非住院麻醉培训。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-23 DOI: 10.1097/ACO.0000000000001428

Nicholas R Cormier, Jaime B Hyman, Michael O'Rourke

{"title":"Educating for success: ambulatory anesthesia training.","authors":"Nicholas R Cormier, Jaime B Hyman, Michael O'Rourke","doi":"10.1097/ACO.0000000000001428","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001428","url":null,"abstract":"Purpose of review: This article explores the unique intersection of the challenges confronting ambulatory anesthesiology education and charts a trajectory forward. The proportion of ambulatory, nonoperating room (NORA), and office-based surgical cases continues to rise; however, the requirements for trainees in these settings have remained static. The rapid evolution of the field combined with a limited workforce also makes continuing education essential, and we discuss the current and future states of ambulatory anesthesia education.Recent findings: Although numerous resources are available across an array of platforms to foster both trainee education and continuing education for practicing anesthesiologists, there is a paucity of current literature evaluating the impact of new curricula developed specifically for ambulatory, NORA, or office-based anesthesiology (OBA).Summary: We begin with an appraisal of the current state of ambulatory anesthesiology training and evaluate the gap between current graduate medical education and trends in ambulatory surgery. We then develop a vision for an ideal state of future ambulatory education for residents as well as anesthesiologists in practice and highlight the priorities necessary to reach this vision.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

More than pacemakers and defibrillators: perioperative management of implantable devices for patient safety. 不仅仅是起搏器和除颤器：为患者安全而进行的植入式设备围手术期管理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-20 DOI: 10.1097/ACO.0000000000001427

Monica W Harbell, Molly B Kraus, Andrea Lopez-Ruiz, Madina Gerasimov, Jillian A Maloney

{"title":"More than pacemakers and defibrillators: perioperative management of implantable devices for patient safety.","authors":"Monica W Harbell, Molly B Kraus, Andrea Lopez-Ruiz, Madina Gerasimov, Jillian A Maloney","doi":"10.1097/ACO.0000000000001427","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001427","url":null,"abstract":"Purpose of review: The use of implantable medical devices (IMDs) continues to increase with estimates that 10% of the American population will have an IMD in their lifetime. IMDs require special considerations for management in the perioperative period to ensure optimal patient care and patient safety. This review summarizes the current perioperative considerations for IMDs.Recent findings: This review summarizes perioperative recommendations for spinal cord stimulators, deep brain stimulators, peripheral nerve stimulators, vagus nerve stimulators, muscle stimulators, intrathecal drug delivery systems, implantable infusion pumps, artificial pancreas devices, continuous glucose monitors, and cochlear implants. There are multiple publications and guidelines regarding the perioperative considerations of cardiac implantable electronic devices; thus, this review excludes those devices. This review includes recommendations on management of the device perioperatively, the potential complications, and postoperative care of the device.Summary: There are very few guidelines regarding the perioperative management of IMDs. Given the significant impact that these devices have on patient care and safety, evidence-based guidelines should be established.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mitigating and preventing perioperative opioid-related harm. 减轻和预防围手术期阿片类药物相关伤害。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-12 DOI: 10.1097/ACO.0000000000001426

Monica W Harbell, Jonathan Cohen, Greg Balfanz, Emily Methangkool

{"title":"Mitigating and preventing perioperative opioid-related harm.","authors":"Monica W Harbell, Jonathan Cohen, Greg Balfanz, Emily Methangkool","doi":"10.1097/ACO.0000000000001426","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001426","url":null,"abstract":"Purpose of review: Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm.Recent findings: Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.g., pruritis, constipation, nausea) to potentially catastrophic (e.g. opioid-induced ventilatory impairment, respiratory depression, death). Overprescribing of opioids can lead to opioid diversion and drug driving. In this review, we will discuss opioid-related harm and what strategies can be used perioperatively to mitigate this harm. Interventions such as optimizing nonopioid analgesia, implementing Enhanced Recovery after Surgery programs, effective respiratory monitoring, patient education and opioid stewardship programs will be discussed.Summary: We will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Beyond adverse events in anesthesiology: 'unanticipated events' and strategies for improved reporting. 麻醉学不良事件之外："意外事件 "和改进报告的策略。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-12 DOI: 10.1097/ACO.0000000000001425

Karolina Brook, Molly Wilde, Andrea Vannucci, Aalok V Agarwala

{"title":"Beyond adverse events in anesthesiology: 'unanticipated events' and strategies for improved reporting.","authors":"Karolina Brook, Molly Wilde, Andrea Vannucci, Aalok V Agarwala","doi":"10.1097/ACO.0000000000001425","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001425","url":null,"abstract":"Purpose of review: Patient safety in anesthesiology has advanced significantly over the past several decades. The current process of improving care is often based on studying adverse events (AEs) and near misses. However, there is a wealth of information not captured by focusing solely on these events, potentially resulting in missed opportunities for care improvements.Recent findings: We review terms such as AEs and nonroutine events (NREs), and introduce the concept of unanticipated events (UEs), defined as events that deviate from intended care that may/may not have been caused by error, may/may not be preventable, and may/may not have caused injury to a patient. UEs incorporate AEs in addition to many other anesthetic events not routinely tracked, allowing for trend analysis over time and the identification of additional opportunities for quality improvement. We review both automated and self-reporting tools that currently exist to capture this often-neglected wealth of data. Finally, we discuss the responsibility of quality/safety leaders for data monitoring.Summary: Consistent reporting and monitoring for trends related to UEs could allow departments to identify risks and mitigate harm before it occurs. We review various proposed methods to expand data collection, and recommend anesthesia practices pursue UE tracking through department-specific reporting interfaces.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia. 重症监护创新：重症监护中的镇痛导航：区域麻醉的作用。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-08 DOI: 10.1097/aco.0000000000001422

Amber Campbell,Mackenzie Jacoby,Nadia Hernandez

引用次数: 0

Why sedative hypnotics often fail in development. 镇静催眠药为何常常研发失败？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-03 DOI: 10.1097/ACO.0000000000001381

J Robert Sneyd

引用次数: 0

Artificial intelligence and nonoperating room anesthesia. 人工智能与非手术室麻醉。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-16 DOI: 10.1097/ACO.0000000000001388

Emmanuel Pardo, Elena Le Cam, Franck Verdonk

{"title":"Artificial intelligence and nonoperating room anesthesia.","authors":"Emmanuel Pardo, Elena Le Cam, Franck Verdonk","doi":"10.1097/ACO.0000000000001388","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001388","url":null,"abstract":"Purpose of review: The integration of artificial intelligence (AI) in nonoperating room anesthesia (NORA) represents a timely and significant advancement. As the demand for NORA services expands, the application of AI is poised to improve patient selection, perioperative care, and anesthesia delivery. This review examines AI's growing impact on NORA and how it can optimize our clinical practice in the near future.Recent findings: AI has already improved various aspects of anesthesia, including preoperative assessment, intraoperative management, and postoperative care. Studies highlight AI's role in patient risk stratification, real-time decision support, and predictive modeling for patient outcomes. Notably, AI applications can be used to target patients at risk of complications, alert clinicians to the upcoming occurrence of an intraoperative adverse event such as hypotension or hypoxemia, or predict their tolerance of anesthesia after the procedure. Despite these advances, challenges persist, including ethical considerations, algorithmic bias, data security, and the need for transparent decision-making processes within AI systems.Summary: The findings underscore the substantial benefits of AI in NORA, which include improved safety, efficiency, and personalized care. AI's predictive capabilities in assessing hypoxemia risk and other perioperative events, have demonstrated potential to exceed human prognostic accuracy. The implications of these findings advocate for a careful yet progressive adoption of AI in clinical practice, encouraging the development of robust ethical guidelines, continual professional training, and comprehensive data management strategies. Furthermore, AI's role in anesthesia underscores the need for multidisciplinary research to address the limitations and fully leverage AI's capabilities for patient-centered anesthesia care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0