Refresher courses in anesthesiology最新文献_第2页

Virtual Cadaver Laboratory—Anatomy Pearls in Regional Anesthesia to Improve Clinical Success 虚拟尸体实验室-区域麻醉解剖珍珠提高临床成功率

Refresher courses in anesthesiology Pub Date : 2015-01-01 DOI: 10.1097/ASA.0000000000000026

D. Auyong, S. Yuan

引用次数: 1

Patient Safety in the Cardiac Operating Room: What Can, Will, and Might Make Patients Safer and You Happier? 心脏手术室的病人安全:什么能、什么会、什么可能让病人更安全，让你更快乐?

Refresher courses in anesthesiology Pub Date : 2015-01-01 DOI: 10.1097/ASA.0000000000000031

J. Abernathy

{"title":"Patient Safety in the Cardiac Operating Room: What Can, Will, and Might Make Patients Safer and You Happier?","authors":"J. Abernathy","doi":"10.1097/ASA.0000000000000031","DOIUrl":"https://doi.org/10.1097/ASA.0000000000000031","url":null,"abstract":"The cardiac operating room (OR) is a complex environment consisting of four teams of providers—surgeons, nurses, perfusionists, and anesthesiologists—and where a myriad of complicated equipment is often crammed into a space that might not have been designed for this purpose. Despite the obstacles, mortality and morbidity from cardiac surgery have steadily decreased over the past decade. Inevitably, however, humans continue to make errors. Gawande and colleagues found that adverse events occurred in 12% of cardiac surgical operations, compared with only 3% in a general surgery population. Some 28,000 of the 350,000 cardiac surgical patients in the United States each year will have an adverse, preventable event. Preventable errors are not related to failure of technical skill, training, or knowledge, but represent cognitive, system, or teamwork failures (Supplemental Digital Content 1, http://links.lww.com/ASA/A558). Jim Reason, the renowned human factors engineer, was the first to propose a simplified model of error, now referred to as the ‘‘Swiss cheese’’ model (Figure 1). This model eloquently describes how hidden—or, in human factors terminology, latent— errors can line up to create actual errors or patient harm. In one example, originally outlined by Pronovost et al., a patient suffered from a venous air embolism not because a doctor was careless, but because there were many hidden failures, often termed latent failures, that added up to create a catastrophe. In this example, components of latent error included poor communication, lack of protocols or lack of knowledge of protocols, inadequate training, and fear of retribution if the nurse spoke up. Resilient systems are designed to reduce the number of latent errors. If there are fewer latent errors, the holes in the Swiss cheese for an error to pass through are harder to align.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"43 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0000000000000031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62017276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Anesthesia for Head and Neck Surgery 头颈外科麻醉

Refresher courses in anesthesiology Pub Date : 2015-01-01 DOI: 10.1097/ASA.0000000000000021

D. Healy

{"title":"Anesthesia for Head and Neck Surgery","authors":"D. Healy","doi":"10.1097/ASA.0000000000000021","DOIUrl":"https://doi.org/10.1097/ASA.0000000000000021","url":null,"abstract":"The unique surgical demands and characteristics of patients undergoing head and neck surgery have led to the gradual development of the subspecialty of Head and Neck Anesthesia. The expansion of the surgical specialties of otolaryngology, maxillofacial surgery, dentistry, neurotology, and facial plastic surgery in academic medical centers has led to a corresponding increase in and development of anesthetic expertise. Communication and teamwork are essential for the safe performance of any surgical procedure, but are of particular importance during operations that require the surgical and anesthesia teams to share the patient’s airway. Furthermore, multiple pathologic processes and surgical requirements may result in an increased incidence of difficulty encountered during airway management. As a result, providers specializing in this work require additional skill and experience in advanced airway management techniques such as awake flexible endoscopic intubation, jet ventilation, and transtracheal oxygenation. Many head and neck procedures have unique and challenging requirements for anesthesia care beyond airway management. Patients undergoing oncologic surgery of the head and neck often have comorbidities related to smoking, particularly ischemic heart disease, vasculopathies, and chronic obstructive pulmonary disease. This chapter provides a practical review of the anesthesia skills required for a variety of operations on the head and neck. It emphasizes patient safety, exploring preoperative airway risk assessment, and the prevention of avoidable complications such as intraoperative fire.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"43 1","pages":"66–72"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0000000000000021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62016565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Do the Right Thing: Resolving Ethical Dilemmas in the OR 做正确的事:解决手术室的伦理困境

Refresher courses in anesthesiology Pub Date : 2015-01-01 DOI: 10.1097/ASA.0000000000000034

Sarah C. Smith

{"title":"Do the Right Thing: Resolving Ethical Dilemmas in the OR","authors":"Sarah C. Smith","doi":"10.1097/ASA.0000000000000034","DOIUrl":"https://doi.org/10.1097/ASA.0000000000000034","url":null,"abstract":"Although there have been ethical debates in medicine for centuries, only in the last few decades has bioethics, a term first coined in the 1970s, developed into a formalized and independent field of philosophy. Today, the influence of bioethics is far-reaching, impacting the drafting of laws pertaining to medicine and biotechnology, guiding the development of hospital policies and procedures, and even affecting the physician–patient relationship. Education about bioethics is incorporated into the curriculum for nurses, doctors, and other practitioners, and knowledge of the topic is assessed in many licensing and board certification examinations, including that of the American Board of Anesthesiology. Like bioethics, anesthesiology is also a relatively young field that has experienced tremendous growth in the modern era, and its history is marked by several prominent ethical debates. At one time, the use of anesthesia itself was quite controversial. Within months of William Morton’s successful demonstration of ether anesthesia on October 16, 1846, physicians around the world were utilizing this new discovery on countless surgical patients. Although the advent of painless surgery was met with widespread enthusiasm, it was also recognized almost immediately as a potentially dangerous new technology. Reports of anesthesia-related injuries and deaths were almost immediate and led many to recommend only its most cautious and judicious use. Surgeons at the Pennsylvania Hospital in Philadelphia went so far as to prohibit anesthesia altogether for a full 7 years after its introduction. The ethical debate of whether to utilize anesthesia was not simply limited to issues of safety, however. Many 19th century physicians subscribed to the philosophy of ‘‘natural healing’’ and the belief that pain and sickness arose from behavior that violated the laws of Nature. If anesthesia masked such pain, the patient would not rectify his or her behavior, and the illness would persist (Supplemental Digital Content 1, http://links.lww.com/ASA/A573).","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"43 1","pages":"104–111"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0000000000000034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62017021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric Advanced Life Support for the Anesthesiologist 麻醉师的儿科高级生命支持

Refresher courses in anesthesiology Pub Date : 2015-01-01 DOI: 10.1097/ASA.0000000000000029

E. Heitmiller, Justin T. Hamrick

{"title":"Pediatric Advanced Life Support for the Anesthesiologist","authors":"E. Heitmiller, Justin T. Hamrick","doi":"10.1097/ASA.0000000000000029","DOIUrl":"https://doi.org/10.1097/ASA.0000000000000029","url":null,"abstract":"Pediatric advanced life support guidelines published by the American Heart Association are designed for resuscitation in a broad range of scenarios and environments. The perioperative environment is unlike most others in that the majority of arrests are witnessed, the patients are being monitored at the time of arrest, and the reason for the arrest may be related to the intervention or treatment. In this chapter, the perioperative period is defined as the period during which the patient is cared for by the anesthesia team and focuses on events that occur in the operating room, procedural areas, and diagnostic imaging areas from the time the patient is first seen by the anesthesia team until the patient is transferred to another service or is discharged home or to another facility. Cardiac arrest is defined as a ‘‘no-flow’’ state requiring chest compressions (open or closed chest) or failure to wean from cardiopulmonary bypass. The overall goal of all perioperative resuscitative efforts is to minimize this no-flow period and to maximize the chance for return of spontaneous circulation. Whereas the indications for resuscitation outside of the operating room may be simple (loss of consciousness, loss of pulse, etc.), the indications in the perioperative period may be more complex. They may include inadequate heart rate or blood pressure based on age, inadequate minute ventilation, cyanosis, failure of noninvasive blood pressure monitoring or pulse oximetry, loss of arterial waveform, or a sudden change in the end-tidal carbon dioxide (ETCO2) waveform or value. 1","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"43 1","pages":"73-79"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0000000000000029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62017066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trauma Anesthesia 创伤麻醉

Refresher courses in anesthesiology Pub Date : 2014-01-01 DOI: 10.1097/ASA.0000000000000005

A. Varon

引用次数: 0

MythBusters Episode: Anesthesia Economic Issues 流言终结者:麻醉经济问题

Refresher courses in anesthesiology Pub Date : 2014-01-01 DOI: 10.1097/ASA.0000000000000004

A. Abouleish

引用次数: 0

Introducing Blood Conservation Into Clinical Practice: Can the New Guidelines Lead Us? 将血液保护引入临床实践:新指南能引领我们吗?

Refresher courses in anesthesiology Pub Date : 2014-01-01 DOI: 10.1097/ASA.0000000000000000

C. Koch

引用次数: 0

Controversies in Pediatric Anesthesia: Drug Labeling and Clinical Update on Anesthetic Neurotoxicity 儿科麻醉的争议:药物标签和麻醉神经毒性的临床更新

Refresher courses in anesthesiology Pub Date : 2014-01-01 DOI: 10.1097/ASA.0000000000000003

Lena S. Sun

引用次数: 0

Tired of Not Being Taken Seriously? Professionalism and How It Affects You 厌倦了不被重视?专业精神及其对你的影响

Refresher courses in anesthesiology Pub Date : 2014-01-01 DOI: 10.1097/ASA.0000000000000006

S. Curry

引用次数: 0