scholarly journals Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Kim ◽  
Brian A. Chang ◽  
Amreen Rahman ◽  
Hung-Mo Lin ◽  
Samuel DeMaria ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Mount Sinai Hospital ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Surgical Specialty ◽  
Factors Associated ◽  
Physical Status Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion. Methods In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA. Results Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient’s “intolerance” of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA. Conclusions This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events.

scholarly journals Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

2015 ◽  
Vol 25 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Mariam AlHilli ◽  
Carrie Langstraat ◽  
Christine Tran ◽  
Janice Martin ◽  
Amy Weaver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Epithelial Ovarian Cancer ◽  
Odds Ratio ◽  
Residual Disease ◽  
Factors Associated ◽  
Primary Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists

BackgroundTo identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery.MethodsPatients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection.ResultsIn total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89;P= 0.007), ascites [1.76 (1.11–2.81);P= 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21);P= 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33;P= 0.04).ConclusionsClinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

scholarly journals Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

A protocol implementation to determine aspiration risk in patients with multiple risk factors for gastroparesis

2021 ◽  
pp. 175045892199692
Author(s):  
Sarah Schwisow ◽  
Christian Falyar ◽  
Susan Silva ◽  
Virginia C Muckler
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Solid Food ◽  
Convenience Sample ◽  
Aspiration Risk ◽  
Physical Status Classification ◽  
Increased Risk ◽  
Gastric Contents ◽  
American Society ◽  
American Society Of Anesthesiologists

Patients with risk factors for gastroparesis are at increased risk for aspiration into the tracheobronchial tree. Current American Society of Anesthesiologists fasting guidelines use subjective measures to determine aspiration risk. A gastric ultrasound protocol can identify patients with risk factors for gastroparesis and determine the need to perform a point-of-care gastric ultrasound to objectively assess gastric antral contents. This enables the anaesthesia provider to assess patients at increased risk for aspiration. Additionally, many patients who present for surgery with risk factors for gastroparesis have an empty gastric antrum. Thus, the gastric ultrasound protocol checklist saves time and manpower requirements of anaesthesia staff without impacting patient safety or perioperative efficiency. A convenience sample of 40 patients consented for surgery was assessed using a screening tool to identify those at risk for gastroparesis and possible aspiration. Patients deemed at risk received a gastric ultrasound examination to evaluate for the presence of gastric contents. Over 12% of these patients had solid food gastric contents on exam. All patients with solid food gastric contents had an American Society of Anesthesiologists Physical Status Classification of 3 or higher, and two or more risk factors for gastroparesis.

scholarly journals Procedural Sedation and Analgesia in Adults - new trends in patients safety

2019 ◽  
Vol 2 (1) ◽  
pp. 11-22
Author(s):  
Mădălina Duţu ◽  
Robert Ivascu ◽  
Darius Morlova ◽  
Alina Stanca ◽  
Dan Corneci ◽  
...  
Keyword(s):  
Patient Monitoring ◽  
Diagnostic Procedures ◽  
Procedural Sedation ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Moderate Sedation ◽  
Procedural Sedation And Analgesia ◽  
Sedation And Analgesia ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSedation and analgesia may be needed for many interventional or diagnostic procedures, whose number has grown exponentially lately. The American Society of Anesthesiologists introduced the term “procedural sedation and analgesia” (PSA) and clarified the terminology, moderate sedation and Monitored Anesthesia Care. This review tries to present a nondissociative sedation classification, follow ing ASA guidelines as well as pre-procedural assessment and preparation, in order to choose the appropriate type and level of sedation, patient monitoring and agents, which are most commonly used for sedation and/or analgesia, along with their possible side effects. The paper also lists the possible complications associated with PSA and a few specific particularities of procedural sedation.

Injury and Liability Associated with Monitored Anesthesia Care

2006 ◽  
Vol 104 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Sanjay M. Bhananker ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
Robert A. Caplan ◽  
Lorri A. Lee ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Respiratory Depression ◽  
Brain Damage ◽  
Regional Anesthesia ◽  
Supplemental Oxygen ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Malpractice Claims ◽  
American Society ◽  
Permanent Brain Damage

Background To assess the patterns of injury and liability associated with monitored anesthesia care (MAC) compared with general and regional anesthesia, the authors reviewed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1990. Methods All surgical anesthesia claims associated with MAC (n = 121) were compared with those associated with general (n = 1,519) and regional (n = 312) anesthesia. A detailed analysis of MAC claims was performed to identify causative mechanisms and liability patterns. Results MAC claims involved older and sicker patients compared with general anesthesia claims (P < 0.025), often undergoing elective eye surgery (21%) or facial plastic surgery (26%). More than 40% of claims associated with MAC involved death or permanent brain damage, similar to general anesthesia claims. In contrast, the proportion of regional anesthesia claims with death or permanent brain damage was less (P < 0.01). Respiratory depression, after absolute or relative overdose of sedative or opioid drugs, was the most common (21%, n = 25) specific damaging mechanism in MAC claims. Nearly half of these claims were judged as preventable by better monitoring, including capnography, improved vigilance, or audible alarms. On-the-patient operating room fires, from the use of electrocautery, in the presence of supplemental oxygen during facial surgery, resulted in burn injuries in 20 MAC claims (17%). Conclusion Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries. Awareness and avoidance of the fire triad (oxidizer, fuel, and ignition source) is essential to prevent on-the-patient fires.

scholarly journals Epidemiology and risk factors associated with surgical site infection following surgery on thoracic aorta

2018 ◽  
Vol 146 (14) ◽  
pp. 1841-1844
Author(s):  
K. Morikane
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Thoracic Aorta ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
National Database ◽  
Site Infection ◽  
Factors Associated ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSurgical site infection (SSI) following cardiovascular surgery has been well documented, possibly owing to its highly invasive nature, but SSI following surgery on the thoracic aorta has not. This study aimed to describe the epidemiology and assess risk factors associated with the latter in Japan using a national database for SSI. Data on surgery on thoracic aorta performed between 2012 and 2014 were extracted from the Japan Nosocomial Infections Surveillance (JANIS) database. Risk factors were assessed initially by univariate analysis, and then entered into a logistic regression model for final evaluation. The cumulative incidence of SSI was 4.1% (146/3538) and staphylococci were the most frequent pathogens isolated. Factors such as the duration of operation, emergency surgery and male gender were significantly associated with SSI. These findings differ from previous studies on open heart and coronary artery bypass surgery, in which the American Society of Anesthesiologists (ASA) score was significantly associated with SSI, but gender was not. This study suggests that risk stratification in the JANIS system might be improved by incorporating additionally identified factors for risk adjustment, when comparing the incidence of SSI between hospitals.

scholarly journals Prescribing Habits of Providers and Risk Factors for Nonadherence to Opioid Prescribing Guidelines

2020 ◽  
pp. 000313482095633
Author(s):  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Pridvi Kandagatla ◽  
Shravan Leonard-Murali ◽  
Adam Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Guideline Implementation ◽  
Multivariable Analysis ◽  
Acute Care Surgery ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Academic Center ◽  
American Society ◽  
Care Surgery ◽  
American Society Of Anesthesiologists

Background The Michigan Opioid Prescribing Engagement Network introduced guidelines in October 2017 to combat opioid overprescription following various surgical procedures. We sought to evaluate changes in opioid prescribing at our academic center and identify factors associated with nonadherence to recently implemented opioid prescribing guidelines. Methods This retrospective review analyzed opioid prescribing data for appendectomy, cholecystectomy, and hernia repair from January 2015 through September 2017 (pre-guidelines group) and November 2017 through December 2018 (post-guidelines group). October 2017 data were excluded to allow for guideline implementation. Opioid prescribing data were recorded as total morphine equivalents (TMEs). Results Of 1493 cases (903 pre-vs. 590 post-guidelines), the mean TME prescribed significantly decreased post-guidelines (231.9 ± 108.6 vs. 112.7 ± 73.9 mg; P < .01). More providers prescribed within recommended limits post-guidelines (2.8% vs. 44.8%; P < .01). On multivariable analysis, independent risk factors for guideline nonadherence were the American Society of Anesthesiologists class > 2 (adjusted odds ratio [AOR]:1.65, 95% confidence interval[CI] 1.09-2.49; P = .02), general surgery vs. acute care surgery service (AOR 1.89, 95% CI 1.15-3.10; P = .01), oxycodone vs. hydrocodone (AOR:1.90, 95% CI:1.06-3.41; P = .03), and nonphysician provider vs. resident prescriber (AOR:2.10, 95% CI:1.14-3.11; P < .01). Conclusions Opioid prescribing significantly reduced after the adoption of opioid prescribing guidelines at our institution. Numerous factors associated with provider guideline nonadherence may identify actionable targets to minimize opioid overprescribing further.

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