Analysis of Perioperative Patient Adverse Event Reports and Anesthesia Safety Management in an Anesthesia Department of a Tertiary A Hospital in 2019-2020

2021 ◽  
Author(s):  
Hongyang Chen ◽  
Zining Wang ◽  
Weiyi Zhang ◽  
Tao Zhu
Keyword(s):  
Adverse Events ◽  
Safety Management ◽  
Surgical Patients ◽  
Anesthesia Induction ◽  
Medical Quality ◽  
Anesthesia Safety ◽  
Management Measures ◽  
Time Period ◽  
American Society

Abstract Objective: To analyze the characteristics of anesthesia adverse events in our department and propose measures for anesthesia safety management, to achieve better improvement of medical quality and promote medical safety. Methods: A total of 589 cases of anesthesia adverse events were collated and analyzed, including the time period of anesthesia adverse events and ASA (American Society of Aneshesiologists) classification of anesthesia adverse events. Results: The anesthesia induction and awakening periods were the main time periods for the occurrence of anesthesia adverse events, other human factors were the main reasons for the occurrence of anesthesia adverse events, and ASA grading II and III surgical patients accounted for the main proportion (mainly because of the heavy proportion of II and III surgical patients). Conclusion: Understanding the causes of adverse anesthesia events and implementing strict anesthesia safety management measures are conducive to reducing the occurrence of adverse anesthesia events and improving the safety of anesthesia.

scholarly journals The impact of age on propofol requirement for inducing loss of consciousness in elderly surgical patients

2021 ◽  
Author(s):  
Hua Yang ◽  
Hui-Min Deng ◽  
Jun-Wei Ji ◽  
Xin Lv ◽  
Jin-Chao Song
Keyword(s):  
Verbal Response ◽  
Surgical Patients ◽  
Anesthesia Induction ◽  
Loss Of Consciousness ◽  
Independent Factor ◽  
Group A ◽  
D 20 ◽  
American Society ◽  
Group B ◽  
The Impact

Aims: It is generally accepted that geriatric patients are more sensitive to propofol than adults; thus, a dose-adjusted propofol is recommended for these patients during the induction of anesthesia. However, for patients aged 75 years and over, established guidelines do not provide dose references for the anesthesiologists. To this end, we observed 80 surgical patients (female 39, male 41, American Society of Anesthesiologists physical status score Ⅰ ~ Ⅱ) to access the appropriate dose of propofol for inducing loss of consciousness (LOC). Methods: Patients were subdivided into group A (20 patients, 45~64 yr), group B (20 patients, 65~74 yr), group C (20 patients, 75~84 yr), and group D (20 patients, ≥ 85 yr). All patients received propofol (at a rate of 0.3 mg/kg/min) alone for inducing LOC, which was defined by loss of both eyelash reflex and verbal response. Results: Compared with group A, the propofol requirement for LOC in Group B, C and D decreased by 14.8%, 25.2% and 38.5%, respectively. Bivariate linear correlation analysis showed that propofol requirement was negatively correlated with age. After adjusting for potential confounders, age was still an independent factor affecting propofol requirement. Conclusion: The propofol requirement for inducing LOC decreased significantly in elderly patients. We demonstrated that age was an independent factor impacting propofol requirement for LOC during the induction of general anesthesia, implying that the propofol dose for anesthesia induction should be further reduced in elderly surgical patients, especially those aged 75 years and over.

scholarly journals Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events

2018 ◽  
Vol 128 (6) ◽  
pp. 1065-1074 ◽  
Author(s):  
Anoop Ramgolam ◽  
Graham L. Hall ◽  
Guicheng Zhang ◽  
Mary Hegarty ◽  
Britta S. von Ungern-Sternberg
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Controlled Trial ◽  
Anesthesia Induction ◽  
Open Label ◽  
Inhalation Induction ◽  
Induction Technique ◽  
The Difference ◽  
American Society ◽  
The Impact

Abstract Background Limited evidence suggests that children have a lower incidence of perioperative respiratory adverse events when intravenous propofol is used compared with inhalational sevoflurane for the anesthesia induction. Limiting these events can improve recovery time as well as decreasing surgery waitlists and healthcare costs. This single center open-label randomized controlled trial assessed the impact of the anesthesia induction technique on the occurrence of perioperative respiratory adverse events in children at high risk of those events. Methods Children (N = 300; 0 to 8 yr) with at least two clinically relevant risk factors for perioperative respiratory adverse events and deemed suitable for either technique of anesthesia induction were recruited and randomized to either intravenous propofol or inhalational sevoflurane. The primary outcome was the difference in the rate of occurrence of perioperative respiratory adverse events between children receiving intravenous induction and those receiving inhalation induction of anesthesia. Results Children receiving intravenous propofol were significantly less likely to experience perioperative respiratory adverse events compared with those who received inhalational sevoflurane after adjusting for age, sex, American Society of Anesthesiologists physical status and weight (perioperative respiratory adverse event: 39/149 [26%] vs. 64/149 [43%], relative risk [RR]: 1.7, 95% CI: 1.2 to 2.3, P = 0.002, respiratory adverse events at induction: 16/149 [11%] vs. 47/149 [32%], RR: 3.06, 95% CI: 1.8 to 5.2, P < 0.001). Conclusions Where clinically appropriate, anesthesiologists should consider using an intravenous propofol induction technique in children who are at high risk of experiencing perioperative respiratory adverse events.

scholarly journals Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

2008 ◽  
Vol 108 (5) ◽  
pp. 822-830 ◽  
Author(s):  
Frances Chung ◽  
Balaji Yegneswaran ◽  
Pu Liao ◽  
Sharon A. Chung ◽  
Santhira Vairavanathan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
High Risk ◽  
Screening Tools ◽  
Surgical Patients ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Obstructive Sleep ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Stop Questionnaire

Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications. Conclusions Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.

scholarly journals Longitudinal rates of hospital adverse events that contributed to death in Norway and Sweden from 2013 to 2018

2021 ◽  
pp. 251604352110261
Author(s):  
Ellen Tveter Deilkås ◽  
Marion Haugen ◽  
Madeleine Borgstedt Risberg ◽  
Hanne Narbuvold ◽  
Øystein Flesland ◽  
...  
Keyword(s):  
Adverse Events ◽  
Acute Care ◽  
Medical Records ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Demographic Characteristics ◽  
Mutual Learning ◽  
Time Period ◽  
Relevant Context ◽  
Linear Trends

Objectives In this paper, we explore and compare types and longitudinal trends of hospital adverse events in Norway and Sweden in the years 2013–2018 with special reference to AEs that contributed to death. Design Acute care hospitals in both countries performed medical record reviews on randomly selected medical records from all eligible admissions. Analysis: Comparison between Norway and Sweden of linear trends from 2013–2018, and percentage rates of admissions with at least one AE according to types and severities. Setting Norway and Sweden have similar socio-economic and demographic characteristics, which constitutes a relevant context for cooperation, comparison and mutual learning. This setting has promoted the use of GTT to monitor national rates of AEs in hospital care in the two countries. Participants 53 367 medical records in Norway and 88 637 medical records in Sweden were reviewed. Results 13.2% of hospital admissions in Norway and 13.1% in Sweden were associated with an AE of all severities (E-I). 0.23% of hospital admissions in Norway and 0.26% in Sweden were associated with an AE that contributed to death (I). The differences between the two countries were not statistically significant. Conclusions There were no significant differences in overall rates (E-I) of AEs in Norway and Sweden, nor in rates of AEs that contributed to death (I). There was no significant change in AEs or fatal AEs in either country over the six-year time period.

Effect of Opioid-Related Adverse Events on Outcomes in Selected Surgical Patients

2013 ◽  
Vol 27 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Gary M. Oderda ◽  
Tong J. Gan ◽  
Bernadette H. Johnson ◽  
Scott B. Robinson
Keyword(s):  
Adverse Events ◽  
Surgical Patients

scholarly journals A57 THE USE AND INTERPRETATION OF HLA-DQ2/DQ8 GENOTYPING BY PEDIATRIC GASTROENTEROLOGISTS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 14-15
Author(s):  
B Moreau ◽  
E Robidoux
Keyword(s):  
Risk Groups ◽  
Risk Classification ◽  
Low Risk ◽  
Risk Alleles ◽  
Seronegative Patient ◽  
Espghan Guidelines ◽  
Recent Classification ◽  
American Society ◽  
Hla Dq2

Abstract Background A recent classification of high and low risk alleles associated with celiac disease (CD) shows that the presence of a single allele (DQA1*05 or DQB1*02; coding together for HLA-DQ2), without a positive genotype (HLA-DQ2 and or HLA-DQ8), represents a risk of developing the disease. Aims The aim of this study is to evaluate the use and interpretation of the HLA-DQ2/DQ8 genotyping by pediatric gastroenterologists, as there is no study on the matter and the latest guidelines do not address this risk classification. Methods A web-based survey was sent by email to all NASPGHAN (North American society of pediatric gastroenterolgy, hepatology and nutrition) members. Results Results 294 pediatric gastroenterologists sent a complete survey. 86,1% use the HLA-DQ2/DQ8 genotyping according mainly to the NASPGHAN and ESPGHAN guidelines. The main indications considered were to exclude CD in a patient on a gluten-free diet with a resolution of his symptoms and in a seronegative patient with equivocal biopsies. A minority would consider the genotyping for screening high risk groups or for making a diagnosis in children with high specific CD antibodies and strong clinical suspicion without performing biopsies, as suggested by the ESPGHAN guidelines. The alleles associated with CD are not well known, but 76,7% the participants are aware of the risk classification. While only 62,8% have access to the complete genotype, 47,8% consider it useful. Nevertheless, 82,6% would still want to know the presence of a low risk allele. Conclusions The risk classification of alleles related to CD warrants a modification of the genotyping result with access to the alleles and an adaptation of the guidelines. Funding Agencies None

Long-term Safety and Efficacy of Mexiletine in Myotonic Dystrophy Types 1 and 2

2021 ◽  
pp. 10.1212/CPJ.0000000000001073
Author(s):  
Christina Mousele ◽  
Emma Matthews ◽  
Robert Pitceathly ◽  
Michael Hanna ◽  
Susan McDonald ◽  
...  
Keyword(s):  
Myotonic Dystrophy ◽  
Sodium Channels ◽  
Genetic Disorders ◽  
Clinical Feature ◽  
Efficacy And Safety ◽  
Voltage Gated Sodium Channels ◽  
Time Period ◽  
Mean Time

AbstractBackground:Myotonic dystrophy types 1 and 2 are progressive multisystem genetic disorders, whose core clinical feature is myotonia. Mexiletine, an antagonist of voltage-gated sodium channels, is a recommended anti-myotonic agent in the non-dystrophic myotonias, but its use in myotonic dystrophy is limited due to lack of data regarding its long-term efficacy and safety profile.Methods:To address this issue, this study retrospectively evaluated patients with myotonic dystrophy receiving mexiletine over a mean time-period of 32.9 months (range 0.1 to 216 months).Results:This study demonstrated that 96% of patients reported some improvement in myotonia symptoms with mexiletine treatment. No clinically relevant cardiac adverse events were associated with the long-term use of mexiletine.Conclusions:These findings support that mexiletine is both safe and effective when used long-term in myotonic dystrophy.Classification of Evidence:This study provides class IV evidence that mexiletine is a well-tolerated and effective treatment for myotonic dystrophy types 1 and 2.

A pharmacist-managed virtual consult service to improve tuberculosis screening

2021 ◽  
Author(s):  
Veranika Sasnovskaya ◽  
Lisa M Kumor ◽  
JoAnn Stubbings ◽  
Aimee Chevalier
Keyword(s):  
Adverse Events ◽  
Safety Management ◽  
Consult Service ◽  
Practice Model ◽  
Tuberculosis Screening ◽  
Serious Adverse Events ◽  
Pharmacy Benefit ◽  
Serious Infections ◽  
Biologic Response ◽  
Specialty Pharmacy

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe a pharmacist-managed virtual consult service practice model to improve medication safety in a population of rheumatology patients and evaluate its initial impact on guideline compliance. Summary Optimal pharmacologic care of patients with rheumatologic conditions often revolves around the use of specialty medications such as self-injectable biologics and infused therapies, including biologic response modifiers (BRMs), nearly all of which carry risks of serious adverse events due to their immune-suppressive properties. Possible adverse events include serious infections such as reactivation of tuberculosis (TB) and viral hepatitis B (HBV). This articles describes a pharmacist-managed virtual consult service introduced by a large university-affiliated health system in 2018 to integrate clinical, specialty pharmacy, and therapeutic infusion services for proactive medication and safety management for patients with rheumatologic conditions requiring specialty or infused medications. During a 4-month evaluation period, 157 referrals were sent to the consult service; of 137 consults included in the analysis, 42% were for self-injectable biologic medications, 28% were for intra-articular injections, 26% were for infusions, and 4% were for oral specialty medications. Forty-one percent of the pharmacy benefit consult orders required an intervention prior to submission of prior authorization requests. Most interventions (61%) were clinical in nature and involved the pharmacists ensuring that necessary laboratory work, clinical disease activity scoring, or radiographic imaging were completed prior to submission of the consult results for insurer approval. Conclusion National rates of HBV screening and TB screening for patients prescribed BRMs continue to be suboptimal. The pharmacist-managed virtual consult service is a novel practice model to increase the screening rate to 100% to ensure the safety and appropriate monitoring of patients who are starting or continued on these complex medications.

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