Preoperative communication with anesthetists via anesthesia service platform (ASP) helps alleviate patients’ preoperative anxiety

Female gender has been identified as one of the risk factors closely linked to perioperative anxiety and a lower level of satisfaction. A successful preoperative anesthesia education may improve such negative outcomes. The aim of this study was to investigate whether preoperative anesthesia education via an Anesthesia Service Platform (ASP) could reduce the anxiety levels in female patients scheduled for laparoscopic cholecystectomy under general anesthesia, and accelerate rehabilitation. A total of 222 patients scheduled for elective laparoscopic cholecystectomy were randomly assigned to the control group and the ASP group. Patients’ baseline and post-intervention psychological status was measured by the State-Trait Anxiety Inventory and General Well-Being Schedule. Pain management and recovery were assessed by VAS every 12 h for 48 h after surgery; length of stay (LOS) and postoperative analgesic consumption were also assessed. Patients in the control group experienced higher anxiety levels before surgery and had longer LOS than those in the ASP group. Patients in the ASP group had a higher general well-being score; however, they suffered more pain and consumed more analgesics after surgery. ASP is effective for preventing anxiety in female patients before laparoscopic cholecystectomy, improving patients’ general well-being levels, and shortening their LOS, but negatively influences patients’ postoperative pain levels.

The Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study of Endobronchial Intubation: An Analysis of 2,000 Incident Reports

Background: The Royal College of Anesthesiologists of Thailand hosted a multicentered project, namely the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study. Objective: The aims of the present study were to investigate incidences, contributing factors and suggested preventive strategies of anesthesia-related complications particularly the endobronchial intubation (EBI). Materials and Methods: The PAAd Thai study was a collaborative incident report among 22 hospitals across Thailand. After approval by the Institutional Ethical Committee, the structured incident report together with open ended data record form of anesthesia-related complications such as cardiac arrest, death within 24 hours, and respiratory complications including EBI were requested to be sent to the data management center together with monthly statistics of anesthesia service in each hospital for 12 months (between January 2015 and December 2015) on an anonymous and voluntary basis. The EBI reports were reviewed by three anesthesiologists. Any discretion was discussed to achieve a consensus. Descriptive statistics were used. Results: Among the first 2,000 incident reports, there were 23 EBIs, at the rate of 1.06:10,000 (95% CI 0.62 to 1.49) or 1.15% of all reports. Two-thirds of the incidents occurred in patients with age less than 5 years old and more than 60 years old, and in elective cases. The common sites of surgery were trunk, head and neck, and laparoscopic procedures. EBIs were diagnosed by pulse oximeter (13 cases, 54.0%), increased airway pressure (four cases, 17.2%) and clinical monitoring (four cases 17.2%). Common phases of detection were pre-induction (one case, 4.3%), induction (nine cases, 39.2%), maintenance (12 cases, 52.2%), and emergence (one case, 4.3%). Contributing factors were lack of knowledge, inexperience, and haste, while factors minimizing the incidents were having experience and vigilance. Suggested preventive strategies were additional training, including simulation, practice guidelines, improvement of supervision, and communication. Conclusion: The authors have found that EBI was uncommon, but it is one of the serious anesthesia-related adverse events. It can happen anytime during the entire course of anesthesia. Under these circumstances, careful monitoring and vigilance of the anesthesiologists is essential. Keywords: Anesthesia, Complication, Endobronchial intubation, Intubation, Hypoxia

Scalp block untuk Kraniotomi dan Penanganan Nyeri Membandel Pasca Kraniotomi

Pemberian anestesi lokal dari saraf kulit kepala disebut sebagai “Scalp block”. Teknik ini telah diperkenalkan beberapa abad lalu, sempat tidak popular kemudian popular kembali pada era anestesi modern dalam manajemen anestesi intra operatif dan post operatif. Indonesia telah memasuki era pelayanan kesehatan dengan universal health coverage melalui Badan Penyelenggara Jaminan Sosial (BPJS), menyebabkan pemberi layanan anestesi harus familiar dengan prinsip dasar ekonomi medis dan ikut berperan aktif dalam mengendalikan biaya untuk tata kelola anestesi. Pelayanan anestesi memiliki banyak kesempatan mengendalikan biaya, tentu saja dengan tetap menjaga keseimbangan antara keselamatan dan pembiayaan pasien. “Scalp block” adalah salah satu teknik pilihan yang dapat dikombinasikan dengan pembiusan umum. Disini akan ditinjau penggunaan “Scalp block” untuk operasi kraniotomi dan penanganan nyeri membandel pasca kraniotomi dengan dasar anatomi, evolusi histori, teknik yang berkembang saat ini, potensi keuntungan dan kekurangannya. Kami mendukung penggunaan teknik ini untuk penggunaan secara luas pada masa depan “Scalp Block” for Craniotomy and Intractable Pain Management Post CraniotomyAbstract Using local anesthesia of the nerves of the scalp is referred as ‘‘scalp block.’’ This technique was introduced more than a century ago, but has undergone a modern rebirth in intraoperatif and postoperative anesthetic management. Indonesia has entered the era of health services which universal health coverage BPJS (Heath Social Organizing Agency), this causes the provider to be familiar with the basic principles of medical economics and participate actively in controlling costs for anesthesia service. Providers of anesthesia services have many opportunities to reduce these costs, with the aim of maintaining balance between profit, patient safety and costs. Scalp block is an alternative option that can be combined with general anesthesia. Here, we review the use of ‘‘scalp block’’ during craniotomy and refractory post craniotomy pain with its anatomic basis, historical evolution, current technique, potential advantages, and pitfalls. We also address its current and potential future applications

Constructing a Measure of Anesthesia Intensity Using Cross-Sectional Claims Data

With intensifying emphasis on episodes of care and bundled payments for surgical admissions, anesthesia expenditures are increasingly important in assessing variation in expenditures for surgical episodes. When comparing anesthesia expenditures across surgical settings, adjustment for anesthesia case complexity and duration of anesthesia services, also known as anesthesia service intensity, is desirable. A single anesthesia intensity measure allows researchers to make more direct comparisons between anesthesia outcomes across settings and services. We describe a process for creating a claims-based anesthesia intensity measure using Medicare claims. We create the measure using two fields: base units associated with American Medical Association Current Procedural Terminology codes on the anesthesia claim and time units associated with the service. We rescaled the time component of the anesthesia intensity measure to equally represent base units and time units. For illustration, we applied the measure to Medicare anesthesia expenditures stratified by rural/urban location. We found that adjustments for intensity were greater in urban settings because the level of intensity is greater. Compared with rural settings, unadjusted expenditures in urban settings are roughly 26 percent higher, whereas adjusted expenditures in urban settings are only 20 percent higher. Even absent longitudinal data, researchers can adjust anesthesia outcomes for intensity using our cross-sectional claims-based intensity method.

Regulatory Issues

Under current Center for Medicare and Medicaid Services (CMS) regulations, hospitals are responsible for establishing policies and procedures that differentiate anesthesia from analgesia/sedation. They are also responsible for determining the qualifications for practitioners who administer sedation based on nationally recognized guidelines. CMS regulations require the anesthesia service in CMS-certified hospitals to develop hospital policies and procedures governing the provision of all categories of anesthesia services, including specifying the minimum qualifications for practitioners permitted to provide procedural sedation. Additional regulatory bodies such as state survey agencies, which may include departments of health and accrediting organizations, follow CMS interpretive guidelines to determine a facility’s compliance with the Medicare Conditions of Participation. State laws, health department requirements, professional boards, accrediting organization standards, and facility bylaws and policy may exceed CMS requirements.