ROLE OF ANAESTHETIST IN POST ANAESTHESIA VISIT - QUESTIONNAIRE STUDY AMONG ANAESTHESIOLOGISTS

Background The role of anaesthetist has increased tremendously from just being in the operative team to the recovery of the patient in the post-operative period. The recovery without any complication requires multidisciplinary team which should be embedded in a clinical care pathway with focus on enhancing patient recovery. Objectives: To evaluate the need for post anaesthesia visit, among Anaesthesiologists to improve the post-operative and post anaesthesia quality care. Methodology: This was a cross sectional study conducted among 275 anaesthesiologists by an online survey using a validated pretested questionnaire Results: Majority of the study participants were males. 92.4 % had regular post-anaesthesia service available in their hospitals. More than 70% of the patients had post-operative visits. Majority of the post-operative visit was on the day of surgery and on the rst post-operative day. Conclusion: It is the responsibility of the anaesthesiologist to guarantee that patients have completely recovered from the given anaesthesia and to detect and treat any probable anaesthetic-related complications. Hence, a post-operative care team involving the surgeons and anaesthetist can alleviate the complications, shorten the duration of hospital stay and improved recovery.

Impact assessment following implementation of a vascular access team

Background: A vascular access team (VAT) was created in 2018 with the aim of improving vascular access and reducing complications associated with catheters. The impact of the introduction of a VAT in the insertion and maintenance of peripheral insertion central catheters (PICCs) was assessed. The cost-benefit associated with the use of a VAT was evaluated and the satisfaction of patients and professionals interacting with the VAT was measured. Methods: In a prospective study, 275 PICCs inserted by the VAT were assessed for their impact on complications. PICCs were implanted with maximum barrier measures using an ultrasound with IC-ECG. Also, patient and professional satisfaction have been analysed thought a questionnaire over the phone or online, and hospital financial data was used to assess the cost impact of the insertion methodology followed by the VAT versus Anaesthesia Service. Results: The thrombosis rate was 2.5% (7) and the bacteraemia rate was 1.1% (3). The use of the IC-ECG was correlated with a lower complication than the RX + IC-ECG (OR = 3.28, p = 0.021). In addition, there was a high level of perceived satisfaction for the patients surveyed and for the healthcare professionals involved in the care and management of these devices. The calculated saving for the implementation of the VAT was 61.81% compared with PICCs implanted in Anaesthesia Service. Conclusion: Low complication rates and high overall satisfaction scores in patients and professionals were observed, showing that a specialist VAT can have a positive impact in the insertion of PICCs and which also has a clear economic benefit.

Patient satisfaction in middle ear surgery under monitored anaesthesia care

Background: Monitored anaesthesia care is a specific anaesthesia service for diagnostic or therapeutic procedures performed under local anaesthesia along with sedation and analgesia titrated to a level with the provision to convert into general anaesthesia when required. We conducted a retrospective study to determine patient satisfaction in middle ear surgery under monitored anaesthesia care. Materials and Methods: The number of patients undergoing middle ear surgery under monitored anaesthesia care, over a period of one year were included. They received sedation with midazolam 0.02 mg/kg and fentanyl 1 mcg/kg along with local anaesthetic infiltration. Patient’s satisfaction was measured using a five point Likert scale. Intraoperative pain, nausea, vomiting and other discomforts were inquired. Results: The total number of patients was 64. Fifty-one patients (79.7%) were satisfied, 10 were neutral (15.6%) and 3 patients (4.7%) were dissatisfied with the technique. Earache (4.7%), followed by dizziness (3.1%) and bodyache (3.1%) were the most common cause of discomfort. Nausea occurred in 6 patients (9.4%) and vomiting in 5 patients (7.8%). Conclusion: Middle ear surgeries can be performed under monitored anaesthesia care with good patient satisfaction.

What is the minimum number of specialist anaesthetists needed in low-income and middle-income countries?

IntroductionThe number of specialist anaesthetists in most low-income and middle-income countries is below what is needed to provide a safe quality anaesthesia service. There are no estimates of the optimal number; therefore, we estimated the minimum density of specialist anaesthetists to achieve a reasonable standard of healthcare as indicated by the maternal mortality ratio (MMR).MethodsUtilising existing country-level data of the number of physician anaesthesia providers (PAPs), MMR and Human Development Index (HDI), we developed best-fit curves to describe the relationship between MMR and PAPs, controlling for HDI. The aim was to use this relationship to estimate the number of PAPs associated with achieving the median MMR.ResultsWe estimated that, in order to achieve a reasonable standard of healthcare, as indicated by the global median MMR, countries should aim to have at least four PAPs per 100 000 population. Existing data show that currently 80 countries have fewer than this number.ConclusionFour PAPs per 100 000 population is a modest target, but there is a need to increase training of doctors in many countries in order to train more specialist anaesthetists. It is important that this target is considered during the development of national workforce plans, even if a stepwise approach to workforce planning is chosen.