A Survey of Provider Satisfaction of a New, Flexible Extended-Length Pharyngeal Airway to Relieve Upper Airway Obstruction During Deep Sedation

ABSTRACTBackgroundMaintaining an open airway in a spontaneously-breathing patient under deep sedation, or deep monitored anaesthesia care, can be challenging. Specifically, current oral airways are not long enough to displace obstruction caused by redundant pharyngeal tissue, prompting external maneuvers by anesthetists that can impact patient outcomes and facility operational efficiency. As procedures increase at outpatient surgical centers, there is a need for an anesthesia provider-validated airway device that can sufficiently open an obstructed airway and maintain airway patency.MethodsThis prospective, multi-center user-experience survey evaluated anesthesia provider experience of a new airway device for adult patients with airway obstruction during deep sedation. The novel external airway has a longer flexible tubing allowing for displacement of pharyngeal tissue, smaller diameter to allow placement alongside an endoscopy bite block, and is manufactured with softer material to allow ease of insertion and patient comfort.ResultsFifty-four anaesthetists at 15 hospital systems reported their experience of airway use in 86 cases. The novel airway device was 95% successful in establishing and maintaining a patent airway (n=68). Survey responses indicated that the airway was easy to place (93%), allowed for a “hands-off approach” (98%), and would improve airway management practice and patient outcomes (86%).ConclusionsThis pilot study demonstrated that the novel external airway is an effective and satisfactory method for anaesthesia providers to alleviate airway obstruction during deep sedation. Additional studies will be initiated to confirm efficacy and cost-effectiveness in patient populations and clinical environments that will most benefit from the new airway device.

Labor Analgesia in a Patient with Severe Dystrophic Calcinosis Cutis

Introduction Calcinosis cutis is a condition characterized by pathologic calcium deposition into superficial dermal skin layers. It is often associated with an autoimmune disease. However, it may also occur after minor localized trauma and infection. Description of Problem We report a case of lumbar epidural placement of labor analgesia in a parturient with severe dystrophic calcinosis cutis without apparent complications. Clinical Solution We recommend fastidious optimization of epidural placement conditions for all patients who may be at high risk for neuraxial anesthesia, including consideration of ultrasound use, use of an experienced anesthesia provider for neuraxial placement, and placement in early labor. Additionally, judicious discussion of risks, benefits, and alternatives when obtaining informed consent is critical, ideally with the patient identified for a comprehensive visit in a preoperative obstetric anesthesia clinic before delivery.

Extendable mirrors to improve anesthesia provider comfort for eye and positioning checks in prone patients: A pilot study

Prone positioning is frequently used for spinal surgery and is associated with risks including perioperative visual loss and stroke. Frequent eye checks and careful neck positioning are recommended. In our hospital’s current model, anesthesia providers are required to kneel on the operating room floor beneath operating room table, exposing themselves to hazards such as bodily fluids and back and knee strain. This maneuver is both time consuming and unpleasant. While new devices that enable easier visualization of patients in the prone position exist, they are costly and not universally compatible with all operating room tables. Our objective for this feasibility pilot study was to determine if simple, extendable mirrors increase anesthetist comfort during these cases. A nonrandomized survey-based feasibility pilot study was performed, evaluating comfort while performing eye checks with extendable lighted mirrors compared to the standard kneeling practice. A total of 41 nurse anesthetists and anesthesiology residents were analyzed. A mixed model logistic regression demonstrates a three-fold improvement in comfort with the prone position after mirror use (OR = 3.34; 95% CI: 1.06–10.48; p = 0.039). The frequency of eye checks did not change significantly with introduction of the mirror. Use of the extendable mirror improves anesthesia provider comfort with patients in the prone position. We postulate that it may be a useful addition to our practice.

Uncovering the Drape: Observing its Impact on Communication With Anesthesia Providers

In the operating room (OR), opaque drapes are hung between the anesthesia workstation and the operating table. Because OR teams are transient and hierarchical, social order is continuously being negotiated around this partition. We hypothesized that drape transparency, a tool for reimagining the physical and symbolic confines of the OR, might alter behavior. Due to the proximity of anesthesia providers to the drape, we examined how the drape’s transparency affected “social” and “case-related” communication between them and clinicians from surgery and nursing. We observed 58 surgical cases using an OR ethogram to document interprofessional communications (344 exchanges) involving the anesthesia provider. The effect of the type drape showed a statistically significant, GzMLM F(1, 342) = 4.924, p = .027, increase only for “social” communication. The frequency of “social” communication, known to enhance collegiality, was greater when a transparent drape was substituted for the opaque drape (34.9% vs. 21.3%, respectively).