10 Recent Findings on Anesthesia Quality Issues

Here are 10 recent studies on anesthesia quality issues, according to reports from various publications and organizations.

1. Regular training sessions could prevent anesthesia awareness.
According to a report published in the current issue of Deutsches Arzteblatt International, two of every 1,000 patients wake up during their operation, and unintended awareness is classified as an occasional complication of anesthesia. The authors recommended making providers aware of various awareness risk factors by conducting regular training sessions with medical personnel. Additionally, they said anesthesia providers should measure anesthetic gas concentrations regularly and monitor brain electrical activity by EEG.

2. Multimodel analgesia is important for spine surgery pre-op. In a review of methods published in the Dec. 15 issue of Spine, researchers Asokumar Buvanendran, MD, and Vijay Thillainathan, MD, of Rush University Medical Center in Chicago, reviewed the current literature on anesthesia and analgesia for minimally invasive spine surgery and considered applying other principles used for other types of minimally invasive surgery. The study pointed out the importance of using multimodal analgesic therapy during preoperative visits and stressed that multimodal analgesia should also be continued postoperatively.

3. Anesthesia circuit device could prevent post-operative cognitive decline. Michael Schmidt, MD, professor of anesthesiology at Dalhousie University in Germany, has developed a device that could prevent post-operative cognitive decline. The device is designed for the removal of carbon dioxide in the anesthesia circuit, which could make anesthesia safer and prevent patient memory loss and other forms of cognitive dysfunction, according to the report. Dr. Schmidt hopes to bring the device from "bench to bedside" by 2014, pending clinical trials and a regulatory process.

4. SSI, HCAI studies should be repeated in more facilities. Healthcare-associated infections and surgical site infections deserve more attention from the anesthesia community, and hand-washing studies should be repeated at other institutions, according to the authors of an editorial published in Anesthesia & Analgesia. According to the editorial, anesthesiologists should take the following measures to decrease the incidence of HCAIs and SSIs:

1. Determine the effectiveness of local anesthesia work area decontamination protocols.
2. Continue to administer the proper antibiotic in a timely manner.
3. Continue to wash hands in all cases.

5. Anesthesiologist and surgeon perception of turnover times could be flawed.
Managers should not rely on surgeons or anesthesiologists for expert judgment on turnover times, according to a study published in Anesthesia & Analgesia. The study concluded that perception of turnover times were influenced by opinion of team activity during shift change, and time of day influenced perception of turnovers. According to the researchers, managers should not interpret comments about turnover times as literally referring to the time, but instead as factors perceived as contributing to the time.

6. Anesthesiologist ordering could reduce unnecessary tests.
According to the results of a study published in Anesthesia & Analgesia, more than half of the patients examined had at least one unnecessary test based on testing guidelines. Among the 175 anesthesiologists who responded to the survey, 46 percent ordered one or more of the tests considered unnecessary. Likelihood of anesthesiologists ordering unnecessary tests was considerably lower than the likelihood of gynecologists, otolaryngologists, orthopedists and general surgeons ordering unnecessary tests.

7. Methadone reduces post-op pain in complex spine surgery patients. Perioperative treatment with a single bolus of methadone improves postoperative pain control for patients undergoing complex spine surgery, according to a study published in Anesthesia & Analgesia. Results of the study showed methadone reduced postoperative opioid requirement by approximately 50 percent at 48 hours after surgery, and pain scores were lower by approximately 50 percent in the methadone group 48 hours after surgery.

8. Body temperature can be monitored non-invasively with new technique. Anesthesiologists Marc Abreu, MD, David Silverman, MD, and colleagues at Yale University in New Haven, Conn., have identified an area of the brain that transmits brain temperature to an area of the skin and has the potential to prevent death from heat stroke and hypothermia and to detect infectious diseases, according to a Yale News report on the study. The researchers found that a small area of skin near the eyes and noses is the point of entry to the "brain temperature tunnel," a connection to a thermal storage center in the brain.

9. Anesthesia information management systems improve case documentation. Accreditation organizations should support uploading of case log files based on anesthesia information management systems, as AIMS databases have been widely adopted by academic anesthesia departments, according to a study published in Anesthesia & Analgesia. The researchers found that manually-entered cases were rife with errors — with more than 50 percent of residents either underreporting or overreporting total case counts by at least 5 percent — compared to the AIMS database.  

10. Preoperative cerebral oxygen saturation prevents health risks. Researchers observed Sc02 levels in 1,178 patients by using noninvasive near-infrared spectroscopy, a quick and simple method of monitoring the adequacy of a patient's brain oxygen supply, in a study published in the Jan. 2011 issue of Anesthesiology. The study's data indicated that preoperative Sc02 levels reflect cardiopulmonary function, meaning patients with low preoperative Sc02 may not be appropriate for surgery. A preoperative ScO2 level of less than 50 percent was an independent indicator of mortality in the patients observed.

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