Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project.

BACKGROUND AND OBJECTIVES: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. METHODS: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. CONCLUSION: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia.

There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.

Pre-operative methods to predict need for shunting during carotid endarterectomy.

OBJECTIVES: To establish whether pre-operative investigations are able to predict cerebral tolerance to carotid cross clamping during carotid endarterectomy (CEA). METHODS: A search of the MEDLINE database from 1950 to 2015 was made in combination with manual cross-referencing using the search strategy: ("carotid" [all fields] AND "endarterectomy" [all fields]) AND "preoperative" [all fields]) AND "clamping" [all fields]) AND ("MRA" [all fields] OR "MRI" [all fields] OR "CT" [all fields] OR "CTA" [all fields] OR "EEG" [all fields] OR "Doppler" [all fields] OR "angiography" [all fields]). A total of 20 studies were identified as eligible for inclusion. RESULTS: 3D Time of Flight MRA and acetazolomide stress SPECT imaging have been reported to have a negative predictive value of 96% and 94% respectively for the need for intraoperative shunting during carotid endarterectomy. CONCLUSIONS: There is some evidence to suggest that pre-operative imaging investigations can reliably identify which patients undergoing CEA will not require carotid shunting for neurological protection. However, this evidence is limited and there is a need for more rigorous studies to be conducted.