Preoperative point-of-care neck ultrasound: beyond the airway.

PURPOSE: A preoperative point-of-care neck ultrasound, carried out during preoperative airway evaluation by extending the scans to the regions close to the larynx and trachea, can allow for the rapid identification of unknown pathologies or abnormalities in a cost-effective and non-invasive manner. This prospective, observational study examines a series of ultrasound findings in structures close to the airway, made through preoperative point-of-care neck ultrasound in a cohort of 230 patients. METHODS: We conducted a prospective observational study, enrolling 230 adult patients selected for elective abdominal surgery. The primary goal was to verify the predictive role of airway ultrasound in identifying difficult airways, while the secondary goal was to evaluate structures close to the airway such as jugular veins, carotid arteries, thyroid gland and soft tissues. RESULTS: Overall, preoperative point-of-care neck ultrasound proved to be an effective and reliable method of obtaining details about local or systemic pathologies, which could affect perioperative care. For example, the exam consistently revealed the presence of carotid plaques or venous congestion, which could be used to best determine the patient's cardiovascular risk or to instigate further investigations. It also allowed for more accurate central venous catheter placement planning and better airway management and it warned about possible thyroid or neoplastic pathologies that would have otherwise remained unknown. In some cases, information from preoperative point-of-care neck ultrasound has even led to modifications in perioperative therapy. CONCLUSION: Preoperative point-of-care neck ultrasound is fast, inexpensive, and non-invasive, and it can be easily performed by a properly trained professional during the preoperative airway ultrasound evaluation. It can be considered as a new preoperative assessment tool.

Patient and Provider Satisfaction With Telehealth Preanesthesia Examinations.

PURPOSE: Telehealth has become commonplace in many healthcare systems across the United States. Due to the COVID-19 pandemic, a large academic medical center in the southeast USA has increased the use of telehealth in the anesthesia department to complete preanesthetic assessments before the patient's surgery. This has allowed high-risk patient populations to limit potential exposure to COVID-19 and limit the financial burden of traveling from neighboring counties to complete their preanesthetic assessment in person. The purpose of this quality improvement project was to evaluate the effectiveness of a preanesthetic assessment via telehealth among patients undergoing anesthesia. DESIGN: A quality improvement project. METHODS: Two separate surveys assessing patient and provider satisfaction with telehealth preanesthesia assessments were developed. Patients undergoing anesthesia at the medical center completed a telehealth preanesthesia assessment and received a satisfaction survey via email post-procedure. Certified registered nurse anesthetists (CRNAs) who cared for patients that completed a telehealth preanesthesia assessment also received an emailed satisfaction survey. FINDINGS: Results demonstrate high satisfaction scores for both patients and providers. CONCLUSIONS: Current telehealth preanesthetic assessments prompt high satisfaction scores, supporting continued, and expanded use.

Pre-anesthetic clinic internship: new teaching method of pre-anesthesia evaluation for undergraduates.

BACKGROUND: This study aimed to observe the effect of internship in a pre-anesthetic clinic on the teaching quality of pre-anesthesia evaluation for undergraduates. METHODS: A total of 120 undergraduates from July 2017 to July 2018 in the anesthesia department of our hospital were randomly divided into two groups: pre-anesthetic clinic internship teaching group (n = 60) and traditional teaching group (n = 60). The knowledge in the pre-anesthesia evaluation teaching chapters was evaluated between the two groups of undergraduates. RESULTS: There were no significant differences in the demographic information between the two groups. The scores in the case analysis and theoretical knowledge test in the pre-anesthetic clinic internship teaching group were significantly higher than those in the traditional teaching group. In addition, the students' satisfaction with the curriculum design was significantly higher in the pre-anesthetic clinic internship teaching group than in the traditional teaching group. CONCLUSION: Pre-anesthetic clinic internships can improve the quality of pre-anesthesia assessment teaching for undergraduates.

Clinical Audit on the Practice of Documentation at Preanesthetic Evaluation in a Specialized University Hospital.

BACKGROUND: Performing preanesthetic evaluation, documenting, and keeping readily accessible record are responsibilities of anesthetists. Documentation can improve overall patient outcome. It also has an irreplaceable role in medico-legal aspects. Documentation is one of the challenges of providing quality care. AIM: The aim of this study was to evaluate the quality of documentation practice during preanesthetic visits. MATERIALS AND METHODS: This clinical audit was conducted in the University of Gondar Hospital. Predefined 22 practice quality indicators were prepared according to modified global quality index. STATISTICAL ANALYSIS: Descriptive statistics was performed using SPSS version 20. RESULTS: A total of 122 preanesthetic evaluation tools (PAETs) were reviewed. None of PAETs found fully completed according to the indicators. Trends differ between elective and emergency conditions. Indicators with high completion rate (>90%) were signed a consent, medical history, history of medication, allergy, anesthesia and surgery, cardiopulmonary examination, airway examination, preoperative diagnosis, and planned procedure. Anesthetic plan, vital signs, a name, per-oral status, premedication, and age were found with below average (<50%) completion rate. CONCLUSIONS: Documentation practice during the preanesthetic visit was below the standard. Unclear instructions should be replaced with standardized contents. Providing regular trainings on clinical documentation for students and staffs, and introducing modern electronic-based documentation system and preanesthetic clinics may improve the practice.

Preanesthetic evaluation of the patient with end-stage heart failure.

Heart failure (HF) currently affects more than 5 million patients in the United States [1]. Advanced HF is associated with high mortality and poor quality of life. It is estimated that between 5% and 10% of all patients with HF have an advanced form of the disease [1]. Orthotopic heart transplantation (OHT) is an accepted therapy for stage D HF [3] (Fig. 1). Unfortunately, the number of patients with the disease exceeds the number of available organs. This makes appropriate patient selection vital in the field of heart transplantation. Anesthetic evaluation of the patient presenting for OHT or mechanical circulatory support (MCS) implantation is a vital component of the patient's perioperative course. Patients often have had extensive diagnostic testing and assessment prior to being listed for OHT or considered for MCS implantation. Because of the often urgent nature of these procedures, the cardiac anesthesiologist must conduct a focused review of the relevant information and perform a focused patient interview and physical exam.

Epidemiological profile of patients seen in the pre-anesthetic assessment clinic of a university hospital / Perfil epidemiológico de pacientes atendidos no ambulatório de avaliação pré-anestésica de um hospital universitário

Abstract Objective Assess the demographic and clinical characteristics of surgical patients seen in the Pre-anesthetic Assessment Clinic of the Hospital Universitário Gaffrée e Guinle (APA/HUGG), in order to assist in the pursuit for quality, effectiveness, and resource rationalization of hospital management. Method Cross-sectional descriptive study with 491 patients undergoing elective surgery, treated at APA/HUGG Clinic from March to December 2014. The following variables were assessed: sex, age, BMI, smoking status, associated diseases, classification of MET's and ASA, presence of decompensated disease, medical associated appointments interconsultation, specialty and surgical risk, history of prior anesthetic-surgical procedure, and complications. Results There was a predominance of female (64.8%) and overweight patients (55.9%), aged 18-59 years. The prevalence of associated diseases was high (71.3%), with hypertension pressure prevailing (50.1%). Most patients had clinically compensated morbidity (96.3%) and long-term use of medication (77.4%). Regarding the surgical characteristics, the most frequent specialty was general and medium risk surgeries. The analysis of the characteristics by age showed that the elderly have more associated diseases and long-term use of medication, in addition to predominance of ASA II-III. Conclusion The epidemiological profile of surgical patients seen at the APA/HUGG was female, age 18-59 years, overweight, with associated diseases, long-term use of medication, without clinical decompensation, ASA II and MET's ≥4. Knowledge of the clinical characteristics of surgical patients is critical to schedule the perioperative care, allowing the improvement of quality and safety in anesthesia and surgery.

Resumo Objetivo Verificar as características demográficas e clínicas dos pacientes cirúrgicos atendidos no Ambulatório de Avaliação Pré-Anestésica do Hospital Universitário Gaffrée e Guinle (APA/HUGG), com o objetivo de auxiliar na busca de qualidade, efetividade e racionalização de recursos da gestão hospitalar. Método Estudo descritivo transversal, feito com 491 pacientes de operação eletiva, atendidos no Ambulatório de APA/HUGG de março a dezembro de 2014. Foram estudadas as variáveis: sexo, faixa etária, índice de massa corporal (IMC), tabagismo, doenças associadas, classificação da capacidade funcional (METs), (ASA), doença descompensada, interconsultas, especialidade e porte cirúrgicos, história de procedimento anestésico-cirúrgico prévio e possíveis complicações. Resultados Predominaram pacientes do sexo feminino (64,8%), na faixa de 18 a 59 anos (55,9%) e com sobrepeso (38,3%). A prevalência de doenças associadas foi elevada (71,3%) sendo a hipertensão arterial a principal (50,1%). A maior parcela dos pacientes apresentava morbidade clinicamente compensada (96,3%) e uso contínuo de medicamento (77,4%). Em relação às características cirúrgicas, a especialidade mais frequente foi a cirurgia geral e o porte médio. A análise das características por faixa etária mostrou que os idosos apresentaram mais doenças associadas e uso contínuo de medicação além de predomínio de ASA II e III. Conclusão O perfil epidemiológico dos pacientes cirúrgicos atendidos na APA/HUGG foi: sexo feminino, faixa etária de 18 a 59 anos, sobrepeso, com doenças associadas, em uso de medicação contínua, sem descompensação clínica, ASA II e METs ≥ 4. O conhecimento das características clínicas dos pacientes cirúrgicos é fundamental para o planejamento dos cuidados perioperatórios e permite avançar na qualidade e segurança em anestesia e cirurgia.

[Epidemiological profile of patients seen in the pre-anesthetic assessment clinic of a university hospital]. / Perfil epidemiológico de pacientes atendidos no ambulatório de avaliação pré­anestésica de um hospital universitário.

OBJECTIVE: Assess the demographic and clinical characteristics of surgical patients seen in the Pre-anesthetic Assessment Clinic of the Hospital Universitário Gaffrée e Guinle (APA/HUGG), in order to assist in the pursuit for quality, effectiveness, and resource rationalization of hospital management. METHOD: Cross-sectional descriptive study with 491 patients undergoing elective surgery, treated at APA/HUGG Clinic from March to December 2014. The following variables were assessed: sex, age, BMI, smoking status, associated diseases, classification of MET's and ASA, presence of decompensated disease, medical associated appointments interconsultation, specialty and surgical risk, history of prior anesthetic-surgical procedure, and complications. RESULTS: There was a predominance of female (64.8%) and overweight patients (55.9%), aged 18-59 years. The prevalence of associated diseases was high (71.3%), with hypertension pressure prevailing (50.1%). Most patients had clinically compensated morbidity (96.3%) and long-term use of medication (77.4%). Regarding the surgical characteristics, the most frequent specialty was general and medium risk surgeries. The analysis of the characteristics by age showed that the elderly have more associated diseases and long-term use of medication, in addition to predominance of ASA II-III. CONCLUSION: The epidemiological profile of surgical patients seen at the APA/HUGG was female, age 18-59 years, overweight, with associated diseases, long-term use of medication, without clinical decompensation, ASA II and MET's ≥4. Knowledge of the clinical characteristics of surgical patients is critical to schedule the perioperative care, allowing the improvement of quality and safety in anesthesia and surgery.

Update on complications in pediatric anesthesia.

Complications in pediatric anesthesia can happen, even in our modern hospitals with the most advanced equipment and skilled anesthesiologists. It is important, albeit in a tranquil and reassuring way, to inform parents of the possibility of complications and, in general, of the anesthetic risks. This is especially imperative when speaking to the parents of children who will be operated on for minor procedures: in our experience, they tend to think that the anesthesia will be a light anesthesia without risks. Often the surgeons tell them that the operation is very simple without stressing the fact that it will be done under general anesthesia which is identical to the one we give for major operations. Different is the scenario for the parents of children who are affected by malignant neoplasms: in these cases they already know that the illness is serious. They have this tremendous burden and we choose not to add another one by discussing anesthetic risks, so we usually go along with the examination of the child without bringing up the possibility of complications, unless there is some specific problem such as a mediastinal mass.

A Statistical Analysis of Preanesthetic Consultation in the Pediatric Patient / 대한마취과학회지

BACKGROUND: Adequate pre-anesthetic evaluation could improve both patient outcome and hospital management by reducing the rates of operation delay and cancellation. We undertook this study to contribute to the establishment of a pre-anesthetic evaluation system by studying pediatric patients who had preoperatively consulted the anesthesiology department. METHODS: Data were collected using the EMR (Electronic Medical Record) system. 260 pediatric patients, age limitation 15 years, who had consulted our anesthesiology staff, were enrolled. The age distributions, departments consulted and clinical causes were analyzed. RESULTS: The age distributions were as follow; <1 month: 1.5%, 1 month-1 year: 29.2%, 1-4 years: 23.8%, 5-7 years: 18.1% and 8-15 years: 27.3%. The causes of the consultations were mainly pulmonary (27.3%), cardiovascular (21.9%), gastrointestinal (12.3%), airway (9.6%) problems and other causes (26.5%). The most common diseases were congenital heart disease, prematurity and URI. The major departments consulted were general surgery (16.2%), ophthalmology (15.4%), thoracic surgery (15.0%), plastic surgery (15.0%) and orthopedic surgery (14.6%). CONCLUSIONS: The establishment of a communication system with surgeons concerning patient management guidelines about the common causes of consultations would improve hospital management by reducing the incidences of delay and the cancellation of operations.