Implications of Perioperative Team Setups for Operating Room Management Decisions

Doll, D. et al. (2017) Anesthesia & Analgesia. 124(1) pp. 262–269

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Background: Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient.

 

Conclusions: A surgeon is usually predefined for scheduled surgeries (surgical list). Allocation of the right anesthesiologist to a list and to a surgeon can affect the team performance; thus, this assignment has managerial implications regarding the operating room efficiency affecting turnaround times and thus potentially overutilized time of a list at our hospital

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New Guidelines: Consent for Anaesthesia 2017

This is a consensus document produced by expert members of a Working Party established by the AAGBI. 

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Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients’ autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.

Read the full guidance here

 

Serious procedural complications secondary to central venous catheterisation

Lathey, R.K. et al. Anaesthesia. Published online: 16 December 2016

Despite the high number of central venous access devices inserted annually, there are limited data on the incidence of the associated procedural complications, many of which carry substantial clinical risk. This point was highlighted in the recently published Association of Anaesthetists of Great Britain and Ireland ‘Safe vascular access 2016’ guidelines. This trainee-led snapshot study aimed to identify the number of central venous catheter insertions and the incidence of serious complications across multiple hospital sites within a fixed two-week period. Secondary aims were to identify the availability of resources and infrastructure to facilitate safe central venous catheter insertion and management of potential complications.

The most common complication was failure of insertion, which occurred in seven (1.4%) cases. Facilities to enable safer central venous catheter insertion and manage complications varied widely between hospitals, with little evidence of standardisation of guidelines or protocols.

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NICE: Traditional under the tongue temperature-taking helps patients avoid hypothermia during surgery

Traditional under the tongue or armpit temperature-taking are among the recommended ways of monitoring a patient’s temperature to help avoid hypothermia during surgery, says NICE.

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The updated guideline on preventing and managing hypothermia during surgery also says that some familiar methods of taking a patient’s temperature – such as infrared ear thermometers and forehead strips – should not be used to measure the temperature in adults before, during or after surgery.

Hypothermia is classed as the body temperature dropping below 36.0°C – if this happens during surgery it can lead to the patient losing more blood, more chance of heart problems, and slower healing.  Normal body temperature is typically in a range between 36.5ºC and 37.5ºC.

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Patient reported outcome of adult perioperative anaesthesia

Walker, E.M.K. et al. (2016) British Journal of Anaesthesia. 117 (6) pp. 758-766.

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Background. Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement.

Conclusions. Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.

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Sedation of Patients With Disorders of Consciousness During Neuroimaging

Kirsch, M. et al. Anesthesia & Analgesia. Published online: December 8, 2016

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Background: To reduce head movement during resting state functional magnetic resonance imaging, post-coma patients with disorders of consciousness (DOC) are frequently sedated with propofol. However, little is known about the effects of this sedation on the brain connectivity patterns in the damaged brain essential for differential diagnosis. In this study, we aimed to assess these effects.

Conclusions: Our findings indicate that connectivity decreases associated with propofol sedation, involving the thalamus and insula, are relatively small compared with those already caused by DOC-associated structural brain injury. Nonetheless, given the known importance of the thalamus in brain arousal, its disruption could well reflect the diminished movement obtained in these patients. However, more research is needed on this topic to fully address the research question.

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