Information format and timing before scheduled adult surgery for peri-operative anxiety

A systematic review including 34 trials with 3742 participants, identified through 6 database and supplementary searches | Anaesthesia

21148879163_e6fa3e0d1c_z

Image source: chico945 – Flickr // CC BY 2.0

A multimedia format, alone or in combination with text or verbal formats, was studied in 20/34 (59%) trials: pre-operative anxiety was unaffected in 10 out of 14 trials and reduced by the multimedia format in three; postoperative anxiety was unaffected in four out of five trials in which formats were compared. Multimedia formats increased knowledge more than text, which in turn increased knowledge more than verbal formats. Other outcomes were unaffected by information format.

The timing of information did not affect pre-operative anxiety, postoperative pain or length of stay.

In conclusion, the effects of pre-operative information on peri-operative anxiety and other outcomes were affected little by format or timing.

Full reference: Hounsome, J. et al. (2017) A systematic review of information format and timing before scheduled adult surgery for peri-operative anxiety. Anaesthesia. Vol. 72 (Issue 10) pp. 1265–1272

Advertisements

Regional anesthesia and analgesia after surgery in ICU

The aim is to demonstrate that ICU physicians should play a pivotal role in developing regional anesthesia techniques that are underused in critically ill patients despite the proven facts in perioperative and long-term pain, organ dysfunction, and postsurgery patient health-related quality of life improvement | Current Opinion in Critical Care

Regional anesthesia and/or analgesia strategies in ICU reduce the surgical and trauma–stress response in surgical patients as well as complications incidence. Recent studies suggested that surgical/trauma ICU patients receive opioid–hypnotics continuous infusions to prevent pain and agitation that could increase the risk of posttraumatic stress disorder and chronic neuropathic pain symptoms, and chronic opioid use. Regional anesthesia use decrease the use of intravenous opioids and the ectopic activity of injured small fibers limiting those phenomena. In Cochrane reviews and prospective randomized trials in major surgery patients, regional anesthesia accelerates the return of the gastrointestinal transit and rehabilitation, decreases postoperative pain and opioids use, reduces ICU/hospital stay, improves pulmonary outcomes, including long period of mechanical ventilation and early extubation, reduces overall adverse cardiac events, and reduces ICU admissions when compared with general anesthesia and intravenous opiates alone. The reduction of long-term mortality has been reported in major vascular or orthopedic surgeries.

Promoting regional anesthesia/analgesia in ICU surgical/trauma patients could undoubtedly limit the risk of complications, ICU/hospital stay, and improve patient’s outcome. The use of regional anesthesia permits a high doses opioid use limitation which is mandatory and should be considered as feasible and well tolerated in ICU.

Full reference: Capdevila, M. et al. (2017) Regional anesthesia and analgesia after surgery in ICU. Current Opinion in Critical Care. Vol. 23 (Issue 5) pp. 430–439

Anaesthesia for maxillofacial surgery

Airway management is central to anaesthesia for maxillofacial surgery. Not only is there a shared airway to contend with, difficult airways are frequently encountered | Anaesthesia and Intensive Care Medicine 

The main pathologies that present for surgery include trauma, infection, cancer and craniofacial deformities. All of these may present an airway challenge in either elective or emergency settings but a similar approach to the airway can be used in all these scenarios. Other surgical procedures include dental extractions, temporomandibular joint (TMJ) arthrocentesis, salivary gland surgery and facial aesthetic surgery.

It is vital that clear airway management plans including rescue plans are made at the outset. These must be communicated to the surgical and anaesthetic team in advance. Trauma is excluded as it will be covered in a separate review article.

Full reference: Kersan, L. & Ratnasabapathy, U. (2017) Anaesthesia for maxillofacial surgery. Anaesthesia and Intensive Care Medicine. Published online: 29 July 2017

Improving communication during anaesthesia care transition in the operating room

Jullia, Marion et al. Training in intraoperative handover and display of a checklist improve communication during transfer of care: An interventional cohort study of anaesthesia residents and nurse anaesthetists. European Journal of Anaesthesiology: July 2017 – Volume 34 – Issue 7 – p 471–476

BACKGROUND: Handovers during anaesthesia are common, and failures in communication may lead to morbidity and mortality.

OBJECTIVES: We hypothesised that intraoperative handover training and display of a checklist would improve communication during anaesthesia care transition in the operating room.

DESIGN: Interventional cohort study.

SETTING: Single-centre tertiary care university hospital.

PARTICIPANTS: A total of 204 random observations of handovers between anaesthesia providers (residents and nurse anaesthetists) over a 6-month period in 2016.

INTERVENTION: Two geographically different hospital sites were studied simultaneously (same observations, but no training/checklist at the control site): first a 2-week ‘baseline’ observation period; then handover training and display of checklists in each operating room (at the intervention site only) followed by an ‘immediate’ second and finally a third (3 months later) observation period.

MAIN OUTCOME MEASURES: A 22-item checklist was created by a modified DELPHI method and a checklist score calculated for each handover by adding the individual scores for each item as follows: −1, if error in communicating item; 0, unreported item; 0.5, if partly communicated item; 1, if correctly communicated item.

RESULTS: Before training and display of the checklist, the scores in the interventional and the control groups were similar. There was no improvement in the control group’s scores over the three observation periods. In the interventional group, the mean (95% confidence interval) score increased by 43% [baseline 7.6 (6.7 to 8.4) n = 42; ‘immediate’ 10.9 (9.4 to 12.4) n = 27, P < 0.001]. This improvement persisted at 3 months without an increase in the mean duration of handovers.

CONCLUSION: Intraoperative handover training and display of a checklist in the operating room improved the checklist score for intraoperative transfer of care in anaesthesia.

Full article available at European Journal of Anaesthesiology

Measuring and Improving the Quality of Preprocedural Assessments

Preprocedural assessments are used by anesthesia providers to optimize perioperative care for patients undergoing invasive procedures | Anesthesia & Analgesia

measurement-1476918_960_720.jpg

When these assessments are performed in advance by providers who are not caring for the patient during the procedure, there is an additional layer of complexity in ensuring that the workup meets the needs of the primary anesthesia care team. In this study, anesthesia providers were asked to rate the quality of preprocedural assessments prepared by other providers to evaluate anesthesia care team

The overwhelming majority of preprocedural assessments performed at our institution were considered satisfactory or exemplary by day-of-surgery anesthesia providers. This was demonstrated by both the case-by-case ratings and midpoint survey. However, the perceived frequency of “unsatisfactory” evaluations was worse when providers were asked to reflect on the quality of preprocedural evaluations generally versus rate them individually. Analysis of comments left by providers allowed us to identify specific and actionable areas for improvement. This method can be used by other institutions to identify systemic deficiencies in the preprocedural evaluation process.

Full reference: Manji, F. et al. (2017) Measuring and Improving the Quality of Preprocedural Assessments. Anesthesia & Analgesia. 124(6 ) pp. 1846–1854

Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery

Meng, T. et al. (2017) Anaesthesia. 72(3) pp. 391-401

Introduction: The authors systematically reviewed the comparative evidence for the use of spinal anaesthesia versus general anaesthesia for lumbar spinal surgery.

Results: Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias. Compared with general anaesthesia, the risk ratio (95% confidence interval [CI]) with spinal anaesthesia for intraoperative hypertension was 0.31 (0.15 to 0.64), I2 = 0% (p=0.002); for intraoperative tachycardia 0.51 (0.30 to 0.84), I2 = 0% (p=0.009); for analgesic requirement in the post-anaesthesia care unit 0.32 (0.24 to 0.43), I2 = 0% (p<0.0001); and for nausea/vomiting within 24 hours postoperatively 0.29 (0.18 to 0.46), I2 = 12% (p<0.00001). The standardised mean difference (95% CI) for hospital stay was -1.15 (–1.98 to –0.31), I2 = 89% (p=0.007). There was no evidence of a difference in intraoperative hypotension and bradycardia, blood loss, surgical time and analgesic requirement within 24 hours postoperatively or nausea/vomiting in the post-anaesthesia care unit.

Conclusions: The authors conclude that spinal anaesthesia appears to offer advantages over general anaesthesia for lumbar spine surgery.

Read the full abstract here

Implications of Perioperative Team Setups for Operating Room Management Decisions

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

play-stone-1237457_960_720.jpg

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

Read the full abstract here