Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cro...Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery.We collected information of respondents’ demographic data,education background,health literacy and previous experience of anesthesia,perception of anesthesiologist’s job,the expectation on anesthesia care.Descriptive analyses,χ^2 test and multiple linear regression analysis were used for data analysis.Results Of 550 participants,521(94.7%)completed the questionnaire.In these respondents,335 (64.3%) considered anesthesiology as an independent medical discipline,225 (43.2%) believed that anesthesiology department was an independent clinical department,and 243 (46.6%) recognized anesthesiologists as qualified doctors.Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well.Younger patients (β=-0.044,P<0.001),those with higher education (β=1.200,P<0.001),or with better health literacy (β=0.781,P=0.005) had significant more knowledge about the job roles of anesthesiologists.Most patients demanded pre-anesthetic visit (80.5%),expected availability of preoperative anesthetic clinic (74.1%),wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients’ perception about anesthesiologists might be limited.Efforts should be made on education about anesthesia,especially for elderly patients and those under-educated patients.Preoperative anesthetic clinic is expected by most in-patients.展开更多
Objective To investigate the baseline levels of microorganisms’growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital.Methods This study performed in nine operating rooms and ...Objective To investigate the baseline levels of microorganisms’growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital.Methods This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital.Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination.Results Microorganisms’growth results showed that 20%(5/25)of anesthesiologists’hands carried microorganisms(>10 CFU/cm^(2))before patient contact began.Female anesthesiologists performed hand hygiene better than did their male counterparts,with fewer CFUs(P=0.0069)and fewer species(P=0.0202).Our study also found that 55.6%(5/9)of ready-to-use operating rooms carried microorganisms(>5 CFU/cm^(2)).Microorganisms regrowth began quickly(1 hour)after disinfection,and increased gradually over time,reaching the threshold at 4 hours after disinfection.Staphylococcus aureus was isolated from the hands of 20%(5/25)of anesthesiologists and 33.3%(3/9)of operating rooms.Conclusion Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene,daily cleaning rate of the operating room may be insufficient,and we would suggest that there should be a repeat cleaning every four hours.展开更多
Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of a...Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.展开更多
With the advancement of technology and health sciences,health care delivery costs are steadily increasing.This affects both households and governments.Unfortunately,the present truth is that health has become an essen...With the advancement of technology and health sciences,health care delivery costs are steadily increasing.This affects both households and governments.Unfortunately,the present truth is that health has become an essential but unaffordable commodity.This is very concerning.Quality,up-to-date,costeffective health care delivery is one of the prime objectives,and focuses on administration and health care authority.As the per capita spent on health from public/government funds is very poor in developing countries,the responsibility of cost-effective health care delivery falls primarily on the shoulder of the treating physicians.Anesthesiologists are becoming an indispensable part of health care delivery,having a diverse role in the emergency,critical care,pain,and perioperative care of patients.As the population ages,the need for surgical care is also increasing.Therefore,the anesthesiologist can also play a more significant role in delivering cost-effective health care,and minimize the cost without affecting the quality.This brief narrative review analyzes the current practice of anesthesiologists in two prime areas in the context of cost-savings:Preoperative investigation and low/minimal flow anesthesia.展开更多
Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2...Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.展开更多
Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale(KPS)and American Society of Anesthesiologists(ASA)scores on perioperative complications in patients with...Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale(KPS)and American Society of Anesthesiologists(ASA)scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy.Methods:A total of 96 patients were retrospectively reviewed.Based on KPS and ASA scores,patients were categorized into high KPS(>70)or low KPS(≤70)and high ASA(3~4)or low ASA(1~2)groups.Differences in intraoperative risk factors and perioperative complications among the groups were analyzed.Multivariate analysis was performed to identify risk factors for perioperative complications.Results:The most frequent perioperative complications were cerebrospinal fluid leakage(31.8%)and intracranial infection(27.0%);30-day mortality was 5.2%.The incidence rates of severe complications,central nervous system complications,and total complications were comparable in the low and high KPS groups and in the low and high ASA groups(all p>0.05).Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications.Conclusion:Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.展开更多
文摘Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery.We collected information of respondents’ demographic data,education background,health literacy and previous experience of anesthesia,perception of anesthesiologist’s job,the expectation on anesthesia care.Descriptive analyses,χ^2 test and multiple linear regression analysis were used for data analysis.Results Of 550 participants,521(94.7%)completed the questionnaire.In these respondents,335 (64.3%) considered anesthesiology as an independent medical discipline,225 (43.2%) believed that anesthesiology department was an independent clinical department,and 243 (46.6%) recognized anesthesiologists as qualified doctors.Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well.Younger patients (β=-0.044,P<0.001),those with higher education (β=1.200,P<0.001),or with better health literacy (β=0.781,P=0.005) had significant more knowledge about the job roles of anesthesiologists.Most patients demanded pre-anesthetic visit (80.5%),expected availability of preoperative anesthetic clinic (74.1%),wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients’ perception about anesthesiologists might be limited.Efforts should be made on education about anesthesia,especially for elderly patients and those under-educated patients.Preoperative anesthetic clinic is expected by most in-patients.
基金supported by the Young Scientific Research Fund of PUMCH(Peking Union Medical College Hospital)[Grant No.pumch201911291]。
文摘Objective To investigate the baseline levels of microorganisms’growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital.Methods This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital.Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination.Results Microorganisms’growth results showed that 20%(5/25)of anesthesiologists’hands carried microorganisms(>10 CFU/cm^(2))before patient contact began.Female anesthesiologists performed hand hygiene better than did their male counterparts,with fewer CFUs(P=0.0069)and fewer species(P=0.0202).Our study also found that 55.6%(5/9)of ready-to-use operating rooms carried microorganisms(>5 CFU/cm^(2)).Microorganisms regrowth began quickly(1 hour)after disinfection,and increased gradually over time,reaching the threshold at 4 hours after disinfection.Staphylococcus aureus was isolated from the hands of 20%(5/25)of anesthesiologists and 33.3%(3/9)of operating rooms.Conclusion Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene,daily cleaning rate of the operating room may be insufficient,and we would suggest that there should be a repeat cleaning every four hours.
文摘Background: Significant resource constraints and critical care training gaps are responsible for the limited development of intensive care units (ICUs) in resource limited settings. We describe the implementation of an ICU in Haiti and report the successes and difficulties encountered throughout the process. We present a consecutive case series investigating an anesthesiologist, emergency, and critical care physician implemented endotracheal intubation and mechanical ventilation protocol in an austere environment with the assistance of telemedicine. Methods: A consecutive case series of fifteen patients admitted to an ICU at St. Luc Hospital located in Portau-Prince, Haiti, between the months of February 2012 to April 2014 is reported. Causes of respiratory failure and the clinical course are presented. Patients were followed to either death or discharge. Results: Fifteen patients (eight women and seven men) were included in the study with an average age of 37.7 years. The mean duration of ventilation was three days. Of the fifteen patients intubated, five patients (33.3%) survived and were discharged from the ICU. Of the five surviving patients, two were intubated for status epilepticus, one for status asthmaticus and one for hyperosmolar coma associated with intracerebral hemorrhage. Of the patients dying on the ventilator, four patients died from pneumonia, two from renal failure, and one from tetanus. The remaining three died from strokes and cardiac arrests. Conclusions: Mortality of mechanically ventilated patients in a resource-limited country is significant. Focused training in core critical care skills aimed at increasing the endotracheal intubation and ventilatory management capacity of local medical staff should be a priority in order to continue to develop ICUs in these austere environments. Collaborative educational and training efforts directed by anesthesiologists, emergency, and critical care physicians, and aided by telemedicine can facilitate realizing this goal.
文摘With the advancement of technology and health sciences,health care delivery costs are steadily increasing.This affects both households and governments.Unfortunately,the present truth is that health has become an essential but unaffordable commodity.This is very concerning.Quality,up-to-date,costeffective health care delivery is one of the prime objectives,and focuses on administration and health care authority.As the per capita spent on health from public/government funds is very poor in developing countries,the responsibility of cost-effective health care delivery falls primarily on the shoulder of the treating physicians.Anesthesiologists are becoming an indispensable part of health care delivery,having a diverse role in the emergency,critical care,pain,and perioperative care of patients.As the population ages,the need for surgical care is also increasing.Therefore,the anesthesiologist can also play a more significant role in delivering cost-effective health care,and minimize the cost without affecting the quality.This brief narrative review analyzes the current practice of anesthesiologists in two prime areas in the context of cost-savings:Preoperative investigation and low/minimal flow anesthesia.
文摘Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.
基金supported by National Natural Science Foundation of China(grant no.81802502)the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University,China(No.XJTU1AF-2016-018).
文摘Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale(KPS)and American Society of Anesthesiologists(ASA)scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy.Methods:A total of 96 patients were retrospectively reviewed.Based on KPS and ASA scores,patients were categorized into high KPS(>70)or low KPS(≤70)and high ASA(3~4)or low ASA(1~2)groups.Differences in intraoperative risk factors and perioperative complications among the groups were analyzed.Multivariate analysis was performed to identify risk factors for perioperative complications.Results:The most frequent perioperative complications were cerebrospinal fluid leakage(31.8%)and intracranial infection(27.0%);30-day mortality was 5.2%.The incidence rates of severe complications,central nervous system complications,and total complications were comparable in the low and high KPS groups and in the low and high ASA groups(all p>0.05).Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications.Conclusion:Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.
