Guidelines to the Practice of Anesthesia Revised Edition 2013

Merchant, Richard; Chartrand, Daniel; Dain, Steven; Dobson, Gregory; Kurrek, Matthias; Lagacé, Annie; Stacey, Shean; Thiessen, Barton

doi:10.1007/s12630-012-9820-7

Cited by 32 publications

(20 citation statements)

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“…9,12,14,40 Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. 9,41 Factors such as current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data support these recommendations. Presently, it may be early and premature to anticipate how this new technology could affect practice, although we believe it is a promising clinical skill to pursue.…”

Section: Discussionmentioning

confidence: 98%

Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study

Arzola

Carvalho

Cubillos

et al. 2013

Can J Anesth/J Can Anesth

115

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Purpose Focused assessment of the gastric antrum by ultrasound is a feasible tool to evaluate the quality of the stomach content. We aimed to determine the amount of training an anesthesiologist would need to achieve competence in the bedside ultrasound technique for qualitative assessment of gastric content. Methods Six anesthesiologists underwent a teaching intervention followed by a formative assessment; then learning curves were constructed. Participants received didactic teaching (reading material, picture library, and lecture) and an interactive hands-on workshop on live models directed by an expert sonographer. The participants were instructed on how to perform a systematic qualitative assessment to diagnose one of three distinct categories of gastric content (empty, clear fluid, solid) in healthy volunteers. Individual learning curves were constructed using the cumulative sum method, and competence was defined as a 90% success rate in a series of ultrasound examinations. A predictive model was further developed based on the entire cohort performance to determine the number of cases required to achieve a 95% success rate. Results Each anesthesiologist performed 30 ultrasound examinations (a total of 180 assessments), and three of the six participants achieved competence. The average number of cases required to achieve 90% and 95% success rates was estimated to be 24 and 33, respectively. Conclusion With appropriate training and supervision, it is estimated that anesthesiologists will achieve a 95% success rate in bedside qualitative ultrasound assessment after performing approximately 33 examinations. RésuméObjectif L'évaluation ciblée de l'antre pylorique par échographie est un outil utile pour estimer la qualité du contenu de l'estomac. Notre objectif était de déterminer la quantité de formation nécessaire à un anesthésiologiste afin d'acquérir des compétences en échographie au chevet pour l'évaluation qualitative du contenu gastrique. Méthode Six anesthésiologistes ont suivi une formation, puis une évaluation formative; des courbes d'apprentissage ont ensuite été élaborées. Les participants ont reçu un enseignement didactique (matériel de lecture, bibliothèque d'images, et cours) et suivi un atelier pratique interactif sur

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Section: Discussionmentioning

confidence: 98%

Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study

Arzola

Carvalho

Cubillos

et al. 2013

Can J Anesth/J Can Anesth

115

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“…Upon arrival in the operating room, standard vital sign monitors (pulse oximetry, electrocardiogram, and noninvasive blood pressure) were applied to the patients. 14 Anesthesia was induced with propofol 1.5 mgÁkg -1 and remifentanil (targeting a Ce of 1 ngÁmL -1 ). The Ce of remifentanil (using Minto's pharmacokinetic model) 15,16 was maintained with a commercial target-controlled infusion (TCI) system (Orchestra Ò Base Primea; Fresenius Vial, Brezins, France).…”

Section: Methodsmentioning

confidence: 99%

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Lee

Choi

Kang

et al. 2014

Can J Anesth/J Can Anesth

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Purpose Maintenance of a remifentanil infusion during anesthetic emergence has been reported to decrease the incidence of coughing and thereby help to ensure a smooth emergence. It may, however, cause respiratory depression and possibly delay emergence. The purpose of this study was to investigate the effect of a single dose of dexmedetomidine combined with a low-dose remifentanil infusion on cough suppression during emergence from general anesthesia. Methods American Society of Anesthesiologists physical status I-II adults undergoing elective thyroidectomy under sevoflurane anesthesia were recruited and randomly allocated to receive either dexmedetomidine 0.5 lgÁkg -1 iv (Group D, n = 70) or saline (Group S, n = 71), each combined with a low-dose remifentanil infusion ten minutes before the end of surgery. Coughing was assessed using a four-point scale. The respiratory rate (RR), heart rate (HR), and mean arterial pressure were also recorded. Results The incidence of coughing was lower in Group D than in Group S (64% vs 91%, respectively; mean difference 27%; 95% confidence interval [CI] 13 to 41; P \ 0.001). The median cough grade at extubation was also lower in Group D. Mean arterial pressure and HR were elevated in Group S during tracheal extubation but were similar to baseline values in Group D. There was no difference in RR between the two groups throughout the study. A small delay in extubation was observed in Group D (3 minutes longer than Group S; 95% CI 2 to 4; P \ 0.001). Conclusion Compared with an infusion of low-dose remifentanil alone, the addition of a single dose (0.5 lgÁkg -1 ) of dexmedetomidine during emergence from sevofluraneremifentanil anesthesia was effective in attenuating coughing and hemodynamic changes and did not exacerbate respiratory depression after thyroid surgery. This trial was registered at Clinicaltrial.gov, identifier: NCT01774305. RésuméObjectif Il a été rapporté que le maintien d'une perfusion de remifentanil pendant l'émergence anesthésique diminuait This study was presented as a scientific poster at the

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“…Many risk factors to be aware of are a history of sleep apnea, alcohol or substance abuse, adverse reaction to sedative drugs, and prolonged duration of procedure. Patients should be classified using the criteria of the ASA [6] . Cardiorespiratory problems which could occur during the GIE procedure should be carefully evaluated.…”

Section: Pre-sedation Assessmentmentioning

confidence: 99%

Sedation-related complications in gastrointestinal endoscopy

Amornyotin

2013

WJGE

110

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Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Sedation; Complication; Gastrointestinal; EndoscopyCore tip: Gastrointestinal endoscopic (GIE) procedures are relatively safe. However, these procedures have been shown to cause various effects on cardiorespiratory systems. Sedation-related complications while providing any level of sedation can occur. Fortunately, these complications during GIE procedures are commonly transient and of a mild degree. In addition, significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support. Periodical assessment of the level of sedation and continuous monitoring of cardiovascular and respiratory systems provides timely information. Standardized discharge criteria should be used to determine the patient's readiness for discharge.Amornyotin S. Sedation-related complications in gastrointestinal endoscopy.

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Guidelines to the Practice of Anesthesia Revised Edition 2013

Abstract: How does this statement differ from the 2012 Guidelines? Specific minor changes include the term ''agent-specific filling system'' for vapourizers and consistency in the use of the Ramsay Sedation Scale. The recommendation for preoperative electrocardio-123

Cited by 32 publications

References 0 publications

Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study

Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Sedation-related complications in gastrointestinal endoscopy

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