Prevention of pulmonary complications in sedated patients undergoing interventional procedures in the nonoperating room anesthesia setting

Urdaneta, Felipe; Wardhan, Richa; Wells, G Margaret; White, Jeffrey D.

doi:10.1097/aco.0000000000001158

Cited by 3 publications

(3 citation statements)

References 54 publications

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“…In this study, we obtained a similar complete resection rate of 96.2% and 93.6% in the S-D and M-D groups, respectively, which are comparable with previous studies[ 7 , 29 , 30 ]. Larger specimen sizes correlate with longer procedural duration[ 11 ], which is an independent risk factor for pulmonary risk during anesthesia[ 31 ], and specimen size ≥ 4 cm is associated with delayed bleeding[ 20 ]. So when we started the S-D strategy in 2020, patients with estimated specimens smaller than 4 cm were selected as the S-D discharge candidates to minimize the associated risk above.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

Wang¹,

Li²,

Yan³

et al. 2022

World J Gastroenterol

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BACKGROUND Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasia. Generally, multi-day (M-D) admission is required for patients undergoing ESD due to potential complications. AIM To evaluate the feasibility of a same-day (S-D) discharge strategy for ESD of the esophagus or stomach. METHODS The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital. The propensity score matching (PSM) method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups. Intraoperative and postoperative parameters were compared between the matched groups. RESULTS Among the 479 patients reviewed, 470 patients, including 91 in the S-D group and 379 in the M-D group, fulfilled the inclusion and exclusion criteria. Following PSM, 78 patients in each group were paired using the 1:1 nearest available score match algorithm. No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events (AEs). Tumor size, complete resection rate, and procedural duration were comparable between the groups. The S-D group demonstrated a significantly shorter length of hospital stay ( P < 0.001) and lower overall medical expenses ( P < 0.001) compared with the M-D group. CONCLUSION The S-D discharge strategy may be feasible and effective for esophagogastric ESD, and the procedural-related AEs can be managed successfully.

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Section: Discussionmentioning

confidence: 99%

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

Wang¹,

Li²,

Yan³

et al. 2022

World J Gastroenterol

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“…Intubation problems are a frequent cause of anesthesia-related morbidity and mortality. Intubation challenges are typically accompanied by challenges during direct laryngoscopy glottis exposure 15,16,17 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Hyomental Distance Ratio (HMDR) for Prediction of Difficult Laryngoscopy in Patients Undergoing Surgery Under General Anesthesia Using Tracheal Intubation

Ashraf¹,

Ahmed²,

Khurshid³

et al. 2022

PJMHS

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Background: To keep the airway open, a flexible plastic tube (ETT) is inserted into the trachea during tracheal intubation. Even when done correctly, tracheal intubation requires much clinical experience, and catastrophic problems can occur. Mandibular space has been estimated using hyomental distance (HMD), although HMD has only been found to provide a limited amount of diagnostic accuracy on its own. In order to determine how well the Hyomental Distance Ratio (HMDR) predicts difficult laryngoscopy, we conducted this study. Objectives: Using the Cormack and Lehane classification as the gold standard, the objective is to assess the diagnostic validity of the Hyomental Distance Ratio (HMDR) for the prediction of challenging laryngoscopy in patients undergoing surgery under general anaesthesia. Materials & Methods: The department of anesthesiology and the general surgery operating rooms at Sir Ganga Ram Hospital in Lahore conducted this cross-sectional study over the course of six months in 2015–2016. The approach of non-probability purposive sampling was applied. Informed consent was acquired, and patient demographics were recorded. The researcher herself then assessed patients for HDMR. In order to determine if a patient had a difficult or normal laryngoscopy, HDMR was determined. After that, the researcher performed a laryngoscopy on the patients. If the vocal cords were visible, the mouth was opened, and the case was assessed using the Cormack and Lehane classification (CL), with easy or difficult laryngoscopy being designated. SPSS version 20 was used to enter and analyse all of the data. Results: The patients in our study had a mean age of 43.23 11.63 years and a male to female ratio of 1.5:1. In this study, 43.91% of patients had an HDR difficult intubation. HDR's difficult intubation has a sensitivity of 95.05%, a specificity of 96.12%, and a diagnostic accuracy of 95.65% when using CL as the gold standard. Practical Implication: According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Conclusion: According to the findings of our study, the HMDR is a viable diagnostic tool for anticipating challenging laryngoscopy in patients having general anaesthesia with tracheal intubation. According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Keywords: Laryngoscopy, difficult intubation, Cormack Classification, difficult surgery

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“…Standardization of processes may reduce variation, some authors have recently provided compelling evidence supporting implementation of site-specific checklists and protocols to optimize safety, workflows, and operations [19,20]. Due to the high degree of specialization and differences between NORA sites, others emphasize strategic planning such as patient and comorbidity-specific pharmacologic regimens, consistent staffing assignments, routine safety drills, and emergency management preparedness [21,22 ▪ ].…”

Section: Nonoperating Room Anesthesia Difficultiesmentioning

confidence: 99%

Patient selection for nonoperating room anesthesia

Georgiadis,

Tsai,

Routman

2024

Current Opinion in Anaesthesiology

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Purpose of review Given the rapid growth of nonoperating room anesthesia (NORA) in recent years, it is essential to review its unique challenges as well as strategies for patient selection and care optimization. Recent findings Recent investigations have uncovered an increasing prevalence of older and higher ASA physical status patients in NORA settings. Although closed claim data regarding patient injury demonstrate a lower proportion of NORA cases resulting in a claim than traditional operating room cases, NORA cases have an increased risk of claim for death. Challenges within NORA include site-specific differences, limitations in ergonomic design, and increased stress among anesthesia providers. Several authors have thus proposed strategies focusing on standardizing processes, site-specific protocols, and ergonomic improvements to mitigate risks. Summary Considering the unique challenges of NORA settings, meticulous patient selection, risk stratification, and preoperative optimization are crucial. Embracing data-driven strategies and leveraging technological innovations (such as artificial intelligence) is imperative to refine quality control methods in targeted areas. Collaborative efforts led by anesthesia providers will ensure personalized, well tolerated, and improved patient outcomes across all phases of NORA care.

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Prevention of pulmonary complications in sedated patients undergoing interventional procedures in the nonoperating room anesthesia setting

Cited by 3 publications

References 54 publications

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

Diagnostic Accuracy of Hyomental Distance Ratio (HMDR) for Prediction of Difficult Laryngoscopy in Patients Undergoing Surgery Under General Anesthesia Using Tracheal Intubation

Patient selection for nonoperating room anesthesia

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