麻醉学科实验室建设初探

麻醉学科实验室是研究麻醉领域及相关领域基础理论以及临床中亟待解决科学问题的重要场所.麻醉学实验室建设将对麻醉学科的发展起到非常重要的作用.此文立足于麻醉学科发展的现状,在提出实验室建设总体构思的基础上,从实验室的现状、建设具体内容、拟采取措施和实验室发展带动学科发展几方面加以阐述,最终目的 是提高麻醉学科水平.     

麻醉科管理模式与理念的探讨

我院是一家拥有1380张床位的综合性医院,去年麻醉科完成麻醉总量21700例(手术室内16200例,手术室外5500例)。据近5年的统计结果,我科的麻醉相关死亡率为3.5/100000,据国外一份研究报道显示[1],1996～2000年法国的麻醉相关死亡率为4.7/100000。另一份麻醉相关死亡率的最新统计资     

麻醉学科的组织构架与内涵建设

结合我国麻醉学科的发展现状,分别从麻醉学科内涵建设的基本内容,麻醉学科的组织架构和麻醉学科的发展趋势进行了探讨.重点讨论麻醉学的基本理论和基本技能、麻醉医师的专业特长对危重病医学和疼痛医学的贡献,以及进一步完善和发展麻醉学学科及提高医疗质量的意义.目前麻醉学界应当不断转变观念,强化人才意识、创新意识、跨学科意识和学术交流意识,争取主动发展麻醉学科的各个分支专科,推进到互动发展阶段,才能真正地发展麻醉学学科.     

Future anesthesiologists will be as much outside as inside operating theaters

During the first decade of the new millennium the intense reorganization of hospitals and of medical care will be replaced by stability and long-term goals. An anesthesiologist is now as active outside as within the operating theater, being a predominant resource in intensive care, pain management, emergency and prehospital care. The anesthesiologist will also have a key part to play in risk analysis of patients scheduled for various kinds of advanced treatment. Anesthesiologists are now also more involved in primary home care where, together with other physicians and categories of health care providers, they offer qualified treatment of various diseases at home – the environment preferred by the patient.     

Outcomes of a Failure Mode and Effects Analysis for medication errors in pediatric anesthesia

The Institute of Medicine has called for development of strategies to prevent medication errors, which are one important cause of preventable harm. Although the field of anesthesiology is considered a leader in patient safety, recent data suggest high medication error rates in anesthesia practice. Unfortunately, few error prevention strategies for anesthesia providers have been implemented. Using Toyota Production System quality improvement methodology, a multidisciplinary team observed 133 h of medication practice in the operating room at a tertiary care freestanding children's hospital. A failure mode and effects analysis was conducted to systematically deconstruct and evaluate each medication handling process step and score possible failure modes to quantify areas of risk. A bundle of five targeted countermeasures were identified and implemented over 12 months. Improvements in syringe labeling (73 to 96%), standardization of medication organization in the anesthesia workspace (0 to 100%), and two‐provider infusion checks (23 to 59%) were observed. Medication error reporting improved during the project and was subsequently maintained. After intervention, the median medication error rate decreased from 1.56 to 0.95 per 1000 anesthetics. The frequency of medication error harm events reaching the patient also decreased. Systematic evaluation and standardization of medication handling processes by anesthesia providers in the operating room can decrease medication errors and improve patient safety.     

Desire for perioperative information and parental ethnicity

Objectives: To examine the role of ethnicity, language, and socioeconomic variables in parental desire for information regarding children’s surgery. Aim: To compare anesthetic and surgical information desired between English‐ and Spanish‐speaking White and Hispanic mothers of children undergoing outpatient surgery. Background: Parents report wanting to receive detailed information regarding children’s preoperative care; however, variables such as parent ethnicity and language spoken have not been accounted for in understanding desire for information. Methods/Materials: One hundred and eighty‐one mothers of children undergoing outpatient surgery, elective surgery, and general anesthesia were recruited and categorized into one of three groups: English‐speaking White (ESW, n = 79), English‐speaking Hispanic (ESH, n = 63), and Spanish‐speaking Hispanic (SSH, n = 39). In addition to providing demographic questionnaire, mothers completed the Parental Desire for Information (PDI) questionnaire, a 14‐item measure of surgery and anesthesia‐related statements. Results: Overall, mothers desired receiving information about the majority of the items on the PDI. As compared to ESW mothers, SSH mothers and ESH mothers were overrepresented in the ‘have a right to know’ response option, with significant differences existing in items concerning alternative methods of anesthesia, details of needles used, and location of PACU and OR. Conclusions: Anesthesiologists should tailor the provision of preoperative information based on ethnicity and language of mothers involved. Ethnic and language differences shown in this study may exist in other populations as well.     

Anesthesia in the modern world of apps and technology: Implications and impact on wellness

Recent decades have seen an unprecedented leap in digital innovation, with far‐reaching implications in healthcare. Anesthesiologists have historically championed the adoption of new technologies. However, the rapid evolution of these technologies has outpaced attempts at studying their potential impact on healthcare providers' well‐being. This document introduces several categories of workplace technologies commonly encountered by the anesthesiologist. We examine examples of novel technology and the impact of these digital interventions on the anesthesiologist's well‐being. We also review popular personalized technology aimed at improving wellness and the impact on well‐being examined. Finally, technology acceptance models are introduced to improve technology adoption, which, when appropriately applied, may minimize the negative impacts of technology on anesthesiologists' well‐being. Incorporating quantitative, serial assessments of well‐being as part of technology implementation are proposed as a future direction for examining the wellness impact of technology on anesthesiologists.     

Outstanding contribution to pediatric anesthesiology: An interview with Dr. Robert H. Friesen

Dr. Robert H. Friesen, (1946–) Professor of Anesthesiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, has played a pivotal and pioneering role in the development of pediatric and congenital cardiac anesthesiology. His transformative research included the study of the hemodynamic effects of inhalational and intravenous anesthetic agents in the newborn and the effects of anesthetic agents on pulmonary vascular resistance in patients with pulmonary hypertension. As a model clinician‐scientist, educator, and administrator, he changed the practice of pediatric anesthesia and shaped the careers of hundreds of physicians‐in‐training, imbuing them with his core values of honesty, integrity, and responsibility. Based on a series of interviews with Dr. Friesen, this article reviews a career that advanced pediatric and congenital cardiac anesthesia during the formative years of the specialties.     

Being a young and inexperienced trainee anesthetist: a phenomenological study on tough working conditions

BACKGROUND: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work. METHODS: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed. RESULTS: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations. CONCLUSIONS: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.     

Training of residents in peripheral nerve blocks during anesthesiology residency

STUDY OBJECTIVE: To survey American anesthesiology residency program directors to determine the availability and extent of training in peripheral nerve block techniques. DESIGN: Survey questionnaire was mailed and faxed to 132 American anesthesiology residency program directors and followed up 4 weeks later with another mailing to nonresponders. SETTING: University medical center. MEASUREMENTS AND MAIN RESULTS: Of the 132 American anesthesiology residency program directors surveyed, 69 (52%) responded. Of the responders, 40 (58%) offered a specific peripheral nerve block rotation. The rotation was of 1 month's duration in 61% of these programs. Formal instruction was administered during the rotation in 69%. The regional instruction approach consisted of a nerve stimulator (98%), paresthesia (75%), and transarterial (85%). Multimedia, mannequins, and cadaver dissection were used infrequently (13-25%). During the rotation, residents performed a variety of blocks, but the number of each block varied from 2 (supraclavicular) to 10 (axillary). These blocks were performed in the operating room in 48% of programs. Finally, in the programs with a specific peripheral nerve block rotation, residents were evaluated. CONCLUSIONS: Specific peripheral nerve block rotations are not always included in anesthesiology residents' curriculum. In addition, residents in programs with a specific nerve block rotation are exposed to a greater number of peripheral nerve block techniques than those who do not have such a rotation included in their curriculum.