Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2021
Randomized Controlled Trial Multicenter StudyEfficacy of an Online Curriculum for Perioperative Goals of Care and Code Status Discussions: A Randomized Controlled Trial.
Preoperative goals of care (GOC) and code status (CS) discussions are important in achieving an in-depth understanding of the patient's care goals in the setting of a serious illness, enabling the clinician to ensure patient autonomy and shared decision making. Past studies have shown that anesthesiologists are not formally trained in leading these discussions and may lack the necessary skill set. We created an innovative online video curriculum designed to teach these skills. This curriculum was compared to a traditional method of learning from reading the medical literature. ⋯ Our novel video curriculum led to significant increases in resident performance during simulated GOC discussions and modest increases during CS discussions. Further development and refinement of this curriculum are warranted.
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Anesthesia and analgesia · Jun 2021
Development and Pilot Testing of Entrustable Professional Activities for US Anesthesiology Residency Training.
Modern medical education requires frequent competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) provides a descriptive framework of competencies and milestones but does not provide standardized instruments to assess and track trainee competency over time. Entrustable professional activities (EPAs) represent a workplace-based method to assess the achievement of competency milestones at the point-of-care that can be applied to anesthesiology training in the United States. ⋯ A list of 20 anesthesiology EPAs and 159 procedural skills assessments were developed using a rigorous methodology to reach consensus among education experts. The assessments were pilot tested at 7 US anesthesiology residency programs demonstrating the feasibility of implementation using a mobile app and the ability to collect assessment data. Adoption at the pilot sites was variable; however, the use of the system was not mandatory for faculty or trainees at any site.
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Anesthesia and analgesia · Jun 2021
Randomized Controlled Trial Comparative StudySugammadex Versus Neostigmine for Reversal of Rocuronium Neuromuscular Block in Patients Having Catheter-Based Neurointerventional Procedures: A Randomized Trial.
Catheter-based endovascular neurointerventions require deep neuromuscular blocks during the procedure and rapid subsequent recovery of strength to facilitate neurological evaluation. We tested the primary hypothesis that sugammadex reverses deep neuromuscular blocks faster than neostigmine reverses moderate neuromuscular blocks. ⋯ Sugammadex reversed deep rocuronium neuromuscular blocks considerably faster than neostigmine reversed moderate neuromuscular blocks. However, times to extubation did not differ significantly, apparently because extubation was largely determined by the time required for awaking from general anesthesia and because clinicians were willing to extubate before full neuromuscular recovery. Sugammadex may nonetheless be preferable to procedures that require a deep neuromuscular block and rapid recovery.
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Anesthesia and analgesia · Jun 2021
Attenuation of Muscle Mass and Density Is Associated With Poor Outcomes Among Patients Undergoing Major Gynecologic Surgery: A Retrospective Cohort Study.
The aim of this study was to explore the associations of preoperative sarcopenia (muscle mass depletion) and myosteatosis (muscle quality attenuation) with the incidence of postinduction hypotension (PIH) and postoperative complications among patients undergoing major gynecologic surgery. ⋯ Muscle assessments using preoperative CT scans may help identify high-risk patients and determine perioperative management strategies among gynecologic patients.