Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2024
Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.
Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications. ⋯ Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.
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Anesthesia and analgesia · Dec 2024
Racial and Ethnic Disparities in Failure-to-Rescue After Postoperative Sepsis After Noncardiac Surgery.
Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis. ⋯ Black and Hispanic individuals experienced higher rates of postoperative sepsis but did not experience higher rates of failure-to-rescue. Reducing inequity in surgical care should focus on efforts to prevent postoperative sepsis.
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Anesthesia and analgesia · Nov 2024
Handoff Mnemonics Used in Perioperative Handoff Intervention Studies: A Systematic Review.
Perioperative handoffs are known to present unique challenges to safe and effective patient care. Numerous national accrediting bodies have called for standardized, structured handoff processes. Handoff mnemonics provide a memory aid and standardized structure, as well as promote a shared mental model. We set out to identify perioperative handoff intervention studies that included a handoff mnemonic; critically assess process and patient outcome improvements that support specific mnemonics; and propose future recommendations. ⋯ While the evidence supporting one handoff mnemonic over others is weak, SBAR/SBAR variants have been studied more often in the perioperative environment demonstrating some process improvements. A key finding is that 70% of included studies converted their handoff mnemonic to a list or checklist. Finally, given the essential nature of effective handoffs to perioperative patient safety, it is crucial that handoff interventions are well developed, implemented, and evaluated. We propose 8 recommendations for future perioperative handoff mnemonic clinical interventions and research.