Anesthesiology clinics
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Anesthesiology clinics · Dec 2017
ReviewSafety of Non-Operating Room Anesthesia: A Closed Claims Update.
Malpractice claims for non-operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. ⋯ The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations. Although NORA is safe, adherence to safe clinical practice is important.
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The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.
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Anesthesiology clinics · Dec 2017
ReviewImplementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.
Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety.
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Anesthesiology clinics · Dec 2017
ReviewAn Anesthesiologist's View of Tumor Ablation in the Radiology Suite.
The advent of radiology image-guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. ⋯ Anesthesiologists play a critical role in optimizing outcome in these patients. Knowledge by anesthesiologists of procedural goals, technology used, and inherit safety concerns of anesthetizing patients in the radiology suite are all critical to patients and proceduralists.
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Anesthesiology clinics · Dec 2017
ReviewPediatric Anesthesia Considerations for Interventional Radiology.
Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan. Several unique pediatric patient populations with specific procedural implications and anesthetic considerations who will benefit from additional periprocedural planning are discussed.