31 de maio de 2016

Artigo recomendado: Aspiration under anaesthesia: risk assessment and decision-making

Michael Robinson, Andrew Davidson

Continuing Education in Anaesthesia, Critical Care & Pain j 2013

Pulmonary aspiration complicates between 1 in 900 to 1 in 10 000 general anaesthetics, dependent on risk factors. All novice anaesthetists in the UK are taught to consider the risk of aspiration and to modify their anaesthetic technique accordingly. The prevention of aspiration remains a cornerstone of anaesthetic practice. The recent Royal College of Anaesthetists 4th National Audit Project (NAP4) collected data on the incidence and causes of major airway complications in the UK. Over 50% of airway-related deaths in anaesthesia were as a consequence of aspiration, outweighing the much feared can’t intubate can’t ventilate (CICV) scenario. In addition, 23% of all cases reported to NAP4 involved aspiration as either the primary or secondary event. Cases not resulting in death commonly resulted in significant morbidity and prolonged stay on intensive care.

Despite the awareness among anaesthetists of the need to minimize the risks of aspiration and advances in anaesthetic practices, NAP4 provided evidence that aspiration often occurred as a consequence of incomplete assessment of aspiration risk or a failure to modify anaesthetic technique. This review aims to highlight the key findings from NAP4 with regard to aspiration and evaluates the literature on aspiration risk assessment and decision-making.

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22 de março de 2016

Microbiological Contamination of Drugs during Their Administration for Anesthesia in the Operating Room

Derryn A. Gargiulo, Simon J. Mitchell, Janie Sheridan, Timothy G. Short, Simon Swift, Jane Torrie,  Craig S. Webster, Alan F. Merry

Anesthesiology 2016; 124:785-94


Background: The aseptic techniques of anesthesiologists in the preparation and administration of injected medications have not been extensively investigated, but emerging data demonstrate that inadvertent lapses in aseptic technique may be an important contributor to surgical site and other postoperative infections.

Methods: A prospective, open, microbiological audit of 303 cases in which anesthesiologists were asked to inject all bolus drugs, except propofol and antibiotics, through a 0.2-μm filter was performed. The authors cultured microorganisms, if present, from the 0.2-μm filter unit and from the residual contents of the syringes used for drawing up or administering drugs. Participating anesthesiologists rated ease of use of the filters after each case.

Results: Twenty-three anesthesiologists each anesthetized up to 25 adult patients. The authors isolated microorganisms from filter units in 19 (6.3%) of 300 cases (3 cases were excluded), including Staphylococcus capitis, Staphylococcus warneri, Staphylococcus epidermidis, Staphylococcus haemolyticus, Micrococcus luteus/lylae, Corynebacterium, and Bacillus species. 
The authors collected used syringes at the end of each case and grew microorganisms from residual drug in 55 of these 2,318 (2.4%) syringes including all the aforementioned microorganisms and also Kocuria kristinae, Staphylococcus aureus, and Staphylococcus hominus. Participants’ average rating of ease of use of the filter units was 3.5 out of 10 (0 being very easy and 10 being very difficult).

Conclusions: Microorganisms with the potential to cause infection are being injected (presumably inadvertently) into some patients during the administration of intravenous drugs by bolus during anesthesia. The relevance of this finding to postoperative infections warrants further investigation. 

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23 de fevereiro de 2016

Artigo recomendado: Providing Anesthesia Care in Resource-limited Settings

A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities

Promise Ariyo, Miguel Trelles, Rahmatullah Helmand, Yama Amir, Ghulam Haidar Hassani, Julien Mftavyanka, Zenon Nzeyimana, Clemence Akemani, Innocent Bagura Ntawukiruwabo, Adelin Charles, Yanang Yana, Kalla Moussa, Mustafa Kamal, Mohamed Lamin Suma, Mowlid Ahmed, Mohamed Abdullahi, Evan G. Wong, Adam Kushner, Asad Latif

Anesthesiology 2016;124:561-9


Background: Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures.

Methods: The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed.

Results: Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively.

Conclusions: A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

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16 de fevereiro de 2016

Campanha Anestesia e Prevenção de Infecções - SMA

Campanha do Passo 1: Anestesia e Prevenção de Infecções do Programa "10 PASSOS PARA A ANESTESIA SEGURA", elaborada pelo Comitê de Qualidade e Segurança dos Serviços Médicos de Anestesia (SMA) de São Paulo.

27 de janeiro de 2016

Leitura recomendado: Using Examples Best When Classifying ASA Physical Status

Clinical Anesthesiology - January, 2016

San Diego — Despite being an important part of clinical practice for more than five decades, the American Society of Anesthesiologists (ASA) physical status classification system occasionally is criticized for its subjective nature, a trait that can lead to inconsistent assignments among health care professionals.

This problem can be ameliorated, a recent study has found, with the use of ASA-approved class-specific examples, which help anesthesia and nonanesthesia providers alike substantially increase their ability to determine the correct ASA class.

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14 de janeiro de 2016

Artigo recomendado: Evaluation of Perioperative Medication Errors and Adverse Drug Events

Karen C. Nanji, Amit Patel, Sofia Shaikh, Diane L. Seger, David W. Bates

Anesthesiology 2016; 124:25-34


Background: The purpose of this study is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, to evaluate their root causes, and to formulate targeted solutions to prevent them.

Methods: In this prospective observational study, anesthesia-trained study staff (anesthesiologists/nurse anesthetists) observed randomly selected operations at a 1,046-bed tertiary care academic medical center to identify MEs and ADEs over 8 months. Retrospective chart abstraction was performed to flag events that were missed by observation. All events subsequently underwent review by two independent reviewers. Primary outcomes were the incidence of MEs and ADEs.

Results: A total of 277 operations were observed with 3,671 medication administrations of which 193 (5.3%; 95% CI, 4.5 to 6.0) involved a ME and/or ADE. Of these, 153 (79.3%) were preventable and 40 (20.7%) were nonpreventable. The events included 153 (79.3%) errors and 91 (47.2%) ADEs. Although 32 (20.9%) of the errors had little potential for harm, 51 (33.3%) led to an observed ADE and an additional 70 (45.8%) had the potential for patient harm. Of the 153 errors, 99 (64.7%) were serious, 51 (33.3%) were significant, and 3 (2.0%) were life-threatening.

Conclusions: One in 20 perioperative medication administrations included an ME and/or ADE. More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. These rates are markedly higher than those reported by retrospective surveys. Specific solutions exist that have the potential to decrease the incidence of perioperative MEs.

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