Anesthesiology Service

Isle of Wight, VA, United States

Anesthesiology Service

Isle of Wight, VA, United States

Time filter

Source Type

Gimenez S.,Hospital Of La Santa Creu I Sant Pau | Gimenez S.,Autonomous University of Barcelona | Gimenez S.,CIBER ISCIII | Romero S.,Polytechnic University of Catalonia | And 10 more authors.
Journal of Clinical Monitoring and Computing | Year: 2015

The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. Due to similarities in EEG synchronization between anesthesia and sleep, several studies have assessed BIS as a sleep monitor with contradictory results. The aim of this study was to evaluate objectively both the feasibility and reliability of BIS for sleep monitoring through a robust methodology, which included full PSG recordings at a baseline situation and after 40 h of sleep deprivation. Results confirmed that the BIS index was highly correlated with the hypnogram (0.89 ± 0.02), showing a progressive decrease as sleep deepened, and an increase during REM sleep (awake: 91.77 ± 8.42; stage N1: 83.95 ± 11.05; stage N2: 71.71 ± 11.99; stage N3: 42.41 ± 9.14; REM: 80.11 ± 8.73). Mean and median BIS values were lower in the post-deprivation night than in the baseline night, showing statistical differences for the slow wave sleep (baseline: 42.41 ± 9.14 vs. post-deprivation: 39.49 ± 10.27; p = 0.02). BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care. © 2015 Springer Science+Business Media Dordrecht


Segall N.,Duke University | Bonifacio A.S.,Anesthesiology Service | Schroeder R.A.,Duke University | Barbeito A.,Duke University | And 5 more authors.
Anesthesia and Analgesia | Year: 2012

Postoperative patient handovers are fraught with technical and communication errors and may negatively impact patient safety. We systematically reviewed the literature on handover of care operating room to postanesthesia or intensive care units and summarized process and communication recommendations based on these findings. From >500 papers, we identified 31 dealing with postoperative handovers. Twenty-four included recommendations for structuring the handover process or information transfer. Several recommendations were broadly supported, including (1) standardize processes (e.g., through the use of checklists and protocols); (2) complete urgent clinical tasks before the information transfer; (3) allow only patient-specific discussions during verbal handovers; (4) require that all relevant team members be present; and (5) provide training in team skills and communication. Only 4 of the studies developed an intervention and formally assessed its impact on different process measures. All 4 interventions improved metrics of effectiveness, efficiency, and perceived teamwork. Most of the papers were cross-sectional studies that identified barriers to safe, effective postoperative handovers including the incomplete transfer of information and other communication issues, inconsistent or incomplete teams, absent or inefficient execution of clinical tasks, and poor standardization. An association between poor-quality handovers and adverse events was also demonstrated. More innovative research is needed to define optimal patient handovers and to determine the effect of handover quality on patient outcomes. Copyright © 2012 International Anesthesia Research Society.


PubMed | Hospital Of La Santa Creu I Sant Pau, Polytechnic University of Catalonia and Anesthesiology Service
Type: | Journal: Journal of clinical monitoring and computing | Year: 2015

The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. Due to similarities in EEG synchronization between anesthesia and sleep, several studies have assessed BIS as a sleep monitor with contradictory results. The aim of this study was to evaluate objectively both the feasibility and reliability of BIS for sleep monitoring through a robust methodology, which included full PSG recordings at a baseline situation and after 40h of sleep deprivation. Results confirmed that the BIS index was highly correlated with the hypnogram (0.890.02), showing a progressive decrease as sleep deepened, and an increase during REM sleep (awake: 91.778.42; stage N1: 83.9511.05; stage N2: 71.7111.99; stage N3: 42.419.14; REM: 80.118.73). Mean and median BIS values were lower in the post-deprivation night than in the baseline night, showing statistical differences for the slow wave sleep (baseline: 42.419.14 vs. post-deprivation: 39.4910.27; p=0.02). BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care.


Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients.Hemodynamically Unstable Pelvic Trauma is a frequent death cause among people who sustain blunt trauma. We present the results of the First Italian Consensus Conference. © 2014 Magnone et al.; licensee BioMed Central Ltd.


Carroll I.,Stanford University | Barelka P.,Anesthesiology Service | Wang C.K.M.,Stanford University | Wang B.M.,Stanford University | And 14 more authors.
Anesthesia and Analgesia | Year: 2012

Background: Determinants of the duration of opioid use after surgery have not been reported. We hypothesized that both preoperative psychological distress and substance abuse would predict more prolonged opioid use after surgery. Methods: Between January 2007 and April 2009, a prospective, longitudinal inception cohort study enrolled 109 of 134 consecutively approached patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured the daily use of opioids until patients reported the cessation of both opioid consumption and pain. The primary end point was time to opioid cessation. All analyses were controlled for the type of surgery done. Results: Overall, 6% of patients continued on new opioids 150 days after surgery. Preoperative prescribed opioid use, depressive symptoms, and increased self-perceived risk of addiction were each independently associated with more prolonged opioid use. Preoperative prescribed opioid use was associated with a 73% (95% confidence interval [CI] 0.51%-87%) reduction in the rate of opioid cessation after surgery (P = 0.0009). Additionally, each 1-point increase (on a 4-point scale) of self-perceived risk of addiction was associated with a 53% (95% CI 23%-71%) reduction in the rate of opioid cessation (P = 0.003). Independent of preoperative opioid use and self-perceived risk of addiction, each 10-point increase on a preoperative Beck Depression Inventory II was associated with a 42% (95% CI 18%-58%) reduction in the rate of opioid cessation (P = 0.002). The variance in the duration of postoperative opioid use was better predicted by preoperative prescribed opioid use, self-perceived risk of addiction, and depressive symptoms than postoperative pain duration or severity. Conclusions: Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity. © 2012 International Anesthesia Research Society.


Lopierre E.R.T.,Anesthesiology Service
Revista Colombiana de Gastroenterologia | Year: 2011

Deep sedation for gastrointestinal endoscopy is a desirable strategy for enhancing patients tolerance to procedures and for making those procedures easier to perform by endoscopists. Sedation for endoscopy administered by medical and paramedical personnel who have no training in anesthesiology, advanced resuscitation and vital support techniques has been widely debated. It is the object of studies and consensus. In general, the relative risk fi gures are low, but the absolute numbers might be judged high if we take into account the great number of procedures that take place on a daily basis throughout the world. The main focus of this discussion should be on the patient's safety. In this regard there are many solid arguments for stating that the anesthesiologist should administer deep sedation in endoscopy. © 2011 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.


PubMed | Anesthesiology Service and Digestive and Endocrine Surgery
Type: Journal Article | Journal: Journal of visceral surgery | Year: 2016

Outpatient left colectomy has been described in several small series or case reports. We conducted a prospective study to determine whether an optimized management approach could allow performance of this procedure in a broader patient population.Between December 2014 and December 2015, all eligible patients were prospectively and consecutively included in this study. They all underwent surgery following the same outpatient management protocol. After discharge, patients were followed by home health nurses with surgeon follow-up visits on days 10 and 21 (D10, D21) or earlier, if necessary.During this period, 56 patients underwent a left colectomy, 47 of whom met the inclusion criteria. Seven patients refused the outpatient care approach, leaving a total of 40 patients included (8 ASA 3 [American Society of Anesthesiologists], 24 ASA 2, 8 ASA 1). All but one of the patients were able to return home the same evening. Bowel motility was restored on D1 for most patients. Two patients had abdominal pain that required a follow-up visit before D10 but their subsequent course was uneventful. No patient was re-hospitalized. An uncomplicated post-operative course was confirmed at follow-up visits on D10 and D21.Our study confirms that outpatient left colectomy is feasible for most patients, including fragile patients and/or those undergoing more complex procedures. Communication and close coordination by all stakeholders as well AS optimal organization of downstream patient care are essential to guarantee quality and safety.

Loading Anesthesiology Service collaborators
Loading Anesthesiology Service collaborators