Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2019
ReviewNonoperating room anesthesia education: preparing our residents for the future.
Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education. ⋯ Implementing new medical technologies for anesthesia outside the operating room will help to successfully master this ever evolving subspecialty. Anesthesiologists require specific preparation for the diverse settings that they will encounter during their training. In this rapidly changing field, cognitive fitness must be factored into teaching and evaluation of residents. We describe the most important topics to consider when educating anesthesiology residents, and highlight research that addresses upcoming challenges.
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Curr Opin Anaesthesiol · Aug 2019
ReviewEfficiency and scheduling in the nonoperating room anesthesia suite: implications from patient satisfaction to increased revenue operating room: a common (Dollars and Sense) approach.
Although the NORA setting continues to outgrow the main operating room in cases, there are few studies addressing efficiency metrics, and even fewer studies addressing those of a single specialty outpatient gastroenterology facility. In order to capitalize on this growing trend, gastrointestinal endoscopies must be scheduled in a way that prevents lost potential revenue while maintaining patient convenience, comfort, safety, and satisfaction. By standardizing our scheduling for procedure block time among various endoscopists and converting our sedation practices from conscious sedation to solely Propofol sedation in a 4 : 1 CRNA to Anesthesiologist model, we increased revenue while maximizing physician efficiency and site utilization. ⋯ By adapting our sedation practices to solely Propofol sedation and by standardizing our procedural schedule times among all the endoscopists, we maximized the number of cases and revenue in our outpatient gastrointestinal endoscopy suite while increasing patient satisfaction through reduction in overall patient facility time and procedure to discharge time.
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Curr Opin Anaesthesiol · Aug 2019
Anesthesia-administered sedation for endoscopic retrograde cholangiopancreatography: monitored anesthesia care or general endotracheal anesthesia?
The decision to undertake monitored anesthesia care (MAC) or general endotracheal anesthesia (GEA) for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is influenced by many factors. These include locoregional practice preferences, procedure complexity, patient position, and comorbidities. We aim to review the data regarding anesthesia-administered sedation for ERCP and identify the impact of airway management on procedure success, adverse event rates and endoscopy unit efficiency. ⋯ Pursuing MAC or GEA for patients undergoing ERCP is best-approached on an individual basis. Patients at high risk for sedation-related adverse events likely benefit from GEA. Larger, multicenter randomized controlled trials will aid significantly in better delineating which sedation approach is best for an individual patient.