Abstract:
OBJECTIVE:The American Society of Anesthesiologists physical status (ASA-PS) is associated with increased morbidity and mortality in the perioperative period. When surgeries are scheduled by surgeons and their staff at our large institution a presumed ASA-PS is chosen. This is because our institution (and, anecdotally, others in our hospital system and elsewhere), recognizing the relationship between higher ASA-PS and poorer postoperative outcomes, requires all patients with higher ASA-PS levels (≥3) to undergo enhanced preoperative workup. The patients may not, however, necessarily be seen in the anesthesia clinic prior to surgery. As a result, patients are assigned a presumed ASA-PS by a non-anesthesia provider (e.g., surgeons and physician extenders) that may not reflect the ASA-PS chosen by the anesthesiologist on the day of surgery. Errors in the accuracy of the ASA-PS prior to surgery lead to unnecessary and costly preoperative testing, delays in operative procedures, and potential case cancellations. Our study aimed to determine whether there are significant differences in the assignment of ASA-PS by non-anesthesia providers when compared to anesthesia providers. DESIGN:We administered an IRB-approved survey asking the ASA-PS of 20 hypothetical case vignettes to 229 clinicians in various departments. Responses by non-anesthesia providers were compared to the consensus of the department of anesthesiology. SETTING:Faculty office spaces and conferences. PATIENTS:No patients, physicians only. INTERVENTIONS:Survey administration. MEASUREMENTS:ASA-PS scores acquired from surveys. MAIN RESULTS:Residents and faculty in the department of anesthesiology demonstrated no statistical difference in the median ASA score in 19/20 case scenarios. All other departments were statistically different when compared to the department of anesthesiology (p<0.05). The probability of a department either over- or under-rating the ASA-PS was calculated, and is summarized in Fig. 3. All departments, except anesthesiology, had a 30-40% chance of under-rating the ASA-PS of the patients in the clinical vignettes. CONCLUSIONS:Non-anesthesia providers assign ASA-PS with significantly less accuracy than do anesthesia providers, even when adjusted for multiple comparisons. Surgical and procedural departments were found to consistently under-rate the ASA-PS of patients in our clinical vignettes.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Curatolo C,Goldberg A,Maerz D,Lin HM,Shah H,Trinh Mdoi
10.1016/j.jclinane.2017.02.002subject
Has Abstractpub_date
2017-05-01 00:00:00pages
123-128eissn
0952-8180issn
1873-4529pii
S0952-8180(16)30804-2journal_volume
38pub_type
杂志文章abstract::Tracheobronchopathia osteochondroplastica is a rare disorder characterized by cartilaginous or ossified submucosal nodules that project into the tracheobronchial lumen. It is typically discovered in the evaluation of chronic upper respiratory symptoms. A case of a completely asymptomatic man diagnosed with extensive d...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.05.010
更新日期:2013-12-01 00:00:00
abstract::The acceptance of new and increasingly expensive technologies is a major component of the rising costs of health care. While the practice of anesthesia has been relatively immune from the effects of cost containment, it is inevitable that practitioners will have to justify costly practices. Available pharmacoeconomic ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(05)80008-x
更新日期:1994-09-01 00:00:00
abstract:STUDY OBJECTIVE:Breast cancer is the most common malignancy of women all over the world. In this study, we compared the effects of ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane (ESP) block on postoperative opioid consumption, pain scores, and intraoperative fentanyl need of patients un...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2018.10.040
更新日期:2019-05-01 00:00:00
abstract:STUDY OBJECTIVE:To determine if the use of ultrasound guidance (vs non-ultrasound techniques) improves the success rate of nerve blocks. DESIGN:Meta-analysis of randomized controlled trials (RCTs) in the published literature. SETTING:University medical center. MEASUREMENTS:16 RCTs of patients undergoing elective sur...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,meta分析
doi:10.1016/j.jclinane.2010.12.005
更新日期:2011-03-01 00:00:00
abstract:STUDY OBJECTIVE:To ascertain patients' recall of the risks of labor epidural analgesia from a discussion of informed consent during active labor. DESIGN:Survey analysis following an intervention. SETTING:Labor and delivery unit of a tertiary-care teaching hospital. PATIENTS:101 ASA physical status I and II parturien...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/s0952-8180(97)00258-4
更新日期:1998-03-01 00:00:00
abstract:STUDY OBJECTIVES:To compare patients' perception of topical anesthesia (TA) with combined peribulbar and retrobulbar block (PRBB) for cataract surgery. DESIGN:Prospective, randomized, controlled, cross-over observational study. SETTING:Private clinic. PATIENTS:98 ASA physical status I and II patients presenting for ...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(00)00117-3
更新日期:2000-02-01 00:00:00
abstract::We report the use of high-frequency oscillatory ventilation in the operating room during repair of multiple bronchopleural fistulae in a 9-year-old boy. In addition, we used principles of permissive hypercapnia to further minimize barotrauma. There were no cardiovascular consequences due to either the high-frequency v...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/S0952-8180(96)00206-1
更新日期:1997-02-01 00:00:00
abstract::Administration of vecuronium by infusion is an increasingly common technique, both in the operating room and in the intensive care unit (ICU), for patients requiring prolonged neuromuscular blockade and mechanical ventilation. The major advantage of vecuronium over older neuromuscular blocking agents is its rapid excr...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(90)90107-e
更新日期:1990-07-01 00:00:00
abstract:STUDY OBJECTIVE:To compare spinal anesthesia and combined sciatic-femoral nerve block for outpatient knee arthroscopy. DESIGN:Prospective, randomized, controlled study. SETTING:Postoperative recovery area at a university-affiliated medical center. PATIENTS:50 ASA physical status I and II adult outpatients undergoing...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2008.04.003
更新日期:2008-09-01 00:00:00
abstract::A young, healthy adult man exhibited naloxone-reversible, prolonged apnea after a 4-hour infusion of remifentanil, which was used as the opioid component of a general endotracheal anesthetic. Clinical experience and pharmacokinetic simulations indicate that the apnea was clearly atypical. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.05.024
更新日期:2007-02-01 00:00:00
abstract::We investigate an incident in which a carbon dioxide absorber caused difficulty with ventilation. The problem as it developed throughout the anesthetic, and clues that led to the determination that the carbon dioxide canister was the problem, is discussed. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2007.06.018
更新日期:2008-02-01 00:00:00
abstract::Lung transplantation has become an accepted option for many patients with end-stage pulmonary diseases. Anesthesia and surgery following lung transplantation may be required for various diseases that may affect both systemic organs and the transplanted graft. When a patient with a lung transplant undergoes surgery, th...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/j.jclinane.2011.05.002
更新日期:2011-09-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the risk factors of perioperative complications and the impact of intrathecal morphine (ITM) in major vascular surgery. DESIGN:Retrospective analysis of a prospective cohort. SETTINGS:Operating room, intensive care unit, and Postanesthesia Care Unit of a university hospital. MEASUREMENTS...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.01.009
更新日期:2013-06-01 00:00:00
abstract::Subcutaneous targeted neuromodulation has been used successfully in chronic neuropathic pain. A 26 year-old patient with severe postthoracotomy pain and ipsilateral "wing scapula" due to intraoperative injury of the long thoracic nerve, is reported. Application of targeted neuromodulation resulted in immediate pain re...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2009.10.018
更新日期:2010-12-01 00:00:00
abstract:STUDY OBJECTIVE:To estimate the optimal endotracheal tube (ETT) length in orotracheally intubated patients. DESIGN:Prospective study. SETTING:Operating room of a medical center hospital. PATIENTS:293 ASA physical status I and II patients (150 male and 143 female), requiring general anesthesia and orotracheal intubat...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(02)00355-0
更新日期:2002-06-01 00:00:00
abstract::Fibrodysplasia ossificans progressiva (FOP) is a rare disorder of the connective tissue leading to progressive tissue ossification and immobilization. Soft-tissue trauma may exacerbate this condition, causing further ossification. Multisystem involvement includes restrictive lung disease, cervical ankylosis with limit...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2010.11.004
更新日期:2011-11-01 00:00:00
abstract::The anesthetic management of a parturient with a circulating lupus anticoagulant and an anticardiolipin antibody presenting to the obstetric suite taking heparin and aspirin is discussed. Issues concerning placement of a regional anesthetic with recent aspirin ingestion and heparin therapy are discussed. Documentation...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(95)00175-1
更新日期:1996-02-01 00:00:00
abstract:INTRODUCTION:There have been numerous reports studying the effect of neuraxial analgesia on breastfeeding success, but the results are inconsistent. METHODS:We performed a literature search in various databases for studies comparing neuraxial analgesia to non-neuraxial or no analgesia. Outcomes were the percentage of ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/j.jclinane.2020.110105
更新日期:2021-02-01 00:00:00
abstract:STUDY OBJECTIVE:To test the feasibility and efficacy of a new approach to paravertebral catheter placement in patients undergoing major surgery of the breast. DESIGN:Single-group, single-center observational study. SETTING:Operating room, postoperative recovery area, and normal ward of a university hospital. PATIENT...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2010.12.015
更新日期:2011-09-01 00:00:00
abstract:OBJECTIVE:Although parental presence during anesthesia induction is suggested to diminish operative stress level in children, there have been conflicting results about this strategy. The aim of this study was to evaluate the effects of maternal presence during induction on operative stress level in children who had ton...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2017.03.001
更新日期:2017-06-01 00:00:00
abstract::Brugada syndrome is an electrical cardiac disease predisposing to ventricular arrhythmias in which typical electrocardiographic (ECG) features consist of nonischemic repolarization abnormalities in the right precordial leads V1-V3. The appearance of a Brugada-ECG pattern is increasingly observed in critically ill pati...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.02.012
更新日期:2013-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the accuracy and precision of estimation of partial pressure of carbon dioxide (Pa(CO2)) using end-tidal or transcutaneous CO2 (TcP(CO2)) measurements during mechanical ventilation in the elderly patient. DESIGN:A prospective, observational study was conducted. SETTINGS:The study was done ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.02.007
更新日期:2006-09-01 00:00:00
abstract:STUDY OBJECTIVES:To evaluate five different preoperative anxiolytic regimens in cataract surgery performed under regional anesthesia; to quantify the pain associated with combined peri- and retrobulbar injection (PRBI) of local anesthetic drugs; and to describe a technique of painless eye block. DESIGN:Randomized, dou...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(98)00008-7
更新日期:1998-05-01 00:00:00
abstract::Turner syndrome is a complex and common genetic disorder that affects women and is associated with a wide variety of anatomic and physiological disorders. These abnormalities, especially those relating to the airway and cardiovascular system, pose a challenge to the anesthesiologist. We report a case of Turner syndrom...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2004.06.010
更新日期:2005-03-01 00:00:00
abstract:STUDY OBJECT:To investigate the changes in hemodynamics and hypnotic levels during propofol infusion and tracheal intubation with and without fentanyl. DESIGN:Randomized, double-blinded study. SETTING:Teaching hospital. PATIENTS:40 ASA physical status I adult patients scheduled for elective surgery. INTERVENTIONS:P...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(01)00375-0
更新日期:2002-03-01 00:00:00
abstract::The local anesthetic systemic toxicity can be due to increased blood lignocaine levels or due to increased sensitivity to lignocaine. Several cases of lignocaine-induced central nervous system toxicity have been noted, but none have reported only loss of consciousness without any seizure-like activity. Intravenous lip...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.08.039
更新日期:2017-02-01 00:00:00
abstract:STUDY OBJECTIVE:To determine risk factors associated with reintubations in adult patients with soft tissue infections. DESIGN:A retrospective case-control design. SETTING:Operating room and postoperative recovery area. PATIENTS:There were 39 patients who presented for surgical intervention of their soft tissue infec...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.03.073
更新日期:2016-11-01 00:00:00
abstract::In conclusion, providing anesthesia for a small child undergoing craniofacial reconstructive surgery is an enormous challenge. Even with the most experienced pediatric anesthesiologist and pediatric surgeons, problems can develop suddenly and lead, as they did in this case, to serious morbidity and even death. It is d...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(97)00162-1
更新日期:1997-11-01 00:00:00
abstract::Insertion of drug-eluting stents is one of the strategies for treating patients with coronary artery disease. These patients can be a perioperative challenge in management as they need to be maintained on antiplatelet therapy to prevent stent thrombosis, which puts them at an increased risk for surgical bleeding. Rece...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2008.11.013
更新日期:2009-11-01 00:00:00
abstract::The most frequent and acute complications of subclavian vein catheterization are arterial puncture to the subclavian artery and pneumothorax. We report an arterial puncture directly to the pulmonary artery in infant during subclavian vein catheterization. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2007.10.012
更新日期:2008-05-01 00:00:00