Abstract:
BACKGROUND:We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an implementation intervention intended to increase the rate of scanning. METHODS:Using our Anesthesia Information Management System and Smart Anesthesia Manager software, we quantified syringe drug administrations by anesthesia providers with and without barcode scanning. We use an anesthesia team model in which an attending anesthesiologist is paired with a certified registered nurse anesthetist (CRNA) or a resident. Our system identified the pair of providers associated with a particular drug administration, but did not distinguish which providers actually administered the drug. Therefore, the rate of barcode scanning for a particular case was assigned to both providers equally. A baseline rate of scanning was established over a period of 17 months. An audit and feedback intervention was then performed that consisted of monthly performance reports sent by email to individual providers along with coffee gift card awards for top performers. The coffee gift cards were awarded in only the first 2 months of the intervention, while the email performance reports continued on a monthly basis. The coffee card awards were made public. The monthly emails reported the individual provider's rank order of performance relative to other providers, but was otherwise anonymous. The baseline rate of scanning was compared to the rate of scanning after the intervention for a period of 7 months. RESULTS:From November 2014 to March 2017, we accumulated 60,197 cases performed by 88 attending anesthesiologists, 65 CRNAs, and 148 residents. The total number of syringe drug administrations was 653,355. Average scanning performance improved from 8.7% of syringe barcodes scanned during the baseline period from November 2014 to February 2016 to 64.4% scanned during the period September 2016 to March 2017 (P < .001). Variation in performance among individuals was marked, ranging from 0% to 100% of syringes scanned. The performance of some individuals showed marked oscillation over time. There was greater variation in performance attributable to residents than in performance attributable to CRNAs. CONCLUSIONS:Feedback of individual provider performance data from the anesthesia information system to providers can be used in conjunction with other measures to improve performance. Despite improved average performance, there was marked variation in performance between individuals, and some individuals had marked oscillation of their performance over time.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Bowdle TA,Jelacic S,Nair B,Zucker F,Bussey LS,Togashi K,Yang JT,Lang Jdoi
10.1213/ANE.0000000000003861subject
Has Abstractpub_date
2019-08-01 00:00:00pages
418-425issue
2eissn
0003-2999issn
1526-7598journal_volume
129pub_type
杂志文章abstract::Spontaneous or evoked electrical brain activity is increasingly used to monitor general anesthesia. Previous studies investigated the variables from spontaneous electroencephalogram (EEG), acoustic (AEP), or somatosensory evoked potentials (SSEP). But, by monitoring them separately, the available information from simu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/01.ane.0000237231.73261.92
更新日期:2006-10-01 00:00:00
abstract::Prior studies have suggested that the antifibrinolytic drug aprotinin increases the infarct size after ischemia and reperfusion (I/R) and attenuates the effect of ischemic preconditioning (IPC). Aprotinin was replaced by tranexamic acid (TXA) in clinical practice. Here, we investigated whether TXA influences I/R injur...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002230
更新日期:2018-02-01 00:00:00
abstract::Patients who undergo infrainguinal revascularization surgery are at increased risk for perioperative thrombotic complications. Aspirin decreases thrombotic events in the nonoperative setting; however, aspirin is often discontinued to avoid perioperative hemorrhagic complications. We used a decision analysis to determi...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,meta分析
doi:10.1097/00000539-200109000-00009
更新日期:2001-09-01 00:00:00
abstract::Because of its slow onset of action, intrathecal morphine may not be the optimal drug for intraoperative analgesia during short cases, such as cesarean sections. It is not known whether adding fentanyl to a morphine-lidocaine spinal solution would provide any benefits to patients undergoing cesarean sections. Sixty-tw...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199405000-00014
更新日期:1994-05-01 00:00:00
abstract::The effects of isoflurane or halothane on cerebral blood flow (CBF) reactivity to changes in arterial carbon dioxide tension (PaCO2) during carotid endarterectomy were compared using the intravenous method of 133Xe-CBF determination. Patients, aged 65 +/- 3 yr (mean +/- SE), received O2 and N2O (1:1) and either 0.75% ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Animal models show us that specific activation of the p38 mitogen-activated protein kinase (MAPK) may be a pivotal step in lidocaine neurotoxicity, but this has not been investigated in the case of two very widely used local anesthetics, bupivacaine and ropivacaine. We investigated the hypotheses that these ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318168514b
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Studies in a variety of disciplines have shown that the readability of Web-based patient education materials is above that of the sixth grade reading level recommended by the U.S. Department of Health and Human Services. The aim of this study was to evaluate the readability, content, and quality of English- ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000000888
更新日期:2015-11-01 00:00:00
abstract::To evaluate the effects of acute sympathetic denervation on the baroreflex control of heart rate, baroreflex sensitivities were compared in lightly anesthetized humans who had either cervical (N = 20) or lumbar epidural anesthesia (N = 18), or neither (N = 18). Levels of anesthesia during cervical block using 10 ml of...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract:UNLABELLED:IV droperidol inhibits epidural morphine-induced pruritus, but this effect disappears when the dose is increased from 2.5 to 5.0 mg. This study was performed to determine whether epidural droperidol would have a similar effect. In this double-blinded study, we enrolled 140 patients undergoing Cesarean delive...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200003000-00025
更新日期:2000-03-01 00:00:00
abstract::Antagonists of the serotonergic 5-hydroxytryptamine 3A receptor (5-HT(3A)R) and muscle nicotinic acetylcholine receptors (nAChR) are widely used in anesthesia practice. Both 5-HT(3A)R and nAChR are ligand-gated ion channels with known pharmacological overlap between some of their agonists and antagonists. We studied t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000160531.65953.77
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Basic science studies suggest that perioperative immune impairment may augment the risk of cancer recurrence after otherwise potentially curative surgery. Despite its immunosuppressant properties, dexamethasone is commonly given to oncologic patients in an effort to reduce postoperative nausea and vomiting. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182a5d656
更新日期:2014-06-01 00:00:00
abstract::To assess the evolution of satisfactory neohepatic graft function or failure, hemodynamic variables, along with data for oxygen delivery and utilization, were analyzed retrospectively in 99 patients undergoing orthotopic liver transplantation. Caval cross-clamping without venovenous bypass initiated a series of hemody...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199303000-00022
更新日期:1993-03-01 00:00:00
abstract::Acid-base status and blood levels of bupivacaine were determined in 16 diabetic parturients and their infants after epidural anesthesia for cesarean section. The newborn infants were divided into two groups based on umbilical artery pH at birth. Group A consisted of 10 infants who had a pH of less than 7.2 and group B...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1981-08-01 00:00:00
abstract::Although the use of fine-gauge spinal needles reduces the incidence of postdural puncture headache, they are associated with increased risk of placement failure as a result of deflection and bending. This in vitro study quantifies spinal needle deflection from the axis of insertion with respect to needle type, gauge, ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199602000-00014
更新日期:1996-02-01 00:00:00
abstract::The insertion of implantable cardioverter/defibrillators (ICD) requires induction of repeated episodes of ventricular fibrillation (VF). The neuropsychological repercussions associated with repeated inducement of hypotension and cerebral ischemia are unknown. In this prospective clinical trial, 1 day prior to ICD asse...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-199706000-00003
更新日期:1997-06-01 00:00:00
abstract:UNLABELLED:Thiamylal, a chiral thiobarbiturate, is marketed as a racemic product. We studied the serum protein binding and microsomal metabolism of thiamylal enantiomers in vitro. The unbound fraction of R(+)-thiamylal was greater than that of S(-)-thiamylal. The analysis of binding data revealed that both enantiomers ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200009000-00045
更新日期:2000-09-01 00:00:00
abstract:UNLABELLED:We evaluated the blood-sparing effects of intraoperative moderate acute normovolemic hemodilution (ANH) combined with intraoperative tranexamic acid treatment and shed blood reinfusion in patients undergoing off-pump coronary artery bypass (OPCAB). One-hundred consecutive OPCAB patients (baseline hematocrit ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000113238.35409.fe
更新日期:2004-05-01 00:00:00
abstract::Colloids and crystalloids are usually administered as treatment for hypovolemia in severely injured patients. However, dilution of clotting factors and platelets together with impaired fibrinogen polymerization are associated with fluid therapy and may aggravate hemorrhage, thus worsening final outcome of these patien...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000194359.06286.d4
更新日期:2006-02-01 00:00:00
abstract::The purpose of the present study was to assess patients' anxiety level and information requirement in the preoperative phase. During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Informatio...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199603000-00002
更新日期:1996-03-01 00:00:00
abstract::Because no completely effective antiemetic exists for the prevention of postoperative nausea and vomiting (PONV), we hypothesize that a multimodal approach to management of PONV may reduce both vomiting and the need for rescue antiemetics in high-risk patients. After IRB approval, women undergoing outpatient laparosco...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200012000-00020
更新日期:2000-12-01 00:00:00
abstract::Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199503000-00007
更新日期:1995-03-01 00:00:00
abstract:UNLABELLED:The sciatic nerve (SN) originates from the L4-S3 roots in the form of two nerve trunks: the tibial nerve (TN) and the common peroneal nerve (CPN). The TN and CPN are encompassed by a single epineural sheath and eventually separate (divide) in the popliteal fossa. This division of the SN occurs at a variable ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200101000-00041
更新日期:2001-01-01 00:00:00
abstract::A well secured endotracheal tube is very essential for the safe conduct of anesthesia. In maxillofacial surgeries, providing secure fixation of the nasotracheal tube has always been a problem. We have used an infant feeding tube that goes around the nasal septum for the fixation of the nasal endotracheal tube. This me...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ANE.0000134801.87404.3F
更新日期:2004-11-01 00:00:00
abstract::The hemodynamic effects of mivacurium chloride were studied in 54 adult cardiac patients anesthetized with midazolam and sufentanil. After baseline data were collected, a placebo (N = 9) or mivacurium was administered over 60 seconds, the latter in doses of 0.15 (N = 18), 0.20 (N = 18), or 0.25 (N = 9) mg/kg. Measurem...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:
更新日期:1989-03-01 00:00:00
abstract::We determined the cardiovascular effects of 0.91, 1.34, and 1.74 MAC of desflurane/nitrous oxide anesthesia (60% inspired nitrous oxide contributed 0.5 MAC at each level) in 12 healthy, normocapnic male volunteers. Desflurane/nitrous oxide anesthesia decreased systemic blood pressures, cardiac index, stroke volume ind...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199108000-00008
更新日期:1991-08-01 00:00:00
abstract:UNLABELLED:Our aim in this study, performed using a closed cranial window preparation, was to investigate the effect of systemic pretreatment with dexmedetomidine on cerebrovascular response to isoflurane or sevoflurane. After instrumentation under pentobarbital anesthesia, 48 dogs were assigned to one of two groups: t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199908000-00023
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:Lung-protective ventilation (LPV) has been demonstrated to improve clinical outcomes in surgical patients. There are very limited data on the current use of LPV for patients undergoing 1-lung ventilation (1LV) despite evidence that 1LV may be a particularly important setting for its use. In this multicenter ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000002642
更新日期:2018-02-01 00:00:00
abstract::Apnea and airway obstruction are common during monitored anesthesia care (MAC). Because their early detection is essential, we sought to measure the efficacy of capnography as an indicator of apnea during MAC at a variety of oxygen flow rates compared with thoracic impedance. Anesthesia care providers using standard A...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ANE.0000131964.67524.E7
更新日期:2004-08-01 00:00:00
abstract:BACKGROUND:Remifentanil and propofol are increasingly used for short-duration procedures in spontaneously breathing patients. In this setting, it is preferable to block the response to moderate stimuli while avoiding loss of responsiveness (LOR) and intolerable ventilatory depression (IVD). In this study, we explored s...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e318210fc45
更新日期:2011-09-01 00:00:00
abstract:IMPLICATIONS:In this study, although 41%-94% of the patients were fast-track eligible after laparoscopic surgery, only 35%-53% of the patients actually bypassed the postanesthesia care unit (PACU) because of anesthetic-related factors and surgical complications. Residual sedation was the most common anesthetic-related ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-200107000-00024
更新日期:2001-07-01 00:00:00