Abstract:
BACKGROUND:With health care practice consolidation, the increasing geographic scope of health care systems, and the advancement of mobile telecommunications, there is increasing interest in telemedicine-based health care consultations. Anesthesiology has had experience with telemedicine consultation for preoperative evaluation since 2004, but the majority of studies have been conducted in rural settings. There is a paucity of literature of use in metropolitan areas. In this article, we describe the implementation of a telemedicine-based anesthesia preoperative evaluation and report the program's patient satisfaction, clinical case cancellation rate outcomes, and cost savings in a large metropolitan area (Los Angeles, CA). METHODS:This is a descriptive study of a telemedicine-based preoperative anesthesia evaluation process in an academic medical center within a large metropolitan area. In a 2-year period, we evaluated 419 patients scheduled for surgery by telemedicine and 1785 patients who were evaluated in-person. RESULTS:Day-of-surgery case cancellations were 2.95% and 3.23% in the telemedicine and the in-person cohort, respectively. Telemedicine patients avoided a median round trip driving distance of 63 miles (Q1 24; Q3 119) and a median time saved of 137 (Q1 95; Q3 195) and 130 (Q1 91; Q3 237) minutes during morning and afternoon traffic conditions, respectively. Patients experienced time-based savings, particularly from traveling across a metropolitan area, which amounted to $67 of direct and opportunity cost savings. From patient satisfaction surveys, 98% (129 patients out of 131 completed surveys) of patients who were consulted via telemedicine were satisfied with their experience. CONCLUSIONS:This study demonstrates the implementation of a telemedicine-based preoperative anesthesia evaluation from an academic medical center in a metropolitan area with high patient satisfaction, cost savings, and without increase in day-of-procedure case cancellations.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Kamdar NV,Huverserian A,Jalilian L,Thi W,Duval V,Beck L,Brooker L,Grogan T,Lin A,Cannesson Mdoi
10.1213/ANE.0000000000005208subject
Has Abstractpub_date
2020-12-01 00:00:00pages
1647-1656issue
6eissn
0003-2999issn
1526-7598pii
00000539-202012000-00001journal_volume
131pub_type
杂志文章abstract:BACKGROUND:The spinal cord is an important site where volatile anesthetics decrease sensation and produce immobility. Beyond this knowledge, our understanding of a site of anesthetic action is limited. Previous evidence suggests that dorsal horn neurons with ascending projections may be more susceptible to depression b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318163f8f3
更新日期:2008-03-01 00:00:00
abstract::Informed consent for pediatric anesthesia challenges practitioners to navigate complex ethical, medical, and legal ambiguities. A patient's status as a minor does not negate the importance of his or her participation in the decision-making process but, rather, necessitates a nuanced evaluation of age and development t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000003705
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Pain in sickle cell disease (SCD) is characterized by episodes of acute pain, primarily responsible for acute health care utilization, and persistent chronic pain. Pain severity and frequency vary significantly among patients with SCD. In this study, we investigated the possible contribution of monoamine gen...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000382
更新日期:2014-11-01 00:00:00
abstract:UNLABELLED:The enhancing action of propofol on gamma-amino-n-butyric acid subtype A (GABA(A)) receptors purportedly underlies its anesthetic effects. However, a recent study found that a GABA(A) antagonist did not alter the capacity of propofol to depress the righting reflex. We examined whether the noncompetitive GABA...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000048821.23225.3a
更新日期:2003-03-01 00:00:00
abstract::In a prospective, randomized, double-blind study, we investigated whether epinephrine increased the efficacy of levobupivacaine and sufentanil during epidural labor analgesia. Seventy term parturients received an epidural injection of levobupivacaine 0.125% and sufentanil 0.75 microg/mL with or without 1:800,000 epine...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1213/01.ane.0000221038.46094.c0
更新日期:2006-07-01 00:00:00
abstract::Substance P, a neuropeptide associated with pain perception, is widely distributed in the central nervous system and is decreased in the cerebrospinal fluid of chronic pain patients as compared with that of healthy human volunteers. In this study, we have demonstrated the presence of immunoreactive substance P in sali...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199001000-00010
更新日期:1990-01-01 00:00:00
abstract:UNLABELLED:We designed this study to assess the efficacy of dolasetron compared with clonidine and placebo in prophylaxis of postanesthetic shivering. We included 90 patients undergoing elective abdominal or urologic surgery. The patients were randomly assigned to one three groups (each group n = 30) using a double-bli...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验,收录出版
doi:10.1097/00000539-200201000-00020
更新日期:2002-01-01 00:00:00
abstract:UNLABELLED:Animal studies have suggested that the temporal summation of nociceptive inputs might play a significant role in the development of central sensitization (i.e., hyperexcitability of central nociceptive neurons) and hyperalgesia via the activation of N-methyl-D-aspartate receptors. To further analyze these pr...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200002000-00031
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:Previously, our group successfully established one of the nation's first Perioperative Surgical Homes (PSHs) aimed at coordinating services to patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). As we now focus on extending the PSH to other service lines within...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001308
更新日期:2016-07-01 00:00:00
abstract::Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000189613.61910.32
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in th...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000002004
更新日期:2017-05-01 00:00:00
abstract::Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. The...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000002758
更新日期:2018-06-01 00:00:00
abstract::Patients referred to the Pain Clinic at the University of Virginia Medical Center with genuine phantom pain rather than stump pain have been treated by a variety of technics. Simple revision of drug therapy has proved helpful in some instances, as has repeated injection of trigger areas or neuromata, though surgical e...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197711000-00019
更新日期:1977-11-01 00:00:00
abstract::Hemodynamic responses to physostigmine were evaluated in eight patients with coma due to overdose with mainly anticholinergic drugs (AC) and in five patients with coma due to overdose with nonanticholinergic drugs (NAC). After correction of hypovolemia, but before administration of physostigmine, AC patients had signi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1983-10-01 00:00:00
abstract:BACKGROUND:Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pu...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181b278a3
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:The perioperative assessment of right ventricular (RV) function remains a challenge. Tricuspid annular plane systolic excursion (TAPSE) using M-mode is a widely used measure of RV function. However, accurate alignment of the ultrasound beam with the direction of annular movement can be difficult with transes...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000002614
更新日期:2018-01-01 00:00:00
abstract::Blood levels of many medications are acutely lowered by cardiopulmonary bypass (CPB). Because nifedipine is often used to provide protection from coronary ischemia, a determination of the effect of CPB on plasma nifedipine levels might help to determine the potential clinical benefit of nifedipine during and after byp...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199010000-00016
更新日期:1990-10-01 00:00:00
abstract:UNLABELLED:Urethane is widely used as an anesthetic for animal studies because of its minimal effects on cardiovascular and respiratory systems and maintenance of spinal reflexes. Despite its usefulness in animal research, there are no reports concerning its molecular actions. We designed this study to determine whethe...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200202000-00015
更新日期:2002-02-01 00:00:00
abstract:UNLABELLED:General anesthesia promotes atelectasis formation, which is augmented by administration of large oxygen concentrations. We studied the efficacy of positive end-expiratory pressure (PEEP) application during the induction of general anesthesia (fraction of inspired oxygen [FIO(2)] 1.0) to prevent atelectasis. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000087042.02266.f6
更新日期:2003-12-01 00:00:00
abstract::To determine the incidence of atrioventricular (A-V) block, 86 patients, aged 58.9 +/- 10.4 yr, undergoing elective coronary artery bypass grafting (CABG) during aortic cross-clamping (ACC) and cold potassium cardioplegia were investigated. The incidence and duration of complete A-V block after release of the aortic c...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199501000-00009
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:In this study, we evaluated the efficacy of celiac plexus block for the treatment of feeding intolerance in critically ill patients. METHODS:Nineteen mechanically ventilated medical patients intolerant of enteral nutrition and receiving metoclopramide underwent bilateral celiac plexus block. The anterior pr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验,收录出版
doi:10.1213/ANE.0b013e3181cde870
更新日期:2010-04-01 00:00:00
abstract::There has been no description of the hemodynamic dose-response relationship between halothane and sodium nitroprusside (SNP), although these drugs are used together frequently for induction of deliberate hypotension. Utilizing aortic root cannulation and thermister-tipped pulmonary artery catheterization, this relatio...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-197807000-00016
更新日期:1978-07-01 00:00:00
abstract:BACKGROUND:Oral opioid formulations contribute to postoperative analgesia. In this study, we evaluated the perioperative application of oral controlled-release oxycodone to reduce postoperative IV morphine consumption and opioid side effects after lumbar discectomy. METHODS:Forty patients scheduled for elective lumbar...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000266451.77524.0d
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Obstructive sleep apnea (OSA) patients are at increased risk for pulmonary and cardiovascular complications; perioperative mortality risk is unclear. This report analyzes cases submitted to the OSA Death and Near Miss Registry, focusing on factors associated with poor outcomes after an OSA-related event. We ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000005005
更新日期:2020-10-01 00:00:00
abstract::The swallowing reflex is depressed by anesthetics. During recovery from anesthesia the rapid return of laryngeal and upper airway reflexes is important to protect the lower airway from aspiration. This study measures the recovery of the swallowing reflex after propofol anesthesia. Fifteen patients undergoing a colonos...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199411000-00007
更新日期:1994-11-01 00:00:00
abstract::Intraoperative early detection of anemia, identifying toxic levels of carboxyhemoglobin after carbon monoxide exposure and titrating drug dosage to prevent toxic levels of methemoglobin are important goals. The pulse oximeter works by illuminating light into the tissue and sensing the amount of light absorbed. The sam...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e318233041a
更新日期:2012-05-01 00:00:00
abstract::We were interested in determining the effect of enflurane, halothane, and isoflurane on the uptake and removal of 5-hydroxytryptamine (5-HT) and phenylethylamine (PEA) from the lung. Isolated rabbit lungs were perfused in a recirculating system in vitro with 0.1 microM [14C]5-HT or 0.1 microM [14C]PEA in Krebs-Ringer ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1982-08-01 00:00:00
abstract:UNLABELLED:We compared sedation quality, intraocular pressure (IOP) changes, and recovery profiles in patients who received propofol or propofol-ketamine sedation during placement of the retrobulbar nerve block (RBB). Seventy elderly patients undergoing cataract extraction according to a prospective, randomized, double...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199908000-00013
更新日期:1999-08-01 00:00:00
abstract:UNLABELLED:Bleeding after cardiopulmonary bypass (CPB) is related to multiple factors. Excess protamine weakens clot structure and decreases platelet function; therefore, an increased activated clotting time (ACT) after protamine reversal of heparin may be misinterpreted as residual heparin anticoagulation. We evaluate...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199810000-00008
更新日期:1998-10-01 00:00:00
abstract::The safety and utility of pediatric epidural analgesia is well established, but the risk of permanent neurological injury is unknown and largely must be extrapolated from adult literature. In this article we present a series of 4 cases of longterm or permanent neurologic complications associated with epidural analgesi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31826918b6
更新日期:2012-12-01 00:00:00