Tag Archives: anaesthesia

Resetting the Bar for Acute Perioperative Pain Management

https://www.axonista.com/uncategorized/0dp61ggngwf Despite previously published guidelines and practice recommendations, there remains unwarranted variation in the quality of pain management provided to patients having surgery. Unwarranted variations in healthcare are inconsistencies in clinical practice that have no basis in science or patient preference.

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https://mechanicslien.com/aa2agug In 2019, the U.S. Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force published its report, which called on medical societies to work together to develop evidence-based guidelines to improve the quality of pain care delivery. The Task Force, which was Chaired by Stanford anesthesiology and pain medicine specialist Dr. Vanila Singh when she was Chief Medical Officer of HSS, recommended individualized, multimodal, and multidisciplinary approaches to pain management to help decrease an over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders.

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https://tractorsarena.com/tnhmdupsi Following the release of this Task Force report, leaders of the American Society of Anesthesiologists (ASA) decided to take action and launched a 2-year project. As Chair of the ASA Committee on Regional Anesthesia and Pain Medicine, I participated as a member of the steering committee and served as Co-Chair of the Pain Summit. ASA invited 13 other medical societies to join a new consortium dedicated to improving pain management (in alphabetical order):

  • American Academy of Orthopaedic Surgeons
  • American Academy of Otolaryngology-Head and Neck Surgery
  • American Association of Neurological Surgeons
  • American Association of Oral and Maxillofacial Surgeons
  • American College of Obstetricians and Gynecologists
  • American College of Surgeons
  • American Hospital Association
  • American Medical Association
  • American Society of Breast Surgeons
  • American Society of Plastic Surgeons
  • American Society of Regional Anesthesia and Pain Medicine
  • American Urological Association
  • Society of Thoracic Surgeons

https://www.hoppercommunities.com/qgtjzms114o For its first initiative, the consortium agreed to focus on the pain care of the routine, non-complex (i.e., opioid-naïve) adult surgical patient. Over the course of several months, using Delphi methodology and culminating in the first live virtual Pain Summit involving all participating societies, this multiorganizational consensus process resulted in the establishment of 7 guiding principles for acute perioperative pain management.

Now published in Regional Anesthesia & Pain Medicine, these principles are intended to help healthcare systems and individual clinicians provide better care for patients having surgery. These principles include the need for preoperative evaluation of medical and psychological conditions and potential substance use disorders, a focus on multimodal analgesia including nonpharmacologic interventions, use of validated pain assessment tools to guide and adjust treatment, and the importance of individualized care and education, among others.

https://gottbs.com/2022/06/20/6lzlp0v4cqf The final seven principles are:

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  1. Clinicians should conduct a preoperative evaluation including assessment of medical and psychological conditions, concomitant medications, history of chronic pain, substance use disorder, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan.
  2. Clinicians should use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.
  3. Clinicians should offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacological interventions, for the treatment of postoperative pain in adults.
  4. Clinicians should provide patient and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for managing postoperative pain, and document the plan and goals for postoperative pain management.
  5. Clinicians should provide education to all patients (adult) and primary caregivers on the pain treatment plan, including proper storage and disposal of opioids and tapering of analgesics after hospital discharge.
  6. Clinicians should adjust the pain management plan based on adequacy of pain relief and presence of adverse events.
  7. Clinicians should have access to consultation with a pain specialist for patients who have inadequately controlled postoperative pain or are at high risk of inadequately controlled postoperative pain at their facilities (e.g., long-term opioid therapy, history of substance use disorder).

https://dmhs.ca/uncategorized/gwf20wqilu The formation of this consortium is a critical first step to widespread quality improvement in perioperative pain management for surgical patients across the country. The fact that 14 professional healthcare organizations could agree on these 7 principles means that the bar for acute perioperative pain management has been reset.

http://foundationforpmr.org/2022/06/20/ww52cgicu The work product of this consortium can now form the basis of all future guidelines and influence the products of legislation and regulation that affect pain management for surgical patients. There is still so much work to do, however, and this consortium is already looking at how to tailor these principles to more complex surgical populations, better assess barriers to change implementation, and provide each organization’s members with the tools they need to improve acute perioperative pain management where they are.

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You Are Not “Asleep” Under Anesthesia

“You will be asleep for your surgery,” anesthesiologists often reassure their patients. Just before the start of anesthesia, a patient may hear the operating room nurse saying, “Think of a nice dream as you go off to sleep.”

Zolpidem Buying While these statements are intended to soothe patients during a stressful time, they gloss over this critical fact: Anesthesia is not like normal sleep at all. 

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That’s why you need medical doctors – anesthesiologists – to take care of you under anesthesia, and why you don’t need us when you’re sleeping comfortably in your own bed.

https://www.audiotherapyuk.com/2022/06/20/j6x09yt Differences between natural sleep and general anesthesia

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https://gottbs.com/2022/06/20/56m22ua0vjo Natural sleep represents an active though resting brain state. Every 90 minutes, the brain cycles between rapid eye movement or “REM” sleep and non-REM sleep. During each of these REM cycles, the brain is active, and dreams can take place. The rest and rejuvenation that result from getting a good night’s sleep are essential for overall health and wellbeing.

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On the other hand, general anesthesia produces a brain wave pattern known as “burst-suppression,” where brief clusters of fast waves alternate with periods of minimal activity. In a recent article published in Frontiers in Psychology, Drs. Akshay Shanker and Emery Brown explain brain wave patterns found in patients under general anesthesia. They are similar to those of critically ill patients who fall into a coma, have a dangerously low body temperature, or suffer from other serious diseases. Under general anesthesia, patients do not dream.

Confusing general anesthesia and natural sleep seems innocent but can be dangerous. A person who falls into natural sleep doesn’t require constant monitoring or observation. A patient under anesthesia, like an intensive care unit patient in a coma, may appear peaceful and relaxed, but anesthetic drugs don’t produce natural sleep and may cause breathing to stop or have other serious side effects.  Some may recall that Michael Jackson died at home while receiving the anesthetic drug propofol in his veins without an anesthesiologist nearby to protect him.

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https://dmhs.ca/uncategorized/olk61ci8ee For patients with chronic health problems, having surgery and anesthesia can put significant stress on the body. Anesthesia gases and medications can temporarily decrease the heart’s pumping ability and affect blood flow to the liver and kidneys. Patients under general anesthesia often need a breathing tube and a ventilator to breathe for them and support their lungs with oxygen.

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Buying Zolpidem In Mexico https://www.gramercygold.com/o7q9mtz1h6r Respect anesthesia, but don’t fear it

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Buy Zolpidem In India While having anesthesia and surgery should never be taken lightly, anesthesia care today is very safe as long as it is directed by a physician specializing in anesthesiology: an anesthesiologist. Anesthesiology is a medical specialty just like cardiology, surgery, or pediatrics. Research by anesthesiologists has led to the development of better monitors, better training using simulation methods inspired by the aviation industry, and new medications and techniques to give safer pain relief.

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As a medical specialty, anesthesiology focuses on improving patient safety, outcomes and experiences.  Anesthesiologists work with surgeons and other healthcare professionals to get you or your family member ready for surgery, designing an anesthesia care and pain management plan specific to the type of operation you need. The anesthesia plan will guide your care during your procedure and throughout your recovery. While general anesthesia is far different from natural sleep, the job of the anesthesiologist is to make sure that you wake up just the same.

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https://www.gramercygold.com/8rfztlnsyjg This post has also been featured on KevinMD.com.

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The Problem of Burnout in Anesthesiology

Can You Buy Ambien At Walmart I have written previously about what I love about being an anesthesiologist and why I still love being an anesthesiologist after all these years.

https://www.bakersfieldpropertysolutions.com/2022/06/20/mb5sk4vn93z Recent articles have drawn attention to the pervasive problem of burnout among anesthesiologists, and the numbers are alarming. The overall prevalence within anesthesiology is approximately 60%, and this rate varies by subspecialty with pain physicians being at highest risk.

Our writing group has published two letters in the Journal of Clinical Anesthesia that offer additional perspectives and highlight important work on this subject: “A field on fire: Why has there been so much attention focused on burnout among anesthesiologists?” and “Fighting burnout in the COVID-19 era is a family matter.”

The previously-published studies by Hyman et al and Afonso et al report data collected prior to the onset of the COVID-19 pandemic. While anesthesiologists were hailed as frontline heroes worldwide for their roles in the emergency response, airway management, and critical care of COVID-19 patients, their lives and their careers were also completely disrupted.

At work, anesthesiologists had to deal with confronting a previously unknown and highly transmissible respiratory pandemic, long hours and uncertain schedules, new personal protective equipment (PPE) protocols and PPE shortages, quarantines, and frequently-changing guidelines. Shelter-in-place orders led to school and office closures which added the stressors of working from home and virtual schooling on top of pandemic parenting, and women anesthesiologists were disproportionately affected.

Cheap Zolpidem Er Moving forward, the ongoing assessment and mitigation of burnout among anesthesiologists will take dedicated effort and leadership. Our letter recommends periodic evaluation of work-related risk factors and check-ins with anesthesiologist team members. Further, recognition of the challenges to work-life integration imposed by the COVID-19 pandemic warrants implementation of reliable interventions that may prevent the same issues from happening again in the future.

In addition, it may be more appropriate to promote wellness at the family level, rather than simply the individual level, because anesthesiologists cannot reasonably focus on their important physician roles when there are concurrent and competing stressors at home.

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Practical Tips for Successful Virtual Fellowship Interviews

https://www.hefren.com/blog/b4y77dm1 Guest authored by Jody C. Leng, MD, MS, and Kariem El-Boghdadly, MBBS, BSc (Hons), FRCA, EDRA, MSc. Dr. Leng is a Clinical Assistant Professor at Stanford University School of Medicine and is the Director of Regional Anesthesiology and Acute Pain Medicine at the Veterans Affairs Palo Alto Health Care System. Dr. El-Boghdadly is a consultant anaesthetist and the research and development lead for anaesthesia and perioperative medicine at Guy’s and St Thomas’ NHS Foundation Trust and is an honorary senior lecturer at King’s College in London.

The Covid-19 pandemic has normalized virtual everything. For both interviewers and interviewees, participating in virtual interviews for subspecialty fellowship programs has required major adjustment. We have summarized some key lessons we have learned in preparing for our second year in a row of virtual regional anesthesiology and acute pain medicine fellowship interviews in the following infographic.

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My Top Ten Articles for #RAUK20

I have the honor of being the next Bruce Scott Lecturer for the 2020 Regional Anaesthesia United Kingdom (RA-UK) meeting in Sheffield on May 18 and 19, 2020.

As part of the preparation for what will be a fantastic conference filled with the latest education in regional anesthesia, point-of-care ultrasound, acute pain management, and social media for medical education, Dr. Amit Pawa has started a thread on Twitter featuring my “Top Ten” published articles.

I hope to see you at #RAUK20! You can access the thread and check out the list of articles by clicking the tweet below:

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