Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project.

Background: A successful anesthesia pre-assessment clinic needs to identify patients who need further testing, evaluation, and optimization prior to the day of surgery to avoid delays and cancelations. Although the ASA Physical Status Classification system (ASA PS) has been used widely for over 50 years, it has poor interrater agreement when only using the definitions. In 2014, ASA-approved examples for each ASA physical status class (ASA PS).

Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period.

Background: Women have blamed epidurals for their post-partum back pain for decades. Survey-based studies have shown similar incidence of chronic back pain between women who delivered with epidurals compared to those who did not. However, epidural insertion site pain has yet to be evaluated by a quantitative measure: pressure pain threshold (PPT).

Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients.

Background: Despite its widespread use, the American Society of Anesthesiologists (ASA)-Physical Status Classification System has been shown to result in inconsistent assignments among anesthesiologists. The ASA-Physical Status Classification System is also used by nonanesthesia-trained clinicians and others. In 2014, the ASA developed and approved examples to assist clinicians in determining the correct ASA-Physical Status Classification System assignment.

Broken spinal needle: case report and review of the literature.

The occurrence of broken spinal and epidural needles has been reported. However, most case reports have focused primarily on prevention rather than on management. A broken spinal needle fragment was left in a patient before it was removed one month later due to back pain.