Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early.

Background: Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA, adding measures of postoperative delirium, cognitive function, systemic cytokines, and astrocyte activation.

Predictive Validity of Anesthesiologists' Quality of Clinical Supervision and Nurse Anesthetists' Work Habits Assessed by Their Associations With Operating Room Times.

Background: At all Joint Commission-accredited hospitals, the anesthesia department chair must report quantitative assessments of anesthesiologists' and nurse anesthetists' (CRNAs') clinical performance at least annually. Most metrics lack evidence of usefulness, cost-effectiveness, reliability, or validity. Earlier studies showed that anesthesiologists' clinical supervision quality and CRNAs' work habits have content, convergent, discriminant, and construct validity.

Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists' Clinical Supervision and Nurse Anesthetists' Work Habits.

Introduction: Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area. Associations between non-technical skills in anesthesia, specifically anesthesiologists' quality of clinical supervision and nurse anesthetists' work habits, and patient and operational factors were examined.

Lack of Benefit of Adjusting Adaptively Daily Invitations for the Evaluation of the Quality of Anesthesiologists' Supervision and Nurse Anesthetists' Work Habits.

Introduction Whenever a department implements the evaluation of professionals, a reasonable operational goal is to request as few evaluations as possible. In anesthesiology, evaluations of anesthesiologists (by trainees) and nurse anesthetists (by anesthesiologists) with valid and psychometrically reliable scales have been made by requesting daily evaluations of the ratee's performance on the immediately preceding day. However, some trainees or nurse anesthetists are paired with the same anesthesiologist for multiple days of the same week.

Association between an anesthesia department development program for junior faculty and long-term production of publications: A longitudinal cohort study.

Background: An important mission of academic medical departments is to further the scholarship and education of its junior faculty. In 2013, Hindman et al. described the design and initial outcomes of a faculty development program for junior faculty at the University of Iowa Department of Anesthesia.

Narrative Review of Prolonged Times to Tracheal Extubation After General Anesthesia With Intubation and Extubation in the Operating Room.

This narrative review summarizes research about prolonged times to tracheal extubation after general anesthesia with both intubation and extubation occurring in the operating room or other anesthetizing location where the anesthetic was performed. The literature search was current through May 2023 and included prolonged extubations defined either as >15 minutes or at least 15 minutes. The studies showed that prolonged times to extubation can be measured accurately, are associated with reintubations and respiratory treatments, are rated poorly by anesthesiologists, are treated with flumazenil and naloxone, are associated with impaired operating room workflow, are associated with longer operating room times, are associated with tardiness of starts of to-follow cases and surgeons, and are associated with longer duration workdays.

Systematic review with meta-analysis of relative risk of prolonged times to tracheal extubation with desflurane versus sevoflurane or isoflurane.

The objective of this systematic review was to estimate the relative risk of prolonged times to tracheal extubation with desflurane versus sevoflurane or isoflurane. Prolonged times are defined as ≥15 min from end of surgery (or anesthetic discontinuation) to extubation in the operating room. They are associated with reintubations, naloxone and flumazenil administration, longer times from procedure end to operating room exit, greater differences between actual and scheduled operating room times, longer times from operating room exit to next case start, longer durations of the workday, and more operating room personnel idle while waiting for extubation.

Overall anesthesia department quality of clinical supervision of trainees over a year evaluated using mixed effects models.

Background: Earlier studies of supervision in anesthesiology focused on how to evaluate the quality of individual anesthesiologist's clinical supervision of trainees. What is unknown is how to evaluate clinical supervision collectively, as provided by the department's faculty anesthesiologists. This information can be a metric that departments report annually or use to evaluate the effect of programs on the quality of clinical supervision over time.

Surgeon-Specific Treatment Selection Bias and Heterogeneous Perioperative Practices in an Observational Spine Surgery Study. A Statistical Tutorial with Implications for Analysis of Observational Studies of Perioperative Interventions.

Background: It is essential that treatment effects reported from retrospective observational studies are as reliable as possible. In a retrospective analysis of spine surgery patients, we obtained a spurious result: tranexamic acid (TXA) had no effect on intraoperative blood loss. This statistical tutorial explains how this result occurred and why statistical analyses of observational studies must consider the effects of individual surgeons.

Intubation biomechanics: Computational modeling to identify methods to minimize cervical spine motion and spinal cord strain during laryngoscopy and tracheal intubation in an intact cervical spine.

Study Objective: To minimize the risk of cervical spinal cord injury in patients who have cervical spine pathology, minimizing cervical spine motion during laryngoscopy and tracheal intubation is commonly recommended. However, clinicians may better aim to reduce cervical spinal cord strain during airway management of their patients. The aim of this study was to predict laryngoscope force characteristics (location, magnitude, and direction) that would minimize cervical spine motions and cord strains.

Relationship Between Glottic View and Intubation Force During Macintosh and Airtraq Laryngoscopy and Intubation.

Background: Because intubation-mediated cervical spine and spinal cord injury are likely determined by intubation force magnitude, understanding the determinants of intubation force magnitude is clinically relevant. With direct (Macintosh) laryngoscopy, when glottic view is less favorable, anesthesiologists apply greater force. We hypothesized that, when compared with direct (Macintosh) laryngoscopy, intubation force with an optical indirect laryngoscope (Airtraq) would be less dependent on glottic visualization.

Effect of Insufficient Interaction on the Evaluation of Anesthesiologists' Quality of Clinical Supervision by Anesthesiology Residents and Fellows.

Introduction In this study, we tested whether raters' (residents and fellows) decisions to evaluate (or not) critical care anesthesiologists were significantly associated with clinical interactions documented from electronic health record progress notes and whether that influenced the reliability of supervision scores. We used the de Oliveira Filho clinical supervision scale for the evaluation of faculty anesthesiologists. Email requests were sent to raters who worked one hour or longer with the anesthesiologist the preceding day in an operating room.

Mice recognize 3D objects from recalled 2D pictures, support for picture-object equivalence.

Picture-object equivalence or recognizing a three-dimensional (3D) object after viewing a two-dimensional (2D) photograph of that object, is a higher-order form of visual cognition that may be beyond the perceptual ability of rodents. Behavioral and neurobiological mechanisms supporting picture-object equivalence are not well understood. We used a modified visual recognition memory task, reminiscent of those used for primates, to test whether picture-object equivalence extends to mice.

Intubation Biomechanics: Clinical Implications of Computational Modeling of Intervertebral Motion and Spinal Cord Strain during Tracheal Intubation in an Intact Cervical Spine.

Background: In a closed claims study, most patients experiencing cervical spinal cord injury had stable cervical spines. This raises two questions. First, in the presence of an intact (stable) cervical spine, are there tracheal intubation conditions in which cervical intervertebral motions exceed physiologically normal maximum values? Second, with an intact spine, are there tracheal intubation conditions in which potentially injurious cervical cord strains can occur?

Methods: This study utilized a computational model of the cervical spine and cord to predict intervertebral motions (rotation, translation) and cord strains (stretch, compression).

Association between leniency of anesthesiologists when evaluating certified registered nurse anesthetists and when evaluating didactic lectures.

Daily evaluations of certified registered nurse anesthetists' (CRNAs') work habits by anesthesiologists should be adjusted for rater leniency. The current study tested the hypothesis that there is a pairwise association by rater between leniencies of evaluations of CRNAs' daily work habits and of didactic lectures. The historical cohorts were anesthesiologists' evaluations over 53 months of CRNAs' daily work habits and 65 months of didactic lectures by visiting professors and faculty.

Sex-Specific Intubation Biomechanics: Intubation Forces Are Greater in Male Than in Female Patients, Independent of Body Weight.

Background Studies of head, neck, and cervical spine morphology and tissue material properties indicate that cervical spine biomechanics differ between adult males and females. These differences result in sex-specific cervical spine kinematics and injury patterns in response to standardized loading conditions. Because direct laryngoscopy and endotracheal intubation require the application of a load to the cervical spine, intubation biomechanics should be sex-specific.

Reliability and Validity of Performance Evaluations of Pain Medicine Clinical Faculty by Residents and Fellows Using a Supervision Scale.

Background: Annual and/or semiannual evaluations of pain medicine clinical faculty are mandatory for multiple organizations in the United States. We evaluated the validity and psychometric reliability of a modified version of de Oliveira Filho et al clinical supervision scale for this purpose.

Methods: Six years of weekly evaluations of pain medicine clinical faculty by resident physicians and pain medicine fellows were studied.

Reliability of ranking anesthesiologists and nurse anesthetists using leniency-adjusted clinical supervision and work habits scores.

Study Objective: Evaluation of faculty anesthesiologists' clinical supervision is psychometrically reliable. Supervision scores often are used for ongoing professional practice and teaching evaluations. We evaluated whether anesthesiologists' clinical supervision rank could be determined reliably using 6- vs.

C1-C2 Motion During C-MAC D-Blade Videolaryngoscopy and Endotracheal Intubation in 2 Patients With Type II Odontoid Fractures: A Case Report.

Laryngoscopy and endotracheal intubation in patients with unstable cervical spines may cause pathological spinal motion and resultant cord injury. Cadaver and mathematical (finite element) models of a type II odontoid fracture predict C1-C2 motions during intubation to be of low magnitude, especially with the use of a low-force videolaryngoscope. Using continuous fluoroscopy, we recorded C1-C2 motion during C-MAC D videolaryngoscopy and intubation in 2 patients with type II odontoid fractures.

Anesthetic Management of Emergency Endovascular Thrombectomy for Acute Ischemic Stroke, Part 2: Integrating and Applying Observational Reports and Randomized Clinical Trials.

The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made: (1) within 6 h of symptom onset; or (2) within 6-24 h of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of endovascular thrombectomy patients. In the preceding companion article (part 1), the rationale for rapid workflow and maintenance of blood pressure before reperfusion were reviewed.

Anesthetic Management of Emergency Endovascular Thrombectomy for Acute Ischemic Stroke, Part 1: Patient Characteristics, Determinants of Effectiveness, and Effect of Blood Pressure on Outcome.

In the United States, stroke ranks fifth among all causes of death and is the leading cause of serious long-term disability. The 2018 American Heart Association stroke care guidelines consider endovascular thrombectomy to be the standard of care for patients who have acute ischemic stroke in the anterior circulation when arterial puncture can be made within 6 hours of symptom onset or within 6-24 hours of symptom onset when specific eligibility criteria are satisfied. The aim of this 2-part review is to provide practical perspective on the clinical literature regarding anesthesia care of patients treated with endovascular thrombectomy.