Increasing Utilization of Scrubbing Devices for Peripheral Intravenous Disinfectable Needleless Closed Connectors.

Introduction Peripheral intravenous (IV) administration sets are a source of infection that increases morbidity, mortality, and healthcare costs. In this quality improvement project, we aimed to enhance compliance with peripheral IV hub disinfection at anesthesia induction to follow the American Society of Anesthesiologists (ASA) safe medication injection guidelines. Methods This study was conducted in the main operating suite of the University of Miami's principal hospital between June and October 2023.

Evaluation of a Course to Teach Medical Students Latent Hazard Identification in the Operating Room.

Introduction: To improve situational awareness in the operating room (OR), a virtual online operating room of hazards (ROH) with deliberately placed risks was created. We hypothesized that subjects first participating in the virtual online ROH would identify more hazards during an in-person ROH exercise in a physical OR than those in the control group who only received didactic training.

Methods: We conducted a randomized controlled trial at a major academic medical center, enrolling 48 pre-clinical medical students with no previous OR exposure during their classes.

A Novel Approach to the Room of Errors (ROE): A Three-Dimensional Virtual Tour Activity to Spotlight Patient Safety Threats.

Live simulation-based activities are effective tools in teaching situational awareness to improve patient safety training in healthcare settings. The coronavirus disease 2019 (COVID-19) pandemic forced the discontinuation of these in-person sessions. We describe our solution to this challenge: an online interactive activity titled the "Virtual Room of Errors.

Co2 Rebreathing Observed While Using a Bag-Mask Resuscitator With Integrated Manometer: A Case Report.

Bag-mask resuscitators with integrated manometry help reduce the risk of pulmonary injury during manual ventilation. All such devices must function as intended while preventing carbon dioxide rebreathing, as unintended hypercapnia can be harmful in critically ill patients. We describe a case of carbon dioxide rebreathing in a patient suspected of having a brain injury after blunt trauma who was manually ventilated with a widely available bag-mask resuscitator with integrated manometry after emergent intubation.

Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports.

Purpose: To report and discuss the incidence of severe lower extremity injuries associated with robotic procedures in Trendelenburg with lithotomy position.

Design And Methods: A case study method was used to describe three cases of patients who underwent robotically assisted urological procedures in Trendelenburg with lithotomy position and developed serious lower extremities injuries resulting in fasciotomies. Furthermore, a literature review was conducted to evaluate risk factors and possible interventions for the prevention of similar injuries.

Unconsciousness After Regional Anesthesia for Arteriovenous Fistula Revision in a Patient with End-stage Renal Disease.

Chronic kidney disease can lead to different chronic complications. We describe a case where a patient with end-stage renal disease (ESRD) became unresponsive during transportation to the recovery room, following finishing an arteriovenous fistula revision. The patient had received supraclavicular block ninety minutes prior to the incident and surgery was finished under monitored anesthesia care (MAC).

Prevalence of discordant elevations of state entropy and bispectral index in patients at amnestic sevoflurane concentrations: a historical cohort study.

Background: Processed electroencephalogram (EEG) monitors help assess the hypnotic state during general anesthesia or sedation. Maintaining the bispectral index (BIS) or state entropy (SE) between 40 and 60 has been recommended to mitigate anesthesia awareness. Nonetheless, SEs > 70 were frequently observed at end-tidal sevoflurane concentrations unlikely to allow awareness.

Validation of a New Method to Automatically Select Cases With Intraoperative Red Blood Cell Transfusion for Audit.

Background: Hospitals review allogeneic red blood cell (RBC) transfusions for appropriateness. Audit criteria have been published that apply to 5 common procedures. We expanded on this work to study the management decision of selecting which cases involving transfusion of at least 1 RBC unit to audit (review) among all surgical procedures, including those previously studied.

Perioperative Temperature Measurement Considerations Relevant to Reporting Requirements for National Quality Programs Using Data From Anesthesia Information Management Systems.

Background: Perioperative hypothermia may increase the incidences of wound infection, blood loss, transfusion, and cardiac morbidity. US national quality programs for perioperative normothermia specify the presence of at least 1 "body temperature" ≥35.5°C during the interval from 30 minutes before to 15 minutes after the anesthesia end time.

Case report: management of differential diagnosis and treatment of severe anaphylaxis in the setting of spinal anesthesia.

The purpose of this case report is to educate fellow anesthesiologists of a complicated differential diagnosis for sudden cardiovascular collapse after spinal anesthesia. We report a case where anaphylaxis occurred while under spinal anesthesia and resulted in difficult resuscitation. A 58-year-old woman undergoing bilateral knee replacements under spinal anesthesia experienced sudden seizure and cardiovascular collapse from acute anaphylactic shock while administering a cephalosporin.

Outpatient regional anesthesia for upper extremity surgery update (2005 to present) distal to shoulder.

Multiple different approaches to the brachial plexus are available for the regional anesthesiologist to provide successful anesthesia and analgesia for ambulatory surgery of the upper extremity. Although supraclavicular and infraclavicular blocks are faster to perform than axillary blocks, the operator needs to keep in mind that blocks performed around the clavicle carry the risk for specific side effects and complications, no matter whether ultrasound or nerve stimulation is the chosen modality for neurolocation. Owing to the ambulatory nature of the planned surgical intervention, even significant side effects may not become clinically symptomatic until the patient is discharged from the facility.