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Background: Frailty is a multidimensional condition characterized by loss of functional reserve, which results in increased vulnerability to adverse outcomes following surgery. Anesthesiologists can reduce adverse outcomes when risk factors are recognized early and dedicated care pathways are operational. As the frail elderly population is growing, we investigated the perspective on the aging population, familiarity with the frailty syndrome and current organization of perioperative care for elderly patients among Dutch anesthesiologists., Methods: A fifteen-item survey was distributed among anesthesiologists and residents during the annual meeting of the Dutch Society of Anesthesiology. The first section included questions on self-reported competence on identification of frailty, acquaintance with local protocols and attitude towards the increasing amounts of elderly patients presenting for surgery. The second part included questions on demographic features of the participant such as job position, experience and type of hospital. Answers are presented as percentages, using the total number of replies for the question per group as a denominator., Results: A sample of 132 surveys was obtained. The increasing number of elderly patients was primarily perceived as challenging by 76% of respondents. Ninety-nine percent agreed that frailty should influence anesthetic management, while 85% of respondents claimed to feel competent to recognize frailty. Thirty-four percent of respondents reported the use of a dedicated pathway in the preoperative approach of frail elderly patients. However, only 30% of respondents reported to know where to find the frailty screening in the patient file and appointed that frailty is not consistently documented. Interestingly, only 43% of respondents reported adequate collaboration with geriatricians. This could include for example a standardized preoperative multidisciplinary approach or dedicated pathway for the elderly patient., Conclusions: This survey demonstrated that the increasing number of frail elderly patients is perceived as important and relevant for anesthetic management. Opportunities lie in improving the organization and effectuation of perioperative care by more consistent involvement of anesthesiologists., (© 2021. The Author(s).)

Cardiopulmonary resuscitation is perceived as a stressful task. Additional external distractors, such as noise and bystanders, may interfere with crucial tasks and might adversely influence patient outcome. We investigated the effects of external distractors on resuscitation performance of anaesthesia residents and consultants with different levels of experience. Thirty physicians performed two simulated resuscitation scenarios in random order, one scenario without additional distractors (control) and one scenario with additional distractors (noise, scripted family member). Resuscitation performance was assessed by a score based on European Resuscitation Council guidelines, presented as median (IQR [range]). We found that performance scores were lower under experimental conditions (11.8 (9.0-19.5 [−9.0 to 28.5]) than under control conditions 19.5 (14.0-25.5 [5.0-29.5]), p = 0.0002). No interaction was observed between additional distractors and experience level (p = 0.4480). External distractors markedly reduce the quality of cardiopulmonary resuscitation. This suggests that all team members, including senior healthcare providers, require training to improve performance under stressful conditions. [ABSTRACT FROM AUTHOR]

Alarms are ubiquitous in anaesthetic practice, but their net effect on anaesthesiologists' performance and patient safety is debated. In this study, 27 anaesthesiologists performed two simulation sessions in random order; one session was programmed to include an alarm condition, with a standard, frequent, clearly audible alarm sound. During these sessions, adverse events were simulated and anaesthesiologists' response times to these events were recorded. Perceived workload was assessed with the NASA Task Load Index. Response times to adverse events and perceived workload were similar in both groups. Pooled response times to atrial fibrillation and desaturation were fast, with a median (range [IQR]) of 8 (4-14 [1-41]) s and 9 (6-16 [1-44]) s, respectively. Pooled response times to an ST segment elevation on the ECG and an obstructed intravenous line were significantly slower, with median (IQR[range]) times of 34 (21-76[4-300]) s and 227 (95-399 [2-600]) s, respectively (p < 0.001). This study shows that in a simulated anaesthesia environment, response times to adverse events are similar in the absence or presence of an audible alarm, and that response times to various critical events differ. [ABSTRACT FROM AUTHOR]

Closed circuit anaesthesia was described decades ago but did not achieve wide popularity among anaesthesiologists mainly because reliable control of inspiratory gas concentrations was not possible. Recent innovations including fast gas analysers, electronically controlled dosage systems and algorithms for feedback control have made possible the development of sophisticated closed circuit ventilators designed for routine clinical practice. The main advantages comprise economic use of medical gases and volatile anaesthetics, reduction of anaesthetic gas loss into the atmosphere, improved airway acclimatization as well as estimations of oxygen consumption. This article reviews historical aspects, recent developments as well as advantages and limitations of closed system anaesthesia. [ABSTRACT FROM AUTHOR]

Background: The Cormack–Lehane (CL) classification is broadly used to describe laryngeal view during direct laryngoscopy. This classification, however, has been validated by only a few studies reporting inconclusive data concerning its reliability. This discrepancy between widespread use and limited evidence prompted us to investigate the knowledge about the classification among anaesthesiologists and its intra- and inter-observer reliability. [ABSTRACT FROM PUBLISHER]