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Background: International guidelines recommend preoperative multidisciplinary team (MDT) assessment for high-risk surgical patients. Preoperative MDT meetings can help to improve surgical care, but there is little evidence on whether they improve patient outcomes., Methods: This paper aims to share our experience of MDT meetings for high-risk surgical patients to underline their added value to the current standard of care. An observational study of a retrospective cohort of preoperative high-risk MDT meetings of a tertiary referral hospital between January 2015 and December 2020. For 249 patients the outcomes preoperative data, MDT decisions, and patient outcomes were collected from electronic health records., Main Results: A total of 249 patients were discussed at high-risk MDT meetings. Most of the patients (97%) were assessed as having an American Society of Anesthesiology score ≥ 3, and 219 (88%) had a European Society of Cardiology and European Society of Anaesthesiology risk score of intermediate or high. After MDT assessment, 154 (62%) were directly approved for surgery, and 39 (16%) were considered ineligible for surgery. The remaining 56 (23%) patients underwent additional assessments before reconsideration at a high-risk MDT meeting. The main reason for patients being discussed at the high-risk MDT meeting was to assess the risk-benefit ratio of surgery. Ultimately, 184 (74%) patients underwent surgery. Of the operated patients, 122 (66%) did not have a major complication in the postoperative period, and 149 patients (81%) were alive after one year., Conclusions: This cohort study shows the vulnerability and complexity of high-risk patients but also shows that the use of an MDT assessment contributes too improved peri- and postoperative treatment strategies in high-risk patients. Most patients underwent surgery after careful risk assessment and, if deemed necessary, preoperative and perioperative treatment optimization to reduce their risk., (© 2023. The Author(s).)

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).)

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., (© 2014 The Association of Anaesthetists of Great Britain and Ireland.)

Background and objectives: Salt-water aspiration results in pulmonary oedema and hypoxia. We tested the hypothesis that partial liquid ventilation has beneficial effects on gas exchange and rate of survival in acute and extended saltwater-induced lung injury. Methods: Anaesthetized, ventilated rats (tidal volume 6 mL kg-1, PEEP 5 cmH2O) received a tracheal salt-water instillation (3%, 8 mLkg-1 body weight) and were randomly assigned to three groups (n = 10 per group). While lungs of Group 1 were gas-ventilated, lungs of Group 2 received a single perfluorocarbon instillation (30 min after the injury, 5 mLkg-1 perfluorocarbon) and lungs of Group 3 received an additional continuous perfluorocarbon application into the treachea (5 mLkg-1h-1). Arterial blood gases were measured with an intravascular blood gas sensor. Results: Salt-water instillation resulted in a marked decrease in PaO2 values within 30min (from 432 ± 65 to 83 ± 40 mmHg, F1O2 = 1.0, P « 0.01). Arterial oxygenation improved in all three groups irrespective of treatment. We observed no significant differences between groups in peak PaO2 and PaCO2 values. Conclusions: Our results suggest that partial liquid ventilation has no additional beneficial effects on gas exchange after life-threatening salt water-induced lung injury when compared to conventional gas ventilation with positive end-expiratory pressure. [ABSTRACT FROM AUTHOR]

Background: Given the increasing international recognition of clinical teaching as a competency and regulation of residency training, evaluation of anesthesiology faculty teaching is needed. The System for Evaluating Teaching Qualities (SETQ) Smart questionnaires were developed for assessing teaching performance of faculty in residency training programs in different countries. This study investigated (1) the structure, (2) the psychometric qualities of the new tools, and (3) the number of residents' evaluations needed per anesthesiology faculty to use the instruments reliably.Methods: Two SETQ Smart questionnaires-for faculty self-evaluation and for resident evaluation of faculty-were developed. A multicenter survey was conducted among 399 anesthesiology faculty and 430 residents in six countries. Statistical analyses included exploratory factor analysis, reliability analysis using Cronbach α, item-total scale correlations, interscale correlations, comparison of composite scales to global ratings, and generalizability analysis to assess residents' evaluations needed per faculty.Results: In total, 240 residents completed 1,622 evaluations of 247 faculty. The SETQ Smart questionnaires revealed six teaching qualities consisting of 25 items. Cronbach α's were very high (greater than 0.95) for the overall SETQ Smart questionnaires and high (greater than 0.80) for the separate teaching qualities. Interscale correlations were all within the acceptable range of moderate correlation. Overall, questionnaire and scale scores correlated moderately to highly with the global ratings. For reliable feedback to individual faculty, three to five resident evaluations are needed.Conclusions: The first internationally piloted questionnaires for evaluating individual anesthesiology faculty teaching performance can be reliably, validly, and feasibly used for formative purposes in residency training. [ABSTRACT FROM AUTHOR]