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Author(s): Garrett W. Burnett [sup.1], Daniel Katz [sup.1], Chang H. Park [sup.1], Jaime B. Hyman [sup.1] [sup.2], Elisha Dickstein [sup.1], Matthew A. Levin [sup.1], Alan Sim [sup.1], Benjamin Salter [sup.1], [...], In March 2020, the New York City metropolitan area became the epicenter of the United States' SARS-CoV-2 pandemic and the surge of new cases threatened to overwhelm the area's hospital systems. This article describes how an anesthesiology department at a large urban academic hospital rapidly adapted and deployed to meet the threat head-on. Topics included are preparatory efforts, development of a team-based staffing model, and a new strategy for resource management. While still maintaining a fully functioning operating theater, discrete teams were deployed to both COVID-19 and non-COVID-19 intensive care units, rapid response/airway management team, the difficult airway response team, and labor and delivery. Additional topics include the creation of a temporary 'pop-up' anesthesiology-run COVID-19 intensive care unit utilizing anesthesia machines for monitoring and ventilatory support as well as the development of a simulation and innovation team that was instrumental in the rapid prototyping of a controlled split-ventilation system and conversion of readily available BIPAP units into emergency ventilators. As the course of the disease is uncertain, the goal of this article is to assist others in preparation for what may come next with COVID-19 as well as potential future pandemics. more...

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of critically ill patients. This was especially true in New York City. We present a roadmap for hospitals and healthcare systems to prepare for a Pandemic. Methods: This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the pandemic. MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds, expanded the workforce, and created guidelines. Results: MSH a 1,139-bed quaternary care academic referral hospital with 104 ICU beds expanded to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 42.8% (n=263) died, and 47.8% (n=294) were discharged alive. Conclusions: Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines were critical accommodating the surge of critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives. [ABSTRACT FROM AUTHOR] more...

Intraoperative anesthetic technique directly impacts immediate postoperative recovery, yet there are few opportunities for anesthesiologists to receive feedback and no easily available benchmarks, making it difficult to reflect on one's own practice. This initial implementation study used retrospective data from 5,712 ambulatory surgery cases with healthy adult patients undergoing general anesthesia in 2018 at a large tertiary care academic center. It examines variation in practice among anesthesiologists for eight surgical specialties. Scorecards assessing intraoperative and postoperative opioids, antiemetics, nonopioid analgesics, regional blocks, recovery time, and severe postoperative pain compared with peers were given to anesthesiologists with prefeedback and postfeedback surveys assessing their attitudes toward feedback. Before receiving their scorecard, 71% of providers predicted their performance was average, and 29% predicted their performance was above average. After receiving their scorecards, 42% rated their quality of recovery as worse than expected, 42% rated it as expected, and 16% rated it as better than expected. Thirteen percent disagreed, 44% were neutral, and 44% agreed that this feedback will change their practice. Implementing a scorecard of patientcentered measures that shows where an anesthesiologist stands in the distribution of their peers was well-received, provides a benchmark, and has the potential to change practice. [ABSTRACT FROM AUTHOR] more...

Objectives/hypothesis: Video laryngoscopy has grown tremendously in popularity over the last decade for management of the anticipated difficult airway. The use of video laryngoscopy has not been adequately studied in the head and neck pathology patient population, including those with masses, previous head and neck surgery, or radiation.Study Design: Prospective observational study.Methods: This study included 100 patients with head and neck pathology undergoing awake flexible bronchoscopic intubation for nonemergency surgery requiring general anesthesia. After the performance of awake flexible bronchoscopic intubation and induction of anesthesia, video laryngoscopy was performed with the CMAC D blade and Glidescope AVL. The primary outcome was the modified Cormack-Lehane view obtained on video laryngoscopy.Results: One hundred patients were enrolled in the study. After exclusions, 92 patients underwent video laryngoscopy with both the CMAC D blade and the Glidescope AVL. Thirty-seven patients (40.2%) had a Cormack-Lehane view ≥3 with the CMAC D blade, and 28 patients (30.4%) had a Cormack-Lehane view ≥3 with the Glidescope AVL. There were no complications from awake flexible bronchoscopic intubation or video laryngoscopy.Conclusions: There is a high incidence of inability to obtain a view of the glottis with video laryngoscopy in patients with head and neck pathology, particularly airway masses.Level Of Evidence: 3 Laryngoscope, 131:82-86, 2021. [ABSTRACT FROM AUTHOR] more...