Outcomes Reporting in Regional Anesthesia Patients: A Comparison of Manual Phone Calls Versus Automated Phone App Messaging

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure. As part of normal follow up, anesthesia team members contact surgical patients who have received a regional nerve block to assess for potential side effects or complications. This study is comparing two different modes patient outreach. Patients will be randomized to receive either a manual phone call from a member of the anesthesia care team or the APO treatment. Of patients randomized to the APO treatment, automated messages will request the patient to download the “JeffAnesthesia” app and answer post-care surveys. Both treatment arms will contain the same survey questions. The primary endpoint, the follow-up success rate defined by a patient completing a set of survey questions, will be compared. Secondary endpoints, such as patient satisfaction, will also be recorded from the survey responses. Patient enrollment is ongoing, and data to formulate preliminary results is forthcoming to understand the impact of outreach modalities on patient outcomes reporting and satisfaction

High concentration versus incremental induction of anesthesia with sevoflurane in children: A comparison of induction times, vital signs, and complications

Study Objective: To compare sevoflurane induction times and complications in children during a high concentration, primed-circuit method and an incremental induction technique. Design: Randomized, prospective open-label study. Setting: Academic university hospital. Patients: 40 unpremeditated ASA physical status I and II children age 4 months to 15 years undergoing elective surgical procedures with general anesthesia. Interventions: Patients were randomized to one of two study groups. In the high concentration group, the anesthesia circuit was primed with 8% sevoflurane in a 2:1 nitrous oxide:oxygen (N 2O:O 2) mixture. Patients breathed this gas mixture spontaneously until loss of the eyelash reflex. In the incremental group, the face mask was applied and 1% sevoflurane in a 2:1 N 2O:O 2 mixture was administered. In this group, the sevoflurane concentration was increased by 1% every 2 to 3 breaths. Gas flows of 6 L/min were administered to both groups during the study period. Following loss of the eyelash reflex, the sevoflurane concentration was decreased to 5% until a depth of anesthesia sufficient to start an intravenous catheter was achieved. Measurements and Main Results: Induction cooperation, induction time (face mask application to loss of the eyelash reflex), one-minute vital signs [blood pressure, heart rate, oxygen saturation via pulse oximetry (SpO 2)], induction complications. Induction of anesthesia was faster in the high concentration group than in the incremental group (mean (SD) 42 (9) sec vs. 66 (12) sec, respectively; p < 0.001). Induction complications were minor and occurred with similar frequencies ( 4 20 patients vs. 3 20 patients). There were no significant intergroup heart rate, blood pressure, or SpO 2 differences during induction. No patients required treatment for hypotension or bradycardia. Conclusions: In healthy pediatric patients undergoing mask induction of general anesthesia with sevoflurane, the induction time can be significantly shortened without an increase in the frequency of airway or vital sign complications using a high concentration, primed circuit technique compared with a conventional, incremental induction method

Clinical Accuracy of a Hospital Point-of-Care Glucose Meter

Summary: Glucose meter performance was evaluated against the ISO 15197 guidelines in 221 time-matched venous and capillary blood samples. Accuracy decreased when the source of the reference and meter blood samples was not the same

Do heated humidifiers and heat and moisture exchangers prevent temperature drop during lower abdominal surgery?

Study Objective: To compare the effects of using a heated humidifier (HH), a heat and moisture exchanger (HME), or no warming device in maintaining body temperature during surgical procedures of 1 to 4 hours' duration. Design: A randomized, controlled study. Setting: Operating room, Thomas Jefferson University Hospital, Philadelphia, PA. Patients: 51 ASA physical status I, II, and III patients, age 16 to 69 years, scheduled, for a variety of lower abdominal procedures under general endotracheal anesthesia anticipated to last 1 to 4 hours. Interventions: We randomly assigned patients to receiving an IIH, an HME, or no warming device during the procedure. We then measured the patient's sublingual temperature every 5 minutes prior to induction, every 15 minutes intraoperatively, and every 15 minutes postoperatively until he or she was discharged from the postanesthesia care unit, (PACU). We also measured the esophageal temperature every 15 minutes intraoperatively. Measurements and Main Results: Sublingual temperature or esophageal temperature probes placed at the site of maximal heart tones indicated that the patients' temperatures dropped significantly from baseline values in all three groups during the first 60 minutes of surgery, then remained constant during the next 120 minutes of surgery. Patients who had no warming device shivered and felt cold significantly more often than patients in the HH group but not more often than patients in the HME group. There was no difference in shivering between the HH and HME groups. The patients who received an HH tended to have a higher temperature (a mean of 0.5°C) throughout the study, but this did not reach statistical significance. Conclusions: Results indicate that these warming devices provide little benefit in preventing a temperature drop during procedures of 1 to 4 hours' duration, although patients with an HH tended to have a higher temperature than those with an HME or no device

Sevoflurane versus halothane for general anesthesia in pediatric patients: A comparative study of vital signs, induction, and emergence

Study Objective: To compare vital signs and the speed of induction and emergence with sevoflurane versus halothane in pediatric patients. Design: Prospective, randomized, open study. Setting: Thomas Jefferson University Hospital. Patients: 40 unpremedicated ASA Physical Status I and II children age 9 months to 16 years undergoing elective inpatient otorhinolaryngologic or orthopedic surgery. Interventions: Standardized induction of anesthesia with sevoflurane (start: 1%, maximum: 7%) or halothane (start: 0.5%, maximum: 5%) in nitrous oxide/oxygen ( N 2O O 2 ). Intubation following vecuronium and 4 minutes of controlled ventilation with 2 minimum alveolar concentration (MAC) drug in O 2; 1.5 MAC drug in N 2O O 2 delivered for 20 minutes; then 0.75 MAC until the end of surgery. Fentanyl 1 mcg/kg was administered 15 minutes before the anticipated end of surgery, at which time anesthetics were stopped and mechanical ventilation continued until eye opening (emergence). Measurements and Main Results: Blood pressure, heart rate (HR), oxygen saturation, end-tidal gas concentrations, and temperature were recorded. Induction and emergence times were measured to the nearest second. Induction (loss of eyelash reflex) was faster with sevoflurane (97 ± 31 sec) than halothane (120 ± 36 sec; p < 0.05), despite a lower inspired sevoflurane MAC. Emergence was faster with sevoflurane (9.9 ± 2.9 min vs. 12.5 ± 4.7 min; p < 0.05), despite a higher MAC multiple of end-tidal sevoflurane concentration at the end of surgery. Following intubation, HR (compared with the preinduction value in the operating room) was significantly higher in the halothane group (136.8% ± 16.3% vs. 115.0% ± 25.6%), as was mean arterial pressure (113.2% ± 25.5% vs. 87.8% ± 22.6%). This finding corresponded with a higher MAC multiple of end-tidal concentration in the sevoflurane group than in the halothane group. Conclusion: Induction of and emergence from anesthesia was faster with sevoflurane than halothane. Airway complications were low in both groups. Vital signs were stable with sevoflurane during maintenance. Sevoflurane is an excellent drug for inhalation induction in pediatric patients

The Safety and Efficacy of Oral Transmucosal Fentanyl Citrate for Preoperative Sedation in Young Children

Oral transmucosal fentanyl citrate (OTFC) is a labeled preoperative pediatric sedative.Doses greater than 15 micro g/kg are associated with a high incidence of postoperative nausea and vomiting and occasional respiratory depression. We studied the safety and efficacy of OTFC in children 6 yr old and younger at a dose of 15 micro g/kg. Nineteen patients undergoing surgery associated with postoperative pain were randomized to receive OTFC/intravenous (IV) saline or placebo lozenge/IV fentanyl. After 45 min, patients receiving OTFC became more sedated than the placebo group, but there were no differences in cooperation, apprehension, parental separation, or induction cooperation scores. Preoperatively, neither respiratory depression nor oxygen desaturation occurred. Nine of 10 OTFC patients developed mild pruritus, and three of 10 OTFC patients vomited preoperatively; neither complication occurred in the placebo group. (The high incidence of preoperative vomiting led to the termination of the protocol before the anticipated enrollment of 40 patients.) General anesthesia was induced via a mask, followed by a propofol infusion. SpO2 and respiratory rate were monitored, and sedation, apprehension, cooperation, ease of parental separation, and induction cooperation were scored. One OTFC patient developed rigidity during induction. Emergence and recovery were not delayed by OTFC despite a 50% incidence of postoperative vomiting. We do not recommend the use of OTFC in a 15-micro g/kg dose as a routine preoperative sedative in children 6 yr old and younger.(Anesth Analg 1996;83:1200-5