Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Point-of-care ultrasound for the pediatric regional anesthesiologist and pain specialist: a technique review.

Point-of-care ultrasound (PoCUS) has been well described for adult perioperative patients; however, the literature on children remains limited. Regional anesthesiologists have gained interest in expanding their clinical repertoire of PoCUS from regional anesthesia to increasing numbers of applications. This manuscript reviews and highlights emerging PoCUS applications that may improve the quality and safety of pediatric care.In infants and children, lung and airway PoCUS can be used to identify esophageal intubation, size airway devices such as endotracheal tubes, and rule in or out a pulmonary etiology for clinical decompensation. Gastric ultrasound can be used to stratify aspiration risk when nil-per-os compliance and gastric emptying are uncertain. Cardiac PoCUS imaging is useful to triage causes of undifferentiated hypotension or tachycardia and to determine reversible causes of cardiac arrest. Cardiac PoCUS can assess for pericardial effusion, gross ventricular systolic function, cardiac volume and filling, and gross valvular pathology. When PoCUS is used, a more rapid institution of problem-specific therapy with improved patient outcomes is demonstrated in the pediatric emergency medicine and critical care literature.Overall, PoCUS saves time, expedites the differential diagnosis, and helps direct therapy when used in infants and children. PoCUS is low risk and should be readily accessible to pediatric anesthesiologists in the operating room

Influence of the obtaining method on the properties of amorphous aluminum compounds

© 2019 by the authors. Amorphous aluminum compounds are formed during the synthesis of the γ -Al2O3 catalyst precursor. Amorphous compounds influence on the alumina catalyst variously due to different physicochemical properties, which depend on the method of their preparation. In this research, the comparative analysis of physicochemical properties of amorphous aluminum compounds that were obtained by the precipitation method, the thermal decomposition of aluminum nitrate, and alcoxide hydrolysis product were studied. It is the first time that a new method for calculating of quantitative phase composition of amorphous aluminum compounds using the X-ray powder diffraction, thermogravimetric and differential scanning calorimetry analysis, mass-spectrometry, and CHN-analysis was described. Properties of obtaining samples were studied using scanning electron microscopy, low-temperature nitrogen adsorption, and temperature programmed desorption of ammonium analyses. The methods of precipitation and thermal decomposition of aluminum nitrate allows for obtaining non-porous samples consisting of a mixture of amorphous phases (hydroxide and basic salt) that contain the metals impurities and have low acidity of the oxides obtained from them. The highly porous amorphous alumina formed by the thermal decomposition of the alcoxide hydrolysis product with the least amount of impurities and a high acidity of the surface was observed

Influence of the obtaining method on the properties of amorphous aluminum compounds

© 2019 by the authors. Amorphous aluminum compounds are formed during the synthesis of the γ -Al2O3 catalyst precursor. Amorphous compounds influence on the alumina catalyst variously due to different physicochemical properties, which depend on the method of their preparation. In this research, the comparative analysis of physicochemical properties of amorphous aluminum compounds that were obtained by the precipitation method, the thermal decomposition of aluminum nitrate, and alcoxide hydrolysis product were studied. It is the first time that a new method for calculating of quantitative phase composition of amorphous aluminum compounds using the X-ray powder diffraction, thermogravimetric and differential scanning calorimetry analysis, mass-spectrometry, and CHN-analysis was described. Properties of obtaining samples were studied using scanning electron microscopy, low-temperature nitrogen adsorption, and temperature programmed desorption of ammonium analyses. The methods of precipitation and thermal decomposition of aluminum nitrate allows for obtaining non-porous samples consisting of a mixture of amorphous phases (hydroxide and basic salt) that contain the metals impurities and have low acidity of the oxides obtained from them. The highly porous amorphous alumina formed by the thermal decomposition of the alcoxide hydrolysis product with the least amount of impurities and a high acidity of the surface was observed