Emerging Kids, Emerging Questions: Sugammadex Versus Neostigmine in the Pediatric Population No abstract available

Pediatric Liver Transplants: Now With Less Blood Loss! No abstract available

Two-Sample Unpaired t Tests in Medical Research No abstract available

Patient Blood Management in Pediatric Complex Cranial Vault Reconstruction: Time for Some Action No abstract available

Enhancing the Sounds of Urgency: Lessons From Music and Aviation on Human Response to Critical Auditory Stimuli No abstract available

Patient Satisfaction: Measuring the Association Between Anesthetic Management and Patient Experience No abstract available

Focused Cardiac Ultrasound in the Pediatric Perioperative Setting Focused cardiac ultrasonography (FoCUS) has become an important diagnostic tool for acute care physicians. FoCUS allows real-time visualization of the heart and, in combination with the physical examination, acts as a hemodynamic monitor to manage patient care in acute situations. Most of the available perioperative literature has focused on adult patients. Little has been published on the perioperative application of FoCUS for pediatric patients. This article provides an overview of FoCUS used at the bedside by pediatric anesthesiologists. Variations in clinical applications, technical aspects, and interpretation of FoCUS findings in children are described. Discussion of training and competency is included. Barriers to implementation by pediatric intensivists and emergency medicine physicians include a lack of understanding of indications and training opportunities in pediatric FoCUS. It is likely that similar barriers exist in pediatric anesthesiology resulting in underutilization of FoCUS. The use of FoCUS in the pediatric operating room, however, may positively impact care of infants and children and should be encouraged.

Development and Validation of an Electronic Postoperative Morbidity Score BACKGROUND: Electronic health records are being adopted due to numerous potential benefits. This requires the development of objective metrics to characterize morbidity, comparable to studies performed in centers without an electronic health record. We outline the development of an electronic version of the postoperative morbidity score for integration into our electronic health record. METHODS: Twohundred and three frail patients who underwent elective surgery were reviewed. We retrospectively defined postoperative morbidity score on postoperative day 3. We also recorded potential electronic surrogates for morbidities that could not be easily extracted in an objective format. We compared discriminative capability (area under the receiver operator curve) for patients having prolonged length of stay or complex discharge requirements. RESULTS: One hundred thirty-nine patients (68%) had morbidity in ≥1 postoperative morbidity score domain. Initial electronic surrogates were overly sensitive, identifying 173 patients (84%) as having morbidity. We refined our definitions using backward logistic regression against “gold-standard” postoperative morbidity score. The final electronic postoperative morbidity score differed from the initial version in its definition of cardiac and neurological morbidity. There was no significant difference in the discriminative capability between electronic postoperative morbidity score and postoperative morbidity score for either outcome (area under the receiver operator curve: 0.66 vs 0.66 for complex discharge requirement, area under the receiver operator curve: 0.66 vs 0.67 for a prolonged length of stay; P> .05 for both). Patients with postoperative morbidity score or electronic postoperative morbidity score–defined morbidity on day 3 had increased risk of prolonged length of stay (P < .001 for both). CONCLUSIONS: We present a variant of postoperative morbidity score based on objective electronic metrics. Discriminative performance appeared comparable to gold-standard definitions for discharge outcomes. Electronic postoperative morbidity score may allow characterization of morbidity within our electronic health record, but further study is required to assess external validity.

Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials BACKGROUND: Perioperative IV dextrose infusions have been investigated for their potential to reduce the risk of postoperative nausea and vomiting. In this meta-analysis, we investigated the use of an intraoperative or postoperative infusion of dextrose for the prevention of postoperative nausea and vomiting. METHODS: Our group searched PubMed, Embase, Cochrane library, and Google Scholar for relevant randomized controlled trials examining the use of perioperative IV dextrose for prevention of postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting (both in the postanesthesia care unit and within the first 24 h of surgery). Secondary outcomes included postoperative antiemetic administration and serum glucose level. RESULTS: Our search yielded a total of 10 randomized controlled trials (n = 987 patients) comparing the use of a perioperative dextrose infusion (n = 465) to control (n = 522). Perioperative dextrose infusion was not associated with a significant reduction in postoperative nausea and vomiting in the postanesthesia care unit (risk ratio = 0.91, 95% CI, 0.73–1.15; P = .44) or within the first 24 h (risk ratio = 0.76, 95% CI, 0.55–1.04; P = .09) of surgery. Although the use of dextrose was associated with a significant reduction in antiemetic administration within the first 24 h (risk ratio = 0.55, 95% CI, 0.45–0.69; P < .001), it also increased postoperative plasma glucose levels compared to controls. CONCLUSIONS: The use of perioperative dextrose did not result in a statistically significant association with postoperative nausea and vomiting. When utilized, plasma glucose monitoring is recommended to assess for postoperative hyperglycemia. Further prospective trials are necessary to examine the potential impact of timing of administration of a dextrose infusion on incidence of postoperative nausea and vomiting and rescue antiemetic requirements.

Factors Affecting Patient Satisfaction With Their Anesthesiologist: An Analysis of 51,676 Surveys From a Large Multihospital Practice BACKGROUND: An increasing focus of health care quality is the assessment of patient-reported outcomes, including satisfaction. Because anesthesia care occurs in the context of perioperative surgical care, direct associations between anesthetic management and patient experience may be difficult to identify. We analyzed anesthesia-specific patient satisfaction survey data from a large private practice group to identify patient, procedure, and anesthetic-specific predictors of patient satisfaction with their anesthesiologist, measured via responses to a validated patient satisfaction survey instrument. We hypothesized that some factors governing satisfaction with an anesthesia provider are beyond their ability to control. METHODS: We retrospectively reviewed responses to the Anesthesia Patient Satisfaction Questionnaire (APSQ), administered online to patients cared for by US Anesthesia Partners, a multistate anesthesia group practice. The APSQ focuses on patient satisfaction with their anesthesiologist and patient-reported outcomes and is administered after discharge. Responses from May to November 2016 were aggregated, and relationships between responses and patient, procedural, and clinician-related factors were assessed using multivariable logistic regression. RESULTS: Out of 629,220 adult patients cared for during the study period, 51,676 responded to the survey request for a 9.3% overall response rate for patients. Nonresponders were slightly older and more likely to be male than responders. After multivariable regression, no patient or procedural factor was associated with patient rating of their anesthesiologist. However, ≥55 years of age, inpatient (versus outpatient) setting, and nighttime surgery (between 6 pm and 6 am) were associated with lower scores on other satisfaction questions. CONCLUSIONS: Our data suggest that some factors governing satisfaction with an anesthesia provider are beyond their ability to control. Further work is needed to identify elements of patient satisfaction with their anesthesiologist and to optimize these aspects of perioperative care.