Anesthesia Sedation: The After Affect

As we all know anesthesia comes in varying degrees. It can be conscious sedation, to monitored anesthesia care where the patient gets very little sedation to deep sedation. It can also be general anesthesia or combination of all of those mentioned with a regional technique.

Regardless of the type of anesthesia what we need to remember is this….anesthesia affects everyone differently. The onset of Propofol has made the outpatient anesthesia experience very pleasant for patients. If used as the sole source of anesthesia the patients wake quickly with little to no side-effects and are alert and oriented when they leave.However, when sedation is given by using a combination of benzodiazepines and narcotics; with or without Propofol, patients may respond differently post-procedure. 

Before patients can leave a facility they must meet the discharge criteria determined by that facility. Their vitals are stable, they can drink, go to the bathroom and ambulate without problems. They may feel a little groggy but they know what is going on and appear “normal.” The problem is there is really know way of knowing how the patient really feels. They will tell the nurses they feel fine and they probably do but ask them an hour later and they will not remember talking to the nurses.

The medications given in a combination anesthesia will cause amnesia and a lack of inhibition, like an intoxicated type state. The degrees of the state of inhibition may vary but this behavior is something that we as anesthesia clinicians need to be more conscious of. We tell people that they should not drive following sedation or general anesthesia; we tell them they should not make important, life changing decisions. But, do we tell them they should not get on the internet?

In a recent article I found the following incident that occurred:

“Recently, a patient’s husband was upset when his wife returned for a diagnostic test.  On further discussion, it was revealed that his concern wasn’t the quality of care, the size of the bill, the amount of the deductible, or the length of the wait, but the fact that his wife had spent a large amount on the Home Shopping Network (“HSN”) during the afternoon following her last procedures and sedation.”

After reading this I realized that we owe it to our patients to ensure that they truly understand the affects that anesthesia may have on them and advise them accordingly. In our high tech world we should stop and consider that people may get on line and shop

or even text people and say things they may not normally say. This could cause devastating consequences that ultimately we as clinicians could be responsible for.

Source: PhySynergy

Could White Coats Be Obsolete?

A new infection control recommendation could make white coats obsolete according to Newswise.com. 

In a move to reduce health care associated infections, certain attire for health care professionals, including the traditional white coat, could become a thing of the past.

“White coats, neckties, and wrist watches can become contaminated and may potentially serve as vehicles to carry germs from one patient to another,” said Mark Rupp, M.D., chief of the division of infectious diseases at the University of Nebraska Medical Center and one of the authors of recommendations issued by the Society for Healthcare Epidemiology of America (SHEA), one of the world’s top infection control organizations.

“However, it is unknown whether white coats and neck ties play any real role in transmission of infection,” said Dr. Rupp, who is a past president of SHEA. “Until better data are available, hospitals and doctor’s offices should first concentrate on well-known ways to prevent transmission of infection -- like hand hygiene, environmental cleaning, and careful attention to insertion and care of invasive devices like vascular catheters.”

Read the entire article here.

Stethoscopes Hold More Germs Than Doctors’ Hands, Study Says

While doctors and other medical professionals tend to put a great deal of emphasis on cleanliness and hand washing, a new study indicates that the number one tool that a doctors uses to interact with patients – a stethoscope – may actually hold more germs than his or her hands.

Surprisingly, the new report says that a typical stethoscope is generally cleaned less than once a month – if it gets cleaned at all.

The University of Geneva research team who conducted the study found that stethoscopes often hold just as much bacteria as the palms of doctors’ hands with only the tips of the fingers holding more.

To read the entire article visit Liberty Voice.

You can also view this segment from Fox News' Sunday House Call for more information.

How to Clean a Stethoscope

1. Remove the ear tips from the stethoscope.
2. Mix together a cup of one-fifth antibacterial soap and four-fifths water. Put the ear tips into this solution and allow them to sit for five minutes.
3. Remove the ear tips and rinse them off. Allow time for them to dry.
4. Wipe all areas of the stethoscope with 70 percent isopropyl alcohol wipes.
5. Put the ear tips back on the stethoscope when they are completely dry.

Read more at eHow.com.

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Patient Safety Awareness Week March 2-8

Patient safety is an issue that all medical professionals need to address. Anesthesia is no different than anyone else. Malpractice attorneys just cannot wait for an anesthesia provider to make a mistake. According to attorneys Meyers, Evans and Associates, the most common causes of anesthesia error during surgery are:

1. Overdose or under dose of anesthesia

2. Delayed delivery of anesthesia

3. Failure to avoid an allergic reaction if it could have reasonably been prevented.

4. Drug interactions complications

5. Failure to properly administer oxygen during surgery

6. Failure to properly monitor the patient

7. Use of defective medical equipment during sedation

So now ask yourself, are you performing inadequate anesthesia? Are you doing your best to provide the safest anesthesia for your patients? Can you say that any of the above items you have been guilty of doing?

As an anesthesia clinician I think there are several other items that could be added to the above list.

1. Labeling of syringes: There are numerous occasions at numerous facilities where I will see that medications are not being labeled, dated or initialed. It is so easy to place a label on a syringe.

2. Poor hand hygiene: The use of gloves is not only a safety issue for the patient but it is also to protect you as a clinician. So many times gloves are not even used. When gloves are used then they are used improperly.

Think….after you intubate a patient do you immediately remove your gloves or do you grab the circuit, bag, or any other part of the anesthesia machine with gloves that have been contaminated with patient secretions? How many times have you reached for your pen or now the computer key board with dirty gloves on? Then do you foam or wash your hands when you take your gloves off? Do you foam or wash your hands in between patient contact?

3. IV ports:  IV tubing….where has it been? Draped over the end of the stretcher or on the floor while rolling the patient to the OR? Have no idea what has occurred with the IV tubing if the patient has come from the medical floor from within the hospital. This is why it is important to clean the IV ports prior to injecting medications. Those IV ports are exposed to everything.

Patient safety should not be an occasional thought. It should be at the forefront of each anesthetic that we administer from the pre-operative evaluation all the way through to patient’s discharge from PACU.

We must help to remind each other of the safety issues we face every day for our patients.

Remember, a lot of times we are the “gate keeper” for our patients to ensure their surgical experience is not only optimal but of the highest quality and safety.

A Retrospective Study of A Gastroenterology Facility: Are the Patients Sicker?

With the ever increasing number of outpatient surgeries coupled with advancement in technology for non-invasive procedures and shorter acting anesthetics, more and more patients are being treated at freestanding surgery facilities. However, the trend in patient co-morbities has also risen, increasing the risk of providing anesthesia even though the procedures are so-called "low-risk". This makes one wonder are the patients being treated in freestanding surgery facilities really sicker than they appear? And therefore is their patient safety at risk?

In this excerpt from her dissertation titled A Retrospective Study of A Gastroenterology Facility:Are The Patients Sicker, Kim Riviello DNP, MBA/HCM, CRNA, President of ASG, will discuss the concerns for patient safety in freestanding surgery facilities, despite the procedures being considered "low-risk".

There has been substantial growth in the number of ambulatory surgery centers across the United States. With the advancement in technology for non-invasive procedures, and shorter acting anesthetics, more patients are being seen in the freestanding surgery facility (FSF). However, the trend in patient co-morbidities, i.e., obesity, diabetes, cardiac, and respiratory diseases has also risen, increasing the anesthetic risk even though low risk procedures are performed. The most common malpractice claims have been associated with diagnostic procedures performed in ambulatory surgery centers under monitored anesthesia care (MAC) with patient co-morbidities as contributing factors. The morbidity and mortality of ambulatory surgery patients has led to an increased concern for patient safety in freestanding facilities. Of particular concern is sedation, specifically in gastroenterology (GI) centers. Yet, the Journal of the American Medical Association (JAMA) recently reported that two-thirds of the anesthesia procedures provided during colonoscopies and endoscopies (EGDs) were on “low-risk patients;” suggesting the lack of need for professionally administered anesthesia in GI facilities and implying that specialist monitored anesthesia would contribute to the increased cost of these procedures (Liu, Waxman, Main, & Mattke, 2012). 

Download PDF to continue reading.