BOOK
Anesthesia Outside the Operating Room, An Issue of Anesthesiology Clinics, E-Book
Mark S. Weiss | Wendy L. Gross
(2017)
Additional Information
Book Details
Abstract
This issue of Anesthesiology Clinics focuses on Anesthesia Out of the Operating Room. Editors Mark Weiss and Wendy Gross have assembled an expert team of authors on topics such as: A Changing Landscape: Demands of Integrated Care Delivery: Interventional Medicine and Anesthesiology: Engineering Challenges and Interdisciplinary Teamwork; Organizational Infrastructure: Attaining and Teaching Clinical Excellence. Improvement across specialties by implementing an “Institute” mentality in the clinical arena; Quality: Who’s rules apply?; Electronic Health Records; Monitoring; Interventional Radiology (NOT RADIATION): (Safety/Tumor Ablation/Adult radiology/ equipment); Approaches to Vascular Disease; Cath Lab: Structural Heart Disease, Devices and TAVR; EP Lab; Cardioversions and TEEs; Upper GI EGD and new procedures; Colonoscopy and new procedures anesthesiologist and GI person; Endoscopic Surgery, repair of surgical procedures, bariatric procedures; Interventional Pulmonology; Pediatrics; Market Evaluation; Finances, Bundled Payments and ACOs; Competitive Strategy or Joint Venture Finance: potential threats and likely future scenarios.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Anesthesia Outsidethe Operating Room\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | ix | ||
| Foreword: Anesthesia Outside of the Operating Room: The Wild West or the New Frontier? | ix | ||
| Preface: Anesthesia Outside the Operating Room | ix | ||
| Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology: Interdisciplinary Teamwork and Strategy | ix | ||
| Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence | ix | ||
| Safety of Non–Operating Room Anesthesia: A Closed Claims Update | ix | ||
| Implementation and Use of Anesthesia Information Management Systems for Non–Operating Room Locations | x | ||
| Monitoring for Nonoperating Room Anesthesia | x | ||
| Use of Anesthesiology Services in Radiology | x | ||
| An Anesthesiologist’s View of Tumor Ablation in the Radiology Suite | x | ||
| A Radiologist’s View of Tumor Ablation in the Radiology Suite | xi | ||
| Catheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement | xi | ||
| Anesthesia in the Electrophysiology Laboratory | xi | ||
| Cardioversions and Transthoracic Echocardiography | xii | ||
| Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures | xii | ||
| Anesthesia for Colonoscopy and Lower Endoscopic Procedures | xii | ||
| Interventional Pulmonology | xii | ||
| Pediatric Anesthesia Considerations for Interventional Radiology | xiii | ||
| Market Evaluation: Finances, Bundled Payments, and Accountable Care Organizations | xiii | ||
| Value-Based Care and Strategic Priorities | xiii | ||
| ANESTHESIOLOGY CLINICS\r | xiv | ||
| FORTHCOMING ISSUES | xiv | ||
| March 2018 | xiv | ||
| June 2018 | xiv | ||
| September 2018 | xiv | ||
| RECENT ISSUES | xiv | ||
| September 2017 | xiv | ||
| June 2017 | xiv | ||
| March 2017 | xiv | ||
| Foreword:\rAnesthesia Outside of the Operating Room: The Wild West or the New Frontier? | xv | ||
| Preface:\rAnesthesia Outside the Operating Room | xvii | ||
| Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology | 555 | ||
| Key points | 555 | ||
| REFERENCES | 558 | ||
| Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence | 559 | ||
| Key points | 559 | ||
| ESTABLISHING COMPREHENSIVE TEAMS | 560 | ||
| STANDARDS FOR THE WORK ENVIRONMENT | 562 | ||
| TEACHING CLINICAL EXCELLENCE | 563 | ||
| QUALITY IMPROVEMENT | 565 | ||
| Leadership Commitment to Quality Improvement | 565 | ||
| Safety Reporting | 566 | ||
| Using Data: Electronic Medical Records and Dashboards | 566 | ||
| SUMMARY | 567 | ||
| REFERENCES | 567 | ||
| Safety of Non–Operating Room Anesthesia | 569 | ||
| Key points | 569 | ||
| INTRODUCTION | 569 | ||
| METHODS | 570 | ||
| Closed Claims Project Methodology | 570 | ||
| Statistical Analysis | 571 | ||
| RESULTS | 571 | ||
| Patient and Case Characteristics | 571 | ||
| Non–Operating Room Anesthesia Care Claims by Specific Location and Anesthetic Technique | 571 | ||
| Common Complications and Severity of Injuries | 571 | ||
| Mechanisms of Injury | 571 | ||
| Characteristics of Non–Operating Room Anesthesia Care Claims Associated with Oversedation | 572 | ||
| Non–Operating Room Anesthesia Care Cases in National Anesthesia Clinical Outcomes Registry Versus Claims | 573 | ||
| Preventability of Injury and Liability | 574 | ||
| DISCUSSION | 574 | ||
| Greater Relative Risk in Cardiology and Radiology Locations | 575 | ||
| Predominance of Respiratory Adverse Events and Monitoring Requirements | 576 | ||
| Overall Safety and Risk | 577 | ||
| Changing Trends in Non–Operating Room Anesthesia and Opportunities for Future Data Collection | 578 | ||
| Alternative Sources of Non–Operating Room Anesthesia Outcomes Data: Pediatric Sedation Consortium | 578 | ||
| Limitations in Data Comparison | 579 | ||
| SUMMARY | 579 | ||
| REFERENCES | 580 | ||
| Implementation and Use of Anesthesia Information Management Systems for Non–operating Room Locations | 583 | ||
| Key points | 583 | ||
| INTRODUCTION | 583 | ||
| PREOPERATIVE WORKFLOW | 585 | ||
| Replacing the Paper Chart | 585 | ||
| Increasing Preparedness and Reducing Delays | 585 | ||
| Facilitating Emergent Procedures | 586 | ||
| INTRAPROCEDURE WORKFLOW | 586 | ||
| Challenging Work Environments | 586 | ||
| Intraprocedure Documentation | 586 | ||
| Support Aids | 587 | ||
| Care Coordination | 587 | ||
| CURRENT ISSUES AND FUTURE DIRECTIONS | 587 | ||
| Anesthesia Information Management Systems | 588 | ||
| Steep Learning Curves | 589 | ||
| Siloed Services | 589 | ||
| Plug and Play | 589 | ||
| Real-Time Decision Aids | 589 | ||
| SUMMARY | 589 | ||
| REFERENCES | 590 | ||
| Monitoring for Nonoperating Room Anesthesia | 591 | ||
| Key points | 591 | ||
| INTRODUCTION | 591 | ||
| PULSE OXIMETRY | 592 | ||
| CAPNOGRAPHY | 593 | ||
| ELECTROCARDIOGRAM | 593 | ||
| NONINVASIVE BLOOD PRESSURE | 594 | ||
| TEMPERATURE | 594 | ||
| ADVANCED MONITORS | 594 | ||
| Invasive Intravascular Monitoring | 594 | ||
| Near Infrared Spectroscopy | 595 | ||
| Bispectral Index Monitoring | 595 | ||
| SITE-SPECIFIC MONITORING CONSIDERATIONS | 595 | ||
| Magnetic Resonance Imaging | 595 | ||
| Endoscopy Suite | 596 | ||
| Cardiac Catheterization Laboratory | 596 | ||
| Hyperbaric Oxygen Chamber | 596 | ||
| Office-Based Anesthesia | 597 | ||
| Intensive Care Unit | 597 | ||
| SUMMARY | 597 | ||
| REFERENCES | 597 | ||
| Use of Anesthesiology Services in Radiology | 601 | ||
| Key points | 601 | ||
| INTRODUCTION | 601 | ||
| AMERICAN COLLEGE OF RADIOLOGY AND SOCIETY OF INTERVENTIONAL RADIOLOGY PRACTICE PARAMETER ON SEDATION AND ANALGESIA | 602 | ||
| CONSIDERATIONS FOR ANESTHESIOLOGY CONSULTATION | 603 | ||
| USE TRENDS AND PROCEDURAL NEEDS | 604 | ||
| UNDERSTANDING THE INTRICACIES OF INTERVENTIONAL RADIOLOGY PROCEDURES AND THE INTERVENTIONAL RADIOLOGY SUITE | 605 | ||
| COMMUNICATION AND COLLABORATION FOR PROCEDURE PLANNING | 606 | ||
| POSTPROCEDURE CARE | 608 | ||
| FUTURE AREAS FOR IMPROVEMENT | 608 | ||
| REFERENCES | 609 | ||
| An Anesthesiologist’s View of Tumor Ablation in the Radiology Suite | 611 | ||
| Key points | 611 | ||
| INTRODUCTION | 611 | ||
| CHEMICAL ABLATION | 612 | ||
| RADIOFREQUENCY ABLATION | 612 | ||
| CRYOABLATION | 613 | ||
| IRREVERSIBLE ELECTROPORATION | 613 | ||
| INTERSTITIAL THERMAL THERAPY) FOR EPILEPSY AND BRAIN TUMORS | 614 | ||
| SUMMARY | 614 | ||
| REFERENCES | 614 | ||
| A Radiologist’s View of Tumor Ablation in the Radiology Suite | 617 | ||
| Key points | 617 | ||
| INTRODUCTION | 617 | ||
| ABLATION TECHNIQUES | 618 | ||
| Radiofrequency Ablation | 618 | ||
| Microwave Ablation | 618 | ||
| Cryoablation | 618 | ||
| Postprocedural Management and Potential Complications | 619 | ||
| IMAGING GUIDANCE MODALITIES | 619 | ||
| Computed Tomography | 619 | ||
| PET-Computed Tomography | 620 | ||
| Ultrasound Imaging | 620 | ||
| MRI | 621 | ||
| IMPLICATIONS FOR ANESTHESIA | 621 | ||
| Positioning in the Interventional Suite | 621 | ||
| Patient Monitoring | 622 | ||
| Sedation and Pain Management | 622 | ||
| Personnel Safety | 623 | ||
| Ablation of Adrenal Masses | 623 | ||
| SUMMARY | 624 | ||
| REFERENCES | 624 | ||
| Catheterization Laboratory | 627 | ||
| Key points | 627 | ||
| INTRODUCTION | 627 | ||
| AORTIC STENOSIS | 628 | ||
| INTRODUCTION TO TRANSCATHETER AORTIC VALVE REPLACEMENT | 628 | ||
| TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS MEDICAL THERAPY | 629 | ||
| TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL THERAPY | 629 | ||
| ROUTES OF DELIVERY | 629 | ||
| TYPES OF TRANSCATHETER AORTIC VALVE REPLACEMENT VALVES | 630 | ||
| Edwards SAPIEN System | 630 | ||
| Medtronic CoreValve Revalving System | 630 | ||
| COMPARISON OF TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTIC VALVE REPLACEMENT | 630 | ||
| FUTURE DIRECTIONS FOR TRANSCATHETER AORTIC VALVE REPLACEMENT | 630 | ||
| ANESTHESIA PREEVALUATION | 631 | ||
| MONITORING | 633 | ||
| PROCEDURE | 633 | ||
| ENDOVASCULAR EDGE-TO-EDGE MITRAL VALVE REPAIR PROCEDURE | 634 | ||
| LEFT ATRIAL APPENDAGE CLOSURE DEVICE | 635 | ||
| CLOSING | 636 | ||
| REFERENCES | 637 | ||
| Anesthesia in the Electrophysiology Laboratory | 641 | ||
| Key points | 641 | ||
| INTRODUCTION | 641 | ||
| PREPROCEDURAL PLANNING | 642 | ||
| ANTICIPATED CHALLENGES | 643 | ||
| SEDATION | 644 | ||
| GENERAL ANESTHESIA | 646 | ||
| BETA-ADRENERGIC STIMULATION FOR ARRHYTHMIA INDUCTION AND TESTING | 647 | ||
| EFFECTS OF RESPIRATORY MOTION ON CATHETER STABILITY | 647 | ||
| MONITORING BRAIN PERFUSION DURING VENTRICULAR TACHYCARDIA | 650 | ||
| HEMODYNAMIC SUPPORT | 650 | ||
| SUMMARY | 651 | ||
| SUPPLEMENTARY DATA | 651 | ||
| REFERENCES | 651 | ||
| Cardioversions and Transthoracic Echocardiography | 655 | ||
| Key points | 655 | ||
| Atrial Flutter | 655 | ||
| Treatment | 656 | ||
| Atrial Fibrillation | 656 | ||
| Classification | 656 | ||
| Pathophysiology | 657 | ||
| Treatment | 657 | ||
| Cardioversion | 657 | ||
| Intraoperative | 659 | ||
| Postcardioversion | 661 | ||
| Complications | 661 | ||
| Recovery | 662 | ||
| Emergency Cardioversion | 662 | ||
| Anesthesia for Transesophageal Echocardiography | 663 | ||
| REFERENCES | 665 | ||
| Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures | 669 | ||
| Key points | 669 | ||
| INTRODUCTION | 669 | ||
| OPERATING ROOM COMMUNICATION | 670 | ||
| PHARMACOLOGIC STRATEGIES | 671 | ||
| NONPHARMACOLOGIC STRATEGIES | 671 | ||
| GASTROINTESTINAL PROCEDURES | 671 | ||
| Routine Esophagogastroduodenostomy | 671 | ||
| Advanced Upper Gastrointestinal Procedures | 672 | ||
| Balloon-Assisted Deep Enteroscopy | 673 | ||
| Endoscopic Ultrasound | 674 | ||
| Endoscopic Retrograde Cholangiopancreatography | 674 | ||
| Natural Orifice Transluminal Endoscopic Surgery | 675 | ||
| Endoscopic cystgastrostomy | 675 | ||
| Per-Oral Endoscopic Myotomy | 675 | ||
| SUMMARY | 676 | ||
| REFERENCES | 676 | ||
| Anesthesia for Colonoscopy and Lower Endoscopic Procedures | 679 | ||
| Key points | 679 | ||
| INTRODUCTION | 679 | ||
| SEDATION PRACTICE FOR LOWER ENDOSCOPY | 680 | ||
| QUALITY, SAFETY, AND OUTCOMES | 682 | ||
| UTILIZATION, COST, AND REIMBURSEMENT | 684 | ||
| SUMMARY | 685 | ||
| REFERENCES | 685 | ||
| Interventional Pulmonology | 687 | ||
| Key points | 687 | ||
| AIRWAY ACCESS | 688 | ||
| Supraglottic Airway Devices | 688 | ||
| Endotracheal Tube | 688 | ||
| Rigid Bronchoscopy | 689 | ||
| Tracheostomy Patients | 690 | ||
| Tracheoesophageal Fistula | 691 | ||
| Central Airway Obstruction | 691 | ||
| APPROACHES TO SEDATION | 692 | ||
| Awake Methods | 692 | ||
| Moderate (Conscious) Sedation | 692 | ||
| Deep Sedation | 693 | ||
| General Anesthesia | 693 | ||
| Topical Anesthesia | 693 | ||
| Precautions in Critical Airway Obstruction | 694 | ||
| Critical tracheal stenosis | 694 | ||
| Mediastinal mass | 694 | ||
| Laryngospasm | 694 | ||
| VENTILATION | 695 | ||
| Ventilation Using the Jet Ventilator | 695 | ||
| SUMMARY | 697 | ||
| REFERENCES | 697 | ||
| Pediatric Anesthesia Considerations for Interventional Radiology | 701 | ||
| Key points | 701 | ||
| INTRODUCTION | 701 | ||
| PEDIATRIC AND PATIENT-SPECIFIC CONSIDERATIONS | 702 | ||
| Oncology Patients | 702 | ||
| Conjoined Twins | 702 | ||
| PROCEDURE-SPECIFIC CONSIDERATIONS | 703 | ||
| Interventional Radiology | 703 | ||
| Nonvascular Procedures | 703 | ||
| Placement of Drainage Catheters | 703 | ||
| Biopsies | 704 | ||
| Biopsy in Patients with an Anterior Mediastinal Mass | 704 | ||
| Vascular Procedures | 706 | ||
| Percutaneously Inserted Central Catheter Lines, Central Venous Catheters, and Indwelling Ports | 706 | ||
| Vascular Imaging Procedures | 707 | ||
| Vascular Malformations | 707 | ||
| Neuroendovascular Tumor Embolization | 709 | ||
| Ophthalmic Artery Chemosurgery | 709 | ||
| Exposure to Radiation | 710 | ||
| Adverse Reactions to Radiographic Contrast Media | 711 | ||
| SUMMARY | 712 | ||
| REFERENCES | 712 | ||
| Market Evaluation | 715 | ||
| Key points | 715 | ||
| INTRODUCTION | 715 | ||
| EVOLUTION OF HEALTH INSURANCE IN THE UNITED STATES | 716 | ||
| TRANSITION FROM HOSPITAL-BASED SURGERIES TO AMBULATORY SURGICAL CENTERS | 717 | ||
| OUTPATIENT CARE COORDINATION | 718 | ||
| PATIENT-CENTERED MEDICAL AND SURGICAL HOMES | 719 | ||
| BUNDLED PAYMENTS | 719 | ||
| ACCOUNTABLE CARE ORGANIZATIONS | 720 | ||
| THE MEDICARE ACCESS AND CHILDREN'S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT | 721 | ||
| PROLIFERATION OF NEW PAYMENT MODELS | 722 | ||
| FUTURE DIRECTIONS | 722 | ||
| REFERENCES | 722 | ||
| Value-Based Care and Strategic Priorities | 725 | ||
| Key points | 725 | ||
| THEORY OF THE BUSINESS | 726 | ||
| Market Forces and Analysis | 727 | ||
| Buyers | 727 | ||
| Suppliers | 727 | ||
| Quality | 728 | ||
| Barriers to entry | 728 | ||
| Substitution | 728 | ||
| Rivalry | 728 | ||
| STRATEGIC PRIORITIES | 729 | ||
| OPERATIONAL EFFECTIVENESS | 729 | ||
| VALUE, COST, AND OUTCOMES | 729 | ||
| STRATEGIC POSITION | 730 | ||
| TEAMWORK AND FINANCIAL SILOS | 730 | ||
| KEY ELEMENTS OF SUSTAINABLE STRATEGY | 730 | ||
| REFERENCES | 731 |