Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Editorial

Advances in anesthesia technology are improving patient care, but many challenges remain

Authors: D. John Doyle, Ashraf A. Dahaba, Yannick LeManach

Published in: BMC Anesthesiology | Issue 1/2018

Login to get access

Abstract

Although significant advances in clinical monitoring technology and clinical practice development have taken place in the last several decades, in this editorial we argue that much more still needs to be done. We begin by identifying many of the improvements in perioperative technology that have become available in recent years; these include electroencephalographic depth of anesthesia monitoring, bedside ultrasonography, advanced neuromuscular transmission monitoring systems, and other developments. We then discuss some of the perioperative technical challenges that remain to be satisfactorily addressed, such as products that incorporate poor software design or offer a confusing user interface. Finally we suggest that the journal support initiatives to help remedy this problem by publishing reports on the evaluation of medical equipment as a means to restore the link between clinical research and clinical end-users.
Literature
1.
Pedersen T, Nicholson A, Hovhannisyan K, Møller AM, Smith AF, Lewis SR. Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev. 2014 Mar 17;3:CD002013.
2.
Imhoff M, Kuhls S, Gather U, Fried R. Smart alarms from medical devices in the OR and ICU. Best Pract Res Clin Anaesthesiol. 2009 Mar;23(1):39–50.CrossRefPubMed
3.
4.
Johnson KR, Hagadorn JI, Sink DW. Alarm safety and alarm fatigue. Clin Perinatol. 2017 Sep;44(3):713–28.CrossRefPubMed
5.
Tang R, Ranmuthugala G, Cunningham F. Surgical safety checklists: a review. ANZ J Surg. 2014 Mar;84(3):148–54.CrossRefPubMed
6.
Staender S, Smith A. Enhancing the quality and safety of the perioperative patient. Curr Opin Anaesthesiol. 2017 Dec;30(6):730–5.CrossRefPubMed
7.
8.
Bose E, Hoffman L, Hravnak M. Monitoring cardiorespiratory instability: current approaches and implications for nursing practice. Intensive Crit Care Nurs. 2016 Jun;34:73–80.CrossRefPubMedPubMedCentral
9.
10.
Kroll RR, McKenzie ED, Boyd JG, Sheth P, Howes D, Wood M, et al. Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study. J Intensive Care. 2017 Nov 21;5:64.CrossRefPubMedPubMedCentral
11.
Stark AP, Maciel RC, Sheppard W, Sacks G, Hines OJ. An early warning score predicts risk of death after in-hospital cardiopulmonary arrest in surgical patients. Am Surg. 2015 Oct;81(10):916–21.PubMed
12.
13.
Wright SM. Patient safety in anesthesia: learning from the culture of high-reliability organizations. Crit Care Nurs Clin North Am. 2015 Mar;27(1):1–16.CrossRefPubMed
14.
Krombach JW, Marks JD, Dubowitz G, Radke OC. Development and implementation of checklists for routine anesthesia care: a proposal for improving patient safety. Anesth Analg. 2015 Oct;121(4):1097–103.CrossRefPubMed
15.
Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb;118(2):251–70.CrossRefPubMed
16.
Merchant R, Chartrand D, Dain S, Dobson G, Kurrek MM, Lagacé A, et al. Guidelines to the practice of anesthesia - revised edition 2016. Can J Anaesth. 2016 Jan;63(1):86–112.CrossRefPubMed
17.
Hamzaoui O, Monnet X, Teboul JL. Evolving concepts of hemodynamic monitoring for critically ill patients. Indian J Crit Care Med. 2015 Apr;19(4):220–6.CrossRefPubMedPubMedCentral
18.
Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013 Jan 17;368(3):246–53.CrossRefPubMed
19.
Low D, Walker I, Heitmiller ES, Kurth D. Implementing checklists in the operating room. Paediatr Anaesth. 2012 Oct;22(10):1025–31.CrossRefPubMed
20.
Rosenfield LK, Chang DS. The error of omission: a simple checklist approach for improving operating room safety. Plast Reconstr Surg. 2009 Jan;123(1):399–402.CrossRefPubMed
21.
Boat AC, Spaeth JP. Handoff checklists improve the reliability of patient handoffs in the operating room and postanesthesia care unit. Paediatr Anaesth. 2013 Jul;23(7):647–54.CrossRefPubMed
22.
Erestam S, Haglind E, Bock D, Andersson AE, Angenete E. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study. Patient Saf Surg. 2017 Jan 31;11:4.CrossRefPubMedPubMedCentral
23.
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491–9.CrossRefPubMed
24.
McGill J. Airway management in trauma: an update. Emerg Med Clin North Am. 2007;25(3):603–22. viiCrossRefPubMed
25.
Frova G, Sorbello M. Algorithms for difficult airway management: a review. Minerva Anestesiol. 2009 Apr;75(4):201–9.PubMed
26.
27.
Bjoernsen LP, Lindsay B. Video laryngoscopy in the prehospital setting. Prehosp Disaster Med. 2009 Jun;24(3):265–70.CrossRefPubMed
28.
Aziz MF, Kim D, Mako J, Hand K, Brambrink AM. A retrospective study of the performance of video laryngoscopy in an obstetric unit. Anesth Analg. 2012 Oct;115(4):904–6.CrossRefPubMed
29.
30.
Russo SG, Weiss M, Eich C. Video laryngoscopy olé! Time to say good bye to direct and flexible intubation? Anaesthesist. 2012 Dec;61(12):1017–26.CrossRefPubMed
31.
Xue FS, Liu GP, Sun C, Li RP. Comparing emergency intubation with direct and video laryngoscopy. Acad Emerg Med. 2016 May 14;23(6):747–8.CrossRefPubMed
32.
Mort TC. Continuous airway access for the difficult extubation: the efficacy of the airway exchange catheter. Anesth Analg. 2007;105(5):1357–62. table of contentsCrossRefPubMed
33.
Cooper RM. The use of an endotracheal ventilation catheter in the management of difficult extubations. Can J Anaesth. 1996 Jan;43(1):90–3.CrossRefPubMed
34.
Moyers G, McDougle L. Use of the cook airway exchange catheter in “bridging” the potentially difficult extubation: a case report. AANA J. 2002 Aug;70(4):275–8.PubMed
35.
36.
Hernandez MC, Aho JM, Zielinski MD, Zietlow SP, Kim BD, Morris DS. Definitive airway management after pre-hospital supraglottic airway insertion: outcomes and a management algorithm for trauma patients. Am J Emerg Med. 2018 Jan;36(1):114–9.CrossRefPubMed
37.
Huang AS, Hajduk J, Jagannathan N. Advances in supraglottic airway devices for the management of difficult airways in children. Expert Rev Med Devices. 2016 Jan 29;13(2):157–69.CrossRefPubMed
38.
Vithalani VD, Vlk S, Davis SQ, Richmond NJ. Unrecognized failed airway management using a supraglottic airway device. Resuscitation. 2017 Oct;119:1–4.CrossRefPubMed
39.
Katsnelson Y, Raman J, Katsnelson F, Mor-Avi V, Heller LB, Jayakar D, et al. Current state of intraoperative echocardiography. Echocardiography. 2003 Nov;20(8):771–80.CrossRefPubMed
40.
Pislaru SV, Michelena HI, Mankad SV. Interventional echocardiography. Prog Cardiovasc Dis. 2014 Aug;57(1):32–46.CrossRefPubMed
41.
Stock KF, Klein B, Steubl D, Lersch C, Heemann U, Wagenpfeil S, et al. Comparison of a pocket-size ultrasound device with a premium ultrasound machine: diagnostic value and time required in bedside ultrasound examination. Abdom Imaging. 2015 Oct;40(7):2861–6.CrossRefPubMed
42.
Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005 Oct 1;96(7):1002–6.CrossRefPubMed
43.
Galusko V, Khanji MY, Bodger O, Weston C, Chambers J, Ionescu A. Hand-held ultrasound scanners in medical education: a systematic review. J Cardiovasc Ultrasound. 2017 Sep 29;25(3):75–83.CrossRefPubMedPubMedCentral
44.
Kimura BJ, Shaw DJ, Amundson SA, Phan JN, Blanchard DG, DeMaria AN. Cardiac limited ultrasound examination techniques to augment the bedside cardiac physical examination. J Ultrasound Med. 2015 Sep;34(9):1683–90.CrossRefPubMed
45.
Smith ME, Chiovaro JC, O’Neil M, Kansagara D, Quiñones AR, Freeman M, et al. Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. Ann Am Thorac Soc. 2014 Nov;11(9):1454–65.CrossRefPubMed
46.
Friedman AM. Maternal early warning systems. Obstet Gynecol Clin N Am. 2015 Jun;42(2):289–98.CrossRef
47.
Paliwoda M, New K, Bogossian F. Neonatal early warning tools for recognising and responding to clinical deterioration in neonates cared for in the maternity setting: a retrospective case-control study. Int J Nurs Stud. 2016 Sep;61:125–35.CrossRefPubMed
48.
Parfitt SE, Bogat ML, Hering SL, Ottley C, Roth C. Sepsis in obstetrics: clinical features and early warning tools. MCN Am J Matern Child Nurs. 2017;42(4):199–205.CrossRefPubMed
49.
Miranda JOF, Camargo CL, Nascimento CL, Portela DS, Monaghan A. Accuracy of a pediatric early warning score in the recognition of clinical deterioration. Rev Lat Am Enfermagem. 2017 Jul 10;25:e2912.CrossRefPubMedPubMedCentral
50.
Hasselmann K, Munk W, MacDonald G. Bispectra of ocean waves. In: Rosenblatt M, editor. Time series analysis; 1963. p. 125–39.
51.
Haubrich RA. Earth noise 5 to 500 millicycles per second. J Geophys Res. 1965;70:1415–27.CrossRef
52.
Sigl JC, Chamoun NG. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit. 1994 Nov;10(6):392–404.CrossRefPubMed
53.
Vuyk J, Lichtenbelt BJ, Vieveen J, Dahan A, Engbers FH, Burm AG. Low bispectral index values in awake volunteers receiving a combination of propofol and midazolam. Anesthesiology. 2004 Jan 1;100(1):179–81.CrossRefPubMed
54.
Edwards JJ, Soto RG, Thrush DM, Bedford RF. Bispectral index scale is higher for halothane than sevoflurane during intraoperative anesthesia. Anesthesiology. 2003 Dec;99(6):1453–5.CrossRefPubMed
55.
Davidson AJ, Czarnecki C. The Bispectral index in children: comparing isoflurane and halothane. Br J Anaesth. 2004 Jan;92(1):14–7.CrossRefPubMed
56.
Vereecke HE, Struys MM, Mortier EPA. Comparison of bispectral index and ARX-derived auditory evoked potential index in measuring the clinical interaction between ketamine and propofol anaesthesia. Anaesthesia. 2003 Oct;58(10):957–61.CrossRefPubMed
57.
Rampil IJA. Primer for EEG signal processing in anesthesia. Anesthesiology. 1998 Oct;89(4):980–1002.CrossRefPubMed
58.
Dahaba AA. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg. 2005 Sep;101(3):765–73.CrossRefPubMed
59.
Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J, et al. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007 Aug;51(7):789–808.CrossRefPubMed
60.
Dahaba AA, Von Klobucar F, Rehak PH, List WF. Comparison of a new piezoelectric train-of-four neuromuscular monitor, the ParaGraph, and the Relaxometer mechanomyograph. Br J Anaesth. 1999 May;82(5):780–2.CrossRefPubMed
61.
Dahaba AA, von Klobucar F, Rehak PH, List WF. The neuromuscular transmission module versus the relaxometer mechanomyograph for neuromuscular block monitoring. Anesth Analg. 2002;94(3):591–6. table of contentsCrossRefPubMed
62.
Loan PB, Paxton LD, Mirakhur RK, Connolly FM, McCoy EP. The TOF-guard neuromuscular transmission monitor. A comparison with the Myograph 2000. Anaesthesia. 1995 Aug;50(8):699–702.CrossRefPubMed
63.
Claudius C, Viby-Mogensen J. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence. Anesthesiology. 2008 Jun;108(6):1117–40.CrossRefPubMed
64.
Cosper P, Zellinger M, Enebo A, Jacques S, Razzano L, Flack MN. Improving clinical alarm management: guidance and strategies. Biomed Instrum Technol. 2017 Apr;51(2):109–15.CrossRefPubMed
65.
Ronquillo JG, Zuckerman DM. Software-related recalls of health information technology and other medical devices: implications for FDA regulation of digital health. Milbank Q. 2017;95(3):535–53.CrossRefPubMedPubMedCentral
66.
Ergonomics DD. Patient safety, and engineering ethics: a case study and cautionary tale. J Long-Term Eff Med Implants. 2007;17(1):27–33.CrossRef
67.
Bennett KB. Ecological interface design and system safety: one facet of Rasmussen’s legacy. Appl Ergon. 2017 Mar;59(Pt B):625–36.CrossRefPubMed
68.
Israelski EW, Muto WH. Human factors risk management as a way to improve medical device safety: a case study of the Therac 25 radiation therapy system. Jt Comm J Qual Saf. 2004 Dec;30(12):689–95.CrossRefPubMed
69.
Doyle DJ. Consumer reports for anesthesia equipment: an idea whose time has come? Anesth Analg. 2007;105(6):1866–7. author reply 1867CrossRefPubMed
Metadata
Title
Advances in anesthesia technology are improving patient care, but many challenges remain
Authors
D. John Doyle
Ashraf A. Dahaba
Yannick LeManach
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0504-x

Other articles of this Issue 1/2018

BMC Anesthesiology 1/2018 Go to the issue

Research article

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon’s up-and-down sequential allocation method

Research article

Association between the use of a stylet in endotracheal intubation and postoperative arytenoid dislocation: a case-control study

Study protocol

The prevention of delirium in elderly with obstructive sleep apnea (PODESA) study: protocol for a multi-centre prospective randomized, controlled trial

Research article

Ultrasound guided repositioning of a new suture-method catheter for adductor canal block – a randomized pilot study in healthy volunteers

Software

Design of a Novel Multifunction Decision Support Display for Anesthesia Care: AlertWatch® OR

Research article

Experiences of ICU survivors in a low middle income country- a multicenter study