Anesthesiologist [Extra Quality]

This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Gastric US can provide valuable insight into the nature and volume of gastric content before performing a block with sedation or inducing anesthesia for an urgent or emergent procedure where NPO status is unknown. Patients with comorbidities that delay gastric emptying, such as diabetic gastroparesis, neuromuscular disorders, morbid obesity, and advanced hepatic or renal disease, may potentially benefit from additional assessment via gastric US before an elective procedure. Although gastric US should not replace strict adherence to current fasting guidelines or be used routinely in situations when clinical risk is clearly high or low, it can be a useful tool to guide clinical decision making when there is uncertainty about gastric contents.In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.

In the operating room, the anesthesiologist is responsible for patient safety and well-being throughout the surgery. Per the American Society of Anesthesiologists, the primary roles of anesthesiologist during surgery are to:

Anesthesiologist

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Anesthesiologist are trained to manage pain during and after surgery. Surgical pain, or pain following an injury, is commonly known as acute pain. This is pain that usually resolves over time as the body heals. Pain that persists longer than expected, is known as chronic pain. Chronic pain can be related to trauma, such as a nerve injury, or a disease process such as cancer or diabetes. Some anesthesiologists take an additional year of specialized training and become board certified in Pain Medicine. They are uniquely qualified to manage and help patients with acute and chronic pain.

Importance: The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity among work team members is associated with enhanced success in multiple fields but rarely studied in the operating room.

Objective: To examine the association between surgeon-anesthesiologist dyad familiarity-as the number of times working together-with short-term postoperative outcomes for complex gastrointestinal cancer surgery.

Results: Seven thousand eight hundred ninety-three patients with a median age of 65 years (66.3% men) were included. They were cared for by 737 anesthesiologists and 163 surgeons who were also included. The median surgeon-anesthesiologist dyad volume was 1 (range, 0-12.2) procedures per year. Ninety-day major morbidity occurred in 43.0% of patients. There was a linear association between dyad volume and 90-day major morbidity. After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with an odds ratio of 0.95 (95% CI, 0.92-0.98; P = .01) for each incremental procedure per year, per dyad. The results did not change when examining 30-day major morbidity.

Conclusions and relevance: Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.

Our certification process, multi-specialty exams and certification maintenance program ensure our board-certified anesthesiologists remain at the forefront of quality clinical outcomes and patient safety.

If there is a change in employment or physician group practice, the anesthesiologist assistant needs to complete and submit the Change/Addition of Supervising Physician Application, and a new practice protocol. Additional instructions concerning practice protocols can be found in the AA Practice Protocol Helpful Documents section of the Application Instructions.

If additional supervisors are added at a current place of employment or physician group practice, and the practice protocol for the anesthesiologist assistant at that place of employment has been approved, the names of the additional supervisors can be added as an addendum to the practice protocol. The anesthesiologist assistant will need to complete the Change/Addition of Supervising Physician Application, but does not need to submit a new practice protocol.

Applicants can help expedite the application process by including all relevant materials with their application packets (anesthesiologist assistant diploma, NCCAA certificate, etc). We will mail you a deficiency letter approximately 30 days after receiving your application. Please refrain from contacting our office until after you have received your initial deficiency letter. E-mail contact is more efficient. Time spent on the telephone impacts time available for staff to process applications.

To practice in the state of Florida, you must have a valid Florida anesthesiologist assistant license. The licensing process involves the collection of credentials from the applicant and from other sources. Once all materials are submitted, an application specialist will review them; however, it may be necessary for the application specialist to request additional information. Our goal is to review materials as quickly as possible, but we must be thorough.

An anesthesiologist at the center of the $200 million Forest Park Medical Center fraud has been sentenced to five and a half years in federal prison and ordered to pay more than $82.9 million in restitution, announced U.S. Attorney for the Northern District of Texas Erin Nealy Cox.

A pediatric anesthesiologist is a fully trained anesthesiologist who has completed at least 1 year of specialized training in anesthesia care of infants and children. Most pediatric surgeons deliver care to children in the operating room along with a pediatric anesthesiologist. Many children who need surgery or various procedures have very complex medical problems that affect many parts of the body. The pediatric anesthesiologist is best qualified to evaluate these complex problems and plan a safe anesthetic for each child. Through special training and experience, pediatric anesthesiologists provide the safest care for infants and children undergoing anesthesia.

Pediatric anesthesiologists treat children from the newborn period through the teenage years, and beyond in patients with chronic pediatric conditions. They choose to make pediatric care the core of their medical practice, and the unique nature of medical and surgical care of children is learned from advanced training and experience in practice.

Children are not just small adults. They cannot always say what is bothering them. They cannot always answer medical questions, and are not always able to be patient and cooperative during a medical examination. Pediatric anesthesiologists know how to examine and treat children in a way that makes them relaxed and cooperative. In addition, pediatric anesthesiologists use equipment and facilities specifically designed for children. Most pediatric anesthesiology offices are arranged and decorated with children in mind. This includes the examination rooms and waiting rooms, which may have toys and reading materials for children. This helps create a comfortable and nonthreatening environment for your child.

If your pediatrician suggests that your child see a pediatric anesthesiologist, you can be assured that he or she has the widest range of treatment options, the most extensive and complete training, and the greatest expertise in dealing with children and their anesthesiology needs.

Anesthesiologist Assistants are highly skilled professionals who work under the direction of licensed anesthesiologists (doctors) and exclusively within the Anesthesia Care Team environment as described by the American Society of Anesthesiologists (ASA) to design and implement anesthesia care plans. They may accompany the patient before, during and after anesthesia to ensure quality and continuity of care. In an emergency, Anesthesiology Assistants are trained to assist in life saving measures, such as CPR, and life support.

Traditionally, in surgical practice, the decision to operate or not is made between a surgeon and the patient with or without the presence of the spouse, partner, or caregiver. The patient is then sent, if necessary, to other physicians (anesthesiologists, cardiologists, pneumonologists, geriatricians, oncologists) for consultation before pursuing an elective surgical procedure.

Incorporating prehabilitation within the enhanced recovery after surgery program would allow the anesthesiologist as a perioperative physician to have a leadership role and work together with a multidisciplinary team. Because prehabilitation is a patient-centric program, participants would be empowered and develop a sense of purpose and resiliency as they choose to prepare themselves for an upcoming surgery. Prehabilitation is an innovative concept that requires more research to better elucidate the mechanistic aspects of how exercise intensity, in synergy with anabolic stimuli, can modulate the catabolic response to surgery and to enhance recovery. In addition, knowledge gaps remain to be addressed on issues such as outcomes to be measured, organization, technology, and costs. Ultimately patients will benefit from our efforts to improve surgical care. 2351a5e196