An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.

GI = gastrointestinal; HMEF = heat and moisture exchanging filter; HSCT = hematopoietic stem cell transplant; ICU = intensive care unit; IL-6 = Interleukin 6; JAKi = Janus kinase inhibitors; LFTs = liver function tests; MERS-CoV = Middle East respiratory syndrome coronavirus; OR = operating rooms; PACU = postanesthesia care unit; PAPR = powered air-purifying respirator; PPE = personal protective equipment; RSV = human respiratory syncytial virus; SARS = severe acute respiratory syndrome; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; TIL = tumor-infiltrating lymphocytes; VEGF = vascular endothelial growth factor The novel Coronavirus Disease 2019 (COVID-19) was first reported in China in December 2019. Since then, it has spread across the world to become one of the most serious life-threatening pandemics since the influenza pandemic of 1918. This review article will focus on the specific risks and nuanced considerations of COVID-19 in the cancer patient. Important perioperative management recommendations during this outbreak are emphasized, in addition to discussion of current treatment techniques and strategies available in the battle against COVID-19.

Summary Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end‐stage renal disease; however, reports exist of its use in this group of patients. This two‐institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end‐stage renal disease who required pre‐operative renal replacement therapy. Adult surgical patients with end‐stage renal disease requiring pre‐operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied. The primary outcome was the incidence of postoperative tracheal re‐intubation within 48 h. The secondary outcome was the incidence of deferred tracheal extubation in the operating theatre. One hundred and fifty‐eight patients were identified from 125,653 surgical patients: 48 patients (30%) underwent renal transplantation and 110 (70%) underwent non‐renal transplantation procedures. There were 22 instances (14%) of deferred tracheal extubation due to surgical and/or pre‐existing medical conditions. Out of the 136 patients who had the tracheal tube removed at the end of the procedure, three patients had their trachea re‐intubated within 48 h: two patients developed pulmonary oedema resulting from volume overload; and one patient had worsening sepsis. No incidence of recurrence of neuromuscular blockade was observed. Of note, 24 (18%) patients were found to have incomplete neuromuscular blockade reversal with neostigmine but administration of sugammadex led to successful tracheal extubation. In conclusion, sugammadex appears to be safe and effective in adult patients with end‐stage renal disease receiving pre‐operative renal replacement therapy.

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In contrast to observations in earlier studies, findings indicate poor agreement in inter-rater reliability. Although there was moderate agreement in intra-rater reliability, one would expect to find stronger, even perfect, intra-rater reliability. These findings suggest the need to develop a specific physical status classification system directed toward patients with a systemic illness such as cancer in both young and adult patients.

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Effective communication is integral to patient safety, especially during high-risk periods where patients are transitioning to different care areas or to different providers. However, communication failures continue to occur; The Joint Commission (TJC) reports that the number one cause of anesthesia-related sentinel events is breakdown in communication. 1 The operating room (OR), the postanesthesia care unit (PACU), and the intensive care unit (ICU) are especially vulnerable to communication failures between providers; inadequate communication in the PACU has been shown to affect mortality and morbidity. 2,3 A review of 419 reports from the Anaesthetic Incident Monitoring Study (AIMS) indicated failure in communication as the second most common contributing factor to adverse events in recovery units. 4 Indeed, observational studies have shown a direct correlation between poor handover and patient harm. 5 Therefore, the handover process is critical to the safe care of the surgical patient. The handover is a transfer of not only information but also of professional responsibilities across teams. 6 Ideally, a handover report is attended by surgical and anesthesia staff, a nurse, and a PACU or an ICU clinician, and relays information on the patient's history, intraoperative events, and postoperative care plan. According to the American Society of Anesthesiologists, standard of care requires the presence of intraoperative anesthesia staff for monitoring during transport and verbal report. 7 However, beyond this, there is a lack of consistent guidelines; reports are vulnerable to omission of pertinent information. 8 A complete omission of information occurred in 57% of surgical malpractice claims 9 and has

PURPOSE: Minimization of postoperative complications is important in patients with cancer. We wished to improve compliance with anesthesiology quality measures through staff education reinforced with automated monthly feedback. METHODS: The anesthesiology department implemented a program to capture and report quality metrics. After staff education, monthly e-mail reports were sent to each anesthesiology physician and nurse anesthetist to detail individual compliance rates for a set of quality measures. For each measure, the proportion of patient cases that passed the measure before and after implementation of the program was compared using a two-sample proportion test. RESULTS: After exclusions, we analyzed 15 of 23 quality measures. Of the 15 measures, 11 were process measures, and four were outcome measures. Of the 11 process measures, seven demonstrated statistically significant improvements ( P < .01). The most improved measure was TEMP-02 (core temperature measurement), which increased from 69.6% to 85.7% (16.1% difference; P < .001). Also improved were PUL-02 (low tidal volume, less than 8 mL/kg ideal body weight; 15.4% difference; P < .001) and NMB-01 (train of four taken; 12.2% difference; P < .001). The outcome measure TEMP-03 (perioperative temperature management) had a statistically significant increase of a small magnitude (0.2% difference; P < .001). No other outcome measures showed statistically significant improvement. CONCLUSION: After implementation of a comprehensive quality improvement program, our group observed significant improvements in anesthesia quality measure compliance for several process measures. Future work is needed to determine if this initial success can be preserved and associated with improved outcomes.