Anesthesia Providers, Patient Outcomes, and Costs

Miller, Ronald D.

doi:10.1213/00000539-199612000-00041

Cited by 4 publications

(6 citation statements)

References 1 publication

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“…17 It contained no new primary data yet, being the first publication in a peer-reviewed journal on the subject for some years, has been frequently cited since. An accompanying editorial (acknowledging that the article was subjective and clearly partisan 18 ), and subsequent correspondence in the journal [19][20][21] are, in contrast, seldom referred to. The article provoked vociferous responses from nurse anesthetists in the US, correcting some errors of fact as well as arguing over points of opinion.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review †

Smith

Kane

Milne

2004

British Journal of Anaesthesia

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In view of the paucity of high-level primary evidence in this area, it is not possible to draw a conclusion regarding differences in patient safety as a function of provider type. There are difficulties in classifying events as "anaesthesia-related", and also in the variable definitions of "supervision" and "anaesthesia care team". We suggest that existing attempts to show differences in outcome might usefully be complemented by studies examining measures of anaesthetic process.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review †

Smith

Kane

Milne

2004

British Journal of Anaesthesia

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“…Although the report was destined primarily for the Minnesota state legislature, its authors, Abenstein & Warner, were encouraged to submit the article for publication in a professional journal [24] and it was sent to Anaesthesia and Analgesia. It was eventually accepted after an intensive peer review process involving nine reviewers and multiple revisions, despite the initial inclination of Ronald Miller, the journal's editor‐in‐chief, to reject it [25].…”

Section: A Case Study In Conflict: ‘Anaesthesia Providers Outcomes Amentioning

confidence: 99%

“…In an accompanying editorial, the journal's editor‐in‐chief explained why they had, despite the article's limitations and political nature, decided to publish it. He noted that the study was based on limited data, illustrated the authors' biases and repeated commonly known facts about training, but felt that because there is so little literature of quality available that any addition to the evidence on this topic was of value [25].…”

Section: A Case Study In Conflict: ‘Anaesthesia Providers Outcomes Amentioning

confidence: 99%

An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom

Kane¹,

Smith

2004

Anaesthesia

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Summary Professional conflict between nurse anaesthetists and anaesthesiologists in the United States of America is well known in the UK but has not been explored and documented in detail. We present an account, based on critical analysis of published literature and other documentary evidence, of the historical, professional and financial factors which have led to this. In the USA, anaesthesia developed as a nursing specialty until physicians began to take on this work after the Second World War. Payment arrangements between the 1960s and the 1990s made anaesthesiology a lucrative career choice for medical graduates and this led both to considerable growth in the number of anaesthesiologists and to a strengthening of the resolve of nurse anaesthetists to retain their scope of work and preserve their professional status. Changes in payment regulations in the 1980s and 1990s threatened anaesthesiologists' income and led to re‐appraisal of evidence over relative cost‐effectiveness and safety of different provider models. More recently, the terms of engagement have shifted from disputes over evidence to political lobbying to promote the professional capabilities and status of each of the anaesthesia providers. Factors of relevance to possible changes in the provision of anaesthesia in the United Kingdom are highlighted.

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“…The contemporary views on safe anesthesia imply good analgesia and patient comfort during surgical interventions. 1 In that context, anesthesiology today strives for increased patient care of particular interest to anesthesiologists are short and very painful surgical interventions, such as interventions in plastic and reconstructive surgery, which usually involve a one-day hospital stay of patients. For this pathology, the choice of right analgesia and sedation is crucial for a good outcome (of the intervention).…”

Section: Introductionmentioning

confidence: 99%

Comparative study of the effects of dexmedetomidin and midazolam on respiration and hemodynamics used during facial surgery

et al. 2023

JACCOA

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Background: The interventions in facial surgery are specific, short, and very painful. The place of the surgery can compromise a patient’s airway. Surgeons prefer to give local infiltrative anesthetics, but during the surgery patients are nervous, stressed, restless and ask for drugs to be asleep/ask for sleep medication. Dexmedetomidine (Dex) as an agent for analgosedation can meet the needs of those patients. Dex is an alpha 2 adrenergic agonist with sedative, anxiolytic and analgesic properties; Midazolam (Mdz) is the most often used drug for classical sedation, a drug from the benzodiazepine group. Aims: The aim of this study was to compare the effects on circulation and respiration of two drugs, dexmedetomidine (Dex) and midazolam (Mdz). Blood pressure, Puls/min, respiration/min, SpO2, incidents of bradycardia, hypotension, hypoxia, and other complications were measured and compared in the two groups. Material and methods: Sixty patients for facial surgery who met the inclusion criteria were enrolled in the study. Due to a computed choice/option, patients were allocated to be sedated with Dex (n=30) or Mdz (n=30). After signing a written consent for inclusion in the study, prior to surgery all patients got two venous lines and were preoperatively monitored. Patients of Dex group received a bolus of Dex 1 mcg/kg given in 10 minutes. The sedation was maintained with an additional dose of Dex of 0.5 mcg/kg/h, which was disconnected at the end of the surgery. Patients of Mdz group received a bolus of Mdz of 0.03 mg/kg followed by an infusion of Mdz of 0.2 mg/kg/h, which was disconnected at the end of the surgery. The vital signs (ECG, BP, P/min, Res/min, SpO2, ETCO2, BIS) were monitored and noted on 5-minute intervals. Results: The obtained results were statistically analyzed. Demographic data showed homogeneity between the groups. All patients prior to procedural sedation got local infiltrative anesthesia with lidocaine 1%. There was insignificant difference in duration of the surgical procedure between the groups (p>0.05) and prolonged induction to sedation in the Dex group (10.6±2.7* vs. 1.9±1.7); p=0.01. Blood pressure of patients in the Dex group showed a significant decrease and was lower than that in the Mdz group (p=0.05). Also, P/min in the Dex group was lower than in the Mdz group (74.45±14.84*vs. 84.13±12.88) p=0.03. The results from the monitored respiration showed a statistically significant decrease in respiration/minute in the Mdz group (p=0.05) and decrease in SpO2, (p=0.02). Conclusion: We found that Dex, used as an agent for analgosedation for facial surgery, is a safe drug providing hypotension and mild bradycardia which are easy for treatment with vasoconstrictors and a sedation without effects on respiration. Patients in the Dex group were more comfortable, and their satisfaction was higher than in patients in the Mdz group.

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Anesthesia Providers, Patient Outcomes, and Costs

Cited by 4 publications

References 1 publication

Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review †

Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review †

An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom

Comparative study of the effects of dexmedetomidin and midazolam on respiration and hemodynamics used during facial surgery

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