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2081. Root Cause Analysis | PSNet
      psnet.ahrq.gov/primer/root-cause-analysis
      March 30, 2022 - Work environment An  anesthesia care provider, who had only slept 3 of the previous 32 hours on-call

2082. Uterine Artery Injury during Cesarean Delivery Leads to Cardiac Arrests and Emergency Hysterectomy | PSNet
      psnet.ahrq.gov/web-mm/uterine-artery-injury-during-cesarean-delivery-leads-cardiac-arrests-and-emergency
      September 30, 2020 - obstetric hemorrhage simulation should be interdisciplinary and interprofessional (e.g., obstetrics, anesthesia … WebM&M Cases Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia

2083. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/851099/psn-pdf
      June 28, 2023 - reasons why it has replaced sodium thiopental as the most commonly used drug for inducing general anesthesia … Inadvertent intraarterial injection of propofol in a patient under general anesthesia.

2084. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/861738/psn-pdf
      January 31, 2024 - Liberal use of local or regional anesthesia facilitates adequate exploration. … believed to cause digital ischemia, its use is now considered safe and highly effective at prolonging anesthesia

2085. Patient Safety Events Involving Opioid Dose Stacking | PSNet
      psnet.ahrq.gov/web-mm/patient-safety-events-involving-opioid-dose-stacking
      July 08, 2022 - Evaluation of a Standardized Sedation Assessment for Opioid Administration in the Post Anesthesia Care … Multiple High-Risk Events Involving Workflow for Wasting of Medications Used by Anesthesia

2086. The Risks of Absent Interoperability: Medication-Induced Hemolysis in a Patient With a Known Allergy | PSNet
      psnet.ahrq.gov/web-mm/risks-absent-interoperability-medication-induced-hemolysis-patient-known-allergy
      April 08, 2019 - : Clinical and Educational Uses May 1, 2015 Analysis of deaths related to anesthesia … June 19, 2024 Peer support and second victim programs for anesthesia professionals involved

2087. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/867357/psn-pdf
      December 18, 2024 - The introduction of capnography into clinical anesthesia practice has led to a significant reduction … Capnography has therefore been recommended for safe intrahospital transport of intubated patients.25,26 Many anesthesia

2088. In Conversation With… Matthew Weinger, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-matthew-weinger-md
      August 01, 2018 - Around the same time, David had translated aviation crew resource management into anesthesia crisis … that simulation-based training as part of dyadic teams substantially improved handovers provided by anesthesia … Should they be saying that to graduate in an anesthesia program or a medicine residency you need to do

2089. Patient Advocacy in Patient Safety: Have Things Changed? | PSNet
      psnet.ahrq.gov/perspective/patient-advocacy-patient-safety-have-things-changed
      June 01, 2014 - like the 1975 Congressional hearings on unnecessary surgery and ABC's 1982 "The Deep Sleep" special on anesthesia … National Patient Safety Foundation (NPSF), an attempt to duplicate for mainstream medicine the success the Anesthesia … Anesthesia Patient Safety Foundation Newsletter. Spring 2007;22. [Available at] 5.

2090. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33882/psn-pdf
      June 01, 2019 - been designed to elicit seminarrative information about adaptive practices, including workarounds, in anesthesia

2091. Reporting Patient Safety Events | PSNet
      psnet.ahrq.gov/primer/reporting-patient-safety-events
      March 30, 2022 - such as the Intensive Care Unit Safety Reporting System and systems for reporting surgical and anesthesia-related

2092. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49537/psn-pdf
      June 01, 2007 - preoperative medical evaluation provides an opportunity for collaboration between medicine, surgery, and anesthesia … Case & Commentary: Part 3 Review of the preoperative assessment by anesthesia and orthopedics revealed

2093. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/843051/psn-pdf
      February 01, 2023 - The patient recovered in the Post-Anesthesia Care Unit (PACU) overnight, was evaluated by physical therapy … Surgical and anesthesia teams should work together to ensure a plan for airway access, as hematoma evacuation

2094. Respiratory Distress after Neck Surgery: Two Cases of Postoperative Cervical Hematoma. | PSNet
      psnet.ahrq.gov/web-mm/respiratory-distress-after-neck-surgery-two-cases-postoperative-cervical-hematoma
      August 14, 2024 - The patient recovered in the Post-Anesthesia Care Unit (PACU) overnight, was evaluated by physical therapy … Surgical and anesthesia teams should work together to ensure a plan for airway access, as hematoma evacuation

2095. Medication Handling and Compounding Errors in the Operating Room. | PSNet
      psnet.ahrq.gov/web-mm/medication-handling-and-compounding-errors-operating-room
      May 16, 2022 - The anesthesia team, the surgical team, the operating room nurse, and the scrub technician all can ask … October 27, 2021 WebM&M Cases Inadequate Anesthesia

2096. Monitoring Fetal Health | PSNet
      psnet.ahrq.gov/web-mm/monitoring-fetal-health
      September 08, 2010 - monitor critical life signals of patients in the ICU, labor and delivery units, or individuals under anesthesia … WebM&M Cases Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia

2097. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73153/psn-pdf
      April 28, 2021 - At the handoff to the post-anesthesia care unit (PACU) nurse, the OR nurse stated that there was packing … into the vagina in the OR or procedural area, where the patient is likely sedated or under general anesthesia

2098. A Laceration that Needed a Proper Exam, Not an X-Ray | PSNet
      psnet.ahrq.gov/web-mm/laceration-needed-proper-exam-not-x-ray
      November 25, 2020 - Liberal use of local or regional anesthesia facilitates adequate exploration. … believed to cause digital ischemia, its use is now considered safe and highly effective at prolonging anesthesia

2099. How Does Health Care Simulation Affect Patient Care? | PSNet
      psnet.ahrq.gov/perspective/how-does-health-care-simulation-affect-patient-care
      August 01, 2018 - Around the same time, David had translated aviation crew resource management into anesthesia crisis … that simulation-based training as part of dyadic teams substantially improved handovers provided by anesthesia … Should they be saying that to graduate in an anesthesia program or a medicine residency you need to do

2100. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33715/psn-pdf
      July 01, 2011 - Adverse respiratory events in anesthesia: a closed claims analysis.