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THE INDEPENDENT MONTHLY NEWSPAPER FOR ANESTHESIOLOGISTS AnesthesiologyNews.com • A u g u s t 2 0 1 4 • Volume 40 Number 8
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Optimism on OIC After FDA Panel Rejects Call For More Cardiac Data
VTE May Be Misleading Quality Measure Hospitals face penalties for greater vigilance
A
MI ‘signal’ seen with one drug, but not others
key measure used by the Centers for Medicare & Medicaid Services (CMS) to assess a hospital’s quality performance may not reflect quality at all, according to a new report. Instead, a hospital’s rate of venous thromboembolism (VTE) events directly reflects how frequently the hospital conducts imaging tests to diagnose the condition. In other words, the more a hospital looks for VTEs, the more of them it finds. “Hospitals may be unfairly deemed a poor performer for the outcome VTE measure if they have increased vigilance for VTE by performing more VTE imaging studies,” said
E
xperts said they hoped a recent FDA advisory panel recommendation against requiring randomized controlled cardiovascular outcomes trials for new drugs to treat constipation associated with use of opioids would unblock the field for more such medications. Opioid-inducedd constipation (OIC) “is a real problem,” said Eugene Viscusi, MD, professor of anesthesiology and director of acute pain management at Thomas Jefferson University, in Philadelphia. Additional drugs in development “are at a critical point that if the FDA required see OIC page 42
see VTE page 46
Does Anesthesia Need Its Own NTSB? San Francisco—When disaster strikes the aviation industry, the National Transportation Safety Board (NTSB)—an independent federal agency—is there to investigate the accident and disseminate subsequent recommendations. Is there room for such an agency in health care? A group of experts discussed the issue during a special symposium at the American Society of Anesthesiologists 2013 annual meeting, concluding that although such an organization would undoubtedly benefit patient care in the long run, logistical issues
make its inception challenging, if not impossible. Although there seems to be little appetite for the creation of another arm of bureaucracy in health care, improvements in the airline industry’s safety record have been due in part to practice changes introduced after NTSB investigations, the panelists agreed. And they agreed that a similar model could benefit the medical community as well. Indeed, the NTSB not only points out errors in process but also provides professionals with
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Supplement to Anesthesiol ogy News • Anesthesiol ogyNews.co
m • 2014-2015
See page 17 27th Annual
2014-2015
Available online @ AnesthesiologyNews.com
Anesthesia Business Consultants 18 Grifols 19 B. Braun Medical Inc. 20 Dräger 22 Edwards Lifesciences 24 MAQUET Medical Systems USA 26 Masimo 28 Mindray 30 Pacira Pharmaceuticals, Inc. 32 Teleflex 33 Par Sterile Products, LLC 34 Spacelabs Healthcare 36 TeamHealth Anesthesia 38 McMahon Publishing 40
Anesthesiology News Guide to Airway Management Accompanies this issue.
CLINICAL ANESTHESIOLOGY
Inadequate neuromuscular blockade and other things that go bump in the night.
see Safety page 10 A nn ua l
27
Corporate ANNUAL Profiles
th
POLICY & MANAGEMENT
Work in an ASC? Seven things to know.
50 2014-2015
COMMENTARY
The Prime Directive.
Introduction by Ashutosh Wali, MD Advancements in Lung Isolation Techniques Congenital Syndromes Associated With Difficult Airway Management in the Pediatric Patient Oxygen Delivery, Use, and Toxicity: Achieving a Rational Balance Secrets of Flexible Fiber-Opt ic Pearls for Success in Unusual Bronchoscopy: Circumstances
Supraglottic Airways As Bridges to Safe Exutabtio n of the Difficult Airway Surgical Management of the Failed Airway: A Guide to Percutaneous Cricothyroidotomy The Video Laryngoscopy Market: Past, Present, and Future
REPORT Enhanced Direct Laryngoscopy
CME: PREANESTHETIC ASSESSMENT
Lesson 311: PreAnesthetic Assessment of the Patient With Acute Ischemic Stroke—Part 1.