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Comparison of Postoperative Outcomes between Male and Female Surgeons: A Matched Cohort Study

This study compares the postoperative outcomes of patients treated by male and female surgeons, accounting for various factors. The results show a small decrease in 30-day mortality for patients treated by female surgeons, along with similar surgical outcomes.

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Comparison of Postoperative Outcomes between Male and Female Surgeons: A Matched Cohort Study

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  1. BMJ. 2017 Oct 10;359:j4366 Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. Wallis et al. Conclusions : After accounting for patient, surgeon, and hospital characteristics, patients treated by female surgeons had a small but statistically significant decrease in 30 day mortality and similar surgical outcomes (length of stay, complications, and readmission), compared with those treated by male surgeons.

  2. Anesthesia monitoring

  3. Objectives • Interpret available clinical data to recognize mishaps or unfavorable system conditions • Understanding of the technology of monitoring

  4. Patient Monitoring and Management Involves …

  5. Physiological measurement, such as BP or HR • Observation of pupils • Endobronchial intubation

  6. ASA Monitoring Guidelines • STANDARD I Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics and monitored anesthesia care.

  7. ASA Monitoring Guidelines • STANDARD II During all anesthetics, the patient’s oxygenation, ventilation, circulation and temperature shall be continually evaluated.

  8. Basic Monitoring • Blood Pressure, Heart Rate, ECG • Airway Pressure, Capnogram, Pulse Oximeter • Temperature • Urine output • Peripheral nerve stimulator • ETT cuff pressure • Auscultation • Visual surveillance of the anesthesia workspace and some exposed portion of the patient

  9. Special Monitoring • PAC • TEE • ICP • EEG • PT • ABG • BIS

  10. Alarms Alarms serve to alert operators

  11. Clinical Anesthesia Monitoring • Axis I - Airway /Respiratory • Axis II - Circulatory / Volume • Axis III - Depth of Anesthesia • Axis IV - Neurological • Axis V - Muscle Relaxation • Axis VI - Temperature • Axis VII - Electrolytes / Metabolic • Axis VIII - Coagulation

  12. Airway / Respiratory Axis • Correct ETT placement • ETT cuff pressure • Airway pressure • Oxygenation • Ventilation • Spirometry • Airway gas monitoring • Clinical: wheezing, crackles, equal air entry, color, respiratory pattern (rate, rhythm, depth, etc.)

  13. Pulse Oximeter • Noninvasively measure oxygen saturation in arterial blood. • The pulse oximeter probe contains two light emitting diodes at wavelengths of 940nm and 660 nm. • Oxygenated and reduced hemoglobin differ in light absorption (940 and 660 nm respectively). • Thus the change in light absorption during arterial pulsation is the basis of oximetry determination. • The ratio of the absorption at the two wavelengths is analyzed by a microprocessor to record the oxygen saturation.

  14. Artifact: • Nail polish • Intravenous dyes • Diminished pulse

  15. Monitoring ETCO2 • Confirms the movement of air in and out of the lungs • Reflect alveolar CO2 • Indicate adequacy of ventilation

  16. CO2 Increases with: • Hypoventilation • Malignant hyperthermia • Sepsis and fever • Insufflation of CO2

  17. CO2 Decreases with: • Hyperventilation • Low cardiac output • pulmonary embolism • Circuit disconnect • Cardiac arrest

  18. Circulatory Axis • COP • CVP • BP, PAP • SVR, PVR

  19. Arterial blood pressure: Indirect/Direct Indirect Bp • Contraindication: best to be avoided in patient vascular abnormalities(A-V fistula )

  20. Direct Bp

  21. ECG • The electrocardiogram only monitors the electrical activity of the heart and the heart rate • Essential for diagnosis and treatment of arrhythmias .

  22. CVP • Indications: • monitoring CVP for fluid management • Infusion of drugs/TPN • Aspiration of air embolism • Insertion of pacemaker • Access for insertion of PAC

  23. CVP • Contraindication: Anticoagulation

  24. CVP • Complications : • Air embolism • Infection • Thromboembolism • Dysrrhythmias • Hematoma • Pneumothorax , hemothorax • Cardiac tamponade • Trauma to nearby tissue

  25. Pulmonary artery catheter • Indication: to monitor CO, PAP , SVR , mixed venous oxygenation

  26. Anesthetic Gas Monitoring • What types/concentrations of gases

  27. Peripheral Nerve Stimulation • Neuromuscular blockade

  28. Depth of Anesthesia • Clinical Signs • eye signs • respiratory signs • cardiovascular signs • CNS signs • EEG monitoring

  29. Bispectral index • BIS value 65-85 advocated a measure of sedation BIS value 40-65 recommended for general anesthesia

  30. Temperature Monitoring Indications: • Hypothermia • Hyperthermia

  31. Electrolyte / Metabolic Axis • Fluid balance • Sugar • Electrolytes • Acid-base balance • Nutritional status

  32. Coagulation Monitoring • Clinical signs • PT / PTT / INR • ACT • Platelet counts • Factor assays • TEG

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