Monthly Poll

Use a pre-incision timeout to verify site of surgery only.

4%

Use the JCAHO Universal Protocol only

7%

Use the WHO Surgical Checklist approach

23%

Use a checklist developed by an outside agency other than WHO (SCOAP, Lifewings, etc.)

6%

Use your institution's own multiple-item (patient ID, allergies, surgical procedure, DVT prophylaxis, etc.) checklist

57%

Total Votes: 64

Monitoring used per individual provider judgment.

11%

Use pulse oximetry monitoring on all while in PACU, then up to surgeon.

35%

Use pulse oximetry monitoring as a hospital standard until narcotics discontinued.

26%

Continued use of pulse oximetry only on those receiving oxygen therapy.

9%

In patients on oxygen therapy, mandate use of pulse oximetry AND capnography.

15%

Total Votes: 101

Higher safety than hospital ORs

4%

Less safe for patients than hospital ORs due to infrastructure issues

72%

Less safe for patients than hospital ORs due to patient selection

5%

Similarly safe to hospital-based ORs

17%

Total Votes: 69

Regulatory or other external restrictions

6%

Medication errors

15%

Noise or other distractions in OR

13%

Production pressure

27%

Inexperience or inadequate knowledge or skills

20%

Opioid use and respiratory depression in risky patients

16%

Total Votes: 119

Use in standard O.R.s but not "satellite" areas (minor procedures, GI, etc.)

17%

Have it available if needed

22%

Use in cases in which deep sedation is planned

14%

Used in all cases

46%

Total Votes: 99

Yes, with resulting death

5%

Yes, with major injuries

16%

Yes, with minor injuries

16%

Yes, but only a near miss

30%

None

32%

Total Votes: 56

None

15%

BLS only

1%

ACLS

42%

ACLS & PALS

22%

ACLS & ATLS

3%

ACLS, ATLS, & PALS

15%

Total Votes: 90

Provide specific counseling or aid regarding specific smoking cessation resources

20%

Suggest cessation of tobacco long-term

55%

Focus on ceasing tobacco use prior to surgery only

10%

Quantify tobacco use only

13%

Total Votes: 58

Only treat with beta-blockers if the patient develops hypertension or tachycardia

25%

Have the patient take a standard dose of beta-blocker prior to surgery for several days

18%

Titrate doses of a beta-blocker intraoperatively to a specific heart rate

23%

Use prophylactic standardized dose beta-blocker intraoperatively

4%

Follow the POISE study protocol by administering perioperative metoprolol

27%

Total Votes: 139

Fentanyl

5%

Local anesthetics

4%

Propofol or thiopental

54%

Succinylcholine

31%

Non-depolarizing NMB drugs

5%

Total Votes: 234

I currently use fospropofol primarily in order to preserve my propofol supply for general anesthetic use

8%

I currently use fospropofol as a preferred intravenous sedative over propofol

5%

I am currently considering using fospropofol

20%

I would like to use fospropofol but it is not approved for my pharmacy's formulary

11%

I do not and have no plans to use fospropofol due to concerns over safety

17%

I do not and have no plans to use fospropofol due to cost factors

35%

Total Votes: 34

Just suggest that the patient obtain a medical alert bracelet

4%

Just document the event in the anesthesia record

4%

Just document the event in the patient's medical record (chart or EMR)

4%

Just verbally inform the patient and/or family

22%

Write a letter to the patient's primary care physician

0%

Write a letter to the patient about the event

9%

Give or send the patient/family a form letter to show to future providers

13%

Inform and provide documentation to the patient

40%

Total Votes: 22

A. Never = virtually eliminated from my practice

14%

B. Rare = analgesic supplementation during regional anesthesia, etc

11%

C. Uncommon = brief use during inhalation induction for children

36%

D. Common = supplements a majority of general anesthetics

23%

E. Routine = supplements virtually all general anesthetics

13%

Total Votes: 76

A. LATERAL - MAC sedation

18%

B. LATERAL - GA with ETT

15%

C. SUPINE – MAC sedation

1%

D. SUPINE – GA with ETT

5%

E. PRONE – MAC sedation

23%

F. PRONE - General Anesthesia (GA) with ETT

34%

Total Votes: 69

Strongly disagree

3%

Somewhat disagree

3%

Neutral

9%

Somewhat agree

25%

Strongly agree

58%

Total Votes: 172

Routinely (virtually always):

50%

51 - 75% :

7%

26 - 50%:

7%

1 - 25%:

16%

Never:

17%

Total Votes: 129

Refuse to use beach chair position for such cases:

4%

Brachial plexus block plus GA with ETT:

40%

Brachial plexus block plus GA with LMA:

15%

Brachial plexus block plus MAC sedation:

5%

GA with LMA or similar airway device:

4%

General Anesthesia (GA) with ETT:

30%

Total Votes: 268

Varies, depends on obstetrician:

9%

After infant is delivered and the umbilical cord is clamped:

31%

Maximum of 60 min prior to abdominal incision:

50%

Just prior to insertion of the spinal needle or epidural catheter:

2%

Antibiotics are not given for healthy, clean C-sections:

6%

Total Votes: 177

75% or more:

22%

One in two (50%):

15%

One in three (33%):

13%

One in five (20%):

13%

One in ten (10%):

17%

None:

16%

Total Votes: 179

Vital signs, ECG, SpO2, capnography, and ICU admission:

7%

Vital signs, ECG, SpO2 and capnography:

22%

Vital signs, ECG, and SpO2:

46%

Vial signs and ECG:

4%

Frequent vital signs (RR, BP, HR) by R.N.:

19%

Total Votes: 221

inhalation induction:

14%

ketamine:

3%

midazolam:

7%

etomidate:

33%

methohexital :

5%

thiopental:

34%

Total Votes: 271

EtO2 > 80%:

16%

EtO2 = 50 - 80%:

6%

SpO2 = 100%:

10%

3 min of tight-fitting face-mask oxygen:

20%

Four deep breathes of face mask oxygen:

31%

Pre-oxygenation is not required:

13%

Total Votes: 382

Standard fiberoptic bronchoscope:

15%

LMA Fastrach? :

22%

Trachlight? or lightwand device:

2%

McGrath® videolaryngoscope:

5%

Glidescope® or Storz® videolaryngoscope:

48%

AirTraq® disposable laryngoscope:

5%

Total Votes: 752

mandatory during needle and vein location (i.e., a standard-of-care):

35%

optional during needle and vein location:

27%

for a "quick look" prior to skin prep and drape:

10%

for "rescue" after anatomic landmark attempts have failed:

13%

frequently unnecessary:

14%

Total Votes: 174

None:

12%

Temp, BP, ECG, and SpO2 (oximetry):

6%

Temp, BP, and ECG:

3%

Temp and ECG leads (ECG):

2%

Temp and non-invasive blood pressure (BP) cuff:

6%

Esophageal stethoscope/ oral temperature (temp):

68%

Total Votes: 233

insulin only if acidotic:

6%

200 mg/dL:

38%

180 mg/dL :

31%

140 mg/dL:

16%

110 mg/dL :

5%

80 mg/dL:

0%

Total Votes: 172

Should not be stocked in the anesthesia cart:

18%

Three or more different concentrations:

2%

At least two different concentrations:

8%

One: the 10,000 U/mL vial:

4%

One: the 1,000 U/mL vial:

57%

One: the 100 U/mL vial:

8%

Total Votes: 150

Markedly worse:

0%

Slightly worse:

1%

Lots of talk; but no real change:

20%

Slightly improved:

41%

Markedly improved:

35%

Total Votes: 113

Would not administer Intralipid for this indication:

3%

Regional anesthesia cart:

37%

Drug-dispensing machine/device in the OR suite:

16%

'Code' cart/ box:

14%

OR ("satellite") pharmacy:

13%

Main hospital pharmacy:

14%

Total Votes: 189

Mechanomyography (for instance, NMT module):

5%

Accelerography (for instance, TOF-Guard) :

16%

Tactile evaluation of response to neuromuscular block monitor :

35%

Visual observation of response to neuromuscular block monitor :

27%

Visual observation of patient or diaphragmatic movement:

6%

I don't monitor depth of NMB:

9%

Total Votes: 131

I don't administer anticholinesterase reversal drugs:

2%

Clinical (patient) signs of weakness:

5%

Timing of last dose of NMB drug:

7%

DBS or tetanus response to neuromuscular stimulation:

22%

TOF response to neuromuscular stimulation:

46%

Clinical experience:

14%

Total Votes: 171

'Tough it out' and do the elective cases:

40%

Urgently call in a locum tenens replacement:

10%

Postpone elective surgical list until later that day after you sleep:

25%

Politely refuse to do elective cases:

23%

Total Votes: 183

No axillary roll is necessary:

1%

Segment of the vinyl bean bag positioner:

5%

Liter bag of intravenous fluid:

16%

Inflated air-filled support (e.g., Shoulder-FloatTM) :

24%

Commercial gel pad:

41%

Commercial foam cylinder:

9%

Total Votes: 155

I was not aware of this complication:

22%

I have had several patients with this complication :

1%

I have had ONE patient with this complication :

1%

I have not seen this in my practice :

74%

Total Votes: 176

Indefinitely :

26%

> Eight hours :

0%

Six to eight hours:

3%

Four to six hours:

9%

Two to four hours:

20%

One to two hours:

39%

Total Votes: 376

Strongly DISAGREE; never eliminate the paper copy!:

22%

Somewhat DISAGREE: paper copy is more convenient:

19%

NEUTRAL:

9%

Somewhat AGREE: paper copy only for special issues:

12%

Strongly AGREE: eliminate paper copy :

36%

Total Votes: 269

Other:

1%

ACLS, PALS, plus ATLS:

5%

ACLS plus ATLS:

0%

ACLS plus PALS:

17%

ACLS:

34%

No special certificates beyond professional licensure:

40%

Total Votes: 126

Other:

1%

Felt-tip black ink marker ('Sharpie'):

5%

Adhesive color-coded labels:

77%

Adhesive black and white labels:

2%

Peel-off labels from the drug vial(s):

3%

Tape actual drug vial to the syringe:

9%

Total Votes: 253

No:

73%

No, but have seen colleagues do this:

10%

Yes, but have now ceased :

2%

Yes, but rarely:

4%

Yes, regularly:

9%

Total Votes: 249

Only if patient initiates the discussion :

0%

No:

17%

Yes:

81%

Total Votes: 146

Hospital Risk Manager:

0%

The patient :

14%

Neither:

0%

Both:

28%

Anesthesia professional:

7%

Surgeon:

50%

Total Votes: 14

No, but currently working on a policy to invoke this practice :

14%

No :

58%

Yes :

26%

Total Votes: 187

Varies depending on time (daytime vs. night call):

7%

Commercial (manufacturer) pre-mixed solutions:

2%

Only pharmacists:

5%

Usually pharmacist, anesthesia personnel on occasion :

22%

Usually anesthesia personnel, pharmacist on occasion :

22%

Only anesthesia professionals :

38%

Total Votes: 180

Cesarean section:

5%

Emergency-trauma surgery :

15%

ASA Status IV or V :

5%

Patient awareness during past general anesthetic:

50%

Cardiac surgery using cardiopulmonary bypass:

16%

Current use or history of substance abuse:

5%

Total Votes: 168

> 36 hours (e.g.,entire weekend):

15%

36 hours:

3%

32 hours :

5%

24 hours :

48%

12 hours:

17%

8 hours:

9%

Total Votes: 282

never:

14%

only with unanimous consent of all OR personnel:

44%

only after consent of anesthesia professional(s):

11%

times OTHER THAN induction or emergence:

19%

any time patient is unconscious/amnestic:

3%

any time:

6%

Total Votes: 364

never:

0%

only with unanimous consent of all OR personnel:

0%

only after consent of anesthesia professional(s):

0%

times OTHER THAN induction or emergence:

0%

any time patient is unconscious/amnestic:

0%

any time:

0%

Total Votes: 0

> 10 years:

2%

5-10 years:

3%

5 years:

15%

2 years:

37%

12 Months:

27%

6 Months:

13%

Total Votes: 360

Postoperative - beyond PACU:

20%

Postoperative - PACU:

11%

Emergence:

16%

Maintenance:

12%

Induction:

21%

Preoperatively (holding room or transport):

17%

Total Votes: 241

local anesthetics:

5%

inhaled anesthetics:

4%

opioid analgesics:

37%

insulin:

4%

muscle relaxants:

35%

anticoagulants :

13%

Total Votes: 239

insulin only if acidotic:

2%

240 and above (13.3 mM):

13%

200 mg/dL (11.1 mM):

33%

180 mg/dL (10 mM):

28%

140 mg/dL (7.8 mM):

17%

110 mg/dL (6.1 mM):

2%

Total Votes: 243

ICU or ?step-down? ICU monitoring:

26%

Pulse oximetry plus capnography:

12%

Continuous pulse oximetry:

42%

Vital signs/LOC/intermittent pulse oximetry:

10%

Vital signs/LOC q 1 hour:

3%

Routine post-op vital signs:

4%

Total Votes: 140

Surgical (operative) errors:

6%

Communication/ teamwork errors:

30%

Machine/equipment errors :

2%

Medication/ drug errors :

10%

Production pressure (?turnover?) :

23%

Inadequate preoperative information/preparation:

25%

Total Votes: 212

Specific institutional algorithm (protocol):

3%

Team management (multiple providers):

16%

Medical Consultant (hematologist, etc):

5%

Cardiologist:

40%

Operating surgeon:

8%

Anesthesia professional:

25%

Total Votes: 280

Never:

15%

Once a year:

24%

Once a quarter:

11%

Once a month:

15%

Once a week:

14%

Once a day:

18%

Total Votes: 152

Has deteriorated significantly:

8%

Has declined slightly:

9%

Is the same:

18%

Is slightly better:

27%

Has definitely improved:

36%

Total Votes: 132