Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2012
ReviewSociety for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery.
The suitability of ambulatory surgery for a patient with obstructive sleep apnea (OSA) remains controversial because of concerns of increased perioperative complications including postdischarge death. Therefore, a Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for ambulatory surgery. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ⋯ How does this guideline differ from existing guidelines? Unlike the ASA guidelines, this consensus statement recommends the use of the STOP-Bang criteria for preoperative OSA screening and considers patients' comorbid conditions in the patient selection process. Also, current literature does not support the ASA recommendations that upper abdominal procedures are not appropriate for ambulatory surgery. Why does this guideline differ from existing guidelines? This consensus statement differs from existing ASA guidelines because of the availability of new evidence.
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Anesthesia and analgesia · Nov 2012
ReviewWhat's new in obstetric anesthesia in 2011? Reducing maternal adverse outcomes and improving obstetric anesthesia quality of care.
This article accompanied the "What's New in Obstetric Anesthesia?" lecture presented at the Society for Obstetric Anesthesia and Perinatology Annual Meeting in May 2012. The invited lecturer reviewed the obstetric, obstetric anesthesiology, perinatology, and key medical literature published in 2011. This review identifies key topics and themes from the 2011 literature relevant to the science and clinical practice of obstetric anesthesiology and the interdisciplinary care of obstetric patients. Specific topics include health care policy issues that affect pregnant women, updated information on maternal mortality and morbidity, and clinical and outcomes-based research related to anesthetic practices for women undergoing cesarean delivery.
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Anesthesia and analgesia · Nov 2012
ReviewCore review: physician-performed ultrasound: the time has come for routine use in acute care medicine.
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. ⋯ The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Anesthesia and analgesia · Nov 2012
ReviewOff-label use of medications in children undergoing sedation and anesthesia.
Many drugs used for anesthesia and analgesia in children are administered "off-label." We undertook an audit of drugs commonly used for pediatric anesthesia to determine which drugs have United States Food and Drug Administration (FDA) labeling for pediatric use, which drugs are age-restricted, and which have no labeling for pediatric use. ⋯ Many drugs used for children during anesthesia continue to lack FDA labeling for pediatric use. Off-label use of these drugs is an accepted practice that is considered superior to the alternative of withholding needed medications. Studies are still needed to determine the safety and efficacy of drugs that lack FDA labeling for this vulnerable patient population.