Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Apr 2006
ReviewFactors affecting supply and demand of anesthesiologists in Western Europe.
Current demographic and macroeconomic trends indicate that, in Western Europe, the demand for anesthesia services will continue to increase. It is, however, questionable whether there will be sufficient supply. ⋯ Steps must be taken to augment the number of practitioners to ensure a sufficient number of anesthesiologists. Employers will have to offer flexible working practices and adequate compensation to attract new anesthesiologists. Alternatively, more responsibilities and tasks may be allocated to well-trained anesthesia assistants (e.g. nurses). National anesthesia associations must improve and coordinate resident training, which may alleviate the recruitment problem. A European training standard in anesthesia might adjust the regional disequilibrium of supply and demand, as might salary competition. In the long run, the undersupply of anesthesiologists may be offset by factors such as more procedures being performed non-invasively and further demand-lowering healthcare policies.
-
Transfusion therapy in the intensive care unit is an ever-growing field, with new understanding of potential complications, new drug therapies to reduce the need for transfusion, and new additions in component therapy. In addition to the risks of sepsis, ABO blood group mismatch, and other complications associated with transfusion, the intensivist needs to be familiar with alternative therapies to minimize transfusion. ⋯ Recognizing early signs of transfusion-related acute lung injury may aid in the treatment and reporting of this entity. Realizing the mechanism and severity of immunosuppression associated with transfusion may alter transfusion triggers in the intensive care unit. rHuEPO and aprotinin are now being used with increasing frequency to increase red cell counts and minimize the need for transfusion. Recombinant factor FVIIa targets coagulation cascade activation which helps to reduce the number of units of blood products transfused in the actively bleeding patient.
-
Curr Opin Anaesthesiol · Apr 2006
ReviewPatient-safety and quality initiatives in the intensive-care unit.
Patient safety has become the primary focus of health-care improvement in the last few years as an increasing body of evidence emphasizes the magnitude of harm posed to patients by medical errors. The intensive-care unit, by virtue of the high technology aggressive level of care the unit provides, has been identified as a significant source of patient harm. Consequently, the intensive-care unit also represents a tremendous opportunity to study and implement patient-safety initiatives, as significant improvements can be realized in this environment. ⋯ Many patient safety and quality-of-care initiatives that have broad application to all areas of medical care have been successfully developed in the intensive-care unit. The intensive-care unit appears to be a fertile ground for the development of safety initiatives.
-
Curr Opin Anaesthesiol · Apr 2006
ReviewCost drivers in anesthesia: manpower, technique and other factors.
This article reviews the recent literature on cost drivers in anesthesia with respect to staff, techniques and drug costs, and with special focus on anesthesia workflow in the postanesthesia care unit. Moreover, the costs of post-operative pain management provided by an acute pain service are highlighted. ⋯ Clear definition of the meaning of cost drivers and of criteria which allow assessment of patients' condition, and peri-operative standard operating procedures are warranted to ensure comparability of economic data in anesthesia.