Current opinion in anaesthesiology
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Improving perioperative efficiency and throughput has become increasingly important in facilitating the fast-track recovery process following ambulatory surgery. This review focuses on the important role played by the anesthesiologist as a perioperative physician in fast-track ambulatory surgery. ⋯ The pivotal role played by the anesthesiologist as the key perioperative physician in facilitating the recovery process has assumed increased importance in the current outpatient fast-track recovery environment. The choice of premedication, anesthetic, analgesic and antiemetic drugs, as well as cardiovascular, hormonal and fluid therapies, can all influence the ability to fast-track outpatients after ambulatory surgery.
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Curr Opin Anaesthesiol · Dec 2007
ReviewDuty hours restriction and their effect on resident education and academic departments: the American perspective.
Resident duty hour limits were implemented in 2003 by the Accreditation Council for Graduate Medical Education to improve resident wellness, increase patient safety and improve the educational environment of American residents. Now that academic anesthesiology departments and medical centers have had more than 3 years of experience under the duty hour rules, it is critical to review the available evidence on the effectiveness of these rules. ⋯ Accreditation Council for Graduate Medical Education duty hour rules are generally being followed by American anesthesiology residency programs. Residents perceive an improvement in their overall wellness, but it remains unclear if there has been an improvement in patient safety or quality of resident education.
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We examined the advantages and disadvantages of certifying additional subspecialties in anesthesiology from five vantage points - patients, generalist anesthesiologists, subspecialist anesthesiologists, departments of anesthesiology, and society as a whole - in order to recommend a course of action. ⋯ Based on our examination, from the five perspectives given above, we recommend that training in all subspecialties of anesthesiology be encouraged. Official fellowship accreditation and subspecialty certification, however, should be reserved for subspecialties in which anesthesiologists provide services comparable to those provided by nonanesthesiologist subspecialists, such as critical care medicine and pain medicine.
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Perioperative beta-blockade has been advocated by multiple authors and recent guidelines as a strategy to reduce cardiac risk in noncardiac surgery. Knowledge about application of this treatment modality to the ambulatory surgery population is poor. ⋯ Based upon the available evidence and guidelines, patients currently taking beta-blockers and undergoing ambulatory surgery should continue these agents and protocols employing this strategy should be beneficial. In patients who are not currently taking beta-blockers and in whom long-term therapy is not warranted, current evidence does not support instituting prophylactic therapy in the ambulatory surgery population.
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Curr Opin Anaesthesiol · Dec 2007
ReviewAnesthesia and sedation outside the operating room: how to prevent risk and maintain good quality.
The purpose of this review is to define risks for anesthesia and sedation outside the operating room, and to suggest how to prevent these risks and maintain quality of care. ⋯ Complications of anesthesia outside the operating room are not well studied, although a few closed claims are appearing in the literature suggesting there is a higher risk. Topics discussed focus on MRI and surgical procedures, principally dental, plastic, and gastrointestinal endoscopy. Risk factors for these procedures are identified and quantified and measures to reduce them discussed, with emphasis on full oxygenation and end-tidal carbon dioxide monitoring. Nonoperating room anesthesia requires skills, experience and organization. Quality can only be assured by ensuring all alternative locations adhere to operating room standards.