Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2008
ReviewThe measurement of dyshemoglobins and total hemoglobin by pulse oximetry.
Recent advances in pulse oximetry have made it possible to noninvasively measure total hemoglobin, as well as the two most common dyshemoglobins. This review will trace the development and clinical application of multiwavelength pulse oximetry. ⋯ The development of multiwavelength pulse oximeters, which can measure total hemoglobin as well as dyshemoglobins, should result in improved patient care.
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Advances in minimally invasive procedures have resulted in an increased demand for procedural sedation. Patient-controlled sedation (PCS) has been in clinical use for almost 20 years, but has not been reviewed in over 10 years. ⋯ PCS has been applied to a wide variety of procedures, but systems that can be applied 'off-the-shelf' are not easy to tune. New approaches to PCS may address these limitations. Better understanding of the psychology of sedation may lead to better patient acceptance of PCS.
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Elimination of flammable anesthetic gases has had little effect on operating-room fires except to change their etiology. Electrocautery and lasers, in an oxygen-enriched environment, can ignite even the most fire-resistant materials, including the patient, and the fire triad possibilities in the operating room are nearly limitless. This review will: identify operating room contents capable of acting as ignition/oxidizer/fuel sources, highlight operating room items that are uniquely potent fire triad contributors, and operating room identify settings where fire risk is enhanced by proximity of triad components in time or space. ⋯ Operating room fires are infrequent but catastrophic. Operating room fire prevention depends on: (a)understanding how fire triad elements interact to create a fire, (b) recognizing how standard operating-room equipment, materials, and supplemental oxygen can become one of those elements, and (c) vigilance for circumstances that bring fire triad elements into close proximity.
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The purview of ambulatory anesthesia continues to broaden in response to national interest in controlling healthcare costs and eliminating unnecessarily expensive hospital stays. Recent advances in anesthesia allow us to minimize side effects and complications of anesthesia and surgery that might otherwise delay recovery and discharge. The purpose of this review is to highlight some of these latest advances in clinical care that may soon change how we practice. ⋯ The research and advances in clinical care described will likely influence how we manage our patients in the future, eliminating the need for prolonged hospital stay after surgery.
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Curr Opin Anaesthesiol · Dec 2008
ReviewUsing ventilation-induced plethysmographic variations to optimize patient fluid status.
Hypovolemia is one of the most frequent causes of arterial hypotension in the operating room. Pulse oximeter plethysmographic waveform, obtained using a noninvasive and widely available device, has recently shown its potential interest in predicting fluid responsiveness in mechanically ventilated patients under mechanical ventilation. This review highlights new applications of this routine monitoring. ⋯ Automatic detection of respiratory variations in pulse oximetry plethysmographic waveform amplitude can predict fluid responsiveness in the operating room in patients under mechanical ventilation and has potential for fluid optimization in this setting.