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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Curr Opin Anaesthesiol · Dec 2008
ReviewManagement of outcomes in the ambulatory surgery center: the role of standard work and evidence-based medicine.
Quality and safety in the manufacturing and airline industries have benefited from evidenced-based process-improvement strategies. This review investigates the rationale for application of these same processes in the ambulatory anesthesia setting. ⋯ Ambulatory surgery and anesthesia care is uniquely oriented to the application of repetitive processes in the provision of highly predictable and reproducible surgical services. Ambulatory anesthesiologists should lead the healthcare industry in the much wider adoption of standard practice protocols and team training to maximally improve the safety and quality of patients' experiences.
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Curr Opin Anaesthesiol · Dec 2008
ReviewPreoperative screening, evaluation, and optimization of the patient's medical status before outpatient surgery.
Preoperative evaluation and optimization of a patient's medical condition are important components of anesthesia practice. With ever increasing numbers of patients with serious comorbidities having complex procedures as outpatients, the task of gathering information and properly preparing for their care is challenging. Improvements in assessment and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. ⋯ Preparation of patients before surgery is a necessary and vital component of perioperative medicine. Practices are developing to guide effective interventions that benefit patients and healthcare systems. Outpatients present special challenges to preoperative assessment.
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American Society of Aesthetic Plastic Surgery statistics show outpatient cosmetic procedures increased from 3 to 11 million (1997-2007), an increase of 457%, and $13 billion was spent. Exponential growth, complexity of cases and patients, and media attention to high-profile untoward events are accompanied with concerns for patient safety and development of safer anesthesia practices. ⋯ The methods presented improve patient safety. The number of cosmetic procedures will continue to grow exponentially and evolve additional patient safety concerns. This larger population is the foundation for prospective trials to develop evidence-based anesthesia for cosmetic surgery.