Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2008
ReviewPerioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery.
Pulmonary hypertension is a condition that has a multitude of causes. Left untreated, patients with pulmonary hypertension will experience progressive symptoms of dyspnea and right heart failure resulting in significant morbidity and mortality. This review details the many evolving aspects of understanding related to pulmonary hypertension including signs and symptoms, pathophysiology, classification, anesthetic management including perioperative considerations and treatment options. ⋯ Coupled with aggressive use of improved diagnostic hemodynamic monitors perioperatively, these patients can be medically optimized during their hospitalization and possibly aid in improving their long-term prognosis.
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To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. ⋯ Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.
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Curr Opin Anaesthesiol · Aug 2008
ReviewAnesthesia outside the operating room in the office-based setting.
The majority of anesthesia services provided outside the operating room or ambulatory surgery center is in the office-based setting. This review will focus on three areas that are critical to office-based anesthesia: safety, quality of care and patient satisfaction. ⋯ There is rapid growth for the need of safe and high quality office-based anesthesia. To meet these needs, a special set of skills is required, which may require expanded exposure and experience during training. An office-based anesthesia central data repository is needed for benchmarking and identifying areas for improvement. Finally, with advances in surgical technology, there is a need for focused research in office-based anesthetic techniques and modalities and patient satisfaction.
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To discuss closed-loop systems, the engineering behind them, and the application of these systems. ⋯ The future anesthesiologist may devote less time to easily delegated tasks when in the operating room. The ability of computers to maintain variables in a set range allows some tasks to be automated. Although monitoring of these systems will never be completely eliminated, the necessity for minute-to-minute intervention may.
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Curr Opin Anaesthesiol · Aug 2008
ReviewThe role of neurokinin-1 receptor antagonists for the management of postoperative nausea and vomiting.
To review the characteristics of neurokinin-1 receptor antagonists and their potential role in the management of postoperative nausea and vomiting. ⋯ Postoperative vomiting can lead to rare but serious complications. Neurokinin-1 receptor antagonists are significantly more efficacious against postoperative vomiting than other antiemetics. Because the benefit in terms of absolute risk reduction is critically dependent on the patient's baseline risk, it is recommended to use a validated risk score to identify patients who will benefit most from prophylaxis using neurokinin-1 receptor antagonists.