Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2009
ReviewForced-air warming: technology, physical background and practical aspects.
There is an ever-increasing number of forced-air warming devices available in the market. However, there is also a paucity of studies that have investigated the physical background of these devices, making it difficult to find the most suitable ones. ⋯ The efficacy of a forced-air warming system is mainly determined by the design of the blankets. A good forced-air warming blanket can easily be detected by measuring the temperature difference between the highest blanket temperature and the lowest blanket temperature. This temperature difference should be as low as possible. Because of the limited efficacy of forced-air warming systems to prevent hypothermia, patients must be prewarmed for 30-60 min even if a forced-air warming system is used during the operation. During the operation, the largest blanket that is possible for the operation should be used.
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The focus of intraoperative monitoring is moving away from invasive monitoring. This has been attributed to procedure time, cost, and the known risks, which include carotid artery puncture, arrhythmia, pneumothorax, and infection. Until recently, the venous system's contribution to the circulatory system has been incorrectly identified as being insignificant. This article summarizes the unique characteristics of the peripheral venous system. ⋯ The veins play a critical role in cardiovascular homeostasis; they do more than conduct blood to the heart. Considering the ease of measurement from a peripheral intravenous catheter, further study should be conducted to investigate the usefulness and limitations of such a minimally invasive and inexpensive monitoring device.
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We outline and discuss recent work on auditory displays, covering both auditory alarms that indicate technical or physiological threshold levels and informative auditory displays that provide a continuous awareness of a patient's well being. ⋯ Auditory display in anesthesia can extend well beyond auditory alarms to displays that give the anesthesiologist a continuous peripheral awareness of patient well being. Much more rigorous approaches should be taken to evaluating auditory displays so they add information rather than noise.
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Curr Opin Anaesthesiol · Dec 2009
ReviewAnaesthesia for the patient with dementia undergoing outpatient surgery.
Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery. ⋯ Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.
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Head-mounted displays (HMDs) are head-worn display devices that project an information display over the wearer's field of view. This article reviews a recent program of research that investigates the advantages and disadvantages of monitoring with HMDs, and discusses the design considerations and implementation issues that must be addressed before HMDs can be clinically adopted. ⋯ Anesthesiologists may be able to monitor their patients more effectively when an HMD is used in conjunction with existing monitors, but several engineering and implementation issues need to be resolved before HMDs can be adopted in practice. Further research is needed on the design of information displays for HMDs.