Current opinion in anaesthesiology
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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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Curr Opin Anaesthesiol · Dec 2009
ReviewEscort accompanying discharge after ambulatory surgery: a necessity or a luxury?
There is a growing demand for greater efficiency in ambulatory surgery. The patient population is increasingly sick which is also undergoing more advanced and complex surgery. This creates a danger in discharging patients without meeting the criterion of requirement of a responsible adult as an escort to accompany the patient home. The purpose of this review is to examine the most recent findings to determine whether an escort for patient discharge is necessary. ⋯ Both clinicians and patients may have underestimated the risks associated with discharging patients without an escort after ambulatory anesthesia. There should be greater awareness of this problem. Patient discharge without an escort after ambulatory surgery under general anesthesia, sedation or premedication can potentially be dangerous and is not recommended.
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Curr Opin Anaesthesiol · Dec 2009
ReviewPerioperative management of outpatients with implantable cardioverter defibrillators.
Implantable cardioverter defibrillators (ICDs) are increasingly being placed in patients worldwide. These patients pose significant perioperative challenges and are at an increased risk of complications; the suitability of ambulatory surgery in this patient population remains controversial. The purpose of the present review is to examine the potential challenges and optimal perioperative care of patients with an ICD. ⋯ Anesthesia practitioners involved in the care of patients with ICDs should familiarize themselves with the response to magnets application on ICD function as well as understand the situations in which magnet use is not advisable. Perioperative communication with the patient's cardiologist and surgeon is critical in reducing adverse outcome.
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Curr Opin Anaesthesiol · Dec 2009
ReviewControl of perioperative muscle strength during ambulatory surgery.
This review describes strategies to control perioperative muscle strength in patients undergoing ambulatory surgery. ⋯ Optimal muscle relaxation for ambulatory surgery results from a judicious combination of regional anesthesia, opioids, and low doses of NMBAs. The effects of NMBAs should be monitored quantitatively by acceleromyography and reversed appropriately.
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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.