Current opinion in anaesthesiology
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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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This review is designed to evaluate various aspects of the teaching, demonstration and assessment of competence in anesthesiology. ⋯ The traditional evaluation of clinical competence in anesthesiology has focused on written examinations and global evaluation of skill. Limits to this approach have become obvious. Assessment has evolved to specific competencies with performance and behavior-based standards and criteria for mastery of each competency. As standards for competency are better understood, multimedia tools, such as simulation and electronic portfolio, will further advance this evolution.
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There are an increasing number of monitors being developed to measure physiological parameters during the perioperative period. This review provides an overview of some of these new monitors developed for use in clinical anesthesia and outlines the potential advantages of each device. Pitfalls concerning the introduction of additional monitoring devices and the research gaps for introducing these monitors into clinical practice are discussed. ⋯ More research is needed on how to integrate the newly developed monitors into the clinical context to assist information-overloaded anesthesiologists. This is essential to achieve the potential benefit of new monitoring devices.
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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.