Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2010
ReviewShaping the operating room and perioperative systems of the future: innovating for improved competitiveness.
To review the current state of anesthesiology for operative and invasive procedures, with an eye toward possible future states. ⋯ Anesthesiologists must create more headroom between costs and revenues in order to sustain the academic vigor and creativity required to create better clinical practice. We outline three areas in which technological and organizational innovation in anesthesiology can improve competitiveness and become a driving force in collaborative efforts to develop the operating rooms and perioperative systems of the future: increasing the profitability of operating rooms; increasing the efficiency of anesthesia; and technological and organizational innovation to foster improved patient flow, communication, coordination, and organizational learning.
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Curr Opin Anaesthesiol · Dec 2010
ReviewBeta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?
As day surgery continues to expand, more patients will be encountered who are chronically taking a range of cardiovascular medications for the management of hypertension and ischaemic heart disease. This review will consider the available evidence relating to whether or not these medications should be continued throughout the perioperative period in ambulatory surgical patients. ⋯ Patients should continue to take beta-blockers and calcium channel blockers on the day of surgery. Continuing angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers increases the likelihood of intraoperative hypotension. This can be reduced by withholding these drugs, but will also respond to simple treatments without any apparent adverse outcomes. It may therefore simplify instructions to patients if they are told to take all cardiac medications as normal.
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Curr Opin Anaesthesiol · Dec 2010
ReviewTopical application of analgesics: a clinical option in day case anaesthesia?
To examine the available and emerging evidence of the use of topically applied analgesics with particular reference to day case anaesthesia. ⋯ A variety of targets for peripherally applied analgesics exists, some of which can be accessed using currently available drugs, whereas others may need development of new formulations before they can be clinically targeted.