Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2010
ReviewNeurokinin-1 and novel serotonin antagonists for postoperative and postdischarge nausea and vomiting.
This review will address novel options for the prevention and treatment of postoperative and postdischarge nausea and vomiting (PONV and PDNV) after ambulatory anesthesia. In particular, this paper will review the characteristics of neurokinin-1 receptor antagonists (NK1-RAs) and the new serotonin receptor antagonist (5HT3-RA) palonosetron. Finally, we will discuss strategies for prophylaxis and treatment of PONV and PDNV that address the unique concerns in ambulatory surgery patients. ⋯ Because of the high incidence of PDNV, a predictive model for PDNV would be helpful to determine appropriate antiemetic interventions for each individual patient. Drugs that may be particularly favorable are the novel NK1-RA aprepitant and the next generation 5HT3-RA palonosetron.
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Curr Opin Anaesthesiol · Dec 2010
ReviewPatient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice.
WHO makes clear recommendations on how to improve patient safety during surgical procedures by using the WHO Surgical Safety Checklist. We will review the scientific basis of these recommendations and the practical problems encountered during introduction. ⋯ There is sufficient scientific evidence to make the use of checklists and structured perioperative briefings and debriefings mandatory for the broad spectrum of operative procedures.
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Curr Opin Anaesthesiol · Dec 2010
Editorial ReviewPreoperative single-dose intravenous dexamethasone during ambulatory surgery: update around the benefit versus risk.
Pain, emesis, and fatigue are not uncommon symptoms after ambulatory surgery having impact on patients' satisfaction with quality of care. Multimodal management of postoperative pain and nausea and vomiting has become standard of care. ⋯ The benefits versus risk associated to single preoperative i.v. dose of dexamethasone seem positive based on current evidence facilitating the recovery reducing pain and postoperative nausea and vomiting.
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Curr Opin Anaesthesiol · Dec 2010
ReviewAnaesthesia for the elderly outpatient: preoperative assessment and evaluation, anaesthetic technique and postoperative pain management.
Epidemiological data show a continuous expansion of elderly population, associated with an increased demand for surgical treatments by older patients. Geriatric anaesthesia is emerging as a new subspecialty. Outpatient anaesthesia for elderly patients requires greater specific knowledge and skills. Given the high economic and social pressure, anaesthetists will be requested to treat an increasing number of elderly as outpatients. ⋯ Recent findings contribute to a better comprehension of the most important specificities of elderly patients undergoing day surgery and provide basic elements for a safe perioperative management in the outpatient setting.
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Curr Opin Anaesthesiol · Dec 2010
ReviewThe role of multimodal analgesia in pain management after ambulatory surgery.
As outpatient (day-case) surgery had continued to grow throughout the world, many more complex and potentially painful procedures are being routinely performed in the ambulatory setting. Opioid analgesics, once considered the standard approach to preventing acute postoperative pain, are being replaced by a combination of nonopioid analgesic drugs with diverse modes of action as part of a multimodal approach to preventing pain after ambulatory surgery. This review will provide an update on the topic of multimodal pain management for ambulatory (day-case) surgery. ⋯ This article discusses recent evidence from the peer-reviewed literature regarding the role of local anesthetics, NSAIDs, gabapentinoids, and acetaminophen, as well as alpha-2 agonists, ketamine, esmolol, and nonpharmacologic approaches (e.g., transcutaneous electrical stimulation) as parts of multimodal pain management strategies in day-case surgery.