Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2013
ReviewAnesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain.
Retrospective studies show that a single anesthesia exposure before age 3 may undermine language acquisition and abstract reasoning, and exposure to two or more anesthetics before age 2 almost doubles the risk of attention-deficit hyperactivity disorder, although in both cases causality has not yet been established.
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Curr Opin Anaesthesiol · Dec 2013
ReviewThreat and error management for anesthesiologists: a predictive risk taxonomy.
Patient care in the operating room is a dynamic interaction that requires cooperation among team members and reliance upon sophisticated technology. Most human factors research in medicine has been focused on analyzing errors and implementing system-wide changes to prevent them from recurring. We describe a set of techniques that has been used successfully by the aviation industry to analyze errors and adverse events and explain how these techniques can be applied to patient care. ⋯ TEM offers a multifaceted strategy for identifying hazards, reducing errors, and training physicians. A threat taxonomy may improve analysis of critical events with subsequent development of specific interventions, and may also serve as a framework for training programs in risk mitigation.
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Curr Opin Anaesthesiol · Dec 2013
ReviewPreanesthesia evaluation for ambulatory surgery: do we make a difference?
Ambulatory surgery is considered low risk; however, both surgery-related and patient-related factors combine to determine the overall risk of a procedure. The preanesthesia evaluation is useful to gather information and determine whether additional testing or medical optimization is necessary prior to surgery with the goal to prevent adverse events and improve outcomes. ⋯ Current literature supports a preanesthesia visit that focuses on individual patient evaluations and patient-directed effective interventions. This is in contrast to the previous routine, protocolized preoperative preparations. The challenge for anesthesiologists lies in understanding both surgery-specific and patient-specific risk factors, and targeting interventions to optimize the outcomes.
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Changing attitudes toward global health are affecting medical education programs at all levels in the USA and abroad. This review describes some of these changes, and how these affect the educational aspects of US global health programs and anesthesia training in developing countries. ⋯ The past 5 years have brought a new global focus on workforce development and education in anesthesia. Programs need to be supported by all stakeholders and monitored for safety, quality and outcomes.
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To assess the current use of simulation in medical education, specifically, the teaching of the basic sciences to accomplish the goal of improved integration. ⋯ Medical education is undergoing tremendous change. One of the directions of that change is increasing integration of the basic and clinical sciences to improve the efficiency and quality of medical education, and ultimately to improve the patient care. Integration is thought to improve the understanding of basic science conceptual knowledge and to better prepare the learners for clinical practice. Simulation because of its unique effects on learning is currently being successfully used by many institutions as a means to produce that integration through its use in the teaching of the basic sciences. Preliminary data indicate that simulation is an effective tool for basic science education and garners high learner satisfaction.