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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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.
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Curr Opin Anaesthesiol · Dec 2013
ReviewThe changing landscape of anesthesia education: is Flipped Classroom the answer?
Educators in the specialty of anesthesiology are facing a number of challenges. A new generation of residents are entering the specialty and they have unique learning styles and expectations. The new duty hour regulations also encroach on the time available to the residents for education. In the last decade, a number of models for teaching and learning have been proposed to tackle these issues. ⋯ The 'Flipped Classroom' model seems to combine the best of both worlds. It allows the learner to assimilate basic information (lower order cognitive skills) from material that is placed online, allowing asynchronous learning. It frees up the teacher to use the face-to-face interaction time in the operating room and classroom for training the student in advanced concepts (higher order cognitive skills). This model allows efficient and effective use of time and technology, but involves the redesign of how in person time between faculty and residents are spent, along with the faculty development to effectively engage this new type of curriculum.
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Curr Opin Anaesthesiol · Dec 2013
ReviewThe patient with a history of congenital heart disease who is to undergo ambulatory surgery.
There is a strong pressure to widen the indications of ambulatory anaesthesia in children. Making a decision concerning a child with a history of cardiac disease is often difficult. The aim of this review is to give practical recommendations to help the anaesthesiologist recognize potentially dangerous situations in children with a history of cardiac disease. ⋯ A child whose cardiac disease has been corrected, who is developing well, has no exercise restriction and undergoes regular cardiologic follow-up does not present more risks than any normal American Society of Anesthesiologists physical status 1-2 child. Any other situation requires close communication with the child's paediatric cardiologist to evaluate the risks of both anaesthesia and outpatient care, and make an individualized decision accordingly.
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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.