Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2013
Administrative issues to ensure safe anesthesia care in the office-based setting.
Office-based practice is distinct from other ambulatory practices and has unique considerations for an effective administrative structure to support its operations. ⋯ Office-based practice will continue to evolve with the national emphasis on patient safety, cost reduction, value-based care, and outcomes measurement and reporting. Each practice must comply with the state and national regulations that could limit the types of procedures being performed and who can administer sedation or anesthesia, and require the facility to be accredited by a nationally recognized accrediting agency.
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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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Advances in surgery and anesthesia have allowed for more surgeries to be done on an outpatient basis. A recent important advance entails availability of suitable recovery criteria to capitalize on the benefits of regional anesthesia for ambulatory surgery. With ever-escalating healthcare costs and expectations for faster recovery, anesthesiologists are now challenged to design anesthesia plans focused on Phase I postanesthesia care unit bypass and early facility discharge. Satisfying the recently published WAKE Score criteria upon operating room exit is associated with hospital cost reductions. This review highlights regional anesthesia techniques with focus on outpatient orthopedics. We also discuss 'multimodalities' addressing postoperative nausea and vomiting prophylaxis, perioperative analgesia (including perineural analgesia), and sedation-hypnosis, which are all central to timely recovery using now-available suitable recovery criteria. ⋯ Routine regional anesthesia use, multimodal postoperative nausea and vomiting prophylaxis, multimodal sedation-hypnosis, and multimodal analgesia, along with avoiding volatile agents and short-duration opioids, can lead to both routine Phase 1 postanesthesia care unit bypass and expedited same-day discharge, when using suitable recovery criteria.
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Curr Opin Anaesthesiol · Dec 2013
ReviewSimulation and psychology: creating, recognizing and using learning opportunities.
Psychology is relevant for improving the use of simulation in anesthesiology, as it allows us to describe, explain and optimize the interactions of learners and instructors as well as the design of simulation scenarios and debriefings. Much psychological expertise is not used for simulation in healthcare. This article aims to help bridging the gap between professions. ⋯ See the Video Supplementary Digital Content 1 (http://links.lww.com/COAN/A26).
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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.