Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2014
ReviewUpdate on the management of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) continues to be one of the most common postsurgical medical problems. An understanding of the pathophysiology of PONV and the pharmacological profiles of agents affecting receptors involved in emesis is necessary to effectively treat PONV. ⋯ Proper management of PONV includes an evaluation of risk factors, a strategy for prophylaxis, and rescue antiemetic treatment if necessary. In high-risk patients, combination therapy is recommended in preventing PONV. Knowledge of antiemetic efficacy and safety may facilitate an increase in patient satisfaction, decreased negative health consequences, and reduced medical costs.
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Curr Opin Anaesthesiol · Dec 2014
ReviewValue of expert systems, quick reference guides and other cognitive aids.
Cognitive aids and other methods of decision support are receiving increased interest by the anesthesia community. These tools have significant safety implications because of the possibility to decrease variability in human performance. ⋯ The early work in this field of decision support is encouraging but there are many questions regarding the optimal design, presentation and use.
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For patients requiring surgery in the prone position, an alternative to a traditional supine induction is allowing the patient to position themselves comfortably prone and inducing anesthesia in that position. The purpose of this review is to examine the current literature and evaluate the safety of induction of anesthesia in the prone position. ⋯ The reviewed literature shows that elective prone induction of anesthesia using supraglottic airways, in select patients, is feasible and associated with very low complication rates; however, there is insufficient evidence to suggest that this should be done routinely.
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Curr Opin Anaesthesiol · Dec 2014
ReviewPatient safety challenges in low-income and middle-income countries.
The global burden of surgical disease is significant and growing. As a result, the vital role of essential surgical care and safe anesthesia in low-income and middle-income countries is gaining increasing attention. Importantly, vast disparities in access to essential surgery and safe anesthesia exist. In this review, we summarize the current knowledge surrounding the global crisis of inadequate anesthesia capacity and barriers to patient safety in low-income and middle-income countries. ⋯ Explicit mention of essential surgery and safe anesthesia in the Post-2015 Development Agenda is a critical step forward in advancing the cause of global perioperative care. Tracking surgical and anesthesia outcomes with a metric, such as the perioperative mortality rate, must be required at the hospital, country, and global level to guide improvement of surgical and anesthetic interventions aimed at the burden of surgical disease.
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As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly patients will assume increased importance. ⋯ This review article describes the demographics of ambulatory surgery in the elderly population. This review article describes the effects of aging on the responses of geriatric patients to anesthetic and analgesic drugs used during ambulatory surgery. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative side-effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. Finally, we discuss the future challenges related to the continued expansion of ambulatory surgery practice in this growing segment of our surgical population. The role of anesthesiologists as perioperative physicians is of critical importance for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. Providing high-quality, evidence-based anesthetic and analgesic care for elderly patients undergoing elective operations on an ambulatory basis will assume greater importance in the future.