Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2014
ReviewThe role of the anesthesiologist in perioperative patient safety.
Despite the benefits of rapidly advancing therapeutic and diagnostic possibilities, the perioperative setting still exposes patients to significant risks of adverse events and harm. Anesthesiologists are in midstream of perioperative care and can make significant contributions to patient safety and patient outcomes. This article reviews recent research results outlining the current trends of perioperative patient harm and summarizes the evidence in favor of patient safety practices. ⋯ Current research provides growing evidence for the effectiveness of several patient safety practices designed to prevent or diminish perioperative adverse events and patient harm. Future investigations will hopefully fill the numerous persisting knowledge gaps.
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Many patients presenting for surgical or other procedures in an ambulatory setting are taking new antiplatelet or anticoagulant agents. This review assesses how the novel features of these new agents affect the management of antithrombotic therapy in the ambulatory setting. ⋯ As there are few clinical studies to guide management, clinicians must make rational decisions in relation to continuing or ceasing new antithrombotic agents. This requires knowledge of their pharmacokinetics, and a careful multidisciplinary assessment of the relative thrombotic and bleeding risks in individual patients.
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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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Curr Opin Anaesthesiol · Dec 2014
ReviewCurrent recommendations for monitoring depth of neuromuscular blockade.
Residual neuromuscular block is a relatively frequent occurrence and is associated with postoperative pulmonary complications, including aspiration, pneumonia and hypoxia, impaired hypoxic ventilatory drive and decreased patient satisfaction. Although adequate recovery of neuromuscular function has been defined as a train-of-four ratio of at least 0.9, monitoring with a qualitative peripheral nerve stimulator makes it impossible to determine the actual train-of-four ratio. ⋯ Use of peripheral nerve stimulators allows clinicians to administer neuromuscular blocking and reversal agents in a rational manner. Routine use of quantitative monitors of depth of neuromuscular blockade is the best guarantee of the adequacy of recovery of postoperative muscle strength.
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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.