Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2014
ReviewTransfusion errors: causes, incidence, and strategies for prevention.
Miss-transfusion of blood has become one of the leading causes of death related to blood transfusion. New technology is able to better prevent miss-transfusions than older methods. ⋯ Humans make errors. New technology can prevent those errors.
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Incidence of obesity continues to rise and ambulatory surgical centers will need to be prepared for the increase in the obese surgical patients. This review aims to provide recent updates in managing the obese patients in an ambulatory surgical center and to address key clinical questions, such as patient selection, assessment and optimization, as well as important perioperative consideration. ⋯ With extra considerations and meticulous perioperative management, it is well tolerated to accept obese patients for ambulatory surgery. The super-obese patients, however, are at a higher risk for perioperative adverse events.
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Curr Opin Anaesthesiol · Dec 2014
ReviewManagement of neuromuscular blockade in ambulatory patients.
The use of neuromuscular blocking agents in ambulatory surgery has been described as a double-edged sword. Muscle relaxants may improve the outcome following endotracheal intubation and could be helpful for the surgeon to some extent. However, these agents might increase the risk of postoperative complications because of residual paralysis. This review should summarize recent developments in neuromuscular blockade, neuromuscular monitoring, and reversal with a special reference to day case surgery. ⋯ The management of neuromuscular blocks in day case surgery requests a comprehensive approach that should include an adequate dosing of the muscle relaxant, quantitative objective monitoring, and a sufficient and appropriate reversal.
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There has been a renewed interest in the short-acting local anesthetics articaine, chloroprocaine, and prilocaine for ambulatory spinal anesthesia because of numerous potentially beneficial factors both clinically and economically speaking. This review covers the current advances of the past 1 to 2 years. ⋯ Intrathecal articaine (off-label use for the time being), chloroprocaine, and prilocaine (the latter two officially approval in several European countries) remain a very appealing option in the ambulatory setting. Chloroprocaine may have a slight edge as regards ultra-short and short surgery, whereas articaine and prilocaine may suit well for somewhat longer procedures. Future follow-up investigations should establish possible differences between these local anesthetics, also with respect to other anesthetic techniques and to economical aspects.
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Curr Opin Anaesthesiol · Dec 2014
ReviewThe Helsinki Declaration on Patient Safety in Anaesthesiology: the past, present and future.
Four years after the launch of the Helsinki Declaration on Patient Safety in Anaesthesiology, it is of interest to assess its role in European and Global Patient Safety efforts. ⋯ The launch of Helsinki Declaration of Patient Safety in Anaesthesiology in 2010 was a major step forward for patient safety initiatives in European and Global anesthesiology. Several steps have been taken in the 4 years that have passed, but the task needs continuous attention to ensure that every patient received the safest possible anesthesiology care.