Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2014
ReviewDetection and management of perioperative myocardial ischemia.
To review the current evidence for detection and management of perioperative myocardial ischemia. ⋯ Perioperative physicians should refrain from the use of nonsurgical diagnostic criteria for myocardial infarction and adopt the clinical entity known as myocardial injury after noncardiac surgery in order to allow for better determination of the prevalence of this perioperative complication. Studies should focus on establishing the feasibility of broad postoperative troponin surveillance following noncardiac surgery. Clinical trials of potential therapies for myocardial injury after noncardiac surgery are urgently needed.
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Curr Opin Anaesthesiol · Jun 2014
ReviewAnesthesia and ventilation strategies in children with asthma: part II - intraoperative management.
As asthma is a frequent disease especially in children, anesthetists are increasingly providing anesthesia for children requiring elective surgery with well controlled asthma but also for those requiring urgent surgery with poorly controlled or undiagnosed asthma. This second part of this two-part review details the medical and ventilatory management throughout the perioperative period in general but also includes the perioperative management of acute bronchospasm and asthma exacerbations in children with asthma. ⋯ To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, perioperative management should be based on two main pillars: the preoperative optimization of asthma treatment (please refer to the first part of this two-part review) and - the focus of this second part of this review - the optimization of anesthesia management in order to optimize lung function and minimize bronchial hyperreactivity in the perioperative period.
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Postoperative nausea and vomiting (PONV) has a high incidence in children and requires prophylactic and therapeutic strategies. ⋯ Concluding from the existing guidelines and data on the handling of PONV in children at least 3 years, the following recommendations are given: outpatients undergoing small procedures should receive a single prophylaxis, outpatients at high risk a double prophylaxis, inpatients with surgery time of more than 30 min and use of postoperative opioids should get double prophylaxis, and inpatients receiving a high-risk surgical procedure or with other risk factors a triple prophylaxis (two drugs and total intravenous anesthesia). Dimenhydrinate can be used as a second choice, whereas droperidol and metoclopramide can only be recommended as rescue therapy.
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Curr Opin Anaesthesiol · Jun 2014
ReviewQuality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?
Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes. ⋯ Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.
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Curr Opin Anaesthesiol · Jun 2014
ReviewPerioperative implications of the patient with autonomic dysfunction.
The autonomic nervous system functions to control heart rate, blood pressure, respiratory rate, gastrointestinal motility, hormone release, and body temperature on a second-to-second basis. Here we summarize some of the latest literature on autonomic dysfunction, focusing primarily on the perioperative implications. ⋯ Patients with dysautonomia often have unpredictable and paradoxical physiological responses to various perioperative stimuli. Knowledge of the underlying pathophysiology of their condition is required in order to reduce symptom exacerbation and limit morbidity and mortality during the perioperative period.