Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2016
ReviewEnhanced recovery after surgery, perioperative medicine, and the perioperative surgical home: current state and future implications for education and training.
The purpose of this review is to summarize the current state of perioperative medicine, including the perioperative surgical home (PSH) and enhanced recovery after surgery pathways (ERAS) as well as the educational implications of these concepts for current and future anesthesiology trainees. ⋯ There is sufficient evidence to support widespread adoption of ERAS principles, although the specifics of local implementation may vary from site to site. There is significant uncertainty as to what the PSH actually is. However, perioperative medicine is a defined specialty in medicine that overlaps significantly with anesthesiology core training and practice and will be a significant focus in future education, research, and clinical care provided by anesthesiologists.
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Curr Opin Anaesthesiol · Dec 2016
ReviewThe future of postoperative quality of recovery assessment: multidimensional, dichotomous, and directed to individualize care to patients after surgery.
Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment. ⋯ Recovery is best defined as a multidimensional dichotomous construct encompassing nociceptive, emotive, functional, and cognitive domains. Its assessment tool should provide both real-time and restrospective recovery data, thus enabling clinical and research applications, and be validated for repeat measures over a breadth of multiple clinically relevant postoperative time points.
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The purpose of this article is to provide a structural and functional understanding of the systems used for the regulation of medical devices in the USA and European Union (EU). ⋯ The US and EU medical device regulatory systems are similar in many ways, but differ in important ways too, which impacts the afforded level of safety and effectiveness assurance. In both systems, medical devices are classified and regulated on a risk basis, which fundamentally differs from drug regulation, where uniform requirements are imposed. Anesthesia providers must gain knowledge of these systems and be active players in both premarket and postmarket activities, particularly with regard to vigilance and adverse event/device failure reporting.
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Curr Opin Anaesthesiol · Dec 2016
ReviewAssessing the value of risk indices of postoperative nausea and vomiting in ambulatory surgical patients.
Postoperative and postdischarge nausea and vomiting have profound impact on the efficient delivery of quality healthcare. In addition to patient dissatisfaction, physical morbidities as well as unplanned hospital admissions may result. It is important to risk stratify and intervene on patients at risk. The aim of this review is to explore the benefits and shortcomings of the scoring systems commonly used today. ⋯ Risk-stratifying scoring systems seek to identify patients at risk for postoperative/postdischarge nausea and vomiting. A protocol-based approach is recommended. A number of risk stratification systems have been validated and have been simplified for widespread adoption. Some institutions report a decrease in postoperative nausea and vomiting rates when an algorithm is followed based on one of the three scoring systems. By identifying at risk patients, an anesthetic can be better planned. A reduction in the incidence of postoperative/postdischarge nausea and vomiting will have a direct effect upon patient satisfaction, morbidity, and healthcare costs.