Current opinion in anaesthesiology
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Needle-based and cannula-based eye blocks are 'blind' techniques prone to rare but serious complications. Ultrasound, an established adjunct for peripheral nerve block, may be beneficial for ophthalmic anesthesia application. The present review details the evolution of ultrasound-guided eye blocks, outlines safety issues, and reviews recent studies and editorial opinions. ⋯ Ultrasound-guided ophthalmic regional anesthesia is evolving beyond simple visualization of the anatomy. Recent research emphasizes the imprecision of needle tip location without ultrasound and the key role of imaging local anesthetic dispersion. There is ongoing debate in the literature regarding the utility of routine ultrasound for eye blocks.
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Measuring clinically relevant and patient-centered perioperative outcomes provides the knowledge that enables clinicians to optimize their practice and guide shared decision-making, researchers to set a future agenda and policymakers to prioritize healthcare spending. ⋯ Future clinical trials in perioperative medicine should utilize clearly defined, validated and standardized patient-centered outcome measures.
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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
ReviewAnaesthesia in outer space: the ultimate ambulatory setting?
Missions to the Moon or more distant planets are planned in the next future, and will push back the limits of our experience in providing medical support in remote environments. Medical preparedness is ongoing, and involves planning for emergency surgical interventions and anaesthetic procedures. This review will summarize what principles of ambulatory anaesthesia on Earth could benefit the environment of a space mission with its unique constraints. ⋯ The application of some of the key principles of ambulatory anaesthesia, as well as recent advances in anaesthetic techniques and better understanding of human adaptation to the space environment might allow nonanaesthesiologist physicians to perform common anaesthetic procedures, whilst maximizing crew safety and minimizing the impact of medical events on the mission.
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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.