Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2017
ReviewChallenges in the anesthetic management of ambulatory patients in the MRI suites.
MRI is becoming an indispensable diagnostic tool. The need for prolonged motion-free periods has substantially increased the need for deep sedation or anesthesia in a challenging environment. This review summarises recent literature with respect to pharmacological sedative strategies, nonpharmacological alternative approaches, airway management and safety issues in the ambulatory setting. ⋯ The anesthetic management of ambulatory patients in the MRI environment has its specific challenges and safety issues. However, the implementation of safety guidelines, new pharmacological and alternative nonpharmacological sedation strategies offer interesting perspectives to tackle these challenges.
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Curr Opin Anaesthesiol · Dec 2017
ReviewDifficult airway management and training: simulation, communication, and feedback.
Successful and sustainable training and learning of the management of difficult and normal airway is essential for all clinically active anesthesiologists. We emphasize the importance of a continuously updated learning and training environment based on actual knowledge, best available equipment, standardized procedures, and educational theory. ⋯ We present the details of the Zurich Airway Training and Simulation program, which has been constantly updated to the actual state of knowledge and available equipment.
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Curr Opin Anaesthesiol · Dec 2017
ReviewThe future of nonoperating room anesthesia in the 21st century: emphasis on quality and safety.
Nonoperating room anesthesia (NORA) has grown from an insignificant percentage of total anesthesia cases into a major percentage of anesthesia workload over the past 30 years. This trend evidences no signs of abating. ⋯ It may be anticipated that in the next decade that NORA cases will constitute over 50% of the number of cases performed with anesthesia involvement. As the last century belonged to invasive surgery, the next century will belong to interventionalists. There is also an increasing national emphasis on quality measurement and metrics reporting. Future anesthesia payment models under Medicare Access and CHIP Reauthorization Act, such as merit-based incentive payment system (MIPS), emphasize various process and outcomes measures. Anesthesiologists will be evaluated based on a composite performance score consisting of four components: quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology.
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Curr Opin Anaesthesiol · Dec 2017
ReviewHeart rate variability: implications for perioperative anesthesia care.
Heart rate variability (HRV) is a measure of the balance between both the parasympathetic and sympathetic nervous system and may provide useful information for anesthesia care providers. HRV may offer predictive information about critically ill and operative patients. Further, HRV collection provides real-time information of patient autonomic nervous system status and may allow tailoring of the analgesia for patients in the ICU and operating room. ⋯ Not applicable.
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Curr Opin Anaesthesiol · Dec 2017
ReviewAnesthesia information management: clinical decision support.
Perioperative informatics tools continue to be developed at a rapid pace and offer clinicians the potential to greatly enhance clinical decision making. The goal of this review is to bring the reader updates on perioperative information management and discuss future research directions in the field. ⋯ Perioperative informaticians continue to test new and innovative ways to enhance the delivery of anesthesia care, improving the safety and efficacy of perioperative management. Future work will continue to refine tools to ensure that perioperative informatics provides clinicians timely and accurate feedback, with demonstrable evidence that a decision support system improves patient outcomes.