Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2017
ReviewTumescent anaesthesia: its applications and well tolerated use in the out-of-operating room setting.
Tumescent anaesthesia is a method of administering dilute local anaesthetic into the subcutaneous tissue. Many anaesthesiologists are unfamiliar with the technique, its applications and potential risks. ⋯ Although appealing because of its ability to provide prolonged analgesia, high doses of local anaesthetic are frequently administered using the tumescent technique, and absorption of local anaesthetic from the subcutaneous tissue is variable. When caring for patients having procedures in which tumescent anaesthesia is used, the risk of local anaesthetic toxicity should be acknowledged and lipid emulsion should be available for prompt treatment if needed.
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The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. ⋯ There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams.