Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Jun 2017
ReviewPrevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.
Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. ⋯ Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.
-
Curr Opin Anaesthesiol · Jun 2017
ReviewStrategies to reduce blood product utilization in obstetric practice.
Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. ⋯ Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.
-
Curr Opin Anaesthesiol · Jun 2017
ReviewThe American College of Surgeons Children's Surgery Verification and Quality Improvement Program: implications for anesthesiologists.
The Task Force for Children's Surgical Care, an ad-hoc multidisciplinary group of invited leaders in pediatric perioperative medicine, was assembled in May 2012 to consider approaches to optimize delivery of children's surgical care in today's competitive national healthcare environment. Over the subsequent 3 years, with support from the American College of Surgeons (ACS) and Children's Hospital Association (CHA), the group established principles regarding perioperative resource standards, quality improvement and safety processes, data collection, and verification that were used to develop an ACS-sponsored Children's Surgery Verification and Quality Improvement Program (ACS CSV). ⋯ The present review outlines the history of the ACS CSV, key elements of the program, and the standards specific to pediatric anesthesiology. As with the pediatric trauma programs initiated more than 40 years ago, this program has the potential to significantly improve surgical care for infants and children in the United States and Canada.
-
Curr Opin Anaesthesiol · Jun 2017
ReviewAn update on the perioperative management of children with upper respiratory tract infections.
This review summarizes the current evidence for the management of children with recent upper respiratory tract infections (URTIs). Furthermore, the review includes management guidelines for children with URTIs. ⋯ Most children can be safely anaesthetized even in the presence of an URTIs if the perioperative anaesthesia management is optimized. In this review article, we have included a management algorithm for children with URTI presenting for elective surgery.
-
Curr Opin Anaesthesiol · Jun 2017
ReviewThe implications of immunization in the daily practice of pediatric anesthesia.
Vaccination is an important prevention measure, but requires an intact immune system. Surgery and anesthesia suppress the immune system and may interfere with the benefits of immunization. Moreover, common vaccine side-effects may be misinterpreted as postsurgical complications. This review summarizes the essential basis of immunization and its potential interactions with anesthesia. ⋯ Inactive vaccines are generally well tolerated. Live vaccines provide an effective and long-lasting immunization, but may carry more serious complications. Elective operations should be postponed 1 week after an inactive vaccine and 3 weeks after immunization with a live vaccine. To avoid misinterpretation of vaccine-related side-effects, vaccination should be also delayed after surgery.