Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2018
ReviewBest perioperative practice in management of ambulatory patients with obstructive sleep apnea.
Obstructive sleep apnoea patients receiving opioids should have post-operative continuous monitoring.
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Curr Opin Anaesthesiol · Dec 2018
ReviewPostanesthesia care by remote monitoring of vital signs in surgical wards.
Boer, Touw and Loer describe the concept of continuous, remote vital sign monitoring and the current level of evidence for it's proposed benefit.
We know that...
- Post-operative complications occur in 25-40% of patients, making this the most important focus for improving perioperative outcomes.
- Failure to rescue is a common problem, and few postoperative patients actually experience sudden deterioration, instead hindsight shows a slow and steady decline leading to the critical event that generates an emergency response.
Continuous remote vital sign monitoring on surgical wards may improve early recognition of deterioration.
- Remote monitoring uses medical-grade biosensors wirelessly linked to a central receiver, integrated with an electronic patient record, allowing patients free movement.
- The handful of currently available systems monitor combinations of heart rate ± variability, ECG, respiratory rate, pulse oximetry, blood pressure, temperature, posture and activity.
- Continuous monitoring may then be integrated with systems that calculate an Early Warning Score, automatically notify staff of early deterioration, or in more advanced future systems, allow prediction of deterioration.
- Although feasible, all current systems suffer from practical and technical issues that can limit their sensitivity and specificity.
So, any real evidence?
- Evidence of benefit is still very patchy, although data suggests that automated notification of deterioration leads to earlier responses by treating teams, with small interventions, reducing the burden on rapid response / MET systems.
- No actual morbidity or mortality outcome data is yet available.
Be cautious...
While the hope is that remote monitoring can improve patient safety, it could disingenuously be used to justify reduced ward staffing and hospital stay length by normalizing the risk of our current postoperative harm status quo.
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The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives. ⋯ Pharmacogenetic approach marks the dawn of personalized pain medicine both in perioperative and chronic pain settings.
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This article reviews the recent clinical evidence published between January 2017 and June 2018 - related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention, diagnosis and diagnostic tools and treatment. ⋯ Clinical evidence on POD/POCD is continuously evolving, which is essential in guiding clinical management to provide the highest quality of clinical care.
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Curr Opin Anaesthesiol · Dec 2018
ReviewWhat we can learn from Big Data about factors influencing perioperative outcome.
This narrative review will discuss what value Big Data has to offer anesthesiology and aims to highlight recently published articles of large databases exploring factors influencing perioperative outcome. Additionally, the future perspectives of Big Data and its major pitfalls will be discussed. ⋯ Big Data is becoming increasingly popular with the collaborative collection of registries offering anesthesia a way to explore rare perioperative complications and outcome to encourage further hypotheses testing. Although Big Data has its flaws in security, lack of expertise and methodological concerns, the future potential of analytics combined with genomics, machine learning and real-time decision support looks promising.