Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2020
ReviewThe Bowtie diagram: a simple tool for analysis and planning in anesthesia.
The purpose is to show the advantages of a Bowtie diagram as a versatile tool for displaying and understanding the evolvement and management of critical incidents. ⋯ The Bowtie Diagram. Designed and created by Yasmin Endlich, Martin D. Culwick and Stavros N. Prineas, http://links.lww.com/COAN/A68.
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Curr Opin Anaesthesiol · Dec 2020
ReviewUse of cannabis and cannabinoids in palliative care setting.
Cannabis products have been used for various ailments since ancient times. But their use diminished in the medical community due to the legal and social concerns of substance abuse. With evolving evidence of their use in alleviating various symptoms, resurgence of interest in their medicinal use is seen in the past decade. ⋯ A few symptoms in palliative care setting can be difficult to treat in a few patients with the available treatment measures. Anecdotal reports and early clinical data have proved cannabinoids to be a promising pharmacological option in managing this subset of patients. However, absence of robust clinical data in proving that cannabinoids have definitely favorable risk-benefit ratio, precludes the inclusion of cannabinoids in the routine recommendation for palliative symptom management. Before cannabinoids enter the broader market with patient-driven and industry-driven hype, high-quality clinical evidence is emergently needed.
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Implementation of enhanced recovery pathways have allowed migration of complex surgical procedures from inpatient setting to the outpatient setting. These programs improve patient safety and patient-reported outcomes. The present article discusses the principles of enhanced recovery pathways in adults undergoing ambulatory surgery with an aim of improving patient safety and postoperative outcomes. ⋯ Implementation of enhanced recovery pathways requires a multidisciplinary approach in which the anesthesiologist should take a lead in collaborating with surgeons and perioperative nurses. Measuring compliance with enhanced recovery pathways through an audit program is essential to evaluate success and need for protocol modification. The metrics to assess the impact of enhanced recovery pathways include complication rates, patient reported outcomes, duration of postoperative stay in the surgical facility, unplanned hospital admission rate, and 7-day and 30-day readmission rates.
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Curr Opin Anaesthesiol · Dec 2020
ReviewCurrent state of noninvasive, continuous monitoring modalities in pediatric anesthesiology.
The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. ⋯ New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.
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Curr Opin Anaesthesiol · Dec 2020
ReviewMaternal safety: recent advances and implications for the obstetric anesthesiologist.
Recognition of the increasing maternal mortality rate in the United States has been accompanied by intense efforts to improve maternal safety. This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. ⋯ Anesthesiologists play an essential role in ensuring maternal safety. While continued intrapartum vigilance is appropriate, addressing the full spectrum of contributors to maternal mortality, including those with larger roles beyond the immediate peripartum time period, will be essential to ongoing efforts to improve maternal safety.