Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2020
ReviewProcedure-specific and patient-specific pain management for ambulatory surgery with emphasis on the opioid crisis.
Postoperative pain is frequent while, on the other hand, there is a grooving general concern on using effective opioid pain killers in view of the opioid crisis and significant incidence of opioid abuse. The present review aims at describing nonopioid measures in order to optimize and tailor perioperative pain management in ambulatory surgery. ⋯ Basic multimodal analgesia should start preoperatively or peroperatively and include paracetamol, cyclo-oxygenase (COX)-2 specific inhibitor or conventional nonsteroidal anti-inflammatory drug (NSAID) and in most cases dexamethasone and local anaesthetic wound infiltration. If any of these basic analgesics are contraindicated or there is an extra risk of severe postoperative pain, further measures may be considered: nerve-blocks or interfascial plane blocks, gabapentinnoids, clonidine, intravenous lidocaine infusion or ketamine infusion. In the abuse-prone patient, a preferably nonopioid perioperative approach should be aimed at.
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To discuss the importance of validated tools that measure patient-reported outcomes and their use in ambulatory surgery. ⋯ Use of validated tools to measure patient-reported outcomes allows internal and external quality comparison. Tools can be combined to measure objective outcomes and patient satisfaction. These are both key factors in driving forward improvements in perioperative ambulatory surgical care.
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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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Curr Opin Anaesthesiol · Dec 2020
ReviewSpinal anesthesia for ambulatory surgery: current controversies and concerns.
General anesthesia is a popular choice for ambulatory surgery. Spinal anesthesia is often avoided because of perceived delays due to time required to administer it and prolonged onset, as well as concerns of delayed offset, which may delay recovery and discharge home. However, the reports of improved outcomes in hospitalized patients undergoing total joint arthroplasty have renewed the interest in spinal anesthesia. This review article critically assesses the role of spinal anesthesia in comparison with fast-track general anesthesia for the outpatient setting. ⋯ The benefits of spinal anesthesia in the outpatient setting remain questionable at best. Further studies should seek clarification of these goals and outcomes.