Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2020
ReviewWhat we can learn from nonoperating room anesthesia registries: analysis of closed claims liability data.
The prevalence of procedures performed outside of the operating room is steadily growing around the world, especially in the United States. This review aims to discuss the risks and safety of anesthesia performed in remote locations based on an up-to-date literature review, with a focus on the results from closed claims and other database analyses. ⋯ The current literature demonstrates that procedures performed in the endoscopy suite make up the largest number of nonoperating room closed claims anesthesia cases. Oversedation and subsequent inadequate oxygenation/ventilation account for the majority of malpractice claims. Conclusions from the current literature emphasize the importance of complying with monitoring standards and having well prepared providers to improve patient outcomes in nonoperating room locations.
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The present review provides a summary of the literature on recent development of new neuromuscular blocking agents and presents clinically well established and new reversal agents. ⋯ Although the recent advancements in neuromuscular research are very promising, to date, the presented drugs are currently not available for clinical use. Clinical studies will determine the role of these developments in anesthesia practice. Therefore, well established combinations such as rocuronium-sugammadex are popular in clinical practice to offer quick paralysis for intubation and to optimize surgical conditions, while providing a fast neuromuscular recovery at the end of surgery.
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Anaesthesia and sedation are ubiquitous in contemporary medical practice. Developments in anaesthetic pharmacology are targeted on reducing physiological disturbance whilst maintaining or improving titrateability, recovery profile and patient experience. Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development. ⋯ Remimazolam provides effective procedural sedation with superior success rates and recovery profile when compared to midazolam. Comparisons with propofol are required. Preliminary studies suggest potential for using remimazolam as the hypnotic component of general anaesthesia. Definitive studies are awaited. As a benzodiazepine, remimazolam could be evaluated as an anticonvulsant and for intensive care sedation.
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Curr Opin Anaesthesiol · Aug 2020
ReviewTerminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era.
Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery. ⋯ There is significant opportunity for anaesthesiologists and clinical informaticians to collaborate and apply major advances in the perioperative informatics field to NORA environments, particularly given rapid recent changes in the field during the COVID-19 epidemic. Given the complexity of NORA patients and care delivered in NORA environments, applied clinical informatics has the potential to drastically improve care delivered.
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Curr Opin Anaesthesiol · Aug 2020
ReviewNonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2.
With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the operating room to more unfamiliar environments. ⋯ As NORA caseloads increase, understanding structural and anaesthetic requirements is essential to patient safety. The severe acute respiratory syndrome coronavirus 2 pandemic has provided an opportunity for anaesthesiologists to implement lessons learned from previous analyses, share expertise as patient safety leaders and provide valuable input into protecting patients and caregivers.