Current opinion in anaesthesiology
-
Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips. ⋯ Medical missions fulfill acute medical needs and have the opportunity to make a positive contribution to host communities by fulfilling local needs and supporting educational efforts for local providers.
-
Curr Opin Anaesthesiol · Apr 2021
ReviewCOVID-19: should we consider it as a septic shock? (The treatment of COVID-19 patients in the ICU).
The severe acute respiratory syndrome coronavirus 2 associated coronavirus disease 2019 (COVID-19) illness combines a syndrome of viral replication and a host dysregulated inflammatory response. Despite sharing a similar etiology, COVID-19 patients present different patterns from asymptomatic to severely hypoxemic patients. In some patients, patterns of multiorgan failure have been observed similarly to patients with bacterial sepsis. This review aimed to analyze the currently available data on the treatment of COVID-19, specifically the most studied antiviral agents and therapies targeting the immune system including those that have been investigated in sepsis. ⋯ To date, the vast majority of the studied antiviral and immunomodulatory agents have failed to improve outcomes of patients with COVID-19 except for dexamethasone. Many other trials are currently underway with new antiviral agents and various immunomodulatory agents with potential clinical benefit for COVID-19 patients. Despite these emerging data, robust controlled clinical trials assessing patient-centered outcomes remain imperative.
-
Disclosure after medical error is a complex process that goes beyond a single provider and the patient. The types and severity of errors occurring in the practice of anesthesiology may have more implications for patients, requiring a thoughtful approach to the patient, their families and the healthcare system as a whole. ⋯ Despite education and systems-based improvements in quality and safety in medicine, errors will undoubtably occur. Communication with patients and their families after an event is key in maintaining trust in the therapeutic relationship. A concerted effort is required by a team to ensure a well-executed disclosure.
-
Advances in the care of inhalational injuries have not kept pace with advances that have been seen in the treatment of cutaneous burns. There is not yet a standard of care for best outcomes for airway management of patients with known or suspected inhalational injuries. Clinicians must decide if to intubate the patient, and if so, whether to intubate early or late in their presentation. Unnecessary intubation affects morbidity and mortality. This review will summarize literature that highlights present practices in the treatment of patients with inhalation injuries. ⋯ Inhalational injuries are a significant source of morbidity and mortality in thermally injured patients. Treatment modalities, such as modified ventilator settings, alteration in fluid resuscitation, and a standardized grading system may improve morbidity and mortality.
-
Curr Opin Anaesthesiol · Apr 2021
ReviewProfessionalism: microaggression in the healthcare setting.
Microaggressions are daily commonplace, subtle behaviors and attitudes toward others that arise from conscious or unconscious bias. Not only can microaggressions affect one's access to power, resources, and opportunity, but they could also contribute to the persistent disparities faced by marginalized groups among healthcare professionals as well as patients. ⋯ This review offers education on the correlation of microaggression and unconscious bias to health disparities, provides tools to address microaggressions as a bystander, and outlines processes for institutional improvement.