Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2021
ReviewPreoperative optimization of patients undergoing interventional procedures: infrastructure, logistics, and evidence-based medicine.
Patients presenting for non-operating room procedures are often 'too sick' for surgery and require specific anesthesia care in remote areas with logistical and scheduling challenges. ⋯ Our review of recent literature confirms the complexity and supports the safety of providing care in non-operating room anesthesia locations. Standard preanesthesia assessments and principles apply to these areas.
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Preoperative testing in elderly patients is performed to examine the patient's current medical condition in the context of evaluating vulnerabilities and predicting postoperative complications to ensure that all functions recover before surgery. This review focused on preoperative laboratory tests in geriatric patients. ⋯ Preoperative laboratory testing helps predict postoperative adverse complications; thus, a plan of care can be initiated.
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Curr Opin Anaesthesiol · Aug 2021
ReviewInhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation.
Following their use for medicinal purposes, volatile inhalational anaesthetic agents are expelled into the atmosphere where they contribute to anthropogenic climate change. We describe recent evidence examining the benefits and harms associated with their use. ⋯ There is now compelling evidence that anaesthetists, departments and hospitals should avoid desflurane completely, and limit nitrous oxide use to settings where there is no viable alternative, as their environmental harms outweigh any perceived clinical benefit. Life cycle analyses seem supportive of total intravenous and/or regional anaesthesia. There are many other areas where choices can be made by individual anaesthetists that contribute towards reducing the environmental burden of healthcare, such as prioritising the reduction of inappropriate resource use and over-treatment. However, this all requires joined up solutions where all parts of an organisation engage.