Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2022
ReviewOpioid abuse and perioperative care: a new medical disease.
This review article aims to describe the perioperative clinical implications of opioid use or opioid use disorder (OUD) and to provide recommendations related to analgesia, anesthesia, and postoperative care for patients with this 'new medical disease'. ⋯ A coordinated, evidence-based, multidisciplinary team approach is critical when caring for patients with OUD to ensure safety, provide adequate analgesia, and reduce the risk of relapse. Enhanced postoperative monitoring, multimodal analgesia, and a plan for preoperative opioid management may help to modify the risks of adverse postoperative outcomes.
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Curr Opin Anaesthesiol · Jun 2022
ReviewLimited English proficiency in the labor and delivery unit.
Limited English proficiency (LEP) impacts patient access to safe and comprehensive care during the antepartum, intrapartum, and postpartum periods. In this review, we explore disparities in care delivery and outcomes that LEP women experience, and discuss the importance of providing language concordant care and using interpretation services appropriately. ⋯ The pregnant woman with limited English proficiency is at risk of receiving suboptimal care and experiencing negative outcomes during the antepartum, intrapartum, and postpartum periods. The use of medically trained interpreters and the provision of language concordant care, through workforce diversification and the creation of forms and educational materials in diverse languages, can improve patient safety, outcomes, and quality of care.
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Curr Opin Anaesthesiol · Jun 2022
ReviewMonitoring of analgesia level during general anesthesia in children.
Monitoring of intraoperative nociception has made substantial progress in adult anesthesia during the last 10 years. Several monitors have been validated and their use has been associated with intraoperative or postoperative benefits in the adult population. In pediatric anesthesia, less data are available. However, several recent publications have assessed the performance of nociception monitors in children, and investigated their potential benefits in this context. This review will describe the main validated intraoperative nociception monitors, summarize adult findings and describe the available pediatric data. ⋯ To date, four monitors may provide a relevant assessment of intraoperative nociception in children. However, the potential clinical benefits associated with their use to guide analgesia remain to be demonstrated.
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Curr Opin Anaesthesiol · Jun 2022
ReviewLGBTQ+ health and anaesthesia for obstetric and gynaecological procedures.
People who self-identify as lesbian, gay, bisexual, transgender, queer, two-spirited and intersex (LGBTQ2SI) make up approximately 10% of the US population. Black, Native American and Latino/a/x communities are known to have a higher percentage of people who self-identify as LGBTQ2SI than white communities. Despite growing acceptance of LGBTQ2SI communities in the USA, these populations continue to experience health inequities. This review article will provide a narrative review of recent publications that discuss topics of LGBTQ2SI health and anaesthetic care during obstetric and gynaecological procedures. ⋯ There are unique considerations when providing anaesthetic care for obstetric and gynaecological procedures to LGBTQ2SI communities. There is a limited, yet growing, body of literature exploring this aspect of perioperative and perinatal care. Researchers and clinicians must continue to pursue clinical research which seeks to improve the quality of care we provide all patients.