Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2013
ReviewSimulation and psychology: creating, recognizing and using learning opportunities.
Psychology is relevant for improving the use of simulation in anesthesiology, as it allows us to describe, explain and optimize the interactions of learners and instructors as well as the design of simulation scenarios and debriefings. Much psychological expertise is not used for simulation in healthcare. This article aims to help bridging the gap between professions. ⋯ See the Video Supplementary Digital Content 1 (http://links.lww.com/COAN/A26).
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Advances in surgery and anesthesia have allowed for more surgeries to be done on an outpatient basis. A recent important advance entails availability of suitable recovery criteria to capitalize on the benefits of regional anesthesia for ambulatory surgery. With ever-escalating healthcare costs and expectations for faster recovery, anesthesiologists are now challenged to design anesthesia plans focused on Phase I postanesthesia care unit bypass and early facility discharge. Satisfying the recently published WAKE Score criteria upon operating room exit is associated with hospital cost reductions. This review highlights regional anesthesia techniques with focus on outpatient orthopedics. We also discuss 'multimodalities' addressing postoperative nausea and vomiting prophylaxis, perioperative analgesia (including perineural analgesia), and sedation-hypnosis, which are all central to timely recovery using now-available suitable recovery criteria. ⋯ Routine regional anesthesia use, multimodal postoperative nausea and vomiting prophylaxis, multimodal sedation-hypnosis, and multimodal analgesia, along with avoiding volatile agents and short-duration opioids, can lead to both routine Phase 1 postanesthesia care unit bypass and expedited same-day discharge, when using suitable recovery criteria.
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Curr Opin Anaesthesiol · Dec 2013
ReviewBeyond the caudal: truncal blocks an alternative option for analgesia in pediatric surgical patients.
To discuss and compare the more commonly used truncal blocks with neuraxial techniques in children undergoing a variety of thoracic, abdominal and urological procedures. ⋯ The use of regional anesthesia particularly with ultrasound guidance is an integral part of pain management during the intraoperative and postoperative period in children who undergo surgery. Its use is essential in improving patient pain control and overall satisfaction as well as decreasing hospital stay and reducing hospital admission after surgery. Truncal blocks serve as an excellent alternative to neuraxial blockade, in patients who have a contraindication to neuraxial blockade, patients undergoing a unilateral procedure and those in an outpatient ambulatory setting undergoing routine procedures, wherein the adverse effects of neuraxial blockade such as motor weakness, difficulty ambulating, urinary retention, increased nausea and vomiting, may delay same day discharge.