Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2024
ReviewGet your 7-point golden medal for pain management in video-assisted thoracoscopic surgery.
Thoracic surgery is evolving, necessitating an adaptation for perioperative anesthesia and analgesia. This review highlights the recent advancements in perioperative (multimodal) analgesia for minimally invasive thoracic surgery. ⋯ In the realm of minimally invasive thoracic surgery, perioperative analgesia is typically administered through systemic and regional techniques. Nevertheless, collaboration between anesthesiologists and surgeons, utilizing surgically placed nerve blocks and an active chest drain management, has the potential to significantly improve overall patient care.
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Curr Opin Anaesthesiol · Feb 2024
ReviewA decade-long analysis of gender, race, and ethnic representation of incoming cardiothoracic anesthesiology fellows.
This study calls attention to the necessity for increasing representation of minority groups among cardiothoracic fellowship programs. ⋯ In November of 2022, medical student, anesthesia resident and cardiothoracic fellow demographics were analyzed from 2011 to 2021 to assess the changes in program diversity. Although male and female individuals have relatively similar representation in medical schools, female individuals only represent 34.8% of total US anesthesia residents. Cardiothoracic anesthesia fellowship programs continue to be male-sex dominant and white racial representation has consistently made up a majority of the total trainees. Increasing diversity amongst healthcare providers increases the likelihood of providing culturally competent care, thereby decreasing the healthcare gap in minority communities.
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Curr Opin Anaesthesiol · Dec 2023
HOCUS POCUS: ultrasound beyond regional anesthesia in the ambulatory setting.
Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point of care applications of ultrasound in perioperative care and anesthetic management with special emphasis on ambulatory practice. ⋯ Perioperative POCUS skill is a natural extension of ultrasound guided regional anesthesia. Utilizing POCUS in the perioperative period would accelerate the level of appropriate care, safety and improve outcomes in ambulatory centers. More anesthesiologists embracing POCUS would enhance patient care in a timely fashion at the ambulatory centers. POCUS in ambulatory practice can be valuable in avoiding delay or cancellation of surgeries and improving patient satisfaction.
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We review current evidence about organizational structures, patient selection criteria, safety measures, economic considerations, quality management, and staffing challenges in ambulatory anesthesia. The focus is on the facilitators and barriers related to the peri-interventional period and the potential concepts and innovations for the future development of ambulatory anesthesia services. ⋯ Ambulatory anesthesia is gaining importance due to advancements in surgical techniques and peri-interventional care. The review highlights the need for addressing challenges related to organizational structures, patient selection, patient safety, economic considerations, quality management, and staffing in ambulatory anesthesia. Understanding and addressing these factors are crucial for promoting the further development and improvement of ambulatory anesthesia services.
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Curr Opin Anaesthesiol · Dec 2023
ReviewThe future of postoperative vital sign monitoring in general wards: improving patient safety through continuous artificial intelligence-enabled alert formation and reduction.
Monitoring of vital signs at the general ward with continuous assessments aided by artificial intelligence (AI) is increasingly being explored in the clinical setting. This review aims to describe current evidence for continuous vital sign monitoring (CVSM) with AI-based alerts - from sensor technology, through alert reduction, impact on complications, and to user-experience during implementation. ⋯ The current evidence for AI-aided CSVM suggest a significant role for the technology in reducing the constant 10-30% in-hospital risk of severe postoperative complications. However, large, randomized trials documenting the benefit for patient improvements are still sparse. And the clinical uptake of explainable AI to improve implementation needs investigation.