Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2010
ReviewBeta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?
As day surgery continues to expand, more patients will be encountered who are chronically taking a range of cardiovascular medications for the management of hypertension and ischaemic heart disease. This review will consider the available evidence relating to whether or not these medications should be continued throughout the perioperative period in ambulatory surgical patients. ⋯ Patients should continue to take beta-blockers and calcium channel blockers on the day of surgery. Continuing angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers increases the likelihood of intraoperative hypotension. This can be reduced by withholding these drugs, but will also respond to simple treatments without any apparent adverse outcomes. It may therefore simplify instructions to patients if they are told to take all cardiac medications as normal.
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Curr Opin Anaesthesiol · Dec 2010
ReviewPatient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice.
WHO makes clear recommendations on how to improve patient safety during surgical procedures by using the WHO Surgical Safety Checklist. We will review the scientific basis of these recommendations and the practical problems encountered during introduction. ⋯ There is sufficient scientific evidence to make the use of checklists and structured perioperative briefings and debriefings mandatory for the broad spectrum of operative procedures.
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Curr Opin Anaesthesiol · Dec 2010
ReviewTopical application of analgesics: a clinical option in day case anaesthesia?
To examine the available and emerging evidence of the use of topically applied analgesics with particular reference to day case anaesthesia. ⋯ A variety of targets for peripherally applied analgesics exists, some of which can be accessed using currently available drugs, whereas others may need development of new formulations before they can be clinically targeted.