Current opinion in anaesthesiology
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Safety, quality, and patient satisfaction are not only defined by the incidences of serious adverse events but also include postoperative outcomes such as postdischarge nausea and vomiting (PDNV). PDNV has a high impact on patient recovery and may influence the cost-effectiveness of office-based surgical procedures. This article reviews the incidences and risk factors for PDNV as well as medications and concepts for prophylaxis and treatment. ⋯ PDNV is an under-recognized problem after outpatient anesthesia. Valid data for the incidence and the best treatment of PDNV after office-based anesthesia are rare. For safety, quality, and patient satisfaction, further research is needed to develop a prediction model to better identify patients at risk for PDNV in order to direct antiemetic prophylaxis for ambulatory patients undergoing office-based anesthesia.
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Curr Opin Anaesthesiol · Aug 2009
The risk and safety of anesthesia at remote locations: the US closed claims analysis.
A growing number of procedures are performed outside the operating room. In spite of their relatively noninvasive nature, serious adverse outcomes can occur. We analyzed claims from 1990 and later in the American Society of Anesthesiologists Closed Claims database to assess patterns of injury and liability associated with claims from anesthesia in remote locations (n = 87) compared with claims from operating room procedures (n = 3287). ⋯ Data from the American Society of Anesthesiologists, Closed Claims database suggest that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care. Similar anesthesia and monitoring standards and guidelines should be used in all anesthesia care areas.
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Curr Opin Anaesthesiol · Aug 2009
ReviewRisk and safety of pediatric sedation/anesthesia for procedures outside the operating room.
Sedation and anesthesia outside the operating room represents a rapidly growing field of practice that involves a number of different specialty providers including anesthesiology. The literature surrounding this work is found in a variety of journals - many outside anesthesiology. This review is intended to inform readers about the current status of risk and safety involving sedation/anesthesia for tests and minor procedures utilizing a wide range of sources. ⋯ The latest publications continue to document a relatively low risk to pediatric sedation yet also warn us about the potential adverse events in this field. The results help to define competencies required to deliver pediatric sedation and make this practice even safer. Particularly interesting are new jargon and methodologies for defining adverse events and the use of new methods for training sedation providers.
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Opioid administration is a mainstay of anesthetic practice both for treating acute perioperative pain and for chronic pain syndromes. Growing pharmacogenetic data make it evident that many opiate-related phenomena are influenced by genetics. Genetic variation may significantly affect opiate absorption, distribution, metabolism, excretion and toxicity. We provide a current review of opiate pharmacogenetics. ⋯ Knowledge of genetic factors that affect opioid efficacy, metabolism, and side effects have the potential for personalizing both acute and chronic pain management, and for designing more effective opiate pain medications with lower side effect profiles.