Current opinion in anaesthesiology
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The purview of ambulatory anesthesia continues to broaden in response to national interest in controlling healthcare costs and eliminating unnecessarily expensive hospital stays. Recent advances in anesthesia allow us to minimize side effects and complications of anesthesia and surgery that might otherwise delay recovery and discharge. The purpose of this review is to highlight some of these latest advances in clinical care that may soon change how we practice. ⋯ The research and advances in clinical care described will likely influence how we manage our patients in the future, eliminating the need for prolonged hospital stay after surgery.
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Curr Opin Anaesthesiol · Dec 2008
ReviewUsing ventilation-induced plethysmographic variations to optimize patient fluid status.
Hypovolemia is one of the most frequent causes of arterial hypotension in the operating room. Pulse oximeter plethysmographic waveform, obtained using a noninvasive and widely available device, has recently shown its potential interest in predicting fluid responsiveness in mechanically ventilated patients under mechanical ventilation. This review highlights new applications of this routine monitoring. ⋯ Automatic detection of respiratory variations in pulse oximetry plethysmographic waveform amplitude can predict fluid responsiveness in the operating room in patients under mechanical ventilation and has potential for fluid optimization in this setting.
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Curr Opin Anaesthesiol · Dec 2008
ReviewPulse oximetry and photoplethysmographic waveform analysis of the esophagus and bowel.
This article reviews the development of novel reflectance pulse oximetry sensors for the esophagus and bowel, and presents some of the techniques used to analyze the waveforms acquired with such devices. ⋯ The use of novel reflectance pulse oximetry sensors has been successfully demonstrated. Such sensors, combined with the application of more advanced signal processing, will hopefully open new avenues of research leading to the development of new types of pulse oximetry-based monitoring techniques.
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Curr Opin Anaesthesiol · Dec 2008
ReviewManagement of outcomes in the ambulatory surgery center: the role of standard work and evidence-based medicine.
Quality and safety in the manufacturing and airline industries have benefited from evidenced-based process-improvement strategies. This review investigates the rationale for application of these same processes in the ambulatory anesthesia setting. ⋯ Ambulatory surgery and anesthesia care is uniquely oriented to the application of repetitive processes in the provision of highly predictable and reproducible surgical services. Ambulatory anesthesiologists should lead the healthcare industry in the much wider adoption of standard practice protocols and team training to maximally improve the safety and quality of patients' experiences.