Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2008
ReviewPostdischarge complications and rehabilitation after ambulatory surgery.
To present the literature on recent developments in anesthetic and analgesic techniques in ambulatory surgery. ⋯ During the last year, several studies have demonstrated the benefits of regional anesthesia techniques in reducing postdischarge complications and improving rehabilitation. Perioperative use of the COX-2 selective inhibitor celecoxib seems to provide short-term and long-term postoperative advantages.
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Curr Opin Anaesthesiol · Dec 2008
ReviewReview of video laryngoscopy and rigid fiberoptic laryngoscopy.
Recent advances in fiberoptic systems and video technology have resulted in the development of new intubation devices and techniques. A defining characteristic of rigid fiberoptic and videolaryngoscopic techniques is that glottic opening is viewed indirectly in place of direct line-of-sight. Various issues common to all instruments in this group are highlighted, and a few recently released tools are described. The aim of this article is to review material published since January 2007. ⋯ As indirect laryngoscopic tools become more available, and clinicians become more facile in their use, the management of (potentially) difficult intubations is likely to change. Further technological advances are likely to lead to the development of even more new instruments.
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Curr Opin Anaesthesiol · Dec 2008
ReviewPreoperative screening, evaluation, and optimization of the patient's medical status before outpatient surgery.
Preoperative evaluation and optimization of a patient's medical condition are important components of anesthesia practice. With ever increasing numbers of patients with serious comorbidities having complex procedures as outpatients, the task of gathering information and properly preparing for their care is challenging. Improvements in assessment and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. ⋯ Preparation of patients before surgery is a necessary and vital component of perioperative medicine. Practices are developing to guide effective interventions that benefit patients and healthcare systems. Outpatients present special challenges to preoperative assessment.
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American Society of Aesthetic Plastic Surgery statistics show outpatient cosmetic procedures increased from 3 to 11 million (1997-2007), an increase of 457%, and $13 billion was spent. Exponential growth, complexity of cases and patients, and media attention to high-profile untoward events are accompanied with concerns for patient safety and development of safer anesthesia practices. ⋯ The methods presented improve patient safety. The number of cosmetic procedures will continue to grow exponentially and evolve additional patient safety concerns. This larger population is the foundation for prospective trials to develop evidence-based anesthesia for cosmetic surgery.
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Curr Opin Anaesthesiol · Dec 2008
ReviewRegional anesthesia techniques for ambulatory orthopedic surgery.
The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. ⋯ In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.