Current opinion in anaesthesiology
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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.
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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
ReviewAirway management in the outpatient setting: new devices and techniques.
There are an ever-increasing number of supraglottic airway devices available on the market, many being suitable for ambulatory surgery and the specific demands it creates. These include constraints of time, high turnover and the need for early and effective discharge. This article hopes to highlight the potential benefits of the current devices available. ⋯ Some of the unique advantages offered by certain devices lend themselves well to anaesthesia in ambulatory surgery. The laryngeal mask airway has a proven track record but newer airway devices are becoming more popular and may offer advantages. Further research is needed in this fast-moving field to assess these benefits, especially in specific cohorts of patients (such as the obese), who are appearing with increasing regularity on outpatient surgery lists.