Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2006
ReviewWhich muscle relaxants should be used in day surgery and when.
After myorelaxants, myalgia and residual curarization may complicate recovery. Local anaesthesia and minimally invasive airway management make myorelaxants disputable in many outpatient procedures; nevertheless, neuromuscular blockade may be necessary to facilitate intubation or maintain muscle relaxation. Agent selection criteria are discussed. ⋯ Ear-nose-throat, open eye surgery and laparoscopy may demand myoresolution. Regional and minimally invasive anaesthesia are alternative solutions. Central and peripheral nerve blocks are associated with increased induction time, reduced pain scores, and decreased need for analgesics. Central neuraxial block, however, is associated with prolonged outpatient unit stay. Bad intubating conditions may cause pharyngo-laryngeal complications: the decision to avoid myorelaxants for tracheal intubation appears illogical. Incidence of postoperative residual curarization remains very high. Sugammadex offers new perspectives.
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This review introduces state-of-the-art Web-based education and shows how the e-learning model can be applied to an anaesthesia department using Open Source solutions, as well as lifelong learning programs, which is happening in several European research projects. ⋯ The first step when adapting a course to e-learning is to re-define the educational/learning model adopted: cooperative learning and tutoring are the two key concepts. This means that traditional lecture notes, books and exercises are no longer effective; teaching files must use rich multimedia content and have to be developed using the new media. This can lead to several pitfalls that can be avoided with an accurate design phase.
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Curr Opin Anaesthesiol · Dec 2006
ReviewNitrous oxide in ambulatory anaesthesia: does it have a place in day surgical anaesthesia or is it just a threat for personnel and the global environment?
Nitrous oxide is by far the oldest anaesthetic still in routine use and its continued use is often questioned. Nitrous oxide is toxic with prolonged exposure, can damage the environment, causes pressure effects through expansion of closed air-filled spaces and has long been suspected of being harmful following chronic exposure to trace concentrations. What could possibly justify the continuing use of nitrous oxide? ⋯ Not only is nitrous oxide almost certainly less hazardous than is sometimes perceived, it has numerous benefits which are not easily replicated by possible alternatives. In particular, its use improves the quality and safety of induction and maintenance of anaesthesia and facilitates faster recovery with minimal adverse effects. All of these benefits are achieved while at the same time reducing overall costs. With few significant drawbacks and numerous advantages, there appears still to be a valuable place for nitrous oxide in modern ambulatory anaesthesia.
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An increasing number of day-case surgical patients is challenging the presently used methods of anaesthesia: reliable surgical anaesthesia should be fast, with rapid recovery and minimal side effects. To compete with modern ambulatory general anaesthesia a knowledge of special spinal anaesthesia techniques is essential. This review brings together important issues concerning the spinal technique, anaesthetic agents and benefits as well as the disadvantages of spinal anaesthesia in outpatients. ⋯ To produce reliable spinal anaesthesia with a reasonable recovery time it is essential to understand the factors affecting the spread of spinal block and to choose the optimal drug and adequate dose for specific surgical procedures.
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To summarize and examine the updated published results on the outcome measures that can be used to assess the quality of ambulatory surgery and anesthesia. ⋯ Ambulatory surgery, as currently practiced, provides quality care that is cost-effective. Minor adverse events such as pain and postoperative nausea and vomiting are still common, and improvement could be targeted in these areas.