Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2024
ReviewCritical patient safeguards for ambulatory surgery centers.
The role of ambulatory surgery centers in surgical care is evolving, as lower facility fees and improved patient experience increase the popularity of these venues. As care expands in ambulatory surgery center, so does the complexity of cases and patients cared for in these centers, which may pose a risk for patient safety. Anesthesiologists should lead multidisciplinary teams to screen for appropriate patients and procedures. ⋯ Procedural concerns start with the capabilities of the facility such as equipment, pharmacy, and staffing for each phase of care. However, nuances such as patient throughput in a given day, emergency preparedness, and after-hours staffing will affect both patient safety and staff morale. This article outlines the issues leaders need to consider to ensure patient safety in ambulatory surgery centers.
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Curr Opin Anaesthesiol · Dec 2024
ReviewDepth of anesthesia monitoring: an argument for its use for patient safety.
There have been significant advancements in depth of anesthesia (DoA) technology. The Anesthesia Patient Safety Foundation recently published recommendations to use a DoA monitor in specific patient populations receiving general anesthesia. However, the universal use of DoA monitoring is not yet accepted. This review explores the current state of DoA monitors and their potential impact on patient safety. ⋯ There is evidence that DoA monitoring may decrease the incidence of awareness, postoperative delirium, POCD and improve several postoperative outcomes. In children, DoA monitoring may decrease the incidence of awareness and emergence delirium, but long-term effects are unknown. While there are key limitations to DoA monitoring technology, we argue that DoA monitoring shows great promise in improving patient safety in most, if not all anesthetic populations.
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Curr Opin Anaesthesiol · Dec 2024
ReviewCardiovascular procedures in ambulatory cardiac procedures: really?
To evaluate the current trends, safety, and feasibility of same-day discharge (SDD) in ambulatory cardiac procedures, with a focus on percutaneous coronary interventions (PCI). This review also discusses the impact of technological advancements and explores future directions for expanding the scope of SDD in more complex cardiac procedures. ⋯ SDD is a viable and cost-effective option for low-risk patients undergoing PCI and other ambulatory cardiac procedures. The successful implementation of SDD requires careful patient selection, adherence to standardized protocols, and vigilant postprocedural monitoring. Future research should focus on refining patient selection tools, expanding the scope of SDD to include more complex procedures, and enhancing postdischarge monitoring through advanced technologies. Multidisciplinary collaboration and ongoing education are essential to support the well tolerated and effective adoption of SDD in ambulatory cardiac care.
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Curr Opin Anaesthesiol · Dec 2024
ReviewCaring for patients with diabetes in the outpatient surgical setting: current recommendations and controversies.
Perioperative outpatient (ambulatory) care of the adult patient with diabetes requires unique considerations that vary from the inpatient setting. This review highlights specific pre, intra, and postoperative care steps for patients with diabetes undergoing ambulatory surgery, summarizing recent clinical trials, expert reviews, and emerging evidence. ⋯ Future research needs to specifically examine chronic blood glucose control, day of surgery targets, effective home medication management and the risk of perioperative hyperglycemia in ambulatory surgery. Education, protocols and resources to support the care of perioperative patients in the outpatient setting will aid providers on the day of surgery and provide optimal diabetes care leading up to surgery.