Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jan 2024
The importance of simulation-based multi professional training in obstetric anesthesia: an update.
Simulation-based training remains an integral component of medical education by providing a well tolerated, controlled, and replicable environment for healthcare professionals to enhance their skills and improve patient outcomes. Simulation technology applied to obstetric anesthesiology continues to evolve as a valuable tool for the training and assessment of the multidisciplinary obstetric care team. ⋯ The evolution of simulation for interdisciplinary training and assessment in obstetric anesthesia has accelerated, playing a greater role in aspects of communication, management of hemorrhage and supporting low or strained resource settings. Augmented reality, virtual reality and mixed reality have advanced dramatically, spurred on by the need for remote and asynchronous simulation-based training during the pandemic.
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The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. ⋯ Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.
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Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. ⋯ Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.
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Curr Opin Anaesthesiol · Dec 2023
ReviewThe future of postoperative vital sign monitoring in general wards: improving patient safety through continuous artificial intelligence-enabled alert formation and reduction.
Monitoring of vital signs at the general ward with continuous assessments aided by artificial intelligence (AI) is increasingly being explored in the clinical setting. This review aims to describe current evidence for continuous vital sign monitoring (CVSM) with AI-based alerts - from sensor technology, through alert reduction, impact on complications, and to user-experience during implementation. ⋯ The current evidence for AI-aided CSVM suggest a significant role for the technology in reducing the constant 10-30% in-hospital risk of severe postoperative complications. However, large, randomized trials documenting the benefit for patient improvements are still sparse. And the clinical uptake of explainable AI to improve implementation needs investigation.
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Curr Opin Anaesthesiol · Dec 2023
ReviewDecision-making in anesthesiology: will artificial intelligence make intraoperative care safer?
This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making. ⋯ To fully realize the benefits of artificial intelligence in anesthesiology, several important considerations must be addressed, including its usability and workflow integration, appropriate level of trust placed on artificial intelligence, its impact on decision-making, the potential de-skilling of practitioners, and issues of accountability. Further research is needed to enhance anesthesiologists' clinical decision-making in collaboration with artificial intelligence.