Anesthesiology clinics
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Anesthesiology clinics · Sep 2012
ReviewManagement of postoperative nausea and vomiting: how to deal with refractory PONV.
Postoperative nausea and vomiting (PONV) constitutes a significant factor in delaying recovery after anesthesia and impairing patient satisfaction. To date the prevention of PONV using single or multimodal interventions, usually based on risk assessment, has gained some popularity. ⋯ This review comments mainly on the management of refractory PONV. As the data on coping with established PONV are rare, further studies focusing on treatment of established PONV are needed.
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Health care quality and safety are becoming more transparent, and consumers will increasingly value safety and quality rating in choosing where they go for surgery. Perioperative services are major drivers to a hospital's safety rating. Surgical services are often the most, or one of the most, profitable services, and loss of referrals and poor media reports will directly reduce margins. This article aims to guide leaders and perioperative staff in how to start improving perioperative quality and safety in health care and surgical services.
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Postoperative anxiety has received less attention historically than preoperative anxiety. Recognition that anxiety occurs throughout the perioperative period has led to increased interest in identifying and treating anxiety in the postoperative period. This article outlines the causes of postoperative anxiety, how it is classified, the effects of anxiety on outcomes after surgery, and some of the clinical procedures that produce the highest levels of anxiety for patients. In addition, an attempt is made to delineate the major risk factors for developing postoperative anxiety and the classic therapeutic modalities used to reduce symptoms and treat the psychological manifestations of anxiety.
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Spinal and epidural anesthesia and analgesia, and the combination of the two techniques, have been excellent choices for the management of certain surgical procedures and continue to grow in popularity. The demand for increased patient mobility and quicker discharge for both inpatients and outpatients lends itself to the benefits of regional anesthesia. A neuraxial block is indicated for any surgical procedure in which the appropriate sensory level can be accomplished without any adverse outcome. This article outlines the indications and contraindications for these techniques.