Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2006
ReviewRisk reduction: perioperative smoking intervention.
Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of postoperative intensive care admission. ⋯ An intensive, individual approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation, and offered a smoking intervention programme whenever possible.
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Preoperative assessment is a complex and multidisciplinary task. It encompasses surgical and anaesthesia assessment, preoperative testing, preparation of patients for surgery, and obtaining consent to the surgery. The scope of this chapter is to review the available evidence on anaesthesia preoperative evaluation (who, when and how to conduct it) and its relevance to clinical practice, and to indicate areas for future research.
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Best Pract Res Clin Anaesthesiol · Jun 2006
Review Comparative StudyRegional anaesthesia versus general anaesthesia, morbidity and mortality.
The regional versus general anaesthesia debate is an age-old debate that has brought about few clear answers. Most concur that multiple factors including the patient, the surgery, the method of regional and general anaesthesia, and the quality of perioperative care, all influence surgical outcome. ⋯ This review considers general issues such as the type of available evidence, and its limitations, particularly with regard to the relatively broad question of neuraxial versus general anaesthesia. It then assesses current evidence on regional versus general anaesthesia for specific scenarios such as hip fracture surgery, carotid endarterectomy, Caesarean section, ambulatory orthopaedic surgery, and postoperative cognitive dysfunction in elderly patients after non-cardiac surgery.
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Best Pract Res Clin Anaesthesiol · Jun 2006
ReviewPatient satisfaction with anaesthesia care: what is patient satisfaction, how should it be measured, and what is the evidence for assuring high patient satisfaction?
Patient satisfaction is a part of outcome quality. Many theories of satisfaction include patients' expectation. One definition of satisfaction is therefore the degree of congruence between expectation and accomplishment. ⋯ Based on the few available studies in anaesthesia, patient satisfaction is primarily determined by information and communication. There is great potential for improvement in this area. However, we do not know the best way to continuously improve patient satisfaction with anaesthesia care, or to what extent decisions should be shared between the anaesthetist and the patient.
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Best Pract Res Clin Anaesthesiol · Jun 2006
ReviewBenefits and harms of perioperative beta-blockade.
Cardiac events in patients undergoing surgery may have serious consequences for both short- and long-term postoperative prognosis. Recently conducted trials have not demonstrated beneficial effects of perioperative beta-blockade, although originally small trials with methodological flaws did suggest this. ⋯ The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk or diabetes, and with lower mortality in patients with high cardiac risk undergoing non-cardiac surgery. Larger randomized trials are needed to determine dosage, optimal duration, and safety of therapy, and to identify populations in whom-and how-perioperative beta-blockade may be beneficial.