Best practice & research. Clinical anaesthesiology
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Perioperative allergic reactions are rare, yet important complications of anesthesia. Severe, generalized allergic reactions called anaphylaxis are estimated to have a mortality of 3.5-4.8%. Adequate recognition and handling of a severe perioperative anaphylactic reaction result in better outcomes, including less hypoxic-ischemic encephalopathy and death. ⋯ Therefore, to ensure future patient safety, a thorough investigation following a perioperative allergic reaction is mandatory. A collaborate approach by allergists and anesthesiologists is advised. In this article, we discuss the basic approach of the allergic patient and of patients with a suspected allergy to perioperatively administered medication.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewOptimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review.
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. ⋯ Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
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Early warning scores (EWS) have the objective to provide a preventive approach for detecting those patients in general wards at risk of deterioration before it begins. Well implemented and combined with a tiered response, the EWS expect to be a relevant tool for patient safety. ⋯ Their strengths, such as objectivity and systematic response, health provider training, universal applicability and automatization potential need to be highlighted to counterbalance the weakness and limitations that have also been described. The near future will probably increase availability of EWS, reliability and predictive value through the spread and acceptability of continuous monitoring in general ward, its integration in decision support algorithms with automatic alerts and the elaboration of temporal vital signs patterns that will finally allow to perform a personal modelling depending on individual patient characteristics.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewSafety and quality of perioperative anesthesia care-Ensuring safe care for older people living with frailty.
The clinical concept of frailty as a detectable and improvable clinical condition has emerged in the field of geriatric medicine over the past two decades. Albeit frailty can be described as the rapid deterioration of organ function during the physiological aging process, this syndrome is not exclusively limited to the elderly. Recently, this concept has been introduced in the field of anesthesia and critical care as a means to better appraise perioperative risks and offer patient-centered individual treatment pathways. ⋯ Ongoing and future research is aimed at developing automated systems that help in harnessing standard medical records for reliable frailty screening without additional user input. Further efforts are pointed at understanding the potential reversibility of frailty through interventions such as exercise or nutritional supplements. While the role of frailty detection, quantification, and treatment in anesthesia and critical care is limited today, it is likely that it may become a key element of perioperative care of older patients in the near future.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewScores for preoperative risk evaluation of postoperative mortality.
Preoperative risk evaluation scores are used prior to surgery to predict perioperative risks. They are also a useful tool to help clinicians communicate the risk-benefit balance of the procedure to patients. This review identifies and assesses the existing preoperative risk evaluation scores (also called prediction scores) of postoperative mortality in all types of surgery (emergency or scheduled) in an adult population. ⋯ We found 26 scores described within 60 different reports. The most suitable scores with the highest validity identified for anaesthesia practice were the Preoperative Score to Predict Postoperative Mortality (POSPOM), the Universal ACS NSQIP surgical risk calculator (ACS-NSQUIP), the Clinical Frailty Scale (CFS) and the American Society of Anesthesiologists Physical Status (ASA-PS) classification system. While other scores identified in this review could also be endorsed, their level of validity and generalizability to the general surgical population should be carefully considered.