Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewCentral venous catheter insertion: Review of recent evidence.
Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. ⋯ These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewAnaesthesia and perioperative incident reporting systems: Opportunities and challenges.
Incident Reporting Systems (IRS) continue to be an important influence on improving patient safety. IRS can provide valuable insights into how to prevent patients from being harmed at the organizational level. ⋯ Health care organizations need to develop effective strategies built on trust and truth telling to improve the impact of IRS. This requires strategies to address the limited resources to analyse the near-misses or adverse events; avoid the punitive drift through maintaining the anonymity and protective legislation; integrating IRS and avoiding its confusion with mandatory adverse event response systems; training data analysts to focus on the system instead of the individual through a balanced simple taxonomy; combine the analyses at the local level, to reinforce effective and personalized feedback, with the potential of a national or supranational learning platform.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewSex and gender differences in anesthesia: Relevant also for perioperative safety?
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. ⋯ Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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Postdischarge nausea and vomiting (PDNV) occurs in at least 30% of patients leaving hospital, especially after day-case surgery. A significant number of ambulatory patients may develop PDNV associated with the use of analgesics for postsurgical pain. A validated PDNV prediction score and international evidence-based consensus guidelines for PONV/PDNV management are available. ⋯ Patient education is often overlooked in this context. All clinicians involved in the ambulatory surgery care process should participate in the development of institutional protocol for PONV/PDNV management. Constant quality control and patients' feedback should be integrated as part of an efficient implementation strategy.
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Best Pract Res Clin Anaesthesiol · Dec 2020
ReviewIs there a place for genetics in the management of PONV?
Antiemetic prophylaxis for postoperative nausea and vomiting (PONV) - a frequent complication in the postoperative period - is routinely given to high-risk patients. However, standard PONV risk models do not account for genetic factors, which have been shown to have a significant influence on PONV incidence and drug response. In this review, we describe the polymorphisms of various genes (serotonin, dopamine, cholinergic, etc.) and how pharmacogenomics is involved in the pathophysiology of PONV. This review also addresses how genetics is involved in today's clinical practice related to PONV and how it will change in the upcoming years as personalized medicine advances.