Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewPoint of care ultrasound for the clinical anesthesiologist.
Diagnostic ultrasonography was first utilized in the 1940s. The past 70+ years have seen an explosion in both ultrasound technology and availability of ultrasound technology to more and more clinicians. As ultrasound technology and availability have grown, the utility of ultrasound technology in the clinical setting as only been limited by clinicians' imagination. ⋯ Once an accurate diagnosis is established, the anesthesiologist and his/her team can then confidently optimize an anesthetic pain, prevent harm, and/or treat a patient condition. In this day and age, the ability to rapidly establish an accurate diagnosis cannot be overstated-especially in a critical situation. It is the authors' sincerest hope that the following discussion will help regional anesthesiologist to become even better and well-rounded clinical leaders.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewRegional techniques for head and neck surgical procedures.
Regional anesthesia has evolved as an important tool for anesthesiologists and surgeons managing patients for surgery of the head and neck region. In recent years, ultrasound use has increased significantly, and newer nerve blocks have been established for surgeries of the head and regions. ⋯ Evolving practice strongly suggests that regional nerve blocks for the head and neck region are safe and effective. Future studies and education will likely evolve practice to make these regional techniques standards for future surgeries of the head and neck region.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewUltrasound practice for chronic pain procedures: A comprehensive review.
Chronic pain management techniques have evolved in recent years. With regard to this, ultrasound (US) technology has become a standard for most acute pain procedures and essential for postsurgical pain relief and enhanced recovery after surgery protocols. ⋯ In summary, US use for chronic pain procedures is emerging as a viable, safe, and effective modality. Additional studies are needed to best appreciate US and its role in chronic pain management.
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Peripheral venous access is perhaps the most commonly performed procedure in hospitals, urgent care, or surgical centers across the country. The ability to obtain peripheral intravenous (IV) access, and in a timely manner, is arguably one of the most important skill sets to be mastered by health care professionals. While skill and experience play a role in successful and timely vascular access, numerous patient factors such as obesity, diabetes, IV drug use, and chronic kidney disease may pose unique challenges to even the most skilled health care professional. ⋯ Direct visualization of blood vessels using ultrasonography has an advantage over the standard landmark technique and can improve the success rate of peripheral IV or arterial line placement in this patient population. Given the success of ultrasound guidance with access placement, it is imperative that all health care profesionals become proficient with this technique. The aim of this review article is to provide concise and practical information on the basics of ultrasound and its application to obtain peripheral venous and arterial access.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewAdjuvants in clinical regional anesthesia practice: A comprehensive review.
Adjuvants are medications that work synergistically with local anesthetics to help enhance the duration and quality of analgesia in regional techniques. Regional anesthesia has become more prevalent as evidence continues to show efficacy, enhancement of patient care, increased patient satisfaction, and improved patient safety. Practitioners in the perioperative setting need to not only be familiar with regional techniques but also the medications used for them. ⋯ The aim of the present investigation, therefore, is to provide a comprehensive review of the most commonly used non-opioid adjuvants in clinical practice today. Regional adjuvants can improve patient safety, increase patient satisfaction, and enhance clinical efficacy. Future studies and best practice techniques can facilitate standardization of regional anesthesia adjuvant dosing when providing nerve blocks in clinical practice.