Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Editorial Comment
Depth of anesthesia causality dilemmas: the next generation.
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The purpose of this narrative review is to address perioperative bleeding and transfusion as determinants of adverse outcomes after cardiac surgery. ⋯ Perioperative bleeding itself is a complex syndrome that can be classified as an outcome measure. Red blood cell transfusion has limitations when considered as an outcome variable and can be biased by many confounders. Its relationship with clinical outcome remains uncertain. In addition to being potential outcome measures, transfusion rates and the number of allogeneic blood products transfused may also be considered as quality-of-care markers.
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The goal of this narrative review is to consider and categorize the clinically relevant outcomes that have been previously investigated in neuroanesthesia and to propose the essential outcomes and directions that deserve priority in clinical care and future outcome-oriented research. ⋯ Future endeavours in neuroanesthesia research should advocate prospective randomized trials that focus on long-term neurologic outcomes. These initiatives will require coordination of multiple centres through a clinical trials network.
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Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. Asa result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. ⋯ Ideally, recovery measures should assess outcomes in a simple dichotomous fashion and maintain relevancy by assessing in multiple domains at various time points. Assessment of recovery in a dichotomous fashion also has both clinical and research applications. It allows identification of suboptimal recovery at both individual and group levels,respectively, and when performed in real time, it allows the opportunity for timely targeted intervention specific to individual patients as well as for resource rationalization.