Journal of clinical anesthesia
-
Managed care, especially health maintenance organizations (HMOs), has expanded rapidly in the United States, with nearly 52,300,000 enrollees. HMOs seek to provide health services in an efficient setting at the most reasonable price. To facilitate this objective, HMOs are shifting the financial risk from payors to the providers. ⋯ Subcapitation of anesthesia services is being implemented or discussed in regions with very high HMO market penetration. This paper reviews the concept of bundling of services involving anesthesia in ambulatory surgery. It also seeks to provide a process that will assist anesthesiologists to achieve appropriate capitation reimbursement rates from HMOs.
-
Review Comparative Study
Inhalational anesthetics: desflurane and sevoflurane.
This article reviews the physico-chemical properties and performance characteristics of the two new potent inhaled anesthetics, desflurane and sevoflurane. Both drugs provide a greater degree of control of anesthetic depth and a more rapid immediate recovery from anesthesia than is currently available with other inhaled agents because of their decreased solubility. Desflurane is currently in widespread clinical use in the United States and parts of Europe. ⋯ These byproducts, including Compound A and fluoride, have been extensively studied, and although the possibility for iatrogenic sequelae from sevoflurane exists, the likelihood of long-term toxicity appears quite low. Phase IV studies are indicated to determine the safety of administering sevoflurane (1) to renally impaired patients and (2) to any patient with fresh gas flows less than 2 L/min. Sevoflurane is otherwise very well tolerated and appears to offer the advantage of rapid and smooth induction and emergence from general anesthesia.
-
The PACU is a dynamic environment where children undergo significant physiologic changes. Their safe care is dependent on the concerted, prospective efforts of the medical and nursing staff. This can best be done when the staff is well trained in the care of children and the unit is sufficiently equipped. Attention and leadership from anesthesiologists can ensure ongoing quality care for children.
-
Review Comparative Study
Recovery advantages of regional anesthesia compared with general anesthesia: adult patients.
The data support but do not conclusively prove, that RA results in a superior recovery compared with GA. However, several questions need to be answered. ⋯ Anesthetic techniques need to be carefully compared to determine whether they are equal in quality, efficiency, and cost. Finally, to determine whether RA is cost-effective, future studies involving ambulatory patients with a focus on outcome and well-being need to be conducted.
-
Remifentanil appears to have pharmacodynamic properties similar to other potent mu opioid agonists. It does, however, have unique pharmacokinetic properties, with a rapid onset and rapid offset of effect, irrespective of the duration of its administration. With this property, remifentanil appears to be a very titratable opioid that will make it suitable for administration for either very brief periods, in which analgesia is required, or over prolonged periods, without the concern for prolonged recovery.