Current opinion in anaesthesiology
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In this review, the most recent and relevant developments in the field of emergence agitation in children, as related to its assessment, etiology, and management, are discussed. ⋯ It is recommended that children at high risk are identified in order to decrease their level of preoperative anxiety, to supplement low-solubility inhalational agents with adjuvant drugs, to prevent postoperative pain and to allow parents to be with their children during recovery from anesthesia.
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To evaluate the evidence regarding decisions made in the perioperative management of patients undergoing ambulatory surgery for the following: the elderly, hyper-reactive airways disease, coronary artery disease, diabetes, obesity, obstructive sleep apnea, the ex-premature infant and the child with an upper respiratory infection. ⋯ Evidence indicates that ambulatory anesthesia is currently very safe. Ambulatory surgery, however, is being offered to a population with increasing co-morbidity. As the population undergoing ambulatory surgery changes over time, the evidence regarding patient outcomes will need re-examination.
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Curr Opin Anaesthesiol · Dec 2005
Thermal management of the patient: where does the patient lose and/or gain temperature?
Anesthesia inhibits normal thermoregulatory control, leading to perioperative hypothermia or allowing therapeutic hypothermia. During the last decade many studies have shown the effects of anesthesia on thermoregulation. As a consequence many active warming and cooling devices are available to manipulate patients' core temperature. This review focuses on new findings in the field of temperature management. ⋯ Anesthesia affects thermoregulatory control and leads to perioperative hypothermia. The prevention of perioperative hypothermia improves patient's outcome. Therapeutic hypothermia can be induced and also improves outcome in certain conditions.
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Simulation is frequently cited as the ideal method to improve the training of health care professionals. Studies from specialties such as anesthesia and intensive care report that life-sized mannequins reliably measure acute care skills. Task trainers, such as laparoscopic simulators, effectively improve participants' ability to perform minimally invasive surgery. This review will chart the progress made in defining the role of simulation training in medical education. ⋯ Task trainers are recommended for training physicians for a number of minimally invasive procedures. Life-sized mannequins can be used to train residents to manage a range of critical events in a simulated setting. These exercises train residents to conduct a sequential, logical examination, perform various tasks, interpret clinical findings and use clinical reasoning to resolve the simulated crisis.
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Curr Opin Anaesthesiol · Dec 2005
Anesthetic management of the child with an upper respiratory tract infection.
The decision to proceed with anesthesia for the child with an upper respiratory tract infection is often difficult. Whereas most studies suggest that children who present for elective procedures with an upper respiratory tract infection are at increased risk of perioperative adverse events, these events are typically easy to recognize and treat. This review will discuss the current literature regarding outcome in children who present for elective surgery with an upper respiratory tract infection and suggests approaches to optimize their perioperative management. ⋯ An understanding of the risk factors associated with administering anesthesia to the child with an upper respiratory tract infection is important in identifying elements of the preoperative assessment that merit attention and in optimizing the anesthetic plan as a means to limit any perioperative complications.