Current opinion in anaesthesiology
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Obese patients are more and more frequently proposed for elective surgery, including acts specifically aimed at curing this condition, i.e. bariatric surgery. Many of these acts present characteristics compatible with ambulatory treatment, but anesthesiologists are reluctant to treat the morbidly obese as outpatients due to lack of data on the safety of this approach. The purpose of this review is to present the information that could be found in the literature on the safety and feasibility of ambulatory procedures in obese patients, and outline the specificity of this population. ⋯ Ambulatory care in the obese patient is both feasible and well suited to this population provided a few specificities are taken into account.
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Curr Opin Anaesthesiol · Dec 2006
ReviewUltrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques.
This article introduces the use of ultrasound to facilitate peripheral regional anesthesia. ⋯ Ultrasound technology represents an ideal mechanism by which the regional anesthesiologist can attain the safety, speed, and efficacy of general anesthesia. Ultimately, it is the correct peri-neural spread of local anesthetic around a nerve that provides safe, effective, and efficient anesthetic conditions.
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This review introduces state-of-the-art Web-based education and shows how the e-learning model can be applied to an anaesthesia department using Open Source solutions, as well as lifelong learning programs, which is happening in several European research projects. ⋯ The first step when adapting a course to e-learning is to re-define the educational/learning model adopted: cooperative learning and tutoring are the two key concepts. This means that traditional lecture notes, books and exercises are no longer effective; teaching files must use rich multimedia content and have to be developed using the new media. This can lead to several pitfalls that can be avoided with an accurate design phase.
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Curr Opin Anaesthesiol · Dec 2006
ReviewWhich muscle relaxants should be used in day surgery and when.
After myorelaxants, myalgia and residual curarization may complicate recovery. Local anaesthesia and minimally invasive airway management make myorelaxants disputable in many outpatient procedures; nevertheless, neuromuscular blockade may be necessary to facilitate intubation or maintain muscle relaxation. Agent selection criteria are discussed. ⋯ Ear-nose-throat, open eye surgery and laparoscopy may demand myoresolution. Regional and minimally invasive anaesthesia are alternative solutions. Central and peripheral nerve blocks are associated with increased induction time, reduced pain scores, and decreased need for analgesics. Central neuraxial block, however, is associated with prolonged outpatient unit stay. Bad intubating conditions may cause pharyngo-laryngeal complications: the decision to avoid myorelaxants for tracheal intubation appears illogical. Incidence of postoperative residual curarization remains very high. Sugammadex offers new perspectives.
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Curr Opin Anaesthesiol · Dec 2006
ReviewPharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting.
The use of selective 5-hydroxytryptamine type 3 receptor antagonists has improved the management of postoperative nausea and vomiting, but has not completely eliminated it. In this article, we discuss the pharmacology of 5-hydroxytryptamine type 3 receptor antagonists and the impact of pharmacogenetics on postoperative nausea and vomiting. ⋯ Pharmacogenetics testing in patients may help differentiate responders to 5-hydroxytryptamine type 3 receptor antagonists from non-responders and allow the anesthesiologist to individualize antiemetic therapy. The cost-effectiveness of such screening in postoperative nausea and vomiting management has, however, not been evaluated. Given the multifactorial nature of postoperative nausea and vomiting, a multimodal approach to reduce or eliminate risk factors will be most successful in its management.