Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2006
ReviewPropofol infusion syndrome in anaesthesia and intensive care medicine.
Propofol infusion syndrome is a rare but often fatal syndrome, characterized by lactacidosis, lipaemic plasma and cardiac failure, associated with propofol infusion over prolonged periods of time. As propofol is used worldwide, knowledge of propofol infusion syndrome is essential for all anaesthesiologists and intensive care physicians. This review will provide an update on reported cases, and describe recent findings relevant to the pathophysiology and clinical presentation of propofol infusion syndrome. ⋯ Propofol infusion syndrome must be kept in mind as a rare but highly lethal complication of propofol use, not necessarily confined to the prolonged use of propofol. Dose limitations must be adhered to, and early warning signs such as lactacidosis should lead to the immediate cessation of propofol infusion.
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Curr Opin Anaesthesiol · Aug 2006
ReviewClosed claims review of anesthesia for procedures outside the operating room.
The demand for anesthesia services is increasing due to more complex procedures being performed outside the operating room. We reviewed the literature and closed malpractice claims in the American Society of Anesthesiologists' Closed Claims database to assess liability and injury associated with anesthesia for procedures outside the operating room (nonoperating-room anesthesia, n = 24) compared with intra-operative surgical anesthesia (operating room, n = 1927) claims. ⋯ Nonoperating-room anesthesia claims had a higher severity of injury and more substandard care than operating room claims. Inadequate oxygenation/ventilation was the most common mechanism of injury. Maintenance of minimum monitoring standards and airway management training is required for staff involved in patient sedation.
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Curr Opin Anaesthesiol · Aug 2006
ReviewEquipment and environmental issues for nonoperating room anesthesia.
The demand for anesthesia care outside the operating room continues to grow, driven by trends in advanced diagnostic techniques and the financial advantages of providing care out of the hospital setting. This review examines recent literature identifying new equipment and environmental issues that impact on nonoperating-room anesthesia care. ⋯ Practitioners who render anesthesia care outside of the operating room need to be cognizant of changing equipment design, which raises new challenges for rendering safe care.
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Curr Opin Anaesthesiol · Aug 2006
ReviewBeneficial effects of statins on perioperative cardiovascular outcome.
This review evaluates clinical and experimental articles that have recently been published on the cardioprotective effect of perioperative statin therapy. ⋯ Perioperative statin therapy may stabilize coronary plaques due to pleiotropic effects and results in a reduction of perioperative cardiovascular complications.
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Curr Opin Anaesthesiol · Aug 2006
ReviewStaffing and case scheduling for anesthesia in geographically dispersed locations outside of operating rooms.
Scheduling and staffing for anesthetics outside of the operating room that are geographically dispersed is different than for operating room cases. Whereas methods to predict how long such cases take were published recently, this article reviews staffing and case scheduling. ⋯ Plan staffing based on providing open access to anesthesia time within a reasonable number of days (e.g., 2 weeks). Schedule cases and release allocated time based on reducing overutilized anesthesia time.