Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2007
ReviewDuty hours restriction and their effect on resident education and academic departments: the American perspective.
Resident duty hour limits were implemented in 2003 by the Accreditation Council for Graduate Medical Education to improve resident wellness, increase patient safety and improve the educational environment of American residents. Now that academic anesthesiology departments and medical centers have had more than 3 years of experience under the duty hour rules, it is critical to review the available evidence on the effectiveness of these rules. ⋯ Accreditation Council for Graduate Medical Education duty hour rules are generally being followed by American anesthesiology residency programs. Residents perceive an improvement in their overall wellness, but it remains unclear if there has been an improvement in patient safety or quality of resident education.
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Curr Opin Anaesthesiol · Dec 2007
ReviewThe European Working Time Directive: effect on education and clinical care.
In 2009 the European Working Time Directive limits the weekly working hours to an average of 48 in all European Union member states. The recent published effects on education and patient care are discussed. ⋯ There are less measured clinical facts than political statements published. The actual working time directives in the European Union member states are inconsistent and further political development on this topic across the European Union remains unclear.
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Curr Opin Anaesthesiol · Dec 2007
ReviewBariatric procedures as day/short stay surgery: is it possible and reasonable?
There is an increasing tendency to extend the repertoire of procedures suitable for ambulatory care. The purpose of this review is to present recent information on progress in bariatric surgery and anaesthesia for morbidly obese patients, specifically looking for clinical reports on the success and/or problems related to an ambulatory or short-stay setting. ⋯ Despite proper safety and feasibility, it may still be a question of patient quality and acceptance for increasing the number of bariatric procedures performed as true ambulatory care. There is definitely potential for doing most of these procedures on a short-stay basis, however, allowing for a low threshold for individual management of those patients who require more extensive care.
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Curr Opin Anaesthesiol · Dec 2007
ReviewAre there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?
As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed. ⋯ When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.
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Curr Opin Anaesthesiol · Dec 2007
ReviewLow-dose aspirin and clopidogrel: how to act in patients scheduled for day surgery.
With the increasing use of antiplatelet drug treatment, complications resulting from its interference with invasive procedures (surgery or regional anaesthesia) have become an everyday challenge to the surgical team. The purpose of this review is to examine the most recent findings and integrate them into the ambulatory surgery setting. ⋯ Most ambulatory surgical procedures present low bleeding risk. The current attitude in this setting is to maintain aspirin therapy and possible antiplatelet drug inhibitors throughout the perioperative period. High-risk patients proposed for high-risk surgery should not be treated as outpatients.