Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2007
ReviewAnesthesia and sedation outside the operating room: how to prevent risk and maintain good quality.
The purpose of this review is to define risks for anesthesia and sedation outside the operating room, and to suggest how to prevent these risks and maintain quality of care. ⋯ Complications of anesthesia outside the operating room are not well studied, although a few closed claims are appearing in the literature suggesting there is a higher risk. Topics discussed focus on MRI and surgical procedures, principally dental, plastic, and gastrointestinal endoscopy. Risk factors for these procedures are identified and quantified and measures to reduce them discussed, with emphasis on full oxygenation and end-tidal carbon dioxide monitoring. Nonoperating room anesthesia requires skills, experience and organization. Quality can only be assured by ensuring all alternative locations adhere to operating room standards.
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To present the evidence available for the management of pain, for the prevention of nausea and vomiting, and for the best anaesthetic technique during ambulatory surgery. ⋯ Pain should be prevented adequately and treated vigorously. Postoperative nausea and vomiting is common and should be prevented in the at-risk patient. The choice of inhalation agents during ambulatory surgery is of minor importance in recovery from anaesthesia.
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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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The number of alarms in the anaesthesia environment has gone from none to many dozens during the past 50 years. Until recently, each equipment manufacturer designed their own alarm set, resulting overall in a chaotic acoustic environment. Anaesthesiologists tend to have an uneasy relationship with monitoring alarms. On one hand they warn of mishaps, but on the other the many unnecessary alarms can be irritating and actually impede clinical care. There is evidence that these factors prevent alarms from realizing their full potential to enhance patient safety. This review explores current developments in clinical alarm design and technology. ⋯ The disadvantages of current clinical alarms have been identified and are in the process of being addressed.