Current opinion in anaesthesiology
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To discuss closed-loop systems, the engineering behind them, and the application of these systems. ⋯ The future anesthesiologist may devote less time to easily delegated tasks when in the operating room. The ability of computers to maintain variables in a set range allows some tasks to be automated. Although monitoring of these systems will never be completely eliminated, the necessity for minute-to-minute intervention may.
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The demand of procedures performed on children outside the operating room setting often exceeds the capacity of anesthesia services. The number of children requiring sedation outside the traditional operating room is rapidly approaching the number of children requiring anesthesia in the operating room. We address some of the major issues and controversies in this continuously evolving field. ⋯ A standard approach (adequate preparation, clinical assessment of the child, fasting as required and right sedation plan) is mandatory to provide safety and efficiency. Sedation is a continuum, and it can be easy to advance from one level to the next and even reach a state of general anesthesia. Newer modalities such as end-tidal CO2 and, maybe, bispectral index monitoring are indeed enhancing the safety of procedural sedation and analgesia.
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Curr Opin Anaesthesiol · Aug 2008
ReviewAnesthesia outside the operating room in the office-based setting.
The majority of anesthesia services provided outside the operating room or ambulatory surgery center is in the office-based setting. This review will focus on three areas that are critical to office-based anesthesia: safety, quality of care and patient satisfaction. ⋯ There is rapid growth for the need of safe and high quality office-based anesthesia. To meet these needs, a special set of skills is required, which may require expanded exposure and experience during training. An office-based anesthesia central data repository is needed for benchmarking and identifying areas for improvement. Finally, with advances in surgical technology, there is a need for focused research in office-based anesthetic techniques and modalities and patient satisfaction.
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The purpose of the present review is to focus on the literature in the past year and specifically the development of recent guidelines, the debate on who does the sedation anaesthesia for MRI in a paediatric patient, the use of medications and techniques, and the use of monitors and equipment. ⋯ The MRI suite is a challenging environment for anaesthetists and nonanaesthetists, and has serious risks. A systematic approach, similar to that of anaesthesia provided in the operating room, is mandatory. A well equipped anaesthesia machine, standard monitoring, trained personnel and adequate planning should be standard for all procedures out of the operating room.