Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2009
ReviewAnaesthesia for the patient with dementia undergoing outpatient surgery.
Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery. ⋯ Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.
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This review is designed to evaluate various aspects of the teaching, demonstration and assessment of competence in anesthesiology. ⋯ The traditional evaluation of clinical competence in anesthesiology has focused on written examinations and global evaluation of skill. Limits to this approach have become obvious. Assessment has evolved to specific competencies with performance and behavior-based standards and criteria for mastery of each competency. As standards for competency are better understood, multimedia tools, such as simulation and electronic portfolio, will further advance this evolution.
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Curr Opin Anaesthesiol · Dec 2009
ReviewControl of perioperative muscle strength during ambulatory surgery.
This review describes strategies to control perioperative muscle strength in patients undergoing ambulatory surgery. ⋯ Optimal muscle relaxation for ambulatory surgery results from a judicious combination of regional anesthesia, opioids, and low doses of NMBAs. The effects of NMBAs should be monitored quantitatively by acceleromyography and reversed appropriately.
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There are an increasing number of monitors being developed to measure physiological parameters during the perioperative period. This review provides an overview of some of these new monitors developed for use in clinical anesthesia and outlines the potential advantages of each device. Pitfalls concerning the introduction of additional monitoring devices and the research gaps for introducing these monitors into clinical practice are discussed. ⋯ More research is needed on how to integrate the newly developed monitors into the clinical context to assist information-overloaded anesthesiologists. This is essential to achieve the potential benefit of new monitoring devices.
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Head-mounted displays (HMDs) are head-worn display devices that project an information display over the wearer's field of view. This article reviews a recent program of research that investigates the advantages and disadvantages of monitoring with HMDs, and discusses the design considerations and implementation issues that must be addressed before HMDs can be clinically adopted. ⋯ Anesthesiologists may be able to monitor their patients more effectively when an HMD is used in conjunction with existing monitors, but several engineering and implementation issues need to be resolved before HMDs can be adopted in practice. Further research is needed on the design of information displays for HMDs.