Current opinion in anaesthesiology
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Poor pain management has been a problem after ambulatory surgery. This review examines the current situation and recent advances in the area. ⋯ Multimodal analgesia and local anaesthetic techniques are the avenues to improve the still disappointing quality of analgesia after ambulatory surgery.
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Curr Opin Anaesthesiol · Dec 2009
ReviewEscort accompanying discharge after ambulatory surgery: a necessity or a luxury?
There is a growing demand for greater efficiency in ambulatory surgery. The patient population is increasingly sick which is also undergoing more advanced and complex surgery. This creates a danger in discharging patients without meeting the criterion of requirement of a responsible adult as an escort to accompany the patient home. The purpose of this review is to examine the most recent findings to determine whether an escort for patient discharge is necessary. ⋯ Both clinicians and patients may have underestimated the risks associated with discharging patients without an escort after ambulatory anesthesia. There should be greater awareness of this problem. Patient discharge without an escort after ambulatory surgery under general anesthesia, sedation or premedication can potentially be dangerous and is not recommended.
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Anesthesiologists are overloaded with information and multitasking necessities in an extremely complex work environment. The purpose of this review is to present recent developments toward automated anesthesia and present future technologies for everyday clinical practice. ⋯ Decision support systems help to make reliable and standardized decisions in complex environments. Target-controlled infusion systems reduce the anesthetic workload. Closed-loop systems will automate anesthesia care in the near future. Teleanesthesia offers the opportunity to provide safe anesthetic care whenever trained personnel are not available or need support.
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Curr Opin Anaesthesiol · Dec 2009
ReviewPreoperative screening and risk assessment in the ambulatory surgery patient.
With the rapid increase in the number of sicker patients with multiple co-morbidities and extremes of age who are undergoing ambulatory surgery, a thorough and detailed preoperative workup has become increasingly important. Case cancellation on the morning of surgery should be an exception. Therefore, much attention is focused on the optimization of the sicker patients. Although the anesthesiologist plays a central role in the preoperative assessment, a multidisciplinary approach is critical. This review was done to provide the reader with current trends and practices in preoperative assessment of the ambulatory surgical patient. ⋯ Risk management involves the identification of the patient at risk, optimization of preoperative health status, risk reduction through medical intervention as well as appropriate perioperative care. Thus, patient outcome can be improved, specifically for the sicker patients at a higher risk.
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Curr Opin Anaesthesiol · Dec 2009
ReviewForced-air warming: technology, physical background and practical aspects.
There is an ever-increasing number of forced-air warming devices available in the market. However, there is also a paucity of studies that have investigated the physical background of these devices, making it difficult to find the most suitable ones. ⋯ The efficacy of a forced-air warming system is mainly determined by the design of the blankets. A good forced-air warming blanket can easily be detected by measuring the temperature difference between the highest blanket temperature and the lowest blanket temperature. This temperature difference should be as low as possible. Because of the limited efficacy of forced-air warming systems to prevent hypothermia, patients must be prewarmed for 30-60 min even if a forced-air warming system is used during the operation. During the operation, the largest blanket that is possible for the operation should be used.