Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2009
ReviewTotal intravenous anaesthesia techniques for ambulatory surgery.
The purpose of the present review is to provide an updated discussion on the use of total intravenous anaesthesia (TIVA) for ambulatory surgery, based on results from recent studies put into the context of issues already known. ⋯ TIVA is well tolerated and simple. It is associated with less postoperative nausea and vomiting than inhalational anaesthesia and has no residual paralyses as are possible with locoregional techniques. Propofol with remifentanil seems to be the dominating TIVA technique, delivered either by conventional pumps or by target control systems.
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The focus of intraoperative monitoring is moving away from invasive monitoring. This has been attributed to procedure time, cost, and the known risks, which include carotid artery puncture, arrhythmia, pneumothorax, and infection. Until recently, the venous system's contribution to the circulatory system has been incorrectly identified as being insignificant. This article summarizes the unique characteristics of the peripheral venous system. ⋯ The veins play a critical role in cardiovascular homeostasis; they do more than conduct blood to the heart. Considering the ease of measurement from a peripheral intravenous catheter, further study should be conducted to investigate the usefulness and limitations of such a minimally invasive and inexpensive monitoring device.
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This review will summarize and comment upon recent developments in the evolution and implementation of anesthesia information management systems (AIMS) in current practice. ⋯ The searchable, timed, and dated perioperative documentation generated by an AIMS appears to be an evolving requirement for contemporary anesthetic practice. The obstacles to more widespread AIMS adoption appear to be behavioral and financial rather than technical.