Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2009
ReviewLink between coagulation abnormalities and microcirculatory dysfunction in critically ill patients.
The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion. ⋯ The activation of coagulation may play an indirect role in microvascular dysfunction, through interplay with endothelium and inflammation.
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Curr Opin Anaesthesiol · Apr 2009
ReviewAnesthetic process, organization, management and economic issues: the French perspective.
Anesthesia is a three-step process: preoperative evaluation, the intervention itself and postanesthetic care. In France, this scheme has been legally regulated since 1994. Since then, significant progress has been made in terms of safety. Nevertheless, challenges in the delivery and financing of anesthesia services persist; in particular, demographic (patients and medical staff, as in other western countries), budgetary and organizational restrictions. ⋯ Paths to improvement of delivery of anesthesia in France may include: more optimal sharing of medical resources; better utilization of operating sites, perhaps by consolidating and reducing locations; applying improved organizational skills; and improved risk management.
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Curr Opin Anaesthesiol · Apr 2009
Time for changing coagulation management in trauma-related massive bleeding.
New insights into the pathophysiology of trauma-induced coagulopathy, the increasing availability of point-of-care devices and awareness of side effects of intravenous fluids and traditional fresh frozen plasma therapy has encouraged new concepts for managing massive blood loss. ⋯ During massive blood loss, viscoelastic measurements should guide aggressive treatment of deficiency or hyperfibrinolysis or both. In addition, the impact of contributing factors should be considered and as far as possible corrected. New data underscore the importance of avoiding hypoperfusion, and the use of coagulation factor concentrates should enable more effective correction of coagulopathy.
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Curr Opin Anaesthesiol · Apr 2009
ReviewCan anesthesia information management systems improve quality in the surgical suite?
To summarize developments related to the use of anesthesia information management systems (AIMS) and quality assurance and quality improvement. ⋯ Implementation of information technologies in anesthesia as well as in all aspects of healthcare redesigns how patients receive care. AIMS accurately measure, store, query, and recall vital sign data, and enable the systematic analysis of anesthesia-related perioperative data. Using AIMS, quality management programs will be able to study more incidents and analyze them more quickly. Ideally, decision-support systems with practice guidelines delivered via AIMS should help overcome the usual barriers to guideline adherence, and improve care and safety.
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To provide a practical approach to measure and then improve the quality of an academic anesthesia department. ⋯ Departments of anesthesia should develop performance criteria in multiple domains and recognize the importance of human relationships (between staff and between staff and patients) in quality and safety. To improve the value of anesthesia services, departments should identify their user groups, survey them to determine what attributes are important to the user, then deliver, measure, monitor and improve them on an ongoing basis.